# Step 1 vignettes from your own pathology and physiology notes

> Single best answer Step 1 style questions written from your own pathology and physiology material, each one carrying the sentence and page it came from.

Markdown copy of https://meduniexam.com/exam/usmle-step-1 (the HTML page), published by MedUni Exam. Published September 12, 2026, updated September 22, 2026. Site guide for agents: https://meduniexam.com/llms.txt.

Two weeks out you are rereading the same chapter for the fourth time, and rereading is not retrieval. This turns the chapter into single best answer vignettes, each one printed with the sentence it was written from and the page that sentence sits on.

[Take the ten question sample exam](https://meduniexam.com/#/sample)

No upload and no account, about a minute. Or [upload a chapter](https://meduniexam.com/#/) and get USMLE Step 1 style questions from it.

Free: 300 verified questions a month. The Exam Pass is $19.99 once for 90 days on the priority models; [get it here](https://meduniexam.com/#/pricing?buy=exam_pass). 14 day refund, in full before you generate.

## USMLE Step 1 passing score, pass rates 2025, fees and attempts

Step 1 passing score: 196 on the three digit scale, reported to you as pass or fail. Step 1 pass rate 2025: 93 percent of first takers from US MD schools, 89 percent from US DO schools, 75 percent of first takers from non-US schools. Step 1 fee: USD 695 for 2026 and 2027, plus a USD 210 region fee outside the US and Canada.

| Step 1 fact | Number | Applies to |
| --- | --- | --- |
| Questions and time | Approximately 280 questions in fourteen 30 minute blocks, one 8 hour session | Exams from May 14, 2026 |
| Passing standard | 196 on the three digit scale, reported as pass or fail | Exams from January 26, 2022 |
| Percent correct to pass | Approximately 60 percent, varying by form | Every Step exam |
| Pass rate, US MD first takers | 93 percent, 23,028 tested | 2025 |
| Pass rate, US DO first takers | 89 percent, 4,623 tested | 2025 |
| Pass rate, non-US first takers | 75 percent; repeaters 54 percent | 2025 |
| Fee | USD 695, plus USD 210 outside the US and Canada | 2026 and 2027 |
| Eligibility period | Three months; USD 70 to extend | NBME, US and Canadian students |
| Results | Typically two to four weeks; allow at least eight | Every exam |
| Attempts | Four per Step; no more than three in 12 months | Current rule |

Source: [USMLE examination results and scoring](https://www.usmle.org/scores-transcripts/examination-results-and-scoring), [USMLE performance data](https://www.usmle.org/performance-data), [USMLE fees](https://www.usmle.org/apply-exams), [USMLE eligibility and attempts](https://www.usmle.org/bulletin-information/eligibility), checked on September 21, 2026.

## Where your own notes line up with the Step 1 blueprint

The NBME pool is not published. Your pathology chapter is. Items on Step 1 are coded to more than one discipline, and the two that carry the most weight are pathology at 45 to 55 percent and physiology at 30 to 40 percent of items. That is the part of Step 1 a student already owns: the pathology chapter and the physiology lecture are sitting on your drive. Feed those in and the questions that come back test the same mechanisms, in the same format, with the sentence they were written from printed underneath.

The part you do not own is the rest of the blueprint. Communication and interpersonal skills is 6 to 9 percent of items and biostatistics, epidemiology and population health is 4 to 6 percent, and almost nobody has notes on either. Those questions will not appear unless you upload material that covers them.

## One question, as it arrives

A 65-year-old man presents with swelling and pain in his left leg. Physical examination reveals a dilated, tortuous vein on the medial aspect of his thigh. The vein is palpable and visible under the skin. Which of the following veins is most likely involved in this patient's condition?

1. **A.** Great saphenous vein correct answer
2. **B.** Popliteal vein
3. **C.** Fibular vein
4. **D.** Femoral vein
5. **E.** Small saphenous vein

PAGE 505"Great saphenous vein: Prominent surface vessel located on the medial surface of the leg and thigh; drains the superficial portions of these areas and flows into the femoral vein"

double-checked

Written on September 15, 2026 on the free lane, job 247, question 13647, from [Anatomy and Physiology II (KCC), adapted from OpenStax Anatomy and Physiology](https://archive.org/details/cnx-org-col11907) (Jonathon Cohen, Kingsborough Community College, via the Internet Archive), page 505, published under the [Creative Commons Attribution 4.0](https://creativecommons.org/licenses/by/4.0/). The quote is the line the check found on that page, and a second model from a different family picked the same answer from the quote alone. Nothing here was edited by hand.

**54 percent of the questions drafted since counting began on September 14, 2026 failed a check and never reached a student.** Counted from this site's own database, as of September 24, 2026, refreshed twice an hour. A question fails when its quote is not on the page it cites, when a second model picks a different answer, when it breaks a writing rule or when it repeats one already written. [Each check, with its own rate](https://meduniexam.com/stats/rejections.md).

**Exam Pass, $19.99 once.** 90 days of the priority models for your USMLE Step 1 block, with the downloads and an unlimited tutor. Nothing renews. [Get the Exam Pass](https://meduniexam.com/#/pricing?buy=exam_pass) Start on the free plan first if you like: 300 verified questions a month with an account, 60 as a guest.

## A practice recipe for USMLE Step 1

Ask for 20 questions from one chapter and set a 30 minute timer, because Step 1 now runs in 30 minute blocks of no more than 20 questions.

Paste this into the extra instructions box on the generate form, or let the button carry it there:

Write single best answer items with five options, A to E. Start each stem with a short clinical situation and ask for the underlying mechanism or the most likely finding. Weight the set toward pathology and physiology: the process, the consequence and the finding that follows from it, not the name of the person who described it. Never test a number unless the number decides the answer.

[Use this recipe in the generate form](https://meduniexam.com/#/?recipe=usmle-step-1)

The extra instructions box overrides the general guidance the model is given, so the wording above is followed on every question in the set.

## What this cannot do

- This is not the NBME item pool and it has no connection to the USMLE. It writes items in that style from the file you upload.
- Step 1 items lean on gross and microscopic specimens, graphs and tables. Images are not read as images here, so an item whose answer lives in a photomicrograph cannot be produced.
- The 8 hour, 280 item endurance of a real exam day is not something a generated set reproduces. A 20 question block matched to the clock is the closest honest equivalent.
- Nothing here calibrates difficulty against a national cohort. A question is accepted because its quote checks out and a second model agrees with the key, not because it discriminates at a known ability level.

## Format facts, and where each one comes from

- One patient centered vignette carries one question followed by four or more options, and one of them is the single best answer.Source: [https://www.usmle.org/exam-resources/step-1-materials/step-1-test-question-formats](https://www.usmle.org/exam-resources/step-1-materials/step-1-test-question-formats)
- Taken on or after May 14, 2026, Step 1 is fourteen 30 minute blocks inside an 8 hour session, with no more than 20 questions per block and a total that will not exceed 280 items.Source: [https://www.usmle.org/step-exams/step-1](https://www.usmle.org/step-exams/step-1)
- Pathology is 45 to 55 percent of items and physiology 30 to 40 percent. Items are coded to more than one discipline, so the discipline percentages add up to more than 100.Source: [https://www.usmle.org/exam-resources/step-1-materials/step-1-content-outline-and-specifications](https://www.usmle.org/exam-resources/step-1-materials/step-1-content-outline-and-specifications)
- Communication and interpersonal skills is 6 to 9 percent of items and biostatistics, epidemiology and population health is 4 to 6 percent.Source: [https://www.usmle.org/exam-resources/step-1-materials/step-1-content-outline-and-specifications](https://www.usmle.org/exam-resources/step-1-materials/step-1-content-outline-and-specifications)

Format checked on September 12, 2026. These pages are reviewed once a quarter by the person who runs MedUni Exam, and the review is what moves the date above. If a number here is out of date, write to [support@meduniexam.com](mailto:support@meduniexam.com) and it gets fixed.

## What it costs in USMLE Step 1 units

With a free account the allowance is 300 verified questions a month, which in this exam's units is 15 runs of a 30 minute block of 20 questions, or more than a full 280 item Step 1 exam, every month, at no cost. A guest workspace with no account gets 60 questions a month, which is 3 such runs.

The Exam Pass, $19.99 once, is one payment that puts the priority models on your jobs for 90 days and then stops on its own.

[Get the Exam Pass, $19.99 once](https://meduniexam.com/#/pricing?buy=exam_pass)

Paid through Stripe, which shows the total before you pay. One payment, nothing renews, and the [refund policy](https://meduniexam.com/refund-policy.md) gives you 14 days, in full before you generate. A 500 question pack at $5.99 and the Pro subscription are on the [pricing page](https://meduniexam.com/pricing.md).

Works in any language, and quality varies by language: the questions come out in the language of your document, or in the one you pick from a list of every living language. [What works in your language, and what does not](https://meduniexam.com/for/any-language.md).

## Questions students ask

### Are these real Step 1 questions?

No. They are questions written from the file you upload, in the single best answer format Step 1 uses. The official item pool is not published, and nothing on this site reproduces it.

### What should I upload first?

One pathology or physiology chapter, or the lecture deck for a single system. A chapter gives the generator enough prose to write mechanism questions from, and the page citations line up with the book you are already reading.

### Can it write image based items?

No. Only text is read. A page whose fact lives in a photomicrograph or a graph gives nothing to quote, so no question is written from it.

### Does it cover biostatistics?

Only if you upload biostatistics material. The generator writes from your pages and invents nothing, so a topic missing from your file is missing from your questions.

[Upload a chapter](https://meduniexam.com/#/)

[How the checks work](https://meduniexam.com/how-it-works.md)

No account needed to try it. Registering keeps your library, grades and review queue across devices.

[All ten exams](https://meduniexam.com/exam.md) · [Real generated questions and the rejects](https://meduniexam.com/sample.md) · [COMLEX Level 1](https://meduniexam.com/exam/comlex-level-1.md)

## Related pages

- [USMLE Step 1 Passing Score, Pass Rates by Year](https://meduniexam.com/blog/usmle-step-1-passing-score-and-pass-rates.md): The USMLE Step 1 passing standard is 196 on the three digit scale and the result comes back as pass or fail. Every published Step 1 pass rate from 2013 to 2025 sits here by year and examinee group.
- [USMLE Step 2 CK questions from your notes](https://meduniexam.com/exam/usmle-step-2-ck.md): Step 2 CK style management and diagnosis questions generated from a student's own clinical material, with the competency mix the blueprint actually uses.
- [COMLEX Level 1 practice from your notes](https://meduniexam.com/exam/comlex-level-1.md): COMLEX-USA Level 1 practice generated from a DO student's own material, including OMM, with the post May 2026 item count.
- [For medical students](https://meduniexam.com/for/medical-students.md): Why questions generated from your own syllabus beat a generic question bank.
- [How to Turn Notes Into Practice Questions](https://meduniexam.com/blog/how-to-turn-notes-into-practice-questions.md): A method for turning lecture notes into practice questions: the six prompt clauses that change what comes back, what published studies and this site's own counted rejection rates say goes wrong, and when to stop checking a set and rewrite the prompt instead.