USMLE
Application Materials |
Examination |
Type of Applicant |
Registration Entity to Contact
|
Step 1 |
Students and graduates of LCME- and AOA-accredited medical
schools in the United States, Puerto Rico, and Canada |
NBME® |
Step 1 |
Students and graduates of medical schools outside the
United States, Puerto Rico, and Canada |
ECFMG® |
Step 3 |
All medical school graduates who have passed Step 1 and
Step 2 |
FSMB |
Home Pages for
ECFMG, FSMB, NBME Table
1. USMLE Step 1 Specifications*
*Percentages
may be changed without notice. 6 STEP 1 Content Outline
(U1D) General Principles Biochemistry and
molecular biology # gene expression: DNA structure, replication, and
exchange – DNA structure: single-
and double-stranded DNA, stabilizing forces, supercoiling – analysis of DNA:
sequencing, restriction analysis, PCR amplification, hybridization – DNA replication,
mutation, repair, degradation, and inactivation – gene structure and
organization; chromosomes; centromere, telomere – recombination,
insertion sequences, transposons – mechanisms of genetic
exchange (transformation, transduction, conjugation) cross-over,
recombination, linkage – plasmids and
bacteriophages # gene expression: transcription (including defects) – transcription of DNA
into RNA, enzymatic reactions, RNA, RNA degradation – regulation:
cis-regulatory elements, transcription factors, enhancers, promoters,
silencers, repressants, splicing # gene expression: translation (including defects) – the genetic code – structure and function
of tRNA – structure and function
of ribosomes – protein synthesis – regulation of
translation – post-translational
modifications (phosphorylation, addition of CHO units) – protein degradation # structure and function of proteins – principles of protein
structure and folding – enzymes: kinetics,
reaction mechanisms – structural and
regulatory proteins: ligand binding, self-assembly – regulatory properties # energy metabolism (metabolic sequences and
regulation) and disorders – generation of energy
from carbohydrates, fatty acids, and essential amino acids; glycolysis,
pentose phosphate pathway,
tricarboxylic acid cycle, ketogenesis, electron transport and oxidative phosphorylation,
glycogenolysis – storage of energy:
gluconeogenesis, glycogenesis, fatty acid and triglyceride synthesis – thermodynamics: free
energy, chemical equilibria and group transfer potential, energetics of ATP
and other high-energy
compounds # metabolic pathways of small molecules and associated
diseases – biosynthesis and
degradation of amino acids (eg, homocystinuria) – biosynthesis and
degradation of purine and pyrimidine nucleotides (eg, gout, Lesch-Nyhan syndrome) – biosynthesis and
degradation of lipids (eg, dyslipidemias, carnitine deficiency, adrenogenital syndromes) – biosynthesis and degradation
of porphyrins # biosynthesis and degradation of other macromolecules
and associated abnormalities, complex carbohydrates (eg, lysosomal storage
disease), glycoproteins, and proteoglycans Biology of cells # signal transduction: second messenger systems –
voltage- and ligand-gated channels and receptors # cell components (eg, endoplasmic reticulum, plasma
membrane, nucleus) # cytoskeleton (including cell movement and
intracellular transport) # secretion and exocytosis, endocytosis, transcytosis # cell cycle, mitosis, meiosis, structure and
regulation of spindle apparatus, control points # epithelial cells (including surface specialization,
intercellular junctions, gap junctions, and desmosomes) # fibroblasts, endothelial cells, and mesenchymal cells:
basement membrane, extracellular matrix, proteoglycans,
fibronectins, adhesion molecules, annexins # muscle cells (cardiac, smooth, skeletal): structure
and regulation of contractile elements, excitationcontraction coupling # adaptive cell response to injury (eg, hypertrophy,
metaplasia) 7 # mechanisms of cell injury and necrosis (including
free radical mediated cell injury) # apoptosis (programmed cell death) Human development and
genetics # embryogenesis: programmed gene expression, tissue
differentiation and morphogenesis, homeotic genes # congenital abnormalities: principles, patterns of
anomalies, dysmorphogenesis # principles of pedigree analysis (inheritance
patterns, occurrence and recurrence risk) # population genetics: Hardy-Weinberg law, founder
effects, mutation-selection equilibrium # genetic mechanisms: chromosomal abnormalities,
mendelian inheritance, multifactorial diseases # clinical genetics (including genetic testing,
prenatal diagnosis, newborn screening, genetic counseling/ ethics, gene therapy) Biology of tissue
response to disease # inflammation (cells and mediators) – acute inflammation and
mediator systems – vascular response to
injury (including mediators) – inflammatory cell recruitment
(adherence and cell migration) and phagocytosis – bactericidal mechanisms
and tissue injury – clinical manifestations
(including pain, fever, leukocytosis, leukemoid reaction, and chills) – chronic inflammation # reparative processes – wound healing,
hemostasis, and repair: thrombosis, granulation tissue, angiogenesis,
fibrosis, scar/keloid formation – regenerative processes # neoplasia – classification,
histologic diagnosis – grading, and staging of
neoplasms – cell biology,
biochemistry, and molecular biology of neoplastic cells: transformation,
oncogenes, altered cell
differentiation, and proliferation – hereditary neoplastic
disorders – invasion and metastasis – tumor immunology – paraneoplastic
manifestations of cancer – cancer epidemiology and
prevention Gender, ethnic, and
behavioral considerations affecting disease treatment and prevention
(including psychosocial, cultural,
occupational, and environmental) # progression through the life cycle (birth through
senescence) – cognitive, language,
motor skills, and social and interpersonal development – sexual development (eg,
puberty, menopause) – influence of
developmental stage on physician/patient interview # psychologic and social factors influencing patient
behavior – personality traits or coping
style (coping mechanisms) – psychodynamic and
behavioral factors, related past experience – family and cultural
factors, including socioeconomic status, ethnicity, and gender – adaptive and maladaptive
behavioral responses to stress and illness (eg, drug-seeking behavior, sleep deprivation) – interactions between
the patient and the physician or the health care system (eg, transference) – patient adherence
(general and adolescent) # patient interviewing, consultation, and interactions
with the family – establishing and
maintaining rapport – data gathering – approaches to patient
education – enticing patients to
make life style changes – communicating bad news – “difficult” interviews
(eg, anxious or angry patients) – multicultural ethnic
characteristics # medical ethics, jurisprudence, and professional
behavior – consent and informed
consent to treatment – physician-patient
relationships (eg, ethical conduct, confidentiality) 8 – death and dying – birth-related issues – issues related to
patient participation in research – interactions with other
health professionals (eg, referral) – sexuality and the
profession, other “boundary” issues – ethics of managed care – organization and cost
of health-care delivery Multisystem processes # nutrition – generation,
expenditure, and storage of energy at the whole-body level – assessment of
nutritional status across the life span (eg, calories, protein, essential
nutrients, hypoalimentation – functions of nutrients
(essential, transfatty acids, cholesterol) – protein-calorie
malnutrition – vitamin deficiencies
and/or toxicities – mineral deficiencies
and toxicities – eating disorders (eg,
obesity, anorexia, bulimia) # temperature regulation # adaptation to environmental extremes (including
occupational exposures) – physical and associated
disorders (eg, temperature; radiation; burns; decreased atmospheric pressure; high altitude
sickness; increased water pressure) – chemical (eg, gases,
vapors; smoke inhalation; agricultural hazards, volatile organic solvents,
heavy metals; principles of
poisoning and therapy) # fluid, electrolyte, and acid-base balance and
disorders (eg, dehydration, acidosis, alkalosis) Pharmacodynamic and
pharmacokinetic processes # general principles – pharmacokinetics:
absorption, distribution, metabolism, excretion, dosage intervals – mechanisms of drug
action, structure-activity relationships, receptors, signal transduction – concentration- and
dose-effect relationships (eg, efficacy, potency), types of agonists and
antagonists and their actions – individual factors
altering pharmacokinetics and pharmacodynamics (eg, age, gender, disease, tolerance, compliance,
body weight, metabolic proficiency, pharmacogenetics) – drug side effects,
overdosage, toxicology – drug interactions – regulatory issues (eg,
drug development, approval, scheduling) # general properties of autacoids (including peptides
and analogs, biogenic amines, prostanoids and their inhibitors, and smooth
muscle/endothelial autacoids) # general principles of autonomic pharmacology # general properties of antimicrobials (including
mechanisms of action and resistance) # general properties of antineoplastic agents and immunosuppressants,
drug effects on rapidly dividing mammalian cells Microbial biology and
infection # microbial classification and its basis # bacteria and bacterial diseases – structure and
composition – metabolism, physiology,
and regulation – genetics – nature and mechanisms
of action of virulence factors – pathophysiology of
infection – epidemiology and
ecology – principles of
cultivation, assay, and laboratory diagnosis # viruses and viral diseases – physical and chemical
properties – replication – genetics 9 – principles of
cultivation, assay, and laboratory diagnosis – molecular basis of
pathogenesis – pathophysiology of
infection – latent and persistent
infections – epidemiology – oncogenic viruses # fungi and fungal infections – structure, physiology,
cultivation, and laboratory diagnosis – pathogenesis and
epidemiology # parasites and parasitic diseases – structure, physiology,
and laboratory diagnosis – pathogenesis and
epidemiology # principles of sterilization and pure culture
technique Immune responses # production and function of granulocytes, natural
killer cells, macrophages # production and function of T lymphocytes, T
lymphocyte receptors # production and function of B lymphocytes and plasma
cells; immunoglobulin and antibodies: structure and biologic properties # antigenicity and immunogenicity; antigen
presentation; cell activation and regulation; tolerance and clonal deletion # immunologic mediators: chemistry, function,
molecular biology, classic and alternative complement pathways, cytokines,
chemokines # immunogenetics; MHC structure and function, class I,
II molecules; erythrocyte antigens; transplantation # immunizations: vaccines, protective immunity # alterations in immunologic function – T or B lymphocyte
deficiencies – deficiencies of
phagocytic cells – combined
immunodeficiency disease – HIV infection/AIDS and
other acquired disorders of immune responsiveness – drug-induced
alterations in immune responses, immunopharmacology # immunologically mediated disorders – hypersensitivity (types
I–IV) – transplant rejection – autoimmune disorders – risks of
transplantation, transfusion (eg, graft-versus-host disease) – isoimmunization,
hemolytic disease of the newborn – immunopathogenesis # immunologic principles underlying diagnostic
laboratory tests (eg, ELISA, complement fixation, RIA, agglutination) Quantitative methods # fundamental concepts of measurement – scales of measurement – distribution, central
tendency, variability, probability – disease prevalence and
incidence – disease outcomes (eg,
fatality rates) – associations
(correlation or covariance) – health impact (eg, risk
differences and ratios) – sensitivity,
specificity, predictive values # fundamental concepts of study design – types of experimental
studies (eg, clinical trials, community intervention trials) – types of observational
studies (eg, cohort, case-control, cross-sectional, case series, community surveys) – sampling and sample
size – subject selection and
exposure allocation (eg, randomization, stratification, self-selection,
systematic assignment) – outcome assessment 10 – internal and external
validity # fundamental concepts of hypothesis testing and
statistical inference – confidence intervals – statistical
significance and type I error – statistical power and
type II error Hematopoietic and
lymphoreticular systems Normal processes # embryonic development, fetal maturation, and
perinatal changes # organ structure and function # cell/tissue structure and function – production and function
of erythrocytes, hemoglobin, O2 and CO2 transport, transport proteins – production and function
of leukocytes and the lymphoreticular system – production and function
of platelets – production and function
of coagulation and fibrinolytic factors # repair, regeneration, and changes associated with
stage of life Abnormal processes # infectious, inflammatory, and immunologic disorders – infections of the
blood, reticuloendothelial system, and lymphatics – allergic and
anaphylactic reactions and other immunopathologic mechanisms – acquired disorders of
immune deficiency – autoimmunity and
autoimmune diseases (eg, Coombs’ positive hemolytic anemia, pernicious
anemia, cryoglobulinemias, ITP) – anemia of chronic
disease – transfusion
complications, transplant rejection # traumatic and mechanical injury (eg, mechanical
injury to erythrocytes, splenic rupture) # neoplastic disorders (eg, lymphoma, leukemia,
multiple myeloma) # metabolic and regulatory disorders (acquired and
congenital) – anemias and cytopenias
(eg, iron deficiency anemia, hemoglobinopathies, hereditary spherocytosis) – cythemia – hemorrhagic and
hemostatic disorders (eg, coagulopathies, DIC) – bleeding secondary to
platelet disorders (von Willebrand's) # vascular and endothelial disorders (eg, effects and
complications of splenectomy, hypersplenism, TTP, hemolytic-uremic
syndrome) # systemic disorders affecting the hematopoietic and
lymphoreticular system (eg, nutritional deficiencies, systemic lupus
erythematosus) # idiopathic disorders Principles of therapeutics # mechanisms of action, use, and adverse effects of
drugs for treatment of disorders of the hematopoietic system – blood and blood
products – treatment of anemia,
drugs stimulating erythrocyte production (eg, erythropoietin) – drugs stimulating
leukocyte production (eg, G-CSF, GM-CSF) – anticoagulants,
thrombolytic drugs – antiplatelet drugs – antimicrobials (eg,
antimalarials, anti-HIV) – antineoplastic and
immunosuppressive drugs – drugs used to treat
acquired disorders of immune responsiveness # other therapeutic modalities (eg, splenectomy,
chelating agents, radiation therapy for lymphomas, plasmapheresis) Gender, ethnic, and
behavioral considerations affecting disease treatment and prevention
(including psychosocial, cultural,
occupational, and environmental) # emotional and behavioral factors (eg, diet,
depression and immune responses, “blood doping” among athletes) 11 # influence on person, family, and society (eg,
childhood leukemia) # occupational and other environmental risk factors
(eg, heavy metals, hydrocarbons, lead) # gender and ethnic factors (eg, herbal treatments
with bone marrow depression) Central and peripheral
nervous systems Normal processes # embryonic development, fetal maturation, and
perinatal changes (eg, neural tube derivatives, cerebral ventricles, neural crest
derivatives) # organ structure and function – spinal cord (including
gross anatomy, blood supply, and spinal reflexes) – brain stem (including
cranial nerves and nuclei, reticular formation, gross anatomy, and blood supply) – brain (including gross
anatomy and blood supply; cognition, language, memory; hypothalamic function; limbic system
and emotional behavior; circadian rhythms and sleep; and control of eye movement) – sensory systems (including
proprioception, pain, vision, hearing, balance, taste, and olfaction) – motor systems (brain
and spinal cord, basal ganglia and cerebellum) – autonomic nervous
system – peripheral nerves # cell/tissue structure and function – axonal transport – excitable properties of
neurons, axons and dendrites, including channels – synthesis, storage,
release, reuptake, and degradation of neurotransmitters and neuromodulators – pre- and postsynaptic
receptor interactions, trophic and growth factors – brain metabolism – glia, myelin – brain homeostasis:
blood-brain barrier; cerebrospinal fluid formation and flow, choroid plexus # repair, regeneration and changes associated with
stage of life Abnormal processes # infectious, inflammatory, and immunologic disorders
(eg, meningitis, multiple sclerosis, myasthenia gravis) # traumatic and mechanical disorders (subdural and
epidural hematomas, cord compression, peripheral nerve injury) # neoplastic disorders (primary and metastatic) # acquired metabolic and regulatory disorders (eg,
delirium, Reye’s syndrome) # vascular disorders (eg, cerebrovascular occlusion,
venous sinus thrombosis, arterial aneurysms, hemorrhage) # systemic disorders affecting the nervous system (eg,
lupus, diabetic neuropathy) # idiopathic disorders affecting the nervous system # congenital disorders, including metabolic (eg,
neural tube defects, cerebral palsy, mental retardation, Down’s syndrome) # degenerative disorders (eg, peripheral neuropathy,
Alzheimer's dementia, Parkinson*s disease,
Huntington's disease, amyotrophic
lateral sclerosis) # paroxysmal disorders (eg, epilepsy, headache, pain
syndromes, and sleep disorders including narcolepsy, restless legs
syndrome/periodic limb movement, circadian rhythm disorders, parasomnias) # disorders of special senses (eg, blindness,
deafness) # psychopathologic disorders, processes and their
evaluation – early-onset disorders
(eg, learning disorders) – disorders related to
substance use – schizophrenia and other
psychotic disorders – mood disorders – anxiety disorders – somatoform disorders – personality disorders – physical and sexual
abuse of children, adults, and elders – other disorders (eg,
dissociative, impulse control, posttraumatic stress disorder) 12 Principles of
therapeutics # mechanisms of action, use, and adverse effects of
drugs for treatment of disorders of the nervous system – anesthetics – hypnotics – psychopharmacologic
agents (eg, anxiolytics, antidepressants, antipsychotic agents,
moodstabilizing agents) – anticonvulsants – analgesics – stimulants,
amphetamines – antiparkinsonian drugs – skeletal muscle
relaxants, botulinum toxin – neuromuscular junction
blocking agents – antiglaucoma drugs – drugs used to decrease intracranial
pressure (eg, mannitol, high-dose glucocorticoids) – antimigraine agents – drugs affecting
autonomic nervous system (eg, anticholinesterases) # other therapeutic modalities (eg, radiation, CFS
shunting, surgery) Gender, ethnic, and
behavioral considerations affecting disease treatment and prevention
(including psychosocial, cultural,
occupational, and environmental) # emotional and behavioral factors (eg, drug abuse,
dementia, sleep deprivation, accident prevention, pets) # influence on person, family, and society (eg,
developmental disabilities, dementia, generational reversal, nutrition, seizures,
sleep disorders) # occupational and other environmental risk factors
(eg, boxing, carbon monoxide exposure) # gender and ethnic factors Skin and related
connective tissue Normal processes # embryonic development, fetal maturation, and
perinatal changes # organ structure and function # cell/tissue structure and function (eg, barrier
functions, thermal regulation, eccrine function) # repair, regeneration, and changes associated with
stage of life or ethnicity (eg, senile purpura, male pattern baldness,
postmenopausal hair changes) # skin defense mechanisms and normal flora Abnormal processes # infectious, inflammatory, and immunologic disorders – bacterial infections,
(eg, acne, cellulitis, carbuncle, abscess, necrotizing fasciitis, gangrene) – viral infections (eg,
herpes infections, chickenpox, rubella, measles, roseola, verrucae) – fungal infections,
including mycoses, dermatophytosis (eg, tinea) – parasitic infections
(eg, scabies, lice) – immune and autoimmune
disorders (eg, discoid lupus erythematosus, scleroderma, dermatomyositis, alopecia, psoriasis,
urticaria, allergic dermatosis) # traumatic and mechanical disorders (eg, thermal injury,
decubitus ulcers, effects of ultraviolet light and radiation) # neoplastic disorders – keratinocytes (eg,
seborrheic keratosis, actinic keratosis, basal cell carcinoma, squamous cell carcinoma) – melanocytes (eg, nevi,
melanoma, ichthyosis) – vascular neoplasms (eg,
hemangiomas, Kaposi’s sarcoma) – other (eg, T-cell
lymphoma, skin appendage tumors) # metabolic, regulatory, and structural disorders (eg,
vitamin deficiencies, hypervitaminosis, hyperhidrosis) # vascular disorders (eg, vasculitis, Raynaud's
disease) # systemic disorders affecting the skin (eg,
Ehlers-Danlos syndrome, Marfan’s syndrome) Principles of
therapeutics # mechanisms of action, use, and adverse effects of
drugs for treatment of disorders of the skin and 13 connective tissue (including
anti-inflammatory agents (eg, steroids, antihistamines), emollients, sunscreen, retin-A,
antimicrobial agents, cytotoxic therapy (eg, methotrexate, PUVA,
keratinolytics) # other therapeutic modalities (eg, laser, tattoo
removal, cryotherapy) Gender, ethnic, and
behavioral considerations affecting disease treatment and prevention
(including psychosocial, cultural,
occupational, and environmental) # emotional and behavioral factors (eg, sun exposure,
acne) # influence on person, family, and society (eg,
psoriasis) # occupational and other environmental risk factors # gender and ethnic factors (eg, keloid) Musculoskeletal system Normal processes # embryonic development, fetal maturation, and
perinatal changes # organ structure and function # cell/tissue structure and function – biology of bones,
joints, tendons, skeletal muscle – exercise and physical
conditioning # repair, regeneration, and changes associated with
stage of life Abnormal processes # infectious, inflammatory, and immunologic disorders – infectious disorders
(eg, septic arthritis, Lyme disease, osteomyelitis) – inflammatory disorders
(eg, fibrositis, synovitis, tenosynovitis) – immunologic disorders
(eg, rheumatoid arthritis, ankylosing spondylitis, polymyositis, systemic lupus erythematosus,
dermatomyositis, polymyalgia rheumatica) # traumatic and mechanical disorders (eg, fractures,
sprains, strains, dislocations, repetitive motion injuries) # neoplastic disorders (eg, osteosarcoma, metastatic
disease) # metabolic, regulatory, and structural disorders (eg,
dwarfism, osteogenesis imperfecta, osteomalacia, osteoporosis,
osteodystrophy, gout) # vascular disorders (eg, polyarteritis nodosa, bone
infarcts) # systemic disorders affecting the musculoskeletal
system (eg, diabetes mellitus) # idiopathic disorders (eg, Dupuytren's contracture,
scoliosis, Paget's disease) # degenerative disorders (eg, disc disease,
osteoarthritis) Principles of
therapeutics # mechanisms of action, use, and adverse effects of
drugs for treatment of disorders of the musculoskeletal system – nonsteroidal
anti-inflammatory drugs – muscle relaxants – antigout therapy (eg,
allopurinol, colchicine, uricosuric drugs) – immunosuppressive drugs
(eg, glucocorticoids, gold, cytotoxic agents) – drugs affecting bone
mineralization (eg, diphosphonates, calcitonin, estrogen analogs) # other therapeutic modalities (eg, radiation,
surgery, casts, rehabilitation) Gender, ethnic, and
behavioral considerations affecting disease treatment and prevention
(including psychosocial, cultural,
occupational, and environmental) # emotional and behavioral factors (eg, diet,
exercise, seat belts, bicycle helmets) # influence on person, family, and society (eg,
osteoporosis, fractures in elderly, alcohol abuse, fractures) # occupational and other environmental risk factors
(eg, athletes, musicians) # gender and ethnic factors (eg, bone mass) Respiratory system Normal processes # embryonic development, fetal maturation, and
perinatal changes # organ structure and function 14 – airways (eg, mechanics
and regulation of breathing) – lung parenchyma (eg,
ventilation, perfusion, gas exchange) – pleura # cell/tissue structure and function (eg, surfactant
formation, alveolar structure) # repair, regeneration, and changes associated with
stage of life # pulmonary defense mechanisms and normal flora Abnormal processes # infectious, inflammatory, and immunologic disorders – infectious diseases of
the upper and lower respiratory tract and pleura and their complications (eg, bronchiectasis, abscess,
empyema) – immunologic disorders – allergic and
hypersensitivity disorders (eg, asthma) – autoimmune disorders
(eg, Wegener’s granulomatosis, Goodpasture’s syndrome) – inflammatory disorders – pneumoconioses – acute and chronic
alveolar injury (eg, adult respiratory distress syndrome, chlorine gas/smoke inhalation) – obstructive pulmonary
disease – restrictive pulmonary
disease (eg, sarcoidosis, idiopathic fibrosis) # traumatic and mechanical disorders (eg, aspiration,
pneumothorax, atelectasis, sleep apnea) # neoplastic disorders (eg, polyps, bronchogenic
carcinoma, mesothelioma, metastatic tumors) # metabolic, regulatory, and structural disorders (eg,
hypoventilation, disorders of gas exchange, ventilation-perfusion
imbalance, neonatal respiratory distress syndrome) # vascular and circulatory disorders (eg,
thromboembolic disease, pulmonary hypertension, pulmonary edema, pleural effusion) # systemic disorders affecting the respiratory system Principles of
therapeutics # mechanisms of action, use, and adverse effects of
drugs for treatment of disorders of the respiratory system (eg,
decongestants, cough suppressants, expectorants, mucolytics bronchodilator drugs,
anti-inflammatory and cytotoxic drugs, antimicrobial agents, antineoplastic
agents) # other therapeutic modalities (eg, oxygen therapy,
nasal CPAP, mechanical ventilation, physical therapy, surgical procedures,
including transplantation) Gender, ethnic, and
behavioral considerations affecting disease treatment and prevention
(including psychosocial, cultural,
occupational, and environmental) # emotional and behavioral factors (eg, smoking,
substance abuse, pets, allergies) # influence on person, family, and society (eg,
tuberculosis, asthma, chronic obstructive pulmonary disease, school issues,
protective parents, family smoking) # occupational and other environmental risk factors # gender and ethnic factors (eg, sarcoidosis, lung
cancer) Cardiovascular system Normal processes # embryonic development, fetal maturation, and
perinatal changes # organ structure and function – chambers, valves – cardiac cycle,
mechanics, heart sounds, cardiac output – hemodynamics (systemic,
pulmonary, coronary) and blood volume – circulation in specific
vascular beds # cell/tissue structure and function – heart muscle,
metabolism, oxygen consumption, biochemistry, and secretory function (eg,
atrial natriuretic peptide) – endothelium and
secretory function, vascular smooth muscle, microcirculation, and lymph flow – mechanisms of
atherosclerosis – neural and hormonal
regulation of the heart, blood vessels, and blood volume, including responses 15 to change in posture,
exercise, and tissue metabolism # repair, regeneration, and changes associated with
stage of life Abnormal processes # infectious, inflammatory, and immunologic disorders – infectious disorders
(eg, endocarditis, myocarditis, pericarditis ) – inflammatory and
immunologic disorders (eg, acute rheumatic fever, systemic lupus
erythematosus, transplant rejection,
vasculitis, temporal arteritis) # traumatic and mechanical disorders (eg, tamponade,
valvular disease, subaortic stenosis) # neoplastic disorders # metabolic and regulatory disorders (eg,
dysrhythmias, systolic and diastolic dysfunction, low- and highoutput heart failure, cor
pulmonale, systemic hypertension, ischemic heart disease, myocardial
infarction, systemic hypotension,
shock) # vascular disorders (eg, aneurysms, occlusions,
varicosities, atherosclerosis) # systemic diseases affecting the cardiovascular
system (eg, amyloidosis, aortic dissection with Marfan syndrome,
hemochromatosis, scleroderma) # congenital disorders of the heart and central
vessels Principles of
therapeutics # mechanisms of action, use, and adverse effects of
drugs for treatment of disorders of the cardiovascular system – coronary and peripheral
vasodilators – antiarrhythmic drugs – antihypertensive drugs – measures used to combat
hypotension and shock – drugs affecting
cholesterol and lipid metabolism – drugs affecting blood
coagulation, thrombolytic agents – inotropic agents and
treatment of heart failure – immunosuppressive and
antimicrobial drugs – drugs to treat
peripheral arterial disease # other therapeutic modalities (eg, pacemakers,
angioplasty, valves, grafts, other surgical procedures) Gender, ethnic, and
behavioral considerations affecting disease treatment and prevention
(including psychosocial, cultural,
occupational, and environmental) # emotional and behavioral factors (eg, smoking,
alcohol, ischemic heart disease, obesity, exercise, diet) # influence on person, family, and society (eg,
altered lifestyle) # occupational and other environmental risk factors
(eg, stress) # gender and ethnic factors (eg, hypertension) Gastrointestinal
system Normal processes # embryonic development, fetal maturation, and
perinatal changes # organ structure and function (eg, alimentary canal,
liver and biliary system, salivary glands and exocrine pancreas, motility,
digestion and absorption) # cell/tissue structure and function – endocrine and neural
regulatory functions, including GI hormones) – salivary,
gastrointestinal, pancreatic, hepatic secretory products (eg, enzymes,
proteins, bile salts) and processes – synthetic and metabolic
functions of hepatocytes # repair, regeneration, and changes associated with
stage of life # gastrointestinal defense mechanisms and normal flora Abnormal processes # infectious, inflammatory, and immunologic disorders – infectious disorders
(eg, peritonitis, hepatitis, gingivostomatitis, peptic ulcer, gastritis,
esophagitis, traveler’s diarrhea, food
poisoning) – inflammatory disorders
(eg, cholecystitis, pancreatitis) 16 – immunologic disorders
(eg, Crohn's disease, ulcerative colitis) # traumatic and mechanical disorders – malocclusion – hiatus hernia – obstruction (eg, volvulus,
intussusception, esophageal atresia, annular pancreas, post-surgical obstruction) – perforation of hollow
viscus and blunt trauma – inguinal, femoral, and
abdominal wall hernias – esophageal and colonic
diverticula (eg, Meckel's diverticulum) # neoplastic disorders (benign and malignant) # metabolic and regulatory disorders (eg, motility
disorders, malabsorption, hepatic failure, cholelithiasis) # vascular disorders (eg, portal hypertension,
hemorrhoids, ischemia, angiodysplasia) # systemic disorders affecting the gastrointestinal
system Principles of
therapeutics # mechanisms of action, use, and adverse effects of
drugs for treatment of disorders of the gastrointestinal system – treatment and
prophylaxis of peptic ulcer disease and gastroesophageal reflux (eg,
antacids, antisecretory drugs,
motility drugs, mucosal protective agents, antibiotics) – drugs to alter
gastrointestinal motility (eg, cathartics, antidiarrheal drugs, antiemetic
drugs, prokinetic drugs) – fluid replacement (eg,
oral rehydration) – pancreatic replacement
therapy and treatment of pancreatitis – drugs for treatment of
hepatic failure (eg, lactulose) and biliary disease (eg, drugs to dissolve gallstones) – anti-inflammatory,
immunosuppressive, antineoplastic, and antimicrobial drugs # other therapeutic modalities (eg, surgical
procedures, stents, feeding tubes) Gender, ethnic, and
behavioral considerations affecting disease treatment and prevention
(including psychosocial, cultural,
occupational, and environmental) # emotional and behavioral factors (eg, peptic ulcer,
encopresis, Monday morning stomach) # influence on person, family, and society (eg,
inflammatory bowel disease, irritable bowel disease, pancreatitis and alcohol,
chronic laxative abuse) # occupational and other environmental risk factors # gender and ethnic factors (eg, diets) Renal/urinary system Normal processes # embryonic development, fetal maturation, and
perinatal changes # organ structure and function – kidneys, ureters,
bladder, urethra – glomerular filtration
and hemodynamics – tubular reabsorption
and secretion, including transport processes and proteins – urinary concentration
and dilution – renal mechanisms in
acid-base balance – renal mechanisms in
body fluid homeostasis – micturition # cell/tissue structure and function (eg, renal
metabolism and oxygen consumption, hormones produced by or acting on the kidney) # repair, regeneration, and changes associated with
stage of life Abnormal processes # infectious, inflammatory, and immunologic disorders – infectious disorders – upper urinary tract
(eg, pyelonephritis, papillary necrosis) – lower urinary tract
(eg, cystitis, urethritis) – inflammatory and
immunologic disorders 17 – glomerular disorders
(eg, glomerulonephritis, nephrotic syndrome) – tubular interstitial
disease (eg, interstitial nephritis, transplant rejection, IgA nephropathy) # traumatic and mechanical disorders (eg, obstructive
uropathy) # neoplastic disorders (eg, renal, urinary bladder and
collecting system, metastases) # metabolic and regulatory disorders – renal failure, acute
and chronic (acute tubular necrosis) – tubular and collecting
duct disorders (eg, Fanconi’s syndrome, renal tubular acidosis, nephrogenic diabetes insipidus) – renal calculi # vascular disorders (eg, renal artery stenosis) # systemic diseases affecting the renal system (eg,
diabetes mellitus, hepatitis, amyloidosis, systemic lupus erythematosus, Wegener's
granulomatosis) Principles of
therapeutics # mechanisms of action, use, and adverse effects of
drugs for treatment of disorders of the renal and urinary system – diuretics, antidiuretic
drugs – drugs and fluids used
to treat volume, electrolyte, and acid-base disorders – drugs used to enhance
renal perfusion (eg, dopamine) – anti-inflammatory,
antimicrobial, immunosuppressive, and antineoplastic drugs # other therapeutic modalities (eg, dialysis, renal
transplantation) Gender, ethnic, and
behavioral considerations affecting disease treatment and prevention
(including psychosocial, cultural,
occupational, and environmental) # emotional and behavioral factors (eg, drug-induced
interstitial nephritis, diet) # influence on person, family, and society (eg,
hemodialysis, living related kidney donation, transplants) # occupational and other environmental risk factors
(eg, heavy metals) # gender and ethnic factors (eg, disease progression,
urinary tract infections) Reproductive system Normal processes # embryonic development, fetal maturation, and
perinatal changes # organ structure and function – female structure
(including breast) – female function (eg,
menstrual cycle, puberty, menopause) – male structure – male function (eg,
spermatogenesis, puberty) – intercourse, orgasm
(male and female) – pregnancy (including
labor and delivery, the puerperium, lactation, gestational uterus, placenta) # cell/tissue structure and function (including
hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones) # reproductive system defense mechanisms and normal
flora Abnormal processes # infectious, inflammatory, and immunologic disorders
(eg, toxic shock syndrome, breast abscess, orchitis, sexually transmitted
diseases, autoimmune hypogonadism, cystic mastitis) # traumatic and mechanical disorders (eg, female
incontinence, torsion of testis, varicocele) # neoplastic disorders (eg, female reproductive, male
reproductive, breast [male and female, including fibrocystic disease],
trophoblastic disease) # metabolic and regulatory processes – female (eg,
anovulation, infertility, polycystic ovaries, endometriosis, orgasmic
dysfunction, delayed and premature puberty) – menopausal syndrome – male (eg, infertility,
impotence, gynecomastia, delayed and premature puberty) – benign prostatic
hyperplasia # systemic disorders affecting reproductive function
(eg, obesity, myotonic dystrophy, cirrhosis, renal failure) 18 # disorders relating to pregnancy, the puerperium, and
the postpartum period – obstetric problems (eg,
ectopic pregnancy, third trimester bleeding) – complications affecting
other organ systems (eg, eclampsia, gestational diabetes, thyroid disorders) – disorders associated
with the puerperium (eg, postpartum hemorrhage, sepsis, depression) – antepartum,
intrapartum, postpartum disorders of the fetus (eg, prematurity, postmaturity,
cord compression, macrosomia,) Principles of
therapeutics # mechanisms of action, use, and adverse effects of
drugs for treatment of disorders of the reproductive system and management of
normal reproductive function – female reproductive
tract – fertility drugs – oral contraception,
other methods of contraception (eg, condoms) – estrogen, progestogen
replacement – stimulants and
inhibitors of labor – estrogen and
progesterone antagonists, treatment of menopause – stimulators and
inhibitors of lactation – male reproductive tract – fertility drugs – androgen replacement
and antagonists – gonadotropin-releasing
hormone and gonadotropin replacement – abortifacients – antimicrobials – antineoplastics – restoration of potency # other therapeutic modalities affecting the
reproductive system (eg, tampons, anabolic steroids) Gender, ethnic, and
behavioral considerations affecting disease treatment and prevention
(including psychosocial, cultural,
occupational, and environmental) # emotional and behavioral factors(eg, sexually
transmitted diseases) # influence on person, family, and society (eg,
infertility) # occupational and other environmental risk factors
(eg, radiation) # family planning and pregnancy (eg, unwanted) # gender identity, sexual orientation, sexuality,
libido # effects of traumatic stress syndrome, violence,
rape, child abuse Endocrine system Normal processes # embryonic development, fetal maturation, and
perinatal changes # organ structure and function – hypothalamus, posterior
and anterior pituitary gland – thyroid gland – parathyroid glands – adrenal cortex, adrenal
medulla – pancreatic islets – ovary and testis – adipose tissue # cell/tissue structure and function (eg, hormone
synthesis, secretion, action, and metabolism) – peptide hormones – steroid hormones,
including vitamin D – thyroid hormones – catecholamine hormones – renin-angiotensin
system # repair, regeneration, and changes associated with
stage of life Abnormal processes # infectious, inflammatory, and immunologic disorders
(eg, subacute thyroiditis, Graves’ disease, 19 sarcoidosis) # traumatic and mechanical disorders # neoplastic disorders (eg, pituitary, thyroid,
parathyroid, adrenal cortex, pancreatic islets, neural crest, pheochromocytoma) # metabolic and regulatory processes (eg, diabetes
mellitus, pituitary, hypothalamus, thyroid, parathyroid, pancreatic islet
disorders, adrenal disorders) # vascular disorders (eg, pituitary apoplexy) # systemic disorders affecting the endocrine system
(eg, hemochromatosis) # idiopathic disorders (eg, hirsutism) Principles of
therapeutics # mechanisms of action, use, and adverse effects of
drugs for treatment of disorders of the endocrine system – hormones and hormone
analogs – stimulators of hormone
production (eg, sulfonylureas) – inhibitors of hormone
production (eg, thiouracils) – hormone antagonists – potentiators of hormone
action (eg, thiazolidinediones, demeclocycline) – antiobesity agents (eg,
dexfenfluramine) # other therapeutic modalities (eg, surgery,
radiation) Gender, ethnic, and
behavioral considerations affecting disease treatment and prevention
(including psychosocial, cultural,
occupational, and environmental) # emotional and behavioral factors (eg, compliance in
diabetes mellitus, factitious use of insulin, psychogenic polydipsia) # influence on person, family, and society # occupational and other environmental risk factors
(eg, radiation exposure, iodine deficiency) # gender and ethnic factors Table 2. USMLE Step 2 Specifications* Normal Conditions and Disease Categories
Physician Task
·
Percentages
may be changed without notice 7 1. General Principles Infancy and Childhood • Normal growth and
development Adolescence • Sexuality; separation
from parents/autonomy; physical changes of puberty Senescence • Normal physical and
mental changes associated with aging Medical Ethics and
Jurisprudence • Consent and informed
consent to treatment (eg, full disclosure, alternate therapies, risks and benefits) and research
issues (eg, consent, placebos, conflict of interest, vulnerable populations) • Physician-patient
relationship (eg, truth-telling, confidentiality, privacy, autonomy, public reporting) • Death and dying (eg,
diagnosing death, life-support, autopsy, organ donation, euthanasia, suicide) and
birth-related issues (eg, prenatal diagnosis, abortion, maternal-fetal
conflict) Applied Biostatistics
and Clinical Epidemiology • Understanding
statistical concepts of measurement in medical practice • Interpretation of the
medical literature 2. Infectious and Parasitic Diseases (Topic covered under
each organ system) 3. Neoplasms (Topic covered under
each organ system) 4. Immunologic Disorders Health and Health Maintenance • Anaphylaxis and other
allergic reactions • HIV infection/AIDS • Immunization against
infectious agents (including infants, children, adults, the elderly; patients having compromised immune
systems) Mechanisms of Disease • Abnormalities of cell-mediated
immunity • Abnormalities of
humoral immunity 8 4. Immunologic Disorders (continued) Diagnosis • Anaphylactic reactions
and shock • Connective tissue
disorders (eg, mixed connective tissue disease and systemic lupus erythematosus) • HIV infection/AIDS;
deficiencies of cell-mediated immunity • Deficiencies of humoral
immunity; combined immune deficiency Principles of
Management (With emphasis on
topics covered in Diagnosis) • Pharmacotherapy only • Management decision
(treatment/diagnosis steps) • Treatment only 5. Diseases of the Blood and Blood-forming Organs Health and Health
Maintenance • Anemia (iron
deficiency, vitamin-related, drug-induced, sickle cell) • Infection (systemic) Mechanisms of Disease • Red cell disorders • Coagulation disorders • White cell disorders,
including leukopenia, agranulocytosis, and neoplasms Diagnosis • Anemia, disorders of
red cells, hemoglobin, and iron metabolism (eg, blood loss; iron deficiency anemia, nutritional deficiencies;
pernicious anemia, other megaloblastic anemias; hemolytic; anemia associated with
chronic disease; aplastic anemia, pancytopenia; thalassemia;
methemoglobinemia, sickle cell disease;
polycythemia vera; hemochromatosis) • Bleeding disorders, coagulopathies,
thrombocytopenia (eg, hemophilia, von Willebrand’s disease; qualitative and
quantitative platelet deficiencies; disseminated intravascular coagulation; hypofibrinogenemia;
idiopathic thrombocytopenic purpura; hemolytic-uremic syndrome) • Leukopenic disorders,
agranulocytosis • Neoplastic disorders
(eg, Hodgkin’s disease, non-Hodgkin’s lymphomas; acute leukemia in children; acute leukemia
in adults; chronic leukemic states; mycosis fungoides; multiple myeloma) • Eosinophilia and
reactions to transfusion of blood components including complications • Infection (eg, sepsis,
malaria, mononucleosis) Principles of
Management (With emphasis on
topics covered in Diagnosis) • Pharmacotherapy only • Management decision
(treatment/diagnosis steps) • Treatment only 9 6. Mental Disorders Health and Health
Maintenance • Early identification
and intervention (eg, suicide potential, depression, alcohol/substance abuse, family involvement in
schizophrenia) Mechanisms of Disease • Biologic markers of
mental retardation syndromes • Biologic markers of
mental disorders • Intended/unintended
effects of therapeutic interventions, including effects of drugs on neurotransmitters Diagnosis • Mental disorders usually
first diagnosed in infancy, childhood or adolescence (eg, mental retardation;
communication disorders; pervasive developmental disorders; attentiondeficit/ hyperactivity disorder;
disruptive disorders; tic disorders; elimination disorders) • Substance-related
disorders (eg, alcohol and other substances) • Schizophrenia and other
psychotic disorders • Mood disorders (eg,
bipolar disorder s; major unipolar depressive disorders; dysthymic disorder; mood disorder due to a general
medical condition; medication-induced mood disorder) • Anxiety disorders (eg,
panic disorder; phobia; obsessive-compulsive disorder; post-traumatic stress disorder;
generalized anxiety disorder; acute stress disorder; separation anxiety
disorder; anxiety due to a general
medical condition; substance-induced anxiety disorder) • Somatoform disorders
(eg, factitious disorder; somatization disorder; pain disorder; conversion disorder;
hypochondriasis) • Other
disorders/conditions (eg, sexual and gender identity disorders; personality
disorders; child, spouse, elder
abuse; eating disorders; adjustment disorders; dissociative disorders; psychological factors
affecting medical conditions) Principles of
Management (With emphasis on
topics covered in Diagnosis) • Pharmacotherapy only • Management decision
(treatment/diagnosis steps) • Treatment only 7. Diseases of the Nervous System and Special Senses Health and Health
Maintenance • Cerebrovascular
disease, cerebral infarction • Toxic injuries,
occupational disorders and nutritional deficiencies (affecting the nervous
system, eyes, and ears, including
lead poisoning, carbon monoxide, and organophosphate) • Infection involving the
nervous system, eyes, or ears • Degenerative and
demyelinating disorders, including Alzheimer’s disease and multiple sclerosis 10 7. Diseases of the Nervous System and Special Senses (continued) Mechanisms of Disease • Localizing anatomy: - brain and special
senses - brain stem - spinal cord - neuromuscular system • Anatomy of cerebral circulation • Increased intracranial
pressure and altered state of consciousness • Infection • Degenerative/developmental
and metabolic disorders Diagnosis • Disorders of the eye
(eg, blindness; glaucoma; infection; papilledema; optic atrophy; retinal disorders; diabetic
retinopathy; diplopia; cataract; neoplasms; vascular disorders; uveitis; iridocyclitis; traumatic,
toxic injury; toxoplasmosis) • Disorders of the ear,
olfaction, and taste (eg, deafness, hearing loss, otitis, mastoiditis; toxic damage; vertigo,
tinnitus, Meniere’s disease; acoustic neuroma; traumatic, toxic injury) • Disorders of the
nervous system: - paroxysmal disorders
(eg, headache; trigeminal neuralgia; epilepsy; syncope) - cerebrovascular disease
(eg, intracerebral hemorrhage; ischemic disorders; aneurysm, subarachnoid hemorrhage;
cavernous sinus thrombosis) - traumatic, toxic injury
(including lead, carbon monoxide, organophosphate) - infections (eg,
bacterial, fungal, viral, opportunistic infection in immunocompromised patients; Lyme disease;
abscess; neurosyphilis; Guillain-Barré syndrome) - neoplasms (eg, primary;
metastatic; neurofibromatosis) - metabolic disorders
(eg, metabolic encephalopathy, vitamin B12
[cyanocobalamin] deficiency, vitamin B1 [thiamine]
deficiency; coma, confusion, delirium, dementia) - degenerative and
developmental disorders (eg, Alzheimer’s disease; Huntington’s disease; parkinsonism; amyotrophic
lateral sclerosis; Tay-Sachs disease; multiple sclerosis; cerebral palsy; dyslexia) - neuromuscular disorders,
gait abnormalities, and disorders relating to the spine and spinal nerve roots (eg,
myasthenia gravis; muscular dystrophy; peripheral neuropathy; neck pain; cervical radiculopathy;
lumbosacral radiculopathy; spinal stenosis) - sleep disorders Principles of
Management (With emphasis on
topics covered in Diagnosis) • Pharmacotherapy only • Management decision
(treatment/diagnosis steps) • Treatment only 11 8. Cardiovascular Disorders Health and Health
Maintenance • Arterial hypertension • Atherosclerosis and
coronary artery disease; hyperlipidemia • Prevention of rheumatic
heart disease, thromboembolic disease, pulmonary emboli, bacterial endocarditis Mechanisms of Disease • Cardiac output,
resistance, central venous pressure • Valvular stenosis, incompetence • Congenital heart
disease • Regulation of blood
pressure • Disorders of the
arteries and veins Diagnosis • Dysrhythmias;
palpitations, syncope (eg, premature beats; paroxysmal tachycardias; atrial flutter and fibrillation;
bradycardias; ventricular fibrillation; cardiac arrest) • Heart failure
(congestive, diastolic, systolic dysfunction), dyspnea, fatigue, peripheral
edema of cardiac origin (eg,
chronic heart failure; cor pulmonale) • Ischemic heart disease;
chest pain of cardiac origin (eg, angina pectoris; coronary insufficiency; myocardial
infarction) • Diseases of the
myocardium (eg, hypertrophic; myocarditis) • Diseases of the
pericardium (eg, acute pericarditis; chronic constrictive pericardiopathy; pericardial effusion;
pericardial tamponade) • Valvular heart disease
(eg, acute rheumatic fever; mitral and aortic valve disorders; infective endocarditis) • Congenital
cardiovascular disease (eg, patent ductus arteriosus; atrial septal defect;
ventricular septal defect;
endocardial cushion defect; tetralogy of Fallot; coarctation of the aorta) • Systemic hypotension,
hypovolemia, cardiogenic shock, cyanosis • Arterial hypertension
(eg, essential; secondary) • Atherosclerosis -
lipoproteins • Disorders of the great
vessels (eg, dissecting aortic aneurysm; ruptured aneurysm; aortoiliac disease) • Peripheral arterial
vascular diseases, vasculitis (eg, polyarteritis; temporal arteritis;
arteriovenous fistula) • Diseases of the veins,
peripheral edema (eg, varicose veins; thrombophlebitis; deep venous thrombosis) • Traumatic injury Principles of
Management (With emphasis on
topics covered in Diagnosis) • Pharmacotherapy only • Management decision
(treatment/diagnosis steps) • Treatment only 12 9. Diseases of the Respiratory System Health and Health
Maintenance • Chronic bronchitis,
asthma, emphysema, carcinoma of the larynx, carcinoma of the lung; pulmonary aspiration,
atelectasis; tuberculosis Mechanisms of Disease • Ventilatory dysfunction
(eg, obstructive disorders: asthma, chronic obstructive pulmonary disease, cystic fibrosis,
bronchitis, bronchiectasis, emphysema) • Respiratory failure
(eg, interstitial pneumonitis, pulmonary edema, acute respiratory distress syndrome, ventilation
failure) • Circulatory dysfunction • Neoplastic disorders Diagnosis • Disorders of the nose,
paranasal sinuses, pharynx, larynx, and trachea (eg, rhinitis; pharyngitis, tonsillitis,
peritonsillar abscess; thrush; sinusitis; acute laryngotracheitis;
epiglottitis; carcinoma of the larynx; laryngeal,
pharyngeal obstruction, obstruction, trauma; tracheoesophageal fistula) • Infections of the lung
(eg, acute bronchiolitis; pneumonia; tuberculosis) • Obstructive airways
disease (eg, chronic bronchitis, bronchiectasis; asthma, bronchospasm, wheezing; emphysema, a1-antitrypsin deficiency; cystic
fibrosis) • Atelectasis, aspiration • Pneumothorax,
hemothorax, traumatic injury to the lungs • Pneumoconiosis,
fibrosing or restrictive pulmonary disorders (eg, asbestosis; silicosis; sarcoidosis) • Respiratory failure,
hypoxia, hypercapnia, dyspnea (eg, respiratory distress syndrome of the newborn; acute
respiratory distress syndrome; acute and chronic respiratory failure;
drowning) • Pulmonary vascular
disorders (eg, pulmonary embolism; pulmonary hypertension; pulmonary edema) • Disorders involving the
pleura (eg, pleurisy; pleural effusion) • Neoplastic disorders of
the lungs and pleura (eg, primary tumors; metastatic tumors) Principles of
Management (With emphasis on topics
covered in Diagnosis) • Pharmacotherapy only • Management decision
(treatment/diagnosis steps) • Treatment only 13 10. Nutritional and Digestive Disorders Health and Health
Maintenance • Screening (eg, cancer) • Viral hepatitis and
alcohol-related hepatopathy Mechanisms of Disease • Malabsorption/malnutrition • Jaundice • Infections/parasites • Obstruction/mechanical Diagnosis • Disorders of the mouth,
salivary glands, oropharynx, and esophagus (eg, dental disorders; disorders of the salivary
glands; esophageal reflux; dysphagia; motility disorders of the esophagus; hiatal hernia;
carcinoma of the esophagus) • Disorders of the
stomach, small intestine, colon, and rectum/anus (eg, gastritis; peptic ulcer disease; congenital
disorders; malabsorption; appendicitis; granulomatous enterocolitis; ischemic colitis; irritable bowel
syndrome; diverticula; colonic polyps; ulcerative colitis; peritonitis; bowel obstruction, volvulus,
intussusception; hernia; necrotizing enterocolitis; infection; carcinoma of the stomach, colon,
and rectum; antibiotic-associated colitis; hemorrhoids; anal fissures; anal fistula;
perianal/perirectal abscess) • Disorders of the
pancreas (eg, pancreatitis; pseudocyst; carcinoma of the pancreas) • Disorders of the liver
and biliary system (eg, hepatitis; cirrhosis; hepatic failure, hepatic encephalopathy, jaundice;
portal hypertension; ascites, esophageal varices; cholelithiasis; cholecystitis; hepatic
abscess, subphrenic abscess; neoplasms of the liver; storage diseases; neoplasms of the biliary
tract) • Traumatic injury and
poisoning (including drain cleaner ingestion) Principles of
Management (With emphasis on
topics covered in Diagnosis) • Pharmacotherapy only • Management decision
(treatment/diagnosis steps) • Treatment only 14 11. Gynecologic Disorders Health and Health
Maintenance • Postmenarchal/reproductive • Peri/postmenopausal Mechanisms of Disease • Infections (eg,
vulvovaginitis; pelvic inflammatory disease; toxic shock; sexually
transmitted disease; endometritis;
urethritis; Bartholin’s gland abscess; abscess of the breast; mastitis) • Urinary incontinence
and obstruction • Neoplasms • Menstrual and
endocrinologic disorders; infertility Diagnosis • Pelvic relaxation and
urinary incontinence (eg, UTI; uterovaginal prolapse; cystocele, rectocele, urethrocele) • Neoplasms (eg, cervical
dysplasia, cancer; leiomyomata uteri; endometrial cancer; ovarian neoplasms; neoplastic
disorders of the breast; vulvar neoplasms) • Benign conditions of
the breast • Menstrual and endocrinologic
disorders (eg, amenorrhea [including undiagnosed pregnancy]; abnormal uterine
bleeding; dysmenorrhea; menopausal, postmenopausal disorders [osteoporosis];
premenstrual syndrome; hirsutism, virilization; ovarian disorders [ovarian failure, polycystic
ovarian disease]) • Sexual abuse and rape Principles of
Management (With emphasis on
topics covered in Diagnosis) • Pharmacotherapy only • Management decision
(treatment/diagnosis steps) • Treatment only 12. Renal, Urinary, and Male Reproductive Systems Health and Health
Maintenance • Infection (eg, urinary
tract, sexually transmitted diseases [male]) • Acute and chronic renal
failure including risk factors and prevention and methods of limiting progression • Male health maintenance
examination (eg, testicular, prostatic) Mechanisms of Disease • Disorders of the male
reproductive system • Urinary incontinence
and obstruction, enuresis • Renal
insufficiency/failure • Electrolyte and water
metabolism and acid-base balance 15 12. Renal, Urinary, and Male Reproductive Systems (continued) Diagnosis • Disorders of the male
reproductive system (eg, infections; torsion of the testis; undescended testicle; neoplasms of
the testis; benign prostatic hyperplasia; carcinoma of the prostate; hypospadias; hydrocele,
varicocele; urethral stricture, impotence, ejaculation) • Disorders of the
urinary bladder and urinary collecting system (eg, cystitis; pyelitis;
dysuria, hematuria, pyuria;
carcinoma of the bladder; urolithiasis; ureteral reflux; neurogenic bladder; urinary incontinence;
enuresis; obstruction; hydronephrosis) • Disorders of the
kidneys (eg, pyelonephritis; glomerulonephritis; interstitial nephropathy;
renal insufficiency and
failure; oliguria, anuria, azotemia, uremia, renal osteodystrophy;
hypertensive renal disease; lupus
nephritis; inherited disorders) • Traumatic injury Principles of
Management (With emphasis on
topics covered in Diagnosis) • Pharmacotherapy only • Management decision (treatment/diagnosis
steps) • Treatment only 13. Disorders of Pregnancy, Childbirth, and the
Puerperium Health and Health
Maintenance • Prenatal care (eg,
nutrition; prevention of iron deficiency; prevention of vitamin deficiency;
Rh immunoglobulin prophylaxis;
prenatal diagnosis; teratology, diabetes mellitus, urinary tract infection, a-fetoprotein, rubella, genital herpes, streptococcal infections) • Assessment of the
at-risk pregnancy; risk of preterm labor • Intrapartum care; signs
of fetal compromise • Contraception;
sterilization; prevention of pregnancy after rape Mechanisms of Disease • Placenta, placental
dysfunction • Pregnancy and labor
including infection • Postpartum disorders
including infection • Fetus and newborn 16 13. Disorders of Pregnancy, Childbirth, and the
Puerperium (continued) Diagnosis • Pregnancy and labor
including obstetric complications (eg, ectopic pregnancy; spontaneous abortion/septic abortion;
hypertension; third-trimester bleeding; hydramnios; preterm labor, premature rupture of the
membranes, normal labor; multiple gestation; intrapartum fetal distress/fetal death;
maternal mortality; fetal growth and development abnormalities; congenital abnormalities;
gestational trophoblastic disease) • Nonobstetric complications
of pregnancy (eg, major medical complications and preexisting medical conditions;
surgical complications; hyperemesis gravidarum) • Complications of the
puerperium (eg, problems with breast-feeding; postpartum hemorrhage; postpartum sepsis; postpartum
depression, psychosis; mastitis; venous thromboembolism) Principles of
Management (With emphasis on
topics covered in Diagnosis) • Pharmacotherapy only • Management decision
(treatment/diagnosis steps) • Treatment only 14. Disorders of the Skin and Subcutaneous Tissues Health and Health
Maintenance • Epidemiology and
prevention of skin disorders secondary to exposure to the sun; contact dermatitis and drug
reactions; decubitus ulcers; dermatophytic skin disorders Mechanisms of Disease • Skin disorders,
including cancer, infections, and inflammatory disorders Diagnosis • Infections (eg, herpes
simplex, herpes zoster, chickenpox; cellulitis, carbuncle, abscess, gangrene;
dermatophytoses; pilonidal cyst; viral warts; decubitus ulcers) • Neoplasms (eg, squamous
cell carcinoma; melanoma; actinic keratosis, basal cell carcinoma; pigmented nevi;
hemangiomas) • Other skin disorders
(eg, industrial, occupational, and atopic dermatitis; psoriasis; seborrhea; acne) Principles of
Management (With emphasis on topics
covered in Diagnosis) • Pharmacotherapy only • Management decision
(treatment/diagnosis steps) • Treatment only 17 15. Diseases of the Musculoskeletal System and
Connective Tissue Health and Health
Maintenance • Epidemiology, impact, and
prevention of degenerative joint and disc disease • Prevention of
disability due to musculoskeletal disorders or infection (eg, osteomyelitis;
septic arthritis; Lyme disease;
gonococcal tenosynovitis) Mechanisms of Disease • Infections • Nerve compressions and
degenerative, metabolic, and nutritional disorders • Inherited, congenital,
or developmental disorders • Inflammatory or
immunologic disorders Diagnosis • Infections (eg,
osteomyelitis; septic arthritis; Lyme disease; gonococcal tenosynovitis) • Degenerative,
metabolic, and nutritional disorders (eg, degenerative joint disease;
degenerative disc disease; gout;
rickets) • Inherited, congenital,
or developmental disorders (eg, congenital hip dysplasia; phocomelia; osteochondritis; slipped
capital femoral epiphysis; scoliosis; syringomyelia, dislocated hip in infantile spinal muscular
atrophy) • Inflammatory,
immunologic, and other disorders (eg, polymyalgia rheumatica; lupus
arthritis; polymyositis-dermatomyositis;
rheumatoid arthritis; ankylosing spondylitis; bursitis; tendinitis; myofascial pain;
fibromyalgia; shoulder-hand syndrome; Dupuytren’s contracture; Paget’s disease) • Neoplasms (eg,
osteosarcoma; metastases to bone; pulmonary osteoarthropathy) • Traumatic injury and
nerve compression and injury (eg, fractures, sprains, dislocations, carpal tunnel syndrome; cauda
equina syndrome) Principles of
Management (With emphasis on
topics covered in Diagnosis) • Pharmacotherapy only • Management decision
(treatment/diagnosis steps) • Treatment only 16. Endocrine and Metabolic Disorders Health and Health
Maintenance • Diabetes mellitus,
including prevention of morbidity and mortality due to complications • Screening (eg, cancer) Mechanisms of Disease • Thyroid function • Diabetes mellitus and
carbohydrate metabolism • Parathyroid and calcium
metabolism • Pituitary and
hypothalamic function • Adrenal function 16. Endocrine and Metabolic Disorders (continued) Diagnosis • Thyroid disorders (eg,
nodule; carcinoma; acquired hypothyroidism; thyroiditis; thyrotoxicosis; congenital
hypothyroidism; goiter) • Diabetes mellitus (eg,
type 1, type 2; ketoacidosis; hyperosmolar coma; chronic complications) • Hypoglycemia;
hyperinsulinism and parathyroid disorders (eg, iatrogenic; insulinoma) • Parathyroid and calcium
(eg, hyperparathyroidism; hypoparathyroidism) • Pituitary, hypothalamic
disorders (eg, diabetes insipidus; inappropriate ADH secretion; panhypopituitarism;
acromegaly) • Adrenal disorders (eg,
corticoadrenal insufficiency; Cushing’s syndrome; adrenogenital syndrome;
hyperaldosteronism; pheochromocytoma) • Heat-related illness Principles of
Management (With emphasis on
topics covered in Diagnosis) • Pharmacotherapy only • Management decision
(treatment/diagnosis steps) • Treatment only 17. Congenital Anomalies (Topic covered under
each organ system) 18. Conditions Originating in the Perinatal Period (Topic covered under
Disorders of Pregnancy, Childbirth, and the Puerperium [category 13]) 19. Symptoms, Signs, and Ill-defined Conditions (Topic covered under
each organ system) 20. Injury and Poisoning (Topic covered under
each organ system) Table 3. USMLE Step 3 Specifications*
*
Percentages may be changed without notice. 7 Step 3 Clinical Encounter
Frames INITIAL WORK-UPS CONTINUING CARE URGENT INTERVENTION 1 2 3 Patient encounters
characterized by initial assessment and management of clinical
problems among patients seen
principally in ambulatory settings
for the first time. These encounters may also include new problems
arising in patients for whom a
history is available. Clinical problems include
ill-defined signs and symptoms;
behavioralemotional; acute limited; initial manifestation and
presentation of chronic illness. Physician tasks emphasized include data gathering
and initial clinical intervention.
Assessment of patients may lead to
urgent intervention. Patient encounters
characterized by continuing management of previously diagnosed
clinical problems among patients
known to the physician and seen principally in ambulatory
settings. Encounters focused on
health maintenance are located
in this frame. Also included are patient encounters characterized
by acute exacerbations or
complications, principally of chronic,
progressive conditions among patients
known to the physician. These
encounters may occur in in-patient
settings. Clinical problems include frequently-occurring
chronic diseases and
behavioral-emotional problems. Periodic health evaluations of
established patients are included here. Physician tasks
emphasized include recognition of new
problems in an existing condition,
assessment of severity, establishing
prognosis, monitoring therapy, and
long-term management. Patient encounters
characterized by prompt assessment and management of
life-threatening and organ-threatening emergencies, usually
occurring in emergency
department settings. Occasionally, these
encounters may occur in the context
of a hospitalized patient. Clinical problems include
severe life-threatening and organthreatening conditions and exacerbations of chronic
illness. Physician tasks
emphasized include rapid assessment
of complex presentations, assessment of patients' deteriorating condition,
and prompt decision-making. 8 Figure 2: Step 3
Physician Tasks Obtaining history and performing physical exam ! Objectives focus on interpreting the patient’s
history, knowing pertinent factors in
the patient’s history, and interpreting the history in terms of risk factors
for the patient. ! Objectives focus on the physical exam, such as
recognizing and interpreting pertinent
physical findings and knowing required techniques in the
physical exam. Using laboratory and diagnostic studies ! Objectives focus on selecting the appropriate
routine, initial, invasive, special, or follow-up
studies; interpreting the results of laboratory or diagnostic test
findings; knowing the value of and indications for screening tests; and
predicting the most likely test result. Formulating most likely diagnosis ! Objectives focus on selecting the most likely
diagnosis in light of history, physical or
diagnostic test findings. Includes interpreting pictorial material and
establishing a diagnosis. Evaluating severity of patient’s problems ! Objectives focus on interpreting the vignette,
evaluating the severity of the patient’s
condition, and making judgment on the current status or prognosis of the
patient as to the need for further action. Managing the patient ! Health maintenance objectives focus on identifying risk factors, knowing incidence
within patient groups at risk, knowing preliminary steps to ensure
effectiveness of intended therapy, and selecting appropriate preventive
therapeutic agents or techniques. ! Clinical intervention objectives focus on knowing priorities in emergency management,
knowing present and long-term management of selected
conditions, and knowing appropriate surgical treatment, including pre- and
post-surgical events. They also include knowing pre- and
post-procedural management and the appropriate follow-up schedule or monitoring
approach. ! Clinical therapeutics objectives focus on selecting the appropriate pharmacotherapy,
recognizing actions of drugs as applied to patient management, and
knowing the importance of educating patients about effects of drugs and
drug-drug interactions. ! Legal/ethical and health care systems objectives focus on issues such as patient autonomy,
physician/patient relationships, use of unorthodox or experimental
therapies, end-of-life considerations, treatment of minors and physician error
versus negligence. Applying scientific concepts ! Objectives focus on identifying the underlying
processes or pathways responsible for a
given condition, recognizing associated disease conditions and
complications, and recognizing and evaluating clinical findings or diagnostic
studies to identify the underlying factors; e.g., anatomic structure. ! Objectives focus on interpreting results of
experimental or biometric data, including
knowing design features of clinical studies, understanding issues regarding
validity of research protocols, knowing sensitivity and
specificity of selected tests, and recognizing potential bias in clinical
studies. 9 Figure 3 shows how frames
and tasks intersect to create the Step 3 blueprint which specifies the broad
content allocations for
constructing Step 3. Estimates of approximate percentages are provided for
the marginal totals. Figure 3: Step 3
Blueprint PHYSICIAN TASKS CLINICAL ENCOUNTER FRAMES Initial Work-up Continued
Care Urgent Intervention 1 2 3 TOTAL History & Physical
8-12% Diagnostic Studies 8-12% Diagnosis 8-12% Prognosis 8-12% Managing Patients Health Maintenance 5-9% Clinical Intervention
18-22% Clinical Therapeutics
12-16% Legal & Ethical
Issues 4-8% Applying Basic Concepts
8-12% TOTAL 20-30% 50-60% 15-25%
100% 10 10 Problem/Disease List The Step 3
Problem/Disease List provided here is organized at the system level according
to the International Classification of
Diseases, 9th Revision, Clinical Modification (ICD-9-CM). It is subdivided
according to presentation categories and includes
disorders, health problems, and issues relating to health maintenance. This
list has been prepared from empirical
data drawn from several sources; including, for example, the National
Ambulatory Medical Care Survey and the
National Hospital Discharge Survey. The aggregated frequency listings have
been subjected to extensive review.
Although the Problem/Disease List is not comprehensive, it does serve as a
primary reference for identifying the clinical
problems the generalist physician should be prepared to encounter in one or
more of the frames cited. DISEASES/DISORDERS OF THE CENTRAL NERVOUS SYSTEM Infectious Diseases of
CNS Tetanus Acute Poliomyelitis Rabies Meningitis Encephalitis Brain Abscess Degenerative/Hereditary
Diseases of CNS Alzheimer/Cerebral
Atrophy Parkinson Disease Multiple Sclerosis Amyotrophic Lateral
Sclerosis (ALS) Other Diseases of CNS Mental Retardation Seizure Disorder Brain Death Cerebral Palsy Neoplasms Intracranial Neoplasm Malignant Neoplasm of CNS Diseases of Peripheral
Nerves Myasthenia Gravis Neuropathies Neuralgia/Neuritis Vascular Diseases of CNS Cerebral Hemorrhage Transient Cerebral
Ischemia Cerebrovascular Disease Cerebral Embolism and
Thrombosis Ill-defined CNS Symptoms Reye Syndrome Migraine Convulsions Headache Psychalgia Syncope and Collapse,
Ataxia Abnormal Involuntary
Movement Sleep Disturbances Aphasia Coma DISEASES/DISORDERS OF THE EYE Eye Ophthalmologic
Manifestations of Diabetes Retinal Detachments,
Defects and Disorders Chorioretinitis Glaucoma Cataract Visual Disturbances Diplopia Visual Field Defects Pterygium Acute Conjunctivitis Disorders of
Eyelids/Lacrimal System Orbital Cellulitis Diseases of Optic
Nerve/Visual Pathways Strabismus Anomalies of Pupillary
Function Nystagmus Corneal Abrasion Degeneration of Macula 11 DISEASES/DISORDERS OF THE EAR/NOSE/MOUTH/THROAT Ear Diseases of Ear and
Mastoid Process Otitis Media Vertiginous Syndromes Otalgia Hearing Loss Nose/Throat Streptococcal Sore Throat Acute Upper Respiratory
Tract Infection Chronic Rhinitis Peritonsillar Abscess Allergic Rhinitis Diseases of Nasal Cavity;
e.g., Abscess Sinuses Acute Sinusitis Chronic Sinusitis Mouth/Tongue Herpetic
Gingivostomatitis Herpes Simplex Fever
Blister Disorders of Teeth/Jaw Neoplasms Malignant Neoplasm of
Larynx Malignant Neoplasm of
Lip, Oral Cavity, Pharynx DISEASES/DISORDERS OF THE RESPIRATORY SYSTEM Pneumonia/Influenza Croup Acute Bronchitis Acute Bronchiolitis Bronchopneumonia Pneumonia Influenza with Other
Respiratory Manifestations Chronic Obstructive
Pulmonary Disease Bronchitis Obstructive Chronic
Bronchitis Emphysema Asthma Chronic Airway
Obstruction Pneumoconioses Malignant Neoplasm of
Bronchus and Lung, Primary and Secondary Other Diseases of the
Respiratory System Pulmonary Tuberculosis Sarcoidosis Cystic Fibrosis Pulmonary Embolism and
Infarction Pulmonary Hypertension Pleurisy without Effusion Spontaneous Tension
Pneumothorax Mediastinitis Pertussis Ill-defined Symptoms of
the Respiratory System Dyspnea Cough Hemoptysis Stridor Hoarseness DISEASES/DISORDERS OF THE CIRCULATORY SYSTEM Essential Hypertension Hypertensive Disease Hypertensive Heart
Disease Hypertensive Renal
Disease Secondary Hypertension Ischemic Heart Disease Congestive Heart Failure Pericarditis Cardiomyopathy Congestive Heart Failure Arrhythmias/Conduction
Disorders Peripheral Vascular
Disease Aortic Aneurysm Peripheral Vascular
Disease Arterial
Embolism/Thrombosis Phlebitis/Thrombophlebitis Venous
Embolism/Thrombosis Varicose Veins General Arteriosclerosis Arteriosclerotic Disease Atherosclerosis 12 Valvular Heart Disease Rheumatic Heart Disease Valve Disorders Endocarditis Congenital Anomalies of
the Heart Ill-defined Symptoms of
the Circulatory System Tachycardia Palpitations Murmurs Elevated Blood Pressure
without Diagnosis of Hypertension DISEASES/DISORDERS OF THE DIGESTIVE SYSTEM Ill-defined Symptoms of
Digestive System Dyspepsia Constipation Diarrhea Hemorrhage of Rectum and
Anus Gastrointestinal
Hemorrhage Nausea and Vomiting Abdominal Pain Abnormal Stool Contents Indigestion Heartburn Ascites Hepatomegaly Splenomegaly Dysphagia Esophagus Malignant Neoplasm of
Esophagus Esophageal Varices Achalasia/Esophagitis Stomach Malignant Neoplasm of
Stomach Benign Neoplasm of
Stomach Gastric Ulcer Duodenal Ulcer Peptic Ulcer Gastritis/Duodenitis Gallbladder Calculus of Gallbladder Cholecystitis Liver Malignant Neoplasm of
Liver Cirrhosis of Liver Stricture of Common Bile
Duct Small Intestine/Colon Malignant Neoplasm of
Colon Benign Neoplasm of
Duodenum, Jejunum, Ileum Appendicitis Other Noninfectious
Gastroenteritis Intestinal Obstruction Diverticula of Small
Intestine Diverticula of Colon Irritable Colon/Irritable
Bowel Syndrome Peritonitis Intestinal Abscess Hernia Inguinal Hernia Other Hernias with
Obstruction Ventral Hernia Diaphragmatic Hernia Rectum Malignant Neoplasm of
Rectosigmoid Junction Malignant Neoplasm of
Rectum Benign Neoplasm of Rectum Hemorrhoids Anal Fissure Anal Abscess Rectal Prolapse Pancreas Malignant Neoplasm of
Pancreas Benign Neoplasm of
Pancreas Pancreatitis BEHAVIORAL/EMOTIONAL DISORDERS Psychotic Disorders Schizophrenia Paranoid States Disorders Originating in
Childhood Conduct Disturbance Attention-Deficit/Hyperactivity
Disorder Autistic Disorder 13 Anxiety
Disorders/Adjustment Disorders Phobic Disorders Obsessive-compulsive
Disorder Post-traumatic Stress
Disorder Bereavement Mood Disorders Depressive Disorders Bipolar Disorders Psychological-Medical
Interactive Disorders Somatoform Disorders Eating Disorders Psychological Factors
Associated with Other Medical Conditions Cognitive Disorders Confusion States Dementia Substance Abuse Disorders Alcohol Related Disorders Chemical/Drug Abuse Drug Dependence Psychosocial
Problems/Personality Disorders Abuse of Other Person Sexual Dysfunction Personality Disorders DISEASES/DISORDERS OF THE MUSCULOSKELETAL SYSTEM General Musculoskeletal
Problems Internal Derangement of
Knee Effusion of Joint Affections of Shoulder
Region Synovitis/Tenosynovitis Bursitis Ganglion and Cyst of Synovium/Tendon/Bursa Muscular Wasting and
Disuse Atrophy Infective Myositis Myositis Ossificans Myalgia/Myositis Disorders of Bone and
Cartilage Developmental Problems Congenital Anomalies of
Limbs Muscular Dystrophy Disorders of Back/Spine Spinal Enthesopathy Intravertebral Disc
Disorders Disc Displacement Spinal Stenosis Lumbago, Sciatica Kyphoscoliosis and
Scoliosis Sprains and Strains of
Back Contusion of Back Cervicalgia Malignancy Secondary Malignant
Neoplasm of Bone/Marrow Pathologic Fracture Contusions Fractures/Dislocations Closed Fracture of Facial
Bones Fracture of Vertebral
Column Fracture of Ribs Closed Fracture, Upper
Extremity Fracture of Neck of Femur Various Fractures, Lower
Limbs Dislocations/Separations Sprains/Strains Temporomandibular Joint
Disorders Rotator Cuff Syndrome Enthesopathy of Elbow or
Ankle Various Sprains and
Strains Rheumatoid Conditions Collagen Diseases Rheumatoid Arthritis Nonarticular Rheumatism Osteoarthritis and
Arthropathies Infective Arthritis Osteoarthritis Monoarthritis Arthropathy Polyarthritis Ill-defined Symptoms of
the Musculoskeletal System Pain in Joint Stiffness of Joint Pain in Limb Cramp, Swelling 14 DISEASES/DISORDERS OF THE SKIN/SUBCUTANEOUS TISSUE Skin Eruptions Scabies Contact Dermatitis Psoriasis Acne Urticaria Seborrhea Nails/Hair Ingrowing Nail Diseases of Hair and
Follicle Other Cauliflower Ear Decubitus Ulcer Keloid Scar Lumps/Tumors of Skin Viral Warts Malignant Neoplasm of
Skin Benign Neoplasm of Skin Keratoderma Sebaceous Cyst Neurofibromatosis Lipoma Ill-defined Symptoms,
Skin and Integumentary Rash, Edema Localized Swelling, Mass,
or Lump Enlarged Lymph Nodes DISEASES/DISORDERS OF ENDOCRINE/NUTRITION/METABOLISM Diseases of the Thyroid
Gland Malignant Neoplasm of
Thyroid Gland Goiter, Hyperthyroidism,
Hypothyroidism Hyperparathyroidism Diabetes Mellitus Diabetes Mellitus Hypoglycemia Hyperglycemia Nutritional
Deficiencies/Avitaminosis Disorders of Adrenal and
Pituitary Glands Other
Endocrine/Metabolic/Immunity Disorders Pure Hypercholesterolemia Hyperlipidemia Gout Electrolyte Disorders Immunity Deficiency SIADH, Phenylketonuria DISEASES/DISORDERS OF THE KIDNEYS AND URINARY TRACT Lower Malignant Neoplasm of
Prostate Malignant Neoplasm of
Bladder Urethritis Hyperplasia of Prostate Enuresis Hematuria, Urethral
Stricture Upper Malignant Neoplasm of
Kidney Nephrotic
Syndrome/Nephritis Chronic Renal Failure Acute Renal Failure Calculus of Kidney Calculus of Ureter Ill-defined Symptoms of
the Genitourinary System Abnormalities of
Urination Stress Incontinence,
Female 15 DISEASES/DISORDERS OF THE MALE REPRODUCTIVE SYSTEM Testes Testicular Feminization Torsion of Testes Testicular Mass Malignant Neoplasm of
Testes Benign Neoplasm of Testes Other Male Reproductive Male Infertility Disorders of Male Genital
Organs Orchitis/Epididymitis DISEASES/DISORDERS OF THE FEMALE REPRODUCTIVE SYSTEM Uterus Malignant Neoplasm of
Uterus Leiomyoma of Uterus Disorders of Uterus Uterine Prolapse Endometriosis of Uterus Ovary Malignant Neoplasm of
Ovary Benign Neoplasm of Ovary Ovarian Cysts Cervix Malignant Neoplasm of
Cervix Cervicitis/Endocervicitis Dysplasia of Cervix Uteri Abnormal Pap Smear Vagina/Vulva Malignant Neoplasm of
Vagina Malignant Neoplasm of
Vulva Vaginitis/Vulvovaginitis Prolapse of Vaginal Walls Imperforate Hymen Vaginal Discharge Menstrual Disorders Dysmenorrhea Premenstrual Tension Amenorrhea, Excess
Menstruation Irregular Menstrual Cycle Menopause Climacteric States Atrophic Vaginitis Breast Malignant Neoplasm of
Breast Benign Neoplasm of Breast Breast-Related Problems,
e.g., Fibrocystic Breasts Signs and Symptoms in
Breast Female Infertility Acute Parametritis and
Pelvic Cellulitis Pelvic Inflammatory
Disease Salpingitis and
Oophoritis 16 PREGNANCY/CHILDBIRTH/NEONATES Pregnancy, Complicated Adolescent Pregnancy Supervision of At-Risk
Pregnancy Ectopic Pregnancy Spontaneous, Induced, or
Septic Abortion Hemorrhage in Early
Pregnancy Placenta Previa Abruptio Placentae Antepartum Hemorrhage Preeclampsia Eclampsia Premature Labor Complication of Labor or
Delivery Other Viral Disease in
Pregnancy Incompetent Cervix CNS Malformation in Fetus Suspected Fetal
Abnormality Affecting Management of Mother Rh Incompatibility Infection, Amniotic
Cavity Obstruction, Malposition
of Fetus Cesarean Delivery Chromosomal Anomalies Multiple Fetuses Pregnancy, Uncomplicated Delivery and Labor with
Minor or No Complications Supervision of Normal
Pregnancy Single Liveborn Before
Admission to Hospital Conditions Originating in
the Perinatal Period Congenital Anomalies of
the Digestive System Birth Trauma Birth Asphyxia Respiratory Distress
Syndrome Other Respiratory
Problems After Birth Hypocalcemia Infections Specific to
the Perinatal Period Hemolytic Disease Due to Rh-Isoimmunization Perinatal Jaundice DISEASES/DISORDERS OF BLOOD/BLOOD-FORMING ORGANS Malignant Neoplasias Leukemias Multiple Myeloma Lymphomas Anemias Pernicious Anemia Thalassemias Sickle-Cell Trait Other Hemoglobinopathies Iron-Deficiency Anemia Other Septicemia Pancytopenias Coagulation Disorder Disseminated
Intravascular Coagulation Polycythemia Viremia Transfusion Reaction Thrombocytopenic Purpura INFECTIOUS/PARASITIC DISEASES Intestinal Infectious
Diseases Enteric Infections Infections of Skin and
Subcutaneous Tissue Cellulitis and Abscess Impetigo Other Local Skin
Infection Other Bacterial Diseases Streptococcal Infection Staphylococcal Infection Pneumococcal Infection Escherichia coli Infection Hemophilus influenzae Infection Other Bacterial Infections 17 HIV Infection AIDS, HIV Status Viral Diseases
Accompanied by Exanthem Chickenpox Herpes Zoster Measles Rubella and Roseola Erythema Infectiosum Kawasaki Syndrome Arthropod-borne Diseases Rocky Mountain Spotted
Fever Lyme Disease Sexually Transmitted
Diseases Syphilis Gonococcal Infections Other STDs; e.g., Genital
Herpes, Trichomoniasis Mycoses Dermatophytosis Candidiasis Mycoses Infections Involving Bone Acute and Chronic
Osteomyelitis Other Diseases Due to
Viruses and Chlamydiae Hepatitis Mumps Herpangina Infectious Mononucleosis Inclusion Conjunctivitis Molluscum Contagiosum Cat-scratch Disease Foot and Mouth Disease Cytomegalic Inclusion
Disease Echovirus Coxsackievirus Rhinovirus Toxoplasmosis Infectious Diseases of
Urinary System Infections of Kidney Acute Cystitis Infectious Diseases
Complicating Pregnancy Infection of
Genitourinary Tract During Pregnancy Other Infections
Complicating Pregnancy INJURIES/WOUNDS/TOXIC EFFECTS/BURNS Eye Injury Foreign Body in Eye Eye Burn Ocular Injuries Various Toxins Food Poisoning Poisoning by Drugs and
Medicinal Substances Toxic Effects of
Nonmedicinal Substances Adverse Effects of Drugs,
Medicinals and Biological Substances Trauma Rape/Crisis Adjustment Concussion, No Loss of
Consciousness Concussion, Brief Loss of
Consciousness CNS Trauma Cranial Injuries Chest Trauma Internal Injuries,
Abdomen and Pelvis Other Trauma; e.g.,
Traumatic Shock Post-operative
Complications CNS Complications Respiratory Complications GI Complications Hemorrhage Complicating
Surgery Post-operative Infections Complications of Medical
Care, Infection Other Complications of
Device/Graft Wounds Foreign Body Foreign Body in Ear Foreign Body in Nose Foreign Body in
Trachea/Aspiration Swallowed Foreign Body Other Epistaxis Burns Frostbite Heat Stroke 18 HEALTH MAINTENANCE General Checks Community-Related
Prevention Routine Child/Infant
Health Check Other After-Care
Follow-up Other Counseling Follow-up Examinations General Medical Exam Laboratory Examination Child Behavioral/Developmental
Disorders Targeted Checks,
Gynecology Counseling for
Contraception Sterilization Surveillance of
Prescribed Contraception Contraceptive Management Genetic Counseling Antenatal Screening Gynecologic Examination Routine Cervical Pap
Smear Post-Partum Follow-up Breast Cancer Screening Targeted Checks,
Cardiovascular Risk Dietary Surveillance Cardiovascular Risk
Screening Exercise Vaccinations/Other
Chemotherapy Influenza Vaccination DTP and Polio Vaccination Vaccinations Desensitization to Allergens Prophylactic Chemotherapy Skin Sensitization Tests Non-dependent Abuse of
Drugs Alcohol Abuse Tobacco Use Disorder Cannabis Abuse Hallucinogen Abuse Sedative, Hypnotic, or
Anxiolytic Abuse Opioid Abuse Cocaine Abuse Amphetamine Abuse Antidepressant Type Abuse Other Mixed, Unspecified
Drug Abuse ILL-DEFINED SYMPTOM COMPLEXES Symptoms Referable to
Nutrition Abnormal Weight Gain Abnormal Weight Loss Loss of Appetite Ill-defined Causes of
Morbidity Malignant Neoplasm,
Unspecified Site Secondary Malignant
Neoplasm, Other Sites Ill-defined Presentations Chest Pain Pyrexia of Unknown Origin Malaise and Fatigue Lack of Normal
Physiologic Development Septic Shock Allergy Abnormal Test Results Chronic Pain 19 Evaluative Objectives A complete listing of
Step 3 Evaluative Objectives follows. These objectives are categorized
according to the physician tasks and they
serve to guide writing and classification of test items. They can be read as
more detailed descriptions of the kinds
of issues that will be posed to physicians taking Step 3. Step 3 Evaluative
Objectives Obtaining History and
Performing Physical Exam # Knows signs/symptoms of selected disorders. # Interprets elicited history. # Knows individual’s risk factors for development of condition
leading to encounter. # Interprets patient's habitus, posture, and facial expression. # Knows commonly associated pertinent history. # Associates current complaints with presented history and
identifies pertinent factor. # Knows appropriate directed physical examination or required
technique. # Recognizes pertinent physical findings. # Interprets particular physical finding in order to differentiate one
disorder from another. # Performs or interprets mental status and neurologic exams. # Recognizes new physical signs and symptoms in a patient
with an established disease. Objectives Related to
Using Laboratory and Diagnostic Studies # Knows when NO diagnostic or laboratory studies are indicated. # Selects appropriate routine or initial laboratory or diagnostic studies. # Interprets the clinical impact of laboratory or diagnostic test findings. # Knows appropriate invasive, special, non-routine, or follow-up
studies. # Knows appropriate diagnostic studies/procedures in
terms of cost-effectiveness. # Knows appropriate common screening tests for conditions related to
an encounter or complaint. # Identifies study/procedure most likely to establish the diagnosis
or distinguish one diagnosis from another. # Predicts the most likely laboratory or diagnostic test result. 20 Objectives Related to
Formulating the Most Likely Diagnosis # Identifies diagnosis when given a criterion finding. # Selects the most likely diagnosis or evaluates differential in light of
history and/or physical and/or diagnostic test
findings. # Knows the most likely cause or preliminary diagnosis associated with
the presented signs and symptoms or
physical findings. Objectives Related to
Evaluating the Severity of Patient’s Problems
(Prognosis) # Evaluates severity of patient condition and identifies indications
for consultation or diagnostic assessment. # Evaluates appropriateness of available data or therapies. # Assesses severity of patient condition and makes judgment as to
current status, prognosis, or need for
further action. # Recognizes factors in the history (given symptoms) that affect
patient prognosis. # Evaluates patient data in light of management plan. # Recognizes iatrogenic complications, not drug-related. # Knows clinically relevant implications of specifically referenced
treatment. # Interprets laboratory or diagnostic results and identifies current
status of patient. Objectives Related to
Managing the Patient Management of Health
Maintenance and Disease Prevention # Recognizes physician’s best choice of words in eliciting history or
further description from the patient; knows
statements that facilitate communication with the
patient. # Knows risk factors for conditions amenable to prevention or detection
in an asymptomatic patient. # Knows pertinent incidence statistics and identifies patient groups at risk;
knows incidence of symptomless/dangerous
disorders among various groups. # Identifies organ/system at greatest risk in the patient. # Knows appropriate directed physical exam in screening an asymptomatic
patient during a well-care visit. # Knows common screening tests for conditions amenable to prevention or
detection in an asymptomatic patient or
population. # Knows range and timing of diagnostic study in monitoring for
prevention. # Selects appropriate preventive, therapeutic agent/technique. # Selects appropriate follow-up management when first plan is not
effective. 21 Clinical Intervention # Identifies appropriate cost-effective management. # Evaluates severity of patient condition in terms of need for
referral for surgical treatments/procedures
versus other nonsurgical options. # Knows appropriate next step in patient care. # Knows priority in management, specifically in emergency or acute
cases. # Knows immediate management or medical intervention in emergency
situations. # Knows appropriate present management of selected conditions. # Knows appropriate long-term treatment or management goals. # Knows appropriate surgical management among surgical options. # Knows post-surgical or post-procedural management. # Knows indications for hospital admission or other appropriate
setting. # Knows appropriate follow-up schedule or monitoring approach
regarding the general management plan. # Knows appropriate discharge planning; e.g., focusing priorities on
maximizing benefits of hospitalization. # Knows components of rehabilitation program. # Knows various therapeutic modalities for selected
behavioral/affective disorders. # Knows appropriate counseling of patient or family regarding current
and future problems, including risk
factors related to present encounter. # Knows importance of educating patient or family regarding
self-care. # Knows relevant roles of allied health personnel. # Knows issues surrounding management of chronic pain, especially
in terminally ill patients. # Recognizes/manages patient’s expression of fear of injury or death. Clinical Therapeutics # Selects appropriate preliminary steps to ensure effectiveness of intended
therapy. # Knows appropriate management in terms of cost-effectiveness. # Selects most appropriate pharmacotherapy. # Knows appropriate follow-up schedule or monitoring approach
regarding therapeutic regimen. # Assesses patient compliance with treatment regimen by recognizing
techniques to increase compliance or
understanding of the disease state and how therapy may
affect compliance with instructions. # Applies knowledge of drugs to the safe and effective selection and
administration of drugs. # Recognizes factors that alter drug requirements for a
patient. # Recognizes signs and symptoms of drug interactions resulting
from polypharmacy in the therapeutic regimen. # Knows adverse effects of various drugs. # Knows actions in response to acute, specific drug toxicity. # Knows contraindications of various drugs. # Recognizes new signs and symptoms in a patient with an
established medication regimen within the context of
continuing care. # Modifies therapeutic regimen within the context of continuing
care. # Knows importance of educating patient or family specifically about
medication regimen. # Applies results of experimental data or biometric studies to the
treatment of a patient. Legal/Ethical and
Health Care Systems # Knows informed consent. # Recognizes patient’s right to refuse treatment or testing
(patient autonomy). # Knows guidelines for treatment of minors with or without
notification of parent. # Knows guidelines for confidentiality of medical records. # Recognizes opportunities for cost containment. # Knows guidelines for physician/patient relationship. # Assesses quality of life decisions. # Recognizes priorities in decisions to allocate transplant organs and/or
other scarce resources. # Knows use of unorthodox/experimental or folk/alternative therapies. # Recognizes physician error vs. negligence. # Knows Good Samaritan laws. # Knows guidelines for reporting findings to proper authorities. # Recognizes need for third-party permission for treatment in medical
emergencies. # Assesses degree of disclosure to terminally ill patients. # Knows definitions of competence and sanity. # Knows guidelines for commitment. # Recognizes impaired physician. # Knows appropriate prescriptive practices. # Knows definition of and legal issues regarding brain death. Objectives Related to
Applying Scientific Concepts # Identifies the cause/causal agent or predisposing factor(s);
or, given an effect, what is the cause. # Predicts the effect; given a particular cause, identifies what effects
may be expected. Given an anatomic,
pathologic, or physiologic abnormality, predicts the
effect on function, including compensatory
effects. # Recognizes associated disease conditions, including complications,
or indicators for potential disease
complications, of a given disease (excludes
iatrogenic complications). # Identifies the underlying processes/pathways that account for, or
contribute to, the expression or resolution
of a given condition. # Recognizes characteristics of disease relating to natural history or
course of disease, including progression,
severity, duration, and transmission of disease. # Evaluates given clinical or physical findings to identify the underlying
anatomic structure or physical location. # Interprets laboratory or diagnostic studies as to the underlying
pathophysiology; predicts expected diagnostic test
findings for a given disease. # Recognizes appropriate methods and techniques related to
procedures, artifacts of instrumentation,
technical errors/problems contributing to
misinformation. # Interprets results of experimental data or biometric studies. # Knows design features of clinical studies. # Knows issues regarding validity of research protocols. # Recognizes potential bias in clinical studies including the extent to
which bias accounts for study results. # Interprets results of clinical studies. # Distinguishes clinical importance from statistical significance. # Knows sensitivity and specificity of selected test.
Federation
of State Medical Boards (FSMB) National
Board of Medical Examiners®(NBME®) Educational
Commission for Foreign Medical Graduates (ECFMG®) Association
of American Medical Colleges National
Resident Matching Program Liaison
Committee on Medical Education (LCME) Prometric,
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