USMLE Step 1 Free 120 (Official Sample Questions) Review

The USMLE Step 1 Free 120 is the official set of sample questions published by the USMLE program and administered by the NBME, and it is free. The current booklet was updated in April 2026 and contains 119 numbered items in six blocks, with an official answer key at the back.

The interactive version carries one more item than that, which is where the name comes from. This review covers what is in the current release, how long it takes, which of the two interactive links to use, and how to read your result.

Summary Table

USMLE Step 1 Free 120 (Official Sample Questions) Overview

The official practice questions from the people who write Step 1

The Free 120 is the USMLE program's own sample item set, published on USMLE.org as a downloadable booklet and as an interactive test that runs in the real exam software. Because the items are official, they show the integrated, vignette-heavy style of Step 1 better than any third-party set.

What you get in the current release:

• 119 numbered sample items, in six blocks of 20, 20, 20, 20, 20 and 19
• An answer form and a full answer key at the back of the booklet
• The USMLE laboratory values table, the one the booklet says the exam itself uses
• An interactive version that adds a 120th item with audio findings

Which release is this?

The booklet on USMLE.org states on its cover that it was updated in April 2026, and the file itself was last modified on April 2, 2026. That matters more than it sounds. Copies of older forms circulate on file-sharing sites, and a 2022 copy still ranks on the first page of results for the Free 120. If you practiced on one of those, you worked through a different item set from the one USMLE publishes now.

The official page describes the set as "more than 100 sample Step 1 test questions" rather than giving an exact count, which is part of why the "120" number has drifted. The booklet is specific: items are numbered 1 to 119, and the answer key runs to 119.

USMLE Step 1 Free 120 (Official Sample Questions) Review For 2026

119 or 120?

Both, depending on where you take it. The downloadable booklet holds 119 items. In USMLE's own words, the interactive testing experience includes an additional item with associated audio findings that does not appear in the booklet, and that is the 120th.

That one item is the reason to use the interactive version rather than only the PDF. Audio findings are a real item format on Step 1, and the booklet cannot show you one. USMLE says directly that reviewing the questions on paper is not a substitute for running the interactive tutorial before your test date.

How long does the Free 120 take?

Two hours, 58 minutes and 30 seconds, if you time it the way USMLE says to. The booklet instructs you to allow a maximum of 30 minutes for each 20-item block and a maximum of 28 minutes 30 seconds for the 19-item block, which comes to 2 hours 58 minutes 30 seconds across all six.

USMLE adds a warning worth taking seriously: most examinees find the time pressure greater on the real exam than in practice. Treat 2 hours 58 minutes 30 seconds as a ceiling, not a target.

Use the new interactive version, not the old one

USMLE.org currently links two interactive testing experiences, and the right one depends on your test date. Its sample questions page tells examinees sitting Step 1 before May 14 to use the older version, and examinees sitting on or after May 14 to use the new one, to get familiar with its 30-minute blocks and updated functionality.

That date has passed. The USMLE program confirmed on May 14, 2026 that the updated test delivery software is in place for all three Step exams, so anyone testing now is sitting the new interface. According to that announcement, exam content, the total number of items and the overall length of Step 1 are unchanged, but the exam has more blocks and the blocks are shorter. The software also adds a settings menu and per-image contrast adjustment.

Two practical consequences. First, the older interactive link still works, so it is easy to practice on the interface you will not see; the AI summaries search engines show for the Free 120 still link to it. Second, the booklet's recommended 30 minutes per 20-item block now matches the live exam's 30-minute blocks, so a timed Free 120 rehearses the real block rhythm more closely than it used to.

What the Free 120 does not tell you

There is no official passing percentage for the Free 120 and no official conversion to a Step 1 result. USMLE publishes the items and the answer key, and nothing else. Any "you need X percent to pass" figure you have seen is somebody's inference, not an official standard.

The booklet is also explicit that the items exemplify Step 1 content overall but may not reflect the content coverage of any individual exam, and that its photographs, charts and x-rays are not of the same quality as the real pictorials. So read your result as a format and pacing check and as a rough confidence signal, not as a score.

For an actual readiness estimate, that is what the paid forms are for. The NBME self-assessments report an estimated probability of passing Step 1; the Free 120 does not. Since Step 1 is pass or fail, what you want from both is confirmation that you are clear of the line, not a number to chase.

Free 120 or the paid NBME self-assessments?

Different products, often confused because both come from NBME. The Free 120 is free, is one fixed form, and gives you an answer key. The Comprehensive Basic Science Self-Assessment (CBSSA) comes in seven forms with pricing that starts at $62, bought one at a time, and reports your estimated probability of passing.

Most students use both: self-assessments spaced through dedicated to track the trend, and the Free 120 once, timed, near the end. A third option is separate from both: the Prometric practice session, a registration USMLE lists so you can sit in a real test center rather than at your desk.

How to use it

Save it for the back half of dedicated and do it in one sitting, timed, on the new interactive version. A strong, timed Free 120 close to your test date is one of the better signals that you are ready.

The catch is volume. The Free 120 will not teach you content, and 119 items is a calibration tool rather than a question bank. Build mastery on UWorld or AMBOSS and First Aid, then use the Free 120 to check it. Our Step 1 study plan puts the timed Free 120 in week 5 of a 6-week dedicated period.

For explanations, you are on your own officially. The answer key gives you the correct letters; the rationale you have to build yourself or find in community walkthroughs. Working out why each key is right, from the item itself, is better revision than reading someone else's explanation anyway.

Cost

Free. The booklet downloads directly from USMLE.org and both interactive versions launch from links on the same page, with no payment at any point. Both interactive links were live when we checked them on October 12, 2026.

Who USMLE Step 1 Free 120 (Official Sample Questions) Is Best For

• Every Step 1 candidate, in the back half of dedicated
• Students who want to rehearse the post-May-2026 exam interface before test day
• Anyone gauging readiness who wants the most exam-representative free practice
• Students on a tight budget, alongside the rest of the free USMLE Step 1 resources

When You Might Look Elsewhere

• You need practice volume and content, so use a full question bank
• You want an estimated probability of passing, which only the paid self-assessments give
• You want worked explanations, which the official materials do not include

Final Verdict

There is no reason to skip the Free 120. It is official, it is free, and the April 2026 release is the closest look at current Step 1 items that costs nothing.

Do it once, timed, late in dedicated, on the interactive version so you meet the audio item and the current software. Then read the result for what it is: evidence about your pacing and your format comfort, not a score. Check it against the Step 1 pass rates and your self-assessment trend before you decide when to sit the exam.

USMLE Step 1 Free 120 (Official Sample Questions) FAQs

How long does the Free 120 take?

2 hours, 58 minutes and 30 seconds if you follow USMLE's own timing: 30 minutes for each of the five 20-item blocks, and 28 minutes 30 seconds for the 19-item block. The booklet notes that most examinees find the real exam feels more time-pressured than practice does.

How many questions are in the Free 120?

The downloadable booklet has 119, numbered 1 to 119 across six blocks. The interactive version on USMLE.org adds one more item with audio findings that is not in the booklet, which makes 120 and gives the resource its nickname.

Is the USMLE Free 120 really free?

Yes. The booklet and both interactive versions are published on USMLE.org at no cost and with no payment step. The paid NBME products are a different thing: the self-assessment forms start at $62 each.

Which Free 120 is the current one?

The booklet on USMLE.org states that it was updated in April 2026. Older copies circulate on file-sharing sites, including a 2022 version that still ranks for this search, so download it from USMLE.org rather than from a mirror.

Does the Free 120 come with explanations?

It comes with an official answer key, but no official rationales. The booklet gives an answer form and the correct letter for all 119 items, and that is as far as the USMLE program goes.

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