United States Medical Licensing Examination (USMLE) Step 1: Free Mock Test & Practice Questions

United States Medical Licensing Examination (USMLE) Step 1

This examination is typically taken by medical students at the end of their second year of study. Passing Step 1 is required to progress to subsequent USMLE steps and is a crucial component for obtaining residency positions in the United States.

Pass mark 168/40 420 minutes Real test fee approx $670 Federation of State Medical Boards (FSMB) and National Board of Medical Examiners (NBME) How many can I get wrong?

Sit a full mock under the clock at least once. Nerves are half the battle.

Free practice questions

Try 3 real United States Medical Licensing Examination (USMLE) Step 1 questions

Have a go, then reveal the worked explanation. A taster from a bank of 200 original questions — unlock for unlimited drills and full timed mocks.

Q1. A 68-year-old man with a long history of gastroesophageal reflux disease undergoes an upper endoscopy. A biopsy of the distal esophagus reveals the replacement of normal stratified squamous epithelium with non-ciliated, columnar epithelium containing goblet cells. This cellular change is best described as which of the following?

A. Metaplasia
B. Dysplasia
C. Hyperplasia
D. Anaplasia

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✓ Answer: A. Metaplasia

Metaplasia is the reversible replacement of one differentiated cell type with another. In Barrett's esophagus, chronic acid exposure causes squamous epithelium to be replaced by more acid-resistant intestinal columnar epithelium.

Q2. A 65-year-old man exhibits a resting tremor, bradykinesia, and postural instability. The core pathophysiology of his condition, Parkinson's disease, involves the selective loss of which type of neurons in which specific brain region?

A. Cholinergic neurons in the nucleus basalis of Meynert
B. GABAergic neurons in the caudate nucleus
C. Noradrenergic neurons in the locus coeruleus
D. Dopaminergic neurons in the substantia nigra pars compacta

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✓ Answer: D. Dopaminergic neurons in the substantia nigra pars compacta

Parkinson's disease is characterized by the degeneration of dopaminergic neurons in the substantia nigra pars compacta, which leads to a dopamine deficit in the basal ganglia, causing motor symptoms.

Q3. A 72-year-old man reports increasing hat size, hearing loss, and bone pain. Laboratory studies reveal a markedly elevated serum alkaline phosphatase level. Serum calcium, phosphorus, and parathyroid hormone levels are all within the normal range. This condition is initiated by a primary defect in which of the following cells?

A. Osteoblasts
B. Osteoclasts
C. Chondrocytes
D. Osteocytes

Show answer & explanation

✓ Answer: B. Osteoclasts

This presentation is classic for Paget disease of bone. The initial pathogenic phase involves a dramatic increase in the number and activity of abnormal osteoclasts, leading to disorganized bone resorption, followed by a compensatory but chaotic increase in bone formation.

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United States Medical Licensing Examination (USMLE) Step 1 — common questions

Frequently asked

How many questions are in the United States Medical Licensing Examination (USMLE) Step 1?

The exam has 40 questions. Every Revision Robin mock uses the same 40-question format so your practice matches the real thing.

What is the pass mark for the United States Medical Licensing Examination (USMLE) Step 1?

You need 168 out of 40 correct to pass, which is about 420%. Our mocks mark you against this exact threshold.

How long do you get?

The test is timed at 420 minutes. Our full mock runs on the same clock so you can practise your pacing.

Are these the real exam questions?

No. Our questions are original and written to match the current syllabus, so they give realistic practice without copying the official paper. Every answer comes with a plain-English explanation. Always confirm current rules and content with Federation of State Medical Boards (FSMB) and National Board of Medical Examiners (NBME).

How much does the official test cost?

The official Federation of State Medical Boards (FSMB) and National Board of Medical Examiners (NBME) fee is approx $670. Revision Robin practice is separate and helps you pass first time so you only pay that fee once.