USMLE Questions 2026: Formats by Step & Sample MCQs

Last updated on 03-October-2026, by Dr. Muhammad

USMLE Questions 2026: Formats by Step & Sample MCQs

USMLE Questions Quick Summary

USMLE questions are computer-based, single-best-answer MCQs built around patient vignettes, with four or more lettered options. Some include images, audio or video. Step 2 CK and Step 3 add sequential item sets and research abstracts, and Step 3 adds computer-based case simulations. Unanswered questions count as wrong, so never leave one blank.

What are USMLE questions like?

Every Step of the United States Medical Licensing Examination (USMLE) uses clinical vignettes: a short description of a patient followed by a question. Step 1 uses them to test how well you apply the basic sciences, Step 2 CK to test clinical knowledge and patient care under supervision, and Step 3 to test independent management. Other options may be partly correct, but there is only one best answer.

USMLE question formats by Step

Format

Step 1

Step 2 CK

Step 3

Single-item vignette questions

Yes

Images, graphs and audio findings

Yes

Yes (also video)

Yes

Sequential item sets (2-3 questions on one case)

Yes

Research abstract questions

Yes

Drug advertisement questions

Yes

Computer-based case simulations (CCS)

Yes

In Step 3's sequential item sets, each question tests a different point about the same patient, and once you move on you cannot change an earlier answer. For block lengths and question counts, see our guide to the three USMLE Steps.

~280

Step 1 MCQs

~316

Step 2 CK MCQs

Max questions per 30-minute block

100+

Free official Step 1 sample questions

How USMLE recommends you answer

Read each question carefully, try to answer it before looking at the options, eliminate options you know are wrong, and always choose an answer: unanswered questions are counted as wrong. USMLE also offers free sample questions and an interactive testing experience. If your Step 1 is on or after May 14, 2026, use the new version, which reflects the 30-minute blocks.

USMLE sample practice MCQs

Test your knowledge with these original vignette-style questions, written in the single-best-answer format used in the real exam. Tap a question to reveal the answer.

> Question 1: Step 1, Biochemistry

A 6-month-old infant is brought for evaluation of irritability before feeds. Examination shows a protuberant abdomen with marked hepatomegaly. Laboratory studies show fasting hypoglycemia, lactic acidosis, hyperuricemia and hypertriglyceridemia. Deficiency of which of the following enzymes is the most likely cause?

A) Glucose-6-phosphatase
B) Lysosomal acid alpha-glucosidase
C) Muscle glycogen phosphorylase
D) Glycogen debranching enzyme

Correct answer: A) Glucose-6-phosphatase

This is von Gierke disease (glycogen storage disease type I). Without glucose-6-phosphatase the liver cannot release free glucose, causing severe fasting hypoglycemia, while excess glucose-6-phosphate is shunted into lactate, uric acid and triglyceride production. Acid alpha-glucosidase deficiency (Pompe) mainly affects the heart, muscle phosphorylase deficiency (McArdle) causes exercise intolerance, and debranching enzyme deficiency (Cori) gives milder hypoglycemia without marked lactic acidosis.

> Question 2: Step 2 CK, Cardiology

A 62-year-old man comes to the emergency department of a hospital with a cardiac catheterization laboratory 40 minutes after the onset of crushing substernal chest pain. ECG shows ST-segment elevation in leads II, III and aVF. He has been given aspirin. Which of the following is the most appropriate next step in management?

A) Repeat troponin measurement in 6 hours
B) Exercise stress testing
C) Immediate coronary angiography with primary PCI
D) CT coronary angiography

Correct answer: C) Immediate coronary angiography with primary PCI

ST elevation in the inferior leads with ongoing symptoms indicates an acute inferior STEMI. When a PCI-capable center is available, immediate reperfusion with primary PCI is the treatment of choice. Waiting for repeat troponins delays reperfusion, and stress testing or CT angiography are inappropriate in an evolving STEMI.

> Question 3: Biostatistics

A new screening test has a sensitivity of 90% and a specificity of 80%. It is used in a group of 200 people, 100 of whom have the disease. What is the positive predictive value of the test in this group?

A) 80%
B) 82%
C) 89%
D) 90%

Correct answer: B) 82%

Of the 100 people with the disease, 90 test positive (true positives). Of the 100 without it, 80 test negative, so 20 are false positives. PPV = 90 / (90 + 20) = 82%. The 89% option is the negative predictive value: 80 / (80 + 10).

Want thousands more questions like these?

Our Step 1 Qbank (3000+ questions) and Step 2 CK Qbank (2000+ questions) come with detailed explanations and an exam-like test interface.

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Frequently asked questions

> Is the USMLE computer-based or paper-based?

Computer-based only. All Steps are taken on computer at Prometric test centers; there is no paper-and-pencil version.

> Where do I get the USMLE application form?

There is no paper form. Since January 12, 2026, international medical graduates and students apply online through the FSMB via the USMLE website, then book a Prometric date once they receive their scheduling permit.

> Is there a USMLE test center in Karachi?

Yes. Step 1 and Step 2 CK can be taken at Prometric centers in Pakistan, including Karachi, Lahore and Islamabad. Step 3 is offered only in the United States.

> Can nurses take the USMLE?

No. The USMLE is for medical students and graduates of eligible medical schools. Nurses follow separate licensing routes.

> Is there a separate USMLE for specialties like paediatrics?

No. The USMLE is the same three-Step exam for every doctor, whatever their specialty. Specialty training and board certification come later, after residency.

Comments

Questions from readers over time, grouped below, tap any question to expand it and see our reply.

"How and where do I apply, test centre in Karachi and fee?", Dr Pervaiz (Karachi, Pakistan)

"I have done my MBBS and house job and now I am serving in a hospital. I want to appear for USMLE. Can you tell me how and where to approach for application forms, test centre in Karachi and fee etc "
Dr Pervaiz
Medical Qualification: MBBS
City, Country: Karachi, Pakistan

Team Interface: There is no paper application form. Since January 12, 2026, MBBS graduates apply online for Step 1 and Step 2 CK through the FSMB via the USMLE website, provided their medical school is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements. You can test at the Prometric centre in Karachi. Taken in Pakistan, Step 1 costs $905 and Step 2 CK $930, including the region fee. See USMLE for Pakistani doctors and USMLE exam fees.

"Is it only a computer-based test, or paper-pencil?", sadia malik (Lahore, Pakistan)

"hello i want to ask is it only computer based test or i can appear in paper pencil test. kindly inform me about it. "
sadia malik
Medical Qualification: M.Phil
City, Country: Lahore, Pakistan

Team Interface: The USMLE is computer-based only; there is no paper-and-pencil version. Please note that eligibility requires you to be a student or graduate of an eligible medical school, so an M.Phil on its own does not qualify you to sit the exam. See when you can sit each USMLE Step.

Looking for USMLE preparation help in Karachi, Dr. Nadim (Karachi, Pakistan)

"i wanna take usmle step 1 and 2, and i didnt start my preparation yet. i want to know is there any institution in karachi that helps the ppl to get prepared for these test. "
Dr. Nadim
Medical Qualification: mbbs
City, Country: Karachi, Pakistan

Team Interface: Our USMLE course runs live online in small groups, so you can join from Karachi or anywhere else. Pair it with our Step 1 Qbank and Step 2 CK Qbank. Remember that Step 1 and Step 2 CK can be taken in either order.

"USMLE examination centre in Karachi and application form?", saba ahmed (Karachi, Pakistan)

"hi anyone can tell me about the USMLE examination center at karachi. n how can i take application form? "
saba ahmed
Medical Qualification: final year mbbs
City, Country: Karachi, Pakistan

Team Interface: Final-year students can already apply, as long as you are officially enrolled in an eligible medical school when you apply and on your test day. Applications are made online through the FSMB, and Step 1 and Step 2 CK can be taken at Prometric centres in Pakistan, including Karachi. See our USMLE timeline for when students usually sit each Step.

"Where can I get the Step 1 application form, how can I apply?", maham arif (Karachi, Pakistan)

"i have recently given my final year examination.i wanted to ask that where can i get step 1 application form in karachi, how can i apply for step1."
maham arif
Medical Qualification: MBBS
City, Country: karachi,pakistan

Team Interface: You apply online, not with a form from a local office. Create your MyIntealth account with ECFMG for credential verification, then apply for Step 1 through the FSMB via the USMLE website, choose your testing region and eligibility period, and book a Prometric date once your scheduling permit arrives. The fee is $905 when taken in Pakistan.

"How do I download the admission form and what are the exam dates?", shazee (Libya)

"i like to know how i can get addmission form to down load it from net and what are dates of examinations,so i visit pakistan same month to get entry, please reply my question "
shazee
Medical Qualification: MBBS
City, Country: libya

Team Interface: There is no form to download and no fixed exam date. You apply online through the FSMB, select an eligibility period, and then book any available Prometric date within it. Step 1 and Step 2 CK are offered at test centres worldwide, so you can test in Pakistan or another country, as long as you choose that testing region when you apply.

ICU/CCU nurse asking about USMLE for a job abroad, sandya (Kerala, India)

"I am a GNM nurse with 11 years of experience in ICU $ CCU. What should I do get a job abroad throug online (USMLE PREFERRED)?"
sandya
Medical Qualification: GNM
City, Country: Kerala, India

Team Interface: The USMLE is only for medical students and graduates of eligible medical schools, so nurses are not eligible to take it. Nurses in the United States are licensed through a separate exam, the NCLEX. If you are considering the Gulf instead, nurses can also take the DHA, DOH or MOH licensing exams for their category.

MBBS from China, requirements for Step 1, sana (Karachi, Pakistan)

"hi i have completed my MBBS recently from china...can u plzz guide me about the requirements to appear in USEML step 1."
sana
Medical Qualification: M.B;B.S
City, Country: Karachi, Pakistan

Team Interface: The rules are the same wherever you studied: your medical school in China must be listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements (look for the ECFMG Sponsor Note). If it is, you can apply for Step 1 through the FSMB and take it at a Prometric centre in Pakistan. See USMLE eligibility for each Step.

USMLE in paediatrics, Dubai dates and fees, DR sHAISTA QAZI (Karachi, Pakistan)

"I want to know how Icould apply for USMLE in Peadiatric in Dubai and what are dates and fees of examination.my training for MRCPCH part II is complete my experience in pediatrics is 6 years how could I apply for job"
DR sHAISTA QAZI
Medical Qualification: MBBS,MRCPCH PartI
City, Country: karachi,pakistan

Team Interface: There is no paediatric USMLE: it is the same three-Step exam for every doctor, and it leads to US licensure rather than a job in Dubai. Step 1 costs $905 and Step 2 CK $930 outside the US and Canada, and there are no fixed dates. To work as a paediatrician in Dubai, you need a DHA licence instead. See our DHA Paediatrics exam guide.

Asking for general information about the USMLE exam, marcar c. morales (Cavite, Philippines)

"good day everyone! i ll be taking the USMLE exam sometime this year.however, I dont really have an idea in the exam. I would greatly appreciate if you could impart me some information for the exam. I wished us all the luck for our chosen careers.thank you very much."
marcar c. morales
Medical Qualification: MBBS
City, Country: cavite,philippines

Team Interface: The USMLE has three Steps: Step 1 (basic sciences, pass/fail), Step 2 CK (clinical knowledge, passing score 218) and Step 3 (independent practice, passing score 200, taken in the US). Step 1 and Step 2 CK are computer-based exams in 30-minute blocks at Prometric centres worldwide. Start with what the USMLE exam is and our guide to the three USMLE Steps. Good luck!

For eligibility, fees and test day, read USMLE for Pakistani doctors, USMLE exam fees and our USMLE test day guide. Still have a question? Contact us.

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