USMLE Step 1 case studies
USMLE Step 1 · Put your knowledge to work in context.
Step 1 is the first of the three examinations in the United States Medical Licensing Examination (USMLE) program, which is jointly owned by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). It assesses whether an examinee understands and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. The USMLE Step 1 case studies are 5 cases and about 3,195 words.
1Tamoxifen, Paroxetine, and the Prodrug Problem
A 47-year-old premenopausal woman with stage II estrogen receptor–positive, HER2-negative breast cancer began tamoxifen 20 mg daily after surgery. She also takes paroxetine 20 mg daily, begun two years earlier for depression, and reports her mood has been stable on it; a prior taper attempt triggered a relapse.
598 words, about 3 min2Syncope, a Systolic Murmur, and a Dose of Nitroglycerin
A 24-year-old male collegiate rower presents after two episodes of syncope during sprint intervals. He describes chest tightness and lightheadedness with exertion that resolve within a minute of stopping.
600 words, about 3 min3Hyponatremia in Small Cell Lung Cancer: Interpreting the Urine
A 71-year-old man with a 40 pack-year smoking history is admitted with two weeks of confusion and unsteadiness. He is clinically euvolemic: no orthostatic change, jugular venous pressure normal, no edema, mucous membranes moist.
610 words, about 3 min4Diabetic Ketoacidosis with a Low Serum Potassium
A 19-year-old woman with type 1 diabetes managed on basal–bolus insulin is admitted with 24 hours of vomiting, abdominal pain, and polyuria after a viral illness; she has been unable to keep insulin down. She is tachycardic and has deep, rapid respirations with a fruity breath odor.
698 words, about 3 min5A Normal PaCO2 in a Patient Who Cannot Finish a Sentence
A 22-year-old woman with asthma since childhood presents with 8 hours of worsening wheeze after a viral upper respiratory infection. She has used her albuterol inhaler more than 20 times today and has not slept.
689 words, about 3 min