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:
and toward questions that require an application of knowledge such as:
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
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:
The correct answer is E, transitional/central zone.