Доктор Желнов

Медицинский английский, USMLE. Дизайн научных исследований, базы данных, статистический анализ. Синтез доказательств (литобзор): систематический обзор литературы, литературный обзор предметного поля (scoping review).

Д-р Желнов

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Блог петербургского врача

USMLE OASys for IMGs
An Open Access, Systematic approach

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USMLE OASys: Content Outline

[USMLE study for IMGs: an Open Access, Systematic approach]

In Development

Pavel Zhelnov, MD
@drzhelnov

Dear Colleagues,

An excerpt from the original publication (accessed on July 7, 2021):

This outline provides a common organization of content across all USMLE examinations. Each Step exam will emphasize certain parts of the outline, and no single examination will include questions on all topics in the outline. The examples listed within the outline are just examples. Questions may include diseases, symptoms, etc., that are not included in the outline.

Note that Step component specifications next to the content topics are not from the original document but from the official Step 1 Content Description (PDF) as well as the Step 2 CK Content Description (PDF) (accessed on July 29, 2021), so please take these accordingly. Also, Step 3 was not considered.

Interactive features are under development. I presume this outline as well as the USMLE Physician Tasks/Competencies could be nicely aligned with my amalgam USMLE prep schedule made of U.S. med schools syllabi so that each task/competency linked to specific study resources per each content topic. This would effectively create a self-study roadmap with tasks/competencies as its tracks and content topics as the milestones. Naturally, to navigate the roadmap, the prospective Step-taker would need to clear specific resources such as textbook chapters, journal articles, videos, or their glternatives. QBanks would still be required to test one’s competencies and topic knowledge once there is something to test.

For the time being, I am creating glternatives for each topic block (note the [glternative] links next to the topic titles). An glternative, a portmanteau of legal, Google, and alternative, is an open access community-written list of web searches that, in combination, cover all information from a given resource­—in this instance, basically the topic content but as clickable Google links. Check these and other glternatives for free at the website I created, glternative.com (no registration required).

I do not own any outline content, just reproduce it for self-learning purposes and in good faith:

Copyright © 2021 by the Federation of State Medical Boards of the United States, Inc. (FSMB), and National Board of Medical Examiners® (NBME®). All rights reserved. The United States Medical Licensing Examination (USMLE®) is a joint program of the FSMB and NBME.

⚠ Disclaimer: This is an unofficial publication not affiliated with nor endorsed by the FSMB, NBME®, or USMLE® program. For official information please visit usmle.org or other relevant resources.

View this page on GitHub to create a custom copy (also to track versions). Feedback is always welcome via GitHub or Twitter. Enjoy!

General Principles of Foundational Science - BOTH STEPS

Biochemistry and molecular biology [glternative]

Gene expression: DNA structure, replication, exchange, and epigenetics (eg, imprinting, X-activation, DNA methylation)

Gene expression: transcription

Gene expression: translation, post-translational processing, modifications, and disposition of proteins (degradation), including protein/glycoprotein synthesis, intra-extracellular sorting, and processes/functions related to Golgi complex and rough endoplasmic reticulum

Structure and function of proteins and enzymes (eg, enzyme kinetics and structural/regulatory proteins)

Energy metabolism (eg, ATP generation, transport chain)

Biology of cells [glternative]

Adaptive cell responses and cellular homeostasis (eg, hypertrophy)

Mechanisms of injury and necrosis, including pathologic processes (eg, liquefactive necrosis, free radical formation)

Apoptosis

Cell cycle and cell cycle regulation (eg, mitosis)

Mechanisms of dysregulation

Cell/tissue structure, regulation, and function, including cytoskeleton, organelles, glycolipids, channels, gap junctions, extracellular matrix, and receptors

Human development and genetics [glternative]

Principles of pedigree analysis

Population genetics: Hardy-Weinberg law, founder effects, mutation-selection equilibrium

Principles of gene therapy

Genetic testing and counseling

Genetic mechanisms (eg, penetrance, genetic heterogeneity)

Biology of tissue response to disease [glternative]

Acute inflammatory responses (patterns of response)

Chronic inflammatory responses (eg, tumor necrosis factor)

Reparative processes

Pharmacodynamic and pharmacokinetic processes: general principles [glternative]

Pharmacokinetics: absorption, distribution, metabolism, excretion, dosage intervals

Mechanisms of drug action, structure-activity relationships (eg, anticancer drugs)

Concentration and dose-effect relationships (eg, efficacy, potency), types of agonists (eg, full, partial, inverse) and antagonists and their actions

Individual factors altering pharmacokinetics and pharmacodynamics (eg, age, gender, disease, tolerance, compliance, body weight, metabolic proficiency, pharmacogenetics)

Mechanisms of drug adverse effects, overdosage, toxicology

Mechanisms of drug interactions

Signal transduction, including structure/function of all components of signal transduction pathways such as receptors, ligands (eg, general principles of nitric oxide, autocrine and paracrine signaling)

Microbial biology [glternative]

Microbial identification and classification, including principles, microorganism identification, and non-immunologic laboratory diagnosis

Bacteria

Viruses

Fungi

Parasites

Prions

Infancy and childhood (0-12 years) [glternative]

Normal physical changes: linear growth, variations in linear growth, including constitutional delay; weight; head circumference; micturition, defecation, primary incontinence/bedwetting; normal physical examination; screening; sleep; teething syndrome

Developmental stages: motor; speech; cognitive; psychosocial; anticipatory guidance

Lifestyle and routine preventive health care: nutrition; exercise (eg, benefits of exercise); preventive/travel medicine; risk factors and prevention (eg, guns, swimming, motor vehicles, car seats); routine vaccinations

Adolescence (13-17 years) [glternative]

Normal physical changes: linear growth, variations in linear growth including constitutional delay; weight; puberty; normal physical examination; gynecomastia; autonomy/self-identity; sleep

Developmental stages: cognitive (eg, abstract thought); psychosocial (eg, autonomy, role confusion, sexual identity); anticipatory guidance

Lifestyle and routine preventive health care: nutrition; exercise (eg, benefits of exercise); preventive/travel medicine; risk factors and prevention (eg, risk-taking behavior, helmets, safe sex, motor vehicles, seat belts, distractions); routine vaccinations

Adulthood (18-64 years) [glternative]

Normal physical changes: weight; normal physical examination; screening; sleep

Developmental stages: cognitive; intimacy vs isolation; anticipatory guidance

Lifestyle and routine preventive health care: nutrition; exercise (eg, benefits of exercise); preventive/travel medicine; risk factors and prevention; routine vaccinations

Older Adulthood (65 years and older) [glternative]

Normal physical changes, including normal physical exam for age: weight, height (spinal compression), skin, bruising; normal physical examination; response to temperature; micturition, defecation; sleep

Developmental stages: motor; cognitive (eg, psychomotor slowing); psychosocial; integrity vs despair; retrospection; anticipatory guidance

Lifestyle and routine preventive health care: nutrition; exercise (eg, benefits of exercise); preventive/travel medicine; risk factors and prevention (eg, falls, general medical condition; polypharmacy, driving, caregiver stress); routine vaccinations

Immune System - BOTH STEPS

Normal processes

Development of cells of the adaptive immune response, including positive and negative selection during immune development

Structure, production, and function

Cellular basis of the immune response and immunologic mediators

Basis of immunologic diagnostics (eg, antigen-antibody reactions used for diagnostic purposes, ELISA, immunoblotting, antigen-antibody changes over time, ABO typing)

Principles of immunologic protection

Effect of age on the function of components of the immune system

Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis

Disorders associated with immunodeficiency

HIV/AIDS: HIV1 and HIV2; AIDS; AIDS complications (eg, neuropathy, dementia, renal insufficiency); immunology of AIDS; immune reconstitution syndrome (IRS); secondary infections; noninfectious complications

Immunologically mediated disorders

Adverse effects of drugs on the immune system: Jarisch-Herxheimer reaction; drugs affecting the immune system (eg, prednisone, azathioprine, cyclosporine, methotrexate, monoclonal antibody drugs [eg, abciximab, adalimumab; bevacizumab, infliximab, omalizumab, rituximab]); vaccine adverse effects

Blood & Lymphoreticular System - BOTH STEPS

Normal Processes

Embryonic development, fetal maturation, and perinatal changes

Organ structure and function

Cell/tissue structure and function

Repair, regeneration, and changes associated with stage of life

Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis

Infectious and immunologic

Neoplasms: leukemia, acute (ALL, AML); leukemia, chronic (CLL, CML); lymphomas, Hodgkin disease, non-Hodgkin lymphoma, Burkitt lymphoma, T-cell lymphoma; multiple myeloma, dysproteinemias, monoclonal gammopathy of unknown significance (MGUS); myelofibrosis; myelodysplastic syndrome, myelodysplasias; other immunoproliferative neoplasms (eg, Waldenstrom macroglobulinemia)

Anemia, cytopenias, and polycythemia anemias

Coagulation disorders (hypocoagulable and hypercoagulable conditions)

Traumatic, mechanical, and vascular disorders: mechanical injury to erythrocytes (eg, cardiac valve hemolysis); disorders of the spleen; splenic rupture/laceration; splenic infarct; splenic abscess; effects/complications of splenectomy (eg, sepsis due to encapsulated bacteria); hypersplenism

Adverse effects of drugs on the hematologic and lymphoreticular systems: antiplatelet drugs, antithrombin drugs (eg, dabigatran); chemotherapeutic agents; inhibitors of coagulation factors; methemoglobinemia, acquired; propylthiouracil; tumor lysis syndrome; warfarin

Behavioral Health - BOTH STEPS

Normal Processes

Psychodynamic and behavioral factors, related past experience (eg, transference, personality traits)

Adaptive behavioral responses to stress and illness (eg, coping mechanisms)

Maladaptive behavioral responses to stress and illness (eg, drug-seeking behavior, sleep deprivation)

Patient adherence: general adherence; adolescent adherence

Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis

Psychotic disorders: brief psychotic disorder; delusional disorder; psychotic disorder due to another medical condition; schizophrenia; schizoaffective disorder; substance-induced psychotic disorder

Anxiety disorders: acute stress disorder; anxiety disorders (generalized anxiety disorder, anxiety due to another medical condition, social phobia); hyperventilation syndrome; obsessive-compulsive disorder; panic disorder with and without agoraphobia; phobic disorders; post-traumatic stress disorder; separation anxiety disorder; substance-induced anxiety disorder, trichotillomania

Mood disorders: major depressive disorder with and without psychotic features, with and without seasonal pattern; major depressive disorder, postpartum, with and without psychotic features, including screening; cyclothymic disorder; persistent depressive disorder (dysthymia); bipolar disorder, manic/depressed/mixed; premenstrual dysphoric disorder; bipolar and related disorder or depressive disorder due to another medical condition; substance/medication-induced bipolar and related disorder or depressive disorder (illegal or prescribed); suicidal ideation/attempt

Somatoform disorders: body dysmorphic disorder; conversion disorder, including psychogenic seizures; dissociative disorders; illness anxiety disorder (hypochondriasis); malingering; pain disorder; somatic symptom disorder

Factitious disorders: factitious disorder imposed on self

Eating disorders and impulse control disorders: anorexia nervosa; binge-eating disorder; bulimia nervosa; eating disorder; disruptive, impulse-control, and conduct disorders (eg, gambling, kleptomania, pyromania)

Disorders originating in infancy/childhood: reactive attachment disorder; attention-deficit/hyperactivity disorder; speech sound disorder or language disorder; learning disorder/dyslexia; intellectual developmental disorder and developmental delay, undefined, including school problems, fetal alcohol syndrome; oppositional defiant disorder, conduct disorder; autism spectrum disorder, Rett syndrome; psychoses with origin specific to childhood; elimination disorders (incontinence, encopresis); tic disorders/Tourette disorder

Personality disorders: antisocial personality disorder; avoidant personality disorder; borderline personality disorder; dependent personality disorder; histrionic personality disorder; narcissistic personality disorder; obsessive-compulsive personality disorder; paranoid personality disorder; schizoid personality disorder

Psychosocial disorders/behaviors: adjustment disorder; grief response/bereavement, normal and persistent complex; parent-child relational problems other than physical or emotional abuse; other psychosocial stress

Sexual and gender identity disorders: gender dysphoria; psychosexual dysfunction

Substance use disorders: alcohol use disorder/intoxication/dependence/withdrawal; tobacco/nicotine use disorder/dependence/withdrawal; varenicline use; cannabis use disorder/intoxication/dependence; hallucinogen use disorder/intoxication/dependence/withdrawal; inhalant use disorder/intoxication/dependence/withdrawal; opioid, heroin, including prescription drug, use disorder/intoxication/dependence/withdrawal; sedative, hypnotic, including benzodiazepine and barbiturate use disorder/intoxication/dependence/withdrawal; stimulant, cocaine, methamphetamine use disorder/intoxication/dependence/withdrawal; other drugs of use disorders (eg, ecstasy, PCP, bath salts)/intoxication/dependence/withdrawal; polysubstance use disorder/intoxication/dependence/withdrawal

Nervous System & Special Senses - BOTH STEPS

Normal Processes

Embryonic development, fetal maturation, and perinatal changes, including neural tube derivatives, cerebral ventricles, and neural crest derivatives

Organ structure and function

Cell/tissue structure and function, including neuronal cellular and molecular biology

Repair, regeneration, and changes associated with stage of life

Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis

Infectious, immunologic, and inflammatory disorders

Neoplasms (cerebral, spinal, and peripheral): benign (meningioma, neurofibromatosis); malignant (glioblastoma multiforme, astrocytoma, medulloblastoma, primary CNS lymphoma); metastatic (eg, breast, lung, pancreatic, testicular, melanoma)

Cerebrovascular disease: arteriovenous malformations, ectatic cerebral vessels; transient ischemic attack; stroke, thrombotic: cerebral artery occlusion/cerebral infarction; stroke, embolic: cerebral embolism; stroke: intracerebral hemorrhage, including subarachnoid hemorrhage, traumatic intracranial hemorrhage; cerebral artery aneurysm; carotid artery stenosis/atherosclerosis/occlusion/dissection; vertebral artery deficiency/dissection; subclavian steal syndrome; vascular dementia; hypertensive encephalopathy; posterior reversible encephalopathy syndrome; venous sinus thrombosis

Disorders relating to the spine, spinal cord, and spinal nerve roots: cauda equina syndrome; spinal artery thrombosis/embolus/infarct; spinal cord compression; spinal cord transection, paraplegia and quadriplegia, acute and chronic effects (eg, autonomic dysreflexia); spinal stenosis (cervical, lumbar); syringomyelia

Cranial and peripheral nerve disorders

Neurologic pain syndromes: complex regional pain syndrome (reflex sympathetic dystrophy, causalgia); fibromyalgia; postherpetic neuralgia; phantom limb pain/syndrome; thalamic pain syndrome; trigeminal neuralgia

Degenerative disorders/amnestic syndromes: Alzheimer disease; frontotemporal dementia, including progressive supranuclear palsy, Lewy body disease; mild neurocognitive disorder, mild cognitive impairment

Global cerebral dysfunction: altered states of consciousness; delirium; coma/brain death

Neuromuscular disorders: amyotrophic lateral sclerosis/spinal muscular atrophy; muscular dystrophy (eg, Duchenne, myotonic); muscle channelopathies (eg, hypokalemic period paralysis)

Movement disorders: acute dystonia; adult tic disease; essential tremor; Huntington disease; Parkinson disease, including Parkinson dementia

Metabolic disorders: adrenoleukodystrophy; metabolic encephalopathy

Paroxysmal disorders: headache, including migraine, mixed, tension, ice-pick, cluster, medication withdrawal, caffeine withdrawal; seizure disorders, including generalized tonic-clonic, partial, absence, febrile

Sleep disorders: cataplexy and narcolepsy; circadian rhythm sleep-wake disorder; insomnia, primary; sleep terror disorder and sleepwalking; REM sleep behavior disorder; restless legs syndrome

Traumatic and mechanical disorders and disorders of increased intracranial pressure: anoxic brain damage, cerebral hypoxia; epidural, subdural hematoma (cerebral and spinal); intraparenchymal hemorrhage, traumatic subarachnoid hemorrhage; cerebral edema; pseudotumor cerebri (idiopathic intracranial hypertension); torticollis/cervical dystonia; hydrocephalus, including normal-pressure; traumatic brain injury (concussion)/postconcussion syndrome (dementia pugilistica); traumatic brain syndrome

Congenital disorders: Friedreich ataxia; neural tube defects (eg, spina bifida, holoprosencephaly, anencephaly); microcephaly; Sturge-Weber syndrome; tuberous sclerosis, von Hippel-Lindau disease; hydrocephalus, obstructive (Arnold-Chiari)

Adverse effects of drugs on the nervous system: acute dystonic reaction; drug-induced meningitis (eg, NSAIDs, sulfa drugs); drug-induced neuropathy (eg, vincristine, isoniazid, metronidazole); extrapyramidal adverse effects (eg, akathisia, dystonia, drug-induced parkinsonism); neuroleptic malignant syndrome; poisoning by psychotropic agents, including antidepressants; serotonin syndrome; tardive dyskinesia

Disorders of the eye and eyelid

Disorders of the ear

Skin & Subcutaneous Tissue - BOTH STEPS

Normal Processes

Embryonic development, fetal maturation, and neonatal changes

Organ structure and function, including barrier function, thermal regulation

Cell/tissue structure and function, eccrine function

Repair, regeneration, and changes associated with stage of life (eg, senile purpura, male pattern baldness, postmenopausal hair changes)

Skin defense mechanisms and normal flora

Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis

Infectious, immunologic, and inflammatory disorders

Neoplasms

Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes)

Oral disease: aphthous ulcers (stomatitis, canker sores); leukoplakia

Disorders of pigmentation: albinism; lentigo

Traumatic and mechanical disorders: animal bites (dogs, cats, etc); burns or wounds affecting the skin or subcutaneous tissue (eg, sunburn, other including blast injuries and burns); cauliflower ear; effects of ultraviolet light; keloids; tattoo; thermal injury, perniosis, frostbite; ulcers, decubitus

Congenital disorders: xeroderma pigmentosum; benign lesions in neonates, infants, children (eg, congenital nevi)

Adverse effects of drugs on skin and subcutaneous tissue: drug reactions, eruptions, including local reaction to vaccine

Musculoskeletal System - BOTH STEPS

Normal processes

Embryonic development, fetal maturation, and perinatal changes

Organ structure and function

Cell/tissue structure and function

Repair, regeneration, and changes associated with stage of life

Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis

Infectious, inflammatory, and immunologic disorders

Neoplasms: benign neoplasms (e.g., ganglion cyst); malignant neoplasms of bone (eg, osteosarcoma, sarcoma, leiomyosarcoma, rhabdosarcoma); metastases to bone, secondary malignant neoplasm of bone

Degenerative and metabolic disorders [glternative]

Traumatic and mechanical disorders: amputation and care of amputees; backache, including low back pain; blast injuries; compartment syndrome; contractures, hospital-acquired; contusions; dislocations; fractures; sprains, strains; kyphoscoliosis, scoliosis; rotator cuff syndrome; slipped capital femoral epiphysis; dislocation of hip

Congenital disorders: achondroplasia/dwarfism; disorders of limb development (HOX gene mutation, phocomelia); developmental dysplasia of the hip; dislocation of hip in infantile spinal muscular atrophy; genu valgum or varum; foot deformities (flat foot, valgus/varus deformities); osteogenesis imperfecta; McArdle disease; mitochondrial myopathies

Adverse effects of drugs on the musculoskeletal system: drug-induced myopathy (eg, steroids, statins, cocaine, AZT); malignant hyperthermia

Cardiovascular System - BOTH STEPS

Normal Processes

Embryonic development, fetal maturation, and perinatal transitional changes

Organ structure and function

Cell/tissue structure and function

Repair, regeneration, and changes associated with stage of life

Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis

Infectious, immunologic, and inflammatory disorders

Neoplasms: myxoma, metastases

Dysrhythmias: premature beats (PACs, PVCs); atrial flutter/fibrillation; multifocal atrial tachycardia; paroxysmal tachycardias; ventricular tachycardia/fibrillation; wide complex tachycardia; torsades de pointes; bradycardias; atrioventricular block (first-, second-, third-degree); conduction disorder (LBBB, RBBB); cardiac arrest; sick sinus syndrome; prolonged QT syndrome; Wolff-Parkinson-White syndrome; carotid sinus hypersensitivity; pacemaker dysfunction, including failure to sense, capture

Heart failure: chordae tendineae rupture; congestive heart failure; cor pulmonale; diastolic dysfunction; systolic dysfunction; mitral valve dysfunction; heart failure secondary to myocardial infarction; high-output heart failure, including thyrotoxicosis-induced, anemia-induced; tachycardia-induced; cardiogenic pulmonary edema

Ischemic heart disease: acute coronary syndrome, acute myocardial infarction; angina pectoris, stable and unstable/coronary artery disease/coronary insufficiency; coronary artery spasm

Diseases of the myocardium: cardiomyopathy, dilated, including alcoholic, viral, takotsubo; cardiomyopathy, obstructive hypertrophic; cardiomyopathy, familial dilated; cardiomyopathy, restrictive; hypertensive heart disease, left ventricular hypertrophy, right ventricular hypertrophy; complications of myocardial infarction; nontraumatic tamponade post-myocardial infarction; papillary muscle rupture/dysfunction; ventricular free wall rupture; myocarditis

Diseases of the pericardium: chronic constrictive pericarditis; pericardial effusion; pericardial tamponade; acute pericarditis; pericarditis, following myocardial infarction, surgery, trauma

Valvular heart disease: valve disorders, mitral/aortic/tricuspid, pulmonic (eg, regurgitation, stenosis, prolapse, insufficiency, vegetation); functional murmurs; rheumatic heart disease; complications of artificial valves

Hypotension: orthostatic hypotension

Hypertension: elevated blood pressure reading without diagnosis of hypertension; essential hypertension; malignant hypertension; secondary hypertension

Dyslipidemia: hypercholesterolemia; hyperlipidemia; hypertriglyceridemia; lipoproteins/lipoprotein lipase deficiency

Vascular disorders

Traumatic and mechanical disorders: ventricular puncture; myocardial contusion; myocardial rupture; traumatic aortic dissection; traumatic tamponade

Congenital disorders, including disease in adults: anomalous left coronary artery; atrial septal defect; coarctation of the aorta; endocardial cushion defect; patent foramen ovale; patent ductus arteriosus; tetralogy of Fallot; transposition of the great vessels; ventricular septal defect

Adverse effects of drugs on the cardiovascular system: adriamycin; cocaine, amphetamine, PCP; ACE inhibitors, calcium channel blockers, alpha blockers, minoxidil

Respiratory System - BOTH STEPS

Normal Processes

Embryonic development, fetal maturation, and perinatal changes

Organ structure and function

Cell/tissue structure and function, including surfactant formation, and alveolar structure

Repair, regeneration, and changes associated with stage of life

Pulmonary defense mechanisms and normal flora

Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis

Infectious, immunologic, and inflammatory disorders

Neoplasms

Obstructive airway disease: asthma, reactive airway disease; bronchiectasis; chronic airway obstruction; chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema

Pneumoconiosis/fibrosing/restrictive pulmonary disorders/interstitial lung disease: pneumoconiosis; asbestosis; silicosis; silo-filler’s lung, byssinosis, bagassosis, berylliosis; hypersensitivity pneumonitis; hypereosinophilic syndromes, Loeffler syndrome; interstitial pneumonia, usual (UIP), desquamative (DIP), nonspecific

Respiratory failure/respiratory arrest and pulmonary vascular disorders: acute respiratory distress syndrome (ARDS); pulmonary hypertension; pulmonary vascular disorders, arteriovenous fistula; pulmonary edema, pulmonary cause and unspecified; pulmonary embolism; air and fat embolism; respiratory failure due to enteral feeding

Metabolic, regulatory, and structural disorders: disorders of gas exchange; hypoventilation; hypoxia; pulmonary alveolar proteinosis; ventilation-perfusion imbalance

Disorders of the pleura, mediastinum, and chest wall: chylothorax; costochondritis; empyema; hemothorax; mediastinitis; pleural effusion; pleuritis; pneumomediastinum; pneumothorax

Traumatic and mechanical disorders

Congenital disorders: bronchogenic cysts; congenital cysts; congenital diaphragmatic hernia; pulmonary sequestration; immotile cilia syndrome

Adverse effects of drugs on the respiratory system: bleomycin, amiodarone; adverse effects of 100% oxygen; acute effects of tobacco/nicotine, inhalants, cocaine

Gastrointestinal System - BOTH STEPS

Normal Processes

Embryonic development, fetal maturation, and perinatal changes

Organ structure and function

Cell/tissue structure and function

Repair, regeneration, and changes associated with stage of life

Gastrointestinal defense mechanisms and normal flora

Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis

Infectious, immunologic, and inflammatory disorders

Neoplasms

Signs, symptoms, and ill-defined disorders: upper gastrointestinal bleeding; lower gastrointestinal bleeding; constipation; diarrhea; hematochezia; bright red rectal bleeding; melena; nausea, vomiting, rumination

Disorders of the oral cavity, salivary glands, and esophagus

Disorders of the stomach, small intestine, colon, rectum, anus

Disorders of the liver and biliary system, noninfectious

Disorders of the pancreas: pancreatitis, acute; pancreatitis, chronic; pancreatitis, hereditary; pancreatic cyst/pseudocyst; pancreatic duct obstruction; pancreatic insufficiency

Disorders of the peritoneal cavity: ascites

Traumatic and mechanical disorders: abdominal wall defects; adhesions, postsurgical; digestive system complications of surgery; post-gastric surgery syndromes (eg, blind loop syndrome, adhesions); duodenal tear; foreign body in digestive system; inguinal, femoral, and abdominal wall hernias; open wound, abdominal; perforation of hollow viscus and blunt trauma; perforation/rupture of esophagus (Boerhaave syndrome); umbilical hernia

Congenital disorders: annular pancreas, biliary atresia, cleft lip and palate, esophageal atresia, malrotation without volvulus, Meckel diverticulum, pyloric stenosis, tracheoesophageal fistula

Adverse effects of drugs on the gastrointestinal system: drug-induced changes in motility (chronic laxative abuse, opioids); drug-induced gastritis, duodenitis, peptic ulcer disease (NSAIDs); drug-induced hepatitis (eg, acetaminophen, isoniazid); drug-induced pancreatitis (eg, thiazide diuretics)

Renal & Urinary System - BOTH STEPS

Normal Processes

Embryonic development, fetal maturation, and perinatal changes

Organ structure and function

Cell/tissue structure and function

Repair, regeneration, and changes associated with stage of life

Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis

Infectious, immunologic, and inflammatory disorders

Neoplasms

Signs, symptoms, and ill-defined disorders: dysuria; hematuria; oliguria, anuria; proteinuria

Metabolic and regulatory disorders: acute kidney injury; renal insufficiency; azotemia, uremic syndrome; chronic kidney disease, including end-stage renal disease; cystinuria; Fanconi syndrome; hypertensive renal disease (renal complications of hypertension); renal calculi, ureteral calculi, nephrolithiasis; renal tubular acidosis

Vascular disorders: renal artery stenosis (atherosclerosis, fibromuscular dysplasia, nephrosclerosis); renal vein thrombosis; renal infarction

Traumatic and mechanical disorders: bladder rupture; neurogenic bladder; obstructive uropathy; posterior urethral valves; renal laceration; renal vascular injury; ureteral laceration/avulsion/disruption; urethral diverticulum; obstruction/stricture/prolapse, urethral/ureteral, vaginal walls, uterine, uterovaginal; urinary incontinence, including secondary enuresis; vesicoureteral reflux

Congenital disorders: double ureters/ureteral duplication/double collecting system; horseshoe kidney; hydronephrosis/reflux; renal agenesis, renal hypoplasia, renal dysplasia; single kidney

Adverse effects of drugs on the renal and urinary system: ACE inhibitors; aminoglycosides; amphotericin B; cisplatin; furosemide; gadolinium (nephrogenic systemic fibrosis); heroin; iodinated contrast dye; lithium; NSAIDs; penicillins; sulfa drugs; tenofovir; drug-induced urinary retention

Pregnancy, Childbirth, & the Puerperium - STEP 2 CK ONLY

Normal Processes

Organ structure and function: pregnancy, including fertilization, implantation, development of embryo, labor and delivery, the puerperium, lactation, gestational uterus, placenta

Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis

Prenatal care

Obstetric complications: abortion, induced, septic, missed, spontaneous, threatened; acute fatty liver of pregnancy; anemia of pregnancy, sickle cell disease, thalassemia in pregnancy; antepartum hemorrhage, including third-trimester bleeding; cardiomyopathy of pregnancy; cervical insufficiency, cervical shortening; cholestasis of pregnancy, intrahepatic; congenital abnormalities, maternal (eg, bicornuate uterus); ectopic pregnancy; fetal abnormality affecting management of mother (eg, hydrocephalus, spina bifida); fetal growth restriction; gestational diabetes; maternal mortality; multiple gestation; placental abnormalities (abruptio placentae, placenta previa, premature separation of placenta); polyhydramnios, oligohydramnios; preeclampsia, eclampsia, HELLP syndrome, gestational hypertension; prolonged pregnancy; Rh isoimmunization affecting management of mother; vomiting in pregnancy (morning sickness, hyperemesis gravidarum); trauma in pregnancy; infections complicating pregnancy

Labor and delivery: labor and delivery, uncomplicated; labor and delivery, complicated, including shoulder dystocia; cesarean delivery, including complications; cord compression, cord prolapse; fetal malpresentations (eg, breech/external cephalic); intrapartum fetal evaluation, including fetal heart tones; intrapartum prophylaxis (eg, HIV, Chlamydia, gonococcal prophylaxis); premature rupture of membranes; preterm (before 37 weeks’ gestation) and postdates labor and delivery; threatened preterm labor

Puerperium, including complications: lactation problems; breast-feeding problems; lochia; postpartum cardiomyopathy; postpartum blues; postpartum hemorrhage; postpartum sepsis; retained placenta, products of conception (eg, placenta accreta); uterine atony

Newborn (birth to 4 weeks of age)

Congenital disorders, neonatal: congenital malformations and anomalies; neonatal hydrocele

Adverse effects of drugs on pregnancy, childbirth, and the puerperium: alcohol, tobacco, and other drugs (ATOD); prenatal radiation exposure; teratology (eg, ACE inhibitors, SSRIs, warfarin, infections, toxins)

Systemic disorders affecting pregnancy, labor and delivery, and puerperium: appendicitis; asthma; carpal tunnel syndrome in pregnancy; cirrhosis; deep venous thrombosis (DVT); diabetes mellitus; heart failure, valvular heart disease; hypertension; myasthenia gravis; obesity; pancreatitis; psychiatric disorders; renal calculus/calculi; renal failure/renal disease, including SLE; seizure disorders; thyroid disorders, hypothyroidism, hyperthyroidism

Female Reproductive System & Breast - BOTH STEPS

Normal Processes

Embryonic development, fetal maturation, and perinatal changes, gametogenesis

Organ structure and function

Cell/tissue structure and function: hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones

Reproductive system defense mechanisms and normal flora

Repair, regeneration, and changes associated with stage of life

Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis

Breast

Female reproductive system

Neoplasms of the cervix, ovary, uterus, vagina, and vulva

Fertility and infertility: assisted reproductive techniques (ART); contraception (eg, oral contraceptives, IUD, vaginal cap, cervical sponge, diaphragm, implant, morning-after pill, male and female condoms); female infertility; gonadal dysgenesis 45,X (Turner syndrome); sterilization; tubal factors; infertility

Menopause: ovarian failure, premature menopause; perimenopause; premenopausal menorrhagia; postmenopausal atrophic vaginitis (vaginal atrophy); postmenopausal bleeding; vasomotor symptoms

Menstrual and endocrine disorders: abnormal uterine bleeding, including perimenopausal; absence of menstruation (primary amenorrhea, secondary amenorrhea including undiagnosed pregnancy); anovulation; dysmenorrhea; endometriosis; hirsutism, virilization; mittelschmerz; pelvic pain; polycystic ovarian syndrome; postcoital bleeding; premenstrual syndrome

Sexual dysfunction: dyspareunia; orgasmic dysfunction; sexual desire/arousal syndrome; vaginismus

Traumatic and mechanical disorders: Asherman syndrome; chronic inversion of uterus; chronic pelvic pain syndrome; cystocele; imperforate hymen; injuries, wounds, and burns affecting the female reproductive system and injuries, wounds, burns, and blast injuries; ovarian torsion; pelvic relaxation; rectocele; urethrocele

Congenital disorders: müllerian agenesis; uterus didelphys, bicornuate uterus; short cervix

Adverse effects of drugs on the female reproductive system and breast: antihistamines, H2-receptor blockers; benzodiazepines; beta-adrenergic blockers; hormone replacement; opioids; spironolactone; selective serotonin reuptake inhibitors; tricyclic antidepressants

Male Reproductive System - BOTH STEPS

Normal Processes

Embryonic development, fetal maturation, and neonatal changes, gametogenesis

Organ structure and function

Cell/tissue structure and function, including hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones

Reproductive system defense mechanisms and normal flora

Repair, regeneration, and changes associated with stage of life

Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis

Infectious, immunologic, and inflammatory disorders

Neoplasms: malignant neoplasms, penile, prostate, testicular, breast

Metabolic and regulatory disorders, including sexual dysfunction: erectile dysfunction, impotence; infertility, male factor; male sexual dysfunction; premature ejaculation

Traumatic and mechanical disorders: benign prostatic hyperplasia/hypertrophy; circumcision, including complications; epididymal cyst; hydrocele; injuries, wounds, and burns to male genitalia, including blast injuries; penile laceration, penile fracture, Peyronie disease; phimosis; scrotal laceration; spermatocele; testicular rupture/avulsion/laceration; torsion of testis; urethral laceration/disruption; varicocele

Congenital disorders of the male reproductive system: hypospadias; Klinefelter syndrome; undescended testicle

Adverse effects of drugs on the male reproductive system: alcohol; androgens, testosterone; antipsychotics, antidepressants including selective serotonin reuptake inhibitors; beta-adrenergic blockers; diuretic including thiazides; drug-induced priapism (eg, trazodone); finasteride, dutasteride; sildenafil, tadalafil, vardenafil; marijuana; nitric oxide reductase inhibitors

Endocrine System - BOTH STEPS

Normal Processes

Embryonic development, fetal maturation, and perinatal changes

Organ structure and function

Cell/tissue/structure and function, including hormone synthesis, secretion, action, metabolism

Repair, regeneration, and changes associated with stage of life

Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis

Diabetes mellitus and other disorders of the endocrine pancreas

Thyroid disorders: cyst, nodule; euthyroid sick syndrome; goiter (euthyroid-normal thyroid function with goiter); hypothyroidism; hyperthyroidism, including thyrotoxicosis and thyroid storm; thyroiditis, including Hashimoto; Graves disease; neoplasms (benign cysts and nodules, thyroid cancer including papillary, follicular, medullary, and anaplastic); thyroid deficiency from pituitary disorder; infertility due to thyroid disease; secondary hypothyroidism and hyperthyroidism

Parathyroid disorders: hyperparathyroidism; hypoparathyroidism; metabolic bone disease

Adrenal disorders: corticoadrenal insufficiency (Addison disease); adrenal insufficiency, secondary; hypocortisolism; Cushing syndrome; hyperaldosteronism; neoplasms, benign and malignant (adrenal neuroblastoma, pheochromocytoma, adrenal carcinoma, adrenal adenoma, aldosteronoma, adrenal incidentaloma); delayed and precocious puberty; hypertensive endocrine disease

Pituitary disorders: acromegaly/gigantism; diabetes insipidus; galactorrhea not associated with childbirth; panhypopituitarism from any cause; pituitary apoplexy (eg, Sheehan syndrome); growth hormone deficiency; short stature; SIADH (inappropriate secretion of ADH [vasopressin]); neoplasm, benign and malignant (pituitary adenomas, craniopharyngioma, metastatic disease); prolactinoma and hyperprolactinemia, including infertility due to these disorders; hypogonadism, primary and secondary

Hypothalamic endocrine disorders

Multiple endocrine neoplasia (MEN1, MEN2)

Congenital disorders: disorders of sexual differentiation; congenital adrenal hyperplasia; androgen insensitivity/resistance syndrome; congenital hypothyroidism

Adverse effects of drugs on the endocrine system: drug, medicinal, and biologic substance effects; exogenous steroid suppression of adrenal glands, anabolic steroids

Multisystem Processes & Disorders - BOTH STEPS

Normal Processes

Principles of nutrition

Electrolyte and water metabolism

Intracellular accumulations (eg, pigments, fats, proteins, carbohydrates, minerals, inclusions, vacuoles, lysosomal/glycogen storage disease and structures related to storage diseases, glycogen phosphorylase deficiency, Zellweger syndrome)

Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis

Infectious, immunologic, and inflammatory disorders

Neoplasms and related disorders

Signs, symptoms, and ill-defined disorders: arthralgias; abdominal pain; chest pain; cough; dizziness, light-headedness, syncope, including breath-holding spells with syncope; dyspnea, shortness of breath; edema, anasarca; fatigue; fever of unknown origin; hemoptysis; pain management (in a nonaddiction, nonpalliative-care setting); joint pain; lymphedema; palpitations; pruritus; unexpected weight gain/weight loss

Nutrition

Toxins and environmental extremes

Venomous bites and stings: hymenoptera bites and stings; scorpion bites; snake bites; spider bites; jellyfish stings

Fluid, electrolyte, and acid-base balance disorders

Abuse

Multiple trauma (eg, prioritization, blast injury involving more than one organ system)

Shock, cardiogenic, hypovolemic, neurogenic, septic, sepsis, bacteremia, systemic inflammatory response syndrome (SIRS), refractory, multiorgan dysfunction syndrome: meningococcemia

Genetic metabolic and developmental disorders

Adverse effects of drugs on multisystem disorders: drug-induced electrolyte abnormalities and acid base-disorders (eg, albuterol; prednisone; diuretics; alcohol; drugs inducing polydipsia, SIADH, or diabetes insipidus)

Biostatistics, Epidemiology/Population Health, & Interpretation of the Medical Literature - BOTH STEPS

Epidemiology/population health

Study design, types and selection of studies (includes dependent/independent variables)

Measures of association

Distributions of data: measures of central tendency; measures of variability; regression to mean; normal distribution; nominal measurement

Correlation and regression, uses and interpretation: correlation coefficients; multiple regression

Principles of testing and screening

Study interpretation, drawing conclusions from data

Clinical decision making, interpretation and use of evidence-based data and recommendations: application of study results to patient care and practice, including patient preferences and individualization of risk profiles; risk/benefit analysis; synthesis of concepts with real data

Research ethics

Social Sciences - STEP VARIES

Communication and interpersonal skills, including health literacy and numeracy, cultural competence - STEP 1 ONLY

Medical ethics and jurisprudence, include issues related to death and dying and palliative care - STEP 2 CK ONLY

Systems-based practice (including health systems, public health, community, schools) and patient safety (including basic concepts and terminology) - STEP 2 CK ONLY