Questions on the Step 1 Exam

The exam contains 280 multiple choice questions in a clinical vignette format. A clinical vignette is a long patient description with associated labs that is followed by a question regarding the case. Each question will have at least five multiple choice options to pick from. In addition, some questions will have two parts.

Sample Clinical Vignette Question

A 22-year-old college student that is confused and lethargic is brought to the emergency room. His roommates say he was complaining of a severe headache and neck stiffness last night. Vital signs are remarkable for a temperature of 104.3F, blood pressure of 80/60 and heart rate of 120. Physical exam reveals a purpuric rash on the patient’s chest. Lumbar puncture reveals a high neutrophil count. What treatment should be given to his roommates as prophylaxis?

  • A. Acyclovir
  • B. Ceftriaxone
  • C. Doxycycline
  • D. Rifampin
  • E. Vancomycin

Correct answer: D


The difficulty of each question can vary. The questions can be first, second, or third order. These three orders describe the difficulty of the question and how many mental steps it takes to find the answer. Most questions are second or third order in difficulty.

Last updated: September 17, 2020