USMLE Step 1 Preparation Book PDF 2026 (Free Download)

What is in the USMLE Step 1 book

Each model paper carries the same number of MCQs per subject as the real USMLE Step 1 paper, so sitting it is a rehearsal of the real thing, not a random worksheet.

Sample MCQs from the USMLE Step 1 book

The first 10 questions of model paper 1.

1. Pathology

   1. The fading of cellular chromatin is_____________?

   • A. Karyolysis
   • B. Karyorrhexis
   • C. Pyknosis
   • D. Cytolysis
   Show answer

   Answer: A, Karyolysis. See the explanation

2. Physiology

   2. Ammonia in the kidney tubules is excreted in exchange for______________?

   • A. HCO3-
   • B. Na+
   • C. CL-
   • D. PO4-2
   Show answer

   Answer: B, Na+. See the explanation

3. Pharmacology

   3. All are true about metformin except_____________?

   • A. Inhibits cellular respiration in mitochondria
   • B. Excreted unchanged in urine
   • C. Reduce hepatic glucose production
   • D. Used in decompensated heart failure
   Show answer

   Answer: D, Used in decompensated heart failure. See the explanation

4. Microbiology

   4. Anaerobic bacteria grow_______________?

   • A. in the presence of oxygen
   • B. in the presence of nitrogen
   • C. in the absence of oxygen
   • D. differential media
   Show answer

   Answer: C, in the absence of oxygen. See the explanation

5. Biochemistry

   5. Ammonia produced by brain is trapped as_____________?

   • A. Urea
   • B. Uric Acid
   • C. Creatinine
   • D. Glutamine
   Show answer

   Answer: D, Glutamine. See the explanation

6. General Anatomy

   6. Space of Disse is seen in______________?

   • A. Spleen
   • B. Kidney
   • C. Liver
   • D. Small intestine
   Show answer

   Answer: C, Liver. See the explanation

7. Pathology

   7. The drug which is used to treat laryngospasm is_______________?

   • A. Atropine
   • B. Diazepam
   • C. Neostigmine
   • D. Succinylcholine
   Show answer

   Answer: D, Succinylcholine. See the explanation

8. Physiology

   8. Trypsin is an activator of all of the following enzymes EXCEPT_______________?

   • A. Chymotrypsinogen
   • B. Pepsinogen
   • C. Proelastase
   • D. Procolipase
   Show answer

   Answer: B, Pepsinogen. See the explanation

9. Pharmacology

   9. Which is not antiemetic ?

   • A. Domperidone
   • B. Phenazocine
   • C. Cyclizine
   • D. Ondanestron
   Show answer

   Answer: B, Phenazocine. See the explanation

10. Microbiology

    10. The following immunoglobulin is not known to fix complement_________________?

    • A. IgE
    • B. IgM
    • C. IgA
    • D. IgG
    Show answer

    Answer: A, IgE. See the explanation

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