Pick the page that matches the decision in front of you. If you miss questions because the stem feels like a wall of labs, start with the structure guide. If you can do a single item and fall apart across a mixed hour, start with the Step 1 practice guide. If you are not ready to pay, or you want to test the review habit first, start with the free set. All three pages print original questions in full, with every option explained.
The three guides
- NBME-style practice questions. How a chronological vignette, a second-order lead-in, and five options fit together, and how to review a miss down to one educational objective.
- USMLE Step 1 practice questions. Subject tutor blocks, then mixed timed blocks, an error log worth rereading, and a 14-block test day of 20 questions each.
- Free USMLE-style questions. What a free item must include, an evening drill, and how to use a 50-question sample report without treating the percent as a prophecy.
You can read them in that order over three sittings. You do not need to. A student two months from the exam who has never timed a block should open the Step 1 page and the free exam, and use the NBME-style page only for the review checklist. A student in the first organ system should do the opposite: learn the shape of one item before worrying about a 14-block day.
Two banks, one job
Both banks are original StepLobe writing for USMLE Step 1 study. The NBME-style bank has 3,494 questions: vignettes, lab tables, exam mode, and explanations. The USMLE-style bank currently includes 2,984 questions, with step-by-step reasoning and a reason for every other option. “NBME-style” and “USMLE-style” describe format. They do not mean the NBME or the USMLE program wrote or approved the items. StepLobe is not affiliated with or endorsed by NBME, FSMB, or USMLE.
Use the NBME-style bank when you want the longer self-assessment feel, including a practice exam of 4 blocks of 50, and when you are drilling the habit of reading a stem as a timeline. Use the USMLE-style bank, and test-day mode, when you want the current day: 14 blocks of 20, 30 minutes each, since May 2026, with a shared break pool of at least 55 minutes. Many students use both. The mistake is to treat them as rival brands and finish neither.
The 33,914 flashcards are the one-fact layer under both banks. A card has a context cue, a plain answer, and a reason. A question asks you to find that fact inside a story. Do the due cards before a block. After the block, add a card only when the educational objective was new. The 163 visual study packs are for the topics that stick better as a picture you can label. They are not a third question bank.
A path that stays small enough to finish
- Read one guide tonight. Do the printed samples on that page with a letter written down before you open the explanation.
- Tomorrow, take one free 50-question exam. Choose USMLE-style if you want the block screen, or NBME-style if you want the score-report layout. No card.
- The day after, review only the misses. One clause per wrong option you actually considered. One objective per miss, in your own words.
- Put the exam date into the study plan. Let the plan set the daily size. An hour you review beats three hours you only click through.
- Keep one full test-day rehearsal for later, after mixed blocks feel ordinary. If you buy an eligible plan and want the pass guarantee, read the rules before you assume you are covered.
A free account, still with no card, also includes 10 questions from each bank with full explanations, 50 flashcards, 2 study packs, and the first week of the plan. That is enough to learn the interface and to find out whether you will review. It is not the whole bank. Full access is on the pricing section.
How to tell a good question from a noisy one
Use the same checks on StepLobe items and on anything else you are tempted to add. The stem should be tellable as a sequence of events. The lead-in should ask for something beyond the diagnosis name: a mechanism, a structure, a calculation, a nerve, or the best next action given a constraint. Exactly one option should win, and the others should be serious. You should be able to say, after the explanation, why a smart person would have picked each loser.
Walk away from sets that live on buzzwords, from answer keys with no sentences, and from material copied out of someone else’s deck. If a free file depends on a mnemonic you were supposed to have memorized from a video, it is not a question. It is a caption.
What the samples on this hub are for
The three items below are a cross-section, not a mini exam. One is a mechanism that has to explain both a brain lesion and a high hematocrit. One is a calculation with a denominator people usually fill with the wrong people. One is an ethics item about a refusal, where the “most appropriate action” is to keep treating without the treatment the patient declined. Do them with the same rules as a block: lead-in first, timeline second, letter on paper, then every option. More samples in each style are on the three guides linked above.
Tools around the questions
Questions are the test. They are not the whole week. Due flashcards keep the one-fact layer alive. Study packs carry the pictures. The plan keeps the day from becoming whatever video you happened to open. Weekly exams, when you want a standing timed set, are described on the weekly exams page. Case videos, if you want a spoken version of a vignette before you answer, are on Learn. None of those replaces the line you write after a miss.
For study only. Not medical advice. A question about a transfusion refusal, a tumor pathway, or an outbreak calculation is a drill in reasoning. It is not a recommendation for a person in front of you.
Three free sample questions
These items are original StepLobe questions, printed in full. Nothing is hidden behind a login or a click. Read the vignette in time order, answer the lead-in, then use the explanation, every option, and the educational objective.
Free sample 1 · Neurology
Original neurology vignette
A 34-year-old man comes to the office because of a 2-month history of unsteady gait and headaches that are worse on awakening. He has no history of seizures. His mother underwent removal of a kidney tumor at the age of 41 years. He does not smoke cigarettes, drink alcohol, or use illicit drugs. His temperature is 37°C (98.6°F), pulse is 74/min, respirations are 14/min, and blood pressure is 126/78 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. His face is ruddy. Funduscopic examination of the left eye shows a round, elevated, red-orange lesion in the peripheral retina. A dilated, tortuous arteriole supplies the lesion, and a dilated venule drains it. He has dysmetria on right finger-to-nose testing and a wide-based gait. Skin examination shows no abnormalities. There is no splenomegaly. Laboratory studies show:
| Test | Value |
|---|---|
| Hemoglobin | 18.9 g/dL |
| Hematocrit | 56% |
| Leukocyte count | 7200/mm3 |
| Platelet count | 245,000/mm3 |
| Erythropoietin | 52 mU/mL (N=4–26) |
An axial contrast-enhanced T1-weighted MRI of the brain shows a 3.5-cm, well-circumscribed, fluid-filled lesion in the right cerebellar hemisphere. A small, intensely enhancing nodule lies along the wall of the lesion at the pial surface, and the rest of the wall does not enhance. The fourth ventricle is mildly compressed. The supratentorial brain shows no abnormalities.
Which of the following best explains the pathogenesis of this patient's cerebellar lesion and hematologic findings?
- A.Erythropoietin-independent activation of JAK2 tyrosine kinase
- B.Failure of ubiquitin-mediated degradation of hypoxia-inducible factor α
- C.Loss of GTPase-activating protein control of RAS
- D.Loss of hamartin–tuberin inhibition of mTORC1
- E.Persistent Gαq signaling from an activating GNAQ mutation
Correct answer: B
Loss of the VHL protein (pVHL) prevents ubiquitination of oxygen-hydroxylated HIF-α. HIF then accumulates despite normal oxygen and drives VEGF, producing the vascular hemangioblastomas, and erythropoietin, producing the erythrocytosis.
In normal oxygen, prolyl hydroxylases use O2, Fe2+ and 2-oxoglutarate to hydroxylate HIF-α. pVHL, the substrate-recognition subunit of an E3 ubiquitin ligase (with elongin B/C and cullin 2), binds hydroxylated HIF-α and tags it for the proteasome. This patient inherited one mutant VHL allele, and a somatic second hit inactivates the other allele in tumor cells. HIF-α then escapes degradation, pairs with HIF-1β, and activates hypoxia-response genes as if the cell lacked oxygen. VEGF builds the dense capillary network of his cerebellar and retinal hemangioblastomas. Tumor-secreted erythropoietin raises his hematocrit despite an oxygen saturation of 98%.
Why each option is right or wrong
- A. In polycythemia vera (JAK2 V617F), red cell production does not need erythropoietin, so erythropoietin is low. His is high, and polycythemia vera does not cause hemangioblastomas.
- B. Correct. Without pVHL, HIF-α is not ubiquitinated, accumulates in normal oxygen and drives VEGF (hemangioblastomas) and erythropoietin (erythrocytosis).
- C. Loss of neurofibromin (NF1) causes café-au-lait macules, neurofibromas and pilocytic astrocytomas. It does not cause retinal hemangioblastomas or erythropoietin-driven erythrocytosis, and his skin is normal.
- D. Tuberous sclerosis causes cortical tubers, subependymal nodules, retinal astrocytic hamartomas and renal angiomyolipomas with seizures and skin lesions. It does not cause cerebellar hemangioblastoma or erythrocytosis.
- E. A somatic GNAQ mutation (Sturge-Weber syndrome) causes a V1 port-wine stain, leptomeningeal angioma, seizures and choroidal hemangioma. It is sporadic and causes neither cyst-and-nodule tumors nor erythrocytosis.
Educational objective. Loss of pVHL prevents ubiquitin-mediated degradation of HIF-α, causing VEGF-driven hemangioblastomas and erythropoietin-driven erythrocytosis.
Free sample 2 · Biostatistics/Epidemiology
Original biostatistics/epidemiology vignette
A county health department investigates an outbreak of hepatitis A after 40 students aged 7 to 11 years at two elementary schools develop fever, nausea, dark urine and jaundice over 3 weeks. Each student's infection is confirmed by IgM antibody to hepatitis A virus, and each student lives in a different household. Investigators test all 160 household members of these 40 students. Forty household members have IgG antibody to hepatitis A virus from prior vaccination or infection; the other 120 have no antibody and have never been vaccinated. No household member had been ill before the student in that household. Over the next 50 days, 18 household members develop jaundice with IgM antibody to hepatitis A virus.
Which of the following is the secondary attack rate of hepatitis A among household contacts in this outbreak?
- A.11%
- B.15%
- C.25%
- D.29%
- E.45%
Correct answer: B
B (15%). The secondary attack rate is new cases among contacts divided by susceptible contacts. Remove the 40 immune contacts and never count the index students: 18 ÷ (160 − 40) = 18 ÷ 120 = 15%.
The secondary attack rate measures how readily an infection spreads from a primary case to close contacts during one incubation period. Its denominator contains only people who were exposed and could become infected, so contacts who are already immune from vaccination or past infection are removed, and the primary cases never enter the calculation. Hepatitis A spreads by the fecal–oral route and has an incubation period of about 15 to 50 days, so crowded households, schools and child care centers sustain transmission. Hepatitis A vaccine given within 2 weeks of exposure lowers the secondary attack rate.
Why each option is right or wrong
- A. 18 ÷ 160 keeps the 40 immune contacts in the denominator. People who cannot be infected dilute the rate.
- B. Correct. 18 secondary cases ÷ 120 susceptible contacts (160 contacts − 40 immune) = 15%.
- C. 40 ÷ 160 divides the primary cases by the contacts. Primary cases are excluded from the secondary attack rate.
- D. 58 ÷ 200 pools primary and secondary cases over everyone in the households. That is an overall attack rate, not spread to contacts.
- E. 18 ÷ 40 counts secondary cases per primary case. It describes transmission per index case, not the rate among contacts.
Educational objective. The secondary attack rate is new cases among contacts within one incubation period divided by susceptible contacts, excluding index cases and immune contacts.
Free sample 3 · Ethics/Communication
Original ethics/communication vignette
A 46-year-old man is brought to the emergency department because of two episodes of vomiting blood and black, tarry stools over the past 12 hours. He has taken naproxen daily for 3 months for knee pain. His temperature is 37.0°C (98.6°F), pulse is 116/min, respirations are 20/min, and blood pressure is 94/60 mm Hg. He is alert and fully oriented. The conjunctivae are pale. There is mild epigastric tenderness. Laboratory studies show:
| Test | Value |
|---|---|
| Hemoglobin | 6.4 g/dL |
| Hematocrit | 19% |
| Platelet count | 230,000/mm3 |
| Prothrombin time | 12 sec |
| Urea nitrogen | 42 mg/dL |
| Creatinine | 1.0 mg/dL |
Intravenous crystalloid and pantoprazole are begun. Upper endoscopy shows a 1.5-cm duodenal bulb ulcer with a visible vessel, and hemostasis is achieved. The physician recommends red blood cell transfusion and explains that without it he could have a heart attack or die if bleeding recurs. He is a Jehovah's Witness and declines all blood products. He accurately restates these risks, including death, says that accepting blood would violate his deepest beliefs, and asks for every other available therapy. He carries a signed card refusing blood even if he becomes unconscious. His wife, who does not share his faith, urges the team to transfuse him. Two hours later, his decision is unchanged.
Which of the following is the most appropriate action by the physician?
- A.Arrange a court order authorizing transfusion
- B.Ask his wife to provide consent for transfusion
- C.Continue care using blood-free management strategies
- D.Request a psychiatric evaluation of decision-making capacity
- E.Transfuse red blood cells if he loses consciousness
Correct answer: C
An informed adult with decision-making capacity may refuse even lifesaving transfusion. Autonomy governs, so the physician honors the refusal and continues full care with blood-free strategies.
A valid refusal needs the same elements as valid consent: disclosure, decision-making capacity and voluntariness. Capacity is decision-specific and is assessed by the treating physician. This man understands the facts, appreciates that he could die, reasons from deeply held values and holds a stable choice backed by written documentation. Respect for autonomy therefore outweighs beneficence. Honoring the refusal does not mean abandoning him. The team reduces rebleeding risk with a high-dose proton pump inhibitor, repeat endoscopy or angiographic embolization if bleeding recurs, and stopping the NSAID. It also limits phlebotomy, gives intravenous iron and asks which blood fractions he personally accepts.
Why each option is right or wrong
- A. Courts do not override a competent adult's informed refusal of treatment. Seeking an order delays care and disregards his autonomy.
- B. A surrogate's authority begins only when the patient lacks capacity. Even then, his documented refusal would bind her.
- C. Correct. He has capacity and made an informed, voluntary, stable refusal. Respecting it while maximizing blood-free care honors autonomy without abandoning him.
- D. Refusing lifesaving care is not evidence of incapacity. The treating physician can judge capacity, and here every element is clearly met.
- E. Implied consent applies only when the patient's wishes are unknown. His signed card makes his refusal known.
Educational objective. An informed adult with decision-making capacity may refuse lifesaving transfusion; the physician honors the refusal and provides blood-free alternatives.
For study only. Not medical advice. StepLobe is not affiliated with or endorsed by NBME, FSMB or USMLE.
Where to go after these three
If the mechanism item was the hard one, open NBME-style questions and practice saying the task before you read the options. If the calculation felt slippery, your next sessions should be mixed and timed, which is the point of the USMLE Step 1 practice guide. If you want more items tonight without paying, the free questions page has four more fully explained stems and the rules for the 50-question exam. When you are ready for a clock, start the free sample exam.
The sample exam needs a free account and no card. Founding price is $14.99/month or $139/year ($11.58/month). Yearly starts with 3 days free, card required.
Keep going
- NBME-style questionsVignette structure, second-order lead-ins, and four explained samples.
- USMLE Step 1 questionsMixed blocks, an error log, and the 14-by-20 test day.
- Free USMLE-style questionsA standard for free items, plus the no-card sample exam.
- Step 1 exam format 202614 blocks of 30 minutes, the break pool, nutrition at 15–20%, and how to rehearse.
- Step 1 study schedule6-week and 8-week dedicated plans, a sample day and when to move your date.
- Nutrition for Step 1The high-yield vitamins, minerals and malnutrition states, with mechanisms.
- Choosing a Step 1 qbankEight things to check before you pay for a question bank.
- Free 50-question examPick a style, sit a timed block, read a score report.
- Study planTurn an exam date into a daily size you can finish.
- Mnemonics bookStepLobe Mnemonics for USMLE Step 1, 2026 edition. Sample pages. Buy now.
- PricingFounding prices for full access after the free preview.
Questions students ask
Which question guide should I read first?
If single stems feel confusing, read the NBME-style guide. If you can do one item and struggle across an hour, read the USMLE Step 1 practice guide. If you want to try the habit before you pay, read the free questions guide and take the 50-question sample.
What is the difference between the two StepLobe banks?
The NBME-style bank has 3,494 original questions in a vignette format, including a 4-by-50 practice exam. The USMLE-style bank currently has 2,984 original questions and is the set used for the 14-by-20 test-day mode. Both have explanations. Neither is an official NBME or USMLE form.
Where are the free sample questions?
Each guide prints original questions in the page HTML, with the correct answer, every distractor, and an educational objective. A free account also unlocks 10 questions per bank and a 50-question sample exam. No card is required.
Is StepLobe affiliated with the NBME or the USMLE?
No. StepLobe is not affiliated with or endorsed by NBME, FSMB, or USMLE. The names are used only to describe the style of original practice questions and the exam students are preparing for.
How do flashcards fit with the questions?
There are 33,914 one-fact flashcards. Do the due cards before a block, and make a new card only for an objective you could not already say. Questions test the fact inside a story. Cards keep the fact.
StepLobe is not affiliated with or endorsed by NBME, FSMB or USMLE. “NBME-style” and “USMLE-style” describe the format of original StepLobe questions. For study only. Not medical advice.