[PDF] USMLE Content Outline

39702_7USMLE_Content_Outline.pdf ®

This outline provides a common organization of content across all USMLE examinations. Each Step exam will

emphasize certain parts of the outline, and no single examination will include questions on all topics in the outline.

The examples listed within the outline are just examples. Questions may include diseases, symptoms, etc., that are

not included in the outline. The USMLE program continually reviews its examinations to ensure their content is

relevant to the practice of medicine. As practice guidelines evolve or are introduced, the content on USMLE is

reviewed and modified as needed. At times, there is a change in emphasis on new content development that arises

from our ongoing peer-review processes. For example, there has been an emphasis on new content developed

assessing competencies related to geriatric medicine, and prescription drug use and abuse. USMLE has also focused

recent efforts on the often unrecognized health care needs of recently returning servicemen and servicewomen (eg,

traumatic bra in injur y and post-traumatic stress disorder), and the families of deployed se rvicemen an d

servicewomen. While many of the medical issues related to the health care of these special populations are not

unique, certain medical illnesses or conditions are either more prevalent, have a different presentation, or are

managed differently. Knowledge of foundational science and clinical science in these content areas will be assessed

on the USMLE Step 1, Step 2 CK, and Step 3 examinations.

Examinees should refer to the test specifications for each examination for more information about which

parts of the outline will be emphasized in the examination for which they are preparing. See the USMLE eite

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FOR PUBLIC RELEASE

le o Content enel inile o ountionl Siene une Ste iottiti Eieiolooultion elt loo Loetiul Ste eiol elt eou Ste Seil Sene

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eito Ste tointetinl Ste enl Uin Ste enn Cilit te ueeiu ele eoutie Ste et

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Multite oee ioe

nteettion o te Meil Litetue

Soil Siene

1

General Principles of Foundational Science

ioeit n oleul iolo

Biology of cells

Human development and genetics

Biology of tissue response to disease

Pharmacodynamic and pharmacokinetic processes: general principles 2

Microbial biology

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

Bacteria

Viruses

Fungi

Parasites

Prions

ol eelte inin n e o te ell tient nn n iloo e ol il ne

Developmental stages:

Lifestyle and routine preventive health care:

3

Adolescence (13-17 years)

Normal physical changes:

Developmental stages:

Lifestyle and routine preventive health care:

Adulthood (18-64 years)

Normal physical changes:

Developmental stages:

Lifestyle and routine preventive health care:

Older Adulthood (65 years and older)

Normal physical changes, including normal physical exam for age:

Developmental stages:

Lifestyle and routine preventive health care:

Immune System

ol oee eeloent o ell o te tie iune eone inluin oitie n netie eletion uin iune eeloent

Stutue oution n untion

Cellular basis of the immune response and immunologic mediators 4 Basis of immunologic diagnostics (eg, antigen-antibody reactions used for diagnostic purposes, ELISA, immunoblotting, antigen-antibody changes over time, ABO typing)

Principles of immunologic protection

Effect of age on the function of components of the immune system nol oee elt n elt Mintenne Seenin inoi

Mneent i onoi

ioe oite it iunoeiien eiien iil o uol iunit deficiency/dysfunction primarily of cell-mediated immunity: complement deficiency: deficiency of phagocytic cells and natural killer cells:

HIV/AIDS:

Immunologically mediated disorders

hypersensitivity reactions: transplantation:

Adverse effects of drugs on the immune system:

Blood & Lymphoreticular System

ol oee

Eoni eeloent etl tution n eintl ne On

tutue n untion

Celltiue tutue n untion

5 Repair, regeneration, and changes associated with stage of life Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis,

Management, Risks, Prognosis

Infectious and immunologic

infectious disorders bacteria viral: parasitic: Plasmodium Babesia primary infections of lymphoid tissue:

Yersinia pestis

Bartonella henselae

immunologic and inflammatory disorders:

Neoplasms:

Anemia, cytopenias, and polycythemia anemias

decreased production: hemolysis: disorders of hemoglobin, heme, or membrane: other causes of anemia: cytopenias: cythemias: Coagulation disorders (hypocoagulable and hypercoagulable conditions) hypocoagulable: hypercoagulable: reactions to blood components:

Traumatic, mechanical, and vascular disorders:

6 Adverse effects of drugs on the hematologic and lymphoreticular systems:

Behavioral Health

ol oee oni n eiol to elte t eeiene e tneene eonlit tit tie eiol eone to te n illne e oin eni

Mltie eiol eone to te n illne e ueein eio lee

eition tient eene Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis,

Management, Risks, Prognosis

Psychotic disorders

Anxiety disorders:

Mood disorders:

Somatoform disorders

Factitious disorders:

Eating disorders and impulse control disorders:

Disorders originating in infancy/childhood:

eiitetiit ioe ee oun ioe o lnue ioe lenin ioelei intelletul eeloentl ioe n eeloentl el uneine inluin ool ole etl lool noe ooitionl eint ioe onut ioe uti etu ioe ett noe oe it oiin eii to iloo eliintion ioe inontinene enoei ti ioeouette ioe

Personality disorders:

7

Psychosocial disorders/behaviors:

Sexual and gender identity disorders:

Substance use disorders:

Nervous System & Special Senses

ol oee Eoni eeloent etl tution n eintl ne inluin neul tue eitie eel entile n neul et eitie

On tutue n untion

Cell/tissue structure and function, including neuronal cellular and molecular biology 8 Repair, regeneration, and changes associated with stage of life nol oee elt n elt Mintenne Seenin inoi Mneent i onoi netiou iunoloi n inlto ioe inetiou ioe Actinomyces israeliiHaemophilus influenzae Listeria monocytogenesMycobacterium tuberculosisNeisseria meningitidis Staphylococcus aureusepidermidisStreptococcus agalactiaeStreptococcus pneumoniae Blastomycosis dermatitidisCryptococcus neoformans/gattiiBorrelia burgdorferiLeptospiraTreponema pallidum AcanthamoebaNaegleria fowleriStrongyloides stercoralis Angiostrongylus cantonensisBaylisascaris procyonis iellote iu Etein iu toeloiu u iu enteoiu et ile iu St Loui eneliti iu ie iu Eten n eten euine eneliti iu olioiu TaeniaToxoplasma gondii

Clostridium botulinum

Clostridium tetani

immunologic and inflammatory disorders:

Neoplasms (cerebral, spinal, and peripheral):

Cerebrovascular disease:

Disorders relating to the spine, spinal cord, and spinal nerve roots:

Cranial and peripheral nerve disorders

cranial nerve injury/disorders: peripheral nerve/plexus injury/disorders: 9

Neurologic pain syndromes:

Degenerative disorders/amnestic syndromes:

Global cerebral dysfunction:

Neuromuscular disorders:

Movement disorders:

Metabolic disorders:

Paroxysmal disorders:

Sleep disorders:

Traumatic and mechanical disorders and disorders of increased intracranial pressure:

Congenital disorders:

Adverse effects of drugs on the nervous system:

Disorders of the eye and eyelid

infectious and inflammatory disorders of the eye: neoplasms of the eye: disorders of the eye and eyelid, structural: disorders of the pupil, iris, muscles (extraocular): disorders of the retina: 10 traumatic and mechanical disorders: adverse effects of drugs on the eyes:

Disorders of the ear

infectious and inflammatory disorders of the ear: neoplasms: hearing loss/deafness: disorders of balance and spatial orientation: traumatic and mechanical disorders: adverse effects of drugs on the ear:

Skin & Subcutaneous Tissue

ol oee

Eoni eeloent etl tution n neontl ne

On tutue n untion inluin ie untion tel eultion

Celltiue tutue n untion eine untion

ei eenetion n ne oite it te o lie e enile uu le tten lne otenoul i ne

Sin eene eni n nol lo

nol oee elt n elt Mintenne Seenin inoi

Mneent i onoi

netiou iunoloi n inlto ioe inetiou ioe n inettion teil

Bacillus anthracis

Streptococcus

viral: fungal (deep and superficial): parasitic: infestations, nonvenomous bites, stings: immunologic and inflammatory disorders 11 papulosquamous and eczematous dermatoses: vesiculobullous disorders: urticaria, erythema, exanthema, and purpura: autoimmune disorders:

Neoplasms

benign neoplasms, cysts and other skin lesions: malignant neoplasms: Integumentary disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes) disorders of the hair and hair follicles: disorders of the nails (including ingrowing nail) disorders of sweat and sebaceous glands:

Oral disease:

Disorders of pigmentation:

Traumatic and mechanical disorders:

Congenital disorders:

Adverse effects of drugs on skin and subcutaneous tissue:

Musculoskeletal System

ol oee

Eoni eeloent etl tution n eintl ne

On tutue n untion

Celltiue tutue n untion

Repair, regeneration, and changes associated with stage of life nol oee elt n elt Mintenne Seenin inoi

Mneent i onoi

netiou inlto n iunoloi ioe inetiou ioe Clostridium perfringens immunologic disorders: 12 uenile iioti titi eutoi titi elt noe oiti tot inflammatory disorders:

Neoplasms:

Degenerative and metabolic disorders

degenerative/metabolic disorders of bone, tendon, and cartilage: degenerative/metabolic disorders of joints: degenerative/metabolic disorders of muscles, ligaments, fascia:

Traumatic and mechanical disorders:

Congenital disorders:

Adverse effects of drugs on the musculoskeletal system:

Cardiovascular System

ol oee

Eoni eeloent etl tution n eintl tnitionl ne

On tutue n untion

Cell/tissue structure and function

13 Repair, regeneration, and changes associated with stage of life nol oee elt n elt Mintenne Seenin inoi

Mneent i onoi

netiou iunoloi n inlto ioe inetiou ioe immunologic and inflammatory disorders:

Neoplasms:

Dysrhythmias:

Heart failure:

Ischemic heart disease:

Diseases of the myocardium:

Diseases of the pericardium:

Valvular heart disease:

Hypotension:

Hypertension:

Dyslipidemia:

Vascular disorders

disorders of the great vessels: peripheral arterial vascular disease: diseases of the veins:

Traumatic and mechanical disorders:

14 Congenital disorders, including disease in adults: Adverse effects of drugs on the cardiovascular system:

Respiratory System

ol oee

Eoni eeloent etl tution n eintl ne

On tutue n untion

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

nol oee elt n elt Mintenne Seenin inoi

Mneent i onoi

netiou iunoloi n inlto ioe inetiou iunoloi n inlto ioe o te ue i

Bordetella pertussis

infectious, immunologic, and inflammatory disorders of the lower airways:

Bacillus anthracis

Burkholderia pseudomallei

Chlamydophila pneumoniaeCoxiella burnetiiFrancisella tularensisHaemophilus influenzaeKlebsiella pneumoniaeLegionellaMoraxella catarrhalisMycoplasma pneumoniae

Pseudomonas aeruginosaStreptococcus

ŐƌĂŵͲŶĞŐĂƚŝǀĞďĂĐƚĞƌŝĂͿ͖ǀŝƌĂůŝŶĨĞĐƚŝŽŶ;ĞŐ͕ŝŶĨůƵĞŶnjĂ

͕͕ĂĚĞŶŽǀŝƌƵƐ͕ϭϭ͕

Pneumocystis jirovecii

Pneumocystis jirovecii

Neoplasms

benign neoplasms: 15 malignant neoplasms upper airways: lower airways and pleura: metastatic neoplasms including pleural

Obstructive airway disease:

Pneumoconiosis/fibrosing/restrictive pulmonary disorders/interstitial lung disease: Respiratory failure/respiratory arrest and pulmonary vascular disorders:

Metabolic, regulatory, and structural disorders:

Disorders of the pleura, mediastinum, and chest wall:

Traumatic and mechanical disorders

upper airways: lower airways and pleura:

Congenital disorders:

Adverse effects of drugs on the respiratory system:

Gastrointestinal System

ol oee

Eoni eeloent etl tution n eintl ne

On tutue n untion

16

Cell/tissue structure and function

Repair, regeneration, and changes associated with stage of life Gastrointestinal defense mechanisms and normal flora nol oee elt n elt Mintenne Seenin inoi

Mneent i onoi

netiou iunoloi n inlto ioe inetiou ioe teil

Clostridium difficile

Staphylococcus aureusEscherichia coliListeria

monocytogenes Yersinia enterocoliticaCampylobacter Vibrio cholerae

Salmonella Shigella

viral: fungal: parasitic: CryptosporidiumCyclosporaEntamoeba histolyticaGiardiaIsospora belli

Strongyloides stercoralis

immunologic and inflammatory disorders:

Neoplasms

benign neoplasms, including polyps, cysts: malignant neoplasms and pre-malignant conditions: metastatic neoplasms

Signs, symptoms, and ill-defined disorders:

Disorders of the oral cavity, salivary glands, and esophagus oral cavity and salivary glands: esophagus: 17 Disorders of the stomach, small intestine, colon, rectum, anus stomach: small intestine, colon: rectum and anus: Disorders of the liver and biliary system, noninfectious liver: looli tt lie iee otl etenioneoel ie biliary system:

Disorders of the pancreas:

Disorders of the peritoneal cavity:

Traumatic and mechanical disorders:

Congenital disorders:

Adverse effects of drugs on the gastrointestinal system:

Renal & Urinary System

ol oee

Eoni eeloent etl tution n eintl ne

On tutue n untion

18

Cell/tissue structure and function

Repair, regeneration, and changes associated with stage of life nol oee elt n elt Mintenne Seenin inoi

Mneent i onoi

netiou iunoloi n inlto ioe inetiou ioe ue uin tt lower urinary tract and urinary tract infections of unspecified location: immunologic and inflammatory disorders upper urinary tract glomerular disorders: tubular interstitial disease: lower urinary tract:

Neoplasms

benign neoplasms and cysts: malignant neoplasms:

Signs, symptoms, and ill-defined disorders:

Metabolic and regulatory disorders:

Vascular disorders:

Traumatic and mechanical disorders:

Congenital disorders:

Adverse effects of drugs on the renal and urinary system: 19

Pregnancy, Childbirth, & the Puerperium

ol oee

On tutue n untion

Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis,

Management, Risks, Prognosis

Prenatal care

preconception counseling and care: prenatal risk assessment/prevention: ŐĞŶĞƚŝĐƐĐƌĞĞŶŝŶŐ͖ɲ supervision of normal pregnancy:

Chlamydia

trachomatisTreponema pallidumStreptococcus agalactiaeToxoplasma gondii

Obstetric complications:

Labor and delivery:

Chlamydia

Puerperium, including complications:

Newborn (birth to 4 weeks of age)

normal newborn disorders of the newborn: 20

Chlamydia trachomatisStreptococcus agalactiae

Treponema pallidumToxoplasma gondii

Candida

Congenital disorders, neonatal:

Adverse effects of drugs on pregnancy, childbirth, and the puerperium: Systemic disorders affecting pregnancy, labor and delivery, and puerperium:

Female Reproductive System & Breast

ol oee

Eoni eeloent etl tution n eintl ne etoenei

On tutue n untion

Cell/tissue structure and function:

Reproductive system defense mechanisms and normal flora Repair, regeneration, and changes associated with stage of life nol oee elt n elt Mintenne Seenin inoi

Mneent i onoi

et inetiou iunoloi n inlto ioe neoplasms benign and undefined neoplasms: 21
malignant neoplasms (including screening):

Female reproductive system

infectious, immunologic, and inflammatory disorders:

Haemophilus ducreyiNeisseria gonorrhoeae

Chlamydia trachomatis

ʹ

Treponema pallidumTrichomonas vaginalis

Neoplasms of the cervix, ovary, uterus, vagina, and vulva benign neoplasms and cysts: malignant and precancerous neoplasms:

Fertility and infertility:

Menopause:

Menstrual and endocrine disorders:

Sexual dysfunction:

Traumatic and mechanical disorders:

Congenital disorders:

Adverse effects of drugs on the female reproductive system and breast:

Male Reproductive System

ol oee

Eoni eeloent etl tution n neontl ne etoenei

On tutue n untion

22
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 nol oee elt n elt Mintenne Seenin inoi

Mneent i onoi

netiou iunoloi n inlto ioe inetiou ioe

Haemophilus ducreyi

Neisseria gonorrhoeae

Chlamydia

trachomatisTreponema pallidumTrichomonas vaginalis immunologic and inflammatory disorders:

Neoplasms:

Metabolic and regulatory disorders, including sexual dysfunction:

Traumatic and mechanical disorders:

Congenital disorders of the male reproductive system: Adverse effects of drugs on the male reproductive system: enei loe iueti inluin tiie uinue ii e toone inteie utteie ilenil tlil enil iun niti oie eute iniito

Endocrine System

ol oee

Eoni eeloent etl tution n eintl ne

On tutue n untion

Cell/tissue/structure and function, including hormone synthesis, secretion, action, metabolism 23
Repair, regeneration, and changes associated with stage of life nol oee elt n elt Mintenne Seenin inoi

Mneent i onoi

iete ellitu n ote ioe o te enoine ne iete ellitu hypoglycemia and islet cell disorders:

Thyroid disorders:

Parathyroid disorders:

Adrenal disorders:

Pituitary disorders:

Hypothalamic endocrine disorders

Multiple endocrine neoplasia (MEN1, MEN2)

Congenital disorders:

Adverse effects of drugs on the endocrine system:

Multisystem Processes & Disorders

ol oee inile o nutition

Electrolyte and water metabolism

24
Intracellular accumulations (eg, pigments, fats, proteins, carbohydrates, minerals, inclusions, vacuoles, lysosomal/glycogen storage disease and structures related to storage diseases, glycogen phosphorylase deficiency, Zellweger syndrome) nol oee elt n elt Mintenne Seenin inoi

Mneent i onoi

netiou iunoloi n inlto ioe inetiou ioe teil

Brucella Leptospira interrogans

Borrelia burgdorferiBurkholderia pseudomallei

Mycobacterium tuberculosisFrancisella

tularensisCoxiella burnetii

Anaplasma Ehrlichia

Rickettsia rickettsii

viral: fungal: Blastomyces dermatitidisCandida albicans

Coccidioides immitis/posadasiiHistoplasma

capsulatum parasitic: SchistosomaLeishmania tnooiiC iee ute n oni Trypanosoma immunologic and inflammatory disorders:

Neoplasms and related disorders

paraneoplastic syndromes:

ŵĂůŝŐŶĂŶĐLJ΀ƉĂƌĂƚŚLJƌŽŝĚͲƌĞůĂƚĞĚƉƌŽƚĞŝŶĂŶĚƉĂƌĂŶĞŽ

inherited cancer syndromes:

Signs, symptoms, and ill-defined disorders:

25

Nutrition

protein-calorie malnutrition (kwashiorkor, marasmus) vitamin deficiencies and/or toxicities: mineral deficiencies and/or toxicities obesity enteral/parenteral nutrition (TPN)

Toxins and environmental extremes

Venomous bites and stings:

Fluid, electrolyte, and acid-base balance disorders fluid volume and electrolyte/ion disorders: acid-base disorders:

Abuse

child, nonaccidental trauma/inflicted head trauma/factitious disorder by proxy intimate partner abuse, sexual, emotional, and physical including injuries (eg, rib fractures) related to abuse elder abuse, sexual, emotional, and physical including injuries (eg, rib fractures) related to abuse sexual assault Multiple trauma (eg, prioritization, blast injury involving more than one organ system) Shock, cardiogenic, hypovolemic, neurogenic, septic, sepsis, bacteremia, systemic inflammatory response syndrome (SIRS), refractory, multiorgan dysfunction syndrome: meningococcemia

Genetic metabolic and developmental disorders

multifactorial: large genomic changes: enzymatic/metabolic: 26
structural protein disorders: intracellular/extracellular transport receptors: triplet repeat/RNA disorders: Adverse effects of drugs on multisystem disorders: Biostatistics, Epidemiology/Population Health, & Interpretation of the Medical

Literature

Eieiolooultion elt

Meue o iee euen inieneelene

Meue o elt ttu

Survival analysis interpretation (eg, Kaplan-Meier curve) Composite health status indicators, measures of population impact: Population pyramids and impact of demographic changes

Disease surveillance and outbreak investigation:

Communicable disease transmission:

Points of intervention:

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:

Analytical studies: interventional:

Systematic reviews and meta-analysis:

Obtaining and describing samples:

Methods to handle noncompliance:

Qualitative analysis

27

Measures of association

Relative risk

Odds ratio, hazard ratio

Other measures of association:

Distributions of data:

Correlation and regression, uses and interpretation:

Principles of testing and screening

Properties of a screening test:

Sensitivity and specificity; predictive value, positive and negative

ROC curves

Probability:

Study interpretation, drawing conclusions from data

Causation:

Chance

Interpretation of graphs/tables and text

Bias, confounding, and threats to validity (includes methods to address)

Internal vs. external validity:

Statistical vs. clinical significance; clinical and surrogate outcome/end point

Clinil eiion in inteettion n ue o eienee t n

eoention

Research ethics

Informed consent for research

Privacy of patient data (HIPAA)

Roles of institutional review boards (IRBs)

Intervention analysis:

Regulatory issues:

28
Other issues related to research ethics

Soil Siene

Counition n inteeonl ill inluin elt lite n nue ultul oetene tient inteiein onulttion n intetion it te il tient entee ounition ill

Use of an interpreter or surrogate

Meil eti n uiuene inlue iue elte to et n in n

llitie e Conentinoe onent to tetent eiion to tet ull iloue i n eneit leo ltentie teie onlit o inteet n ulnele oultion eteintion o eil eiionin itinoe eul nolunt iion

Lel iue elte to ue il ele n intite tne

il otetie eie ote e iunition lel euieent o eotin ue o neletolition to n itelte iue et n in n llitie e Physician-patient relationship (boundaries, confidentiality including HIPAA, privacy, truth- telling, other principles of medical ethics, eg, 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

Stee tie inluin elt te uli elt ounit ool

n tient et inluin i onet n teinolo

Coleitte tinin

Cteiti o ole te n to lein to oleit

29

Health care/organizational behavior and culture:

Quality im provement

Improvement science principles

Specific models of quality improvement:

Quality measurement

Strategies to improve quality

Attributes of high-quality health care

Patient Safety

Patient safety principles

ʹ

Specific types of error

30
ʹ

Strategies to reduce error

Health care policy and economics

Health care policy

31

Health care economics/Health care financing

ʹ 32