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USMLE techniques - United States Medical Licensing Examination Step 1 Updated: 2024 | ||||||||
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Exam Code: USMLE United States Medical Licensing Examination Step 1 techniques January 2024 by Killexams.com team | ||||||||
USMLE United States Medical Licensing Examination Step 1 Beginning in May 2020, Step 1 examinations will include an increased number of questions that assess communications skills. The tables below provide information on the content weighting for Step 1 examinations administered before and after May 2020. Table of Contents - General Principles of Foundational Science - 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 - Biostatistics, Epidemiology/Population Health - Interpretation of the Medical Literature - Social Sciences Biochemistry and molecular biology Gene expression: DNA structure, replication, exchange, and epigenetics (eg, imprinting, Xactivation, DNA methylation) Gene expression: transcription Gene expression: translation, post-translational processing, 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 (eg, enzyme kinetics and structural/regulatory proteins) Energy metabolism (eg, ATP generation, transport chain) Biology of cells Adaptive cell responses and cellular homeostasis (eg, hypertrophy) Mechanisms of injury and necrosis, including pathologic processes (eg, liquefactive necrosis, free radical formation) Apoptosis Cell cycle and cell cycle regulation (eg, mitosis) Mechanisms of dysregulation cell biology of cancer (eg, 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 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 (eg, penetrance, genetic heterogeneity) Biology of tissue response to disease Acute inflammatory responses (patterns of response) acute inflammation and mediator systems (eg, histamine, prostaglandins, bradykinins, eosinophilic basic protein, nitric oxide) vascular response to injury, including mediators principles of cell adherence and migration (eg, ECAMs, selectins, leukocytic diapedesis, and rolling) microbicidal mechanisms and tissue injury (eg, defensins) clinical manifestations (eg, pain, fever, leukocytosis, leukemoid reaction, chills) Chronic inflammatory responses (eg, tumor necrosis factor) Reparative processes wound healing, repair: thrombosis, granulation tissue, angiogenesis, fibrosis, scar/keloid formation regenerative process Pharmacodynamic and pharmacokinetic processes: general principles Pharmacokinetics: absorption, distribution, metabolism, excretion, dosage intervals Mechanisms of drug action, structure-activity relationships (eg, anticancer drugs) Concentration and dose-effect relationships (eg, efficacy, potency), types of agonists (eg, full, partial, inverse) and antagonists and their actions Individual factors altering pharmacokinetics and pharmacodynamics (eg, 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 (eg, general principles of nitric oxide, autocrine and paracrine signaling) Microbial biology Microbial identification and classification, including principles, microorganism identification, and non-immunologic laboratory diagnosis Bacteria structure (eg, cell walls, composition, appendages, virulence factors, extracellular products, toxins, mechanism of action of toxins) processes, replication, and genetics (eg, metabolism, growth, and regulation) oncogenesis antibacterial agents (eg, mechanisms of action on organism, toxicity to humans, and mechanisms of resistance) Viruses structure (eg, physical and chemical properties, virulence factors) processes, replication, and genetics (eg, life cycles, location of virus in latent infection) oncogenesis antiviral agents (eg, mechanisms of action on virus, toxicity to humans, and mechanisms of resistance) Fungi structure (eg, cell wall, composition, appendages, virulence factors, extracellular products, toxins, mechanisms of action of toxins) processes, replication, and genetics (eg, asexual vs. sexual, metabolism, growth) antifungal agents (eg, mechanisms of action on fungus, toxicity to humans, and mechanisms of resistance) Parasites structure (eg, appendages, macroscopic features, and virulence factors) processes, replication, and genetics (eg, life cycles, metabolism, and growth) oncogenesis antiparasitic agents (eg, mechanisms of action on parasite, toxicity to humans, and mechanisms of resistance) Prions Normal age-related findings and care of the well patient Infancy and childhood (0-12 years) Normal physical changes: linear growth, variations in linear growth, including constitutional delay; weight; head circumference; micturition, defecation,primary incontinence/bedwetting; normal physical examination; screening; sleep; teething syndrome Developmental stages: motor; speech; cognitive; psychosocial; anticipatory guidance Lifestyle and routine preventive health care: nutrition; exercise (eg, benefits of exercise); preventive/travel medicine; risk factors and prevention (eg, guns, swimming, motor vehicles, car seats); routine vaccinations Adolescence (13-17 years) Normal physical changes: linear growth, variations in linear growth including constitutional delay; weight; puberty; normal physical examination; gynecomastia; autonomy/self-identity; sleep Developmental stages: cognitive (eg, abstract thought); psychosocial (eg, autonomy, role confusion, sexual identity); anticipatory guidance Lifestyle and routine preventive health care: nutrition; exercise (eg, benefits of exercise); preventive/travel medicine; risk factors and prevention (eg, risk-taking behavior, helmets, safe sex, motor vehicles, seat belts, distractions); routine vaccinations Adulthood (18-64 years) Normal physical changes: weight; normal physical examination; screening; sleep Developmental stages: cognitive; intimacy vs isolation; anticipatory guidance Lifestyle and routine preventive health care: nutrition; exercise (eg, benefits of exercise); preventive/travel medicine; risk factors and prevention; routine vaccinations Senescence (65 years and older) Normal physical changes, including normal physical exam for age: weight, height (spinal compression), skin, bruising; normal physical examination; response to temperature; micturition, defecation;sleep Developmental stages: motor; cognitive (eg, benign senescent forgetfulness); psychosocial; integrity vs despair; retrospection; anticipatory guidance Lifestyle and routine preventive health care: nutrition; exercise (eg, benefits of exercise); preventive/travel medicine; risk factors and prevention (eg, falls, general medical condition; polypharmacy, driving, caregiver stress); routine vaccinations Immune System 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 (eg, complement receptors and toll-like receptors), cytokines, chemokines T lymphocytes, including T-lymphocyte receptors, accessory molecules (eg, CD3, CD4, CD8, B7), cell activation and proliferation, cytotoxic T lymphocytes, and memory T lymphocytes B lymphocytes and plasma cells, including B-lymphocyte receptors, immunoglobulins, cell activation and proliferation, including development of antibodies and memory B lymphocytes host defense mechanisms, host barriers to infection, mucosal immunity (eg, gutassociated 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 (eg, TAP, beta-2 microglobulin), intracellular pathways, mechanisms by which MHC is expressed on the surface; including distribution of MHC I and MHC II on different cells, mechanisms of MHC I and MHC II deficiencies, and the genetics of MHC regulation of the adaptive immune response (eg, peripheral tolerance, anergy, regulatory T lymphocytes, termination of immune response, and B-T lymphocyte interactions) activation, function, and molecular biology of complement (eg, anaphylatoxins) functional and molecular biology of cytokines (eg, IL 1-15) 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 vaccine production and mechanisms of vaccine action biologically active antibodies (eg, monoclonal antibodies, polyclonal antibodies including IVIG, VZIG, rabies immunoglobulin) Effect of age on the function of components of the immune system Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Disorders associated with immunodeficiency deficiency primarily of humoral immunity: common variable immunodeficiency; hyper IgM syndrome; hypogammaglobulinemia/agammaglobulinemia, X-linked (Bruton); selective immunodeficiency (eg, IgA, IgM, IgE) deficiency/dysfunction primarily of cell-mediated immunity: adenosine deaminase deficiency; DiGeorge syndrome; severe combined immunodeficiency disease (SCID); Wiskott-Aldrich syndrome; granulomatosis; allergic reactions/skin complement deficiency: alternative pathway component deficiency (C2, C3b, C3bB, C36B6); classical pathway component deficiency (C1q, C1r, C1-C5); terminal component deficiency (C5b-C9; terminal complement complex); C1 esterase inhibitor deficiency, hereditary angioedema; mannose-binding lectin (MBL) deficiency; membrane attack complex deficiency deficiency of phagocytic cells and natural killer cells: Chediak-Higashi disease; chronic granulomatous disease and other disorders of phagocytosis; leukocyte adhesion deficiency HIV/AIDS: HIV1 and HIV2; AIDS; AIDS complications (eg, neuropathy, dementia, renal insufficiency); immunology of AIDS; immune reconstitution syndrome (IRS); secondary infections; noninfectious complications Immunologically mediated disorders hypersensitivity reactions: type 1, 2, 3, including anaphylaxis; type 4; drug reactions; serum sickness transplantation: rejection; graft-vs-host disease Adverse effects of drugs on the immune system: Jarisch-Herxheimer reaction; drugs affecting the immune system (eg, prednisone, azathioprine, cyclosporine, methotrexate, monoclonal antibody drugs [eg, abciximab, adalimumab; bevacizumab, infliximab, omalizumab, rituximab]); vaccine adverse effects Blood & Lymphoreticular System 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 O2 and CO2 transport, transport proteins, erythropoietin production and function of platelets production and function of coagulation and fibrinolytic factors; hemostasis 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: hemorrhagic fever (Ebola virus, Marburg virus); chikungunya; dengue fever; Zika virus disease parasitic: malaria (Plasmodium spp); babesiosis (Babesia species) primary infections of lymphoid tissue: lymphadenitis (viral, bacterial, fungal, parasitic); lymphangitis; buboes, bubonic plague (Yersinia pestis); cat scratch disease (Bartonella henselae) immunologic and inflammatory disorders: cryoglobinemia, essential mixed cryoglobinemia; autoimmune hemolytic anemia; paroxysmal nocturnal hemoglobinuria; thrombotic thrombocytopenic purpura; 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); myelofibrosis; myelodysplastic syndrome, myelodysplasias; other immunoproliferative neoplasms (eg, Waldenstrom macroglobulinemia) Anemia, cytopenias, and polycythemia anemias decreased production: anemia of chronic disease hemolysis: glucose-6-phosphate dehydrogenase deficiency; pyruvate kinase deficiency disorders of hemoglobin, heme, or membrane: disorders of red cell membranes; hereditary spherocytosis, elliptocytosis; methemoglobinemia, congenital; sickle cell disease; sideroblastic anemia; thalassemias other causes of anemia: blood loss, acute and chronic as a cause of anemia cytopenias: aplastic anemia; leukopenia; neutropenia, cyclic neutropenia, agranulocytosis; pancytopenia; thrombocytopenia, quantitative; immune thrombocytopenic purpura (ITP) cythemias: leukocytosis; polycythemia vera; secondary polycythemia Coagulation disorders (hypocoagulable and hypercoagulable conditions) hypocoagulable: disseminated intravascular coagulation; hemophilia, congenital factor VIII [hemophilia A] and IX [hemophilia B]; hypofibrinogenemia; von Willebrand disease; platelet dysfunction, qualitative hypercoagulable: heparin-induced thrombocytopenia; other coagulopathies (eg, homocysteinemia, hypoplasminogenemia, antithrombin III, protein C/protein S deficiency, Factor V Leiden, anticardiolipin antibodies, lupus anticoagulant, prothrombin G20210A mutation) reactions to blood components: ABO incompatibility/anaphylaxis; Rh incompatibility/anaphylaxis; hemolysis, delayed; 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 (eg, cardiac valve hemolysis); disorders of the spleen; splenic rupture/laceration; splenic infarct; splenic abscess; effects/complications of splenectomy (eg, sepsis due to encapsulated bacteria); hypersplenism Adverse effects of drugs on the hematologic and lymphoreticular systems: antiplatelet drugs, antithrombin drugs (eg, dabigatran); chemotherapeutic agents; inhibitors of coagulation factors; methemoglobinemia, acquired; propylthiouracil; tumor lysis syndrome; warfarin Behavioral Health Normal Processes Psychodynamic and behavioral factors, related past experience (eg, transference, personality traits) Adaptive behavioral responses to stress and illness (eg, coping mechanisms) Maladaptive behavioral responses to stress and illness (eg, drug-seeking behavior, sleep deprivation) Patient adherence: general adherence; adolescent adherence 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; 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; persistent depressive disorder (dysthymia); bipolar disorder, manic/depressed/mixed; premenstrual dysphoric disorder; bipolar and related disorder or depressive disorder due to another medical condition; 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 (eg, gambling, kleptomania, pyromania) Disorders originating in infancy/childhood: reactive attachment disorder; attentiondeficit/hyperactivity disorder; speech sound disorder or language disorder; learning disorder/dyslexia; intellectual developmental disorder and developmental delay, undefined, including school problems, fetal alcohol syndrome; oppositional defiant disorder, conduct disorder; autism spectrum disorder, Rett syndrome; psychoses with origin specific to 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; 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; hallucinogen use disorder/intoxication/dependence/withdrawal; inhalant use disorder/intoxication/dependence/withdrawal; opioid, heroin, including prescription drug, use disorder/intoxication/dependence/withdrawal; sedative, hypnotic, including benzodiazepine and barbiturate use disorder/intoxication/dependence/withdrawal; stimulant, cocaine, methamphetamine use disorder/intoxication/dependence/withdrawal; other drugs of use disorders (eg, ecstasy, PCP, bath salts)/intoxication/dependence/withdrawal; polysubstance use disorder/intoxication/dependence/withdrawal Nervous System & Special Senses Normal Processes Embryonic development, fetal maturation, and perinatal changes, including neural tube derivatives, cerebral ventricles, and neural crest derivatives Organ structure and function spinal cord gross anatomy and blood supply spinal reflexes brain stem (eg, cranial nerves and nuclei, reticular formation, anatomy and blood supply, control of eye movements) 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 sensory systems general sensory modalities, including sharp, dull, temperature, vibratory, and proprioception special sensory modalities, including vision, hearing, taste, olfaction, and balance motor systems brain and spinal cord (upper motoneuron) 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, reuptake, and degradation of neurotransmitters and neuromodulators presynaptic and postsynaptic receptor interactions, trophic and growth factors brain metabolism glia, myelin brain homeostasis: blood-brain barrier, cerebrospinal fluid formation and flow, choroid plexus Repair, regeneration, and changes associated with stage of life Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, immunologic, and inflammatory disorders infectious disorders: meningitis: bacterial (Actinomyces israelii; Haemophilus influenzae; Listeria monocytogenes; Mycobacterium tuberculosis; Neisseria meningitidis; Staphylococcus aureus, epidermidis; Streptococcus agalactiae; Streptococcus pneumoniae); viral (adenovirus, arboviruses, echovirus and coxsackie A & B viruses, polioviruses, herpes simplex virus, varicella zoster, human immunodeficiency virus, lymphocytic choriomeningitis virus, measles virus, mumps virus, St. Louis encephalitis virus, California encephalitis virus, Western equine encephalitis virus); fungal (Blastomycosis dermatitidis, Cryptococcus neoformans/gattii); spirochetal (Borrelia burgdorferi; Leptospira; Treponema pallidum, including neurosyphilis); protozoal/helminths (Acanthamoeba, Naegleria fowleri, Strongyloides stercoralis, Angiostrongylus cantonensis, Baylisascaris procyonis); encephalitis (herpesvirus [HSVI], varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, mumps virus, enterovirus, West Nile virus, St. Louis encephalitis virus, rabies virus, Eastern and Western equine encephalitis virus, poliovirus, Taenia, Toxoplasma gondii); prion disease (eg, Creutzfeldt-Jakob disease); botulism (Clostridium botulinum), tetanus (Clostridium tetani); CNS disorders associated with AIDS (eg, progressive multifocal leukoencephalopathy) 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 (eg, 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; stroke: intracerebral hemorrhage, including subarachnoid hemorrhage, traumatic intracranial hemorrhage; cerebral artery aneurysm; carotid artery stenosis/atherosclerosis/occlusion/dissection; 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, acute and chronic effects (eg, autonomic dysreflexia); spinal stenosis (cervical, lumbar); syringomyelia Cranial and peripheral nerve disorders cranial nerve injury/disorders: cranial nerve injury; Bell palsy; anisocoria, miosis, mydriasis; internuclear ophthalmoplegia; nystagmus and other irregular eye movements; vestibular neuritis, labyrinthitis; ptosis of the eyelid; Horner syndrome peripheral nerve/plexus injury/disorders: peripheral nerve injury, including brachial plexus; carpal/cubital/tarsal/peroneal tunnel syndrome; mononeuritis, Guillain-Barré syndrome; Miller Fisher syndrome; neuropathy (eg, Charcot-Marie-Tooth disease); 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 (eg, Duchenne, myotonic); muscle channelopathies (eg, 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; pseudotumor cerebri (idiopathic intracranial hypertension); torticollis/cervical dystonia; hydrocephalus, including normal-pressure; traumatic brain injury (concussion)/postconcussion syndrome (dementia pugilistica); traumatic brain syndrome Congenital disorders: Friedreich ataxia; neural tube defects (eg, 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 (eg, NSAIDs, sulfa drugs); drug-induced neuropathy (eg, vincristine, isoniazid, metronidazole); extrapyramidal adverse effects (eg, akathisia, dystonia, drug-induced parkinsonism); neuroleptic malignant syndrome; poisoning by psychotropic agents, including antidepressants; serotonin syndrome; tardive dyskinesia Disorders of the eye and eyelid infectious and inflammatory disorders of the eye: blepharitis/eyelid inflammation; chalazion; chorioretinitis; conjunctivitis (adenovirus)/keratoconjunctivitis; dacryocystitis; endophthalmitis; hordeolum; iridocyclitis; optic neuritis; periorbital cellulitis; uveitis neoplasms of the eye: melanoma; retinoblastoma disorders of the eye and eyelid, structural: cataract; glaucoma; lacrimal system disorders; pterygium; refractive disorders (presbyopia, myopia, hyperopia, astigmatism) disorders of the pupil, iris, muscles (extraocular): amblyopia; strabismus disorders of the retina: hypertensive retinopathy; macular degeneration; papilledema; retinal detachment; retinitis pigmentosa; vascular disorders affecting the retina, including central retinal artery embolus, retinal hemorrhage, amaurosis fugax, embolus, carotid artery stenosis, central retinal vein occlusion; visual impairment/blindness, night blindness traumatic and mechanical disorders: black eye; burn of the eye and adnexa; corneal abrasion, ulcer; dislocated lens; foreign body in eye; hyphema; injury to optic nerve and pathways; laceration of the eye and eyelid; ocular open wounds; orbital fracture; subconjunctival hemorrhage adverse effects of drugs on the eyes: ethambutol; hydroxychloroquine; prednisone Disorders of the ear infectious and inflammatory disorders of the ear: chondritis; mastoiditis; otitis, externa, media, interna, serous, suppurative, malignant otitis externa neoplasms: acoustic neuroma, neurofibromatosis type 2; cholesteatoma hearing loss/deafness: hearing loss, including noise-induced; otosclerosis; tinnitus disorders of balance and spatial orientation: Ménière disease; motion sickness; vertigo, including benign positional vertigo traumatic and mechanical disorders: barotrauma; foreign body in ear; impacted cerumen; laceration, avulsion; perforation of tympanic membrane; eustachian tube disorders adverse effects of drugs on the ear: antineoplastic agents, including cisplatin; aminoglycosides; furosemide; salicylates Skin & Subcutaneous Tissue 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 (eg, senile purpura, male pattern baldness, postmenopausal hair changes) Skin defense mechanisms and normal flora Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, immunologic, and inflammatory disorders infectious disorders and infestations bacterial: cellulitis, erysipelas, impetigo, staphylococcal scalded skin syndrome; abscess, cutaneous, including septic abscess; anthrax (Bacillus anthracis); carbuncle; folliculitis; pilonidal cyst, infected; pyoderma gangrenosum; MSSA and MRSA skin infections; mycobacterial infections (eg, leprosy, draining sinus); scarlet fever (group A Streptococcus) viral: herpes simplex type 1 & type 2, herpes zoster, Ramsay-Hunt syndrome; molluscum contagiosum; hand-foot-and-mouth disease; herpangina; parvovirus; chickenpox, erythema infectiosum (fifth disease), rubella, measles, roseola (exanthema subitum); verrucae vulgaris fungal (deep and superficial): candidiasis, skin; dermatophytosis, tinea corporis; dermatomycoses; diaper rash; onychomycosis parasitic: cutaneous larva migrans; cutaneous leishmaniasis infestations, nonvenomous bites, stings: scabies; lice; insect bites, including bed bugs immunologic and inflammatory disorders papulosquamous and eczematous dermatoses: psoriasis; lichen planus and lichenoid dermatoses; allergic/irritant contact dermatitis (eg, nickel); dermatoses caused by plants (poison ivy, poison oak) vesiculobullous disorders: epidermolysis bullosa; dermatitis herpetiformis; pemphigus; pemphigoid urticaria, erythema, exanthema, and purpura: erythema nodosum; atopic dermatitis; pityriasis rosea; urticaria; Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis autoimmune disorders: vitiligo Neoplasms benign neoplasms, cysts and other skin lesions: actinic keratoses; cysts, including epidermal; hemangiomas; lipoma; pigmented nevi; seborrheic keratosis; xanthomas malignant neoplasms: basal cell carcinoma; squamous cell carcinoma; melanoma, including genital; Kaposi sarcoma; cutaneous T-cell lymphoma, mycosis fungoides Adnexal disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes) disorders of the hair and hair follicles: alopecia; seborrhea capitis/seborrheic dermatitis; tinea barbae and capitis disorders of the nails (including ingrowing nail) disorders of sweat and sebaceous glands: acne vulgaris; hidradenitis suppurativa; 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 (eg, sunburn, other including blast injuries and burns); cauliflower ear; effects of ultraviolet light; keloids; tattoo; thermal injury, perniosis, frostbite; ulcers, decubitus Congenital disorders: xeroderma pigmentosum; benign lesions in neonates, infants, children (eg, congenital nevi) Adverse effects of drugs on skin and subcutaneous tissue: drug reactions, eruptions, including local reaction to vaccine Musculoskeletal System Normal processes Embryonic development, fetal maturation, and perinatal changes Organ structure and function Cell/tissue structure and function biology of bones, joints, tendons, skeletal muscle, cartilage exercise and physical conditioning/deconditioning Repair, regeneration, and changes associated with stage of life Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, inflammatory, and immunologic disorders infectious disorders: gangrene, dry and wet, clostridial myonecrosis (Clostridium perfringens); discitis; myositis, infective; necrotizing fasciitis; osteomyelitis; septic arthritis; spondylitis, tuberculous immunologic disorders: ankylosing spondylitis; dermatomyositis/polymyositis; juvenile idiopathic arthritis; rheumatoid arthritis, Felty syndrome; psoriatic arthropathy inflammatory disorders: adhesive capsulitis of shoulder (frozen shoulder syndrome); ankylosis/spondylopathy (inflammatory); bursitis; fasciitis; osteochondritis, osteochondritis dissecans; tendinitis, supraspinatus syndrome, enthesopathy of spine, elbow, ankle; temporomandibular joint disorders; fibrositis, myofascial pain syndrome; synovitis; tenosynovitis; myositis Neoplasms: benign neoplasms (e.g., ganglion cyst); malignant neoplasms of bone (eg, osteosarcoma, sarcoma, leiomyosarcoma, rhabdosarcoma); metastases to bone, secondary malignant neoplasm of bone Degenerative and metabolic disorders degenerative/metabolic disorders of bone, tendon, and cartilage: chondromalacia; disc degeneration, herniated disc; Legg-Calvé-Perthes disease; Osgood-Schlatter disease; osteodystrophy; osteomalacia; osteonecrosis (avascular), bone infarct; osteoporosis; osteopenia; osteitis deformans (Paget disease of bone); pathologic fracture; radiculopathies; spondylolisthesis/spondylosis (degenerative) degenerative/metabolic disorders of joints: gout, gouty arthritis, pseudogout; joint effusion; osteoarthritis degenerative/metabolic disorders of muscles, ligaments, fascia: Dupuytren contracture; muscle calcification and ossification; 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; 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; foot deformities (flat foot, valgus/varus deformities); osteogenesis imperfecta; McArdle disease; mitochondrial myopathies Adverse effects of drugs on the musculoskeletal system: drug-induced myopathy (eg, steroids, statins, cocaine, AZT); malignant hyperthermia Cardiovascular System 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 (eg, atrial natriuretic peptide) endothelium and secretory function, vascular smooth muscle, 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 Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, immunologic, and inflammatory disorders infectious disorders: bacterial endocarditis, myocarditis immunologic and inflammatory disorders: atherosclerosis (eg, 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; 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; 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; 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, 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 (eg, regurgitation, stenosis, prolapse, insufficiency, vegetation); functional murmurs; rheumatic heart disease; complications of artificial valves Hypotension: orthostatic hypotension Hypertension: elevated blood pressure memorizing without diagnosis of hypertension; essential hypertension; malignant hypertension; secondary hypertension Dyslipidemia: hypercholesterolemia; hyperlipidemia; hypertriglyceridemia; lipoproteins/lipoprotein lipase deficiency Vascular disorders disorders of the great vessels: aneurysm, aortic (abdominal/thoracic), dissection, ruptured; aneurysm, iliac, other peripheral vascular, ruptured; aortoiliac disease peripheral arterial vascular disease: arterial embolus/thrombosis; arteriovenous fistula; atheroembolic disease; claudication; cholesterol emboli; hypertensive vascular disease; peripheral arterial disease; thromboangiitis obliterans diseases of the veins: deep venous thrombosis, venous thromboembolism; phlebitis/thrombophlebitis; varicose veins; venous insufficiency; stasis ulcers, 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; 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 Respiratory System 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 Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, immunologic, and inflammatory disorders infectious, immunologic, and inflammatory disorders of the upper airways: acute upper respiratory infection; viral infections (adenovirus, coronaviruses, coxsackievirus, influenza virus, parainfluenza virus, rhinoviruses); sinusitis; nasopharyngitis; epiglottitis; Bordetella pertussis pneumonia; croup; acute laryngitis; acute laryngotracheitis; tracheitis; pharyngitis; streptococcal throat infections; tonsillitis; peritonsillar abscess; rhinitis, allergic, chronic; ulcers of nasal cavity/sinuses infectious, immunologic, and inflammatory disorders of the lower airways: hospitalacquired pneumonia; ventilator-associated pneumonia, community-acquired pneumonia, acute bronchiolitis; bronchiolitis obliterans with organizing pneumonia (BOOP); anthrax, pulmonary (Bacillus anthracis); aspiration pneumonia, pneumonitis; bronchitis, acute; bronchopneumonia; pneumonia (Burkholderia pseudomallei, Chlamydophila pneumoniae, Coxiella burnetii, Francisella tularensis, Haemophilus influenzae, Klebsiella pneumoniae, Legionella, Moraxella catarrhalis, Mycoplasma pneumoniae, Pseudomonas aeruginosa, Streptococcus, MSSA, MRSA, other gram‐negative bacteria); viral infection (eg, influenza A, B, adenovirus, H1N1, respiratory syncytial virus, parainfluenza virus); fungal infection (aspergillosis, including allergic bronchopulmonary aspergillosis and aspergilloma, histoplasmosis, coccidioidomycosis, Pneumocystis jirovecii); pulmonary tuberculosis; lung abscess; viral infection (eg, influenza A, B, adenovirus, respiratory syncytial virus, parainfluenza virus, avian influenza virus); fungal infection (aspergillosis, including allergic bronchopulmonary aspergillosis and aspergilloma, histoplasmosis, coccidioidomycosis, Pneumocystis jirovecii) Neoplasms benign neoplasms: upper airways (eg, vocal cord polyps, nasal polyps, juvenile papillomatosis); lungs and pleura (eg, solitary pulmonary nodule, bronchial carcinoid tumors) malignant neoplasms upper airways: lip, oral cavity, and pharynx; head and neck cancer; larynx; trachea lower airways and pleura: malignant neoplasms of bronchus and/or lung (squamous cell, adenocarcinoma, large cell, small cell); malignant neoplasms of pleura (mesothelioma); secondary malignant neoplasms of lung; secondary malignant neoplasms of pleura 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, 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; 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 upper airways: epistaxis; barotrauma, sinus; laryngeal/pharyngeal obstruction; tracheoesophageal fistula; tracheal stenosis; tracheomalacia; trauma (eg, tracheal injury); foreign body (nose, pharynx, larynx, trachea); traumatic/mechanical disorders of the nasal cavity/sinuses (eg, septal perforation) lower airways and pleura: atelectasis; diaphragm/chest wall injury; drowning and neardrowning; foreign body, upper and lower respiratory tract; penetrating chest wounds; pulmonary contusion; sleep apnea, 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 Gastrointestinal System 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 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 (eg, gastrin) salivary, gastrointestinal, pancreatic, hepatic secretory products, including enzymes, proteins, bile salts, and processes synthetic and metabolic functions of hepatocytes Repair, regeneration, and changes associated with stage of life Gastrointestinal defense mechanisms and normal flora Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, immunologic, and inflammatory disorders infectious disorders bacterial: pseudomembranous colitis (Clostridium difficile); enteritis/enteric infections (includes gastroenteritis) (eg, Staphylococcus aureus, Escherichia coli, Listeria monocytogenes, Yersinia enterocolitica, Campylobacter species, Vibrio cholerae, Salmonella species, Shigella species, traveler's/infectious diarrhea); hepatic abscess, subhepatic abscess, subphrenic abscess; peritonitis, primary and secondary; Whipple disease viral: infectious esophagitis (eg, CMV, herpes); hepatitis A, B, C, D, E; coxsackievirus enteritis/colitis; Echovirus enteritis/colitis; rotavirus enteritis; mumps; gingivostomatitis, herpetic fungal: thrush parasitic: Cryptosporidium, Cyclospora, Entamoeba histolytica, Giardia, Isospora belli, Strongyloides stercoralis immunologic and inflammatory disorders: autoimmune hepatitis; celiac disease; eosinophilic esophagitis; granulomatous enteritis; inflammatory bowel disease, including Crohn disease, regional enteritis, microscopic colitis (collagenous and lymphocytic colitis), ulcerative colitis, toxic megacolon Neoplasms benign neoplasms, including polyps, cysts: stomach; small intestine; colon, rectum, and anus, including polyps malignant neoplasms and pre-malignant conditions: oral cancer (eg, lips, mouth, tongue, salivary glands); esophageal, squamous and adenocarcinoma; Barrett esophagus; gastrinoma, Zollinger-Ellison syndrome; gastrointestinal carcinoid tumors; gastrointestinal stromal tumors; small intestine; stomach, adenocarcinoma, lymphoma, MALT; colon, rectum, anus; hereditary colon cancer syndromes, familial adenomatous polyposis (eg, Peutz-Jeghers syndrome, Gardner syndrome, Turcot syndrome, ); MUTYH-associated polyposis; gallbladder, cholangiocarcinoma, adenocarcinoma of the ampulla of Vater; liver, including hepatoma; peritoneal cancer, including metastatic studding with cancer; pancreas 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 oral cavity and salivary glands: abscessed tooth; dental caries; malocclusion; disorders of the salivary glands (eg, stones, sialadenitis, parotitis) esophagus: achalasia and cardiospasm; dysphagia; diverticulum (eg, Zenker); esophageal periapical abscess without sinus; esophagitis/esophageal reflux (GERD); esophagitis, pill; Mallory-Weiss syndrome; paraesophageal (hiatal) hernia; stricture and stenosis of esophagus Disorders of the stomach, small intestine, colon, rectum, anus stomach: dyspepsia/hyperacidity; gastric ulcer; gastritis; peptic ulcer; peptic ulcer perforation; gastroparesis small intestine, colon: appendicitis; angiodysplasia; diverticula, diverticulitis, diverticulosis; duodenitis, duodenal ulcer, peptic ulcer; gastroenteritis and colitis (noninfectious); granulomatous enterocolitis; Hirschsprung disease; impaction of intestine; intestinal obstruction/stricture; intussusception; irritable colon/irritable bowel syndrome; mesenteric ischemia/ischemic bowel/ischemic colitis; necrotizing enterocolitis; paralytic ileus; volvulus; malnutrition and malabsorption, including lactose intolerance, short bowel syndrome rectum and anus: abscess of anal and rectal regions; anal fissure; anal fistula; ulcer; fecal incontinence; hemorrhage (rectum, anus); proctitis; hemorrhoids; rectal prolapse Disorders of the liver and biliary system, noninfectious liver: cirrhosis; Dubin-Johnson, Rotor syndromes; end-stage liver disease, including indications for transplantation; Gilbert syndrome, Crigler-Najjar syndrome; hepatic coma/hepatic encephalopathy; hepatitis, noninfectious; hepatitis, fatty liver, alcoholic; hepatorenal syndrome; hepatopulmonary syndrome; jaundice; nonalcoholic fatty liver disease; portal hypertension/esophageal varices biliary system: bile duct obstruction/cholestasis; cholangitis, including ascending; choledocholithiasis; 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 (eg, blind loop syndrome, adhesions); duodenal tear; foreign body in digestive system; 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 (eg, acetaminophen, isoniazid); drug-induced pancreatitis (eg, thiazide diuretics) Renal & Urinary System 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 hormones produced by or acting on the kidney (eg, renin, aldosterone, angiotensin II, vasopressin) Repair, regeneration, and changes associated with stage of life Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, immunologic, and inflammatory disorders infectious disorders upper urinary tract: granulomatous pyelonephritis; perinephric abscess; pyelonephritis; pyonephrosis; renal abscess; renal tuberculosis lower urinary tract and urinary tract infections of unspecified location: cystitis; chlamydial and nonchlamydial immunologic and inflammatory disorders upper urinary tract glomerular disorders: Alport syndrome; glomerular disease due to hepatitis B, C; glomerulonephritis, including poststreptococcal; IgA nephropathy; lupus nephritis; minimal change disease; nephrotic syndrome; thin basement membrane disease tubular interstitial disease: acute tubular necrosis (ATN); acute interstitial nephritis; papillary necrosis; HIV nephropathy lower urinary tract: interstitial cystitis Neoplasms benign neoplasms and cysts: polycystic kidney disease malignant neoplasms: renal (eg, Wilms tumor/nephroblastoma, renal cell carcinoma, renal tumors associated with congenital/hereditary conditions); 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; 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; urethral/ureteral obstruction/stricture/prolapse; 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; tenofovir; drug - induced urinary retention Pregnancy, Childbirth, & the Puerperium Normal Processes Organ structure and function: pregnancy, including fertilization, implantation, development of embryo, labor and delivery, the puerperium, lactation, gestational uterus, placenta Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Prenatal care preconception counseling and care: folate deficiency prevention; immunizations; nutritional assessment, including vitamins; Rh screening prenatal risk assessment/prevention: adolescent pregnancy; antepartum fetal evaluation, including biophysical profile; genetic screening; α-fetoprotein; diabetes mellitus; neural tube defects; Rh isoimmunization supervision of normal pregnancy: assessment of gestational age; iron deficiency prevention; nutrition, including weight management; surveillance, including ultrasonography and assessment of fetal growth; vitamin deficiency prevention; infections, maternal, fetal, 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, 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; cardiomyopathy of pregnancy; cervical incompetence, cervical shortening; cholestasis of pregnancy, intrahepatic; congenital abnormalities, maternal (eg, bicornuate uterus); ectopic pregnancy; fetal abnormality affecting management of mother (eg, hydrocephalus, spina bifida); fetal growth restriction; gestational diabetes; maternal mortality; multiple gestation; placental abnormalities (abruptio placentae, placenta previa, premature separation of placenta); polyhydramnios, oligohydramnios; preeclampsia, eclampsia, HELLP syndrome, gestational hypertension; prolonged pregnancy; 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 (eg, breech); intrapartum fetal evaluation, including fetal heart tones; intrapartum prophylaxis (eg, HIV, Chlamydia, gonococcal prophylaxis); premature rupture of membranes; preterm (before 37 weeks' gestation) and postdates labor and delivery; threatened preterm labor Puerperium, including complications: lactation problems; breast-feeding problems; lochia; postpartum cardiomyopathy; postpartum blues; postpartum hemorrhage; postpartum sepsis; retained placenta, products of conception (eg, placenta accreta); uterine atony Newborn (birth to 4 weeks of age) normal newborn examination of liveborn at admission to hospital screening, newborn disorders of the newborn: screening, newborn; ABO incompatibility in newborn; hemolytic disease due to Rh incompatibility; birth asphyxia syndrome (liveborn neonate); birth trauma (eg, cord compression, brachial palsy, lacerations); drug withdrawal syndrome in newborn; feeding problems in newborn; fetal growth and development abnormalities, including fetal growth restriction; gastrointestinal obstruction; hypocalcemia of newborn; infections, congenital or peripartum (cytomegalovirus, herpes simplex viruses, HIV, hepatitis B, rubella virus, parvovirus B19 virus, varicella zoster virus, Chlamydia trachomatis, Streptococcus agalactiae, Treponema pallidum, Toxoplasma gondii); intrapartum fetal distress/death including stillborn; jaundice, fetal/neonatal/perinatal; laryngomalacia; macrosomia (large for gestational age); meconium aspiration syndrome; neonatal acne; neonatal Candida infection (thrush); neonatal hypoglycemia; neonatal conjunctivitis and dacryocystitis; ophthalmic gonorrhea; phenylketonuria; premature infant; postterm infant; pseudomembranous colitis of infancy; respiratory distress syndrome (hyaline membrane disease); respiratory problems after birth (eg, bronchopulmonary dysplasia, tracheomalacia; tracheoesophageal fistula in neonates); retinitis of prematurity; seizures in 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 (eg, 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; myasthenia gravis; obesity; pancreatitis; psychiatric disorders; renal calculus/calculi; renal failure/renal disease, including SLE; seizure disorders; thyroid disorders, hypothyroidism, hyperthyroidism Female Reproductive System & Breast Normal Processes Embryonic development, fetal maturation, and perinatal changes, gametogenesis Organ structure and function female structure, including breast female function (eg, 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 Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Breast infectious, immunologic, and inflammatory disorders: breast abscess; inflammatory disease of breast, fat necrosis; mastitis; nipple discharge neoplasms benign and undefined neoplasms: breast cyst, solitary; fibrocystic changes; fibroadenoma; hypertrophy of breast; intraductal papilloma malignant neoplasms (including screening): breast cancer; intraductal carcinoma; Paget disease of breast; phyllodes tumors Female reproductive system 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; cervicitis and endocervicitis; chancroid (Haemophilus ducreyi); genital herpes; gonorrhea (Neisseria gonorrhoeae); human papillomavirus infection, genital/venereal/anal warts, condylomata acuminata; lymphogranuloma venereum (Chlamydia trachomatis), non-lymphogranuloma venereum; pelvic inflammatory disease; 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 benign neoplasms and cysts: abnormal Pap smear; benign neoplasm of ovary; endocervical and endometrial polyps; leiomyomata uteri; ovarian cyst malignant and precancerous neoplasms: cervical cancer; HPV causing cancer; cervical dysplasia, HPV causing dysplasia; endometrial hyperplasia; endometrial/uterine cancer; gestational trophoblastic disease (hydatidiform mole); ovarian cancer; vulvar dysplasia and cancer Fertility and infertility: assisted reproductive techniques (ART); contraception (eg, oral contraceptives, IUD, vaginal cap, cervical sponge, diaphragm, implant, morning-after pill, male and female condoms); female 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; 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, burns, and blast injuries; ovarian torsion; pelvic relaxation; prolapse, vaginal walls, uterine, uterovaginal; 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; tricyclic antidepressants Male Reproductive System Normal Processes Embryonic development, fetal maturation, and neonatal changes, gametogenesis Organ structure and function structure, male genitalia and prostate function, male genitalia and prostate (eg, 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 Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, immunologic, and inflammatory disorders infectious disorders: balan | ||||||||
United States Medical Licensing Examination Step 1 USMLE Examination techniques | ||||||||
Other USMLE examsUSMLE United States Medical Licensing Examination Step 1 | ||||||||
Nothing is more enjoyable when you pass your USMLE exam. You come out of Test Center jumping. We work hard for your exam passing joy. We provide real exam questions of USMLE exam that we obtain from our resources in real USMLE test and incorporate it in our USMLE dumps and vce exam simulators so that candidate can benefit from it and pass their USMLE exam real fast. | ||||||||
USMLE USMLE United States Medical Licensing Examination https://killexams.com/pass4sure/exam-detail/USMLE Answer: A Question: 389 Capillary loops located in the medulla are also known as _________. A. Vasa recta B. Urea collectors C. Trigone D. Macula densa Answer: A Question: 390 The primary function of the descending loop of Henle in the kidney is? A. Reabsorption of sodium ions B. Reabsoption of water by osmosis C. Secretion of hydrogen ions D. Secretion of potassium ions Answer: B Question: 391 Which of the following is not considered a part of the male urethra? A. Prostatic B. Membranous C. Vasapore D. Penile Answer: C Question: 392 When glucose if found in urine it is called _____. A. Glucosuria B. Uremia C. Ureteritis D. Glucose intolerance 97 Answer: A Question: 393 Which of the following is not considered a component of kidney stones? A. Calcium phosphate B. Uric Acid C. Calcium oxalate D. HCO3 Answer: D Question: 394 The one of the functions occurring at the distal convoluted tubule in the kidney is? A. Passive secretion of hydrogen ions B. Passive secretion of potassium ions C. Limited re-absorption of water D. No re-absorption of sodium Answer: B Question: 395 ADH has which of the following effects on the distal convoluted tubule? A. Decrease water re-absorption B. Increase water re-absorption C. Decrease the concentration of urine D. Increase the urine volume Answer: B Question: 396 Which of the following is not associated with the role of the kidneys? A. Release of erythropoietin (hormone) B. Release of renin (enzyme) C. Release of Vitamin E D. Activate Vitamin D Answer: C 98 Question: 397 Each kidney contains approximately ______ nephrons. A. 10 million B. 1 million C. 100,000 D. 10,000 Answer: B Question: 398 The release of Angiotension II causes which of the following to occur? A. Increased filtration rate B. Decreased glomerular hydrostatic pressure C. Increase synthesis of Vitamin E D. Increased release of erythropoietin Answer: A Question: 399 Which of the following is an effect of a diuretic? A. Decreased Cardiac Output B. Increased fluid volume C. Increased sodium re-absorption D. Increased chloride ion re-absorption Answer: A Question: 400 Which of the following is not considered a loop diuretic? A. Bumetadine (BUMEX) B. Furosemide (LASIX) C. Chlorthiazide (DIURIL) D. Ethacrynic Acid (EDECRIN) Answer: C 99 For More exams visit https://killexams.com/vendors-exam-list Kill your exam at First Attempt....Guaranteed! | ||||||||
IntroductionWith the dreaded USMLE Step 1 now always around the corner -- it's now given 6 days a week, every week! -- the test has become a popular course of questions on Medscape Med Students' discussion boards. I decided to go straight to the source for some answers, so here's a Q & A with Chirag Amin, MD, and Tao Le, MD, 2 of the authors of that USMLE bible, First Aid for the USMLE Step 1 2001: A Student to Student Guide. Dr. Amin is now Vice President of Content and Community for www.medschool.com, where Dr. Le is Chief Medical Officer. Medscape: Describe the USMLE. Drs. Amin and Lee: The USMLE Step 1 computer-based test (CBT) is a 1-day test, taken on a computer, that's administered once a day (except Sunday) on a year-round basis at hundreds of testing centers around the world. The test consists of a total of 350 multiple-choice, single-best-answer questions that are broken down into seven 1-hour blocks, with 50 questions per block. Examinees are given short breaks between blocks, as well as a lunch break. M: How long in advance of Step 1 should students start preparing? Should they make studying for the USMLE a part of studying for regular courses? A&L: The USMLE Step 1 was designed to assess medical science knowledge and concepts taught during the preclinical years at a typical medical school. Therefore, medical students who studied diligently during their first- and second-year coursework end up minimizing the stress and workload of a USMLE Step 1 review. Regardless, most students start intensive examination preparation on a full-time basis (ie, 6-8 hours of studying per day) approximately 4-6 weeks before the genuine examination date. Due to differences in their medical education/training and curriculum as well as the time that often lapses since the completion of basic science coursework, international medical graduates (IMGs) usually need 2-4 months of study before taking the USMLE Step 1. M: If you have a month, as many schools provide students, what's a good schedule? A&L: In the month leading up to the exam, the majority of medical students find themselves studying anywhere from 6-12 hours each day, dividing their study time proportionally over the 7 traditional basic science disciplines, which include anatomy, behavioral sciences, biochemistry, microbiology/immunology, pathology, pharmacology, and physiology. In addition, many students devote the last week of their exam preparation to comprehensive review as well as going through sample questions. Many students recommend thorough review of the high-yield facts in First Aid for the USMLE Step 1 during the last week. Generally, students devote more time to the more clinically relevant disciplines, such as pathology, pharmacology, and microbiology/immunology. However, a common mistake that students make is not spending enough time covering all subject disciplines thoroughly. M: What books can you recommend for general review? For specific subjects? A&L: Students usually find themselves buying anywhere from 10-25 review as well as question-and-answer (Q&A) books, but most will start with our First Aid for the USMLE Step 1. The major medical publishing companies such as McGraw-Hill, Lippincott Williams & Wilkins, Blackwell Science, and Harcourt Health Sciences have several excellent titles for USMLE review. In addition, many students have benefited from books that present this basic science material from a clinical perspective, such as our Underground Clinical Vignettes series. M: What kind of surprises, in terms of subject material, have students told you about? A&L: Many medical students that we have talked to underestimate the amount of clinical material on the USMLE Step 1 examination. For example, a significant portion of the anatomy that is tested on the USMLE exam is based on one's ability to recognize anatomical structures on common radiographic images, such as x-rays, CT, and MRI scans. Furthermore, many students also leave the exam feeling somewhat intimidated regarding the clinical slant of how the basic science material is tested. Knowing specific disease pathophysiology as well as drug mechanism of action in the context of a clinical scenario is essential for doing well on the USMLE. M: Do courses work? A&L: This depends on the student's learning style and level of discipline. Only a small percentage of students take a review course for the USMLE Step 1 examination. Many students feel that they can benefit more by organizing a study schedule that is focused around their own strengths and weaknesses. However, there are some students who are not effectively able to manage their own study time. Those students may benefit from a structured review course. M: What about cramming? A&L: Because the material tested on the USMLE Step 1 examination covers a large amount of information that is learned over the course of 2 years in medical school, strict cramming is usually not an effective method for USMLE preparation. Furthermore, since many questions on the exam are asked from a clinical standpoint, requiring medical reasoning and problem-solving skills, a structured and disciplined review over the course of several weeks is far more effective in terms of doing well on the exam as compared to cramming. That being said, anecdotes abound about medical students passing just by cramming First Aid for the USMLE Step 1. Again, cramming is not recommended. M: What kind of advice do you have for international medical graduates? A&L: The most important advice for international medical graduates is to become familiar with taking exams on the computer. The vast majority of international medical graduates have never taken an exam on the computer, and this is a major obstacle. Factors such as eye strain and mouse dexterity can serve as a major obstacle when taking the examination. The more that one is able to become familiar with the specific test-taking environment, the better that person is able to concentrate on the test itself. M: Any particular advice for students who are retaking the exam after failing? Honestly assess your weaknesses and shortfalls in your previous exam preparation, and focus on improving in those areas. Retakers have the advantage of experience, and most use this advantage to their benefit in terms of revising their method of exam preparation when studying the second time around. The good news is that retakers generally have a very high pass rate. M: Can you list helpful resources? A&L: There are a number of helpful resources for USMLE preparation. In terms of textbooks, one textbook that gives an excellent overview of the exam, including a database of high-yield facts and a detailed list of useful resources, is our First Aid for the USMLE Step 1. Many students consider this book the best place to start their exam preparation. In addition, Medschool.com's community Web site (https://students.medschool.com) has a USMLE Study Center that provides a wealth of free information, including online USMLE lectures, sample training schedules, simulated exam modules, recommended books, discussion forums, and much more. Another important resource is the National Board of Medical Examiners (NBME) Web site at https://www.nbme.org, which provides students with the most up-to-date information about the examination. In today’s column, I will be closely looking at whether generative AI could potentially pass an official mental health counseling licensing exam. This is part of my ongoing in-depth series about generative AI or large language models (LLMs) that are or can be anticipated to be used for mental health guidance or advisement. Before I dive into today’s particular topic, I’d like to provide a quick background for you so that you’ll have a suitable context about the arising use of generative AI for mental health advisement purposes. I’ve mentioned this in prior columns and believe the contextual establishment is essential overall. If you are already familiar with the overarching background on this topic, you are welcome to skip down below to the next section of this discussion. The use of generative AI for mental health treatment is a burgeoning area of tremendously significant societal ramifications. We are witnessing the adoption of generative AI for providing mental health advice on a widescale basis, yet little is known about whether this is beneficial to humankind or perhaps contrastingly destructively adverse for humanity. Some would affirmatively assert that we are democratizing mental health treatment via the impending rush of low-cost always-available AI-based mental health apps. Others sharply decry that we are subjecting ourselves to a global wanton experiment in which we are the guinea pigs. Will these generative AI mental health apps steer people in ways that harm their mental health? Will people delude themselves into believing they are getting sound mental health advice, ergo foregoing treatment by human mental therapists, and become egregiously dependent on AI that at times has no demonstrative mental health improvement outcomes? Hard questions are aplenty and not being given their due airing. Furthermore, be forewarned that it is shockingly all too easy nowadays to craft a generative AI mental health app, and just about anyone anywhere can do so, including while sitting at home in their pajamas and not knowing any bona fide substance about what constitutes suitable mental health therapy. Via the use of what are referred to as establishing prompts, it is easy-peasy to make a generative AI app that purportedly gives mental health advice. No coding is required, and no software development skills are needed. We sadly are faced with a free-for-all that bodes for bad tidings, mark my words. I’ve been hammering away at this course and hope to raise awareness about where we are and where things are going when it comes to the advent of generative AI mental health advisement uses. If you’d like to get up-to-speed on my prior coverage of generative AI across a wide swath of the mental health sphere, you might consider for example these cogent analyses:
Here’s how I will approach today’s discussion. First, I will introduce you to a pioneering research study that sought to assess whether generative AI could potentially pass an exam taken by medical school students as part of their pursuit of achieving their medical degree. The exam is known as the United States Medical Licensing exam (USMLE). This study received a great deal of headlines since it showcased that generative AI seems to do well on the arduous medical exams taken by budding doctors. Next, I will share with you some salient details about an exam for mental health professionals known as the National Clinical Mental Health Counseling Examination (NCMHCE). I’m guessing you might be wondering whether generative AI might be able to do well on that type of exam. Great question, thanks. I opted to use a popular generative AI app called ChatGPT to try out a half-dozen questions from the NCMHCE. Please note that this was merely an official sample set and not by any means the full exam. Would you be surprised to know that the generative AI was able to successfully answer many of the sampled sample questions? I provide some important caveats and limitations about this mini experiment of sorts, and I want to emphasize this was principally done on an ad hoc basis and merely intended to be illustrative. Here’s the deal. Please do not jump the shark on this matter. Hold your horses. My mainstay aims here are simply to inspire others to do a deep dive on this and perform a fully comprehensive rigorous research study of an akin nature, perhaps modeled somewhat on the same approach taken by the study on the USMLE or similar such professional licensing domains. Anyway, I believe you will find this interesting, engaging, and possibly whet your appetite to find out more on these topics. My discussion is yet another angle to considering where we are and where things are going pertaining to generative AI and the field of mental health therapy. Please buckle up and prepare yourself for quite a ride. Generative AI And Medical School Standardized Licensing Exam Let’s talk about tests. We generally assume that to practice medicine a test of some kind should be required to attest to the proficiency of the person that will be serving as a medical professional. I’d like to start by discussing perhaps one of the most famous such medical proficiency tests known as the United States Medical Licensing Examination (USMLE). This is the test typically expected of those attaining a medical degree in the United States. The USMLE was devised to aid in standardizing upon one major medical examination test that would be acceptable across every state and ensure that MDs were meeting the same set of standards. The test is composed of three separate stages and is taken during medical school and also upon graduation from medical school. Here’s some additional detail as noted on the USMLE website:
Humans take the USMLE to showcase their proficiency in medicine. When you encounter a medical doctor, you are likely to assume they probably took the test and passed it. On an intuitive basis we realize that having to pass such an arduous test is impressive and helps to provide us comfort that the person knows their stuff when it comes to the medical field. Shift gears. Can generative AI potentially also be proficient enough to pass the USMLE? That’s an interesting and some would say important question worthy of considering. First, some quick background about generative AI. Realize that generative AI is not sentient and only consists of mathematical and computational pattern matching. The way that generative AI works is that a great deal of data is initially fed into a pattern-matching algorithm that tries to identify patterns in the words that humans use. Most of the modern-day generative AI apps were data trained by scanning data such as text essays and narratives that were found on the Internet. Doing this was a means of getting the pattern-matching to statistically figure out which words we use and when we tend to use those words. Generative AI is built upon the use of a large language model (LLM), which entails a large-scale data structure to hold the pattern-matching facets and the use of a vast amount of data to undertake the setup data training. There are numerous generative AI apps available nowadays, including GPT-4, Bard, Gemini, Claude, ChatGPT, etc. The one that is seemingly the most popular would be ChatGPT by AI maker OpenAI. In November 2022, OpenAI’s ChatGPT was made available to the public at large and the response was astounding in terms of how people rushed to make use of the newly released AI app. There are an estimated one hundred million active weekly users at this time. Using generative AI is relatively simple. You log into a generative AI app and enter questions or comments as prompts. The generative AI app takes your prompting and uses the already devised pattern matching based on the original data training to try and respond to your prompts. You can interact or carry on a dialogue that appears to be nearly fluent. The nature of the prompts that you use can be a make-or-break when it comes to getting something worthwhile out of using generative AI and I’ve discussed at length the use of state-of-the-art prompt engineering techniques to best leverage generative AI, see the link here. Shortly after ChatGPT was made publicly available, many AI researchers began to test the AI app by administering various well-known standardized tests to see how the AI app would do. In February 2023, a research study was posted that indicated ChatGPT had performed surprisingly well on the USMLE. The study was entitled “Performance of ChatGPT on USMLE: Potential for AI-Assisted Medical Education Using Large Language Models” by Tiffany H. Kung, Morgan Cheatham, ChatGPT, Arielle Medenilla, Czarina Sillos, Lorie De Leon, Camille Elepaño, Maria Madriaga, Rimel Aggabao, Giezel Diaz-Candido, James Maningo, Victor Tseng, PLOS Digital Health, and posted on February 9, 2023. Here is what the research paper stated overall (excerpts):
Consider mindfully those above-noted remarks from the AI research effort. ChatGPT was able to score either at or near the passing threshold for the three staged USMLE. Thus, an arduous medical proficiency exam that we expect human medical doctors to pass was nearly passed by a generative AI app. Some would decry this result as misleading in the sense that the generative AI was doing this without genuine “knowledge” akin to what humans seem to possess. The concern is that generative AI is nothing more than a so-called stochastic parrot that mimics human wording and fails to “understand” or “comprehend” what is going on. Nonetheless, the aspect that generative AI could accomplish such a feat is unto itself impressive, even if done via smoke and mirrors as some suggest. The result is additionally surprising because the researchers used ChatGPT out of the box, as it were, namely the generic version of ChatGPT. Another approach would be to add additional data training on the medical field to ChatGPT, but that’s not what they did in this experiment. A generic data-trained generative AI was able to do well on a highly specialized medical domain exam. For more about how generic generative AI can be fine-tuned to specific domains, see my coverage at the link here. Let’s consider a few other detailed aspects about the notable research result and then I’ll move to my next course of discussion. The research paper noted these salient details (excerpted):
I’d like to bring your attention to a few points made in those excerpts. Notice that the experiment consisted of identifying a sample of publicly available questions associated with the exam. The idea is to usually feed samples of questions and not necessarily an entire test per se. It is important to consider how a sample was chosen and whether the sample is suitably representative of what the full test might contain. Fair is fair. Another fairness consideration is that there is always a chance that the generative AI might have been initially data-trained on the very same questions. If those questions were found when the startup data training took place, you could say it is absurd to feed the same questions into the generative AI. The answers will likely already be known simply due to having seen the questions and their answers beforehand. If you select questions that arose after the cutoff date of the generative AI app’s data training, you are somewhat comfortable that the content wasn’t encountered already. But even that is readily questioned since the questions might have appeared in other guises. Some exams modify old questions and reuse them in later versions of the exam. There is a chance that a new question is close enough to an older question that perhaps this gives the generative AI a leg up on answering the new question. My point is that you need to carefully consider how these experiments are conducted. Overall, make sure to look at what sample was chosen and how appropriate it is. What are the odds that the generative AI has previously encountered the same or similar questions? As much as feasible, the goal is to set a fair and square playing field to see whether the generative AI can genuinely answer questions that have not previously been used as part of the data training effort. You now have a semblance of what takes place when trying to assess generative AI about being able to pass exams such as the pervasive USMLE in the medical domain. Let’s continue our exploration. Generative AI And Mental Health Therapy exam Taking The research study that explored the use of generative AI such as ChatGPT on the USMLE can serve as a role model for similar kinds of studies. The conception is to identify publicly available sample questions, administer the questions to the generative AI, and see how well or poorly the generative AI scores on answering the questions. As much as possible, try to keep the playing field level and fair. I decided to try this quickly for the field of mental health therapy or mental health counseling. There is a well-known exam known as the National Clinical Mental Health Counseling Examination (NCMHCE). sample questions are publicly posted online. I selected some of the sample questions and fed them into ChatGPT. I opted to use ChatGPT due to its immense popularity and it has generally been the default choice of similar research studies. I might note that a more advanced generative AI such as GPT-4 by OpenAI or others would likely do a better job than ChatGPT. In that manner, you could interpret the ChatGPT usage as the floor and that we might expect heightened results by using a more advanced generative AI app. There isn’t an ironclad ensure that a more advanced generative AI will do better. The odds though are in that direction. We also have to be watchful for in a sense polluting an experiment by perchance using questions that have already been seen by the generative AI during the initial data-training. Furthermore, if the generative AI is hooked up to the Internet, the AI might simply go out and find the questions and their answers, similar to a search engine, rather than trying to directly answer the questions. ChatGPT in that sense is a handy choice because the free version does not readily allow for Internet access to perform its activities and the data training was last cut off in January 2022 (at the time of writing of this discussion). Let’s dive into the ad hoc experiment by first establishing the nature of the mental health therapy or mental health counseling exam. The National Clinical Mental Health Counseling Examination (NCMHCE) is devised and administered via an organization known as the National Board for Certified Counselors, Inc. Here is what the website for the organization says (excerpts):
The gist is that this is a well-known and widely accepted organization, and the exam is likewise well-known and widely accepted. I bring this up in case you read a study that used generative AI on some relatively unknown exam or less than a stellar reputational exam, in which case, you would want to gauge the result of the study as partially on the rigor and standing of the test being given at the get-go. Here is what the website about the NCMHCE says about the exam (excerpts):
Observe some key points mentioned in those excerpts. First, the exam is used to assess entry-level clinical mental health counselors. You might say that this is handy for my ad hoc experiment since I want to focus on the keystone threshold needed to be considered suitably knowledgeable for proceeding to perform mental health therapy with genuine clients or patients. Other exams might be used to assess more advanced skill levels, but I’m aiming here to start with the usual starting point. I’m sure that other researchers are or will try to do the same for more advanced instances. Second, note that candidates who want to sit for the exam must have a graduate-level degree or higher from an accredited counseling program or as administered by an accredited college or university. This sets the bar higher than perhaps allowing an undergraduate to take the exam or maybe wantonly opening the exam to anyone who wants to take it. We can presume that the test is likely to ask questions of a hard nature. That’s good since we would want to make sure we provide something challenging to generative AI rather than some easy-peasy questions or materials. We might also note that of course, generative AI would not qualify to officially take the exam since it has not met all the criteria to do so. The official exam website provides an NCMHCE Sample Case Study that indicates the case study is considered updated as of March 2023. I selected six sample questions from this sample set. I want to loudly emphasize that this is an ad hoc selection and I do so merely to be illustrative of what might be done on a more rigorous basis. Though the date says March 2023, there of course is a chance that these questions and their answers have been around before that date, for which ChatGPT might have seen before the January 2022 cutoff date. I tried to do various probing into ChatGPT to see if the content had already been prior encountered. By and large, it doesn’t seem to be, but that’s not known for sure, and a deeper analysis would need to be undertaken to ascertain this. For the moment, let’s go with the flow and assume that the sample questions weren’t previously seen by ChatGPT during its data training. The six sampled sample questions cover these six respective topics:
Keep that in mind as I walk you through what ChatGPT provided as answers to the posed questions. The test is essentially based on case studies. For these six sampled sample questions, a case study was provided in the publicly posted material. The case study was fed into ChatGPT for this analysis. Rather than displaying for you the entirety of the case study, I will do a quick recap to bring you up to speed. In this instance, the case study entails a divorced female of age 35 who is first undertaking a mental health counseling session with a mental health therapist who has some background about the client or patient but otherwise, this is the first meeting of the two. The client or patient has already been provisionally diagnosed as having a major depressive disorder. Additional background is given about the client or patient. For example, after her divorce, she began staying in bed quite a lot and moved back in with her mother. She got fired from her job. She has had financial difficulties. Most days, she feels sad, empty, and anxious. She has joint legal custody with her ex-husband of their two children, respectively aged 10 and 12. And so on. That outlines the nature of the underlying case study. Questions And The Answers Generated By The Generative AI I am going to walk you through each of the six multiple-choice questions and also showcase the answers that were generated by ChatGPT so that you can follow along step-by-step. My initiating prompt asks ChatGPT to provide answers plus explain why each chosen answer was considered the correct answer by ChatGPT. Asking for an explanation is not necessary, but I thought getting explanations might be interesting to see. There is also a bit of prompting strategy involved, namely that by asking for an explanation the chances are that a generative AI app might be more extensive in trying to solve a given question or problem, see my discussion at the link here. You could suggest that I was aiding the generative AI by giving an establishing prompt that would urge it to do a better job than otherwise. Whenever you look at research studies doing just about anything with generative AI, make sure to find out what prompts they used. This is a significant factor related to the performance of the generative AI. Studies that fail to showcase their prompts are unfortunately doing a bit of a disservice by not revealing how they got the generative AI to undertake things. The sampled sample questions are based on the case study, and I’ve placed them in quotes to indicate they came from the case study. In some instances, the wording is slightly reworded merely and strictly for purposes of feeding them into ChatGPT. I am purposely not going to speculate or comment on the answers that are given by ChatGPT. I will simply note whether ChatGPT selected the correct multiple-choice selection as stipulated in the sample set. I’m guessing that mental health therapists and mental health counselors will undoubtedly find the explanations of special interest and will indubitably get them extensively mulling over what ChatGPT had to say. Here is my establishing prompt and the answer provided by ChatGPT:
Okay, we are good to go. Here’s the first question: “Q1. What would be the best way for a mental therapist to at initial intake seek to establish a therapeutic relationship with this person?” “A. Reflect on what is irrational about the woman’s self-evaluations.” “B. Advise her about how to manage her painful experiences.” “C. Summarize her emotions and her desire for change.” “D. Explore how she could Boost her role in relationships.”
“Answer to Q1 is C. Summarize her emotions and her desire for change.” “Explanation: Establishing a therapeutic relationship involves demonstrating empathy, understanding, and acknowledging the client's emotions. Summarizing her emotions and desire for change (Option C) helps validate her experiences and shows that the therapist is actively listening and comprehending her situation. This approach helps build rapport and sets the foundation for a collaborative therapeutic relationship. It also allows the client to feel heard and understood, creating a safe space for further exploration and intervention.” End of ChatGPT response ChatGPT selected answer C, which is considered the correct answer as per the sample set. The explanation indicates the presumed basis. I could have also asked ChatGPT to explain why the other answers weren’t as good as the selected answer. That would have gotten quite wordy and didn’t seem needed for this ad hoc analysis. A deeper study might want to consider getting a lengthier reply with a more elaborate explanation. We move to the second question: “Q2. What information should a mental health therapist explore to help the client remember her strengths?” “A. The client’s disclosure about her previous level of functioning.” “B. The client’s recollections of past mistakes. “C. The client’s feelings about her mother paying for counseling.” “D. The client’s use of cognitive distortions.”
“Answer to Q2 is A. The client’s disclosure about her previous level of functioning.” “Exploring the client's disclosure about her previous level of functioning (Option A) would be most relevant to identify and highlight her strengths. Understanding her past achievements, abilities, and positive aspects of her life before the onset of depressive symptoms can help the therapist and the client focus on resources that can be tapped into for recovery. This approach emphasizes a strengths-based perspective and encourages the client to recognize her capabilities, fostering a more positive outlook on her current situation.” End of ChatGPT response The answer indicated by ChatGPT is answer A, which is also the correct answer per the sample set. We are now two-for-two in terms of having gotten the questions right. Next, let’s see what happens with the third question: “Q3. How should a mental health therapist handle the client’s concern about confidentiality?” “A. Explain that as a mental therapist, they will share progress updates with the mother but not provide any details.” “B. Clarify what can and cannot be shared through informed consent.” “C. Request the mother’s assent to the treatment and obtain the client’s consent.” “D. Ask the client for a signed release that would include her mother as part of the treatment process.”
“Answer to Q3 is B. Clarify what can and cannot be shared through informed consent.” “The best approach is to clarify confidentiality issues through informed consent (Option B). The therapist should explain the limits of confidentiality, outlining what information can be shared and under what circumstances. This empowers the client to make an informed decision about what aspects of her treatment will remain confidential and what may need to be shared. It respects the client's autonomy and privacy while addressing concerns about the involvement of her mother in the therapy process.” End of ChatGPT response The answer indicated by ChatGPT is B, which is also the correct answer via the sample set. Three for three, so far. Here’s the fourth question: “Q4. From the perspective of the mental health therapist, what self-report from the client is a discernable criterion for the given diagnosis?” “A. Her disagreements with her mother.” “B. Her increased psychomotor agitation.” “C. Her difficulty managing her children.” “D. Her decreased pleasure in her activities.”
“Answer to Q4 is D. Her decreased pleasure in her activities.” “A discernible criterion for a major depressive disorder is often a pervasive and persistent decrease in pleasure or interest in previously enjoyed activities. This is commonly referred to as anhedonia. The client's report of not being able to remember the last time she enjoyed something and the cessation of an activity she used to find enjoyable (creating jewelry) aligns with this criterion. While other aspects, such as disagreements with her mother (Option A) or difficulty managing her children (Option C), may be related to her emotional state, the decreased pleasure in activities is a more specific indicator for depression.” End of ChatGPT response The answer indicated by ChatGPT is D, which is the correct answer according to the sample set. You will also note that this time the explanation opted to explain why the chosen answer was considered a better choice than some of the other proposed answers. We are at four of four in terms of getting the correct answers. Let’s see what occurs with the fifth question: “Q5. What criteria were likely used to determine the severity specified for the client’s major depressive disorder?” “A. The number of symptoms is not substantially in excess of those needed to make the diagnosis, yet functional impairment exists.” “B. The intensity of the symptoms is distressing but manageable, and results in minor impairment of social or occupational functioning.” “C. The intensity of symptoms is high and is accompanied by psychomotor agitation and mixed features associated with a major depressive episode.” “D. The number of symptoms and their intensity are distressing and unmanageable and interfere with the client’s social and occupational functioning.”
“Answer to Q5 is D. The number of symptoms and their intensity are distressing and unmanageable and interfere with the client’s social and occupational functioning.” “The severity specified for major depressive disorder is often determined by the number and intensity of symptoms, as well as their impact on the client's social and occupational functioning. In this case, the client reports feeling sad, empty, and anxious most days, experiences tension every day, has difficulty getting out of bed, and has ceased engaging in previously enjoyed activities. Additionally, she has lost her job, faces financial difficulties, and expresses guilt about her interactions with her children. These factors suggest a significant impact on both social and occupational functioning, aligning with the criteria for a more severe form of major depressive disorder.” End of ChatGPT response ChatGPT indicates the answer should be D, but the sample set indicates the correct answer is A. This is the first miss by ChatGPT in this set of sampled sample questions. I was curious whether ChatGPT could justify the answer D versus the answer A. One thing to keep in mind is that some generative AI apps such as ChatGPT tend to immediately back down when you challenge them about an answer. The AI will indicate that it was wrong and switch to the answer that you say is the correct answer. In a sense, this is somewhat disconcerting because you would generally prefer the AI to moderately push back and support an answer that was chosen. I am not saying this should be doggedly dogmatic. It certainly makes sense to have the AI back down if the user is telling the AI that the answer is wrong, though I think you can see how this might be a dangerous slope to slide upon. Just because a user says that something is wrong does not mean that it indeed is wrong. You can end up with the AI being too easily convinced of falsehoods simply because the user said they were truths. This is an ongoing issue of concern about generative AI, see my analysis at the link here. All in all, rather than telling the AI that it was wrong, which would possibly get it to collapse like a deck of cards, I came to the matter politely and tangentially. I merely asked ChatGPT to compare the answer D with the answer A. I didn’t tip my hand that the answer A is considered the correct answer. Here we go:
“Let's compare options D and A:” “D. The number of symptoms and their intensity are distressing and unmanageable and interfere with the client’s social and occupational functioning.” “A. The number of symptoms is not substantially in excess of those needed to make the diagnosis, yet functional impairment exists.” “The main distinction lies in the severity of functional impairment. Option D suggests that the number of symptoms and their intensity are distressing and unmanageable, leading to significant interference with social and occupational functioning. This aligns with a more severe form of major depressive disorder, where the impairment is substantial.” “On the other hand, Option A acknowledges functional impairment but does not emphasize the distressing and unmanageable nature of the symptoms. It leaves room for interpretation that the impairment might be present but not to the extent that it is distressing or unmanageable.” “In the context of major depressive disorder, severity is often determined not just by the presence of symptoms but also by the impact on daily functioning. Option D explicitly addresses the distress and interference with functioning, making it a more comprehensive and accurate description of a severe presentation of major depressive disorder.” End of ChatGPT response I’d bet that mental health professionals could readily debate the indication of ChatGPT about why one of the answers is construed as better than the other. Please do so at your leisure. Moving to the sixth and final question, take a look at this one: “Q6. From the perspective of the mental health therapist, what short-term goal would guide the treatment of the client’s presenting problem?’ “A. Spend one hour each day rewriting difficult childhood memories with her mother.” “B. Return to her previous sleep schedule to be more present with her children.” “C. Spend one hour each day journaling about her vision for her next marriage.” “D. Return to full-time work in nursing to boost her self-image and mood.”
“Answer is B. Return to her previous sleep schedule to be more present with her children.” “The most appropriate short-term goal would be to address the immediate issue affecting her daily functioning, which is her disrupted sleep schedule. Returning to her previous sleep schedule (Option B) can have a positive impact on her mood, energy levels, and ability to engage with her children. This goal is specific, achievable, and directly addresses a key factor contributing to her distress. It also aligns with improving her overall well-being and functioning in the short term.” End of ChatGPT response The answer selected by ChatGPT is answer B, which is the correct answer according to the sample set. Conclusion Please do not try to calculate the percentage of times that ChatGPT was able to correctly answer the sampled sample. Doing so would be ridiculous as this was not a rigorous experiment but instead an ad hoc one and meant solely to get the juices flowing about examining how generative AI might do on these kinds of tests. That being said, I believe there is enough indication that performing a thorough study would be worthwhile. Had the generative AI got none of the answers correctly I would probably be leaning toward suggesting that a full-on study wasn’t likely worth the effort. This snippet suggests that doing more might be valuable. There are flies in the ointment on these matters. One argument about having generative AI take these various types of tests is that there isn’t any human soul or human connection that is also being assessed, see my discussion at the link here. In other words, just because a generative AI app can answer questions on a dry test does not mean that we would want the generative AI to interact with real people in real life and provide advice as to whatever domain or realm of expertise is being tested. The argument is further amplified when considering the course of mental health. Some would assert that only another human can adequately counsel another human. An AI system is not human and does not have human experience under its belt. A counterviewpoint is that notwithstanding humanness, there is still a place for AI to aid humans, including in the sphere of mental health guidance or advice. Let’s conclude this discussion for now by invoking a famous line. The renowned American psychologist Carl Rogers purportedly said this: “In my early professional years, I was asking the question, how can I treat, or cure, or change this person? Now I would phrase the question in this way, how can I provide a relationship that this person may use for their personal growth?” Can generative AI form a relationship with humans and if so, do we want that to be how mental health is conveyed or advised? More questions ostensibly need more answers; thus, the endeavor must continue. (MENAFN- EIN Presswire) Dr. Vijay Naik, Owner of Survivors exam Preps, Reviews the Best Ways to Study for the USMLE Exam BOSTON, MA, UNITED STATES, January 4, 2024 /EINPresswire / -- Dr. Vijay Naik, founder of Survivors exam Prep, is a medical professional who has made it his mission to prepare and support aspiring doctors and physicians. With a deep understanding of the rigorous journey that lies ahead for these students, Dr. Naik founded Survivors exam Prep to offer personalized guidance and mentorship. His program has been developed based on reviews and feedback from current and previous students, ensuring that the curriculum is tailored to their needs. Dr. Naik's dedication to helping students successfully pass their USMLE exam is backed by his own experiences and the challenges he faced on his path to becoming a doctor. With Survivors exam Prep, students can feel confident that they will have the support and resources they need to thrive in their medical careers. Dr. Vijay Naik has reviewed his previous students' success and compiled three essential tips to help them pass the exam with flying colors. Understand the fundamental reasoning behind all medical information. Dr. Naik advises that by comprehending where terms come from and their function that serves a bigger purpose, students can apply the knowledge in a more effective and memorable way. Dr. Vijay Naik's tips may make the difference between success and failure for USMLE exam takers. In a exact review a previous student said, “Dr. Naik does a great job at explaining and teaching the toughest and biggest concepts in medicine. He drills you throughout the course to ensure you retain these high-yield concepts. He is a wizard when it comes to breaking down questions, and a large part of why this course is so special is the test-taking skills and principles of management that he drills into you during the course. The combination of understanding the big concepts in GI, NEURO, CARDIO, RESP, and OBGYN to name a few, coupled with the test-taking skills is what helped to boost my exam score by over 20 points.” Developing a deep and thorough understanding of medical terminology is essential for anyone pursuing a career in the healthcare industry. Fortunately, Dr. Vijay Naik offers some valuable tips for students, including the importance of consistent quizzing and testing. It's not enough to simply memorize medical terms; students must also understand how to apply them in real-life situations. By taking the time to quiz themselves and ask questions, they can develop a deep knowledge of the subject matter. Additionally, Dr. Naik also teaches test-taking skills that can help reduce stress and ensure proper time management during rigorous exams like the USMLE. With these tips in mind, students can feel confident and well-prepared as they move forward in their healthcare careers. Dr. Naik is a committed and dedicated medical professional who has made it his mission to support aspiring students in their journey to becoming successful medical practitioners. With access to a wealth of high-quality resources and up-to-date information, Dr. Naik utilizes a personalized approach to ensure that students have the tools and skills they need to succeed. His Survivors exam Prep program focuses on the unique needs of each candidate, providing essential practice materials and personalized study plans. What's more, Dr. Naik's commitment to staying up-to-date with the latest medical industry trends through updated lessons and a supportive community makes his program a trustworthy choice for anyone preparing to take the USMLE. His dedication, perseverance, and unerring belief in his students' potential make him an exemplary leader and mentor to aspiring medical professionals. Jon Smith MENAFN04012024003118003196ID1107683177 Legal Disclaimer: Orthopaedic Examination Techniques comprehensively covers the basic examination skills and key special tests needed to evaluate the adult and paediatric musculoskeletal system. Chapters are presented in a clear and logical way to allow readers to understand then master the techniques of orthopaedic clinical examination. Written by a diverse group of chapter authors with extensive experience in teaching clinical examination and who use a uniform system that is taught on national courses, every aspect of musculoskeletal examination is covered in the adult and paediatric patient. Numerous illustrations and new clinical photographs help readers to visualise and understand the key techniques, and five new chapters at the end of the book demonstrate the value of clinical examination through more than 80 clinical case examples. Easy-to-follow throughout, this book is invaluable memorizing for trainee orthopaedic surgeons, especially those preparing for the FRCS (Tr&Orth) postgraduate examination, practising orthopaedic surgeons, medical students, physiotherapists, and rheumatologists. Crossref Citations This Book has been cited by the following publications. This list is generated based on data provided by Crossref.Phillips, Jonathan R. A. and Gooding, Benjamin W. T. 2017. Postgraduate Orthopaedics. p. 9. Alazzawi, Sulaiman Sukeik, Mohamed King, Daniel and Vemulapalli, Krishna 2017. Foot and ankle history and clinical examination: A guide to everyday practice. World Journal of Orthopedics, Vol. 8, Issue. 1, p. 21. Brewer, P. E. Racy, M. Hampton, M. Mushtaq, F. Tomlinson, J. E. and Ali, F. M. 2021. A three-arm single blind randomised control trial of naïve medical students performing a shoulder joint clinical examination. BMC Medical Education, Vol. 21, Issue. 1, The example answers included in this guide are for reference only. You may need to use different exam techniques and adapt your approach to the context of the question, depending on the exam board you are following. The case study examples use the PINCC method. PINCC stands for product, industry, customers and competitors. State questions (1 mark) require you to show knowledge and therefore only require a short response. Examples of state Braindumps include: Outline questions are often a one-mark question, requiring a short phrase answer or one or two words. Examples of outline questions include: The Ministry of Health has indicated that it cannot automatically absorb all Sri Lankan doctors to the Heath Services. This, and many other reasons, may prompt a doctor to explore working overseas. One country that regularly employs a substantial number of foreign doctors is the United States of America. This question and answer session attempts to answer some of the initial questions posed by doctors interested in practicing in the US. We invite readers to ask questions from the author so that we may provide the most relevant information to those considering practicing medicine in the US. Can Sri Lankan Doctors Practice Medicine in the United States of America? Yes, there are no nationality barriers to practice medicine in the USA. The USA has a very fair system of examinations that are open to its nationals as well as foreigners. Both foreign doctors and American medical students/doctors sit for the same standardized examinations. However, hospitals usually interview their prospective doctors before they employ them. American medical graduates usually have an advantage because of the language, their familiarity with the US hospital system and the fact that there are fewer restrictions on them in general (i.e. no requirement for a work visa). However, as the amount of doctors that the US produces is grossly inadequate to cater to their demand, each year thousands of foreign doctors enter the US medical practice. In exact years about 6500 foreign medical graduates applied for US residency out of which about 45% succeed in securing a place. This is in addition to about 15,000 US medical graduate applicants out of which about 90% secure a place. First, the doctor should have graduated from a medical school that is listed in the World Health Organization (WHO) directory of medical schools. Six Sri Lankan medical faculties are in the directory. They are Colombo, Peradeniya, Jaffna, Galle, Ragama (incuding North Colombo Medical College) and Sri Jayawardenapura medical faculties. A full list is available in the United States Medical Licensing Examination (USMLE) web site. Sri Lankan doctors who have gone abroad for medical education should check whether their medical school is in the directory. The doctor should register with the Education Commission for Foreign Medical Graduates (ECFMG). This can be done online by visiting the ECFMG Web site (www.usmle.org) - CHECK. Registering involves answering many questions related to you and your medical education. All clinical appointments need to be entered with dates, consultants etc. No errors should be made during this process. Therefore it's a good idea to get the help of someone who has gone through the process to avoid delays and rejection of the application. The doctor should pass the USMLE Step 1 and Step 2 (Clinical Knowledge and Clinical Skills) examinations to be eligible to apply for residency. What is ECFMG ? What is USMLE ? How do I Register to take the USMLE? This question and answer session is the first one in a series of three. In the next session, we will be addressing issues such as, details of the different USMLE examinations, whether there is any order in which you should sit the examinations, where you can sit the examinations, advise on preparation etc. LOS ANGELES, CA / ACCESSWIRE / December 5, 2023 / For many aspiring medical professionals, the United States medical license examination is a challenging obstacle that must be overcome. Fortunately, Survivors exam Prep by Dr. Vijay Naik provides a comprehensive learning experience that is designed to help students prepare themselves for success. With access to up-to-date information and resources that have been carefully crafted by industry experts, students can rest assured that they are learning from the best of the best. Survivors exam Prep by Dr. Vijay Naik is committed to continuously improving the quality of their materials by adapting to changes in the medical industry. With a supportive community and a wealth of trusted resources, it's no wonder why so many medical professionals trust Survivors exam Prep by Dr. Vijay Naik as their go-to source for test preparation. The Survivors exam Prep by Dr. Vijay Naik offers aspiring physicians a comprehensive resource for exam preparation by providing specialized training and focus for various stages of the process. Of the three distinct programs offered, the Step 1 program is a six-week course that includes six one-on-one tutoring sessions. In the medical field, students are often overwhelmed with medical terminology and disease-specific details. This program provides the foundation for a strong understanding of medicine that will be built upon throughout a medical career. The Step 1 course emphasizes the importance of grasping key concepts rather than memorization, and encourages students to think critically and beyond surface-level details. The goal is to equip physicians with the tools they need to make informed decisions and provide quality care to their patients. With this program's focus on comprehensive learning and critical thinking, students will have the necessary skills to excel in their medical career. For students enrolled in the Survivors exam Prep by Dr. Vijay Naik , the benefits continue with Step 2 and Step 3 courses. Step 2 is a rigorous 12-week program that focuses on the practical application of medical knowledge. Students must be able to manage diseases effectively, which requires a deep understanding of the disease process and critical concepts from basic sciences. Step 3 is the ultimate test of knowledge and proficiency, with an 18-week program that includes 30 one-on-one tutoring sessions. This program tests the complete understanding of basic and clinical sciences, with a rigorous two-day examination. Through both programs, students gain invaluable knowledge and skills that will benefit them throughout their medical careers. The Survivors exam Prep by Dr. Vijay Naik offers personalized, one-on-one tutoring services for medical students who want to feel confident and prepared for the United States Medical Licensing Exam. These coaches prioritize each student's unique needs and learning style, tailoring each session to help them focus on the most critical material. With this specialized level of support and motivation, medical students can gain the tools they need to not only survive but thrive in their studies and beyond. During these tutor sessions, students work with a tutor who shares their screen and guides them through the process of solving vignettes step by step. This personalized approach to learning allows students to break down the complex information found within each vignette in the quickest and most effective way possible. With the help of these expert tutors, medical students can feel confident on test day and may be better prepared to solve even the most challenging vignettes. The Survivors exam Prep by Dr. Vijay Naik offers an array of benefits for students looking to master the concepts of medicine. With a proven success rate in assisting students to pass their USMLE tests, the course is designed system-wise, allowing students to connect the dots and understand each system in-depth. The lectures are highly interactive, with active quizzing throughout each class to keep students involved and engaged. By diving deeper into the world of medicine, students can gain a greater understanding of the human body, leading to a higher level of success on their exams and in their future careers. If you are looking to learn more about Survivors exam Prep and sign up, visit http://survivorsexamprep.com Media Contact: Dr Vijay Naik SOURCE: Survivors exam Prep View source version on accesswire.com: | ||||||||
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