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USMLE 2023 Step 1, 2 and 3 – Dates, Online Form, Admit Card, Syllabus
Updated on 11th Sep, 2023 by M Anusha
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About USMLE 2023
The USMLE is a three-step examination written by international students worldwide to get an initial license to practice medicine in the USA. This USMLE is owned by two entities namely the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners(NBME). Every year more than 12000 candidates take part in the exam. This USMLE 2023 Step 1, Step CK2 can be attempted from any major city all over the world in USMLE test centers, while USMLE Step 3 must be taken in the US. This USMLE 2023 exam assesses the physician characteristics required for patient care like medical knowledge, skills, values, attitudes, etc. Candidates outside of the USA & Canada can register for the USMLE 2023 exam through ECFMG’s online services on the USMLE official website. Before applying for USMLE exam or selecting the USMLE exam dates 2023, kindly check this exam page for prior information.
USMLE Full Form
The full form of the word USMLE is the United States Medical Licensing Examination. It is a medical licensing exam. Usually taken during the different stages of the medical education. The USMLE test is suitable for medical graduates who are planning to practice medicine in the USA country. The USMLE is a computer-based test that uses the Computer-based Case Simulation software(CCS).
What is USMLE Exam?
The USMLE acts as a qualifying exam for obtaining the license to practice medicine in the USA. Candidates who are studying MBBS or graduated from medical programs are eligible to take this USMLE 2023 exam. The exam includes USMLE Step 1, Step 2 CK, and Step 3. Step 2 comprises two components - Clinical Knowledge (CK); each component has to be taken separately. USMLE Step 1 and USMLE Step 2 components can be taken in any sequence, but Step 3 can be taken only after all other steps and step components are complete. USMLE steps 2023 will be conducted in computer-based mode.
USMLE Steps
As stated there are 3 steps in USMLE exam, each step assess the candidate in understanding and apppplication of concepts in the practice of medicine.
USMLE Step 1 - Step 1 is a one-day exam to assess the candidate in understanding and applying important concepts of basic science with special emphasis on principles and mechanisms.
USMLE Step 2 - Step 2 is a one-day exam that assesses the application of medical knowledge and understanding of clinical science essential in patient care under supervision.
USMLE Step 3 - It is the final assessment for physicians assuming independent responsibility in delivering medical care.
USMLE Latest Update 1
USMLE Step 1 score reporting will transition from a numeric score and pass/fail outcome to pass/fail only for exams taken on or after January 26, 2022. The USMLE exam program views this change as an important first step toward facilitating broader, system-wide changes to improve the transition from undergraduate to graduate medical education. To receive a numeric score, examinees must take their exam on or before January 25, 2022. For multi-day exams, the date of the first day of the USMLE testing will determine score reporting. Both Scores and Transcripts will include only Pass/Fail outcome.
USMLE Latest Update 2:
The number of USMLE exam attempts allowed on each Step is reduced from six to four.
USMLE Latest Update 3:
The USMLE program has released the 2022 examinee performance data for each of its three Step exams. The performance tables show the passing rates for each Step by various examinee groups and are available at www.usmle.org/performance-data.
USMLE 2023 Highlights
| Full Exam Name | United States Medical Licensing Examination |
| Short Exam Name | USMLE |
| Conducting Body | Federation of State Medical Boards |
| Exam Level | International Level Exam |
| Languages | English |
| Mode of Application | Online |
| USMLE Step 1 - Duration | 8 Hours +2 More |
Download all details about USMLE 2023
Before applying to any step or step component of the USMLE 2023, the applicant should carefully go through the USMLE eligibility criteria of that step or step component. It is because the USMLE eligibility criteria 2023 of one step can vary from another; for example Step 3 is allowed only after completion of all other steps.
Eligibility for USMLE Step 1 2023
Step | USMLE Eligibility Criteria |
Step 1 | The medical student or graduate must be enrolled in, or a graduate of, a medical school that is located outside the US or Canada and is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements; In addition, any other ECFMG criteria also have to be fulfilled. Other mentionable:
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Eligibility for USMLE 2023: USMLE Step 2 (CK)
Step | USMLE Eligibility Criteria |
Steps 2 CK | The applicant must be admitted to, or should be a graduate of, a medical school which is:
The applicant also has to fulfil ECFMG criteria as may be prescribed. Other details:
|
Eligibility for USMLE 2023 Step 3
USMLE Step | USMLE Eligibility Criteria |
STEP 3 | To be eligible for USMLE Step 3, the applicant must have completed an MD or an equivalent degree from a medical school that is located outside the US or Canada, which is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements. Apart from this, the applicant must:
Other Information: Must meet eligibility requirements before submitting the application and on test day. |
Sequence of USMLE examination:
USMLE Step 1, Step 2 CK can be taken in any order or sequence. However, Step 3 can be taken only on completion of all other steps, i.e. USMLE Step 1 and USMLE Step 2 components.
Mode of Application : Online
Mode of Payment : Credit Card
Each step and step component of the USMLE 2023 has a separate application form. So, depending on the USMLE exam steps for international students, the USMLE 2023 application form has to be filled. Also, one must note that Step 1 and Step 2 components (CS and CK) can be taken in any sequence, but Step 3 is only allowed after completion of USMLE Step 1, Step 2 CK and Step 2 CS.
USMLE 2023 Registration Entity
Step 1, Step 2 CK, Step 2 CS | Step 1, Step 2 CK, Step 2 CS | Step 3 |
For students / graduates of LCME-or AOA-accredited medical programs in the US or Canada: | For students / graduates of medical schools located outside the US and Canada: | All medical school graduates who have passed Step 1, Step 2 CK, and Step 2 CS: |
Apply through NBME on NLES (NBME Licensing Examination Services) | Apply through ECFMG on IWA (Interactive Web Applications) | Apply through FSMB. |
Step 1, Step 2 CK, and Step 3 of USMLE 2023 are usually not offered in the first 2 weeks of January or on major local holidays. So make it a point to check available USMLE step 1 dates 2023, step 2 dates in the scheduling system.
USMLE Fees 2023
USMLE Component | USMLE Fees 2023 |
Application for ECFMG Certification | US $150 |
USMLE Step 1 | US $975 - Examination Fee + International Test Delivery Surcharge, if testing outside the United States and Canada |
USMLE Step 2 CK | US $975 - Examination Fee + International Test Delivery Surcharge, if testing outside the United States and Canada |
USMLE Step 2 CS | US $1,600 - Examination Fee |
USMLE Step 3 | US $895 |
Extension of Eligibility Period (for Step 1/Step 2 CK) | US $90 per exam |
Testing Region Change (for Step 1/Step 2 CK ) | US $85 per region change |
Rescheduling Fee (for Step 1/Step 2 CK) | US $0 – $604 (depending on exam, testing region, and USMLE dates 2023 of cancellation) |
Rescheduling Fee (for Step 2 CS) | US $0 – $1,300 (depending on USMLE dates 2023 of cancellation) |
Score Recheck (for Step 1/Step 2 CK/Step 2 CS) | US $80 per exam |
USMLE 2023 Syllabus
USMLE Step 1 Syllabus
System specifications-General principles of foundational science
System specifications-General principles of foundational science: Unit 01
Biochemistry and molecular biology |
|---|
| Gene expression: DNA structure, replication, exchange, and epigenetics (example imprinting, X-activation, DNA methylation), gene expression: Transcription, gene expression: Translation, post-translational processing |
| Gene expression: Modifications and disposition of proteins (degradation), including protein/ glycoprotein synthesis, intra-extracellular sorting, and processes/ functions related to golgi complex and rough endoplasmic reticulum |
| Structure and function of proteins and enzymes (example enzyme kinetics and structural/ regulatory proteins), energy metabolism (example ATP generation, transport chain) |
System specifications-General principles of foundational science: Unit 02
Biology of cells |
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| Adaptive cell responses and cellular homeostasis (example, hypertrophy), mechanisms of injury and necrosis, including pathologic processes (example liquefactive necrosis, free radical formation), apoptosis |
| Cell cycle and cell cycle regulation (example mitosis), mechanisms of dysregulation, cell biology of cancer (example role of p53, proto-oncogenes), general principles of invasion and metastasis, including cancer staging |
| Cell/ tissue structure, regulation, and function, including cytoskeleton, organelles, glycolipids, channels, gap junctions, extracellular matrix, and receptors |
System specifications-General principles of foundational science: Unit 03
Human development and genetics |
|---|
| Principles of pedigree analysis, inheritance patterns, occurrence and recurrence risk determination, population genetics: Hardy-Weinberg law, founder effects, mutation-selection equilibrium, principles of gene therapy, genetic testing and counseling |
| Genetic mechanisms (example penetrance, genetic heterogeneity) |
System specifications-General principles of foundational science: Unit 04
Biology of tissue response to disease |
|---|
| Acute inflammatory responses (patterns of response), acute inflammation and mediator systems (example histamine, prostaglandins, bradykinins, eosinophilic basic protein, nitric oxide), vascular response to injury, including mediators |
| Principles of cell adherence and migration (example ECAMs, selectins, leukocytic diapedesis, and rolling), microbicidal mechanisms and tissue injury (example defensins) |
| Clinical manifestations (example, pain, fever, leukocytosis, leukemoid reaction, chills), chronic inflammatory responses (example tumor necrosis factor) |
| Reparative processes, wound healing, repair: Thrombosis, granulation tissue, angiogenesis, fibrosis, scar/ keloid formation, regenerative process |
System specifications-General principles of foundational science: Unit 05
Pharmacodynamic and pharmacokinetic processes: General principles |
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| Pharmacokinetics: Absorption, distribution, metabolism, excretion, dosage intervals, mechanisms of drug action, structure-activity relationships (example, anticancer drugs), concentration and dose-effect relationships (example efficacy, potency) |
| Types of agonists (example full, partial, inverse) and antagonists and their actions |
| Individual factors altering pharmacokinetics and pharmacodynamics (example age, gender, disease, tolerance, compliance, body weight, metabolic proficiency, pharmacogenetics) |
| Mechanisms of drug adverse effects, overdosage, toxicology, mechanisms of drug interactions |
| Signal transduction, including structure/ function of all components of signal transduction, pathways such as receptors, ligands (example general principles of nitric oxide, autocrine and paracrine signaling) |
System specifications-General principles of foundational science: Unit 06
Microbial biology |
|---|
| Microbial identification and classification, including principles, microorganism identification, and non-immunologic laboratory diagnosis |
| Bacteria: Structure (example cell walls, composition, appendages, virulence factors, extracellular products, toxins, mechanism of action of toxins), processes, replication, and genetics (example metabolism, growth, and regulation), oncogenesis |
| Bacteria: Antibacterial agents (example mechanisms of action on organism, toxicity to humans, and mechanisms of resistance) |
| Viruses: Structure (example physical and chemical properties, virulence factors), processes, replication, and genetics (example life cycles, location of virus in latent infection), oncogenesis |
| Viruses: Antiviral agents (example mechanisms of action on virus, toxicity to humans, and mechanisms of resistance) |
| Fungi: Structure (example cell wall, composition, appendages, virulence factors, extracellular products, toxins, mechanisms of action of toxins), processes, replication, and genetics (example asexual vs. sexual, metabolism, growth) |
| Fungi: Antifungal agents (example mechanisms of action on fungus, toxicity to humans, and mechanisms of resistance) |
| Parasites: Structure (example appendages, macroscopic features, and virulence factors), processes, replication, and genetics (example life cycles, metabolism, and growth), oncogenesis |
| Antiparasitic agents (example mechanisms of action on parasite, toxicity to humans, and mechanisms of resistance) |
| Prions |
System specifications-General principles of foundational science: Unit 07
Normal age-related findings and care of the well patient |
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| Infancy and childhood (0-12 years): (a) Normal physical changes-linear growth, variations in linear growth, including constitutional delay; weight; head circumference; micturition, defecation, primary incontinence/ bedwetting; normal physical examination |
| Infancy and childhood (0-12 years): (a) Normal physical changes-screening; sleep; teething syndrome, (b) developmental stages: Motor; speech; cognitive; psychosocial; anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition |
| Infancy and childhood (0-12 years): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine; risk factors and prevention (example guns, swimming, motor vehicles, car seats) |
| Infancy and childhood (0-12 years): (c) Lifestyle and routine preventive health care-routine vaccinations |
| Adolescence (13-17 years): (a) Normal physical changes-linear growth, variations in linear growth including constitutional delay; weight; puberty; normal physical examination; gynecomastia; autonomy/ self-identity; sleep |
| Adolescence (13-17 years): (b) Developmental stages-cognitive (example abstract thought); psychosocial (example autonomy, role confusion, sexual identity); anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition |
| Adolescence (13-17 years): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine |
| Adolescence (13-17 years): (c) Lifestyle and routine preventive health care-risk factors and prevention (example risk-taking behavior, helmets, safe sex, motor vehicles, seat belts, distractions); routine vaccinations |
| Adulthood (18-64 years): (a) Normal physical changes-weight; normal physical examination; screening; sleep, (b) developmental stages: Cognitive; intimacy vs. isolation; anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition |
| Adulthood (18-64 years): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine; risk factors and prevention; routine vaccinations |
| Older adulthood (65 years and older): (a) Normal physical changes, including normal physical exam for age-weight, height (spinal compression), skin, bruising; normal physical examination; response to temperature; micturition, defecation; sleep |
| Older adulthood (65 years and older): (b) Developmental stages-motor; cognitive (example psychomotor slowing); psychosocial; integrity vs. despair; retrospection; anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition |
| Older adulthood (65 years and older): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine |
| Older adulthood (65 years and older): (c) Lifestyle and routine preventive health care-risk factors and prevention (example falls, general medical condition; polypharmacy, driving, caregiver stress); routine vaccinations |
System specifications-Behavioral health
System specifications-Behavioral health: Unit 01
Normal processes |
|---|
| Psychodynamic and behavioral factors, related past experience (example transference, personality traits) |
| Adaptive behavioral responses to stress and illness (example coping mechanisms) |
| Maladaptive behavioral responses to stress and illness (example drug-seeking behavior, sleep deprivation) |
| Patient adherence: General adherence; adolescent adherence |
System specifications-Behavioral health: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Psychotic disorders: Brief psychotic disorder; delusional disorder; psychotic disorder due to another medical condition; schizophrenia; schizoaffective disorder; substance-induced psychotic disorder |
| Anxiety disorders: Acute stress disorder; anxiety disorders (generalized anxiety disorder, anxiety due to another medical condition, social phobia); hyperventilation syndrome; obsessive-compulsive disorder; panic disorder with and without agoraphobia |
| Anxiety disorders: Phobic disorders; post-traumatic stress disorder; separation anxiety disorder; substance-induced anxiety disorder, trichotillomania |
| Mood disorders: Major depressive disorder with and without psychotic features, with and without seasonal pattern; major depressive disorder, postpartum, with and without psychotic features, including screening; cyclothymic disorder |
| Mood disorders: Persistent depressive disorder (dysthymia); bipolar disorder, manic/ depressed/ mixed; premenstrual dysphoric disorder; bipolar and related disorder or depressive disorder due to another medical condition |
| Mood disorders: Substance/ medication-induced bipolar and related disorder or depressive disorder (illegal or prescribed); suicidal ideation/ attempt |
| Somatoform disorders: Body dysmorphic disorder; conversion disorder, including psychogenic seizures; dissociative disorders; illness anxiety disorder (hypochondriasis); malingering; pain disorder; somatic symptom disorder |
| Factitious disorders: Factitious disorder imposed on self |
| Eating disorders and impulse control disorders: Anorexia nervosa; binge-eating disorder; bulimia nervosa; eating disorder; disruptive, impulse-control, and conduct disorders (example gambling, kleptomania, pyromania) |
| Disorders originating in infancy/ childhood: Reactive attachment disorder; attention deficit/ hyperactivity disorder; speech sound disorder or language disorder; learning disorder/ dyslexia; intellectual developmental disorder and developmental delay |
| Disorders originating in infancy/ childhood: Undefined, including school problems, fetal alcohol syndrome; oppositional defiant disorder, conduct disorder; autism spectrum disorder, rett syndrome; psychoses with origin specific to childhood |
| Disorders originating in infancy/ childhood: Elimination disorders (incontinence, encopresis); tic disorders/ tourette disorder |
| Personality disorders: Antisocial personality disorder; avoidant personality disorder; borderline personality disorder; dependent personality disorder; histrionic personality disorder; narcissistic personality disorder |
| Personality disorders: Obsessive-compulsive personality disorder; paranoid personality disorder; schizoid personality disorder |
| Psychosocial disorders/ behaviors: Adjustment disorder; grief response/ bereavement, normal and persistent complex; parent-child relational problems other than physical or emotional abuse; other psychosocial stress |
| Sexual and gender identity disorders: Gender dysphoria; psychosexual dysfunction |
| Substance use disorders: Alcohol use disorder/ intoxication/ dependence/ withdrawal; tobacco/ nicotine use disorder/ dependence/ withdrawal; varenicline use; cannabis use disorder/ intoxication/ dependence |
| Substance use disorders: Hallucinogen use disorder/ intoxication/ dependence/ withdrawal; inhalant use disorder/ intoxication/ dependence/ withdrawal; opioid, heroin, including prescription drug, use disorder/ intoxication/ dependence/ withdrawal |
| Substance use disorders: Sedative, hypnotic, including benzodiazepine and barbiturate use disorder/ intoxication/ dependence/ withdrawal; stimulant, cocaine, methamphetamine use disorder/ intoxication/ dependence/ withdrawal |
| Substance use disorders: Other drugs of use disorders (example ecstasy, PCP, bath salts)/ intoxication/ dependence/ withdrawal; polysubstance use disorder/ intoxication/ dependence/ withdrawal |
System specifications-Nervous system and special senses
System specifications-Nervous system and special senses: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes, including neural tube derivatives, cerebral ventricles, and neural crest derivatives |
| Organ structure and function: (a) Spinal cord-gross anatomy and blood supply, spinal reflexes, brain stem (example cranial nerves and nuclei, reticular formation, anatomy and blood supply, control of eye movements) |
| Organ structure and function: (b) Brain-gross anatomy and blood supply, higher function: Cognition, language, memory, executive function, hypothalamic function, limbic system and emotional behavior, circadian rhythm sleep-wake disorder |
| Organ structure and function: (c) Sensory systems-general sensory modalities, including sharp, dull, temperature, vibratory, and proprioception, special sensory modalities, including vision, hearing, taste, olfaction, and balance |
| Organ structure and function: (d) Motor systems-brain and spinal cord (upper motor neuron), basal ganglia and cerebellum, autonomic nervous system, peripheral nerves |
| Cell/ tissue structure and function, including neuronal cellular and molecular biology: Axonal transport, excitable properties of neurons, axons, and dendrites, including channels synthesis, storage, release |
| Cell/ tissue structure and function, including neuronal cellular and molecular biology: Reuptake, and degradation of neurotransmitters and neuromodulators, presynaptic and postsynaptic receptor interactions, trophic and growth factors, brain metabolism |
| Cell/ tissue structure and function, including neuronal cellular and molecular biology: Glia, myelin, brain homeostasis: Blood-brain barrier, cerebrospinal fluid formation and flow, choroid plexus |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Nervous system and special senses: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
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| 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
System specifications-Female reproductive system and breast: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes, gametogenesis |
| Organ structure and function: Female structure, including breast female function (example ovulation, menstrual cycle, puberty) intercourse, sexual response |
| Cell/ tissue structure and function: Hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones |
| Reproductive system defense mechanisms and normal flora |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Female reproductive system and breast: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Breast: (a) Infectious, immunologic, and inflammatory disorders-breast abscess; inflammatory disease of breast, fat necrosis; mastitis; nipple discharge, (b) neoplasms-(i) benign and undefined neoplasms: Breast cyst, solitary; fibrocystic changes |
| Breast: (b) Neoplasms-(i) Benign and undefined neoplasms-fibroadenoma; hypertrophy of breast; intraductal papilloma, (ii) malignant neoplasms (including screening): Breast cancer; intraductal carcinoma; Paget disease of breast; phyllodes tumors |
| Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-bacterial vaginosis; Bartholin gland abscess; cellulitis, pelvic; candidiasis of the vulva or vagina; lichen sclerosus; sexually transmitted infections and exposure |
| Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-cervicitis and endocervicitis; chancroid (Haemophilus ducreyi); genital herpes; gonorrhea (Neisseria gonorrhoeae); human papillomavirus infection |
| Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-genital/ venereal/ anal warts, condylomata acuminata; lymphogranuloma venereum (Chlamydia trachomatis), non-lymphogranuloma venereum; pelvic inflammatory disease |
| Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-Fitz-Hugh–Curtis syndrome; salpingitis and oophoritis; syphilis (Treponema pallidum); trichomoniasis (Trichomonas vaginalis); urethritis; vaginitis; vulvovaginitis |
| Neoplasms of the cervix, ovary, uterus, vagina, and vulva: (a) Benign neoplasms and cysts-abnormal Pap smear; benign neoplasm of ovary; endocervical and endometrial polyps; leiomyomata uteri; ovarian cyst |
| Neoplasms of the cervix, ovary, uterus, vagina, and vulva: (b) Malignant and precancerous neoplasms-cervical cancer; HPV causing cancer; cervical dysplasia, HPV causing dysplasia; endometrial hyperplasia; endometrial/ uterine cancer |
| Neoplasms of the cervix, ovary, uterus, vagina, and vulva: (b) Malignant and precancerous neoplasms-gestational trophoblastic disease (hydatidiform mole); ovarian cancer; vulvar dysplasia, and cancer |
| Fertility and infertility: Assisted reproductive techniques (ART); contraception (example oral contraceptives, IUD, vaginal cap, cervical sponge, diaphragm, implant, morning-after pill, male and female condoms); female infertility |
| Fertility and infertility: Gonadal dysgenesis 45,X (Turner syndrome); sterilization; tubal factors; infertility |
| Menopause: Ovarian failure, premature menopause; perimenopause; premenopausal menorrhagia; postmenopausal atrophic vaginitis (vaginal atrophy); postmenopausal bleeding; vasomotor symptoms |
| Menstrual and endocrine disorders: Abnormal uterine bleeding, including perimenopausal; absence of menstruation (primary amenorrhea, secondary amenorrhea including undiagnosed pregnancy); anovulation; dysmenorrhea; endometriosis; hirsutism, virilization |
| Menstrual and endocrine disorders: Mittelschmerz; pelvic pain; polycystic ovarian syndrome; postcoital bleeding; premenstrual syndrome |
| Sexual dysfunction: Dyspareunia; orgasmic dysfunction; sexual desire/ arousal syndrome; vaginismus |
| Traumatic and mechanical disorders: Asherman syndrome; chronic inversion of uterus; chronic pelvic pain syndrome; cystocele; imperforate hymen; injuries, wounds, and burns affecting the female reproductive system and injuries, wounds |
| Traumatic and mechanical disorders: Burns, and blast injuries; ovarian torsion; pelvic relaxation; rectocele; urethrocele |
| Congenital disorders: Müllerian agenesis; uterus didelphys, bicornuate uterus; short cervix |
| Adverse effects of drugs on the female reproductive system and breast: Antihistamines, H2-receptor blockers; benzodiazepines; beta-adrenergic blockers; hormone replacement; opioids; spironolactone; selective serotonin reuptake inhibitors |
| Adverse effects of drugs on the female reproductive system and breast: Tricyclic antidepressants |
System specifications-Male reproductive system
System specifications-Male reproductive system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and neonatal changes, gametogenesis |
| Organ structure and function: Structure, male genitalia and prostate function, male genitalia and prostate (example spermatogenesis, puberty) intercourse, orgasm, erection |
| Cell/ tissue structure and function, including hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones |
| Reproductive system defense mechanisms and normal flora |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Male reproductive system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-balanitis; epididymitis; orchitis; prostatitis; sexually transmitted infections and exposure; chancroid (Haemophilus ducreyi); genital herpes; gonorrhea (Neisseria gonorrhoeae) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-human papillomavirus infection, genital/ venereal/ anal warts, condylomata acuminata; lymphogranuloma venereum (Chlamydia trachomatis); syphilis (Treponema pallidum) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-trichomoniasis (Trichomonas vaginalis); urethritis, chlamydial and nonchlamydial, nongonococcal, (b) immunologic and inflammatory disorders: Autoimmune hypogonadism |
| Neoplasms: Malignant neoplasms, penile, prostate, testicular, breast |
| Metabolic and regulatory disorders, including sexual dysfunction: Erectile dysfunction, impotence; infertility, male factor; male sexual dysfunction; premature ejaculation |
| Traumatic and mechanical disorders: Benign prostatic hyperplasia/ hypertrophy; circumcision, including complications; epididymal cyst; hydrocele; injuries, wounds, and burns to male genitalia, including blast injuries; penile laceration, penile fracture |
| Traumatic and mechanical disorders: Peyronie disease; phimosis; scrotal laceration; spermatocele; testicular rupture/ avulsion/ laceration; torsion of testis; urethral laceration/ disruption; varicocele |
| Congenital disorders of the male reproductive system: Hypospadias; Klinefelter syndrome; undescended testicle |
| Adverse effects of drugs on the male reproductive system: Alcohol; androgens, testosterone; antipsychotics, antidepressants including selective serotonin reuptake inhibitors; beta adrenergic blockers; diuretic including thiazides |
| Adverse effects of drugs on the male reproductive system: Drug-induced priapism (example trazodone); finasteride, dutasteride; sildenafil, tadalafil, vardenafil; marijuana; nitric oxide reductase inhibitors |
System specifications-Endocrine system
System specifications-Endocrine system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes |
| Organ structure and function: Hypothalamus, posterior and anterior pituitary gland, thyroid gland, parathyroid gland, adrenal cortex, adrenal medulla, pancreatic islets, ovary and testis, adipose tissue |
| Cell/ tissue/ structure and function, including hormone synthesis, secretion, action, metabolism: Peptide hormones, steroid hormones, including vitamin D, thyroid hormones, catecholamine hormones, renin-angiotensin system |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Endocrine system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Diabetes mellitus and other disorders of the endocrine pancreas: (a) Diabetes mellitus-diabetes mellitus, type 1; diabetes mellitus, type 1.5; diabetes mellitus, type 2; diabetes mellitus, acute complications: hyperosmolar coma, hypoglycemic shock |
| Diabetes mellitus and other disorders of the endocrine pancreas: (a) Diabetes mellitus-ketoacidosis, including cerebral edema, associated electrolyte abnormalities; diabetes mellitus, chronic complications: gastrointestinal/ gastroparesis |
| Diabetes mellitus and other disorders of the endocrine pancreas: (a) Diabetes mellitus-chronic complications: Neurologic/ neuropathy, ophthalmologic/ retinopathy, peripheral vascular, renal/ nephropathy, metabolic syndrome |
| Diabetes mellitus and other disorders of the endocrine pancreas: (b) Hypoglycemia and islet cell disorders-hypoglycemia (secondary to insulinoma, surreptitious insulin use, sepsis, liver failure); hyperglycemia (secondary to glucagonoma); hyperinsulinism |
| Diabetes mellitus and other disorders of the endocrine pancreas: (b) Hypoglycemia and islet cell disorders-islet cell tumors/ insulinoma/ somatostatinoma; pancreatic neuroendocrine tumors |
| Thyroid disorders: Cyst, nodule; euthyroid sick syndrome; goiter (euthyroid-normal thyroid function with goiter); hypothyroidism; hyperthyroidism, including thyrotoxicosis and thyroid storm; thyroiditis, including Hashimoto; Graves disease |
| Thyroid disorders: Neoplasms (benign cysts and nodules, thyroid cancer including papillary, follicular, medullary, and anaplastic); thyroid deficiency from pituitary disorder; infertility due to thyroid disease |
| Thyroid disorders: Secondary hypothyroidism and hyperthyroidism |
| Parathyroid disorders: Hyperparathyroidism; hypoparathyroidism; metabolic bone disease |
| Adrenal disorders: Corticoadrenal insufficiency (Addison disease); adrenal insufficiency, secondary; hypocortisolism; cushing syndrome; hyperaldosteronism; neoplasms, benign and malignant (adrenal neuroblastoma, pheochromocytoma, adrenal carcinoma |
| Adrenal disorders: Adrenal adenoma, aldosteronoma, adrenal incidentaloma); delayed and precocious puberty; hypertensive endocrine disease |
| Pituitary disorders: Acromegaly/ gigantism; diabetes insipidus; galactorrhea not associated with childbirth; panhypopituitarism from any cause; pituitary apoplexy (example sheehan syndrome); growth hormone deficiency; short stature |
| Pituitary disorders: SIADH (inappropriate secretion of ADH [vasopressin]); neoplasm, benign and malignant (pituitary adenomas, craniopharyngioma, metastatic disease); prolactinoma and hyperprolactinemia, including infertility due to these disorders |
| Diabetes mellitus and other disorders of the endocrine pancreas: Pituitary disorders-hypogonadism, primary and secondary |
| Hypothalamic endocrine disorders |
| Multiple endocrine neoplasia (MEN1, MEN2) |
| Congenital disorders: Disorders of sexual differentiation; congenital adrenal hyperplasia; androgen insensitivity/ resistance syndrome; congenital hypothyroidism |
| Adverse effects of drugs on the endocrine system: Drug, medicinal, and biologic substance effects; exogenous steroid suppression of adrenal glands, anabolic steroids |
System specifications-Respiratory system
System specifications-Respiratory system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes |
| Organ structure and function: Airways, including mechanics and regulation of breathing, lung parenchyma, including ventilation, perfusion, gas exchange, pleura, nasopharynx, sinuses |
| Cell/ tissue structure and function, including surfactant formation, and alveolar structure |
| Repair, regeneration, and changes associated with stage of life |
| Pulmonary defense mechanisms and normal flora |
System specifications-Respiratory system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-acute upper respiratory infection; viral infections (adenovirus, corona viruses, coxsackievirus, influenza virus) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-viral infections (parainfluenza virus, rhinoviruses); sinusitis; nasopharyngitis; epiglottitis |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-bordetella pertussis pneumonia; croup; acute laryngitis; acute laryngotracheitis; tracheitis; pharyngitis |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-streptococcal throat infections; tonsillitis; peritonsillar abscess; rhinitis, allergic, chronic |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-ulcers of nasal cavity/ sinuses |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-hospital acquired pneumonia; ventilator-associated pneumonia, community-acquired pneumonia, acute bronchiolitis |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-bronchiolitis obliterans with organizing pneumonia (BOOP); anthrax, pulmonary (Bacillus anthracis); aspiration pneumonia |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-pneumonitis; bronchitis, acute; bronchopneumonia; pneumonia (Burkholderia pseudomallei, chlamydophila pneumoniae |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-coxiella burnetii, francisella tularensis, haemophilus influenzae, klebsiella pneumoniae, legionella, moraxella catarrhalis |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-mycoplasma pneumoniae, pseudomonas aeruginosa, streptococcus, MSSA, MRSA, other gram‐negative bacteria) |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-viral infection (example influenza A, B, adenovirus, H1N1, respiratory syncytial virus, parainfluenza virus) |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-fungal infection (aspergillosis, including allergic bronchopulmonary aspergillosis and aspergilloma, histoplasmosis) |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-fungal infection (coccidioidomycosis, pneumocystis jirovecii); pulmonary tuberculosis; lung abscess |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-viral infection (example influenza A, B, adenovirus, respiratory syncytial virus, parainfluenza virus, avian influenza virus) |
| Neoplasms: (a) Benign neoplasms-upper airways (example vocal cord polyps, nasal polyps, juvenile, papillomatosis); lungs and pleura (example solitary pulmonary nodule, bronchial carcinoid tumors) |
| Neoplasms: (b) Malignant neoplasms-(i) upper airways: Lip, oral cavity, and pharynx; head and neck cancer; larynx; trachea, (ii) lower airways and pleura: Malignant neoplasms of bronchus and/ or lung (squamous cell, adenocarcinoma, large cell, small cell) |
| Neoplasms: (b) Malignant neoplasms-(ii) lower airways and pleura: Malignant neoplasms of pleura (mesothelioma); secondary malignant neoplasms of lung; secondary malignant neoplasms of pleura, (c) metastatic neoplasms including pleural |
| Obstructive airway disease: Asthma, reactive airway disease; bronchiectasis; chronic airway obstruction; chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema |
| Pneumoconiosis/ fibrosing/ restrictive pulmonary disorders/ interstitial lung disease: Pneumoconiosis; asbestosis; silicosis; silo-filler's lung, byssinosis, bagassosis, berylliosis; hypersensitivity pneumonitis; hypereosinophilic syndromes |
| Pneumoconiosis/ fibrosing/ restrictive pulmonary disorders/ interstitial lung disease: Loeffler syndrome; interstitial pneumonia, usual (UIP), desquamative (DIP), nonspecific |
| Respiratory failure/ respiratory arrest and pulmonary vascular disorders: Acute respiratory distress syndrome (ARDS); pulmonary hypertension; pulmonary vascular disorders, arteriovenous fistula; pulmonary edema, pulmonary cause and unspecified |
| Respiratory failure/ respiratory arrest and pulmonary vascular disorders: Pulmonary embolism; air and fat embolism; respiratory failure due to enteral feeding |
| Metabolic, regulatory, and structural disorders: Disorders of gas exchange; hypoventilation; hypoxia; pulmonary alveolar proteinosis; ventilation-perfusion imbalance |
| Disorders of the pleura, mediastinum, and chest wall: Chylothorax; costochondritis; empyema; hemothorax; mediastinitis; pleural effusion; pleuritis; pneumomediastinum; pneumothorax |
| Traumatic and mechanical disorders: (a) Upper airways-epistaxis; barotrauma, sinus; laryngeal/pharyngeal obstruction; tracheoesophageal fistula; tracheal stenosis; tracheomalacia; trauma (example tracheal injury) |
| Traumatic and mechanical disorders: (a) Upper airways-foreign body (nose, pharynx, larynx, trachea); traumatic/ mechanical disorders of the nasal cavity/ sinuses (example septal perforation) |
| Traumatic and mechanical disorders: (b) Lower airways and pleura-atelectasis; diaphragm/ chest wall injury; drowning and near drowning; foreign body, upper and lower respiratory tract; penetrating chest wounds; pulmonary contusion; sleep apnea |
| Traumatic and mechanical disorders: (b) Lower airways and pleura-obstructive and central; hypoventilation syndrome, obesity-hypoventilation syndrome |
| Congenital disorders: Bronchogenic cysts; congenital cysts; congenital diaphragmatic hernia; pulmonary sequestration; immotile cilia syndrome |
| Adverse effects of drugs on the respiratory system: Bleomycin, amiodarone; adverse effects of 100% oxygen; acute effects of tobacco/ nicotine, inhalants, cocaine |
System specifications-Renal and urinary system
System specifications-Renal and urinary system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes |
| Organ structure and function: Kidneys, ureters, bladder, urethra, glomerular filtration and hemodynamics, urine concentration and dilution, renal mechanisms in acid-base balance, renal mechanisms in body fluid homeostasis, micturition |
| Cell/ tissue structure and function: Renal metabolism and oxygen consumption, tubular reabsorption and secretion, including transport processes and proteins |
| Cell/ tissue structure and function: Hormones produced by or acting on the kidney (example renin, aldosterone, angiotensin II, vasopressin) |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Renal and urinary system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) upper urinary tract: Granulomatous pyelonephritis; perinephric abscess; pyelonephritis; pyonephrosis; renal abscess; renal tuberculosis |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) lower urinary tract and urinary tract infections of unspecified location: Cystitis; chlamydial and nonchlamydial |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) upper urinary tract: Glomerular disorders-Alport syndrome; glomerular disease due to hepatitis B, C; glomerulonephritis, including poststreptococcal |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) upper urinary tract: Glomerular disorders-IgA nephropathy; lupus nephritis; minimal change disease; nephrotic syndrome; thin basement membrane disease |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) upper urinary tract: Tubulointerstitial disease-acute tubular necrosis (ATN); acute interstitial nephritis; papillary necrosis; HIV nephropathy |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(ii) lower urinary tract: interstitial cystitis |
| Neoplasms: (a) Benign neoplasms and cysts-polycystic kidney disease, (b) malignant neoplasms: Renal (example Wilms tumor/ nephroblastoma, renal cell carcinoma, renal tumors associated with congenital/ hereditary conditions) |
| Neoplasms: (b) Malignant neoplasms-urinary bladder and collecting system |
| Signs, symptoms, and ill-defined disorders: dysuria; hematuria; oliguria, anuria; proteinuria |
| Metabolic and regulatory disorders: Acute kidney injury; renal insufficiency; azotemia, uremic syndrome; chronic kidney disease, including end-stage renal disease; cystinuria; Fanconi syndrome |
| Metabolic and regulatory disorders: Hypertensive renal disease (renal complications of hypertension); renal calculi, ureteral calculi, nephrolithiasis; renal tubular acidosis |
| Vascular disorders: Renal artery stenosis (atherosclerosis, fibromuscular dysplasia, nephrosclerosis); renal vein thrombosis; renal infarction |
| Traumatic and mechanical disorders: Bladder rupture; neurogenic bladder; obstructive uropathy; posterior urethral valves; renal laceration; renal vascular injury; ureteral laceration/ avulsion/ disruption; urethral diverticulum |
| Traumatic and mechanical disorders: Obstruction/ stricture/ prolapse, urethral/ ureteral, vaginal walls, uterine, uterovaginal; urinary incontinence, including secondary enuresis; vesicoureteral reflux |
| Congenital disorders: Double ureters/ ureteral duplication/ double collecting system; horseshoe kidney; hydronephrosis/ reflux; renal agenesis, renal hypoplasia, renal dysplasia; single kidney |
| Adverse effects of drugs on the renal and urinary system: ACE inhibitors; aminoglycosides; amphotericin B; cisplatin; furosemide; gadolinium (nephrogenic systemic fibrosis); heroin; iodinated contrast dye; lithium; NSAIDs; penicillins; sulfa drugs |
| Adverse effects of drugs on the renal and urinary system: Tenofovir; drug-induced urinary retention |
System specifications-Blood and lymphoreticular system
System specifications-Blood and lymphoreticular system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes, organ structure and function |
| Cell/ tissue structure and function: Production and function of erythrocytes, including heme and hemoglobin synthesis; hemoglobin O and CO transport, transport proteins, erythropoietin production and function of platelets |
| Cell/ tissue structure and function: Production and function of coagulation and fibrinolytic factors; hemostasis |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Blood and lymphoreticular system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious and immunologic infectious disorders: (a) bacteria, (b) viral-hemorrhagic fever (Ebola virus, Marburg virus); chikungunya; dengue fever; Zika virus disease, (c) parasitic: malaria (Plasmodium spp); babesiosis (Babesia species) |
| Infectious and immunologic infectious disorders: (d) Primary infections of lymphoid tissue-lymphadenitis (viral, bacterial, fungal, parasitic); lymphangitis; buboes, bubonic plague (Yersinia pestis); cat scratch disease (Bartonella henselae) |
| Infectious and immunologic infectious disorders (e) Immunologic and inflammatory disorders-cryoglobulinemia, essential mixed cryoglobulinemia; autoimmune hemolytic anemia; paroxysmal nocturnal hemoglobinuria; thrombotic thrombocytopenic purpura |
| Infectious and immunologic infectious disorders: (e) Immunologic and inflammatory disorders-hemolytic uremic syndrome |
| Neoplasms: Leukemia, acute (ALL, AML); leukemia, chronic (CLL, CML); lymphomas, Hodgkin disease, non-Hodgkin lymphoma, Burkitt lymphoma, T-cell lymphoma; multiple myeloma, dysproteinemias, monoclonal gammopathy of unknown significance (MGUS) |
| Neoplasms: Myelofibrosis; myelodysplastic syndrome, myelodysplasias; other immunoproliferative neoplasms (example Waldenstrom macroglobulinemia) |
| Anemia, cytopenias, and polycythemia anemias: (a) Decreased production-anemia of chronic disease, (b) hemolysis: Glucose-6-phosphate dehydrogenase deficiency; pyruvate kinase deficiency |
| Anemia, cytopenias, and polycythemia anemias: (c) Disorders of hemoglobin, heme, or membrane-disorders of red cell membranes; hereditary spherocytosis, elliptocytosis; methemoglobinemia, congenital; sickle cell disease; sideroblastic anemia; thalassemias |
| Anemia, cytopenias, and polycythemia anemias: (d) Other causes of anemia-blood loss, acute and chronic as a cause of anemia, (e) cytopenias: Aplastic anemia; leukopenia; neutropenia, cyclic neutropenia, agranulocytosis; pancytopenia; thrombocytopenia |
| Anemia, cytopenias, and polycythemia anemias: (e) Cytopenias-quantitative; immune thrombocytopenic purpura (ITP), (f) cythemias: Leukocytosis; polycythemia vera; secondary polycythemia |
| Coagulation disorders (hypercoagulable and hypercoagulable conditions): (a) Hypercoagulable-disseminated intravascular coagulation; hemophilia, congenital factor VIII [hemophilia A] and IX [hemophilia B]; hypofibrinogenemia; von Willebrand disease |
| Coagulation disorders (hypercoagulable and hypercoagulable conditions): (b) Hypercoagulable-platelet dysfunction, qualitative, hypercoagulable: Heparin-induced thrombocytopenia; other coagulopathies (example homocysteinemia, hypoplasminogenemia) |
| Coagulation disorders (hypercoagulable and hypercoagulable conditions): (b) Hypercoagulable-other coagulopathies (example antithrombin III, protein C/ protein S deficiency, factor V Leiden, anticardiolipin antibodies, lupus anticoagulant) |
| Coagulation disorders (hypercoagulable and hypercoagulable conditions): (b) Hypercoagulable-prothrombin G20210A mutation), (c) reactions to blood components: ABO incompatibility/ anaphylaxis; Rh incompatibility/anaphylaxis; hemolysis, delayed |
| Coagulation disorders (hypercoagulable and hypercoagulable conditions): (c) Reactions to blood components-transfusion reaction; transfusion contaminated with bacteria; transfusion-related acute lung injury (TRALI); anaphylactoid reaction (IgA deficiency) |
| Traumatic, mechanical, and vascular disorders: Mechanical injury to erythrocytes (example cardiac valve hemolysis); disorders of the spleen; splenic rupture/ laceration; splenic infarct; splenic abscess |
| Traumatic, mechanical, and vascular disorders: Effects/ complications of splenectomy (example sepsis due to encapsulated bacteria); hypersplenism |
| Adverse effects of drugs on the hematologic and lymphoreticular systems: Antiplatelet drugs, antithrombin drugs (example dabigatran); chemotherapeutic agents; inhibitors of coagulation factors; methemoglobinemia, acquired; propylthiouracil |
| Adverse effects of drugs on the hematologic and lymphoreticular systems: Tumor lysis syndrome; warfarin |
System specifications-Immune system
System specifications-Immune system: Unit 01
Normal processes |
|---|
| Development of cells of the adaptive immune response, including positive and negative selection during immune development |
| Structure, production, and function: Granulocytes, natural killer cells, macrophages, mast cells, dendritic cells, cell receptors (example complement receptors and Toll-like receptors), cytokines, chemokines, T lymphocytes |
| Structure, production, and function: Including T-lymphocyte receptors, accessory molecules (example CD3, CD4, CD8, B7), cell activation and proliferation, cytotoxic T lymphocytes, and memory T lymphocytes, B lymphocytes and plasma cells |
| Structure, production, and function: Including B-lymphocyte receptors, immunoglobulins, cell activation and proliferation, including development of antibodies and memory B lymphocytes, host defense mechanisms, host barriers to infection |
| Structure, production, and function: Mucosal immunity (example gut-associated lymphoid tissue and bronchus-associated lymphoid tissue), anatomical locations of T and B lymphocytes |
| Cellular basis of the immune response and immunologic mediators: Antigen processing and presentation in the context of MHC I and MHC II molecules (example TAP, beta-2 microglobulin), intracellular pathways |
| Cellular basis of the immune response and immunologic mediators: Mechanisms by which MHC is expressed on the surface; including distribution of MHC I and MHC II on different cells |
| Cellular basis of the immune response and immunologic mediators: Mechanisms of MHC I and MHC II deficiencies, and the genetics of MHC regulation of the adaptive immune response (example peripheral tolerance, anergy, regulatory T lymphocytes |
| Cellular basis of the immune response and immunologic mediators: Termination of immune response, and B-T lymphocyte interactions) activation |
| Cellular basis of the immune response and immunologic mediators: Function, and molecular biology of complement (example anaphylatoxins) functional and molecular biology of cytokines (example IL 1-15) |
| Basis of immunologic diagnostics (example antigen-antibody reactions used for diagnostic purposes, ELISA, immunoblotting, antigen-antibody changes over time, ABO typing) |
| Principles of immunologic protection: Vaccine production and mechanisms of vaccine action biologically active antibodies (example monoclonal antibodies, polyclonal antibodies including IVIG, VZIG, rabies immunoglobulin) |
| Effect of age on the function of components of the immune system |
System specifications-Immune system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Disorders associated with immunodeficiency: (a) Deficiency primarily of humoral immunity-common variable immunodeficiency; hyper IgM syndrome; hypogammaglobulinemia/ agammaglobulinemia, X-linked (Bruton); selective immunodeficiency (example IgA, IgM, IgE) |
| Disorders associated with immunodeficiency: (b) Deficiency/ dysfunction primarily of cell-mediated immunity-adenosine deaminase deficiency; thymic aplasia (DiGeorge syndrome); severe combined immunodeficiency disease (SCID); Wiskott-Aldrich syndrome |
| Disorders associated with immunodeficiency: (b) Deficiency/ dysfunction primarily of cell-granulomatosis; allergic reactions/ skin, (c) complement deficiency: Alternative pathway component deficiency (C2, C3b, C3bB, C36B6) |
| Disorders associated with immunodeficiency: (c) Complement deficiency-classical pathway component deficiency (C1q, C1r, C1-C5); terminal component deficiency (C5b-C9; terminal complement complex); C1 esterase inhibitor deficiency, hereditary angioedema |
| Disorders associated with immunodeficiency: (c) Complement deficiency-mannose-binding lectin (MBL) deficiency; membrane attack complex deficiency, (d) deficiency of phagocytic cells and natural killer cells: Chediak-Higashi disease |
| Disorders associated with immunodeficiency: (d) Deficiency of phagocytic cells and natural killer cells-chronic granulomatous disease and other disorders of phagocytosis; leukocyte adhesion deficiency |
| HIV/ AIDS: HIV1 and HIV2; AIDS; AIDS complications (example neuropathy, dementia, renal insufficiency); immunology of AIDS; immune reconstitution syndrome (IRS); secondary infections; noninfectious complications |
| Immunologically mediated disorders: (a) Hypersensitivity reactions-type 1, 2, 3, including anaphylaxis; type 4; drug reactions; serum sickness, (b) transplantation: rejection; graft-vs.-host disease |
| Adverse effects of drugs on the immune system: Jarisch-Herxheimer reaction; drugs affecting the immune system (example prednisone, azathioprine, cyclosporine, methotrexate |
| Adverse effects of drugs on the immune system: Monoclonal antibody drugs [example abciximab, adalimumab; bevacizumab, infliximab, omalizumab, rituximab]); vaccine adverse effects |
System specifications-Multisystem processes and disorders
System specifications-Multisystem processes and disorders: Unit 01
Normal processes |
|---|
| Principles of nutrition: Generation, expenditure, and storage of energy at the whole-body level functions of nutrients (example essential, trans-fatty acids, cholesterol) |
| Electrolyte and water metabolism: Electrolyte metabolism (calcium, potassium, phosphorus), water metabolism |
| Intracellular accumulations (example pigments, fats, proteins, carbohydrates, minerals, inclusions, vacuoles, lysosomal/ glycogen storage disease and structures related to storage diseases, glycogen phosphorylase deficiency, Zellweger syndrome) |
System specifications-Multisystem processes and disorders: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Brucellosis (Brucella spp); leptospirosis (Leptospira interrogans); Lyme disease (Borrelia burgdorferi); melioidosis (Burkholderia pseudomallei) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Miliary (disseminated) tuberculosis (Mycobacterium tuberculosis); tularemia (Francisella tularensis); toxic shock syndrome; Q fever (Coxiella burnetii) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Anaplasmosis and ehrlichiosis (Anaplasma and Ehrlichia species); rickettsiosis (Rocky Mountain spotted fever [Rickettsia rickettsii]) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral: Infectious mononucleosis (Epstein-Barr virus); cytomegalovirus infection; yellow fever; human herpesvirus 8 (HHV-8), fungal: Blastomycosis (Blastomyces dermatitidis) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iii) fungal: Candidiasis (Candida albicans); coccidioidomycosis (Coccidioides immitis/ posadasii); histoplasmosis (Histoplasma capsulatum) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iv) parasitic: Schistosomiasis (Schistosoma); Leishmaniasis (Leishmania spp), visceral (kala azar); trypanosomiasis/ Chagas disease, acute and chronic (Trypanosoma) |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-acute rheumatic fever; autoimmune arteritis/ vasculitis; Behçet syndrome; Churg-Strauss syndrome; eosinophilic granuloma, histiocytosis |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-Langerhans cell histiocytosis; Goodpasture syndrome; Henoch-Schönlein purpura; Kawasaki disease; mixed connective tissue disease; polyangiitis |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-polyarteritis nodosa; polyglandular autoimmune syndrome, type 1; polymyalgia rheumatica, temporal arteritis; Raynaud disease/ Raynaud syndrome |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-reactive arthritis, formerly Reiter disease, including Reiter arthritis; scleroderma (systemic sclerosis); Sjögren syndrome; systemic lupus erythematosus |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-Takayasu arteritis; granulomatosis with polyangiitis (formerly Wegener granulomatosis); familial Mediterranean fever; sarcoidosis, Lofgren syndrome |
| Neoplasms and related disorders: (a) Paraneoplastic syndromes-endocrine (example SIADH, Cushing syndrome, hypercalcemia of malignancy [parathyroid‐related protein and paraneoplastic syndrome with hypercalcemia]) |
| Neoplasms and related disorders: (a) Paraneoplastic syndromes-hematologic (polycythemia, nonbacterial thrombotic endocarditis); neurologic (myasthenic syndrome, paraneoplastic cerebellar degeneration, limbic encephalitis, pure sensory neuropathy) |
| Neoplasms and related disorders: (a) Paraneoplastic syndromes-(anti-NMDA receptor encephalitis); mucocutaneous (example acanthosis nigricans); musculoskeletal (example pulmonary osteoarthropathy, polymyositis); other (membranous glomerulonephritis) |
| Neoplasms and related disorders: (b) Inherited cancer syndromes-DNA repair abnormalities (example Fanconi anemia); Lynch syndrome (gastrointestinal and female reproductive) |
| Signs, symptoms, and ill-defined disorders: Arthralgias; abdominal pain; chest pain; cough; dizziness, lightheadedness, syncope, including breath-holding spells with syncope; dyspnea, shortness of breath; edema, anasarca; fatigue; fever of unknown origin |
| Signs, symptoms, and ill-defined disorders: Hemoptysis; pain management (in a non addiction, non palliative-care setting); joint pain; lymphedema; palpitations; pruritus; unexpected weight gain/ weight loss |
| Nutrition: (a) Protein-calorie malnutrition (kwashiorkor, marasmus), vitamin deficiencies and/ or toxicities: (b) vitamin A; vitamin B; vitamin B1, thiamine (example Wernicke-Korsakoff syndrome, beriberi); vitamin B3, niacin; vitamin B6, pyridoxine |
| Nutrition: (b) Vitamin deficiencies and/ or toxicities-vitamin B9, folic acid; vitamin B12, cobalamins (pernicious anemia); vitamin C (scurvy); vitamin D (rickets); vitamin E; vitamin K, (c) mineral deficiencies and/ or toxicities |
| Nutrition: (d) Obesity, enteral/ parenteral nutrition (TPN) |
| Toxins and environmental extremes: Physical and associated disorders, temperature (example hypothermia, hyperthermia, heat stroke), radiation (example radon, uranium mining, imaging studies), thermal injury, burns, electrocution |
| Toxins and environmental extremes: Lightning, decreased atmospheric pressure, high-altitude sickness, increased water pressure, (nitrogen narcosis), chemical including Gulf War illness, gases, vapors |
| Toxins and environmental extremes: Smoke inhalation agricultural hazards (example pesticides, green tobacco poisoning, anhydrous ammonia, agent Orange) volatile organic solvents metals (example lead) |
| Toxins and environmental extremes: Other chemical agents (example ethylene glycol, carbon tetrachloride, methanol; BPA) principles of poisoning and therapy (example acetylsalicylic acid [ASA], acetaminophen) |
| Venomous bites and stings: Hymenoptera bites and stings; scorpion bites; snake bites; spider bites; jellyfish stings |
| Fluid, electrolyte, and acid-base balance disorders: (a) Fluid volume and electrolyte/ ion disorders-fluid volume disorders; dehydration; hypovolemia; volume overload; electrolyte disorders; hyponatremia, hypernatremia; hypokalemia, hyperkalemia |
| Fluid, electrolyte, and acid-base balance disorders: (a) Fluid volume and electrolyte/ ion disorders-hypocalcemia, hypercalcemia; hypophosphatemia, hyperphosphatemia; hypomagnesemia, (b) acid-base disorders: Metabolic acidosis; metabolic alkalosis |
| Fluid, electrolyte, and acid-base balance disorders: (b) Acid-base disorders-respiratory acidosis; respiratory alkalosis; mixed acid-base disturbances |
| Abuse: Child, nonaccidental trauma/ inflicted head trauma/ factitious disorder by proxy intimate partner abuse, sexual, emotional, and physical including injuries (example rib fractures) related to abuse, elder abuse, sexual |
| Abuse: Emotional, and physical including injuries (example rib fractures) related to abuse, sexual assault |
| Multiple trauma (example prioritization, blast injury involving more than one organ system) |
| Shock, cardiogenic, hypovolemic, neurogenic, septic, sepsis, bacteremia, systemic, inflammatory response syndrome (SIRS), refractory, multiorgan dysfunction syndrome: Meningococcemia |
| Genetic metabolic and developmental disorders: (a) Multifactorial-VATER syndrome, association syndromes, (b) large genomic changes: Beckwith-Wiedemann syndrome; Down syndrome; Prader-Willi syndrome, (c) enzymatic/ metabolic: Alpha-1 antitrypsin deficiency |
| Genetic metabolic and developmental disorders: (c) Enzymatic/ metabolic-porphyria; inborn errors of metabolism (example maple syrup urine disease, diseases involving urea cycle) |
| Genetic metabolic and developmental disorders: (c) Enzymatic/ metabolic-storage diseases (example Fabry disease, Tay-Sachs disease, glycogen storage disease, mucopolysaccharidoses), (b) structural protein disorders: Amyloidosis; Ehlers-Danlos syndrome |
| Genetic metabolic and developmental disorders: (b) Structural protein disorders-immotile cilia syndrome (Kartagener syndrome; primary ciliary dyskinesia); Marfan syndrome, (c) intracellular/ extracellular transport receptors: Cystic fibrosis |
| Genetic metabolic and developmental disorders: (c) Intracellular/ extracellular transport receptors-hemochromatosis; Wilson disease, (d) triplet repeat/ RNA disorders: Fragile X syndrome |
| Adverse effects of drugs on multisystem disorders: Drug-induced electrolyte abnormalities and acid base-disorders (example albuterol; prednisone; diuretics; alcohol; drugs inducing polydipsia, SIADH, or diabetes insipidus) |
System specifications-Cardiovascular system
System specifications-Cardiovascular system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal transitional changes |
| Organ structure and function: Chambers, valves cardiac cycle, mechanics, heart sounds, cardiac conduction hemodynamics, including blood volume and systemic vascular resistance circulation in specific vascular beds, including pulmonary and coronary |
| Cell/ tissue structure and function: Heart muscle, metabolism, oxygen consumption, biochemistry, and secretory function (example atrial natriuretic peptide), endothelium and secretory function, vascular smooth muscle |
| Cell/ tissue structure and function: Microcirculation, and lymph flow, neural and hormonal regulation of the heart, blood vessels, and blood volume, including responses to change in posture, exercise, and tissue metabolism, and autonomic responses |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Cardiovascular system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-bacterial endocarditis, myocarditis, (b) immunologic and inflammatory disorders: Atherosclerosis (example atherosclerosis of the aorta) |
| Neoplasms: Myxoma, metastases |
| Dysrhythmias: Premature beats (PACs, PVCs); atrial flutter/ fibrillation; multifocal atrial tachycardia; paroxysmal tachycardias; ventricular tachycardia/ fibrillation; wide complex tachycardia; torsades de pointes; bradycardias |
| Dysrhythmias: Atrioventricular block (first-, second-, third-degree); conduction disorder (LBBB, RBBB); cardiac arrest; sick sinus syndrome; prolonged QT syndrome; Wolff-Parkinson-White syndrome; carotid sinus hypersensitivity |
| Dysrhythmias: Pacemaker dysfunction, including failure to sense, capture |
| Heart failure: Chordae tendineae rupture; congestive heart failure; cor pulmonale; diastolic dysfunction; systolic dysfunction; mitral valve dysfunction; heart failure secondary to myocardial infarction |
| Heart failure: High-output heart failure, including thyrotoxicosis-induced, anemia-induced; tachycardia-induced; cardiogenic pulmonary edema |
| Ischemic heart disease: Acute coronary syndrome, acute myocardial infarction; angina pectoris, stable and unstable/ coronary artery disease/ coronary insufficiency; coronary artery spasm |
| Diseases of the myocardium: Cardiomyopathy, dilated, including alcoholic, viral, takotsubo; cardiomyopathy, obstructive hypertrophic; cardiomyopathy, familial dilated; cardiomyopathy, restrictive; hypertensive heart disease, left ventricular hypertrophy |
| Diseases of the myocardium: Right ventricular hypertrophy; complications of myocardial infarction; nontraumatic tamponade post-myocardial infarction; papillary muscle rupture/ dysfunction; ventricular free wall rupture; myocarditis |
| Diseases of the pericardium: Chronic constrictive pericarditis; pericardial effusion; pericardial tamponade; acute pericarditis; pericarditis, following myocardial infarction, surgery, trauma |
| Valvular heart disease: Valve disorders, mitral/ aortic/ tricuspid, pulmonic (example regurgitation, stenosis, prolapse, insufficiency, vegetation); functional murmurs; rheumatic heart disease; complications of artificial valves |
| Hypotension: Orthostatic hypotension |
| Hypertension: Elevated blood pressure reading without diagnosis of hypertension; essential hypertension; malignant hypertension; secondary hypertension |
| Dyslipidemia: Hypercholesterolemia; hyperlipidemia; hypertriglyceridemia; lipoproteins/ lipoprotein lipase deficiency |
| Vascular disorders: (a) Disorders of the great vessels-aneurysm, aortic (abdominal/ thoracic), dissection, ruptured; aneurysm, iliac, other peripheral vascular, ruptured; aortoiliac disease |
| Vascular disorders: (b) Peripheral arterial vascular disease-arterial embolism/ thrombosis, arteriovenous fistula; atheroembolic disease; claudication; cholesterol emboli; hypertensive vascular disease; peripheral arterial disease |
| Vascular disorders: (b) Peripheral arterial vascular disease-thromboangiitis obliterans, (c) diseases of the veins-deep venous thrombosis, venous thromboembolism; phlebitis/ thrombophlebitis; varicose veins; venous insufficiency; stasis ulcers |
| Vascular disorders: (c) Diseases of the veins-stasis dermatitis |
| Traumatic and mechanical disorders: Ventricular puncture; myocardial contusion; myocardial rupture; traumatic aortic dissection; traumatic tamponade |
| Congenital disorders, including disease in adults: Anomalous left coronary artery; atrial septal defect; coarctation of the aorta; endocardial cushion defect; patent foramen ovale; patent ductus arteriosus; tetralogy of Fallot |
| Congenital disorders, including disease in adults: Transposition of the great vessels; ventricular septal defect |
| Adverse effects of drugs on the cardiovascular system: Adriamycin; cocaine, amphetamine, PCP; ACE inhibitors, calcium channel blockers, alpha blockers, minoxidil |
System specifications-Musculoskeletal system
System specifications-Musculoskeletal system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes |
| Organ structure and function |
| Cell/ tissue structure and function: Biology of bones, joints, tendons, skeletal muscle, cartilage exercise and physical conditioning/ deconditioning |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Musculoskeletal system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, inflammatory, and immunologic disorders: (a) Infectious disorders-gangrene, dry and wet, clostridial myonecrosis (clostridium perfringens); discitis; myositis, infective; necrotizing fasciitis; osteomyelitis; septic arthritis |
| Infectious, inflammatory, and immunologic disorders: (a) Infectious disorders-spondylitis, tuberculous, (b) immunologic disorders: Ankylosing spondylitis; dermatomyositis/ polymyositis; juvenile idiopathic arthritis; rheumatoid arthritis, felty syndrome |
| Infectious, inflammatory, and immunologic disorders: (b) Immunologic disorders-psoriatic arthropathy, (c) inflammatory disorders: Adhesive capsulitis of shoulder (frozen shoulder syndrome); ankylosing/spondylopathy (inflammatory); bursitis; fasciitis |
| Infectious, inflammatory, and immunologic disorders: (c) Inflammatory disorders-osteochondritis, osteochondritis dissecans; tendinitis, supraspinatus syndrome, enthesopathy of spine, elbow, ankle; temporomandibular joint disorders; fibrositis |
| Infectious, inflammatory, and immunologic disorders: (c) Inflammatory disorders-myofascial pain syndrome; synovitis; tenosynovitis; myositis |
| Neoplasms: Benign neoplasms (example ganglion cyst); malignant neoplasms of bone (example osteosarcoma, sarcoma, leiomyosarcoma, rhabdomyosarcoma); metastases to bone, secondary malignant neoplasm of bone |
| Degenerative and metabolic disorders: (a) Degenerative/ metabolic disorders of bone, tendon, and cartilage-chondromalacia; disc degeneration, herniated disc; Legg-Calvé-Perthes disease; Osgood-Schlatter disease; osteodystrophy; osteomalacia |
| Degenerative and metabolic disorders: (a) Degenerative/ metabolic disorders of bone, tendon, and cartilage-osteonecrosis (avascular), bone infarct; osteoporosis; osteopenia; osteitis deformans (Paget disease of bone); pathologic fracture; radiculopathies |
| Degenerative and metabolic disorders: (a) Degenerative/ metabolic disorders of bone, tendon, and cartilage-spondylolisthesis/spondylosis (degenerative), (b) degenerative/ metabolic disorders of joints: Gout, gouty arthritis, pseudogout; joint effusion |
| Degenerative and metabolic disorders: (b) Degenerative/ metabolic disorders of joints-osteoarthritis, degenerative/ metabolic disorders of muscles, ligaments, fascia: Dupuytren contracture; muscle calcification and ossification |
| Degenerative and metabolic disorders: (c) Degenerative/ metabolic disorders of muscles, ligaments, fascia-muscle wasting and diffuse atrophy; rhabdomyolysis |
| Traumatic and mechanical disorders: Amputation and care of amputees; backache, including low back pain; blast injuries; compartment syndrome; contractures, hospital-acquired; contusions; dislocations; fractures; sprains, strains; kyphoscoliosis, scoliosis |
| Traumatic and mechanical disorders: Rotator cuff syndrome; slipped capital femoral epiphysis; dislocation of hip |
| Congenital disorders: Achondroplasia/ dwarfism; disorders of limb development (HOX gene mutation, phocomelia); developmental dysplasia of the hip; dislocation of hip in infantile spinal muscular atrophy; genu valgum or varum |
| Congenital disorders: Foot deformities (flat foot, valgus/ varus deformities); osteogenesis imperfecta; McArdle disease; mitochondrial myopathies |
| Adverse effects of drugs on the musculoskeletal system: Drug-induced myopathy (example steroids, statins, cocaine, AZT); malignant hyperthermia |
System specifications-Skin and subcutaneous tissue
System specifications-Skin and subcutaneous tissue: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and neonatal changes |
| Organ structure and function, including barrier function, thermal regulation |
| Cell/ tissue structure and function, eccrine function |
| Repair, regeneration, and changes associated with stage of life (example senile purpura, male pattern baldness, postmenopausal hair changes) |
| Skin defense mechanisms and normal flora |
System specifications-Skin and subcutaneous tissue: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(i) bacterial: Cellulitis, erysipelas, impetigo, staphylococcal scalded skin syndrome; abscess, cutaneous, including septic abscess |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(i) bacterial: Anthrax (Bacillus anthracis); carbuncle; folliculitis; pilonidal cyst, infected; pyoderma gangrenosum; MSSA and MRSA skin infections |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(i) bacterial: Mycobacterial infections (example leprosy, draining sinus); scarlet fever (group A Streptococcus), (ii) viral: Herpes simplex type 1 and type 2 |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(ii) viral: Herpes zoster; Ramsay-hunt syndrome; molluscum contagiosum; hand-foot-and-mouth disease; herpangina; parvovirus; chickenpox |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(ii) viral: Erythema infectiosum (fifth disease), rubella, measles, roseola (exanthema subitum); verrucae vulgaris |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(iii) fungal (deep and superficial): Candidiasis, skin; dermatophytosis, tinea corporis; dermatomycoses; diaper rash; onychomycosis |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(iv) parasitic: Cutaneous larva migrans; cutaneous leishmaniasis; (vi) infestations, non venomous bites, stings: Scabies; lice; insect bites, including bed bugs |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) papulosquamous and eczematous dermatoses: Psoriasis; lichen planus and lichenoid dermatoses; allergic/irritant contact dermatitis (example nickel) |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) papulosquamous and eczematous dermatoses: Dermatoses caused by plants (poison ivy, poison oak), (ii) vesiculobullous disorders: Epidermolysis bullosa |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(ii) vesiculobullous disorders: Dermatitis herpetiformis; pemphigus; pemphigoid, (iii) urticaria, erythema, exanthema, and purpura: Erythema nodosum |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(iii) urticaria, erythema, exanthema, and purpura: Atopic dermatitis; pityriasis rosea; urticaria; Stevens-Johnson syndrome, erythema multiforme |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(iii) urticaria, erythema, exanthema, and purpura: Toxic epidermal necrolysis, (iv) autoimmune disorders: Vitiligo |
| Neoplasms: (a) Benign neoplasms, cysts, and other skin lesions-actinic keratoses; cysts, including epidermal; hemangiomas; lipoma; pigmented nevi; seborrheic keratosis; xanthomas, (b) malignant neoplasms: Basal cell carcinoma; squamous cell carcinoma |
| Neoplasms: (b) Malignant neoplasms-melanoma, including genital; Kaposi sarcoma; cutaneous T-cell lymphoma, mycosis fungoides |
| Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes): (a) Disorders of the hair and hair follicles-alopecia; seborrhea capitis/seborrheic dermatitis; tinea barbae and capitis |
| Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes): (b) Disorders of the nails (including ingrowing nail), (c) disorders of sweat and sebaceous glands: Acne vulgaris; hidradenitis suppurativa |
| Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes): (c) Disorders of sweat and sebaceous glands-hyperhidrosis; ichthyosis; rosacea |
| Oral disease: Aphthous ulcers (stomatitis, canker sores); leukoplakia |
| Disorders of pigmentation: Albinism; lentigo |
| Traumatic and mechanical disorders: Animal bites (dogs, cats, etc); burns or wounds affecting the skin or subcutaneous tissue (example sunburn, other including blast injuries and burns); cauliflower ear; effects of ultraviolet light; keloids; tattoo |
| Traumatic and mechanical disorders: Thermal injury, perniosis, frostbite; ulcers, decubitus |
| Congenital disorders: Xeroderma pigmentosum; benign lesions in neonates, infants, children (example congenital nevi) |
| Adverse effects of drugs on skin and subcutaneous tissue: Drug reactions, eruptions, including local reaction to vaccine |
System specifications-Gastrointestinal system
System specifications-Gastrointestinal system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes |
| Organ structure and function: Anatomy of the alimentary canal, including mouth, pharynx, esophagus, stomach, small intestine, large intestine, anus, peritoneal cavity, liver and biliary system, including enterohepatic circulation |
| Organ structure and function: Salivary glands and exocrine pancreas, gastrointestinal motility, including defecation digestion and absorption |
| Cell/ tissue structure and function: Endocrine and neural regulatory functions, including GI hormones (example gastrin) salivary, gastrointestinal, pancreatic, hepatic secretory products, including enzymes, proteins |
| Cell/ tissue structure and function: Bile salts, and processes synthetic and metabolic functions of hepatocytes |
| Repair, regeneration, and changes associated with stage of life |
| Gastrointestinal defense mechanisms and normal flora |
System specifications-Gastrointestinal system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Pseudomembranous colitis (Clostridium difficile); enteritis/ enteric infections (includes gastroenteritis) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) bacterial: (example Staphylococcus aureus, Escherichia coli, Listeria monocytogenes, Yersinia enterocolitica, Campylobacter species, Vibrio cholerae, Salmonella species) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: (Shigella species, traveler's/ infectious diarrhea); hepatic abscess, subhepatic abscess, subphrenic abscess; peritonitis, primary and secondary; Whipple disease |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral: Infectious esophagitis (example CMV, herpes); hepatitis A, B, C, D, E; coxsackievirus enteritis/ colitis; Echovirus enteritis/colitis; rotavirus enteritis; mumps |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral: Gingivostomatitis, herpetic, (iii) fungal: Thrush, (iv) parasitic: Cryptosporidium, cyclospora, entamoeba histolytica, giardia, isospora belli |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iv) parasitic: Strongyloides stercoralis |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-autoimmune hepatitis; celiac disease; eosinophilic esophagitis; granulomatous enteritis; inflammatory bowel disease, including Crohn disease |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-regional enteritis; microscopic colitis (collagenous and lymphocytic colitis), ulcerative colitis, toxic megacolon |
| Neoplasms: (a) Benign neoplasms, including polyps, cysts-stomach; small intestine; colon, rectum, and anus, including polyps, (b) malignant neoplasms and premalignant conditions: Oral cancer (example lips, mouth, tongue, salivary glands) |
| Neoplasms: (b) Malignant neoplasms and premalignant conditions-esophageal, squamous and adenocarcinoma; Barrett esophagus; gastrinoma, Zollinger-Ellison syndrome; gastrointestinal carcinoid tumors; gastrointestinal stromal tumors; small intestine |
| Neoplasms: (b) Malignant neoplasms and premalignant conditions-stomach, adenocarcinoma, lymphoma, MALT; colon, rectum, anus; hereditary colon cancer syndromes |
| Neoplasms: (b) Malignant neoplasms and premalignant conditions-familial adenomatous polyposis (example Peutz-Jeghers syndrome, Gardner syndrome, Turcot syndrome,); MUTYH-associated polyposis; gallbladder, cholangiocarcinoma |
| Neoplasms: (b) Malignant neoplasms and premalignant conditions-adenocarcinoma of the ampulla of Vater; liver, including hepatoma; peritoneal cancer, including metastatic studding with cancer; pancreas, (c) metastatic neoplasms |
| Signs, symptoms, and ill-defined disorders: Upper gastrointestinal bleeding; lower gastrointestinal bleeding; constipation; diarrhea; hematochezia; bright red rectal bleeding; melena; nausea, vomiting, rumination |
| Disorders of the oral cavity, salivary glands, and esophagus: (a) Oral cavity and salivary glands-abscessed tooth; dental caries; malocclusion; disorders of the salivary glands (example stones, sialadenitis, parotitis) |
| Disorders of the oral cavity, salivary glands, and esophagus: (b) Esophagus-achalasia and cardiospasm; dysphagia; diverticulum (example Zenker); esophageal periapical abscess without sinus; esophagitis/ esophageal reflux (GERD); esophagitis, pill |
| Disorders of the oral cavity, salivary glands, and esophagus: (b) Esophagus-Mallory-Weiss syndrome; paraesophageal (hiatal) hernia; stricture and stenosis of esophagus |
| Disorders of the stomach, small intestine, colon, rectum, anus: (a) Stomach-dyspepsia/ hyperacidity; gastric ulcer; gastritis; peptic ulcer; peptic ulcer perforation; gastroparesis, small intestine, colon: Appendicitis; angiodysplasia; diverticula |
| Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-diverticulitis, diverticulosis; duodenitis, duodenal ulcer, peptic ulcer; gastroenteritis and colitis (noninfectious); granulomatous enterocolitis |
| Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-Hirschsprung disease; impaction of intestine; intestinal obstruction/ stricture; intussusception; irritable colon/ irritable bowel syndrome |
| Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-mesenteric ischemia/ ischemic bowel/ ischemic colitis; necrotizing enterocolitis; paralytic ileus; volvulus; malnutrition and malabsorption |
| Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-including lactose intolerance, short bowel syndrome, rectum and anus: Abscess of anal and rectal regions; anal fissure; anal fistula; ulcer; fecal incontinence |
| Disorders of the stomach, small intestine, colon, rectum, anus: (c) Rectum and anus-hemorrhage (rectum, anus); proctitis; hemorrhoids; rectal prolapse |
| Disorders of the liver and biliary system, noninfectious: (a) Liver-cirrhosis; Dubin-Johnson, Rotor syndromes; end-stage liver disease, including indications for transplantation; Gilbert syndrome, Crigler-Najjar syndrome |
| Disorders of the liver and biliary system, noninfectious: (a) Liver-hepatic coma/ hepatic encephalopathy; hepatitis, noninfectious; hepatitis, fatty liver, alcoholic; hepatorenal syndrome; hepatopulmonary syndrome; jaundice |
| Disorders of the liver and biliary system, noninfectious: (a) Liver-nonalcoholic fatty liver disease; portal hypertension/ esophageal varices, (b) biliary system: Bile duct obstruction/ cholestasis; cholangitis, including ascending; choledocholithiasis |
| Disorders of the liver and biliary system, noninfectious: (b) Biliary system-cholelithiasis/ cholecystitis; cholestasis due to parenteral nutrition; gallstone ileus; Mirizzi syndrome; primary biliary cirrhosis; primary sclerosing cholangitis |
| Disorders of the pancreas: Pancreatitis, acute; pancreatitis, chronic; pancreatitis, hereditary; pancreatic cyst/ pseudocyst; pancreatic duct obstruction; pancreatic insufficiency |
| Disorders of the peritoneal cavity: Ascites |
| Traumatic and mechanical disorders: Abdominal wall defects; adhesions, postsurgical; digestive system complications of surgery; post-gastric surgery syndromes (example blind loop syndrome, adhesions); duodenal tear; foreign body in digestive system |
| Traumatic and mechanical disorders: Inguinal, femoral, and abdominal wall hernias; open wound, abdominal; perforation of hollow viscus and blunt trauma; perforation/rupture of esophagus (Boerhaave syndrome); umbilical hernia |
| Congenital disorders: Annular pancreas, biliary atresia, cleft lip and palate, esophageal atresia, malrotation without volvulus, Meckel diverticulum, pyloric stenosis, tracheoesophageal fistula |
| Adverse effects of drugs on the gastrointestinal system: Drug-induced changes in motility (chronic laxative abuse, opioids); drug-induced gastritis, duodenitis, peptic ulcer disease (NSAIDs); drug-induced hepatitis (example acetaminophen, isoniazid) |
| Adverse effects of drugs on the gastrointestinal system: Drug-induced pancreatitis (example thiazide diuretics) |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 01
Epidemiology/ population health |
|---|
| Measures of disease frequency: Incidence/ prevalence |
| Measures of health status: Rates, crude and adjusted; reproductive rates (example maternal mortality, neonatal/ infant/ under-5 mortality); mortality, morbidity; standardization; life expectancy, health-adjusted life expectancy |
| Measures of health status: Population attributable risk (PAR), population attributable risk percent (PAR%); risk factors |
| Survival analysis interpretation (example Kaplan-Meier curve) |
| Composite health status indicators, measures of population impact: Years of potential life lost; quality-adjusted life years; disability-adjusted life years; standardized mortality ratio |
| Population pyramids and impact of demographic changes |
| Disease surveillance and outbreak investigation: Disease reporting; response to public health advisory, health promotion; recognition of clusters |
| Communicable disease transmission: Attack rate; herd immunity; reportable diseases |
| Points of intervention: Primary, secondary; community level (example cigarette taxes, soda taxes, smoke-free cities, buildings: Restaurants, public buildings); school policies; access, healthy food, transportation, clean air, safe environments |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 02
Study design, types, and selection of studies (includes dependent/ independent variables) |
|---|
| Descriptive studies (case report [one person]/ case series [more than one]) |
| Analytical studies: Observational-community surveys; cross-sectional (individuals); ecological (populations); case control; retrospective and prospective cohort |
| Analytical studies: Interventional-clinical trial (randomized controlled trial; double-blind; placebo-controlled; non inferiority/ equivalence trials); community intervention |
| Systematic reviews and meta-analysis: Potential uses; estimation of effect sizes; heterogeneity; publication bias; forest plots, funnel diagrams; risk of bias, bias risk scale |
| Obtaining and describing samples: Matching, inclusion/ exclusion criteria, selecting appropriate controls for studies, lack of controls, concealed allocation, randomization, stratification |
| Methods to handle noncompliance: Loss to follow-up; intention-to-treat analysis |
| Qualitative analysis |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 03
Measures of association |
|---|
| Relative risk |
| Odds ratio, hazard ratio |
| Other measures of association: Number needed to treat/ harm; absolute risk (AR), absolute risk percent (AR%); population attributable risk (PAR), population attributable risk percent (PAR%) |
| Distributions of data: Measures of central tendency; measures of variability; regression to mean; normal distribution; nominal measurement |
| Correlation and regression, uses and interpretation: Correlation coefficients; multiple regression |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 04
Principles of testing and screening |
|---|
| Properties of a screening test: Validity, accuracy, reliability; criteria for a screening test; confirmatory testing; appropriateness; lead-time bias, length bias; screening vs. diagnostic tests |
| Sensitivity and specificity; predictive value, positive and negative |
| ROC curves |
| Probability: Theory (independence, product, addition rules); decision trees; likelihood ratios (application of Bayes theorem); posttest, pretest |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 05
Study interpretation, drawing conclusions from data |
|---|
| Causation: Hypothesis-generating vs. hypothesis-driven testing; causal criteria, temporality, temporal sequence, dose-response relationship; reverse causality |
| Chance: Null hypothesis, type I error and alpha level (multiple comparisons, random error/ chance), sample size and type II error, beta, power, selection and interpretation of basic tests of statistical significance: chi-square; confidence intervals |
| Chance: P-values; t-test, a priori vs. post hoc analysis: Subgroup analysis; error rate; affect types |
| Interpretation of graphs/ tables and text |
| Bias, confounding, and threats to validity (includes methods to address): Selection, sampling bias, information bias: Recall; ascertainment, ecological fallacy, lack of blinding; loss to follow up, confounding variables |
| Bias, confounding, and threats to validity (includes methods to address): Hawthorne effect (includes methods to address), other threats to validity (example placebo effect) |
| Internal vs. external validity: Generalizability (external validity); efficacy vs. effectiveness |
| Statistical vs. clinical significance; clinical and surrogate outcome/ end point |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 06
Clinical decision making, interpretation and use of evidence-based data and recommendations |
|---|
| Application of study results to patient care and practice, including patient preferences and individualization of risk profiles; risk/ benefit analysis; synthesis of concepts with real data |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 07
Research ethics |
|---|
| Informed consent for research |
| Privacy of patient data (HIPAA) |
| Roles of institutional review boards (IRBs) |
| Intervention analysis: Intervention analysis; stopping analysis; safety monitoring |
| Regulatory issues: Drug development, phases of approval; appropriateness of placebo; appropriateness of randomized clinical trial; components of studies; ethics; scheduling; off-label use |
| Other issues related to research ethics |
System specifications-Social sciences
System specifications-Social sciences: Unit 01
Communication and interpersonal skills, including health literacy and numeracy, cultural competence |
|---|
| Patient interviewing, consultation, and interactions with the family (patient-centered communication skills): Fostering the relationship (example expressing interest), information gathering (example exploring patient's reaction to illness) |
| Patient interviewing, consultation, and interactions with the family (patient-centered communication skills): Information provision (example providing information about working diagnosis), making decisions (example eliciting patient's perspectives) |
| Patient interviewing, consultation, and interactions with the family (patient-centered communication skills): Supporting emotions (example effective discussion with difficult patients), enabling patient behaviors (example education and counseling) |
| Use of an interpreter or surrogate |
System specifications-Social sciences: Unit 02
Medical ethics and jurisprudence, include issues related to death and dying and palliative care |
|---|
| Consent/ informed consent to treatment, permission to treat (full disclosure, risks and benefits, placebos, alternative therapies, conflict of interest, and vulnerable populations) |
| Determination of medical decision-making capacity/ informed refusal |
| Involuntary admission |
| Legal issues related to abuse (child, elder, and intimate partner): Child protective services, foster care, immunizations, legal requirements for reporting abuse or neglect/ obligation to warn |
| Birth-related issues |
| Death and dying and palliative care: Life support, advance directive, health care proxy, advance care planning, euthanasia and physician-assisted suicide, brain death/ diagnosing brain death/ diagnosing death, pronouncing death, organ donation, hospice |
| Death and dying and palliative care: Pain management, including ethical issues related to death and dying, information sharing, counseling families, psychosocial and spiritual counseling, fear and loneliness |
| Physician-patient relationship (boundaries, confidentiality including HIPAA, privacy, truth telling, other principles of medical ethics, example, autonomy, justice, beneficence) |
| Impaired physician, including duty to report impaired physician |
| Negligence/ malpractice, including duty to report negligence and malpractice |
| Physician misconduct, including duty to report physician misconduct |
| Referrals |
| Cultural issues not otherwise coded |
System specifications-Social sciences: Unit 03
Systems-based practice (including health systems, public health, community, schools) and patient safety (including basic concepts and terminology) |
|---|
| Complexity/ systems thinking: Characteristics of a complex system and factors leading to complexity-how complexity leads to error, health care/ organizational behavior and culture: Environmental factors, workplace design and process; staffing |
| Complexity/ systems thinking: Health care/ organizational behavior and culture-overcommitment, space, people, time, scheduling; standardization, reducing variance, simplification, metrics; safety culture; integration of care across settings |
| Complexity/ systems thinking: Health care/ organizational behavior and culture-overutilization of resources (imaging studies, antibiotics, opioids); economic factors |
System specifications-Social sciences: Unit 04
Quality improvement |
|---|
| Improvement science principles: Variation and standardization-variation in process, practice; checklists, guidelines, and clinical pathways, reliability |
| Specific models of quality improvement: Model for improvement-plan-do-study-act (PDSA); plan-do-check-act (PDCA) |
| Quality measurement: Structure, process, outcome, and balancing measures, measurement tools: Run and control charts; development and application of system and individual quality measures: Core measures; physician quality report system (PQRS) |
| Quality measurement: Development and application of system and individual quality measures: Core measures; physician quality report system (PQRS); event reporting system |
| Strategies to improve quality: Role of leadership; principles of change management in quality improvement: Specific strategies |
| Attributes of high-quality health care: High-value/ cost-conscious care-overutilization of resources including diagnostic testing, medications, equitable care: Access, patient-centered care, timely care |
System specifications-Social sciences: Unit 05
Patient safety |
|---|
| Patient safety principles: (a) Epidemiology of medical error, (b) error categorization/ definition: Active vs. latent errors; Swiss cheese model of error; preventable vs. non-preventable; near miss events/ safety hazards |
| Patient safety principles: (c) Causes of error-(i) patient factors: Understanding of medication use; health literacy; economic status; cultural factors (example religion); failure to make appointments; socioeconomic status |
| Patient safety principles: (c) Causes of error-(ii) physician factors: Deficiency of knowledge; judgment errors; diagnostic errors; fatigue, sleep deprivation; bias-cognitive, availability, heuristic, anchoring, framing |
| Patient safety principles: (c) Causes of error-(iii) human factors (example cognitive, physical, environmental), (d) High reliability of organization (HRO) principles-change management and improvement science |
| Patient safety principles: (d) High reliability of organization (HRO) principles-conceptual models of improvement, (e) reporting and monitoring for errors: Event reporting systems |
| Patient safety principles: (e) Reporting and monitoring for errors-communication with patients after adverse events (disclosure/ transparency) |
| Specific types of error: (a) Transitions of care errors (example handoff communication including shift-to-shift, transfer, and discharge): Handoffs and related communication; discontinuities; gaps; discharge; transfers |
| Specific types of error: (b) Medication errors-ordering, transcribing, dispensing, administration (wrong quantity, wrong route, wrong drug), medication reconciliation, mathematical error, (c) procedural errors: Universal protocol (time out); wrong patient |
| Specific types of error: (c) Procedural errors-wrong site; wrong procedure; retained foreign bodies, injury to structures: Paracentesis; bowel perforation; thoracentesis; pneumothorax; central venous/ arterial line injuries |
| Specific types of error: (c) Procedural errors-Injury to structures: Arterial puncture and bleeding and venous thrombosis; lumbar puncture bleeding; paralysis, other errors: Anesthesia-related errors; mathematical errors |
| Specific types of error: (d) Health care-associated infections-nosocomial infection-example, surgical site, ventilator associated; catheter-related; handwashing procedures or inadequate number of handwashing stations |
| Specific types of error: (d) Health care-associated infections-central line-associated blood stream infections; surgical site infections; catheter-associated urinary tract infections; ventilator-associated pneumonia |
| Specific types of error: (e) Documentation errors-electronic medical record (including voice-recognition software errors); record keeping; incorrect documentation (example wrong patient, wrong date, copying and pasting, pre-labeling) |
| Specific types of error: (f) Patient identification errors-mislabeling-transfusion errors related to mislabeling; verification/ two identifiers: Lack of dual validation, including verbal verification of lab results |
| Specific types of error: (g) Diagnostic errors-errors in diagnostic studies; misinterpretation; (h) monitoring errors-cardiac monitoring/ telemetry, drug monitoring (warfarin, antibiotics), device-related errors: Malfunction, programming error |
| Specific types of error: (i) Device-related errors-incorrect use |
| Strategies to reduce error: (a) Human factors engineering, (b) situational awareness, (c) hierarchy of effective interventions: Forcing function; visual cues, (d) error analysis tools: Error/ near miss analysis; failure modes and effect analysis |
| Strategies to reduce error: (d) Error analysis tools-morbidity and mortality review; root cause analysis, (e) safety behavior and culture at the individual level: Hierarchy of health care, flattening hierarchy, speak up to power; afraid to report, fear |
| Strategies to reduce error: (e) Safety behavior and culture at the individual level-psychological safety; closed-loop communication, (f) teamwork: Principles of highly effective teams; case management; physician teams, physician-physician communication |
| Strategies to reduce error: (f) Teamwork-interprofessional/ interprofessional teams; strategies for communication among teams, including system-provider communication, physician-physician communication (example consultations) |
| Strategies to reduce error: (f) Teamwork-provider-interprofessional communication, patient communication |
System specifications-Social sciences: Unit 06
Health care policy and economics |
|---|
| Health care policy: (a) Health care disparities-race/ ethnicity; numeracy/ literacy; socioeconomic status, (b) access to care: Critical access systems or hospitals, social justice |
| Health care economics/ health care financing: (a) Types of insurance-medicare, medicaid, private insurance, self-pay, (b) navigating the insurance system: Deductibles/ co-pays; in-/ out-of-network; preferred providers |
| Health care economics/ health care financing: (c) Reimbursement issues affecting safety and quality: Emergency services-EMTALA; pay-for-performance |
Physician tasks/ competencies specifications-Medical knowledge/ scientific concepts
Physician tasks/ competencies specifications-Medical knowledge/ scientific concepts: Unit 01
Applying foundational science concepts |
|---|
| Identifies the cause/ infectious agent or predisposing factor(s) or, given an effect, determines the cause |
| Identifies the underlying processes/ pathways that account for, or contribute to, the expression or resolution of a given condition |
| Recognizes or evaluates given clinical or physical findings to identify the underlying anatomic structure or physical location |
| Recognizes the mechanisms of action of various drugs; selects from an option set list of drugs based on mechanism of action |
Physician tasks/ competencies specifications-Patient care: Diagnosis
Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 01
Diagnosis: Obtaining and predicting history and physical examination |
|---|
| Knows signs/ symptoms of selected disorders |
| Knows individual's risk factors for development of conditions: Given current symptoms in presented history, identifies other pertinent factors in the history |
| Given a specific problem, knows what to ask in obtaining further pertinent additional history |
| Predicts the most likely additional physical finding; selects either the finding itself or the appropriate examination technique that would result in the finding |
Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 02
Diagnosis: Selecting and Interpreting Laboratory and diagnostic studies |
|---|
| Selects most appropriate laboratory or diagnostic study, including neuropsychiatric testing, or study most likely to establish/confirm the diagnosis |
| Interprets laboratory or other study findings |
| Predicts the most likely laboratory or diagnostic study result |
| Selects most appropriate laboratory or diagnostic study after a change in patient status |
Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 03
Diagnosis: Formulating the diagnosis |
|---|
| Selects the most likely diagnosis |
| Assesses the developmental level of the patient |
Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 04
Diagnosis: Determining prognosis/ outcome |
|---|
| Recognizes factors in the history, physical or laboratory study findings that affect patient prognosis or outcome or determine therapy |
| Interprets laboratory or other diagnostic study results and identifies current/ future status of patient |
| Recognizes associated conditions of a disease, including complications, or indicators of potential complications, of a given disease |
| Recognizes characteristics of disease relating to natural history or course of disease, including progression, severity, duration, and transmission of disease from a specific patient |
Physician tasks/ competencies specifications-Patient care: Management
Physician tasks/ competencies specifications-Patient care: Management: Unit 01
Management: Health maintenance and disease prevention |
|---|
| Knows risk factors for conditions amenable to prevention or detection in an asymptomatic patient, or knows the potential condition for which the patient may be at risk |
| Knows pertinent incidence statistics and identifies patient groups at risk; knows incidence of symptoms/ dangerous disorders among various groups |
| Knows common screening tests for conditions amenable to prevention or detection in an asymptomatic patient or population |
| Selects appropriate preventive agent or technique (eg, contraception, vaccines, vitamins) |
| Knows appropriate counseling of patient or family regarding maintenance of current and future problems, including risk factors related to present encounter |
| Educates patients on screening, health maintenance, self-care |
| Assesses the developmental level of a healthy patient |
| Knows the indications for surveillance for recurrence or progression of disease following treatment |
| Monitoring chronic disease in a stable patient where a change in patient status might cause a change in therapy |
| Knows appropriate long-term surveillance goals |
Physician tasks/ competencies specifications-Patient care: Management: Unit 02
Management: Selecting and monitoring pharmacotherapy |
|---|
| Selects most appropriate pharmacotherapy |
| Assesses patient adherence with treatment regimen, recognizes techniques to increase adherence or understanding of the disease state, and knows how adherence may be affected by providing instructions with therapy |
| Recognizes factors that alter drug dosing requirements for a patient |
| Knows adverse effects of various drugs, or recognizes signs and symptoms of drug (and drug-drug) interactions resulting from polypharmacy in the therapeutic regimenand knows steps to prevent polypharmacy including lab studies to monitor drug therapy |
| Knows contraindications of various medications |
| Modifies therapeutic regimen within the context of continuing care; selects appropriate modifications in therapeutic regimen |
| Knows appropriate monitoring to evaluate effectiveness of drug therapy or to monitor for the adverse effects of drug therapy in a patient that has not had a recurrence or progression of disease |
Physician tasks/ competencies specifications-Patient care: Management: Unit 03
Management: Clinical interventions/ treatment |
|---|
| Knows most appropriate management of selected conditions, including recognizing misuse of medication or drug or alcohol use |
| Knows immediate management or priority in management, specifically in emergency or acute cases |
| Knows most appropriate follow-up or monitoring approach regarding the management plan |
| Knows current/ short-term management of patients |
| Evaluates severity of patient condition in terms of need for referral for surgical treatments/ procedures versus other nonsurgical options |
| Knows appropriate surgical management |
| Knows pre/ post surgical or procedural management |
| Knows indications for admission to the hospital or to other appropriate setting (eg, ICU) |
| Knows appropriate non-hospital health care settings |
| Knows most appropriate discharge planning |
| Knows components of rehabilitation program |
| Knows appropriate use and procedures regarding hospice care |
| Educates patient or family regarding self-care |
| Knows relevant roles of allied health personnel |
Physician tasks/ competencies specifications-Patient care: Management: Unit 04
Management: Selecting clinical interventions (mixed management) |
|---|
| Selects most appropriate management option from set of mixed management options (eg, mix of diagnostic studies, pharmacotherapy, procedures, observation, or referral) |
Physician tasks/ competencies specifications-Communication
Physician tasks/ competencies specifications-Communication: Unit 01
Fostering the relationship |
|---|
Physician tasks/ competencies specifications-Communication: Unit 02
Gathering information |
|---|
Physician tasks/ competencies specifications-Communication: Unit 03
Providing information |
|---|
Physician tasks/ competencies specifications-Communication: Unit 04
Making decisions |
|---|
Physician tasks/ competencies specifications-Communication: Unit 05
Supporting emotions |
|---|
Physician tasks/ competencies specifications-Communication: Unit 06
Enabling patient behaviors |
|---|
Physician tasks/ competencies specifications-Communication: Unit 07
Using an interpreteror surrogate |
|---|
Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues
Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues: Unit 01
Understanding and applying principles of professionalism, legal and ethical issues in interactions with patients |
|---|
| Knows the guidelines for obtaining informed consent for treatment including children and adolescents, third-party permission, and emergent situations |
| Recognizes need for third-party permission for treatment in medical emergencies |
| Knows guidelines for treatment of minors with/ without notification of parents |
| Knows definitions of competence and sanity |
| Knows the guidelines for involuntary admission |
| Knows guidelines for confidentiality of medical records |
| Knows guidelines for physician-patient relationship |
| Knows issues related to cultural competence and can apply knowledge in specific patient situations |
Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues: Unit 02
Understanding and applying legal and ethical issues related to death and dying |
|---|
| Assesses degree of disclosure to terminally ill patients |
| Recognizes patient's right to refuse treatment or testing (patient autonomy); knows issues of advance directives and living wills |
| Assesses quality-of-life decisions |
| Knows appropriate prescriptive practices; knows appropriate use of opioids in terminally ill patients |
| Knows definition of and legal issues regarding brain death |
| Knows management of terminally ill patients related to treating chronic pain, and recognizing patient's expression of fear of pain, injury, or death; knows how to comfort patient or family during crisis such as trauma or death |
Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues: Unit 03
Understanding and applying professionalism, legal, and ethical issues in dealing with physicians and other health professionals |
|---|
| Knows guidelines for reporting findings to proper authorities |
| Knows good Samaritan laws |
| Recognizes physician error and negligence |
| Recognizes and deals appropriately with impaired physician |
Physician tasks/ competencies specifications-Systems based practice, including patient safety
Physician tasks/ competencies specifications-Systems based practice, including patient safety: Unit 01
Systems based practice |
|---|
| Understands basic concepts and terminology, principles, and application of quality improvement science and outcome analysis |
| Recognizes and optimizes human and environmental factors (eg, workplace design, standardization, processes) |
| Understands the role and characteristics of teams and communication strategies |
Physician tasks/ competencies specifications-Systems based practice, including patient safety: Unit 02
Patient safety |
|---|
| Anticipates, recognizes, analyzes, and mitigates risk (sources of error) |
| Evaluates, reports, and responds to near-misses and system errors |
| Identifies sources of error and suggests appropriate measures to evaluate or reduce the likelihood of specific errors |
Physician tasks/ competencies specifications-Practice-based learning
Physician tasks/ competencies specifications-Practice-based learning: Unit 01
Understanding and application of the principles of biostatistics and epidemiology |
|---|
| Understands and can apply principles of epidemiology and population health, including health status indicators, outbreak investigation, points of intervention |
| Understands and can apply principles of study design and study flaws |
| Understands and can apply the principles of screening and other tests |
| Understands use and interpretation of statistical principles and measures of association |
Physician tasks/ competencies specifications-Practice-based learning: Unit 02
Application of information from studies or other written material to patient care |
|---|
| Decisions about patient care based on results of study or other written materials |
Physician tasks/ competencies specifications-Practice-based learning: Unit 03
Understanding of the principles of research ethics and regulatory issues |
|---|
Discipline specifications-Behavioral sciences
Discipline specifications-Biochemistry and nutrition
Discipline specifications-Genetics
Discipline specifications-Gross anatomy and embryology
Discipline specifications-Histology and cell biology
Discipline specifications-Immunology
Discipline specifications-Microbiology
Discipline specifications-Pathology
Discipline specifications-Pharmacology
Discipline specifications-Physiology
USMLE Step 2 CK Syllabus
System specifications-General principles of foundational science
System specifications-General principles of foundational science: Unit 01
Biochemistry and molecular biology |
|---|
| Gene expression: DNA structure, replication, exchange, and epigenetics (example imprinting, X-activation, DNA methylation), gene expression: Transcription, gene expression: Translation, post-translational processing |
| Gene expression: Modifications and disposition of proteins (degradation), including protein/ glycoprotein synthesis, intra-extracellular sorting, and processes/ functions related to golgi complex and rough endoplasmic reticulum |
| Structure and function of proteins and enzymes (example enzyme kinetics and structural/ regulatory proteins), energy metabolism (example ATP generation, transport chain) |
System specifications-General principles of foundational science: Unit 02
Biology of cells |
|---|
| Adaptive cell responses and cellular homeostasis (example, hypertrophy), mechanisms of injury and necrosis, including pathologic processes (example liquefactive necrosis, free radical formation), apoptosis |
| Cell cycle and cell cycle regulation (example mitosis), mechanisms of dysregulation, cell biology of cancer (example role of p53, proto-oncogenes), general principles of invasion and metastasis, including cancer staging |
| Cell/ tissue structure, regulation, and function, including cytoskeleton, organelles, glycolipids, channels, gap junctions, extracellular matrix, and receptors |
System specifications-General principles of foundational science: Unit 03
Human development and genetics |
|---|
| Principles of pedigree analysis, inheritance patterns, occurrence and recurrence risk determination, population genetics: Hardy-Weinberg law, founder effects, mutation-selection equilibrium, principles of gene therapy, genetic testing and counseling |
| Genetic mechanisms (example penetrance, genetic heterogeneity) |
System specifications-General principles of foundational science: Unit 04
Biology of tissue response to disease |
|---|
| Acute inflammatory responses (patterns of response), acute inflammation and mediator systems (example histamine, prostaglandins, bradykinins, eosinophilic basic protein, nitric oxide), vascular response to injury, including mediators |
| Principles of cell adherence and migration (example ECAMs, selectins, leukocytic diapedesis, and rolling), microbicidal mechanisms and tissue injury (example defensins) |
| Clinical manifestations (example, pain, fever, leukocytosis, leukemoid reaction, chills), chronic inflammatory responses (example tumor necrosis factor) |
| Reparative processes, wound healing, repair: Thrombosis, granulation tissue, angiogenesis, fibrosis, scar/ keloid formation, regenerative process |
System specifications-General principles of foundational science: Unit 05
Pharmacodynamic and pharmacokinetic processes: General principles |
|---|
| Pharmacokinetics: Absorption, distribution, metabolism, excretion, dosage intervals, mechanisms of drug action, structure-activity relationships (example, anticancer drugs), concentration and dose-effect relationships (example efficacy, potency) |
| Types of agonists (example full, partial, inverse) and antagonists and their actions |
| Individual factors altering pharmacokinetics and pharmacodynamics (example age, gender, disease, tolerance, compliance, body weight, metabolic proficiency, pharmacogenetics) |
| Mechanisms of drug adverse effects, overdosage, toxicology, mechanisms of drug interactions |
| Signal transduction, including structure/ function of all components of signal transduction, pathways such as receptors, ligands (example general principles of nitric oxide, autocrine and paracrine signaling) |
System specifications-General principles of foundational science: Unit 06
Microbial biology |
|---|
| Microbial identification and classification, including principles, microorganism identification, and non-immunologic laboratory diagnosis |
| Bacteria: Structure (example cell walls, composition, appendages, virulence factors, extracellular products, toxins, mechanism of action of toxins), processes, replication, and genetics (example metabolism, growth, and regulation), oncogenesis |
| Bacteria: Antibacterial agents (example mechanisms of action on organism, toxicity to humans, and mechanisms of resistance) |
| Viruses: Structure (example physical and chemical properties, virulence factors), processes, replication, and genetics (example life cycles, location of virus in latent infection), oncogenesis |
| Viruses: Antiviral agents (example mechanisms of action on virus, toxicity to humans, and mechanisms of resistance) |
| Fungi: Structure (example cell wall, composition, appendages, virulence factors, extracellular products, toxins, mechanisms of action of toxins), processes, replication, and genetics (example asexual vs. sexual, metabolism, growth) |
| Fungi: Antifungal agents (example mechanisms of action on fungus, toxicity to humans, and mechanisms of resistance) |
| Parasites: Structure (example appendages, macroscopic features, and virulence factors), processes, replication, and genetics (example life cycles, metabolism, and growth), oncogenesis |
| Antiparasitic agents (example mechanisms of action on parasite, toxicity to humans, and mechanisms of resistance) |
| Prions |
System specifications-General principles of foundational science: Unit 07
Normal age-related findings and care of the well patient |
|---|
| Infancy and childhood (0-12 years): (a) Normal physical changes-linear growth, variations in linear growth, including constitutional delay; weight; head circumference; micturition, defecation, primary incontinence/ bedwetting; normal physical examination |
| Infancy and childhood (0-12 years): (a) Normal physical changes-screening; sleep; teething syndrome, (b) developmental stages: Motor; speech; cognitive; psychosocial; anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition |
| Infancy and childhood (0-12 years): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine; risk factors and prevention (example guns, swimming, motor vehicles, car seats) |
| Infancy and childhood (0-12 years): (c) Lifestyle and routine preventive health care-routine vaccinations |
| Adolescence (13-17 years): (a) Normal physical changes-linear growth, variations in linear growth including constitutional delay; weight; puberty; normal physical examination; gynecomastia; autonomy/ self-identity; sleep |
| Adolescence (13-17 years): (b) Developmental stages-cognitive (example abstract thought); psychosocial (example autonomy, role confusion, sexual identity); anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition |
| Adolescence (13-17 years): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine |
| Adolescence (13-17 years): (c) Lifestyle and routine preventive health care-risk factors and prevention (example risk-taking behavior, helmets, safe sex, motor vehicles, seat belts, distractions); routine vaccinations |
| Adulthood (18-64 years): (a) Normal physical changes-weight; normal physical examination; screening; sleep, (b) developmental stages: Cognitive; intimacy vs. isolation; anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition |
| Adulthood (18-64 years): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine; risk factors and prevention; routine vaccinations |
| Older adulthood (65 years and older): (a) Normal physical changes, including normal physical exam for age-weight, height (spinal compression), skin, bruising; normal physical examination; response to temperature; micturition, defecation; sleep |
| Older adulthood (65 years and older): (b) Developmental stages-motor; cognitive (example psychomotor slowing); psychosocial; integrity vs. despair; retrospection; anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition |
| Older adulthood (65 years and older): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine |
| Older adulthood (65 years and older): (c) Lifestyle and routine preventive health care-risk factors and prevention (example falls, general medical condition; polypharmacy, driving, caregiver stress); routine vaccinations |
System specifications-Immune system
System specifications-Immune system: Unit 01
Normal processes |
|---|
| Development of cells of the adaptive immune response, including positive and negative selection during immune development |
| Structure, production, and function: Granulocytes, natural killer cells, macrophages, mast cells, dendritic cells, cell receptors (example complement receptors and Toll-like receptors), cytokines, chemokines, T lymphocytes |
| Structure, production, and function: Including T-lymphocyte receptors, accessory molecules (example CD3, CD4, CD8, B7), cell activation and proliferation, cytotoxic T lymphocytes, and memory T lymphocytes, B lymphocytes and plasma cells |
| Structure, production, and function: Including B-lymphocyte receptors, immunoglobulins, cell activation and proliferation, including development of antibodies and memory B lymphocytes, host defense mechanisms, host barriers to infection |
| Structure, production, and function: Mucosal immunity (example gut-associated lymphoid tissue and bronchus-associated lymphoid tissue), anatomical locations of T and B lymphocytes |
| Cellular basis of the immune response and immunologic mediators: Antigen processing and presentation in the context of MHC I and MHC II molecules (example TAP, beta-2 microglobulin), intracellular pathways |
| Cellular basis of the immune response and immunologic mediators: Mechanisms by which MHC is expressed on the surface; including distribution of MHC I and MHC II on different cells |
| Cellular basis of the immune response and immunologic mediators: Mechanisms of MHC I and MHC II deficiencies, and the genetics of MHC regulation of the adaptive immune response (example peripheral tolerance, anergy, regulatory T lymphocytes |
| Cellular basis of the immune response and immunologic mediators: Termination of immune response, and B-T lymphocyte interactions) activation |
| Cellular basis of the immune response and immunologic mediators: Function, and molecular biology of complement (example anaphylatoxins) functional and molecular biology of cytokines (example IL 1-15) |
| Basis of immunologic diagnostics (example antigen-antibody reactions used for diagnostic purposes, ELISA, immunoblotting, antigen-antibody changes over time, ABO typing) |
| Principles of immunologic protection: Vaccine production and mechanisms of vaccine action biologically active antibodies (example monoclonal antibodies, polyclonal antibodies including IVIG, VZIG, rabies immunoglobulin) |
| Effect of age on the function of components of the immune system |
System specifications-Immune system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Disorders associated with immunodeficiency: (a) Deficiency primarily of humoral immunity-common variable immunodeficiency; hyper IgM syndrome; hypogammaglobulinemia/ agammaglobulinemia, X-linked (Bruton); selective immunodeficiency (example IgA, IgM, IgE) |
| Disorders associated with immunodeficiency: (b) Deficiency/ dysfunction primarily of cell-mediated immunity-adenosine deaminase deficiency; thymic aplasia (DiGeorge syndrome); severe combined immunodeficiency disease (SCID); Wiskott-Aldrich syndrome |
| Disorders associated with immunodeficiency: (b) Deficiency/ dysfunction primarily of cell-granulomatosis; allergic reactions/ skin, (c) complement deficiency: Alternative pathway component deficiency (C2, C3b, C3bB, C36B6) |
| Disorders associated with immunodeficiency: (c) Complement deficiency-classical pathway component deficiency (C1q, C1r, C1-C5); terminal component deficiency (C5b-C9; terminal complement complex); C1 esterase inhibitor deficiency, hereditary angioedema |
| Disorders associated with immunodeficiency: (c) Complement deficiency-mannose-binding lectin (MBL) deficiency; membrane attack complex deficiency, (d) deficiency of phagocytic cells and natural killer cells: Chediak-Higashi disease |
| Disorders associated with immunodeficiency: (d) Deficiency of phagocytic cells and natural killer cells-chronic granulomatous disease and other disorders of phagocytosis; leukocyte adhesion deficiency |
| HIV/ AIDS: HIV1 and HIV2; AIDS; AIDS complications (example neuropathy, dementia, renal insufficiency); immunology of AIDS; immune reconstitution syndrome (IRS); secondary infections; noninfectious complications |
| Immunologically mediated disorders: (a) Hypersensitivity reactions-type 1, 2, 3, including anaphylaxis; type 4; drug reactions; serum sickness, (b) transplantation: rejection; graft-vs.-host disease |
| Adverse effects of drugs on the immune system: Jarisch-Herxheimer reaction; drugs affecting the immune system (example prednisone, azathioprine, cyclosporine, methotrexate |
| Adverse effects of drugs on the immune system: Monoclonal antibody drugs [example abciximab, adalimumab; bevacizumab, infliximab, omalizumab, rituximab]); vaccine adverse effects |
System specifications-Blood and lymphoreticular system
System specifications-Blood and lymphoreticular system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes, organ structure and function |
| Cell/ tissue structure and function: Production and function of erythrocytes, including heme and hemoglobin synthesis; hemoglobin O and CO transport, transport proteins, erythropoietin production and function of platelets |
| Cell/ tissue structure and function: Production and function of coagulation and fibrinolytic factors; hemostasis |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Blood and lymphoreticular system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious and immunologic infectious disorders: (a) bacteria, (b) viral-hemorrhagic fever (Ebola virus, Marburg virus); chikungunya; dengue fever; Zika virus disease, (c) parasitic: malaria (Plasmodium spp); babesiosis (Babesia species) |
| Infectious and immunologic infectious disorders: (d) Primary infections of lymphoid tissue-lymphadenitis (viral, bacterial, fungal, parasitic); lymphangitis; buboes, bubonic plague (Yersinia pestis); cat scratch disease (Bartonella henselae) |
| Infectious and immunologic infectious disorders (e) Immunologic and inflammatory disorders-cryoglobulinemia, essential mixed cryoglobulinemia; autoimmune hemolytic anemia; paroxysmal nocturnal hemoglobinuria; thrombotic thrombocytopenic purpura |
| Infectious and immunologic infectious disorders: (e) Immunologic and inflammatory disorders-hemolytic uremic syndrome |
| Neoplasms: Leukemia, acute (ALL, AML); leukemia, chronic (CLL, CML); lymphomas, Hodgkin disease, non-Hodgkin lymphoma, Burkitt lymphoma, T-cell lymphoma; multiple myeloma, dysproteinemias, monoclonal gammopathy of unknown significance (MGUS) |
| Neoplasms: Myelofibrosis; myelodysplastic syndrome, myelodysplasias; other immunoproliferative neoplasms (example Waldenstrom macroglobulinemia) |
| Anemia, cytopenias, and polycythemia anemias: (a) Decreased production-anemia of chronic disease, (b) hemolysis: Glucose-6-phosphate dehydrogenase deficiency; pyruvate kinase deficiency |
| Anemia, cytopenias, and polycythemia anemias: (c) Disorders of hemoglobin, heme, or membrane-disorders of red cell membranes; hereditary spherocytosis, elliptocytosis; methemoglobinemia, congenital; sickle cell disease; sideroblastic anemia; thalassemias |
| Anemia, cytopenias, and polycythemia anemias: (d) Other causes of anemia-blood loss, acute and chronic as a cause of anemia, (e) cytopenias: Aplastic anemia; leukopenia; neutropenia, cyclic neutropenia, agranulocytosis; pancytopenia; thrombocytopenia |
| Anemia, cytopenias, and polycythemia anemias: (e) Cytopenias-quantitative; immune thrombocytopenic purpura (ITP), (f) cythemias: Leukocytosis; polycythemia vera; secondary polycythemia |
| Coagulation disorders (hypercoagulable and hypercoagulable conditions): (a) Hypercoagulable-disseminated intravascular coagulation; hemophilia, congenital factor VIII [hemophilia A] and IX [hemophilia B]; hypofibrinogenemia; von Willebrand disease |
| Coagulation disorders (hypercoagulable and hypercoagulable conditions): (b) Hypercoagulable-platelet dysfunction, qualitative, hypercoagulable: Heparin-induced thrombocytopenia; other coagulopathies (example homocysteinemia, hypoplasminogenemia) |
| Coagulation disorders (hypercoagulable and hypercoagulable conditions): (b) Hypercoagulable-other coagulopathies (example antithrombin III, protein C/ protein S deficiency, factor V Leiden, anticardiolipin antibodies, lupus anticoagulant) |
| Coagulation disorders (hypercoagulable and hypercoagulable conditions): (b) Hypercoagulable-prothrombin G20210A mutation), (c) reactions to blood components: ABO incompatibility/ anaphylaxis; Rh incompatibility/anaphylaxis; hemolysis, delayed |
| Coagulation disorders (hypercoagulable and hypercoagulable conditions): (c) Reactions to blood components-transfusion reaction; transfusion contaminated with bacteria; transfusion-related acute lung injury (TRALI); anaphylactoid reaction (IgA deficiency) |
| Traumatic, mechanical, and vascular disorders: Mechanical injury to erythrocytes (example cardiac valve hemolysis); disorders of the spleen; splenic rupture/ laceration; splenic infarct; splenic abscess |
| Traumatic, mechanical, and vascular disorders: Effects/ complications of splenectomy (example sepsis due to encapsulated bacteria); hypersplenism |
| Adverse effects of drugs on the hematologic and lymphoreticular systems: Antiplatelet drugs, antithrombin drugs (example dabigatran); chemotherapeutic agents; inhibitors of coagulation factors; methemoglobinemia, acquired; propylthiouracil |
| Adverse effects of drugs on the hematologic and lymphoreticular systems: Tumor lysis syndrome; warfarin |
System specifications-Behavioral health
System specifications-Behavioral health: Unit 01
Normal processes |
|---|
| Psychodynamic and behavioral factors, related past experience (example transference, personality traits) |
| Adaptive behavioral responses to stress and illness (example coping mechanisms) |
| Maladaptive behavioral responses to stress and illness (example drug-seeking behavior, sleep deprivation) |
| Patient adherence: General adherence; adolescent adherence |
System specifications-Behavioral health: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Psychotic disorders: Brief psychotic disorder; delusional disorder; psychotic disorder due to another medical condition; schizophrenia; schizoaffective disorder; substance-induced psychotic disorder |
| Anxiety disorders: Acute stress disorder; anxiety disorders (generalized anxiety disorder, anxiety due to another medical condition, social phobia); hyperventilation syndrome; obsessive-compulsive disorder; panic disorder with and without agoraphobia |
| Anxiety disorders: Phobic disorders; post-traumatic stress disorder; separation anxiety disorder; substance-induced anxiety disorder, trichotillomania |
| Mood disorders: Major depressive disorder with and without psychotic features, with and without seasonal pattern; major depressive disorder, postpartum, with and without psychotic features, including screening; cyclothymic disorder |
| Mood disorders: Persistent depressive disorder (dysthymia); bipolar disorder, manic/ depressed/ mixed; premenstrual dysphoric disorder; bipolar and related disorder or depressive disorder due to another medical condition |
| Mood disorders: Substance/ medication-induced bipolar and related disorder or depressive disorder (illegal or prescribed); suicidal ideation/ attempt |
| Somatoform disorders: Body dysmorphic disorder; conversion disorder, including psychogenic seizures; dissociative disorders; illness anxiety disorder (hypochondriasis); malingering; pain disorder; somatic symptom disorder |
| Factitious disorders: Factitious disorder imposed on self |
| Eating disorders and impulse control disorders: Anorexia nervosa; binge-eating disorder; bulimia nervosa; eating disorder; disruptive, impulse-control, and conduct disorders (example gambling, kleptomania, pyromania) |
| Disorders originating in infancy/ childhood: Reactive attachment disorder; attention deficit/ hyperactivity disorder; speech sound disorder or language disorder; learning disorder/ dyslexia; intellectual developmental disorder and developmental delay |
| Disorders originating in infancy/ childhood: Undefined, including school problems, fetal alcohol syndrome; oppositional defiant disorder, conduct disorder; autism spectrum disorder, rett syndrome; psychoses with origin specific to childhood |
| Disorders originating in infancy/ childhood: Elimination disorders (incontinence, encopresis); tic disorders/ tourette disorder |
| Personality disorders: Antisocial personality disorder; avoidant personality disorder; borderline personality disorder; dependent personality disorder; histrionic personality disorder; narcissistic personality disorder |
| Personality disorders: Obsessive-compulsive personality disorder; paranoid personality disorder; schizoid personality disorder |
| Psychosocial disorders/ behaviors: Adjustment disorder; grief response/ bereavement, normal and persistent complex; parent-child relational problems other than physical or emotional abuse; other psychosocial stress |
| Sexual and gender identity disorders: Gender dysphoria; psychosexual dysfunction |
| Substance use disorders: Alcohol use disorder/ intoxication/ dependence/ withdrawal; tobacco/ nicotine use disorder/ dependence/ withdrawal; varenicline use; cannabis use disorder/ intoxication/ dependence |
| Substance use disorders: Hallucinogen use disorder/ intoxication/ dependence/ withdrawal; inhalant use disorder/ intoxication/ dependence/ withdrawal; opioid, heroin, including prescription drug, use disorder/ intoxication/ dependence/ withdrawal |
| Substance use disorders: Sedative, hypnotic, including benzodiazepine and barbiturate use disorder/ intoxication/ dependence/ withdrawal; stimulant, cocaine, methamphetamine use disorder/ intoxication/ dependence/ withdrawal |
| Substance use disorders: Other drugs of use disorders (example ecstasy, PCP, bath salts)/ intoxication/ dependence/ withdrawal; polysubstance use disorder/ intoxication/ dependence/ withdrawal |
System specifications-Nervous system and special senses
System specifications-Nervous system and special senses: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes, including neural tube derivatives, cerebral ventricles, and neural crest derivatives |
| Organ structure and function: (a) Spinal cord-gross anatomy and blood supply, spinal reflexes, brain stem (example cranial nerves and nuclei, reticular formation, anatomy and blood supply, control of eye movements) |
| Organ structure and function: (b) Brain-gross anatomy and blood supply, higher function: Cognition, language, memory, executive function, hypothalamic function, limbic system and emotional behavior, circadian rhythm sleep-wake disorder |
| Organ structure and function: (c) Sensory systems-general sensory modalities, including sharp, dull, temperature, vibratory, and proprioception, special sensory modalities, including vision, hearing, taste, olfaction, and balance |
| Organ structure and function: (d) Motor systems-brain and spinal cord (upper motor neuron), basal ganglia and cerebellum, autonomic nervous system, peripheral nerves |
| Cell/ tissue structure and function, including neuronal cellular and molecular biology: Axonal transport, excitable properties of neurons, axons, and dendrites, including channels synthesis, storage, release |
| Cell/ tissue structure and function, including neuronal cellular and molecular biology: Reuptake, and degradation of neurotransmitters and neuromodulators, presynaptic and postsynaptic receptor interactions, trophic and growth factors, brain metabolism |
| Cell/ tissue structure and function, including neuronal cellular and molecular biology: Glia, myelin, brain homeostasis: Blood-brain barrier, cerebrospinal fluid formation and flow, choroid plexus |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Nervous system and special senses: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) meningitis: Bacterial (actinomyces israelii; haemophilus influenzae; listeria monocytogenes; mycobacterium tuberculosis; neisseria meningitidis; staphylococcus aureus) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) meningitis: Bacterial (epidermidis; streptococcus agalactiae; streptococcus pneumoniae); viral (adenovirus, arboviruses, echovirus and coxsackie A and B viruses) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral (echovirus and coxsackie A and B viruses, polioviruses, herpes simplex virus, varicella zoster human immunodeficiency virus, lymphocytic choriomeningitis virus) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral (lymphocytic choriomeningitis virus, measles virus, mumps virus, St. Louis encephalitis virus, California encephalitis virus, Western equine encephalitis virus) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iii) fungal (blastomycosis dermatitidis, cryptococcus neoformans/ gattii); spirochetal (borrelia burgdorferi; leptospira; treponema pallidum, including neurosyphilis) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iv) protozoal/ helminths (acanthamoeba, naegleria fowleri, strongyloides stercoralis, angiostrongylus cantonensis, baylisascaris procyonis) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(v) encephalitis (herpesvirus [HSVI], varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, mumps virus, enterovirus, West Nile virus, St. Louis encephalitis virus) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(v) encephalitis (rabies virus, eastern and western equine encephalitis virus, poliovirus, Taenia, Toxoplasma gondii), (vi) prion disease (example Creutzfeldt-Jakob disease) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(vi) botulism (Clostridium botulinum), (vii) tetanus (Clostridium tetani); (viii) CNS disorders associated with AIDS (example progressive multifocal leukoencephalopathy) |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-myasthenia gravis, including thymoma; multiple sclerosis; transverse myelitis |
| Neoplasms (cerebral, spinal, and peripheral): Benign (meningioma, neurofibromatosis); malignant (glioblastoma multiforme, astrocytoma, medulloblastoma, primary CNS lymphoma); metastatic (example breast, lung, pancreatic, testicular, melanoma) |
| Cerebrovascular disease: Arteriovenous malformations, ectatic cerebral vessels; transient ischemic attack; stroke, thrombotic: Cerebral artery occlusion/ cerebral infarction; stroke, embolic: Cerebral embolism |
| Cerebrovascular disease: Stroke-intracerebral hemorrhage including subarachnoid hemorrhage, traumatic intracranial hemorrhage; cerebral artery aneurysm; carotid artery stenosis/ atherosclerosis/ occlusion/ dissection |
| Cerebrovascular disease: Vertebral artery deficiency/ dissection; subclavian steal syndrome; vascular dementia; hypertensive encephalopathy; posterior reversible encephalopathy syndrome; venous sinus thrombosis |
| Disorders relating to the spine, spinal cord, and spinal nerve roots: Cauda equina syndrome; spinal artery thrombosis/ embolus/ infarct; spinal cord compression; spinal cord transection, paraplegia and quadriplegia |
| Disorders relating to the spine, spinal cord, and spinal nerve roots: Acute and chronic effects (example autonomic dysreflexia); spinal stenosis (cervical, lumbar); syringomyelia |
| Cranial and peripheral nerve disorders: (a) Cranial nerve injury/ disorders-cranial nerve injury; bell palsy; anisocoria, miosis, mydriasis; internuclear ophthalmoplegia; nystagmus and other irregular eye movements; vestibular neuritis, labyrinthitis |
| Cranial and peripheral nerve disorders: (a) Cranial nerve injury/ disorders-ptosis of the eyelid; Horner syndrome, peripheral nerve/ plexus injury/ disorders: Peripheral nerve injury, including brachial plexus |
| Cranial and peripheral nerve disorders: (b) Peripheral nerve/plexus injury/disorders-carpal/ cubital/ tarsal/ peroneal tunnel syndrome; mononeuritis, Guillain-Barré syndrome; Miller Fisher syndrome; neuropathy (example Charcot-Marie-Tooth disease) |
| Cranial and peripheral nerve disorders: (b) Peripheral nerve/plexus injury/disorders-herpes zoster |
| Neurologic pain syndromes: Complex regional pain syndrome (reflex sympathetic dystrophy, causalgia); fibromyalgia; postherpetic neuralgia; phantom limb pain/ syndrome; thalamic pain syndrome; trigeminal neuralgia |
| Degenerative disorders/ amnestic syndromes: Alzheimer disease; frontotemporal dementia, including progressive supranuclear palsy, Lewy body disease; mild neurocognitive disorder, mild cognitive impairment |
| Global cerebral dysfunction: Altered states of consciousness; delirium; coma/ brain death |
| Neuromuscular disorders: Amyotrophic lateral sclerosis/ spinal muscular atrophy; muscular dystrophy (example Duchenne, myotonic); muscle channelopathies (example hypokalemic period paralysis) |
| Movement disorders: Acute dystonia; adult tic disease; essential tremor; Huntington disease; Parkinson disease, including Parkinson dementia |
| Metabolic disorders: Adrenoleukodystrophy; metabolic encephalopathy |
| Paroxysmal disorders: Headache, including migraine, mixed, tension, ice-pick, cluster, medication withdrawal, caffeine withdrawal; seizure disorders, including generalized tonic-clonic, partial, absence, febrile |
| Sleep disorders: Cataplexy and narcolepsy; circadian rhythm sleep-wake disorder; insomnia, primary; sleep terror disorder and sleepwalking; REM sleep behavior disorder; restless legs syndrome |
| Traumatic and mechanical disorders and disorders of increased intracranial pressure: Anoxic brain damage, cerebral hypoxia; epidural, subdural hematoma (cerebral and spinal); intraparenchymal hemorrhage, traumatic subarachnoid hemorrhage; cerebral edema |
| Traumatic and mechanical disorders and disorders of increased intracranial pressure: Pseudotumor cerebri (idiopathic intracranial hypertension); torticollis/ cervical dystonia; hydrocephalus, including normal-pressure |
| Traumatic and mechanical disorders and disorders of increased intracranial pressure: Traumatic brain injury (concussion)/ post concussion syndrome (dementia pugilistica); traumatic brain syndrome |
| Congenital disorders: Friedreich ataxia; neural tube defects (example spina bifida, holoprosencephaly, anencephaly); microcephaly; Sturge-Weber syndrome; tuberous sclerosis, von Hippel-Lindau disease; hydrocephalus, obstructive (Arnold-Chiari) |
| Adverse effects of drugs on the nervous system: Acute dystonic reaction; drug-induced meningitis (example NSAIDs, sulfa drugs); drug-induced neuropathy (example vincristine, isoniazid, metronidazole) |
| Adverse effects of drugs on the nervous system: Extrapyramidal adverse effects (example akathisia, dystonia, drug-induced parkinsonism); neuroleptic malignant syndrome; poisoning by psychotropic agents, including antidepressants; serotonin syndrome |
| Adverse effects of drugs on the nervous system: Tardive dyskinesia |
| Disorders of the eye and eyelid: (a) Infectious and inflammatory disorders of the eye-blepharitis/ eyelid inflammation; chalazion; chorioretinitis; conjunctivitis (adenovirus)/ keratoconjunctivitis; dacryocystitis; endophthalmitis; hordeolum |
| Disorders of the eye and eyelid: (a) Infectious and inflammatory disorders of the eye-iridocyclitis; optic neuritis; periorbital cellulitis; uveitis, (b) neoplasms of the eye: Melanoma; retinoblastoma |
| Disorders of the eye and eyelid: (c) Disorders of the eye and eyelid, structural-cataract; glaucoma; lacrimal system disorders; pterygium; refractive disorders (presbyopia, myopia, hyperopia, astigmatism) |
| Disorders of the eye and eyelid: (d) Disorders of the pupil, iris, muscles (extraocular): Amblyopia; strabismus, (e) disorders of the retina-hypertensive retinopathy; macular degeneration; papilledema; retinal detachment; retinitis pigmentosa |
| Disorders of the eye and eyelid: (e) Disorders of the retina-vascular disorders affecting the retina, including central retinal artery embolus, retinal hemorrhage, amaurosis fugax, embolus, carotid artery stenosis, central retinal vein occlusion |
| Disorders of the eye and eyelid: (e) Disorders of the retina-visual impairment/ blindness, night blindness , (f) traumatic and mechanical disorders: Black eye; burn of the eye and adnexa; corneal abrasion, ulcer; dislocated lens; foreign body in eye |
| Disorders of the eye and eyelid: (f) Traumatic and mechanical disorders-hyphema; injury to optic nerve and pathways; laceration of the eye and eyelid; ocular open wounds; orbital fracture; subconjunctival hemorrhage |
| Disorders of the eye and eyelid: (g) Adverse effects of drugs on the eyes-ethambutol; hydroxychloroquine; prednisone |
| Disorders of the ear: (a) Infectious and inflammatory disorders of the ear-chondritis; mastoiditis; otitis, externa, media, interna, serous, suppurative, malignant otitis externa, (b) neoplasms: Acoustic neuroma, neurofibromatosis type 2; cholesteatoma |
| Disorders of the ear: (c) Hearing loss/ deafness-hearing loss, including noise-induced; otosclerosis; tinnitus, (d) disorders of balance and spatial orientation: Meniere disease; motion sickness; vertigo, including benign positional vertigo |
| Disorders of the ear: (e) Traumatic and mechanical disorders: Barotrauma; foreign body in ear; impacted cerumen; laceration, avulsion; perforation of tympanic membrane; eustachian tube disorders |
| Disorders of the ear: (f) Adverse effects of drugs on the ear-antineoplastic agents, including cisplatin; aminoglycosides; furosemide; salicylates |
System specifications-Skin and subcutaneous tissue
System specifications-Skin and subcutaneous tissue: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and neonatal changes |
| Organ structure and function, including barrier function, thermal regulation |
| Cell/ tissue structure and function, eccrine function |
| Repair, regeneration, and changes associated with stage of life (example senile purpura, male pattern baldness, postmenopausal hair changes) |
| Skin defense mechanisms and normal flora |
System specifications-Skin and subcutaneous tissue: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(i) bacterial: Cellulitis, erysipelas, impetigo, staphylococcal scalded skin syndrome; abscess, cutaneous, including septic abscess |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(i) bacterial: Anthrax (Bacillus anthracis); carbuncle; folliculitis; pilonidal cyst, infected; pyoderma gangrenosum; MSSA and MRSA skin infections |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(i) bacterial: Mycobacterial infections (example leprosy, draining sinus); scarlet fever (group A Streptococcus), (ii) viral: Herpes simplex type 1 and type 2 |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(ii) viral: Herpes zoster; Ramsay-hunt syndrome; molluscum contagiosum; hand-foot-and-mouth disease; herpangina; parvovirus; chickenpox |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(ii) viral: Erythema infectiosum (fifth disease), rubella, measles, roseola (exanthema subitum); verrucae vulgaris |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(iii) fungal (deep and superficial): Candidiasis, skin; dermatophytosis, tinea corporis; dermatomycoses; diaper rash; onychomycosis |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(iv) parasitic: Cutaneous larva migrans; cutaneous leishmaniasis; (vi) infestations, non venomous bites, stings: Scabies; lice; insect bites, including bed bugs |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) papulosquamous and eczematous dermatoses: Psoriasis; lichen planus and lichenoid dermatoses; allergic/irritant contact dermatitis (example nickel) |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) papulosquamous and eczematous dermatoses: Dermatoses caused by plants (poison ivy, poison oak), (ii) vesiculobullous disorders: Epidermolysis bullosa |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(ii) vesiculobullous disorders: Dermatitis herpetiformis; pemphigus; pemphigoid, (iii) urticaria, erythema, exanthema, and purpura: Erythema nodosum |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(iii) urticaria, erythema, exanthema, and purpura: Atopic dermatitis; pityriasis rosea; urticaria; Stevens-Johnson syndrome, erythema multiforme |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(iii) urticaria, erythema, exanthema, and purpura: Toxic epidermal necrolysis, (iv) autoimmune disorders: Vitiligo |
| Neoplasms: (a) Benign neoplasms, cysts, and other skin lesions-actinic keratoses; cysts, including epidermal; hemangiomas; lipoma; pigmented nevi; seborrheic keratosis; xanthomas, (b) malignant neoplasms: Basal cell carcinoma; squamous cell carcinoma |
| Neoplasms: (b) Malignant neoplasms-melanoma, including genital; Kaposi sarcoma; cutaneous T-cell lymphoma, mycosis fungoides |
| Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes): (a) Disorders of the hair and hair follicles-alopecia; seborrhea capitis/seborrheic dermatitis; tinea barbae and capitis |
| Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes): (b) Disorders of the nails (including ingrowing nail), (c) disorders of sweat and sebaceous glands: Acne vulgaris; hidradenitis suppurativa |
| Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes): (c) Disorders of sweat and sebaceous glands-hyperhidrosis; ichthyosis; rosacea |
| Oral disease: Aphthous ulcers (stomatitis, canker sores); leukoplakia |
| Disorders of pigmentation: Albinism; lentigo |
| Traumatic and mechanical disorders: Animal bites (dogs, cats, etc); burns or wounds affecting the skin or subcutaneous tissue (example sunburn, other including blast injuries and burns); cauliflower ear; effects of ultraviolet light; keloids; tattoo |
| Traumatic and mechanical disorders: Thermal injury, perniosis, frostbite; ulcers, decubitus |
| Congenital disorders: Xeroderma pigmentosum; benign lesions in neonates, infants, children (example congenital nevi) |
| Adverse effects of drugs on skin and subcutaneous tissue: Drug reactions, eruptions, including local reaction to vaccine |
System specifications-Musculoskeletal system
System specifications-Musculoskeletal system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes |
| Organ structure and function |
| Cell/ tissue structure and function: Biology of bones, joints, tendons, skeletal muscle, cartilage exercise and physical conditioning/ deconditioning |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Musculoskeletal system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, inflammatory, and immunologic disorders: (a) Infectious disorders-gangrene, dry and wet, clostridial myonecrosis (clostridium perfringens); discitis; myositis, infective; necrotizing fasciitis; osteomyelitis; septic arthritis |
| Infectious, inflammatory, and immunologic disorders: (a) Infectious disorders-spondylitis, tuberculous, (b) immunologic disorders: Ankylosing spondylitis; dermatomyositis/ polymyositis; juvenile idiopathic arthritis; rheumatoid arthritis, felty syndrome |
| Infectious, inflammatory, and immunologic disorders: (b) Immunologic disorders-psoriatic arthropathy, (c) inflammatory disorders: Adhesive capsulitis of shoulder (frozen shoulder syndrome); ankylosing/spondylopathy (inflammatory); bursitis; fasciitis |
| Infectious, inflammatory, and immunologic disorders: (c) Inflammatory disorders-osteochondritis, osteochondritis dissecans; tendinitis, supraspinatus syndrome, enthesopathy of spine, elbow, ankle; temporomandibular joint disorders; fibrositis |
| Infectious, inflammatory, and immunologic disorders: (c) Inflammatory disorders-myofascial pain syndrome; synovitis; tenosynovitis; myositis |
| Neoplasms: Benign neoplasms (example ganglion cyst); malignant neoplasms of bone (example osteosarcoma, sarcoma, leiomyosarcoma, rhabdomyosarcoma); metastases to bone, secondary malignant neoplasm of bone |
| Degenerative and metabolic disorders: (a) Degenerative/ metabolic disorders of bone, tendon, and cartilage-chondromalacia; disc degeneration, herniated disc; Legg-Calvé-Perthes disease; Osgood-Schlatter disease; osteodystrophy; osteomalacia |
| Degenerative and metabolic disorders: (a) Degenerative/ metabolic disorders of bone, tendon, and cartilage-osteonecrosis (avascular), bone infarct; osteoporosis; osteopenia; osteitis deformans (Paget disease of bone); pathologic fracture; radiculopathies |
| Degenerative and metabolic disorders: (a) Degenerative/ metabolic disorders of bone, tendon, and cartilage-spondylolisthesis/spondylosis (degenerative), (b) degenerative/ metabolic disorders of joints: Gout, gouty arthritis, pseudogout; joint effusion |
| Degenerative and metabolic disorders: (b) Degenerative/ metabolic disorders of joints-osteoarthritis, degenerative/ metabolic disorders of muscles, ligaments, fascia: Dupuytren contracture; muscle calcification and ossification |
| Degenerative and metabolic disorders: (c) Degenerative/ metabolic disorders of muscles, ligaments, fascia-muscle wasting and diffuse atrophy; rhabdomyolysis |
| Traumatic and mechanical disorders: Amputation and care of amputees; backache, including low back pain; blast injuries; compartment syndrome; contractures, hospital-acquired; contusions; dislocations; fractures; sprains, strains; kyphoscoliosis, scoliosis |
| Traumatic and mechanical disorders: Rotator cuff syndrome; slipped capital femoral epiphysis; dislocation of hip |
| Congenital disorders: Achondroplasia/ dwarfism; disorders of limb development (HOX gene mutation, phocomelia); developmental dysplasia of the hip; dislocation of hip in infantile spinal muscular atrophy; genu valgum or varum |
| Congenital disorders: Foot deformities (flat foot, valgus/ varus deformities); osteogenesis imperfecta; McArdle disease; mitochondrial myopathies |
| Adverse effects of drugs on the musculoskeletal system: Drug-induced myopathy (example steroids, statins, cocaine, AZT); malignant hyperthermia |
System specifications-Cardiovascular system
System specifications-Cardiovascular system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal transitional changes |
| Organ structure and function: Chambers, valves cardiac cycle, mechanics, heart sounds, cardiac conduction hemodynamics, including blood volume and systemic vascular resistance circulation in specific vascular beds, including pulmonary and coronary |
| Cell/ tissue structure and function: Heart muscle, metabolism, oxygen consumption, biochemistry, and secretory function (example atrial natriuretic peptide), endothelium and secretory function, vascular smooth muscle |
| Cell/ tissue structure and function: Microcirculation, and lymph flow, neural and hormonal regulation of the heart, blood vessels, and blood volume, including responses to change in posture, exercise, and tissue metabolism, and autonomic responses |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Cardiovascular system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-bacterial endocarditis, myocarditis, (b) immunologic and inflammatory disorders: Atherosclerosis (example atherosclerosis of the aorta) |
| Neoplasms: Myxoma, metastases |
| Dysrhythmias: Premature beats (PACs, PVCs); atrial flutter/ fibrillation; multifocal atrial tachycardia; paroxysmal tachycardias; ventricular tachycardia/ fibrillation; wide complex tachycardia; torsades de pointes; bradycardias |
| Dysrhythmias: Atrioventricular block (first-, second-, third-degree); conduction disorder (LBBB, RBBB); cardiac arrest; sick sinus syndrome; prolonged QT syndrome; Wolff-Parkinson-White syndrome; carotid sinus hypersensitivity |
| Dysrhythmias: Pacemaker dysfunction, including failure to sense, capture |
| Heart failure: Chordae tendineae rupture; congestive heart failure; cor pulmonale; diastolic dysfunction; systolic dysfunction; mitral valve dysfunction; heart failure secondary to myocardial infarction |
| Heart failure: High-output heart failure, including thyrotoxicosis-induced, anemia-induced; tachycardia-induced; cardiogenic pulmonary edema |
| Ischemic heart disease: Acute coronary syndrome, acute myocardial infarction; angina pectoris, stable and unstable/ coronary artery disease/ coronary insufficiency; coronary artery spasm |
| Diseases of the myocardium: Cardiomyopathy, dilated, including alcoholic, viral, takotsubo; cardiomyopathy, obstructive hypertrophic; cardiomyopathy, familial dilated; cardiomyopathy, restrictive; hypertensive heart disease, left ventricular hypertrophy |
| Diseases of the myocardium: Right ventricular hypertrophy; complications of myocardial infarction; nontraumatic tamponade post-myocardial infarction; papillary muscle rupture/ dysfunction; ventricular free wall rupture; myocarditis |
| Diseases of the pericardium: Chronic constrictive pericarditis; pericardial effusion; pericardial tamponade; acute pericarditis; pericarditis, following myocardial infarction, surgery, trauma |
| Valvular heart disease: Valve disorders, mitral/ aortic/ tricuspid, pulmonic (example regurgitation, stenosis, prolapse, insufficiency, vegetation); functional murmurs; rheumatic heart disease; complications of artificial valves |
| Hypotension: Orthostatic hypotension |
| Hypertension: Elevated blood pressure reading without diagnosis of hypertension; essential hypertension; malignant hypertension; secondary hypertension |
| Dyslipidemia: Hypercholesterolemia; hyperlipidemia; hypertriglyceridemia; lipoproteins/ lipoprotein lipase deficiency |
| Vascular disorders: (a) Disorders of the great vessels-aneurysm, aortic (abdominal/ thoracic), dissection, ruptured; aneurysm, iliac, other peripheral vascular, ruptured; aortoiliac disease |
| Vascular disorders: (b) Peripheral arterial vascular disease-arterial embolism/ thrombosis, arteriovenous fistula; atheroembolic disease; claudication; cholesterol emboli; hypertensive vascular disease; peripheral arterial disease |
| Vascular disorders: (b) Peripheral arterial vascular disease-thromboangiitis obliterans, (c) diseases of the veins-deep venous thrombosis, venous thromboembolism; phlebitis/ thrombophlebitis; varicose veins; venous insufficiency; stasis ulcers |
| Vascular disorders: (c) Diseases of the veins-stasis dermatitis |
| Traumatic and mechanical disorders: Ventricular puncture; myocardial contusion; myocardial rupture; traumatic aortic dissection; traumatic tamponade |
| Congenital disorders, including disease in adults: Anomalous left coronary artery; atrial septal defect; coarctation of the aorta; endocardial cushion defect; patent foramen ovale; patent ductus arteriosus; tetralogy of Fallot |
| Congenital disorders, including disease in adults: Transposition of the great vessels; ventricular septal defect |
| Adverse effects of drugs on the cardiovascular system: Adriamycin; cocaine, amphetamine, PCP; ACE inhibitors, calcium channel blockers, alpha blockers, minoxidil |
System specifications-Respiratory system
System specifications-Respiratory system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes |
| Organ structure and function: Airways, including mechanics and regulation of breathing, lung parenchyma, including ventilation, perfusion, gas exchange, pleura, nasopharynx, sinuses |
| Cell/ tissue structure and function, including surfactant formation, and alveolar structure |
| Repair, regeneration, and changes associated with stage of life |
| Pulmonary defense mechanisms and normal flora |
System specifications-Respiratory system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-acute upper respiratory infection; viral infections (adenovirus, corona viruses, coxsackievirus, influenza virus) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-viral infections (parainfluenza virus, rhinoviruses); sinusitis; nasopharyngitis; epiglottitis |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-bordetella pertussis pneumonia; croup; acute laryngitis; acute laryngotracheitis; tracheitis; pharyngitis |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-streptococcal throat infections; tonsillitis; peritonsillar abscess; rhinitis, allergic, chronic |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-ulcers of nasal cavity/ sinuses |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-hospital acquired pneumonia; ventilator-associated pneumonia, community-acquired pneumonia, acute bronchiolitis |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-bronchiolitis obliterans with organizing pneumonia (BOOP); anthrax, pulmonary (Bacillus anthracis); aspiration pneumonia |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-pneumonitis; bronchitis, acute; bronchopneumonia; pneumonia (Burkholderia pseudomallei, chlamydophila pneumoniae |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-coxiella burnetii, francisella tularensis, haemophilus influenzae, klebsiella pneumoniae, legionella, moraxella catarrhalis |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-mycoplasma pneumoniae, pseudomonas aeruginosa, streptococcus, MSSA, MRSA, other gram‐negative bacteria) |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-viral infection (example influenza A, B, adenovirus, H1N1, respiratory syncytial virus, parainfluenza virus) |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-fungal infection (aspergillosis, including allergic bronchopulmonary aspergillosis and aspergilloma, histoplasmosis) |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-fungal infection (coccidioidomycosis, pneumocystis jirovecii); pulmonary tuberculosis; lung abscess |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-viral infection (example influenza A, B, adenovirus, respiratory syncytial virus, parainfluenza virus, avian influenza virus) |
| Neoplasms: (a) Benign neoplasms-upper airways (example vocal cord polyps, nasal polyps, juvenile, papillomatosis); lungs and pleura (example solitary pulmonary nodule, bronchial carcinoid tumors) |
| Neoplasms: (b) Malignant neoplasms-(i) upper airways: Lip, oral cavity, and pharynx; head and neck cancer; larynx; trachea, (ii) lower airways and pleura: Malignant neoplasms of bronchus and/ or lung (squamous cell, adenocarcinoma, large cell, small cell) |
| Neoplasms: (b) Malignant neoplasms-(ii) lower airways and pleura: Malignant neoplasms of pleura (mesothelioma); secondary malignant neoplasms of lung; secondary malignant neoplasms of pleura, (c) metastatic neoplasms including pleural |
| Obstructive airway disease: Asthma, reactive airway disease; bronchiectasis; chronic airway obstruction; chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema |
| Pneumoconiosis/ fibrosing/ restrictive pulmonary disorders/ interstitial lung disease: Pneumoconiosis; asbestosis; silicosis; silo-filler's lung, byssinosis, bagassosis, berylliosis; hypersensitivity pneumonitis; hypereosinophilic syndromes |
| Pneumoconiosis/ fibrosing/ restrictive pulmonary disorders/ interstitial lung disease: Loeffler syndrome; interstitial pneumonia, usual (UIP), desquamative (DIP), nonspecific |
| Respiratory failure/ respiratory arrest and pulmonary vascular disorders: Acute respiratory distress syndrome (ARDS); pulmonary hypertension; pulmonary vascular disorders, arteriovenous fistula; pulmonary edema, pulmonary cause and unspecified |
| Respiratory failure/ respiratory arrest and pulmonary vascular disorders: Pulmonary embolism; air and fat embolism; respiratory failure due to enteral feeding |
| Metabolic, regulatory, and structural disorders: Disorders of gas exchange; hypoventilation; hypoxia; pulmonary alveolar proteinosis; ventilation-perfusion imbalance |
| Disorders of the pleura, mediastinum, and chest wall: Chylothorax; costochondritis; empyema; hemothorax; mediastinitis; pleural effusion; pleuritis; pneumomediastinum; pneumothorax |
| Traumatic and mechanical disorders: (a) Upper airways-epistaxis; barotrauma, sinus; laryngeal/pharyngeal obstruction; tracheoesophageal fistula; tracheal stenosis; tracheomalacia; trauma (example tracheal injury) |
| Traumatic and mechanical disorders: (a) Upper airways-foreign body (nose, pharynx, larynx, trachea); traumatic/ mechanical disorders of the nasal cavity/ sinuses (example septal perforation) |
| Traumatic and mechanical disorders: (b) Lower airways and pleura-atelectasis; diaphragm/ chest wall injury; drowning and near drowning; foreign body, upper and lower respiratory tract; penetrating chest wounds; pulmonary contusion; sleep apnea |
| Traumatic and mechanical disorders: (b) Lower airways and pleura-obstructive and central; hypoventilation syndrome, obesity-hypoventilation syndrome |
| Congenital disorders: Bronchogenic cysts; congenital cysts; congenital diaphragmatic hernia; pulmonary sequestration; immotile cilia syndrome |
| Adverse effects of drugs on the respiratory system: Bleomycin, amiodarone; adverse effects of 100% oxygen; acute effects of tobacco/ nicotine, inhalants, cocaine |
System specifications-Gastrointestinal system
System specifications-Gastrointestinal system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes |
| Organ structure and function: Anatomy of the alimentary canal, including mouth, pharynx, esophagus, stomach, small intestine, large intestine, anus, peritoneal cavity, liver and biliary system, including enterohepatic circulation |
| Organ structure and function: Salivary glands and exocrine pancreas, gastrointestinal motility, including defecation digestion and absorption |
| Cell/ tissue structure and function: Endocrine and neural regulatory functions, including GI hormones (example gastrin) salivary, gastrointestinal, pancreatic, hepatic secretory products, including enzymes, proteins |
| Cell/ tissue structure and function: Bile salts, and processes synthetic and metabolic functions of hepatocytes |
| Repair, regeneration, and changes associated with stage of life |
| Gastrointestinal defense mechanisms and normal flora |
System specifications-Gastrointestinal system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Pseudomembranous colitis (Clostridium difficile); enteritis/ enteric infections (includes gastroenteritis) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) bacterial: (example Staphylococcus aureus, Escherichia coli, Listeria monocytogenes, Yersinia enterocolitica, Campylobacter species, Vibrio cholerae, Salmonella species) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: (Shigella species, traveler's/ infectious diarrhea); hepatic abscess, subhepatic abscess, subphrenic abscess; peritonitis, primary and secondary; Whipple disease |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral: Infectious esophagitis (example CMV, herpes); hepatitis A, B, C, D, E; coxsackievirus enteritis/ colitis; Echovirus enteritis/colitis; rotavirus enteritis; mumps |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral: Gingivostomatitis, herpetic, (iii) fungal: Thrush, (iv) parasitic: Cryptosporidium, cyclospora, entamoeba histolytica, giardia, isospora belli |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iv) parasitic: Strongyloides stercoralis |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-autoimmune hepatitis; celiac disease; eosinophilic esophagitis; granulomatous enteritis; inflammatory bowel disease, including Crohn disease |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-regional enteritis; microscopic colitis (collagenous and lymphocytic colitis), ulcerative colitis, toxic megacolon |
| Neoplasms: (a) Benign neoplasms, including polyps, cysts-stomach; small intestine; colon, rectum, and anus, including polyps, (b) malignant neoplasms and premalignant conditions: Oral cancer (example lips, mouth, tongue, salivary glands) |
| Neoplasms: (b) Malignant neoplasms and premalignant conditions-esophageal, squamous and adenocarcinoma; Barrett esophagus; gastrinoma, Zollinger-Ellison syndrome; gastrointestinal carcinoid tumors; gastrointestinal stromal tumors; small intestine |
| Neoplasms: (b) Malignant neoplasms and premalignant conditions-stomach, adenocarcinoma, lymphoma, MALT; colon, rectum, anus; hereditary colon cancer syndromes |
| Neoplasms: (b) Malignant neoplasms and premalignant conditions-familial adenomatous polyposis (example Peutz-Jeghers syndrome, Gardner syndrome, Turcot syndrome,); MUTYH-associated polyposis; gallbladder, cholangiocarcinoma |
| Neoplasms: (b) Malignant neoplasms and premalignant conditions-adenocarcinoma of the ampulla of Vater; liver, including hepatoma; peritoneal cancer, including metastatic studding with cancer; pancreas, (c) metastatic neoplasms |
| Signs, symptoms, and ill-defined disorders: Upper gastrointestinal bleeding; lower gastrointestinal bleeding; constipation; diarrhea; hematochezia; bright red rectal bleeding; melena; nausea, vomiting, rumination |
| Disorders of the oral cavity, salivary glands, and esophagus: (a) Oral cavity and salivary glands-abscessed tooth; dental caries; malocclusion; disorders of the salivary glands (example stones, sialadenitis, parotitis) |
| Disorders of the oral cavity, salivary glands, and esophagus: (b) Esophagus-achalasia and cardiospasm; dysphagia; diverticulum (example Zenker); esophageal periapical abscess without sinus; esophagitis/ esophageal reflux (GERD); esophagitis, pill |
| Disorders of the oral cavity, salivary glands, and esophagus: (b) Esophagus-Mallory-Weiss syndrome; paraesophageal (hiatal) hernia; stricture and stenosis of esophagus |
| Disorders of the stomach, small intestine, colon, rectum, anus: (a) Stomach-dyspepsia/ hyperacidity; gastric ulcer; gastritis; peptic ulcer; peptic ulcer perforation; gastroparesis, small intestine, colon: Appendicitis; angiodysplasia; diverticula |
| Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-diverticulitis, diverticulosis; duodenitis, duodenal ulcer, peptic ulcer; gastroenteritis and colitis (noninfectious); granulomatous enterocolitis |
| Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-Hirschsprung disease; impaction of intestine; intestinal obstruction/ stricture; intussusception; irritable colon/ irritable bowel syndrome |
| Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-mesenteric ischemia/ ischemic bowel/ ischemic colitis; necrotizing enterocolitis; paralytic ileus; volvulus; malnutrition and malabsorption |
| Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-including lactose intolerance, short bowel syndrome, rectum and anus: Abscess of anal and rectal regions; anal fissure; anal fistula; ulcer; fecal incontinence |
| Disorders of the stomach, small intestine, colon, rectum, anus: (c) Rectum and anus-hemorrhage (rectum, anus); proctitis; hemorrhoids; rectal prolapse |
| Disorders of the liver and biliary system, noninfectious: (a) Liver-cirrhosis; Dubin-Johnson, Rotor syndromes; end-stage liver disease, including indications for transplantation; Gilbert syndrome, Crigler-Najjar syndrome |
| Disorders of the liver and biliary system, noninfectious: (a) Liver-hepatic coma/ hepatic encephalopathy; hepatitis, noninfectious; hepatitis, fatty liver, alcoholic; hepatorenal syndrome; hepatopulmonary syndrome; jaundice |
| Disorders of the liver and biliary system, noninfectious: (a) Liver-nonalcoholic fatty liver disease; portal hypertension/ esophageal varices, (b) biliary system: Bile duct obstruction/ cholestasis; cholangitis, including ascending; choledocholithiasis |
| Disorders of the liver and biliary system, noninfectious: (b) Biliary system-cholelithiasis/ cholecystitis; cholestasis due to parenteral nutrition; gallstone ileus; Mirizzi syndrome; primary biliary cirrhosis; primary sclerosing cholangitis |
| Disorders of the pancreas: Pancreatitis, acute; pancreatitis, chronic; pancreatitis, hereditary; pancreatic cyst/ pseudocyst; pancreatic duct obstruction; pancreatic insufficiency |
| Disorders of the peritoneal cavity: Ascites |
| Traumatic and mechanical disorders: Abdominal wall defects; adhesions, postsurgical; digestive system complications of surgery; post-gastric surgery syndromes (example blind loop syndrome, adhesions); duodenal tear; foreign body in digestive system |
| Traumatic and mechanical disorders: Inguinal, femoral, and abdominal wall hernias; open wound, abdominal; perforation of hollow viscus and blunt trauma; perforation/rupture of esophagus (Boerhaave syndrome); umbilical hernia |
| Congenital disorders: Annular pancreas, biliary atresia, cleft lip and palate, esophageal atresia, malrotation without volvulus, Meckel diverticulum, pyloric stenosis, tracheoesophageal fistula |
| Adverse effects of drugs on the gastrointestinal system: Drug-induced changes in motility (chronic laxative abuse, opioids); drug-induced gastritis, duodenitis, peptic ulcer disease (NSAIDs); drug-induced hepatitis (example acetaminophen, isoniazid) |
| Adverse effects of drugs on the gastrointestinal system: Drug-induced pancreatitis (example thiazide diuretics) |
System specifications-Renal and urinary system
System specifications-Renal and urinary system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes |
| Organ structure and function: Kidneys, ureters, bladder, urethra, glomerular filtration and hemodynamics, urine concentration and dilution, renal mechanisms in acid-base balance, renal mechanisms in body fluid homeostasis, micturition |
| Cell/ tissue structure and function: Renal metabolism and oxygen consumption, tubular reabsorption and secretion, including transport processes and proteins |
| Cell/ tissue structure and function: Hormones produced by or acting on the kidney (example renin, aldosterone, angiotensin II, vasopressin) |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Renal and urinary system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) upper urinary tract: Granulomatous pyelonephritis; perinephric abscess; pyelonephritis; pyonephrosis; renal abscess; renal tuberculosis |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) lower urinary tract and urinary tract infections of unspecified location: Cystitis; chlamydial and nonchlamydial |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) upper urinary tract: Glomerular disorders-Alport syndrome; glomerular disease due to hepatitis B, C; glomerulonephritis, including poststreptococcal |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) upper urinary tract: Glomerular disorders-IgA nephropathy; lupus nephritis; minimal change disease; nephrotic syndrome; thin basement membrane disease |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) upper urinary tract: Tubulointerstitial disease-acute tubular necrosis (ATN); acute interstitial nephritis; papillary necrosis; HIV nephropathy |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(ii) lower urinary tract: interstitial cystitis |
| Neoplasms: (a) Benign neoplasms and cysts-polycystic kidney disease, (b) malignant neoplasms: Renal (example Wilms tumor/ nephroblastoma, renal cell carcinoma, renal tumors associated with congenital/ hereditary conditions) |
| Neoplasms: (b) Malignant neoplasms-urinary bladder and collecting system |
| Signs, symptoms, and ill-defined disorders: dysuria; hematuria; oliguria, anuria; proteinuria |
| Metabolic and regulatory disorders: Acute kidney injury; renal insufficiency; azotemia, uremic syndrome; chronic kidney disease, including end-stage renal disease; cystinuria; Fanconi syndrome |
| Metabolic and regulatory disorders: Hypertensive renal disease (renal complications of hypertension); renal calculi, ureteral calculi, nephrolithiasis; renal tubular acidosis |
| Vascular disorders: Renal artery stenosis (atherosclerosis, fibromuscular dysplasia, nephrosclerosis); renal vein thrombosis; renal infarction |
| Traumatic and mechanical disorders: Bladder rupture; neurogenic bladder; obstructive uropathy; posterior urethral valves; renal laceration; renal vascular injury; ureteral laceration/ avulsion/ disruption; urethral diverticulum |
| Traumatic and mechanical disorders: Obstruction/ stricture/ prolapse, urethral/ ureteral, vaginal walls, uterine, uterovaginal; urinary incontinence, including secondary enuresis; vesicoureteral reflux |
| Congenital disorders: Double ureters/ ureteral duplication/ double collecting system; horseshoe kidney; hydronephrosis/ reflux; renal agenesis, renal hypoplasia, renal dysplasia; single kidney |
| Adverse effects of drugs on the renal and urinary system: ACE inhibitors; aminoglycosides; amphotericin B; cisplatin; furosemide; gadolinium (nephrogenic systemic fibrosis); heroin; iodinated contrast dye; lithium; NSAIDs; penicillins; sulfa drugs |
| Adverse effects of drugs on the renal and urinary system: Tenofovir; drug-induced urinary retention |
System specifications-Pregnancy, childbirth, and the puerperium
System specifications-Pregnancy, childbirth, and the puerperium: Unit 01
Normal processes |
|---|
| Organ structure and function: Pregnancy, including fertilization, implantation, development of embryo, labor and delivery, the puerperium, lactation, gestational uterus, placenta |
System specifications-Pregnancy, childbirth, and the puerperium: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Prenatal care: (a) Preconception counseling and care-folate deficiency prevention; immunizations; nutritional assessment, including vitamins; Rh screening, (b) prenatal risk assessment/ prevention: Adolescent pregnancy; antepartum fetal evaluation |
| Prenatal care: (b) Prenatal risk assessment/ prevention-including biophysical profile; genetic screening; α-fetoprotein; diabetes mellitus; neural tube defects; Rh isoimmunization, (c) supervision of normal pregnancy: Assessment of gestational age |
| Prenatal care: (c) Supervision of normal pregnancy-iron deficiency prevention; nutrition, including weight management; surveillance, including ultrasonography and assessment of fetal growth; vitamin deficiency prevention; infections, maternal, fetal |
| Prenatal care: (c) Supervision of normal pregnancy-newborn (focus on prevention and screening): Cytomegalovirus, coxsackievirus, hepatitis B virus, herpes simplex viruses, HIV, influenza virus, parvovirus B19 virus, Rubella virus, varicella-zoster virus |
| Prenatal care: (c) Supervision of normal pregnancy-Chlamydia trachomatis, Treponema pallidum, Streptococcus agalactiae, Toxoplasma gondii, amnionitis; asymptomatic urinary tract infection |
| Obstetric complications: Abortion, induced, septic, missed, spontaneous, threatened; acute fatty liver of pregnancy; anemia of pregnancy, sickle cell disease, thalassemia in pregnancy; antepartum hemorrhage, including third-trimester bleeding |
| Obstetric complications: Cardiomyopathy of pregnancy; cervical insufficiency, cervical shortening; cholestasis of pregnancy, intrahepatic; congenital abnormalities, maternal (example bicornuate uterus); ectopic pregnancy |
| Obstetric complications: Fetal abnormality affecting management of mother (example hydrocephalus, spina bifida); fetal growth restriction; gestational diabetes; maternal mortality; multiple gestation |
| Obstetric complications: Placental abnormalities (abruptio placentae, placenta previa, premature separation of placenta); polyhydramnios, oligohydramnios; preeclampsia, eclampsia, HELLP syndrome, gestational hypertension; prolonged pregnancy |
| Obstetric complications: Rh isoimmunization affecting management of mother; vomiting in pregnancy (morning sickness, hyperemesis gravidarum); trauma in pregnancy; infections complicating pregnancy |
| Labor and delivery: Labor and delivery, uncomplicated; labor and delivery, complicated, including shoulder dystocia; cesarean delivery, including complications; cord compression, cord prolapse; fetal malpresentations (example breech/ external cephalic) |
| Labor and delivery: Intrapartum fetal evaluation, including fetal heart tones; intrapartum prophylaxis (example HIV, Chlamydia, gonococcal prophylaxis); premature rupture of membranes; preterm (before 37 weeks' gestation) and postdates labor and delivery |
| Labor and delivery: Threatened preterm labor |
| Puerperium, including complications: Lactation problems; breastfeeding problems; lochia; postpartum cardiomyopathy; postpartum blues; postpartum hemorrhage; postpartum sepsis; retained placenta, products of conception (example placenta accreta) |
| Puerperium, including complications: Uterine atony |
| Newborn (birth to 4 weeks of age): (a) Normal newborn-examination of liveborn at admission to hospital, screening, newborn, (b) disorders of the newborn: Screening, newborn; ABO incompatibility in newborn; hemolytic disease due to Rh incompatibility |
| Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-birth asphyxia syndrome (liveborn neonate); birth trauma (example cord compression, brachial palsy, lacerations); drug withdrawal syndrome in newborn; feeding problems in newborn |
| Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-fetal growth and development abnormalities, including fetal growth restriction; gastrointestinal obstruction; hypocalcemia of newborn; infections |
| Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-congenital or peripartum (cytomegalovirus, herpes simplex viruses, HIV, hepatitis B, rubella virus, parvovirus B19 virus, varicella zoster virus, chlamydia trachomatis) |
| Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-(streptococcus agalactiae, treponema pallidum, toxoplasma gondii), intrapartum fetal distress/ death including stillborn; jaundice, fetal/ neonatal/ perinatal; laryngomalacia |
| Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-macrosomia (large for gestational age); meconium aspiration syndrome; neonatal acne; neonatal Candida infection (thrush); neonatal hypoglycemia; neonatal conjunctivitis and dacryocystitis |
| Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-ophthalmic gonorrhea; phenylketonuria; premature infant; post-term infant; pseudomembranous colitis of infancy; respiratory distress syndrome (hyaline membrane disease) |
| Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-Respiratory problems after birth (example bronchopulmonary dysplasia, tracheomalacia; tracheoesophageal fistula in neonates); retinitis of prematurity; seizures in newborn |
| Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-sudden infant death syndrome (SIDS), apparent life-threatening event (ALTE); tetanus neonatorum |
| Congenital disorders, neonatal: Congenital malformations and anomalies; neonatal hydrocele |
| Adverse effects of drugs on pregnancy, childbirth, and the puerperium: Alcohol, tobacco, and other drugs (ATOD); prenatal radiation exposure; teratology (example ACE inhibitors, SSRIs, warfarin, infections, toxins) |
| Systemic disorders affecting pregnancy, labor and delivery, and puerperium: Appendicitis; asthma; carpal tunnel syndrome in pregnancy; cirrhosis; deep venous thrombosis (DVT); diabetes mellitus; heart failure, valvular heart disease; hypertension |
| Systemic disorders affecting pregnancy, labor and delivery, and puerperium: Myasthenia gravis; obesity; pancreatitis; psychiatric disorders; renal calculus/ calculi; renal failure/ renal disease, including SLE; seizure disorders; thyroid disorders |
| Systemic disorders affecting pregnancy, labor and delivery, and puerperium: Hypothyroidism, hyperthyroidism |
System specifications-Female reproductive system and breast
System specifications-Female reproductive system and breast: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes, gametogenesis |
| Organ structure and function: Female structure, including breast female function (example ovulation, menstrual cycle, puberty) intercourse, sexual response |
| Cell/ tissue structure and function: Hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones |
| Reproductive system defense mechanisms and normal flora |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Female reproductive system and breast: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Breast: (a) Infectious, immunologic, and inflammatory disorders-breast abscess; inflammatory disease of breast, fat necrosis; mastitis; nipple discharge, (b) neoplasms-(i) benign and undefined neoplasms: Breast cyst, solitary; fibrocystic changes |
| Breast: (b) Neoplasms-(i) Benign and undefined neoplasms-fibroadenoma; hypertrophy of breast; intraductal papilloma, (ii) malignant neoplasms (including screening): Breast cancer; intraductal carcinoma; Paget disease of breast; phyllodes tumors |
| Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-bacterial vaginosis; Bartholin gland abscess; cellulitis, pelvic; candidiasis of the vulva or vagina; lichen sclerosus; sexually transmitted infections and exposure |
| Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-cervicitis and endocervicitis; chancroid (Haemophilus ducreyi); genital herpes; gonorrhea (Neisseria gonorrhoeae); human papillomavirus infection |
| Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-genital/ venereal/ anal warts, condylomata acuminata; lymphogranuloma venereum (Chlamydia trachomatis), non-lymphogranuloma venereum; pelvic inflammatory disease |
| Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-Fitz-Hugh–Curtis syndrome; salpingitis and oophoritis; syphilis (Treponema pallidum); trichomoniasis (Trichomonas vaginalis); urethritis; vaginitis; vulvovaginitis |
| Neoplasms of the cervix, ovary, uterus, vagina, and vulva: (a) Benign neoplasms and cysts-abnormal Pap smear; benign neoplasm of ovary; endocervical and endometrial polyps; leiomyomata uteri; ovarian cyst |
| Neoplasms of the cervix, ovary, uterus, vagina, and vulva: (b) Malignant and precancerous neoplasms-cervical cancer; HPV causing cancer; cervical dysplasia, HPV causing dysplasia; endometrial hyperplasia; endometrial/ uterine cancer |
| Neoplasms of the cervix, ovary, uterus, vagina, and vulva: (b) Malignant and precancerous neoplasms-gestational trophoblastic disease (hydatidiform mole); ovarian cancer; vulvar dysplasia, and cancer |
| Fertility and infertility: Assisted reproductive techniques (ART); contraception (example oral contraceptives, IUD, vaginal cap, cervical sponge, diaphragm, implant, morning-after pill, male and female condoms); female infertility |
| Fertility and infertility: Gonadal dysgenesis 45,X (Turner syndrome); sterilization; tubal factors; infertility |
| Menopause: Ovarian failure, premature menopause; perimenopause; premenopausal menorrhagia; postmenopausal atrophic vaginitis (vaginal atrophy); postmenopausal bleeding; vasomotor symptoms |
| Menstrual and endocrine disorders: Abnormal uterine bleeding, including perimenopausal; absence of menstruation (primary amenorrhea, secondary amenorrhea including undiagnosed pregnancy); anovulation; dysmenorrhea; endometriosis; hirsutism, virilization |
| Menstrual and endocrine disorders: Mittelschmerz; pelvic pain; polycystic ovarian syndrome; postcoital bleeding; premenstrual syndrome |
| Sexual dysfunction: Dyspareunia; orgasmic dysfunction; sexual desire/ arousal syndrome; vaginismus |
| Traumatic and mechanical disorders: Asherman syndrome; chronic inversion of uterus; chronic pelvic pain syndrome; cystocele; imperforate hymen; injuries, wounds, and burns affecting the female reproductive system and injuries, wounds |
| Traumatic and mechanical disorders: Burns, and blast injuries; ovarian torsion; pelvic relaxation; rectocele; urethrocele |
| Congenital disorders: Müllerian agenesis; uterus didelphys, bicornuate uterus; short cervix |
| Adverse effects of drugs on the female reproductive system and breast: Antihistamines, H2-receptor blockers; benzodiazepines; beta-adrenergic blockers; hormone replacement; opioids; spironolactone; selective serotonin reuptake inhibitors |
| Adverse effects of drugs on the female reproductive system and breast: Tricyclic antidepressants |
System specifications-Male reproductive system
System specifications-Male reproductive system: Unit 01
Normal processes |
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| Embryonic development, fetal maturation, and neonatal changes, gametogenesis |
| Organ structure and function: Structure, male genitalia and prostate function, male genitalia and prostate (example spermatogenesis, puberty) intercourse, orgasm, erection |
| Cell/ tissue structure and function, including hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones |
| Reproductive system defense mechanisms and normal flora |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Male reproductive system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
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| 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
System specifications-Endocrine system: Unit 01
Normal processes |
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| Embryonic development, fetal maturation, and perinatal changes |
| Organ structure and function: Hypothalamus, posterior and anterior pituitary gland, thyroid gland, parathyroid gland, adrenal cortex, adrenal medulla, pancreatic islets, ovary and testis, adipose tissue |
| Cell/ tissue/ structure and function, including hormone synthesis, secretion, action, metabolism: Peptide hormones, steroid hormones, including vitamin D, thyroid hormones, catecholamine hormones, renin-angiotensin system |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Endocrine system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
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| 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
System specifications-Multisystem processes and disorders: Unit 01
Normal processes |
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| Principles of nutrition: Generation, expenditure, and storage of energy at the whole-body level functions of nutrients (example essential, trans-fatty acids, cholesterol) |
| Electrolyte and water metabolism: Electrolyte metabolism (calcium, potassium, phosphorus), water metabolism |
| Intracellular accumulations (example pigments, fats, proteins, carbohydrates, minerals, inclusions, vacuoles, lysosomal/ glycogen storage disease and structures related to storage diseases, glycogen phosphorylase deficiency, Zellweger syndrome) |
System specifications-Multisystem processes and disorders: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
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| 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
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 01
Epidemiology/ population health |
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| Measures of disease frequency: Incidence/ prevalence |
| Measures of health status: Rates, crude and adjusted; reproductive rates (example maternal mortality, neonatal/ infant/ under-5 mortality); mortality, morbidity; standardization; life expectancy, health-adjusted life expectancy |
| Measures of health status: Population attributable risk (PAR), population attributable risk percent (PAR%); risk factors |
| Survival analysis interpretation (example Kaplan-Meier curve) |
| Composite health status indicators, measures of population impact: Years of potential life lost; quality-adjusted life years; disability-adjusted life years; standardized mortality ratio |
| Population pyramids and impact of demographic changes |
| Disease surveillance and outbreak investigation: Disease reporting; response to public health advisory, health promotion; recognition of clusters |
| Communicable disease transmission: Attack rate; herd immunity; reportable diseases |
| Points of intervention: Primary, secondary; community level (example cigarette taxes, soda taxes, smoke-free cities, buildings: Restaurants, public buildings); school policies; access, healthy food, transportation, clean air, safe environments |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 02
Study design, types, and selection of studies (includes dependent/ independent variables) |
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| Descriptive studies (case report [one person]/ case series [more than one]) |
| Analytical studies: Observational-community surveys; cross-sectional (individuals); ecological (populations); case control; retrospective and prospective cohort |
| Analytical studies: Interventional-clinical trial (randomized controlled trial; double-blind; placebo-controlled; non inferiority/ equivalence trials); community intervention |
| Systematic reviews and meta-analysis: Potential uses; estimation of effect sizes; heterogeneity; publication bias; forest plots, funnel diagrams; risk of bias, bias risk scale |
| Obtaining and describing samples: Matching, inclusion/ exclusion criteria, selecting appropriate controls for studies, lack of controls, concealed allocation, randomization, stratification |
| Methods to handle noncompliance: Loss to follow-up; intention-to-treat analysis |
| Qualitative analysis |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 03
Measures of association |
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| Relative risk |
| Odds ratio, hazard ratio |
| Other measures of association: Number needed to treat/ harm; absolute risk (AR), absolute risk percent (AR%); population attributable risk (PAR), population attributable risk percent (PAR%) |
| Distributions of data: Measures of central tendency; measures of variability; regression to mean; normal distribution; nominal measurement |
| Correlation and regression, uses and interpretation: Correlation coefficients; multiple regression |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 04
Principles of testing and screening |
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| Properties of a screening test: Validity, accuracy, reliability; criteria for a screening test; confirmatory testing; appropriateness; lead-time bias, length bias; screening vs. diagnostic tests |
| Sensitivity and specificity; predictive value, positive and negative |
| ROC curves |
| Probability: Theory (independence, product, addition rules); decision trees; likelihood ratios (application of Bayes theorem); posttest, pretest |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 05
Study interpretation, drawing conclusions from data |
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| Causation: Hypothesis-generating vs. hypothesis-driven testing; causal criteria, temporality, temporal sequence, dose-response relationship; reverse causality |
| Chance: Null hypothesis, type I error and alpha level (multiple comparisons, random error/ chance), sample size and type II error, beta, power, selection and interpretation of basic tests of statistical significance: chi-square; confidence intervals |
| Chance: P-values; t-test, a priori vs. post hoc analysis: Subgroup analysis; error rate; affect types |
| Interpretation of graphs/ tables and text |
| Bias, confounding, and threats to validity (includes methods to address): Selection, sampling bias, information bias: Recall; ascertainment, ecological fallacy, lack of blinding; loss to follow up, confounding variables |
| Bias, confounding, and threats to validity (includes methods to address): Hawthorne effect (includes methods to address), other threats to validity (example placebo effect) |
| Internal vs. external validity: Generalizability (external validity); efficacy vs. effectiveness |
| Statistical vs. clinical significance; clinical and surrogate outcome/ end point |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 06
Clinical decision making, interpretation and use of evidence-based data and recommendations |
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| Application of study results to patient care and practice, including patient preferences and individualization of risk profiles; risk/ benefit analysis; synthesis of concepts with real data |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 07
Research ethics |
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| 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
System specifications-Social sciences: Unit 01
Communication and interpersonal skills, including health literacy and numeracy, cultural competence |
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| Patient interviewing, consultation, and interactions with the family (patient-centered communication skills): Fostering the relationship (example expressing interest), information gathering (example exploring patient's reaction to illness) |
| Patient interviewing, consultation, and interactions with the family (patient-centered communication skills): Information provision (example providing information about working diagnosis), making decisions (example eliciting patient's perspectives) |
| Patient interviewing, consultation, and interactions with the family (patient-centered communication skills): Supporting emotions (example effective discussion with difficult patients), enabling patient behaviors (example education and counseling) |
| Use of an interpreter or surrogate |
System specifications-Social sciences: Unit 02
Medical ethics and jurisprudence, include issues related to death and dying and palliative care |
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| Consent/ informed consent to treatment, permission to treat (full disclosure, risks and benefits, placebos, alternative therapies, conflict of interest, and vulnerable populations) |
| Determination of medical decision-making capacity/ informed refusal |
| Involuntary admission |
| Legal issues related to abuse (child, elder, and intimate partner): Child protective services, foster care, immunizations, legal requirements for reporting abuse or neglect/ obligation to warn |
| Birth-related issues |
| Death and dying and palliative care: Life support, advance directive, health care proxy, advance care planning, euthanasia and physician-assisted suicide, brain death/ diagnosing brain death/ diagnosing death, pronouncing death, organ donation, hospice |
| Death and dying and palliative care: Pain management, including ethical issues related to death and dying, information sharing, counseling families, psychosocial and spiritual counseling, fear and loneliness |
| Physician-patient relationship (boundaries, confidentiality including HIPAA, privacy, truth telling, other principles of medical ethics, example, autonomy, justice, beneficence) |
| Impaired physician, including duty to report impaired physician |
| Negligence/ malpractice, including duty to report negligence and malpractice |
| Physician misconduct, including duty to report physician misconduct |
| Referrals |
| Cultural issues not otherwise coded |
System specifications-Social sciences: Unit 03
Systems-based practice (including health systems, public health, community, schools) and patient safety (including basic concepts and terminology) |
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| Complexity/ systems thinking: Characteristics of a complex system and factors leading to complexity-how complexity leads to error, health care/ organizational behavior and culture: Environmental factors, workplace design and process; staffing |
| Complexity/ systems thinking: Health care/ organizational behavior and culture-overcommitment, space, people, time, scheduling; standardization, reducing variance, simplification, metrics; safety culture; integration of care across settings |
| Complexity/ systems thinking: Health care/ organizational behavior and culture-overutilization of resources (imaging studies, antibiotics, opioids); economic factors |
System specifications-Social sciences: Unit 04
Quality improvement |
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| 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 |
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| Patient safety principles: (a) Epidemiology of medical error, (b) error categorization/ definition: Active vs. latent errors; Swiss cheese model of error; preventable vs. non-preventable; near miss events/ safety hazards |
| Patient safety principles: (c) Causes of error-(i) patient factors: Understanding of medication use; health literacy; economic status; cultural factors (example religion); failure to make appointments; socioeconomic status |
| Patient safety principles: (c) Causes of error-(ii) physician factors: Deficiency of knowledge; judgment errors; diagnostic errors; fatigue, sleep deprivation; bias-cognitive, availability, heuristic, anchoring, framing |
| Patient safety principles: (c) Causes of error-(iii) human factors (example cognitive, physical, environmental), (d) High reliability of organization (HRO) principles-change management and improvement science |
| Patient safety principles: (d) High reliability of organization (HRO) principles-conceptual models of improvement, (e) reporting and monitoring for errors: Event reporting systems |
| Patient safety principles: (e) Reporting and monitoring for errors-communication with patients after adverse events (disclosure/ transparency) |
| Specific types of error: (a) Transitions of care errors (example handoff communication including shift-to-shift, transfer, and discharge): Handoffs and related communication; discontinuities; gaps; discharge; transfers |
| Specific types of error: (b) Medication errors-ordering, transcribing, dispensing, administration (wrong quantity, wrong route, wrong drug), medication reconciliation, mathematical error, (c) procedural errors: Universal protocol (time out); wrong patient |
| Specific types of error: (c) Procedural errors-wrong site; wrong procedure; retained foreign bodies, injury to structures: Paracentesis; bowel perforation; thoracentesis; pneumothorax; central venous/ arterial line injuries |
| Specific types of error: (c) Procedural errors-Injury to structures: Arterial puncture and bleeding and venous thrombosis; lumbar puncture bleeding; paralysis, other errors: Anesthesia-related errors; mathematical errors |
| Specific types of error: (d) Health care-associated infections-nosocomial infection-example, surgical site, ventilator associated; catheter-related; handwashing procedures or inadequate number of handwashing stations |
| Specific types of error: (d) Health care-associated infections-central line-associated blood stream infections; surgical site infections; catheter-associated urinary tract infections; ventilator-associated pneumonia |
| Specific types of error: (e) Documentation errors-electronic medical record (including voice-recognition software errors); record keeping; incorrect documentation (example wrong patient, wrong date, copying and pasting, pre-labeling) |
| Specific types of error: (f) Patient identification errors-mislabeling-transfusion errors related to mislabeling; verification/ two identifiers: Lack of dual validation, including verbal verification of lab results |
| Specific types of error: (g) Diagnostic errors-errors in diagnostic studies; misinterpretation; (h) monitoring errors-cardiac monitoring/ telemetry, drug monitoring (warfarin, antibiotics), device-related errors: Malfunction, programming error |
| Specific types of error: (i) Device-related errors-incorrect use |
| Strategies to reduce error: (a) Human factors engineering, (b) situational awareness, (c) hierarchy of effective interventions: Forcing function; visual cues, (d) error analysis tools: Error/ near miss analysis; failure modes and effect analysis |
| Strategies to reduce error: (d) Error analysis tools-morbidity and mortality review; root cause analysis, (e) safety behavior and culture at the individual level: Hierarchy of health care, flattening hierarchy, speak up to power; afraid to report, fear |
| Strategies to reduce error: (e) Safety behavior and culture at the individual level-psychological safety; closed-loop communication, (f) teamwork: Principles of highly effective teams; case management; physician teams, physician-physician communication |
| Strategies to reduce error: (f) Teamwork-interprofessional/ interprofessional teams; strategies for communication among teams, including system-provider communication, physician-physician communication (example consultations) |
| Strategies to reduce error: (f) Teamwork-provider-interprofessional communication, patient communication |
System specifications-Social sciences: Unit 06
Health care policy and economics |
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| 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
Physician tasks/ competencies specifications-Medical knowledge/ scientific concepts: Unit 01
Applying foundational science concepts |
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| 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
Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 01
Diagnosis: Obtaining and predicting history and physical examination |
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| Knows signs/ symptoms of selected disorders |
| Knows individual's risk factors for development of conditions |
| Given current symptoms in presented history, identifies other pertinent factors in the history |
| Given a specific problem, knows what to ask in obtaining further pertinent additional history |
| Predicts the most likely additional physical finding; selects either the finding itself or the appropriate examination technique that would result in the finding |
Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 02
Diagnosis: Selecting and Interpreting Laboratory and diagnostic studies |
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| Selects most appropriate laboratory or diagnostic study, including neuropsychiatric testing, or study most likely to establish/confirm the diagnosis |
| Interprets laboratory or other study findings |
| Predicts the most likely laboratory or diagnostic study result |
| Selects most appropriate laboratory or diagnostic study after a change in patient status |
Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 03
Diagnosis: Formulating the diagnosis |
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| Selects the most likely diagnosis |
| Assesses the developmental level of the patient |
Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 04
Diagnosis: Determining prognosis/ outcome |
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| 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
Physician tasks/ competencies specifications-Patient care: Management: Unit 01
Management: Health maintenance and disease prevention |
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| Knows risk factors for conditions amenable to prevention or detection in an asymptomatic patient, or knows the potential condition for which the patient may be at risk |
| Knows pertinent incidence statistics and identifies patient groups at risk; knows incidence of symptoms/ dangerous disorders among various groups |
| Knows common screening tests for conditions amenable to prevention or detection in an asymptomatic patient or population |
| Selects appropriate preventive agent or technique (eg, contraception, vaccines, vitamins) |
| Knows appropriate counseling of patient or family regarding maintenance of current and future problems, including risk factors related to present encounter |
| Educates patients on screening, health maintenance, self-care |
| Assesses the developmental level of a healthy patient |
| Knows the indications for surveillance for recurrence or progression of disease following treatment |
| Monitoring chronic disease in a stable patient where a change in patient status might cause a change in therapy |
| Knows appropriate long-term surveillance goals |
Physician tasks/ competencies specifications-Patient care: Management: Unit 02
Management: Selecting and monitoring pharmacotherapy |
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| Selects most appropriate pharmacotherapy |
| Assesses patient adherence with treatment regimen, recognizes techniques to increase adherence or understanding of the disease state, and knows how adherence may be affected by providing instructions with therapy |
| Recognizes factors that alter drug dosing requirements for a patient |
| Knows adverse effects of various drugs, or recognizes signs and symptoms of drug (and drug-drug) interactions resulting from polypharmacy in the therapeutic regimenand knows steps to prevent polypharmacy including lab studies to monitor drug therapy |
| Knows contraindications of various medications |
| Modifies therapeutic regimen within the context of continuing care; selects appropriate modifications in therapeutic regimen |
| Knows appropriate monitoring to evaluate effectiveness of drug therapy or to monitor for the adverse effects of drug therapy in a patient that has not had a recurrence or progression of disease |
Physician tasks/ competencies specifications-Patient care: Management: Unit 03
Management: Clinical interventions/ treatment |
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| Knows most appropriate management of selected conditions, including recognizing misuse of medication or drug or alcohol use |
| Knows immediate management or priority in management, specifically in emergency or acute cases |
| Knows most appropriate follow-up or monitoring approach regarding the management plan |
| Knows current/ short-term management of patients |
| Evaluates severity of patient condition in terms of need for referral for surgical treatments/ procedures versus other nonsurgical options |
| Knows appropriate surgical management |
| Knows pre/ post surgical or procedural management |
| Knows indications for admission to the hospital or to other appropriate setting (eg, ICU) |
| Knows appropriate non-hospital health care settings |
| Knows most appropriate discharge planning |
| Knows components of rehabilitation program |
| Knows appropriate use and procedures regarding hospice care |
| Educates patient or family regarding self-care |
| Knows relevant roles of allied health personnel |
Physician tasks/ competencies specifications-Patient care: Management: Unit 04
Management: Selecting clinical interventions (mixed management) |
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| 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
Physician tasks/ competencies specifications-Communication: Unit 01
Fostering the relationship |
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Physician tasks/ competencies specifications-Communication: Unit 02
Gathering information |
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Physician tasks/ competencies specifications-Communication: Unit 03
Providing information |
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Physician tasks/ competencies specifications-Communication: Unit 04
Making decisions |
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Physician tasks/ competencies specifications-Communication: Unit 05
Supporting emotions |
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Physician tasks/ competencies specifications-Communication: Unit 06
Enabling patient behaviors |
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Physician tasks/ competencies specifications-Communication: Unit 07
Using an interpreteror surrogate |
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Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues
Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues: Unit 01
Understanding and applying principles of professionalism, legal and ethical issues in interactions with patients |
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| Knows the guidelines for obtaining informed consent for treatment including children and adolescents, third-party permission, and emergent situations |
| Recognizes need for third-party permission for treatment in medical emergencies |
| Knows guidelines for treatment of minors with/ without notification of parents |
| Knows definitions of competence and sanity |
| Knows the guidelines for involuntary admission |
| Knows guidelines for confidentiality of medical records |
| Knows guidelines for physician-patient relationship |
| Knows issues related to cultural competence and can apply knowledge in specific patient situations |
Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues: Unit 02
Understanding and applying legal and ethical issues related to death and dying |
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| Assesses degree of disclosure to terminally ill patients |
| Recognizes patient's right to refuse treatment or testing (patient autonomy); knows issues of advance directives and living wills |
| Assesses quality-of-life decisions |
| Knows appropriate prescriptive practices; knows appropriate use of opioids in terminally ill patients |
| Knows definition of and legal issues regarding brain death |
| Knows management of terminally ill patients related to treating chronic pain, and recognizing patient's expression of fear of pain, injury, or death; knows how to comfort patient or family during crisis such as trauma or death |
Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues: Unit 03
Understanding and applying professionalism, legal, and ethical issues in dealing with physicians and other health professionals |
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| 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
Physician tasks/ competencies specifications-Systems based practice, including patient safety: Unit 01
Systems based practice |
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| Understands basic concepts and terminology, principles, and application of quality improvement science and outcome analysis |
| Recognizes and optimizes human and environmental factors (eg, workplace design, standardization, processes) |
| Understands the role and characteristics of teams and communication strategies |
Physician tasks/ competencies specifications-Systems based practice, including patient safety: Unit 02
Patient safety |
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| 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
Physician tasks/ competencies specifications-Practice-based learning: Unit 01
Understanding and application of the principles of biostatistics and epidemiology |
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| Understands and can apply principles of epidemiology and population health, including health status indicators, outbreak investigation, points of intervention |
| Understands and can apply principles of study design and study flaws |
| Understands and can apply the principles of screening and other tests |
| Understands use and interpretation of statistical principles and measures of association |
Physician tasks/ competencies specifications-Practice-based learning: Unit 02
Application of information from studies or other written material to patient care |
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| Decisions about patient care based on results of study or other written materials |
Physician tasks/ competencies specifications-Practice-based learning: Unit 03
Understanding of the principles of research ethics and regulatory issues |
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Discipline specifications-Medicine
Discipline specifications-Surgery
Discipline specifications-Pediatrics
Discipline specifications-Obstetrics and gynecology
Discipline specifications-Psychiatry
USMLE Step 3 Syllabus
System specifications-General principles of foundational science
System specifications-General principles of foundational science: Unit 01
Biochemistry and molecular biology |
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| Gene expression: DNA structure, replication, exchange, and epigenetics (example imprinting, X-activation, DNA methylation), gene expression: Transcription, gene expression: Translation, post-translational processing |
| Gene expression: Modifications and disposition of proteins (degradation), including protein/ glycoprotein synthesis, intra-extracellular sorting, and processes/ functions related to golgi complex and rough endoplasmic reticulum |
| Structure and function of proteins and enzymes (example enzyme kinetics and structural/ regulatory proteins), energy metabolism (example ATP generation, transport chain) |
System specifications-General principles of foundational science: Unit 02
Biology of cells |
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| Adaptive cell responses and cellular homeostasis (example, hypertrophy), mechanisms of injury and necrosis, including pathologic processes (example liquefactive necrosis, free radical formation), apoptosis |
| Cell cycle and cell cycle regulation (example mitosis), mechanisms of dysregulation, cell biology of cancer (example role of p53, proto-oncogenes), general principles of invasion and metastasis, including cancer staging |
| Cell/ tissue structure, regulation, and function, including cytoskeleton, organelles, glycolipids, channels, gap junctions, extracellular matrix, and receptors |
System specifications-General principles of foundational science: Unit 03
Human development and genetics |
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| Principles of pedigree analysis, inheritance patterns, occurrence and recurrence risk determination, population genetics: Hardy-Weinberg law, founder effects, mutation-selection equilibrium, principles of gene therapy, genetic testing and counseling |
| Genetic mechanisms (example penetrance, genetic heterogeneity) |
System specifications-General principles of foundational science: Unit 04
Biology of tissue response to disease |
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| Acute inflammatory responses (patterns of response), acute inflammation and mediator systems (example histamine, prostaglandins, bradykinins, eosinophilic basic protein, nitric oxide), vascular response to injury, including mediators |
| Principles of cell adherence and migration (example ECAMs, selectins, leukocytic diapedesis, and rolling), microbicidal mechanisms and tissue injury (example defensins) |
| Clinical manifestations (example, pain, fever, leukocytosis, leukemoid reaction, chills), chronic inflammatory responses (example tumor necrosis factor) |
| Reparative processes, wound healing, repair: Thrombosis, granulation tissue, angiogenesis, fibrosis, scar/ keloid formation, regenerative process |
System specifications-General principles of foundational science: Unit 05
Pharmacodynamic and pharmacokinetic processes: General principles |
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| Pharmacokinetics: Absorption, distribution, metabolism, excretion, dosage intervals, mechanisms of drug action, structure-activity relationships (example, anticancer drugs), concentration and dose-effect relationships (example efficacy, potency) |
| Types of agonists (example full, partial, inverse) and antagonists and their actions |
| Individual factors altering pharmacokinetics and pharmacodynamics (example age, gender, disease, tolerance, compliance, body weight, metabolic proficiency, pharmacogenetics) |
| Mechanisms of drug adverse effects, overdosage, toxicology, mechanisms of drug interactions |
| Signal transduction, including structure/ function of all components of signal transduction, pathways such as receptors, ligands (example general principles of nitric oxide, autocrine and paracrine signaling) |
System specifications-General principles of foundational science: Unit 06
Microbial biology |
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| Microbial identification and classification, including principles, microorganism identification, and non-immunologic laboratory diagnosis |
| Bacteria: Structure (example cell walls, composition, appendages, virulence factors, extracellular products, toxins, mechanism of action of toxins), processes, replication, and genetics (example metabolism, growth, and regulation), oncogenesis |
| Bacteria: Antibacterial agents (example mechanisms of action on organism, toxicity to humans, and mechanisms of resistance) |
| Viruses: Structure (example physical and chemical properties, virulence factors), processes, replication, and genetics (example life cycles, location of virus in latent infection), oncogenesis |
| Viruses: Antiviral agents (example mechanisms of action on virus, toxicity to humans, and mechanisms of resistance) |
| Fungi: Structure (example cell wall, composition, appendages, virulence factors, extracellular products, toxins, mechanisms of action of toxins), processes, replication, and genetics (example asexual vs. sexual, metabolism, growth) |
| Fungi: Antifungal agents (example mechanisms of action on fungus, toxicity to humans, and mechanisms of resistance) |
| Parasites: Structure (example appendages, macroscopic features, and virulence factors), processes, replication, and genetics (example life cycles, metabolism, and growth), oncogenesis |
| Antiparasitic agents (example mechanisms of action on parasite, toxicity to humans, and mechanisms of resistance) |
| Prions |
System specifications-General principles of foundational science: Unit 07
Normal age-related findings and care of the well patient |
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| Infancy and childhood (0-12 years): (a) Normal physical changes-linear growth, variations in linear growth, including constitutional delay; weight; head circumference; micturition, defecation, primary incontinence/ bedwetting; normal physical examination |
| Infancy and childhood (0-12 years): (a) Normal physical changes-screening; sleep; teething syndrome, (b) developmental stages: Motor; speech; cognitive; psychosocial; anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition |
| Infancy and childhood (0-12 years): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine; risk factors and prevention (example guns, swimming, motor vehicles, car seats) |
| Infancy and childhood (0-12 years): (c) Lifestyle and routine preventive health care-routine vaccinations |
| Adolescence (13-17 years): (a) Normal physical changes-linear growth, variations in linear growth including constitutional delay; weight; puberty; normal physical examination; gynecomastia; autonomy/ self-identity; sleep |
| Adolescence (13-17 years): (b) Developmental stages-cognitive (example abstract thought); psychosocial (example autonomy, role confusion, sexual identity); anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition |
| Adolescence (13-17 years): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine |
| Adolescence (13-17 years): (c) Lifestyle and routine preventive health care-risk factors and prevention (example risk-taking behavior, helmets, safe sex, motor vehicles, seat belts, distractions); routine vaccinations |
| Adulthood (18-64 years): (a) Normal physical changes-weight; normal physical examination; screening; sleep, (b) developmental stages: Cognitive; intimacy vs. isolation; anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition |
| Adulthood (18-64 years): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine; risk factors and prevention; routine vaccinations |
| Older adulthood (65 years and older): (a) Normal physical changes, including normal physical exam for age-weight, height (spinal compression), skin, bruising; normal physical examination; response to temperature; micturition, defecation; sleep |
| Older adulthood (65 years and older): (b) Developmental stages-motor; cognitive (example psychomotor slowing); psychosocial; integrity vs. despair; retrospection; anticipatory guidance, (c) lifestyle and routine preventive health care: Nutrition |
| Older adulthood (65 years and older): (c) Lifestyle and routine preventive health care-exercise (example benefits of exercise); preventive/ travel medicine |
| Older adulthood (65 years and older): (c) Lifestyle and routine preventive health care-risk factors and prevention (example falls, general medical condition; polypharmacy, driving, caregiver stress); routine vaccinations |
System specifications-Immune system
System specifications-Immune system: Unit 01
Normal processes |
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| Development of cells of the adaptive immune response, including positive and negative selection during immune development |
| Structure, production, and function: Granulocytes, natural killer cells, macrophages, mast cells, dendritic cells, cell receptors (example complement receptors and Toll-like receptors), cytokines, chemokines, T lymphocytes |
| Structure, production, and function: Including T-lymphocyte receptors, accessory molecules (example CD3, CD4, CD8, B7), cell activation and proliferation, cytotoxic T lymphocytes, and memory T lymphocytes, B lymphocytes and plasma cells |
| Structure, production, and function: Including B-lymphocyte receptors, immunoglobulins, cell activation and proliferation, including development of antibodies and memory B lymphocytes, host defense mechanisms, host barriers to infection |
| Structure, production, and function: Mucosal immunity (example gut-associated lymphoid tissue and bronchus-associated lymphoid tissue), anatomical locations of T and B lymphocytes |
| Cellular basis of the immune response and immunologic mediators: Antigen processing and presentation in the context of MHC I and MHC II molecules (example TAP, beta-2 microglobulin), intracellular pathways |
| Cellular basis of the immune response and immunologic mediators: Mechanisms by which MHC is expressed on the surface; including distribution of MHC I and MHC II on different cells |
| Cellular basis of the immune response and immunologic mediators: Mechanisms of MHC I and MHC II deficiencies, and the genetics of MHC regulation of the adaptive immune response (example peripheral tolerance, anergy, regulatory T lymphocytes |
| Cellular basis of the immune response and immunologic mediators: Termination of immune response, and B-T lymphocyte interactions) activation |
| Cellular basis of the immune response and immunologic mediators: Function, and molecular biology of complement (example anaphylatoxins) functional and molecular biology of cytokines (example IL 1-15) |
| Basis of immunologic diagnostics (example antigen-antibody reactions used for diagnostic purposes, ELISA, immunoblotting, antigen-antibody changes over time, ABO typing) |
| Principles of immunologic protection: Vaccine production and mechanisms of vaccine action biologically active antibodies (example monoclonal antibodies, polyclonal antibodies including IVIG, VZIG, rabies immunoglobulin) |
| Effect of age on the function of components of the immune system |
System specifications-Immune system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
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| 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
System specifications-Blood and lymphoreticular system: Unit 01
Normal processes |
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| Embryonic development, fetal maturation, and perinatal changes, organ structure and function |
| Cell/ tissue structure and function: Production and function of erythrocytes, including heme and hemoglobin synthesis; hemoglobin O and CO transport, transport proteins, erythropoietin production and function of platelets |
| Cell/ tissue structure and function: Production and function of coagulation and fibrinolytic factors; hemostasis |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Blood and lymphoreticular system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
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| 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
System specifications-Multisystem processes and disorders: Unit 01
Normal processes |
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| Principles of nutrition: Generation, expenditure, and storage of energy at the whole-body level functions of nutrients (example essential, trans-fatty acids, cholesterol) |
| Electrolyte and water metabolism: Electrolyte metabolism (calcium, potassium, phosphorus), water metabolism |
| Intracellular accumulations (example pigments, fats, proteins, carbohydrates, minerals, inclusions, vacuoles, lysosomal/ glycogen storage disease and structures related to storage diseases, glycogen phosphorylase deficiency, Zellweger syndrome) |
System specifications-Multisystem processes and disorders: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Brucellosis (Brucella spp); leptospirosis (Leptospira interrogans); Lyme disease (Borrelia burgdorferi); melioidosis (Burkholderia pseudomallei) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Miliary (disseminated) tuberculosis (Mycobacterium tuberculosis); tularemia (Francisella tularensis); toxic shock syndrome; Q fever (Coxiella burnetii) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Anaplasmosis and ehrlichiosis (Anaplasma and Ehrlichia species); rickettsiosis (Rocky Mountain spotted fever [Rickettsia rickettsii]) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral: Infectious mononucleosis (Epstein-Barr virus); cytomegalovirus infection; yellow fever; human herpesvirus 8 (HHV-8), fungal: Blastomycosis (Blastomyces dermatitidis) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iii) fungal: Candidiasis (Candida albicans); coccidioidomycosis (Coccidioides immitis/ posadasii); histoplasmosis (Histoplasma capsulatum) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iv) parasitic: Schistosomiasis (Schistosoma); Leishmaniasis (Leishmania spp), visceral (kala azar); trypanosomiasis/ Chagas disease, acute and chronic (Trypanosoma) |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-acute rheumatic fever; autoimmune arteritis/ vasculitis; Behçet syndrome; Churg-Strauss syndrome; eosinophilic granuloma, histiocytosis |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-Langerhans cell histiocytosis; Goodpasture syndrome; Henoch-Schönlein purpura; Kawasaki disease; mixed connective tissue disease; polyangiitis |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-polyarteritis nodosa; polyglandular autoimmune syndrome, type 1; polymyalgia rheumatica, temporal arteritis; Raynaud disease/ Raynaud syndrome |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-reactive arthritis, formerly Reiter disease, including Reiter arthritis; scleroderma (systemic sclerosis); Sjögren syndrome; systemic lupus erythematosus |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-Takayasu arteritis; granulomatosis with polyangiitis (formerly Wegener granulomatosis); familial Mediterranean fever; sarcoidosis, Lofgren syndrome |
| Neoplasms and related disorders: (a) Paraneoplastic syndromes-endocrine (example SIADH, Cushing syndrome, hypercalcemia of malignancy [parathyroid‐related protein and paraneoplastic syndrome with hypercalcemia]) |
| Neoplasms and related disorders: (a) Paraneoplastic syndromes-hematologic (polycythemia, nonbacterial thrombotic endocarditis); neurologic (myasthenic syndrome, paraneoplastic cerebellar degeneration, limbic encephalitis, pure sensory neuropathy) |
| Neoplasms and related disorders: (a) Paraneoplastic syndromes-(anti-NMDA receptor encephalitis); mucocutaneous (example acanthosis nigricans); musculoskeletal (example pulmonary osteoarthropathy, polymyositis); other (membranous glomerulonephritis) |
| Neoplasms and related disorders: (b) Inherited cancer syndromes-DNA repair abnormalities (example Fanconi anemia); Lynch syndrome (gastrointestinal and female reproductive) |
| Signs, symptoms, and ill-defined disorders: Arthralgias; abdominal pain; chest pain; cough; dizziness, lightheadedness, syncope, including breath-holding spells with syncope; dyspnea, shortness of breath; edema, anasarca; fatigue; fever of unknown origin |
| Signs, symptoms, and ill-defined disorders: Hemoptysis; pain management (in a non addiction, non palliative-care setting); joint pain; lymphedema; palpitations; pruritus; unexpected weight gain/ weight loss |
| Nutrition: (a) Protein-calorie malnutrition (kwashiorkor, marasmus), vitamin deficiencies and/ or toxicities: (b) vitamin A; vitamin B; vitamin B1, thiamine (example Wernicke-Korsakoff syndrome, beriberi); vitamin B3, niacin; vitamin B6, pyridoxine |
| Nutrition: (b) Vitamin deficiencies and/ or toxicities-vitamin B9, folic acid; vitamin B12, cobalamins (pernicious anemia); vitamin C (scurvy); vitamin D (rickets); vitamin E; vitamin K, (c) mineral deficiencies and/ or toxicities |
| Nutrition: (d) Obesity, enteral/ parenteral nutrition (TPN) |
| Toxins and environmental extremes: Physical and associated disorders, temperature (example hypothermia, hyperthermia, heat stroke), radiation (example radon, uranium mining, imaging studies), thermal injury, burns, electrocution |
| Toxins and environmental extremes: Lightning, decreased atmospheric pressure, high-altitude sickness, increased water pressure, (nitrogen narcosis), chemical including Gulf War illness, gases, vapors |
| Toxins and environmental extremes: Smoke inhalation agricultural hazards (example pesticides, green tobacco poisoning, anhydrous ammonia, agent Orange) volatile organic solvents metals (example lead) |
| Toxins and environmental extremes: Other chemical agents (example ethylene glycol, carbon tetrachloride, methanol; BPA) principles of poisoning and therapy (example acetylsalicylic acid [ASA], acetaminophen) |
| Venomous bites and stings: Hymenoptera bites and stings; scorpion bites; snake bites; spider bites; jellyfish stings |
| Fluid, electrolyte, and acid-base balance disorders: (a) Fluid volume and electrolyte/ ion disorders-fluid volume disorders; dehydration; hypovolemia; volume overload; electrolyte disorders; hyponatremia, hypernatremia; hypokalemia, hyperkalemia |
| Fluid, electrolyte, and acid-base balance disorders: (a) Fluid volume and electrolyte/ ion disorders-hypocalcemia, hypercalcemia; hypophosphatemia, hyperphosphatemia; hypomagnesemia, (b) acid-base disorders: Metabolic acidosis; metabolic alkalosis |
| Fluid, electrolyte, and acid-base balance disorders: (b) Acid-base disorders-respiratory acidosis; respiratory alkalosis; mixed acid-base disturbances |
| Abuse: Child, nonaccidental trauma/ inflicted head trauma/ factitious disorder by proxy intimate partner abuse, sexual, emotional, and physical including injuries (example rib fractures) related to abuse, elder abuse, sexual |
| Abuse: Emotional, and physical including injuries (example rib fractures) related to abuse, sexual assault |
| Multiple trauma (example prioritization, blast injury involving more than one organ system) |
| Shock, cardiogenic, hypovolemic, neurogenic, septic, sepsis, bacteremia, systemic, inflammatory response syndrome (SIRS), refractory, multiorgan dysfunction syndrome: Meningococcemia |
| Genetic metabolic and developmental disorders: (a) Multifactorial-VATER syndrome, association syndromes, (b) large genomic changes: Beckwith-Wiedemann syndrome; Down syndrome; Prader-Willi syndrome, (c) enzymatic/ metabolic: Alpha-1 antitrypsin deficiency |
| Genetic metabolic and developmental disorders: (c) Enzymatic/ metabolic-porphyria; inborn errors of metabolism (example maple syrup urine disease, diseases involving urea cycle) |
| Genetic metabolic and developmental disorders: (c) Enzymatic/ metabolic-storage diseases (example Fabry disease, Tay-Sachs disease, glycogen storage disease, mucopolysaccharidoses), (b) structural protein disorders: Amyloidosis; Ehlers-Danlos syndrome |
| Genetic metabolic and developmental disorders: (b) Structural protein disorders-immotile cilia syndrome (Kartagener syndrome; primary ciliary dyskinesia); Marfan syndrome, (c) intracellular/ extracellular transport receptors: Cystic fibrosis |
| Genetic metabolic and developmental disorders: (c) Intracellular/ extracellular transport receptors-hemochromatosis; Wilson disease, (d) triplet repeat/ RNA disorders: Fragile X syndrome |
| Adverse effects of drugs on multisystem disorders: Drug-induced electrolyte abnormalities and acid base-disorders (example albuterol; prednisone; diuretics; alcohol; drugs inducing polydipsia, SIADH, or diabetes insipidus) |
System specifications-Behavioral health
System specifications-Behavioral health: Unit 01
Normal processes |
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| Psychodynamic and behavioral factors, related past experience (example transference, personality traits) |
| Adaptive behavioral responses to stress and illness (example coping mechanisms) |
| Maladaptive behavioral responses to stress and illness (example drug-seeking behavior, sleep deprivation) |
| Patient adherence: General adherence; adolescent adherence |
System specifications-Behavioral health: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Psychotic disorders: Brief psychotic disorder; delusional disorder; psychotic disorder due to another medical condition; schizophrenia; schizoaffective disorder; substance-induced psychotic disorder |
| Anxiety disorders: Acute stress disorder; anxiety disorders (generalized anxiety disorder, anxiety due to another medical condition, social phobia); hyperventilation syndrome; obsessive-compulsive disorder; panic disorder with and without agoraphobia |
| Anxiety disorders: Phobic disorders; post-traumatic stress disorder; separation anxiety disorder; substance-induced anxiety disorder, trichotillomania |
| Mood disorders: Major depressive disorder with and without psychotic features, with and without seasonal pattern; major depressive disorder, postpartum, with and without psychotic features, including screening; cyclothymic disorder |
| Mood disorders: Persistent depressive disorder (dysthymia); bipolar disorder, manic/ depressed/ mixed; premenstrual dysphoric disorder; bipolar and related disorder or depressive disorder due to another medical condition |
| Mood disorders: Substance/ medication-induced bipolar and related disorder or depressive disorder (illegal or prescribed); suicidal ideation/ attempt |
| Somatoform disorders: Body dysmorphic disorder; conversion disorder, including psychogenic seizures; dissociative disorders; illness anxiety disorder (hypochondriasis); malingering; pain disorder; somatic symptom disorder |
| Factitious disorders: Factitious disorder imposed on self |
| Eating disorders and impulse control disorders: Anorexia nervosa; binge-eating disorder; bulimia nervosa; eating disorder; disruptive, impulse-control, and conduct disorders (example gambling, kleptomania, pyromania) |
| Disorders originating in infancy/ childhood: Reactive attachment disorder; attention deficit/ hyperactivity disorder; speech sound disorder or language disorder; learning disorder/ dyslexia; intellectual developmental disorder and developmental delay |
| Disorders originating in infancy/ childhood: Undefined, including school problems, fetal alcohol syndrome; oppositional defiant disorder, conduct disorder; autism spectrum disorder, rett syndrome; psychoses with origin specific to childhood |
| Disorders originating in infancy/ childhood: Elimination disorders (incontinence, encopresis); tic disorders/ tourette disorder |
| Personality disorders: Antisocial personality disorder; avoidant personality disorder; borderline personality disorder; dependent personality disorder; histrionic personality disorder; narcissistic personality disorder |
| Personality disorders: Obsessive-compulsive personality disorder; paranoid personality disorder; schizoid personality disorder |
| Psychosocial disorders/ behaviors: Adjustment disorder; grief response/ bereavement, normal and persistent complex; parent-child relational problems other than physical or emotional abuse; other psychosocial stress |
| Sexual and gender identity disorders: Gender dysphoria; psychosexual dysfunction |
| Substance use disorders: Alcohol use disorder/ intoxication/ dependence/ withdrawal; tobacco/ nicotine use disorder/ dependence/ withdrawal; varenicline use; cannabis use disorder/ intoxication/ dependence |
| Substance use disorders: Hallucinogen use disorder/ intoxication/ dependence/ withdrawal; inhalant use disorder/ intoxication/ dependence/ withdrawal; opioid, heroin, including prescription drug, use disorder/ intoxication/ dependence/ withdrawal |
| Substance use disorders: Sedative, hypnotic, including benzodiazepine and barbiturate use disorder/ intoxication/ dependence/ withdrawal; stimulant, cocaine, methamphetamine use disorder/ intoxication/ dependence/ withdrawal |
| Substance use disorders: Other drugs of use disorders (example ecstasy, PCP, bath salts)/ intoxication/ dependence/ withdrawal; polysubstance use disorder/ intoxication/ dependence/ withdrawal |
System specifications-Nervous system and special senses
System specifications-Nervous system and special senses: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes, including neural tube derivatives, cerebral ventricles, and neural crest derivatives |
| Organ structure and function: (a) Spinal cord-gross anatomy and blood supply, spinal reflexes, brain stem (example cranial nerves and nuclei, reticular formation, anatomy and blood supply, control of eye movements) |
| Organ structure and function: (b) Brain-gross anatomy and blood supply, higher function: Cognition, language, memory, executive function, hypothalamic function, limbic system and emotional behavior, circadian rhythm sleep-wake disorder |
| Organ structure and function: (c) Sensory systems-general sensory modalities, including sharp, dull, temperature, vibratory, and proprioception, special sensory modalities, including vision, hearing, taste, olfaction, and balance |
| Organ structure and function: (d) Motor systems-brain and spinal cord (upper motor neuron), basal ganglia and cerebellum, autonomic nervous system, peripheral nerves |
| Cell/ tissue structure and function, including neuronal cellular and molecular biology: Axonal transport, excitable properties of neurons, axons, and dendrites, including channels synthesis, storage, release |
| Cell/ tissue structure and function, including neuronal cellular and molecular biology: Reuptake, and degradation of neurotransmitters and neuromodulators, presynaptic and postsynaptic receptor interactions, trophic and growth factors, brain metabolism |
| Cell/ tissue structure and function, including neuronal cellular and molecular biology: Glia, myelin, brain homeostasis: Blood-brain barrier, cerebrospinal fluid formation and flow, choroid plexus |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Nervous system and special senses: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) meningitis: Bacterial (actinomyces israelii; haemophilus influenzae; listeria monocytogenes; mycobacterium tuberculosis; neisseria meningitidis; staphylococcus aureus) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) meningitis: Bacterial (epidermidis; streptococcus agalactiae; streptococcus pneumoniae); viral (adenovirus, arboviruses, echovirus and coxsackie A and B viruses) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral (echovirus and coxsackie A and B viruses, polioviruses, herpes simplex virus, varicella zoster human immunodeficiency virus, lymphocytic choriomeningitis virus) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral (lymphocytic choriomeningitis virus, measles virus, mumps virus, St. Louis encephalitis virus, California encephalitis virus, Western equine encephalitis virus) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iii) fungal (blastomycosis dermatitidis, cryptococcus neoformans/ gattii); spirochetal (borrelia burgdorferi; leptospira; treponema pallidum, including neurosyphilis) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iv) protozoal/ helminths (acanthamoeba, naegleria fowleri, strongyloides stercoralis, angiostrongylus cantonensis, baylisascaris procyonis) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(v) encephalitis (herpesvirus [HSVI], varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, mumps virus, enterovirus, West Nile virus, St. Louis encephalitis virus) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(v) encephalitis (rabies virus, eastern and western equine encephalitis virus, poliovirus, Taenia, Toxoplasma gondii), (vi) prion disease (example Creutzfeldt-Jakob disease) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(vi) botulism (Clostridium botulinum), (vii) tetanus (Clostridium tetani); (viii) CNS disorders associated with AIDS (example progressive multifocal leukoencephalopathy) |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-myasthenia gravis, including thymoma; multiple sclerosis; transverse myelitis |
| Neoplasms (cerebral, spinal, and peripheral): Benign (meningioma, neurofibromatosis); malignant (glioblastoma multiforme, astrocytoma, medulloblastoma, primary CNS lymphoma); metastatic (example breast, lung, pancreatic, testicular, melanoma) |
| Cerebrovascular disease: Arteriovenous malformations, ectatic cerebral vessels; transient ischemic attack; stroke, thrombotic: Cerebral artery occlusion/ cerebral infarction; stroke, embolic: Cerebral embolism |
| Cerebrovascular disease: Stroke-intracerebral hemorrhage including subarachnoid hemorrhage, traumatic intracranial hemorrhage; cerebral artery aneurysm; carotid artery stenosis/ atherosclerosis/ occlusion/ dissection |
| Cerebrovascular disease: Vertebral artery deficiency/ dissection; subclavian steal syndrome; vascular dementia; hypertensive encephalopathy; posterior reversible encephalopathy syndrome; venous sinus thrombosis |
| Disorders relating to the spine, spinal cord, and spinal nerve roots: Cauda equina syndrome; spinal artery thrombosis/ embolus/ infarct; spinal cord compression; spinal cord transection, paraplegia and quadriplegia |
| Disorders relating to the spine, spinal cord, and spinal nerve roots: Acute and chronic effects (example autonomic dysreflexia); spinal stenosis (cervical, lumbar); syringomyelia |
| Cranial and peripheral nerve disorders: (a) Cranial nerve injury/ disorders-cranial nerve injury; bell palsy; anisocoria, miosis, mydriasis; internuclear ophthalmoplegia; nystagmus and other irregular eye movements; vestibular neuritis, labyrinthitis |
| Cranial and peripheral nerve disorders: (a) Cranial nerve injury/ disorders-ptosis of the eyelid; Horner syndrome, peripheral nerve/ plexus injury/ disorders: Peripheral nerve injury, including brachial plexus |
| Cranial and peripheral nerve disorders: (b) Peripheral nerve/plexus injury/disorders-carpal/ cubital/ tarsal/ peroneal tunnel syndrome; mononeuritis, Guillain-Barré syndrome; Miller Fisher syndrome; neuropathy (example Charcot-Marie-Tooth disease) |
| Cranial and peripheral nerve disorders: (b) Peripheral nerve/plexus injury/disorders-herpes zoster |
| Neurologic pain syndromes: Complex regional pain syndrome (reflex sympathetic dystrophy, causalgia); fibromyalgia; postherpetic neuralgia; phantom limb pain/ syndrome; thalamic pain syndrome; trigeminal neuralgia |
| Degenerative disorders/ amnestic syndromes: Alzheimer disease; frontotemporal dementia, including progressive supranuclear palsy, Lewy body disease; mild neurocognitive disorder, mild cognitive impairment |
| Global cerebral dysfunction: Altered states of consciousness; delirium; coma/ brain death |
| Neuromuscular disorders: Amyotrophic lateral sclerosis/ spinal muscular atrophy; muscular dystrophy (example Duchenne, myotonic); muscle channelopathies (example hypokalemic period paralysis) |
| Movement disorders: Acute dystonia; adult tic disease; essential tremor; Huntington disease; Parkinson disease, including Parkinson dementia |
| Metabolic disorders: Adrenoleukodystrophy; metabolic encephalopathy |
| Paroxysmal disorders: Headache, including migraine, mixed, tension, ice-pick, cluster, medication withdrawal, caffeine withdrawal; seizure disorders, including generalized tonic-clonic, partial, absence, febrile |
| Sleep disorders: Cataplexy and narcolepsy; circadian rhythm sleep-wake disorder; insomnia, primary; sleep terror disorder and sleepwalking; REM sleep behavior disorder; restless legs syndrome |
| Traumatic and mechanical disorders and disorders of increased intracranial pressure: Anoxic brain damage, cerebral hypoxia; epidural, subdural hematoma (cerebral and spinal); intraparenchymal hemorrhage, traumatic subarachnoid hemorrhage; cerebral edema |
| Traumatic and mechanical disorders and disorders of increased intracranial pressure: Pseudotumor cerebri (idiopathic intracranial hypertension); torticollis/ cervical dystonia; hydrocephalus, including normal-pressure |
| Traumatic and mechanical disorders and disorders of increased intracranial pressure: Traumatic brain injury (concussion)/ post concussion syndrome (dementia pugilistica); traumatic brain syndrome |
| Congenital disorders: Friedreich ataxia; neural tube defects (example spina bifida, holoprosencephaly, anencephaly); microcephaly; Sturge-Weber syndrome; tuberous sclerosis, von Hippel-Lindau disease; hydrocephalus, obstructive (Arnold-Chiari) |
| Adverse effects of drugs on the nervous system: Acute dystonic reaction; drug-induced meningitis (example NSAIDs, sulfa drugs); drug-induced neuropathy (example vincristine, isoniazid, metronidazole) |
| Adverse effects of drugs on the nervous system: Extrapyramidal adverse effects (example akathisia, dystonia, drug-induced parkinsonism); neuroleptic malignant syndrome; poisoning by psychotropic agents, including antidepressants; serotonin syndrome |
| Adverse effects of drugs on the nervous system: Tardive dyskinesia |
| Disorders of the eye and eyelid: (a) Infectious and inflammatory disorders of the eye-blepharitis/ eyelid inflammation; chalazion; chorioretinitis; conjunctivitis (adenovirus)/ keratoconjunctivitis; dacryocystitis; endophthalmitis; hordeolum |
| Disorders of the eye and eyelid: (a) Infectious and inflammatory disorders of the eye-iridocyclitis; optic neuritis; periorbital cellulitis; uveitis, (b) neoplasms of the eye: Melanoma; retinoblastoma |
| Disorders of the eye and eyelid: (c) Disorders of the eye and eyelid, structural-cataract; glaucoma; lacrimal system disorders; pterygium; refractive disorders (presbyopia, myopia, hyperopia, astigmatism) |
| Disorders of the eye and eyelid: (d) Disorders of the pupil, iris, muscles (extraocular): Amblyopia; strabismus, (e) disorders of the retina-hypertensive retinopathy; macular degeneration; papilledema; retinal detachment; retinitis pigmentosa |
| Disorders of the eye and eyelid: (e) Disorders of the retina-vascular disorders affecting the retina, including central retinal artery embolus, retinal hemorrhage, amaurosis fugax, embolus, carotid artery stenosis, central retinal vein occlusion |
| Disorders of the eye and eyelid: (e) Disorders of the retina-visual impairment/ blindness, night blindness , (f) traumatic and mechanical disorders: Black eye; burn of the eye and adnexa; corneal abrasion, ulcer; dislocated lens; foreign body in eye |
| Disorders of the eye and eyelid: (f) Traumatic and mechanical disorders-hyphema; injury to optic nerve and pathways; laceration of the eye and eyelid; ocular open wounds; orbital fracture; subconjunctival hemorrhage |
| Disorders of the eye and eyelid: (g) Adverse effects of drugs on the eyes-ethambutol; hydroxychloroquine; prednisone |
| Disorders of the ear: (a) Infectious and inflammatory disorders of the ear-chondritis; mastoiditis; otitis, externa, media, interna, serous, suppurative, malignant otitis externa, (b) neoplasms: Acoustic neuroma, neurofibromatosis type 2; cholesteatoma |
| Disorders of the ear: (c) Hearing loss/ deafness-hearing loss, including noise-induced; otosclerosis; tinnitus, (d) disorders of balance and spatial orientation: Meniere disease; motion sickness; vertigo, including benign positional vertigo |
| Disorders of the ear: (e) Traumatic and mechanical disorders: Barotrauma; foreign body in ear; impacted cerumen; laceration, avulsion; perforation of tympanic membrane; eustachian tube disorders |
| Disorders of the ear: (f) Adverse effects of drugs on the ear-antineoplastic agents, including cisplatin; aminoglycosides; furosemide; salicylates |
System specifications-Skin and subcutaneous tissue
System specifications-Skin and subcutaneous tissue: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and neonatal changes |
| Organ structure and function, including barrier function, thermal regulation |
| Cell/ tissue structure and function, eccrine function |
| Repair, regeneration, and changes associated with stage of life (example senile purpura, male pattern baldness, postmenopausal hair changes) |
| Skin defense mechanisms and normal flora |
System specifications-Skin and subcutaneous tissue: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(i) bacterial: Cellulitis, erysipelas, impetigo, staphylococcal scalded skin syndrome; abscess, cutaneous, including septic abscess |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(i) bacterial: Anthrax (Bacillus anthracis); carbuncle; folliculitis; pilonidal cyst, infected; pyoderma gangrenosum; MSSA and MRSA skin infections |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(i) bacterial: Mycobacterial infections (example leprosy, draining sinus); scarlet fever (group A Streptococcus), (ii) viral: Herpes simplex type 1 and type 2 |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(ii) viral: Herpes zoster; Ramsay-hunt syndrome; molluscum contagiosum; hand-foot-and-mouth disease; herpangina; parvovirus; chickenpox |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(ii) viral: Erythema infectiosum (fifth disease), rubella, measles, roseola (exanthema subitum); verrucae vulgaris |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(iii) fungal (deep and superficial): Candidiasis, skin; dermatophytosis, tinea corporis; dermatomycoses; diaper rash; onychomycosis |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders and infestations-(iv) parasitic: Cutaneous larva migrans; cutaneous leishmaniasis; (vi) infestations, non venomous bites, stings: Scabies; lice; insect bites, including bed bugs |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) papulosquamous and eczematous dermatoses: Psoriasis; lichen planus and lichenoid dermatoses; allergic/irritant contact dermatitis (example nickel) |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) papulosquamous and eczematous dermatoses: Dermatoses caused by plants (poison ivy, poison oak), (ii) vesiculobullous disorders: Epidermolysis bullosa |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(ii) vesiculobullous disorders: Dermatitis herpetiformis; pemphigus; pemphigoid, (iii) urticaria, erythema, exanthema, and purpura: Erythema nodosum |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(iii) urticaria, erythema, exanthema, and purpura: Atopic dermatitis; pityriasis rosea; urticaria; Stevens-Johnson syndrome, erythema multiforme |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(iii) urticaria, erythema, exanthema, and purpura: Toxic epidermal necrolysis, (iv) autoimmune disorders: Vitiligo |
| Neoplasms: (a) Benign neoplasms, cysts, and other skin lesions-actinic keratoses; cysts, including epidermal; hemangiomas; lipoma; pigmented nevi; seborrheic keratosis; xanthomas, (b) malignant neoplasms: Basal cell carcinoma; squamous cell carcinoma |
| Neoplasms: (b) Malignant neoplasms-melanoma, including genital; Kaposi sarcoma; cutaneous T-cell lymphoma, mycosis fungoides |
| Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes): (a) Disorders of the hair and hair follicles-alopecia; seborrhea capitis/seborrheic dermatitis; tinea barbae and capitis |
| Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes): (b) Disorders of the nails (including ingrowing nail), (c) disorders of sweat and sebaceous glands: Acne vulgaris; hidradenitis suppurativa |
| Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes): (c) Disorders of sweat and sebaceous glands-hyperhidrosis; ichthyosis; rosacea |
| Oral disease: Aphthous ulcers (stomatitis, canker sores); leukoplakia |
| Disorders of pigmentation: Albinism; lentigo |
| Traumatic and mechanical disorders: Animal bites (dogs, cats, etc); burns or wounds affecting the skin or subcutaneous tissue (example sunburn, other including blast injuries and burns); cauliflower ear; effects of ultraviolet light; keloids; tattoo |
| Traumatic and mechanical disorders: Thermal injury, perniosis, frostbite; ulcers, decubitus |
| Congenital disorders: Xeroderma pigmentosum; benign lesions in neonates, infants, children (example congenital nevi) |
| Adverse effects of drugs on skin and subcutaneous tissue: Drug reactions, eruptions, including local reaction to vaccine |
System specifications-Musculoskeletal system
System specifications-Musculoskeletal system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes |
| Organ structure and function |
| Cell/ tissue structure and function: Biology of bones, joints, tendons, skeletal muscle, cartilage exercise and physical conditioning/ deconditioning |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Musculoskeletal system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, inflammatory, and immunologic disorders: (a) Infectious disorders-gangrene, dry and wet, clostridial myonecrosis (clostridium perfringens); discitis; myositis, infective; necrotizing fasciitis; osteomyelitis; septic arthritis |
| Infectious, inflammatory, and immunologic disorders: (a) Infectious disorders-spondylitis, tuberculous, (b) immunologic disorders: Ankylosing spondylitis; dermatomyositis/ polymyositis; juvenile idiopathic arthritis; rheumatoid arthritis, felty syndrome |
| Infectious, inflammatory, and immunologic disorders: (b) Immunologic disorders-psoriatic arthropathy, (c) inflammatory disorders: Adhesive capsulitis of shoulder (frozen shoulder syndrome); ankylosing/spondylopathy (inflammatory); bursitis; fasciitis |
| Infectious, inflammatory, and immunologic disorders: (c) Inflammatory disorders-osteochondritis, osteochondritis dissecans; tendinitis, supraspinatus syndrome, enthesopathy of spine, elbow, ankle; temporomandibular joint disorders; fibrositis |
| Infectious, inflammatory, and immunologic disorders: (c) Inflammatory disorders-myofascial pain syndrome; synovitis; tenosynovitis; myositis |
| Neoplasms: Benign neoplasms (example ganglion cyst); malignant neoplasms of bone (example osteosarcoma, sarcoma, leiomyosarcoma, rhabdomyosarcoma); metastases to bone, secondary malignant neoplasm of bone |
| Degenerative and metabolic disorders: (a) Degenerative/ metabolic disorders of bone, tendon, and cartilage-chondromalacia; disc degeneration, herniated disc; Legg-Calvé-Perthes disease; Osgood-Schlatter disease; osteodystrophy; osteomalacia |
| Degenerative and metabolic disorders: (a) Degenerative/ metabolic disorders of bone, tendon, and cartilage-osteonecrosis (avascular), bone infarct; osteoporosis; osteopenia; osteitis deformans (Paget disease of bone); pathologic fracture; radiculopathies |
| Degenerative and metabolic disorders: (a) Degenerative/ metabolic disorders of bone, tendon, and cartilage-spondylolisthesis/spondylosis (degenerative), (b) degenerative/ metabolic disorders of joints: Gout, gouty arthritis, pseudogout; joint effusion |
| Degenerative and metabolic disorders: (b) Degenerative/ metabolic disorders of joints-osteoarthritis, degenerative/ metabolic disorders of muscles, ligaments, fascia: Dupuytren contracture; muscle calcification and ossification |
| Degenerative and metabolic disorders: (c) Degenerative/ metabolic disorders of muscles, ligaments, fascia-muscle wasting and diffuse atrophy; rhabdomyolysis |
| Traumatic and mechanical disorders: Amputation and care of amputees; backache, including low back pain; blast injuries; compartment syndrome; contractures, hospital-acquired; contusions; dislocations; fractures; sprains, strains; kyphoscoliosis, scoliosis |
| Traumatic and mechanical disorders: Rotator cuff syndrome; slipped capital femoral epiphysis; dislocation of hip |
| Congenital disorders: Achondroplasia/ dwarfism; disorders of limb development (HOX gene mutation, phocomelia); developmental dysplasia of the hip; dislocation of hip in infantile spinal muscular atrophy; genu valgum or varum |
| Congenital disorders: Foot deformities (flat foot, valgus/ varus deformities); osteogenesis imperfecta; McArdle disease; mitochondrial myopathies |
| Adverse effects of drugs on the musculoskeletal system: Drug-induced myopathy (example steroids, statins, cocaine, AZT); malignant hyperthermia |
System specifications-Cardiovascular system
System specifications-Cardiovascular system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal transitional changes |
| Organ structure and function: Chambers, valves cardiac cycle, mechanics, heart sounds, cardiac conduction hemodynamics, including blood volume and systemic vascular resistance circulation in specific vascular beds, including pulmonary and coronary |
| Cell/ tissue structure and function: Heart muscle, metabolism, oxygen consumption, biochemistry, and secretory function (example atrial natriuretic peptide), endothelium and secretory function, vascular smooth muscle |
| Cell/ tissue structure and function: Microcirculation, and lymph flow, neural and hormonal regulation of the heart, blood vessels, and blood volume, including responses to change in posture, exercise, and tissue metabolism, and autonomic responses |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Cardiovascular system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-bacterial endocarditis, myocarditis, (b) immunologic and inflammatory disorders: Atherosclerosis (example atherosclerosis of the aorta) |
| Neoplasms: Myxoma, metastases |
| Dysrhythmias: Premature beats (PACs, PVCs); atrial flutter/ fibrillation; multifocal atrial tachycardia; paroxysmal tachycardias; ventricular tachycardia/ fibrillation; wide complex tachycardia; torsades de pointes; bradycardias |
| Dysrhythmias: Atrioventricular block (first-, second-, third-degree); conduction disorder (LBBB, RBBB); cardiac arrest; sick sinus syndrome; prolonged QT syndrome; Wolff-Parkinson-White syndrome; carotid sinus hypersensitivity |
| Dysrhythmias: Pacemaker dysfunction, including failure to sense, capture |
| Heart failure: Chordae tendineae rupture; congestive heart failure; cor pulmonale; diastolic dysfunction; systolic dysfunction; mitral valve dysfunction; heart failure secondary to myocardial infarction |
| Heart failure: High-output heart failure, including thyrotoxicosis-induced, anemia-induced; tachycardia-induced; cardiogenic pulmonary edema |
| Ischemic heart disease: Acute coronary syndrome, acute myocardial infarction; angina pectoris, stable and unstable/ coronary artery disease/ coronary insufficiency; coronary artery spasm |
| Diseases of the myocardium: Cardiomyopathy, dilated, including alcoholic, viral, takotsubo; cardiomyopathy, obstructive hypertrophic; cardiomyopathy, familial dilated; cardiomyopathy, restrictive; hypertensive heart disease, left ventricular hypertrophy |
| Diseases of the myocardium: Right ventricular hypertrophy; complications of myocardial infarction; nontraumatic tamponade post-myocardial infarction; papillary muscle rupture/ dysfunction; ventricular free wall rupture; myocarditis |
| Diseases of the pericardium: Chronic constrictive pericarditis; pericardial effusion; pericardial tamponade; acute pericarditis; pericarditis, following myocardial infarction, surgery, trauma |
| Valvular heart disease: Valve disorders, mitral/ aortic/ tricuspid, pulmonic (example regurgitation, stenosis, prolapse, insufficiency, vegetation); functional murmurs; rheumatic heart disease; complications of artificial valves |
| Hypotension: Orthostatic hypotension |
| Hypertension: Elevated blood pressure reading without diagnosis of hypertension; essential hypertension; malignant hypertension; secondary hypertension |
| Dyslipidemia: Hypercholesterolemia; hyperlipidemia; hypertriglyceridemia; lipoproteins/ lipoprotein lipase deficiency |
| Vascular disorders: (a) Disorders of the great vessels-aneurysm, aortic (abdominal/ thoracic), dissection, ruptured; aneurysm, iliac, other peripheral vascular, ruptured; aortoiliac disease |
| Vascular disorders: (b) Peripheral arterial vascular disease-arterial embolism/ thrombosis, arteriovenous fistula; atheroembolic disease; claudication; cholesterol emboli; hypertensive vascular disease; peripheral arterial disease |
| Vascular disorders: (b) Peripheral arterial vascular disease-thromboangiitis obliterans, (c) diseases of the veins-deep venous thrombosis, venous thromboembolism; phlebitis/ thrombophlebitis; varicose veins; venous insufficiency; stasis ulcers |
| Vascular disorders: (c) Diseases of the veins-stasis dermatitis |
| Traumatic and mechanical disorders: Ventricular puncture; myocardial contusion; myocardial rupture; traumatic aortic dissection; traumatic tamponade |
| Congenital disorders, including disease in adults: Anomalous left coronary artery; atrial septal defect; coarctation of the aorta; endocardial cushion defect; patent foramen ovale; patent ductus arteriosus; tetralogy of Fallot |
| Congenital disorders, including disease in adults: Transposition of the great vessels; ventricular septal defect |
| Adverse effects of drugs on the cardiovascular system: Adriamycin; cocaine, amphetamine, PCP; ACE inhibitors, calcium channel blockers, alpha blockers, minoxidil |
System specifications-Respiratory system
System specifications-Respiratory system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes |
| Organ structure and function: Airways, including mechanics and regulation of breathing, lung parenchyma, including ventilation, perfusion, gas exchange, pleura, nasopharynx, sinuses |
| Cell/ tissue structure and function, including surfactant formation, and alveolar structure |
| Repair, regeneration, and changes associated with stage of life |
| Pulmonary defense mechanisms and normal flora |
System specifications-Respiratory system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-acute upper respiratory infection; viral infections (adenovirus, corona viruses, coxsackievirus, influenza virus) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-viral infections (parainfluenza virus, rhinoviruses); sinusitis; nasopharyngitis; epiglottitis |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-bordetella pertussis pneumonia; croup; acute laryngitis; acute laryngotracheitis; tracheitis; pharyngitis |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-streptococcal throat infections; tonsillitis; peritonsillar abscess; rhinitis, allergic, chronic |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious, immunologic, and inflammatory disorders of the upper airways-ulcers of nasal cavity/ sinuses |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-hospital acquired pneumonia; ventilator-associated pneumonia, community-acquired pneumonia, acute bronchiolitis |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-bronchiolitis obliterans with organizing pneumonia (BOOP); anthrax, pulmonary (Bacillus anthracis); aspiration pneumonia |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-pneumonitis; bronchitis, acute; bronchopneumonia; pneumonia (Burkholderia pseudomallei, chlamydophila pneumoniae |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-coxiella burnetii, francisella tularensis, haemophilus influenzae, klebsiella pneumoniae, legionella, moraxella catarrhalis |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-mycoplasma pneumoniae, pseudomonas aeruginosa, streptococcus, MSSA, MRSA, other gram‐negative bacteria) |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-viral infection (example influenza A, B, adenovirus, H1N1, respiratory syncytial virus, parainfluenza virus) |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-fungal infection (aspergillosis, including allergic bronchopulmonary aspergillosis and aspergilloma, histoplasmosis) |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-fungal infection (coccidioidomycosis, pneumocystis jirovecii); pulmonary tuberculosis; lung abscess |
| Infectious, immunologic, and inflammatory disorders: (b) Infectious, immunologic, and inflammatory disorders of the lower airways-viral infection (example influenza A, B, adenovirus, respiratory syncytial virus, parainfluenza virus, avian influenza virus) |
| Neoplasms: (a) Benign neoplasms-upper airways (example vocal cord polyps, nasal polyps, juvenile, papillomatosis); lungs and pleura (example solitary pulmonary nodule, bronchial carcinoid tumors) |
| Neoplasms: (b) Malignant neoplasms-(i) upper airways: Lip, oral cavity, and pharynx; head and neck cancer; larynx; trachea, (ii) lower airways and pleura: Malignant neoplasms of bronchus and/ or lung (squamous cell, adenocarcinoma, large cell, small cell) |
| Neoplasms: (b) Malignant neoplasms-(ii) lower airways and pleura: Malignant neoplasms of pleura (mesothelioma); secondary malignant neoplasms of lung; secondary malignant neoplasms of pleura, (c) metastatic neoplasms including pleural |
| Obstructive airway disease: Asthma, reactive airway disease; bronchiectasis; chronic airway obstruction; chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema |
| Pneumoconiosis/ fibrosing/ restrictive pulmonary disorders/ interstitial lung disease: Pneumoconiosis; asbestosis; silicosis; silo-filler's lung, byssinosis, bagassosis, berylliosis; hypersensitivity pneumonitis; hypereosinophilic syndromes |
| Pneumoconiosis/ fibrosing/ restrictive pulmonary disorders/ interstitial lung disease: Loeffler syndrome; interstitial pneumonia, usual (UIP), desquamative (DIP), nonspecific |
| Respiratory failure/ respiratory arrest and pulmonary vascular disorders: Acute respiratory distress syndrome (ARDS); pulmonary hypertension; pulmonary vascular disorders, arteriovenous fistula; pulmonary edema, pulmonary cause and unspecified |
| Respiratory failure/ respiratory arrest and pulmonary vascular disorders: Pulmonary embolism; air and fat embolism; respiratory failure due to enteral feeding |
| Metabolic, regulatory, and structural disorders: Disorders of gas exchange; hypoventilation; hypoxia; pulmonary alveolar proteinosis; ventilation-perfusion imbalance |
| Disorders of the pleura, mediastinum, and chest wall: Chylothorax; costochondritis; empyema; hemothorax; mediastinitis; pleural effusion; pleuritis; pneumomediastinum; pneumothorax |
| Traumatic and mechanical disorders: (a) Upper airways-epistaxis; barotrauma, sinus; laryngeal/pharyngeal obstruction; tracheoesophageal fistula; tracheal stenosis; tracheomalacia; trauma (example tracheal injury) |
| Traumatic and mechanical disorders: (a) Upper airways-foreign body (nose, pharynx, larynx, trachea); traumatic/ mechanical disorders of the nasal cavity/ sinuses (example septal perforation) |
| Traumatic and mechanical disorders: (b) Lower airways and pleura-atelectasis; diaphragm/ chest wall injury; drowning and near drowning; foreign body, upper and lower respiratory tract; penetrating chest wounds; pulmonary contusion; sleep apnea |
| Traumatic and mechanical disorders: (b) Lower airways and pleura-obstructive and central; hypoventilation syndrome, obesity-hypoventilation syndrome |
| Congenital disorders: Bronchogenic cysts; congenital cysts; congenital diaphragmatic hernia; pulmonary sequestration; immotile cilia syndrome |
| Adverse effects of drugs on the respiratory system: Bleomycin, amiodarone; adverse effects of 100% oxygen; acute effects of tobacco/ nicotine, inhalants, cocaine |
System specifications-Gastrointestinal system
System specifications-Gastrointestinal system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes |
| Organ structure and function: Anatomy of the alimentary canal, including mouth, pharynx, esophagus, stomach, small intestine, large intestine, anus, peritoneal cavity, liver and biliary system, including enterohepatic circulation |
| Organ structure and function: Salivary glands and exocrine pancreas, gastrointestinal motility, including defecation digestion and absorption |
| Cell/ tissue structure and function: Endocrine and neural regulatory functions, including GI hormones (example gastrin) salivary, gastrointestinal, pancreatic, hepatic secretory products, including enzymes, proteins |
| Cell/ tissue structure and function: Bile salts, and processes synthetic and metabolic functions of hepatocytes |
| Repair, regeneration, and changes associated with stage of life |
| Gastrointestinal defense mechanisms and normal flora |
System specifications-Gastrointestinal system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: Pseudomembranous colitis (Clostridium difficile); enteritis/ enteric infections (includes gastroenteritis) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) bacterial: (example Staphylococcus aureus, Escherichia coli, Listeria monocytogenes, Yersinia enterocolitica, Campylobacter species, Vibrio cholerae, Salmonella species) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) bacterial: (Shigella species, traveler's/ infectious diarrhea); hepatic abscess, subhepatic abscess, subphrenic abscess; peritonitis, primary and secondary; Whipple disease |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral: Infectious esophagitis (example CMV, herpes); hepatitis A, B, C, D, E; coxsackievirus enteritis/ colitis; Echovirus enteritis/colitis; rotavirus enteritis; mumps |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) viral: Gingivostomatitis, herpetic, (iii) fungal: Thrush, (iv) parasitic: Cryptosporidium, cyclospora, entamoeba histolytica, giardia, isospora belli |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(iv) parasitic: Strongyloides stercoralis |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-autoimmune hepatitis; celiac disease; eosinophilic esophagitis; granulomatous enteritis; inflammatory bowel disease, including Crohn disease |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-regional enteritis; microscopic colitis (collagenous and lymphocytic colitis), ulcerative colitis, toxic megacolon |
| Neoplasms: (a) Benign neoplasms, including polyps, cysts-stomach; small intestine; colon, rectum, and anus, including polyps, (b) malignant neoplasms and premalignant conditions: Oral cancer (example lips, mouth, tongue, salivary glands) |
| Neoplasms: (b) Malignant neoplasms and premalignant conditions-esophageal, squamous and adenocarcinoma; Barrett esophagus; gastrinoma, Zollinger-Ellison syndrome; gastrointestinal carcinoid tumors; gastrointestinal stromal tumors; small intestine |
| Neoplasms: (b) Malignant neoplasms and premalignant conditions-stomach, adenocarcinoma, lymphoma, MALT; colon, rectum, anus; hereditary colon cancer syndromes |
| Neoplasms: (b) Malignant neoplasms and premalignant conditions-familial adenomatous polyposis (example Peutz-Jeghers syndrome, Gardner syndrome, Turcot syndrome,); MUTYH-associated polyposis; gallbladder, cholangiocarcinoma |
| Neoplasms: (b) Malignant neoplasms and premalignant conditions-adenocarcinoma of the ampulla of Vater; liver, including hepatoma; peritoneal cancer, including metastatic studding with cancer; pancreas, (c) metastatic neoplasms |
| Signs, symptoms, and ill-defined disorders: Upper gastrointestinal bleeding; lower gastrointestinal bleeding; constipation; diarrhea; hematochezia; bright red rectal bleeding; melena; nausea, vomiting, rumination |
| Disorders of the oral cavity, salivary glands, and esophagus: (a) Oral cavity and salivary glands-abscessed tooth; dental caries; malocclusion; disorders of the salivary glands (example stones, sialadenitis, parotitis) |
| Disorders of the oral cavity, salivary glands, and esophagus: (b) Esophagus-achalasia and cardiospasm; dysphagia; diverticulum (example Zenker); esophageal periapical abscess without sinus; esophagitis/ esophageal reflux (GERD); esophagitis, pill |
| Disorders of the oral cavity, salivary glands, and esophagus: (b) Esophagus-Mallory-Weiss syndrome; paraesophageal (hiatal) hernia; stricture and stenosis of esophagus |
| Disorders of the stomach, small intestine, colon, rectum, anus: (a) Stomach-dyspepsia/ hyperacidity; gastric ulcer; gastritis; peptic ulcer; peptic ulcer perforation; gastroparesis, small intestine, colon: Appendicitis; angiodysplasia; diverticula |
| Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-diverticulitis, diverticulosis; duodenitis, duodenal ulcer, peptic ulcer; gastroenteritis and colitis (noninfectious); granulomatous enterocolitis |
| Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-Hirschsprung disease; impaction of intestine; intestinal obstruction/ stricture; intussusception; irritable colon/ irritable bowel syndrome |
| Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-mesenteric ischemia/ ischemic bowel/ ischemic colitis; necrotizing enterocolitis; paralytic ileus; volvulus; malnutrition and malabsorption |
| Disorders of the stomach, small intestine, colon, rectum, anus: (b) Small intestine, colon-including lactose intolerance, short bowel syndrome, rectum and anus: Abscess of anal and rectal regions; anal fissure; anal fistula; ulcer; fecal incontinence |
| Disorders of the stomach, small intestine, colon, rectum, anus: (c) Rectum and anus-hemorrhage (rectum, anus); proctitis; hemorrhoids; rectal prolapse |
| Disorders of the liver and biliary system, noninfectious: (a) Liver-cirrhosis; Dubin-Johnson, Rotor syndromes; end-stage liver disease, including indications for transplantation; Gilbert syndrome, Crigler-Najjar syndrome |
| Disorders of the liver and biliary system, noninfectious: (a) Liver-hepatic coma/ hepatic encephalopathy; hepatitis, noninfectious; hepatitis, fatty liver, alcoholic; hepatorenal syndrome; hepatopulmonary syndrome; jaundice |
| Disorders of the liver and biliary system, noninfectious: (a) Liver-nonalcoholic fatty liver disease; portal hypertension/ esophageal varices, (b) biliary system: Bile duct obstruction/ cholestasis; cholangitis, including ascending; choledocholithiasis |
| Disorders of the liver and biliary system, noninfectious: (b) Biliary system-cholelithiasis/ cholecystitis; cholestasis due to parenteral nutrition; gallstone ileus; Mirizzi syndrome; primary biliary cirrhosis; primary sclerosing cholangitis |
| Disorders of the pancreas: Pancreatitis, acute; pancreatitis, chronic; pancreatitis, hereditary; pancreatic cyst/ pseudocyst; pancreatic duct obstruction; pancreatic insufficiency |
| Disorders of the peritoneal cavity: Ascites |
| Traumatic and mechanical disorders: Abdominal wall defects; adhesions, postsurgical; digestive system complications of surgery; post-gastric surgery syndromes (example blind loop syndrome, adhesions); duodenal tear; foreign body in digestive system |
| Traumatic and mechanical disorders: Inguinal, femoral, and abdominal wall hernias; open wound, abdominal; perforation of hollow viscus and blunt trauma; perforation/rupture of esophagus (Boerhaave syndrome); umbilical hernia |
| Congenital disorders: Annular pancreas, biliary atresia, cleft lip and palate, esophageal atresia, malrotation without volvulus, Meckel diverticulum, pyloric stenosis, tracheoesophageal fistula |
| Adverse effects of drugs on the gastrointestinal system: Drug-induced changes in motility (chronic laxative abuse, opioids); drug-induced gastritis, duodenitis, peptic ulcer disease (NSAIDs); drug-induced hepatitis (example acetaminophen, isoniazid) |
| Adverse effects of drugs on the gastrointestinal system: Drug-induced pancreatitis (example thiazide diuretics) |
System specifications-Renal and urinary system
System specifications-Renal and urinary system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes |
| Organ structure and function: Kidneys, ureters, bladder, urethra, glomerular filtration and hemodynamics, urine concentration and dilution, renal mechanisms in acid-base balance, renal mechanisms in body fluid homeostasis, micturition |
| Cell/ tissue structure and function: Renal metabolism and oxygen consumption, tubular reabsorption and secretion, including transport processes and proteins |
| Cell/ tissue structure and function: Hormones produced by or acting on the kidney (example renin, aldosterone, angiotensin II, vasopressin) |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Renal and urinary system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(i) upper urinary tract: Granulomatous pyelonephritis; perinephric abscess; pyelonephritis; pyonephrosis; renal abscess; renal tuberculosis |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-(ii) lower urinary tract and urinary tract infections of unspecified location: Cystitis; chlamydial and nonchlamydial |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) upper urinary tract: Glomerular disorders-Alport syndrome; glomerular disease due to hepatitis B, C; glomerulonephritis, including poststreptococcal |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) upper urinary tract: Glomerular disorders-IgA nephropathy; lupus nephritis; minimal change disease; nephrotic syndrome; thin basement membrane disease |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(i) upper urinary tract: Tubulointerstitial disease-acute tubular necrosis (ATN); acute interstitial nephritis; papillary necrosis; HIV nephropathy |
| Infectious, immunologic, and inflammatory disorders: (b) Immunologic and inflammatory disorders-(ii) lower urinary tract: interstitial cystitis |
| Neoplasms: (a) Benign neoplasms and cysts-polycystic kidney disease, (b) malignant neoplasms: Renal (example Wilms tumor/ nephroblastoma, renal cell carcinoma, renal tumors associated with congenital/ hereditary conditions) |
| Neoplasms: (b) Malignant neoplasms-urinary bladder and collecting system |
| Signs, symptoms, and ill-defined disorders: dysuria; hematuria; oliguria, anuria; proteinuria |
| Metabolic and regulatory disorders: Acute kidney injury; renal insufficiency; azotemia, uremic syndrome; chronic kidney disease, including end-stage renal disease; cystinuria; Fanconi syndrome |
| Metabolic and regulatory disorders: Hypertensive renal disease (renal complications of hypertension); renal calculi, ureteral calculi, nephrolithiasis; renal tubular acidosis |
| Vascular disorders: Renal artery stenosis (atherosclerosis, fibromuscular dysplasia, nephrosclerosis); renal vein thrombosis; renal infarction |
| Traumatic and mechanical disorders: Bladder rupture; neurogenic bladder; obstructive uropathy; posterior urethral valves; renal laceration; renal vascular injury; ureteral laceration/ avulsion/ disruption; urethral diverticulum |
| Traumatic and mechanical disorders: Obstruction/ stricture/ prolapse, urethral/ ureteral, vaginal walls, uterine, uterovaginal; urinary incontinence, including secondary enuresis; vesicoureteral reflux |
| Congenital disorders: Double ureters/ ureteral duplication/ double collecting system; horseshoe kidney; hydronephrosis/ reflux; renal agenesis, renal hypoplasia, renal dysplasia; single kidney |
| Adverse effects of drugs on the renal and urinary system: ACE inhibitors; aminoglycosides; amphotericin B; cisplatin; furosemide; gadolinium (nephrogenic systemic fibrosis); heroin; iodinated contrast dye; lithium; NSAIDs; penicillins; sulfa drugs |
| Adverse effects of drugs on the renal and urinary system: Tenofovir; drug-induced urinary retention |
System specifications-Male reproductive system
System specifications-Male reproductive system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and neonatal changes, gametogenesis |
| Organ structure and function: Structure, male genitalia and prostate function, male genitalia and prostate (example spermatogenesis, puberty) intercourse, orgasm, erection |
| Cell/ tissue structure and function, including hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones |
| Reproductive system defense mechanisms and normal flora |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Male reproductive system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-balanitis; epididymitis; orchitis; prostatitis; sexually transmitted infections and exposure; chancroid (Haemophilus ducreyi); genital herpes; gonorrhea (Neisseria gonorrhoeae) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-human papillomavirus infection, genital/ venereal/ anal warts, condylomata acuminata; lymphogranuloma venereum (Chlamydia trachomatis); syphilis (Treponema pallidum) |
| Infectious, immunologic, and inflammatory disorders: (a) Infectious disorders-trichomoniasis (Trichomonas vaginalis); urethritis, chlamydial and nonchlamydial, nongonococcal, (b) immunologic and inflammatory disorders: Autoimmune hypogonadism |
| Neoplasms: Malignant neoplasms, penile, prostate, testicular, breast |
| Metabolic and regulatory disorders, including sexual dysfunction: Erectile dysfunction, impotence; infertility, male factor; male sexual dysfunction; premature ejaculation |
| Traumatic and mechanical disorders: Benign prostatic hyperplasia/ hypertrophy; circumcision, including complications; epididymal cyst; hydrocele; injuries, wounds, and burns to male genitalia, including blast injuries; penile laceration, penile fracture |
| Traumatic and mechanical disorders: Peyronie disease; phimosis; scrotal laceration; spermatocele; testicular rupture/ avulsion/ laceration; torsion of testis; urethral laceration/ disruption; varicocele |
| Congenital disorders of the male reproductive system: Hypospadias; Klinefelter syndrome; undescended testicle |
| Adverse effects of drugs on the male reproductive system: Alcohol; androgens, testosterone; antipsychotics, antidepressants including selective serotonin reuptake inhibitors; beta adrenergic blockers; diuretic including thiazides |
| Adverse effects of drugs on the male reproductive system: Drug-induced priapism (example trazodone); finasteride, dutasteride; sildenafil, tadalafil, vardenafil; marijuana; nitric oxide reductase inhibitors |
System specifications-Pregnancy, childbirth, and the puerperium
System specifications-Pregnancy, childbirth, and the puerperium: Unit 01
Normal processes |
|---|
| Organ structure and function: Pregnancy, including fertilization, implantation, development of embryo, labor and delivery, the puerperium, lactation, gestational uterus, placenta |
System specifications-Pregnancy, childbirth, and the puerperium: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Prenatal care: (a) Preconception counseling and care-folate deficiency prevention; immunizations; nutritional assessment, including vitamins; Rh screening, (b) prenatal risk assessment/ prevention: Adolescent pregnancy; antepartum fetal evaluation |
| Prenatal care: (b) Prenatal risk assessment/ prevention-including biophysical profile; genetic screening; α-fetoprotein; diabetes mellitus; neural tube defects; Rh isoimmunization, (c) supervision of normal pregnancy: Assessment of gestational age |
| Prenatal care: (c) Supervision of normal pregnancy-iron deficiency prevention; nutrition, including weight management; surveillance, including ultrasonography and assessment of fetal growth; vitamin deficiency prevention; infections, maternal, fetal |
| Prenatal care: (c) Supervision of normal pregnancy-newborn (focus on prevention and screening): Cytomegalovirus, coxsackievirus, hepatitis B virus, herpes simplex viruses, HIV, influenza virus, parvovirus B19 virus, Rubella virus, varicella-zoster virus |
| Prenatal care: (c) Supervision of normal pregnancy-Chlamydia trachomatis, Treponema pallidum, Streptococcus agalactiae, Toxoplasma gondii, amnionitis; asymptomatic urinary tract infection |
| Obstetric complications: Abortion, induced, septic, missed, spontaneous, threatened; acute fatty liver of pregnancy; anemia of pregnancy, sickle cell disease, thalassemia in pregnancy; antepartum hemorrhage, including third-trimester bleeding |
| Obstetric complications: Cardiomyopathy of pregnancy; cervical insufficiency, cervical shortening; cholestasis of pregnancy, intrahepatic; congenital abnormalities, maternal (example bicornuate uterus); ectopic pregnancy |
| Obstetric complications: Fetal abnormality affecting management of mother (example hydrocephalus, spina bifida); fetal growth restriction; gestational diabetes; maternal mortality; multiple gestation |
| Obstetric complications: Placental abnormalities (abruptio placentae, placenta previa, premature separation of placenta); polyhydramnios, oligohydramnios; preeclampsia, eclampsia, HELLP syndrome, gestational hypertension; prolonged pregnancy |
| Obstetric complications: Rh isoimmunization affecting management of mother; vomiting in pregnancy (morning sickness, hyperemesis gravidarum); trauma in pregnancy; infections complicating pregnancy |
| Labor and delivery: Labor and delivery, uncomplicated; labor and delivery, complicated, including shoulder dystocia; cesarean delivery, including complications; cord compression, cord prolapse; fetal malpresentations (example breech/ external cephalic) |
| Labor and delivery: Intrapartum fetal evaluation, including fetal heart tones; intrapartum prophylaxis (example HIV, Chlamydia, gonococcal prophylaxis); premature rupture of membranes; preterm (before 37 weeks' gestation) and postdates labor and delivery |
| Labor and delivery: Threatened preterm labor |
| Puerperium, including complications: Lactation problems; breastfeeding problems; lochia; postpartum cardiomyopathy; postpartum blues; postpartum hemorrhage; postpartum sepsis; retained placenta, products of conception (example placenta accreta) |
| Puerperium, including complications: Uterine atony |
| Newborn (birth to 4 weeks of age): (a) Normal newborn-examination of liveborn at admission to hospital, screening, newborn, (b) disorders of the newborn: Screening, newborn; ABO incompatibility in newborn; hemolytic disease due to Rh incompatibility |
| Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-birth asphyxia syndrome (liveborn neonate); birth trauma (example cord compression, brachial palsy, lacerations); drug withdrawal syndrome in newborn; feeding problems in newborn |
| Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-fetal growth and development abnormalities, including fetal growth restriction; gastrointestinal obstruction; hypocalcemia of newborn; infections |
| Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-congenital or peripartum (cytomegalovirus, herpes simplex viruses, HIV, hepatitis B, rubella virus, parvovirus B19 virus, varicella zoster virus, chlamydia trachomatis) |
| Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-(streptococcus agalactiae, treponema pallidum, toxoplasma gondii), intrapartum fetal distress/ death including stillborn; jaundice, fetal/ neonatal/ perinatal; laryngomalacia |
| Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-macrosomia (large for gestational age); meconium aspiration syndrome; neonatal acne; neonatal Candida infection (thrush); neonatal hypoglycemia; neonatal conjunctivitis and dacryocystitis |
| Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-ophthalmic gonorrhea; phenylketonuria; premature infant; post-term infant; pseudomembranous colitis of infancy; respiratory distress syndrome (hyaline membrane disease) |
| Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-Respiratory problems after birth (example bronchopulmonary dysplasia, tracheomalacia; tracheoesophageal fistula in neonates); retinitis of prematurity; seizures in newborn |
| Newborn (birth to 4 weeks of age): (b) Disorders of the newborn-sudden infant death syndrome (SIDS), apparent life-threatening event (ALTE); tetanus neonatorum |
| Congenital disorders, neonatal: Congenital malformations and anomalies; neonatal hydrocele |
| Adverse effects of drugs on pregnancy, childbirth, and the puerperium: Alcohol, tobacco, and other drugs (ATOD); prenatal radiation exposure; teratology (example ACE inhibitors, SSRIs, warfarin, infections, toxins) |
| Systemic disorders affecting pregnancy, labor and delivery, and puerperium: Appendicitis; asthma; carpal tunnel syndrome in pregnancy; cirrhosis; deep venous thrombosis (DVT); diabetes mellitus; heart failure, valvular heart disease; hypertension |
| Systemic disorders affecting pregnancy, labor and delivery, and puerperium: Myasthenia gravis; obesity; pancreatitis; psychiatric disorders; renal calculus/ calculi; renal failure/ renal disease, including SLE; seizure disorders; thyroid disorders |
| Systemic disorders affecting pregnancy, labor and delivery, and puerperium: Hypothyroidism, hyperthyroidism |
System specifications-Female reproductive system and breast
System specifications-Female reproductive system and breast: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes, gametogenesis |
| Organ structure and function: Female structure, including breast female function (example ovulation, menstrual cycle, puberty) intercourse, sexual response |
| Cell/ tissue structure and function: Hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones |
| Reproductive system defense mechanisms and normal flora |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Female reproductive system and breast: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Breast: (a) Infectious, immunologic, and inflammatory disorders-breast abscess; inflammatory disease of breast, fat necrosis; mastitis; nipple discharge, (b) neoplasms-(i) benign and undefined neoplasms: Breast cyst, solitary; fibrocystic changes |
| Breast: (b) Neoplasms-(i) Benign and undefined neoplasms-fibroadenoma; hypertrophy of breast; intraductal papilloma, (ii) malignant neoplasms (including screening): Breast cancer; intraductal carcinoma; Paget disease of breast; phyllodes tumors |
| Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-bacterial vaginosis; Bartholin gland abscess; cellulitis, pelvic; candidiasis of the vulva or vagina; lichen sclerosus; sexually transmitted infections and exposure |
| Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-cervicitis and endocervicitis; chancroid (Haemophilus ducreyi); genital herpes; gonorrhea (Neisseria gonorrhoeae); human papillomavirus infection |
| Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-genital/ venereal/ anal warts, condylomata acuminata; lymphogranuloma venereum (Chlamydia trachomatis), non-lymphogranuloma venereum; pelvic inflammatory disease |
| Female reproductive system: (a) Infectious, immunologic, and inflammatory disorders-Fitz-Hugh–Curtis syndrome; salpingitis and oophoritis; syphilis (Treponema pallidum); trichomoniasis (Trichomonas vaginalis); urethritis; vaginitis; vulvovaginitis |
| Neoplasms of the cervix, ovary, uterus, vagina, and vulva: (a) Benign neoplasms and cysts-abnormal Pap smear; benign neoplasm of ovary; endocervical and endometrial polyps; leiomyomata uteri; ovarian cyst |
| Neoplasms of the cervix, ovary, uterus, vagina, and vulva: (b) Malignant and precancerous neoplasms-cervical cancer; HPV causing cancer; cervical dysplasia, HPV causing dysplasia; endometrial hyperplasia; endometrial/ uterine cancer |
| Neoplasms of the cervix, ovary, uterus, vagina, and vulva: (b) Malignant and precancerous neoplasms-gestational trophoblastic disease (hydatidiform mole); ovarian cancer; vulvar dysplasia, and cancer |
| Fertility and infertility: Assisted reproductive techniques (ART); contraception (example oral contraceptives, IUD, vaginal cap, cervical sponge, diaphragm, implant, morning-after pill, male and female condoms); female infertility |
| Fertility and infertility: Gonadal dysgenesis 45,X (Turner syndrome); sterilization; tubal factors; infertility |
| Menopause: Ovarian failure, premature menopause; perimenopause; premenopausal menorrhagia; postmenopausal atrophic vaginitis (vaginal atrophy); postmenopausal bleeding; vasomotor symptoms |
| Menstrual and endocrine disorders: Abnormal uterine bleeding, including perimenopausal; absence of menstruation (primary amenorrhea, secondary amenorrhea including undiagnosed pregnancy); anovulation; dysmenorrhea; endometriosis; hirsutism, virilization |
| Menstrual and endocrine disorders: Mittelschmerz; pelvic pain; polycystic ovarian syndrome; postcoital bleeding; premenstrual syndrome |
| Sexual dysfunction: Dyspareunia; orgasmic dysfunction; sexual desire/ arousal syndrome; vaginismus |
| Traumatic and mechanical disorders: Asherman syndrome; chronic inversion of uterus; chronic pelvic pain syndrome; cystocele; imperforate hymen; injuries, wounds, and burns affecting the female reproductive system and injuries, wounds |
| Traumatic and mechanical disorders: Burns, and blast injuries; ovarian torsion; pelvic relaxation; rectocele; urethrocele |
| Congenital disorders: Müllerian agenesis; uterus didelphys, bicornuate uterus; short cervix |
| Adverse effects of drugs on the female reproductive system and breast: Antihistamines, H2-receptor blockers; benzodiazepines; beta-adrenergic blockers; hormone replacement; opioids; spironolactone; selective serotonin reuptake inhibitors |
| Adverse effects of drugs on the female reproductive system and breast: Tricyclic antidepressants |
System specifications-Endocrine system
System specifications-Endocrine system: Unit 01
Normal processes |
|---|
| Embryonic development, fetal maturation, and perinatal changes |
| Organ structure and function: Hypothalamus, posterior and anterior pituitary gland, thyroid gland, parathyroid gland, adrenal cortex, adrenal medulla, pancreatic islets, ovary and testis, adipose tissue |
| Cell/ tissue/ structure and function, including hormone synthesis, secretion, action, metabolism: Peptide hormones, steroid hormones, including vitamin D, thyroid hormones, catecholamine hormones, renin-angiotensin system |
| Repair, regeneration, and changes associated with stage of life |
System specifications-Endocrine system: Unit 02
Abnormal processes: Health and health maintenance, screening, diagnosis, management, risks, prognosis |
|---|
| Diabetes mellitus and other disorders of the endocrine pancreas: (a) Diabetes mellitus-diabetes mellitus, type 1; diabetes mellitus, type 1.5; diabetes mellitus, type 2; diabetes mellitus, acute complications: hyperosmolar coma, hypoglycemic shock |
| Diabetes mellitus and other disorders of the endocrine pancreas: (a) Diabetes mellitus-ketoacidosis, including cerebral edema, associated electrolyte abnormalities; diabetes mellitus, chronic complications: gastrointestinal/ gastroparesis |
| Diabetes mellitus and other disorders of the endocrine pancreas: (a) Diabetes mellitus-chronic complications: Neurologic/ neuropathy, ophthalmologic/ retinopathy, peripheral vascular, renal/ nephropathy, metabolic syndrome |
| Diabetes mellitus and other disorders of the endocrine pancreas: (b) Hypoglycemia and islet cell disorders-hypoglycemia (secondary to insulinoma, surreptitious insulin use, sepsis, liver failure); hyperglycemia (secondary to glucagonoma); hyperinsulinism |
| Diabetes mellitus and other disorders of the endocrine pancreas: (b) Hypoglycemia and islet cell disorders-islet cell tumors/ insulinoma/ somatostatinoma; pancreatic neuroendocrine tumors |
| Thyroid disorders: Cyst, nodule; euthyroid sick syndrome; goiter (euthyroid-normal thyroid function with goiter); hypothyroidism; hyperthyroidism, including thyrotoxicosis and thyroid storm; thyroiditis, including Hashimoto; Graves disease |
| Thyroid disorders: Neoplasms (benign cysts and nodules, thyroid cancer including papillary, follicular, medullary, and anaplastic); thyroid deficiency from pituitary disorder; infertility due to thyroid disease |
| Thyroid disorders: Secondary hypothyroidism and hyperthyroidism |
| Parathyroid disorders: Hyperparathyroidism; hypoparathyroidism; metabolic bone disease |
| Adrenal disorders: Corticoadrenal insufficiency (Addison disease); adrenal insufficiency, secondary; hypocortisolism; cushing syndrome; hyperaldosteronism; neoplasms, benign and malignant (adrenal neuroblastoma, pheochromocytoma, adrenal carcinoma |
| Adrenal disorders: Adrenal adenoma, aldosteronoma, adrenal incidentaloma); delayed and precocious puberty; hypertensive endocrine disease |
| Pituitary disorders: Acromegaly/ gigantism; diabetes insipidus; galactorrhea not associated with childbirth; panhypopituitarism from any cause; pituitary apoplexy (example sheehan syndrome); growth hormone deficiency; short stature |
| Pituitary disorders: SIADH (inappropriate secretion of ADH [vasopressin]); neoplasm, benign and malignant (pituitary adenomas, craniopharyngioma, metastatic disease); prolactinoma and hyperprolactinemia, including infertility due to these disorders |
| Diabetes mellitus and other disorders of the endocrine pancreas: Pituitary disorders-hypogonadism, primary and secondary |
| Hypothalamic endocrine disorders |
| Multiple endocrine neoplasia (MEN1, MEN2) |
| Congenital disorders: Disorders of sexual differentiation; congenital adrenal hyperplasia; androgen insensitivity/ resistance syndrome; congenital hypothyroidism |
| Adverse effects of drugs on the endocrine system: Drug, medicinal, and biologic substance effects; exogenous steroid suppression of adrenal glands, anabolic steroids |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 01
Epidemiology/ population health |
|---|
| Measures of disease frequency: Incidence/ prevalence |
| Measures of health status: Rates, crude and adjusted; reproductive rates (example maternal mortality, neonatal/ infant/ under-5 mortality); mortality, morbidity; standardization; life expectancy, health-adjusted life expectancy |
| Measures of health status: Population attributable risk (PAR), population attributable risk percent (PAR%); risk factors |
| Survival analysis interpretation (example Kaplan-Meier curve) |
| Composite health status indicators, measures of population impact: Years of potential life lost; quality-adjusted life years; disability-adjusted life years; standardized mortality ratio |
| Population pyramids and impact of demographic changes |
| Disease surveillance and outbreak investigation: Disease reporting; response to public health advisory, health promotion; recognition of clusters |
| Communicable disease transmission: Attack rate; herd immunity; reportable diseases |
| Points of intervention: Primary, secondary; community level (example cigarette taxes, soda taxes, smoke-free cities, buildings: Restaurants, public buildings); school policies; access, healthy food, transportation, clean air, safe environments |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 02
Study design, types, and selection of studies (includes dependent/ independent variables) |
|---|
| Descriptive studies (case report [one person]/ case series [more than one]) |
| Analytical studies: Observational-community surveys; cross-sectional (individuals); ecological (populations); case control; retrospective and prospective cohort |
| Analytical studies: Interventional-clinical trial (randomized controlled trial; double-blind; placebo-controlled; non inferiority/ equivalence trials); community intervention |
| Systematic reviews and meta-analysis: Potential uses; estimation of effect sizes; heterogeneity; publication bias; forest plots, funnel diagrams; risk of bias, bias risk scale |
| Obtaining and describing samples: Matching, inclusion/ exclusion criteria, selecting appropriate controls for studies, lack of controls, concealed allocation, randomization, stratification |
| Methods to handle noncompliance: Loss to follow-up; intention-to-treat analysis |
| Qualitative analysis |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 03
Measures of association |
|---|
| Relative risk |
| Odds ratio, hazard ratio |
| Other measures of association: Number needed to treat/ harm; absolute risk (AR), absolute risk percent (AR%); population attributable risk (PAR), population attributable risk percent (PAR%) |
| Distributions of data: Measures of central tendency; measures of variability; regression to mean; normal distribution; nominal measurement |
| Correlation and regression, uses and interpretation: Correlation coefficients; multiple regression |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 04
Principles of testing and screening |
|---|
| Properties of a screening test: Validity, accuracy, reliability; criteria for a screening test; confirmatory testing; appropriateness; lead-time bias, length bias; screening vs. diagnostic tests |
| Sensitivity and specificity; predictive value, positive and negative |
| ROC curves |
| Probability: Theory (independence, product, addition rules); decision trees; likelihood ratios (application of Bayes theorem); posttest, pretest |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 05
Study interpretation, drawing conclusions from data |
|---|
| Causation: Hypothesis-generating vs. hypothesis-driven testing; causal criteria, temporality, temporal sequence, dose-response relationship; reverse causality |
| Chance: Null hypothesis, type I error and alpha level (multiple comparisons, random error/ chance), sample size and type II error, beta, power, selection and interpretation of basic tests of statistical significance: chi-square; confidence intervals |
| Chance: P-values; t-test, a priori vs. post hoc analysis: Subgroup analysis; error rate; affect types |
| Interpretation of graphs/ tables and text |
| Bias, confounding, and threats to validity (includes methods to address): Selection, sampling bias, information bias: Recall; ascertainment, ecological fallacy, lack of blinding; loss to follow up, confounding variables |
| Bias, confounding, and threats to validity (includes methods to address): Hawthorne effect (includes methods to address), other threats to validity (example placebo effect) |
| Internal vs. external validity: Generalizability (external validity); efficacy vs. effectiveness |
| Statistical vs. clinical significance; clinical and surrogate outcome/ end point |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 06
Clinical decision making, interpretation and use of evidence-based data and recommendations |
|---|
| Application of study results to patient care and practice, including patient preferences and individualization of risk profiles; risk/ benefit analysis; synthesis of concepts with real data |
System specifications-Biostatistics, epidemiology/ population health, and interpretation of the medical literature: Unit 07
Research ethics |
|---|
| Informed consent for research |
| Privacy of patient data (HIPAA) |
| Roles of institutional review boards (IRBs) |
| Intervention analysis: Intervention analysis; stopping analysis; safety monitoring |
| Regulatory issues: Drug development, phases of approval; appropriateness of placebo; appropriateness of randomized clinical trial; components of studies; ethics; scheduling; off-label use |
| Other issues related to research ethics |
System specifications-Social sciences: Communication skills/ ethics/ patient safety
System specifications-Social sciences: Communication skills/ ethics/ patient safety: Unit 01
Communication and interpersonal skills, including health literacy and numeracy, cultural competence |
|---|
| Patient interviewing, consultation, and interactions with the family (patient-centered communication skills): Fostering the relationship (example expressing interest), information gathering (example exploring patient's reaction to illness) |
| Patient interviewing, consultation, and interactions with the family (patient-centered communication skills): Information provision (example providing information about working diagnosis), making decisions (example eliciting patient's perspectives) |
| Patient interviewing, consultation, and interactions with the family (patient-centered communication skills): Supporting emotions (example effective discussion with difficult patients), enabling patient behaviors (example education and counseling) |
| Use of an interpreter or surrogate |
System specifications-Social sciences: Communication skills/ ethics/ patient safety: Unit 02
Medical ethics and jurisprudence, include issues related to death and dying and palliative care |
|---|
| Consent/ informed consent to treatment, permission to treat (full disclosure, risks and benefits, placebos, alternative therapies, conflict of interest, and vulnerable populations) |
| Determination of medical decision-making capacity/ informed refusal |
| Involuntary admission |
| Legal issues related to abuse (child, elder, and intimate partner): Child protective services, foster care, immunizations, legal requirements for reporting abuse or neglect/ obligation to warn |
| Birth-related issues |
| Death and dying and palliative care: Life support, advance directive, health care proxy, advance care planning, euthanasia and physician-assisted suicide, brain death/ diagnosing brain death/ diagnosing death, pronouncing death, organ donation, hospice |
| Death and dying and palliative care: Pain management, including ethical issues related to death and dying, information sharing, counseling families, psychosocial and spiritual counseling, fear and loneliness |
| Physician-patient relationship (boundaries, confidentiality including HIPAA, privacy, truth telling, other principles of medical ethics, example, autonomy, justice, beneficence) |
| Impaired physician, including duty to report impaired physician |
| Negligence/ malpractice, including duty to report negligence and malpractice |
| Physician misconduct, including duty to report physician misconduct |
| Referrals |
| Cultural issues not otherwise coded |
System specifications-Social sciences: Communication skills/ ethics/ patient safety: Unit 03
Systems-based practice (including health systems, public health, community, schools) and patient safety (including basic concepts and terminology) |
|---|
| Complexity/ systems thinking: Characteristics of a complex system and factors leading to complexity-how complexity leads to error, health care/ organizational behavior and culture: Environmental factors, workplace design and process; staffing |
| Complexity/ systems thinking: Health care/ organizational behavior and culture-overcommitment, space, people, time, scheduling; standardization, reducing variance, simplification, metrics; safety culture; integration of care across settings |
| Complexity/ systems thinking: Health care/ organizational behavior and culture-overutilization of resources (imaging studies, antibiotics, opioids); economic factors |
System specifications-Social sciences: Communication skills/ ethics/ patient safety: Unit 04
Quality improvement |
|---|
| Improvement science principles: Variation and standardization-variation in process, practice; checklists, guidelines, and clinical pathways, reliability |
| Specific models of quality improvement: Model for improvement-plan-do-study-act (PDSA); plan-do-check-act (PDCA) |
| Quality measurement: Structure, process, outcome, and balancing measures, measurement tools: Run and control charts; development and application of system and individual quality measures: Core measures; physician quality report system (PQRS) |
| Quality measurement: Development and application of system and individual quality measures: Core measures; physician quality report system (PQRS); event reporting system |
| Strategies to improve quality: Role of leadership; principles of change management in quality improvement: Specific strategies |
| Attributes of high-quality health care: High-value/ cost-conscious care-overutilization of resources including diagnostic testing, medications, equitable care: Access, patient-centered care, timely care |
System specifications-Social sciences: Communication skills/ ethics/ patient safety: Unit 05
Patient safety |
|---|
| Patient safety principles: (a) Epidemiology of medical error, (b) error categorization/ definition: Active vs. latent errors; Swiss cheese model of error; preventable vs. non-preventable; near miss events/ safety hazards |
| Patient safety principles: (c) Causes of error-(i) patient factors: Understanding of medication use; health literacy; economic status; cultural factors (example religion); failure to make appointments; socioeconomic status |
| Patient safety principles: (c) Causes of error-(ii) physician factors: Deficiency of knowledge; judgment errors; diagnostic errors; fatigue, sleep deprivation; bias-cognitive, availability, heuristic, anchoring, framing |
| Patient safety principles: (c) Causes of error-(iii) human factors (example cognitive, physical, environmental), (d) High reliability of organization (HRO) principles-change management and improvement science |
| Patient safety principles: (d) High reliability of organization (HRO) principles-conceptual models of improvement, (e) reporting and monitoring for errors: Event reporting systems |
| Patient safety principles: (e) Reporting and monitoring for errors-communication with patients after adverse events (disclosure/ transparency) |
| Specific types of error: (a) Transitions of care errors (example handoff communication including shift-to-shift, transfer, and discharge): Handoffs and related communication; discontinuities; gaps; discharge; transfers |
| Specific types of error: (b) Medication errors-ordering, transcribing, dispensing, administration (wrong quantity, wrong route, wrong drug), medication reconciliation, mathematical error, (c) procedural errors: Universal protocol (time out); wrong patient |
| Specific types of error: (c) Procedural errors-wrong site; wrong procedure; retained foreign bodies, injury to structures: Paracentesis; bowel perforation; thoracentesis; pneumothorax; central venous/ arterial line injuries |
| Specific types of error: (c) Procedural errors-Injury to structures: Arterial puncture and bleeding and venous thrombosis; lumbar puncture bleeding; paralysis, other errors: Anesthesia-related errors; mathematical errors |
| Specific types of error: (d) Health care-associated infections-nosocomial infection-example, surgical site, ventilator associated; catheter-related; handwashing procedures or inadequate number of handwashing stations |
| Specific types of error: (d) Health care-associated infections-central line-associated blood stream infections; surgical site infections; catheter-associated urinary tract infections; ventilator-associated pneumonia |
| Specific types of error: (e) Documentation errors-electronic medical record (including voice-recognition software errors); record keeping; incorrect documentation (example wrong patient, wrong date, copying and pasting, pre-labeling) |
| Specific types of error: (f) Patient identification errors-mislabeling-transfusion errors related to mislabeling; verification/ two identifiers: Lack of dual validation, including verbal verification of lab results |
| Specific types of error: (g) Diagnostic errors-errors in diagnostic studies; misinterpretation; (h) monitoring errors-cardiac monitoring/ telemetry, drug monitoring (warfarin, antibiotics), device-related errors: Malfunction, programming error |
| Specific types of error: (i) Device-related errors-incorrect use |
| Strategies to reduce error: (a) Human factors engineering, (b) situational awareness, (c) hierarchy of effective interventions: Forcing function; visual cues, (d) error analysis tools: Error/ near miss analysis; failure modes and effect analysis |
| Strategies to reduce error: (d) Error analysis tools-morbidity and mortality review; root cause analysis, (e) safety behavior and culture at the individual level: Hierarchy of health care, flattening hierarchy, speak up to power; afraid to report, fear |
| Strategies to reduce error: (e) Safety behavior and culture at the individual level-psychological safety; closed-loop communication, (f) teamwork: Principles of highly effective teams; case management; physician teams, physician-physician communication |
| Strategies to reduce error: (f) Teamwork-interprofessional/ interprofessional teams; strategies for communication among teams, including system-provider communication, physician-physician communication (example consultations) |
| Strategies to reduce error: (f) Teamwork-provider-interprofessional communication, patient communication |
System specifications-Social sciences: Communication skills/ ethics/ patient safety: Unit 06
Health care policy and economics |
|---|
| Health care policy: (a) Health care disparities-race/ ethnicity; numeracy/ literacy; socioeconomic status, (b) access to care: Critical access systems or hospitals, social justice |
| Health care economics/ health care financing: (a) Types of insurance-medicare, medicaid, private insurance, self-pay, (b) navigating the insurance system: Deductibles/ co-pays; in-/ out-of-network; preferred providers |
| Health care economics/ health care financing: (c) Reimbursement issues affecting safety and quality: Emergency services-EMTALA; pay-for-performance |
CCS test content specifications-Immune system, blood and lymphoreticular system, and multisystem processes/ disorders
CCS test content specifications-Behavioral health
CCS test content specifications-Nervous system and special senses
CCS test content specifications-Skin and subcutaneous tissue
CCS test content specifications-Musculoskeletal system
CCS test content specifications-Cardiovascular system
CCS test content specifications-Respiratory system
CCS test content specifications-Gastrointestinal system
CCS test content specifications-Renal/ urinary system and male reproductive
CCS test content specifications-Pregnancy/ childbirth, and female reproductive system and breast
CCS test content specifications-Endocrine system
CCS test content specifications-Social sciences: Communication skills/ ethics/ patient safety
Physician tasks/ competencies specifications-Medical knowledge/ scientific concepts
Physician tasks/ competencies specifications-Medical knowledge/ scientific concepts: Unit 01
Applying foundational science concepts |
|---|
| Identifies the cause/ infectious agent or predisposing factor(s) or, given an effect, determines the cause |
| Identifies the underlying processes/ pathways that account for, or contribute to, the expression or resolution of a given condition |
| Recognizes or evaluates given clinical or physical findings to identify the underlying anatomic structure or physical location |
| Recognizes the mechanisms of action of various drugs; selects from an option set list of drugs based on mechanism of action |
Physician tasks/ competencies specifications-Patient care: Diagnosis
Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 01
Diagnosis: Obtaining and predicting history and physical examination |
|---|
| Knows signs/ symptoms of selected disorders |
| Knows individual's risk factors for development of conditions |
| Given current symptoms in presented history, identifies other pertinent factors in the history |
| Given a specific problem, knows what to ask in obtaining further pertinent additional history |
| Predicts the most likely additional physical finding; selects either the finding itself or the appropriate examination technique that would result in the finding |
Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 02
Diagnosis: Selecting and Interpreting Laboratory and diagnostic studies |
|---|
| Selects most appropriate laboratory or diagnostic study, including neuropsychiatric testing, or study most likely to establish/confirm the diagnosis |
| Interprets laboratory or other study findings |
| Predicts the most likely laboratory or diagnostic study result |
| Selects most appropriate laboratory or diagnostic study after a change in patient status |
Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 03
Diagnosis: Formulating the diagnosis |
|---|
| Selects the most likely diagnosis |
| Assesses the developmental level of the patient |
Physician tasks/ competencies specifications-Patient care: Diagnosis: Unit 04
Diagnosis: Determining prognosis/ outcome |
|---|
| Recognizes factors in the history, physical or laboratory study findings that affect patient prognosis or outcome or determine therapy |
| Interprets laboratory or other diagnostic study results and identifies current/ future status of patient |
| Recognizes associated conditions of a disease, including complications, or indicators of potential complications, of a given disease |
| Recognizes characteristics of disease relating to natural history or course of disease, including progression, severity, duration, and transmission of disease from a specific patient |
Physician tasks/ competencies specifications-Patient care: Management
Physician tasks/ competencies specifications-Patient care: Management: Unit 01
Management: Health maintenance and disease prevention |
|---|
| Knows risk factors for conditions amenable to prevention or detection in an asymptomatic patient, or knows the potential condition for which the patient may be at risk |
| Knows pertinent incidence statistics and identifies patient groups at risk; knows incidence of symptoms/ dangerous disorders among various groups |
| Knows common screening tests for conditions amenable to prevention or detection in an asymptomatic patient or population |
| Selects appropriate preventive agent or technique (eg, contraception, vaccines, vitamins) |
| Knows appropriate counseling of patient or family regarding maintenance of current and future problems, including risk factors related to present encounter |
| Educates patients on screening, health maintenance, self-care |
| Assesses the developmental level of a healthy patient |
| Knows the indications for surveillance for recurrence or progression of disease following treatment |
| Monitoring chronic disease in a stable patient where a change in patient status might cause a change in therapy |
| Knows appropriate long-term surveillance goals |
Physician tasks/ competencies specifications-Patient care: Management: Unit 02
Management: Selecting and monitoring pharmacotherapy |
|---|
| Selects most appropriate pharmacotherapy |
| Assesses patient adherence with treatment regimen, recognizes techniques to increase adherence or understanding of the disease state, and knows how adherence may be affected by providing instructions with therapy |
| Recognizes factors that alter drug dosing requirements for a patient |
| Knows adverse effects of various drugs, or recognizes signs and symptoms of drug (and drug-drug) interactions resulting from polypharmacy in the therapeutic regimenand knows steps to prevent polypharmacy including lab studies to monitor drug therapy |
| Knows contraindications of various medications |
| Modifies therapeutic regimen within the context of continuing care; selects appropriate modifications in therapeutic regimen |
| Knows appropriate monitoring to evaluate effectiveness of drug therapy or to monitor for the adverse effects of drug therapy in a patient that has not had a recurrence or progression of disease |
Physician tasks/ competencies specifications-Patient care: Management: Unit 03
Management: Clinical interventions/ treatment |
|---|
| Knows most appropriate management of selected conditions, including recognizing misuse of medication or drug or alcohol use |
| Knows immediate management or priority in management, specifically in emergency or acute cases |
| Knows most appropriate follow-up or monitoring approach regarding the management plan |
| Knows current/ short-term management of patients |
| Evaluates severity of patient condition in terms of need for referral for surgical treatments/ procedures versus other nonsurgical options |
| Knows appropriate surgical management |
| Knows pre/ post surgical or procedural management |
| Knows indications for admission to the hospital or to other appropriate setting (eg, ICU) |
| Knows appropriate non-hospital health care settings |
| Knows most appropriate discharge planning |
| Knows components of rehabilitation program |
| Knows appropriate use and procedures regarding hospice care |
| Educates patient or family regarding self-care |
| Knows relevant roles of allied health personnel |
Physician tasks/ competencies specifications-Patient care: Management: Unit 04
Management: Selecting clinical interventions (mixed management) |
|---|
| Selects most appropriate management option from set of mixed management options (eg, mix of diagnostic studies, pharmacotherapy, procedures, observation, or referral) |
Physician tasks/ competencies specifications-Communication
Physician tasks/ competencies specifications-Communication: Unit 01
Fostering the relationship |
|---|
Physician tasks/ competencies specifications-Communication: Unit 02
Gathering information |
|---|
Physician tasks/ competencies specifications-Communication: Unit 03
Providing information |
|---|
Physician tasks/ competencies specifications-Communication: Unit 04
Making decisions |
|---|
Physician tasks/ competencies specifications-Communication: Unit 05
Supporting emotions |
|---|
Physician tasks/ competencies specifications-Communication: Unit 06
Enabling patient behaviors |
|---|
Physician tasks/ competencies specifications-Communication: Unit 07
Using an interpreteror surrogate |
|---|
Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues
Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues: Unit 01
Understanding and applying principles of professionalism, legal and ethical issues in interactions with patients |
|---|
| Knows the guidelines for obtaining informed consent for treatment including children and adolescents, third-party permission, and emergent situations |
| Recognizes need for third-party permission for treatment in medical emergencies |
| Knows guidelines for treatment of minors with/ without notification of parents |
| Knows definitions of competence and sanity |
| Knows the guidelines for involuntary admission |
| Knows guidelines for confidentiality of medical records |
| Knows guidelines for physician-patient relationship |
| Knows issues related to cultural competence and can apply knowledge in specific patient situations |
Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues: Unit 02
Understanding and applying legal and ethical issues related to death and dying |
|---|
| Assesses degree of disclosure to terminally ill patients |
| Recognizes patient's right to refuse treatment or testing (patient autonomy); knows issues of advance directives and living wills |
| Assesses quality-of-life decisions |
| Knows appropriate prescriptive practices; knows appropriate use of opioids in terminally ill patients |
| Knows definition of and legal issues regarding brain death |
| Knows management of terminally ill patients related to treating chronic pain, and recognizing patient's expression of fear of pain, injury, or death; knows how to comfort patient or family during crisis such as trauma or death |
Physician tasks/ competencies specifications-Professionalism, including legal and ethical issues: Unit 03
Understanding and applying professionalism, legal, and ethical issues in dealing with physicians and other health professionals |
|---|
| Knows guidelines for reporting findings to proper authorities |
| Knows good Samaritan laws |
| Recognizes physician error and negligence |
| Recognizes and deals appropriately with impaired physician |
Physician tasks/ competencies specifications-Systems based practice, including patient safety
Physician tasks/ competencies specifications-Systems based practice, including patient safety: Unit 01
Systems based practice |
|---|
| Understands basic concepts and terminology, principles, and application of quality improvement science and outcome analysis |
| Recognizes and optimizes human and environmental factors (eg, workplace design, standardization, processes) |
| Understands the role and characteristics of teams and communication strategies |
Physician tasks/ competencies specifications-Systems based practice, including patient safety: Unit 02
Patient safety |
|---|
| Anticipates, recognizes, analyzes, and mitigates risk (sources of error) |
| Evaluates, reports, and responds to near-misses and system errors |
| Identifies sources of error and suggests appropriate measures to evaluate or reduce the likelihood of specific errors |
Physician tasks/ competencies specifications-Practice-based learning
Physician tasks/ competencies specifications-Practice-based learning: Unit 01
Understanding and application of the principles of biostatistics and epidemiology |
|---|
| Understands and can apply principles of epidemiology and population health, including health status indicators, outbreak investigation, points of intervention |
| Understands and can apply principles of study design and study flaws |
| Understands and can apply the principles of screening and other tests |
| Understands use and interpretation of statistical principles and measures of association |
Physician tasks/ competencies specifications-Practice-based learning: Unit 02
Application of information from studies or other written material to patient care |
|---|
| Decisions about patient care based on results of study or other written materials |
Physician tasks/ competencies specifications-Practice-based learning: Unit 03
Understanding of the principles of research ethics and regulatory issues |
|---|
CCS physician tasks/ competencies specifications-Patient care: diagnosis
CCS physician tasks/ competencies specifications-Patient care: diagnosis: Unit 01
History/ physical exam |
|---|
CCS physician tasks/ competencies specifications-Patient care: diagnosis: Unit 02
Laboratory/ diagnostic studies |
|---|
CCS physician tasks/ competencies specifications-Patient care: diagnosis: Unit 03
Diagnosis |
|---|
CCS physician tasks/ competencies specifications-Patient care: diagnosis: Unit 04
Prognosis/ outcome |
|---|
CCS physician tasks/ competencies specifications-Patient care: Management
CCS physician tasks/ competencies specifications-Patient care: Management: Unit 01
Health maintenance/ disease prevention |
|---|
CCS physician tasks/ competencies specifications-Patient care: Management: Unit 02
Pharmacotherapy |
|---|
CCS physician tasks/ competencies specifications-Patient care: Management: Unit 03
Clinical interventions |
|---|
CCS physician tasks/ competencies specifications-Patient care: Management: Unit 04
Mixed management |
|---|
CCS physician tasks/ competencies specifications-Patient care: Management: Unit 05
Surveillance for disease recurrence |
|---|
CCS physician tasks/ competencies specifications-Communication/ professionalism/ systems-based practice and patient safety
USMLE 2023 Exam Pattern
USMLE Step 1 Exam Pattern
USMLE Step 1 2023 will be an one-day exam of around 8 hours duration. The exam will comprise 7 different 60 minute blocks and cover the following topics:
- Anatomy
- Aging
- Behavioral sciences
- Biochemistry
- Biostatistics and epidemiology
- Genetics
- Immunology
- Microbiology
- Molecular and cellular biology
- Nutrition
- Pathology
- Pharmacology
- Physiology
USMLE 2023 Step 1 Exam Pattern
Step and purpose | Format | Length |
It accesses a candidate’s understanding of and ability to apply important concepts of the basic sciences to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy | There will be around 280 MCQs, split over seven 60-minute blocks Mode of exam will be Computer-based that will be administered at Prometric test centers across the world | Single day test Duration of test: Around eight hours |
The USMLE Step 1 test content can be classified into the two dimensions of system and process. The broad categorisation of the Step 1 test material can be done on the basis of these two dimensions.
USMLE Step 1 2023 Exam Pattern : System and Process
| System | Percentage of Test Content |
| General Principles of Foundational Science | 15% - 20% |
Immune System ; Blood & Lymphoreticular System ; Behavioral Health ; Nervous System & Special Senses ; Skin & Subcutaneous Tissue ; Musculoskeletal System ; Cardiovascular System ; Respiratory System ; Gastrointestinal System ; Renal & Urinary System ; Pregnancy, Childbirth, & the Puerperium ; Female Reproductive & Breast ; Male Reproductive ; Endocrine System | 60% - 70% |
| Multisystem Processes & Disorders ; Biostatistics & Epidemiology ; Population Health ; Social Sciences | 15% - 20% |
| Process | Percentage of Test Content |
| Normal Processes | 10% - 15% |
| Abnormal Processes | 55% - 60% |
| Principles of Therapeutics | 15% - 20% |
| Other | 10% - 15% |
USMLE Step 1 2023 Exam Pattern : Physician Competency/Task
In addition to test content categorisation on the basis of system and process, the USMLE Step 1 exam can also be categorised by physician competency and task.
| Physician Competency/Task | Percentage of Test Content |
| Scientific Concepts/Medical Knowledge | 55% - 65% |
Patient Care: Diagnosis
| 20% - 30% |
Patient Care: Management
| 15% - 20% |
| Communication Professionalism | 2% - 5% |
| Practice-based Learning and Improvement | 4% - 8% |
USMLE Step 2 CK Exam Pattern
The USMLE Step 2 CK 2023 examination or USMLE Step 2 Clinical Knowledge examination will have 8 different 60 minute blocks totalling around 9 hours. The number of test items varies with each block although it remains under 40 per block. The total number of test items for the examination does not exceed 318.
USMLE Step 2 Exam Pattern
Step component and purpose | Format | Length |
Step 2 Clinical Knowledge (CK) Tests the candidate’s ability to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision, with an emphasis on health promotion and disease Prevention | Around 318 multiple choice questions, divided into eight 60-minute blocks Computer-based test administered at Prometric test centers. | One-day test Session -Approximately nine hours |
The USMLE Step 2 CK test content is classified into 18 areas of organ systems and general principles.
USMLE Step 2 CK 2023 Exam Pattern - System
| System | Percentage of Test Content |
| General Principles of Foundational Science | 1% - 3% |
| Immune System ; Blood & Lymphoreticular Systems ; Behavioral Health ; Nervous System & Special Senses ; Skin & Subcutaneous Tissue ; Musculoskeletal System ; Cardiovascular System ; Respiratory System ; Gastrointestinal System ; Renal & Urinary Systems ; Pregnancy, Childbirth, & the Puerperium ; Female Reproductive System & Breast ; Male Reproductive System ; Endocrine System ; Multisystem Processes & Disorders | 85% - 95% |
| Biostatistics & Epidemiology/Population Health Interpretation of the Medical Literature | 1% - 5% |
Additionally, the test content for USMLE Step 2 CK can be divided in accordance to Physician competencies and tasks.
USMLE Step 2 CK 2023 Exam Pattern - Physician Competency and Task
| Physician Competency/Task | Percentage of Test Content |
| Scientific Concepts/Medical Knowledge | 10% - 15% |
Patient Care: Diagnosis
| 40% - 50% |
Patient Care: Management
| 30% - 35% |
| 3% - 7% |
USMLE Step 3 Exam Pattern
The USMLE Step 3 2023 examination is the last step or final assessment in the USMLE examination series and leads to a medical practitioner certificate upon successful completion. The exam is conducted over a 2-day period and is split into two parts:
- Day 1 - Foundations of Independent Practice (FIP)
The Step 3 Day 1 exam is of 7-hour duration and comprises 6 different 60-minute blocks. Each of these blocks has around 38 - 40 questions each and the total examination for Day 1 does not exceed 233 questions.
- Day 2 - Advanced Clinical Medicine (ACM)
The Step 3 Day 2 exam is of 9-hour duration and comprises 6 different blocks of 30 questions in each. Additionally, 13 case simulations are a part of the assessment and the total number of questions is 180.
The overall test content can be divided on the basis of system and process as well as on the basis of physician competencies and tasks.
Exam pattern of USMLE Step 3
Purpose | Test Format | Length |
STEP 3 The step tests the applicant to apply medical knowledge and understanding of biomedical and clinical science that are vital in performing unsupervised practice of medicine, with emphasis on patient management in an ambulatory setting. Day 1: FOUNDATIONS OF INDEPENDENT PRACTICE (FIP) assesses the examinee’s knowledge of basic medical and scientific principles essential for effective health care. Day 2: ADVANCED CLINICAL MEDICINE (ACM) assesses the examinee’s ability to apply comprehensive knowledge of health and disease in the context of patient management and the evolving manifestation of disease over time. | Day 1 FIP: Approximately 232 MCQs, divided into six 60-minute blocks. Computer-based test (CBT) administered at Prometric test centers in the US Day 2 ACM: Approximately 180 MCQs, divided into six 45-minute blocks. Thirteen computer-based case simulations (CCS). Each simulation is 10 to 20 minutes of real-time. Computer-based test, administered at Prometric test centers in the US | One-day test session -approximately seven hours One-day test session -approximately nine hours |
USMLE Step 3 2023 Exam Pattern - System
| System | Percentage of Test Content |
| General Principles of Foundational Science | 1% - 3% |
| Immune System; Blood & Lymphoreticular System; Behavioral Health; Nervous System & Special Senses; Skin & Subcutaneous Tissue; Musculoskeletal System; Cardiovascular System; Respiratory System; Gastrointestinal System; Renal & Urinary System; Pregnancy, Childbirth, & the Puerperium; Female Reproductive System & Breast; Male Reproductive System; Endocrine System; Multisystem Processes & Disorders | 80% - 85% |
| Biostatistics & Epidemiology/Population Health, & Interpretation of the Medical Literature, Social Sciences | 14% - 18% |
USMLE Step 3 2023 Exam Pattern - Physician Competency and Tasks
| Physician Competency/Task | Percentage of Test Content | |
| Day 1 - FIP | Day 2 - ACM | |
| Scientific Concepts/Medical Knowledge | 18% - 22% | |
Patient Care: Diagnosis
| 40% - 45% | |
Patient Care: Diagnosis
| 20% - 25% | |
Patient Care: Management
| 75% - 80% | |
| Communication and Professionalism | 8% - 12% | |
| Systems-based Practice/Patient Safety and Practice-based Learning | 22% - 27% | |
Documents Required at Exam
- Scheduling permit for USMLE
- Valid government issued photo ID (preferably passport)
NBME determines the results for all USMLE 2023 steps and step components and issues score cards. Once Step 1, Step 2 CK, and Step 2 CS score reports are available, ECFMG notify the international medical students/graduates through their registered email accounts. Notification regarding availability of Step 3 reports will be notified by FSMB.
The score reports of USMLE 2023 will be available in electronic format only and can be accessed using ECFMG's OASIS; score reports will not be sent separately by post mail. The result of USMLE 2023 Step 1, Step 2 CK and Step 3 is typically available within three to four weeks from USMLE exam date 2023.
USMLE Scoring System
The scores for the USMLE exam are reported on 3 3-digit scale from 0 to 300. For Step 1 the scores are reported as either pass or fail.
USMLE 2023 Minimum Pass Marks
USMLE Component | Minimum Pass Marks |
USMLE Step 1 | Pass |
USMLE Step 2 CK | 206 |
USMLE Step 3 | 196 |
Candidates who would like to know the score for minimum pass marks, refer the table above, will qualify in the exam. The pass rates can vary from one medical school to another medical school in USA.
General Information
Contacts
0081786840
Relevant Links
Official Website Link Click Here
Frequently Asked Questions (FAQs)
Question:Can I get residency in the USA without USMLE?
Answer:
You cannot apply for residency in the US as a foreign medical graduate without passing the USMLE (Steps 1 and 2). You won't be able to apply for a medical license in the US if you don't pass all USMLE components, including Step 3.
Question:Can I work as a doctor in the USA without USMLE?
Answer:
To receive your MD degree from a US medical school, you must pass parts 1 and 2 of the United States Medical Licensing Examination (USMLE). The majority of DOs educated in the US take it as well. Additionally, you cannot obtain a medical license without completing USMLE parts 1, 2, and 3.
Question:Is there an age limit for USMLE?
Answer:
There is no age limit for USMLE.
Question:How many years are USMLE scores valid?
Answer:
The USMLE scores are valid for 7 years. In the said period, you have to pass the additional ECFMG certification.
Question:How many times can you attempt USMLE?
Answer:
There can be a maximum of four attempts for each Step (4). Examinees who have taken four or more attempts at any USMLE Step (including Step 2 CS) and failed are ineligible to apply for USMLE Steps.
Questions related to USMLE
Showing 156 out of 156 Questions
16 Views
after completing MBBS from government medical college Thanjavur, I like to go to US after USMLE. After studying at US, what is the chance of me getting a good placement in India
6th Jul, 2021
Hi,
After doing your residency program from USA, you can come back to India to practice medicine but you will have to give the licensing exam in India cause without that your degree won't be valid. And then once you qualify, you can join any hospital depending on where is the vacancy available and what are their demands and can start practicing medicine in India. There is no such thing as placement in India for doctors as in where the university or college will get you jobs like in engineering colleges.
I hope this helps.
All the best.
Answer later 35 Views
what does the statistics say about clearing USMLE and to practise in the US as primary as practitioner to emergency medicine treatment and critical care management from kokrajhar btr assam india and basically for a santhal community.
11th Jun, 2021
Hi,
There is no specific statistical data available to show what percentage of people from Assam can practice as a doctor in US. But a study showed that nearly 150 students did medical studies in US and out of which only 75 were able to get into residency program and half of which were finally able to come out as doctors in respective fields.
I hope this helps.
All the best.
100 Views
I am in second year of MBBS . i am not sure if I want to pursue further career in india or abroad. also , I need a bit briefing about usmle .
26th May, 2020
Hi,
If you are planning to settle abroad do PG in abroad and make sure that MCI has approved it. The medical council of India has approved PG courses only from these 5 countries- USA, UK, Canada, Australia, New Zealand.
I can get from your question that you are willing to write the US Medical License Exam (USMLE). Since you are an international applicant you need to score higher than the average marks scored by the US applicants.
All the best.
135 Views
I wish to become a Neurosurgeon, I predict that I have a career period of 30 years. I wish to practice half career in the countries of the US, Singapore, the UK, Canada, New Zealand, or Australia and I wish to practice last half of my career in India. Is my wish possible? Is my wish a good one?
2nd Apr, 2020
As long as you have an active medical license in your country that being india yes you can practice medicine anywhere in the world provided that you have some references who can recommend you to the place you want to work at and a good background check. That is the most important thing to consider. And yes your wish can come true if you work hard for it. All the best
378 Views
I am studying MBBS in China in Guangxi University Of Chinese medicine .This is my 3rd year .I am from India .I want to give USMLE and rest of the exams like MCI .How to apply what should I do now ..I need some suggestions
Student Expert 18th Feb, 2020
Hi,
Well I would like to tell you that after MBBS you can give USMLE exam in order to qualify for residency program in USA and for India you will have to give fmge qualifying exam and then you can practice medicine here. Either way the path is going to be difficult cause both the exams are difficult and USMLE happens in three levels.
I hope my answer helps.
All the best.
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