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Case file · Segment A
Pass/Fail · up to 280 items · one 8-hour day

USMLE Step 1 qbank and practice test — the 14-block format

Every Step 1 item is a clinical vignette: a patient, a story, a set of findings — and a question that only yields to the mechanism underneath. Myndaq's Step 1 course is built to dissect that vignette with you, from the first line of the stem to the reason the other four options fail.

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19 chapters · 47 modules — the Step 1 basic-science map, discipline by discipline, every folder open on the desk today
Segment A the stem

What USMLE Step 1 actually asks of you

Pass / Fail
the only outcome reported — three-digit scores ended for administrations from 26 January 2022
14 × 30 min
blocks in one 8-hour testing session, for administrations on or after 14 May 2026
≤ 280
multiple-choice items in total — no more than 20 in any single block
Prometric
one computer-based day at a test centre, the first of the three-step USMLE sequence

Step 1 is the integrated basic-science examination of the United States Medical Licensing Examination, sponsored by the NBME and the FSMB. It is delivered by computer at Prometric test centres across one 8-hour testing session, and its content is organised along two dimensions — system and process — so a single item can reach for biochemistry, pathology, pharmacology and physiology in the same breath.

Since January 2022 the outcome has been reported as pass or fail only. That single change rewrote what preparation means: there is no number to chase and no margin to buy with speed alone. What is left is competence — whether you can read a vignette, find the mechanism and defend one option against four plausible neighbours, item after item, for a full day.

Students of LCME-accredited US and Canadian schools register through the NBME; students and graduates of medical schools outside the US and Canada register through ECFMG. Either way, the exam in front of you is the same one — and it rewards the same habit: reasoning, out loud, on every single item.

Exam day, at a glance 14 blocks · 30 min each · 8-hour session
block 1block 14
Segment B the dissection

One vignette, taken apart

This is the habit the exam rewards, and the habit the course builds. Four passes over the same paragraph — and by the fourth, the answer is not a guess, it is a conclusion.

Pass 1 · the story

Who is the patient, how long has this been happening, and what changed? Age, duration and the one detail that does not fit are doing most of the work — long before any lab value appears.

Pass 2 · the data

Vitals, examination findings, laboratory values, an image. Each one is either confirming the story or breaking it. Step 1 rarely gives a number you do not need.

Pass 3 · the question

Read the last sentence twice. “Which of the following best explains” is a mechanism question; “most likely to be found” is a consequence question. The same vignette can ask either, and they have different answers.

Pass 4 · the four that fail

Every distractor is right for a different vignette. Naming which one, out loud, is the single highest-yield habit in Step 1 preparation — and the one the AI tutor drills with you on every item.

Reasoning, not recall

Facts are the raw material; the exam scores the assembly. Content organised along system and process is exactly what a vignette forces you to cross.

Stamina is a skill

Fourteen blocks in an 8-hour session means your fourteenth block has to read like your first. Short, daily, focused sessions build that far better than marathon days.

Segment C the index plate

Two dimensions, cross-referenced

The official content outline organises basic-science material along system and process. Myndaq's course is built on the same cross-reference, so studying a discipline never means losing sight of the organ system it will be tested through — 19 chapters and 47 modules covering the map end to end.

19 chapters — the disciplines and the organ systems they run through
47 modules — each one a focused surface with the tutor attached

Your personalised map opens after sign-in: which cells you have worked, which are cold, and where the next session should land.

Segment D the question

The item, in the shape you will meet it

A clinical stem, the findings that matter, a lab panel where the exam would give you one — and a single best answer to defend. You choose, you commit, and then the explanation does the part that actually changes your next attempt: it says why the option you liked belonged to a different patient.

Vignette-first practice across every discipline on the map
An explanation on every item — the answer and the four refusals
Short sessions that keep block-fourteen reading like block one
Segment E the reasoning

An attending in your browser

The Myndaq AI Tutor sees the exact vignette you are on. Ask it why the ferritin matters, what the distractor would have needed to be true, or to walk the mechanism one step at a time. It guides — it never just hands you the letter. That is the whole difference between reading an explanation and being able to reproduce it under a 30-minute block clock.

Segment F the follow-up

Analytics built for a pass/fail exam

There is no number to chase, so Myndaq does not invent one. It tracks the thing that decides the day: how consistently you reason correctly, and where you still do not.

Consistency, not a score
accuracy across your recent sessions, read as a readiness signal — never as a predicted three-digit score
Days to your exam
the map planned backwards from your test date
Weakest areas, ranked
which cells of the system-by-process plate cost you most
Your next move
one concrete recommendation, recalculated as you practise

Why Myndaq for Step 1

🧠
A tutor on every vignette

Ask about the exact stem in front of you — mechanism, distractor, the finding you skipped.

🎯
Real task format

Single-best-answer clinical vignettes with a lab-values panel — the shape Step 1 uses, not flashcard prompts.

📈
Weakness-first analytics

Your cold cells on the system-by-process plate quietly become your next practice set.

📱
Study anywhere

Browser-based on any device — a ward-round gap is long enough for a vignette or two.

The plan, in three lines

01
Open the case file

Sign in with Google and the Step 1 map opens — 19 chapters and 47 modules, with nothing to configure first.

02
Dissect vignettes daily

Short sessions in the real item shape, with the tutor on hand for the mechanism and the four refusals.

03
Close the cold cells

Let the analytics point at the weakest cross-references and work them until the whole plate reads warm.

Ask the attending

Six questions, pinned to the segments above.

◇ A1

Is USMLE Step 1 still pass/fail?

Yes. Step 1 outcomes are reported as pass or fail only — three-digit numeric scores ended for administrations on or after 26 January 2022. Prepare for competence across the whole map, not for a number.

◇ A2

How long is Step 1 and how is the day structured?

One 8-hour testing session at a Prometric centre. For administrations on or after 14 May 2026 it is divided into fourteen 30-minute blocks; earlier administrations used seven 60-minute blocks.

◇ A3

How many questions are on Step 1?

No more than 280 multiple-choice items in total, and no more than 20 in any single block. Every one of them is a single-best-answer item, and most arrive as a clinical vignette.

◇ B1

Why are vignettes so much harder than the facts behind them?

Because the exam organises content along system and process, one item can cross four disciplines at once. Knowing each fact separately is not the same as assembling them under time — which is exactly what the four-pass dissection above trains.

◇ C1

Who can take Step 1, and how do international graduates register?

Students and graduates of LCME-accredited US and Canadian medical schools register through the NBME; students and graduates of medical schools outside the US and Canada register through ECFMG. Check the current eligibility rules with your registration entity before you book.

◇ F1

What does the Myndaq Step 1 course cover?

19 chapters and 47 modules built on the same system-and-process cross-reference the official outline uses — the disciplines mapped onto the organ systems they get tested through, each module a focused surface with the AI tutor attached. Every one of them is open to work through from your first session — nothing in the case file is held back for later.

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Start free — no card needed. Explore the course and chat with the AI tutor, then see plans on the welcome page.

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One vignette at a time. That is how Step 1 is passed.

Open the case file and start reasoning today.

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Myndaq is an AI-powered preparation platform for USMLE Step 1, the integrated basic-science examination of the United States Medical Licensing Examination. Step 1 is a computer-based, pass/fail exam delivered at Prometric test centres in one 8-hour session — fourteen 30-minute blocks and no more than 280 single-best-answer items for administrations on or after 14 May 2026 — with content organised along system and process. Myndaq trains the reasoning it actually rewards: clinical vignettes read the way an examiner writes them, an explanation for the answer and for each of the four options that fail, weakness-first analytics across the whole system-by-process map, and a Myndaq AI Tutor that walks the mechanism with you — on any device, right in your browser. Myndaq is an independent study platform and is not affiliated with, endorsed by or sponsored by the NBME, the FSMB, ECFMG or the USMLE program.

Sample questions

Try 5 real USMLE Step 1 questions

Taken from the 2,115-item USMLE Step 1 bank on Myndaq. Work them here; sign in (Google or email link, no card) to check each answer and have the AI tutor explain why the other options are wrong.

  1. Question 1 · medium · Macronutrient Micronutrient Deficiency · Environmental Nutritional Disease

    A 45-year-old woman with chronic alcohol use is admitted with confusion and receives intravenous dextrose before any vitamin supplementation. She acutely develops nystagmus, ophthalmoplegia, and gait ataxia. The deficient cofactor is required by transketolase, pyruvate dehydrogenase, and alpha-ketoglutarate dehydrogenase. Administering the glucose load before this vitamin worsened her state primarily by which mechanism?

    • Direct glucose toxicity to peripheral nerve myelin
    • Stimulation of insulin causing intracellular potassium depletion
    • Increased demand for the cofactor as glucose is funneled into pyruvate/citric acid cycle metabolism
    • Accumulation of methylmalonic acid from impaired odd-chain fatty acid metabolism
    • Osmotic shift of water into neurons causing cerebral edema
    Check your answer with the AI tutor
  2. Question 2 · medium · Hormonal Physiology Of Pregnancy And The Placenta

    A 30-year-old woman at 8 weeks' gestation has a rising serum human chorionic gonadotropin (hCG). Her physician notes hCG maintains progesterone secretion at this stage. Through which receptor does hCG act to sustain the corpus luteum?

    • The follicle-stimulating hormone receptor
    • The luteinizing hormone/choriogonadotropin receptor
    • The estrogen receptor alpha
    • The thyroid-stimulating hormone receptor
    • The progesterone nuclear receptor
    Check your answer with the AI tutor
  3. Question 3 · medium · Gram Positive Cocci · Bacterial Toxins

    A 5-year-old boy develops a rapidly spreading skin infection with honey-colored crusts. A gram-positive coccus in clusters is isolated. Some strains of this organism cause a widespread blistering disease in which the superficial epidermis separates at the granular layer. The toxin responsible cleaves which of the following host structures?

    • Type VII collagen anchoring fibrils
    • The GTPase Rho by glucosylation
    • Desmoglein 1 in desmosomes
    • Elongation factor 2 by ADP-ribosylation
    • Hemidesmosomal integrin adhesion
    Check your answer with the AI tutor
  4. Question 4 · easy · Biliary Secretion · Gi Hormones

    A 34-year-old woman is studied after eating a fatty meal. Investigators observe that her gallbladder contracts vigorously and the sphincter of Oddi relaxes, delivering bile into the duodenum. This response is triggered by a hormone released from duodenal I cells in response to fatty acids and amino acids in chyme. Which hormone is chiefly responsible for gallbladder contraction in this scenario?

    • Somatostatin
    • Secretin
    • Motilin
    • Gastrin
    • Cholecystokinin
    Check your answer with the AI tutor
  5. Question 5 · hard · Pathology Of Pregnancy And Gestational Disease

    A 27-year-old woman presents with amenorrhea and a positive pregnancy test. Ultrasound shows no intrauterine gestational sac but an adnexal mass with a tubal ring, and serum beta-hCG is lower than expected for gestational age with an abnormally slow rise. She has a history of chlamydial pelvic inflammatory disease. Which pathophysiologic factor most directly predisposed her to this condition?

    • Failure of trophoblastic invasion of spiral arteries
    • Excessive corpus luteum progesterone secretion
    • Premature rupture of the amniotic membranes
    • Increased endometrial receptivity to trophoblast
    • Scarring and impaired ciliary transport within the fallopian tube
    Check your answer with the AI tutor
Exam essentials

USMLE Step 1 at a glance

USMLE Step 1 is the first of the United States Medical Licensing Examination steps, open to students and graduates of US MD and DO schools and of international medical schools listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements. From 14 May 2026 it runs as fourteen 30-minute blocks at Prometric centres.

Facts below were read on Federation of State Medical Boards (FSMB) and National Board of Medical Examiners (NBME)'s own pages on . Dates and fees change between cycles — the official page linked on each row is authoritative.

Conducting body
FSMB and NBME; delivered at Prometric test centres
Source: USMLE — Step 1
Eligibility
Students or graduates of LCME-accredited MD schools, COCA-accredited DO schools, or international schools listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements
Source: USMLE — Bulletin of Information: eligibility
Format (from 14 May 2026)
One 8-hour session; fourteen 30-minute blocks with no more than 20 questions each; 5-minute optional tutorial; at least 55 minutes of break
Before 14 May 2026: seven 60-minute blocks of up to 40 questions; total still no more than 280 items
Source: USMLE — Step 1
Question type
Single-best-answer multiple choice applying basic science to clinical vignettes
Source: USMLE — Step 1
Fee (2026 and 2027)
US$695 application fee · +US$210 region fee for testing outside the US and Canada · +18% GST for tests taken in India
Source: USMLE — Apply for exams (fees)
Registration route
US MD/DO students via NBME (MyUSMLE); international graduates via the FSMB USMLE portal since 12 January 2026
Source: USMLE — Service transition launching January 2026
ECFMG certification application
US$580
Source: ECFMG — Fees
FAQ

USMLE Step 1 — common questions

What is the USMLE Step 1 format from 14 May 2026?

Step 1 is now fourteen 30-minute blocks in one eight-hour day, with no more than 20 questions per block, a five-minute optional tutorial and at least 55 minutes of break time. Before 14 May 2026 it was seven 60-minute blocks of up to 40 questions. The total item count still does not exceed 280.

How much does Step 1 cost for an Indian MBBS graduate?

The 2026 and 2027 application fee is US$695. Testing outside the United States and Canada adds a US$210 region fee, and tests taken in India attract 18 per cent GST on top. Budget roughly US$1,070 for the exam before ECFMG certification costs, whose application fee is US$580.

Where do international graduates register for Step 1 now?

Since 12 January 2026 all USMLE Step exam services for international medical graduates are handled by FSMB through its USMLE portal rather than ECFMG's MyIntealth. US MD and DO students continue through NBME's MyUSMLE. ECFMG certification itself is still required for the Match and for Step 3.

Who is eligible to sit Step 1?

Students or graduates of LCME-accredited US MD schools, COCA-accredited DO schools, or any medical school outside the United States listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements. Indian MBBS students from listed colleges can therefore apply while still enrolled.

How many questions are on Step 1 and how much time per question?

Up to 280 single-best-answer questions. With no more than 20 questions in each 30-minute block you have about 90 seconds per item, the same pace as the old format but with twice as many block boundaries, so time lost at transitions matters more than it used to.

Where is Step 1 held?

At Prometric test centres worldwide, including centres in India. You choose a three-month eligibility period during application and then schedule a specific date with Prometric within that period; dates are available year-round rather than in fixed windows.

Is there a free full-length Step 1 practice test in the 14-block format?

Yes. Myndaq's free mock gives 280 questions across fourteen timed 30-minute sections on a server-controlled clock, mirroring the post-May-2026 structure, one attempt per account and no card. Results come back as a per-section breakdown with an AI tutor explanation for every vignette. See free mock tests

What does the Myndaq USMLE Step 1 course include?

Practice across Biochemistry & Molecular Biology, Microbiology & Immunology, Pathology & Pharmacology, Physiology by organ system, Behavioral Science with an AI tutor that explains every answer, plus progress analytics.

Is there a free USMLE Step 1 mock test?

Myndaq runs a free mock test programme. Availability varies by exam and publication status — check the free mock tests page. One attempt per account, for one eligible exam; sign in with Google or an email link, no payment card required. See free mock tests