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How Many Questions Are On The USMLE Step 1?
By Connor Reed Updated on January 3, 2024
Peter Bailey, MD Peter Bailey, MD

How Many Questions Are On The USMLE Step 1?

Everything you need to know about USMLE Step 1 questions

The USMLE Step 1 is taken by students at the end of their second year in medical school. The goal of the test is to determine whether you understand how to apply certain core concepts of the sciences that were covered during your first and second years in medical school. In this guide, we discuss the quantity and types of questions you should expect to see on the USMLE Step 1 exam.

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USMLE Step 1—How Many Questions Total?

The USMLE Step 1 test is a one-day exam spread over eight hours divided into seven 60-minute blocks or sections, depending on which term you would like to use. There is also a 45-minute break and a 15-minute optional tutorial as well.

The number of questions for each block can vary, but there will never be more than 40 questions per block. The total number of questions on the exam will not exceed the 280 mark.

What Types Of Questions Are On The USMLE Step 1?

Questions on the test will generally require several steps of knowledge and reasoning to answer.

The questions will often require that test takers do one or more of the following: (1) apply basic science knowledge to clinical problems; (2) identify gross and microscopic pathologic and normal specimens; and (3) interpret graphic and tabular material to answer questions.

USMLE Step 1 Question
Example USMLE Step 1 exam question

In some cases, there will be a single, best answer. Other times, a problem will include a story about a patient followed by one or more questions.

What Topics Do The USMLE Step 1 Questions Cover?

The questions on the USMLE Step 1 cover a range of disciplines and topics. This includes anatomy, behavioral sciences, biochemistry, biostatistics, epidemiology, microbiology, pathology, pharmacology, and physiology.

It can also include interdisciplinary topics including aging, genetics, immunology, nutrition, and molecular and cellular biology.

Sample USMLE Step 1 Questions

Question 1: In a study of prokaryotic metabolism, growth rates of E. coli are viewed in the setting of various nutrient environments. The bacteria grow at a stable rate in a glucose-rich environment. When transitioned to a lactose-rich environment, growth slows at first but resumes following a short delay. What is the mechanism of this shift in nutrient metabolism?

(A) Metabolite inhibition of a transcription repressor
(B) Metabolite stimulation of a transcription repressor
(C) Metabolite inhibition of a translation repressor
(D) Metabolite stimulation of a translation repressor

Question 2: A 5-year-old boy is treated for a cough that has been present for the last 7 weeks. He was seen by his pediatrician 6 weeks ago for a low-grade fever, cough, and runny nose. The coughing spells last for minutes at a time and are usually associated with post-tussive emesis. His mother reports that he has not had any immunizations since 5 months of age. His vital signs are normal and his physical examination is commonplace. Laboratory evaluation reveals an absolute lymphocyte count of 21,000 lymphocytes/microL. Which of the following is the most appropriate treatment for this boy’s symptoms?

(A) Azithromycin
(B) Amoxycillin
(C) Isoniazid
(D) Oseltamivir

To help you prepare for questions like these, you may want to consider signing up for a prep course, which typically include a multitude of USMLE study materials, including video lessons, live classes, and of course, additional practice questions.

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USMLE courses are a great way to prepare for the exam

A couple top-rated USMLE prep courses include Kaplan, PASS Program, and Med School Bootcamp. These courses will get you prepared to answer any question that will likely appear on Step 1 of the USMLE exam.


How many questions per block in USMLE Step 1?

The number of questions you will be asked per block on the USMLE Step 1 exam will vary. However, in most cases, each block typically contains 30 to 40 questions.

How many questions on USMLE Step 1 are experimental?

The exact number of experimental questions asked on the USMLE step 1 is unknown. However, it is estimated that approximately 15% to 20% of questions are considered experimental and do not count towards your overall score.

What percentage of questions must you answer correctly to pass the USMLE Step 1?

In order to pass the USMLE Step 1, you must answer approximately 60% of questions correctly. In numerical terms, if there are 280 questions in total, you must answer at least 168 questions correctly.

What is the best way to answer USMLE Step 1 questions?

Most USMLE tutors agree that reading the last line of the question first is often the best way to answer USMLE questions. That way you know what to look for as you begin to read questions that are more lengthy.