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USMLE - United States Medical Licensing Examination Step 1 - Dump Information

Vendor : USMLE
Exam Code : USMLE
Exam Name : United States Medical Licensing Examination Step 1
Questions and Answers : 849 Q & A
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USMLE Questions and Answers

USMLE


QUESTION 834

A 68-year-old postmenopausal female with a history of osteoprosis and essential hypertension is placed on the thiazide diuretic chlorothiazide, which has a beneficial action toward both conditions. Which letter in below figure depicts the tubular location of epithelial cells containing a / cotransport


image


protein inhibited by thiazide diuretics?


image


  1. A

  2. B

  3. C

  4. D

  5. E


Answer: D

Section: Physiology Explanation


Explanation:

The epithelial cells of the early portion of the distal tubule contain a / cotransporter that is


image


inhibited by thiazide diuretics which promote a diuresis and a natriuresis, and which secondarily, promote increased renal reabsorption of filtered calcium. Choices A and B denote the proximal and thin loop of Henle segments, respectively; which do not have the properties of the early distal tubular segment. Likewise, choices C and E denote the thick ascending loop of Henle and the collecting duct, which also do not have the same properties as the early distal tubular segment.


QUESTION 835

Worldwide, one of the most common parasitic infections is schistosomiasis. Assume a complete blood cell count is performed in a patient with this condition. Which of the following blood cells would most likely be present in elevated amounts?


  1. eosinophils

  2. erythrocytes

  3. monocytes

  4. neutrophils

  5. platelets


Answer: A

Section: Physiology Explanation


Explanation:

Eosinophils normally constitute about 2% of all blood leukocytes. These cells are phagocytic and exhibit chemotaxis. Their primary role is in fighting parasitic infection. In schistosomiasis the eosinophil attaches to the immature parasite and, by releasing various cytotoxic compounds, is able to kill the parasite. Erythrocytes (choice B) are the most numerous blood cells. They are not leukocytes, but function in blood gas transport. Erythrocyte number would not be increased in schistosomiasis. Monocytes (choice C) are leukocytes found in the blood. They are immature cells which migrate to the tissues, where they mature into macrophages. These cells are very active in phagocytosis and play a prominent role in the inflammatory response. They are not, however, particularly important in parasitic infections. Neutrophils (choice D) are another type of leukocyte that, though essential to combat bacterial infections, are not particularly sensitive to parasitic challenge. Platelets (choice E) are not leukocytes. The platelet is a cell fragment that functions in hemostasis.


QUESTION 836

After total thyroidectomy as a result of a car accident, a 47-year-old woman is positive for Trousseau sign. It is manifested as carpopedal spasm occurring after an inflated blood pressure cuff is held above systolic blood pressure for a few minutes. Which of the following would best describe her postoperative condition when compared to preoperative?


  1. decreased deep tendon reflexes

  2. higher serum calcitonin levels

  3. lower serum calcium levels

  4. lower serum phosphate levels


  5. shorter Q-T interval of her ECG


Answer: C

Section: Physiology Explanation


Explanation:

A positive Trousseau sign indicates increased neuromuscular irritability, which is caused by low serum calcium levels. Apositive Trousseau sign or a positive Chvostek sign (spasms of facial muscles) can often diagnose hypocalcemia before other gross manifestations develop. Serum calcium is regulated by parathyroid hormone produced by the parathyroid glands. During the woman's accident, the glands, or their vasculature, were most likely damaged enough so that they could not be saved during the total thyroidectomy. If total thyroidectomy occurs as a consequence of thyroid cancer, damage to all four parathyroid glands would be considered an operative mishap. A consequence of hypocalcemia is hyperreflexia and not hyporeflexia (choice A). Calcitonin is secreted by parafollicular or "C" cells in the thyroid gland. Since no other cells of the body make this hormone, serum calcitonin levels do not rise (choice B), but instead go to zero postoperative. Low serum phosphate levels (choice D) typically signify secondary hyperparathyroidism or low dietary phosphate intake. In the current case, high or unchanged serum phosphate would be expected. The Q-T interval of the ECG represents the time for both ventricular depolarization and repolarization to occur. It therefore roughly estimates the duration of an average ventricular action potential. Hypocalcemia leads to a long Q-T interval, not a short Q-T as in choice E. In severe cases, this can lead to arrhythmias, hypotension, and heart failure.


QUESTION 837

A 60-year-old woman is admitted to the hospital with a fever and severe diarrhea for the last 24 hours. Cultures of blood, cerebrospinal fluid, urine, and stool are all negative for pathogens. The profile of gut hormones reveals elevated levels of VIP. An analogue of which of the following would most likely lower her VIP levels?


  1. erythromycin

  2. histamine

  3. motilin

  4. somatostatin

  5. trypsin


Answer: D

Section: Physiology Explanation


Explanation:

VIP is a neurotransmitter in the brain and in the parasympathetic nerves of the digestive tract. It also acts as a hormone. VIP has a secretin-like effect on the pancreas. It increases the volume of water and bicarbonate output and affects GI blood flow and motility. All this contributes to severe secretory diarrhea in the case of VIP overproduction. Somatostatin is the best choice because it has a broad range of inhibitory effects, inhibiting GI secretions, slowing GI motility, and reducing splanchnic blood flow. An analogue of somatostatin, called octreotide, was found useful for treatment of syndromes related with VIP overproduction. Octreotide has a longer half-life than physiologic somatostatin. Erythromycin (choice A) is known to have antibiotic


features. This is not the best choice, since no pathogens were found. Histamine (choice B) is a physiologic stimulant of gastric hydrochloric acid secretion, potentiating the effects of acetylcholine and gastrin. Motilin (choice C) stimulates gastric motility, which is contraindicated for diarrhea. Trypsin (choice E) is a protease released by pancreatic cells, breaking peptide bonds as well as converting many other proteolytic enzymes to their active form. All of the negative choices will not affect, and in fact may even worsen the VIPrelated symptoms.


QUESTION 838

Malignant hyperthermia is a relatively rare genetic disorder, found in approximately one in 10,000 individuals. Affected individuals can exhibit a life- threatening response to inhalation anesthetics, which entails elevated core body temperature, skeletal muscle rigidity, and elevated blood carbon dioxide levels. Based on these observed symptoms, which of the following is most likely present in malignant hyperthermia?


  1. decreased release of acetylcholine at the neuromuscular junction

  2. increased activation of myosin light chain kinase

  3. increased activation of skeletal muscle potassium channels

  4. increased activation of the calcium release channels of the sarcoplasmic reticulum

  5. inhibition of skeletal muscle sodium channels


Answer: D

Section: Physiology Explanation


Explanation:

Malignant hyperthermia is caused by a mutation to the calcium release channel of the skeletal muscle sarcoplasmic reticulum (the socalled ryanodine receptor). Increased calcium release into the myoplasm causes strong, sustained skeletal muscle contraction. This causes excessive ATP hydrolysis, increased metabolic activity to replenish ATP levels, heat generation, and carbon dioxide production. Decreased acetylcholine release would decrease muscle contraction (choice A). Myosin light chain kinase is involved in contractile activation in smooth muscle (choice B). Activation of K channels would hyperpolarize muscle fibers and tend to decrease susceptibility to contractile activation (choice C). Inhibition of sodium channels would diminish the ability of skeletal muscle to generate action potentials and thus decrease excitability (choice E).


QUESTION 839

Below figure shows the conversions of cholesterol into the hormones C and D within follicular cells of the ovary (large arrows) and the regulation of these processes (small arrows) by pituitary hormones (A, B, E), when binding to their receptors on the cell surfaces (dark squares). Which of the letters in the figure best represents the hormone the concentration of which in serum changes in the following way?


image


  1. A

  2. B

  3. C

  4. D

  5. E


Answer: D

Section: Physiology Explanation


Explanation:

It represents the estrogen estradiol, which is produced from androgen by granulosa cells of the ovaries and released into the capillaries. A woman's estradiol serum concentration roughly reflects the activities of her ovaries. Estradiol levels rise during the follicular phase of the menstrual cycle (days 0 13). They reach peak levels shortly before ovulation on day 1314, and drop back during the luteal phase (days 1428). They reach menstrual/follicular levels at the end of the luteal phase unless there is a pregnancy. After menopause, the ovaries atrophy and estradiol levels become very low. During reproductive cycles, androgens are the main substrate for estrogen synthesis in the granulosa cells. The androgen-estrogen conversion is under the influence of FSH (choice E). FSH concentrations are high after menopause compared to their premenopausal concentrations. The source of androgens is theca cells. They produce it from cholesterol under the influence of LH (choice B). LH concentrations, like FSH, are high postmenopausal. Both, FSH and LH levels are used as a diagnostic tool to determine menopause. Granulosa cells also produce progesterone (choice C) from cholesterol. Progesterone serum levels are low during follicular phase of the menstrual cycle and high during the luteal phase of the menstrual cycle. The transition of cholesterol to progesterone is under the influence of LH (choice A).


QUESTION 840


During a marathon attempt a runner collapses and is admitted with severe acute dehydration. Which of the following is most likely to occur in this patient?


  1. decreased baroreceptor firing rate

  2. decreased plasma osmolarity

  3. high renal water excretion

  4. low plasma ADH levels

  5. low water permeability of collecting duct tubular cells


Answer: A

Section: Physiology Explanation


Explanation:

Acute dehydration results in decreased plasma volume, cardiac output, and arterial pressure, which leads to a lower firing rate of the baroreceptors. Plasma osmolarity increases (choice B) because more water than salt is lost in sweat. The increase in plasma osmolarity leads to increased ADH secretion (choice D). High plasma ADH levels cause increased water permeability of collecting duct cells (choice E). Therefore, more water is reabsorbed by the kidneys and renal water excretion is low (choice C).


QUESTION 841

When glucose is chronically elevated in poorly controlled diabetes mellitus, nonenzymatic glycosylation of various proteins occurs. The change of which of the following substances is most commonly monitored as indicator for the efficiency of blood glucose control?


  1. hemoglobin A1c (HbA1c)

  2. lipoprotein A.

  3. modified albumin

  4. myoinositol

  5. sorbitol


Answer: A

Section: Physiology Explanation


Explanation:

The hallmark of poorly controlled diabetes mellitus is elevated blood glucose, which causes unphysiological glycosylation of proteins. An important long- term measure of blood glucose control in patients with diabetes mellitus is to monitor the modification of hemoglobin A to form glycated hemoglobins. HbA1c is the major subfraction, and determination of HbA1c is usually achieved by ion- exchange or gel electrophoresis. The level of glycated hemoglobins in the blood is directly related to the average blood glucose levels over the life span of the hemoglobin in the circulation. Since the half- life of red blood cells is about 120 days, a single determination of glycated hemoglobin reflects the average blood glucose level during the preceding 812


weeks. Lipoprotein A. (choice B) is a lipoprotein particle implicated in atherosclerosis and thrombosis. Albumin (choice C) is the most abundant plasma protein, but is not significantly affected by glycosylation. Myoinositol (choice D) is a signaling molecule the decrease in response of which to elevated sorbitol has been suggested as a complication of diabetes. Sorbitol (choice E) is another sugar derivative, unrelated to HbA1c that is believed important in causing other diabetic complications such as cataracts and peripheral neuropathy.


QUESTION 842

Apatient on intensive care is ventilated with a frequency of 12 per minute and a tidal volume of 0.6 L. His arterial pH increases to >7.5. What is the most reasonable action to correct this respiratory alkalosis?


  1. decrease dead space

  2. decrease tidal volume

  3. increase minute ventilation

  4. increase oxygen fraction

  5. use positive end-expiratory pressure (PEEP)


Answer: B

Section: Physiology Explanation


Explanation:

Respiratory alkalosis is due to hyperventilation, which lowers . Decreasing tidal volume will


image


reduce alveolar ventilation and correct the respiratory alkalosis. Assuming a dead space of 150 mL, alveolar ventilation in this patient is 450 mL × 12/ min = 5400 mL/min. If the tidal volume were decreased from 600 to 300 mL and the frequency increased from 12 to 24 per minute, then the alveolar ventilation would decrease to 150 × 24/min = 3600 mL/min even though the minute ventilation (12 × 600 mL/min = 24 × 300 mL/min) remains unchanged. The fraction of (choice D) in the respiratory


image


air does not affect respiratory volumes or frequencies in a mechanically ventilated patient. Increasing minute ventilation (choice C) or decreasing dead space (choice A) would increase alveolar ventilation and worsen respiratory alkalosis. PEEP (choice E) is positive pressure applied during the expiratory phase to prevent the collapse of alveoli and to increase FRC of the lungs. It is used primarily to improve arterial oxygenation in severely hypoxic patients.


QUESTION 843

Below figure illustrates the extracellular and intracellular volumeosmolarity status of a patient (broken lines) and that of a normal subject (solid lines) for comparison. This patient most likely suffers from which of the following conditions?


image


  1. adrenal insufficiency

  2. chronic vomiting

  3. iatrogenic fluid overload with 0.9% NaCl

  4. iatrogenic fluid overload with hypertonic solution

  5. syndrome of inappropriate hypersecretion of antidiuretic hormone (SIADH)


Answer: E

Section: Physiology Explanation


Explanation:

This patient has increased extra- and intracellular volumes and a decreased osmolarity. SIADH results in inappropriately low water permeability of the renal collecting duct tubular cells and inappropriate water retention. As a result, patients with SIADH often present with hypotonic overhydration. Adrenal insufficiency (lack of aldosterone) (choice A) and chronic vomiting (choice B) lead to dehydration. Fluid overload with isotonic NaCl (choice C) results in volume expansion without change in osmolarity. Fluid overload with hypertonic solution (choice D) results in volume expansion with increased osmolarity.


QUESTION 844

Gamma-aminobutyric acid (GABA) is an amino acid that functions as a neurotransmitter in the central nervous system. GABA typically causes increased chloride conductance and functions as an inhibitory transmitter. Assume that the equilibrium potential for chloride (ECl-) in a particular cell is - 80 mV and that application of GABA inhibits the cell without any change in resting membrane potential. What is the resting membrane potential of the cell?


A. +80 mV

  1. 0 mV


  2. -70 mV

  3. -80 mV

  4. -90 mV


Answer: D

Section: Physiology Explanation


Explanation:

This problem addresses two issues: (1) the mechanism of action of inhibitory neurotransmitters and (2) the relationship of equilibrium potential and membrane potential. First, an inhibitory neurotransmitter acts by increasing conductance of an ion the equilibrium potential of which is either equal to or more negative than the cell resting membrane potential. If the equilibrium potential of the ion is more negative than the resting membrane potential, increasing the conductance of that ion will hyperpolarize the membrane--will generate an inhibitory postsynaptic potential (IPSP). Second, if the equilibrium potential of the ion is equal to resting membrane potential, increasing the conductance of that ion will "clamp" the membrane potential more tightly at its resting level--this will make the cell less excitable. In this problem, the membrane potential must equal -80 mV D.. If, and only if, the resting membrane potential equals the equilibrium potential for an ion, will an increase in the conductance to that ion not cause a change in membrane potential.


QUESTION 845

The striped area in below figure indicates a red light on the receptive fields of a red on-center, green off-center surround retina ganglion cell. How will the light spot be perceived?


image


  1. brown (red + green)

  2. green

  3. no color


  4. red

  5. reddish green


Answer: D

Section: Physiology Explanation


Explanation:

A light spot exclusively hitting the center would be perceived as deep red. Some of the light hits the inhibitory surround area. In this area, light is processed coming from cones that are best excited by green light (middle wavelength) and inhibited by red light (long wavelength). In the below figure the on-response dominates the off-response so that the perceived light is different from deep red, but not green (choice B). At the retina ganglion level, the trichromate signals from the cones are transferred into the neuronal stage of color processing, the opponent color stage. The cone photoreceptors are linked together to form opposing color pairs, in this case red versus green. Activation of one member of the pair inhibits the activity in the other so that a color pair cannot be seen at the same location. We cannot experience reddish green (choice E). Physiological color image formation differs from the physical process of coloring a piece of paper with a red and green pencil (choice A), one on top of the other, called subtractive color mixture. It starts with the presence of all colors of light and then dyes subtract some of the reflected light so that adding more dyes results in a darker image such as brown. For physiological color mixing, the presence of all colors is perceived as white, the absence as black (choice C).


QUESTION 846

Creatinine clearance is often used to evaluate glomerular function. Which of the curves in below figure best represents the relationship between plasma creatinine concentration and creatinine clearance in a normal healthy person?


image


  1. A

  2. B


  3. C

  4. D

  5. E


Answer: C

Section: Physiology Explanation


Explanation:

Creatinine clearance is independent of plasma creatinine concentration; otherwise, creatinine would not be a useful measure of GFR. Clearance is defined as the amount of plasma that delivered the excreted substance, and for a substance that is neither actively secreted nor reabsorbed by the kidneys; its clearance equals the amount of plasma filtered through the glomerular membrane. All creatinine contained in that amount of plasma is excreted by the kidney, no matter what the concentration of creatinine in that plasma volume was. Because in the normal person a small amount of creatinine is secreted by the renal tubules, clearance at low plasma concentrations is slightly higher than at elevated plasma concentration (slight initial upward bend of curve). Curve Adescribes the relationship between creatinine plasma concentration and renal excretion of creatinine. Note that excretion and clearance are not synonymous. Curves B and D describe the clearance of a substance that is secreted and filtered, or filtered and reabsorbed, respectively. At large plasma concentration, the active transporters become saturated and the clearance of these substances approaches the creatinine clearance. Curve E depicts an improbable event with relatively increased clearance at both low and high concentrations of a substance, although there is an independent linear clearance at intermediate substance concentrations.


QUESTION 847

The patient is a 43-year-old male. He is anemic, with a hemoglobin level of 12.2 g/dL (normal is 15.5 g/dL). The erythrocytes are microcytic (MCV = 70 fL, with normal MCV = 80100 fL). Which of the following would most likely be present in this patient?


  1. acute bleeding

  2. folate deficiency

  3. iron deficiency

  4. vitamin deficiency

  5. vitamin K deficiency


Answer: C

Section: Physiology Explanation


Explanation:

Microcytic anemia can often be associated with defective hemoglobin synthesis. In the case of iron deficiency, heme synthesis is impaired due to the lack of iron. Acute bleeding (choice A) is normally associated with erythrocytes of normal size, since the anemia is due to simple loss of blood, with plasma expansion to maintain total volume. Both vitamin and folate (choices B and D) are


image


required for DNA synthesis. Due to the extremely active cell division required to sustain the erythrocyte pool, impaired DNA synthesis first normally manifests as a lack of erythrocyte production. Anemia due to vitamin B12 or folate deficiency is macrocytic. Vitamin K (choice E) is required for synthesis of several clotting factors. Lack of vitamin K often presents as a problem with coagulation.


QUESTION 848

Which of the following statements concerning total body energy storage is correct?


  1. Most of the body's energy store is held as carbohydrate.

  2. Most of the body's energy store is held as lipid.

  3. Most of the body's energy store is held as plasma glucose.

  4. Most of the body's energy store is held as protein.

  5. Total body's energy storage approximately equals resting metabolic rate.


Answer: B

Section: Physiology Explanation


Explanation:

Lipid is the most concentrated form of energy storage, holding 9.4 kcal/g. For a typical 70 kg human over 130,000 kcal is typically stored as fat. Storage of energy as available protein (choice D) is about 20,000 kcal, while storage as carbohydrate (choice A) is about 3,000 kcal. Though blood glucose (choice C) is critically important, in particular as a source of energy for the brain, blood glucose does not provide a significant fraction of total body energy storage. While total body energy stores typically exceed 150,000 kcal, resting metabolic rate (depending on age and body mass) is about 2100 kcal/day (choice E).


QUESTION 849

During a brain surgery, during which the patient remained conscious, a part of the DC/ML (dorsal column, medial lemniscal) system was exposed and stimulated. Which of the following sensations might the patient most likely experience?


  1. a feeling as if his fingers are warming up

  2. a feeling as if something were touching his index finger

  3. a tingling sensation

  4. mild pain but he is unable to explain exactly where it hurts


Answer: B

Section: Physiology Explanation


Explanation:

The dorsal column-medial lemniscus (DC/ML) system is the sensory pathway that transmits conscious proprioceptive information with fine gradations such as a fine touch on the index finger to the cerebral cortex. The brain interprets any signals coming along the "labeled lines," the nerves that carry messages from the sensory organ to the cortex, as being information about a particular sense. Hence, activation of certain neurons in the somatic sensory system can cause a sensation as if it originated from mechanical pressure on the finger (choice E). Thermal sensations (choice A), tingling (choice C), and crude undetermined pain (choice D) are sensory modalities that are processed in the spinothalamic or anterolateral system.


USMLE USMLE Exam (United States Medical Licensing Examination Step 1) Detailed Information

What is USMLE?
The United States Medical Licensing Examination ® (USMLE®) is a three-step examination for medical licensure in the United States and is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners® (NBME®).
The USMLE assesses a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care. Each of the three Steps of the USMLE complements the others; no Step can stand alone in the assessment of readiness for medical licensure.
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Step 2 CS - limited hotel availability in Philadelphia April 2017
Posted: September 14, 2016
Please be advised that between April 27, 2017 and April 29, 2017, hotel availability in Philadelphia will be limited and rates may be higher than usual. Examinees planning to take the USMLE Step 2 Clinical Skills (CS) exam in Philadelphia should note that while the Philadelphia Clinical Skills Evaluation Collaboration (CSEC) test centers will remain open, it may be difficult and/or more expensive to obtain a hotel room during this time.
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UPDATE: USMLE Score Report Retrieval System
Posted: July 14, 2016
The Score Report Retrieval System is now back online.
Please be advised there are intermittent outages with the system that NBME- and FSMB-registered examinees use to retrieve their USMLE score reports. If you have encountered an error when attempting to retrieve your USMLE score report, please try again later. We are working to resolve the issue and will update this message when the system functionality has been fully restored.
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USMLE Bulletin of Information
The Bulletin includes information on all aspects of USMLE, such as eligibility requirements, scheduling test dates, testing, and score reporting. You must review and become familiar with the Bulletin before completing your application for USMLE Step 1, Step 2 (CK and CS), or Step 3. Start reading the Bulletin of Information »
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A summary of planned changes over the next few years is available. [Updated!]
The Composite Committee of the USMLE initiated a process to undertake a comprehensive review of the USMLE program in 2004. The Composite Committee establishes policy for the USMLE and is composed of representatives of the Federation of State Medical Boards (FSMB), National Board of Medical Examiners (NBME), the Educational Commission for Foreign Medical Graduates (ECFMG), and the American public.
This multi-year project to review and revise the USMLE sequence is called the Comprehensive Review of USMLE (CRU). Additional information about CRU is available.
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Applying, Scheduling, and Rescheduling
How do I apply for USMLE?
To apply for USMLE examinations, you must read the USMLE Bulletin of Information and submit an application through your registration entity.
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A fee may be charged if you change your appointment, depending on how much notice you provide. See the appointment change fee schedule for more information.
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No test preparation courses are affiliated with or sanctioned by the USMLE program. Information on such courses is not available from the ECFMG, FSMB, NBME, USMLE Secretariat, or medical licensing authorities.
The best preparation for the USMLE is a general, thorough review of the content reflected in the examination descriptions. You should also practice for your exams using the sample test materials. Self-assessment information and materials are also available. In addition, registered examinees who want the opportunity to become familiar with the Prometric test center environment may take a practice exam at the test center, for a fee. Register for a CBT Practice Session »
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The USMLE Bulletin can be found at http://www.usmle.org/bulletin. You have the option of viewing the Bulletin online or downloading a PDF file.
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How do I update my contact information (email, mailing address, phone number) or register a name change?
Go to the website of your registration entity to submit a name change request and/or obtain the form for completing the change, or to request a change to contact information. Supporting document is required for a name change request
Name change forms and documentation must be received and processed by your registration entity no later than 7 business days before your scheduled testing appointment.
NOTE: If you have a scheduling permit, a revised permit will be issued to you with your new name. You must bring your new permit for admittance to the test center or you will not be permitted to test.
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If you have a documented disability covered under the Americans with Disabilities Act (ADA) and require test accommodations, you must obtain information regarding procedures and documentation requirements from the Test Accommodations section of this website.
You must submit your application for the Step and your request for test accommodations with required documentation at the same time.
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Is there a limit on the number of times Steps can be taken?
You are ineligible to take a Step or Step Component if you have made six or more prior attempts to pass that Step or Step Component, including incomplete attempts.
Do the Steps have to be taken at particular points during my medical education and career?
You must pass Step 1 and Step 2 before you are eligible to take Step 3. In LCME-accredited medical schools, although Step 1 and Step 2 can be taken in any order, most students will take Step 1 at the end of their second year and Step 2 in their fourth year; Step 3 is usually taken during the first or second year of postgraduate training. Students and graduates of medical schools outside the United States and Canada should contact the ECFMG for information on ECFMG Certification and Step 1 and Step 2 eligibility. Most medical licensing authorities require completion of USMLE Steps 1, 2, and 3 within a seven-year period, which begins when you pass your first Step. Check the FSMB website for further information on such requirements.
If a physician currently holds a license in one state and has not taken USMLE, is it necessary to pass USMLE to seek licensure in another state?
Generally no, although this should be specifically checked with individual medical licensing authorities or the FSMB.
I am a graduate of a medical school outside the United States and Canada. How can I get information on what is required to enter graduate medical education and/or practice medicine in the United States?
The Educational Commission for Foreign Medical Graduates (ECFMG) provides such information. Through its Certification program, ECFMG assesses the readiness of graduates of medical schools outside the United States and Canada to enter residency or fellowship programs in the United States. The ECFMG® Certification Fact Sheet provides an overview of ECFMG Certification and preliminary information on entry into US programs of graduate medical education. For detailed information on these topics, including eligibility to take the USMLE, refer to the ECFMG Information Booklet. Both publications are available on the ECFMG website.
I am a MD/PhD candidate and the state board where I am applying for licensure requires applicants to complete all three Steps within seven years. Is there an exception to this policy?
The USMLE program recognizes that the recommended seven-year time limit may pose problems for medical licensure for some candidates with a combined degree (i.e., MD/PhD). For this reason, the USMLE program recommends to licensing jurisdictions that they consider allowing exceptions to the seven-year limit for MD/PhD candidates who meet the following requirements:
The candidate has obtained both degrees from an institution or program accredited by the LCME and a regional university accrediting body.
The PhD should reflect an area of study which ensures the candidate a continuous involvement with medicine and/or issues related, or applicable to, medicine.
A candidate seeking an exception to the seven-year rule should be required to present a verifiable and rational explanation for the fact that he or she was unable to meet the seven-year limit. These explanations will vary and each licensing jurisdiction will need to decide on its own which explanation justifies an exception. Students who pursue both degrees should understand that while many states' regulations provide specific exceptions to the seven-year rule for dual-degree candidates, others do not. Students pursuing a dual degree are advised to check the state-specific requirements for licensure listed by the FSMB.
Retakes
What are the rules regarding retakes?
You may take the same examination no more than three times within a 12-month period. Your fourth and subsequent attempts must be at least 12 months after your first attempt at that exam and at least six months after your most recent attempt at that exam.
Can I retake a Step that I previously passed?
If you pass a Step or Step Component, you are not allowed to retake it, except to comply with certain state board requirements which have been previously approved by USMLE governance. For example, you may retake a passed Step to comply with the time limit of a medical licensing authority for the completion of all Steps or a requirement imposed by another authority recognized by the USMLE program for this purpose. The medical licensing authority must provide information showing that you are an applicant for licensure in that jurisdiction; have fulfilled all requirements for licensure in that jurisdiction; are eligible for licensure except for the out-of-date examination; and have completed the full USMLE sequence, including Step 3. Information regarding retakes allowed to comply with ECFMG requirements is provided at the time of exam application using ECFMG's Interactive Web Applications (IWA).
If you are repeating a previously passed Step or Step Component because of a time limit, you may apply to retake the examination only after the applicable time limit has expired. An exception to this policy can be granted if, at the time of application and testing:
you are currently enrolled in an LCME- or AOA accredited medical school program leading to the MD or DO degree;
you have previously passed Step 1 and/or Step 2 but have not passed Step 3;
you are expected to graduate from the medical school program six or more years after the date you first passed Step 1 and/or Step 2; and
you are otherwise eligible to retake the examination.
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What is ERAS?
ERAS®, the Electronic Residency Application Service, is sponsored by the Association of American Medical Colleges (AAMC) and was developed to transmit residency applications via the Internet, including electronic transmittal of USMLE transcripts to residency programs which participate in ERAS.
Information on electronic transmittal of USMLE transcripts through ERAS is available for students and graduates of accredited medical schools in the United States and Canada from the medical schools.
ERAS is available to students and graduates of medical schools outside the United States and Canada through ECFMG.
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If you experience a computer issue during the test, notify test center staff immediately. The testing software is designed to restart the test at the point that it was interrupted.
To report test day issues, such as computer problems or not completing your exam (for any reason), send a written description of the incident to Test AdministrationS ervices at testadmin@nbme.org or by fax to (215) 590-9457. Test Administration Services must receive your notice within 10 days of your testing date or it may not be possible to investigate your concerns.
Your correspondence should include your name, your USMLE ID number, the examination name (Step 1, 2 CK, 2 CS, or 3), date of administration, and a detailed description of the difficulty experienced or the reason you decided not to finish the examination.
Please allow at least 15 business days for your report to be investigated and evaluated. You will receive written notification of the investigation results.
If you wish to appeal the results of the investigation, you may submit a written statement to the above office within 10 days of the date of the correspondence containing the results of the investigation. Please include a detailed explanation of the basis for your appeal. A group of senior staff will review the matter. Please be advised that the appeal process can take at least four weeks to complete and may not result in a change to the original decision.
What are the rules regarding what I can and cannot bring into the secure areas of the testing center?
It is important that you read and understand the rules regarding personal possessions. Unauthorized possession of personal items while in the secure areas of the testing centers may lead to a finding of irregular behavior and permanent annotation of your USMLE transcript.
For all Steps, if you bring personal items to the test center, you must store them in a small designated locker outside the secure testing area or in the designated storage area for Step 2 CS; electronic devices must be turned off. All personal items are subject to inspection and are prohibited in the secure areas of the testing center.
For Step 2 CS, the entire testing session from orientation until the evaluation is completed, including all breaks, is considered a closed and secure testing session, and the entire test center, including the orientation room and the restrooms, is a secure testing area. Therefore, the rules regarding unauthorized possession during Step 2 CS apply to the orientation room and to all breaks.
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