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Key Facts: CMA Step 1 Exam
300 MCQs
Official question count across two 150-question 3-hour sessions
Center for Medical Competency Assessment and Accreditation (CMA) exam announcements
6 hours
Total testing time split into morning and afternoon 3-hour testing blocks
CMA examination candidate instructions
One best response
Official item type for the basic medical sciences assessment
CMA Step 1 table of specifications
English with exceptions
Thai may be used for specialized legal or forensic terminology
CMA FAQ, item 15
Independent practice by OpenExamPrep for CMA Step 1 (NL1): 100 high-yield multiple-choice questions covering anatomy, physiology, biochemistry, microbiology, pathology, and pharmacology. Written in English with comprehensive explanations, it provides focused pre-clinical review for medical students preparing for licensing assessment.
Sample CMA Step 1 Practice Questions
Try these sample questions to review concepts for the CMA Step 1 exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A 58-year-old man presents to the emergency department with acute retrosternal chest pressure radiating to his left jaw and arm. An electrocardiogram reveals ST-segment elevations in leads V1 through V4 with reciprocal ST depressions in leads II, III, and aVF. Which coronary artery is most likely occluded?
A.Left anterior descending artery
B.Right coronary artery
C.Left circumflex artery
D.Right marginal artery
Explanation: ST-segment elevation in precordial leads V1 through V4 indicates an acute anterior (or anteroseptal) wall myocardial infarction, which is classically caused by occlusion of the left anterior descending (LAD) artery. The LAD supplies the anterior two-thirds of the interventricular septum, the anterior wall of the left ventricle, and the cardiac apex.
2A 62-year-old woman with a history of long-standing tobacco use presents with progressive hoarseness over the past 3 months. Contrast-enhanced CT of the chest demonstrates a mass in the left pulmonary hilar region invading the aortopulmonary window. Compression of which nerve accounts for her hoarseness?
A.Left recurrent laryngeal nerve
B.Right recurrent laryngeal nerve
C.Left phrenic nerve
D.Left vagus nerve above the jugular foramen
Explanation: The left recurrent laryngeal nerve loops beneath the aortic arch near the ligamentum arteriosum before ascending toward the larynx. A hilar malignancy extending into the aortopulmonary window can compress this nerve, causing left vocal-fold paralysis and hoarseness. The term Ortner syndrome is reserved for recurrent laryngeal palsy caused by cardiovascular disease.
3During an exploratory laparotomy for blunt hepatic trauma with severe ongoing hemorrhage, the trauma surgeon performs a Pringle maneuver to achieve temporary hemostasis. Which anatomical structure is clamped during this maneuver?
A.Hepatoduodenal ligament
B.Falciform ligament
C.Gastrocolic ligament
D.Lesser omentum along the lesser curvature
Explanation: The Pringle maneuver involves clamping the hepatoduodenal ligament, which forms the free edge of the lesser omentum and the anterior boundary of the epiploic foramen of Winslow. This compresses the portal triad (proper hepatic artery, portal vein, and common bile duct) to stem inflow hemorrhage from the liver parenchyma.
4A 4-week-old male infant is brought to the clinic because of an intermittent bulge in his right groin that becomes prominent during crying. Physical examination reveals that the mass extends into the right scrotum. Surgical repair confirms an indirect inguinal hernia. What is the anatomical landmark that distinguishes an indirect inguinal hernia from a direct inguinal hernia?
A.Inferior epigastric vessels
B.Deep circumflex iliac vessels
C.Superficial epigastric vessels
D.External iliac artery
Explanation: Indirect inguinal hernias arise lateral to the inferior epigastric vessels, entering the deep inguinal ring due to a patent processus vaginalis. In contrast, direct inguinal hernias protrude medial to the inferior epigastric vessels through Hesselbach's triangle due to acquired weakness in the transversalis fascia.
5A primigravid woman in active labor requires an episiotomy. To provide perineal anesthesia, the obstetrician performs a transvaginal pudendal nerve block. Which anatomical landmark is palpated transvaginally to guide needle placement for this nerve block?
A.Ischial spine
B.Pubic tubercle
C.Coccyx
D.Obturator foramen
Explanation: The pudendal nerve originates from the sacral plexus (S2-S4) and exits the pelvis through the greater sciatic foramen, crosses behind the ischial spine and sacrospinous ligament, and re-enters the pelvis through the lesser sciatic foramen into the pudendal (Alcock's) canal. The ischial spine is the key palpable landmark transvaginally for infiltration of local anesthetic.
6A 24-year-old motorcyclist sustains a midshaft fracture of the right humerus following a road traffic accident. On physical examination, he is unable to extend his right wrist or fingers, and has diminished sensation over the dorsal surface of the first web space. Which muscle remains functional because its innervation branches proximal to the injury site?
A.Triceps brachii
B.Extensor carpi radialis longus
C.Brachioradialis
D.Extensor digitorum
Explanation: The radial nerve passes around the midshaft of the humerus within the radial (spiral) groove. The branches of the radial nerve that supply the triceps brachii muscle originate high in the axilla, proximal to the radial groove. Therefore, elbow extension is typically preserved in midshaft humerus fractures, while wrist extension (wrist drop) and finger extension are paralyzed.
7A 45-year-old administrative assistant complains of tingling and burning pain in her right hand that awakens her at night. Physical examination reveals wasting of the thenar eminence and decreased sensation over the palmar aspect of the lateral three and a half digits. Sensation over the thenar eminence itself is intact. Which nerve is compressed, and why is sensation over the thenar eminence spared?
A.Median nerve; the palmar cutaneous branch passes superficial to the flexor retinaculum
B.Ulnar nerve; the deep branch passes through Guyon's canal
C.Radial nerve; the superficial branch passes lateral to the scaphoid
D.Median nerve; the recurrent motor branch passes beneath the transverse carpal ligament
Explanation: Carpal tunnel syndrome involves compression of the median nerve within the carpal tunnel beneath the flexor retinaculum (transverse carpal ligament). Sensation over the thenar eminence is preserved because the palmar cutaneous branch of the median nerve branches off approximately 5 cm proximal to the wrist and passes superficial (external) to the flexor retinaculum.
8A 30-year-old football player receives a direct lateral blow to his right knee. Radiographs reveal a fracture of the neck of the fibula. Physical examination reveals an inability to dorsiflex or evert the right foot, resulting in a high-stepping gait (foot drop). Which nerve has been injured?
A.Common fibular nerve
B.Tibial nerve
C.Femoral nerve
D.Obturator nerve
Explanation: The common fibular (peroneal) nerve winds superficial to the neck of the fibula, making it exceptionally vulnerable to blunt trauma or fractures at this site. Injury damages both the deep fibular nerve (paralyzing anterior compartment muscles responsible for dorsiflexion and toe extension) and superficial fibular nerve (paralyzing lateral compartment muscles responsible for eversion).
9A 68-year-old woman presents with a tender, irreducible mass in her upper right medial thigh, just below the inguinal ligament. A diagnosis of an incarcerated femoral hernia is made. In relation to the structures in the femoral sheath, in which compartment does a femoral hernia typically protrude?
A.Medial compartment (femoral canal)
B.Intermediate compartment (femoral vein)
C.Lateral compartment (femoral artery)
D.Lateral to the femoral sheath (femoral nerve)
Explanation: The femoral sheath is divided into three compartments from lateral to medial: lateral (femoral artery), intermediate (femoral vein), and medial (femoral canal). A femoral hernia protrudes through the femoral ring into the medial compartment (femoral canal), which normally contains loose connective tissue and deep inguinal lymph nodes (node of Cloquet).
10A 32-year-old woman with a severe furuncle in the danger area of the face develops high fevers, severe retro-orbital headache, periorbital edema, and proptosis. Physical examination reveals an isolated inability to abduct the left eye on horizontal gaze. Thrombosis of which dural venous sinus is the most likely cause, and which cranial nerve is affected first?
A.Cavernous sinus; Abducens nerve (CN VI)
B.Superior sagittal sinus; Oculomotor nerve (CN III)
C.Transverse sinus; Trochlear nerve (CN IV)
D.Sigmoid sinus; Ophthalmic nerve (CN V1)
Explanation: Infections from the facial 'danger triangle' can track via the superior and inferior ophthalmic veins into the cavernous sinus, causing septic cavernous sinus thrombosis. The abducens nerve (CN VI) runs freely through the interior of the cavernous sinus adjacent to the internal carotid artery, making it the most vulnerable structure, whereas CN III, IV, V1, and V2 are embedded in the lateral fibrous wall.
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