Step 1 Test Question Formats


  • Read each question carefully. It is important to understand what is being asked.
  • Try to generate an answer and then look for it in the response option list.
  • Alternatively, read each option carefully, eliminating those that are clearly incorrect.
  • Of the remaining options, select the one that is most correct.
  • If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong answers.

A single patient-centered vignette is associated with one question followed by four or more response options. The response options are lettered (ie, A, B, C, D, E). A portion of the questions involves interpretation of graphic or pictorial materials. You are required to select the best answer to the question. Other options may be partially correct, but there is only ONE BEST answer. This is the traditional, most frequently used multiple-choice question format on the examination.

Example Single-Best-Answer Question

A 22-year-old woman is brought to the emergency department by ambulance 30 minutes after she was struck by an oncoming motor vehicle while bicycling. The paramedics report that the patient sustained substantial blood loss at the scene. On arrival, she appears anxious, pale, and diaphoretic. Her pulse is 140/min, respirations are 24/min, and blood pressure is 88/46 mm Hg. Physical examination shows numerous abrasions and a 12-cm laceration on the anterior portion of the right thigh, which was bandaged at the scene but is now saturated with blood. Cardiopulmonary and abdominal examinations show no abnormalities. Compared with a healthy person, which of the following sets of findings is most likely in this patient?

Option Mixed Venous O2 Saturation Systemic Peripheral Vascular Resistance Cardiac Output Urine Flow Rate
A. No change
B. No change
C. No change No change
D. No change No change No change
F. No change

(Answer: E)