USMLE Step 1 Practice Questions and a Full 280-Question Mock Exam
Work through clinical vignettes that ask for the mechanism behind the case, read why each option is right or wrong, then sit a full 280-question Step 1 mock in the 2026 format: fourteen 30-minute blocks of 20. Every drill has a free try.
280 questions in 14 timed 30-minute blocks, the 2026 USMLE format, with a score for every content area and an explanation for every option.
Or start with a free drill- 345 original Step 1 questions, each with a note on every option and its source
- 280 questions in the full mock, in 14 timed 30-minute blocks
- 12 free drills: one per content-outline system plus a mixed drill
A 29-year-old woman at 30 weeks' gestation comes to the physician because of fever, myalgias, and diarrhea for 3 days. Ten days ago she ate unpasteurized soft cheese bought at a market. Her temperature is 38.7°C (101.7°F). Blood cultures grow small gram-positive rods that are β-hemolytic, catalase-positive, and show tumbling motility at room temperature. Which of the following virulence features allows this organism to spread from cell to cell without exposure to extracellular antibodies?
USMLE Step 1 at a glance
Step 1 tests whether you can apply the foundational sciences to medicine: pathology and physiology above all, with pharmacology, microbiology, anatomy, biochemistry, behavioral science, immunology, histology and genetics woven through organ-system vignettes. It is pass/fail, and for international medical graduates it is the first exam toward ECFMG Certification.
- Owners
- The United States Medical Licensing Examination is sponsored by the Federation of State Medical Boards (FSMB) and NBME. Step 1 is the first of three Steps
- Format
- Single-best-answer multiple-choice questions, almost all built on a clinical vignette. 280 questions in one 8-hour testing day
- Blocks
- Since May 14, 2026: fourteen 30-minute blocks of up to 20 questions (before that, seven 60-minute blocks of up to 40). You can review only the questions in the block you are in, and you cannot return to a block once you close it
- Breaks
- At least 55 minutes of break time for the day, taken between blocks, plus a 5-minute optional tutorial
- Content
- Foundational science applied to medicine: pathology 45–55%, physiology 30–40%, then pharmacology, microbiology, anatomy, biochemistry, behavioral science and more, organized by organ system
- Scoring
- Pass/fail only for exams taken on or after January 26, 2022. The passing standard sits at 196 on the old three-digit scale. USMLE says examinees typically need about 60% of questions correct to pass
- Fee
- $695 for 2026 and 2027. Students and graduates of medical schools outside the US apply through FSMB and pay a $210 region fee to test outside the US and Canada
- Attempts
- No more than three attempts at the same Step in 12 months. Four or more attempts at a Step without a pass make you ineligible for the USMLE
- Results
- Usually two to four weeks after the exam; allow up to eight weeks
USMLE Step 1 practice test: the full 280 questions
The mock follows the 2026 USMLE test software: 280 single-best-answer questions in 14 blocks of 20, each with its own 30-minute clock. Inside a block you can skip, go back and mark questions; once a block closes you cannot return to it. Each content area takes its share of the exam from the USMLE content outline, and your result shows your score in every one, with a worked review of all 280 questions.
The Step 1 content outline, and a free drill for each system
USMLE publishes the share of Step 1 that each system takes. Each drill is ten questions from one system with an explanation after every answer, and each system has its own guide page. The mock column shows how many questions each system has on our 280-question mock.
| System | Share of exam | On our mock | In the bank | Drill |
|---|---|---|---|---|
| Human DevelopmentNormal growth, development and aging, normal age-related findings and care of the well patient. | 1–3% | 6 | 13 | 10-question drill |
| Blood & Lymphoreticular/Immune SystemsAnemias, hemoglobinopathies, hemostasis and thrombosis, leukemia, lymphoma and myeloma, immunodeficiency, hypersensitivity, transplant immunology and the drugs that act on blood. | 9–13% | 30 | 36 | 10-question drill |
| Behavioral Health & Nervous Systems/Special SensesNeuroanatomy and lesion localization, stroke, seizures, neurodegeneration, CNS infection and tumors, the eye and ear, psychiatric disorders, psychopharmacology and substance use. | 10–14% | 34 | 41 | 10-question drill |
| Musculoskeletal, Skin & Subcutaneous TissueLimb anatomy and nerve injuries, bone and connective tissue disease, arthritis and autoimmune rheumatology, muscle disease, skin disorders and skin cancer. | 8–12% | 27 | 33 | 10-question drill |
| Cardiovascular SystemCardiac physiology and pressure-volume loops, embryology and congenital heart disease, ischemic and valvular disease, heart failure, cardiomyopathy, vasculitis, hypertension and cardiovascular drugs. | 7–11% | 25 | 31 | 10-question drill |
| Respiratory & Renal/Urinary SystemsPulmonary physiology, obstructive and restrictive disease, pneumonia, lung cancer and embolism; renal physiology, acid-base, electrolytes, glomerular disease, kidney injury and diuretics. | 11–15% | 35 | 42 | 10-question drill |
| Gastrointestinal SystemGI anatomy, embryology and hormones, esophageal to colonic disease, malabsorption, inflammatory bowel disease, GI cancer, liver and biliary disease, the pancreas and GI drugs. | 6–10% | 22 | 27 | 10-question drill |
| Reproductive & Endocrine SystemsThe hypothalamic-pituitary axis, thyroid, adrenal and calcium disorders, diabetes and its drugs, sexual development, the menstrual cycle and pregnancy, and gynecologic, breast, testicular and prostate disease. | 12–16% | 38 | 45 | 10-question drill |
| Multisystem Processes & DisordersMicrobiology and antimicrobials, sepsis, genetics and inheritance, metabolism and vitamins, cell injury, inflammation and neoplasia, pharmacokinetics and toxicology. | 8–12% | 28 | 34 | 10-question drill |
| Biostatistics & Epidemiology/Population HealthStudy designs, bias, test characteristics, risk and number-needed-to-treat calculations, hypothesis testing, confidence intervals, screening and prevention. | 4–6% | 14 | 17 | 10-question drill |
| Social Sciences: Communication and Interpersonal SkillsCommunicating with patients and families, breaking bad news, informed consent, capacity, confidentiality, minors, advance directives and disclosing medical errors. | 6–9% | 21 | 26 | 10-question drill |
Ready for the full exam day?
280 questions in 14 timed 30-minute blocks, the 2026 USMLE format, with a score for every content area and an explanation for every option.
Or start with a free drillUSMLE Step 1 pass rates
From USMLE performance data. First-time takers from medical schools outside the US pass at a lower rate than US MD students, and repeaters lower still, so a realistic full-length practice run matters.
| Examinees | Year | Tested | Passed |
|---|---|---|---|
| Non-US schools, first takers | 2025 | 22,066 | 75% |
| Non-US schools, repeaters | 2025 | 3,594 | 54% |
| Non-US schools, first takers | 2024 | 22,713 | 73% |
| US MD schools, first takers | 2025 | 23,028 | 93% |
How to use these Step 1 practice questions
- Take the free mixed drill to see where you stand across every system.
- Drill the largest categories first: reproductive and endocrine, respiratory and renal, behavioral health and nervous system, and blood and immune.
- Read every option note, including on questions you got right. Step 1 distractors are near misses, and the notes teach the difference.
- Sit the 280-question mock in 30-minute blocks to train the new pacing of about 90 seconds a question, then drill your two lowest systems.
Common questions
How many questions are on USMLE Step 1?
280 questions in one 8-hour day. Since May 14, 2026 they come in fourteen 30-minute blocks of up to 20 questions, with at least 55 minutes of break time for the day.
Is Step 1 still pass/fail?
Yes. Step 1 has been reported as pass/fail only for exams taken on or after January 26, 2022. The passing standard sits at 196 on the three-digit scale, and USMLE says examinees typically need about 60% of questions correct to pass.
Can I practice Step 1 questions for free?
Yes. Each of the twelve ten-question drills (one per content-outline system plus a mixed drill) has a free try, and every guide and mock page has free sample questions with full explanations. The full 280-question mock in 14 timed blocks comes with a USMLE pass.
What does Step 1 test?
Whether you can apply foundational science to medicine. Pathology (45–55%) and physiology (30–40%) lead, with pharmacology, microbiology, anatomy, biochemistry, behavioral science, immunology, histology and genetics woven through organ-system vignettes.
How long is a Step 1 block?
30 minutes for up to 20 questions, so about 90 seconds a question. Our mock uses the same 30-minute, 20-question blocks, so you train the new pacing rather than the old 60-minute rhythm.
How much does Step 1 cost for an IMG?
The application fee is $695 for 2026 and 2027. Applicants from medical schools outside the US apply through FSMB and pay a $210 region fee to test outside the US and Canada.
Ready for exam day?
280 questions in 14 timed 30-minute blocks, the 2026 USMLE format, with a score for every content area and an explanation for every option.
Or start with a free drillSources
- 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. Follow current guidelines in clinical practice.