Step 1

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USMLE Practice Session

UWorld's Qbank Mobile App allows you to access your USMLE STEP 1, STEP 2 CK/Shelf and STEP 3 on your Android phone and tablet devices. Please use the 'UWorld Boards' app for ABIM and ABFM Qbanks. This app REQUIRES a valid UWorld USMLE Qbank or Self assessment subscription to access the course material, which can be purchased from UWorld website. USMLE Step 2 CS, Step 3 CCS, Subject Reviews & Self-Assessment Exams: These subscriptions are non-refundable, non-transferable, and cannot be converted into another subscription. CPA Review: Students may request to cancel their CPA review product only within 10-days of activation of any of the materials. To qualify for a refund, no more than 10. The USMLE Step 1 is a multiple-choice exam that assesses your knowledge of the basic sciences, principles, and mechanisms underlying human health and disease. The USMLE program provides a Content Description outlining the distribution of disciplines and organ systems covered on the USMLE Step 1. Tested disciplines include.

Practice Sessions are available, for a fee, for registered examinees who want the opportunity to become familiar with the Prometric test center environment. Register for a Practice Session »

Step 2 Clinical Knowledge (CK)

Practice materials updated August 2020

Please view the announcement regarding upcoming Step 2 CK content changes.

If you have questions or issues, check out the Frequently Asked Questions: Practice Materials. If you do not find the answer you need, please fill out our contact form.

USMLE Practice Session

Practice Sessions are available, for a fee, for registered examinees who want the opportunity to become familiar with the Prometric test center environment. Register for a Practice Session »

Step 3

Practice materials updated November 2020
Download Step 3 tutorial and practice items, including practice CCS cases

Content Description and General Information Booklet (PDF)

If you have questions or issues, check out the Frequently Asked Questions: Practice Materials. If you do not find the answer you need, please fill out our contact form.

USMLE Practice Session

Practice Sessions are available, for a fee, for registered examinees who want the opportunity to become familiar with the Prometric test center environment. Register for a Practice Session »

• Watch the instructional video below that illustrates how to run a case using the Primum® software. Then, let us know what you think by taking our brief survey.

• Download the Step 3 tutorial and practice items, which includes practice CCS cases.

• Read the Primum CCS FAQs (PDF) to learn more about the Primum experience.

• Review the links below, which provide feedback on diagnostic and management steps for the sample Step 3 Computer-Based Case Simulations. These also appear at the end of the practice cases.

The CCS database contains thousands of possible tests and treatments. Therefore, it is not feasible to list every action that might affect an examinee's score. The descriptions are meant to serve as examples of actions that would add to, subtract from, or have no effect on an examinee's score for each case.

Case 1: Feedback on a 65-year-old man presenting with acute chest pain and respiratory distress (10-minute case)

Orientation Feedback for Tension Pneumothorax

Stata 15 mac .dmg software. In evaluating case performance, the domains of diagnosis (including physical examination and appropriate diagnostic tests), therapy, monitoring, timing, sequencing, and location are considered.

In this case, a 65-year-old man is brought to the emergency department by ambulance because of acute chest pain and respiratory distress. Initially the presentation and reason for visit suggest a broad differential diagnosis, but the limited available history narrows the differential. The patient had an acute onset of right-sided chest pain 10 minutes before the ambulance arrived. He rates the pain as an 8 on a 10-point scale. The pain is excruciating, sharp, and increases with respiration.

The patient appears pale and in marked respiratory distress. He is moaning and holding his hands over the right side of his chest. Vital signs show tachypnea, tachycardia, and low blood pressure. Physical examination shows no breath sounds; there is tracheal deviation, jugular venous distention, hyperresonance to percussion on the right side of the chest, faint heart sounds, and weak peripheral pulses. The skin is pale, cool, and diaphoretic. The remainder of the physical examination is unremarkable. The patient's illness, at this point, seems most consistent with an intrathoracic process.

The computer-based case simulation database contains thousands of possible tests and treatments. Therefore, it is not feasible to list every action that might affect an examinee's score. The following descriptions are meant to serve as examples of actions that would add to, subtract from, or have no effect on an examinee's score for this case.

Timely diagnosis and management are essential in this case. An optimal, efficient diagnostic approach would include quickly performing a targeted physical examination that includes chest/lung and cardiovascular examination, cardiac monitoring, and assessing oxygen saturation by pulse oximetry. Treatment should be initiated immediately before the patient’s condition worsens. Ordering anything that might delay treatment (eg, a 12 lead ECG, arterial blood gases, or a portable chest x-ray) would be suboptimal in this case if ordered before the patient’s condition is stabilized.

As soon as the absent breath sounds and exam findings consistent with tension pneumothorax are discovered, optimal treatment would include performing a needle thoracostomy for decompression followed by a chest tube insertion for lung reexpansion. A chest x-ray should be ordered to confirm appropriate tube placement and lung reexpansion. The patient’s blood pressure and respiratory rate should be closely monitored until the patient’s condition has stabilized.

Examples of additional tests, treatments, or actions that could be ordered but would be neither useful nor harmful to the patient include:

Bronchodilators
Complete blood count
Electrolytes
Analgesics
Intravenous fluids

Examples of suboptimal or poor management would include failure to examine the chest, admission before treatment, failure to order a chest x-ray after inserting the chest tube and/or needle thoracostomy, delay in treatment to reexpand the lung, or absence of treatment.

In this acute presentation, timing is critically important. An optimal approach would include completing the above diagnostic and management actions as quickly as possible. Delaying diagnosis or treatment and pursuing alternative diagnoses with tests such as a lung scan will waste valuable time and could be harmful or even fatal to the patient. Other examples of treatments that would waste time, subject the patient to unnecessary discomfort or risk, and add no real benefit to this patient include:

CT before lung reexpansion
Intubation
Pulmonary function testing
Thrombolytic therapy

Case 2: Feedback on a 32-year-old woman presenting with knee pain and swelling (20-minute case)

Orientation Feedback for Rheumatoid Arthritis

In evaluating case performance, the domains of diagnosis (including physical examination and appropriate diagnostic tests), therapy, monitoring, timing, sequencing, and location are considered.

In this case, a 32-year-old woman comes to the office because of knee pain and swelling. From the chief complaint, the differential diagnosis is broad. It includes osteoarthritis, infectious arthritis, rheumatoid arthritis, systemic lupus erythematosus (SLE), gout, and psoriatic arthritis. The comprehensive history, however, narrows the differential. The patient has experienced increasing fatigue and generalized weakness during the past 4 months. She developed generalized aches and morning joint stiffness during the past 8 weeks and, more recently, pain and intermittent swelling of both wrists, and of the proximal metacarpophalangeal joints, as well as bilateral knee swelling. These signs and symptoms are hi

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