United States
USMLE Step 1 and Step 2 CK: 2026 format, scoring and practice questions
The USMLE is the three-step examination for medical licensure in the United States. This guide summarizes what usmle.org publishes, including the 2026 format change, with real practice questions.
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The exam at a glance
- Official name
- United States Medical Licensing Examination (USMLE) [1]
- Where it is taken
- On computer, at Prometric test centers [1]
- Step 1 from May 14, 2026
- Fourteen 30-minute blocks, up to 20 questions per block, in one 8-hour session [1]
- Step 1 result
- Pass/fail only, since January 26, 2022 [3]
- Step 2 CK from May 7, 2026
- Sixteen 30-minute blocks, up to 20 questions per block, in one 9-hour session [2]
- Step 2 CK passing score
- 218, for exams taken on or after July 1, 2025 [3]
- Step 3 passing score
- 200, since January 1, 2024 [3]
- Break time
- At least 55 minutes on Step 1 and Step 2 CK [1]
Facts reviewed in October 2026.
What changed in 2026
In May 2026 the USMLE moved to shorter, more numerous blocks. Step 1 went from seven 60-minute blocks to fourteen 30-minute blocks. Step 2 CK went from eight 60-minute blocks to sixteen 30-minute blocks.
The session length did not change: 8 hours for Step 1 and 9 hours for Step 2 CK. What changes is pacing, because you now manage your time in half-hour stretches.
The three Steps
- Step 1 covers the basic sciences applied to medicine. It is reported as pass/fail only.
- Step 2 CK covers clinical knowledge. It is scored on a three-digit scale and the passing score is 218.
- Step 3 is the final Step and is taken over two days. The passing score is 200.
International medical graduates
If you studied medicine outside the United States, your school must be listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements. Check this before you pay for any exam.
How to study
With the new format, train in 30-minute blocks of about 20 questions. Read the explanation for every question, including the ones you get right, and review your mistakes often.
Sample questions
These are real questions from the MedSteps bank. Pick an option to see the answer and explanation.
Pathology
A 50-year-old man has progressive weight loss, cough, and bilateral pulmonary infiltrates. CT shows bilateral opacities in an upper-lobe predominant distribution. He worked in a sandblasting factory for 20 years. Which diagnosis?
Show answer and explanation
Correct answer: B. Silicosis
Silicosis follows exposure to crystalline silica, as in sandblasting, mining and foundry work. Chronic silicosis shows upper-lobe predominant nodules and eggshell calcification of hilar lymph nodes, and it increases the risk of tuberculosis.
Ambulatory care
A 62-year-old man has a 5-year history of bilateral hand tremor that is worse when using his hands and dramatically improves with 1-2 glasses of wine. Neurological examination shows a bilateral action tremor only. Which of the following is the most appropriate initial pharmacological treatment?
Show answer and explanation
Correct answer: D. Propranolol
Essential tremor is an action or postural tremor that is absent at rest and typically improves with alcohol. First-line treatment is propranolol or primidone. Levodopa treats the resting tremor of Parkinson disease, not essential tremor.
Internal medicine
A 65-year-old man with CLL has increasing fatigue. CBC shows Hb 7.2 g/dL, MCV 110, platelets 180,000, WBC 45,000 with small lymphocytes. Reticulocyte count is 8%. Direct Coombs is positive for IgG. Which diagnosis?
Show answer and explanation
Correct answer: B. Warm autoimmune hemolytic anemia complicating CLL
Immune dysregulation in CLL can produce IgG autoantibodies against red cells. A positive direct Coombs test for IgG with a high reticulocyte count indicates hemolysis, and the macrocytosis comes from reticulocytosis. Corticosteroids are first-line treatment.
How MedSteps helps you prepare
- 2,700+explained questions
- 1,000+practice activities
- 7different formats
Every question comes with an explanation. Beyond multiple choice, you practice with flashcards, true or false, ordering, matching, fill-in-the-blank and clinical cases. A daily streak helps you study a little every day.
You can start for free. The PRO plan unlocks unlimited access.
Course figures as of October 2026.
Frequently asked questions
Is USMLE Step 1 pass/fail?
Yes. Step 1 outcomes are reported as pass/fail only for exams taken on or after January 26, 2022.
What is the Step 1 format in 2026?
From May 14, 2026, Step 1 has fourteen 30-minute blocks with up to 20 questions each, in one 8-hour session with at least 55 minutes of break time.
What is the Step 2 CK format in 2026?
From May 7, 2026, Step 2 CK has sixteen 30-minute blocks with up to 20 questions each, in one 9-hour session.
What is the passing score for Step 2 CK?
The minimum passing score is 218 for exams taken on or after July 1, 2025.
Can international medical graduates take the USMLE?
Yes, if their medical school is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements.
Where can I practice USMLE questions?
MedSteps has more than 2,700 USMLE questions with explanations, plus flashcards and clinical cases. You can start for free.
Sources
The exam facts on this page come from these official documents. Requirements change: always confirm with the source.
MedSteps is an independent study tool. It is not affiliated with the organizations that administer this exam.
