USMLE Step 1

The USMLE Step 1 is the first test of the three-part United States Medical Licensing Examination that is required in order to receive a license to practice medicine within the United States. The test is a computerized exam consisting of 350 multiple-choice questions split into seven sections that are primarily related to knowledge of basic science. The exam takes approximately eight hours to complete with one hour being allotted to each section and an hour break. Each section is not separated by topic, but rather contains 50 randomly distributed questions that pertain primarily to information about Anatomy, Biochemistry, Biology, Behavioral Science, Micro-Immunology, Pathology, Pharmacology, and Physiology. These questions include information related specifically to general principles related to the above areas, the cardiovascular system, the central and peripheral nervous systems, the endocrine system, the gastrointestinal system, the hematopoietic and lymphoreticular systems, the musculoskeletal system, the renal system, the reproductive system, the respiratory system, and the integumentary system.

The USMLE Step 1 exam is scored based on the number of correct responses and then scaled so that the individual will receive a three-digit and a two-digit scaled score. Scores for the three-digit scale usually fall between 140 and 260 with 185 set as the minimum score required to pass the exam. The two-digit scale is not actually an exact percentage score, but still ranges from 0 - 100 with 75 representing the minimum score necessary to pass the exam. The current registration fee for the exam is $470, which will be raised to $480 in 2008.

USMLE Step 1 Exam Review

USMLE Step I Exam - General Principles

The USMLE Step I Exam covers a wide-range of general principles related to Anatomy, Biochemistry, Biology Behavioral Science, Micro-Immunology, Pathology, Pharmacology, and Physiology. The Step I Exam specifically covers biochemistry topics such as the structure of DNA, the process of DNA replication, processes for exchanging genetic information from cell to cell, the process of transcription of DNA into RNA, cell defects that might occur as a result of transcription, the process of translation and the defects that can occur as a result of translation, the structure and function of proteins, metabolic processes, metabolic pathways and diseases associated with metabolic problems, the process of biosynthesis, and other similar topics. The biology topics specifically covered on the exam include topics such as the structure and function of a cell's nucleus, plasma membrane, and other cell components, cell adhesion, the life cycle of a cell, cellular homeostasis, signal transduction, intracellular accumulations, intracellular sorting, the structure and function of various types of cells, the process that cells use to respond to injury, necrosis, and other similar topics. The behavioral science questions on the Step I exam specifically covers topics such as the human life cycle, development of motor skills, development of social skills, sexual development, social and psychological factors that affect patient behavior, communicating with the patient and his or her family, medical ethics, and professional behavior. The Micro-Immunology questions on the Step I exam cover information related to classifying and identifying microbes, bacteria and bacterial diseases, viruses and viral diseases, fungi and fungal infections, parasites and parasitic diseases, processes and principles of sterilization, and the pure culture technique.

The pathology questions on the Step I exam cover topics such as inflammation, reparative processes, neoplasia, biology of neoplasms, cell differentiation, cell proliferation, immunizations, immune disorders, innate immunity, immunogenetics, and other similar topics. The pharmacology topics covered on the exam include pharmacokinetics, drug action, the relationship between the efficiency and the potency of a drug, factors that affect how a drug functions, drug side effects, drug interactions, drug regulations, the effect of drugs on various cells, how microbes resist and react with antimicrobial drugs, the properties of autacoids such as analogs and peptides, and other similar topics. The Step I exam also covers information such as environmental adaptation, nutrition, fluid and electrolyte disorders, concepts related to medical measurements, concepts related to medical studies, and a variety of other similar topics. These topics do not necessarily reflect every general principle covered on the Step I exam, but rather the majority of the major principles that the exam covers.

USMLE Step I Exam - Cardiovascular System

The USMLE Step I Exam, in addition to covering general principles related to various scientific fields, covers a wide range of information regarding the major systems of the body. The exam primarily focuses on the normal operations of each system, the disorders, diseases, and other abnormal conditions that might affect each system, how to treat each system if there is a problem, and what factors might affect the patient's treatment. The Step I Exam specifically covers information related to the cardiovascular system such as embryonic development, fetal maturation, function of organs and organ structure, perinatal changes, and the structure and function of the cells and tissue that make up the organs in the cardiovascular system. The exam also covers cardiovascular topics such as infections, immune disorders, and other types of disorders that might affect the cardiovascular system, how the cardiovascular system repairs itself and regenerates cells and tissue, how the cardiovascular system changes as an individual ages, and methods for treating cardiovascular diseases and disorders. The types of cardiovascular diseases and disorders covered on the exam include congenital disorders, infectious disorders, inflammatory disorders, immunologic disorders, mechanical disorders, metabolic disorders, neoplastic disorders, regulatory disorders, traumatic disorders, vascular disorders, and diseases that specifically affect the cardiovascular system. Specific examples of cardiovascular diseases and disorders normally covered on the exam include diseases such as amyloidosis and scleroderma, and disorders such as acute rheumatic fever, dysrhythmias, endocarditis, myocarditis, pericarditis, temporal arteritis, and many other similar diseases and disorders. The diseases, disorders, and other topics mentioned here do not necessarily include every topic that will be covered on the exam, but most of the questions regarding the cardiovascular system will relate specifically to these topics.

USMLE Step I Exam - Hematopoietic, Lymphoreticular, Musculoskeletal, Renal, and Urinary Systems

The types of hematopoietic and lymphoreticular diseases and disorders covered on the exam include allergic reactions, autoimmune diseases, endothelial disorders, idiopathic disorders, infections of the blood, mechanical injuries, metabolic disorders, neoplastic disorders, regulatory disorders, traumatic disorders, vascular disorders, and other diseases and disorders that specifically affect the hematopoietic system of the lymphoreticular system. The types of musculoskeletal diseases and disorders covered on the exam include degenerative disorders, idiopathic disorders, infectious disorders, inflammatory disorders, immunologic disorders, mechanical injuries, metabolic disorders, neoplastic disorders, regulatory disorders, structural disorders, traumatic disorders, vascular disorders, and other diseases and disorders that specifically affect the musculoskeletal system. The types of renal and urinary diseases and disorders covered on the exam include infectious disorders, inflammatory disorders, immunologic disorders, mechanical disorders, metabolic disorders, neoplastic disorders, traumatic disorders, vascular disorders, and other diseases and disorders that specifically affect the renal and/or urinary system. The diseases, disorders, and topics mentioned here do not necessarily include every topic that will be covered on the exam, but most of the questions regarding these systems will relate specifically to these topics.

USMLE Step I Exam - Gastrointestinal System

The types of gastrointestinal diseases and disorders covered on the exam include infectious disorders, inflammatory disorders, immunologic disorders, mechanical disorders, metabolic disorders, neoplastic disorders, regulatory disorders, traumatic disorders, vascular disorders, and other diseases and disorders that specifically affect the gastrointestinal system. Specific examples of gastrointestinal diseases and disorders normally covered on the exam include hepatitis, malocclusion, malabsorption, pancreatitis, perforation of the hollow viscus, portal hypertension, and many other similar diseases and disorders. These diseases, disorders, and topics do not necessarily include every topic that will be covered on the exam, but most of the questions regarding the gastrointestinal system will relate specifically to these topics.

USMLE Step I Exam - Respiratory System and the Skin and Related Connected Tissue

The topics covered on the exam related to the respiratory system, the skin, and the related tissue connected to the skin are actually almost identical to the gastrointestinal topics covered on the exam except that each of the topics covered relates to its respective body system instead of the gastrointestinal system. As a result, the questions on the exam related to the respiratory system, the skin, and any related tissue connected to the skin are based on topics such as embryonic development, fetal maturation, function of organs and organ structure, defense mechanisms, natural flora of the system, perinatal changes, and the structure and function of the cells and tissue that make up the organs of each system. The questions on the exam for these systems also cover topics related to diseases, disorders, and other abnormal conditions that might affect each system, how each system repairs itself and regenerates cells and tissue, how each system changes as an individual ages, and methods for treating diseases and disorders affecting these systems. The types of respiratory diseases and disorders covered on the exam include circulatory disorders, infectious diseases, inflammatory disorders, immunologic disorders, mechanical disorders, metabolic disorders, neoplastic disorders, regulatory disorders, structural disorders, traumatic disorders, vascular disorders, and other diseases and disorders that affect the respiratory system. Some specific examples of the respiratory diseases and disorders normally covered on the exam are asthma, hyperventilation, pneumonia, pulmonary hypertension, polyps, sinusitis, sleep apnea, and many other similar diseases and disorders.

The types of diseases and disorders that affect the skin and any tissue related to the skin covered on the exam include all of the groups indicated in the list above for the respiratory system except for circulatory disorders. Some specific examples of skin diseases and disorders normally covered on the exam are acne, chickenpox, lice, injuries caused by heat, injuries caused by exposure to the sun, injuries caused by radiation, melanoma, Marfan syndrome, vasculitis, vitamin deficiencies, and many other similar diseases and disorders. These diseases, disorders, and topics do not necessarily include every topic that will be covered on the exam, but most of the questions regarding these systems will relate specifically to these topics.

USMLE Step I Exam - Central and Peripheral Nervous Systems

The types of diseases and disorders that affect the central or peripheral nervous system covered on the exam include congenital disorders, degenerative disorders, disorders related to the senses, idiopathic disorders, infectious disorders, inflammatory disorders, immunologic disorders, mechanical disorders, metabolic disorders, neoplastic disorders, paroxysmal disorders, psychopathologic disorders, regulatory disorders, traumatic disorders, vascular disorders, and other diseases and disorders that affect the nervous system. Some specific examples of diseases and disorders covered on the exam that affect the nervous system include Alzheimer dementia, arterial aneurysms, blindness, cerebral palsy, delirium, diabetic neuropathy, epilepsy, hematomas, learning disorders, meningitis, multiple sclerosis, Parkinson disease, and many other similar diseases and disorders. These diseases, disorders, and topics do not necessarily reflect every topic that will be covered on the exam, but most of the questions regarding the central and peripheral nervous systems will relate specifically to these topics.

USMLE Step I Exam - Endocrine System

The USMLE Step I exam, in addition to covering general principles related to various scientific fields, covers a wide range of information regarding the major systems of the body. The exam primarily focuses on the normal operations of each system, the diseases, disorders, and other abnormal conditions that might affect each system, how to treat each system if there is a problem, and what factors might affect a patients treatment. The Step I exam specifically covers topics related to the endocrine system such as embryonic development, fetal maturation, the function of the organs in the endocrine system and the structure of those organs, hormone synthesis, hormone secretion, hormone action, hormone metabolism, perinatal changes, and the structure and function of the cells and tissue that make up the organs of the endocrine system. The Step I Exam also covers topics related to the endocrine system such as infections, immune disorders, and other types of disorders that might affect the endocrine system, how the endocrine system repairs itself and regenerates cells and tissue, how the endocrine system changes as an individual ages, and methods for treating diseases and disorders that affect the endocrine system.

The types of endocrine diseases and disorders covered on the exam include idiopathic disorders, infectious disorders, inflammatory disorders, immunologic disorders, mechanical disorders, metabolic disorders, neoplastic disorders, regulatory disorders, traumatic disorders, vascular disorders, and other diseases and disorders that affect the endocrine system. Some specific examples of endocrine diseases and disorders covered on the exam include adrenal disorders, diabetes mellitus, Graves disease, hirsutism, pituitary apoplexy, thyroid disorders, and many other similar diseases and disorders. The diseases, disorders, and topics mentioned here do not necessarily include every topic that will be covered on the exam, but most of the questions regarding the endocrine system will relate specifically to these topics.

USMLE Step I Exam - Reproductive System

The USMLE Step I Exam, in addition to covering general principles related to various scientific fields, covers a wide range of information regarding the major systems of the body. The exam primarily focuses on the normal operations of each system, the diseases, disorders, and other abnormal conditions that might affect each system, how to treat each system if there is a problem, and what factors might affect a patient's treatment. The Step I Exam specifically covers topics related to the reproductive system such as defense mechanisms of the reproductive system, embryonic development, fetal maturation, the function of the organs in the reproductive system and the structure of those organs, gestational hormones, hypothalamic-pituitary-gonadal axis, natural flora of the reproductive system, perinatal changes, sex steroids, and the structure and function of the cells and tissue that make up the organs of the reproductive system. The Step I Exam also covers topics related to the reproductive system such as infections, immune disorders, and other types of disorders that might affect the reproductive system, and methods for treating diseases and disorders that affect the reproductive system. The types of reproductive diseases and disorders covered on the exam include disorders that affect pregnancy, disorders related to the puerperium, disorders related to the postpartum period, infectious disorders, inflammatory disorders, immunologic disorders, mechanical disorders, metabolic disorders, neoplastic disorders, regulatory disorders, traumatic disorders, and other diseases and disorders that may affect the reproductive system. Some specific examples of the reproductive diseases and disorders covered on the exam include breast abscesses, cirrhosis, cystic mastitis, impotence, female incontinence, infertility, premature birth, premature puberty, trophoblastic disease, and many other similar diseases and disorders. The diseases, disorders, and topics mentioned here do not necessarily reflect every topic covered on the exam, but the majority of the questions on the exam about the reproductive system will relate specifically to these topics.

USMLE Step I Exam - Treatment and Factors that Affect Treatment and Prevention

The USMLE Step I Exam covers a variety of topics related to the general principles that an individual must know in order to effectively practice medicine and information about the normal and abnormal functioning of each system of the body. The questions on the exam that are related to the systems of the body are there primarily in order to determine if an individual understands how the body functions as a whole and how a problem in one part of the body can cause problems in other parts of the body as well. However, many of the questions on the exam are not only designed to assess an individual's knowledge of how each system of the body functions, but are instead also designed to determine if an individual knows how to treat problems that arise in each system and understands the factors that can affect how effective a particular treatment will be. The types of treatment covered for each system varies from system to system, but most of the treatment questions on the exam focus on the effects, normal use, and side effects of drugs that can be used to treat a particular condition. However, treatment questions on the exam will also focus on other types of treatment such as surgery, specific medical procedures related to that body system, rehabilitation, and other similar treatments.

The specific factors that can affect a patient's treatment that are covered on the exam include behavioral factors, emotional factors, environmental factors, ethnic factors, factors related to the patient's gender, occupational factors, factors related to the patient's lifestyle and history, factors related to the family's lifestyle and history, and factors related to societal influence. These factors are covered on the exam for each system of the body as they relate to that particular system. However, the reproductive system, in addition to these factors, also has questions regarding the effect of gender identity on a patient's treatment, the effect of a patient's libido on a patient's treatment, factors related to family planning, factors related to pregnancy, factors related to the patient's sexuality, factors related to the patient's sexual orientation, and the effects of stress and violence factors such as child abuse, rape, traumatic stress syndrome, and other forms of violence. These topics do not necessarily reflect every treatment and treatment factor that will be covered on the exam, but most of the treatment questions will relate to these specific topics or topics similar to the ones mentioned here.