USMLE Step Assessment — Questions and Answers

Question 1: A rectangular room has a length of 12 meters and a width of 9 meters. If the room's floor is to be tiled, and each tile covers an area of 0.36 square meters, how many tiles are needed?

250
400
350
300 (Correct answer)

Correct answer: 300

First, calculate the total area of the rectangular room: Area = length × width = 12 meters × 9 meters = 108 square meters. Next, divide the total room area by the area covered by each tile to determine the number of tiles needed. Number of tiles = 108 m² / 0.36 m²/tile = 300 tiles.

Question 2: What is the purpose of the 'Omitted' filter in UWorld's block creation?

To exclude questions from archived subjects
To remove questions with images
To practice only questions that were left unanswered in a previous session (Correct answer)
To filter out questions above a certain difficulty

Correct answer: To practice only questions that were left unanswered in a previous session

The Omitted filter selects questions that were skipped or left unanswered in prior sessions, ensuring they don't go unreviewed.

Question 3: Which approach to UWorld flashcards is most commonly recommended?

Memorize every word in every UWorld explanation
Avoid flashcards entirely and rely only on question practice
Create flashcards from information in UWorld explanations that you find difficult to remember (Correct answer)
Use only the pre-made UWorld flashcard deck without additions

Correct answer: Create flashcards from information in UWorld explanations that you find difficult to remember

Making personalized flashcards from challenging UWorld explanation content leverages active recall and spaced repetition for the specific facts you find hardest.

Question 4: What is the most effective way to use UWorld's incorrect question filter during exam preparation?

Regularly revisit incorrect questions to reinforce learning and correct misunderstandings (Correct answer)
Avoid incorrect questions to reduce stress
Only review incorrect questions once per study block
Save all incorrect questions for the final week before the exam

Correct answer: Regularly revisit incorrect questions to reinforce learning and correct misunderstandings

Regularly cycling back to previously incorrect questions in UWorld helps correct misconceptions and reinforces the correct reasoning over time.

Question 5: Which USMLE Step does UWorld's foundational science question bank primarily prepare students for?

USMLE Step 3
USMLE Step 1 (Correct answer)
USMLE Step 2 CS
USMLE Step 2 CK exclusively

Correct answer: USMLE Step 1

UWorld's Step 1 question bank is designed to prepare students for the foundational science licensing exam covering basic sciences and their clinical correlations.

Question 6: On USMLE Step 1, approximately how much time should you allocate per question when practicing with UWorld?

5 minutes per question to ensure thorough analysis
There is no time limit on the real exam
30 seconds per question to maximize speed
About 90 seconds per question, which is the average time allocated on the real exam (Correct answer)

Correct answer: About 90 seconds per question, which is the average time allocated on the real exam

The USMLE allows roughly 90 seconds per question on average, and training with UWorld at this pace builds the habit of reading efficiently and selecting answers decisively.

Question 7: In UWorld, what does the 'Mark' (flag) feature during a timed block allow you to do without losing time?

Submit the question for grading immediately
Skip the question without it counting against your score
Quickly tag a question to return to before submitting the block, keeping you moving through other questions without dwelling (Correct answer)
Pause the block timer permanently

Correct answer: Quickly tag a question to return to before submitting the block, keeping you moving through other questions without dwelling

Flagging a question allows you to move on quickly and maintain pacing, returning to it at the end if time remains rather than wasting time on one difficult item.

Question 8: A 40-year-old woman has the worst headache of her life, which began 12 hours ago, and a noncontrast head CT is normal. What is the next best step?

Start a triptan for migraine
MRI of the brain in 2 weeks
Lumbar puncture to look for xanthochromia (Correct answer)
Discharge with an NSAID and follow-up

Correct answer: Lumbar puncture to look for xanthochromia

CT sensitivity for subarachnoid hemorrhage falls after 6 hours, so a normal CT must be followed by LP looking for xanthochromia or elevated RBCs.

Question 9: What is the most common bacterial cause of community-acquired pneumonia in adults?

Mycoplasma pneumoniae
Streptococcus pneumoniae (Correct answer)
Haemophilus influenzae
Klebsiella pneumoniae

Correct answer: Streptococcus pneumoniae

Streptococcus pneumoniae, a lancet-shaped Gram-positive diplococcus, is the most common cause of typical community-acquired pneumonia in adults.

Question 10: Which UWorld feature allows you to review only questions you previously answered incorrectly?

Create a custom block filtering by 'Incorrect' questions (Correct answer)
Switch to tutor mode
Reset the entire question bank
Use the timed mode exclusively

Correct answer: Create a custom block filtering by 'Incorrect' questions

UWorld's custom block creation lets you filter by incorrect answers so you can focus your review on weak areas.

Question 11: A day after total thyroidectomy, a woman reports perioral tingling, and tapping the facial nerve causes the corner of her mouth to twitch. What laboratory pattern is expected?

High calcium, low phosphate, high PTH
Low calcium, high phosphate, low PTH (Correct answer)
Low calcium, low phosphate, high PTH
Normal calcium, low magnesium, normal PTH

Correct answer: Low calcium, high phosphate, low PTH

Removal of or injury to the parathyroid glands causes hypoparathyroidism, with hypocalcemia, hyperphosphatemia, and low PTH.

Question 12: Can a student retake a UWSA after completing it once to get an updated score prediction?

No, UWorld does not permit any form of repeated assessment
Yes, unlimited retakes are always available and valid
No, each UWSA is designed to be taken only once to maintain predictive validity (Correct answer)
Yes, and the question set changes completely upon each retake

Correct answer: No, each UWSA is designed to be taken only once to maintain predictive validity

Each UWSA is designed for a single attempt; retaking it would expose you to identical questions, invalidating the score prediction through familiarity bias.

Question 13: How does UWorld's three-digit predicted score help students planning their USMLE Step 1 exam date?

It provides a score estimate that helps students decide whether they are ready to sit for the exam or need more preparation time (Correct answer)
It tells students which medical school to apply to
It automatically registers the student for the exam
It replaces the official NBME score report

Correct answer: It provides a score estimate that helps students decide whether they are ready to sit for the exam or need more preparation time

The predicted three-digit score from UWorld's self-assessment gives students a benchmark to compare against their target score, informing whether to proceed to testing or continue studying.

Question 14: A man with HIV (CD4 count 60/µL) has headache and focal weakness, and MRI shows multiple ring-enhancing lesions at the gray-white junction. Toxoplasma IgG is positive. What is the best initial treatment?

Amphotericin B and flucytosine
High-dose dexamethasone alone
Pyrimethamine, sulfadiazine, and leucovorin (Correct answer)
Stereotactic brain biopsy before any therapy

Correct answer: Pyrimethamine, sulfadiazine, and leucovorin

Empiric anti-Toxoplasma therapy is first-line, and biopsy is reserved for lesions that fail to improve after 10-14 days.

Question 15: A nurse is preparing to administer an intravenous (IV) antibiotic to a patient. Which of the following steps is the most appropriate to prevent medication errors?

Administering the medication immediately after retrieval from storage
Verifying the medication label with the pharmacy order only
Asking the patient about their known allergies before administration (Correct answer)
Using only verbal confirmation of the medication by another nurse

Correct answer: Asking the patient about their known allergies before administration

Before administering any medication, especially an intravenous antibiotic, verifying the patient's known allergies is a crucial step to prevent severe adverse drug reactions. This aligns with the 'rights of medication administration' and ensures patient safety by avoiding potentially life-threatening allergic responses. While other steps like verifying the label are important, directly confirming allergies with the patient is a unique and essential safety check.

Question 16: What is the recommended approach for reviewing a completed UWSA to maximize learning?

Systematically review all questions—both correct and incorrect—to reinforce reasoning (Correct answer)
Share your detailed results publicly to solicit feedback from peers
Delete the results and focus exclusively on the main question bank
Review only the questions answered incorrectly to save time

Correct answer: Systematically review all questions—both correct and incorrect—to reinforce reasoning

Reviewing every question, including correct ones, reinforces sound reasoning and uncovers gaps even in answers you got right for the wrong reasons.

Question 17: What role do UWorld's diagrams and tables in explanations play in exam preparation?

They consolidate complex information visually, aiding memorization of high-yield patterns (Correct answer)
They replace the need to read the question stem
They are decorative and not used on the real exam
They are only available in the premium version

Correct answer: They consolidate complex information visually, aiding memorization of high-yield patterns

UWorld's explanatory diagrams and tables distill complex physiological or clinical relationships into visual formats that are easier to memorize and apply on exam day.

Question 18: A nurse is caring for a patient with a nasogastric tube who is at risk for aspiration pneumonia. Which intervention is most appropriate to minimize the risk?

Flushing the NG tube every 2 hours
Elevating the head of the bed to at least 30 degrees (Correct answer)
Administering thickened liquids through the NG tube
Keeping the patient in a supine position

Correct answer: Elevating the head of the bed to at least 30 degrees

Elevating the head of the bed to at least 30 degrees, and ideally 30-45 degrees, is a crucial intervention to minimize the risk of aspiration pneumonia in patients with a nasogastric tube. This position utilizes gravity to help keep gastric contents in the stomach, significantly reducing the likelihood of reflux and subsequent aspiration into the lungs. It is a standard and highly effective nursing practice for aspiration prevention.

Question 19: A student's UWSA predicted score and their most recent NBME score differ by 15 points. What is the best approach?

Ignore the NBME and trust only the UWSA
Retake the UWSA until it matches the NBME
Consider both, along with trends across multiple assessments (Correct answer)
Ignore the UWSA and trust only the NBME

Correct answer: Consider both, along with trends across multiple assessments

Combining multiple assessments and looking at the trend gives a more reliable estimate than any single score.

Question 20: What is the maximum number of questions per UWorld session you can customize for a practice block?

Up to 25 questions per block
Up to 40 questions per block (Correct answer)
Up to 10 questions per block
Up to 100 questions per block

Correct answer: Up to 40 questions per block

UWorld allows you to create blocks of up to 40 questions per session to match real exam block lengths.

Question 21: A 55-year-old male with chest pain radiating to the left arm, diaphoresis, and ST elevation in leads II, III, and aVF presents to the ER. What is the most likely diagnosis?

Stable angina
Inferior STEMI (Correct answer)
Pulmonary embolism
Aortic dissection

Correct answer: Inferior STEMI

ST elevation in leads II, III, and aVF localizes ischemia to the inferior wall of the left ventricle, most commonly from right coronary artery occlusion.

Question 22: Which UWorld feature lets you review the complete explanation for a question, including tables and images?

The explanation panel on the results page (Correct answer)
The subject filter menu
The performance dashboard
The flagged question list

Correct answer: The explanation panel on the results page

After answering a question, UWorld's explanation panel displays the full rationale, including any accompanying tables, diagrams, or images.

Question 23: How should a student interpret a UWorld predicted score that falls in a borderline range?

As confirmation that no further preparation is needed
As an indication to switch to a different question bank
As a guarantee of failure on the real exam
As a warning to intensify preparation immediately and take another self-assessment after focused review (Correct answer)

Correct answer: As a warning to intensify preparation immediately and take another self-assessment after focused review

A borderline UWorld prediction signals the need for targeted improvement—focused study followed by a follow-up self-assessment will reveal whether your preparation has moved you into a safer zone.

Question 24: How does practicing UWorld in full timed blocks help with 'decision fatigue' on exam day?

It reduces the total number of questions you need to answer
It trains your brain to maintain decision quality over sustained periods, replicating the mental endurance required on exam day (Correct answer)
It allows you to skip the hardest questions automatically
It makes you immune to fatigue permanently

Correct answer: It trains your brain to maintain decision quality over sustained periods, replicating the mental endurance required on exam day

Full-block timed practice conditions your brain to maintain reasoning quality over a 40-question session, directly building the stamina needed for multiple consecutive exam blocks.

Question 25: How many times can you typically reset a UWorld question bank during a subscription period?

It depends on the subscription plan, but UWorld usually allows at least one full reset per subject (Correct answer)
No resets are allowed once questions are answered
Resets are only available in the premium tier
Unlimited resets at any time

Correct answer: It depends on the subscription plan, but UWorld usually allows at least one full reset per subject

UWorld's reset policy varies by plan, but most subscriptions allow at least one full bank reset, enabling a complete second pass through all questions.

Question 26: Which UWorld study strategy is recommended for students with limited preparation time?

Only do self-assessment exams without individual question blocks
Focus exclusively on high-yield subjects with the lowest personal accuracy (Correct answer)
Complete all questions in random order without filters
Skip explanations to cover more questions per day

Correct answer: Focus exclusively on high-yield subjects with the lowest personal accuracy

When time is short, UWorld is most effective when used to target high-yield subjects where your personal accuracy is lowest, maximizing score improvement per hour.

Question 27: A 55-year-old woman presents with bone pain, fatigue, and lab results showing: calcium 11.5, creatinine 2.1, total protein 10 g/dL, and a spike on serum protein electrophoresis. Urinalysis shows Bence Jones proteins. What is the diagnosis?

Monoclonal gammopathy of undetermined significance (MGUS)
Waldenström macroglobulinemia
Primary amyloidosis
Multiple myeloma (Correct answer)

Correct answer: Multiple myeloma

Multiple myeloma presents with the CRAB criteria: Hypercalcemia, Renal failure, Anemia, and Bone lesions, along with an M-protein spike and Bence Jones proteinuria.

Question 28: What type of questions does USMLE Step 2 CK primarily consist of, and how does UWorld align with this format?

Oral examination questions presented as audio clips
Short answer questions about anatomy diagrams
Clinical vignette-based multiple choice questions, and UWorld mirrors this format with detailed patient presentations (Correct answer)
True or false questions about pharmacology

Correct answer: Clinical vignette-based multiple choice questions, and UWorld mirrors this format with detailed patient presentations

Step 2 CK uses patient vignettes with single best answer choices, and UWorld replicates this exact format to give students realistic practice.

Question 29: What happens when you select 'incorrect' as a filter when building a UWorld block?

Questions are arranged by difficulty
Incorrect questions are removed from your bank
Questions from the highest-yield topics are added
Only questions you previously answered wrong are included in the new block (Correct answer)

Correct answer: Only questions you previously answered wrong are included in the new block

Filtering by Incorrect in UWorld builds a block consisting only of questions you have previously answered incorrectly, enabling targeted review.

Question 30: A man with alcohol use disorder has an upper lobe cavitary pneumonia with thick, currant jelly sputum. The organism is an encapsulated, lactose-fermenting gram-negative rod. What is it?

Klebsiella pneumoniae (Correct answer)
Legionella pneumophila
Pseudomonas aeruginosa
Haemophilus influenzae

Correct answer: Klebsiella pneumoniae

Klebsiella causes aspiration pneumonia with currant jelly sputum in people with alcohol use disorder and diabetes.

Question 31: In UWorld, what does a low 'Percentile' on a specific system suggest you should do?

Prioritize studying that system more intensively since you are underperforming relative to peers (Correct answer)
Stop studying that system since it is rarely tested
Ignore it because percentiles do not matter
Switch to a different question bank for that topic

Correct answer: Prioritize studying that system more intensively since you are underperforming relative to peers

A low percentile on a system indicates you are scoring below most peers, making it a priority area requiring additional focused study.

Question 32: When is a UWorld Self-Assessment generally most predictive of the actual exam score?

Halfway through the Qbank in tutor mode
Immediately after finishing a single subject block
At the very start of dedicated study
Within roughly the final 1-2 weeks before the exam (Correct answer)

Correct answer: Within roughly the final 1-2 weeks before the exam

Assessments taken close to test day best capture the knowledge level you will bring to the exam.

Question 33: A patient with HIV and a CD4 count of 60/mm3 has multiple ring-enhancing brain lesions. Which drug used as prophylaxis would have prevented this?

Valganciclovir
Azithromycin
Fluconazole
Trimethoprim-sulfamethoxazole (Correct answer)

Correct answer: Trimethoprim-sulfamethoxazole

TMP-SMX prophylaxis at CD4 <100 with positive Toxoplasma IgG prevents toxoplasmic encephalitis.

Question 34: What UWorld scheduling approach is recommended during the 4-6 weeks before USMLE exam day?

Switching entirely to passive reading without doing new questions
Doing only 10-question blocks on easy subjects to build confidence
Avoiding all question practice and focusing exclusively on lecture videos
Transitioning primarily to timed mode with 40-question blocks, full-length self-assessments, and targeted review of weak subjects (Correct answer)

Correct answer: Transitioning primarily to timed mode with 40-question blocks, full-length self-assessments, and targeted review of weak subjects

The final weeks before the exam should prioritize exam simulation — timed blocks, full self-assessments, and focused weak-subject review — to peak at the right time.

Question 35: What does comparing your UWorld percent correct to the 'National Average' help you determine?

Your exact board exam score prediction
Whether your performance is above or below that of other users preparing for the same exam (Correct answer)
How many questions remain in the bank
Which questions are most frequently missed nationally

Correct answer: Whether your performance is above or below that of other users preparing for the same exam

Comparing against the national average shows you where you stand relative to peers, helping you gauge competitiveness and identify priority study areas.

Question 36: Why is it important to practice under timed conditions in UWorld before your licensing exam?

To identify and correct pacing issues before exam day (Correct answer)
To increase the difficulty of future questions
To earn bonus questions for correct answers
To unlock advanced analytics

Correct answer: To identify and correct pacing issues before exam day

Timed practice in UWorld reveals whether you can complete each block within the allotted time, helping you correct pacing problems before the real exam.

Question 37: What does the 'Percent Correct' metric in UWorld represent?

The percentage of flagged questions answered correctly
The percentage of timed-out questions
The percentage of all questions answered correctly (Correct answer)
The percentage of omitted questions

Correct answer: The percentage of all questions answered correctly

Percent Correct in UWorld represents the proportion of all attempted questions answered correctly.

Question 38: After completing a UWorld Self-Assessment, which follow-up step best improves the next predicted score?

Reviewing explanations for missed and guessed questions to target weak areas (Correct answer)
Immediately retaking the same assessment
Skipping review to save time
Switching to a different Qbank without review

Correct answer: Reviewing explanations for missed and guessed questions to target weak areas

Reviewing errors and guesses converts assessment data into targeted learning that raises future scores.

Question 39: What is the recommended ratio of UWorld practice to passive study for dedicated exam prep?

20 percent questions and 80 percent reading
100 percent question practice with no reading
Approximately 60 to 70 percent active question practice, 30 to 40 percent passive review (Correct answer)
50/50 split between questions and lectures

Correct answer: Approximately 60 to 70 percent active question practice, 30 to 40 percent passive review

Most exam preparation experts recommend spending roughly 60 to 70 percent of dedicated study time on active question practice like UWorld, with passive review filling the rest.

Question 40: A patient stands up quickly from a supine position. Which immediate change occurs in the carotid sinus baroreflex?

Increased baroreceptor firing and decreased sympathetic outflow
Decreased baroreceptor firing and increased vagal tone
Increased baroreceptor firing and increased vagal tone
Decreased baroreceptor firing and increased sympathetic outflow (Correct answer)

Correct answer: Decreased baroreceptor firing and increased sympathetic outflow

Venous pooling lowers arterial pressure, reducing carotid sinus stretch and firing, which disinhibits sympathetic output.

Question 41: Why do many successful USMLE test-takers complete UWorld twice?

A second pass reinforces retention of difficult concepts and fills gaps missed the first time (Correct answer)
The second pass unlocks 500 bonus questions
UWorld requires two completions for a score report
The question bank updates between the first and second pass

Correct answer: A second pass reinforces retention of difficult concepts and fills gaps missed the first time

Doing UWorld twice reinforces knowledge by re-exposing you to difficult concepts, and a second pass specifically targeting incorrect and flagged questions fills remaining gaps.

Question 42: Oxygen consumption is 250 mL/min, arterial O2 content is 200 mL/L, and mixed venous O2 content is 150 mL/L. What is the cardiac output?

2.5 L/min
10 L/min
7.5 L/min
5 L/min (Correct answer)

Correct answer: 5 L/min

By the Fick principle, CO = 250 / (200 − 150) = 5 L/min.

Question 43: In UWorld pharmacology, which antiarrhythmic drug class works by blocking sodium channels and is used for ventricular arrhythmias?

Class IV antiarrhythmics (calcium channel blockers)
Class I antiarrhythmics (e.g., lidocaine, mexiletine, flecainide) (Correct answer)
Class III antiarrhythmics (e.g., amiodarone)
Class II antiarrhythmics (beta-blockers)

Correct answer: Class I antiarrhythmics (e.g., lidocaine, mexiletine, flecainide)

Class I antiarrhythmics block fast sodium channels, reducing phase 0 depolarization velocity; they are subdivided by their effects on action potential duration and are used for ventricular arrhythmias.

Question 44: How does taking the UWSA in tutor mode (with immediate answer explanations) affect its predictive accuracy?

It significantly improves the accuracy of the score prediction
It has no measurable effect on score prediction accuracy
It substantially reduces the accuracy of the score prediction by inflating performance (Correct answer)
It changes which questions are presented to the student

Correct answer: It substantially reduces the accuracy of the score prediction by inflating performance

Pausing to review explanations between questions disrupts exam simulation and inflates performance, making the predicted score far less accurate.

Question 45: A 64-year-old heavy smoker with a central hilar lung mass has a serum sodium of 126 mEq/L, is clinically euvolemic, and has a urine osmolality of 450 mOsm/kg. What is the best initial treatment for his asymptomatic hyponatremia?

Fluid restriction (Correct answer)
Normal saline infusion
Hydrochlorothiazide
3% hypertonic saline bolus

Correct answer: Fluid restriction

Paraneoplastic SIADH from small cell lung cancer is first treated with fluid restriction when hyponatremia is mild and causes no symptoms.

Question 46: During which phase of the cardiac cycle does left ventricular volume remain at its maximum?

Isovolumetric relaxation
Reduced ventricular filling
Isovolumetric contraction (Correct answer)
Rapid ejection

Correct answer: Isovolumetric contraction

After the mitral valve closes and before the aortic valve opens, the ventricle contracts with volume fixed at end-diastolic volume.

Question 47: When delivering a new diagnosis of metastatic disease, what should the physician do first after ensuring privacy?

Provide prognosis in months
Discuss treatment options
Ask what the patient already understands about the condition (Correct answer)
State the diagnosis clearly

Correct answer: Ask what the patient already understands about the condition

Assessing the patient's perception (SPIKES) guides how information is delivered.

Question 48: When is UWSA1 most strategically taken during Step 1 dedicated study?

Approximately 3–4 weeks before the exam (Correct answer)
After receiving your official Step 1 score report
On the very first day of dedicated study
The night before the actual USMLE

Correct answer: Approximately 3–4 weeks before the exam

Taking UWSA1 about 3–4 weeks out identifies weaknesses while leaving enough time to make meaningful improvements before exam day.

Question 49: What metric does UWorld use to compare your performance against other test-takers?

Raw score
Percentile rank (Correct answer)
Z-score
Letter grade

Correct answer: Percentile rank

UWorld shows your percentile rank to indicate how you compare to other users who answered the same questions.

Question 50: What does the 'Mark' feature in UWorld allow you to do during a timed block?

Submit the question for grading immediately
Skip the question permanently
Flag a question to revisit before submitting the block (Correct answer)
Add the question to a shared study group

Correct answer: Flag a question to revisit before submitting the block

The Mark feature in UWorld lets you flag a question during a timed block to revisit it before the block is submitted.

Question 51: How does reviewing your UWorld 'Weakest Subjects' report help prioritize study time?

It generates a pre-made study schedule automatically
It ranks subjects by your lowest percent correct so you can allocate more study time to the areas with the greatest improvement potential (Correct answer)
It shows which subjects have the fewest questions
It lists subjects excluded from your exam

Correct answer: It ranks subjects by your lowest percent correct so you can allocate more study time to the areas with the greatest improvement potential

The Weakest Subjects report highlights where your accuracy is lowest relative to other subjects, making it a direct guide for high-impact study prioritization.

Question 52: In UWorld embryology, failure of the neural tube to close at the caudal end results in which condition?

Anencephaly
Spina bifida (myelomeningocele in severe cases) (Correct answer)
Holoprosencephaly
Dandy-Walker malformation

Correct answer: Spina bifida (myelomeningocele in severe cases)

Failure of caudal neural tube closure leads to spina bifida, ranging from spina bifida occulta to myelomeningocele, while cranial non-closure causes anencephaly.

Question 53: A 65-year-old patient with hypertension is started on a medication that inhibits angiotensin-converting enzyme (ACE). Which adverse effect is most commonly associated with this drug?

Hypocalcemia
Hypokalemia
Hyperkalemia (Correct answer)
Bradycardia

Correct answer: Hyperkalemia

ACE inhibitors block the conversion of angiotensin I to angiotensin II, which leads to reduced aldosterone secretion. Aldosterone normally promotes sodium reabsorption and potassium excretion in the kidneys. By inhibiting aldosterone, ACE inhibitors can cause decreased potassium excretion, thereby increasing the risk of hyperkalemia (elevated potassium levels) as a common adverse effect.

Question 54: Why do UWorld explanations often include 'Key Associations' or tables?

To help students memorize high-yield comparisons between similar conditions that are commonly tested together on USMLE (Correct answer)
To list all possible diagnoses for a given symptom
To replace the need to read a textbook
To fill space in the explanation layout

Correct answer: To help students memorize high-yield comparisons between similar conditions that are commonly tested together on USMLE

Key Association tables in UWorld explanations highlight commonly tested differentials and distinguishing features, condensing high-yield comparison information for efficient retention.

Question 55: How do you create a custom question block in UWorld?

By importing questions from external sources
By contacting UWorld support to curate a block
By downloading questions as a PDF
By selecting subjects, difficulty, and question status filters, then generating a block (Correct answer)

Correct answer: By selecting subjects, difficulty, and question status filters, then generating a block

UWorld lets you build custom blocks by choosing filters like subject, difficulty, and question status before generating your session.

Question 56: In UWorld musculoskeletal pathology, which crystal arthropathy shows needle-shaped negatively birefringent crystals under polarized light?

Reactive arthritis
Pseudogout (calcium pyrophosphate crystals)
Septic arthritis
Gout (monosodium urate crystals) (Correct answer)

Correct answer: Gout (monosodium urate crystals)

Monosodium urate crystals in gout are needle-shaped and negatively birefringent (yellow when parallel to the compensator), while CPPD crystals in pseudogout are rhomboid and positively birefringent.

Question 57: Why are aminoglycosides ineffective against anaerobic bacteria?

Anaerobes have thick peptidoglycan walls
Anaerobes lack the 30S ribosomal subunit
Drug uptake requires oxygen-dependent transport (Correct answer)
Anaerobes secrete beta-lactamases

Correct answer: Drug uptake requires oxygen-dependent transport

Aminoglycosides enter bacteria through an oxygen-dependent active transport process.

Question 58: How does UWorld organize questions within its question bank?

Alphabetically by question stem
By publication date only
By question length only
By subject, system, and topic categories (Correct answer)

Correct answer: By subject, system, and topic categories

UWorld organizes its question bank by subject, organ system, and topic, making it easy to target specific areas during block creation.

Question 59: A patient started on lisinopril develops lip and tongue swelling without urticaria. What is the most likely mechanism?

Decreased bradykinin degradation (Correct answer)
Direct histamine release
Acquired C1 esterase inhibitor deficiency
IgE-mediated mast cell degranulation

Correct answer: Decreased bradykinin degradation

ACE also breaks down bradykinin, so inhibiting it lets bradykinin build up and cause angioedema.

Question 60: If a student's UWorld predicted score fluctuates significantly between sessions, what does this most likely indicate?

Inconsistent performance or a small sample size of completed questions (Correct answer)
That UWorld's prediction system is unreliable
That the student is improving rapidly
A technical error in UWorld's algorithm

Correct answer: Inconsistent performance or a small sample size of completed questions

Large fluctuations in UWorld's predicted score typically reflect inconsistent performance across sessions or an insufficient number of completed questions to produce a stable estimate.

Question 61: A 22-year-old male college student presents with fever, severe sore throat, cervical lymphadenopathy, and splenomegaly. Monospot test is positive. He is prescribed amoxicillin for presumed strep throat by an urgent care provider. What rash does he develop?

Vesicular rash from HSV superinfection
Urticarial hives from true penicillin allergy
Petechial rash from thrombocytopenia
Diffuse maculopapular rash due to EBV-associated reaction to amoxicillin (Correct answer)

Correct answer: Diffuse maculopapular rash due to EBV-associated reaction to amoxicillin

EBV (infectious mononucleosis) causes a characteristic diffuse maculopapular rash when aminopenicillins (ampicillin, amoxicillin) are administered, a hypersensitivity reaction specific to active EBV infection.

Question 62: A student retakes a UWorld Self-Assessment (UWSA) they completed two months earlier and scores 20 points higher. How should this result be interpreted?

As a reliable sign of a 20-point improvement
As proof the first attempt was underpredicted
As likely inflated because of question recall (Correct answer)
As equivalent to taking a new NBME form

Correct answer: As likely inflated because of question recall

Repeated questions are recognized from memory, so retake scores overstate true readiness.

Question 63: A 58-year-old male with hypertension is started on a new antihypertensive. He develops a dry, persistent cough 2 weeks later. What class of medication most likely caused this side effect?

Beta-blocker
ACE inhibitor (Correct answer)
Calcium channel blocker
Angiotensin receptor blocker (ARB)

Correct answer: ACE inhibitor

ACE inhibitors cause a dry, persistent cough in approximately 10–15% of patients due to bradykinin accumulation; switching to an ARB eliminates the cough while maintaining similar blood pressure control.

Question 64: What does the UWorld 'Percent Correct' metric represent in your performance dashboard?

The percentage of subjects you have finished
The percentage of questions flagged for review
The percentage of questions you answered correctly out of all questions attempted (Correct answer)
The percentage of questions you completed in timed mode

Correct answer: The percentage of questions you answered correctly out of all questions attempted

Percent Correct reflects the ratio of correctly answered questions to total questions attempted, giving you a snapshot of your overall accuracy.

Question 65: Which of the following arteries is most likely injured in a midshaft humerus fracture?

Brachial artery
Radial artery (Correct answer)
Axillary artery
Subclavian artery

Correct answer: Radial artery

A midshaft humerus fracture is notoriously associated with injury to the radial nerve, which courses in the radial groove of the humerus. While the deep brachial artery (profunda brachii) runs alongside the radial nerve, severe trauma to the humerus shaft can also compromise the main brachial artery, which is the primary blood supply to the forearm. Although the radial artery is located distally in the forearm, its perfusion can be critically affected by a more proximal brachial artery injury, or in complex fractures, direct trauma could extend to affect its integrity.

Question 66: A 40-year-old Jehovah's Witness with decision-making capacity refuses a blood transfusion for life-threatening GI bleeding after being informed of the risks. What is the most appropriate action?

Respect the refusal and offer alternative treatments (Correct answer)
Transfuse because the condition is life-threatening
Ask the patient's spouse to consent to transfusion
Obtain a court order to transfuse

Correct answer: Respect the refusal and offer alternative treatments

Competent adults may refuse any treatment, including life-saving care, after informed refusal.

Question 67: A 32-year-old woman in her third trimester presents with severe hypertension (180/110), proteinuria (4+ on dipstick), and headache. Labs show elevated LFTs, low platelets, and hemolytic anemia. What is this condition?

HELLP syndrome (Correct answer)
Gestational hypertension
Thrombotic thrombocytopenic purpura
Preeclampsia without severe features

Correct answer: HELLP syndrome

HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe variant of preeclampsia requiring prompt delivery regardless of gestational age.

Question 68: What does a 'cumulative score' represent in UWorld analytics?

Your overall percent correct across all completed questions (Correct answer)
The score from your last quiz only
Points earned per subject
Score adjusted for difficulty

Correct answer: Your overall percent correct across all completed questions

The cumulative score reflects your overall accuracy across every question you have completed in UWorld.

Question 69: What UWorld gastroenterology finding is characteristic of celiac disease on small bowel biopsy?

Villous atrophy with crypt hyperplasia and increased intraepithelial lymphocytes (Correct answer)
Non-caseating granulomas throughout all layers of the bowel wall
Cobblestoning with skip lesions in the terminal ileum
Pseudomembranes overlying colonic mucosa

Correct answer: Villous atrophy with crypt hyperplasia and increased intraepithelial lymphocytes

Celiac disease causes villous blunting with compensatory crypt hyperplasia and increased intraepithelial lymphocytes, triggered by gluten-induced immune damage to the small intestinal mucosa.

Question 70: A screening test has 90% sensitivity and 80% specificity and is used in 1,000 people with a disease prevalence of 10%. What is the positive predictive value?

About 11%
About 33% (Correct answer)
About 50%
About 90%

Correct answer: About 33%

TP = 90 and FP = 180, so PPV = 90/270 ≈ 33%.

Question 71: In UWorld microbiology, which organism causes the classic 'rose spots' rash, relative bradycardia, and stepwise fever pattern in typhoid fever?

Salmonella typhi (Correct answer)
Yersinia enterocolitica
Shigella dysenteriae
Campylobacter jejuni

Correct answer: Salmonella typhi

Salmonella typhi causes typhoid fever characterized by stepwise fever, relative bradycardia (Faget's sign), salmon-colored rose spots on the trunk, and systemic infection via Peyer's patches.

Question 72: Adding which lipid-lowering drug to a statin most increases the risk of rhabdomyolysis?

Ezetimibe
Gemfibrozil (Correct answer)
Colesevelam
Omega-3 fatty acids

Correct answer: Gemfibrozil

Gemfibrozil blocks statin glucuronidation, which raises statin levels and the risk of myopathy.

Question 73: A traveler develops profuse rice-water diarrhea. The toxin responsible increases intracellular cAMP by which action?

ADP-ribosylating Gs, keeping it permanently active (Correct answer)
Cleaving 28S rRNA
Directly binding guanylate cyclase
Inhibiting Gi

Correct answer: ADP-ribosylating Gs, keeping it permanently active

Cholera toxin ADP-ribosylates Gs, causing constant adenylate cyclase activation and chloride secretion.

Question 74: Antidiuretic hormone increases water reabsorption primarily by which mechanism?

Increasing Na-K-2Cl cotransporter activity in the thin descending limb
Stimulating aldosterone release from the adrenal cortex
Inserting aquaporin-2 channels into principal cells of the collecting duct via V2 receptors (Correct answer)
Activating V1 receptors on proximal tubule cells

Correct answer: Inserting aquaporin-2 channels into principal cells of the collecting duct via V2 receptors

V2 receptor activation raises cAMP, driving aquaporin-2 insertion into the apical membrane of collecting duct principal cells.

Question 75: A newborn has hypocalcemic tetany, a conotruncal heart defect, and no thymic shadow on chest x-ray. What is the most likely cause?

Trisomy 13
Mutation in the AIRE gene
Microdeletion of 22q11.2 (Correct answer)
Chromosome 5p deletion

Correct answer: Microdeletion of 22q11.2

DiGeorge syndrome comes from a 22q11.2 deletion that disrupts development of the 3rd and 4th pharyngeal pouches.

Question 76: In UWorld, what does a 'Percentile' score indicate?

The number of subjects remaining
The total number of questions you have answered
Your predicted board exam score
The percentage of other UWorld users you scored higher than on a given subject (Correct answer)

Correct answer: The percentage of other UWorld users you scored higher than on a given subject

A percentile score shows how your performance compares to other UWorld users, meaning a 70th percentile means you outperformed 70% of users on that topic.

Question 77: How does UWorld's search function help with navigation?

It searches only within completed blocks
It filters questions by user rating
It locates questions by answer choice only
It allows you to search for specific topics or keywords within the question bank (Correct answer)

Correct answer: It allows you to search for specific topics or keywords within the question bank

UWorld's search function lets you find questions related to specific topics or clinical concepts by entering keywords.

Question 78: What is the benefit of reviewing UWorld explanations even for questions you answered correctly?

Explanations often contain high-yield details and teaching points that reinforce and deepen understanding beyond the answer (Correct answer)
It reduces your exam fee
It unlocks additional question blocks
It increases your percent correct score

Correct answer: Explanations often contain high-yield details and teaching points that reinforce and deepen understanding beyond the answer

Even correct answers may have been reached by partial reasoning; reading explanations ensures you understand the full concept and related high-yield facts.

Question 79: In UWorld neurology, what is the classic presentation of Wernicke encephalopathy and its underlying cause?

Bilateral arm weakness from cervical cord compression
Memory loss and confabulation from B12 deficiency
Tremors and rigidity from dopamine depletion
Confusion, ophthalmoplegia, and ataxia caused by thiamine (B1) deficiency, commonly in alcoholics (Correct answer)

Correct answer: Confusion, ophthalmoplegia, and ataxia caused by thiamine (B1) deficiency, commonly in alcoholics

Wernicke encephalopathy presents with the classic triad of confusion, eye movement abnormalities, and gait ataxia due to thiamine deficiency, requiring immediate IV thiamine treatment.

Question 80: What does it mean if your UWorld predicted score is consistently above the passing threshold over multiple sessions?

Your preparation is on track, but continued practice is still recommended to build confidence and fill gaps (Correct answer)
You can stop studying immediately and register for the exam
You have mastered all content and no further review is needed
UWorld's prediction model has failed and your score is unreliable

Correct answer: Your preparation is on track, but continued practice is still recommended to build confidence and fill gaps

Consistent above-threshold predictions indicate strong preparation, but continued practice to solidify performance and close any remaining gaps is still the recommended approach.

Question 81: How does UWorld's 'Omitted' question status differ from 'Incorrect'?

Omitted questions were skipped without an answer selected, while incorrect means a wrong answer was chosen (Correct answer)
Omitted and incorrect are the same in UWorld
Omitted questions count as correct for scoring purposes
Omitted means the question was too easy to answer

Correct answer: Omitted questions were skipped without an answer selected, while incorrect means a wrong answer was chosen

Omitted questions are those left unanswered, whereas incorrect questions received a wrong answer selection; both affect your percent correct differently.

Question 82: A test has a sensitivity of 90% and a specificity of 80%. What is its positive likelihood ratio?

9.0
0.125
4.5 (Correct answer)
1.125

Correct answer: 4.5

LR+ = sensitivity / (1 − specificity) = 0.9/0.2 = 4.5.

Question 83: How does UWorld define a question as 'Omitted' in performance tracking?

A question marked incorrect
A question that was left unanswered during a timed session (Correct answer)
A question completed in Tutor Mode
A question flagged for review

Correct answer: A question that was left unanswered during a timed session

An Omitted question in UWorld is one where no answer was selected before the session ended.

Question 84: What is the purpose of the UWorld 'Reset' feature for a question bank?

It deletes your account data permanently
It removes flagged questions from your queue
It resets only your timed mode scores
It clears your previous answers so you can redo questions as if attempting them for the first time (Correct answer)

Correct answer: It clears your previous answers so you can redo questions as if attempting them for the first time

The Reset feature allows you to wipe your prior responses for a subject or entire bank so you can reattempt questions fresh for additional practice.

Question 85: What is the purpose of UWorld's Test Mode for exam preparation?

To simulate real exam conditions by hiding explanations until the block is complete (Correct answer)
To provide immediate feedback after each question
To allow unlimited time per question
To skip difficult questions automatically

Correct answer: To simulate real exam conditions by hiding explanations until the block is complete

UWorld's Test Mode replicates actual exam conditions by withholding explanations until the entire block is submitted.

Question 86: What is a UWorld Self-Assessment exam primarily used for?

Testing internet speed for the platform
Practicing free-form essay questions
Reviewing flashcard decks
Predicting your likely performance on the actual licensing exam (Correct answer)

Correct answer: Predicting your likely performance on the actual licensing exam

UWorld's Self-Assessment exams are designed to predict your probability of passing or your expected score on the actual licensing exam.

Question 87: A 19-year-old woman has her third episode of Neisseria meningitidis bacteremia. A deficiency of which component most likely explains this?

C5-C9 (membrane attack complex) (Correct answer)
C3
C1 esterase inhibitor
CD18

Correct answer: C5-C9 (membrane attack complex)

Terminal complement (MAC) deficiency predisposes to recurrent Neisseria infections.

Question 88: Which UWorld strategy has been shown to most reliably improve score predictions over a study period?

Focusing only on the subjects you already score highest in
Daily targeted question practice combined with thorough explanation review and systematic second passes on missed questions (Correct answer)
Exclusively using self-assessment exams without individual practice blocks
Completing the largest possible number of questions per day without reviewing explanations

Correct answer: Daily targeted question practice combined with thorough explanation review and systematic second passes on missed questions

The combination of daily targeted practice, deep explanation review, and systematically revisiting missed questions is the most validated approach for improving UWorld performance and score predictions over time.

Question 89: Which of the following innovations is most associated with the Industrial Revolution?

The personal computer
The steam engine (Correct answer)
The printing press
The telescope

Correct answer: The steam engine

The steam engine, significantly improved by James Watt in the late 18th century, was a foundational innovation of the Industrial Revolution. It provided a powerful and reliable source of energy that transformed manufacturing, enabling factories to operate independently of water power, and revolutionized transportation through its application in locomotives and steamships. This invention was central to the shift from agrarian to industrial societies.

Question 90: What strategy is recommended for the final weeks before a USMLE exam using UWorld?

Shift primarily to Test Mode with full timed blocks to simulate exam day conditions (Correct answer)
Stop using UWorld and only read textbooks
Switch exclusively to Tutor Mode to maximize explanation reading
Use only flashcards for review

Correct answer: Shift primarily to Test Mode with full timed blocks to simulate exam day conditions

In the final weeks before USMLE, transitioning to full Test Mode blocks simulates exam-day pacing and conditions, reinforcing readiness.

Question 91: What trend graph feature in UWorld helps track your improvement over time?

The leaderboard showing top scorers
The daily login streak tracker
The performance graph that plots percent correct across sequential question blocks (Correct answer)
The countdown timer for exam day

Correct answer: The performance graph that plots percent correct across sequential question blocks

UWorld's performance graph displays your percent correct for each block over time, allowing you to visualize whether your accuracy is trending upward.

Question 92: What is the advantage of using UWorld's subject filter over random question selection?

It provides bonus explanations not available in random mode
It increases the number of available questions
It allows targeted practice of specific weak areas rather than random coverage (Correct answer)
It automatically sets the timer to unlimited

Correct answer: It allows targeted practice of specific weak areas rather than random coverage

Using UWorld's subject filter ensures your session is concentrated on one topic area, allowing more deliberate and efficient practice of identified weaknesses.

Question 93: How does UWorld help students master the 'Most Likely Diagnosis' question type common on USMLE?

By presenting detailed patient vignettes with classic findings that require pattern recognition to reach the correct diagnosis (Correct answer)
By giving the diagnosis in the question stem to focus on management
By only showing imaging questions without clinical history
By providing a list of diagnoses to memorize without context

Correct answer: By presenting detailed patient vignettes with classic findings that require pattern recognition to reach the correct diagnosis

UWorld's vignette format trains diagnostic reasoning by presenting classic and atypical presentations, building the pattern recognition skills needed for 'most likely diagnosis' questions.

Question 94: When simulating exam conditions in UWorld, which setting should be disabled?

Immediate feedback (Tutor Mode) (Correct answer)
Question shuffling
Percentile display
Subject filtering

Correct answer: Immediate feedback (Tutor Mode)

Disabling Tutor Mode (immediate feedback) is essential for realistic exam simulation, as real exams do not provide explanations between questions.

Question 95: Which UWorld feature allows you to identify your weakest subject areas?

Case simulation timer
Flashcard deck
Performance by subject report (Correct answer)
Peer comparison chart

Correct answer: Performance by subject report

UWorld's performance by subject report breaks down your accuracy by topic so you can target weak areas.

Question 96: What is the recommended approach for using UWorld's self-assessment in relation to exam scheduling?

Take it at least 4 to 6 weeks before the exam to allow time to act on results (Correct answer)
Take it only once the question bank is 100% complete
Take it the night before the exam for final practice
Take it exclusively in Tutor Mode

Correct answer: Take it at least 4 to 6 weeks before the exam to allow time to act on results

Taking UWorld's self-assessment 4 to 6 weeks before the exam gives enough time to address identified weaknesses before test day.

Question 97: What does UWorld's 'Time Per Question' metric help a student identify?

Speed of internet connection
Total study hours per week
Number of breaks taken per session
Whether they are spending too much or too little time on individual questions (Correct answer)

Correct answer: Whether they are spending too much or too little time on individual questions

The Time Per Question metric in UWorld reveals pacing patterns, helping students identify if they rush through or dwell too long on questions.

Question 98: Which UWorld simulation feature is most useful for students who struggle with test anxiety?

Skipping questions and reviewing explanations only
Full timed Test Mode blocks that replicate exam conditions repeatedly (Correct answer)
Unlimited Tutor Mode with no time pressure
Using only mobile mode for practice

Correct answer: Full timed Test Mode blocks that replicate exam conditions repeatedly

Repeatedly practicing under timed Test Mode conditions desensitizes students to exam pressure, reducing test anxiety over time.

Question 99: Why is consistent daily UWorld practice generally more effective than marathon weekend sessions?

Daily practice reinforces spaced repetition, while cramming leads to rapid forgetting (Correct answer)
UWorld limits the number of questions available on weekends
Daily practice earns more performance points in the system
Marathon sessions unlock harder questions

Correct answer: Daily practice reinforces spaced repetition, while cramming leads to rapid forgetting

Consistent daily UWorld practice spaces learning across time, leveraging the spacing effect to produce stronger, more durable memory than equivalent cramming sessions.

Question 100: Why should you avoid spending more than 2 minutes on any single UWorld question during timed practice?

Spending more than 2 minutes per question risks running out of time on later questions and does not significantly improve your accuracy on the current one (Correct answer)
UWorld automatically locks questions after 2 minutes
The timer resets after 2 minutes automatically
Questions answered after 2 minutes are scored differently

Correct answer: Spending more than 2 minutes per question risks running out of time on later questions and does not significantly improve your accuracy on the current one

Exceeding 2 minutes on one question jeopardizes your ability to answer remaining questions, and research shows that prolonged deliberation rarely improves accuracy on board-style questions.

Question 101: How does UWorld indicate the difficulty level of a question?

By a color-coded tag on the question stem
Through percentile data showing how many users answered it correctly (Correct answer)
By sorting questions in difficulty order automatically
By a star rating system from 1 to 5

Correct answer: Through percentile data showing how many users answered it correctly

UWorld uses peer performance data—showing what percentage of users answered correctly—as a proxy for question difficulty rather than a static rating.

Question 102: What does UWorld's 'Unused' question count indicate?

Questions marked incorrect
Questions not yet attempted by the user (Correct answer)
Questions with no explanations
Questions outside the exam scope

Correct answer: Questions not yet attempted by the user

The Unused count in UWorld reflects questions in the bank that the user has not yet attempted.

Question 103: How can a UWorld user organize their study sessions to cover the entire question bank systematically?

By working through each subject filter sequentially and tracking unused question counts (Correct answer)
By using flashcards exclusively
By answering questions in random order with no filters
By completing only the self-assessment exams

Correct answer: By working through each subject filter sequentially and tracking unused question counts

Systematically filtering by subject and monitoring the unused question count ensures you work through every topic area in the bank without omissions.

Question 104: What does the UWorld 'Subject Breakdown' report show?

The total number of questions available per subject
A list of subjects you have not yet started
Your daily study time per subject
Your performance organized by subject area so you can identify strong and weak topics (Correct answer)

Correct answer: Your performance organized by subject area so you can identify strong and weak topics

The Subject Breakdown report displays your percent correct for each subject area, helping you identify which topics need more attention.

Question 105: What UWorld hematology concept explains why sickle cell patients are functionally asplenic?

The spleen is absent due to a developmental defect in sickle cell disease
Repeated splenic infarctions from sickling cause autosplenectomy, leaving patients susceptible to encapsulated organisms (Correct answer)
Splenomegaly compresses splenic vasculature, reducing function
Sickle cell patients have surgically removed spleens at birth

Correct answer: Repeated splenic infarctions from sickling cause autosplenectomy, leaving patients susceptible to encapsulated organisms

Repeated vaso-occlusive episodes in the spleen cause progressive infarction and fibrosis (autosplenectomy), rendering patients susceptible to infections with encapsulated bacteria like Streptococcus pneumoniae.

Question 106: After drinking stream water on a hiking trip, a man has bloating and foul-smelling, greasy, non-bloody diarrhea. What is the most likely pathogen?

Cryptosporidium parvum
Entamoeba histolytica
Shigella sonnei
Giardia lamblia (Correct answer)

Correct answer: Giardia lamblia

Giardia causes malabsorptive, fatty diarrhea after drinking untreated water, and trophozoites attach to the duodenal mucosa.

Question 107: What does UWorld's predicted score range indicate?

The range of scores you are likely to achieve on the actual licensing exam based on your UWorld performance (Correct answer)
A guaranteed minimum score on the real exam
The average score of all UWorld users
The score needed to pass the UWorld platform's internal assessment

Correct answer: The range of scores you are likely to achieve on the actual licensing exam based on your UWorld performance

UWorld's predicted score range estimates the span of scores you are statistically likely to earn on the real licensing exam based on your performance patterns in the question bank.

Question 108: What is the relationship between UWorld subject accuracy and the predicted licensing exam score?

Subject accuracy is not factored into the prediction
Higher accuracy across all subjects is directly associated with a higher predicted score (Correct answer)
Only accuracy in the final self-assessment exam counts toward prediction
Predictions are based solely on the number of questions completed

Correct answer: Higher accuracy across all subjects is directly associated with a higher predicted score

UWorld's score prediction model incorporates your accuracy rates across all subject areas, so consistent high performance across subjects raises the predicted score.

Question 109: An unconscious patient has no advance directive or healthcare power of attorney. His wife, adult daughter, and brother are present. Who is typically the surrogate decision-maker?

Adult daughter
Wife (Correct answer)
The attending physician
Brother

Correct answer: Wife

Most state hierarchies place the spouse first, followed by adult children, parents, and siblings.

Question 110: A 40-year-old male with HIV (CD4 count 50 cells/µL) presents with headache, fever, and neck stiffness. CSF India ink stain shows encapsulated yeast. What is the treatment of choice?

Fluconazole monotherapy immediately
Amphotericin B plus flucytosine for induction, followed by fluconazole consolidation (Correct answer)
Acyclovir IV for viral meningitis
Ceftriaxone plus vancomycin for bacterial meningitis

Correct answer: Amphotericin B plus flucytosine for induction, followed by fluconazole consolidation

Cryptococcal meningitis in HIV patients is treated with amphotericin B plus flucytosine for induction (2 weeks), followed by fluconazole for consolidation and maintenance.

Question 111: How should a student respond if their UWorld self-assessment score is significantly lower than their target exam score?

Switch to a different question bank entirely
Identify the lowest-performing subjects, increase question practice in those areas, and retake the self-assessment in 2 to 3 weeks (Correct answer)
Postpone the exam immediately
Stop using UWorld and only read textbooks

Correct answer: Identify the lowest-performing subjects, increase question practice in those areas, and retake the self-assessment in 2 to 3 weeks

A low self-assessment score is diagnostic—it tells you which subjects need more work, allowing you to focus your remaining time strategically before retesting your progress.

Question 112: In UWorld reproductive pathology, what is the mechanism of action of methotrexate when used to treat ectopic pregnancy?

It induces prostaglandin-mediated cervical ripening to expel the ectopic tissue
It inhibits dihydrofolate reductase, blocking DNA synthesis and causing trophoblastic cell death (Correct answer)
It blocks progesterone receptors, terminating trophoblast support
It promotes endometrial shedding to displace the ectopic implant

Correct answer: It inhibits dihydrofolate reductase, blocking DNA synthesis and causing trophoblastic cell death

Methotrexate is a folate antagonist that inhibits DHFR, halting DNA synthesis in rapidly dividing trophoblastic cells and allowing the ectopic pregnancy to resolve without surgery.

Question 113: What should you do if your UWorld predicted score is lower than your target?

Reset your question bank and start over completely
Assume UWorld predictions are inaccurate and proceed without changes
Analyze your performance by subject and intensify focus on weak areas before the exam (Correct answer)
Immediately register for a different licensing exam

Correct answer: Analyze your performance by subject and intensify focus on weak areas before the exam

A below-target UWorld prediction is a signal to perform a detailed performance analysis by subject and redirect your remaining study time toward identified weaknesses.

Question 114: Why does UWorld report a predicted score as a range rather than one exact number?

To avoid comparing students to each other
Because the scoring algorithm is randomized
Because answers are scored by different graders
To account for measurement error in any single assessment (Correct answer)

Correct answer: To account for measurement error in any single assessment

Every test score has measurement error, so a range better represents the likely true score.

Question 115: A traveler develops profuse 'rice-water' diarrhea. How does the responsible toxin work?

Inactivates the 60S ribosomal subunit
Ribosylates Gi, raising cAMP
ADP-ribosylates Gs, raising cAMP (Correct answer)
Cleaves SNARE proteins

Correct answer: ADP-ribosylates Gs, raising cAMP

Cholera toxin from Vibrio cholerae permanently activates Gs by ADP-ribosylation. The resulting rise in cAMP drives chloride and water secretion into the gut lumen. Pertussis toxin inactivates Gi. Shiga toxin inactivates the 60S subunit.

Question 116: In which exam mode should a UWSA be taken to most accurately simulate real USMLE conditions?

Mixed mode alternating timed and untimed blocks
Timed mode with no interruptions between blocks (Correct answer)
Untimed mode to eliminate time-related stress
Tutor mode with explanations displayed after each question

Correct answer: Timed mode with no interruptions between blocks

Taking the UWSA in fully timed mode without interruptions best replicates actual USMLE conditions and produces the most valid score prediction.

Question 117: What is the most accurate way to use UWorld's score prediction in your overall exam preparation plan?

As a replacement for all other practice exams
As the single definitive measure of exam readiness
As one data point among several, including NBME practice exams and self-assessment results (Correct answer)
As a metric to share with medical school administration only

Correct answer: As one data point among several, including NBME practice exams and self-assessment results

UWorld's predicted score is most useful as one component of a broader readiness picture that includes NBME practice exams and other self-assessments for a comprehensive view.

Question 118: What distinguishes the UWSA from simply generating a random timed block within the UWorld question bank?

UWSA blocks can be reviewed without any time constraints afterward
The main question bank does not include clinical vignette-style questions
UWSA questions are notably easier than regular question bank questions
UWSA provides a normed, standardized predicted USMLE score based on a separate question pool (Correct answer)

Correct answer: UWSA provides a normed, standardized predicted USMLE score based on a separate question pool

Unlike random question bank blocks, the UWSA uses a separate question pool and a normed scoring algorithm that produces a validated, predicted USMLE score.

Question 119: A 45-year-old male presents with severe epigastric pain radiating to the back, nausea, vomiting, and a serum lipase three times the upper limit of normal after a weekend of heavy alcohol use. What is the most appropriate initial management?

IV fluid resuscitation, bowel rest (NPO), and pain management (Correct answer)
Emergency ERCP
Immediate surgical consultation for pancreatectomy
Oral pancreatic enzyme replacement

Correct answer: IV fluid resuscitation, bowel rest (NPO), and pain management

Acute pancreatitis is initially managed with aggressive IV fluid resuscitation, NPO status, and analgesics; surgery is reserved for complications such as infected necrosis.

Question 120: Which UWorld feature most closely mimics NBME exam-style question formatting?

Tutor Mode with unlimited time
Test Mode with timed 40-question blocks (Correct answer)
Flashcard review sessions
Video lecture modules

Correct answer: Test Mode with timed 40-question blocks

UWorld's Test Mode with timed 40-question blocks most closely replicates the structure and pacing of NBME-style licensing exams.

Question 121: Approximately how long does it take to complete a full UWSA for USMLE Step 1, including scheduled breaks?

1–2 hours
3–4 hours
5–6 hours (Correct answer)
10–12 hours

Correct answer: 5–6 hours

With 200 timed questions across multiple blocks plus optional breaks, a full UWSA typically requires approximately 5–6 hours to complete.

Question 122: A spelunker in Kentucky develops pneumonia. Biopsy shows small oval yeasts inside macrophages. What is the organism?

Blastomyces dermatitidis
Coccidioides immitis
Histoplasma capsulatum (Correct answer)
Paracoccidioides brasiliensis

Correct answer: Histoplasma capsulatum

Histoplasma lives in bird and bat droppings in the Ohio and Mississippi River valleys and resides inside macrophages.

Question 123: Three days after an inferior MI, a 62-year-old man suddenly develops pulmonary edema and a new holosystolic murmur at the apex radiating to the axilla. What is the most likely cause?

Posteromedial papillary muscle rupture (Correct answer)
Ventricular free wall rupture
Postinfarction pericarditis
Left ventricular aneurysm

Correct answer: Posteromedial papillary muscle rupture

The posteromedial papillary muscle usually has a single blood supply (the PDA, from the RCA), so it ruptures after inferior MI and causes acute mitral regurgitation.

Question 124: Which of the following best describes what a UWorld percentile rank tells you?

How much time you spent compared to other users
Your raw score as a percentage of total possible points
The percentage of questions you answered correctly
The percentage of UWorld users who scored lower than you on the same questions (Correct answer)

Correct answer: The percentage of UWorld users who scored lower than you on the same questions

Your UWorld percentile rank indicates the proportion of users who scored below you on the same question set, placing your performance in context relative to peers.

Question 125: How should a student use UWorld's 'Timed' mode differently from 'Tutor' mode during Step preparation?

Tutor mode is only for Step 3 and Timed mode only for Step 1
There is no functional difference between the two modes
Timed mode simulates real exam pacing without feedback between questions, while Tutor mode shows explanations immediately after each question for active learning (Correct answer)
Timed mode shows easier questions while Tutor mode shows harder ones

Correct answer: Timed mode simulates real exam pacing without feedback between questions, while Tutor mode shows explanations immediately after each question for active learning

Timed mode builds exam stamina and pacing discipline, while Tutor mode accelerates learning by providing immediate feedback; both serve distinct purposes in a study plan.

Question 126: A student plans to delay their exam if their final self-assessment predicts a score below their goal. What is the most sound basis for that decision?

A single difficult subject block
Feeling tired on the practice day
One low score on an untimed block
Consistent assessment results below target across multiple recent tests (Correct answer)

Correct answer: Consistent assessment results below target across multiple recent tests

Decisions should rest on consistent, recent, exam-like results rather than one-off performances.

Question 127: When is it appropriate to use UWorld in random subject mode rather than a targeted filter?

When practicing only high-yield topics
During early preparation to identify unknown weaknesses across all subjects (Correct answer)
When resetting the question bank for a second pass
During the final week before the exam

Correct answer: During early preparation to identify unknown weaknesses across all subjects

Random mode is most useful early in preparation because it reveals unexpected weak areas across all subjects that you might not have thought to target.

Question 128: A patient in hypertensive emergency on a prolonged high-dose infusion develops metabolic acidosis and confusion. Which drug is responsible?

Labetalol
Nitroglycerin
Sodium nitroprusside (Correct answer)
Hydralazine

Correct answer: Sodium nitroprusside

Nitroprusside releases cyanide as it is metabolized, and cyanide builds up with long or high-dose infusions.

Question 129: A 67-year-old male presents with progressive dysphagia to solids then liquids, significant weight loss, and a barium swallow showing an irregular narrowing in the distal esophagus. He has a 30-year history of GERD. What is the most likely diagnosis?

Esophageal adenocarcinoma arising from Barrett's esophagus (Correct answer)
Esophageal leiomyoma
Squamous cell carcinoma of the upper esophagus
Esophageal achalasia

Correct answer: Esophageal adenocarcinoma arising from Barrett's esophagus

Chronic GERD leads to Barrett's metaplasia, which is the major risk factor for esophageal adenocarcinoma, typically occurring at the gastroesophageal junction.

Question 130: How does UWorld's score prediction compare to NBME practice exam predictions in terms of accuracy?

Both are considered strong predictors, but using both together provides a more reliable estimate than either alone (Correct answer)
UWorld is always more accurate than NBME
NBME is always more accurate than UWorld
Neither predicts actual exam scores with any reliability

Correct answer: Both are considered strong predictors, but using both together provides a more reliable estimate than either alone

Both UWorld and NBME practice exams are validated predictors of USMLE performance, and using both in tandem gives a more comprehensive and reliable readiness estimate.

Question 131: What advantage does practicing USMLE-style biostatistics questions on UWorld provide?

It builds familiarity with interpreting study designs, p-values, confidence intervals, and sensitivity/specificity, all of which appear on USMLE exams (Correct answer)
It is only relevant for Step 3, not Step 1 or 2
It counts as a research credit for residency applications
It exempts students from the epidemiology shelf exam

Correct answer: It builds familiarity with interpreting study designs, p-values, confidence intervals, and sensitivity/specificity, all of which appear on USMLE exams

Biostatistics appears on all three USMLE Steps, and UWorld's targeted questions build the calculation and interpretation skills needed to answer these reliably under time pressure.

Question 132: Why might a high UWorld score not guarantee success on the actual USMLE?

Because UWorld does not cover all tested subjects
Because the real exam tests application of knowledge under pressure, which requires more than question bank familiarity alone (Correct answer)
Because the USMLE uses a completely different scoring algorithm
Because UWorld questions are always identical to USMLE questions

Correct answer: Because the real exam tests application of knowledge under pressure, which requires more than question bank familiarity alone

A high UWorld score reflects strong question bank performance, but the real USMLE also demands composure under pressure, endurance, and transfer of knowledge to novel scenarios.

Question 133: In UWorld Step 1 preparation, what does mastering 'Pathophysiology' questions improve?

Your surgical anatomy knowledge
Your ability to answer mechanism-based questions by understanding how diseases develop at the cellular and molecular level (Correct answer)
Your ability to read ECG strips accurately
Your speed at memorizing drug names

Correct answer: Your ability to answer mechanism-based questions by understanding how diseases develop at the cellular and molecular level

Pathophysiology mastery allows you to reason through unfamiliar clinical scenarios by understanding disease mechanisms, which is how USMLE Step 1 is designed to be answered.

Question 134: A 28-year-old woman has severe abdominal pain, confusion, and dark urine shortly after starting phenobarbital, and urine porphobilinogen is elevated. What is the most appropriate treatment?

Low-dose hydroxychloroquine
Strict sun avoidance and beta-carotene
Phlebotomy
Intravenous hemin (Correct answer)

Correct answer: Intravenous hemin

IV hemin (with glucose) suppresses ALA synthase and is the treatment for an acute intermittent porphyria attack.

Question 135: Why is reading the last sentence of a UWorld vignette before the full stem sometimes recommended?

The last sentence always contains the answer
The last sentence contains the actual question, so knowing it first lets you read the vignette with a focused, targeted goal (Correct answer)
UWorld recommends starting from the middle of each question
It is faster to skip the vignette entirely

Correct answer: The last sentence contains the actual question, so knowing it first lets you read the vignette with a focused, targeted goal

Reading the question stem last-sentence-first lets you know exactly what is being asked, so you can identify relevant details in the vignette more efficiently without being distracted by extraneous information.

Question 136: Which UWorld report helps you see how your performance on specific organ systems compares to peers?

The leaderboard section
The System Performance report within the analytics dashboard (Correct answer)
The note-sharing community board
The daily quiz summary email

Correct answer: The System Performance report within the analytics dashboard

The System Performance report breaks down your accuracy by organ system and displays it alongside peer averages, helping prioritize weak systems.

Question 137: Which UWorld tracking feature helps identify questions you struggled with multiple times?

The time tracker
The highlight tool
The incorrect answer filter (Correct answer)
The notes section

Correct answer: The incorrect answer filter

UWorld's incorrect answer filter lets you isolate questions you have answered wrong so you can review and retry them.

Question 138: A 25-year-old female presents with fatigue, pallor, and glossitis. Laboratory tests reveal hemoglobin of 8.5 g/dL, mean corpuscular volume (MCV) of 105 fL, and hypersegmented neutrophils on a peripheral smear. Which of the following is the most likely diagnosis?

Anemia of chronic disease
Sickle cell anemia
Vitamin B12 deficiency (Correct answer)
Iron deficiency anemia

Correct answer: Vitamin B12 deficiency

The patient's symptoms (fatigue, pallor, glossitis) combined with laboratory findings of anemia (low hemoglobin), macrocytosis (high MCV of 105 fL), and hypersegmented neutrophils on a peripheral smear are classic indicators of megaloblastic anemia. This type of anemia is most commonly caused by a deficiency in vitamin B12 or folate. Given the options, Vitamin B12 deficiency is the most fitting diagnosis.

Question 139: How does completing full timed blocks in UWorld benefit exam preparation?

It removes previously seen questions from future sessions
It builds stamina and improves pacing for the real exam (Correct answer)
It increases the total number of questions in the bank
It unlocks premium content

Correct answer: It builds stamina and improves pacing for the real exam

Practicing full timed blocks in UWorld builds endurance and trains you to maintain focus and pacing over an extended period, which is critical for exam day.

Question 140: What should a student do after completing a UWorld block to maximize learning?

Immediately start another block without reviewing
Skip explanations for questions answered on the first try
Only review the questions answered correctly
Carefully review all explanations, especially for incorrect and flagged questions (Correct answer)

Correct answer: Carefully review all explanations, especially for incorrect and flagged questions

Reviewing all explanations after a UWorld block, especially for wrong and flagged questions, reinforces learning and prevents repeating mistakes.

Question 141: What is the recommended block size for students who are early in their UWorld study period?

Only self-assessment exams for the first month
Smaller blocks of 10 to 20 questions in Tutor Mode to allow immediate feedback and explanation review (Correct answer)
Full 40-question timed blocks from day one
No limit—answer as many questions as possible per session

Correct answer: Smaller blocks of 10 to 20 questions in Tutor Mode to allow immediate feedback and explanation review

Starting with smaller Tutor Mode blocks early in preparation allows immediate review of each explanation, building strong conceptual foundations before simulating exam conditions.

Question 142: A 9-month-old boy has recurrent bacterial sinopulmonary infections, absent tonsils, and no circulating B cells. Which gene is most likely mutated?

BTK (Correct answer)
WAS
ADA
CD40L

Correct answer: BTK

X-linked (Bruton) agammaglobulinemia comes from BTK mutations that block B-cell maturation.

Question 143: A bond with a face value of $1,000 pays a 5% annual coupon and matures in 10 years. If the market interest rate is 6%, is this bond trading at a premium, discount, or par?

Premium
Par
Discount (Correct answer)
Cannot be determined

Correct answer: Discount

A bond trades at a discount when its coupon rate is lower than the prevailing market interest rate (yield to maturity). In this scenario, the bond pays a 5% annual coupon, but the market interest rate is 6%. Investors demand a 6% return, so they will only purchase this bond at a price below its face value to achieve that higher yield, making it trade at a discount.

Question 144: What does the UWorld 'Self-Assessment' (SA) exam simulate?

A writing assessment for clinical skills
A full-length, NBME-style practice exam that predicts your actual USMLE score (Correct answer)
A short 10-question quiz on a single topic
A comprehensive oral board examination

Correct answer: A full-length, NBME-style practice exam that predicts your actual USMLE score

The UWorld Self-Assessment is a full-length standardized practice test designed to predict your actual USMLE performance with high correlation to real exam scores.

Question 145: A test with unchanged sensitivity and specificity is moved from a community clinic to a specialty referral center, where disease prevalence is much higher. What happens to its predictive values?

PPV decreases and NPV increases
Neither predictive value changes
PPV increases and NPV decreases (Correct answer)
Both PPV and NPV increase

Correct answer: PPV increases and NPV decreases

Higher prevalence raises PPV and lowers NPV, while sensitivity and specificity stay the same.

Question 146: What is the benefit of using UWorld's highlight tool on question stems?

It changes the difficulty rating of the question
It lets you mark key clinical details in the question text for focused reading (Correct answer)
It reveals the correct answer
It adds the question to your flagged list

Correct answer: It lets you mark key clinical details in the question text for focused reading

UWorld's highlight tool lets you emphasize important details in the question stem, helping you practice identifying key information quickly.

Question 147: The tuberculin skin (PPD) test is an example of which type of hypersensitivity reaction?

Type III
Type II
Type I
Type IV (Correct answer)

Correct answer: Type IV

The PPD test is a delayed-type (type IV) hypersensitivity reaction mediated by sensitized T cells, not antibodies. Induration peaks at 48–72 hours.

Question 148: How does UWorld help students prepare for the integrated, interdisciplinary nature of USMLE Step 1?

By providing separate pure-science question sets with no clinical context
By writing questions that blend concepts from multiple basic science disciplines within a single clinical vignette (Correct answer)
By focusing only on pharmacology and pathology
By offering one subject at a time in rigid silos

Correct answer: By writing questions that blend concepts from multiple basic science disciplines within a single clinical vignette

UWorld's Step 1 questions deliberately weave together pathology, pharmacology, physiology, and microbiology within clinical scenarios to mirror the integrated testing style of the real exam.

Question 149: How can you identify which UWorld questions include associated images or media?

By contacting UWorld support for a list
By selecting an image questions filter at block creation
By reviewing the question during your block, as UWorld embeds images directly in the question stem (Correct answer)
By downloading a media-only PDF

Correct answer: By reviewing the question during your block, as UWorld embeds images directly in the question stem

UWorld embeds images directly in question stems where relevant, so you encounter them naturally as you work through your blocks.

Question 150: In UWorld pathology, what is the significance of the Philadelphia chromosome (t(9;22)) in leukemia?

It results in loss of chromosome 9, reducing cell cycle control
It inactivates the TP53 tumor suppressor gene
It causes overexpression of the BCL-2 anti-apoptotic protein
It creates the BCR-ABL fusion gene producing a constitutively active tyrosine kinase, driving uncontrolled myeloid proliferation in CML and some ALL cases (Correct answer)

Correct answer: It creates the BCR-ABL fusion gene producing a constitutively active tyrosine kinase, driving uncontrolled myeloid proliferation in CML and some ALL cases

The t(9;22) translocation fuses BCR to ABL, creating a constitutively active tyrosine kinase that drives uncontrolled proliferation, targeted by imatinib (Gleevec) in treatment.

Question 151: Which UWorld strategy is most effective for consolidating a topic where you are scoring below 40% correct?

Skip the topic and focus on higher-scoring areas
Attempt the topic exclusively in Test Mode with no feedback
Only use the flashcard feature for that topic
Combine UWorld practice with targeted reading of the relevant content before redoing those questions (Correct answer)

Correct answer: Combine UWorld practice with targeted reading of the relevant content before redoing those questions

When your UWorld accuracy in a subject is very low, pairing targeted reading with follow-up question practice reinforces the foundational knowledge needed to improve.

Question 152: Which factor would most likely cause a UWorld assessment to OVERESTIMATE a student's exam score?

Taking it in a quiet room
Taking it within two weeks of the exam
Taking it after already seeing many of its questions in another resource (Correct answer)
Taking it under strict timed conditions

Correct answer: Taking it after already seeing many of its questions in another resource

Prior exposure to the same questions inflates performance beyond true ability.

Question 153: What should a student do with UWorld notes before their platform access expires?

Submit them to UWorld for content improvements
Share them with classmates via UWorld's social feature
Export or screenshot them for future reference since platform access is time-limited (Correct answer)
Delete them to reset the bank for another student

Correct answer: Export or screenshot them for future reference since platform access is time-limited

Since UWorld access is time-limited, exporting or saving your personal notes before expiration preserves valuable study material you created.

Question 154: What happens to your UWorld session score if you omit a question in Test Mode?

Omitted questions are excluded from scoring
Omitted questions count as incorrect in your score calculation (Correct answer)
Omitted questions are flagged for review only
Omitted questions receive partial credit

Correct answer: Omitted questions count as incorrect in your score calculation

In UWorld Test Mode, unanswered questions are counted as incorrect, reflecting how real licensing exams penalize unanswered items.

Question 155: What does UWorld's 'System' breakdown in performance analytics refer to?

Computer-based testing system
Operating system compatibility
Organ system categories such as Cardiology and Renal (Correct answer)
Clinical system protocols

Correct answer: Organ system categories such as Cardiology and Renal

UWorld organizes performance data by organ system, allowing you to see accuracy rates per category like Cardiology or Renal.

Question 156: A newborn male fails to pass meconium within the first 48 hours. Rectal exam causes explosive release of stool. Biopsy of the rectal wall shows absence of ganglion cells. What is the diagnosis?

Imperforate anus
Hirschsprung disease (congenital aganglionic megacolon) (Correct answer)
Meconium ileus
Intussusception

Correct answer: Hirschsprung disease (congenital aganglionic megacolon)

Hirschsprung disease results from failed neural crest cell migration, leaving an aganglionic segment of bowel that cannot relax, causing functional obstruction relieved by rectal exam.

Question 157: What is the significance of UWorld's 'passing probability' metric?

It tracks whether you are on pace to complete the question bank before your exam date
It shows the percentage of UWorld users who passed a quiz
It estimates the statistical likelihood that your current performance level will result in a passing score on the real exam (Correct answer)
It measures your reading speed through explanations

Correct answer: It estimates the statistical likelihood that your current performance level will result in a passing score on the real exam

UWorld's passing probability is a statistical estimate derived from your performance data, indicating how likely a student with your profile is to pass the actual licensing exam.

Question 158: How does UWorld's Test Mode performance tracking differ from Tutor Mode?

Test Mode does not record scores
Test Mode withholds explanations until after the session is complete (Correct answer)
Test Mode only tracks time
Test Mode skips incorrect answers

Correct answer: Test Mode withholds explanations until after the session is complete

In Test Mode, UWorld hides explanations until the entire block is finished, simulating real exam conditions.

Question 159: A hiker develops an itchy, vesicular linear rash 48 hours after contact with poison ivy. What type of hypersensitivity is this?

Type IV (Correct answer)
Type II
Type I
Type III

Correct answer: Type IV

Contact dermatitis is a delayed, T-cell-mediated type IV hypersensitivity reaction.

Question 160: What is the primary reason experienced UWorld users recommend completing the question bank at least once before the exam?

To expose yourself to the full range of tested concepts and gain familiarity with question styles (Correct answer)
To memorize all correct answers
To qualify for exam registration
To unlock additional features

Correct answer: To expose yourself to the full range of tested concepts and gain familiarity with question styles

Completing the entire UWorld question bank exposes you to the breadth of tested topics and the reasoning style required on the actual exam.

Question 161: How should you review a UWorld block immediately after finishing it to maximize learning?

Review only flagged questions and skip the rest
Only review incorrect answers and skip correct ones to save time
Save all review for the end of the week in a single session
Go through every question — correct, incorrect, and omitted — reading explanations while the reasoning is fresh in your mind (Correct answer)

Correct answer: Go through every question — correct, incorrect, and omitted — reading explanations while the reasoning is fresh in your mind

Reviewing all questions immediately after finishing preserves the memory of your reasoning process, allowing you to understand both why you got questions wrong and why you got them right.

Question 162: Read the passage below and answer the question that follows: <br> <br> "The innovations of the 21st century have undoubtedly improved communication. However, they have also fostered a reliance on technology that may impede face-to-face social interactions." <br> <br> Which statement best supports the author’s argument?

Digital tools increase productivity in collaborative work environments.
Modern communication devices are more user-friendly than older models.
Social media platforms allow users to connect with friends globally.
Studies show a decline in conversational skills among frequent technology users. (Correct answer)

Correct answer: Studies show a decline in conversational skills among frequent technology users.

The author argues that technology, despite improving communication, 'may impede face-to-face social interactions.' The statement 'Studies show a decline in conversational skills among frequent technology users' directly supports this argument. It provides evidence that heavy technology use can negatively impact the very skills necessary for effective face-to-face interaction, thus demonstrating how technology could impede such interactions.

Question 163: How does UWorld prepare students for the 'Next Step in Management' question type?

By providing stepwise protocols without requiring students to prioritize
By presenting clinical scenarios where students must choose the immediate next appropriate action from options at various stages of workup or treatment (Correct answer)
By only asking diagnosis questions, not management questions
By giving the management plan in the vignette and asking students to justify it

Correct answer: By presenting clinical scenarios where students must choose the immediate next appropriate action from options at various stages of workup or treatment

UWorld's management questions train the decision hierarchy — stabilize, diagnose, treat — which is the framework needed to answer 'next best step' questions correctly on USMLE.

Question 164: How many questions are typically in a UWorld timed block for USMLE Step 1 simulation?

100
20
60
40 (Correct answer)

Correct answer: 40

UWorld Step 1 timed blocks contain 40 questions each, matching the standard USMLE block format.

Question 165: What role does the UWorld Step 3 question bank play for residents?

It is used exclusively for international medical graduates
It prepares residents for the final USMLE Step 3 exam covering clinical management, patient care, and biostatistics (Correct answer)
It recertifies attending physicians every five years
It replaces board review for specialty certification exams

Correct answer: It prepares residents for the final USMLE Step 3 exam covering clinical management, patient care, and biostatistics

UWorld Step 3 targets residents preparing for the final licensing exam, which emphasizes clinical decision-making, patient management, and applied biostatistics.

Question 166: A 9-month-old boy has recurrent bacterial infections, absent tonsils, and very low levels of all immunoglobulins. Which defect is most likely?

Adenosine deaminase deficiency
Defective BTK tyrosine kinase (Correct answer)
Defective CD40 ligand
Absent thymus (22q11 deletion)

Correct answer: Defective BTK tyrosine kinase

X-linked (Bruton) agammaglobulinemia is caused by a BTK mutation that blocks B-cell maturation. The result is absent B cells, absent lymphoid tissue such as tonsils, and very low immunoglobulins. Symptoms start after maternal IgG wanes, at around 6 months.

Question 167: How can you filter UWorld questions to practice only topics from a single organ system?

By sorting questions alphabetically
By selecting that organ system in the subject filter when creating a block (Correct answer)
By resetting the question bank for that system only
By using the global search bar

Correct answer: By selecting that organ system in the subject filter when creating a block

When building a custom block in UWorld, selecting a specific organ system in the subject filter limits your session to questions from that system only.

Question 168: A newborn with Down syndrome has bilious vomiting within hours of birth, and an abdominal x-ray shows a 'double bubble' with no distal gas. What is the most likely diagnosis?

Hypertrophic pyloric stenosis
Meconium ileus
Hirschsprung disease
Duodenal atresia (Correct answer)

Correct answer: Duodenal atresia

Duodenal atresia, which is linked to trisomy 21, causes early bilious vomiting and the classic double-bubble sign from a dilated stomach and proximal duodenum.

Question 169: What is the value of tracking 'Time per Question' in UWorld analytics?

It increases your score if you answer faster
It helps you identify if you are spending too long on certain question types, informing pacing strategy for the real exam (Correct answer)
It determines your subscription renewal date
It controls which difficulty level questions appear next

Correct answer: It helps you identify if you are spending too long on certain question types, informing pacing strategy for the real exam

Monitoring time per question reveals pacing patterns, so if you consistently exceed the recommended time on certain topics, you can adjust your strategy accordingly.

Question 170: A screening program mostly detects slow-growing, indolent tumors, which makes screening look more beneficial than it really is. What is this bias?

Observer bias
Attrition bias
Length-time bias (Correct answer)
Lead-time bias

Correct answer: Length-time bias

Slowly progressing disease spends longer in the detectable preclinical phase, so screening catches it more often.

Question 171: Which UWorld filter combination is most useful for a second pass through the question bank?

Time-based filter
Unused question filter only
Difficulty filter set to easy only
Incorrect and flagged question filters combined (Correct answer)

Correct answer: Incorrect and flagged question filters combined

On a second pass, combining incorrect and flagged filters targets questions that were previously missed or identified as tricky, maximizing review efficiency.

Question 172: A randomized controlled trial (RCT) studying the effectiveness of a new antihypertensive drug reports a relative risk (RR) of 0.75 (95% CI: 0.60–0.90, 𝑝<0.05). What does this finding suggest?

The drug has no statistically significant effect.
The drug increases the risk of hypertension-related events by 25%.
The drug reduces the risk of hypertension-related events by 75%.
The drug reduces the risk of hypertension-related events by 25%. (Correct answer)

Correct answer: The drug reduces the risk of hypertension-related events by 25%.

A relative risk (RR) of 0.75 means that the risk of hypertension-related events in the drug group is 75% of the risk in the control group. To find the percentage reduction in risk, subtract the RR from 1 (1 - 0.75 = 0.25). This indicates a 25% reduction in risk. The 95% confidence interval (0.60–0.90) does not include 1, and the p-value is less than 0.05, confirming that this reduction is statistically significant.

Question 173: A student completes most Qbank blocks in tutor mode with untimed settings. What is the main limitation for score prediction?

Tutor mode does not record percent correct
Tutor mode blocks are excluded from percentile rankings
Tutor mode questions are easier than timed questions
Untimed tutor performance does not reflect real exam pacing and pressure (Correct answer)

Correct answer: Untimed tutor performance does not reflect real exam pacing and pressure

Exam-day performance depends on timing and endurance, which untimed tutor mode does not simulate.

Question 174: Why might a student's actual USMLE score be higher than UWorld predicted?

Because UWorld always under-predicts scores intentionally
Because the USMLE exam is easier than UWorld in every respect
Because UWorld does not track time, inflating difficulty
Because UWorld questions can be harder than the actual exam, leading to underestimation (Correct answer)

Correct answer: Because UWorld questions can be harder than the actual exam, leading to underestimation

UWorld questions are often considered more difficult than the actual USMLE, so students who perform well under these tougher conditions may exceed their predicted score on exam day.

Question 175: How many Self-Assessment Exams (UWSA) does UWorld offer for USMLE Step 1 preparation?

One (UWSA1 only)
Two (UWSA1 and UWSA2) (Correct answer)
Four, one per dedicated study week
Three (UWSA1, UWSA2, and UWSA3)

Correct answer: Two (UWSA1 and UWSA2)

UWorld provides two Self-Assessment Exams—UWSA1 and UWSA2—each designed to predict exam readiness at different stages of preparation.

Question 176: A 28-year-old woman presents with fatigue, cold intolerance, weight gain, constipation, and a TSH of 12 mIU/L with low free T4. What is the most appropriate next step?

Prescribe propylthiouracil
Refer for thyroid surgery
Start levothyroxine therapy (Correct answer)
Order a thyroid ultrasound immediately

Correct answer: Start levothyroxine therapy

Elevated TSH with low free T4 confirms primary hypothyroidism, and first-line treatment is oral levothyroxine replacement to normalize thyroid hormone levels.

Question 177: How does UWorld's block structure compare to the actual USMLE Step 1 exam?

Both use 40-question timed blocks with similar allotted time per block (Correct answer)
UWorld blocks are untimed unlike USMLE
UWorld uses 60-question blocks while USMLE uses 40
USMLE allows Tutor Mode while UWorld does not

Correct answer: Both use 40-question timed blocks with similar allotted time per block

UWorld's 40-question timed blocks directly mirror the USMLE Step 1 exam structure, making its simulation highly realistic.

Question 178: Which of the following best describes UWorld's 'High-Yield' content labels?

Topics covered only in optional modules
Topics that are frequently tested and most important for exam success (Correct answer)
Questions exclusive to first-year students
Questions that are easier than average

Correct answer: Topics that are frequently tested and most important for exam success

UWorld labels content as High-Yield to indicate topics that appear frequently on exams and are critical for maximizing your score.

Question 179: What does UWorld's two-part self-assessment process measure?

Speed and accuracy only
Predicted exam score and probability of passing (Correct answer)
Number of questions completed
Subject preference and test anxiety level

Correct answer: Predicted exam score and probability of passing

UWorld's self-assessment provides both a predicted score range and a pass probability, giving a comprehensive readiness estimate.

Question 180: When a UWorld question presents an ACUTE emergency scenario, what should your first-answer instinct prioritize?

Stabilizing the patient (airway, breathing, circulation) before pursuing diagnosis or specific treatment (Correct answer)
Calling a specialist before taking any action
Administering the most commonly used medication for the suspected diagnosis
Ordering the most comprehensive diagnostic workup immediately

Correct answer: Stabilizing the patient (airway, breathing, circulation) before pursuing diagnosis or specific treatment

USMLE emergency management questions follow the ABCs — airway, breathing, circulation — as the first priority, and UWorld trains this reflex through repeated clinical scenarios.

Question 181: Which factor most strongly influences UWorld's ability to predict your actual exam score?

The number of flashcards you have reviewed
The percentage of the question bank you have completed and your accuracy across subjects (Correct answer)
The number of self-assessment exams taken
The total time spent on the platform

Correct answer: The percentage of the question bank you have completed and your accuracy across subjects

UWorld's score prediction is most accurate when based on a large sample—completing more of the question bank with consistent accuracy across subjects yields the most reliable prediction.

Question 182: A child has recurrent Staphylococcus aureus and Aspergillus infections. A dihydrorhodamine flow cytometry test is abnormal. Which enzyme is deficient?

Lysosomal trafficking regulator
NADPH oxidase (Correct answer)
Myeloperoxidase
Adenosine deaminase

Correct answer: NADPH oxidase

Chronic granulomatous disease comes from NADPH oxidase deficiency, which causes susceptibility to catalase-positive organisms.

Question 183: What does UWorld emphasize as the primary mechanism of injury in acetaminophen overdose causing hepatotoxicity?

Immune-mediated hepatitis triggered by acetaminophen binding to liver proteins
Direct inhibition of hepatic mitochondrial function by acetaminophen itself
Accumulation of the toxic metabolite NAPQI when glucuronidation and sulfation are saturated, depleting glutathione and causing hepatocyte necrosis (Correct answer)
Renal tubular toxicity that secondarily damages the liver

Correct answer: Accumulation of the toxic metabolite NAPQI when glucuronidation and sulfation are saturated, depleting glutathione and causing hepatocyte necrosis

In overdose, CYP2E1 metabolism produces excess NAPQI that exhausts glutathione stores, allowing NAPQI to covalently bind hepatocyte proteins and cause centrilobular necrosis.

Question 184: What information does the post-UWSA score report provide beyond a single predicted score?

Only the raw number of correct answers
Only a pass/fail designation
A predicted three-digit score plus a subject- and system-based performance breakdown (Correct answer)
A letter grade and a national percentile rank exclusively

Correct answer: A predicted three-digit score plus a subject- and system-based performance breakdown

The UWSA score report includes a predicted three-digit USMLE score alongside subject- and organ-system-based breakdowns to pinpoint strengths and gaps.

Question 185: An 8-year-old boy presents with sudden onset periorbital edema, proteinuria (>3.5g/day), hypoalbuminemia, and hyperlipidemia. Kidney biopsy shows normal light microscopy with effacement of podocyte foot processes on electron microscopy. What is the diagnosis?

IgA nephropathy
Focal segmental glomerulosclerosis
Membranous nephropathy
Minimal change disease (Correct answer)

Correct answer: Minimal change disease

Minimal change disease is the most common cause of nephrotic syndrome in children, characterized by normal light microscopy but diffuse foot process effacement on electron microscopy.

Question 186: A patient on long-term therapy for atrial fibrillation develops progressive dyspnea and bilateral interstitial infiltrates. Which drug is most likely the cause?

Procainamide
Amiodarone (Correct answer)
Verapamil
Metoprolol

Correct answer: Amiodarone

Amiodarone causes dose-related pulmonary fibrosis, so patients need baseline and follow-up pulmonary function testing.

Question 187: What is the primary benefit of completing a UWorld Self-Assessment in 'exam simulation' mode?

It shows you the answers before you submit the block
It counts as a formal NBME practice exam for residency applications
It mirrors real USMLE testing conditions including timed blocks, no feedback, and a break schedule so you can practice test-day stamina (Correct answer)
It gives you unlimited time to answer each question

Correct answer: It mirrors real USMLE testing conditions including timed blocks, no feedback, and a break schedule so you can practice test-day stamina

Exam simulation mode replicates the actual USMLE environment, including pacing, block structure, and no mid-question feedback, training your cognitive endurance for the real exam.

Question 188: A 50-year-old woman has dry eyes, dry mouth, and bilateral parotid enlargement, and anti-Ro/SSA antibodies are positive. Which complication carries the greatest increased risk?

B-cell non-Hodgkin lymphoma (Correct answer)
Squamous cell carcinoma of the oral cavity
Interstitial nephritis progressing to ESRD
Primary biliary cholangitis

Correct answer: B-cell non-Hodgkin lymphoma

Sjögren syndrome greatly raises the risk of B-cell lymphoma, especially MALT lymphoma of the parotid gland.

Question 189: When should you change an answer on a UWorld question before submitting a block?

Never change an answer once selected
Whenever you feel nervous about your first choice
Only when you find a specific detail in the vignette that clearly contradicts your first answer, not just because you feel uncertain (Correct answer)
Always change your answer on the second read

Correct answer: Only when you find a specific detail in the vignette that clearly contradicts your first answer, not just because you feel uncertain

Research shows that changing answers is beneficial only when a concrete reason is identified; changing due to anxiety tends to lower scores compared to sticking with the initial well-reasoned choice.

Question 190: According to current guidelines, what is the first-line treatment for a 55-year-old male with newly diagnosed Stage 1 hypertension and no other comorbidities?

ACE inhibitors
Beta-blockers
Thiazide diuretics
Lifestyle modifications (Correct answer)

Correct answer: Lifestyle modifications

According to current hypertension guidelines (e.g., ACC/AHA), for a patient with newly diagnosed Stage 1 hypertension and no other comorbidities, lifestyle modifications are the recommended first-line treatment. These include dietary changes, regular physical activity, weight management, and limiting alcohol intake. Pharmacological therapy is typically initiated if lifestyle changes are insufficient after a certain period or if the patient has higher risk factors or Stage 2 hypertension.

Question 191: A traveler is treated for Plasmodium vivax malaria with chloroquine. Which additional drug prevents relapse, and what must be checked first?

Primaquine; G6PD activity (Correct answer)
Mefloquine; liver function tests
Doxycycline; pregnancy test
Atovaquone; renal function

Correct answer: Primaquine; G6PD activity

Primaquine eradicates liver hypnozoites but can cause hemolysis in G6PD deficiency.

Question 192: A man returns from camping in Connecticut with an expanding annular red rash and later develops a facial nerve palsy. What is the first-line treatment for this stage?

Oral ciprofloxacin
Oral metronidazole
Oral doxycycline (Correct answer)
IV vancomycin

Correct answer: Oral doxycycline

Early disseminated Lyme disease with isolated facial palsy is treated with oral doxycycline.

Question 193: In UWorld psychiatry, what distinguishes major depressive disorder (MDD) from persistent depressive disorder (dysthymia)?

Dysthymia includes psychotic features while MDD does not
MDD lasts at least 6 months while dysthymia lasts only 2 weeks
MDD is treated with therapy only while dysthymia requires medication exclusively
MDD requires discrete episodes with at least 5 DSM criteria for 2+ weeks, while dysthymia involves chronically depressed mood for at least 2 years with fewer symptoms (Correct answer)

Correct answer: MDD requires discrete episodes with at least 5 DSM criteria for 2+ weeks, while dysthymia involves chronically depressed mood for at least 2 years with fewer symptoms

MDD requires a distinct episode of 5 or more depressive symptoms for at least 2 weeks, while dysthymia (PDD) is characterized by chronic low-grade depressed mood lasting at least 2 years with fewer diagnostic criteria.

Question 194: Which pulmonary condition in UWorld is classically associated with the radiographic finding of 'honeycomb lung' on CT?

Lobar pneumonia
Pulmonary embolism
Idiopathic pulmonary fibrosis (IPF) (Correct answer)
Sarcoidosis

Correct answer: Idiopathic pulmonary fibrosis (IPF)

Honeycombing on CT with a subpleural, basal-predominant pattern is the hallmark of IPF, representing end-stage fibrosis with cystic airspace formation.

Question 195: What is the benefit of resetting your UWorld question bank?

It unlocks bonus questions
It resets only flagged questions
It allows you to reattempt all questions as if seeing them for the first time (Correct answer)
It deletes your performance history permanently

Correct answer: It allows you to reattempt all questions as if seeing them for the first time

Resetting the question bank in UWorld lets you go through all questions fresh, without the influence of prior attempt markings.

Question 196: A 30-year-old man with treatment-resistant schizophrenia started a new antipsychotic 6 weeks ago and now has fever and a sore throat. What is the most important next step?

Check a serum prolactin level
Check an absolute neutrophil count (Correct answer)
Obtain a rapid strep test and start amoxicillin
Obtain an ECG for QT prolongation

Correct answer: Check an absolute neutrophil count

Clozapine can cause life-threatening agranulocytosis, so fever or infection during treatment requires an urgent ANC.

Question 197: An unvaccinated child has fever, cough, coryza, conjunctivitis, and small blue-white spots on the buccal mucosa, followed by a rash that spreads head to toe. Which supplement lowers mortality?

Zinc
Vitamin D
Vitamin C
Vitamin A (Correct answer)

Correct answer: Vitamin A

Vitamin A reduces morbidity and mortality in measles, especially in malnourished children.

Question 198: How should a student handle a UWorld question they got correct but for the wrong reason?

Report it to UWorld as ambiguous
Count it as a full success and move on
Flag it and reread the explanation carefully to understand the correct reasoning (Correct answer)
Reset the question to mark it as unused

Correct answer: Flag it and reread the explanation carefully to understand the correct reasoning

Getting a question right for the wrong reason is just as problematic as getting it wrong—flagging and reviewing the explanation ensures you learn the correct clinical reasoning.

Question 199: A new screening program shows that patients diagnosed by screening survive 2 years longer after diagnosis, but the age at death does not change. Which bias best explains this?

Length-time bias
Lead-time bias (Correct answer)
Selection bias
Recall bias

Correct answer: Lead-time bias

Earlier detection starts the survival clock sooner without delaying death.

Question 200: Which electrolyte abnormality most increases the risk of digoxin toxicity?

Hypokalemia (Correct answer)
Hyponatremia
Hypermagnesemia
Hyperkalemia

Correct answer: Hypokalemia

Low potassium increases digoxin binding to Na+/K+-ATPase, which makes toxicity more likely.

Question 201: What does flagging a question in UWorld do?

Deletes it from your question bank
Automatically moves it to a flashcard deck
Marks it for later review in a dedicated flagged filter (Correct answer)
Sends it to UWorld support

Correct answer: Marks it for later review in a dedicated flagged filter

Flagging a question in UWorld tags it so you can easily filter and review it in a future session using the flagged question filter.

Question 202: The cutoff for a positive fasting glucose screening test is lowered from 126 mg/dL to 110 mg/dL. Which change is expected?

Sensitivity increases and specificity decreases (Correct answer)
Sensitivity decreases and specificity increases
Positive predictive value increases
Both sensitivity and specificity increase

Correct answer: Sensitivity increases and specificity decreases

A lower cutoff labels more people positive, so there are fewer false negatives and more false positives.

Question 203: Selective constriction of the efferent arteriole produces which combination of changes?

↑GFR, ↑RPF, ↓filtration fraction
↑GFR, ↓RPF, ↑filtration fraction (Correct answer)
↓GFR, ↑RPF, ↓filtration fraction
↓GFR, ↓RPF, no change in filtration fraction

Correct answer: ↑GFR, ↓RPF, ↑filtration fraction

Efferent constriction raises glomerular capillary pressure (↑GFR) while reducing plasma flow, so FF = GFR/RPF rises.

Question 204: A 68-year-old man has painless jaundice, weight loss, and a palpable, nontender gallbladder. What is the most likely diagnosis?

Acute calculous cholecystitis
Adenocarcinoma of the pancreatic head (Correct answer)
Choledocholithiasis
Primary sclerosing cholangitis

Correct answer: Adenocarcinoma of the pancreatic head

Courvoisier sign (painless jaundice with a palpable nontender gallbladder) points to malignant distal biliary obstruction, most often pancreatic head cancer.

Question 205: What is the recommended next step after receiving a UWorld self-assessment score report?

Review the detailed breakdown by subject and create a targeted study plan for remaining weak areas (Correct answer)
Immediately schedule your real exam date regardless of the score
Submit the score to your medical school as proof of readiness
Share the score publicly to compare with classmates

Correct answer: Review the detailed breakdown by subject and create a targeted study plan for remaining weak areas

After receiving your UWorld self-assessment report, reviewing the subject-by-subject breakdown and building a targeted study plan is the most productive use of the score data.

Question 206: A neonate has delayed separation of the umbilical cord, marked neutrophilia, and skin infections without pus. What is the defect?

Interferon-gamma receptor
IL-12 receptor
Complement C3
CD18 (beta-2 integrin) (Correct answer)

Correct answer: CD18 (beta-2 integrin)

Leukocyte adhesion deficiency type 1 comes from a CD18 defect that blocks neutrophil migration into tissue.

Question 207: A 24-year-old man has his third kidney stone in 2 years. Urinalysis shows hexagonal crystals, and a urine cyanide-nitroprusside test is positive. What is the most likely underlying defect?

Increased intestinal oxalate absorption
Overproduction of uric acid from purine turnover
Distal tubular inability to secrete hydrogen ions
Impaired renal tubular reabsorption of dibasic amino acids (Correct answer)

Correct answer: Impaired renal tubular reabsorption of dibasic amino acids

Cystinuria is a defect in proximal tubular reabsorption of cystine, ornithine, lysine, and arginine, and it produces hexagonal cystine stones with a positive nitroprusside test.

Question 208: What does UWorld's 'reset' function do to a question's status?

Resets only the timer for that question
Deletes the question from the database
Clears its correct, incorrect, or used status so it appears as unused again (Correct answer)
Removes your notes and highlights from that question only

Correct answer: Clears its correct, incorrect, or used status so it appears as unused again

Resetting a question in UWorld clears its prior completion status, allowing it to appear as a fresh, unused question in future sessions.

Question 209: A 45-year-old female presents with proximal muscle weakness, difficulty rising from a chair, and a heliotrope rash with Gottron's papules over the knuckles. CK is markedly elevated. What is the most likely diagnosis?

Inclusion body myositis
Systemic lupus erythematosus
Dermatomyositis (Correct answer)
Polymyositis

Correct answer: Dermatomyositis

Dermatomyositis is distinguished from polymyositis by its characteristic skin findings: heliotrope rash around the eyes and Gottron's papules over the dorsal metacarpophalangeal joints.

Question 210: A 45-year-old woman on long-term lithium for bipolar disorder has polyuria and a urine osmolality of 150 mOsm/kg that does not rise after desmopressin. Which medication is most appropriate?

Amiloride (Correct answer)
Demeclocycline
Furosemide
Desmopressin at a higher dose

Correct answer: Amiloride

Amiloride blocks lithium entry through ENaC channels in collecting duct cells and is the preferred treatment for lithium-induced nephrogenic diabetes insipidus.

Question 211: Which UWorld dermatology condition is characterized by hyperkeratotic, silvery plaques on extensor surfaces with nail pitting and is associated with HLA-Cw6?

Psoriasis (Correct answer)
Lichen planus
Seborrheic dermatitis
Pityriasis rosea

Correct answer: Psoriasis

Psoriasis presents with well-demarcated, silvery-scaled plaques on extensor surfaces, nail pitting, and is associated with HLA-Cw6 and systemic conditions like psoriatic arthritis.

Question 212: What is the benefit of taking detailed notes on UWorld explanations throughout your study period?

It qualifies you for a UWorld score bonus
It creates a personalized high-yield review sheet to study from in the final days before the exam (Correct answer)
It automatically generates flashcards
It shortens the length of future question blocks

Correct answer: It creates a personalized high-yield review sheet to study from in the final days before the exam

Building notes from UWorld explanations throughout your study period creates a personalized, high-yield resource that is highly efficient for final review.

Question 213: UWorld marks a question as 'Correct' in analytics when which condition is met?

The question is flagged and revisited
The correct answer is selected on the first attempt (Correct answer)
The question is answered correctly after review
The explanation is read

Correct answer: The correct answer is selected on the first attempt

UWorld counts a question as correct only when the right answer is selected on the initial attempt during the session.

Question 214: What is the benefit of completing UWorld questions on ethical/legal scenarios before USMLE exams?

These questions test predictable principles like patient autonomy, informed consent, and confidentiality that appear regularly and have consistent correct-answer patterns (Correct answer)
They are only relevant for the Psychiatry shelf exam
Answering them incorrectly does not affect your overall score
They are extra-credit questions that boost your total question count

Correct answer: These questions test predictable principles like patient autonomy, informed consent, and confidentiality that appear regularly and have consistent correct-answer patterns

Ethics questions on USMLE follow consistent principles, and practicing them on UWorld allows you to recognize and apply those principles quickly rather than reasoning from scratch each time.

Question 215: On a UWorld NCLEX Self-Assessment, how is the predicted outcome primarily expressed?

A three-digit scaled score
A letter grade from A to F
A percentile among nursing schools
A likelihood of passing category (Correct answer)

Correct answer: A likelihood of passing category

NCLEX is pass/fail, so UWorld NCLEX assessments report a chance of passing rather than a numeric score.

Question 216: Hepatitis B serology: HBsAg negative, anti-HBs positive, anti-HBc negative. What is the most likely interpretation?

Window period
Resolved past infection
Immunity from vaccination (Correct answer)
Chronic infection

Correct answer: Immunity from vaccination

Only anti-HBs without anti-HBc means vaccine-induced immunity, because the vaccine contains only surface antigen.

Question 217: A woman at 34 weeks' gestation has a BP of 165/112 mm Hg, RUQ pain, platelets of 70,000/µL, elevated transaminases, and schistocytes on smear. What is the most appropriate management?

Plasma exchange for TTP
Expectant management until 37 weeks
Platelet transfusion and discharge
Magnesium sulfate, antihypertensives, and prompt delivery (Correct answer)

Correct answer: Magnesium sulfate, antihypertensives, and prompt delivery

HELLP syndrome is a severe form of preeclampsia, and definitive treatment is delivery with seizure prophylaxis and BP control.

Question 218: A 68-year-old man has lobar pneumonia. Sputum shows lancet-shaped gram-positive diplococci that are catalase-negative, alpha-hemolytic, and optochin-sensitive. What is the organism?

Enterococcus faecalis
Streptococcus pneumoniae (Correct answer)
Streptococcus viridans
Staphylococcus aureus

Correct answer: Streptococcus pneumoniae

S. pneumoniae is alpha-hemolytic, optochin-sensitive, and bile-soluble, unlike viridans streptococci.

Question 219: What is the recommended UWorld question block size to best simulate USMLE test-day conditions?

5 questions per block focused on a single disease
100 questions per block for maximum efficiency
10 questions per block for quick daily practice
40 questions per block, matching the actual USMLE block length (Correct answer)

Correct answer: 40 questions per block, matching the actual USMLE block length

USMLE exams deliver questions in 40-question blocks, and practicing in 40-question sets with UWorld trains both endurance and pacing for real exam conditions.

Question 220: A 70-year-old male smoker with a 50 pack-year history presents with hemoptysis, weight loss, and a central lung mass on chest X-ray. Biopsy shows small cells with necrosis. What is the most likely diagnosis?

Pulmonary carcinoid tumor
Squamous cell carcinoma
Adenocarcinoma of the lung
Small cell lung carcinoma (Correct answer)

Correct answer: Small cell lung carcinoma

Small cell lung carcinoma classically presents as a central mass in a heavy smoker with neuroendocrine features on biopsy and is strongly associated with paraneoplastic syndromes.

Question 221: Which UWorld Qbank metric is most useful for gauging readiness relative to other test-takers?

Average time spent per question
Percentile rank among UWorld users (Correct answer)
Number of flagged questions
Total number of questions completed

Correct answer: Percentile rank among UWorld users

Percentile rank compares your performance to peers using the same questions, which is more informative than raw volume.

Question 222: A man with heart failure develops painful gynecomastia on spironolactone. Which aldosterone antagonist should he be switched to?

Amiloride
Acetazolamide
Eplerenone (Correct answer)
Triamterene

Correct answer: Eplerenone

Eplerenone is a more selective mineralocorticoid receptor antagonist with little antiandrogenic effect.

Question 223: Which feature best distinguishes UWSA questions from UWorld's main question bank questions?

UWSA questions use a multiple-select format exclusively
UWSA questions only cover basic science disciplines
UWSA questions are significantly easier than main bank questions
UWSA questions have not been previously seen in the main question bank (Correct answer)

Correct answer: UWSA questions have not been previously seen in the main question bank

UWSA questions are entirely separate from the main question bank so that encountering them feels novel, accurately simulating real exam conditions.

Question 224: Which practice habit most improves the accuracy of a UWorld score prediction?

Taking the assessment in one sitting under timed, exam-like conditions (Correct answer)
Splitting the assessment across several days
Using notes for difficult topics only
Looking up answers in a textbook during the block

Correct answer: Taking the assessment in one sitting under timed, exam-like conditions

Simulating real exam conditions makes the result comparable to actual test-day performance.

Question 225: A student's UWSA2 score is significantly higher than all of their NBME scores. What is the MOST appropriate interpretation?

Ignore all NBME scores entirely and proceed based solely on UWSA2
The higher UWSA2 score definitively predicts the actual exam outcome
The UWSA is always more accurate than NBME assessments and should be fully trusted
Investigate potential differences in test conditions and use an average across all assessments (Correct answer)

Correct answer: Investigate potential differences in test conditions and use an average across all assessments

When UWSA and NBME scores diverge significantly, averaging multiple assessments and examining testing-condition differences yields a more reliable overall prediction.

Question 226: A man remains HIV-negative despite repeated high-risk exposures. A homozygous mutation in which receptor most likely explains his resistance?

CCR5 (Correct answer)
CXCR4
CD4
TLR4

Correct answer: CCR5

Homozygous CCR5-delta32 prevents entry of R5 (macrophage-tropic) HIV strains.

Question 227: How can a student use UWorld's performance data most effectively?

Only practice subjects already mastered
Focus review time on subjects with the lowest percent correct (Correct answer)
Avoid reviewing incorrect answers
Skip questions outside their specialty

Correct answer: Focus review time on subjects with the lowest percent correct

Targeting subjects with the lowest accuracy in UWorld's analytics ensures study time is directed where improvement is most needed.

Question 228: For USMLE Step 2 CK preparation, why are UWorld's ethics and communication questions important?

Step 2 CK includes a significant ethics and physician-patient communication component that UWorld specifically tests (Correct answer)
They are bonus questions that do not affect the real exam score
Ethics questions make up over half of Step 2 CK
They only appear on Step 3, not Step 2 CK

Correct answer: Step 2 CK includes a significant ethics and physician-patient communication component that UWorld specifically tests

Step 2 CK tests professionalism, ethics, and communication skills, and UWorld dedicates a dedicated subject area to these scenarios to ensure students are prepared.

Question 229: How does UWorld account for question difficulty when generating score predictions?

By excluding the easiest questions from prediction calculations
By applying a flat difficulty multiplier to all questions equally
By weighting questions based on the percentage of test-takers who answered them correctly (Correct answer)
By only using flagged questions in the prediction model

Correct answer: By weighting questions based on the percentage of test-takers who answered them correctly

UWorld factors in question difficulty—measured by how many users answered correctly—when generating score predictions, giving harder questions more weight in the model.

Question 230: What is the primary function of the three-digit score reported after completing a UWSA?

To measure typing speed during timed test-taking
To track total daily study hours logged in UWorld
To predict your likely score on the actual USMLE exam (Correct answer)
To unlock premium features in the UWorld question bank

Correct answer: To predict your likely score on the actual USMLE exam

The UWSA three-digit score is a normed, predicted USMLE score based on your performance, helping gauge true exam readiness.

Question 231: Endogenous (intracellular) antigens presented on MHC class I are recognized by which cells?

B cells
CD4+ helper T cells
CD8+ cytotoxic T cells (Correct answer)
Eosinophils

Correct answer: CD8+ cytotoxic T cells

MHC class I is found on all nucleated cells and presents intracellular peptides, such as viral peptides, to CD8+ cytotoxic T cells. MHC class II presents to CD4+ T cells (rule of 8: 1 × 8 = 8, 2 × 4 = 8).

Question 232: In UWorld Step 1 preparation, what does a 'first-pass' completion strategy mean?

Completing the bank in alphabetical subject order only
Answering only the first question of each block
Doing timed mode exclusively on the first attempt
Going through all questions in the bank once before circling back to review incorrect or flagged questions (Correct answer)

Correct answer: Going through all questions in the bank once before circling back to review incorrect or flagged questions

A first-pass strategy means working through the entire question bank once, then using subsequent passes to focus on weak areas, incorrect answers, and flagged questions.

Question 233: A student's Qbank average is 55% but their first-pass percentage on brand-new questions is 48%. Which number better reflects true readiness?

Neither, only time per question matters
The 48% first-pass score on unseen questions (Correct answer)
Both equally, so average them
The 55% overall average

Correct answer: The 48% first-pass score on unseen questions

Performance on never-seen questions mirrors the real exam, where every question is new.

Question 234: A patient has anaphylaxis during his first blood transfusion. He has a history of recurrent sinusitis and giardiasis. What is the most likely underlying condition?

Hyper-IgM syndrome
Selective IgA deficiency (Correct answer)
Complement C2 deficiency
Common variable immunodeficiency

Correct answer: Selective IgA deficiency

Patients with IgA deficiency may have anti-IgA antibodies that react to IgA in donor blood.

Question 235: What does it mean to 'second-pass' the UWorld question bank?

Completing the bank in reverse alphabetical subject order
Sharing your performance data with a study partner for peer review
Starting the entire bank over from scratch for a completely fresh attempt
Going through previously answered incorrect, flagged, or weak-subject questions again after completing the full bank once (Correct answer)

Correct answer: Going through previously answered incorrect, flagged, or weak-subject questions again after completing the full bank once

A second pass focuses your limited remaining study time on the most impactful questions — those you missed, flagged, or that cover weak subjects — rather than reattempting the entire bank.

Question 236: Which drug, added to hydralazine, lowers mortality in self-identified Black patients with HFrEF?

Spironolactone
Isosorbide dinitrate (Correct answer)
Ivabradine
Digoxin

Correct answer: Isosorbide dinitrate

The A-HeFT trial showed a mortality benefit for hydralazine plus isosorbide dinitrate in this group.

Question 237: An unvaccinated child has a gray pseudomembrane over the pharynx and myocarditis. The toxin responsible acts by which mechanism?

Cleavage of SNARE proteins
Activation of adenylate cyclase via Gs
Inactivation of the 60S ribosomal subunit
ADP-ribosylation of elongation factor 2 (Correct answer)

Correct answer: ADP-ribosylation of elongation factor 2

Diphtheria toxin ADP-ribosylates EF-2, inhibiting protein synthesis.

Question 238: What is the most important mindset shift that separates high-scoring UWorld users from low-scoring ones?

Focusing only on memorizing correct answers
Prioritizing speed over accuracy in every block
Treating every wrong answer as a learning opportunity rather than a failure (Correct answer)
Skipping questions outside their comfort zone

Correct answer: Treating every wrong answer as a learning opportunity rather than a failure

High scorers view incorrect UWorld answers as high-value teaching moments that expose knowledge gaps, rather than setbacks to be avoided.

Question 239: Which UWorld feature allows you to pause and resume a timed test block?

The suspend and resume function within Test Mode (Correct answer)
The highlight tool
The bookmark feature
Tutor Mode's auto-save

Correct answer: The suspend and resume function within Test Mode

UWorld allows you to suspend an in-progress timed block and resume it later, preserving your answers and remaining time.

Question 240: In evidence-based practice, what is the primary purpose of a likelihood ratio in diagnostic testing?

To compare the test to a gold standard
To assess the reliability of the test over time
To calculate the probability of disease after testing (Correct answer)
To determine the sensitivity of the test

Correct answer: To calculate the probability of disease after testing

Likelihood ratios (LRs) are a key component in evidence-based practice for diagnostic testing. They quantify how much a positive or negative test result changes the probability of a disease. LRs are used to convert pre-test probability into post-test probability of disease, helping clinicians update their diagnostic certainty after a test is performed.

Question 241: A 35-year-old woman presents with a butterfly rash, joint pain, fatigue, and a positive ANA with anti-dsDNA antibodies. Urinalysis shows hematuria and proteinuria. What is the most likely diagnosis?

Systemic lupus erythematosus with lupus nephritis (Correct answer)
Sjögren syndrome
Dermatomyositis
Rheumatoid arthritis with renal involvement

Correct answer: Systemic lupus erythematosus with lupus nephritis

The combination of butterfly rash, polyarthritis, positive ANA, anti-dsDNA antibodies, and renal involvement is classic for SLE with lupus nephritis.

Question 242: When creating a UWorld custom block, which filter helps you focus only on new, unseen questions?

Timed questions filter
Unused questions filter (Correct answer)
Flagged questions filter
Incorrect questions filter

Correct answer: Unused questions filter

Selecting the Unused filter in UWorld ensures your block contains only questions you have not previously encountered.

Question 243: A 62-year-old woman with a history of atrial fibrillation on warfarin presents with sudden onset left-sided weakness and facial droop lasting 2 hours that fully resolved. What is the most likely diagnosis?

Hemiplegic migraine
Todd's paralysis following a seizure
Completed ischemic stroke
Transient ischemic attack (TIA) (Correct answer)

Correct answer: Transient ischemic attack (TIA)

A TIA presents with focal neurological deficits that resolve completely within 24 hours (typically minutes to hours) without evidence of infarction on imaging.

Question 244: How does UWorld's 'Tutor Mode' help students who are early in their dedicated study period?

By removing the timer to allow unlimited time per question
By providing immediate explanations after each question so students can learn concepts in real time rather than waiting until the end of a block (Correct answer)
By only presenting easy questions to build initial confidence
By skipping questions that students have already answered correctly

Correct answer: By providing immediate explanations after each question so students can learn concepts in real time rather than waiting until the end of a block

Early in dedicated study, Tutor Mode's immediate feedback loop accelerates knowledge acquisition by linking each answer with its explanation while the clinical scenario is still fresh.

Question 245: In UWorld nephrology, what is the classic urinalysis finding in acute tubular necrosis (ATN)?

Muddy brown granular casts (Correct answer)
RBC casts
WBC casts
Waxy casts

Correct answer: Muddy brown granular casts

Muddy brown granular casts in the urine are pathognomonic for ATN, resulting from sloughed tubular epithelial cells in the setting of ischemic or nephrotoxic injury.

Question 246: How does spaced repetition integrate with UWorld's study approach?

By hiding questions for 24 hours after correct answers
By scheduling re-review of incorrect and flagged questions at increasing intervals (Correct answer)
By limiting the number of questions per day
By automatically spacing new questions based on an algorithm

Correct answer: By scheduling re-review of incorrect and flagged questions at increasing intervals

Students apply spaced repetition principles to UWorld by scheduling follow-up review of missed questions at progressively longer intervals, reinforcing long-term retention.

Question 247: Which of the following is a key difference between UWorld's Tutor Mode and Test Mode?

Tutor Mode hides your score; Test Mode shows it
Tutor Mode provides explanations immediately after each answer; Test Mode does not (Correct answer)
Test Mode includes only easy questions; Tutor Mode includes all difficulties
Test Mode allows unlimited time; Tutor Mode does not

Correct answer: Tutor Mode provides explanations immediately after each answer; Test Mode does not

Tutor Mode gives immediate feedback after each question, while Test Mode withholds all explanations until the block is complete.

Question 248: How does UWorld's 'Unused' filter help exam preparation?

It shows questions that have been removed from the bank
It filters out questions below a certain difficulty level
It identifies duplicate questions in the bank
It lets you create question blocks from questions you have not yet attempted, maximizing fresh practice (Correct answer)

Correct answer: It lets you create question blocks from questions you have not yet attempted, maximizing fresh practice

The Unused filter allows you to build blocks exclusively from unattempted questions, ensuring you expose yourself to new material rather than repeating seen questions.

Question 249: A nurse is educating a patient with newly diagnosed type 2 diabetes. Which dietary recommendation is most appropriate to improve glycemic control?

"Eat small amounts of sugary snacks to avoid hypoglycemia."
"Avoid all carbohydrates entirely."
"Focus on high-fiber foods and limit refined sugars." (Correct answer)
"Replace all proteins with carbohydrate-rich meals."

Correct answer: "Focus on high-fiber foods and limit refined sugars."

For patients with type 2 diabetes, dietary recommendations aim to improve glycemic control and overall health. Focusing on high-fiber foods helps slow glucose absorption, promoting more stable blood sugar levels and increasing satiety. Limiting refined sugars prevents rapid spikes in blood glucose, which is crucial for managing diabetes effectively. This approach is a cornerstone of diabetes self-management.

Question 250: Which UWorld navigation feature allows you to add personal study notes to a question?

The subject filter in question settings
The flag button in the question header
The notes field on the explanation page (Correct answer)
The highlight tool on the question stem

Correct answer: The notes field on the explanation page

UWorld's notes field, accessible on the explanation page, lets you type and save personal study notes directly alongside the question.

Question 251: In UWorld renal pathology, what is the mechanism behind the hyponatremia seen in SIADH?

Excess ADH blocks aquaporin channels, causing water to remain in the tubule
SIADH causes the kidneys to excrete excess sodium in the urine
Excess ADH causes inappropriate free water reabsorption by the kidneys, diluting serum sodium without total body sodium depletion (Correct answer)
SIADH reduces aldosterone, causing sodium loss and water retention

Correct answer: Excess ADH causes inappropriate free water reabsorption by the kidneys, diluting serum sodium without total body sodium depletion

In SIADH, persistently elevated ADH drives free water reabsorption via collecting duct aquaporins, expanding intravascular volume and diluting serum sodium with a euvolemic picture.

Question 252: Which DNA virus replicates in the cytoplasm rather than the nucleus?

Herpes simplex virus
Poxvirus (Correct answer)
Adenovirus
Human papillomavirus

Correct answer: Poxvirus

Poxviruses carry their own DNA-dependent RNA polymerase and replicate in the cytoplasm.

Question 253: Which population most benefits from the UWorld Step 2 CK question bank?

Physicians renewing their medical licenses
Nursing students preparing for the NCLEX
Third and fourth year medical students and graduates preparing for the clinical licensing exam (Correct answer)
First-year medical students studying gross anatomy

Correct answer: Third and fourth year medical students and graduates preparing for the clinical licensing exam

UWorld Step 2 CK is specifically designed for clinical-year medical students and graduates preparing for the clinical knowledge licensing examination.

Question 254: In UWorld analytics, what does a 'Confidence Level' tag help you track?

The number of times a question appeared on real exams
Your exam date readiness score
How confident you felt about each answer, allowing you to identify lucky correct guesses (Correct answer)
The difficulty rating assigned by UWorld

Correct answer: How confident you felt about each answer, allowing you to identify lucky correct guesses

Confidence Level tagging lets you flag answers you were unsure about so you can revisit them even when you happened to answer correctly.

Question 255: A farmer has 10 cows, 5 chickens, and 3 goats. If he sells 40% of his cows, how many cows does he have left?

6 (Correct answer)
5
4
7

Correct answer: 6

The farmer initially has 10 cows. He sells 40% of his cows. To find out how many cows he sold, calculate 40% of 10: 0.40 × 10 = 4 cows. To determine the number of cows he has left, subtract the number sold from the original number: 10 cows - 4 cows = 6 cows.

Question 256: Why is completing a high percentage of the UWorld question bank important for USMLE Step 1 preparation?

Higher completion rates expose you to more concepts and patterns, which correlates with better exam performance (Correct answer)
It unlocks a certificate of completion
It reduces the cost of the exam registration
Completing all questions guarantees a passing score

Correct answer: Higher completion rates expose you to more concepts and patterns, which correlates with better exam performance

Research and anecdotal evidence from medical students consistently show that finishing a large portion of UWorld correlates with improved Step 1 scores due to broad concept exposure.

Question 257: A patient has recurrent nonpitting facial swelling and abdominal pain without urticaria. C4 levels are low. Which drug class is contraindicated?

Beta-blockers
Thiazide diuretics
Calcium channel blockers
ACE inhibitors (Correct answer)

Correct answer: ACE inhibitors

Hereditary angioedema comes from C1 esterase inhibitor deficiency, and ACE inhibitors raise bradykinin levels further.

Question 258: Which UWorld feature lets you review only questions you previously marked for follow-up?

Flagged question filter (Correct answer)
Incorrect question filter
Omitted question filter
Timed question filter

Correct answer: Flagged question filter

UWorld's flagged question filter lets you isolate and review questions you marked during a session for later follow-up.

Question 259: Why is it important to avoid looking up answers before submitting a UWorld question?

UWorld tracks whether you looked up answers and penalizes your score
It blocks access to future questions
It defeats active recall, which is the mechanism that drives long-term memory consolidation (Correct answer)
Looking up answers increases question difficulty

Correct answer: It defeats active recall, which is the mechanism that drives long-term memory consolidation

Attempting to retrieve answers from memory before checking references maximizes active recall, the cognitive process most responsible for durable learning.

Question 260: How does using UWorld's subject filter during the early dedicated phase differ from its use during final review?

Both phases should always use random mixed subjects for consistency
Early phase: use random mixed mode; final phase: restrict to a single system per day
Early phase: study one system at a time while reading First Aid; final phase: mix subjects to simulate the integrated, randomized real exam experience (Correct answer)
The subject filter should never be used; always study in random order

Correct answer: Early phase: study one system at a time while reading First Aid; final phase: mix subjects to simulate the integrated, randomized real exam experience

System-based filtering helps you consolidate new knowledge early, while mixed random mode later trains the integration and retrieval flexibility the USMLE demands.

Question 261: What is the purpose of using UWorld's 'break timer' during a Self-Assessment exam?

To pause the exam indefinitely when needed
To add extra time to your remaining blocks
To remind you to drink water every hour
To simulate the USMLE's structured break schedule so you can plan and practice your optimal rest strategy for exam day (Correct answer)

Correct answer: To simulate the USMLE's structured break schedule so you can plan and practice your optimal rest strategy for exam day

Practicing with the break timer helps you decide how to allocate your limited break time across blocks, which is a real strategy decision on USMLE exam day.

Question 262: What is the recommended frequency for taking UWorld self-assessments during a dedicated study period?

Every single day
Once at the very beginning only
Two to three times, spaced throughout the study period (Correct answer)
Only after finishing the entire question bank

Correct answer: Two to three times, spaced throughout the study period

Taking UWorld self-assessments two to three times throughout your study period tracks progress and allows you to adjust your study plan accordingly.

Question 263: A patient's HSV lesions keep growing despite acyclovir. What is the most common resistance mechanism, and what drug should be used?

Absent viral thymidine kinase; switch to foscarnet (Correct answer)
Neuraminidase mutation; switch to zanamivir
Efflux pump; switch to famciclovir
Altered DNA polymerase; switch to valacyclovir

Correct answer: Absent viral thymidine kinase; switch to foscarnet

Thymidine kinase mutations are the most common cause of acyclovir resistance, and foscarnet does not need TK activation.

Question 264: Which nephron segment reabsorbs the largest fraction of filtered sodium?

Proximal convoluted tubule (Correct answer)
Cortical collecting duct
Thick ascending limb
Distal convoluted tubule

Correct answer: Proximal convoluted tubule

The proximal convoluted tubule reabsorbs about two-thirds of filtered sodium isosmotically.

Question 265: A cohort study observes that patients who exercise regularly have a lower incidence of diabetes. Which of the following is true about this type of study?

It can establish causality between exercise and diabetes prevention.
It eliminates confounding variables through randomization.
It is more expensive and time-consuming than randomized controlled trials.
It measures the incidence of diabetes in an exposed and unexposed group. (Correct answer)

Correct answer: It measures the incidence of diabetes in an exposed and unexposed group.

A cohort study is an observational study design where a group of individuals (a cohort) is followed over time. Researchers compare the incidence of a specific outcome (like diabetes) between a group exposed to a factor (e.g., regular exercise) and a group not exposed. While cohort studies can identify associations and measure incidence, they do not involve randomization and therefore cannot definitively establish causality like randomized controlled trials.

Question 266: In UWorld cardiology content, what ECG finding is most associated with Wolff-Parkinson-White (WPW) syndrome?

Prolonged PR interval with dropped QRS complexes
ST elevation in all leads simultaneously
Short PR interval with a delta wave (slurred upstroke of the QRS) (Correct answer)
Peaked T waves with widened QRS

Correct answer: Short PR interval with a delta wave (slurred upstroke of the QRS)

WPW features a short PR interval due to accessory pathway conduction and a delta wave from ventricular pre-excitation, both hallmarks tested extensively in UWorld cardiology questions.

Question 267: Why do most UWorld experts recommend reading explanations for ALL questions, including correct ones?

Because UWorld scores are based on explanation reading time
Because correct answers may change over time
Because the explanations contain additional teaching points not explicitly tested in the question (Correct answer)
Because skipping explanations reduces question bank access

Correct answer: Because the explanations contain additional teaching points not explicitly tested in the question

UWorld explanations include high-yield teaching points and clinical pearls beyond the question's specific answer, making them valuable even for questions answered correctly.

Question 268: Why should students avoid relying on a single Qbank block score to predict their exam result?

Single blocks do not count toward percentile
Block scores are always lower than exam scores
Single blocks are not scored
Small samples have high variability by topic and difficulty (Correct answer)

Correct answer: Small samples have high variability by topic and difficulty

A short block can be skewed by topic mix, so larger samples give more stable estimates.

Question 269: In UWorld analytics, what does a consistently low percentile in a subject suggest?

Questions in that subject are too easy
Performance is above average in that area
The subject is not tested on the real exam
That subject needs significant additional review and focused study (Correct answer)

Correct answer: That subject needs significant additional review and focused study

A consistently low percentile in a UWorld subject indicates you are scoring below most peers and that area requires focused review.

Question 270: A 25-year-old male presents with painless testicular swelling. Ultrasound shows a solid intratesticular mass. Tumor markers reveal elevated AFP and beta-hCG. What is the most likely diagnosis?

Non-seminomatous germ cell tumor (mixed) (Correct answer)
Epididymo-orchitis
Pure seminoma
Testicular lymphoma

Correct answer: Non-seminomatous germ cell tumor (mixed)

Elevated AFP is not produced by pure seminomas, so its presence indicates a non-seminomatous component; elevated beta-hCG can be seen in both but combined elevation suggests mixed NSGCT.

Question 271: If 𝑥²−4𝑥+3=0, what are the solutions for 𝑥?

𝑥=−2 or 𝑥=−3
𝑥=2 or 𝑥=3
𝑥=1 or 𝑥=3 (Correct answer)
𝑥=−1 or 𝑥=−3

Correct answer: 𝑥=1 or 𝑥=3

To solve the quadratic equation 𝑥²−4𝑥+3=0, we can factor it. We need two numbers that multiply to +3 and add to -4, which are -1 and -3. Therefore, the equation factors into (𝑥−1)(𝑥−3)=0. Setting each factor to zero gives the solutions: 𝑥−1=0 implies 𝑥=1, and 𝑥−3=0 implies 𝑥=3.

Question 272: What does the UWorld 'Notes' feature allow you to add to each question?

Audio recordings of explanations
Automatic mnemonics generated by UWorld
Personal written annotations that are saved alongside the question for future review (Correct answer)
Peer ratings for question quality

Correct answer: Personal written annotations that are saved alongside the question for future review

The Notes feature lets you write your own comments, mnemonics, or clarifications directly on each question, creating a personalized study resource.

Question 273: What is the best strategy for handling a UWorld question whose vignette contains unfamiliar information?

Skip the question entirely and leave it blank
Use process of elimination to narrow down answers, choose the best remaining option, and flag it for review if time allows (Correct answer)
Always choose the longest answer choice
Guess immediately without reading the answer choices

Correct answer: Use process of elimination to narrow down answers, choose the best remaining option, and flag it for review if time allows

Process of elimination is the most reliable strategy when the vignette contains unfamiliar content, as you can often remove clearly wrong answers and improve your odds significantly.

Question 274: What USMLE content area does UWorld's 'Pharmacology' subject specifically target?

Herbal supplement interactions exclusively
Only over-the-counter medication dosing
Drug mechanisms, side effects, contraindications, and clinical indications that are high-yield across all USMLE Steps (Correct answer)
Pharmacokinetics equations only without clinical applications

Correct answer: Drug mechanisms, side effects, contraindications, and clinical indications that are high-yield across all USMLE Steps

UWorld's Pharmacology questions cover mechanisms of action, adverse effects, drug interactions, and clinical use scenarios that directly mirror high-frequency USMLE pharmacology content.

Question 275: What does UWorld's 'Marked' (flagged) question feature allow you to do?

Submit the block early
Save specific questions to revisit later during or after a test block (Correct answer)
Share a question with a study partner
Hide a question from scoring

Correct answer: Save specific questions to revisit later during or after a test block

Flagging or marking a question during a block saves it so you can return to it before submitting or review it afterward without searching through all questions.

Question 276: If 𝑥 is an integer such that 3𝑥−7<11, what is the largest possible value of 𝑥?

8
5 (Correct answer)
6
7

Correct answer: 5

To solve the inequality 3x - 7 < 11, first add 7 to both sides, which gives 3x < 18. Then, divide both sides by 3, resulting in x < 6. Since x must be an integer and less than 6, the largest possible integer value for x is 5.

Question 277: How many questions does each UWSA for USMLE Step 1 typically contain?

160
200 (Correct answer)
100
280

Correct answer: 200

Each UWSA contains 200 questions divided across multiple timed blocks, providing a comprehensive assessment of exam readiness.

Question 278: A patient with AIDS (CD4 40/mm3) has headache and high CSF opening pressure. India ink stain shows encapsulated yeast. What is the induction therapy?

Amphotericin B plus flucytosine (Correct answer)
Caspofungin
Itraconazole
Fluconazole alone

Correct answer: Amphotericin B plus flucytosine

Cryptococcal meningitis induction is amphotericin B plus flucytosine, followed by fluconazole consolidation.

Question 279: What is the most effective use of UWorld during the final 2 weeks before the USMLE?

Review your most missed subjects and complete full timed blocks daily to simulate exam conditions (Correct answer)
Start UWorld for the first time with all questions unused
Attempt all remaining unused questions in Tutor Mode
Stop using UWorld and transition to only reading First Aid

Correct answer: Review your most missed subjects and complete full timed blocks daily to simulate exam conditions

In the final two weeks, combining targeted review of weak areas with daily full timed blocks builds both knowledge and exam-day stamina simultaneously.

Question 280: What strategy should you use when two UWorld answer choices both seem correct?

Choose the first answer listed
Select the longer answer always
Identify which answer is more specific to what the question is directly asking and select the one that most precisely addresses the core question (Correct answer)
Pick the answer containing a more complex medical term

Correct answer: Identify which answer is more specific to what the question is directly asking and select the one that most precisely addresses the core question

When two choices seem plausible, focusing on the exact wording of the question stem usually reveals which answer more precisely matches what is being asked.

USMLE Step Assessment

The USMLE Step series tests the knowledge and skills of medical students and graduates. UWorld is the leading question bank for USMLE Step 1, Step 2 CK, and Step 3 preparation, offering timed simulations, performance analytics, and high-yield clinical vignettes.

280

Questions

480 min

Time Limit

60%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds

These practice questions were written with AI tools. They are not real exam questions. We have not yet matched this exam's facts to an official source, so confirm fees, dates and rules with the exam body. Not reviewed by a subject-matter expert. Editorial policy