2200+ USMLE® Step 1 Practice Questions

Are you preparing for the USMLE® Step 1? Try 10 free practice questions below or access more questions for all major Step 1 topics in Lecturio’s free USMLE Step 1 Qbank.

Preview 10 Free USMLE Step 1 Questions

A 25-year-old man is admitted to the hospital after a severe motor vehicle accident as an unrestrained front-seat passenger. Appropriate life-saving measures are given, and the patient is now hemodynamically stable. Physical examination shows a Glasgow Coma Score of 12. There are no motor or ocular movements with painful stimuli. The patient has bilaterally intact pupillary light reflexes. The patient is placed in a 30° semi-recumbent position for further examination. What is the most likely finding on the examination of this patient’s right ear?

A. Cold water causing ipsilateral saccadic movement

B. Warm water causing an ipsilateral slow pursuit

C. Warm water causing ipsilateral saccadic movement

D. Warm water mimicking the head-turning left

E. Cold water causing contralateral slow pursuit

A 50-year-old man presents to the office with complaints of fever and chills for 4 weeks. He adds that he is fatigued all the time and has a generalized weakness. He has drenching night sweats and has had 2 episodes of non-bilious vomiting over the past few days. He traveled to the Netherlands for 4 days a month ago. His symptoms started a few days after he returned home. Laboratory testing revealed the following:

Hemoglobin11.2 g/dL
Hematocrit29%
Leukocyte count2,950/mm3
Neutrophils59%
Bands3%
Eosinophils1%
Basophils0%
Lymphocytes31%
Monocytes4%
Platelet count60,000/mm3
Unconjugated bilirubin12 mg/dL
Alanine aminotransferase200 IU/L
Aspartate aminotransferase355 IU/L

The peripheral blood smear showed basophilic ring- and pear-shaped structures inside many red cells and extracellular basophilic rings on Wright-Giemsa staining. Further evaluation revealed parasitemia and a few schistocytes, poikilocytes, and merozoites in tetrad formation. The findings are most consistent with which diagnosis?

A. Malaria

B. Babesiosis

C. Anaplasmosis

D. Tuberculosis

E. Lyme disease

A 22-year-old professional softball player is undergoing an annual check-up. Her medical history is significant for hallux valgus and scoliosis. She additionally notes that she frequently has bumps and bruises from playing softball, but she has no injuries today. Her family history is significant for heart disease. The patient’s blood pressure is 110/70 mm Hg, heart rate is 78/min, and respiratory rate is 15/min. A physical examination is unremarkable except for an indurated palpable mass on her left breast. A biopsy of the mass is performed. Which biopsy findings are most likely to be present in this patient?

A. Chronic inflammation with plasma cells

B. Necrotic fat with calcifications and giant cells

C. Leaf-like projections

D. Duct-like structures

E. Abundant extracellular mucin

A 55-year-old woman presents to the office because she has been feeling weak. For the past 2 years, she has been urinating a considerable volume every time she goes to the bathroom. She has no past medical history. Her heart rate is 86/min, respiratory rate is 15/min, temperature is 37.4°C (99.3°F), and blood pressure is 111/79 mm Hg. Laboratory studies are significant for the following:

Calcium13.8 mg/dL
PTH230 pg/mL

Her complete metabolic panel is otherwise within normal limits. Imaging studies show subperiosteal resorption and osteoporosis. Scintigraphy reveals the most common pathologic condition associated with the patient’s diagnosis. Which of the following is the most likely diagnosis in this patient?

A. Adenoma

B. Carcinoma

C. Decreased calcitriol concentration

D. Glandular hyperplasia

E. Phosphate retention

A 48-year-old man is brought to the emergency department by his neighbor, who found him lying unconscious at the door of his house. The patient lives alone and no further history is available. On physical examination, his temperature is 37.2ºC (98.9ºF), pulse rate is 114/min, blood pressure is 116/78 mm Hg, and respiratory rate is 22/min. His Glasgow Coma Scale score is 7 and the patient is intubated. A stat serum osmolality is reported at 260 mmol/kg. Based on the provided information, which of the following conditions is most likely present in this patient?

A. Acute ethanol intoxication

B. Central diabetes insipidus

C. Diabetic ketoacidosis

D. Nonketotic hyperosmolar hyperglycemic coma

E. Syndrome of inappropriate antidiuretic hormone

A 40-year-old woman with a recent history of carcinoma of the breast status-post mastectomy and neoadjuvant chemotherapy 1 week ago presents for follow-up. She reports adequate pain control with the analgesic drug she was prescribed. Her past medical history is significant for hepatitis C and major depressive disorder. The patient denies any history of smoking or alcohol use but says she is currently using intravenous heroin and has been doing so for the past 10 years. However, she reports that she has been using much less heroin since she started taking the pain medication, which is confirmed by the toxicology screen. Which of the following is the primary mechanism of action of the analgesic drug she was most likely prescribed?

A. Partial agonist at opioid receptors

B. Pure antagonist at opioid receptors

C. Inhibits prostaglandin synthesis

D. Pure agonist at the µ-opioid receptor

E. Central action via blockade of serotonin reuptake

A 60-year-old man seeks evaluation at a medical office due to leg pain while walking. He says the pain starts in his buttocks and extends to the thighs and down to the calves. Previously, the pain resolved with rest, but the pain now persists in his feet, even during rest. The past medical history is significant for diabetes mellitus, hypertension, and cigarette smoking. The vital signs are within normal limits. The physical examination shows an atrophied leg with bilateral loss of hair. Which of the following is the most likely cause of this patient’s condition?

A. Decreased permeability of endothelium

B. Narrowing and calcification of vessels

C. Peripheral emboli formation

D. Thrombus formation

E. Weakening of vessel wall

A 33-year-old woman presents with lethargy and neck pain. She says that, for the past 6 months, she has been feeling tired all the time and has noticed a lot of muscle tension around the base of her neck. She also says she finds herself constantly worrying about everything, such as if her registered mail would reach family and friends in time for the holidays or if the children had their nightly baths while she was away for the weekend. She says that this worrying has prevented her from sleeping at night and has made her more irritable and edgy with her family and friends. Which of the following is the best course of treatment for this patient?

A. Buspirone

B. Diazepam

C. Family therapy

D. Support groups

E. A vacation

A healthy 37-year-old gravida-3-para-1 (G-3-P-1) who underwent in vitro fertilization delivers a boy vaginally. On examination, he is found to have a ventral urethral meatus inferior to the glans. Which statement is correct?

A. Younger age of the mother is a major risk factor for this condition

B. It results from failure of the genital swellings to fuse

C. Hypospadias repair before the age of 3 years is associated with an increased incidence of urethrocutaneous fistula

D. Such anatomy is formed before the 12th week of intrauterine development

E. It results from failure of the urethral folds to fuse

Parkinson’s disease is a progressive neurodegenerative disease. It is characterized by a loss of dopaminergic neurons in the substantia nigra pars compacta and the formation of cellular inclusions called Lewy bodies. These are composed of α-synuclein that has been bound to ubiquitin. In healthy individuals, α-synuclein bound to ubiquitin would be degraded by which of the following?

A. Vesicle

B. Peroxisome

C. Proteasome

D. Ribosome

E. Lysosome

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Learning from clinical cases

As a medical student, you’ll spend a lot of time learning about medicine, practicing with cadavers, and eventually training a hospital with real patients. But before you put on your white coat and start taking vitals, you’ll likely go through thousands of USMLE practice questions. 

On the USMLE Step 1 exam, you’ll encounter up to 280 patient-centered clinical vignettes paired with multiple choice answers. These clinical cases will require multi-step thinking and some will also require you to interpret graphic or pictorial materials. These are single best answer questions, so while multiple answers may be partially correct, each question only has one best answer. 

Familiarizing yourself with how to best approach USMLE Qbank questions is almost as important as knowing the material itself – with this eBook, you can go step-by-step through 30 practice questions to learn important tricks for tackling the stems of USMLE questions, practice different types of questions, and to get an overview of your current state of knowledge of various USMLE Step 1 question topics.

You can then study using Lecturio’s subject-based study schedules or create a custom Qbank tests in either “tutor” or “test” mode. Doing a Lecturio Qbank block in “tutor mode” provides detailed answer explanations and connects you to related videos and resources, including First Aid® page references so that you can study as you go. Doing a Lecturio Qbank block in “test mode” simulates your exam day experience, from the time pressure to the interface of the test itself.

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