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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 reading 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

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USMLE United States Medical Licensing Examination Step 1

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USMLE
USMLE
United States Medical Licensing Examination
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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
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USMLE Examination techniques - BingNews https://killexams.com/pass4sure/exam-detail/USMLE Search results USMLE Examination techniques - BingNews https://killexams.com/pass4sure/exam-detail/USMLE https://killexams.com/exam_list/USMLE The USMLE: Ten Questions

Introduction

With 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 topic 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 actual 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 give 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.

Wed, 03 Jan 2024 10:00:00 -0600 en text/html https://www.medscape.com/viewarticle/403686
An Exploratory Look At Whether Generative AI Can Pass An Official Mental Health Counseling Licensing Exam That Professionals Take

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 topic 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:

  • (1) Use of generative AI to perform mental health advisement, see the link here.
  • (2) Role-playing with generative AI and the mental health ramifications, see the link here.
  • (3) Generative AI is both a cure and a curse when it comes to the loneliness epidemic, see the link here.
  • (4) Mental health therapies struggle with the Dodo verdict for which generative AI might help, see the link here.
  • (5) Mental health apps are predicted to embrace multi-modal, e-wearables, and a slew of new AI advances, see the link here.
  • (6) AI for mental health got its start via ELIZA and PARRY, here’s how it compares to generative AI, see the link here.
  • (7) The latest online trend entails using generative AI as a rage-room catalyst, see the link here.
  • (8) Watching out for when generative AI is a mental manipulator of humans, see the link here.
  • (9) FTC aiming to crack down on outlandish claims regarding what AI can and cannot do, see the link here.
  • (10) Important AI lessons learned from the mental health eating-disorders chatbot Tessa that went awry and had to be shut down, see the link here.
  • (11) Generative AI that is devised to express humility might be a misguided approach including when used for mental health advisement, see the link here.
  • (12) Creatively judging those AI-powered mental health chatbots via the use of AI levels of autonomy, see the link here.
  • (13) Considering whether generative AI should be bold and brazen or meek and mild when proffering AI mental health advisement to humans, see the link here.
  • (14) Theory of Mind (ToM) is an important tool for mental health therapists and the question arises whether generative AI can do the same, see the link here.
  • And so on.

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:

  • “In the United States and its territories, the individual medical licensing authorities (‘state medical boards’) of the various jurisdictions grant a license to practice medicine. Each medical licensing authority sets its own rules and regulations and requires passing an examination that demonstrates qualification for licensure. Results of the USMLE are reported to these authorities for use in granting the initial license to practice medicine. The USMLE provides them with a common evaluation system for applicants for initial medical licensure.”
  • “USMLE was created in response to the need for one path to medical licensure for allopathic physicians in the United States. Before USMLE, multiple examinations (the NBME Parts examination and the Federation Licensing Examination [FLEX]) offered paths to medical licensure. It was desirable to create one examination system accepted in every state, to ensure that all licensed MDs had passed the same assessment standards – no matter in which school or which country they had trained.”
  • “The United States Medical Licensing Examination® (USMLE®) is a three-step examination for medical licensure in the U.S. The USMLE assesses a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care.”

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):

  • “We evaluated the performance of a large language model called ChatGPT on the United States Medical Licensing Exam (USMLE), which consists of three exams: Step 1, Step 2CK, and Step 3. ChatGPT performed at or near the passing threshold for all three exams without any specialized training or reinforcement. Additionally, ChatGPT demonstrated a high level of concordance and insight in its explanations.”
  • “USMLE questions are textually and conceptually dense; text vignettes contain multimodal clinical data (i.e., history, physical examination, laboratory values, and study results) often used to generate ambiguous scenarios with closely-related differential diagnoses.”

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 actual “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 topic of discussion.

The research paper noted these salient details (excerpted):

  • “The data analyzed in this study were obtained from USMLE sample question sets which are publicly available.”
  • “376 publicly-available test questions were obtained from the June 2022 sample exam release on the official USMLE website. Random spot checking was performed to ensure that none of the answers, explanations, or related content were indexed on Google prior to January 1, 2022, representing the last date accessible to the ChatGPT training dataset. All sample test questions were screened, and questions containing visual assets such as clinical images, medical photography, and graphs were removed. After filtering, 305 USMLE items (Step 1: 93, Step 2CK: 99, Step 3: 113) were advanced to encoding.”
  • “In this present study, ChatGPT performed at >50% accuracy across all examinations, exceeding 60% in most analyses. The USMLE pass threshold, while varying by year, is approximately 60%.”
  • “Therefore, ChatGPT is now comfortably within the passing range. Being the first experiment to reach this benchmark, we believe this is a surprising and impressive result. Moreover, we provided no prompting or training to the AI, minimized grounding bias by expunging the AI session before inputting each question variant, and avoided chain-of-thought biasing by requesting forced justification only as the final input.”

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 guarantee 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 National Board for Certified Counselors, Inc. and Affiliates (NBCC) is the premier credentialing body for counselors, ensuring that counselors who become nationally certified have achieved the highest standard of practice through education, examination, supervision, experience, and ethical guidelines.”
  • “Established as a not-for-profit, independent certification organization in 1982, NBCC’s original and primary purposes have broadened, and its divisions and affiliates have taken on additional responsibilities to advance the counseling profession and enhance mental health worldwide.”
  • “Today, there are over 69,000 National Certified Counselors (NCCs) in more than 40 countries.”

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):

  • “The National Clinical Mental Health Counseling Examination (NCMHCE) is designed to assess the knowledge, skills, and abilities determined to be important for providing effective counseling services. The NCMHCE is a requirement for counselor licensure in many states. It is one of two examination options for the National Certified Counselor (NCC) certification and also fulfills the examination requirement for the Certified Clinical Mental Health Counselor (CCMHC) specialty certification.”
  • “The NCMHCE measures an individual’s ability to apply and evaluate knowledge in core counselor skills and competencies and to practice competently as a professional counselor. Specifically, it assesses an entry-level clinical mental health counselor’s ability to apply knowledge of theoretical and skill-based tenets to clinical case studies. The case studies are designed to capture a candidate’s ability to identify, analyze, diagnose, and develop plans for treatment of clinical concerns.”
  • “Candidates for the NCMHCE must have a graduate-level degree or higher from a counseling program accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP) or administered by an institutionally accredited college or university. The counseling degree program must contain courses in eight requirement areas.”

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 actual 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 give 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:

  • Q1. Establish a therapeutic alliance.
  • Q2. Identify strengths that improve the likelihood of goal attainment.
  • Q3. Discuss limits of confidentiality.
  • Q4. Determine a diagnosis.
  • Q5. Assess the presenting problem and level of distress.
  • Q6. Establish short- and long-term counseling goals consistent with the client’s diagnosis.

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:

  • My prompt: “I am going to ask you a series of questions about the case study. The questions are multiple-choice. You are to select an answer of either A, B, C, or D from the choices provided for each question. I want you to carefully read each question and then indicate which answer is the best answer of the choices provided. You are to also explain why the answer you’ve chosen is the best answer. Are you ready to answer the first question?”
  • ChatGPT generated a response: “Yes, I'm ready. Please proceed with the first question.”

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 improve her role in relationships.”

  • ChatGPT generated response:

“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.”

  • ChatGPT generated response:

“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.”

  • ChatGPT generated response:

“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.”

  • ChatGPT generated response:

“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.”

  • ChatGPT generated response:

“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:

  • My prompt: “I'd like you to compare the answer D that you selected to the choice A. What makes answer D better than answer A?”
  • ChatGPT generated response:

“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.”

  • ChatGPT generated response:

“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 topic 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.

Mon, 01 Jan 2024 09:36:00 -0600 Lance Eliot en text/html https://www.forbes.com/sites/lanceeliot/2024/01/01/an-exploratory-look-at-whether-generative-ai-can-pass-an-official-mental-health-counseling-licensing-exam-that-professionals-take/
Dr. Vijay Naik, Owner Of Survivors Exam Preps, Reviews The Best Ways To Study For The USMLE Exam

(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.
Pay attention to current medical information as medicine is an ever-evolving field, and it's crucial to stay updated.
Invest in joining a study program such as Survivors Exam Prep. This program offers access to the exact course material, one-on-one help, and access to all the questions students may have.

Dr. Vijay Naik's tips may make the difference between success and failure for USMLE Exam takers.

In a recent 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
News Live
email us here

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Orthopaedic Examination Techniques

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 reading for trainee orthopaedic surgeons, especially those preparing for the FRCS (Tr&Orth) postgraduate examination, practising orthopaedic surgeons, medical students, physiotherapists, and rheumatologists.

Wed, 06 Dec 2023 07:53:00 -0600 en text/html https://www.cambridge.org/core/books/orthopaedic-examination-techniques/4B2330B31DB9D6A0910CA69DBBD41FB1
Examination Techniques in Orthopaedics

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,


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Introduction and state vs outline

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 questions and answers include:

Outline questions are often a one-mark question, requiring a short phrase answer or one or two words.

Examples of outline questions include:

Mon, 01 Jan 2024 18:54:00 -0600 en-GB text/html https://www.bbc.co.uk/bitesize/guides/zj2ff4j/revision/1
USMLE - The Gateway for Sri Lankan doctors to practice in the USA.

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 recent 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.
What are the things a doctor has to do to be eligible to practice medicine in America?

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 ?
ECFMG is the Education Commission for Foreign Medical Graduates. It is the entity that coordinates all examination related affairs of a foreign medical graduate until he or she has completed residency. It also sponsors foreign medical graduates so that they legally work in the US during their period of training as a resident.

What is USMLE ?
USMLE is the United States Medical Licensing Examination . The USMLE consists of 3 steps, Step 1, Step 2 and Step 3. In step 1, students are mainly tested in the pre-clinical subjects. Step 2 has two parts, Step 2 CK or Clinical Knowledge and Step 2 CS or Clinical Skills. Then there is the Step 3. Step 3 is not necessary to get a residency. Most US doctors do Step 3 during their 2nd or 3rd year of residency. Doing Step 3 early is a special advantage to foreign doctors as there are certain advantages in securing a less restrictive working visa if all USMLE examinations have been passed at the time of applying.

How do I Register to take the USMLE?
Unlike US doctors, foreign medical graduates do not directly register with the USMLE. They register with the ECFMG to do the USMLE examination. As I have stated earlier, one should first visit the ECFMG web site, apply and get a registration number from ECFMG. This number is necessary to fill the online application for the USMLE examinations. The ECFMG and USMLE examination application process can take quite some time as the ECFMG writes directly to your medical school and gets your transcript etc.

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.
"Please log in to www.sl2college.com and visit the USMLE forum to post your questions. The questions will be used as a guide to generate the next article by the author."

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Exam Tips No result found, try new keyword!Exam days can be stressful and to reduce down the pressure on your kids, your must follow some diet tricks. Today, we have listed some of the foods that one should avoid during exams. After the ... Sat, 13 Oct 2018 18:32:00 -0500 en text/html https://www.thehealthsite.com/topics/exam-tips/ Survivors Exam Preps Discusses the Benefits of Survivors Exam Preps for Students taking the USMLE test

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
Website: http://survivorsexamprep.com
Phone Number: +1 (610) 7877020
Email: registration@survivorscourses.com

SOURCE: Survivors Exam Prep

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