Explanations for the 2015-2016 Official Step 1 Practice Questions

The NBME just released the updated 2015 sample questions this past month, and there are no new questions in this iteration (at least in the downloadable pdf version). In fact, six questions have been removed (two from each section), which was done to reflect the decrease in total Step 1 test items starting May 11 from 322 to 308.

I’ve made a note of which questions were removed from the 2014-15 set. Therefore, at this time, my explanations for the 2014-15 set are still current. The question order is the same, but the numbering is off a bit.

If an updated set with new questions is eventually released, the explanations will appear below as they have in prior years.

Block 1

#20 and #29 from 2014-15 were removed.

Block 2

#74 and #85 from 2014-15 were removed.

Block 3

#98 and #130 from 2014-15 were removed.


Again, the still current 2014-15 explanations can be found here.


  1. Thank you for doing this! Our dean mentioned they are changing Step 1 because scores are climbing so high now. I don’t know what this means but I hope it doesn’t change anything significantly since I’ve been studying with USMLE World!

  2. Your dean is probably more privy to upcoming changes than I am, but despite a lot of discussion on forums etc, the recent changes made to the various Steps in recent years have been pretty insignificant. The current change is just to make each section two questions shorter (322 – 7(2) = 308). Still seven 60-minute sections, just be slightly easier to finish each on time!

    As for increasing the difficulty, there haven’t been any official announcements concerning such, so nothing is happening for the current crop of MS2s (and probably not for current MS1s either). The simplest way to make the test more challenging would be to change the relative frequency of hard versus easy questions. This would be straightforward for the NBME to do and would not significantly change the value of the current test-prep materials. So, ultimately, enjoy your UW.

  3. and regarding the changes i hope they r not making it more difficult……m only relying on uworld, pathoma and fa for that matter…..

  4. The Fred and PDF questions typically match, though I think the Fred software might include a couple of multimedia questions. The changes actually make the test a bit shorter. I imagine this is to counteract some of the more involved new question formats they’ve added in recent years.

  5. Thank you so much for doing all this! I have heard recently that the emphasis has been on more “next step of management” questions on the step and questions on anatomy have increased in frequency. how much of this is true?

  6. “Next Step” questions have always been a part of Step 1, often in the form of classic emergency cases and especially microbiology treatment questions. They’re still going to be way more common on Step 2 CK. Either way, any increased relative proportion of such is unlikely to be different enough that it need affect your studying or resource selection etc. The salient parts have always been there.

    Hadn’t heard about any anatomy change, that sounds most likely apocryphal. They did report this:

    In 2015, examinees will see an increased focus on quality improvement principles and safety science.

  7. What would be a good resource to tackling the “next step in management” questions. I feel like any prep or question banks haven’t given me any practice on this!

  8. Hi Ben, thank you so much for your help. There is an updated pdf with a few new questions it seems on the USMLE website. There are new 2016 practice questions. Can you please upload the explanations to those questions? Also, the USMLE is changing the number of items from 308 down to 280, 40 questions per block after May 9th 2016. Please check the USMLE annoucements page.

  9. Good Morning Ben! Thank you so much for your explanations!!!
    New questions have been added to the 2016 official step1 practice . . . Will you be posting those explanations???


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