USMLE Step 1

High-yield Step 1, ranked by what the NBME actually tests

We broke down 3,978 NBME practice questions for USMLE Step 1 into the concept each one tests. Here is how those questions split by discipline and the topics that come up most.

3,978Step 1 NBME questions analysed

20NBME forms (NBME 11 to NBME 31)

23disciplines and systems

Study these topics free

Step 1 high-yield topics by discipline

Share of the 3,978 questions in each discipline or system. Pharmacology leads, and the basic sciences together (biochemistry, genetics, immunology, microbiology, biostatistics) make up a large part of the exam.

Step 1 NBME practice questions by discipline
Area	Questions	Share
Pharmacology	416	10.5%
Endocrinology	290	7.3%
Microbiology	283	7.1%
Neurology	274	6.9%
Cardiology	216	5.4%
Pathology	206	5.2%
Immunology	199	5.0%
Hematology and oncology	194	4.9%
Biostatistics	177	4.4%
Anatomy	176	4.4%
Biochemistry	171	4.3%
Gastroenterology	165	4.1%
Genetics	157	3.9%
Pediatrics	139	3.5%
Renal	126	3.2%
Psychiatry	119	3.0%
Pulmonology	108	2.7%
Ethics	101	2.5%
Physiology	97	2.4%
Musculoskeletal and rheumatology	95	2.4%
Dermatology	75	1.9%
Embryology	55	1.4%
Reproductive and OB/GYN	42	1.1%
Other (smaller areas combined)	97	2.4%

Most-tested Step 1 topics

The topics that come up most across all 3,978 questions, matched from the concept each question tests. The number is how many questions involve each topic.

Inheritance patterns 139
Electrolyte disorders 118
Drug adverse effects 118
Cell injury, apoptosis and necrosis 104
Hypertension 102
Diabetes mellitus 96
Acid-base disorders 92
Inflammation and wound healing 91
Embryologic development 85
Vitamins 83
Autonomic drugs 77
Pregnancy and preeclampsia 70
Consent, capacity and confidentiality 70
Glomerulonephritis and nephrotic syndrome 67
Coagulation disorders and anticoagulants 64
Pneumonia 62
Pharmacokinetics 60
HIV 57
Hypersensitivity reactions 56
Sensitivity, specificity and predictive value 56
Heart failure 55
Depression 55
Herpesviruses (HSV, VZV, EBV, CMV) 54
Study design and bias 54

The high-yield list for each discipline

The topics tested most often inside each of the larger disciplines.

Pharmacology

Drug adverse effects83
Autonomic drugs43
Pharmacokinetics34
Chemotherapy drugs30
Antibiotic mechanisms27
Cell injury, apoptosis and necrosis17

Endocrinology

Electrolyte disorders53
Diabetes mellitus36
Vitamins25
Ovarian disorders21
Hyperparathyroidism20
Hyperthyroidism and Graves disease17

Microbiology

HIV30
Herpesviruses (HSV, VZV, EBV, CMV)26
Pneumonia25
Streptococci18
E. coli16
Fungal infections15

Neurology

Spinal cord lesions30
Cranial nerve lesions26
Stroke19
Alzheimer disease and dementia17
Seizures and epilepsy16
Multiple sclerosis10

Cardiology

Heart failure39
Hypertension30
Myocardial infarction25
Stroke16
Congenital heart defects13
Aortic stenosis12

Pathology

Inflammation and wound healing20
Cell injury, apoptosis and necrosis17
Glomerulonephritis and nephrotic syndrome10
Diabetes mellitus8
Hypertension6
Colorectal cancer6

Immunology

Hypersensitivity reactions35
Inflammation and wound healing30
Immunodeficiencies29
Inheritance patterns21
Transplant rejection14
Cell injury, apoptosis and necrosis13

Hematology and oncology

Coagulation disorders and anticoagulants31
Leukemia24
Hemolytic anemia23
Thrombocytopenia (ITP, TTP, HIT)22
Electrolyte disorders13
Vitamin B12 and folate deficiency11

Biostatistics

Study design and bias53
Relative risk and odds ratio30
Sensitivity, specificity and predictive value22
Colorectal cancer4

Anatomy

Brachial plexus and nerve injuries16
Testicular disorders9
Ovarian disorders8
Prostate disorders7
Embryologic development5
Cranial nerve lesions3

Biochemistry

Inheritance patterns19
Vitamins16
Lysosomal storage diseases12
Amino acid and urea cycle disorders11
Inflammation and wound healing8
Acid-base disorders7

Gastroenterology

Cirrhosis and portal hypertension27
Peptic ulcer and H. pylori14
Gallstones13
Pancreatitis13
Inheritance patterns6
Celiac disease6

How to study high-yield for Step 1

Study mechanisms, not lists
Step 1 rewards knowing why. When a drug, enzyme or pathogen keeps showing up, learn the mechanism that links it to the clinical picture.
Weight your time by discipline
Use the table above. Pharmacology, endocrinology, neurology and microbiology together account for a large share of questions.
Do not skip biostatistics and ethics
They are a reliable source of points, they are fast to review, and they appear on every form.
Review with spaced repetition
Turn every missed concept into a flashcard and keep reviewing it until test day.
Keep a few NBME forms unseen
Study the concepts they test without reading the questions so your practice scores stay an honest predictor.

Step 1 high-yield questions

What is high-yield for USMLE Step 1?

High-yield means the concepts NBME questions keep testing. Across 3,978 Step 1 NBME practice questions, pharmacology, endocrinology and microbiology are the largest areas, and most questions test a mechanism or a pathophysiology link rather than an isolated fact.

Which NBME forms is OnlyHighYield built from for Step 1?

Step 1 content is built from 20 NBME Comprehensive Basic Science self-assessment forms, NBME 11 to NBME 31.

Does OnlyHighYield show the real NBME questions?

No. Summaries and flashcards teach the concept each question tests without quoting its wording, and form and question references stay off until you turn them on.

Is OnlyHighYield free?

Yes. It is free with unlimited access during the beta, with no credit card needed.

Can I use it for a last-minute Step 1 review?

Yes. Beta testers use the flashcards as a rapid review in the final weeks, especially for biostatistics and pharmacology, because every card comes from a tested concept.

Free during beta

Study only what's tested

Ask about any topic and get a summary built only from what NBME questions test, then drill it as flashcards. Free while we are in beta.

Join the Beta Program

Also see high-yield Step 2 CK topics.