USMLE Practice Questions for Step 1 and Step 2 CK
Original USMLE-style vignettes with a note on every option, a free drill for every content-outline system, and full-length mocks in the 2026 block format. Built for international medical graduates working toward ECFMG Certification and a US residency.
280 questions in 14 timed 30-minute blocks, scored by system, with an explanation for every option. Step 2 CK has its own 316-question mock.
Go to Step 2 CK practice- 734 original questions across Step 1 and Step 2 CK, each with its source
- 2 full-length mocks: 280 Step 1 questions in 14 blocks, 316 Step 2 CK questions in 16
- 27 free ten-question drills, one per system plus a mixed drill for each Step
A 61-year-old man who has smoked for 40 years comes to the physician because of blood in his urine and left flank discomfort for 1 month. Examination shows a palpable left flank mass. Hemoglobin is 18.5 g/dL. CT of the abdomen shows a 7-cm mass in the upper pole of the left kidney. The nephrectomy specimen shows a golden-yellow tumor with areas of hemorrhage; microscopically, nests of tumor cells have abundant clear cytoplasm and are separated by delicate, branching blood vessels. Which of the following genetic alterations is most likely present in the tumor cells?
Choose your Step
Foundational science applied to clinical vignettes. Pass/fail. 280 questions in 14 blocks of 30 minutes, 8-hour testing day.
Diagnosis and management by current US guidelines. Three-digit score, 218 to pass. 316 questions in 16 blocks of 30 minutes, 9-hour testing day.
The USMLE path for international medical graduates
- Register with FSMB. Students and graduates of medical schools outside the US apply for Step 1 and Step 2 CK through the Federation of State Medical Boards. The 2026 and 2027 fee is $695 per Step, plus a region fee to test outside the US and Canada: $210 for Step 1 and $235 for Step 2 CK.
- Pass Step 1. 280 questions in fourteen 30-minute blocks, reported pass/fail.
- Pass Step 2 CK. 316 questions in sixteen 30-minute blocks, with a three-digit score; the minimum pass is 218.
- Complete ECFMG Certification. Passing Steps 1 and 2 CK meets the medical science examination requirement; Intealth (ECFMG) also requires its clinical and communication skills requirements before certification.
Attempt limits apply to every Step: no more than three attempts at the same Step in 12 months, and four or more attempts at a Step without passing make you ineligible for the USMLE.
How IMGs do on Step 1 and Step 2 CK
| Step | Examinees | Year | Tested | Passed |
|---|---|---|---|---|
| Step 1 | Non-US schools, first takers | 2025 | 22,066 | 75% |
| Step 1 | Non-US schools, repeaters | 2025 | 3,594 | 54% |
| Step 1 | US MD schools, first takers | 2025 | 23,028 | 93% |
| Step 2 CK | Non-US schools, first takers | 2024–2025 | 16,186 | 90% |
| Step 2 CK | Non-US schools, repeaters | 2024–2025 | 1,762 | 64% |
| Step 2 CK | US MD schools, first takers | 2024–2025 | 22,249 | 98% |
Practice in the real block format
280 questions in 14 timed 30-minute blocks, scored by system, with an explanation for every option. Step 2 CK has its own 316-question mock.
Go to Step 2 CK practiceWeighing the UK as well?
Many international medical graduates prepare for both the USMLE and the UK route. PLAB 1, the GMC’s knowledge test, is 180 five-option questions in three hours, answered by UK guidance such as NICE and the BNF. Practice PLAB 1 questions with free drills for all ten GMC areas and two full mock papers.
Common questions
Which USMLE Steps can I practice here?
Step 1 and Step 2 CK, the two Steps that international medical graduates pass for ECFMG Certification before applying to US residency. Each Step has a free ten-question drill for every content-outline system, a mixed drill, guide pages and a full-length mock exam in the 2026 block format.
What changed on the USMLE in 2026?
The test software. Step 2 CK (from May 7, 2026) and Step 1 (from May 14, 2026) moved to 30-minute blocks of up to 20 questions: 14 blocks for Step 1 and 16 for Step 2 CK. The content, the total number of questions (280 and 316) and the length of the testing day did not change.
How do international medical graduates register for the USMLE?
Students and graduates of medical schools outside the US apply for Step 1 and Step 2 CK through the Federation of State Medical Boards (FSMB). The 2026 and 2027 application fee is $695 per Step, plus a region fee to test outside the US and Canada: $210 for Step 1 and $235 for Step 2 CK.
How do IMGs do on the USMLE?
In 2025, 75% of the 22,066 first-time Step 1 takers from schools outside the US passed. On Step 2 CK, 90% of the 16,186 first-time takers from schools outside the US passed in 2024–2025. US MD first takers passed at 93% and 98%.
Are these the real USMLE questions?
No. Every question is original, written to the USMLE content outlines and checked against current US guidelines and standard textbooks, then answered blind by a second reviewer before it went in the bank. The official sample questions are free on usmle.org.
I am also considering the UK. Do you have PLAB 1?
Yes. PLAB 1 is the GMC’s knowledge test for doctors who qualified outside the UK: 180 five-option questions in three hours, answered by UK guidance. Our PLAB 1 pages have free drills for all ten GMC areas and two full mock papers.
Ready for exam day?
280 questions in 14 timed 30-minute blocks, scored by system, with an explanation for every option. Step 2 CK has its own 316-question mock.
Go to Step 2 CK practiceSources
- USMLE: Step 1 (blocks, items, testing day, break time)
- USMLE: Step 2 CK (blocks, items, testing day, break time)
- USMLE: Test delivery software updates for Step 2 CK and Step 1 (May 2026)
- USMLE: Step 1 content outline and specifications
- USMLE: Step 2 CK content outline and specifications
- USMLE: Examination results and scoring (minimum passing scores)
- USMLE Bulletin: Scoring and score reporting (about 60% correct to pass; result timing)
- USMLE Bulletin: Eligibility (attempt limits)
- USMLE: Apply for exams (2026 and 2027 fees, FSMB registration, region fees)
- USMLE: Performance data (pass rates)
- Intealth ECFMG: Fees overview (ECFMG Certification)
Original practice questions written to the USMLE content outlines and current standard references. USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and NBME. Independent practice, not affiliated with or endorsed by the FSMB, NBME or Intealth (ECFMG). The official USMLE sample questions are free on usmle.org.