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USMLE Step 1 cheat sheets

Struggling to go beyond rote memorization?  Use my cheat sheets to master some of the most difficult topics!






  1. Mohamed Ahmed says:

    Hey dear Alec!
    I hope you are doing well..

    I really appreciate all the efforts and the advices that you provide.
    If you don’t mind I have a question for you in regard to USMLE step 1 preparation and I know that you have the full right to answer it, However; I don’t know anyone in this pathway to guide me and as an IMG from war-torn country I couldn’t afford to get a one.

    Now, my question is I have been studying for step 1 for more than 5 months now. Till this moment I finished half of the contest (if that appropriate to say) using FA, BNB & UW, The problem is that I had skipped the initial subjects specifically (Microbiology and General Pathology) so while doing UW, Rx and amboss qbank I score very low! That completely depressing for me .. I started to feel stressed and burned out.

    Should I return to those subjects now ? Or leave them to the end because I’m really afraid of keep forgetting them that’s why I want keep them till the end.

    Really sorry for inconvenience and thanks again

    1. Yousmle says:

      Hi! I’m not sure I understand your question. I think you’re asking if you should learn Micro + pathology – the answer would be yes, definitely. More generally, though, if your scores are very low the most important thing I can say is that HOW you approach the material matters more than WHAT material you use:

  2. Bharat Rawlley says:

    Hey alec

    One of your flashcards says that metoclopramide interferes with action of Digoxin and Diabetic medications.
    I understand it impairs absorption of Digoxin because of Increased GI motility but what’s the problem with antidiabetic drugs?


  3. Bharat Rawlley says:

    Hey Alec, Just wanted to confirm from your flash cards that increasing the lipophilicity of a local anesthetic increases the speed of onset while increasing the lipophilicity of an inhalational anesthetic will decrease the speed of onset as that would increase the arterio-venous concentration gradient improving the tissue solubility and thus the speed the action?

    Also, while your flash cards have been of great help, many of them have external links to diagrams etc which do not work. I tried posting those links here but your website will not let me do it. Can you help me out with this?

  4. Bharat Rawlley says:

    Hey Alec! A flashcard from your step 1 deck asks – Neutrophils vs T cells- responsible for defense of what in candida infections? and the other side of the card says neutrophils protect against systemic/hematogenous spread while t cells protect locally (eg. thrush, vaginitis)

    can you elaborate a bit on this please? Has this got something to do with T cells being a part of the acquired immune system while Neutrophils a part of the innate system?


  5. Deedee says:

    Hi Alec, can I finish all the decks in step 1 within 8 weeks?

  6. dan says:

    Would purchasing your step 2 deck/pharm would help me for step1? My reasoning behind this question is that certain schools allow their students to take step1 after wards and this has proven to increase the school’s step1 average historically. Not sure if its theres confounding variables behind this claim.

  7. Martin Morales says:

    Hi Alec!!!! What is the best way to put the settings in Anki to study your deck?

  8. Busola Olabiran says:

    Hi Alec! I’m an international medical student in my first year (I know step 1 is a while away but my program isn’t taught in the same style as the US, so I want to start filling in gaps and teaching myself content, early on, alongside my lectures). I’ve noticed you emphasise learning and understanding concepts and then using FA as a review as opposed to trying to learn directly out of FA because it’s difficult to learn from, requires readers to have a lot of knowledge prior to reading it and simply isn’t designed to be used that way. My question is; Which textbooks or online resources can you recommend I use to teach myself the content and knowledge required, primarily, to be able to answer Step 1 questions? So then I can follow it up with FA later on. Also do you know if there’s a list of topics and sub-topics that shows what step 1 tests? Thank you 🙂

    1. Yousmle says:

      Great question – you can find my most recommended resources here:

  9. Irina Kratman says:

    HI! I want to buy basic plan for preparation. But i didn’t thoroughly understand what it includes. It’s unclear from the description. Is it a QBank? or lectures material? OR whatever.. I have my study plan in step 1 preparation. I’m concerned in changing it bc my exam in 1,5 month. I don’t know what to add in my preparation in order to boost my score. My latest NBME 17 242.

  10. Galvino Staroski Berritatadlo says:

    Hello, what program opens anki?? I am test driving the possibility of using it, but now I am stuck , I downloaded the free sample, but it is not opening . HELP Rescue me

  11. Justin says:

    Hi, I have already purchased your Anki Step 1 and Pharm decks. May I know if they will be regularly updated? If yes, where do I get access to the updated versions?

  12. Lina says:

    Hello Alec, I´ve been following your blog for a while, it has been extremely helpful, I cant thank you enough. I have a very important question, my uworld account expires in about 7 days, about 2 weeks before I take step 1, with that in mind I was wondering about strategy. Do you think I should renovate uworld and do these questions ( I have gone through them twice) or opt to finish up my kaplan question bank( About 1000 questions left)? I was also wondering if you did questions until the very last day or gave yourself a couple of days to review material ?

  13. Alexander Christian says:

    Hi Alec,
    I just purchased your pharm deck and would like to discuss the cards with you. Do you have a way I could get into contact with you?

  14. inam says:

    Hi Alec,
    To supplement or to understand a topic in depth from your flash cards, what resource would you recommend I use in order to accomplish the understanding in depth concept.

  15. oluwatosin ayanjoke says:

    How does contraction of the ciliary body help in open angle glaucoma?

    1. Yousmle says:

      It somehow increases drainage via the trabecular meshwork. It’s not clear how it does this. Sympathomimetics also decrease production, which makes more sense to me physiologically.

  16. Jigyasa gupta says:

    hey alec.
    i am an IMG. Since i am already late as in, i am doing my internship in india and hoping to write my step1 in december. so i was planning for more of observerships after writing my step1 and step2,rather than doing electives now. Since i have to apply for 2018, what do you recommend though? Doesnt it count the same, doing electives or observerships?( i mean for evaluation)

    1. Yousmle says:

      That’s a great question. On electives, you’d be able to do more – the downside is that you’d apply much later than the elective, so you’d risk that you’d lose touch with your evaluators/letter-writers. For observerships, you wouldn’t be able to do as much, but you could do it after knowing your USMLE scores, and they would have a better chance of remembering you. If it were me, I’d wait and do observerships, especially since that way you can focus on doing your USMLEs now.

      1. Jigyasa gupta says:

        Hey what if my scores’s not that great ! Or i barely passed. Wouldnt the electives play a beneficial role then?

        1. Yousmle says:

          I doubt bad scores with an elective versus bad scores with and observership would make much of a difference.

          1. Jigyasa gupta says:

            Okay ! Thanks a lot. I am losing it completely. Please guide me how to score Good. Should i start taking nbme now since i have to write my step in december ?
            And what about u world. I have u world offline version 2016. One of my friend just passed it over to me. Should i still subscribe to u world ?

          2. Yousmle says:

            You can read more advice here:
            You can read more about tutoring here:

  17. read says:

    Hello there i just got my usmle score, it was my second attempt, i failed and got a 170. I did first aid, uworld about 75% and some nbme along with other resources like usmle rx, sketchy micro, pathoma etc. I need to appear for the test again within a month. I cannot give up because i need to do this, medicine is my life. I cannot give up, please give me some advice, i am sure my strategy for preparation was really really wrong. I am confused, scared, worried at the moment.I am trying to find help anywhere i can.Any help will be much appreciated.

    1. Yousmle says:

      Fantastic question. The biggest thing I would suggest is to focus more on trying to understand disease processes rather than having a set number of pages in a particular book that you want to read. For example, most students typically focus on learning everything in a particular book, then moving on to another. Instead, I would focus on learning the disease process, and using whatever resources you have available to do that. That way you can structure your day in a more predictable manner, focusing on learning a particular number of diseases or topics during the day, rather than trying to read some predetermined number of pages.

      Keep your chin up. Just focus on one problem/disease at a time, don’t think about the number of pages of a book you’re supposedly supposed to read, or all of the crazy/misguided advice you will read online.

  18. Kamal says:

    Is there a way I should incorporate anki into my study schedule? Or should I just study from anki after I have done first aid?

    1. Yousmle says:

      Better to integrate it into your daily routine. I like to do cards early in the morning, since they can take a lot of mental energy – there is nothing worse than doing hundreds of cards after a long day.

      1. Kamal says:

        Is there a way you could make me a study schedule incorporating everything into it?

  19. Banks says:

    Thanks Dr Alec, this seems to be my particular problem. I always run out of time and never finish any block. I have timing problem and that really affects my score in any diagnostic that I take. May be its a problem with interpretation of the question stem or I’m not using the right strategies. Are there any ways you can help me with these problems? I tend to understand concepts when I read books or do questions but my scores are not improving at all. I have done FA and Uworld more than 4 times each. This is taking so many months and I feel like I should be scoring high based on the number of hours I invest in studying. Thanks in anticipation of your response.

    1. Yousmle says:

      Hi, thank you so much for your question. It’s hard to know exactly why your scores may not be improving, but certainly difficulty with interpretation and application can be an issue. Without working with you directly, my best advice is to focus on understanding what each sentence means, and figuring out exactly what the question is asking.

  20. Nada says:

    Hi Alec,

    I am an IMG, My exam is on 31 jan 2016 (End of my eligibility period). I started studying since 1 year but with so many on and offs. I am doing my 1st read in FA with UW tutor untimed. At this point i feel my level is below average, i am looking for a very efficient way that can help score a 250 in 2 months. I have no time to make my own anki cards. If I were to use your Anki cards what would be the best study plan along with FA & UW?
    Do you advice me to reschedule my test and lose my 1000$, i am very desperate and feel down.
    Thank you

    1. Yousmle says:

      Thank you so much for your question. It’s hard to give you more specific advice without knowing what your NBME scores are. Certainly, the Anki cards can help, particularly if you are looking to learn and retain a large amount of information over a short period of time which you are looking at.

  21. Kurchatov says:

    I am an fmg and I used your deck for step 1 prep..I found it quite useful.I recently took my test and I think I have done ok. I had 260+ in all NBMEs that I had given.. Unfortunately I made some silly mistakes on the test due to nervousness .. What % answers do you suppose is needed for 260+ on the test? do you suppose it is as high as NBMEs ? For instance I got 190 correct answers in NBME 17 and that came to 265 .. Could the real test be so steep as well? I mean it was a lot tougher than NBMEs and other practice tests..I know there is no point crying over spilled milk. But I can’t stop worrying about how much those 4 questions may have cost me.

    1. Yousmle says:

      First of all, your NBME scores suggest that you are doing quite well, so that’s fantastic! I’m happy that the cards to you purchase for able to help as well! There is no guidelines for how many questions you need to get correct on your real exam, or how much each question is worth. Each NBME has a different number of questions required to get a particular score, so my intuition is that each exam will be different. That said, most people walk out of their exam feeling not great, even the ones who score above 250 or 260, so I wouldn’t put too much thought into it.

      We all have questions that we would like to have back.

      I would love it if you would let us know how your exam goes when you get your final score, so we can learn from your experience!


      1. Kurchatov says:

        Thanks . I received my score yesterday. It is 269. I am relieved because I made 8 stupid mistakes . I started my preparations immediately after my university exams . I took about 4 months of dedicated prep time. I used first aid as a guide for the exam content. I used costanzo for physiology , abbas for immunology , pathoma and goljan for pathology , kaplan notes for neuroanatomy and gross anatomy and the ‘ridiculously simple’ series for microbiology. I used your anki deck and I added more flash cards that correlated pathogenesis with clinical features. I also reviewed in depth some of the topics asked in nbme 13/15/16 and 17 because those topics were not well covered in FA or any other review book/course . And many of them turned up on my test.

        1. Yousmle says:

          Wow, congratulations! That’s fantastic news. I would love it if you would share more of your experience with other students, as I’m sure they could gain a lot from your perspective and experiences! Please contact me at if you’re interested.

  22. Hassam Rasool says:

    Hi Alec!

    I’m currently enrolled in a foreign medical college and I subscribed to this website a few months ago. I love the e-mails that I receive and the advice that you give.
    I’ve recently bought your Step 1 Anki cards and have been learning them since the day i got them. I’ve also been adding my own simple cards from First Aid as I give it a read. I plan on giving my Step 1 by the end of December so I hope that me joining the Yousmle method this late doesn’t end up being a wrong move. Do you think I have sufficient time? Also, I make cards of almost every page of first aid, and try to make them as integrated as yours; I google anything I don’t understand for a better understanding. Any other advice?
    Last question and perhaps the most important one. I am considering purchasing your Pharma deck, however it costs as much as the Step 1 deck! So my question is would I need to add my own cards into the deck(like I said, making every page of First aid into a card) or will your cards suffice? Making my own cards takes quite some time as I am new to this and I am already behind my schedule.

    Awaiting your response.
    Thank you!

    1. Yousmle says:

      Hi Hassam,

      Thank you so much for your question and kind words. I don’t think that it is too late at all! For the pharmacology deck, the cards contained the vast majority of drugs that you will find on the exam. That said, there are always some drugs that may not be covered in question banks, or that may have been added to First Aid since it was created. If you find any drugs that are missing, or that you feel should be added, I will personally create cards to address those drugs if you email me now or in the future.

      Best of luck!


  23. Fahad says:


    I purchase your flash cards. Should I copy past the (USMLE Cheat sheets) to Anki or it is involved in the your flash cards?

    Thank you

    1. Yousmle says:

      Hi Fahad,

      I would add any information from the USMLE Cheat Sheets to your deck, since most of it will not be covered in the cards themselves.


      1. Fahad says:

        Thanks for replying. In this case, do you have anymore decks that’s can be added to the purchased one?

        1. Yousmle says:

          There are various decks available on the website, including:


          1. Fahad says:

            I think the Pharma deck is involved with the whole deck that’s I purchased ( Step 1 + Step 2). Right?

          2. Yousmle says:

            No, the pharm deck is actually an entirely different deck from the Step 1 and Step 2 decks; it is entirely focused on pharmacology, and learning many of the basic facts tested on your exam.

          3. Fahad says:

            Thanks. Really, this is unfair to purchase the whole decks from you, then discover that’s Pharm isn’t involved. So bad feeling and I didn’t expect that from you.

          4. Yousmle says:

            That is correct. The information in the pharm deck is more focused on principles, with some drugs. So many students were asking for a separate pharm deck that I eventually made one, which is the one you will find in the link.

          5. Fahad says:

            I purchased both decks for 160$. The Pharm deck for 119$ which is very expensive. May have a good discount for it as promotion code?
            Thank you

          6. Yousmle says:

            There are no promotions running at this time.

  24. Theodore says:

    I received the jaundice deck in my dropbox, but not the micro deck. I’m not sure what I need to do to get it. I just clicked on the link that was supposed to provide both decks (I think). Help please.

    1. Alec Palmerton, MD says:

      You should receive the link in a follow-up e-mail. Let me know if you have any issues!


    2. H.B says:

      Hi where is this Jaundice deck available from?

      1. Yousmle says:

        If you sign up for the newsletter, you will have an opportunity for a special offer, which in this case is the Jaundice deck.


  25. RAJWINDER says:


    1. Yousmle says:

      I’m happy to help, and I’m sorry that you’ve been having difficulties. Can you please describe the issue more, particularly by you having issues with downloading it, opening it, or something else? You can email me at .


      1. RAJWINDER says:

        application not found message comes up when i click on the link that was e-mailed to me.

        1. Yousmle says:

          Hi Rajwinder,

          I just responded to your e-mail earlier, but just for other people to know, the key is to know that Anki is a standalone program, which you must download at . The issue you had emailed me about was due to the fact that you were trying to open the cards without having the program installed in your computer.

          I hope this helps!


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