Explanations for the 2017 Official Step 1 Practice Questions

The NBME has released the new 2017 USMLE “Step 1 Sample Items” set last month, which is identical to the one released in 2016.

Last year they finally updated the software version to be browser-based instead of the old downloadable Windows application, so now you can do the interactive version like the real deal regardless of your computing preferences. It also appears that the online question order is now the same as the PDF (with the addition of a few multimedia questions at the very end).

Here are the multimedia question explanations for Block 3 (please be aware you frequently do not need the multimedia information to accurately answer multimedia questions correctly):

  1. E – I’m going to point out that a normal healthy kid with no cardiac history or symptoms and no family history of sudden cardiac death for a pre-sports physical is probably going to have a benign exam no matter what you think you hear.
  2. E – Classic Moro reflex, entirely expected and normal until it disappears around age 4 months.
  3. E – Pill-rolling resting tremor of Parkinson’s disease secondary to loss of dopamine neurons in the substantia nigra.

You can see my otherwise complete explanations for this and last year’s set here. Your best bet for score correlations is probably here.

You may also enjoy some other entries in the USMLE Step 1 series:
How to approach the USMLE Step 1
How to approach NBME/USMLE questions
How I read NBME/USMLE Questions
Free USMLE Step 1 Questions


Sejal 03.20.17 Reply

Hi Ben!

Just started my STEP prep and am in the process of reading through first aid. Thought I would take these questions to get an initial assessment. Any idea of what score would correlate with passing USMLE Step 1? Thanks! This is super helpful!

Ben 03.21.17 Reply

Try this.

Tina H 04.15.17 Reply

Thanks for this! I was wondering if these sample questions were the same as the NMBE self assessment services exams (https://nsas.nbme.org/home) – I think there are 6 of those available?
Thanks so much for your help,

Ben 04.15.17 Reply

No, these are free (historically colloquially called the “free 150” because there were 150 questions). Each NBME practice exam costs money.

Will 05.30.17 Reply

Hi there, these explanations are so helpful, much appreciated! If you have time:

A question: there appears to be an extra skip-beat every few beats on the cardiac auscultation question. Do you have any idea what that is? Is it an S3, but we’re supposed to connect that in younger people that’s normal, or am I hearing something that’s not necessarily there?

For #39 – in a question where there answer is in fact hyperrreflexia of one sort or another, whether Tay-Sachs or something else – how would you know to identify that? How would hyperreflexia appear, visually, or textually in the question stem – in contrast to Moro response? As MS2s, we’re before Ob/Gyn rotations etc so haven’t seen this.. :)

Will 05.30.17 Reply

I turned off the “repeat” on the media player, and the “extra sound” magically disappeared :) – Was the result of it returning immediately to the beginning of the clip right after the last beat of the end of the clip.

Ben 05.30.17 Reply

The nature of multimedia questions is such that they’re almost always either normal or something classic. Don’t sweat these; no one is going to show you something weird, and there is no point in doing any extra to prepare for these.

In this case, in addition to the video being normal, the mom being concerned about delayed milestones at two weeks is a red flag that it’s BS. Not a whole lot happens in two weeks.

People generally talk about increased or decreased “tone” in newborns, not reflexes like DTRs. Overall, you can think of increased tone as rigid extremity flexion and adduction and decreased tone as being generally floppy.

Will 05.31.17

Thanks, much appreciate your reply!

Andrew Pan 06.08.17 Reply

Hi Ben,
First of all, thanks so much for all the advice–your site is a god-send and I have been sharing it with friends. :)

Second, was wondering if you have any thoughts about premade Anki decks (Brosencephalon, etc.) or flashcards in general. I’m a month out from test day and was wondering whether to squeeze them into my routine on top of UWorld. I think you and I have very similar preferences re: passive studying/questions as primary means of preparation.

Ben 06.09.17 Reply

None of that stuff existed when I was in school, so I don’t have any personal experience. I’m generally of the mind that they would be more helpful longitudinally over the year than trying to start during the final push.

Andrew 06.09.17

Many thanks for the timely response–I think I will be sticking w/UFAP. Hope residency is going well!

david 06.12.17 Reply

The link you posted for the answer explanations are for last year. there are some different questions on this years newest set

Ben 06.12.17 Reply

Sorry, fixed the link. The questions contained in the two pdfs are unchanged though, I didn’t see anything new. What did you see that was different?

Ann 06.18.17 Reply

This was amazing. Literally taking my exam tomorrow morning and these explanations were super helpful. Thanks for all the effort you put in. Also love the commentary.

bimbo 06.27.17 Reply

Hello Ann,

how was your exam? would you be able to share your experience

Shah 07.12.17 Reply

Hey Ben!
I am in a bit of a predicament and not sure what to do? I’m a recent IMG and I got a 175 on an NBME and my exam is in 10 days.
Been studying for so long now and has been ineffective. Should I give the exam knowing I may as well fail and if somehow I pass, know that I will have a difficult time matching.

What do you suggest? Kaplan was not helpful at all and I feel had I invested that time in FA and UW maybe I’d be in a better position.

My issue is simple recalling of facts and I do not get to revise as my schedule is very time and haven’t encorpated that.

Please advise soon!!!
Thank you!!

Ben 07.12.17 Reply

I think the odds of matching as an IMG with a fail on Step 1 is very very low. The odds of matching with a borderline pass are also low, so if that’s where you’re currently at I don’t think the outcome of taking now is probably worth it.

Shah 07.13.17 Reply

What do you think is the best approach to improve 30-50 points?
Sticking to the basics or do another fresh run.
My weakness is recall and memorizing straight up facts?

Thank you!

Ben 07.13.17 Reply

If it’s really facts, then it depends on how you best learn facts. I generally think UW is the most important component, but if it’s really foundational knowledge you’re missing, you might try one of the ANKI decks or similar source to try to really memorize stuff. It can be hard to memorize material from just reading books.

Lillian 08.16.18 Reply

Hey Ben,

I was looking up questions and randomly came on here! Impressive work.
I wanted to ask you if you had the pdf for the 2017 Usmle free 120 questions? If you do, where can I access it?

Thank you!

Ben 08.16.18 Reply

Sure, the link in the first sentence at the top of this page is to the PDF.

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