USMLE Step 1 Question Types

The USMLE Step 1 features many types of multiple choice questions. As you practice and review, pay attention to the way the questions are constructed, as well as to the content issues tested. Be aware that the test maker has moved away from questions that require simple basic science recall such as:

Which of the following areas of the heart is supplied by the right coronary artery?

and toward questions that require an application of knowledge such as:

A 77-year-old woman is admitted with angina pectoris. An angiogram is performed and reveals a 90 percent blockage of the right coronary artery. Blood supply is most likely to be diminished to which of the following areas?

You’ll notice the same objective lies within both questions. The first question is a direct request for a fact. The second question asks for the same fact in the context of a clinical presentation.

Step 1 Question Subtypes

There are a number of different subtypes of one best answer questions. Most students find it useful to classify these subtypes as follows:

1. Positively worded questions (“most likely”)

2. Clinical case questions (long clinical cases)

3. “Two-step” (double-jump) questions

4. “Bait and switch” questions

5. Conjunction questions

6. Visual questions


Kaplan Expert Tip

Negatively worded questions, those that ask for the option that is “least likely,” are no longer used on the Step 1 exam. Don’t waste your time mastering the techniques for handling them.


Positively Worded Questions

Positively worded questions ask you to select the answer that is “most likely” to be true. Note that all of the options given may be somewhat likely. Your job is to select the one that is most likely. An example of this type of question is as follows:

An 85-year-old man has had urinary frequency, difficulty initiating stream, and dysuria for the last two months. A rectal exam reveals an enlarged prostate. Prostate-specific antigen (PSA) is not elevated. Which part of the prostate is most likely affected in this patient’s condition?
A. Peripheral zone
B. Prostatic capsule
C. Prostatic urethra
D. Posterior lobe of the prostate
E. Transitional/central zone

The correct answer is E, transitional/central zone.

Previous: USMLE Strategy: How to Pick the Best Answers
Next: USMLE Step 1 Question Type: Clinical Case Questions