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2009 Step 1 Content Description and General Information A Joint Program of the Federation of State Medical Boards of the United States, Inc., and the National Board of Medical Examiners® Copyright © 2008 by the Federation of State Medical Boards of the United States, Inc. And the National Board of Medical Examiners® (NBME®). All rights reserved.

Printed in the United States of America. The USMLE™ is a joint program of the Federation of State Medical Boards of the United States, Inc. And the National Board of Medical Examiners. CONTENTS Introduction.

3 Preparing for the Test, Applying for the Test, Scheduling Test Dates, and Testing. 3 Examination Content. 3 Step 1 Test Question Formats 4 Content Outline. 6 Sample Step 1. 22 Normal Laboratory Values. 23 Test Questions for Sample Step 1 25 Answer Form for Sample Step 1.

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51 Answer Key for Sample Step 1 52 2 Introduction This booklet is intended to help you prepare for Step 1 of the United States Medical Licensing Examination™ (USMLE™) if you are an applicant with an eligibility period that has an ending date in 2009. Eligibility periods are explained in the 2009 USMLE Bulletin of Information, with which you must become familiar to apply for the examination. In addition to reading the Bulletin, you should run the sample Step 1 test materials and tutorials provided at the USMLE website. The information in this booklet, USMLE sample test materials and software tutorials, and other informational materials are available at the USMLE website (Information regarding any changes in the USMLE program will also be posted at the USMLE website. You must obtain the most recent information to ensure an accurate understanding of current USMLE rules. Preparing for the Test, Applying for the Test, Scheduling Test Dates, and Testing In addition to the information in this booklet, you should review the sections that appear in the Bulletin: Preparing for the Test, Applying for the Test and Scheduling Your Test Date, and Testing. Although the sample test materials in this booklet are provided in computer format at the USMLE website, you must run the tutorial and sample materials to become familiar with the test software prior to your test date.

Migration of Step 1 to new test delivery software will occur in 2009. Please monitor the USMLE website (announcements section to check for changes in test delivery software, and to access updated orientation and practice materials. The sample materials available at the USMLE website include an additional block of items with associated audio or video findings and a sequential item set in the FRED V2 interface. You should become familiar with test items that have audio or video components and sequential item sets as these formats may be used in the actual examination.

The block of items with associated audio or video and sequential item sets does not appear in this booklet. The Step 1 examination consists of questions ('test items') presented in standard multiplechoice formats, as described on pages 4 and 5 of this booklet. The test items are divided into 'blocks' (see the Test Lengths and Formats in the Bulletin). You may want to study the descriptions of test item formats that follow before you run the sample test items. A Normal Laboratory Values Table, including Standard International conversions, is reproduced on pages 23 and 24 of this booklet. This table will be available as an online reference when you take the examination. Please note that values shown in the actual examination may differ slightly from those printed in this booklet.

Examination Content Step 1 consists of multiple-choice questions prepared by examination committees composed of faculty members, teachers, investigators, and clinicians with recognized prominence in their respective fields. Committee members are selected to provide broad representation from the academic, practice, and licensing communities across the United States and Canada. The test is designed to measure basic science knowledge. Some questions test the examinee’s fund of information per se, but the majority of questions require the examinee to interpret graphic and tabular material, to identify gross and microscopic pathologic and normal specimens, and to solve problems through application of basic science principles. Step 1 is constructed from an integrated content outline that organizes basic science content according to general principles and individual organ systems.

Test questions are classified in one of these major areas depending on whether they focus on concepts and principles that are important across organ systems or within individual organ systems. Sections focusing on individual organ systems are subdivided according to normal and abnormal processes, principles of therapy, and 3 psychosocial, cultural, and environmental considerations. Each examination covers content related to the traditionally defined disciplines of anatomy, behavioral sciences, biochemistry, microbiology, pathology, pharmacology, and physiology, as well as to interdisciplinary areas including genetics, aging, immunology, nutrition, and molecular and cell biology. Strategies for Answering Single One Best Answer Test Questions While not all topics listed in the content outline are included in every examination, overall content coverage is comparable in the various examination forms that will be taken by different examinees. A full content outline for the USMLE Step 1 examination is provided on pages 6 to 21. It describes the scope of the examination in detail.

To facilitate review, the major categories are indicated in bold type, with the subcategories in regular type. The content outline is not intended as a curriculum development or study guide. It provides a flexible structure for test construction that can readily accommodate new topics, emerging content domains, and shifts in emphasis. The categorizations and content coverage are subject to change.

Broadly based learning that establishes a strong general understanding of concepts and principles in the basic sciences is the best preparation for the examination. Step 1 Test Question Formats Single One Best Answer Questions This is the traditional, most frequently used multiple-choice format.

These items consist of a statement or question followed by three to eleven response options arranged in alphabetical or logical order. A portion of the questions involves interpretation of graphic or pictorial materials. The response options for all questions are lettered (eg, A, B, C, D, E).

Examinees are required to select the best answer to the question. Other options may be partially correct, but there is only ONE BEST answer.

• Read each question carefully. It is important to understand what is being asked. • Try to generate an answer and then look for it in the option list. • Alternatively, read each option carefully, eliminating those that are clearly incorrect. • Of the remaining options, select the one that is most correct. • If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong answers.

Example Item A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. She has not yet started dialysis. Examination shows no abnormalities. Her hemoglobin concentration is 9 g/dL, hematocrit is 28%, and mean corpuscular volume is 94 µm3.

A blood smear shows normochromic, normocytic cells. Which of the following is the most likely cause? (A) (B) (C) (D) (E) (F) (G) (H) (I) (J) Acute blood loss Chronic lymphocytic leukemia Erythrocyte enzyme deficiency Erythropoietin deficiency Immunohemolysis Microangiopathic hemolysis Polycythemia vera Sickle cell disease Sideroblastic anemia β-Thalassemia trait (Answer: D) 4 Sequential Item Sets A single patient-centered vignette may be associated with two or three consecutive questions about the information presented. Each question is linked to the initial patient vignette but is testing a different point.

Questions are designed to be answered in sequential order. You are required to select the one best answer to each question. Other options may be partially correct, but there is only ONE BEST answer. You must click “Proceed to Next Item” to view the next item in the set; once you click on this button, you will not be able to add or change an answer to the displayed (previous) item. 5 Step 1 Content Outline Table of Contents General Principles. Biochemistry and Molecular Biology Biology of Cells Human Development and Genetics Biology of Tissue Response to Disease Gender, Ethnic, and Behavioral Considerations Affecting Disease Treatment and Prevention Multisystem Processes Pharmacodynamic and Pharmacokinetic Processes Microbial Biology and Infection Immune Responses Quantitative Methods 7 Hematopoietic and Lymphoreticular Systems 11 Central and Peripheral Nervous Systems 12 Skin and Related Connective Tissue 13 Musculoskeletal System.

14 Respiratory System 15 Cardiovascular System. 16 Gastrointestinal System.

17 Renal/Urinary System 18 Reproductive System. 19 Endocrine System 20 Examples of diseases and normal processes are listed within this content outline.

The purpose of these examples is only to clarify and illustrate the particular categories they are appended to; they are not intended to direct the examinee toward preparing for questions on them. Examinees should not focus their studies on the examples only. The examination encompasses the categories in the content outline, but the examination will not be limited to or emphasize the examples or the categories for which examples are given.

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