Explanations for the Free 150

[bwmd]

Several months ago I wrote up explanations and take home points for the official 2013-14 NBME Step 1 practice materials (aka the "Free 150"). These are also the same questions that you can pay to take as a practice exam at a Prometric center. There's a (partially) new set of questions that were released this month, but last year's set is still available and very relevant: http://www.usmle.org/pdfs/step-1/2013midMay2014_Step1.pdf

You can find the explanations here. Hope they're helpful. For further reading, feel free to peruse my thoughts on how to approach nbme/usmle questions.

UPDATE: I've now completed the explanations for the new 2014-2015 set (~84 new questions), available here.

UPDATE 2: The 2015-16 set out and essentially unchanged.

UDPATE 3: The 2016 set is out and has ~49 new questions. New explanations here.

UPDATE 4: The 2017 set is out and has nothing new.

UPDATE 5: The 2018 set is out and has 51 new questions. Explanations here.

Over the most recent sets (2013-2018), there are around 322 free official questions.

UPDATE 6: The 2019 set has two new questions. Post here.

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[EazyE1907]

Thanks! much appreciated

 

[Delacroix22]

Wow thanks so much! I've been looking for something like this.

Just a question, anyone know where older versions of the "free 150" are?

 

[bwmd]

You can search the main USMLE website at usmle.org (in the right upper corner) and pull a few old ones. They don't seem to delete the older versions (though the questions typically change minimally per year). Here are the ones I could get:

2013 http://www.usmle.org/pdfs/step-1/2013content_step1.pdf
2012 http://www.usmle.org/pdfs/step-1/2012content_step1.pdf
2011 http://www.usmle.org/pdfs/step-1/2011content_step1.pdf
2010 http://www.usmle.org/pdfs/step-1/2010content_step1.pdf
2009 is still around at this site: http://medsci.indiana.edu/c602web/602/c602web/usmle/2009step1.pdf

UPDATE: They definitely started deleting the old versions. You can, however, still find them by putting those links into archive.org.

 

[Delacroix22]

Thanks! yes my friend looked though them said they aren't that different, but it can never hurt. I just had no idea where to find them. The last place I expected would be to be on the official website. Crazy.

 

[bwmd]

I've written explanations for the newest (2014-2015) "Free 150" set. You can find them here. There are around 85 new questions since last year.

 

[Apoplexy__]

I've written explanations for the newest (2014-2015) "Free 150" set. You can find them here. There are around 85 new questions since last year.

Good stuff, man. I stumbled across your site before my Step 1. Thanks for your hard work.

 

[001100010010011]

Good stuff. Appreciate it.

 

[Bancrofti]

For #18, I was assuming everything would be the same, but to me, both A and D looked all the same. Am I just missing something in D that makes one of the bands different?

Also, for 44, I had A because I remembered that being the answer, but when I tried to think about it it didn't make sense for some reason. If you have mitotic nondisjunction wouldn't the cells that aren't 45 X, therefore have an additional chromosome? It said they were 46XY.

Lastly, for 98. This one I got correct, but I suck at reading images and it took me a while. What is happening in D?

 

[bwmd]

For #18, I was assuming everything would be the same, but to me, both A and D looked all the same. Am I just missing something in D that makes one of the bands different?

Also, for 44, I had A because I remembered that being the answer, but when I tried to think about it it didn't make sense for some reason. If you have mitotic nondisjunction wouldn't the cells that aren't 45 X, therefore have an additional chromosome? It said they were 46XY.

Lastly, for 98. This one I got correct, but I suck at reading images and it took me a while. What is happening in D?

18: D is what a gel looks like without using a restriction enzyme digest (no discrete bands of specific weights)

44: In mitotic nondisjunction, an early cell splits improperly. In the case of Turner's, the trisomic cell dies, while the 45xo cell line lives on. The other cells (from meiosis and any earlier mitoses) are normal. The proportion of a affected cells in an individual person relates to how early this process happens.

98: I wouldn't worry about radiology that much for boards. Though I am radiology resident now, I thought learning rads was a waste of time when I was a medical student (oh how things change), and I don't think my board scores suffered for it one iota. But since you asked: A) ARDS (bilateraly fluffy infiltrates). B) Huge right pneumothorax. C) Enlarged heart with increased interstitial markings = volume overload, CHF. D) Little bit tougher, picture quality is terrible. Looks like they're trying to show the "Westermark sign" of a pulmonary embolism, as the left pulmonary artery branches cut off abruptly, resulting in a relatively more lucent left lung.

 

[bwmd]

The 2015-16 set is out and essentially unchanged. My annual post is here, but the take home message is that the new PDF deletes two questions per section to match the new change of each section being 44 instead of 46 questions. Otherwise the set is unchanged in content and order for now.

 

[pathwizard]

You can search the main USMLE website at usmle.org (in the right upper corner) and pull a few old ones. They don't seem to delete the older versions (though the questions typically change minimally per year). Here are the ones I could get:

2013 http://www.usmle.org/pdfs/step-1/2013content_step1.pdf
2012 http://www.usmle.org/pdfs/step-1/2012content_step1.pdf
2011 http://www.usmle.org/pdfs/step-1/2011content_step1.pdf
2010 http://www.usmle.org/pdfs/step-1/2010content_step1.pdf
2009 is still around at this site: http://medsci.indiana.edu/c602web/602/c602web/usmle/2009step1.pdf

The older links are no longer working. Does anyone have copies of the pdf files or know where I can get access to them? Thanks.

 

[pathwizard]

at the very least, does anyone have the 2013 question set?

 

[bwmd]

They've finally removed all older versions, but you can still find them archive.org (or google) via cachedview.com, which is my go-to for finding broken links.

2013 is available at http://web.archive.org/web/20140612013031/http://www.usmle.org/pdfs/step-1/2013content_step1.pdf

 

[pathwizard]

You are awesome, thanks a lot!

 

[bwmd]

The new 2016 set is out and has ~49 new questions. My new explanations are here.

 

[ninjaman22]

The new 2016 set is out and has ~49 new questions. My new explanations are here.

Thanks for this!

 

[bwmd]

The 2017 set is out, but it's the same as last year's set. Here is my 2017 post (I did address the handful of multimedia questions).

 

[dontwantaids]

The 2017 set is out, but it's the same as last year's set. Here is my 2017 post (I did address the handful multimedia questions).

Thanks. Are the usmle.org questions different from NBME tests (the ones you have to purchase for $60). If so, which is more high yield? Can usmle.org questions predict performance on the actual test? TIA

 

[bwmd]

Thanks. Are the usmle.org questions different from NBME tests (the ones you have to purchase for $60). If so, which is more high yield? Can usmle.org questions predict performance on the actual test? TIA

They are written by the same folks, though the NBMEs you pay for give you a score at the end that corresponds to an estimated Step score, while the free questions do not have prediction built in. There are some unofficial predictions for them though.

 

[forums2012]

Hey could you please elaborate on #70, Narcotics question. Why wouldn't we want to switch the patient to Acetaminophen as soon as she can take medication orally?

(Also would really appreciate if you could recommend a good resource to cover ethics/behavioral/physician's initital response-type questions)

Thanks for the amazing explanations

 

[bwmd]

The Free 150 are still the Free 120 now. The new 2018 set has 51 questions, explanations here: Explanations for the 2018 Official Step 1 Practice Questions | ben white

For the question above re: #70 on the prior set. Oral Tylenol isn't going to cut it for someone who has just been shot or is immediatly post-op from an abdominal surgery or with an acute fracture, even if they can take PO. The route is a distractor.