USMLE Step Assessment — Questions and Answers

Question 1: In UWorld psychiatry, what distinguishes major depressive disorder (MDD) from persistent depressive disorder (dysthymia)?

MDD lasts at least 6 months while dysthymia lasts only 2 weeks
Dysthymia includes psychotic features while MDD does not
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)
MDD is treated with therapy only while dysthymia requires medication exclusively

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 2: 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
Accumulation of the toxic metabolite NAPQI when glucuronidation and sulfation are saturated, depleting glutathione and causing hepatocyte necrosis (Correct answer)
Direct inhibition of hepatic mitochondrial function by acetaminophen itself
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 3: Which of the following innovations is most associated with the Industrial Revolution?

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

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

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

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 5: Which UWorld feature allows you to pause and resume a timed test block?

Tutor Mode's auto-save
The highlight tool
The suspend and resume function within Test Mode (Correct answer)
The bookmark feature

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 6: What is the best strategy for handling a UWorld question whose vignette contains unfamiliar information?

Guess immediately without reading the answer choices
Skip the question entirely and leave it blank
Always choose the longest answer choice
Use process of elimination to narrow down answers, choose the best remaining option, and flag it for review if time allows (Correct answer)

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

It is faster to skip the vignette entirely
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

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 8: 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
Pseudomembranes overlying colonic mucosa
Cobblestoning with skip lesions in the terminal ileum

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

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

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

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

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 11: 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 replace the need to read a textbook
To list all possible diagnoses for a given symptom
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 12: What does UWorld's 'reset' function do to a question's status?

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

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 13: 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
Exclusively using self-assessment exams without individual practice blocks
Daily targeted question practice combined with thorough explanation review and systematic second passes on missed questions (Correct answer)
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 14: Which pulmonary condition in UWorld is classically associated with the radiographic finding of 'honeycomb lung' on CT?

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

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

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

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 16: 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?

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

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

USMLE Step 2 CS
USMLE Step 1 (Correct answer)
USMLE Step 3
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 18: What USMLE content area does UWorld's 'Pharmacology' subject specifically target?

Only over-the-counter medication dosing
Pharmacokinetics equations only without clinical applications
Herbal supplement interactions exclusively
Drug mechanisms, side effects, contraindications, and clinical indications that are high-yield across all USMLE Steps (Correct answer)

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

UWSA questions are significantly easier than main bank questions
UWSA questions use a multiple-select format exclusively
UWSA questions only cover basic science disciplines
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 20: How does completing full timed blocks in UWorld benefit exam preparation?

It increases the total number of questions in the bank
It removes previously seen questions from future sessions
It builds stamina and improves pacing for the real exam (Correct answer)
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 21: Why might a high UWorld score not guarantee success on the actual USMLE?

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

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 22: In UWorld renal pathology, what is the mechanism behind the hyponatremia seen in SIADH?

SIADH reduces aldosterone, causing sodium loss and water retention
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)

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

Practicing free-form essay questions
Testing internet speed for the platform
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 24: Which UWorld feature allows you to identify your weakest subject areas?

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

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 25: What strategy should you use when two UWorld answer choices both seem correct?

Choose the first answer listed
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)
Select the longer answer always
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.

Question 26: How does UWorld's score prediction compare to NBME practice exam predictions in terms of accuracy?

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

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

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

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

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

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 29: If 𝑥 is an integer such that 3𝑥−7<11, what is the largest possible value of 𝑥?

5 (Correct answer)
8
7
6

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 30: What is the recommended frequency for taking UWorld self-assessments during a dedicated study period?

Once at the very beginning only
Every single day
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 31: 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?

Bradycardia
Hypokalemia
Hypocalcemia
Hyperkalemia (Correct answer)

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

Yes, unlimited retakes are always available and valid
No, UWorld does not permit any form of repeated assessment
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 33: If 𝑥²−4𝑥+3=0, what are the solutions for 𝑥?

𝑥=−2 or 𝑥=−3
𝑥=1 or 𝑥=3 (Correct answer)
𝑥=−1 or 𝑥=−3
𝑥=2 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 34: 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 achalasia
Esophageal adenocarcinoma arising from Barrett's esophagus (Correct answer)
Squamous cell carcinoma of the upper esophagus
Esophageal leiomyoma

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

The number of self-assessment exams taken
The number of flashcards you have reviewed
The percentage of the question bank you have completed and your accuracy across subjects (Correct answer)
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 36: 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
Looking up answers increases question difficulty
It blocks access to future questions
It defeats active recall, which is the mechanism that drives long-term memory consolidation (Correct answer)

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 37: A 40-year-old smoker is counseled on lung cancer prevention. What is the most effective intervention to reduce their risk of lung cancer?

Smoking cessation (Correct answer)
Annual low-dose CT screening
Increasing physical activity
Dietary supplementation with antioxidants

Correct answer: Smoking cessation

Smoking is the leading preventable cause of lung cancer and many other serious health conditions. For a smoker, the single most effective intervention to significantly reduce their risk of lung cancer and improve overall health is to quit smoking. While other interventions like screening or diet can play a role, addressing the primary risk factor has the greatest impact on prevention.

Question 38: How does taking the UWSA in tutor mode (with immediate answer explanations) affect its predictive accuracy?

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

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

Salmonella typhi (Correct answer)
Shigella dysenteriae
Yersinia enterocolitica
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 40: A student's UWSA2 score is significantly higher than all of their NBME scores. What is the MOST appropriate interpretation?

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

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

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

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 42: 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?

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

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 43: What is the primary function of the three-digit score reported after completing a UWSA?

To predict your likely score on the actual USMLE exam (Correct answer)
To unlock premium features in the UWorld question bank
To measure typing speed during timed test-taking
To track total daily study hours logged in UWorld

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 44: 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?

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

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

Lichen planus
Psoriasis (Correct answer)
Pityriasis rosea
Seborrheic dermatitis

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

Subclavian artery
Radial artery (Correct answer)
Brachial artery
Axillary 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 47: Which of the following best describes UWorld's 'High-Yield' content labels?

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

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

UWorld's prediction model has failed and your score is unreliable
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

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

Organ system categories such as Cardiology and Renal (Correct answer)
Computer-based testing system
Operating system compatibility
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 50: In UWorld nephrology, what is the classic urinalysis finding in acute tubular necrosis (ATN)?

WBC casts
RBC casts
Waxy casts
Muddy brown granular casts (Correct answer)

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 51: What is the PRIMARY limitation when using UWSA scores to predict actual USMLE performance?

UWSA questions are scored by a proprietary algorithm unrelated to USMLE scoring
UWSA is taken under different conditions—home environment versus a formal testing center—that affect performance (Correct answer)
UWSA uses a completely different numerical scale than the USMLE
UWSA does not assess clinical reasoning in any form

Correct answer: UWSA is taken under different conditions—home environment versus a formal testing center—that affect performance

Real exam conditions—formal testing center, heightened stress, unfamiliar environment—can meaningfully alter performance compared to taking UWSA at home.

Question 52: How does completing more of UWorld's question bank improve score prediction accuracy?

It only improves accuracy for self-assessment exams, not individual blocks
More questions completed automatically raises the predicted score
Completing more questions unlocks a premium prediction algorithm
A larger sample of answered questions provides more data, reducing prediction error (Correct answer)

Correct answer: A larger sample of answered questions provides more data, reducing prediction error

Statistical predictions become more reliable with larger data sets—answering more UWorld questions gives the algorithm more performance data to produce an accurate prediction.

Question 53: A 50-year-old woman presents with recurrent calcium oxalate kidney stones. Labs show hypercalcemia, hypophosphatemia, and elevated PTH. What is the most likely underlying cause?

Primary hyperparathyroidism (Correct answer)
Vitamin D toxicity
Sarcoidosis
Milk-alkali syndrome

Correct answer: Primary hyperparathyroidism

Primary hyperparathyroidism causes hypercalcemia with inappropriately elevated PTH and low phosphate, and is the most common cause of hypercalcemia in outpatients with calcium nephrolithiasis.

Question 54: Which of the following best describes what a UWorld percentile rank tells you?

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

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

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)
Never change an answer once selected
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 56: What is the advantage of using UWorld's subject filter over random question selection?

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

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

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

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 58: When is UWSA2 typically taken relative to the actual USMLE Step 1 exam?

On the same day as the exam
6–8 weeks before the exam
At the very start of the dedicated study period
1–2 weeks before the exam (Correct answer)

Correct answer: 1–2 weeks before the exam

UWSA2 is typically taken 1–2 weeks before the exam as a final readiness checkpoint, close enough to reflect peak preparation.

Question 59: 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?

Thiazide diuretics
Beta-blockers
ACE inhibitors
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 60: A student takes UWSA1 and scores well below their target. What is the BEST next step?

Analyze the subject breakdown and create a targeted study plan for the remaining weeks (Correct answer)
Stop all studying and rest for two full weeks before resuming
Take UWSA2 the very next day to see whether the score improves
Abandon UWorld immediately and switch to a different question bank

Correct answer: Analyze the subject breakdown and create a targeted study plan for the remaining weeks

Using the detailed subject breakdown to build a targeted study plan is the most effective response to a lower-than-expected UWSA1 score.

Question 61: In UWorld Step 1 preparation, what does a 'first-pass' completion strategy mean?

Completing the bank in alphabetical subject order only
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)
Answering only the first question of each block

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 62: A student scores 245 on UWSA2 taken two weeks before Step 1. What is the most appropriate response?

Switch entirely to a different question bank resource
Retake UWSA2 every day until the actual exam
Continue the current study strategy with only minor refinements (Correct answer)
Cancel the exam registration immediately and study for another three months

Correct answer: Continue the current study strategy with only minor refinements

A strong UWSA2 score indicates solid preparation; drastic strategy changes so close to the exam are counterproductive and increase anxiety.

Question 63: What is the benefit of completing UWorld questions on ethical/legal scenarios before USMLE exams?

They are extra-credit questions that boost your total question count
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

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 64: How does UWorld organize questions within its question bank?

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

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

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

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 66: How does UWorld's 'Tutor Mode' help students who are early in their dedicated study period?

By skipping questions that students have already answered correctly
By only presenting easy questions to build initial confidence
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 removing the timer to allow unlimited time per question

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

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

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

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
By excluding the easiest questions from prediction calculations
By applying a flat difficulty multiplier to all questions equally

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 69: 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?

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

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 70: 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)
Oral pancreatic enzyme replacement
Emergency ERCP
Immediate surgical consultation for pancreatectomy

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

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

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 72: What does UWorld's 'Unused' question count indicate?

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

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

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

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

Because UWorld does not track time, inflating difficulty
Because UWorld always under-predicts scores intentionally
Because the USMLE exam is easier than UWorld in every respect
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 75: If a student's UWorld predicted score fluctuates significantly between sessions, what does this most likely indicate?

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

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 76: 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?

Amphotericin B plus flucytosine for induction, followed by fluconazole consolidation (Correct answer)
Acyclovir IV for viral meningitis
Fluconazole monotherapy immediately
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 77: What does UWorld's two-part self-assessment process measure?

Speed and accuracy only
Number of questions completed
Predicted exam score and probability of passing (Correct answer)
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 78: Which approach to UWorld flashcards is most commonly recommended?

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

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

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

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

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

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

Holoprosencephaly
Anencephaly
Spina bifida (myelomeningocele in severe cases) (Correct answer)
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 82: What is the recommended UWorld question block size to best simulate USMLE test-day conditions?

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

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 83: 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)
Questions answered after 2 minutes are scored differently
UWorld automatically locks questions after 2 minutes
The timer resets after 2 minutes automatically

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

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

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

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

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

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

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 87: In UWorld analytics, what does a consistently low percentile in a subject suggest?

The subject is not tested on the real exam
That subject needs significant additional review and focused study (Correct answer)
Performance is above average in that area
Questions in that subject are too easy

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

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

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

Postpone the exam immediately
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)
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 90: 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?

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

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 91: How closely does UWorld's predicted score typically correlate with actual USMLE scores?

UWorld predictions are always exactly accurate
UWorld only predicts pass/fail, not specific scores
UWorld predictions are completely unrelated to real exam scores
Studies show a strong positive correlation, with UWorld predicting scores within approximately 10 to 15 points (Correct answer)

Correct answer: Studies show a strong positive correlation, with UWorld predicting scores within approximately 10 to 15 points

Research consistently shows that UWorld's predicted score has a strong positive correlation with actual USMLE scores, generally within a range of about 10 to 15 points.

Question 92: 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
Keeping the patient in a supine position
Administering thickened liquids through the NG tube
Elevating the head of the bed to at least 30 degrees (Correct answer)

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 93: What does the UWorld 'Notes' feature allow you to add to each question?

Peer ratings for question quality
Automatic mnemonics generated by UWorld
Personal written annotations that are saved alongside the question for future review (Correct answer)
Audio recordings of explanations

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 94: Which of the following is the largest planet in our solar system?

Jupiter (Correct answer)
Saturn
Earth
Neptune

Correct answer: Jupiter

Jupiter is the largest planet in our solar system by a significant margin. It boasts a diameter of approximately 140,000 kilometers, which is more than 11 times the diameter of Earth. Its immense size and mass make it the dominant gravitational force among the planets, distinguishing it from all other celestial bodies in our solar system.

Question 95: 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 automatically spacing new questions based on an algorithm
By limiting the number of questions per day

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

Timed mode with no interruptions between blocks (Correct answer)
Mixed mode alternating timed and untimed blocks
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 97: 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
Combine UWorld practice with targeted reading of the relevant content before redoing those questions (Correct answer)
Only use the flashcard feature for that topic
Attempt the topic exclusively in Test Mode with no feedback

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 98: What is the most effective use of UWorld during the final 2 weeks before the USMLE?

Attempt all remaining unused questions in Tutor Mode
Stop using UWorld and transition to only reading First Aid
Start UWorld for the first time with all questions unused
Review your most missed subjects and complete full timed blocks daily to simulate exam conditions (Correct answer)

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

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

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

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

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 101: 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
300 (Correct answer)
350
400

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 102: What is the most important mindset shift that separates high-scoring UWorld users from low-scoring ones?

Focusing only on memorizing correct answers
Skipping questions outside their comfort zone
Prioritizing speed over accuracy in every block
Treating every wrong answer as a learning opportunity rather than a failure (Correct answer)

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

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

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

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

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 105: 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?

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

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

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

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

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

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

By giving the management plan in the vignette and asking students to justify it
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 providing stepwise protocols without requiring students to prioritize
By only asking diagnosis questions, not management questions

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 109: How does UWorld's 'Unused' filter help exam preparation?

It lets you create question blocks from questions you have not yet attempted, maximizing fresh practice (Correct answer)
It identifies duplicate questions in the bank
It filters out questions below a certain difficulty level
It shows questions that have been removed from the bank

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

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

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

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

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

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

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 strategy is recommended for the final weeks before a USMLE exam using UWorld?

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

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

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

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 115: What does flagging a question in UWorld do?

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

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

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

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 117: 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?

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

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 118: In UWorld analytics, what does a 'Confidence Level' tag help you track?

How confident you felt about each answer, allowing you to identify lucky correct guesses (Correct answer)
The number of times a question appeared on real exams
Your exam date readiness score
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 119: In UWorld endocrinology, what distinguishes Cushing's disease from ectopic ACTH syndrome?

They are clinically identical and require genetic testing to distinguish
Cushing's disease causes bilateral adrenal hyperplasia while ectopic ACTH does not
Cushing's disease has lower cortisol levels than ectopic ACTH syndrome
Cushing's disease is caused by a pituitary adenoma secreting ACTH, while ectopic ACTH is secreted by non-pituitary tumors like small cell lung cancer (Correct answer)

Correct answer: Cushing's disease is caused by a pituitary adenoma secreting ACTH, while ectopic ACTH is secreted by non-pituitary tumors like small cell lung cancer

Cushing's disease specifically refers to pituitary ACTH overproduction, while ectopic ACTH comes from tumors like small cell lung carcinoma; both cause bilateral adrenal hyperplasia, but the source differs.

Question 120: 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?

Pure seminoma
Testicular lymphoma
Epididymo-orchitis
Non-seminomatous germ cell tumor (mixed) (Correct answer)

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

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

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

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

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

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

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 124: In UWorld cardiology content, what ECG finding is most associated with Wolff-Parkinson-White (WPW) syndrome?

Short PR interval with a delta wave (slurred upstroke of the QRS) (Correct answer)
Prolonged PR interval with dropped QRS complexes
ST elevation in all leads simultaneously
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 125: 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 measures the incidence of diabetes in an exposed and unexposed group. (Correct answer)
It eliminates confounding variables through randomization.
It can establish causality between exercise and diabetes prevention.
It is more expensive and time-consuming than randomized controlled trials.

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 126: 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?

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

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

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

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 128: 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 exempts students from the epidemiology shelf exam
It counts as a research credit for residency applications

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

Administering the most commonly used medication for the suspected diagnosis
Calling a specialist before taking any action
Stabilizing the patient (airway, breathing, circulation) before pursuing diagnosis or specific treatment (Correct answer)
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 130: How can you filter UWorld questions to practice only topics from a single organ system?

By using the global search bar
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

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

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

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

As a guarantee of failure on the real exam
As confirmation that no further preparation is needed
As an indication to switch to a different question bank
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 133: What does UWorld's predicted score range indicate?

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

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

By only showing imaging questions without clinical history
By giving the diagnosis in the question stem to focus on management
By presenting detailed patient vignettes with classic findings that require pattern recognition to reach the correct diagnosis (Correct answer)
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 135: What type of questions does USMLE Step 2 CK primarily consist of, and how does UWorld align with this format?

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

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 136: Which UWorld navigation feature allows you to add personal study notes to a question?

The highlight tool on the question stem
The notes field on the explanation page (Correct answer)
The subject filter in question settings
The flag button in the question header

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

No limit—answer as many questions as possible per session
Full 40-question timed blocks from day one
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)

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

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

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

Review only the questions answered incorrectly to save time
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

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

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 surgical anatomy knowledge
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 141: On USMLE Step 1, approximately how much time should you allocate per question when practicing with UWorld?

30 seconds per question to maximize speed
5 minutes per question to ensure thorough analysis
There is no time limit on the real exam
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 142: In UWorld musculoskeletal pathology, which crystal arthropathy shows needle-shaped negatively birefringent crystals under polarized light?

Septic arthritis
Reactive arthritis
Pseudogout (calcium pyrophosphate crystals)
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 143: What is the relationship between UWorld subject accuracy and the predicted licensing exam score?

Higher accuracy across all subjects is directly associated with a higher predicted score (Correct answer)
Subject accuracy is not factored into the prediction
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 144: 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 uses 60-question blocks while USMLE uses 40
UWorld blocks are untimed unlike USMLE
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 145: How should you review a UWorld block immediately after finishing it to maximize learning?

Review only flagged questions and skip the rest
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)
Only review incorrect answers and skip correct ones to save time

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 146: 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?

Todd's paralysis following a seizure
Hemiplegic migraine
Transient ischemic attack (TIA) (Correct answer)
Completed ischemic stroke

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 147: 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 148: What does it mean to 'second-pass' the UWorld question bank?

Going through previously answered incorrect, flagged, or weak-subject questions again after completing the full bank once (Correct answer)
Starting the entire bank over from scratch for a completely fresh attempt
Sharing your performance data with a study partner for peer review
Completing the bank in reverse alphabetical subject order

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 149: 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?

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

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

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

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

60
40 (Correct answer)
100
20

Correct answer: 40

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

Question 152: Which UWorld tracking feature helps identify questions you struggled with multiple times?

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

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

Focus exclusively on high-yield subjects with the lowest personal accuracy (Correct answer)
Only do self-assessment exams without individual question blocks
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 154: How should a student use UWorld's 'Timed' mode differently from 'Tutor' mode during Step preparation?

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
There is no functional difference between the two modes
Tutor mode is only for Step 3 and Timed mode only for Step 1

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 155: 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 calculate the probability of disease after testing (Correct answer)
To assess the reliability of the test over time
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 156: What is the purpose of UWorld's Test Mode for exam preparation?

To provide immediate feedback after each question
To allow unlimited time per question
To simulate real exam conditions by hiding explanations until the block is complete (Correct answer)
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 157: Which UWorld feature lets you review only questions you previously marked for follow-up?

Flagged question filter (Correct answer)
Timed question filter
Incorrect question filter
Omitted 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 158: 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?

Cannot be determined
Premium
Par
Discount (Correct answer)

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 159: How closely do UWSA scores typically correlate with actual USMLE Step 1 scores?

UWSA scores consistently overestimate actual performance by 30 or more points
UWSA scores have essentially no predictive value
UWSA scores are reasonably predictive, generally within 10–15 points of actual scores (Correct answer)
UWSA scores predict the exact same score with zero variance

Correct answer: UWSA scores are reasonably predictive, generally within 10–15 points of actual scores

Research shows UWSA scores correlate well with actual USMLE scores, typically landing within approximately 10–15 points of the real result.

Question 160: 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?

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

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 161: How many questions does each UWSA for USMLE Step 1 typically contain?

200 (Correct answer)
100
280
160

Correct answer: 200

Each UWSA contains 200 questions divided across multiple timed blocks, providing a comprehensive assessment of exam readiness.

Question 162: What is the purpose of using UWorld's 'break timer' during a Self-Assessment exam?

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)
To pause the exam indefinitely when needed
To add extra time to your remaining blocks

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

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

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 164: Why do most UWorld experts recommend reading explanations for ALL questions, including correct ones?

Because correct answers may change over time
Because the explanations contain additional teaching points not explicitly tested in the question (Correct answer)
Because UWorld scores are based on explanation reading time
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 165: What is the benefit of reviewing UWorld explanations even for questions you answered correctly?

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

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 166: How should a student interpret a large discrepancy between their UWSA1 and UWSA2 scores?

Investigate changes in study habits and content coverage that may explain the shift (Correct answer)
Always trust UWSA1 because it reflects baseline knowledge
The higher score automatically predicts the actual exam outcome
Discard both scores and rely solely on NBME assessments going forward

Correct answer: Investigate changes in study habits and content coverage that may explain the shift

A large score discrepancy between UWSA1 and UWSA2 warrants examining what changed—study habits, content coverage, or test-taking conditions—between the two assessments.

Question 167: What information does the post-UWSA score report provide beyond a single predicted score?

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
Only the raw number of correct answers

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

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

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

Number of breaks taken per session
Total study hours per week
Speed of internet connection
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 170: 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 mirrors real USMLE testing conditions including timed blocks, no feedback, and a break schedule so you can practice test-day stamina (Correct answer)
It counts as a formal NBME practice exam for residency applications
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 171: 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 172: What does comparing your UWorld percent correct to the 'National Average' help you determine?

Your exact board exam score prediction
Which questions are most frequently missed nationally
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

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

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

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

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

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

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

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 176: 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 exclusively in Tutor Mode
Take it the night before the exam for final practice

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 177: Which population most benefits from the UWorld Step 2 CK question bank?

First-year medical students studying gross anatomy
Third and fourth year medical students and graduates preparing for the clinical licensing exam (Correct answer)
Physicians renewing their medical licenses
Nursing students preparing for the NCLEX

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

It shows which subjects have the fewest questions
It generates a pre-made study schedule automatically
It lists subjects excluded from your exam
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)

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

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

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 180: Which UWSA score metric is MOST useful for directing final content review?

The time taken to complete each individual block
The total number of questions flagged for review
The single overall predicted score alone
Subject- and organ-system-based performance breakdowns (Correct answer)

Correct answer: Subject- and organ-system-based performance breakdowns

The subject- and organ-system-based breakdowns reveal which disciplines need the most targeted attention before the real exam.

Question 181: How should a student handle a UWorld question they got correct but for the wrong reason?

Report it to UWorld as ambiguous
Flag it and reread the explanation carefully to understand the correct reasoning (Correct answer)
Count it as a full success and move on
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 182: Which UWorld feature allows you to review only questions you previously answered incorrectly?

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

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

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

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 184: When creating a UWorld custom block, which filter helps you focus only on new, unseen questions?

Unused questions filter (Correct answer)
Timed questions filter
Incorrect questions filter
Flagged 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 185: In UWorld, what does a 'Percentile' score indicate?

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

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 186: What does UWorld's 'Marked' (flagged) question feature allow you to do?

Share a question with a study partner
Hide a question from scoring
Save specific questions to revisit later during or after a test block (Correct answer)
Submit the block early

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

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 providing separate pure-science question sets with no clinical context
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 188: A nurse is educating a patient with newly diagnosed type 2 diabetes. Which dietary recommendation is most appropriate to improve glycemic control?

"Focus on high-fiber foods and limit refined sugars." (Correct answer)
"Replace all proteins with carbohydrate-rich meals."
"Eat small amounts of sugary snacks to avoid hypoglycemia."
"Avoid all carbohydrates entirely."

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

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

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

They only appear on Step 3, not Step 2 CK
They are bonus questions that do not affect the real exam score
Step 2 CK includes a significant ethics and physician-patient communication component that UWorld specifically tests (Correct answer)
Ethics questions make up over half of 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 191: A 3-year-old girl presents with a painless abdominal mass that does not cross the midline. CT shows a large intrarenal mass. What is the most likely diagnosis?

Wilms tumor (nephroblastoma) (Correct answer)
Hepatoblastoma
Neuroblastoma
Renal cell carcinoma

Correct answer: Wilms tumor (nephroblastoma)

Wilms tumor is the most common renal malignancy in children, typically presenting as a smooth, unilateral abdominal mass that does not cross the midline.

Question 192: 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?

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

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

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

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 194: A 70-year-old patient with a history of congestive heart failure presents with shortness of breath and orthopnea. Physical examination reveals crackles in the lung bases and pitting edema in the lower extremities. Which of the following is the most appropriate initial treatment?

ACE inhibitors
Calcium channel blockers
Beta-blockers
Loop diuretics (Correct answer)

Correct answer: Loop diuretics

The patient's symptoms (shortness of breath, orthopnea, crackles, pitting edema) are classic signs of acute decompensated congestive heart failure with fluid overload. Loop diuretics, such as furosemide, are the most appropriate initial treatment because they rapidly reduce fluid volume, alleviate pulmonary and systemic congestion, and improve symptoms. Other medications like ACE inhibitors or beta-blockers are typically used for chronic management or after stabilization.

Question 195: What is the purpose of the UWorld 'Reset' feature for a question bank?

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)
It removes flagged questions from your queue
It deletes your account data permanently

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 196: Which of the following is a key difference between UWorld's Tutor Mode and Test Mode?

Test Mode allows unlimited time; Tutor Mode does not
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
Tutor Mode hides your score; Test Mode shows it

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

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

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

Omitted questions count as incorrect in your score calculation (Correct answer)
Omitted questions are excluded from scoring
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 199: What is the maximum number of questions per UWorld session you can customize for a practice block?

Up to 100 questions per block
Up to 25 questions per block
Up to 40 questions per block (Correct answer)
Up to 10 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 200: What should a student do with UWorld notes before their platform access expires?

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

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 201: Which approach BEST leverages UWSA alongside NBME self-assessments for score prediction?

NBME assessments are always superior; UWSA should never be used
Take all assessments on the same day to produce a single consolidated data point
Use both UWSA and NBME assessments to generate multiple data points for a more reliable score estimate (Correct answer)
Use only UWSA and disregard all NBME assessments entirely

Correct answer: Use both UWSA and NBME assessments to generate multiple data points for a more reliable score estimate

Using both UWSA and NBME assessments together provides multiple independent data points that collectively yield a more reliable prediction of actual exam performance.

Question 202: What happens when you select 'incorrect' as a filter when building a UWorld block?

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

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 203: 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 204: What is the recommended next step after receiving a UWorld self-assessment score report?

Share the score publicly to compare with classmates
Submit the score to your medical school as proof of readiness
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

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

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

Correct answer: Percentile rank

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

Question 206: Which UWorld feature lets you review the complete explanation for a question, including tables and images?

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

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 207: What does the UWorld 'Subject Breakdown' report show?

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

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 208: How does using UWorld's subject filter during the early dedicated phase differ from its use during final review?

Early phase: use random mixed mode; final phase: restrict to a single system per day
Both phases should always use random mixed subjects for consistency
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 209: 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 reduces the risk of hypertension-related events by 25%. (Correct answer)
The drug reduces the risk of hypertension-related events by 75%.
The drug has no statistically significant effect.
The drug increases the risk of hypertension-related events by 25%.

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

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

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 211: 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?

Systemic lupus erythematosus
Dermatomyositis (Correct answer)
Inclusion body myositis
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 212: How does UWorld's three-digit predicted score help students planning their USMLE Step 1 exam date?

It automatically registers the student for the exam
It replaces the official NBME score report
It tells students which medical school to apply to
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)

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 213: What is the recommended approach for a UWorld question containing a lab value table with many values?

Identify which values are abnormal, correlate them with the clinical context in the vignette, and use them as clues rather than reading every number (Correct answer)
Memorize all values in the table before selecting an answer
Ignore the lab table and focus only on the vignette text
Always select the answer that references the highest abnormal value

Correct answer: Identify which values are abnormal, correlate them with the clinical context in the vignette, and use them as clues rather than reading every number

Efficient lab interpretation means quickly spotting abnormal values relative to provided reference ranges and linking them to the clinical scenario rather than analyzing every data point.

Question 214: 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 creates the BCR-ABL fusion gene producing a constitutively active tyrosine kinase, driving uncontrolled myeloid proliferation in CML and some ALL cases (Correct answer)
It causes overexpression of the BCL-2 anti-apoptotic protein
It inactivates the TP53 tumor suppressor gene

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 215: 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?

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

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

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

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 217: 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)
Dermatomyositis
Sjögren syndrome
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 218: What is the benefit of taking detailed notes on UWorld explanations throughout your study period?

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

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 219: In UWorld infectious disease, what is the mechanism of resistance in MRSA that makes beta-lactam antibiotics ineffective?

MRSA produces a beta-lactamase enzyme that hydrolyzes all beta-lactam rings
MRSA produces an altered penicillin-binding protein (PBP2a) encoded by the mecA gene that has low affinity for beta-lactams (Correct answer)
MRSA lacks a cell wall, making beta-lactams irrelevant
MRSA efflux pumps expel beta-lactam antibiotics before they can act

Correct answer: MRSA produces an altered penicillin-binding protein (PBP2a) encoded by the mecA gene that has low affinity for beta-lactams

The mecA gene in MRSA encodes PBP2a, an alternative penicillin-binding protein with very low affinity for all beta-lactam antibiotics, rendering the entire class ineffective.

Question 220: Why is completing a high percentage of the UWorld question bank important for USMLE Step 1 preparation?

It unlocks a certificate of completion
Completing all questions guarantees a passing score
It reduces the cost of the exam registration
Higher completion rates expose you to more concepts and patterns, which correlates with better exam performance (Correct answer)

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

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

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