USMLE Step 1

Exam at a glance

Questions

280

Duration

480 minutes

Pass mark

score 196

Sections

One-day exam of up to 280 items, 8 hours · Since 14 May 2026: 14 blocks of 30 minutes, up to 20 items each · Reported pass/fail only (passing standard 196 on the three-digit scale)

Exam type

Written

Language

English

Authority

USMLE

Curriculum

Built from the question bank and updated automatically when new questions are added. 15 modules · 2,580 questions · Last updated: 30 October 2026

1. 01Biochemistry, genetics and nutrition160 questions · 6.2 % of the bank

   Sample question

   Sample question1 / 1 · 0 correct

   A newborn screen shows high phenylalanine. Tetrahydrobiopterin levels are normal. Which amino acid becomes essential in the diet of this infant?

   APhenylalanineBTyrosineCTryptophanDMethionineECysteine

   Keys: 1–5 or A–E to choose, Enter to check and continue, F to mark.

   MarkCheck answer
2. 02Cardiovascular system170 questions · 6.6 % of the bank

   Chapters

   • Cardiovascular physiology and pathology: the high-yield core
   • Foundations: anatomy of the heart
   • Foundations: conduction system and cardiac cycle
   • Foundations: circulation and blood vessels

   Sample question

   Sample question1 / 1 · 0 correct

   In a ventricular myocyte, which ion movement causes the rapid upstroke of the action potential?

   ACalcium influx through L-type channelsBSodium influx through voltage-gated channelsCPotassium efflux through delayed rectifier channelsDChloride influx through ligand channelsESodium efflux via Na+/K+-ATPase

   Keys: 1–5 or A–E to choose, Enter to check and continue, F to mark.

   MarkCheck answer
3. 03Endocrine system173 questions · 6.7 % of the bank

   Chapters

   • Foundations: endocrine glands and feedback control
   • Foundations: the thyroid in the neck and endocrine emergencies

   Sample question

   Sample question1 / 1 · 0 correct

   A 35-year-old woman has thyroid nodule biopsy showing cells with optically clear nuclei, nuclear grooves and psammoma bodies. What is the diagnosis?

   AFollicular carcinomaBMedullary carcinomaCAnaplastic carcinomaDFollicular adenomaEPapillary carcinoma

   Keys: 1–5 or A–E to choose, Enter to check and continue, F to mark.

   MarkCheck answer
4. 04Ethics, biostatistics and epidemiology200 questions · 7.8 % of the bank

   Sample question

   Sample question1 / 1 · 0 correct

   A study sets alpha at 0.05 and finds no difference between two drugs, although a real difference exists. Which error was made?

   AType I errorBConfoundingCType II errorDSelection biasERegression to the mean

   Keys: 1–5 or A–E to choose, Enter to check and continue, F to mark.

   MarkCheck answer
5. 05Gastrointestinal system160 questions · 6.2 % of the bank

   Chapters

   • Foundations: the digestive tract, digestion and absorption
   • Foundations: peptic ulcer disease and upper GI bleeding

   Sample question

   Sample question1 / 1 · 0 correct

   A 4-week-old boy has projectile nonbilious vomiting after every feed and a palpable olive-shaped mass in the epigastrium. Which electrolyte pattern is expected?

   AHyperchloremic metabolic acidosisBHigh anion gap metabolic acidosisCHypochloremic hypokalemic metabolic alkalosisDHyperkalemic metabolic acidosisERespiratory alkalosis with hyponatremia

   Keys: 1–5 or A–E to choose, Enter to check and continue, F to mark.

   MarkCheck answer
6. 06Blood and lymphoreticular system180 questions · 7 % of the bank

   Chapters

   • Foundations: blood cells, haematopoiesis and haemostasis
7. 07Immunology151 questions · 5.9 % of the bank
8. 08Microbiology245 questions · 9.5 % of the bank

   Chapters

   • Microbiology: high-yield bugs and toxins
   • Foundations: bacteria, the Gram stain and antibiotic targets
   • Foundations: infection prevention and antimicrobial stewardship
9. 09Musculoskeletal, skin and subcutaneous tissue166 questions · 6.4 % of the bank

   Chapters

   • Foundations: the skeleton, spine and pelvis
   • Foundations: shoulder, wrist and hand
   • Foundations: hip fractures, knee and ankle ligaments
   • Foundations: skin structure, primary lesions and burn depth
10. 10Nervous system and behavior168 questions · 6.5 % of the bank

    Chapters

    • Foundations: brain anatomy and clinical localisation
    • Foundations: reflexes, the spinal cord and upper versus lower motor neuron signs
    • Foundations: spinal cord tracts and the cranial nerves
    • Foundations: the circle of Willis and intracranial haemorrhage
11. 11Pharmacology200 questions · 7.8 % of the bank

    Chapters

    • Foundations: pharmacokinetics – what the body does to the drug
    • Foundations: pharmacodynamics – what the drug does to the body
12. 12Behavioral health164 questions · 6.4 % of the bank
13. 13Renal and urinary system129 questions · 5 % of the bank

    Chapters

    • Renal and acid–base: from the nephron to the blood gas
    • Foundations: structure and function of the kidney
    • Foundations: fluids and electrolytes
14. 14Reproductive system157 questions · 6.1 % of the bank

    Chapters

    • Foundations: female pelvic anatomy
    • Foundations: placenta, pregnancy physiology and fetal circulation
    • Foundations: labour and the fetal skull
    • Foundations: the menstrual cycle in the ovary, endometrium and cervix
    • Foundations: breast anatomy and lymphatic drainage
    • Foundations: the male urinary tract, prostate and testis
15. 15Respiratory system157 questions · 6.1 % of the bank

    Chapters

    • Foundations: anatomy of the respiratory tract
    • Foundations: alveoli and gas exchange
    • Foundations: mechanics and control of breathing

What you get

• Question bank with a detailed explanation for every answer
• Timed mock exams in the real exam format, with score report by topic
• Personal study plan up to your exam date and review of weak topics
• AI tutor that explains any question in plain words
• One account for the app (iPhone, iPad) and the browser

From registration to licence

The usual steps with USMLE. Details can change; check the current rules with USMLE before you register.

1. Check eligibility and collect your documents (degree, experience, good standing).
2. Create an account with USMLE and submit the application.
3. Receive the exam eligibility and book a date with the test centre.
4. Sit the exam. Results usually come within days.
5. After passing: complete licensing (for example primary source verification) and receive your licence.

Frequently asked questions