USMLE Step 1 Question Types: Visual Questions

As a computer-based test, the USMLE makes use of visual materials, including pictures, histology slides, and MRI and CT scan results as a part of questions. Many candidates are uneasy about these types of questions but need not be. The images presented for the Step 1 exam will be of fairly common phenomena; things you have probably seen before. Your first task when faced with a visual question is to stay calm. Deal with these questions just as you would any other question. When you come to a visual question, look at the presented image and also read any accompanying text. A substantial portion of the visual questions can be answered from hints included in the text.
To prepare for visual questions, review images and then tell yourself what you are looking at. Many students study incorrectly by starting with a concept and then looking at the matching image. The exam always requires you to select the concept that matches the image, not to find the image that matches the concept. The key here is to know what you are looking at when it is presented.
 

Information that appears early in a question stem and information that appears at the end of the question stem exerts a strong influence on the examinee. Early and late information forms your cognitive set, which makes finding the correct answer either easier or harder. Information at the start of the question stem has a primacy effect, which controls your thinking by determining what you start thinking about. Information at the end of the question stem has a recency effect, which controls your thinking by providing the jumping off point for selecting the correct answer.
If the key information for the question appears in the primacy or recency spots, you will be led to the correct answer. The difficulty comes when the key information lies somewhere in between. Primacy and recency information can blind you to other essential content. Examinees sometimes fixate on early or late information and miss other important information given in the question stem.
For example, if a question begins by describing a patient as having a generalized anxiety disorder, all of the information that follows will tend to be seen in that context, even though the anxiety disorder diagnosis may not be directly pertinent to the correct answer for that question.
Primacy or recency effects seem most pronounced when the beginning or ending information in a question stem is something with which you are unfamiliar. We all have a special tendency to fixate on unknown content.
If you suspect that primacy or recency information is distorting your reading of a given question, try changing the order in which you read the question. Skip the initial content, read the rest of the question first, and see if this changes your perspective. Remember, no one single piece of information is the key; you must deal with each question as a whole. Avoid fixating on one word or concept you do not know, and focus on the parts of the question you do know.


The USMLE exam include multimedia in selected multiple-choice questions. Approximately five items with associated media clips will appear in a single examination. Multimedia is in the form of a video or an audio file and typically relates to a physical finding that relates to the case described in the question. Physical findings include heart and lung sounds, reflexes, characteristic tremors, or other distinctive physical examination findings.
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