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USMLE Exam 2025 Step 1, 2 and 3 – Dates, Fees, Centers, Pattern, Result

Updated on 17th December, 2024 by Team Careers360

About USMLE 2025

The USMLE is a three-step examination written by international students worldwide to get an initial license to practice medicine in the USA. This USMLE is owned by two entities namely the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners(NBME). Every year more than 12000 candidates participates in USMLE. This USMLE 2025 Step 1, Step CK2 can be attempted from any major city across the world in USMLE test centres, while USMLE Step 3 must be taken in the US.

This USMLE 2025 exam assesses the physician characteristics required for patient care like medical knowledge, skills, values, attitudes, etc. Candidates outside of the USA & Canada can register for the USMLE 2025 exam through ECFMG’s online services on the USMLE official website. Before applying for USMLE exam or selecting the USMLE exam dates 2025, kindly check this exam page for prior information.

USMLE Full Form

The full form of the word USMLE is the United States Medical Licensing Examination. It is a medical licensing exam. Usually taken during the different stages of the medical education. The USMLE test is suitable for medical graduates planning to practice medicine in the USA. The USMLE is a computer-based test that uses the Computer-based Case Simulation software (CCS).

What is USMLE Exam?

The USMLE acts as a qualifying exam for obtaining the license to practice medicine in the USA. Candidates who are studying MBBS or graduated from medical programs are eligible to take this USMLE 2025 exam. The exam includes USMLE Step 1, Step 2 CK, and Step 3. USMLE Step 1 and USMLE Step 2 components can be taken in any sequence, but Step 3 can be taken only after all other steps and step components are complete. USMLE steps 2025 will be conducted in computer-based mode.

USMLE Steps

As stated there are 3 steps in USMLE exam, each step assesses the candidate's understanding and application of concepts in the practice of medicine.

USMLE Step 1 - It is a one-day exam to assess the candidate in understanding and applying important concepts of basic science with special emphasis on principles and mechanisms.

USMLE Step 2 - It is a one-day exam that assesses the application of medical knowledge and understanding of clinical science essential in patient care under supervision.

USMLE Step 3 - It is the final assessment for physicians assuming independent responsibility in delivering medical care.

USMLE Latest Update 1

USMLE Step 1 score reporting will transition from a numeric score and pass/fail outcome to pass/fail only for exams taken on or after January 26, 2022. The USMLE exam program views this change as an important first step toward facilitating broader, system-wide changes to improve the transition from undergraduate to graduate medical education. For multi-day exams, the date of the first day of the USMLE testing will determine score reporting. Both Scores and Transcripts will include only Pass/Fail outcome.

USMLE Latest Update 2:

The number of USMLE exam attempts allowed on each Step is reduced from six to four.

USMLE Latest Update 3:

The USMLE program has released the 2023 examinee performance data for each of its three Step exams. The performance tables show the passing rates for each Step by various examinee groups and are available at www.usmle.org/performance-data.

USMLE: Sample papers | Preparation Tips | Syllabus

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USMLE 2025 Highlights

Full Exam Name	United States Medical Licensing Examination
Short Exam Name	USMLE
Conducting Body	Federation of State Medical Boards
Exam Level	International Level Exam
Languages	English
Mode Of Application	online
Exam Duration	Step 1:8 Hours +2 more

USMLE 2025 Eligibility Criteria

Before applying to any step or step component of the USMLE 2024, the applicant should carefully go through the USMLE eligibility criteria of that step or step component. It is because the USMLE eligibility criteria 2024 of one step can vary from another; for example Step 3 is allowed only after completion of all other steps.

Eligibility for USMLE Step 1 2024

Step

USMLE Eligibility Criteria

Step 1

The medical student or graduate must be enrolled in, or a graduate of, a medical school that is located outside the US or Canada and is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements;

In addition, any other ECFMG criteria also have to be fulfilled.

Other mentionable:

The applicant must meet eligibility requirements at the time of application and also on the exam day.
Such applicants who have been dismissed or has withdrawn from medical school, isn't eligible for USMLE, irrespective of whether the applicant is appealing the decision or is otherwise contesting the status.

Eligibility for USMLE 2024: USMLE Step 2 (CK)

Step

USMLE Eligibility Criteria

Steps 2 CK

The applicant must be admitted to, or should be a graduate of, a medical school which is:

Located outside the US or Canada
Listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements;

The applicant also has to fulfil ECFMG criteria as may be prescribed.

Other details:

The eligibility criteria has to be satisfied at the time of application and on exam day.
Such applicants who have been dismissed or have been withdrawn from medical school aren’t eligible to apply for USMLE, irrespective of whether he/she is appealing the decision or is otherwise contesting the status.

Eligibility for USMLE 2024 Step 3

USMLE Step

USMLE Eligibility Criteria

STEP 3

To be eligible for USMLE Step 3, the applicant must have completed an MD or an equivalent degree from a medical school that is located outside the US or Canada, which is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements.

Apart from this, the applicant must:

Passed Step 1, Step 2 CK
Have ECFMG certification

Other Information:

Must meet eligibility requirements before applying and on test day.

Sequence of USMLE examination:

USMLE Step 1, Step 2 CK can be taken in any order or sequence. However, Step 3 can be taken only on completion of all other steps, i.e. USMLE Step 1 and USMLE Step 2 components.

USMLE 2025 Application Process

Each step and step component of the USMLE 2024 has a separate application form. So, depending on the USMLE exam steps for international students, the USMLE 2024 application form has to be filled. Also, one must note that Step 1 and Step 2 components (CS and CK) can be taken in any sequence, but Step 3 is only allowed after completion of USMLE Step 1, Step 2 CK and Step 2 CS.

USMLE 2024 Registration Entity

Step 1, Step 2 CK, Step 2 CS	Step 1, Step 2 CK, Step 2 CS	Step 3
For students / graduates of LCME-or AOA-accredited medical programs in the US or Canada:	For students / graduates of medical schools located outside the US and Canada:	All medical school graduates who have passed Step 1, Step 2 CK, and Step 2 CS:
Apply through NBME on NLES (NBME Licensing Examination Services)	Apply through ECFMG on IWA (Interactive Web Applications)	Apply through FSMB.

Step 1, Step 2 CK, and Step 3 of USMLE 2024 are usually not offered in the first 2 weeks of January or on major local holidays. So make it a point to check available USMLE step 1 dates 2024, step 2 dates in the scheduling system.

USMLE Fees 2024

USMLE Component	USMLE Fees 2024
Application for ECFMG Certification	US $150
USMLE Step 1	US $975 - Examination Fee + International Test Delivery Surcharge, if testing outside the United States and Canada
USMLE Step 2 CK	US $975 - Examination Fee + International Test Delivery Surcharge, if testing outside the United States and Canada
USMLE Step 2 CS	US $1,600 - Examination Fee
USMLE Step 3	US $895
Extension of Eligibility Period (for Step 1/Step 2 CK)	US $90 per exam
Testing Region Change (for Step 1/Step 2 CK )	US $85 per region change
Rescheduling Fee (for Step 1/Step 2 CK)	US $0 – $604 (depending on exam, testing region, and USMLE dates 2024 of cancellation)
Rescheduling Fee (for Step 2 CS)	US $0 – $1,300 (depending on USMLE dates 2024 of cancellation)
Score Recheck (for Step 1/Step 2 CK/Step 2 CS)	US $80 per exam

USMLE Admission Guide

This ebook gives you a detailed insight on the exam, its various steps, eligibility, exam pattern, syllabus, and much more.

Download Now

Documents Required at Exam USMLE 2025

United States Medical Licensing Examination 2025

Scheduling permit for USMLE
Valid government issued photo ID (preferably passport)

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Exam Pattern

Step 1

USMLE Step 1 2025 will be a one-day exam of around 8 hours duration. The exam will comprise 7 different 60-minute blocks and cover the following topics:

Anatomy
Ageing
Behavioural sciences
Biochemistry
Biostatistics and epidemiology
Genetics
Immunology
Microbiology
Molecular and cellular biology
Nutrition
Pathology
Pharmacology
Physiology

USMLE 2025 Step 1 Exam Pattern

Step and purpose

Format

Length

It accesses a candidate’s

understanding of and ability to apply important concepts of the basic sciences to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy

There will be around 280 MCQs, split over seven 60-minute blocks

The mode of exam will be Computer-based and will be administered at Prometric test centres across the world

Single day test

Duration of test: Around

eight hours

The USMLE Step 1 test content can be classified into the two dimensions of system and process. The broad categorisation of the Step 1 test material can be done based on these two dimensions.

USMLE Step 1 2025 Exam Pattern: System and Process

System	Percentage of Test Content
General Principles of Foundational Science	15% - 20%
Immune System ; Blood & Lymphoreticular System ; Behavioral Health ; Nervous System & Special Senses ; Skin & Subcutaneous Tissue ; Musculoskeletal System ; Cardiovascular System ; Respiratory System ; Gastrointestinal System ; Renal & Urinary System ; Pregnancy, Childbirth, & the Puerperium ; Female Reproductive & Breast ; Male Reproductive ; Endocrine System	60% - 70%
Multisystem Processes & Disorders ; Biostatistics & Epidemiology ; Population Health ; Social Sciences	15% - 20%
Process	Percentage of Test Content
Normal Processes	10% - 15%
Abnormal Processes	55% - 60%
Principles of Therapeutics	15% - 20%
Other	10% - 15%

USMLE Step 1 2025 Exam Pattern : Physician Competency/Task

In addition to test content categorisation based on system and process, the USMLE Step 1 exam can also be categorised by physician competency and task.

Physician Competency/Task	Percentage of Test Content
Scientific Concepts/Medical Knowledge	55% - 65%
Patient Care: Diagnosis History/Physical Examination Laboratory/Diagnostic Studies Diagnosis Prognosis/Outcome	20% - 30%
Patient Care: Management Health Maintenance/Disease Prevention Pharmacotherapy	15% - 20%
Communication Professionalism	2% - 5%
Practice-based Learning and Improvement	4% - 8%

Step 2 CK

The USMLE Step 2 CK 2025 examination or USMLE Step 2 Clinical Knowledge examination will have 8 different 60-minute blocks totalling around 9 hours. The number of test items varies with each block although it remains under 40 per block. The total number of test items for the examination does not exceed 318.

USMLE Step 2 Exam Pattern

Step component and purpose

Format

Length

Step 2 Clinical Knowledge (CK)

Tests the candidate’s ability to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision, with an emphasis on health promotion and disease prevention.

Around 318 multiple-choice questions, divided into eight 60-minute blocks

A computer-based test administered at Prometric test centres.

One-day test

Session

-Approximately

nine hours

The USMLE Step 2 CK test content is classified into 18 areas of organ systems and general principles.

USMLE Step 2 CK 2025 Exam Pattern - System

System	Percentage of Test Content
General Principles of Foundational Science	1% - 3%
Immune System ; Blood & Lymphoreticular Systems ; Behavioral Health ; Nervous System & Special Senses ; Skin & Subcutaneous Tissue ; Musculoskeletal System ; Cardiovascular System ; Respiratory System ; Gastrointestinal System ; Renal & Urinary Systems ; Pregnancy, Childbirth, & the Puerperium ; Female Reproductive System & Breast ; Male Reproductive System ; Endocrine System ; Multisystem Processes & Disorders	85% - 95%
Biostatistics & Epidemiology/Population Health Interpretation of the Medical Literature	1% - 5%

Additionally, the test content for USMLE Step 2 CK can be divided in accordance with Physician competencies and tasks.

USMLE Step 2 CK 2025 Exam Pattern - Physician Competency and Task

Physician Competency/Task	Percentage of Test Content
Scientific Concepts/Medical Knowledge	10% - 15%
Patient Care: Diagnosis History/Physical Examination Laboratory/Diagnostic Studies Diagnosis Prognosis/Outcome	40% - 50%
Patient Care: Management Health Maintenance/Disease Prevention Pharmacotherapy Clinical Interventions Mixed Management Surveillance for Disease Recurrence	30% - 35%
Professionalism Systems-based Practice/Patient Safety Practice-based Learning	3% - 7%

Step 3

The USMLE Step 3 2025 examination is the last step or final assessment in the USMLE examination series and leads to a medical practitioner certificate upon successful completion. The exam is conducted over a 2-day period and is split into two parts:

Day 1 - Foundations of Independent Practice (FIP)

The Step 3 Day 1 exam is of 7-hour duration and comprises 6 different 60-minute blocks. Each of these blocks has around 38 - 40 questions each and the total examination for Day 1 does not exceed 233 questions.

Day 2 - Advanced Clinical Medicine (ACM)

The Step 3 Day 2 exam is of a 9-hour duration and comprises 6 different blocks of 30 questions in each. Additionally, 13 case simulations are a part of the assessment and the total number of questions is 180.

The overall test content can be divided based on system and process as well as based on physician competencies and tasks.

Exam pattern of USMLE Step 3

Purpose

Test Format

Length

STEP 3

The step tests the applicant to apply medical knowledge and understanding of biomedical and clinical science that are vital in performing unsupervised practice of medicine, with emphasis on patient management in an ambulatory setting.

Day 1: FOUNDATIONS OF INDEPENDENT PRACTICE (FIP) assesses the examinee’s knowledge of basic medical and scientific principles essential for effective health care.

Day 2: ADVANCED CLINICAL MEDICINE (ACM) assesses the examinee’s ability to apply comprehensive knowledge of health and disease in the context of patient management and the evolving manifestation of disease over time.

Day 1 FIP:

Approximately 232 MCQs, divided into six 60-minute blocks.

Computer-based test (CBT) administered at Prometric test centers in the US

Day 2 ACM:

Approximately 180 MCQs, divided into six 45-minute blocks.

Thirteen computer-based case simulations (CCS). Each simulation is 10 to 20 minutes of real-time.

Computer-based test, administered at Prometric test centres in the US

One-day test

session

-approximately

seven hours

One-day test session

-approximately

nine hours

USMLE Step 3 2025 Exam Pattern - System

System	Percentage of Test Content
General Principles of Foundational Science	1% - 3%
Immune System; Blood & Lymphoreticular System; Behavioral Health; Nervous System & Special Senses; Skin & Subcutaneous Tissue; Musculoskeletal System; Cardiovascular System; Respiratory System; Gastrointestinal System; Renal & Urinary System; Pregnancy, Childbirth, & the Puerperium; Female Reproductive System & Breast; Male Reproductive System; Endocrine System; Multisystem Processes & Disorders	80% - 85%
Biostatistics & Epidemiology/Population Health, & Interpretation of the Medical Literature, Social Sciences	14% - 18%

USMLE Step 3 2025 Exam Pattern - Physician Competency and Tasks

Physician Competency/Task	Percentage of Test Content
Physician Competency/Task	Day 1 - FIP	Day 2 - ACM
Scientific Concepts/Medical Knowledge	18% - 22%
Patient Care: Diagnosis History/Physical Examination Laboratory/Diagnostic Studies Diagnosis	40% - 45%
Patient Care: Diagnosis Prognosis/Outcome		20% - 25%
Patient Care: Management Health Maintenance/Disease Prevention Pharmacotherapy Clinical Interventions Mixed Management Surveillance for Disease Recurrence		75% - 80%
Communication and Professionalism	8% - 12%
Systems-based Practice/Patient Safety and Practice-based Learning	22% - 27%

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USMLE 2025 Syllabus

USMLE Step 1 Syllabus

System specifications-General principles of foundational science: Unit 01

Biochemistry and molecular biology

Gene expression: DNA structure, replication, exchange, and epigenetics (example imprinting, X-activation, DNA methylation), gene expression: Transcription, gene expression: Translation, post-translational processing
Gene expression: Modifications and disposition of proteins (degradation), including protein/ glycoprotein synthesis, intra-extracellular sorting, and processes/ functions related to golgi complex and rough endoplasmic reticulum
Structure and function of proteins and enzymes (example enzyme kinetics and structural/ regulatory proteins), energy metabolism (example ATP generation, transport chain)

System specifications-General principles of foundational science: Unit 02

Biology of cells

Adaptive cell responses and cellular homeostasis (example, hypertrophy), mechanisms of injury and necrosis, including pathologic processes (example liquefactive necrosis, free radical formation), apoptosis
Cell cycle and cell cycle regulation (example mitosis), mechanisms of dysregulation, cell biology of cancer (example role of p53, proto-oncogenes), general principles of invasion and metastasis, including cancer staging
Cell/ tissue structure, regulation, and function, including cytoskeleton, organelles, glycolipids, channels, gap junctions, extracellular matrix, and receptors

System specifications-General principles of foundational science: Unit 03

Human development and genetics

Principles of pedigree analysis, inheritance patterns, occurrence and recurrence risk determination, population genetics: Hardy-Weinberg law, founder effects, mutation-selection equilibrium, principles of gene therapy, genetic testing and counseling
Genetic mechanisms (example penetrance, genetic heterogeneity)

System specifications-General principles of foundational science: Unit 04

Biology of tissue response to disease

Acute inflammatory responses (patterns of response), acute inflammation and mediator systems (example histamine, prostaglandins, bradykinins, eosinophilic basic protein, nitric oxide), vascular response to injury, including mediators
Principles of cell adherence and migration (example ECAMs, selectins, leukocytic diapedesis, and rolling), microbicidal mechanisms and tissue injury (example defensins)
Clinical manifestations (example, pain, fever, leukocytosis, leukemoid reaction, chills), chronic inflammatory responses (example tumor necrosis factor)
Reparative processes, wound healing, repair: Thrombosis, granulation tissue, angiogenesis, fibrosis, scar/ keloid formation, regenerative process

System specifications-General principles of foundational science: Unit 05

Pharmacodynamic and pharmacokinetic processes: General principles

Pharmacokinetics: Absorption, distribution, metabolism, excretion, dosage intervals, mechanisms of drug action, structure-activity relationships (example, anticancer drugs), concentration and dose-effect relationships (example efficacy, potency)
Types of agonists (example full, partial, inverse) and antagonists and their actions
Individual factors altering pharmacokinetics and pharmacodynamics (example age, gender, disease, tolerance, compliance, body weight, metabolic proficiency, pharmacogenetics)
Mechanisms of drug adverse effects, overdosage, toxicology, mechanisms of drug interactions
Signal transduction, including structure/ function of all components of signal transduction, pathways such as receptors, ligands (example general principles of nitric oxide, autocrine and paracrine signaling)

System specifications-General principles of foundational science: Unit 06

Microbial biology

Microbial identification and classification, including principles, microorganism identification, and non-immunologic laboratory diagnosis
Bacteria: Structure (example cell walls, composition, appendages, virulence factors, extracellular products, toxins, mechanism of action of toxins), processes, replication, and genetics (example metabolism, growth, and regulation), oncogenesis
Bacteria: Antibacterial agents (example mechanisms of action on organism, toxicity to humans, and mechanisms of resistance)
Viruses: Structure (example physical and chemical properties, virulence factors), processes, replication, and genetics (example life cycles, location of virus in latent infection), oncogenesis
Viruses: Antiviral agents (example mechanisms of action on virus, toxicity to humans, and mechanisms of resistance)
Fungi: Structure (example cell wall, composition, appendages, virulence factors, extracellular products, toxins, mechanisms of action of toxins), processes, replication, and genetics (example asexual vs. sexual, metabolism, growth)
Fungi: Antifungal agents (example mechanisms of action on fungus, toxicity to humans, and mechanisms of resistance)
Parasites: Structure (example appendages, macroscopic features, and virulence factors), processes, replication, and genetics (example life cycles, metabolism, and growth), oncogenesis
Antiparasitic agents (example mechanisms of action on parasite, toxicity to humans, and mechanisms of resistance)
Prions

System specifications-General principles of foundational science: Unit 07

Infancy and childhood (0-12 years): (a) Normal physical changes-linear growth, variations in linear growth, including constitutional delay; weight; head circumference; micturition, defecation, primary incontinence/ bedwetting; normal physical examination
Infancy and childhood (0-12 years): (a) Normal physical changes-screening; sleep; teething syndrome, (b) developmental stages: Motor; speech; cognitive; psychosocial; anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition
Infancy and childhood (0-12 years): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine; risk factors and prevention (example guns, swimming, motor vehicles, car seats)
Infancy and childhood (0-12 years): (c) Lifestyle and routine preventive health care-routine vaccinations
Adolescence (13-17 years): (a) Normal physical changes-linear growth, variations in linear growth including constitutional delay; weight; puberty; normal physical examination; gynecomastia; autonomy/ self-identity; sleep
Adolescence (13-17 years): (b) Developmental stages-cognitive (example abstract thought); psychosocial (example autonomy, role confusion, sexual identity); anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition
Adolescence (13-17 years): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine
Adolescence (13-17 years): (c) Lifestyle and routine preventive health care-risk factors and prevention (example risk-taking behavior, helmets, safe sex, motor vehicles, seat belts, distractions); routine vaccinations
Adulthood (18-64 years): (a) Normal physical changes-weight; normal physical examination; screening; sleep, (b) developmental stages: Cognitive; intimacy vs. isolation; anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition
Adulthood (18-64 years): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine; risk factors and prevention; routine vaccinations
Older adulthood (65 years and older): (a) Normal physical changes, including normal physical exam for age-weight, height (spinal compression), skin, bruising; normal physical examination; response to temperature; micturition, defecation; sleep
Older adulthood (65 years and older): (b) Developmental stages-motor; cognitive (example psychomotor slowing); psychosocial; integrity vs. despair; retrospection; anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition
Older adulthood (65 years and older): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine
Older adulthood (65 years and older): (c) Lifestyle and routine preventive health care-risk factors and prevention (example falls, general medical condition; polypharmacy, driving, caregiver stress); routine vaccinations

System specifications-Behavioral health: Unit 01

Normal processes

Psychodynamic and behavioral factors, related past experience (example transference, personality traits)
Adaptive behavioral responses to stress and illness (example coping mechanisms)
Maladaptive behavioral responses to stress and illness (example drug-seeking behavior, sleep deprivation)
Patient adherence: General adherence; adolescent adherence

System specifications-Behavioral health: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Psychotic disorders: Brief psychotic disorder; delusional disorder; psychotic disorder due to another medical condition; schizophrenia; schizoaffective disorder; substance-induced psychotic disorder
Anxiety disorders: Acute stress disorder; anxiety disorders (generalized anxiety disorder, anxiety due to another medical condition, social phobia); hyperventilation syndrome; obsessive-compulsive disorder; panic disorder with and without agoraphobia
Anxiety disorders: Phobic disorders; post-traumatic stress disorder; separation anxiety disorder; substance-induced anxiety disorder, trichotillomania
Mood disorders: Major depressive disorder with and without psychotic features, with and without seasonal pattern; major depressive disorder, postpartum, with and without psychotic features, including screening; cyclothymic disorder
Mood disorders: Persistent depressive disorder (dysthymia); bipolar disorder, manic/ depressed/ mixed; premenstrual dysphoric disorder; bipolar and related disorder or depressive disorder due to another medical condition
Mood disorders: Substance/ medication-induced bipolar and related disorder or depressive disorder (illegal or prescribed); suicidal ideation/ attempt
Somatoform disorders: Body dysmorphic disorder; conversion disorder, including psychogenic seizures; dissociative disorders; illness anxiety disorder (hypochondriasis); malingering; pain disorder; somatic symptom disorder
Factitious disorders: Factitious disorder imposed on self
Eating disorders and impulse control disorders: Anorexia nervosa; binge-eating disorder; bulimia nervosa; eating disorder; disruptive, impulse-control, and conduct disorders (example gambling, kleptomania, pyromania)
Disorders originating in infancy/ childhood: Reactive attachment disorder; attention deficit/ hyperactivity disorder; speech sound disorder or language disorder; learning disorder/ dyslexia; intellectual developmental disorder and developmental delay
Disorders originating in infancy/ childhood: Undefined, including school problems, fetal alcohol syndrome; oppositional defiant disorder, conduct disorder; autism spectrum disorder, rett syndrome; psychoses with origin specific to childhood
Disorders originating in infancy/ childhood: Elimination disorders (incontinence, encopresis); tic disorders/ tourette disorder
Personality disorders: Antisocial personality disorder; avoidant personality disorder; borderline personality disorder; dependent personality disorder; histrionic personality disorder; narcissistic personality disorder
Personality disorders: Obsessive-compulsive personality disorder; paranoid personality disorder; schizoid personality disorder
Psychosocial disorders/ behaviors: Adjustment disorder; grief response/ bereavement, normal and persistent complex; parent-child relational problems other than physical or emotional abuse; other psychosocial stress
Sexual and gender identity disorders: Gender dysphoria; psychosexual dysfunction
Substance use disorders: Alcohol use disorder/ intoxication/ dependence/ withdrawal; tobacco/ nicotine use disorder/ dependence/ withdrawal; varenicline use; cannabis use disorder/ intoxication/ dependence
Substance use disorders: Hallucinogen use disorder/ intoxication/ dependence/ withdrawal; inhalant use disorder/ intoxication/ dependence/ withdrawal; opioid, heroin, including prescription drug, use disorder/ intoxication/ dependence/ withdrawal
Substance use disorders: Sedative, hypnotic, including benzodiazepine and barbiturate use disorder/ intoxication/ dependence/ withdrawal; stimulant, cocaine, methamphetamine use disorder/ intoxication/ dependence/ withdrawal
Substance use disorders: Other drugs of use disorders (example ecstasy, PCP, bath salts)/ intoxication/ dependence/ withdrawal; polysubstance use disorder/ intoxication/ dependence/ withdrawal

System specifications-Nervous system and special senses: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes, including neural tube derivatives, cerebral ventricles, and neural crest derivatives
Organ structure and function: (a) Spinal cord-gross anatomy and blood supply, spinal reflexes, brain stem (example cranial nerves and nuclei, reticular formation, anatomy and blood supply, control of eye movements)
Organ structure and function: (b) Brain-gross anatomy and blood supply, higher function: Cognition, language, memory, executive function, hypothalamic function, limbic system and emotional behavior, circadian rhythm sleep-wake disorder
Organ structure and function: (c) Sensory systems-general sensory modalities, including sharp, dull, temperature, vibratory, and proprioception, special sensory modalities, including vision, hearing, taste, olfaction, and balance
Organ structure and function: (d) Motor systems-brain and spinal cord (upper motor neuron), basal ganglia and cerebellum, autonomic nervous system, peripheral nerves
Cell/ tissue structure and function, including neuronal cellular and molecular biology: Axonal transport, excitable properties of neurons, axons, and dendrites, including channels synthesis, storage, release
Cell/ tissue structure and function, including neuronal cellular and molecular biology: Reuptake, and degradation of neurotransmitters and neuromodulators, presynaptic and postsynaptic receptor interactions, trophic and growth factors, brain metabolism
Cell/ tissue structure and function, including neuronal cellular and molecular biology: Glia, myelin, brain homeostasis: Blood-brain barrier, cerebrospinal fluid formation and flow, choroid plexus
Repair, regeneration, and changes associated with stage of life

System specifications-Nervous system and special senses: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) meningitis: Bacterial (actinomyces israelii; haemophilus influenzae; listeria monocytogenes; mycobacterium tuberculosis; neisseria meningitidis; staphylococcus aureus)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) meningitis: Bacterial (epidermidis; streptococcus agalactiae; streptococcus pneumoniae); viral (adenovirus, arboviruses, echovirus and coxsackie A and B viruses)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral (echovirus and coxsackie A and B viruses, polioviruses, herpes simplex virus, varicella zoster human immunodeficiency virus, lymphocytic choriomeningitis virus)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral (lymphocytic choriomeningitis virus, measles virus, mumps virus, St. Louis encephalitis virus, California encephalitis virus, Western equine encephalitis virus)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iii) fungal (blastomycosis dermatitidis, cryptococcus neoformans/ gattii); spirochetal (borrelia burgdorferi; leptospira; treponema pallidum, including neurosyphilis)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iv) protozoal/ helminths (acanthamoeba, naegleria fowleri, strongyloides stercoralis, angiostrongylus cantonensis, baylisascaris procyonis)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(v) encephalitis (herpesvirus [HSVI], varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, mumps virus, enterovirus, West Nile virus, St. Louis encephalitis virus)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(v) encephalitis (rabies virus, eastern and western equine encephalitis virus, poliovirus, Taenia, Toxoplasma gondii), (vi) prion disease (example Creutzfeldt-Jakob disease)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(vi) botulism (Clostridium botulinum), (vii) tetanus (Clostridium tetani); (viii) CNS disorders associated with AIDS (example progressive multifocal leukoencephalopathy)
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-myasthenia gravis, including thymoma; multiple sclerosis; transverse myelitis
Neoplasms (cerebral, spinal, and peripheral): Benign (meningioma, neurofibromatosis); malignant (glioblastoma multiforme, astrocytoma, medulloblastoma, primary CNS lymphoma); metastatic (example breast, lung, pancreatic, testicular, melanoma)
Cerebrovascular disease: Arteriovenous malformations, ectatic cerebral vessels; transient ischemic attack; stroke, thrombotic: Cerebral artery occlusion/ cerebral infarction; stroke, embolic: Cerebral embolism
Cerebrovascular disease: Stroke-intracerebral hemorrhage including subarachnoid hemorrhage, traumatic intracranial hemorrhage; cerebral artery aneurysm; carotid artery stenosis/ atherosclerosis/ occlusion/ dissection
Cerebrovascular disease: Vertebral artery deficiency/ dissection; subclavian steal syndrome; vascular dementia; hypertensive encephalopathy; posterior reversible encephalopathy syndrome; venous sinus thrombosis
Disorders relating to the spine, spinal cord, and spinal nerve roots: Cauda equina syndrome; spinal artery thrombosis/ embolus/ infarct; spinal cord compression; spinal cord transection, paraplegia and quadriplegia
Disorders relating to the spine, spinal cord, and spinal nerve roots: Acute and chronic effects (example autonomic dysreflexia); spinal stenosis (cervical, lumbar); syringomyelia
Cranial and peripheral nerve disorders: (a) Cranial nerve injury/ disorders-cranial nerve injury; bell palsy; anisocoria, miosis, mydriasis; internuclear ophthalmoplegia; nystagmus and other irregular eye movements; vestibular neuritis, labyrinthitis
Cranial and peripheral nerve disorders: (a) Cranial nerve injury/ disorders-ptosis of the eyelid; Horner syndrome, peripheral nerve/ plexus injury/ disorders: Peripheral nerve injury, including brachial plexus
Cranial and peripheral nerve disorders: (b) Peripheral nerve/plexus injury/disorders-carpal/ cubital/ tarsal/ peroneal tunnel syndrome; mononeuritis, Guillain-Barré syndrome; Miller Fisher syndrome; neuropathy (example Charcot-Marie-Tooth disease)
Cranial and peripheral nerve disorders: (b) Peripheral nerve/plexus injury/disorders-herpes zoster
Neurologic pain syndromes: Complex regional pain syndrome (reflex sympathetic dystrophy, causalgia); fibromyalgia; postherpetic neuralgia; phantom limb pain/ syndrome; thalamic pain syndrome; trigeminal neuralgia
Degenerative disorders/ amnestic syndromes: Alzheimer disease; frontotemporal dementia, including progressive supranuclear palsy, Lewy body disease; mild neurocognitive disorder, mild cognitive impairment
Global cerebral dysfunction: Altered states of consciousness; delirium; coma/ brain death
Neuromuscular disorders: Amyotrophic lateral sclerosis/ spinal muscular atrophy; muscular dystrophy (example Duchenne, myotonic); muscle channelopathies (example hypokalemic period paralysis)
Movement disorders: Acute dystonia; adult tic disease; essential tremor; Huntington disease; Parkinson disease, including Parkinson dementia
Metabolic disorders: Adrenoleukodystrophy; metabolic encephalopathy
Paroxysmal disorders: Headache, including migraine, mixed, tension, ice-pick, cluster, medication withdrawal, caffeine withdrawal; seizure disorders, including generalized tonic-clonic, partial, absence, febrile
Sleep disorders: Cataplexy and narcolepsy; circadian rhythm sleep-wake disorder; insomnia, primary; sleep terror disorder and sleepwalking; REM sleep behavior disorder; restless legs syndrome
Traumatic and mechanical disorders and disorders of increased intracranial pressure: Anoxic brain damage, cerebral hypoxia; epidural, subdural hematoma (cerebral and spinal); intraparenchymal hemorrhage, traumatic subarachnoid hemorrhage; cerebral edema
Traumatic and mechanical disorders and disorders of increased intracranial pressure: Pseudotumor cerebri (idiopathic intracranial hypertension); torticollis/ cervical dystonia; hydrocephalus, including normal-pressure
Traumatic and mechanical disorders and disorders of increased intracranial pressure: Traumatic brain injury (concussion)/ post concussion syndrome (dementia pugilistica); traumatic brain syndrome
Congenital disorders: Friedreich ataxia; neural tube defects (example spina bifida, holoprosencephaly, anencephaly); microcephaly; Sturge-Weber syndrome; tuberous sclerosis, von Hippel-Lindau disease; hydrocephalus, obstructive (Arnold-Chiari)
Adverse effects of drugs on the nervous system: Acute dystonic reaction; drug-induced meningitis (example NSAIDs, sulfa drugs); drug-induced neuropathy (example vincristine, isoniazid, metronidazole)
Adverse effects of drugs on the nervous system: Extrapyramidal adverse effects (example akathisia, dystonia, drug-induced parkinsonism); neuroleptic malignant syndrome; poisoning by psychotropic agents, including antidepressants; serotonin syndrome
Adverse effects of drugs on the nervous system: Tardive dyskinesia
Disorders of the eye and eyelid: (a) Infectious and inflammatory disorders of the eye-blepharitis/ eyelid inflammation; chalazion; chorioretinitis; conjunctivitis (adenovirus)/ keratoconjunctivitis; dacryocystitis; endophthalmitis; hordeolum
Disorders of the eye and eyelid: (a) Infectious and inflammatory disorders of the eye-iridocyclitis; optic neuritis; periorbital cellulitis; uveitis, (b) neoplasms of the eye: Melanoma; retinoblastoma
Disorders of the eye and eyelid: (c) Disorders of the eye and eyelid, structural-cataract; glaucoma; lacrimal system disorders; pterygium; refractive disorders (presbyopia, myopia, hyperopia, astigmatism)
Disorders of the eye and eyelid: (d) Disorders of the pupil, iris, muscles (extraocular): Amblyopia; strabismus, (e) disorders of the retina-hypertensive retinopathy; macular degeneration; papilledema; retinal detachment; retinitis pigmentosa
Disorders of the eye and eyelid: (e) Disorders of the retina-vascular disorders affecting the retina, including central retinal artery embolus, retinal hemorrhage, amaurosis fugax, embolus, carotid artery stenosis, central retinal vein occlusion
Disorders of the eye and eyelid: (e) Disorders of the retina-visual impairment/ blindness, night blindness , (f) traumatic and mechanical disorders: Black eye; burn of the eye and adnexa; corneal abrasion, ulcer; dislocated lens; foreign body in eye
Disorders of the eye and eyelid: (f) Traumatic and mechanical disorders-hyphema; injury to optic nerve and pathways; laceration of the eye and eyelid; ocular open wounds; orbital fracture; subconjunctival hemorrhage
Disorders of the eye and eyelid: (g) Adverse effects of drugs on the eyes-ethambutol; hydroxychloroquine; prednisone
Disorders of the ear: (a) Infectious and inflammatory disorders of the ear-chondritis; mastoiditis; otitis, externa, media, interna, serous, suppurative, malignant otitis externa, (b) neoplasms: Acoustic neuroma, neurofibromatosis type 2; cholesteatoma
Disorders of the ear: (c) Hearing loss/ deafness-hearing loss, including noise-induced; otosclerosis; tinnitus, (d) disorders of balance and spatial orientation: Meniere disease; motion sickness; vertigo, including benign positional vertigo
Disorders of the ear: (e) Traumatic and mechanical disorders: Barotrauma; foreign body in ear; impacted cerumen; laceration, avulsion; perforation of tympanic membrane; eustachian tube disorders
Disorders of the ear: (f) Adverse effects of drugs on the ear-antineoplastic agents, including cisplatin; aminoglycosides; furosemide; salicylates

System specifications-Female reproductive system and breast: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes, gametogenesis
Organ structure and function: Female structure, including breast female function (example ovulation, menstrual cycle, puberty) intercourse, sexual response
Cell/ tissue structure and function: Hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones
Reproductive system defense mechanisms and normal flora
Repair, regeneration, and changes associated with stage of life

System specifications-Female reproductive system and breast: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Breast: (a) Infectious, immunologic, and inflammatory disorders-breast abscess; inflammatory disease of breast, fat necrosis; mastitis; nipple discharge, (b) neoplasms-(i) benign and undefined neoplasms: Breast cyst, solitary; fibrocystic changes
Breast: (b) Neoplasms-(i) Benign and undefined neoplasms-fibroadenoma; hypertrophy of breast; intraductal papilloma, (ii) malignant neoplasms (including screening): Breast cancer; intraductal carcinoma; Paget disease of breast; phyllodes tumors
Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-bacterial vaginosis; Bartholin gland abscess; cellulitis, pelvic; candidiasis of the vulva or vagina; lichen sclerosus; sexually transmitted infections and exposure
Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-cervicitis and endocervicitis; chancroid (Haemophilus ducreyi); genital herpes; gonorrhea (Neisseria gonorrhoeae); human papillomavirus infection
Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-genital/ venereal/ anal warts, condylomata acuminata; lymphogranuloma venereum (Chlamydia trachomatis), non-lymphogranuloma venereum; pelvic inflammatory disease
Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-Fitz-Hugh–Curtis syndrome; salpingitis and oophoritis; syphilis (Treponema pallidum); trichomoniasis (Trichomonas vaginalis); urethritis; vaginitis; vulvovaginitis
Neoplasms of the cervix, ovary, uterus, vagina, and vulva: (a) Benign neoplasms and cysts-abnormal Pap smear; benign neoplasm of ovary; endocervical and endometrial polyps; leiomyomata uteri; ovarian cyst
Neoplasms of the cervix, ovary, uterus, vagina, and vulva: (b) Malignant and precancerous neoplasms-cervical cancer; HPV causing cancer; cervical dysplasia, HPV causing dysplasia; endometrial hyperplasia; endometrial/ uterine cancer
Neoplasms of the cervix, ovary, uterus, vagina, and vulva: (b) Malignant and precancerous neoplasms-gestational trophoblastic disease (hydatidiform mole); ovarian cancer; vulvar dysplasia, and cancer
Fertility and infertility: Assisted reproductive techniques (ART); contraception (example oral contraceptives, IUD, vaginal cap, cervical sponge, diaphragm, implant, morning-after pill, male and female condoms); female infertility
Fertility and infertility: Gonadal dysgenesis 45,X (Turner syndrome); sterilization; tubal factors; infertility
Menopause: Ovarian failure, premature menopause; perimenopause; premenopausal menorrhagia; postmenopausal atrophic vaginitis (vaginal atrophy); postmenopausal bleeding; vasomotor symptoms
Menstrual and endocrine disorders: Abnormal uterine bleeding, including perimenopausal; absence of menstruation (primary amenorrhea, secondary amenorrhea including undiagnosed pregnancy); anovulation; dysmenorrhea; endometriosis; hirsutism, virilization
Menstrual and endocrine disorders: Mittelschmerz; pelvic pain; polycystic ovarian syndrome; postcoital bleeding; premenstrual syndrome
Sexual dysfunction: Dyspareunia; orgasmic dysfunction; sexual desire/ arousal syndrome; vaginismus
Traumatic and mechanical disorders: Asherman syndrome; chronic inversion of uterus; chronic pelvic pain syndrome; cystocele; imperforate hymen; injuries, wounds, and burns affecting the female reproductive system and injuries, wounds
Traumatic and mechanical disorders: Burns, and blast injuries; ovarian torsion; pelvic relaxation; rectocele; urethrocele
Congenital disorders: Müllerian agenesis; uterus didelphys, bicornuate uterus; short cervix
Adverse effects of drugs on the female reproductive system and breast: Antihistamines, H2-receptor blockers; benzodiazepines; beta-adrenergic blockers; hormone replacement; opioids; spironolactone; selective serotonin reuptake inhibitors
Adverse effects of drugs on the female reproductive system and breast: Tricyclic antidepressants

System specifications-Male reproductive system: Unit 01

Normal processes

Embryonic development, fetal maturation, and neonatal changes, gametogenesis
Organ structure and function: Structure, male genitalia and prostate function, male genitalia and prostate (example spermatogenesis, puberty) intercourse, orgasm, erection
Cell/ tissue structure and function, including hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones
Reproductive system defense mechanisms and normal flora
Repair, regeneration, and changes associated with stage of life

System specifications-Male reproductive system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-balanitis; epididymitis; orchitis; prostatitis; sexually transmitted infections and exposure; chancroid (Haemophilus ducreyi); genital herpes; gonorrhea (Neisseria gonorrhoeae)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-human papillomavirus infection, genital/ venereal/ anal warts, condylomata acuminata; lymphogranuloma venereum (Chlamydia trachomatis); syphilis (Treponema pallidum)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-trichomoniasis (Trichomonas vaginalis); urethritis, chlamydial and nonchlamydial, nongonococcal, (b) immunologic and inflammatory disorders: Autoimmune hypogonadism
Neoplasms: Malignant neoplasms, penile, prostate, testicular, breast
Metabolic and regulatory disorders, including sexual dysfunction: Erectile dysfunction, impotence; infertility, male factor; male sexual dysfunction; premature ejaculation
Traumatic and mechanical disorders: Benign prostatic hyperplasia/ hypertrophy; circumcision, including complications; epididymal cyst; hydrocele; injuries, wounds, and burns to male genitalia, including blast injuries; penile laceration, penile fracture
Traumatic and mechanical disorders: Peyronie disease; phimosis; scrotal laceration; spermatocele; testicular rupture/ avulsion/ laceration; torsion of testis; urethral laceration/ disruption; varicocele
Congenital disorders of the male reproductive system: Hypospadias; Klinefelter syndrome; undescended testicle
Adverse effects of drugs on the male reproductive system: Alcohol; androgens, testosterone; antipsychotics, antidepressants including selective serotonin reuptake inhibitors; beta adrenergic blockers; diuretic including thiazides
Adverse effects of drugs on the male reproductive system: Drug-induced priapism (example trazodone); finasteride, dutasteride; sildenafil, tadalafil, vardenafil; marijuana; nitric oxide reductase inhibitors

System specifications-Endocrine system: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes
Organ structure and function: Hypothalamus, posterior and anterior pituitary gland, thyroid gland, parathyroid gland, adrenal cortex, adrenal medulla, pancreatic islets, ovary and testis, adipose tissue
Cell/ tissue/ structure and function, including hormone synthesis, secretion, action, metabolism: Peptide hormones, steroid hormones, including vitamin D, thyroid hormones, catecholamine hormones, renin-angiotensin system
Repair, regeneration, and changes associated with stage of life

System specifications-Endocrine system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Diabetes mellitus and other disorders of the endocrine pancreas: (a) Diabetes mellitus-diabetes mellitus, type 1; diabetes mellitus, type 1.5; diabetes mellitus, type 2; diabetes mellitus, acute complications: hyperosmolar coma, hypoglycemic shock
Diabetes mellitus and other disorders of the endocrine pancreas: (a) Diabetes mellitus-ketoacidosis, including cerebral edema, associated electrolyte abnormalities; diabetes mellitus, chronic complications: gastrointestinal/ gastroparesis
Diabetes mellitus and other disorders of the endocrine pancreas: (a) Diabetes mellitus-chronic complications: Neurologic/ neuropathy, ophthalmologic/ retinopathy, peripheral vascular, renal/ nephropathy, metabolic syndrome
Diabetes mellitus and other disorders of the endocrine pancreas: (b) Hypoglycemia and islet cell disorders-hypoglycemia (secondary to insulinoma, surreptitious insulin use, sepsis, liver failure); hyperglycemia (secondary to glucagonoma); hyperinsulinism
Diabetes mellitus and other disorders of the endocrine pancreas: (b) Hypoglycemia and islet cell disorders-islet cell tumors/ insulinoma/ somatostatinoma; pancreatic neuroendocrine tumors
Thyroid disorders: Cyst, nodule; euthyroid sick syndrome; goiter (euthyroid-normal thyroid function with goiter); hypothyroidism; hyperthyroidism, including thyrotoxicosis and thyroid storm; thyroiditis, including Hashimoto; Graves disease
Thyroid disorders: Neoplasms (benign cysts and nodules, thyroid cancer including papillary, follicular, medullary, and anaplastic); thyroid deficiency from pituitary disorder; infertility due to thyroid disease
Thyroid disorders: Secondary hypothyroidism and hyperthyroidism
Parathyroid disorders: Hyperparathyroidism; hypoparathyroidism; metabolic bone disease
Adrenal disorders: Corticoadrenal insufficiency (Addison disease); adrenal insufficiency, secondary; hypocortisolism; cushing syndrome; hyperaldosteronism; neoplasms, benign and malignant (adrenal neuroblastoma, pheochromocytoma, adrenal carcinoma
Adrenal disorders: Adrenal adenoma, aldosteronoma, adrenal incidentaloma); delayed and precocious puberty; hypertensive endocrine disease
Pituitary disorders: Acromegaly/ gigantism; diabetes insipidus; galactorrhea not associated with childbirth; panhypopituitarism from any cause; pituitary apoplexy (example sheehan syndrome); growth hormone deficiency; short stature
Pituitary disorders: SIADH (inappropriate secretion of ADH [vasopressin]); neoplasm, benign and malignant (pituitary adenomas, craniopharyngioma, metastatic disease); prolactinoma and hyperprolactinemia, including infertility due to these disorders
Diabetes mellitus and other disorders of the endocrine pancreas: Pituitary disorders-hypogonadism, primary and secondary
Hypothalamic endocrine disorders
Multiple endocrine neoplasia (MEN1, MEN2)
Congenital disorders: Disorders of sexual differentiation; congenital adrenal hyperplasia; androgen insensitivity/ resistance syndrome; congenital hypothyroidism
Adverse effects of drugs on the endocrine system: Drug, medicinal, and biologic substance effects; exogenous steroid suppression of adrenal glands, anabolic steroids

System specifications-Respiratory system: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes
Organ structure and function: Airways, including mechanics and regulation of breathing, lung parenchyma, including ventilation, perfusion, gas exchange, pleura, nasopharynx, sinuses
Cell/ tissue structure and function, including surfactant formation, and alveolar structure
Repair, regeneration, and changes associated with stage of life
Pulmonary defense mechanisms and normal flora

System specifications-Respiratory system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-acute upper respiratory infection; viral infections (adenovirus, corona viruses, coxsackievirus, influenza virus)
Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-viral infections (parainfluenza virus, rhinoviruses); sinusitis; nasopharyngitis; epiglottitis
Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-bordetella pertussis pneumonia; croup; acute laryngitis; acute laryngotracheitis; tracheitis; pharyngitis
Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-streptococcal throat infections; tonsillitis; peritonsillar abscess; rhinitis, allergic, chronic
Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-ulcers of nasal cavity/ sinuses
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-hospital acquired pneumonia; ventilator-associated pneumonia, community-acquired pneumonia, acute bronchiolitis
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-bronchiolitis obliterans with organizing pneumonia (BOOP); anthrax, pulmonary (Bacillus anthracis); aspiration pneumonia
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-pneumonitis; bronchitis, acute; bronchopneumonia; pneumonia (Burkholderia pseudomallei, chlamydophila pneumoniae
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-coxiella burnetii, francisella tularensis, haemophilus influenzae, klebsiella pneumoniae, legionella, moraxella catarrhalis
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-mycoplasma pneumoniae, pseudomonas aeruginosa, streptococcus, MSSA, MRSA, other gram‐negative bacteria)
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-viral infection (example influenza A, B, adenovirus, H1N1, respiratory syncytial virus, parainfluenza virus)
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-fungal infection (aspergillosis, including allergic bronchopulmonary aspergillosis and aspergilloma, histoplasmosis)
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-fungal infection (coccidioidomycosis, pneumocystis jirovecii); pulmonary tuberculosis; lung abscess
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-viral infection (example influenza A, B, adenovirus, respiratory syncytial virus, parainfluenza virus, avian influenza virus)
Neoplasms: (a) Benign neoplasms-upper airways (example vocal cord polyps, nasal polyps, juvenile, papillomatosis); lungs and pleura (example solitary pulmonary nodule, bronchial carcinoid tumors)
Neoplasms: (b) Malignant neoplasms-(i) upper airways: Lip, oral cavity, and pharynx; head and neck cancer; larynx; trachea, (ii) lower airways and pleura: Malignant neoplasms of bronchus and/ or lung (squamous cell, adenocarcinoma, large cell, small cell)
Neoplasms: (b) Malignant neoplasms-(ii) lower airways and pleura: Malignant neoplasms of pleura (mesothelioma); secondary malignant neoplasms of lung; secondary malignant neoplasms of pleura, (c) metastatic neoplasms including pleural
Obstructive airway disease: Asthma, reactive airway disease; bronchiectasis; chronic airway obstruction; chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema
Pneumoconiosis/ fibrosing/ restrictive pulmonary disorders/ interstitial lung disease: Pneumoconiosis; asbestosis; silicosis; silo-filler's lung, byssinosis, bagassosis, berylliosis; hypersensitivity pneumonitis; hypereosinophilic syndromes
Pneumoconiosis/ fibrosing/ restrictive pulmonary disorders/ interstitial lung disease: Loeffler syndrome; interstitial pneumonia, usual (UIP), desquamative (DIP), nonspecific
Respiratory failure/ respiratory arrest and pulmonary vascular disorders: Acute respiratory distress syndrome (ARDS); pulmonary hypertension; pulmonary vascular disorders, arteriovenous fistula; pulmonary edema, pulmonary cause and unspecified
Respiratory failure/ respiratory arrest and pulmonary vascular disorders: Pulmonary embolism; air and fat embolism; respiratory failure due to enteral feeding
Metabolic, regulatory, and structural disorders: Disorders of gas exchange; hypoventilation; hypoxia; pulmonary alveolar proteinosis; ventilation-perfusion imbalance
Disorders of the pleura, mediastinum, and chest wall: Chylothorax; costochondritis; empyema; hemothorax; mediastinitis; pleural effusion; pleuritis; pneumomediastinum; pneumothorax
Traumatic and mechanical disorders: (a) Upper airways-epistaxis; barotrauma, sinus; laryngeal/pharyngeal obstruction; tracheoesophageal fistula; tracheal stenosis; tracheomalacia; trauma (example tracheal injury)
Traumatic and mechanical disorders: (a) Upper airways-foreign body (nose, pharynx, larynx, trachea); traumatic/ mechanical disorders of the nasal cavity/ sinuses (example septal perforation)
Traumatic and mechanical disorders: (b) Lower airways and pleura-atelectasis; diaphragm/ chest wall injury; drowning and near drowning; foreign body, upper and lower respiratory tract; penetrating chest wounds; pulmonary contusion; sleep apnea
Traumatic and mechanical disorders: (b) Lower airways and pleura-obstructive and central; hypoventilation syndrome, obesity-hypoventilation syndrome
Congenital disorders: Bronchogenic cysts; congenital cysts; congenital diaphragmatic hernia; pulmonary sequestration; immotile cilia syndrome
Adverse effects of drugs on the respiratory system: Bleomycin, amiodarone; adverse effects of 100% oxygen; acute effects of tobacco/ nicotine, inhalants, cocaine

System specifications-Renal and urinary system: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes
Organ structure and function: Kidneys, ureters, bladder, urethra, glomerular filtration and hemodynamics, urine concentration and dilution, renal mechanisms in acid-base balance, renal mechanisms in body fluid homeostasis, micturition
Cell/ tissue structure and function: Renal metabolism and oxygen consumption, tubular reabsorption and secretion, including transport processes and proteins
Cell/ tissue structure and function: Hormones produced by or acting on the kidney (example renin, aldosterone, angiotensin II, vasopressin)
Repair, regeneration, and changes associated with stage of life

System specifications-Renal and urinary system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) upper urinary tract: Granulomatous pyelonephritis; perinephric abscess; pyelonephritis; pyonephrosis; renal abscess; renal tuberculosis
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) lower urinary tract and urinary tract infections of unspecified location: Cystitis; chlamydial and nonchlamydial
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) upper urinary tract: Glomerular disorders-Alport syndrome; glomerular disease due to hepatitis B, C; glomerulonephritis, including poststreptococcal
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) upper urinary tract: Glomerular disorders-IgA nephropathy; lupus nephritis; minimal change disease; nephrotic syndrome; thin basement membrane disease
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) upper urinary tract: Tubulointerstitial disease-acute tubular necrosis (ATN); acute interstitial nephritis; papillary necrosis; HIV nephropathy
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(ii) lower urinary tract: interstitial cystitis
Neoplasms: (a) Benign neoplasms and cysts-polycystic kidney disease, (b) malignant neoplasms: Renal (example Wilms tumor/ nephroblastoma, renal cell carcinoma, renal tumors associated with congenital/ hereditary conditions)
Neoplasms: (b) Malignant neoplasms-urinary bladder and collecting system
Signs, symptoms, and ill-defined disorders: dysuria; hematuria; oliguria, anuria; proteinuria
Metabolic and regulatory disorders: Acute kidney injury; renal insufficiency; azotemia, uremic syndrome; chronic kidney disease, including end-stage renal disease; cystinuria; Fanconi syndrome
Metabolic and regulatory disorders: Hypertensive renal disease (renal complications of hypertension); renal calculi, ureteral calculi, nephrolithiasis; renal tubular acidosis
Vascular disorders: Renal artery stenosis (atherosclerosis, fibromuscular dysplasia, nephrosclerosis); renal vein thrombosis; renal infarction
Traumatic and mechanical disorders: Bladder rupture; neurogenic bladder; obstructive uropathy; posterior urethral valves; renal laceration; renal vascular injury; ureteral laceration/ avulsion/ disruption; urethral diverticulum
Traumatic and mechanical disorders: Obstruction/ stricture/ prolapse, urethral/ ureteral, vaginal walls, uterine, uterovaginal; urinary incontinence, including secondary enuresis; vesicoureteral reflux
Congenital disorders: Double ureters/ ureteral duplication/ double collecting system; horseshoe kidney; hydronephrosis/ reflux; renal agenesis, renal hypoplasia, renal dysplasia; single kidney
Adverse effects of drugs on the renal and urinary system: ACE inhibitors; aminoglycosides; amphotericin B; cisplatin; furosemide; gadolinium (nephrogenic systemic fibrosis); heroin; iodinated contrast dye; lithium; NSAIDs; penicillins; sulfa drugs
Adverse effects of drugs on the renal and urinary system: Tenofovir; drug-induced urinary retention

System specifications-Blood and lymphoreticular system: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes, organ structure and function
Cell/ tissue structure and function: Production and function of erythrocytes, including heme and hemoglobin synthesis; hemoglobin O and CO transport, transport proteins, erythropoietin production and function of platelets
Cell/ tissue structure and function: Production and function of coagulation and fibrinolytic factors; hemostasis
Repair, regeneration, and changes associated with stage of life

System specifications-Blood and lymphoreticular system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious and immunologic infectious disorders: (a) bacteria, (b) viral-hemorrhagic fever (Ebola virus, Marburg virus); chikungunya; dengue fever; Zika virus disease, (c) parasitic: malaria (Plasmodium spp); babesiosis (Babesia species)
Infectious and immunologic infectious disorders: (d) Primary infections of lymphoid tissue-lymphadenitis (viral, bacterial, fungal, parasitic); lymphangitis; buboes, bubonic plague (Yersinia pestis); cat scratch disease (Bartonella henselae)
Infectious and immunologic infectious disorders (e) Immunologic and inflammatory disorders-cryoglobulinemia, essential mixed cryoglobulinemia; autoimmune hemolytic anemia; paroxysmal nocturnal hemoglobinuria; thrombotic thrombocytopenic purpura
Infectious and immunologic infectious disorders: (e) Immunologic and inflammatory disorders-hemolytic uremic syndrome
Neoplasms: Leukemia, acute (ALL, AML); leukemia, chronic (CLL, CML); lymphomas, Hodgkin disease, non-Hodgkin lymphoma, Burkitt lymphoma, T-cell lymphoma; multiple myeloma, dysproteinemias, monoclonal gammopathy of unknown significance (MGUS)
Neoplasms: Myelofibrosis; myelodysplastic syndrome, myelodysplasias; other immunoproliferative neoplasms (example Waldenstrom macroglobulinemia)
Anemia, cytopenias, and polycythemia anemias: (a) Decreased production-anemia of chronic disease, (b) hemolysis: Glucose-6-phosphate dehydrogenase deficiency; pyruvate kinase deficiency
Anemia, cytopenias, and polycythemia anemias: (c) Disorders of hemoglobin, heme, or membrane-disorders of red cell membranes; hereditary spherocytosis, elliptocytosis; methemoglobinemia, congenital; sickle cell disease; sideroblastic anemia; thalassemias
Anemia, cytopenias, and polycythemia anemias: (d) Other causes of anemia-blood loss, acute and chronic as a cause of anemia, (e) cytopenias: Aplastic anemia; leukopenia; neutropenia, cyclic neutropenia, agranulocytosis; pancytopenia; thrombocytopenia
Anemia, cytopenias, and polycythemia anemias: (e) Cytopenias-quantitative; immune thrombocytopenic purpura (ITP), (f) cythemias: Leukocytosis; polycythemia vera; secondary polycythemia
Coagulation disorders (hypercoagulable and hypercoagulable conditions): (a) Hypercoagulable-disseminated intravascular coagulation; hemophilia, congenital factor VIII [hemophilia A] and IX [hemophilia B]; hypofibrinogenemia; von Willebrand disease
Coagulation disorders (hypercoagulable and hypercoagulable conditions): (b) Hypercoagulable-platelet dysfunction, qualitative, hypercoagulable: Heparin-induced thrombocytopenia; other coagulopathies (example homocysteinemia, hypoplasminogenemia)
Coagulation disorders (hypercoagulable and hypercoagulable conditions): (b) Hypercoagulable-other coagulopathies (example antithrombin III, protein C/ protein S deficiency, factor V Leiden, anticardiolipin antibodies, lupus anticoagulant)
Coagulation disorders (hypercoagulable and hypercoagulable conditions): (b) Hypercoagulable-prothrombin G20210A mutation), (c) reactions to blood components: ABO incompatibility/ anaphylaxis; Rh incompatibility/anaphylaxis; hemolysis, delayed
Coagulation disorders (hypercoagulable and hypercoagulable conditions): (c) Reactions to blood components-transfusion reaction; transfusion contaminated with bacteria; transfusion-related acute lung injury (TRALI); anaphylactoid reaction (IgA deficiency)
Traumatic, mechanical, and vascular disorders: Mechanical injury to erythrocytes (example cardiac valve hemolysis); disorders of the spleen; splenic rupture/ laceration; splenic infarct; splenic abscess
Traumatic, mechanical, and vascular disorders: Effects/ complications of splenectomy (example sepsis due to encapsulated bacteria); hypersplenism
Adverse effects of drugs on the hematologic and lymphoreticular systems: Antiplatelet drugs, antithrombin drugs (example dabigatran); chemotherapeutic agents; inhibitors of coagulation factors; methemoglobinemia, acquired; propylthiouracil
Adverse effects of drugs on the hematologic and lymphoreticular systems: Tumor lysis syndrome; warfarin

System specifications-Immune system: Unit 01

Normal processes

Development of cells of the adaptive immune response, including positive and negative selection during immune development
Structure, production, and function: Granulocytes, natural killer cells, macrophages, mast cells, dendritic cells, cell receptors (example complement receptors and Toll-like receptors), cytokines, chemokines, T lymphocytes
Structure, production, and function: Including T-lymphocyte receptors, accessory molecules (example CD3, CD4, CD8, B7), cell activation and proliferation, cytotoxic T lymphocytes, and memory T lymphocytes, B lymphocytes and plasma cells
Structure, production, and function: Including B-lymphocyte receptors, immunoglobulins, cell activation and proliferation, including development of antibodies and memory B lymphocytes, host defense mechanisms, host barriers to infection
Structure, production, and function: Mucosal immunity (example gut-associated lymphoid tissue and bronchus-associated lymphoid tissue), anatomical locations of T and B lymphocytes
Cellular basis of the immune response and immunologic mediators: Antigen processing and presentation in the context of MHC I and MHC II molecules (example TAP, beta-2 microglobulin), intracellular pathways
Cellular basis of the immune response and immunologic mediators: Mechanisms by which MHC is expressed on the surface; including distribution of MHC I and MHC II on different cells
Cellular basis of the immune response and immunologic mediators: Mechanisms of MHC I and MHC II deficiencies, and the genetics of MHC regulation of the adaptive immune response (example peripheral tolerance, anergy, regulatory T lymphocytes
Cellular basis of the immune response and immunologic mediators: Termination of immune response, and B-T lymphocyte interactions) activation
Cellular basis of the immune response and immunologic mediators: Function, and molecular biology of complement (example anaphylatoxins) functional and molecular biology of cytokines (example IL 1-15)
Basis of immunologic diagnostics (example antigen-antibody reactions used for diagnostic purposes, ELISA, immunoblotting, antigen-antibody changes over time, ABO typing)
Principles of immunologic protection: Vaccine production and mechanisms of vaccine action biologically active antibodies (example monoclonal antibodies, polyclonal antibodies including IVIG, VZIG, rabies immunoglobulin)
Effect of age on the function of components of the immune system

System specifications-Immune system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Disorders associated with immunodeficiency: (a) Deficiency primarily of humoral immunity-common variable immunodeficiency; hyper IgM syndrome; hypogammaglobulinemia/ agammaglobulinemia, X-linked (Bruton); selective immunodeficiency (example IgA, IgM, IgE)
Disorders associated with immunodeficiency: (b) Deficiency/ dysfunction primarily of cell-mediated immunity-adenosine deaminase deficiency; thymic aplasia (DiGeorge syndrome); severe combined immunodeficiency disease (SCID); Wiskott-Aldrich syndrome
Disorders associated with immunodeficiency: (b) Deficiency/ dysfunction primarily of cell-granulomatosis; allergic reactions/ skin, (c) complement deficiency: Alternative pathway component deficiency (C2, C3b, C3bB, C36B6)
Disorders associated with immunodeficiency: (c) Complement deficiency-classical pathway component deficiency (C1q, C1r, C1-C5); terminal component deficiency (C5b-C9; terminal complement complex); C1 esterase inhibitor deficiency, hereditary angioedema
Disorders associated with immunodeficiency: (c) Complement deficiency-mannose-binding lectin (MBL) deficiency; membrane attack complex deficiency, (d) deficiency of phagocytic cells and natural killer cells: Chediak-Higashi disease
Disorders associated with immunodeficiency: (d) Deficiency of phagocytic cells and natural killer cells-chronic granulomatous disease and other disorders of phagocytosis; leukocyte adhesion deficiency
HIV/ AIDS: HIV1 and HIV2; AIDS; AIDS complications (example neuropathy, dementia, renal insufficiency); immunology of AIDS; immune reconstitution syndrome (IRS); secondary infections; noninfectious complications
Immunologically mediated disorders: (a) Hypersensitivity reactions-type 1, 2, 3, including anaphylaxis; type 4; drug reactions; serum sickness, (b) transplantation: rejection; graft-vs.-host disease
Adverse effects of drugs on the immune system: Jarisch-Herxheimer reaction; drugs affecting the immune system (example prednisone, azathioprine, cyclosporine, methotrexate
Adverse effects of drugs on the immune system: Monoclonal antibody drugs [example abciximab, adalimumab; bevacizumab, infliximab, omalizumab, rituximab]); vaccine adverse effects

System specifications-Multisystem processes and disorders: Unit 01

Normal processes

Principles of nutrition: Generation, expenditure, and storage of energy at the whole-body level functions of nutrients (example essential, trans-fatty acids, cholesterol)
Electrolyte and water metabolism: Electrolyte metabolism (calcium, potassium, phosphorus), water metabolism
Intracellular accumulations (example pigments, fats, proteins, carbohydrates, minerals, inclusions, vacuoles, lysosomal/ glycogen storage disease and structures related to storage diseases, glycogen phosphorylase deficiency, Zellweger syndrome)

System specifications-Multisystem processes and disorders: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Brucellosis (Brucella spp); leptospirosis (Leptospira interrogans); Lyme disease (Borrelia burgdorferi); melioidosis (Burkholderia pseudomallei)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Miliary (disseminated) tuberculosis (Mycobacterium tuberculosis); tularemia (Francisella tularensis); toxic shock syndrome; Q fever (Coxiella burnetii)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Anaplasmosis and ehrlichiosis (Anaplasma and Ehrlichia species); rickettsiosis (Rocky Mountain spotted fever [Rickettsia rickettsii])
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral: Infectious mononucleosis (Epstein-Barr virus); cytomegalovirus infection; yellow fever; human herpesvirus 8 (HHV-8), fungal: Blastomycosis (Blastomyces dermatitidis)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iii) fungal: Candidiasis (Candida albicans); coccidioidomycosis (Coccidioides immitis/ posadasii); histoplasmosis (Histoplasma capsulatum)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iv) parasitic: Schistosomiasis (Schistosoma); Leishmaniasis (Leishmania spp), visceral (kala azar); trypanosomiasis/ Chagas disease, acute and chronic (Trypanosoma)
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-acute rheumatic fever; autoimmune arteritis/ vasculitis; Behçet syndrome; Churg-Strauss syndrome; eosinophilic granuloma, histiocytosis
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-Langerhans cell histiocytosis; Goodpasture syndrome; Henoch-Schönlein purpura; Kawasaki disease; mixed connective tissue disease; polyangiitis
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-polyarteritis nodosa; polyglandular autoimmune syndrome, type 1; polymyalgia rheumatica, temporal arteritis; Raynaud disease/ Raynaud syndrome
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-reactive arthritis, formerly Reiter disease, including Reiter arthritis; scleroderma (systemic sclerosis); Sjögren syndrome; systemic lupus erythematosus
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-Takayasu arteritis; granulomatosis with polyangiitis (formerly Wegener granulomatosis); familial Mediterranean fever; sarcoidosis, Lofgren syndrome
Neoplasms and related disorders: (a) Paraneoplastic syndromes-endocrine (example SIADH, Cushing syndrome, hypercalcemia of malignancy [parathyroid‐related protein and paraneoplastic syndrome with hypercalcemia])
Neoplasms and related disorders: (a) Paraneoplastic syndromes-hematologic (polycythemia, nonbacterial thrombotic endocarditis); neurologic (myasthenic syndrome, paraneoplastic cerebellar degeneration, limbic encephalitis, pure sensory neuropathy)
Neoplasms and related disorders: (a) Paraneoplastic syndromes-(anti-NMDA receptor encephalitis); mucocutaneous (example acanthosis nigricans); musculoskeletal (example pulmonary osteoarthropathy, polymyositis); other (membranous glomerulonephritis)
Neoplasms and related disorders: (b) Inherited cancer syndromes-DNA repair abnormalities (example Fanconi anemia); Lynch syndrome (gastrointestinal and female reproductive)
Signs, symptoms, and ill-defined disorders: Arthralgias; abdominal pain; chest pain; cough; dizziness, lightheadedness, syncope, including breath-holding spells with syncope; dyspnea, shortness of breath; edema, anasarca; fatigue; fever of unknown origin
Signs, symptoms, and ill-defined disorders: Hemoptysis; pain management (in a non addiction, non palliative-care setting); joint pain; lymphedema; palpitations; pruritus; unexpected weight gain/ weight loss
Nutrition: (a) Protein-calorie malnutrition (kwashiorkor, marasmus), vitamin deficiencies and/ or toxicities: (b) vitamin A; vitamin B; vitamin B1, thiamine (example Wernicke-Korsakoff syndrome, beriberi); vitamin B3, niacin; vitamin B6, pyridoxine
Nutrition: (b) Vitamin deficiencies and/ or toxicities-vitamin B9, folic acid; vitamin B12, cobalamins (pernicious anemia); vitamin C (scurvy); vitamin D (rickets); vitamin E; vitamin K, (c) mineral deficiencies and/ or toxicities
Nutrition: (d) Obesity, enteral/ parenteral nutrition (TPN)
Toxins and environmental extremes: Physical and associated disorders, temperature (example hypothermia, hyperthermia, heat stroke), radiation (example radon, uranium mining, imaging studies), thermal injury, burns, electrocution
Toxins and environmental extremes: Lightning, decreased atmospheric pressure, high-altitude sickness, increased water pressure, (nitrogen narcosis), chemical including Gulf War illness, gases, vapors
Toxins and environmental extremes: Smoke inhalation agricultural hazards (example pesticides, green tobacco poisoning, anhydrous ammonia, agent Orange) volatile organic solvents metals (example lead)
Toxins and environmental extremes: Other chemical agents (example ethylene glycol, carbon tetrachloride, methanol; BPA) principles of poisoning and therapy (example acetylsalicylic acid [ASA], acetaminophen)
Venomous bites and stings: Hymenoptera bites and stings; scorpion bites; snake bites; spider bites; jellyfish stings
Fluid, electrolyte, and acid-base balance disorders: (a) Fluid volume and electrolyte/ ion disorders-fluid volume disorders; dehydration; hypovolemia; volume overload; electrolyte disorders; hyponatremia, hypernatremia; hypokalemia, hyperkalemia
Fluid, electrolyte, and acid-base balance disorders: (a) Fluid volume and electrolyte/ ion disorders-hypocalcemia, hypercalcemia; hypophosphatemia, hyperphosphatemia; hypomagnesemia, (b) acid-base disorders: Metabolic acidosis; metabolic alkalosis
Fluid, electrolyte, and acid-base balance disorders: (b) Acid-base disorders-respiratory acidosis; respiratory alkalosis; mixed acid-base disturbances
Abuse: Child, nonaccidental trauma/ inflicted head trauma/ factitious disorder by proxy intimate partner abuse, sexual, emotional, and physical including injuries (example rib fractures) related to abuse, elder abuse, sexual
Abuse: Emotional, and physical including injuries (example rib fractures) related to abuse, sexual assault
Multiple trauma (example prioritization, blast injury involving more than one organ system)
Shock, cardiogenic, hypovolemic, neurogenic, septic, sepsis, bacteremia, systemic, inflammatory response syndrome (SIRS), refractory, multiorgan dysfunction syndrome: Meningococcemia
Genetic metabolic and developmental disorders: (a) Multifactorial-VATER syndrome, association syndromes, (b) large genomic changes: Beckwith-Wiedemann syndrome; Down syndrome; Prader-Willi syndrome, (c) enzymatic/ metabolic: Alpha-1 antitrypsin deficiency
Genetic metabolic and developmental disorders: (c) Enzymatic/ metabolic-porphyria; inborn errors of metabolism (example maple syrup urine disease, diseases involving urea cycle)
Genetic metabolic and developmental disorders: (c) Enzymatic/ metabolic-storage diseases (example Fabry disease, Tay-Sachs disease, glycogen storage disease, mucopolysaccharidoses), (b) structural protein disorders: Amyloidosis; Ehlers-Danlos syndrome
Genetic metabolic and developmental disorders: (b) Structural protein disorders-immotile cilia syndrome (Kartagener syndrome; primary ciliary dyskinesia); Marfan syndrome, (c) intracellular/ extracellular transport receptors: Cystic fibrosis
Genetic metabolic and developmental disorders: (c) Intracellular/ extracellular transport receptors-hemochromatosis; Wilson disease, (d) triplet repeat/ RNA disorders: Fragile X syndrome
Adverse effects of drugs on multisystem disorders: Drug-induced electrolyte abnormalities and acid base-disorders (example albuterol; prednisone; diuretics; alcohol; drugs inducing polydipsia, SIADH, or diabetes insipidus)

System specifications-Cardiovascular system: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal transitional changes
Organ structure and function: Chambers, valves cardiac cycle, mechanics, heart sounds, cardiac conduction hemodynamics, including blood volume and systemic vascular resistance circulation in specific vascular beds, including pulmonary and coronary
Cell/ tissue structure and function: Heart muscle, metabolism, oxygen consumption, biochemistry, and secretory function (example atrial natriuretic peptide), endothelium and secretory function, vascular smooth muscle
Cell/ tissue structure and function: Microcirculation, and lymph flow, neural and hormonal regulation of the heart, blood vessels, and blood volume, including responses to change in posture, exercise, and tissue metabolism, and autonomic responses
Repair, regeneration, and changes associated with stage of life

System specifications-Cardiovascular system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-bacterial endocarditis, myocarditis, (b) immunologic and inflammatory disorders: Atherosclerosis (example atherosclerosis of the aorta)
Neoplasms: Myxoma, metastases
Dysrhythmias: Premature beats (PACs, PVCs); atrial flutter/ fibrillation; multifocal atrial tachycardia; paroxysmal tachycardias; ventricular tachycardia/ fibrillation; wide complex tachycardia; torsades de pointes; bradycardias
Dysrhythmias: Atrioventricular block (first-, second-, third-degree); conduction disorder (LBBB, RBBB); cardiac arrest; sick sinus syndrome; prolonged QT syndrome; Wolff-Parkinson-White syndrome; carotid sinus hypersensitivity
Dysrhythmias: Pacemaker dysfunction, including failure to sense, capture
Heart failure: Chordae tendineae rupture; congestive heart failure; cor pulmonale; diastolic dysfunction; systolic dysfunction; mitral valve dysfunction; heart failure secondary to myocardial infarction
Heart failure: High-output heart failure, including thyrotoxicosis-induced, anemia-induced; tachycardia-induced; cardiogenic pulmonary edema
Ischemic heart disease: Acute coronary syndrome, acute myocardial infarction; angina pectoris, stable and unstable/ coronary artery disease/ coronary insufficiency; coronary artery spasm
Diseases of the myocardium: Cardiomyopathy, dilated, including alcoholic, viral, takotsubo; cardiomyopathy, obstructive hypertrophic; cardiomyopathy, familial dilated; cardiomyopathy, restrictive; hypertensive heart disease, left ventricular hypertrophy
Diseases of the myocardium: Right ventricular hypertrophy; complications of myocardial infarction; nontraumatic tamponade post-myocardial infarction; papillary muscle rupture/ dysfunction; ventricular free wall rupture; myocarditis
Diseases of the pericardium: Chronic constrictive pericarditis; pericardial effusion; pericardial tamponade; acute pericarditis; pericarditis, following myocardial infarction, surgery, trauma
Valvular heart disease: Valve disorders, mitral/ aortic/ tricuspid, pulmonic (example regurgitation, stenosis, prolapse, insufficiency, vegetation); functional murmurs; rheumatic heart disease; complications of artificial valves
Hypotension: Orthostatic hypotension
Hypertension: Elevated blood pressure reading without diagnosis of hypertension; essential hypertension; malignant hypertension; secondary hypertension
Dyslipidemia: Hypercholesterolemia; hyperlipidemia; hypertriglyceridemia; lipoproteins/ lipoprotein lipase deficiency
Vascular disorders: (a) Disorders of the great vessels-aneurysm, aortic (abdominal/ thoracic), dissection, ruptured; aneurysm, iliac, other peripheral vascular, ruptured; aortoiliac disease
Vascular disorders: (b) Peripheral arterial vascular disease-arterial embolism/ thrombosis, arteriovenous fistula; atheroembolic disease; claudication; cholesterol emboli; hypertensive vascular disease; peripheral arterial disease
Vascular disorders: (b) Peripheral arterial vascular disease-thromboangiitis obliterans, (c) diseases of the veins-deep venous thrombosis, venous thromboembolism; phlebitis/ thrombophlebitis; varicose veins; venous insufficiency; stasis ulcers
Vascular disorders: (c) Diseases of the veins-stasis dermatitis
Traumatic and mechanical disorders: Ventricular puncture; myocardial contusion; myocardial rupture; traumatic aortic dissection; traumatic tamponade
Congenital disorders, including disease in adults: Anomalous left coronary artery; atrial septal defect; coarctation of the aorta; endocardial cushion defect; patent foramen ovale; patent ductus arteriosus; tetralogy of Fallot
Congenital disorders, including disease in adults: Transposition of the great vessels; ventricular septal defect
Adverse effects of drugs on the cardiovascular system: Adriamycin; cocaine, amphetamine, PCP; ACE inhibitors, calcium channel blockers, alpha blockers, minoxidil

System specifications-Musculoskeletal system: Unit 01

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, cartilage exercise and physical conditioning/ deconditioning
Repair, regeneration, and changes associated with stage of life

System specifications-Musculoskeletal system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, inflammatory, and immunologic disorders: (a) Infectious disorders-gangrene, dry and wet, clostridial myonecrosis (clostridium perfringens); discitis; myositis, infective; necrotizing fasciitis; osteomyelitis; septic arthritis
Infectious, inflammatory, and immunologic disorders: (a) Infectious disorders-spondylitis, tuberculous, (b) immunologic disorders: Ankylosing spondylitis; dermatomyositis/ polymyositis; juvenile idiopathic arthritis; rheumatoid arthritis, felty syndrome
Infectious, inflammatory, and immunologic disorders: (b) Immunologic disorders-psoriatic arthropathy, (c) inflammatory disorders: Adhesive capsulitis of shoulder (frozen shoulder syndrome); ankylosing/spondylopathy (inflammatory); bursitis; fasciitis
Infectious, inflammatory, and immunologic disorders: (c) Inflammatory disorders-osteochondritis, osteochondritis dissecans; tendinitis, supraspinatus syndrome, enthesopathy of spine, elbow, ankle; temporomandibular joint disorders; fibrositis
Infectious, inflammatory, and immunologic disorders: (c) Inflammatory disorders-myofascial pain syndrome; synovitis; tenosynovitis; myositis
Neoplasms: Benign neoplasms (example ganglion cyst); malignant neoplasms of bone (example osteosarcoma, sarcoma, leiomyosarcoma, rhabdomyosarcoma); metastases to bone, secondary malignant neoplasm of bone
Degenerative and metabolic disorders: (a) Degenerative/ metabolic disorders of bone, tendon, and cartilage-chondromalacia; disc degeneration, herniated disc; Legg-Calvé-Perthes disease; Osgood-Schlatter disease; osteodystrophy; osteomalacia
Degenerative and metabolic disorders: (a) Degenerative/ metabolic disorders of bone, tendon, and cartilage-osteonecrosis (avascular), bone infarct; osteoporosis; osteopenia; osteitis deformans (Paget disease of bone); pathologic fracture; radiculopathies
Degenerative and metabolic disorders: (a) Degenerative/ metabolic disorders of bone, tendon, and cartilage-spondylolisthesis/spondylosis (degenerative), (b) degenerative/ metabolic disorders of joints: Gout, gouty arthritis, pseudogout; joint effusion
Degenerative and metabolic disorders: (b) Degenerative/ metabolic disorders of joints-osteoarthritis, degenerative/ metabolic disorders of muscles, ligaments, fascia: Dupuytren contracture; muscle calcification and ossification
Degenerative and metabolic disorders: (c) Degenerative/ metabolic disorders of muscles, ligaments, fascia-muscle wasting and diffuse atrophy; rhabdomyolysis
Traumatic and mechanical disorders: Amputation and care of amputees; backache, including low back pain; blast injuries; compartment syndrome; contractures, hospital-acquired; contusions; dislocations; fractures; sprains, strains; kyphoscoliosis, scoliosis
Traumatic and mechanical disorders: Rotator cuff syndrome; slipped capital femoral epiphysis; dislocation of hip
Congenital disorders: Achondroplasia/ dwarfism; disorders of limb development (HOX gene mutation, phocomelia); developmental dysplasia of the hip; dislocation of hip in infantile spinal muscular atrophy; genu valgum or varum
Congenital disorders: Foot deformities (flat foot, valgus/ varus deformities); osteogenesis imperfecta; McArdle disease; mitochondrial myopathies
Adverse effects of drugs on the musculoskeletal system: Drug-induced myopathy (example steroids, statins, cocaine, AZT); malignant hyperthermia

System specifications-Skin and subcutaneous tissue: Unit 01

Normal processes

Embryonic development, fetal maturation, and neonatal changes
Organ structure and function, including barrier function, thermal regulation
Cell/ tissue structure and function, eccrine function
Repair, regeneration, and changes associated with stage of life (example senile purpura, male pattern baldness, postmenopausal hair changes)
Skin defense mechanisms and normal flora

System specifications-Skin and subcutaneous tissue: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(i) bacterial: Cellulitis, erysipelas, impetigo, staphylococcal scalded skin syndrome; abscess, cutaneous, including septic abscess
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(i) bacterial: Anthrax (Bacillus anthracis); carbuncle; folliculitis; pilonidal cyst, infected; pyoderma gangrenosum; MSSA and MRSA skin infections
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(i) bacterial: Mycobacterial infections (example leprosy, draining sinus); scarlet fever (group A Streptococcus), (ii) viral: Herpes simplex type 1 and type 2
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(ii) viral: Herpes zoster; Ramsay-hunt syndrome; molluscum contagiosum; hand-foot-and-mouth disease; herpangina; parvovirus; chickenpox
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(ii) viral: Erythema infectiosum (fifth disease), rubella, measles, roseola (exanthema subitum); verrucae vulgaris
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(iii) fungal (deep and superficial): Candidiasis, skin; dermatophytosis, tinea corporis; dermatomycoses; diaper rash; onychomycosis
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(iv) parasitic: Cutaneous larva migrans; cutaneous leishmaniasis; (vi) infestations, non venomous bites, stings: Scabies; lice; insect bites, including bed bugs
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) papulosquamous and eczematous dermatoses: Psoriasis; lichen planus and lichenoid dermatoses; allergic/irritant contact dermatitis (example nickel)
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) papulosquamous and eczematous dermatoses: Dermatoses caused by plants (poison ivy, poison oak), (ii) vesiculobullous disorders: Epidermolysis bullosa
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(ii) vesiculobullous disorders: Dermatitis herpetiformis; pemphigus; pemphigoid, (iii) urticaria, erythema, exanthema, and purpura: Erythema nodosum
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(iii) urticaria, erythema, exanthema, and purpura: Atopic dermatitis; pityriasis rosea; urticaria; Stevens-Johnson syndrome, erythema multiforme
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(iii) urticaria, erythema, exanthema, and purpura: Toxic epidermal necrolysis, (iv) autoimmune disorders: Vitiligo
Neoplasms: (a) Benign neoplasms, cysts, and other skin lesions-actinic keratoses; cysts, including epidermal; hemangiomas; lipoma; pigmented nevi; seborrheic keratosis; xanthomas, (b) malignant neoplasms: Basal cell carcinoma; squamous cell carcinoma
Neoplasms: (b) Malignant neoplasms-melanoma, including genital; Kaposi sarcoma; cutaneous T-cell lymphoma, mycosis fungoides
Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes): (a) Disorders of the hair and hair follicles-alopecia; seborrhea capitis/seborrheic dermatitis; tinea barbae and capitis
Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes): (b) Disorders of the nails (including ingrowing nail), (c) disorders of sweat and sebaceous glands: Acne vulgaris; hidradenitis suppurativa
Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes): (c) Disorders of sweat and sebaceous glands-hyperhidrosis; ichthyosis; rosacea
Oral disease: Aphthous ulcers (stomatitis, canker sores); leukoplakia
Disorders of pigmentation: Albinism; lentigo
Traumatic and mechanical disorders: Animal bites (dogs, cats, etc); burns or wounds affecting the skin or subcutaneous tissue (example sunburn, other including blast injuries and burns); cauliflower ear; effects of ultraviolet light; keloids; tattoo
Traumatic and mechanical disorders: Thermal injury, perniosis, frostbite; ulcers, decubitus
Congenital disorders: Xeroderma pigmentosum; benign lesions in neonates, infants, children (example congenital nevi)
Adverse effects of drugs on skin and subcutaneous tissue: Drug reactions, eruptions, including local reaction to vaccine

System specifications-Gastrointestinal system: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes
Organ structure and function: Anatomy of the alimentary canal, including mouth, pharynx, esophagus, stomach, small intestine, large intestine, anus, peritoneal cavity, liver and biliary system, including enterohepatic circulation
Organ structure and function: Salivary glands and exocrine pancreas, gastrointestinal motility, including defecation digestion and absorption
Cell/ tissue structure and function: Endocrine and neural regulatory functions, including GI hormones (example gastrin) salivary, gastrointestinal, pancreatic, hepatic secretory products, including enzymes, proteins
Cell/ tissue structure and function: 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

System specifications-Gastrointestinal system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Pseudomembranous colitis (Clostridium difficile); enteritis/ enteric infections (includes gastroenteritis)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) bacterial: (example Staphylococcus aureus, Escherichia coli, Listeria monocytogenes, Yersinia enterocolitica, Campylobacter species, Vibrio cholerae, Salmonella species)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: (Shigella species, traveler's/ infectious diarrhea); hepatic abscess, subhepatic abscess, subphrenic abscess; peritonitis, primary and secondary; Whipple disease
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral: Infectious esophagitis (example CMV, herpes); hepatitis A, B, C, D, E; coxsackievirus enteritis/ colitis; Echovirus enteritis/colitis; rotavirus enteritis; mumps
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral: Gingivostomatitis, herpetic, (iii) fungal: Thrush, (iv) parasitic: Cryptosporidium, cyclospora, entamoeba histolytica, giardia, isospora belli
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iv) parasitic: Strongyloides stercoralis
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-autoimmune hepatitis; celiac disease; eosinophilic esophagitis; granulomatous enteritis; inflammatory bowel disease, including Crohn disease
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-regional enteritis; microscopic colitis (collagenous and lymphocytic colitis), ulcerative colitis, toxic megacolon
Neoplasms: (a) Benign neoplasms, including polyps, cysts-stomach; small intestine; colon, rectum, and anus, including polyps, (b) malignant neoplasms and premalignant conditions: Oral cancer (example lips, mouth, tongue, salivary glands)
Neoplasms: (b) Malignant neoplasms and premalignant conditions-esophageal, squamous and adenocarcinoma; Barrett esophagus; gastrinoma, Zollinger-Ellison syndrome; gastrointestinal carcinoid tumors; gastrointestinal stromal tumors; small intestine
Neoplasms: (b) Malignant neoplasms and premalignant conditions-stomach, adenocarcinoma, lymphoma, MALT; colon, rectum, anus; hereditary colon cancer syndromes
Neoplasms: (b) Malignant neoplasms and premalignant conditions-familial adenomatous polyposis (example Peutz-Jeghers syndrome, Gardner syndrome, Turcot syndrome,); MUTYH-associated polyposis; gallbladder, cholangiocarcinoma
Neoplasms: (b) Malignant neoplasms and premalignant conditions-adenocarcinoma of the ampulla of Vater; liver, including hepatoma; peritoneal cancer, including metastatic studding with cancer; pancreas, (c) metastatic neoplasms
Signs, symptoms, and ill-defined disorders: Upper gastrointestinal bleeding; lower gastrointestinal bleeding; constipation; diarrhea; hematochezia; bright red rectal bleeding; melena; nausea, vomiting, rumination
Disorders of the oral cavity, salivary glands, and esophagus: (a) Oral cavity and salivary glands-abscessed tooth; dental caries; malocclusion; disorders of the salivary glands (example stones, sialadenitis, parotitis)
Disorders of the oral cavity, salivary glands, and esophagus: (b) Esophagus-achalasia and cardiospasm; dysphagia; diverticulum (example Zenker); esophageal periapical abscess without sinus; esophagitis/ esophageal reflux (GERD); esophagitis, pill
Disorders of the oral cavity, salivary glands, and esophagus: (b) Esophagus-Mallory-Weiss syndrome; paraesophageal (hiatal) hernia; stricture and stenosis of esophagus
Disorders of the stomach, small intestine, colon, rectum, anus: (a) Stomach-dyspepsia/ hyperacidity; gastric ulcer; gastritis; peptic ulcer; peptic ulcer perforation; gastroparesis, small intestine, colon: Appendicitis; angiodysplasia; diverticula
Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-diverticulitis, diverticulosis; duodenitis, duodenal ulcer, peptic ulcer; gastroenteritis and colitis (noninfectious); granulomatous enterocolitis
Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-Hirschsprung disease; impaction of intestine; intestinal obstruction/ stricture; intussusception; irritable colon/ irritable bowel syndrome
Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-mesenteric ischemia/ ischemic bowel/ ischemic colitis; necrotizing enterocolitis; paralytic ileus; volvulus; malnutrition and malabsorption
Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-including lactose intolerance, short bowel syndrome, rectum and anus: Abscess of anal and rectal regions; anal fissure; anal fistula; ulcer; fecal incontinence
Disorders of the stomach, small intestine, colon, rectum, anus: (c) Rectum and anus-hemorrhage (rectum, anus); proctitis; hemorrhoids; rectal prolapse
Disorders of the liver and biliary system, noninfectious: (a) Liver-cirrhosis; Dubin-Johnson, Rotor syndromes; end-stage liver disease, including indications for transplantation; Gilbert syndrome, Crigler-Najjar syndrome
Disorders of the liver and biliary system, noninfectious: (a) Liver-hepatic coma/ hepatic encephalopathy; hepatitis, noninfectious; hepatitis, fatty liver, alcoholic; hepatorenal syndrome; hepatopulmonary syndrome; jaundice
Disorders of the liver and biliary system, noninfectious: (a) Liver-nonalcoholic fatty liver disease; portal hypertension/ esophageal varices, (b) biliary system: Bile duct obstruction/ cholestasis; cholangitis, including ascending; choledocholithiasis
Disorders of the liver and biliary system, noninfectious: (b) Biliary system-cholelithiasis/ cholecystitis; cholestasis due to parenteral nutrition; gallstone ileus; Mirizzi syndrome; primary biliary cirrhosis; primary sclerosing cholangitis
Disorders of the pancreas: Pancreatitis, acute; pancreatitis, chronic; pancreatitis, hereditary; pancreatic cyst/ pseudocyst; pancreatic duct obstruction; pancreatic insufficiency
Disorders of the peritoneal cavity: Ascites
Traumatic and mechanical disorders: Abdominal wall defects; adhesions, postsurgical; digestive system complications of surgery; post-gastric surgery syndromes (example blind loop syndrome, adhesions); duodenal tear; foreign body in digestive system
Traumatic and mechanical disorders: Inguinal, femoral, and abdominal wall hernias; open wound, abdominal; perforation of hollow viscus and blunt trauma; perforation/rupture of esophagus (Boerhaave syndrome); umbilical hernia
Congenital disorders: Annular pancreas, biliary atresia, cleft lip and palate, esophageal atresia, malrotation without volvulus, Meckel diverticulum, pyloric stenosis, tracheoesophageal fistula
Adverse effects of drugs on the gastrointestinal system: Drug-induced changes in motility (chronic laxative abuse, opioids); drug-induced gastritis, duodenitis, peptic ulcer disease (NSAIDs); drug-induced hepatitis (example acetaminophen, isoniazid)
Adverse effects of drugs on the gastrointestinal system: Drug-induced pancreatitis (example thiazide diuretics)

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 01

Epidemiology/ population health

Measures of disease frequency: Incidence/ prevalence
Measures of health status: Rates, crude and adjusted; reproductive rates (example maternal mortality, neonatal/ infant/ under-5 mortality); mortality, morbidity; standardization; life expectancy, health-adjusted life expectancy
Measures of health status: Population attributable risk (PAR), population attributable risk percent (PAR%); risk factors
Survival analysis interpretation (example Kaplan-Meier curve)
Composite health status indicators, measures of population impact: Years of potential life lost; quality-adjusted life years; disability-adjusted life years; standardized mortality ratio
Population pyramids and impact of demographic changes
Disease surveillance and outbreak investigation: Disease reporting; response to public health advisory, health promotion; recognition of clusters
Communicable disease transmission: Attack rate; herd immunity; reportable diseases
Points of intervention: Primary, secondary; community level (example cigarette taxes, soda taxes, smoke-free cities, buildings: Restaurants, public buildings); school policies; access, healthy food, transportation, clean air, safe environments

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 02

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

Descriptive studies (case report [one person]/ case series [more than one])
Analytical studies: Observational-community surveys; cross-sectional (individuals); ecological (populations); case control; retrospective and prospective cohort
Analytical studies: Interventional-clinical trial (randomized controlled trial; double-blind; placebo-controlled; non inferiority/ equivalence trials); community intervention
Systematic reviews and meta-analysis: Potential uses; estimation of effect sizes; heterogeneity; publication bias; forest plots, funnel diagrams; risk of bias, bias risk scale
Obtaining and describing samples: Matching, inclusion/ exclusion criteria, selecting appropriate controls for studies, lack of controls, concealed allocation, randomization, stratification
Methods to handle noncompliance: Loss to follow-up; intention-to-treat analysis
Qualitative analysis

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 03

Measures of association

Relative risk
Odds ratio, hazard ratio
Other measures of association: Number needed to treat/ harm; absolute risk (AR), absolute risk percent (AR%); population attributable risk (PAR), population attributable risk percent (PAR%)
Distributions of data: Measures of central tendency; measures of variability; regression to mean; normal distribution; nominal measurement
Correlation and regression, uses and interpretation: Correlation coefficients; multiple regression

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 04

Principles of testing and screening

Properties of a screening test: Validity, accuracy, reliability; criteria for a screening test; confirmatory testing; appropriateness; lead-time bias, length bias; screening vs. diagnostic tests
Sensitivity and specificity; predictive value, positive and negative
ROC curves
Probability: Theory (independence, product, addition rules); decision trees; likelihood ratios (application of Bayes theorem); posttest, pretest

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 05

Study interpretation, drawing conclusions from data

Causation: Hypothesis-generating vs. hypothesis-driven testing; causal criteria, temporality, temporal sequence, dose-response relationship; reverse causality
Chance: Null hypothesis, type I error and alpha level (multiple comparisons, random error/ chance), sample size and type II error, beta, power, selection and interpretation of basic tests of statistical significance: chi-square; confidence intervals
Chance: P-values; t-test, a priori vs. post hoc analysis: Subgroup analysis; error rate; affect types
Interpretation of graphs/ tables and text
Bias, confounding, and threats to validity (includes methods to address): Selection, sampling bias, information bias: Recall; ascertainment, ecological fallacy, lack of blinding; loss to follow up, confounding variables
Bias, confounding, and threats to validity (includes methods to address): Hawthorne effect (includes methods to address), other threats to validity (example placebo effect)
Internal vs. external validity: Generalizability (external validity); efficacy vs. effectiveness
Statistical vs. clinical significance; clinical and surrogate outcome/ end point

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 06

Clinical decision making, interpretation and use of evidence-based data and recommendations

Application of study results to patient care and practice, including patient preferences and individualization of risk profiles; risk/ benefit analysis; synthesis of concepts with real data

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 07

Research ethics

Informed consent for research
Privacy of patient data (HIPAA)
Roles of institutional review boards (IRBs)
Intervention analysis: Intervention analysis; stopping analysis; safety monitoring
Regulatory issues: Drug development, phases of approval; appropriateness of placebo; appropriateness of randomized clinical trial; components of studies; ethics; scheduling; off-label use
Other issues related to research ethics

System specifications-Social sciences: Unit 01

Communication and interpersonal skills, including health literacy and numeracy, cultural competence

Patient interviewing, consultation, and interactions with the family (patient-centered communication skills): Fostering the relationship (example expressing interest), information gathering (example exploring patient's reaction to illness)
Patient interviewing, consultation, and interactions with the family (patient-centered communication skills): Information provision (example providing information about working diagnosis), making decisions (example eliciting patient's perspectives)
Patient interviewing, consultation, and interactions with the family (patient-centered communication skills): Supporting emotions (example effective discussion with difficult patients), enabling patient behaviors (example education and counseling)
Use of an interpreter or surrogate

System specifications-Social sciences: Unit 02

Medical ethics and jurisprudence, include issues related to death and dying and palliative care

Consent/ informed consent to treatment, permission to treat (full disclosure, risks and benefits, placebos, alternative therapies, conflict of interest, and vulnerable populations)
Determination of medical decision-making capacity/ informed refusal
Involuntary admission
Legal issues related to abuse (child, elder, and intimate partner): Child protective services, foster care, immunizations, legal requirements for reporting abuse or neglect/ obligation to warn
Birth-related issues
Death and dying and palliative care: Life support, advance directive, health care proxy, advance care planning, euthanasia and physician-assisted suicide, brain death/ diagnosing brain death/ diagnosing death, pronouncing death, organ donation, hospice
Death and dying and palliative care: Pain management, including ethical issues related to death and dying, information sharing, counseling families, psychosocial and spiritual counseling, fear and loneliness
Physician-patient relationship (boundaries, confidentiality including HIPAA, privacy, truth telling, other principles of medical ethics, example, autonomy, justice, beneficence)
Impaired physician, including duty to report impaired physician
Negligence/ malpractice, including duty to report negligence and malpractice
Physician misconduct, including duty to report physician misconduct
Referrals
Cultural issues not otherwise coded

System specifications-Social sciences: Unit 03

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

Complexity/ systems thinking: Characteristics of a complex system and factors leading to complexity-how complexity leads to error, health care/ organizational behavior and culture: Environmental factors, workplace design and process; staffing
Complexity/ systems thinking: Health care/ organizational behavior and culture-overcommitment, space, people, time, scheduling; standardization, reducing variance, simplification, metrics; safety culture; integration of care across settings
Complexity/ systems thinking: Health care/ organizational behavior and culture-overutilization of resources (imaging studies, antibiotics, opioids); economic factors

System specifications-Social sciences: Unit 04

Quality improvement

Improvement science principles: Variation and standardization-variation in process, practice; checklists, guidelines, and clinical pathways, reliability
Specific models of quality improvement: Model for improvement-plan-do-study-act (PDSA); plan-do-check-act (PDCA)
Quality measurement: Structure, process, outcome, and balancing measures, measurement tools: Run and control charts; development and application of system and individual quality measures: Core measures; physician quality report system (PQRS)
Quality measurement: Development and application of system and individual quality measures: Core measures; physician quality report system (PQRS); event reporting system
Strategies to improve quality: Role of leadership; principles of change management in quality improvement: Specific strategies
Attributes of high-quality health care: High-value/ cost-conscious care-overutilization of resources including diagnostic testing, medications, equitable care: Access, patient-centered care, timely care

System specifications-Social sciences: Unit 05

Patient safety

Patient safety principles: (a) Epidemiology of medical error, (b) error categorization/ definition: Active vs. latent errors; Swiss cheese model of error; preventable vs. non-preventable; near miss events/ safety hazards
Patient safety principles: (c) Causes of error-(i) patient factors: Understanding of medication use; health literacy; economic status; cultural factors (example religion); failure to make appointments; socioeconomic status
Patient safety principles: (c) Causes of error-(ii) physician factors: Deficiency of knowledge; judgment errors; diagnostic errors; fatigue, sleep deprivation; bias-cognitive, availability, heuristic, anchoring, framing
Patient safety principles: (c) Causes of error-(iii) human factors (example cognitive, physical, environmental), (d) High reliability of organization (HRO) principles-change management and improvement science
Patient safety principles: (d) High reliability of organization (HRO) principles-conceptual models of improvement, (e) reporting and monitoring for errors: Event reporting systems
Patient safety principles: (e) Reporting and monitoring for errors-communication with patients after adverse events (disclosure/ transparency)
Specific types of error: (a) Transitions of care errors (example handoff communication including shift-to-shift, transfer, and discharge): Handoffs and related communication; discontinuities; gaps; discharge; transfers
Specific types of error: (b) Medication errors-ordering, transcribing, dispensing, administration (wrong quantity, wrong route, wrong drug), medication reconciliation, mathematical error, (c) procedural errors: Universal protocol (time out); wrong patient
Specific types of error: (c) Procedural errors-wrong site; wrong procedure; retained foreign bodies, injury to structures: Paracentesis; bowel perforation; thoracentesis; pneumothorax; central venous/ arterial line injuries
Specific types of error: (c) Procedural errors-Injury to structures: Arterial puncture and bleeding and venous thrombosis; lumbar puncture bleeding; paralysis, other errors: Anesthesia-related errors; mathematical errors
Specific types of error: (d) Health care-associated infections-nosocomial infection-example, surgical site, ventilator associated; catheter-related; handwashing procedures or inadequate number of handwashing stations
Specific types of error: (d) Health care-associated infections-central line-associated blood stream infections; surgical site infections; catheter-associated urinary tract infections; ventilator-associated pneumonia
Specific types of error: (e) Documentation errors-electronic medical record (including voice-recognition software errors); record keeping; incorrect documentation (example wrong patient, wrong date, copying and pasting, pre-labeling)
Specific types of error: (f) Patient identification errors-mislabeling-transfusion errors related to mislabeling; verification/ two identifiers: Lack of dual validation, including verbal verification of lab results
Specific types of error: (g) Diagnostic errors-errors in diagnostic studies; misinterpretation; (h) monitoring errors-cardiac monitoring/ telemetry, drug monitoring (warfarin, antibiotics), device-related errors: Malfunction, programming error
Specific types of error: (i) Device-related errors-incorrect use
Strategies to reduce error: (a) Human factors engineering, (b) situational awareness, (c) hierarchy of effective interventions: Forcing function; visual cues, (d) error analysis tools: Error/ near miss analysis; failure modes and effect analysis
Strategies to reduce error: (d) Error analysis tools-morbidity and mortality review; root cause analysis, (e) safety behavior and culture at the individual level: Hierarchy of health care, flattening hierarchy, speak up to power; afraid to report, fear
Strategies to reduce error: (e) Safety behavior and culture at the individual level-psychological safety; closed-loop communication, (f) teamwork: Principles of highly effective teams; case management; physician teams, physician-physician communication
Strategies to reduce error: (f) Teamwork-interprofessional/ interprofessional teams; strategies for communication among teams, including system-provider communication, physician-physician communication (example consultations)
Strategies to reduce error: (f) Teamwork-provider-interprofessional communication, patient communication

System specifications-Social sciences: Unit 06

Health care policy and economics

Health care policy: (a) Health care disparities-race/ ethnicity; numeracy/ literacy; socioeconomic status, (b) access to care: Critical access systems or hospitals, social justice
Health care economics/ health care financing: (a) Types of insurance-medicare, medicaid, private insurance, self-pay, (b) navigating the insurance system: Deductibles/ co-pays; in-/ out-of-network; preferred providers
Health care economics/ health care financing: (c) Reimbursement issues affecting safety and quality: Emergency services-EMTALA; pay-for-performance

Physician tasks/ competencies specifications-Medical knowledge/ scientific concepts: Unit 01

Applying foundational science concepts

Identifies the cause/ infectious agent or predisposing factor(s) or, given an effect, determines the cause
Identifies the underlying processes/ pathways that account for, or contribute to, the expression or resolution of a given condition
Recognizes or evaluates given clinical or physical findings to identify the underlying anatomic structure or physical location
Recognizes the mechanisms of action of various drugs; selects from an option set list of drugs based on mechanism of action

Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 01

Diagnosis: Obtaining and predicting history and physical examination

Knows signs/ symptoms of selected disorders
Knows individual's risk factors for development of conditions: Given current symptoms in presented history, identifies other pertinent factors in the history
Given a specific problem, knows what to ask in obtaining further pertinent additional history
Predicts the most likely additional physical finding; selects either the finding itself or the appropriate examination technique that would result in the finding

Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 02

Diagnosis: Selecting and Interpreting Laboratory and diagnostic studies

Selects most appropriate laboratory or diagnostic study, including neuropsychiatric testing, or study most likely to establish/confirm the diagnosis
Interprets laboratory or other study findings
Predicts the most likely laboratory or diagnostic study result
Selects most appropriate laboratory or diagnostic study after a change in patient status

Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 03

Diagnosis: Formulating the diagnosis

Selects the most likely diagnosis
Assesses the developmental level of the patient

Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 04

Diagnosis: Determining prognosis/ outcome

Recognizes factors in the history, physical or laboratory study findings that affect patient prognosis or outcome or determine therapy
Interprets laboratory or other diagnostic study results and identifies current/ future status of patient
Recognizes associated conditions of a disease, including complications, or indicators of potential complications, of a given disease
Recognizes characteristics of disease relating to natural history or course of disease, including progression, severity, duration, and transmission of disease from a specific patient

Physician tasks/ competencies specifications-Patient care: Management: Unit 01

Management: Health maintenance and disease prevention

Knows risk factors for conditions amenable to prevention or detection in an asymptomatic patient, or knows the potential condition for which the patient may be at risk
Knows pertinent incidence statistics and identifies patient groups at risk; knows incidence of symptoms/ dangerous disorders among various groups
Knows common screening tests for conditions amenable to prevention or detection in an asymptomatic patient or population
Selects appropriate preventive agent or technique (eg, contraception, vaccines, vitamins)
Knows appropriate counseling of patient or family regarding maintenance of current and future problems, including risk factors related to present encounter
Educates patients on screening, health maintenance, self-care
Assesses the developmental level of a healthy patient
Knows the indications for surveillance for recurrence or progression of disease following treatment
Monitoring chronic disease in a stable patient where a change in patient status might cause a change in therapy
Knows appropriate long-term surveillance goals

Physician tasks/ competencies specifications-Patient care: Management: Unit 02

Management: Selecting and monitoring pharmacotherapy

Selects most appropriate pharmacotherapy
Assesses patient adherence with treatment regimen, recognizes techniques to increase adherence or understanding of the disease state, and knows how adherence may be affected by providing instructions with therapy
Recognizes factors that alter drug dosing requirements for a patient
Knows adverse effects of various drugs, or recognizes signs and symptoms of drug (and drug-drug) interactions resulting from polypharmacy in the therapeutic regimenand knows steps to prevent polypharmacy including lab studies to monitor drug therapy
Knows contraindications of various medications
Modifies therapeutic regimen within the context of continuing care; selects appropriate modifications in therapeutic regimen
Knows appropriate monitoring to evaluate effectiveness of drug therapy or to monitor for the adverse effects of drug therapy in a patient that has not had a recurrence or progression of disease

Physician tasks/ competencies specifications-Patient care: Management: Unit 03

Management: Clinical interventions/ treatment

Knows most appropriate management of selected conditions, including recognizing misuse of medication or drug or alcohol use
Knows immediate management or priority in management, specifically in emergency or acute cases
Knows most appropriate follow-up or monitoring approach regarding the management plan
Knows current/ short-term management of patients
Evaluates severity of patient condition in terms of need for referral for surgical treatments/ procedures versus other nonsurgical options
Knows appropriate surgical management
Knows pre/ post surgical or procedural management
Knows indications for admission to the hospital or to other appropriate setting (eg, ICU)
Knows appropriate non-hospital health care settings
Knows most appropriate discharge planning
Knows components of rehabilitation program
Knows appropriate use and procedures regarding hospice care
Educates patient or family regarding self-care
Knows relevant roles of allied health personnel

Physician tasks/ competencies specifications-Patient care: Management: Unit 04

Management: Selecting clinical interventions (mixed management)

Selects most appropriate management option from set of mixed management options (eg, mix of diagnostic studies, pharmacotherapy, procedures, observation, or referral)

Physician tasks/ competencies specifications-Communication: Unit 01

Fostering the relationship

Physician tasks/ competencies specifications-Communication: Unit 02

Gathering information

Physician tasks/ competencies specifications-Communication: Unit 03

Providing information

Physician tasks/ competencies specifications-Communication: Unit 04

Making decisions

Physician tasks/ competencies specifications-Communication: Unit 05

Supporting emotions

Physician tasks/ competencies specifications-Communication: Unit 06

Enabling patient behaviors

Physician tasks/ competencies specifications-Communication: Unit 07

Using an interpreteror surrogate

Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues: Unit 01

Understanding and applying principles of professionalism, legal and ethical issues in interactions with patients

Knows the guidelines for obtaining informed consent for treatment including children and adolescents, third-party permission, and emergent situations
Recognizes need for third-party permission for treatment in medical emergencies
Knows guidelines for treatment of minors with/ without notification of parents
Knows definitions of competence and sanity
Knows the guidelines for involuntary admission
Knows guidelines for confidentiality of medical records
Knows guidelines for physician-patient relationship
Knows issues related to cultural competence and can apply knowledge in specific patient situations

Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues: Unit 02

Understanding and applying legal and ethical issues related to death and dying

Assesses degree of disclosure to terminally ill patients
Recognizes patient's right to refuse treatment or testing (patient autonomy); knows issues of advance directives and living wills
Assesses quality-of-life decisions
Knows appropriate prescriptive practices; knows appropriate use of opioids in terminally ill patients
Knows definition of and legal issues regarding brain death
Knows management of terminally ill patients related to treating chronic pain, and recognizing patient's expression of fear of pain, injury, or death; knows how to comfort patient or family during crisis such as trauma or death

Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues: Unit 03

Understanding and applying professionalism, legal, and ethical issues in dealing with physicians and other health professionals

Knows guidelines for reporting findings to proper authorities
Knows good Samaritan laws
Recognizes physician error and negligence
Recognizes and deals appropriately with impaired physician

Physician tasks/ competencies specifications-Systems based practice, including patient safety: Unit 01

Systems based practice

Understands basic concepts and terminology, principles, and application of quality improvement science and outcome analysis
Recognizes and optimizes human and environmental factors (eg, workplace design, standardization, processes)
Understands the role and characteristics of teams and communication strategies

Physician tasks/ competencies specifications-Systems based practice, including patient safety: Unit 02

Patient safety

Anticipates, recognizes, analyzes, and mitigates risk (sources of error)
Evaluates, reports, and responds to near-misses and system errors
Identifies sources of error and suggests appropriate measures to evaluate or reduce the likelihood of specific errors

Physician tasks/ competencies specifications-Practice-based learning: Unit 01

Understanding and application of the principles of biostatistics and epidemiology

Understands and can apply principles of epidemiology and population health, including health status indicators, outbreak investigation, points of intervention
Understands and can apply principles of study design and study flaws
Understands and can apply the principles of screening and other tests
Understands use and interpretation of statistical principles and measures of association

Physician tasks/ competencies specifications-Practice-based learning: Unit 02

Application of information from studies or other written material to patient care

Decisions about patient care based on results of study or other written materials

Physician tasks/ competencies specifications-Practice-based learning: Unit 03

Understanding of the principles of research ethics and regulatory issues

USMLE Step 2 CK Syllabus

System specifications-General principles of foundational science: Unit 01

Biochemistry and molecular biology

Gene expression: DNA structure, replication, exchange, and epigenetics (example imprinting, X-activation, DNA methylation), gene expression: Transcription, gene expression: Translation, post-translational processing
Gene expression: Modifications and disposition of proteins (degradation), including protein/ glycoprotein synthesis, intra-extracellular sorting, and processes/ functions related to golgi complex and rough endoplasmic reticulum
Structure and function of proteins and enzymes (example enzyme kinetics and structural/ regulatory proteins), energy metabolism (example ATP generation, transport chain)

System specifications-General principles of foundational science: Unit 02

Biology of cells

Adaptive cell responses and cellular homeostasis (example, hypertrophy), mechanisms of injury and necrosis, including pathologic processes (example liquefactive necrosis, free radical formation), apoptosis
Cell cycle and cell cycle regulation (example mitosis), mechanisms of dysregulation, cell biology of cancer (example role of p53, proto-oncogenes), general principles of invasion and metastasis, including cancer staging
Cell/ tissue structure, regulation, and function, including cytoskeleton, organelles, glycolipids, channels, gap junctions, extracellular matrix, and receptors

System specifications-General principles of foundational science: Unit 03

Human development and genetics

Principles of pedigree analysis, inheritance patterns, occurrence and recurrence risk determination, population genetics: Hardy-Weinberg law, founder effects, mutation-selection equilibrium, principles of gene therapy, genetic testing and counseling
Genetic mechanisms (example penetrance, genetic heterogeneity)

System specifications-General principles of foundational science: Unit 04

Biology of tissue response to disease

Acute inflammatory responses (patterns of response), acute inflammation and mediator systems (example histamine, prostaglandins, bradykinins, eosinophilic basic protein, nitric oxide), vascular response to injury, including mediators
Principles of cell adherence and migration (example ECAMs, selectins, leukocytic diapedesis, and rolling), microbicidal mechanisms and tissue injury (example defensins)
Clinical manifestations (example, pain, fever, leukocytosis, leukemoid reaction, chills), chronic inflammatory responses (example tumor necrosis factor)
Reparative processes, wound healing, repair: Thrombosis, granulation tissue, angiogenesis, fibrosis, scar/ keloid formation, regenerative process

System specifications-General principles of foundational science: Unit 05

Pharmacodynamic and pharmacokinetic processes: General principles

Pharmacokinetics: Absorption, distribution, metabolism, excretion, dosage intervals, mechanisms of drug action, structure-activity relationships (example, anticancer drugs), concentration and dose-effect relationships (example efficacy, potency)
Types of agonists (example full, partial, inverse) and antagonists and their actions
Individual factors altering pharmacokinetics and pharmacodynamics (example age, gender, disease, tolerance, compliance, body weight, metabolic proficiency, pharmacogenetics)
Mechanisms of drug adverse effects, overdosage, toxicology, mechanisms of drug interactions
Signal transduction, including structure/ function of all components of signal transduction, pathways such as receptors, ligands (example general principles of nitric oxide, autocrine and paracrine signaling)

System specifications-General principles of foundational science: Unit 06

Microbial biology

Microbial identification and classification, including principles, microorganism identification, and non-immunologic laboratory diagnosis
Bacteria: Structure (example cell walls, composition, appendages, virulence factors, extracellular products, toxins, mechanism of action of toxins), processes, replication, and genetics (example metabolism, growth, and regulation), oncogenesis
Bacteria: Antibacterial agents (example mechanisms of action on organism, toxicity to humans, and mechanisms of resistance)
Viruses: Structure (example physical and chemical properties, virulence factors), processes, replication, and genetics (example life cycles, location of virus in latent infection), oncogenesis
Viruses: Antiviral agents (example mechanisms of action on virus, toxicity to humans, and mechanisms of resistance)
Fungi: Structure (example cell wall, composition, appendages, virulence factors, extracellular products, toxins, mechanisms of action of toxins), processes, replication, and genetics (example asexual vs. sexual, metabolism, growth)
Fungi: Antifungal agents (example mechanisms of action on fungus, toxicity to humans, and mechanisms of resistance)
Parasites: Structure (example appendages, macroscopic features, and virulence factors), processes, replication, and genetics (example life cycles, metabolism, and growth), oncogenesis
Antiparasitic agents (example mechanisms of action on parasite, toxicity to humans, and mechanisms of resistance)
Prions

System specifications-General principles of foundational science: Unit 07

Infancy and childhood (0-12 years): (a) Normal physical changes-linear growth, variations in linear growth, including constitutional delay; weight; head circumference; micturition, defecation, primary incontinence/ bedwetting; normal physical examination
Infancy and childhood (0-12 years): (a) Normal physical changes-screening; sleep; teething syndrome, (b) developmental stages: Motor; speech; cognitive; psychosocial; anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition
Infancy and childhood (0-12 years): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine; risk factors and prevention (example guns, swimming, motor vehicles, car seats)
Infancy and childhood (0-12 years): (c) Lifestyle and routine preventive health care-routine vaccinations
Adolescence (13-17 years): (a) Normal physical changes-linear growth, variations in linear growth including constitutional delay; weight; puberty; normal physical examination; gynecomastia; autonomy/ self-identity; sleep
Adolescence (13-17 years): (b) Developmental stages-cognitive (example abstract thought); psychosocial (example autonomy, role confusion, sexual identity); anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition
Adolescence (13-17 years): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine
Adolescence (13-17 years): (c) Lifestyle and routine preventive health care-risk factors and prevention (example risk-taking behavior, helmets, safe sex, motor vehicles, seat belts, distractions); routine vaccinations
Adulthood (18-64 years): (a) Normal physical changes-weight; normal physical examination; screening; sleep, (b) developmental stages: Cognitive; intimacy vs. isolation; anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition
Adulthood (18-64 years): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine; risk factors and prevention; routine vaccinations
Older adulthood (65 years and older): (a) Normal physical changes, including normal physical exam for age-weight, height (spinal compression), skin, bruising; normal physical examination; response to temperature; micturition, defecation; sleep
Older adulthood (65 years and older): (b) Developmental stages-motor; cognitive (example psychomotor slowing); psychosocial; integrity vs. despair; retrospection; anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition
Older adulthood (65 years and older): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine
Older adulthood (65 years and older): (c) Lifestyle and routine preventive health care-risk factors and prevention (example falls, general medical condition; polypharmacy, driving, caregiver stress); routine vaccinations

System specifications-Immune system: Unit 01

Normal processes

Development of cells of the adaptive immune response, including positive and negative selection during immune development
Structure, production, and function: Granulocytes, natural killer cells, macrophages, mast cells, dendritic cells, cell receptors (example complement receptors and Toll-like receptors), cytokines, chemokines, T lymphocytes
Structure, production, and function: Including T-lymphocyte receptors, accessory molecules (example CD3, CD4, CD8, B7), cell activation and proliferation, cytotoxic T lymphocytes, and memory T lymphocytes, B lymphocytes and plasma cells
Structure, production, and function: Including B-lymphocyte receptors, immunoglobulins, cell activation and proliferation, including development of antibodies and memory B lymphocytes, host defense mechanisms, host barriers to infection
Structure, production, and function: Mucosal immunity (example gut-associated lymphoid tissue and bronchus-associated lymphoid tissue), anatomical locations of T and B lymphocytes
Cellular basis of the immune response and immunologic mediators: Antigen processing and presentation in the context of MHC I and MHC II molecules (example TAP, beta-2 microglobulin), intracellular pathways
Cellular basis of the immune response and immunologic mediators: Mechanisms by which MHC is expressed on the surface; including distribution of MHC I and MHC II on different cells
Cellular basis of the immune response and immunologic mediators: Mechanisms of MHC I and MHC II deficiencies, and the genetics of MHC regulation of the adaptive immune response (example peripheral tolerance, anergy, regulatory T lymphocytes
Cellular basis of the immune response and immunologic mediators: Termination of immune response, and B-T lymphocyte interactions) activation
Cellular basis of the immune response and immunologic mediators: Function, and molecular biology of complement (example anaphylatoxins) functional and molecular biology of cytokines (example IL 1-15)
Basis of immunologic diagnostics (example antigen-antibody reactions used for diagnostic purposes, ELISA, immunoblotting, antigen-antibody changes over time, ABO typing)
Principles of immunologic protection: Vaccine production and mechanisms of vaccine action biologically active antibodies (example monoclonal antibodies, polyclonal antibodies including IVIG, VZIG, rabies immunoglobulin)
Effect of age on the function of components of the immune system

System specifications-Immune system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Disorders associated with immunodeficiency: (a) Deficiency primarily of humoral immunity-common variable immunodeficiency; hyper IgM syndrome; hypogammaglobulinemia/ agammaglobulinemia, X-linked (Bruton); selective immunodeficiency (example IgA, IgM, IgE)
Disorders associated with immunodeficiency: (b) Deficiency/ dysfunction primarily of cell-mediated immunity-adenosine deaminase deficiency; thymic aplasia (DiGeorge syndrome); severe combined immunodeficiency disease (SCID); Wiskott-Aldrich syndrome
Disorders associated with immunodeficiency: (b) Deficiency/ dysfunction primarily of cell-granulomatosis; allergic reactions/ skin, (c) complement deficiency: Alternative pathway component deficiency (C2, C3b, C3bB, C36B6)
Disorders associated with immunodeficiency: (c) Complement deficiency-classical pathway component deficiency (C1q, C1r, C1-C5); terminal component deficiency (C5b-C9; terminal complement complex); C1 esterase inhibitor deficiency, hereditary angioedema
Disorders associated with immunodeficiency: (c) Complement deficiency-mannose-binding lectin (MBL) deficiency; membrane attack complex deficiency, (d) deficiency of phagocytic cells and natural killer cells: Chediak-Higashi disease
Disorders associated with immunodeficiency: (d) Deficiency of phagocytic cells and natural killer cells-chronic granulomatous disease and other disorders of phagocytosis; leukocyte adhesion deficiency
HIV/ AIDS: HIV1 and HIV2; AIDS; AIDS complications (example neuropathy, dementia, renal insufficiency); immunology of AIDS; immune reconstitution syndrome (IRS); secondary infections; noninfectious complications
Immunologically mediated disorders: (a) Hypersensitivity reactions-type 1, 2, 3, including anaphylaxis; type 4; drug reactions; serum sickness, (b) transplantation: rejection; graft-vs.-host disease
Adverse effects of drugs on the immune system: Jarisch-Herxheimer reaction; drugs affecting the immune system (example prednisone, azathioprine, cyclosporine, methotrexate
Adverse effects of drugs on the immune system: Monoclonal antibody drugs [example abciximab, adalimumab; bevacizumab, infliximab, omalizumab, rituximab]); vaccine adverse effects

System specifications-Blood and lymphoreticular system: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes, organ structure and function
Cell/ tissue structure and function: Production and function of erythrocytes, including heme and hemoglobin synthesis; hemoglobin O and CO transport, transport proteins, erythropoietin production and function of platelets
Cell/ tissue structure and function: Production and function of coagulation and fibrinolytic factors; hemostasis
Repair, regeneration, and changes associated with stage of life

System specifications-Blood and lymphoreticular system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious and immunologic infectious disorders: (a) bacteria, (b) viral-hemorrhagic fever (Ebola virus, Marburg virus); chikungunya; dengue fever; Zika virus disease, (c) parasitic: malaria (Plasmodium spp); babesiosis (Babesia species)
Infectious and immunologic infectious disorders: (d) Primary infections of lymphoid tissue-lymphadenitis (viral, bacterial, fungal, parasitic); lymphangitis; buboes, bubonic plague (Yersinia pestis); cat scratch disease (Bartonella henselae)
Infectious and immunologic infectious disorders (e) Immunologic and inflammatory disorders-cryoglobulinemia, essential mixed cryoglobulinemia; autoimmune hemolytic anemia; paroxysmal nocturnal hemoglobinuria; thrombotic thrombocytopenic purpura
Infectious and immunologic infectious disorders: (e) Immunologic and inflammatory disorders-hemolytic uremic syndrome
Neoplasms: Leukemia, acute (ALL, AML); leukemia, chronic (CLL, CML); lymphomas, Hodgkin disease, non-Hodgkin lymphoma, Burkitt lymphoma, T-cell lymphoma; multiple myeloma, dysproteinemias, monoclonal gammopathy of unknown significance (MGUS)
Neoplasms: Myelofibrosis; myelodysplastic syndrome, myelodysplasias; other immunoproliferative neoplasms (example Waldenstrom macroglobulinemia)
Anemia, cytopenias, and polycythemia anemias: (a) Decreased production-anemia of chronic disease, (b) hemolysis: Glucose-6-phosphate dehydrogenase deficiency; pyruvate kinase deficiency
Anemia, cytopenias, and polycythemia anemias: (c) Disorders of hemoglobin, heme, or membrane-disorders of red cell membranes; hereditary spherocytosis, elliptocytosis; methemoglobinemia, congenital; sickle cell disease; sideroblastic anemia; thalassemias
Anemia, cytopenias, and polycythemia anemias: (d) Other causes of anemia-blood loss, acute and chronic as a cause of anemia, (e) cytopenias: Aplastic anemia; leukopenia; neutropenia, cyclic neutropenia, agranulocytosis; pancytopenia; thrombocytopenia
Anemia, cytopenias, and polycythemia anemias: (e) Cytopenias-quantitative; immune thrombocytopenic purpura (ITP), (f) cythemias: Leukocytosis; polycythemia vera; secondary polycythemia
Coagulation disorders (hypercoagulable and hypercoagulable conditions): (a) Hypercoagulable-disseminated intravascular coagulation; hemophilia, congenital factor VIII [hemophilia A] and IX [hemophilia B]; hypofibrinogenemia; von Willebrand disease
Coagulation disorders (hypercoagulable and hypercoagulable conditions): (b) Hypercoagulable-platelet dysfunction, qualitative, hypercoagulable: Heparin-induced thrombocytopenia; other coagulopathies (example homocysteinemia, hypoplasminogenemia)
Coagulation disorders (hypercoagulable and hypercoagulable conditions): (b) Hypercoagulable-other coagulopathies (example antithrombin III, protein C/ protein S deficiency, factor V Leiden, anticardiolipin antibodies, lupus anticoagulant)
Coagulation disorders (hypercoagulable and hypercoagulable conditions): (b) Hypercoagulable-prothrombin G20210A mutation), (c) reactions to blood components: ABO incompatibility/ anaphylaxis; Rh incompatibility/anaphylaxis; hemolysis, delayed
Coagulation disorders (hypercoagulable and hypercoagulable conditions): (c) Reactions to blood components-transfusion reaction; transfusion contaminated with bacteria; transfusion-related acute lung injury (TRALI); anaphylactoid reaction (IgA deficiency)
Traumatic, mechanical, and vascular disorders: Mechanical injury to erythrocytes (example cardiac valve hemolysis); disorders of the spleen; splenic rupture/ laceration; splenic infarct; splenic abscess
Traumatic, mechanical, and vascular disorders: Effects/ complications of splenectomy (example sepsis due to encapsulated bacteria); hypersplenism
Adverse effects of drugs on the hematologic and lymphoreticular systems: Antiplatelet drugs, antithrombin drugs (example dabigatran); chemotherapeutic agents; inhibitors of coagulation factors; methemoglobinemia, acquired; propylthiouracil
Adverse effects of drugs on the hematologic and lymphoreticular systems: Tumor lysis syndrome; warfarin

System specifications-Behavioral health: Unit 01

Normal processes

Psychodynamic and behavioral factors, related past experience (example transference, personality traits)
Adaptive behavioral responses to stress and illness (example coping mechanisms)
Maladaptive behavioral responses to stress and illness (example drug-seeking behavior, sleep deprivation)
Patient adherence: General adherence; adolescent adherence

System specifications-Behavioral health: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Psychotic disorders: Brief psychotic disorder; delusional disorder; psychotic disorder due to another medical condition; schizophrenia; schizoaffective disorder; substance-induced psychotic disorder
Anxiety disorders: Acute stress disorder; anxiety disorders (generalized anxiety disorder, anxiety due to another medical condition, social phobia); hyperventilation syndrome; obsessive-compulsive disorder; panic disorder with and without agoraphobia
Anxiety disorders: Phobic disorders; post-traumatic stress disorder; separation anxiety disorder; substance-induced anxiety disorder, trichotillomania
Mood disorders: Major depressive disorder with and without psychotic features, with and without seasonal pattern; major depressive disorder, postpartum, with and without psychotic features, including screening; cyclothymic disorder
Mood disorders: Persistent depressive disorder (dysthymia); bipolar disorder, manic/ depressed/ mixed; premenstrual dysphoric disorder; bipolar and related disorder or depressive disorder due to another medical condition
Mood disorders: Substance/ medication-induced bipolar and related disorder or depressive disorder (illegal or prescribed); suicidal ideation/ attempt
Somatoform disorders: Body dysmorphic disorder; conversion disorder, including psychogenic seizures; dissociative disorders; illness anxiety disorder (hypochondriasis); malingering; pain disorder; somatic symptom disorder
Factitious disorders: Factitious disorder imposed on self
Eating disorders and impulse control disorders: Anorexia nervosa; binge-eating disorder; bulimia nervosa; eating disorder; disruptive, impulse-control, and conduct disorders (example gambling, kleptomania, pyromania)
Disorders originating in infancy/ childhood: Reactive attachment disorder; attention deficit/ hyperactivity disorder; speech sound disorder or language disorder; learning disorder/ dyslexia; intellectual developmental disorder and developmental delay
Disorders originating in infancy/ childhood: Undefined, including school problems, fetal alcohol syndrome; oppositional defiant disorder, conduct disorder; autism spectrum disorder, rett syndrome; psychoses with origin specific to childhood
Disorders originating in infancy/ childhood: Elimination disorders (incontinence, encopresis); tic disorders/ tourette disorder
Personality disorders: Antisocial personality disorder; avoidant personality disorder; borderline personality disorder; dependent personality disorder; histrionic personality disorder; narcissistic personality disorder
Personality disorders: Obsessive-compulsive personality disorder; paranoid personality disorder; schizoid personality disorder
Psychosocial disorders/ behaviors: Adjustment disorder; grief response/ bereavement, normal and persistent complex; parent-child relational problems other than physical or emotional abuse; other psychosocial stress
Sexual and gender identity disorders: Gender dysphoria; psychosexual dysfunction
Substance use disorders: Alcohol use disorder/ intoxication/ dependence/ withdrawal; tobacco/ nicotine use disorder/ dependence/ withdrawal; varenicline use; cannabis use disorder/ intoxication/ dependence
Substance use disorders: Hallucinogen use disorder/ intoxication/ dependence/ withdrawal; inhalant use disorder/ intoxication/ dependence/ withdrawal; opioid, heroin, including prescription drug, use disorder/ intoxication/ dependence/ withdrawal
Substance use disorders: Sedative, hypnotic, including benzodiazepine and barbiturate use disorder/ intoxication/ dependence/ withdrawal; stimulant, cocaine, methamphetamine use disorder/ intoxication/ dependence/ withdrawal
Substance use disorders: Other drugs of use disorders (example ecstasy, PCP, bath salts)/ intoxication/ dependence/ withdrawal; polysubstance use disorder/ intoxication/ dependence/ withdrawal

System specifications-Nervous system and special senses: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes, including neural tube derivatives, cerebral ventricles, and neural crest derivatives
Organ structure and function: (a) Spinal cord-gross anatomy and blood supply, spinal reflexes, brain stem (example cranial nerves and nuclei, reticular formation, anatomy and blood supply, control of eye movements)
Organ structure and function: (b) Brain-gross anatomy and blood supply, higher function: Cognition, language, memory, executive function, hypothalamic function, limbic system and emotional behavior, circadian rhythm sleep-wake disorder
Organ structure and function: (c) Sensory systems-general sensory modalities, including sharp, dull, temperature, vibratory, and proprioception, special sensory modalities, including vision, hearing, taste, olfaction, and balance
Organ structure and function: (d) Motor systems-brain and spinal cord (upper motor neuron), basal ganglia and cerebellum, autonomic nervous system, peripheral nerves
Cell/ tissue structure and function, including neuronal cellular and molecular biology: Axonal transport, excitable properties of neurons, axons, and dendrites, including channels synthesis, storage, release
Cell/ tissue structure and function, including neuronal cellular and molecular biology: Reuptake, and degradation of neurotransmitters and neuromodulators, presynaptic and postsynaptic receptor interactions, trophic and growth factors, brain metabolism
Cell/ tissue structure and function, including neuronal cellular and molecular biology: Glia, myelin, brain homeostasis: Blood-brain barrier, cerebrospinal fluid formation and flow, choroid plexus
Repair, regeneration, and changes associated with stage of life

System specifications-Nervous system and special senses: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) meningitis: Bacterial (actinomyces israelii; haemophilus influenzae; listeria monocytogenes; mycobacterium tuberculosis; neisseria meningitidis; staphylococcus aureus)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) meningitis: Bacterial (epidermidis; streptococcus agalactiae; streptococcus pneumoniae); viral (adenovirus, arboviruses, echovirus and coxsackie A and B viruses)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral (echovirus and coxsackie A and B viruses, polioviruses, herpes simplex virus, varicella zoster human immunodeficiency virus, lymphocytic choriomeningitis virus)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral (lymphocytic choriomeningitis virus, measles virus, mumps virus, St. Louis encephalitis virus, California encephalitis virus, Western equine encephalitis virus)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iii) fungal (blastomycosis dermatitidis, cryptococcus neoformans/ gattii); spirochetal (borrelia burgdorferi; leptospira; treponema pallidum, including neurosyphilis)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iv) protozoal/ helminths (acanthamoeba, naegleria fowleri, strongyloides stercoralis, angiostrongylus cantonensis, baylisascaris procyonis)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(v) encephalitis (herpesvirus [HSVI], varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, mumps virus, enterovirus, West Nile virus, St. Louis encephalitis virus)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(v) encephalitis (rabies virus, eastern and western equine encephalitis virus, poliovirus, Taenia, Toxoplasma gondii), (vi) prion disease (example Creutzfeldt-Jakob disease)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(vi) botulism (Clostridium botulinum), (vii) tetanus (Clostridium tetani); (viii) CNS disorders associated with AIDS (example progressive multifocal leukoencephalopathy)
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-myasthenia gravis, including thymoma; multiple sclerosis; transverse myelitis
Neoplasms (cerebral, spinal, and peripheral): Benign (meningioma, neurofibromatosis); malignant (glioblastoma multiforme, astrocytoma, medulloblastoma, primary CNS lymphoma); metastatic (example breast, lung, pancreatic, testicular, melanoma)
Cerebrovascular disease: Arteriovenous malformations, ectatic cerebral vessels; transient ischemic attack; stroke, thrombotic: Cerebral artery occlusion/ cerebral infarction; stroke, embolic: Cerebral embolism
Cerebrovascular disease: Stroke-intracerebral hemorrhage including subarachnoid hemorrhage, traumatic intracranial hemorrhage; cerebral artery aneurysm; carotid artery stenosis/ atherosclerosis/ occlusion/ dissection
Cerebrovascular disease: Vertebral artery deficiency/ dissection; subclavian steal syndrome; vascular dementia; hypertensive encephalopathy; posterior reversible encephalopathy syndrome; venous sinus thrombosis
Disorders relating to the spine, spinal cord, and spinal nerve roots: Cauda equina syndrome; spinal artery thrombosis/ embolus/ infarct; spinal cord compression; spinal cord transection, paraplegia and quadriplegia
Disorders relating to the spine, spinal cord, and spinal nerve roots: Acute and chronic effects (example autonomic dysreflexia); spinal stenosis (cervical, lumbar); syringomyelia
Cranial and peripheral nerve disorders: (a) Cranial nerve injury/ disorders-cranial nerve injury; bell palsy; anisocoria, miosis, mydriasis; internuclear ophthalmoplegia; nystagmus and other irregular eye movements; vestibular neuritis, labyrinthitis
Cranial and peripheral nerve disorders: (a) Cranial nerve injury/ disorders-ptosis of the eyelid; Horner syndrome, peripheral nerve/ plexus injury/ disorders: Peripheral nerve injury, including brachial plexus
Cranial and peripheral nerve disorders: (b) Peripheral nerve/plexus injury/disorders-carpal/ cubital/ tarsal/ peroneal tunnel syndrome; mononeuritis, Guillain-Barré syndrome; Miller Fisher syndrome; neuropathy (example Charcot-Marie-Tooth disease)
Cranial and peripheral nerve disorders: (b) Peripheral nerve/plexus injury/disorders-herpes zoster
Neurologic pain syndromes: Complex regional pain syndrome (reflex sympathetic dystrophy, causalgia); fibromyalgia; postherpetic neuralgia; phantom limb pain/ syndrome; thalamic pain syndrome; trigeminal neuralgia
Degenerative disorders/ amnestic syndromes: Alzheimer disease; frontotemporal dementia, including progressive supranuclear palsy, Lewy body disease; mild neurocognitive disorder, mild cognitive impairment
Global cerebral dysfunction: Altered states of consciousness; delirium; coma/ brain death
Neuromuscular disorders: Amyotrophic lateral sclerosis/ spinal muscular atrophy; muscular dystrophy (example Duchenne, myotonic); muscle channelopathies (example hypokalemic period paralysis)
Movement disorders: Acute dystonia; adult tic disease; essential tremor; Huntington disease; Parkinson disease, including Parkinson dementia
Metabolic disorders: Adrenoleukodystrophy; metabolic encephalopathy
Paroxysmal disorders: Headache, including migraine, mixed, tension, ice-pick, cluster, medication withdrawal, caffeine withdrawal; seizure disorders, including generalized tonic-clonic, partial, absence, febrile
Sleep disorders: Cataplexy and narcolepsy; circadian rhythm sleep-wake disorder; insomnia, primary; sleep terror disorder and sleepwalking; REM sleep behavior disorder; restless legs syndrome
Traumatic and mechanical disorders and disorders of increased intracranial pressure: Anoxic brain damage, cerebral hypoxia; epidural, subdural hematoma (cerebral and spinal); intraparenchymal hemorrhage, traumatic subarachnoid hemorrhage; cerebral edema
Traumatic and mechanical disorders and disorders of increased intracranial pressure: Pseudotumor cerebri (idiopathic intracranial hypertension); torticollis/ cervical dystonia; hydrocephalus, including normal-pressure
Traumatic and mechanical disorders and disorders of increased intracranial pressure: Traumatic brain injury (concussion)/ post concussion syndrome (dementia pugilistica); traumatic brain syndrome
Congenital disorders: Friedreich ataxia; neural tube defects (example spina bifida, holoprosencephaly, anencephaly); microcephaly; Sturge-Weber syndrome; tuberous sclerosis, von Hippel-Lindau disease; hydrocephalus, obstructive (Arnold-Chiari)
Adverse effects of drugs on the nervous system: Acute dystonic reaction; drug-induced meningitis (example NSAIDs, sulfa drugs); drug-induced neuropathy (example vincristine, isoniazid, metronidazole)
Adverse effects of drugs on the nervous system: Extrapyramidal adverse effects (example akathisia, dystonia, drug-induced parkinsonism); neuroleptic malignant syndrome; poisoning by psychotropic agents, including antidepressants; serotonin syndrome
Adverse effects of drugs on the nervous system: Tardive dyskinesia
Disorders of the eye and eyelid: (a) Infectious and inflammatory disorders of the eye-blepharitis/ eyelid inflammation; chalazion; chorioretinitis; conjunctivitis (adenovirus)/ keratoconjunctivitis; dacryocystitis; endophthalmitis; hordeolum
Disorders of the eye and eyelid: (a) Infectious and inflammatory disorders of the eye-iridocyclitis; optic neuritis; periorbital cellulitis; uveitis, (b) neoplasms of the eye: Melanoma; retinoblastoma
Disorders of the eye and eyelid: (c) Disorders of the eye and eyelid, structural-cataract; glaucoma; lacrimal system disorders; pterygium; refractive disorders (presbyopia, myopia, hyperopia, astigmatism)
Disorders of the eye and eyelid: (d) Disorders of the pupil, iris, muscles (extraocular): Amblyopia; strabismus, (e) disorders of the retina-hypertensive retinopathy; macular degeneration; papilledema; retinal detachment; retinitis pigmentosa
Disorders of the eye and eyelid: (e) Disorders of the retina-vascular disorders affecting the retina, including central retinal artery embolus, retinal hemorrhage, amaurosis fugax, embolus, carotid artery stenosis, central retinal vein occlusion
Disorders of the eye and eyelid: (e) Disorders of the retina-visual impairment/ blindness, night blindness , (f) traumatic and mechanical disorders: Black eye; burn of the eye and adnexa; corneal abrasion, ulcer; dislocated lens; foreign body in eye
Disorders of the eye and eyelid: (f) Traumatic and mechanical disorders-hyphema; injury to optic nerve and pathways; laceration of the eye and eyelid; ocular open wounds; orbital fracture; subconjunctival hemorrhage
Disorders of the eye and eyelid: (g) Adverse effects of drugs on the eyes-ethambutol; hydroxychloroquine; prednisone
Disorders of the ear: (a) Infectious and inflammatory disorders of the ear-chondritis; mastoiditis; otitis, externa, media, interna, serous, suppurative, malignant otitis externa, (b) neoplasms: Acoustic neuroma, neurofibromatosis type 2; cholesteatoma
Disorders of the ear: (c) Hearing loss/ deafness-hearing loss, including noise-induced; otosclerosis; tinnitus, (d) disorders of balance and spatial orientation: Meniere disease; motion sickness; vertigo, including benign positional vertigo
Disorders of the ear: (e) Traumatic and mechanical disorders: Barotrauma; foreign body in ear; impacted cerumen; laceration, avulsion; perforation of tympanic membrane; eustachian tube disorders
Disorders of the ear: (f) Adverse effects of drugs on the ear-antineoplastic agents, including cisplatin; aminoglycosides; furosemide; salicylates

System specifications-Skin and subcutaneous tissue: Unit 01

Normal processes

Embryonic development, fetal maturation, and neonatal changes
Organ structure and function, including barrier function, thermal regulation
Cell/ tissue structure and function, eccrine function
Repair, regeneration, and changes associated with stage of life (example senile purpura, male pattern baldness, postmenopausal hair changes)
Skin defense mechanisms and normal flora

System specifications-Skin and subcutaneous tissue: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(i) bacterial: Cellulitis, erysipelas, impetigo, staphylococcal scalded skin syndrome; abscess, cutaneous, including septic abscess
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(i) bacterial: Anthrax (Bacillus anthracis); carbuncle; folliculitis; pilonidal cyst, infected; pyoderma gangrenosum; MSSA and MRSA skin infections
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(i) bacterial: Mycobacterial infections (example leprosy, draining sinus); scarlet fever (group A Streptococcus), (ii) viral: Herpes simplex type 1 and type 2
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(ii) viral: Herpes zoster; Ramsay-hunt syndrome; molluscum contagiosum; hand-foot-and-mouth disease; herpangina; parvovirus; chickenpox
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(ii) viral: Erythema infectiosum (fifth disease), rubella, measles, roseola (exanthema subitum); verrucae vulgaris
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(iii) fungal (deep and superficial): Candidiasis, skin; dermatophytosis, tinea corporis; dermatomycoses; diaper rash; onychomycosis
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(iv) parasitic: Cutaneous larva migrans; cutaneous leishmaniasis; (vi) infestations, non venomous bites, stings: Scabies; lice; insect bites, including bed bugs
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) papulosquamous and eczematous dermatoses: Psoriasis; lichen planus and lichenoid dermatoses; allergic/irritant contact dermatitis (example nickel)
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) papulosquamous and eczematous dermatoses: Dermatoses caused by plants (poison ivy, poison oak), (ii) vesiculobullous disorders: Epidermolysis bullosa
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(ii) vesiculobullous disorders: Dermatitis herpetiformis; pemphigus; pemphigoid, (iii) urticaria, erythema, exanthema, and purpura: Erythema nodosum
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(iii) urticaria, erythema, exanthema, and purpura: Atopic dermatitis; pityriasis rosea; urticaria; Stevens-Johnson syndrome, erythema multiforme
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(iii) urticaria, erythema, exanthema, and purpura: Toxic epidermal necrolysis, (iv) autoimmune disorders: Vitiligo
Neoplasms: (a) Benign neoplasms, cysts, and other skin lesions-actinic keratoses; cysts, including epidermal; hemangiomas; lipoma; pigmented nevi; seborrheic keratosis; xanthomas, (b) malignant neoplasms: Basal cell carcinoma; squamous cell carcinoma
Neoplasms: (b) Malignant neoplasms-melanoma, including genital; Kaposi sarcoma; cutaneous T-cell lymphoma, mycosis fungoides
Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes): (a) Disorders of the hair and hair follicles-alopecia; seborrhea capitis/seborrheic dermatitis; tinea barbae and capitis
Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes): (b) Disorders of the nails (including ingrowing nail), (c) disorders of sweat and sebaceous glands: Acne vulgaris; hidradenitis suppurativa
Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes): (c) Disorders of sweat and sebaceous glands-hyperhidrosis; ichthyosis; rosacea
Oral disease: Aphthous ulcers (stomatitis, canker sores); leukoplakia
Disorders of pigmentation: Albinism; lentigo
Traumatic and mechanical disorders: Animal bites (dogs, cats, etc); burns or wounds affecting the skin or subcutaneous tissue (example sunburn, other including blast injuries and burns); cauliflower ear; effects of ultraviolet light; keloids; tattoo
Traumatic and mechanical disorders: Thermal injury, perniosis, frostbite; ulcers, decubitus
Congenital disorders: Xeroderma pigmentosum; benign lesions in neonates, infants, children (example congenital nevi)
Adverse effects of drugs on skin and subcutaneous tissue: Drug reactions, eruptions, including local reaction to vaccine

System specifications-Musculoskeletal system: Unit 01

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, cartilage exercise and physical conditioning/ deconditioning
Repair, regeneration, and changes associated with stage of life

System specifications-Musculoskeletal system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, inflammatory, and immunologic disorders: (a) Infectious disorders-gangrene, dry and wet, clostridial myonecrosis (clostridium perfringens); discitis; myositis, infective; necrotizing fasciitis; osteomyelitis; septic arthritis
Infectious, inflammatory, and immunologic disorders: (a) Infectious disorders-spondylitis, tuberculous, (b) immunologic disorders: Ankylosing spondylitis; dermatomyositis/ polymyositis; juvenile idiopathic arthritis; rheumatoid arthritis, felty syndrome
Infectious, inflammatory, and immunologic disorders: (b) Immunologic disorders-psoriatic arthropathy, (c) inflammatory disorders: Adhesive capsulitis of shoulder (frozen shoulder syndrome); ankylosing/spondylopathy (inflammatory); bursitis; fasciitis
Infectious, inflammatory, and immunologic disorders: (c) Inflammatory disorders-osteochondritis, osteochondritis dissecans; tendinitis, supraspinatus syndrome, enthesopathy of spine, elbow, ankle; temporomandibular joint disorders; fibrositis
Infectious, inflammatory, and immunologic disorders: (c) Inflammatory disorders-myofascial pain syndrome; synovitis; tenosynovitis; myositis
Neoplasms: Benign neoplasms (example ganglion cyst); malignant neoplasms of bone (example osteosarcoma, sarcoma, leiomyosarcoma, rhabdomyosarcoma); metastases to bone, secondary malignant neoplasm of bone
Degenerative and metabolic disorders: (a) Degenerative/ metabolic disorders of bone, tendon, and cartilage-chondromalacia; disc degeneration, herniated disc; Legg-Calvé-Perthes disease; Osgood-Schlatter disease; osteodystrophy; osteomalacia
Degenerative and metabolic disorders: (a) Degenerative/ metabolic disorders of bone, tendon, and cartilage-osteonecrosis (avascular), bone infarct; osteoporosis; osteopenia; osteitis deformans (Paget disease of bone); pathologic fracture; radiculopathies
Degenerative and metabolic disorders: (a) Degenerative/ metabolic disorders of bone, tendon, and cartilage-spondylolisthesis/spondylosis (degenerative), (b) degenerative/ metabolic disorders of joints: Gout, gouty arthritis, pseudogout; joint effusion
Degenerative and metabolic disorders: (b) Degenerative/ metabolic disorders of joints-osteoarthritis, degenerative/ metabolic disorders of muscles, ligaments, fascia: Dupuytren contracture; muscle calcification and ossification
Degenerative and metabolic disorders: (c) Degenerative/ metabolic disorders of muscles, ligaments, fascia-muscle wasting and diffuse atrophy; rhabdomyolysis
Traumatic and mechanical disorders: Amputation and care of amputees; backache, including low back pain; blast injuries; compartment syndrome; contractures, hospital-acquired; contusions; dislocations; fractures; sprains, strains; kyphoscoliosis, scoliosis
Traumatic and mechanical disorders: Rotator cuff syndrome; slipped capital femoral epiphysis; dislocation of hip
Congenital disorders: Achondroplasia/ dwarfism; disorders of limb development (HOX gene mutation, phocomelia); developmental dysplasia of the hip; dislocation of hip in infantile spinal muscular atrophy; genu valgum or varum
Congenital disorders: Foot deformities (flat foot, valgus/ varus deformities); osteogenesis imperfecta; McArdle disease; mitochondrial myopathies
Adverse effects of drugs on the musculoskeletal system: Drug-induced myopathy (example steroids, statins, cocaine, AZT); malignant hyperthermia

System specifications-Cardiovascular system: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal transitional changes
Organ structure and function: Chambers, valves cardiac cycle, mechanics, heart sounds, cardiac conduction hemodynamics, including blood volume and systemic vascular resistance circulation in specific vascular beds, including pulmonary and coronary
Cell/ tissue structure and function: Heart muscle, metabolism, oxygen consumption, biochemistry, and secretory function (example atrial natriuretic peptide), endothelium and secretory function, vascular smooth muscle
Cell/ tissue structure and function: Microcirculation, and lymph flow, neural and hormonal regulation of the heart, blood vessels, and blood volume, including responses to change in posture, exercise, and tissue metabolism, and autonomic responses
Repair, regeneration, and changes associated with stage of life

System specifications-Cardiovascular system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-bacterial endocarditis, myocarditis, (b) immunologic and inflammatory disorders: Atherosclerosis (example atherosclerosis of the aorta)
Neoplasms: Myxoma, metastases
Dysrhythmias: Premature beats (PACs, PVCs); atrial flutter/ fibrillation; multifocal atrial tachycardia; paroxysmal tachycardias; ventricular tachycardia/ fibrillation; wide complex tachycardia; torsades de pointes; bradycardias
Dysrhythmias: Atrioventricular block (first-, second-, third-degree); conduction disorder (LBBB, RBBB); cardiac arrest; sick sinus syndrome; prolonged QT syndrome; Wolff-Parkinson-White syndrome; carotid sinus hypersensitivity
Dysrhythmias: Pacemaker dysfunction, including failure to sense, capture
Heart failure: Chordae tendineae rupture; congestive heart failure; cor pulmonale; diastolic dysfunction; systolic dysfunction; mitral valve dysfunction; heart failure secondary to myocardial infarction
Heart failure: High-output heart failure, including thyrotoxicosis-induced, anemia-induced; tachycardia-induced; cardiogenic pulmonary edema
Ischemic heart disease: Acute coronary syndrome, acute myocardial infarction; angina pectoris, stable and unstable/ coronary artery disease/ coronary insufficiency; coronary artery spasm
Diseases of the myocardium: Cardiomyopathy, dilated, including alcoholic, viral, takotsubo; cardiomyopathy, obstructive hypertrophic; cardiomyopathy, familial dilated; cardiomyopathy, restrictive; hypertensive heart disease, left ventricular hypertrophy
Diseases of the myocardium: Right ventricular hypertrophy; complications of myocardial infarction; nontraumatic tamponade post-myocardial infarction; papillary muscle rupture/ dysfunction; ventricular free wall rupture; myocarditis
Diseases of the pericardium: Chronic constrictive pericarditis; pericardial effusion; pericardial tamponade; acute pericarditis; pericarditis, following myocardial infarction, surgery, trauma
Valvular heart disease: Valve disorders, mitral/ aortic/ tricuspid, pulmonic (example regurgitation, stenosis, prolapse, insufficiency, vegetation); functional murmurs; rheumatic heart disease; complications of artificial valves
Hypotension: Orthostatic hypotension
Hypertension: Elevated blood pressure reading without diagnosis of hypertension; essential hypertension; malignant hypertension; secondary hypertension
Dyslipidemia: Hypercholesterolemia; hyperlipidemia; hypertriglyceridemia; lipoproteins/ lipoprotein lipase deficiency
Vascular disorders: (a) Disorders of the great vessels-aneurysm, aortic (abdominal/ thoracic), dissection, ruptured; aneurysm, iliac, other peripheral vascular, ruptured; aortoiliac disease
Vascular disorders: (b) Peripheral arterial vascular disease-arterial embolism/ thrombosis, arteriovenous fistula; atheroembolic disease; claudication; cholesterol emboli; hypertensive vascular disease; peripheral arterial disease
Vascular disorders: (b) Peripheral arterial vascular disease-thromboangiitis obliterans, (c) diseases of the veins-deep venous thrombosis, venous thromboembolism; phlebitis/ thrombophlebitis; varicose veins; venous insufficiency; stasis ulcers
Vascular disorders: (c) Diseases of the veins-stasis dermatitis
Traumatic and mechanical disorders: Ventricular puncture; myocardial contusion; myocardial rupture; traumatic aortic dissection; traumatic tamponade
Congenital disorders, including disease in adults: Anomalous left coronary artery; atrial septal defect; coarctation of the aorta; endocardial cushion defect; patent foramen ovale; patent ductus arteriosus; tetralogy of Fallot
Congenital disorders, including disease in adults: Transposition of the great vessels; ventricular septal defect
Adverse effects of drugs on the cardiovascular system: Adriamycin; cocaine, amphetamine, PCP; ACE inhibitors, calcium channel blockers, alpha blockers, minoxidil

System specifications-Respiratory system: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes
Organ structure and function: Airways, including mechanics and regulation of breathing, lung parenchyma, including ventilation, perfusion, gas exchange, pleura, nasopharynx, sinuses
Cell/ tissue structure and function, including surfactant formation, and alveolar structure
Repair, regeneration, and changes associated with stage of life
Pulmonary defense mechanisms and normal flora

System specifications-Respiratory system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-acute upper respiratory infection; viral infections (adenovirus, corona viruses, coxsackievirus, influenza virus)
Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-viral infections (parainfluenza virus, rhinoviruses); sinusitis; nasopharyngitis; epiglottitis
Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-bordetella pertussis pneumonia; croup; acute laryngitis; acute laryngotracheitis; tracheitis; pharyngitis
Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-streptococcal throat infections; tonsillitis; peritonsillar abscess; rhinitis, allergic, chronic
Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-ulcers of nasal cavity/ sinuses
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-hospital acquired pneumonia; ventilator-associated pneumonia, community-acquired pneumonia, acute bronchiolitis
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-bronchiolitis obliterans with organizing pneumonia (BOOP); anthrax, pulmonary (Bacillus anthracis); aspiration pneumonia
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-pneumonitis; bronchitis, acute; bronchopneumonia; pneumonia (Burkholderia pseudomallei, chlamydophila pneumoniae
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-coxiella burnetii, francisella tularensis, haemophilus influenzae, klebsiella pneumoniae, legionella, moraxella catarrhalis
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-mycoplasma pneumoniae, pseudomonas aeruginosa, streptococcus, MSSA, MRSA, other gram‐negative bacteria)
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-viral infection (example influenza A, B, adenovirus, H1N1, respiratory syncytial virus, parainfluenza virus)
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-fungal infection (aspergillosis, including allergic bronchopulmonary aspergillosis and aspergilloma, histoplasmosis)
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-fungal infection (coccidioidomycosis, pneumocystis jirovecii); pulmonary tuberculosis; lung abscess
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-viral infection (example influenza A, B, adenovirus, respiratory syncytial virus, parainfluenza virus, avian influenza virus)
Neoplasms: (a) Benign neoplasms-upper airways (example vocal cord polyps, nasal polyps, juvenile, papillomatosis); lungs and pleura (example solitary pulmonary nodule, bronchial carcinoid tumors)
Neoplasms: (b) Malignant neoplasms-(i) upper airways: Lip, oral cavity, and pharynx; head and neck cancer; larynx; trachea, (ii) lower airways and pleura: Malignant neoplasms of bronchus and/ or lung (squamous cell, adenocarcinoma, large cell, small cell)
Neoplasms: (b) Malignant neoplasms-(ii) lower airways and pleura: Malignant neoplasms of pleura (mesothelioma); secondary malignant neoplasms of lung; secondary malignant neoplasms of pleura, (c) metastatic neoplasms including pleural
Obstructive airway disease: Asthma, reactive airway disease; bronchiectasis; chronic airway obstruction; chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema
Pneumoconiosis/ fibrosing/ restrictive pulmonary disorders/ interstitial lung disease: Pneumoconiosis; asbestosis; silicosis; silo-filler's lung, byssinosis, bagassosis, berylliosis; hypersensitivity pneumonitis; hypereosinophilic syndromes
Pneumoconiosis/ fibrosing/ restrictive pulmonary disorders/ interstitial lung disease: Loeffler syndrome; interstitial pneumonia, usual (UIP), desquamative (DIP), nonspecific
Respiratory failure/ respiratory arrest and pulmonary vascular disorders: Acute respiratory distress syndrome (ARDS); pulmonary hypertension; pulmonary vascular disorders, arteriovenous fistula; pulmonary edema, pulmonary cause and unspecified
Respiratory failure/ respiratory arrest and pulmonary vascular disorders: Pulmonary embolism; air and fat embolism; respiratory failure due to enteral feeding
Metabolic, regulatory, and structural disorders: Disorders of gas exchange; hypoventilation; hypoxia; pulmonary alveolar proteinosis; ventilation-perfusion imbalance
Disorders of the pleura, mediastinum, and chest wall: Chylothorax; costochondritis; empyema; hemothorax; mediastinitis; pleural effusion; pleuritis; pneumomediastinum; pneumothorax
Traumatic and mechanical disorders: (a) Upper airways-epistaxis; barotrauma, sinus; laryngeal/pharyngeal obstruction; tracheoesophageal fistula; tracheal stenosis; tracheomalacia; trauma (example tracheal injury)
Traumatic and mechanical disorders: (a) Upper airways-foreign body (nose, pharynx, larynx, trachea); traumatic/ mechanical disorders of the nasal cavity/ sinuses (example septal perforation)
Traumatic and mechanical disorders: (b) Lower airways and pleura-atelectasis; diaphragm/ chest wall injury; drowning and near drowning; foreign body, upper and lower respiratory tract; penetrating chest wounds; pulmonary contusion; sleep apnea
Traumatic and mechanical disorders: (b) Lower airways and pleura-obstructive and central; hypoventilation syndrome, obesity-hypoventilation syndrome
Congenital disorders: Bronchogenic cysts; congenital cysts; congenital diaphragmatic hernia; pulmonary sequestration; immotile cilia syndrome
Adverse effects of drugs on the respiratory system: Bleomycin, amiodarone; adverse effects of 100% oxygen; acute effects of tobacco/ nicotine, inhalants, cocaine

System specifications-Gastrointestinal system: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes
Organ structure and function: Anatomy of the alimentary canal, including mouth, pharynx, esophagus, stomach, small intestine, large intestine, anus, peritoneal cavity, liver and biliary system, including enterohepatic circulation
Organ structure and function: Salivary glands and exocrine pancreas, gastrointestinal motility, including defecation digestion and absorption
Cell/ tissue structure and function: Endocrine and neural regulatory functions, including GI hormones (example gastrin) salivary, gastrointestinal, pancreatic, hepatic secretory products, including enzymes, proteins
Cell/ tissue structure and function: 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

System specifications-Gastrointestinal system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Pseudomembranous colitis (Clostridium difficile); enteritis/ enteric infections (includes gastroenteritis)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) bacterial: (example Staphylococcus aureus, Escherichia coli, Listeria monocytogenes, Yersinia enterocolitica, Campylobacter species, Vibrio cholerae, Salmonella species)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: (Shigella species, traveler's/ infectious diarrhea); hepatic abscess, subhepatic abscess, subphrenic abscess; peritonitis, primary and secondary; Whipple disease
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral: Infectious esophagitis (example CMV, herpes); hepatitis A, B, C, D, E; coxsackievirus enteritis/ colitis; Echovirus enteritis/colitis; rotavirus enteritis; mumps
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral: Gingivostomatitis, herpetic, (iii) fungal: Thrush, (iv) parasitic: Cryptosporidium, cyclospora, entamoeba histolytica, giardia, isospora belli
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iv) parasitic: Strongyloides stercoralis
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-autoimmune hepatitis; celiac disease; eosinophilic esophagitis; granulomatous enteritis; inflammatory bowel disease, including Crohn disease
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-regional enteritis; microscopic colitis (collagenous and lymphocytic colitis), ulcerative colitis, toxic megacolon
Neoplasms: (a) Benign neoplasms, including polyps, cysts-stomach; small intestine; colon, rectum, and anus, including polyps, (b) malignant neoplasms and premalignant conditions: Oral cancer (example lips, mouth, tongue, salivary glands)
Neoplasms: (b) Malignant neoplasms and premalignant conditions-esophageal, squamous and adenocarcinoma; Barrett esophagus; gastrinoma, Zollinger-Ellison syndrome; gastrointestinal carcinoid tumors; gastrointestinal stromal tumors; small intestine
Neoplasms: (b) Malignant neoplasms and premalignant conditions-stomach, adenocarcinoma, lymphoma, MALT; colon, rectum, anus; hereditary colon cancer syndromes
Neoplasms: (b) Malignant neoplasms and premalignant conditions-familial adenomatous polyposis (example Peutz-Jeghers syndrome, Gardner syndrome, Turcot syndrome,); MUTYH-associated polyposis; gallbladder, cholangiocarcinoma
Neoplasms: (b) Malignant neoplasms and premalignant conditions-adenocarcinoma of the ampulla of Vater; liver, including hepatoma; peritoneal cancer, including metastatic studding with cancer; pancreas, (c) metastatic neoplasms
Signs, symptoms, and ill-defined disorders: Upper gastrointestinal bleeding; lower gastrointestinal bleeding; constipation; diarrhea; hematochezia; bright red rectal bleeding; melena; nausea, vomiting, rumination
Disorders of the oral cavity, salivary glands, and esophagus: (a) Oral cavity and salivary glands-abscessed tooth; dental caries; malocclusion; disorders of the salivary glands (example stones, sialadenitis, parotitis)
Disorders of the oral cavity, salivary glands, and esophagus: (b) Esophagus-achalasia and cardiospasm; dysphagia; diverticulum (example Zenker); esophageal periapical abscess without sinus; esophagitis/ esophageal reflux (GERD); esophagitis, pill
Disorders of the oral cavity, salivary glands, and esophagus: (b) Esophagus-Mallory-Weiss syndrome; paraesophageal (hiatal) hernia; stricture and stenosis of esophagus
Disorders of the stomach, small intestine, colon, rectum, anus: (a) Stomach-dyspepsia/ hyperacidity; gastric ulcer; gastritis; peptic ulcer; peptic ulcer perforation; gastroparesis, small intestine, colon: Appendicitis; angiodysplasia; diverticula
Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-diverticulitis, diverticulosis; duodenitis, duodenal ulcer, peptic ulcer; gastroenteritis and colitis (noninfectious); granulomatous enterocolitis
Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-Hirschsprung disease; impaction of intestine; intestinal obstruction/ stricture; intussusception; irritable colon/ irritable bowel syndrome
Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-mesenteric ischemia/ ischemic bowel/ ischemic colitis; necrotizing enterocolitis; paralytic ileus; volvulus; malnutrition and malabsorption
Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-including lactose intolerance, short bowel syndrome, rectum and anus: Abscess of anal and rectal regions; anal fissure; anal fistula; ulcer; fecal incontinence
Disorders of the stomach, small intestine, colon, rectum, anus: (c) Rectum and anus-hemorrhage (rectum, anus); proctitis; hemorrhoids; rectal prolapse
Disorders of the liver and biliary system, noninfectious: (a) Liver-cirrhosis; Dubin-Johnson, Rotor syndromes; end-stage liver disease, including indications for transplantation; Gilbert syndrome, Crigler-Najjar syndrome
Disorders of the liver and biliary system, noninfectious: (a) Liver-hepatic coma/ hepatic encephalopathy; hepatitis, noninfectious; hepatitis, fatty liver, alcoholic; hepatorenal syndrome; hepatopulmonary syndrome; jaundice
Disorders of the liver and biliary system, noninfectious: (a) Liver-nonalcoholic fatty liver disease; portal hypertension/ esophageal varices, (b) biliary system: Bile duct obstruction/ cholestasis; cholangitis, including ascending; choledocholithiasis
Disorders of the liver and biliary system, noninfectious: (b) Biliary system-cholelithiasis/ cholecystitis; cholestasis due to parenteral nutrition; gallstone ileus; Mirizzi syndrome; primary biliary cirrhosis; primary sclerosing cholangitis
Disorders of the pancreas: Pancreatitis, acute; pancreatitis, chronic; pancreatitis, hereditary; pancreatic cyst/ pseudocyst; pancreatic duct obstruction; pancreatic insufficiency
Disorders of the peritoneal cavity: Ascites
Traumatic and mechanical disorders: Abdominal wall defects; adhesions, postsurgical; digestive system complications of surgery; post-gastric surgery syndromes (example blind loop syndrome, adhesions); duodenal tear; foreign body in digestive system
Traumatic and mechanical disorders: Inguinal, femoral, and abdominal wall hernias; open wound, abdominal; perforation of hollow viscus and blunt trauma; perforation/rupture of esophagus (Boerhaave syndrome); umbilical hernia
Congenital disorders: Annular pancreas, biliary atresia, cleft lip and palate, esophageal atresia, malrotation without volvulus, Meckel diverticulum, pyloric stenosis, tracheoesophageal fistula
Adverse effects of drugs on the gastrointestinal system: Drug-induced changes in motility (chronic laxative abuse, opioids); drug-induced gastritis, duodenitis, peptic ulcer disease (NSAIDs); drug-induced hepatitis (example acetaminophen, isoniazid)
Adverse effects of drugs on the gastrointestinal system: Drug-induced pancreatitis (example thiazide diuretics)

System specifications-Renal and urinary system: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes
Organ structure and function: Kidneys, ureters, bladder, urethra, glomerular filtration and hemodynamics, urine concentration and dilution, renal mechanisms in acid-base balance, renal mechanisms in body fluid homeostasis, micturition
Cell/ tissue structure and function: Renal metabolism and oxygen consumption, tubular reabsorption and secretion, including transport processes and proteins
Cell/ tissue structure and function: Hormones produced by or acting on the kidney (example renin, aldosterone, angiotensin II, vasopressin)
Repair, regeneration, and changes associated with stage of life

System specifications-Renal and urinary system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) upper urinary tract: Granulomatous pyelonephritis; perinephric abscess; pyelonephritis; pyonephrosis; renal abscess; renal tuberculosis
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) lower urinary tract and urinary tract infections of unspecified location: Cystitis; chlamydial and nonchlamydial
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) upper urinary tract: Glomerular disorders-Alport syndrome; glomerular disease due to hepatitis B, C; glomerulonephritis, including poststreptococcal
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) upper urinary tract: Glomerular disorders-IgA nephropathy; lupus nephritis; minimal change disease; nephrotic syndrome; thin basement membrane disease
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) upper urinary tract: Tubulointerstitial disease-acute tubular necrosis (ATN); acute interstitial nephritis; papillary necrosis; HIV nephropathy
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(ii) lower urinary tract: interstitial cystitis
Neoplasms: (a) Benign neoplasms and cysts-polycystic kidney disease, (b) malignant neoplasms: Renal (example Wilms tumor/ nephroblastoma, renal cell carcinoma, renal tumors associated with congenital/ hereditary conditions)
Neoplasms: (b) Malignant neoplasms-urinary bladder and collecting system
Signs, symptoms, and ill-defined disorders: dysuria; hematuria; oliguria, anuria; proteinuria
Metabolic and regulatory disorders: Acute kidney injury; renal insufficiency; azotemia, uremic syndrome; chronic kidney disease, including end-stage renal disease; cystinuria; Fanconi syndrome
Metabolic and regulatory disorders: Hypertensive renal disease (renal complications of hypertension); renal calculi, ureteral calculi, nephrolithiasis; renal tubular acidosis
Vascular disorders: Renal artery stenosis (atherosclerosis, fibromuscular dysplasia, nephrosclerosis); renal vein thrombosis; renal infarction
Traumatic and mechanical disorders: Bladder rupture; neurogenic bladder; obstructive uropathy; posterior urethral valves; renal laceration; renal vascular injury; ureteral laceration/ avulsion/ disruption; urethral diverticulum
Traumatic and mechanical disorders: Obstruction/ stricture/ prolapse, urethral/ ureteral, vaginal walls, uterine, uterovaginal; urinary incontinence, including secondary enuresis; vesicoureteral reflux
Congenital disorders: Double ureters/ ureteral duplication/ double collecting system; horseshoe kidney; hydronephrosis/ reflux; renal agenesis, renal hypoplasia, renal dysplasia; single kidney
Adverse effects of drugs on the renal and urinary system: ACE inhibitors; aminoglycosides; amphotericin B; cisplatin; furosemide; gadolinium (nephrogenic systemic fibrosis); heroin; iodinated contrast dye; lithium; NSAIDs; penicillins; sulfa drugs
Adverse effects of drugs on the renal and urinary system: Tenofovir; drug-induced urinary retention

System specifications-Pregnancy, childbirth, and the puerperium: Unit 01

Normal processes

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

System specifications-Pregnancy, childbirth, and the puerperium: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Prenatal care: (a) Preconception counseling and care-folate deficiency prevention; immunizations; nutritional assessment, including vitamins; Rh screening, (b) prenatal risk assessment/ prevention: Adolescent pregnancy; antepartum fetal evaluation
Prenatal care: (b) Prenatal risk assessment/ prevention-including biophysical profile; genetic screening; α-fetoprotein; diabetes mellitus; neural tube defects; Rh isoimmunization, (c) supervision of normal pregnancy: Assessment of gestational age
Prenatal care: (c) Supervision of normal pregnancy-iron deficiency prevention; nutrition, including weight management; surveillance, including ultrasonography and assessment of fetal growth; vitamin deficiency prevention; infections, maternal, fetal
Prenatal care: (c) Supervision of normal pregnancy-newborn (focus on prevention and screening): Cytomegalovirus, coxsackievirus, hepatitis B virus, herpes simplex viruses, HIV, influenza virus, parvovirus B19 virus, Rubella virus, varicella-zoster virus
Prenatal care: (c) Supervision of normal pregnancy-Chlamydia trachomatis, Treponema pallidum, Streptococcus agalactiae, Toxoplasma gondii, amnionitis; asymptomatic urinary tract infection
Obstetric complications: Abortion, induced, septic, missed, spontaneous, threatened; acute fatty liver of pregnancy; anemia of pregnancy, sickle cell disease, thalassemia in pregnancy; antepartum hemorrhage, including third-trimester bleeding
Obstetric complications: Cardiomyopathy of pregnancy; cervical insufficiency, cervical shortening; cholestasis of pregnancy, intrahepatic; congenital abnormalities, maternal (example bicornuate uterus); ectopic pregnancy
Obstetric complications: Fetal abnormality affecting management of mother (example hydrocephalus, spina bifida); fetal growth restriction; gestational diabetes; maternal mortality; multiple gestation
Obstetric complications: Placental abnormalities (abruptio placentae, placenta previa, premature separation of placenta); polyhydramnios, oligohydramnios; preeclampsia, eclampsia, HELLP syndrome, gestational hypertension; prolonged pregnancy
Obstetric complications: Rh isoimmunization affecting management of mother; vomiting in pregnancy (morning sickness, hyperemesis gravidarum); trauma in pregnancy; infections complicating pregnancy
Labor and delivery: Labor and delivery, uncomplicated; labor and delivery, complicated, including shoulder dystocia; cesarean delivery, including complications; cord compression, cord prolapse; fetal malpresentations (example breech/ external cephalic)
Labor and delivery: Intrapartum fetal evaluation, including fetal heart tones; intrapartum prophylaxis (example HIV, Chlamydia, gonococcal prophylaxis); premature rupture of membranes; preterm (before 37 weeks' gestation) and postdates labor and delivery
Labor and delivery: Threatened preterm labor
Puerperium, including complications: Lactation problems; breastfeeding problems; lochia; postpartum cardiomyopathy; postpartum blues; postpartum hemorrhage; postpartum sepsis; retained placenta, products of conception (example placenta accreta)
Puerperium, including complications: Uterine atony
Newborn (birth to 4 weeks of age): (a) Normal newborn-examination of liveborn at admission to hospital, screening, newborn, (b) disorders of the newborn: Screening, newborn; ABO incompatibility in newborn; hemolytic disease due to Rh incompatibility
Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-birth asphyxia syndrome (liveborn neonate); birth trauma (example cord compression, brachial palsy, lacerations); drug withdrawal syndrome in newborn; feeding problems in newborn
Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-fetal growth and development abnormalities, including fetal growth restriction; gastrointestinal obstruction; hypocalcemia of newborn; infections
Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-congenital or peripartum (cytomegalovirus, herpes simplex viruses, HIV, hepatitis B, rubella virus, parvovirus B19 virus, varicella zoster virus, chlamydia trachomatis)
Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-(streptococcus agalactiae, treponema pallidum, toxoplasma gondii), intrapartum fetal distress/ death including stillborn; jaundice, fetal/ neonatal/ perinatal; laryngomalacia
Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-macrosomia (large for gestational age); meconium aspiration syndrome; neonatal acne; neonatal Candida infection (thrush); neonatal hypoglycemia; neonatal conjunctivitis and dacryocystitis
Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-ophthalmic gonorrhea; phenylketonuria; premature infant; post-term infant; pseudomembranous colitis of infancy; respiratory distress syndrome (hyaline membrane disease)
Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-Respiratory problems after birth (example bronchopulmonary dysplasia, tracheomalacia; tracheoesophageal fistula in neonates); retinitis of prematurity; seizures in newborn
Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-sudden infant death syndrome (SIDS), apparent life-threatening event (ALTE); tetanus neonatorum
Congenital disorders, neonatal: Congenital malformations and anomalies; neonatal hydrocele
Adverse effects of drugs on pregnancy, childbirth, and the puerperium: Alcohol, tobacco, and other drugs (ATOD); prenatal radiation exposure; teratology (example ACE inhibitors, SSRIs, warfarin, infections, toxins)
Systemic disorders affecting pregnancy, labor and delivery, and puerperium: Appendicitis; asthma; carpal tunnel syndrome in pregnancy; cirrhosis; deep venous thrombosis (DVT); diabetes mellitus; heart failure, valvular heart disease; hypertension
Systemic disorders affecting pregnancy, labor and delivery, and puerperium: Myasthenia gravis; obesity; pancreatitis; psychiatric disorders; renal calculus/ calculi; renal failure/ renal disease, including SLE; seizure disorders; thyroid disorders
Systemic disorders affecting pregnancy, labor and delivery, and puerperium: Hypothyroidism, hyperthyroidism

System specifications-Female reproductive system and breast: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes, gametogenesis
Organ structure and function: Female structure, including breast female function (example ovulation, menstrual cycle, puberty) intercourse, sexual response
Cell/ tissue structure and function: Hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones
Reproductive system defense mechanisms and normal flora
Repair, regeneration, and changes associated with stage of life

System specifications-Female reproductive system and breast: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Breast: (a) Infectious, immunologic, and inflammatory disorders-breast abscess; inflammatory disease of breast, fat necrosis; mastitis; nipple discharge, (b) neoplasms-(i) benign and undefined neoplasms: Breast cyst, solitary; fibrocystic changes
Breast: (b) Neoplasms-(i) Benign and undefined neoplasms-fibroadenoma; hypertrophy of breast; intraductal papilloma, (ii) malignant neoplasms (including screening): Breast cancer; intraductal carcinoma; Paget disease of breast; phyllodes tumors
Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-bacterial vaginosis; Bartholin gland abscess; cellulitis, pelvic; candidiasis of the vulva or vagina; lichen sclerosus; sexually transmitted infections and exposure
Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-cervicitis and endocervicitis; chancroid (Haemophilus ducreyi); genital herpes; gonorrhea (Neisseria gonorrhoeae); human papillomavirus infection
Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-genital/ venereal/ anal warts, condylomata acuminata; lymphogranuloma venereum (Chlamydia trachomatis), non-lymphogranuloma venereum; pelvic inflammatory disease
Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-Fitz-Hugh–Curtis syndrome; salpingitis and oophoritis; syphilis (Treponema pallidum); trichomoniasis (Trichomonas vaginalis); urethritis; vaginitis; vulvovaginitis
Neoplasms of the cervix, ovary, uterus, vagina, and vulva: (a) Benign neoplasms and cysts-abnormal Pap smear; benign neoplasm of ovary; endocervical and endometrial polyps; leiomyomata uteri; ovarian cyst
Neoplasms of the cervix, ovary, uterus, vagina, and vulva: (b) Malignant and precancerous neoplasms-cervical cancer; HPV causing cancer; cervical dysplasia, HPV causing dysplasia; endometrial hyperplasia; endometrial/ uterine cancer
Neoplasms of the cervix, ovary, uterus, vagina, and vulva: (b) Malignant and precancerous neoplasms-gestational trophoblastic disease (hydatidiform mole); ovarian cancer; vulvar dysplasia, and cancer
Fertility and infertility: Assisted reproductive techniques (ART); contraception (example oral contraceptives, IUD, vaginal cap, cervical sponge, diaphragm, implant, morning-after pill, male and female condoms); female infertility
Fertility and infertility: Gonadal dysgenesis 45,X (Turner syndrome); sterilization; tubal factors; infertility
Menopause: Ovarian failure, premature menopause; perimenopause; premenopausal menorrhagia; postmenopausal atrophic vaginitis (vaginal atrophy); postmenopausal bleeding; vasomotor symptoms
Menstrual and endocrine disorders: Abnormal uterine bleeding, including perimenopausal; absence of menstruation (primary amenorrhea, secondary amenorrhea including undiagnosed pregnancy); anovulation; dysmenorrhea; endometriosis; hirsutism, virilization
Menstrual and endocrine disorders: Mittelschmerz; pelvic pain; polycystic ovarian syndrome; postcoital bleeding; premenstrual syndrome
Sexual dysfunction: Dyspareunia; orgasmic dysfunction; sexual desire/ arousal syndrome; vaginismus
Traumatic and mechanical disorders: Asherman syndrome; chronic inversion of uterus; chronic pelvic pain syndrome; cystocele; imperforate hymen; injuries, wounds, and burns affecting the female reproductive system and injuries, wounds
Traumatic and mechanical disorders: Burns, and blast injuries; ovarian torsion; pelvic relaxation; rectocele; urethrocele
Congenital disorders: Müllerian agenesis; uterus didelphys, bicornuate uterus; short cervix
Adverse effects of drugs on the female reproductive system and breast: Antihistamines, H2-receptor blockers; benzodiazepines; beta-adrenergic blockers; hormone replacement; opioids; spironolactone; selective serotonin reuptake inhibitors
Adverse effects of drugs on the female reproductive system and breast: Tricyclic antidepressants

System specifications-Male reproductive system: Unit 01

Normal processes

Embryonic development, fetal maturation, and neonatal changes, gametogenesis
Organ structure and function: Structure, male genitalia and prostate function, male genitalia and prostate (example spermatogenesis, puberty) intercourse, orgasm, erection
Cell/ tissue structure and function, including hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones
Reproductive system defense mechanisms and normal flora
Repair, regeneration, and changes associated with stage of life

System specifications-Male reproductive system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-balanitis; epididymitis; orchitis; prostatitis; sexually transmitted infections and exposure; chancroid (Haemophilus ducreyi); genital herpes; gonorrhea (Neisseria gonorrhoeae)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-human papillomavirus infection, genital/ venereal/ anal warts, condylomata acuminata; lymphogranuloma venereum (Chlamydia trachomatis); syphilis (Treponema pallidum)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-trichomoniasis (Trichomonas vaginalis); urethritis, chlamydial and nonchlamydial, nongonococcal, (b) immunologic and inflammatory disorders: Autoimmune hypogonadism
Neoplasms: Malignant neoplasms, penile, prostate, testicular, breast
Metabolic and regulatory disorders, including sexual dysfunction: Erectile dysfunction, impotence; infertility, male factor; male sexual dysfunction; premature ejaculation
Traumatic and mechanical disorders: Benign prostatic hyperplasia/ hypertrophy; circumcision, including complications; epididymal cyst; hydrocele; injuries, wounds, and burns to male genitalia, including blast injuries; penile laceration, penile fracture
Traumatic and mechanical disorders: Peyronie disease; phimosis; scrotal laceration; spermatocele; testicular rupture/ avulsion/ laceration; torsion of testis; urethral laceration/ disruption; varicocele
Congenital disorders of the male reproductive system: Hypospadias; Klinefelter syndrome; undescended testicle
Adverse effects of drugs on the male reproductive system: Alcohol; androgens, testosterone; antipsychotics, antidepressants including selective serotonin reuptake inhibitors; beta adrenergic blockers; diuretic including thiazides
Adverse effects of drugs on the male reproductive system: Drug-induced priapism (example trazodone); finasteride, dutasteride; sildenafil, tadalafil, vardenafil; marijuana; nitric oxide reductase inhibitors

System specifications-Endocrine system: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes
Organ structure and function: Hypothalamus, posterior and anterior pituitary gland, thyroid gland, parathyroid gland, adrenal cortex, adrenal medulla, pancreatic islets, ovary and testis, adipose tissue
Cell/ tissue/ structure and function, including hormone synthesis, secretion, action, metabolism: Peptide hormones, steroid hormones, including vitamin D, thyroid hormones, catecholamine hormones, renin-angiotensin system
Repair, regeneration, and changes associated with stage of life

System specifications-Endocrine system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Diabetes mellitus and other disorders of the endocrine pancreas: (a) Diabetes mellitus-diabetes mellitus, type 1; diabetes mellitus, type 1.5; diabetes mellitus, type 2; diabetes mellitus, acute complications: hyperosmolar coma, hypoglycemic shock
Diabetes mellitus and other disorders of the endocrine pancreas: (a) Diabetes mellitus-ketoacidosis, including cerebral edema, associated electrolyte abnormalities; diabetes mellitus, chronic complications: gastrointestinal/ gastroparesis
Diabetes mellitus and other disorders of the endocrine pancreas: (a) Diabetes mellitus-chronic complications: Neurologic/ neuropathy, ophthalmologic/ retinopathy, peripheral vascular, renal/ nephropathy, metabolic syndrome
Diabetes mellitus and other disorders of the endocrine pancreas: (b) Hypoglycemia and islet cell disorders-hypoglycemia (secondary to insulinoma, surreptitious insulin use, sepsis, liver failure); hyperglycemia (secondary to glucagonoma); hyperinsulinism
Diabetes mellitus and other disorders of the endocrine pancreas: (b) Hypoglycemia and islet cell disorders-islet cell tumors/ insulinoma/ somatostatinoma; pancreatic neuroendocrine tumors
Thyroid disorders: Cyst, nodule; euthyroid sick syndrome; goiter (euthyroid-normal thyroid function with goiter); hypothyroidism; hyperthyroidism, including thyrotoxicosis and thyroid storm; thyroiditis, including Hashimoto; Graves disease
Thyroid disorders: Neoplasms (benign cysts and nodules, thyroid cancer including papillary, follicular, medullary, and anaplastic); thyroid deficiency from pituitary disorder; infertility due to thyroid disease
Thyroid disorders: Secondary hypothyroidism and hyperthyroidism
Parathyroid disorders: Hyperparathyroidism; hypoparathyroidism; metabolic bone disease
Adrenal disorders: Corticoadrenal insufficiency (Addison disease); adrenal insufficiency, secondary; hypocortisolism; cushing syndrome; hyperaldosteronism; neoplasms, benign and malignant (adrenal neuroblastoma, pheochromocytoma, adrenal carcinoma
Adrenal disorders: Adrenal adenoma, aldosteronoma, adrenal incidentaloma); delayed and precocious puberty; hypertensive endocrine disease
Pituitary disorders: Acromegaly/ gigantism; diabetes insipidus; galactorrhea not associated with childbirth; panhypopituitarism from any cause; pituitary apoplexy (example sheehan syndrome); growth hormone deficiency; short stature
Pituitary disorders: SIADH (inappropriate secretion of ADH [vasopressin]); neoplasm, benign and malignant (pituitary adenomas, craniopharyngioma, metastatic disease); prolactinoma and hyperprolactinemia, including infertility due to these disorders
Diabetes mellitus and other disorders of the endocrine pancreas: Pituitary disorders-hypogonadism, primary and secondary
Hypothalamic endocrine disorders
Multiple endocrine neoplasia (MEN1, MEN2)
Congenital disorders: Disorders of sexual differentiation; congenital adrenal hyperplasia; androgen insensitivity/ resistance syndrome; congenital hypothyroidism
Adverse effects of drugs on the endocrine system: Drug, medicinal, and biologic substance effects; exogenous steroid suppression of adrenal glands, anabolic steroids

System specifications-Multisystem processes and disorders: Unit 01

Normal processes

Principles of nutrition: Generation, expenditure, and storage of energy at the whole-body level functions of nutrients (example essential, trans-fatty acids, cholesterol)
Electrolyte and water metabolism: Electrolyte metabolism (calcium, potassium, phosphorus), water metabolism
Intracellular accumulations (example pigments, fats, proteins, carbohydrates, minerals, inclusions, vacuoles, lysosomal/ glycogen storage disease and structures related to storage diseases, glycogen phosphorylase deficiency, Zellweger syndrome)

System specifications-Multisystem processes and disorders: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Brucellosis (Brucella spp); leptospirosis (Leptospira interrogans); Lyme disease (Borrelia burgdorferi); melioidosis (Burkholderia pseudomallei)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Miliary (disseminated) tuberculosis (Mycobacterium tuberculosis); tularemia (Francisella tularensis); toxic shock syndrome; Q fever (Coxiella burnetii)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Anaplasmosis and ehrlichiosis (Anaplasma and Ehrlichia species); rickettsiosis (Rocky Mountain spotted fever [Rickettsia rickettsii])
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral: Infectious mononucleosis (Epstein-Barr virus); cytomegalovirus infection; yellow fever; human herpesvirus 8 (HHV-8), fungal: Blastomycosis (Blastomyces dermatitidis)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iii) fungal: Candidiasis (Candida albicans); coccidioidomycosis (Coccidioides immitis/ posadasii); histoplasmosis (Histoplasma capsulatum)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iv) parasitic: Schistosomiasis (Schistosoma); Leishmaniasis (Leishmania spp), visceral (kala azar); trypanosomiasis/ Chagas disease, acute and chronic (Trypanosoma)
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-acute rheumatic fever; autoimmune arteritis/ vasculitis; Behçet syndrome; Churg-Strauss syndrome; eosinophilic granuloma, histiocytosis
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-Langerhans cell histiocytosis; Goodpasture syndrome; Henoch-Schönlein purpura; Kawasaki disease; mixed connective tissue disease; polyangiitis
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-polyarteritis nodosa; polyglandular autoimmune syndrome, type 1; polymyalgia rheumatica, temporal arteritis; Raynaud disease/ Raynaud syndrome
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-reactive arthritis, formerly Reiter disease, including Reiter arthritis; scleroderma (systemic sclerosis); Sjögren syndrome; systemic lupus erythematosus
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-Takayasu arteritis; granulomatosis with polyangiitis (formerly Wegener granulomatosis); familial Mediterranean fever; sarcoidosis, Lofgren syndrome
Neoplasms and related disorders: (a) Paraneoplastic syndromes-endocrine (example SIADH, Cushing syndrome, hypercalcemia of malignancy [parathyroid‐related protein and paraneoplastic syndrome with hypercalcemia])
Neoplasms and related disorders: (a) Paraneoplastic syndromes-hematologic (polycythemia, nonbacterial thrombotic endocarditis); neurologic (myasthenic syndrome, paraneoplastic cerebellar degeneration, limbic encephalitis, pure sensory neuropathy)
Neoplasms and related disorders: (a) Paraneoplastic syndromes-(anti-NMDA receptor encephalitis); mucocutaneous (example acanthosis nigricans); musculoskeletal (example pulmonary osteoarthropathy, polymyositis); other (membranous glomerulonephritis)
Neoplasms and related disorders: (b) Inherited cancer syndromes-DNA repair abnormalities (example Fanconi anemia); Lynch syndrome (gastrointestinal and female reproductive)
Signs, symptoms, and ill-defined disorders: Arthralgias; abdominal pain; chest pain; cough; dizziness, lightheadedness, syncope, including breath-holding spells with syncope; dyspnea, shortness of breath; edema, anasarca; fatigue; fever of unknown origin
Signs, symptoms, and ill-defined disorders: Hemoptysis; pain management (in a non addiction, non palliative-care setting); joint pain; lymphedema; palpitations; pruritus; unexpected weight gain/ weight loss
Nutrition: (a) Protein-calorie malnutrition (kwashiorkor, marasmus), vitamin deficiencies and/ or toxicities: (b) vitamin A; vitamin B; vitamin B1, thiamine (example Wernicke-Korsakoff syndrome, beriberi); vitamin B3, niacin; vitamin B6, pyridoxine
Nutrition: (b) Vitamin deficiencies and/ or toxicities-vitamin B9, folic acid; vitamin B12, cobalamins (pernicious anemia); vitamin C (scurvy); vitamin D (rickets); vitamin E; vitamin K, (c) mineral deficiencies and/ or toxicities
Nutrition: (d) Obesity, enteral/ parenteral nutrition (TPN)
Toxins and environmental extremes: Physical and associated disorders, temperature (example hypothermia, hyperthermia, heat stroke), radiation (example radon, uranium mining, imaging studies), thermal injury, burns, electrocution
Toxins and environmental extremes: Lightning, decreased atmospheric pressure, high-altitude sickness, increased water pressure, (nitrogen narcosis), chemical including Gulf War illness, gases, vapors
Toxins and environmental extremes: Smoke inhalation agricultural hazards (example pesticides, green tobacco poisoning, anhydrous ammonia, agent Orange) volatile organic solvents metals (example lead)
Toxins and environmental extremes: Other chemical agents (example ethylene glycol, carbon tetrachloride, methanol; BPA) principles of poisoning and therapy (example acetylsalicylic acid [ASA], acetaminophen)
Venomous bites and stings: Hymenoptera bites and stings; scorpion bites; snake bites; spider bites; jellyfish stings
Fluid, electrolyte, and acid-base balance disorders: (a) Fluid volume and electrolyte/ ion disorders-fluid volume disorders; dehydration; hypovolemia; volume overload; electrolyte disorders; hyponatremia, hypernatremia; hypokalemia, hyperkalemia
Fluid, electrolyte, and acid-base balance disorders: (a) Fluid volume and electrolyte/ ion disorders-hypocalcemia, hypercalcemia; hypophosphatemia, hyperphosphatemia; hypomagnesemia, (b) acid-base disorders: Metabolic acidosis; metabolic alkalosis
Fluid, electrolyte, and acid-base balance disorders: (b) Acid-base disorders-respiratory acidosis; respiratory alkalosis; mixed acid-base disturbances
Abuse: Child, nonaccidental trauma/ inflicted head trauma/ factitious disorder by proxy intimate partner abuse, sexual, emotional, and physical including injuries (example rib fractures) related to abuse, elder abuse, sexual
Abuse: Emotional, and physical including injuries (example rib fractures) related to abuse, sexual assault
Multiple trauma (example prioritization, blast injury involving more than one organ system)
Shock, cardiogenic, hypovolemic, neurogenic, septic, sepsis, bacteremia, systemic, inflammatory response syndrome (SIRS), refractory, multiorgan dysfunction syndrome: Meningococcemia
Genetic metabolic and developmental disorders: (a) Multifactorial-VATER syndrome, association syndromes, (b) large genomic changes: Beckwith-Wiedemann syndrome; Down syndrome; Prader-Willi syndrome, (c) enzymatic/ metabolic: Alpha-1 antitrypsin deficiency
Genetic metabolic and developmental disorders: (c) Enzymatic/ metabolic-porphyria; inborn errors of metabolism (example maple syrup urine disease, diseases involving urea cycle)
Genetic metabolic and developmental disorders: (c) Enzymatic/ metabolic-storage diseases (example Fabry disease, Tay-Sachs disease, glycogen storage disease, mucopolysaccharidoses), (b) structural protein disorders: Amyloidosis; Ehlers-Danlos syndrome
Genetic metabolic and developmental disorders: (b) Structural protein disorders-immotile cilia syndrome (Kartagener syndrome; primary ciliary dyskinesia); Marfan syndrome, (c) intracellular/ extracellular transport receptors: Cystic fibrosis
Genetic metabolic and developmental disorders: (c) Intracellular/ extracellular transport receptors-hemochromatosis; Wilson disease, (d) triplet repeat/ RNA disorders: Fragile X syndrome
Adverse effects of drugs on multisystem disorders: Drug-induced electrolyte abnormalities and acid base-disorders (example albuterol; prednisone; diuretics; alcohol; drugs inducing polydipsia, SIADH, or diabetes insipidus)

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 01

Epidemiology/ population health

Measures of disease frequency: Incidence/ prevalence
Measures of health status: Rates, crude and adjusted; reproductive rates (example maternal mortality, neonatal/ infant/ under-5 mortality); mortality, morbidity; standardization; life expectancy, health-adjusted life expectancy
Measures of health status: Population attributable risk (PAR), population attributable risk percent (PAR%); risk factors
Survival analysis interpretation (example Kaplan-Meier curve)
Composite health status indicators, measures of population impact: Years of potential life lost; quality-adjusted life years; disability-adjusted life years; standardized mortality ratio
Population pyramids and impact of demographic changes
Disease surveillance and outbreak investigation: Disease reporting; response to public health advisory, health promotion; recognition of clusters
Communicable disease transmission: Attack rate; herd immunity; reportable diseases
Points of intervention: Primary, secondary; community level (example cigarette taxes, soda taxes, smoke-free cities, buildings: Restaurants, public buildings); school policies; access, healthy food, transportation, clean air, safe environments

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 02

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

Descriptive studies (case report [one person]/ case series [more than one])
Analytical studies: Observational-community surveys; cross-sectional (individuals); ecological (populations); case control; retrospective and prospective cohort
Analytical studies: Interventional-clinical trial (randomized controlled trial; double-blind; placebo-controlled; non inferiority/ equivalence trials); community intervention
Systematic reviews and meta-analysis: Potential uses; estimation of effect sizes; heterogeneity; publication bias; forest plots, funnel diagrams; risk of bias, bias risk scale
Obtaining and describing samples: Matching, inclusion/ exclusion criteria, selecting appropriate controls for studies, lack of controls, concealed allocation, randomization, stratification
Methods to handle noncompliance: Loss to follow-up; intention-to-treat analysis
Qualitative analysis

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 03

Measures of association

Relative risk
Odds ratio, hazard ratio
Other measures of association: Number needed to treat/ harm; absolute risk (AR), absolute risk percent (AR%); population attributable risk (PAR), population attributable risk percent (PAR%)
Distributions of data: Measures of central tendency; measures of variability; regression to mean; normal distribution; nominal measurement
Correlation and regression, uses and interpretation: Correlation coefficients; multiple regression

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 04

Principles of testing and screening

Properties of a screening test: Validity, accuracy, reliability; criteria for a screening test; confirmatory testing; appropriateness; lead-time bias, length bias; screening vs. diagnostic tests
Sensitivity and specificity; predictive value, positive and negative
ROC curves
Probability: Theory (independence, product, addition rules); decision trees; likelihood ratios (application of Bayes theorem); posttest, pretest

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 05

Study interpretation, drawing conclusions from data

Causation: Hypothesis-generating vs. hypothesis-driven testing; causal criteria, temporality, temporal sequence, dose-response relationship; reverse causality
Chance: Null hypothesis, type I error and alpha level (multiple comparisons, random error/ chance), sample size and type II error, beta, power, selection and interpretation of basic tests of statistical significance: chi-square; confidence intervals
Chance: P-values; t-test, a priori vs. post hoc analysis: Subgroup analysis; error rate; affect types
Interpretation of graphs/ tables and text
Bias, confounding, and threats to validity (includes methods to address): Selection, sampling bias, information bias: Recall; ascertainment, ecological fallacy, lack of blinding; loss to follow up, confounding variables
Bias, confounding, and threats to validity (includes methods to address): Hawthorne effect (includes methods to address), other threats to validity (example placebo effect)
Internal vs. external validity: Generalizability (external validity); efficacy vs. effectiveness
Statistical vs. clinical significance; clinical and surrogate outcome/ end point

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 06

Clinical decision making, interpretation and use of evidence-based data and recommendations

Application of study results to patient care and practice, including patient preferences and individualization of risk profiles; risk/ benefit analysis; synthesis of concepts with real data

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 07

Research ethics

Informed consent for research
Privacy of patient data (HIPAA)
Roles of institutional review boards (IRBs)
Intervention analysis: Intervention analysis; stopping analysis; safety monitoring
Regulatory issues: Drug development, phases of approval; appropriateness of placebo; appropriateness of randomized clinical trial; components of studies; ethics; scheduling; off-label use
Other issues related to research ethics

System specifications-Social sciences: Unit 01

Communication and interpersonal skills, including health literacy and numeracy, cultural competence

Patient interviewing, consultation, and interactions with the family (patient-centered communication skills): Fostering the relationship (example expressing interest), information gathering (example exploring patient's reaction to illness)
Patient interviewing, consultation, and interactions with the family (patient-centered communication skills): Information provision (example providing information about working diagnosis), making decisions (example eliciting patient's perspectives)
Patient interviewing, consultation, and interactions with the family (patient-centered communication skills): Supporting emotions (example effective discussion with difficult patients), enabling patient behaviors (example education and counseling)
Use of an interpreter or surrogate

System specifications-Social sciences: Unit 02

Medical ethics and jurisprudence, include issues related to death and dying and palliative care

Consent/ informed consent to treatment, permission to treat (full disclosure, risks and benefits, placebos, alternative therapies, conflict of interest, and vulnerable populations)
Determination of medical decision-making capacity/ informed refusal
Involuntary admission
Legal issues related to abuse (child, elder, and intimate partner): Child protective services, foster care, immunizations, legal requirements for reporting abuse or neglect/ obligation to warn
Birth-related issues
Death and dying and palliative care: Life support, advance directive, health care proxy, advance care planning, euthanasia and physician-assisted suicide, brain death/ diagnosing brain death/ diagnosing death, pronouncing death, organ donation, hospice
Death and dying and palliative care: Pain management, including ethical issues related to death and dying, information sharing, counseling families, psychosocial and spiritual counseling, fear and loneliness
Physician-patient relationship (boundaries, confidentiality including HIPAA, privacy, truth telling, other principles of medical ethics, example, autonomy, justice, beneficence)
Impaired physician, including duty to report impaired physician
Negligence/ malpractice, including duty to report negligence and malpractice
Physician misconduct, including duty to report physician misconduct
Referrals
Cultural issues not otherwise coded

System specifications-Social sciences: Unit 03

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

Complexity/ systems thinking: Characteristics of a complex system and factors leading to complexity-how complexity leads to error, health care/ organizational behavior and culture: Environmental factors, workplace design and process; staffing
Complexity/ systems thinking: Health care/ organizational behavior and culture-overcommitment, space, people, time, scheduling; standardization, reducing variance, simplification, metrics; safety culture; integration of care across settings
Complexity/ systems thinking: Health care/ organizational behavior and culture-overutilization of resources (imaging studies, antibiotics, opioids); economic factors

System specifications-Social sciences: Unit 04

Quality improvement

Improvement science principles: Variation and standardization-variation in process, practice; checklists, guidelines, and clinical pathways, reliability
Specific models of quality improvement: Model for improvement-plan-do-study-act (PDSA); plan-do-check-act (PDCA)
Quality measurement: Structure, process, outcome, and balancing measures, measurement tools: Run and control charts; development and application of system and individual quality measures: Core measures; physician quality report system (PQRS)
Quality measurement: Development and application of system and individual quality measures: Core measures; physician quality report system (PQRS); event reporting system
Strategies to improve quality: Role of leadership; principles of change management in quality improvement: Specific strategies
Attributes of high-quality health care: High-value/ cost-conscious care-overutilization of resources including diagnostic testing, medications, equitable care: Access, patient-centered care, timely care

System specifications-Social sciences: Unit 05

Patient safety

Patient safety principles: (a) Epidemiology of medical error, (b) error categorization/ definition: Active vs. latent errors; Swiss cheese model of error; preventable vs. non-preventable; near miss events/ safety hazards
Patient safety principles: (c) Causes of error-(i) patient factors: Understanding of medication use; health literacy; economic status; cultural factors (example religion); failure to make appointments; socioeconomic status
Patient safety principles: (c) Causes of error-(ii) physician factors: Deficiency of knowledge; judgment errors; diagnostic errors; fatigue, sleep deprivation; bias-cognitive, availability, heuristic, anchoring, framing
Patient safety principles: (c) Causes of error-(iii) human factors (example cognitive, physical, environmental), (d) High reliability of organization (HRO) principles-change management and improvement science
Patient safety principles: (d) High reliability of organization (HRO) principles-conceptual models of improvement, (e) reporting and monitoring for errors: Event reporting systems
Patient safety principles: (e) Reporting and monitoring for errors-communication with patients after adverse events (disclosure/ transparency)
Specific types of error: (a) Transitions of care errors (example handoff communication including shift-to-shift, transfer, and discharge): Handoffs and related communication; discontinuities; gaps; discharge; transfers
Specific types of error: (b) Medication errors-ordering, transcribing, dispensing, administration (wrong quantity, wrong route, wrong drug), medication reconciliation, mathematical error, (c) procedural errors: Universal protocol (time out); wrong patient
Specific types of error: (c) Procedural errors-wrong site; wrong procedure; retained foreign bodies, injury to structures: Paracentesis; bowel perforation; thoracentesis; pneumothorax; central venous/ arterial line injuries
Specific types of error: (c) Procedural errors-Injury to structures: Arterial puncture and bleeding and venous thrombosis; lumbar puncture bleeding; paralysis, other errors: Anesthesia-related errors; mathematical errors
Specific types of error: (d) Health care-associated infections-nosocomial infection-example, surgical site, ventilator associated; catheter-related; handwashing procedures or inadequate number of handwashing stations
Specific types of error: (d) Health care-associated infections-central line-associated blood stream infections; surgical site infections; catheter-associated urinary tract infections; ventilator-associated pneumonia
Specific types of error: (e) Documentation errors-electronic medical record (including voice-recognition software errors); record keeping; incorrect documentation (example wrong patient, wrong date, copying and pasting, pre-labeling)
Specific types of error: (f) Patient identification errors-mislabeling-transfusion errors related to mislabeling; verification/ two identifiers: Lack of dual validation, including verbal verification of lab results
Specific types of error: (g) Diagnostic errors-errors in diagnostic studies; misinterpretation; (h) monitoring errors-cardiac monitoring/ telemetry, drug monitoring (warfarin, antibiotics), device-related errors: Malfunction, programming error
Specific types of error: (i) Device-related errors-incorrect use
Strategies to reduce error: (a) Human factors engineering, (b) situational awareness, (c) hierarchy of effective interventions: Forcing function; visual cues, (d) error analysis tools: Error/ near miss analysis; failure modes and effect analysis
Strategies to reduce error: (d) Error analysis tools-morbidity and mortality review; root cause analysis, (e) safety behavior and culture at the individual level: Hierarchy of health care, flattening hierarchy, speak up to power; afraid to report, fear
Strategies to reduce error: (e) Safety behavior and culture at the individual level-psychological safety; closed-loop communication, (f) teamwork: Principles of highly effective teams; case management; physician teams, physician-physician communication
Strategies to reduce error: (f) Teamwork-interprofessional/ interprofessional teams; strategies for communication among teams, including system-provider communication, physician-physician communication (example consultations)
Strategies to reduce error: (f) Teamwork-provider-interprofessional communication, patient communication

System specifications-Social sciences: Unit 06

Health care policy and economics

Health care policy: (a) Health care disparities-race/ ethnicity; numeracy/ literacy; socioeconomic status, (b) access to care: Critical access systems or hospitals, social justice
Health care economics/ health care financing: (a) Types of insurance-medicare, medicaid, private insurance, self-pay, (b) navigating the insurance system: Deductibles/ co-pays; in-/ out-of-network; preferred providers
Health care economics/ health care financing: (c) Reimbursement issues affecting safety and quality: Emergency services-EMTALA; pay-for-performance

Physician tasks/ competencies specifications-Medical knowledge/ scientific concepts: Unit 01

Applying foundational science concepts

Identifies the cause/ infectious agent or predisposing factor(s) or, given an effect, determines the cause
Identifies the underlying processes/ pathways that account for, or contribute to, the expression or resolution of a given condition
Recognizes or evaluates given clinical or physical findings to identify the underlying anatomic structure or physical location
Recognizes the mechanisms of action of various drugs; selects from an option set list of drugs based on mechanism of action

Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 01

Diagnosis: Obtaining and predicting history and physical examination

Knows signs/ symptoms of selected disorders
Knows individual's risk factors for development of conditions
Given current symptoms in presented history, identifies other pertinent factors in the history
Given a specific problem, knows what to ask in obtaining further pertinent additional history
Predicts the most likely additional physical finding; selects either the finding itself or the appropriate examination technique that would result in the finding

Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 02

Diagnosis: Selecting and Interpreting Laboratory and diagnostic studies

Selects most appropriate laboratory or diagnostic study, including neuropsychiatric testing, or study most likely to establish/confirm the diagnosis
Interprets laboratory or other study findings
Predicts the most likely laboratory or diagnostic study result
Selects most appropriate laboratory or diagnostic study after a change in patient status

Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 03

Diagnosis: Formulating the diagnosis

Selects the most likely diagnosis
Assesses the developmental level of the patient

Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 04

Diagnosis: Determining prognosis/ outcome

Recognizes factors in the history, physical or laboratory study findings that affect patient prognosis or outcome or determine therapy
Interprets laboratory or other diagnostic study results and identifies current/ future status of patient
Recognizes associated conditions of a disease, including complications, or indicators of potential complications, of a given disease
Recognizes characteristics of disease relating to natural history or course of disease, including progression, severity, duration, and transmission of disease from a specific patient

Physician tasks/ competencies specifications-Patient care: Management: Unit 01

Management: Health maintenance and disease prevention

Knows risk factors for conditions amenable to prevention or detection in an asymptomatic patient, or knows the potential condition for which the patient may be at risk
Knows pertinent incidence statistics and identifies patient groups at risk; knows incidence of symptoms/ dangerous disorders among various groups
Knows common screening tests for conditions amenable to prevention or detection in an asymptomatic patient or population
Selects appropriate preventive agent or technique (eg, contraception, vaccines, vitamins)
Knows appropriate counseling of patient or family regarding maintenance of current and future problems, including risk factors related to present encounter
Educates patients on screening, health maintenance, self-care
Assesses the developmental level of a healthy patient
Knows the indications for surveillance for recurrence or progression of disease following treatment
Monitoring chronic disease in a stable patient where a change in patient status might cause a change in therapy
Knows appropriate long-term surveillance goals

Physician tasks/ competencies specifications-Patient care: Management: Unit 02

Management: Selecting and monitoring pharmacotherapy

Selects most appropriate pharmacotherapy
Assesses patient adherence with treatment regimen, recognizes techniques to increase adherence or understanding of the disease state, and knows how adherence may be affected by providing instructions with therapy
Recognizes factors that alter drug dosing requirements for a patient
Knows adverse effects of various drugs, or recognizes signs and symptoms of drug (and drug-drug) interactions resulting from polypharmacy in the therapeutic regimenand knows steps to prevent polypharmacy including lab studies to monitor drug therapy
Knows contraindications of various medications
Modifies therapeutic regimen within the context of continuing care; selects appropriate modifications in therapeutic regimen
Knows appropriate monitoring to evaluate effectiveness of drug therapy or to monitor for the adverse effects of drug therapy in a patient that has not had a recurrence or progression of disease

Physician tasks/ competencies specifications-Patient care: Management: Unit 03

Management: Clinical interventions/ treatment

Knows most appropriate management of selected conditions, including recognizing misuse of medication or drug or alcohol use
Knows immediate management or priority in management, specifically in emergency or acute cases
Knows most appropriate follow-up or monitoring approach regarding the management plan
Knows current/ short-term management of patients
Evaluates severity of patient condition in terms of need for referral for surgical treatments/ procedures versus other nonsurgical options
Knows appropriate surgical management
Knows pre/ post surgical or procedural management
Knows indications for admission to the hospital or to other appropriate setting (eg, ICU)
Knows appropriate non-hospital health care settings
Knows most appropriate discharge planning
Knows components of rehabilitation program
Knows appropriate use and procedures regarding hospice care
Educates patient or family regarding self-care
Knows relevant roles of allied health personnel

Physician tasks/ competencies specifications-Patient care: Management: Unit 04

Management: Selecting clinical interventions (mixed management)

Selects most appropriate management option from set of mixed management options (eg, mix of diagnostic studies, pharmacotherapy, procedures, observation, or referral)

Physician tasks/ competencies specifications-Communication: Unit 01

Fostering the relationship

Physician tasks/ competencies specifications-Communication: Unit 02

Gathering information

Physician tasks/ competencies specifications-Communication: Unit 03

Providing information

Physician tasks/ competencies specifications-Communication: Unit 04

Making decisions

Physician tasks/ competencies specifications-Communication: Unit 05

Supporting emotions

Physician tasks/ competencies specifications-Communication: Unit 06

Enabling patient behaviors

Physician tasks/ competencies specifications-Communication: Unit 07

Using an interpreteror surrogate

Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues: Unit 01

Understanding and applying principles of professionalism, legal and ethical issues in interactions with patients

Knows the guidelines for obtaining informed consent for treatment including children and adolescents, third-party permission, and emergent situations
Recognizes need for third-party permission for treatment in medical emergencies
Knows guidelines for treatment of minors with/ without notification of parents
Knows definitions of competence and sanity
Knows the guidelines for involuntary admission
Knows guidelines for confidentiality of medical records
Knows guidelines for physician-patient relationship
Knows issues related to cultural competence and can apply knowledge in specific patient situations

Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues: Unit 02

Understanding and applying legal and ethical issues related to death and dying

Assesses degree of disclosure to terminally ill patients
Recognizes patient's right to refuse treatment or testing (patient autonomy); knows issues of advance directives and living wills
Assesses quality-of-life decisions
Knows appropriate prescriptive practices; knows appropriate use of opioids in terminally ill patients
Knows definition of and legal issues regarding brain death
Knows management of terminally ill patients related to treating chronic pain, and recognizing patient's expression of fear of pain, injury, or death; knows how to comfort patient or family during crisis such as trauma or death

Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues: Unit 03

Understanding and applying professionalism, legal, and ethical issues in dealing with physicians and other health professionals

Knows guidelines for reporting findings to proper authorities
Knows good Samaritan laws
Recognizes physician error and negligence
Recognizes and deals appropriately with impaired physician

Physician tasks/ competencies specifications-Systems based practice, including patient safety: Unit 01

Systems based practice

Understands basic concepts and terminology, principles, and application of quality improvement science and outcome analysis
Recognizes and optimizes human and environmental factors (eg, workplace design, standardization, processes)
Understands the role and characteristics of teams and communication strategies

Physician tasks/ competencies specifications-Systems based practice, including patient safety: Unit 02

Patient safety

Anticipates, recognizes, analyzes, and mitigates risk (sources of error)
Evaluates, reports, and responds to near-misses and system errors
Identifies sources of error and suggests appropriate measures to evaluate or reduce the likelihood of specific errors

Physician tasks/ competencies specifications-Practice-based learning: Unit 01

Understanding and application of the principles of biostatistics and epidemiology

Understands and can apply principles of epidemiology and population health, including health status indicators, outbreak investigation, points of intervention
Understands and can apply principles of study design and study flaws
Understands and can apply the principles of screening and other tests
Understands use and interpretation of statistical principles and measures of association

Physician tasks/ competencies specifications-Practice-based learning: Unit 02

Application of information from studies or other written material to patient care

Decisions about patient care based on results of study or other written materials

Physician tasks/ competencies specifications-Practice-based learning: Unit 03

Understanding of the principles of research ethics and regulatory issues

USMLE Step 3 Syllabus

System specifications-General principles of foundational science: Unit 01

Biochemistry and molecular biology

Gene expression: DNA structure, replication, exchange, and epigenetics (example imprinting, X-activation, DNA methylation), gene expression: Transcription, gene expression: Translation, post-translational processing
Gene expression: Modifications and disposition of proteins (degradation), including protein/ glycoprotein synthesis, intra-extracellular sorting, and processes/ functions related to golgi complex and rough endoplasmic reticulum
Structure and function of proteins and enzymes (example enzyme kinetics and structural/ regulatory proteins), energy metabolism (example ATP generation, transport chain)

System specifications-General principles of foundational science: Unit 02

Biology of cells

Adaptive cell responses and cellular homeostasis (example, hypertrophy), mechanisms of injury and necrosis, including pathologic processes (example liquefactive necrosis, free radical formation), apoptosis
Cell cycle and cell cycle regulation (example mitosis), mechanisms of dysregulation, cell biology of cancer (example role of p53, proto-oncogenes), general principles of invasion and metastasis, including cancer staging
Cell/ tissue structure, regulation, and function, including cytoskeleton, organelles, glycolipids, channels, gap junctions, extracellular matrix, and receptors

System specifications-General principles of foundational science: Unit 03

Human development and genetics

Principles of pedigree analysis, inheritance patterns, occurrence and recurrence risk determination, population genetics: Hardy-Weinberg law, founder effects, mutation-selection equilibrium, principles of gene therapy, genetic testing and counseling
Genetic mechanisms (example penetrance, genetic heterogeneity)

System specifications-General principles of foundational science: Unit 04

Biology of tissue response to disease

Acute inflammatory responses (patterns of response), acute inflammation and mediator systems (example histamine, prostaglandins, bradykinins, eosinophilic basic protein, nitric oxide), vascular response to injury, including mediators
Principles of cell adherence and migration (example ECAMs, selectins, leukocytic diapedesis, and rolling), microbicidal mechanisms and tissue injury (example defensins)
Clinical manifestations (example, pain, fever, leukocytosis, leukemoid reaction, chills), chronic inflammatory responses (example tumor necrosis factor)
Reparative processes, wound healing, repair: Thrombosis, granulation tissue, angiogenesis, fibrosis, scar/ keloid formation, regenerative process

System specifications-General principles of foundational science: Unit 05

Pharmacodynamic and pharmacokinetic processes: General principles

Pharmacokinetics: Absorption, distribution, metabolism, excretion, dosage intervals, mechanisms of drug action, structure-activity relationships (example, anticancer drugs), concentration and dose-effect relationships (example efficacy, potency)
Types of agonists (example full, partial, inverse) and antagonists and their actions
Individual factors altering pharmacokinetics and pharmacodynamics (example age, gender, disease, tolerance, compliance, body weight, metabolic proficiency, pharmacogenetics)
Mechanisms of drug adverse effects, overdosage, toxicology, mechanisms of drug interactions
Signal transduction, including structure/ function of all components of signal transduction, pathways such as receptors, ligands (example general principles of nitric oxide, autocrine and paracrine signaling)

System specifications-General principles of foundational science: Unit 06

Microbial biology

Microbial identification and classification, including principles, microorganism identification, and non-immunologic laboratory diagnosis
Bacteria: Structure (example cell walls, composition, appendages, virulence factors, extracellular products, toxins, mechanism of action of toxins), processes, replication, and genetics (example metabolism, growth, and regulation), oncogenesis
Bacteria: Antibacterial agents (example mechanisms of action on organism, toxicity to humans, and mechanisms of resistance)
Viruses: Structure (example physical and chemical properties, virulence factors), processes, replication, and genetics (example life cycles, location of virus in latent infection), oncogenesis
Viruses: Antiviral agents (example mechanisms of action on virus, toxicity to humans, and mechanisms of resistance)
Fungi: Structure (example cell wall, composition, appendages, virulence factors, extracellular products, toxins, mechanisms of action of toxins), processes, replication, and genetics (example asexual vs. sexual, metabolism, growth)
Fungi: Antifungal agents (example mechanisms of action on fungus, toxicity to humans, and mechanisms of resistance)
Parasites: Structure (example appendages, macroscopic features, and virulence factors), processes, replication, and genetics (example life cycles, metabolism, and growth), oncogenesis
Antiparasitic agents (example mechanisms of action on parasite, toxicity to humans, and mechanisms of resistance)
Prions

System specifications-General principles of foundational science: Unit 07

Infancy and childhood (0-12 years): (a) Normal physical changes-linear growth, variations in linear growth, including constitutional delay; weight; head circumference; micturition, defecation, primary incontinence/ bedwetting; normal physical examination
Infancy and childhood (0-12 years): (a) Normal physical changes-screening; sleep; teething syndrome, (b) developmental stages: Motor; speech; cognitive; psychosocial; anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition
Infancy and childhood (0-12 years): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine; risk factors and prevention (example guns, swimming, motor vehicles, car seats)
Infancy and childhood (0-12 years): (c) Lifestyle and routine preventive health care-routine vaccinations
Adolescence (13-17 years): (a) Normal physical changes-linear growth, variations in linear growth including constitutional delay; weight; puberty; normal physical examination; gynecomastia; autonomy/ self-identity; sleep
Adolescence (13-17 years): (b) Developmental stages-cognitive (example abstract thought); psychosocial (example autonomy, role confusion, sexual identity); anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition
Adolescence (13-17 years): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine
Adolescence (13-17 years): (c) Lifestyle and routine preventive health care-risk factors and prevention (example risk-taking behavior, helmets, safe sex, motor vehicles, seat belts, distractions); routine vaccinations
Adulthood (18-64 years): (a) Normal physical changes-weight; normal physical examination; screening; sleep, (b) developmental stages: Cognitive; intimacy vs. isolation; anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition
Adulthood (18-64 years): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine; risk factors and prevention; routine vaccinations
Older adulthood (65 years and older): (a) Normal physical changes, including normal physical exam for age-weight, height (spinal compression), skin, bruising; normal physical examination; response to temperature; micturition, defecation; sleep
Older adulthood (65 years and older): (b) Developmental stages-motor; cognitive (example psychomotor slowing); psychosocial; integrity vs. despair; retrospection; anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition
Older adulthood (65 years and older): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine
Older adulthood (65 years and older): (c) Lifestyle and routine preventive health care-risk factors and prevention (example falls, general medical condition; polypharmacy, driving, caregiver stress); routine vaccinations

System specifications-Immune system: Unit 01

Normal processes

Development of cells of the adaptive immune response, including positive and negative selection during immune development
Structure, production, and function: Granulocytes, natural killer cells, macrophages, mast cells, dendritic cells, cell receptors (example complement receptors and Toll-like receptors), cytokines, chemokines, T lymphocytes
Structure, production, and function: Including T-lymphocyte receptors, accessory molecules (example CD3, CD4, CD8, B7), cell activation and proliferation, cytotoxic T lymphocytes, and memory T lymphocytes, B lymphocytes and plasma cells
Structure, production, and function: Including B-lymphocyte receptors, immunoglobulins, cell activation and proliferation, including development of antibodies and memory B lymphocytes, host defense mechanisms, host barriers to infection
Structure, production, and function: Mucosal immunity (example gut-associated lymphoid tissue and bronchus-associated lymphoid tissue), anatomical locations of T and B lymphocytes
Cellular basis of the immune response and immunologic mediators: Antigen processing and presentation in the context of MHC I and MHC II molecules (example TAP, beta-2 microglobulin), intracellular pathways
Cellular basis of the immune response and immunologic mediators: Mechanisms by which MHC is expressed on the surface; including distribution of MHC I and MHC II on different cells
Cellular basis of the immune response and immunologic mediators: Mechanisms of MHC I and MHC II deficiencies, and the genetics of MHC regulation of the adaptive immune response (example peripheral tolerance, anergy, regulatory T lymphocytes
Cellular basis of the immune response and immunologic mediators: Termination of immune response, and B-T lymphocyte interactions) activation
Cellular basis of the immune response and immunologic mediators: Function, and molecular biology of complement (example anaphylatoxins) functional and molecular biology of cytokines (example IL 1-15)
Basis of immunologic diagnostics (example antigen-antibody reactions used for diagnostic purposes, ELISA, immunoblotting, antigen-antibody changes over time, ABO typing)
Principles of immunologic protection: Vaccine production and mechanisms of vaccine action biologically active antibodies (example monoclonal antibodies, polyclonal antibodies including IVIG, VZIG, rabies immunoglobulin)
Effect of age on the function of components of the immune system

System specifications-Immune system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Disorders associated with immunodeficiency: (a) Deficiency primarily of humoral immunity-common variable immunodeficiency; hyper IgM syndrome; hypogammaglobulinemia/ agammaglobulinemia, X-linked (Bruton); selective immunodeficiency (example IgA, IgM, IgE)
Disorders associated with immunodeficiency: (b) Deficiency/ dysfunction primarily of cell-mediated immunity-adenosine deaminase deficiency; thymic aplasia (DiGeorge syndrome); severe combined immunodeficiency disease (SCID); Wiskott-Aldrich syndrome
Disorders associated with immunodeficiency: (b) Deficiency/ dysfunction primarily of cell-granulomatosis; allergic reactions/ skin, (c) complement deficiency: Alternative pathway component deficiency (C2, C3b, C3bB, C36B6)
Disorders associated with immunodeficiency: (c) Complement deficiency-classical pathway component deficiency (C1q, C1r, C1-C5); terminal component deficiency (C5b-C9; terminal complement complex); C1 esterase inhibitor deficiency, hereditary angioedema
Disorders associated with immunodeficiency: (c) Complement deficiency-mannose-binding lectin (MBL) deficiency; membrane attack complex deficiency, (d) deficiency of phagocytic cells and natural killer cells: Chediak-Higashi disease
Disorders associated with immunodeficiency: (d) Deficiency of phagocytic cells and natural killer cells-chronic granulomatous disease and other disorders of phagocytosis; leukocyte adhesion deficiency
HIV/ AIDS: HIV1 and HIV2; AIDS; AIDS complications (example neuropathy, dementia, renal insufficiency); immunology of AIDS; immune reconstitution syndrome (IRS); secondary infections; noninfectious complications
Immunologically mediated disorders: (a) Hypersensitivity reactions-type 1, 2, 3, including anaphylaxis; type 4; drug reactions; serum sickness, (b) transplantation: rejection; graft-vs.-host disease
Adverse effects of drugs on the immune system: Jarisch-Herxheimer reaction; drugs affecting the immune system (example prednisone, azathioprine, cyclosporine, methotrexate
Adverse effects of drugs on the immune system: Monoclonal antibody drugs [example abciximab, adalimumab; bevacizumab, infliximab, omalizumab, rituximab]); vaccine adverse effects

System specifications-Blood and lymphoreticular system: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes, organ structure and function
Cell/ tissue structure and function: Production and function of erythrocytes, including heme and hemoglobin synthesis; hemoglobin O and CO transport, transport proteins, erythropoietin production and function of platelets
Cell/ tissue structure and function: Production and function of coagulation and fibrinolytic factors; hemostasis
Repair, regeneration, and changes associated with stage of life

System specifications-Blood and lymphoreticular system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious and immunologic infectious disorders: (a) bacteria, (b) viral-hemorrhagic fever (Ebola virus, Marburg virus); chikungunya; dengue fever; Zika virus disease, (c) parasitic: malaria (Plasmodium spp); babesiosis (Babesia species)
Infectious and immunologic infectious disorders: (d) Primary infections of lymphoid tissue-lymphadenitis (viral, bacterial, fungal, parasitic); lymphangitis; buboes, bubonic plague (Yersinia pestis); cat scratch disease (Bartonella henselae)
Infectious and immunologic infectious disorders (e) Immunologic and inflammatory disorders-cryoglobulinemia, essential mixed cryoglobulinemia; autoimmune hemolytic anemia; paroxysmal nocturnal hemoglobinuria; thrombotic thrombocytopenic purpura
Infectious and immunologic infectious disorders: (e) Immunologic and inflammatory disorders-hemolytic uremic syndrome
Neoplasms: Leukemia, acute (ALL, AML); leukemia, chronic (CLL, CML); lymphomas, Hodgkin disease, non-Hodgkin lymphoma, Burkitt lymphoma, T-cell lymphoma; multiple myeloma, dysproteinemias, monoclonal gammopathy of unknown significance (MGUS)
Neoplasms: Myelofibrosis; myelodysplastic syndrome, myelodysplasias; other immunoproliferative neoplasms (example Waldenstrom macroglobulinemia)
Anemia, cytopenias, and polycythemia anemias: (a) Decreased production-anemia of chronic disease, (b) hemolysis: Glucose-6-phosphate dehydrogenase deficiency; pyruvate kinase deficiency
Anemia, cytopenias, and polycythemia anemias: (c) Disorders of hemoglobin, heme, or membrane-disorders of red cell membranes; hereditary spherocytosis, elliptocytosis; methemoglobinemia, congenital; sickle cell disease; sideroblastic anemia; thalassemias
Anemia, cytopenias, and polycythemia anemias: (d) Other causes of anemia-blood loss, acute and chronic as a cause of anemia, (e) cytopenias: Aplastic anemia; leukopenia; neutropenia, cyclic neutropenia, agranulocytosis; pancytopenia; thrombocytopenia
Anemia, cytopenias, and polycythemia anemias: (e) Cytopenias-quantitative; immune thrombocytopenic purpura (ITP), (f) cythemias: Leukocytosis; polycythemia vera; secondary polycythemia
Coagulation disorders (hypercoagulable and hypercoagulable conditions): (a) Hypercoagulable-disseminated intravascular coagulation; hemophilia, congenital factor VIII [hemophilia A] and IX [hemophilia B]; hypofibrinogenemia; von Willebrand disease
Coagulation disorders (hypercoagulable and hypercoagulable conditions): (b) Hypercoagulable-platelet dysfunction, qualitative, hypercoagulable: Heparin-induced thrombocytopenia; other coagulopathies (example homocysteinemia, hypoplasminogenemia)
Coagulation disorders (hypercoagulable and hypercoagulable conditions): (b) Hypercoagulable-other coagulopathies (example antithrombin III, protein C/ protein S deficiency, factor V Leiden, anticardiolipin antibodies, lupus anticoagulant)
Coagulation disorders (hypercoagulable and hypercoagulable conditions): (b) Hypercoagulable-prothrombin G20210A mutation), (c) reactions to blood components: ABO incompatibility/ anaphylaxis; Rh incompatibility/anaphylaxis; hemolysis, delayed
Coagulation disorders (hypercoagulable and hypercoagulable conditions): (c) Reactions to blood components-transfusion reaction; transfusion contaminated with bacteria; transfusion-related acute lung injury (TRALI); anaphylactoid reaction (IgA deficiency)
Traumatic, mechanical, and vascular disorders: Mechanical injury to erythrocytes (example cardiac valve hemolysis); disorders of the spleen; splenic rupture/ laceration; splenic infarct; splenic abscess
Traumatic, mechanical, and vascular disorders: Effects/ complications of splenectomy (example sepsis due to encapsulated bacteria); hypersplenism
Adverse effects of drugs on the hematologic and lymphoreticular systems: Antiplatelet drugs, antithrombin drugs (example dabigatran); chemotherapeutic agents; inhibitors of coagulation factors; methemoglobinemia, acquired; propylthiouracil
Adverse effects of drugs on the hematologic and lymphoreticular systems: Tumor lysis syndrome; warfarin

System specifications-Multisystem processes and disorders: Unit 01

Normal processes

Principles of nutrition: Generation, expenditure, and storage of energy at the whole-body level functions of nutrients (example essential, trans-fatty acids, cholesterol)
Electrolyte and water metabolism: Electrolyte metabolism (calcium, potassium, phosphorus), water metabolism
Intracellular accumulations (example pigments, fats, proteins, carbohydrates, minerals, inclusions, vacuoles, lysosomal/ glycogen storage disease and structures related to storage diseases, glycogen phosphorylase deficiency, Zellweger syndrome)

System specifications-Multisystem processes and disorders: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Brucellosis (Brucella spp); leptospirosis (Leptospira interrogans); Lyme disease (Borrelia burgdorferi); melioidosis (Burkholderia pseudomallei)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Miliary (disseminated) tuberculosis (Mycobacterium tuberculosis); tularemia (Francisella tularensis); toxic shock syndrome; Q fever (Coxiella burnetii)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Anaplasmosis and ehrlichiosis (Anaplasma and Ehrlichia species); rickettsiosis (Rocky Mountain spotted fever [Rickettsia rickettsii])
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral: Infectious mononucleosis (Epstein-Barr virus); cytomegalovirus infection; yellow fever; human herpesvirus 8 (HHV-8), fungal: Blastomycosis (Blastomyces dermatitidis)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iii) fungal: Candidiasis (Candida albicans); coccidioidomycosis (Coccidioides immitis/ posadasii); histoplasmosis (Histoplasma capsulatum)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iv) parasitic: Schistosomiasis (Schistosoma); Leishmaniasis (Leishmania spp), visceral (kala azar); trypanosomiasis/ Chagas disease, acute and chronic (Trypanosoma)
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-acute rheumatic fever; autoimmune arteritis/ vasculitis; Behçet syndrome; Churg-Strauss syndrome; eosinophilic granuloma, histiocytosis
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-Langerhans cell histiocytosis; Goodpasture syndrome; Henoch-Schönlein purpura; Kawasaki disease; mixed connective tissue disease; polyangiitis
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-polyarteritis nodosa; polyglandular autoimmune syndrome, type 1; polymyalgia rheumatica, temporal arteritis; Raynaud disease/ Raynaud syndrome
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-reactive arthritis, formerly Reiter disease, including Reiter arthritis; scleroderma (systemic sclerosis); Sjögren syndrome; systemic lupus erythematosus
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-Takayasu arteritis; granulomatosis with polyangiitis (formerly Wegener granulomatosis); familial Mediterranean fever; sarcoidosis, Lofgren syndrome
Neoplasms and related disorders: (a) Paraneoplastic syndromes-endocrine (example SIADH, Cushing syndrome, hypercalcemia of malignancy [parathyroid‐related protein and paraneoplastic syndrome with hypercalcemia])
Neoplasms and related disorders: (a) Paraneoplastic syndromes-hematologic (polycythemia, nonbacterial thrombotic endocarditis); neurologic (myasthenic syndrome, paraneoplastic cerebellar degeneration, limbic encephalitis, pure sensory neuropathy)
Neoplasms and related disorders: (a) Paraneoplastic syndromes-(anti-NMDA receptor encephalitis); mucocutaneous (example acanthosis nigricans); musculoskeletal (example pulmonary osteoarthropathy, polymyositis); other (membranous glomerulonephritis)
Neoplasms and related disorders: (b) Inherited cancer syndromes-DNA repair abnormalities (example Fanconi anemia); Lynch syndrome (gastrointestinal and female reproductive)
Signs, symptoms, and ill-defined disorders: Arthralgias; abdominal pain; chest pain; cough; dizziness, lightheadedness, syncope, including breath-holding spells with syncope; dyspnea, shortness of breath; edema, anasarca; fatigue; fever of unknown origin
Signs, symptoms, and ill-defined disorders: Hemoptysis; pain management (in a non addiction, non palliative-care setting); joint pain; lymphedema; palpitations; pruritus; unexpected weight gain/ weight loss
Nutrition: (a) Protein-calorie malnutrition (kwashiorkor, marasmus), vitamin deficiencies and/ or toxicities: (b) vitamin A; vitamin B; vitamin B1, thiamine (example Wernicke-Korsakoff syndrome, beriberi); vitamin B3, niacin; vitamin B6, pyridoxine
Nutrition: (b) Vitamin deficiencies and/ or toxicities-vitamin B9, folic acid; vitamin B12, cobalamins (pernicious anemia); vitamin C (scurvy); vitamin D (rickets); vitamin E; vitamin K, (c) mineral deficiencies and/ or toxicities
Nutrition: (d) Obesity, enteral/ parenteral nutrition (TPN)
Toxins and environmental extremes: Physical and associated disorders, temperature (example hypothermia, hyperthermia, heat stroke), radiation (example radon, uranium mining, imaging studies), thermal injury, burns, electrocution
Toxins and environmental extremes: Lightning, decreased atmospheric pressure, high-altitude sickness, increased water pressure, (nitrogen narcosis), chemical including Gulf War illness, gases, vapors
Toxins and environmental extremes: Smoke inhalation agricultural hazards (example pesticides, green tobacco poisoning, anhydrous ammonia, agent Orange) volatile organic solvents metals (example lead)
Toxins and environmental extremes: Other chemical agents (example ethylene glycol, carbon tetrachloride, methanol; BPA) principles of poisoning and therapy (example acetylsalicylic acid [ASA], acetaminophen)
Venomous bites and stings: Hymenoptera bites and stings; scorpion bites; snake bites; spider bites; jellyfish stings
Fluid, electrolyte, and acid-base balance disorders: (a) Fluid volume and electrolyte/ ion disorders-fluid volume disorders; dehydration; hypovolemia; volume overload; electrolyte disorders; hyponatremia, hypernatremia; hypokalemia, hyperkalemia
Fluid, electrolyte, and acid-base balance disorders: (a) Fluid volume and electrolyte/ ion disorders-hypocalcemia, hypercalcemia; hypophosphatemia, hyperphosphatemia; hypomagnesemia, (b) acid-base disorders: Metabolic acidosis; metabolic alkalosis
Fluid, electrolyte, and acid-base balance disorders: (b) Acid-base disorders-respiratory acidosis; respiratory alkalosis; mixed acid-base disturbances
Abuse: Child, nonaccidental trauma/ inflicted head trauma/ factitious disorder by proxy intimate partner abuse, sexual, emotional, and physical including injuries (example rib fractures) related to abuse, elder abuse, sexual
Abuse: Emotional, and physical including injuries (example rib fractures) related to abuse, sexual assault
Multiple trauma (example prioritization, blast injury involving more than one organ system)
Shock, cardiogenic, hypovolemic, neurogenic, septic, sepsis, bacteremia, systemic, inflammatory response syndrome (SIRS), refractory, multiorgan dysfunction syndrome: Meningococcemia
Genetic metabolic and developmental disorders: (a) Multifactorial-VATER syndrome, association syndromes, (b) large genomic changes: Beckwith-Wiedemann syndrome; Down syndrome; Prader-Willi syndrome, (c) enzymatic/ metabolic: Alpha-1 antitrypsin deficiency
Genetic metabolic and developmental disorders: (c) Enzymatic/ metabolic-porphyria; inborn errors of metabolism (example maple syrup urine disease, diseases involving urea cycle)
Genetic metabolic and developmental disorders: (c) Enzymatic/ metabolic-storage diseases (example Fabry disease, Tay-Sachs disease, glycogen storage disease, mucopolysaccharidoses), (b) structural protein disorders: Amyloidosis; Ehlers-Danlos syndrome
Genetic metabolic and developmental disorders: (b) Structural protein disorders-immotile cilia syndrome (Kartagener syndrome; primary ciliary dyskinesia); Marfan syndrome, (c) intracellular/ extracellular transport receptors: Cystic fibrosis
Genetic metabolic and developmental disorders: (c) Intracellular/ extracellular transport receptors-hemochromatosis; Wilson disease, (d) triplet repeat/ RNA disorders: Fragile X syndrome
Adverse effects of drugs on multisystem disorders: Drug-induced electrolyte abnormalities and acid base-disorders (example albuterol; prednisone; diuretics; alcohol; drugs inducing polydipsia, SIADH, or diabetes insipidus)

System specifications-Behavioral health: Unit 01

Normal processes

Psychodynamic and behavioral factors, related past experience (example transference, personality traits)
Adaptive behavioral responses to stress and illness (example coping mechanisms)
Maladaptive behavioral responses to stress and illness (example drug-seeking behavior, sleep deprivation)
Patient adherence: General adherence; adolescent adherence

System specifications-Behavioral health: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Psychotic disorders: Brief psychotic disorder; delusional disorder; psychotic disorder due to another medical condition; schizophrenia; schizoaffective disorder; substance-induced psychotic disorder
Anxiety disorders: Acute stress disorder; anxiety disorders (generalized anxiety disorder, anxiety due to another medical condition, social phobia); hyperventilation syndrome; obsessive-compulsive disorder; panic disorder with and without agoraphobia
Anxiety disorders: Phobic disorders; post-traumatic stress disorder; separation anxiety disorder; substance-induced anxiety disorder, trichotillomania
Mood disorders: Major depressive disorder with and without psychotic features, with and without seasonal pattern; major depressive disorder, postpartum, with and without psychotic features, including screening; cyclothymic disorder
Mood disorders: Persistent depressive disorder (dysthymia); bipolar disorder, manic/ depressed/ mixed; premenstrual dysphoric disorder; bipolar and related disorder or depressive disorder due to another medical condition
Mood disorders: Substance/ medication-induced bipolar and related disorder or depressive disorder (illegal or prescribed); suicidal ideation/ attempt
Somatoform disorders: Body dysmorphic disorder; conversion disorder, including psychogenic seizures; dissociative disorders; illness anxiety disorder (hypochondriasis); malingering; pain disorder; somatic symptom disorder
Factitious disorders: Factitious disorder imposed on self
Eating disorders and impulse control disorders: Anorexia nervosa; binge-eating disorder; bulimia nervosa; eating disorder; disruptive, impulse-control, and conduct disorders (example gambling, kleptomania, pyromania)
Disorders originating in infancy/ childhood: Reactive attachment disorder; attention deficit/ hyperactivity disorder; speech sound disorder or language disorder; learning disorder/ dyslexia; intellectual developmental disorder and developmental delay
Disorders originating in infancy/ childhood: Undefined, including school problems, fetal alcohol syndrome; oppositional defiant disorder, conduct disorder; autism spectrum disorder, rett syndrome; psychoses with origin specific to childhood
Disorders originating in infancy/ childhood: Elimination disorders (incontinence, encopresis); tic disorders/ tourette disorder
Personality disorders: Antisocial personality disorder; avoidant personality disorder; borderline personality disorder; dependent personality disorder; histrionic personality disorder; narcissistic personality disorder
Personality disorders: Obsessive-compulsive personality disorder; paranoid personality disorder; schizoid personality disorder
Psychosocial disorders/ behaviors: Adjustment disorder; grief response/ bereavement, normal and persistent complex; parent-child relational problems other than physical or emotional abuse; other psychosocial stress
Sexual and gender identity disorders: Gender dysphoria; psychosexual dysfunction
Substance use disorders: Alcohol use disorder/ intoxication/ dependence/ withdrawal; tobacco/ nicotine use disorder/ dependence/ withdrawal; varenicline use; cannabis use disorder/ intoxication/ dependence
Substance use disorders: Hallucinogen use disorder/ intoxication/ dependence/ withdrawal; inhalant use disorder/ intoxication/ dependence/ withdrawal; opioid, heroin, including prescription drug, use disorder/ intoxication/ dependence/ withdrawal
Substance use disorders: Sedative, hypnotic, including benzodiazepine and barbiturate use disorder/ intoxication/ dependence/ withdrawal; stimulant, cocaine, methamphetamine use disorder/ intoxication/ dependence/ withdrawal
Substance use disorders: Other drugs of use disorders (example ecstasy, PCP, bath salts)/ intoxication/ dependence/ withdrawal; polysubstance use disorder/ intoxication/ dependence/ withdrawal

System specifications-Nervous system and special senses: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes, including neural tube derivatives, cerebral ventricles, and neural crest derivatives
Organ structure and function: (a) Spinal cord-gross anatomy and blood supply, spinal reflexes, brain stem (example cranial nerves and nuclei, reticular formation, anatomy and blood supply, control of eye movements)
Organ structure and function: (b) Brain-gross anatomy and blood supply, higher function: Cognition, language, memory, executive function, hypothalamic function, limbic system and emotional behavior, circadian rhythm sleep-wake disorder
Organ structure and function: (c) Sensory systems-general sensory modalities, including sharp, dull, temperature, vibratory, and proprioception, special sensory modalities, including vision, hearing, taste, olfaction, and balance
Organ structure and function: (d) Motor systems-brain and spinal cord (upper motor neuron), basal ganglia and cerebellum, autonomic nervous system, peripheral nerves
Cell/ tissue structure and function, including neuronal cellular and molecular biology: Axonal transport, excitable properties of neurons, axons, and dendrites, including channels synthesis, storage, release
Cell/ tissue structure and function, including neuronal cellular and molecular biology: Reuptake, and degradation of neurotransmitters and neuromodulators, presynaptic and postsynaptic receptor interactions, trophic and growth factors, brain metabolism
Cell/ tissue structure and function, including neuronal cellular and molecular biology: Glia, myelin, brain homeostasis: Blood-brain barrier, cerebrospinal fluid formation and flow, choroid plexus
Repair, regeneration, and changes associated with stage of life

System specifications-Nervous system and special senses: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) meningitis: Bacterial (actinomyces israelii; haemophilus influenzae; listeria monocytogenes; mycobacterium tuberculosis; neisseria meningitidis; staphylococcus aureus)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) meningitis: Bacterial (epidermidis; streptococcus agalactiae; streptococcus pneumoniae); viral (adenovirus, arboviruses, echovirus and coxsackie A and B viruses)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral (echovirus and coxsackie A and B viruses, polioviruses, herpes simplex virus, varicella zoster human immunodeficiency virus, lymphocytic choriomeningitis virus)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral (lymphocytic choriomeningitis virus, measles virus, mumps virus, St. Louis encephalitis virus, California encephalitis virus, Western equine encephalitis virus)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iii) fungal (blastomycosis dermatitidis, cryptococcus neoformans/ gattii); spirochetal (borrelia burgdorferi; leptospira; treponema pallidum, including neurosyphilis)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iv) protozoal/ helminths (acanthamoeba, naegleria fowleri, strongyloides stercoralis, angiostrongylus cantonensis, baylisascaris procyonis)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(v) encephalitis (herpesvirus [HSVI], varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, mumps virus, enterovirus, West Nile virus, St. Louis encephalitis virus)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(v) encephalitis (rabies virus, eastern and western equine encephalitis virus, poliovirus, Taenia, Toxoplasma gondii), (vi) prion disease (example Creutzfeldt-Jakob disease)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(vi) botulism (Clostridium botulinum), (vii) tetanus (Clostridium tetani); (viii) CNS disorders associated with AIDS (example progressive multifocal leukoencephalopathy)
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-myasthenia gravis, including thymoma; multiple sclerosis; transverse myelitis
Neoplasms (cerebral, spinal, and peripheral): Benign (meningioma, neurofibromatosis); malignant (glioblastoma multiforme, astrocytoma, medulloblastoma, primary CNS lymphoma); metastatic (example breast, lung, pancreatic, testicular, melanoma)
Cerebrovascular disease: Arteriovenous malformations, ectatic cerebral vessels; transient ischemic attack; stroke, thrombotic: Cerebral artery occlusion/ cerebral infarction; stroke, embolic: Cerebral embolism
Cerebrovascular disease: Stroke-intracerebral hemorrhage including subarachnoid hemorrhage, traumatic intracranial hemorrhage; cerebral artery aneurysm; carotid artery stenosis/ atherosclerosis/ occlusion/ dissection
Cerebrovascular disease: Vertebral artery deficiency/ dissection; subclavian steal syndrome; vascular dementia; hypertensive encephalopathy; posterior reversible encephalopathy syndrome; venous sinus thrombosis
Disorders relating to the spine, spinal cord, and spinal nerve roots: Cauda equina syndrome; spinal artery thrombosis/ embolus/ infarct; spinal cord compression; spinal cord transection, paraplegia and quadriplegia
Disorders relating to the spine, spinal cord, and spinal nerve roots: Acute and chronic effects (example autonomic dysreflexia); spinal stenosis (cervical, lumbar); syringomyelia
Cranial and peripheral nerve disorders: (a) Cranial nerve injury/ disorders-cranial nerve injury; bell palsy; anisocoria, miosis, mydriasis; internuclear ophthalmoplegia; nystagmus and other irregular eye movements; vestibular neuritis, labyrinthitis
Cranial and peripheral nerve disorders: (a) Cranial nerve injury/ disorders-ptosis of the eyelid; Horner syndrome, peripheral nerve/ plexus injury/ disorders: Peripheral nerve injury, including brachial plexus
Cranial and peripheral nerve disorders: (b) Peripheral nerve/plexus injury/disorders-carpal/ cubital/ tarsal/ peroneal tunnel syndrome; mononeuritis, Guillain-Barré syndrome; Miller Fisher syndrome; neuropathy (example Charcot-Marie-Tooth disease)
Cranial and peripheral nerve disorders: (b) Peripheral nerve/plexus injury/disorders-herpes zoster
Neurologic pain syndromes: Complex regional pain syndrome (reflex sympathetic dystrophy, causalgia); fibromyalgia; postherpetic neuralgia; phantom limb pain/ syndrome; thalamic pain syndrome; trigeminal neuralgia
Degenerative disorders/ amnestic syndromes: Alzheimer disease; frontotemporal dementia, including progressive supranuclear palsy, Lewy body disease; mild neurocognitive disorder, mild cognitive impairment
Global cerebral dysfunction: Altered states of consciousness; delirium; coma/ brain death
Neuromuscular disorders: Amyotrophic lateral sclerosis/ spinal muscular atrophy; muscular dystrophy (example Duchenne, myotonic); muscle channelopathies (example hypokalemic period paralysis)
Movement disorders: Acute dystonia; adult tic disease; essential tremor; Huntington disease; Parkinson disease, including Parkinson dementia
Metabolic disorders: Adrenoleukodystrophy; metabolic encephalopathy
Paroxysmal disorders: Headache, including migraine, mixed, tension, ice-pick, cluster, medication withdrawal, caffeine withdrawal; seizure disorders, including generalized tonic-clonic, partial, absence, febrile
Sleep disorders: Cataplexy and narcolepsy; circadian rhythm sleep-wake disorder; insomnia, primary; sleep terror disorder and sleepwalking; REM sleep behavior disorder; restless legs syndrome
Traumatic and mechanical disorders and disorders of increased intracranial pressure: Anoxic brain damage, cerebral hypoxia; epidural, subdural hematoma (cerebral and spinal); intraparenchymal hemorrhage, traumatic subarachnoid hemorrhage; cerebral edema
Traumatic and mechanical disorders and disorders of increased intracranial pressure: Pseudotumor cerebri (idiopathic intracranial hypertension); torticollis/ cervical dystonia; hydrocephalus, including normal-pressure
Traumatic and mechanical disorders and disorders of increased intracranial pressure: Traumatic brain injury (concussion)/ post concussion syndrome (dementia pugilistica); traumatic brain syndrome
Congenital disorders: Friedreich ataxia; neural tube defects (example spina bifida, holoprosencephaly, anencephaly); microcephaly; Sturge-Weber syndrome; tuberous sclerosis, von Hippel-Lindau disease; hydrocephalus, obstructive (Arnold-Chiari)
Adverse effects of drugs on the nervous system: Acute dystonic reaction; drug-induced meningitis (example NSAIDs, sulfa drugs); drug-induced neuropathy (example vincristine, isoniazid, metronidazole)
Adverse effects of drugs on the nervous system: Extrapyramidal adverse effects (example akathisia, dystonia, drug-induced parkinsonism); neuroleptic malignant syndrome; poisoning by psychotropic agents, including antidepressants; serotonin syndrome
Adverse effects of drugs on the nervous system: Tardive dyskinesia
Disorders of the eye and eyelid: (a) Infectious and inflammatory disorders of the eye-blepharitis/ eyelid inflammation; chalazion; chorioretinitis; conjunctivitis (adenovirus)/ keratoconjunctivitis; dacryocystitis; endophthalmitis; hordeolum
Disorders of the eye and eyelid: (a) Infectious and inflammatory disorders of the eye-iridocyclitis; optic neuritis; periorbital cellulitis; uveitis, (b) neoplasms of the eye: Melanoma; retinoblastoma
Disorders of the eye and eyelid: (c) Disorders of the eye and eyelid, structural-cataract; glaucoma; lacrimal system disorders; pterygium; refractive disorders (presbyopia, myopia, hyperopia, astigmatism)
Disorders of the eye and eyelid: (d) Disorders of the pupil, iris, muscles (extraocular): Amblyopia; strabismus, (e) disorders of the retina-hypertensive retinopathy; macular degeneration; papilledema; retinal detachment; retinitis pigmentosa
Disorders of the eye and eyelid: (e) Disorders of the retina-vascular disorders affecting the retina, including central retinal artery embolus, retinal hemorrhage, amaurosis fugax, embolus, carotid artery stenosis, central retinal vein occlusion
Disorders of the eye and eyelid: (e) Disorders of the retina-visual impairment/ blindness, night blindness , (f) traumatic and mechanical disorders: Black eye; burn of the eye and adnexa; corneal abrasion, ulcer; dislocated lens; foreign body in eye
Disorders of the eye and eyelid: (f) Traumatic and mechanical disorders-hyphema; injury to optic nerve and pathways; laceration of the eye and eyelid; ocular open wounds; orbital fracture; subconjunctival hemorrhage
Disorders of the eye and eyelid: (g) Adverse effects of drugs on the eyes-ethambutol; hydroxychloroquine; prednisone
Disorders of the ear: (a) Infectious and inflammatory disorders of the ear-chondritis; mastoiditis; otitis, externa, media, interna, serous, suppurative, malignant otitis externa, (b) neoplasms: Acoustic neuroma, neurofibromatosis type 2; cholesteatoma
Disorders of the ear: (c) Hearing loss/ deafness-hearing loss, including noise-induced; otosclerosis; tinnitus, (d) disorders of balance and spatial orientation: Meniere disease; motion sickness; vertigo, including benign positional vertigo
Disorders of the ear: (e) Traumatic and mechanical disorders: Barotrauma; foreign body in ear; impacted cerumen; laceration, avulsion; perforation of tympanic membrane; eustachian tube disorders
Disorders of the ear: (f) Adverse effects of drugs on the ear-antineoplastic agents, including cisplatin; aminoglycosides; furosemide; salicylates

System specifications-Skin and subcutaneous tissue: Unit 01

Normal processes

Embryonic development, fetal maturation, and neonatal changes
Organ structure and function, including barrier function, thermal regulation
Cell/ tissue structure and function, eccrine function
Repair, regeneration, and changes associated with stage of life (example senile purpura, male pattern baldness, postmenopausal hair changes)
Skin defense mechanisms and normal flora

System specifications-Skin and subcutaneous tissue: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(i) bacterial: Cellulitis, erysipelas, impetigo, staphylococcal scalded skin syndrome; abscess, cutaneous, including septic abscess
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(i) bacterial: Anthrax (Bacillus anthracis); carbuncle; folliculitis; pilonidal cyst, infected; pyoderma gangrenosum; MSSA and MRSA skin infections
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(i) bacterial: Mycobacterial infections (example leprosy, draining sinus); scarlet fever (group A Streptococcus), (ii) viral: Herpes simplex type 1 and type 2
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(ii) viral: Herpes zoster; Ramsay-hunt syndrome; molluscum contagiosum; hand-foot-and-mouth disease; herpangina; parvovirus; chickenpox
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(ii) viral: Erythema infectiosum (fifth disease), rubella, measles, roseola (exanthema subitum); verrucae vulgaris
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(iii) fungal (deep and superficial): Candidiasis, skin; dermatophytosis, tinea corporis; dermatomycoses; diaper rash; onychomycosis
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(iv) parasitic: Cutaneous larva migrans; cutaneous leishmaniasis; (vi) infestations, non venomous bites, stings: Scabies; lice; insect bites, including bed bugs
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) papulosquamous and eczematous dermatoses: Psoriasis; lichen planus and lichenoid dermatoses; allergic/irritant contact dermatitis (example nickel)
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) papulosquamous and eczematous dermatoses: Dermatoses caused by plants (poison ivy, poison oak), (ii) vesiculobullous disorders: Epidermolysis bullosa
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(ii) vesiculobullous disorders: Dermatitis herpetiformis; pemphigus; pemphigoid, (iii) urticaria, erythema, exanthema, and purpura: Erythema nodosum
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(iii) urticaria, erythema, exanthema, and purpura: Atopic dermatitis; pityriasis rosea; urticaria; Stevens-Johnson syndrome, erythema multiforme
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(iii) urticaria, erythema, exanthema, and purpura: Toxic epidermal necrolysis, (iv) autoimmune disorders: Vitiligo
Neoplasms: (a) Benign neoplasms, cysts, and other skin lesions-actinic keratoses; cysts, including epidermal; hemangiomas; lipoma; pigmented nevi; seborrheic keratosis; xanthomas, (b) malignant neoplasms: Basal cell carcinoma; squamous cell carcinoma
Neoplasms: (b) Malignant neoplasms-melanoma, including genital; Kaposi sarcoma; cutaneous T-cell lymphoma, mycosis fungoides
Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes): (a) Disorders of the hair and hair follicles-alopecia; seborrhea capitis/seborrheic dermatitis; tinea barbae and capitis
Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes): (b) Disorders of the nails (including ingrowing nail), (c) disorders of sweat and sebaceous glands: Acne vulgaris; hidradenitis suppurativa
Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes): (c) Disorders of sweat and sebaceous glands-hyperhidrosis; ichthyosis; rosacea
Oral disease: Aphthous ulcers (stomatitis, canker sores); leukoplakia
Disorders of pigmentation: Albinism; lentigo
Traumatic and mechanical disorders: Animal bites (dogs, cats, etc); burns or wounds affecting the skin or subcutaneous tissue (example sunburn, other including blast injuries and burns); cauliflower ear; effects of ultraviolet light; keloids; tattoo
Traumatic and mechanical disorders: Thermal injury, perniosis, frostbite; ulcers, decubitus
Congenital disorders: Xeroderma pigmentosum; benign lesions in neonates, infants, children (example congenital nevi)
Adverse effects of drugs on skin and subcutaneous tissue: Drug reactions, eruptions, including local reaction to vaccine

System specifications-Musculoskeletal system: Unit 01

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, cartilage exercise and physical conditioning/ deconditioning
Repair, regeneration, and changes associated with stage of life

System specifications-Musculoskeletal system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, inflammatory, and immunologic disorders: (a) Infectious disorders-gangrene, dry and wet, clostridial myonecrosis (clostridium perfringens); discitis; myositis, infective; necrotizing fasciitis; osteomyelitis; septic arthritis
Infectious, inflammatory, and immunologic disorders: (a) Infectious disorders-spondylitis, tuberculous, (b) immunologic disorders: Ankylosing spondylitis; dermatomyositis/ polymyositis; juvenile idiopathic arthritis; rheumatoid arthritis, felty syndrome
Infectious, inflammatory, and immunologic disorders: (b) Immunologic disorders-psoriatic arthropathy, (c) inflammatory disorders: Adhesive capsulitis of shoulder (frozen shoulder syndrome); ankylosing/spondylopathy (inflammatory); bursitis; fasciitis
Infectious, inflammatory, and immunologic disorders: (c) Inflammatory disorders-osteochondritis, osteochondritis dissecans; tendinitis, supraspinatus syndrome, enthesopathy of spine, elbow, ankle; temporomandibular joint disorders; fibrositis
Infectious, inflammatory, and immunologic disorders: (c) Inflammatory disorders-myofascial pain syndrome; synovitis; tenosynovitis; myositis
Neoplasms: Benign neoplasms (example ganglion cyst); malignant neoplasms of bone (example osteosarcoma, sarcoma, leiomyosarcoma, rhabdomyosarcoma); metastases to bone, secondary malignant neoplasm of bone
Degenerative and metabolic disorders: (a) Degenerative/ metabolic disorders of bone, tendon, and cartilage-chondromalacia; disc degeneration, herniated disc; Legg-Calvé-Perthes disease; Osgood-Schlatter disease; osteodystrophy; osteomalacia
Degenerative and metabolic disorders: (a) Degenerative/ metabolic disorders of bone, tendon, and cartilage-osteonecrosis (avascular), bone infarct; osteoporosis; osteopenia; osteitis deformans (Paget disease of bone); pathologic fracture; radiculopathies
Degenerative and metabolic disorders: (a) Degenerative/ metabolic disorders of bone, tendon, and cartilage-spondylolisthesis/spondylosis (degenerative), (b) degenerative/ metabolic disorders of joints: Gout, gouty arthritis, pseudogout; joint effusion
Degenerative and metabolic disorders: (b) Degenerative/ metabolic disorders of joints-osteoarthritis, degenerative/ metabolic disorders of muscles, ligaments, fascia: Dupuytren contracture; muscle calcification and ossification
Degenerative and metabolic disorders: (c) Degenerative/ metabolic disorders of muscles, ligaments, fascia-muscle wasting and diffuse atrophy; rhabdomyolysis
Traumatic and mechanical disorders: Amputation and care of amputees; backache, including low back pain; blast injuries; compartment syndrome; contractures, hospital-acquired; contusions; dislocations; fractures; sprains, strains; kyphoscoliosis, scoliosis
Traumatic and mechanical disorders: Rotator cuff syndrome; slipped capital femoral epiphysis; dislocation of hip
Congenital disorders: Achondroplasia/ dwarfism; disorders of limb development (HOX gene mutation, phocomelia); developmental dysplasia of the hip; dislocation of hip in infantile spinal muscular atrophy; genu valgum or varum
Congenital disorders: Foot deformities (flat foot, valgus/ varus deformities); osteogenesis imperfecta; McArdle disease; mitochondrial myopathies
Adverse effects of drugs on the musculoskeletal system: Drug-induced myopathy (example steroids, statins, cocaine, AZT); malignant hyperthermia

System specifications-Cardiovascular system: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal transitional changes
Organ structure and function: Chambers, valves cardiac cycle, mechanics, heart sounds, cardiac conduction hemodynamics, including blood volume and systemic vascular resistance circulation in specific vascular beds, including pulmonary and coronary
Cell/ tissue structure and function: Heart muscle, metabolism, oxygen consumption, biochemistry, and secretory function (example atrial natriuretic peptide), endothelium and secretory function, vascular smooth muscle
Cell/ tissue structure and function: Microcirculation, and lymph flow, neural and hormonal regulation of the heart, blood vessels, and blood volume, including responses to change in posture, exercise, and tissue metabolism, and autonomic responses
Repair, regeneration, and changes associated with stage of life

System specifications-Cardiovascular system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-bacterial endocarditis, myocarditis, (b) immunologic and inflammatory disorders: Atherosclerosis (example atherosclerosis of the aorta)
Neoplasms: Myxoma, metastases
Dysrhythmias: Premature beats (PACs, PVCs); atrial flutter/ fibrillation; multifocal atrial tachycardia; paroxysmal tachycardias; ventricular tachycardia/ fibrillation; wide complex tachycardia; torsades de pointes; bradycardias
Dysrhythmias: Atrioventricular block (first-, second-, third-degree); conduction disorder (LBBB, RBBB); cardiac arrest; sick sinus syndrome; prolonged QT syndrome; Wolff-Parkinson-White syndrome; carotid sinus hypersensitivity
Dysrhythmias: Pacemaker dysfunction, including failure to sense, capture
Heart failure: Chordae tendineae rupture; congestive heart failure; cor pulmonale; diastolic dysfunction; systolic dysfunction; mitral valve dysfunction; heart failure secondary to myocardial infarction
Heart failure: High-output heart failure, including thyrotoxicosis-induced, anemia-induced; tachycardia-induced; cardiogenic pulmonary edema
Ischemic heart disease: Acute coronary syndrome, acute myocardial infarction; angina pectoris, stable and unstable/ coronary artery disease/ coronary insufficiency; coronary artery spasm
Diseases of the myocardium: Cardiomyopathy, dilated, including alcoholic, viral, takotsubo; cardiomyopathy, obstructive hypertrophic; cardiomyopathy, familial dilated; cardiomyopathy, restrictive; hypertensive heart disease, left ventricular hypertrophy
Diseases of the myocardium: Right ventricular hypertrophy; complications of myocardial infarction; nontraumatic tamponade post-myocardial infarction; papillary muscle rupture/ dysfunction; ventricular free wall rupture; myocarditis
Diseases of the pericardium: Chronic constrictive pericarditis; pericardial effusion; pericardial tamponade; acute pericarditis; pericarditis, following myocardial infarction, surgery, trauma
Valvular heart disease: Valve disorders, mitral/ aortic/ tricuspid, pulmonic (example regurgitation, stenosis, prolapse, insufficiency, vegetation); functional murmurs; rheumatic heart disease; complications of artificial valves
Hypotension: Orthostatic hypotension
Hypertension: Elevated blood pressure reading without diagnosis of hypertension; essential hypertension; malignant hypertension; secondary hypertension
Dyslipidemia: Hypercholesterolemia; hyperlipidemia; hypertriglyceridemia; lipoproteins/ lipoprotein lipase deficiency
Vascular disorders: (a) Disorders of the great vessels-aneurysm, aortic (abdominal/ thoracic), dissection, ruptured; aneurysm, iliac, other peripheral vascular, ruptured; aortoiliac disease
Vascular disorders: (b) Peripheral arterial vascular disease-arterial embolism/ thrombosis, arteriovenous fistula; atheroembolic disease; claudication; cholesterol emboli; hypertensive vascular disease; peripheral arterial disease
Vascular disorders: (b) Peripheral arterial vascular disease-thromboangiitis obliterans, (c) diseases of the veins-deep venous thrombosis, venous thromboembolism; phlebitis/ thrombophlebitis; varicose veins; venous insufficiency; stasis ulcers
Vascular disorders: (c) Diseases of the veins-stasis dermatitis
Traumatic and mechanical disorders: Ventricular puncture; myocardial contusion; myocardial rupture; traumatic aortic dissection; traumatic tamponade
Congenital disorders, including disease in adults: Anomalous left coronary artery; atrial septal defect; coarctation of the aorta; endocardial cushion defect; patent foramen ovale; patent ductus arteriosus; tetralogy of Fallot
Congenital disorders, including disease in adults: Transposition of the great vessels; ventricular septal defect
Adverse effects of drugs on the cardiovascular system: Adriamycin; cocaine, amphetamine, PCP; ACE inhibitors, calcium channel blockers, alpha blockers, minoxidil

System specifications-Respiratory system: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes
Organ structure and function: Airways, including mechanics and regulation of breathing, lung parenchyma, including ventilation, perfusion, gas exchange, pleura, nasopharynx, sinuses
Cell/ tissue structure and function, including surfactant formation, and alveolar structure
Repair, regeneration, and changes associated with stage of life
Pulmonary defense mechanisms and normal flora

System specifications-Respiratory system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-acute upper respiratory infection; viral infections (adenovirus, corona viruses, coxsackievirus, influenza virus)
Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-viral infections (parainfluenza virus, rhinoviruses); sinusitis; nasopharyngitis; epiglottitis
Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-bordetella pertussis pneumonia; croup; acute laryngitis; acute laryngotracheitis; tracheitis; pharyngitis
Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-streptococcal throat infections; tonsillitis; peritonsillar abscess; rhinitis, allergic, chronic
Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-ulcers of nasal cavity/ sinuses
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-hospital acquired pneumonia; ventilator-associated pneumonia, community-acquired pneumonia, acute bronchiolitis
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-bronchiolitis obliterans with organizing pneumonia (BOOP); anthrax, pulmonary (Bacillus anthracis); aspiration pneumonia
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-pneumonitis; bronchitis, acute; bronchopneumonia; pneumonia (Burkholderia pseudomallei, chlamydophila pneumoniae
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-coxiella burnetii, francisella tularensis, haemophilus influenzae, klebsiella pneumoniae, legionella, moraxella catarrhalis
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-mycoplasma pneumoniae, pseudomonas aeruginosa, streptococcus, MSSA, MRSA, other gram‐negative bacteria)
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-viral infection (example influenza A, B, adenovirus, H1N1, respiratory syncytial virus, parainfluenza virus)
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-fungal infection (aspergillosis, including allergic bronchopulmonary aspergillosis and aspergilloma, histoplasmosis)
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-fungal infection (coccidioidomycosis, pneumocystis jirovecii); pulmonary tuberculosis; lung abscess
Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-viral infection (example influenza A, B, adenovirus, respiratory syncytial virus, parainfluenza virus, avian influenza virus)
Neoplasms: (a) Benign neoplasms-upper airways (example vocal cord polyps, nasal polyps, juvenile, papillomatosis); lungs and pleura (example solitary pulmonary nodule, bronchial carcinoid tumors)
Neoplasms: (b) Malignant neoplasms-(i) upper airways: Lip, oral cavity, and pharynx; head and neck cancer; larynx; trachea, (ii) lower airways and pleura: Malignant neoplasms of bronchus and/ or lung (squamous cell, adenocarcinoma, large cell, small cell)
Neoplasms: (b) Malignant neoplasms-(ii) lower airways and pleura: Malignant neoplasms of pleura (mesothelioma); secondary malignant neoplasms of lung; secondary malignant neoplasms of pleura, (c) metastatic neoplasms including pleural
Obstructive airway disease: Asthma, reactive airway disease; bronchiectasis; chronic airway obstruction; chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema
Pneumoconiosis/ fibrosing/ restrictive pulmonary disorders/ interstitial lung disease: Pneumoconiosis; asbestosis; silicosis; silo-filler's lung, byssinosis, bagassosis, berylliosis; hypersensitivity pneumonitis; hypereosinophilic syndromes
Pneumoconiosis/ fibrosing/ restrictive pulmonary disorders/ interstitial lung disease: Loeffler syndrome; interstitial pneumonia, usual (UIP), desquamative (DIP), nonspecific
Respiratory failure/ respiratory arrest and pulmonary vascular disorders: Acute respiratory distress syndrome (ARDS); pulmonary hypertension; pulmonary vascular disorders, arteriovenous fistula; pulmonary edema, pulmonary cause and unspecified
Respiratory failure/ respiratory arrest and pulmonary vascular disorders: Pulmonary embolism; air and fat embolism; respiratory failure due to enteral feeding
Metabolic, regulatory, and structural disorders: Disorders of gas exchange; hypoventilation; hypoxia; pulmonary alveolar proteinosis; ventilation-perfusion imbalance
Disorders of the pleura, mediastinum, and chest wall: Chylothorax; costochondritis; empyema; hemothorax; mediastinitis; pleural effusion; pleuritis; pneumomediastinum; pneumothorax
Traumatic and mechanical disorders: (a) Upper airways-epistaxis; barotrauma, sinus; laryngeal/pharyngeal obstruction; tracheoesophageal fistula; tracheal stenosis; tracheomalacia; trauma (example tracheal injury)
Traumatic and mechanical disorders: (a) Upper airways-foreign body (nose, pharynx, larynx, trachea); traumatic/ mechanical disorders of the nasal cavity/ sinuses (example septal perforation)
Traumatic and mechanical disorders: (b) Lower airways and pleura-atelectasis; diaphragm/ chest wall injury; drowning and near drowning; foreign body, upper and lower respiratory tract; penetrating chest wounds; pulmonary contusion; sleep apnea
Traumatic and mechanical disorders: (b) Lower airways and pleura-obstructive and central; hypoventilation syndrome, obesity-hypoventilation syndrome
Congenital disorders: Bronchogenic cysts; congenital cysts; congenital diaphragmatic hernia; pulmonary sequestration; immotile cilia syndrome
Adverse effects of drugs on the respiratory system: Bleomycin, amiodarone; adverse effects of 100% oxygen; acute effects of tobacco/ nicotine, inhalants, cocaine

System specifications-Gastrointestinal system: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes
Organ structure and function: Anatomy of the alimentary canal, including mouth, pharynx, esophagus, stomach, small intestine, large intestine, anus, peritoneal cavity, liver and biliary system, including enterohepatic circulation
Organ structure and function: Salivary glands and exocrine pancreas, gastrointestinal motility, including defecation digestion and absorption
Cell/ tissue structure and function: Endocrine and neural regulatory functions, including GI hormones (example gastrin) salivary, gastrointestinal, pancreatic, hepatic secretory products, including enzymes, proteins
Cell/ tissue structure and function: 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

System specifications-Gastrointestinal system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Pseudomembranous colitis (Clostridium difficile); enteritis/ enteric infections (includes gastroenteritis)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) bacterial: (example Staphylococcus aureus, Escherichia coli, Listeria monocytogenes, Yersinia enterocolitica, Campylobacter species, Vibrio cholerae, Salmonella species)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: (Shigella species, traveler's/ infectious diarrhea); hepatic abscess, subhepatic abscess, subphrenic abscess; peritonitis, primary and secondary; Whipple disease
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral: Infectious esophagitis (example CMV, herpes); hepatitis A, B, C, D, E; coxsackievirus enteritis/ colitis; Echovirus enteritis/colitis; rotavirus enteritis; mumps
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral: Gingivostomatitis, herpetic, (iii) fungal: Thrush, (iv) parasitic: Cryptosporidium, cyclospora, entamoeba histolytica, giardia, isospora belli
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iv) parasitic: Strongyloides stercoralis
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-autoimmune hepatitis; celiac disease; eosinophilic esophagitis; granulomatous enteritis; inflammatory bowel disease, including Crohn disease
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-regional enteritis; microscopic colitis (collagenous and lymphocytic colitis), ulcerative colitis, toxic megacolon
Neoplasms: (a) Benign neoplasms, including polyps, cysts-stomach; small intestine; colon, rectum, and anus, including polyps, (b) malignant neoplasms and premalignant conditions: Oral cancer (example lips, mouth, tongue, salivary glands)
Neoplasms: (b) Malignant neoplasms and premalignant conditions-esophageal, squamous and adenocarcinoma; Barrett esophagus; gastrinoma, Zollinger-Ellison syndrome; gastrointestinal carcinoid tumors; gastrointestinal stromal tumors; small intestine
Neoplasms: (b) Malignant neoplasms and premalignant conditions-stomach, adenocarcinoma, lymphoma, MALT; colon, rectum, anus; hereditary colon cancer syndromes
Neoplasms: (b) Malignant neoplasms and premalignant conditions-familial adenomatous polyposis (example Peutz-Jeghers syndrome, Gardner syndrome, Turcot syndrome,); MUTYH-associated polyposis; gallbladder, cholangiocarcinoma
Neoplasms: (b) Malignant neoplasms and premalignant conditions-adenocarcinoma of the ampulla of Vater; liver, including hepatoma; peritoneal cancer, including metastatic studding with cancer; pancreas, (c) metastatic neoplasms
Signs, symptoms, and ill-defined disorders: Upper gastrointestinal bleeding; lower gastrointestinal bleeding; constipation; diarrhea; hematochezia; bright red rectal bleeding; melena; nausea, vomiting, rumination
Disorders of the oral cavity, salivary glands, and esophagus: (a) Oral cavity and salivary glands-abscessed tooth; dental caries; malocclusion; disorders of the salivary glands (example stones, sialadenitis, parotitis)
Disorders of the oral cavity, salivary glands, and esophagus: (b) Esophagus-achalasia and cardiospasm; dysphagia; diverticulum (example Zenker); esophageal periapical abscess without sinus; esophagitis/ esophageal reflux (GERD); esophagitis, pill
Disorders of the oral cavity, salivary glands, and esophagus: (b) Esophagus-Mallory-Weiss syndrome; paraesophageal (hiatal) hernia; stricture and stenosis of esophagus
Disorders of the stomach, small intestine, colon, rectum, anus: (a) Stomach-dyspepsia/ hyperacidity; gastric ulcer; gastritis; peptic ulcer; peptic ulcer perforation; gastroparesis, small intestine, colon: Appendicitis; angiodysplasia; diverticula
Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-diverticulitis, diverticulosis; duodenitis, duodenal ulcer, peptic ulcer; gastroenteritis and colitis (noninfectious); granulomatous enterocolitis
Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-Hirschsprung disease; impaction of intestine; intestinal obstruction/ stricture; intussusception; irritable colon/ irritable bowel syndrome
Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-mesenteric ischemia/ ischemic bowel/ ischemic colitis; necrotizing enterocolitis; paralytic ileus; volvulus; malnutrition and malabsorption
Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-including lactose intolerance, short bowel syndrome, rectum and anus: Abscess of anal and rectal regions; anal fissure; anal fistula; ulcer; fecal incontinence
Disorders of the stomach, small intestine, colon, rectum, anus: (c) Rectum and anus-hemorrhage (rectum, anus); proctitis; hemorrhoids; rectal prolapse
Disorders of the liver and biliary system, noninfectious: (a) Liver-cirrhosis; Dubin-Johnson, Rotor syndromes; end-stage liver disease, including indications for transplantation; Gilbert syndrome, Crigler-Najjar syndrome
Disorders of the liver and biliary system, noninfectious: (a) Liver-hepatic coma/ hepatic encephalopathy; hepatitis, noninfectious; hepatitis, fatty liver, alcoholic; hepatorenal syndrome; hepatopulmonary syndrome; jaundice
Disorders of the liver and biliary system, noninfectious: (a) Liver-nonalcoholic fatty liver disease; portal hypertension/ esophageal varices, (b) biliary system: Bile duct obstruction/ cholestasis; cholangitis, including ascending; choledocholithiasis
Disorders of the liver and biliary system, noninfectious: (b) Biliary system-cholelithiasis/ cholecystitis; cholestasis due to parenteral nutrition; gallstone ileus; Mirizzi syndrome; primary biliary cirrhosis; primary sclerosing cholangitis
Disorders of the pancreas: Pancreatitis, acute; pancreatitis, chronic; pancreatitis, hereditary; pancreatic cyst/ pseudocyst; pancreatic duct obstruction; pancreatic insufficiency
Disorders of the peritoneal cavity: Ascites
Traumatic and mechanical disorders: Abdominal wall defects; adhesions, postsurgical; digestive system complications of surgery; post-gastric surgery syndromes (example blind loop syndrome, adhesions); duodenal tear; foreign body in digestive system
Traumatic and mechanical disorders: Inguinal, femoral, and abdominal wall hernias; open wound, abdominal; perforation of hollow viscus and blunt trauma; perforation/rupture of esophagus (Boerhaave syndrome); umbilical hernia
Congenital disorders: Annular pancreas, biliary atresia, cleft lip and palate, esophageal atresia, malrotation without volvulus, Meckel diverticulum, pyloric stenosis, tracheoesophageal fistula
Adverse effects of drugs on the gastrointestinal system: Drug-induced changes in motility (chronic laxative abuse, opioids); drug-induced gastritis, duodenitis, peptic ulcer disease (NSAIDs); drug-induced hepatitis (example acetaminophen, isoniazid)
Adverse effects of drugs on the gastrointestinal system: Drug-induced pancreatitis (example thiazide diuretics)

System specifications-Renal and urinary system: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes
Organ structure and function: Kidneys, ureters, bladder, urethra, glomerular filtration and hemodynamics, urine concentration and dilution, renal mechanisms in acid-base balance, renal mechanisms in body fluid homeostasis, micturition
Cell/ tissue structure and function: Renal metabolism and oxygen consumption, tubular reabsorption and secretion, including transport processes and proteins
Cell/ tissue structure and function: Hormones produced by or acting on the kidney (example renin, aldosterone, angiotensin II, vasopressin)
Repair, regeneration, and changes associated with stage of life

System specifications-Renal and urinary system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) upper urinary tract: Granulomatous pyelonephritis; perinephric abscess; pyelonephritis; pyonephrosis; renal abscess; renal tuberculosis
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) lower urinary tract and urinary tract infections of unspecified location: Cystitis; chlamydial and nonchlamydial
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) upper urinary tract: Glomerular disorders-Alport syndrome; glomerular disease due to hepatitis B, C; glomerulonephritis, including poststreptococcal
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) upper urinary tract: Glomerular disorders-IgA nephropathy; lupus nephritis; minimal change disease; nephrotic syndrome; thin basement membrane disease
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) upper urinary tract: Tubulointerstitial disease-acute tubular necrosis (ATN); acute interstitial nephritis; papillary necrosis; HIV nephropathy
Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(ii) lower urinary tract: interstitial cystitis
Neoplasms: (a) Benign neoplasms and cysts-polycystic kidney disease, (b) malignant neoplasms: Renal (example Wilms tumor/ nephroblastoma, renal cell carcinoma, renal tumors associated with congenital/ hereditary conditions)
Neoplasms: (b) Malignant neoplasms-urinary bladder and collecting system
Signs, symptoms, and ill-defined disorders: dysuria; hematuria; oliguria, anuria; proteinuria
Metabolic and regulatory disorders: Acute kidney injury; renal insufficiency; azotemia, uremic syndrome; chronic kidney disease, including end-stage renal disease; cystinuria; Fanconi syndrome
Metabolic and regulatory disorders: Hypertensive renal disease (renal complications of hypertension); renal calculi, ureteral calculi, nephrolithiasis; renal tubular acidosis
Vascular disorders: Renal artery stenosis (atherosclerosis, fibromuscular dysplasia, nephrosclerosis); renal vein thrombosis; renal infarction
Traumatic and mechanical disorders: Bladder rupture; neurogenic bladder; obstructive uropathy; posterior urethral valves; renal laceration; renal vascular injury; ureteral laceration/ avulsion/ disruption; urethral diverticulum
Traumatic and mechanical disorders: Obstruction/ stricture/ prolapse, urethral/ ureteral, vaginal walls, uterine, uterovaginal; urinary incontinence, including secondary enuresis; vesicoureteral reflux
Congenital disorders: Double ureters/ ureteral duplication/ double collecting system; horseshoe kidney; hydronephrosis/ reflux; renal agenesis, renal hypoplasia, renal dysplasia; single kidney
Adverse effects of drugs on the renal and urinary system: ACE inhibitors; aminoglycosides; amphotericin B; cisplatin; furosemide; gadolinium (nephrogenic systemic fibrosis); heroin; iodinated contrast dye; lithium; NSAIDs; penicillins; sulfa drugs
Adverse effects of drugs on the renal and urinary system: Tenofovir; drug-induced urinary retention

System specifications-Male reproductive system: Unit 01

Normal processes

Embryonic development, fetal maturation, and neonatal changes, gametogenesis
Organ structure and function: Structure, male genitalia and prostate function, male genitalia and prostate (example spermatogenesis, puberty) intercourse, orgasm, erection
Cell/ tissue structure and function, including hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones
Reproductive system defense mechanisms and normal flora
Repair, regeneration, and changes associated with stage of life

System specifications-Male reproductive system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-balanitis; epididymitis; orchitis; prostatitis; sexually transmitted infections and exposure; chancroid (Haemophilus ducreyi); genital herpes; gonorrhea (Neisseria gonorrhoeae)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-human papillomavirus infection, genital/ venereal/ anal warts, condylomata acuminata; lymphogranuloma venereum (Chlamydia trachomatis); syphilis (Treponema pallidum)
Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-trichomoniasis (Trichomonas vaginalis); urethritis, chlamydial and nonchlamydial, nongonococcal, (b) immunologic and inflammatory disorders: Autoimmune hypogonadism
Neoplasms: Malignant neoplasms, penile, prostate, testicular, breast
Metabolic and regulatory disorders, including sexual dysfunction: Erectile dysfunction, impotence; infertility, male factor; male sexual dysfunction; premature ejaculation
Traumatic and mechanical disorders: Benign prostatic hyperplasia/ hypertrophy; circumcision, including complications; epididymal cyst; hydrocele; injuries, wounds, and burns to male genitalia, including blast injuries; penile laceration, penile fracture
Traumatic and mechanical disorders: Peyronie disease; phimosis; scrotal laceration; spermatocele; testicular rupture/ avulsion/ laceration; torsion of testis; urethral laceration/ disruption; varicocele
Congenital disorders of the male reproductive system: Hypospadias; Klinefelter syndrome; undescended testicle
Adverse effects of drugs on the male reproductive system: Alcohol; androgens, testosterone; antipsychotics, antidepressants including selective serotonin reuptake inhibitors; beta adrenergic blockers; diuretic including thiazides
Adverse effects of drugs on the male reproductive system: Drug-induced priapism (example trazodone); finasteride, dutasteride; sildenafil, tadalafil, vardenafil; marijuana; nitric oxide reductase inhibitors

System specifications-Pregnancy, childbirth, and the puerperium: Unit 01

Normal processes

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

System specifications-Pregnancy, childbirth, and the puerperium: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Prenatal care: (a) Preconception counseling and care-folate deficiency prevention; immunizations; nutritional assessment, including vitamins; Rh screening, (b) prenatal risk assessment/ prevention: Adolescent pregnancy; antepartum fetal evaluation
Prenatal care: (b) Prenatal risk assessment/ prevention-including biophysical profile; genetic screening; α-fetoprotein; diabetes mellitus; neural tube defects; Rh isoimmunization, (c) supervision of normal pregnancy: Assessment of gestational age
Prenatal care: (c) Supervision of normal pregnancy-iron deficiency prevention; nutrition, including weight management; surveillance, including ultrasonography and assessment of fetal growth; vitamin deficiency prevention; infections, maternal, fetal
Prenatal care: (c) Supervision of normal pregnancy-newborn (focus on prevention and screening): Cytomegalovirus, coxsackievirus, hepatitis B virus, herpes simplex viruses, HIV, influenza virus, parvovirus B19 virus, Rubella virus, varicella-zoster virus
Prenatal care: (c) Supervision of normal pregnancy-Chlamydia trachomatis, Treponema pallidum, Streptococcus agalactiae, Toxoplasma gondii, amnionitis; asymptomatic urinary tract infection
Obstetric complications: Abortion, induced, septic, missed, spontaneous, threatened; acute fatty liver of pregnancy; anemia of pregnancy, sickle cell disease, thalassemia in pregnancy; antepartum hemorrhage, including third-trimester bleeding
Obstetric complications: Cardiomyopathy of pregnancy; cervical insufficiency, cervical shortening; cholestasis of pregnancy, intrahepatic; congenital abnormalities, maternal (example bicornuate uterus); ectopic pregnancy
Obstetric complications: Fetal abnormality affecting management of mother (example hydrocephalus, spina bifida); fetal growth restriction; gestational diabetes; maternal mortality; multiple gestation
Obstetric complications: Placental abnormalities (abruptio placentae, placenta previa, premature separation of placenta); polyhydramnios, oligohydramnios; preeclampsia, eclampsia, HELLP syndrome, gestational hypertension; prolonged pregnancy
Obstetric complications: Rh isoimmunization affecting management of mother; vomiting in pregnancy (morning sickness, hyperemesis gravidarum); trauma in pregnancy; infections complicating pregnancy
Labor and delivery: Labor and delivery, uncomplicated; labor and delivery, complicated, including shoulder dystocia; cesarean delivery, including complications; cord compression, cord prolapse; fetal malpresentations (example breech/ external cephalic)
Labor and delivery: Intrapartum fetal evaluation, including fetal heart tones; intrapartum prophylaxis (example HIV, Chlamydia, gonococcal prophylaxis); premature rupture of membranes; preterm (before 37 weeks' gestation) and postdates labor and delivery
Labor and delivery: Threatened preterm labor
Puerperium, including complications: Lactation problems; breastfeeding problems; lochia; postpartum cardiomyopathy; postpartum blues; postpartum hemorrhage; postpartum sepsis; retained placenta, products of conception (example placenta accreta)
Puerperium, including complications: Uterine atony
Newborn (birth to 4 weeks of age): (a) Normal newborn-examination of liveborn at admission to hospital, screening, newborn, (b) disorders of the newborn: Screening, newborn; ABO incompatibility in newborn; hemolytic disease due to Rh incompatibility
Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-birth asphyxia syndrome (liveborn neonate); birth trauma (example cord compression, brachial palsy, lacerations); drug withdrawal syndrome in newborn; feeding problems in newborn
Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-fetal growth and development abnormalities, including fetal growth restriction; gastrointestinal obstruction; hypocalcemia of newborn; infections
Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-congenital or peripartum (cytomegalovirus, herpes simplex viruses, HIV, hepatitis B, rubella virus, parvovirus B19 virus, varicella zoster virus, chlamydia trachomatis)
Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-(streptococcus agalactiae, treponema pallidum, toxoplasma gondii), intrapartum fetal distress/ death including stillborn; jaundice, fetal/ neonatal/ perinatal; laryngomalacia
Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-macrosomia (large for gestational age); meconium aspiration syndrome; neonatal acne; neonatal Candida infection (thrush); neonatal hypoglycemia; neonatal conjunctivitis and dacryocystitis
Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-ophthalmic gonorrhea; phenylketonuria; premature infant; post-term infant; pseudomembranous colitis of infancy; respiratory distress syndrome (hyaline membrane disease)
Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-Respiratory problems after birth (example bronchopulmonary dysplasia, tracheomalacia; tracheoesophageal fistula in neonates); retinitis of prematurity; seizures in newborn
Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-sudden infant death syndrome (SIDS), apparent life-threatening event (ALTE); tetanus neonatorum
Congenital disorders, neonatal: Congenital malformations and anomalies; neonatal hydrocele
Adverse effects of drugs on pregnancy, childbirth, and the puerperium: Alcohol, tobacco, and other drugs (ATOD); prenatal radiation exposure; teratology (example ACE inhibitors, SSRIs, warfarin, infections, toxins)
Systemic disorders affecting pregnancy, labor and delivery, and puerperium: Appendicitis; asthma; carpal tunnel syndrome in pregnancy; cirrhosis; deep venous thrombosis (DVT); diabetes mellitus; heart failure, valvular heart disease; hypertension
Systemic disorders affecting pregnancy, labor and delivery, and puerperium: Myasthenia gravis; obesity; pancreatitis; psychiatric disorders; renal calculus/ calculi; renal failure/ renal disease, including SLE; seizure disorders; thyroid disorders
Systemic disorders affecting pregnancy, labor and delivery, and puerperium: Hypothyroidism, hyperthyroidism

System specifications-Female reproductive system and breast: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes, gametogenesis
Organ structure and function: Female structure, including breast female function (example ovulation, menstrual cycle, puberty) intercourse, sexual response
Cell/ tissue structure and function: Hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones
Reproductive system defense mechanisms and normal flora
Repair, regeneration, and changes associated with stage of life

System specifications-Female reproductive system and breast: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Breast: (a) Infectious, immunologic, and inflammatory disorders-breast abscess; inflammatory disease of breast, fat necrosis; mastitis; nipple discharge, (b) neoplasms-(i) benign and undefined neoplasms: Breast cyst, solitary; fibrocystic changes
Breast: (b) Neoplasms-(i) Benign and undefined neoplasms-fibroadenoma; hypertrophy of breast; intraductal papilloma, (ii) malignant neoplasms (including screening): Breast cancer; intraductal carcinoma; Paget disease of breast; phyllodes tumors
Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-bacterial vaginosis; Bartholin gland abscess; cellulitis, pelvic; candidiasis of the vulva or vagina; lichen sclerosus; sexually transmitted infections and exposure
Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-cervicitis and endocervicitis; chancroid (Haemophilus ducreyi); genital herpes; gonorrhea (Neisseria gonorrhoeae); human papillomavirus infection
Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-genital/ venereal/ anal warts, condylomata acuminata; lymphogranuloma venereum (Chlamydia trachomatis), non-lymphogranuloma venereum; pelvic inflammatory disease
Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-Fitz-Hugh–Curtis syndrome; salpingitis and oophoritis; syphilis (Treponema pallidum); trichomoniasis (Trichomonas vaginalis); urethritis; vaginitis; vulvovaginitis
Neoplasms of the cervix, ovary, uterus, vagina, and vulva: (a) Benign neoplasms and cysts-abnormal Pap smear; benign neoplasm of ovary; endocervical and endometrial polyps; leiomyomata uteri; ovarian cyst
Neoplasms of the cervix, ovary, uterus, vagina, and vulva: (b) Malignant and precancerous neoplasms-cervical cancer; HPV causing cancer; cervical dysplasia, HPV causing dysplasia; endometrial hyperplasia; endometrial/ uterine cancer
Neoplasms of the cervix, ovary, uterus, vagina, and vulva: (b) Malignant and precancerous neoplasms-gestational trophoblastic disease (hydatidiform mole); ovarian cancer; vulvar dysplasia, and cancer
Fertility and infertility: Assisted reproductive techniques (ART); contraception (example oral contraceptives, IUD, vaginal cap, cervical sponge, diaphragm, implant, morning-after pill, male and female condoms); female infertility
Fertility and infertility: Gonadal dysgenesis 45,X (Turner syndrome); sterilization; tubal factors; infertility
Menopause: Ovarian failure, premature menopause; perimenopause; premenopausal menorrhagia; postmenopausal atrophic vaginitis (vaginal atrophy); postmenopausal bleeding; vasomotor symptoms
Menstrual and endocrine disorders: Abnormal uterine bleeding, including perimenopausal; absence of menstruation (primary amenorrhea, secondary amenorrhea including undiagnosed pregnancy); anovulation; dysmenorrhea; endometriosis; hirsutism, virilization
Menstrual and endocrine disorders: Mittelschmerz; pelvic pain; polycystic ovarian syndrome; postcoital bleeding; premenstrual syndrome
Sexual dysfunction: Dyspareunia; orgasmic dysfunction; sexual desire/ arousal syndrome; vaginismus
Traumatic and mechanical disorders: Asherman syndrome; chronic inversion of uterus; chronic pelvic pain syndrome; cystocele; imperforate hymen; injuries, wounds, and burns affecting the female reproductive system and injuries, wounds
Traumatic and mechanical disorders: Burns, and blast injuries; ovarian torsion; pelvic relaxation; rectocele; urethrocele
Congenital disorders: Müllerian agenesis; uterus didelphys, bicornuate uterus; short cervix
Adverse effects of drugs on the female reproductive system and breast: Antihistamines, H2-receptor blockers; benzodiazepines; beta-adrenergic blockers; hormone replacement; opioids; spironolactone; selective serotonin reuptake inhibitors
Adverse effects of drugs on the female reproductive system and breast: Tricyclic antidepressants

System specifications-Endocrine system: Unit 01

Normal processes

Embryonic development, fetal maturation, and perinatal changes
Organ structure and function: Hypothalamus, posterior and anterior pituitary gland, thyroid gland, parathyroid gland, adrenal cortex, adrenal medulla, pancreatic islets, ovary and testis, adipose tissue
Cell/ tissue/ structure and function, including hormone synthesis, secretion, action, metabolism: Peptide hormones, steroid hormones, including vitamin D, thyroid hormones, catecholamine hormones, renin-angiotensin system
Repair, regeneration, and changes associated with stage of life

System specifications-Endocrine system: Unit 02

Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis

Diabetes mellitus and other disorders of the endocrine pancreas: (a) Diabetes mellitus-diabetes mellitus, type 1; diabetes mellitus, type 1.5; diabetes mellitus, type 2; diabetes mellitus, acute complications: hyperosmolar coma, hypoglycemic shock
Diabetes mellitus and other disorders of the endocrine pancreas: (a) Diabetes mellitus-ketoacidosis, including cerebral edema, associated electrolyte abnormalities; diabetes mellitus, chronic complications: gastrointestinal/ gastroparesis
Diabetes mellitus and other disorders of the endocrine pancreas: (a) Diabetes mellitus-chronic complications: Neurologic/ neuropathy, ophthalmologic/ retinopathy, peripheral vascular, renal/ nephropathy, metabolic syndrome
Diabetes mellitus and other disorders of the endocrine pancreas: (b) Hypoglycemia and islet cell disorders-hypoglycemia (secondary to insulinoma, surreptitious insulin use, sepsis, liver failure); hyperglycemia (secondary to glucagonoma); hyperinsulinism
Diabetes mellitus and other disorders of the endocrine pancreas: (b) Hypoglycemia and islet cell disorders-islet cell tumors/ insulinoma/ somatostatinoma; pancreatic neuroendocrine tumors
Thyroid disorders: Cyst, nodule; euthyroid sick syndrome; goiter (euthyroid-normal thyroid function with goiter); hypothyroidism; hyperthyroidism, including thyrotoxicosis and thyroid storm; thyroiditis, including Hashimoto; Graves disease
Thyroid disorders: Neoplasms (benign cysts and nodules, thyroid cancer including papillary, follicular, medullary, and anaplastic); thyroid deficiency from pituitary disorder; infertility due to thyroid disease
Thyroid disorders: Secondary hypothyroidism and hyperthyroidism
Parathyroid disorders: Hyperparathyroidism; hypoparathyroidism; metabolic bone disease
Adrenal disorders: Corticoadrenal insufficiency (Addison disease); adrenal insufficiency, secondary; hypocortisolism; cushing syndrome; hyperaldosteronism; neoplasms, benign and malignant (adrenal neuroblastoma, pheochromocytoma, adrenal carcinoma
Adrenal disorders: Adrenal adenoma, aldosteronoma, adrenal incidentaloma); delayed and precocious puberty; hypertensive endocrine disease
Pituitary disorders: Acromegaly/ gigantism; diabetes insipidus; galactorrhea not associated with childbirth; panhypopituitarism from any cause; pituitary apoplexy (example sheehan syndrome); growth hormone deficiency; short stature
Pituitary disorders: SIADH (inappropriate secretion of ADH [vasopressin]); neoplasm, benign and malignant (pituitary adenomas, craniopharyngioma, metastatic disease); prolactinoma and hyperprolactinemia, including infertility due to these disorders
Diabetes mellitus and other disorders of the endocrine pancreas: Pituitary disorders-hypogonadism, primary and secondary
Hypothalamic endocrine disorders
Multiple endocrine neoplasia (MEN1, MEN2)
Congenital disorders: Disorders of sexual differentiation; congenital adrenal hyperplasia; androgen insensitivity/ resistance syndrome; congenital hypothyroidism
Adverse effects of drugs on the endocrine system: Drug, medicinal, and biologic substance effects; exogenous steroid suppression of adrenal glands, anabolic steroids

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 01

Epidemiology/ population health

Measures of disease frequency: Incidence/ prevalence
Measures of health status: Rates, crude and adjusted; reproductive rates (example maternal mortality, neonatal/ infant/ under-5 mortality); mortality, morbidity; standardization; life expectancy, health-adjusted life expectancy
Measures of health status: Population attributable risk (PAR), population attributable risk percent (PAR%); risk factors
Survival analysis interpretation (example Kaplan-Meier curve)
Composite health status indicators, measures of population impact: Years of potential life lost; quality-adjusted life years; disability-adjusted life years; standardized mortality ratio
Population pyramids and impact of demographic changes
Disease surveillance and outbreak investigation: Disease reporting; response to public health advisory, health promotion; recognition of clusters
Communicable disease transmission: Attack rate; herd immunity; reportable diseases
Points of intervention: Primary, secondary; community level (example cigarette taxes, soda taxes, smoke-free cities, buildings: Restaurants, public buildings); school policies; access, healthy food, transportation, clean air, safe environments

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 02

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

Descriptive studies (case report [one person]/ case series [more than one])
Analytical studies: Observational-community surveys; cross-sectional (individuals); ecological (populations); case control; retrospective and prospective cohort
Analytical studies: Interventional-clinical trial (randomized controlled trial; double-blind; placebo-controlled; non inferiority/ equivalence trials); community intervention
Systematic reviews and meta-analysis: Potential uses; estimation of effect sizes; heterogeneity; publication bias; forest plots, funnel diagrams; risk of bias, bias risk scale
Obtaining and describing samples: Matching, inclusion/ exclusion criteria, selecting appropriate controls for studies, lack of controls, concealed allocation, randomization, stratification
Methods to handle noncompliance: Loss to follow-up; intention-to-treat analysis
Qualitative analysis

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 03

Measures of association

Relative risk
Odds ratio, hazard ratio
Other measures of association: Number needed to treat/ harm; absolute risk (AR), absolute risk percent (AR%); population attributable risk (PAR), population attributable risk percent (PAR%)
Distributions of data: Measures of central tendency; measures of variability; regression to mean; normal distribution; nominal measurement
Correlation and regression, uses and interpretation: Correlation coefficients; multiple regression

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 04

Principles of testing and screening

Properties of a screening test: Validity, accuracy, reliability; criteria for a screening test; confirmatory testing; appropriateness; lead-time bias, length bias; screening vs. diagnostic tests
Sensitivity and specificity; predictive value, positive and negative
ROC curves
Probability: Theory (independence, product, addition rules); decision trees; likelihood ratios (application of Bayes theorem); posttest, pretest

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 05

Study interpretation, drawing conclusions from data

Causation: Hypothesis-generating vs. hypothesis-driven testing; causal criteria, temporality, temporal sequence, dose-response relationship; reverse causality
Chance: Null hypothesis, type I error and alpha level (multiple comparisons, random error/ chance), sample size and type II error, beta, power, selection and interpretation of basic tests of statistical significance: chi-square; confidence intervals
Chance: P-values; t-test, a priori vs. post hoc analysis: Subgroup analysis; error rate; affect types
Interpretation of graphs/ tables and text
Bias, confounding, and threats to validity (includes methods to address): Selection, sampling bias, information bias: Recall; ascertainment, ecological fallacy, lack of blinding; loss to follow up, confounding variables
Bias, confounding, and threats to validity (includes methods to address): Hawthorne effect (includes methods to address), other threats to validity (example placebo effect)
Internal vs. external validity: Generalizability (external validity); efficacy vs. effectiveness
Statistical vs. clinical significance; clinical and surrogate outcome/ end point

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 06

Clinical decision making, interpretation and use of evidence-based data and recommendations

Application of study results to patient care and practice, including patient preferences and individualization of risk profiles; risk/ benefit analysis; synthesis of concepts with real data

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 07

Research ethics

Informed consent for research
Privacy of patient data (HIPAA)
Roles of institutional review boards (IRBs)
Intervention analysis: Intervention analysis; stopping analysis; safety monitoring
Regulatory issues: Drug development, phases of approval; appropriateness of placebo; appropriateness of randomized clinical trial; components of studies; ethics; scheduling; off-label use
Other issues related to research ethics

System specifications-Social sciences: Communication skills/ ethics/ patient safety: Unit 01

Communication and interpersonal skills, including health literacy and numeracy, cultural competence

Patient interviewing, consultation, and interactions with the family (patient-centered communication skills): Fostering the relationship (example expressing interest), information gathering (example exploring patient's reaction to illness)
Patient interviewing, consultation, and interactions with the family (patient-centered communication skills): Information provision (example providing information about working diagnosis), making decisions (example eliciting patient's perspectives)
Patient interviewing, consultation, and interactions with the family (patient-centered communication skills): Supporting emotions (example effective discussion with difficult patients), enabling patient behaviors (example education and counseling)
Use of an interpreter or surrogate

System specifications-Social sciences: Communication skills/ ethics/ patient safety: Unit 02

Medical ethics and jurisprudence, include issues related to death and dying and palliative care

Consent/ informed consent to treatment, permission to treat (full disclosure, risks and benefits, placebos, alternative therapies, conflict of interest, and vulnerable populations)
Determination of medical decision-making capacity/ informed refusal
Involuntary admission
Legal issues related to abuse (child, elder, and intimate partner): Child protective services, foster care, immunizations, legal requirements for reporting abuse or neglect/ obligation to warn
Birth-related issues
Death and dying and palliative care: Life support, advance directive, health care proxy, advance care planning, euthanasia and physician-assisted suicide, brain death/ diagnosing brain death/ diagnosing death, pronouncing death, organ donation, hospice
Death and dying and palliative care: Pain management, including ethical issues related to death and dying, information sharing, counseling families, psychosocial and spiritual counseling, fear and loneliness
Physician-patient relationship (boundaries, confidentiality including HIPAA, privacy, truth telling, other principles of medical ethics, example, autonomy, justice, beneficence)
Impaired physician, including duty to report impaired physician
Negligence/ malpractice, including duty to report negligence and malpractice
Physician misconduct, including duty to report physician misconduct
Referrals
Cultural issues not otherwise coded

System specifications-Social sciences: Communication skills/ ethics/ patient safety: Unit 03

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

Complexity/ systems thinking: Characteristics of a complex system and factors leading to complexity-how complexity leads to error, health care/ organizational behavior and culture: Environmental factors, workplace design and process; staffing
Complexity/ systems thinking: Health care/ organizational behavior and culture-overcommitment, space, people, time, scheduling; standardization, reducing variance, simplification, metrics; safety culture; integration of care across settings
Complexity/ systems thinking: Health care/ organizational behavior and culture-overutilization of resources (imaging studies, antibiotics, opioids); economic factors

System specifications-Social sciences: Communication skills/ ethics/ patient safety: Unit 04

Quality improvement

Improvement science principles: Variation and standardization-variation in process, practice; checklists, guidelines, and clinical pathways, reliability
Specific models of quality improvement: Model for improvement-plan-do-study-act (PDSA); plan-do-check-act (PDCA)
Quality measurement: Structure, process, outcome, and balancing measures, measurement tools: Run and control charts; development and application of system and individual quality measures: Core measures; physician quality report system (PQRS)
Quality measurement: Development and application of system and individual quality measures: Core measures; physician quality report system (PQRS); event reporting system
Strategies to improve quality: Role of leadership; principles of change management in quality improvement: Specific strategies
Attributes of high-quality health care: High-value/ cost-conscious care-overutilization of resources including diagnostic testing, medications, equitable care: Access, patient-centered care, timely care

System specifications-Social sciences: Communication skills/ ethics/ patient safety: Unit 05

Patient safety

Patient safety principles: (a) Epidemiology of medical error, (b) error categorization/ definition: Active vs. latent errors; Swiss cheese model of error; preventable vs. non-preventable; near miss events/ safety hazards
Patient safety principles: (c) Causes of error-(i) patient factors: Understanding of medication use; health literacy; economic status; cultural factors (example religion); failure to make appointments; socioeconomic status
Patient safety principles: (c) Causes of error-(ii) physician factors: Deficiency of knowledge; judgment errors; diagnostic errors; fatigue, sleep deprivation; bias-cognitive, availability, heuristic, anchoring, framing
Patient safety principles: (c) Causes of error-(iii) human factors (example cognitive, physical, environmental), (d) High reliability of organization (HRO) principles-change management and improvement science
Patient safety principles: (d) High reliability of organization (HRO) principles-conceptual models of improvement, (e) reporting and monitoring for errors: Event reporting systems
Patient safety principles: (e) Reporting and monitoring for errors-communication with patients after adverse events (disclosure/ transparency)
Specific types of error: (a) Transitions of care errors (example handoff communication including shift-to-shift, transfer, and discharge): Handoffs and related communication; discontinuities; gaps; discharge; transfers
Specific types of error: (b) Medication errors-ordering, transcribing, dispensing, administration (wrong quantity, wrong route, wrong drug), medication reconciliation, mathematical error, (c) procedural errors: Universal protocol (time out); wrong patient
Specific types of error: (c) Procedural errors-wrong site; wrong procedure; retained foreign bodies, injury to structures: Paracentesis; bowel perforation; thoracentesis; pneumothorax; central venous/ arterial line injuries
Specific types of error: (c) Procedural errors-Injury to structures: Arterial puncture and bleeding and venous thrombosis; lumbar puncture bleeding; paralysis, other errors: Anesthesia-related errors; mathematical errors
Specific types of error: (d) Health care-associated infections-nosocomial infection-example, surgical site, ventilator associated; catheter-related; handwashing procedures or inadequate number of handwashing stations
Specific types of error: (d) Health care-associated infections-central line-associated blood stream infections; surgical site infections; catheter-associated urinary tract infections; ventilator-associated pneumonia
Specific types of error: (e) Documentation errors-electronic medical record (including voice-recognition software errors); record keeping; incorrect documentation (example wrong patient, wrong date, copying and pasting, pre-labeling)
Specific types of error: (f) Patient identification errors-mislabeling-transfusion errors related to mislabeling; verification/ two identifiers: Lack of dual validation, including verbal verification of lab results
Specific types of error: (g) Diagnostic errors-errors in diagnostic studies; misinterpretation; (h) monitoring errors-cardiac monitoring/ telemetry, drug monitoring (warfarin, antibiotics), device-related errors: Malfunction, programming error
Specific types of error: (i) Device-related errors-incorrect use
Strategies to reduce error: (a) Human factors engineering, (b) situational awareness, (c) hierarchy of effective interventions: Forcing function; visual cues, (d) error analysis tools: Error/ near miss analysis; failure modes and effect analysis
Strategies to reduce error: (d) Error analysis tools-morbidity and mortality review; root cause analysis, (e) safety behavior and culture at the individual level: Hierarchy of health care, flattening hierarchy, speak up to power; afraid to report, fear
Strategies to reduce error: (e) Safety behavior and culture at the individual level-psychological safety; closed-loop communication, (f) teamwork: Principles of highly effective teams; case management; physician teams, physician-physician communication
Strategies to reduce error: (f) Teamwork-interprofessional/ interprofessional teams; strategies for communication among teams, including system-provider communication, physician-physician communication (example consultations)
Strategies to reduce error: (f) Teamwork-provider-interprofessional communication, patient communication

System specifications-Social sciences: Communication skills/ ethics/ patient safety: Unit 06

Health care policy and economics

Health care policy: (a) Health care disparities-race/ ethnicity; numeracy/ literacy; socioeconomic status, (b) access to care: Critical access systems or hospitals, social justice
Health care economics/ health care financing: (a) Types of insurance-medicare, medicaid, private insurance, self-pay, (b) navigating the insurance system: Deductibles/ co-pays; in-/ out-of-network; preferred providers
Health care economics/ health care financing: (c) Reimbursement issues affecting safety and quality: Emergency services-EMTALA; pay-for-performance

Physician tasks/ competencies specifications-Medical knowledge/ scientific concepts: Unit 01

Applying foundational science concepts

Identifies the cause/ infectious agent or predisposing factor(s) or, given an effect, determines the cause
Identifies the underlying processes/ pathways that account for, or contribute to, the expression or resolution of a given condition
Recognizes or evaluates given clinical or physical findings to identify the underlying anatomic structure or physical location
Recognizes the mechanisms of action of various drugs; selects from an option set list of drugs based on mechanism of action

Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 01

Diagnosis: Obtaining and predicting history and physical examination

Knows signs/ symptoms of selected disorders
Knows individual's risk factors for development of conditions
Given current symptoms in presented history, identifies other pertinent factors in the history
Given a specific problem, knows what to ask in obtaining further pertinent additional history
Predicts the most likely additional physical finding; selects either the finding itself or the appropriate examination technique that would result in the finding

Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 02

Diagnosis: Selecting and Interpreting Laboratory and diagnostic studies

Selects most appropriate laboratory or diagnostic study, including neuropsychiatric testing, or study most likely to establish/confirm the diagnosis
Interprets laboratory or other study findings
Predicts the most likely laboratory or diagnostic study result
Selects most appropriate laboratory or diagnostic study after a change in patient status

Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 03

Diagnosis: Formulating the diagnosis

Selects the most likely diagnosis
Assesses the developmental level of the patient

Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 04

Diagnosis: Determining prognosis/ outcome

Recognizes factors in the history, physical or laboratory study findings that affect patient prognosis or outcome or determine therapy
Interprets laboratory or other diagnostic study results and identifies current/ future status of patient
Recognizes associated conditions of a disease, including complications, or indicators of potential complications, of a given disease
Recognizes characteristics of disease relating to natural history or course of disease, including progression, severity, duration, and transmission of disease from a specific patient

Physician tasks/ competencies specifications-Patient care: Management: Unit 01

Management: Health maintenance and disease prevention

Knows risk factors for conditions amenable to prevention or detection in an asymptomatic patient, or knows the potential condition for which the patient may be at risk
Knows pertinent incidence statistics and identifies patient groups at risk; knows incidence of symptoms/ dangerous disorders among various groups
Knows common screening tests for conditions amenable to prevention or detection in an asymptomatic patient or population
Selects appropriate preventive agent or technique (eg, contraception, vaccines, vitamins)
Knows appropriate counseling of patient or family regarding maintenance of current and future problems, including risk factors related to present encounter
Educates patients on screening, health maintenance, self-care
Assesses the developmental level of a healthy patient
Knows the indications for surveillance for recurrence or progression of disease following treatment
Monitoring chronic disease in a stable patient where a change in patient status might cause a change in therapy
Knows appropriate long-term surveillance goals

Physician tasks/ competencies specifications-Patient care: Management: Unit 02

Management: Selecting and monitoring pharmacotherapy

Selects most appropriate pharmacotherapy
Assesses patient adherence with treatment regimen, recognizes techniques to increase adherence or understanding of the disease state, and knows how adherence may be affected by providing instructions with therapy
Recognizes factors that alter drug dosing requirements for a patient
Knows adverse effects of various drugs, or recognizes signs and symptoms of drug (and drug-drug) interactions resulting from polypharmacy in the therapeutic regimenand knows steps to prevent polypharmacy including lab studies to monitor drug therapy
Knows contraindications of various medications
Modifies therapeutic regimen within the context of continuing care; selects appropriate modifications in therapeutic regimen
Knows appropriate monitoring to evaluate effectiveness of drug therapy or to monitor for the adverse effects of drug therapy in a patient that has not had a recurrence or progression of disease

Physician tasks/ competencies specifications-Patient care: Management: Unit 03

Management: Clinical interventions/ treatment

Knows most appropriate management of selected conditions, including recognizing misuse of medication or drug or alcohol use
Knows immediate management or priority in management, specifically in emergency or acute cases
Knows most appropriate follow-up or monitoring approach regarding the management plan
Knows current/ short-term management of patients
Evaluates severity of patient condition in terms of need for referral for surgical treatments/ procedures versus other nonsurgical options
Knows appropriate surgical management
Knows pre/ post surgical or procedural management
Knows indications for admission to the hospital or to other appropriate setting (eg, ICU)
Knows appropriate non-hospital health care settings
Knows most appropriate discharge planning
Knows components of rehabilitation program
Knows appropriate use and procedures regarding hospice care
Educates patient or family regarding self-care
Knows relevant roles of allied health personnel

Physician tasks/ competencies specifications-Patient care: Management: Unit 04

Management: Selecting clinical interventions (mixed management)

Selects most appropriate management option from set of mixed management options (eg, mix of diagnostic studies, pharmacotherapy, procedures, observation, or referral)

Physician tasks/ competencies specifications-Communication: Unit 01

Fostering the relationship

Physician tasks/ competencies specifications-Communication: Unit 02

Gathering information

Physician tasks/ competencies specifications-Communication: Unit 03

Providing information

Physician tasks/ competencies specifications-Communication: Unit 04

Making decisions

Physician tasks/ competencies specifications-Communication: Unit 05

Supporting emotions

Physician tasks/ competencies specifications-Communication: Unit 06

Enabling patient behaviors

Physician tasks/ competencies specifications-Communication: Unit 07

Using an interpreteror surrogate

Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues: Unit 01

Understanding and applying principles of professionalism, legal and ethical issues in interactions with patients

Knows the guidelines for obtaining informed consent for treatment including children and adolescents, third-party permission, and emergent situations
Recognizes need for third-party permission for treatment in medical emergencies
Knows guidelines for treatment of minors with/ without notification of parents
Knows definitions of competence and sanity
Knows the guidelines for involuntary admission
Knows guidelines for confidentiality of medical records
Knows guidelines for physician-patient relationship
Knows issues related to cultural competence and can apply knowledge in specific patient situations

Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues: Unit 02

Understanding and applying legal and ethical issues related to death and dying

Assesses degree of disclosure to terminally ill patients
Recognizes patient's right to refuse treatment or testing (patient autonomy); knows issues of advance directives and living wills
Assesses quality-of-life decisions
Knows appropriate prescriptive practices; knows appropriate use of opioids in terminally ill patients
Knows definition of and legal issues regarding brain death
Knows management of terminally ill patients related to treating chronic pain, and recognizing patient's expression of fear of pain, injury, or death; knows how to comfort patient or family during crisis such as trauma or death

Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues: Unit 03

Understanding and applying professionalism, legal, and ethical issues in dealing with physicians and other health professionals

Knows guidelines for reporting findings to proper authorities
Knows good Samaritan laws
Recognizes physician error and negligence
Recognizes and deals appropriately with impaired physician

Physician tasks/ competencies specifications-Systems based practice, including patient safety: Unit 01

Systems based practice

Understands basic concepts and terminology, principles, and application of quality improvement science and outcome analysis
Recognizes and optimizes human and environmental factors (eg, workplace design, standardization, processes)
Understands the role and characteristics of teams and communication strategies

Physician tasks/ competencies specifications-Systems based practice, including patient safety: Unit 02

Patient safety

Anticipates, recognizes, analyzes, and mitigates risk (sources of error)
Evaluates, reports, and responds to near-misses and system errors
Identifies sources of error and suggests appropriate measures to evaluate or reduce the likelihood of specific errors

Physician tasks/ competencies specifications-Practice-based learning: Unit 01

Understanding and application of the principles of biostatistics and epidemiology

Understands and can apply principles of epidemiology and population health, including health status indicators, outbreak investigation, points of intervention
Understands and can apply principles of study design and study flaws
Understands and can apply the principles of screening and other tests
Understands use and interpretation of statistical principles and measures of association

Physician tasks/ competencies specifications-Practice-based learning: Unit 02

Application of information from studies or other written material to patient care

Decisions about patient care based on results of study or other written materials

Physician tasks/ competencies specifications-Practice-based learning: Unit 03

Understanding of the principles of research ethics and regulatory issues

CCS physician tasks/ competencies specifications-Patient care: diagnosis: Unit 01

History/ physical exam

CCS physician tasks/ competencies specifications-Patient care: diagnosis: Unit 02

Laboratory/ diagnostic studies

CCS physician tasks/ competencies specifications-Patient care: diagnosis: Unit 03

Diagnosis

CCS physician tasks/ competencies specifications-Patient care: diagnosis: Unit 04

Prognosis/ outcome

CCS physician tasks/ competencies specifications-Patient care: Management: Unit 01

Health maintenance/ disease prevention

CCS physician tasks/ competencies specifications-Patient care: Management: Unit 02

Pharmacotherapy

CCS physician tasks/ competencies specifications-Patient care: Management: Unit 03

Clinical interventions

CCS physician tasks/ competencies specifications-Patient care: Management: Unit 04

Mixed management

CCS physician tasks/ competencies specifications-Patient care: Management: Unit 05

Surveillance for disease recurrence

USMLE 2025 Result

NBME determines the results for all USMLE 2024 steps and step components and issues scorecards. Once Step 1, Step 2 CK, and Step 2 CS score reports are available, ECFMG notify the international medical students/graduates through their registered email accounts. Notification regarding availability of Step 3 reports will be notified by FSMB.

The score reports of USMLE 2024 will be available in electronic format only and can be accessed using ECFMG's OASIS; score reports will not be sent separately by post mail. The result of USMLE 2024 Step 1, Step 2 CK and Step 3 is typically available within three to four weeks from USMLE exam date 2024.

USMLE Scoring System

The scores for the USMLE exam are reported on 3 3-digit scale from 0 to 300. For Step 1 the scores are reported as either pass or fail.

USMLE 2024 Minimum Pass Marks

USMLE Component	Minimum Pass Marks
USMLE Step 1	Pass
USMLE Step 2 CK	206
USMLE Step 3	196

Candidates who would like to know the score for minimum pass marks, refer to the table above, will qualify for the exam. The pass rates can vary from one medical school to another medical school in USA.

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Frequently Asked Questions

1. How much does USMLE exam cost?

USMLE Steps 1 and 2 costs $940 and the next exam on Clinical Skills costs $1580.

2. Is MBBS required for USMLE?

You can start your USMLE step 1 preparation starting your second year of MBBS in India. If you are an Indian doctor, you are eligible to appear for USMLE step 1 after 2nd year of MBBS in India. You can obtain the USMLE step 1 preparation courses provided by Beckers and Kaplan.

3. Who is eligible for USMLE?

You should possess a DO degree from an AOA accredited medical school which is located in the USA OR an MD degree from WDOMS listed medical schools located outside of the USA and Canada and possess the ECFMG Certification. You should have also successfully cleared USMLE Step 1 and Step 2 examinations.

4. Can I get residency in the USA without USMLE?

You cannot apply for residency in the US as a foreign medical graduate without passing the USMLE (Steps 1 and 2). You won't be able to apply for a medical license in the US if you don't pass all USMLE components, including Step 3.

5. Can I work as a doctor in the USA without USMLE?

To receive your MD degree from a US medical school, you must pass parts 1 and 2 of the United States Medical Licensing Examination (USMLE). The majority of DOs educated in the US take it as well. Additionally, you cannot obtain a medical license without completing USMLE parts 1, 2, and 3.

6. Is there an age limit for USMLE?

There is no age limit for USMLE.

7. How many years are USMLE scores valid?

The USMLE scores are valid for 7 years. In the said period, you have to pass the additional ECFMG certification.

8. How many times can you attempt USMLE?

There can be a maximum of four attempts for each Step (4). Examinees who have taken four or more attempts at any USMLE Step (including Step 2 CS) and failed are ineligible to apply for USMLE Steps.

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Questions related to USMLE

Have a question related to USMLE ?

Can students from Crimea Federal University russia allowed to give USMLE ?

Students from Crimea Federal University in Russia can apply to take the USMLE (United States Medical Licensing Examination) as long as they meet the general eligibility requirements set by the USMLE, which include being a student or graduate of a medical school recognized by the World Directory of Medical Schools. However, due to political and administrative reasons, students from Crimea may face additional challenges, such as verifying their medical school credentials. For comprehensive guidance on navigating these challenges and ensuring eligibility for the USMLE, consulting with Invicta Career Consultancy can provide tailored support and advice for your medical education and licensing plans, While there are other options available, hence you can pay a visit to their website (icclearning.com) and get a consult with them for better guidance. All the best to you.

Read Complete Answer

Amrita Koner 06 August 2024

What is the PLAB exam ( is cracking NEET PG required ) , could you please explain in detail what is the pathway starting from NEET UG ? same with USMLE and MRCS ????

Hi aspirant
See, what you've asked about, are the entrance exams conducted at an international level.
Once you give complete your graduation i.e MBBS. You might want to pursue PG in India. For that you'll have to give NEET PG entrance examination. Now you might also want to settle abroad or pursue specialization abroad. In that case such exams like PLAB and USMLE are conducted.

PLAB is Professional and Linguistic Assessment Board. It is a licensing examination conducted for foreign medical graduates who wish to practice medicine in the UK . PLAB is undertaken by the General Medical Council (UK) in several countries across the globe.
There are two parts of the PLAB exam

Part 1 : 180 single best answer questions.
Part 2 comprises of 18 scenarios, each lasting eight minutes

Candidate are selected according to their score.

Now USMLE is United States The United States Medical Licensing Examination
It is a necessary medical license to practice in the United States of America (USA).
The FSMB (Federation of State Medical Boards) and NBME (National Board of Medical Examiners) are co-sponsors of this exam.
It is took by the students who wish to study and practice in the US.

Hope this helps
All the best:)

Read Complete Answer

Aakanksha 13 August 2022

which country best for USMLE CRACK

Hello aspirant,

India and Phillipines are the best country.

Every year plenty of Indian students apply for USMLE, though everyone should understand that among those many of the students are students studying/studied in foreign medical colleges from various countries. So, when we question whether it is easy to crack USMLE if the student study in local/Indian medical colleges or in Foreign medical colleges, which require a thorough understanding of all the criteria including the student’s individual interest impacting most of their performance.

USMLE—the United States Medical Licensing Examination is the most popular PG entrance examination in the world where all the world’s medical graduates dream to get a chance to qualify and enter into those prestigious institutions to study PG or Residency.

The United States Medical Licensing Examination—USMLE is the licensure cum medical PG entrance examination to obtain a medical license as well to study their Post-Graduation in various US medical colleges. USMLE is co-sponsored by the National Board of Medical Examiner—NBME and the Federation of State Medical Boards—FSMB together.

Read Complete Answer

suchismitaboxi2002 03 August 2022

I want to appear for USMLE after MBBS, which college should I choose for doing MBBS which will allow me to appear for USMLE

Hello,

A MBBS physician's capacity to put knowledge into practical medical practise is evaluated by the United States Medical Licensing Examination (USMLE). Contains Steps 1 and 2. If you take it, you'll be able to practise medicine in the US. After earning 6 Cr and prudently investing 3 Cr over the course of 60 months, you are free to return to India.

List of colleges you can choose for doing MBBS which will allow you to appear for USMLE :-

AIIMS, New Delhi
CMC, Vellore
Osmania Medical College, Hyderabad
King George Medical University, Lucknow and many more.

Thank You

Read Complete Answer

Sayan 01 September 2022

Is an MMBS graduate from Tagore Medical College, Chennai eligible to appear for USMLE and do Residency in USA?

Hello,

You can obviously practice medicine in United States of America. But you need to take the screening test called U.S.M.L.E exam which is The United States Medical Licensing Examination.

To know more about U.S.M.L.E exam, please take a look the below link.

https://studyabroad.careers360.com/exams/usmle

Students whoever want to do medicine in United States of America, you can take U.S.M.L.E exam. The first year of training after medical school is called an internship, or more commonly it is called first year of residency or PGY-1 (Post-Graduate-Year-1). The following years are called PGY-2, PGY-3, etc. The training that is done after a residency (in a subspecialty) is usual called a fellowship.

All the best for your career!!!

Thank You.

Read Complete Answer

Jaysre P 06 August 2022

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USMLE Exam 2025 Step 1, 2 and 3 – Dates, Fees, Centers, Pattern, Result

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USMLE 2025 Syllabus

System specifications-General principles of foundational science

System specifications-Behavioral health

System specifications-Nervous system and special senses

System specifications-Female reproductive system and breast

System specifications-Male reproductive system

System specifications-Endocrine system

System specifications-Respiratory system

System specifications-Renal and urinary system

System specifications-Blood and lymphoreticular system

System specifications-Immune system

System specifications-Multisystem processes and disorders

System specifications-Cardiovascular system

System specifications-Musculoskeletal system

System specifications-Skin and subcutaneous tissue

System specifications-Gastrointestinal system

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature

System specifications-Social sciences

Physician tasks/ competencies specifications-Medical knowledge/ scientific concepts

Physician tasks/ competencies specifications-Patient care: Diagnosis

Physician tasks/ competencies specifications-Patient care: Management

Physician tasks/ competencies specifications-Communication

Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues

Physician tasks/ competencies specifications-Systems based practice, including patient safety

Physician tasks/ competencies specifications-Practice-based learning

Discipline specifications-Behavioral sciences

Discipline specifications-Biochemistry and nutrition

Discipline specifications-Genetics

Discipline specifications-Gross anatomy and embryology

Discipline specifications-Histology and cell biology

Discipline specifications-Immunology

Discipline specifications-Microbiology

Discipline specifications-Pathology

Discipline specifications-Pharmacology

Discipline specifications-Physiology

System specifications-General principles of foundational science

System specifications-Immune system

System specifications-Blood and lymphoreticular system

System specifications-Behavioral health

System specifications-Nervous system and special senses

System specifications-Skin and subcutaneous tissue

System specifications-Musculoskeletal system

System specifications-Cardiovascular system

System specifications-Respiratory system

System specifications-Gastrointestinal system

System specifications-Renal and urinary system

System specifications-Pregnancy, childbirth, and the puerperium

System specifications-Female reproductive system and breast

System specifications-Male reproductive system

System specifications-Endocrine system

System specifications-Multisystem processes and disorders

System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature

System specifications-Social sciences

Physician tasks/ competencies specifications-Medical knowledge/ scientific concepts

Physician tasks/ competencies specifications-Patient care: Diagnosis

Physician tasks/ competencies specifications-Patient care: Management

Physician tasks/ competencies specifications-Communication

Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues