USMLE 2024 Step 1, 2 and 3 – Dates, Online Form, Admit Card, Syllabus

System specifications-Behavioral health: Unit 01

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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 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: (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

• 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

• 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

• 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

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

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

• 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

• 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

• 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

• 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

• 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

Physician tasks/ competencies specifications-Communication: Unit 02

Physician tasks/ competencies specifications-Communication: Unit 03

Physician tasks/ competencies specifications-Communication: Unit 04

Physician tasks/ competencies specifications-Communication: Unit 05

Physician tasks/ competencies specifications-Communication: Unit 06

Physician tasks/ competencies specifications-Communication: Unit 07

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

• 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

• 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

• 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

• 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

• 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

• 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

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

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

System specifications-Immune system: Unit 01

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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 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: (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

• 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

• 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

• 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

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

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

• 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

• 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

• 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

• 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

• 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

Physician tasks/ competencies specifications-Communication: Unit 02

Physician tasks/ competencies specifications-Communication: Unit 03

Physician tasks/ competencies specifications-Communication: Unit 04

Physician tasks/ competencies specifications-Communication: Unit 05

Physician tasks/ competencies specifications-Communication: Unit 06

Physician tasks/ competencies specifications-Communication: Unit 07

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

• 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

• 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

• 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

• 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

• 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

• 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

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

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

System specifications-Immune system: Unit 01

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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 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: (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

• 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

• 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

• 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

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

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

• 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

• 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

• 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

• 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

• 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

Physician tasks/ competencies specifications-Communication: Unit 02

Physician tasks/ competencies specifications-Communication: Unit 03

Physician tasks/ competencies specifications-Communication: Unit 04

Physician tasks/ competencies specifications-Communication: Unit 05

Physician tasks/ competencies specifications-Communication: Unit 06

Physician tasks/ competencies specifications-Communication: Unit 07

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

• 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

• 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

• 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

• 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

• 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

• 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

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

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

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

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

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

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

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

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

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

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

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