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USMLE Step 1 · Step 2 CK · Step 3 Topic Mapping

A comprehensive breakdown of clinical and foundational topics tested across the three USMLE examinations. Use this guide to align your study efforts with the exam content outlines.

3
Exam levels
25+
Core disciplines
100+
High‑yield topics
STEP 1

Foundational Sciences

  • Biochemistry & Nutrition: Methionine synthesis in B12 deficiency; fat malabsorption (vitamin A); familial hypercholesterolemia (LDL receptor); unconjugated bilirubin overload (pigment gallstones in sickle cell); purine metabolism (uric acid calculi); ATP synthesis in mitochondrial myopathies.
  • Gross Anatomy & Embryology: Metanephros fusion (horseshoe kidney); spinal cord lesion at C7; medial longitudinal fasciculus & abducens nerve anatomy; left ventricular hypertrophy; vascular territory of middle cerebral artery.
  • Histology & Cell Biology: Loss of unmyelinated nerve structures → loss of pain/temperature sensation; decreased epithelial cadherins in gastric adenocarcinoma; type II pneumocyte proliferation in ARDS repair.
  • Microbiology & Immunology: Ebola virus detection (RT-PCR); pertussis (macrolide therapy); Epstein‑Barr virus (infectious mononucleosis); viral meningitis (enterovirus); immune deficiency (RAG1/RAG2 alteration); allergy desensitization (IgG blocking antibodies).
  • Pathology (General & Systemic): Emphysema (PFTs); Goodpasture syndrome; Marfan syndrome (stretched aortic annulus); aortic dissection; urothelial carcinoma; atherosclerosis vs. fibromuscular dysplasia; Barrett esophagus; osteoporotic vertebral fractures.
  • Pharmacology: Drug interactions (ciprofloxacin inducing cytochrome enzymes affecting warfarin); ACE inhibitor adverse effects (hyperkalemia); MAO‑B inhibitors for Parkinson disease; amphetamine toxicity (sympathomimetic activity); methotrexate toxicity rescue.
  • Behavioral Sciences & Ethics: Bipolar disorder (manic phase with psychotic features); proper disclosure of bad news (Down syndrome); mechanism of alcohol withdrawal pharmacotherapy.
  • Biostatistics: Normal distribution calculations; Type I and Type II errors; calculating false positives in screening populations.
STEP 2 CK

Clinical Knowledge

  • Internal Medicine (Cardiology, Pulmonology, GI): Atrial fibrillation & amiodarone adverse effects; aortic valve replacement radiologic identification; heart failure & PE diagnostics (BNP vs. D‑dimer); asthma step‑up therapy; COPD exacerbation & PFTs; bleeding esophageal varices (octreotide, endoscopy).
  • Surgery & Emergency Medicine: Right ventricular infarction hemodynamics; acute stroke imaging (CT angiography); cardiac tamponade (FAST, pericardiocentesis); tension pneumothorax (tube thoracostomy); acute spinal cord contusion.
  • Pediatrics: Osteogenesis imperfecta (audiography screening); reactive attachment disorder; cystic fibrosis exacerbations; normal adolescent psychosocial development vs. oppositional defiant disorder.
  • Obstetrics & Gynecology: Hypothalamic hypogonadism (exercise‑induced amenorrhea); postmenopausal bleeding (endometrial biopsy); gestational diabetes screening; Rh isoimmunization (RhoGAM); ectopic pregnancy.
  • Psychiatry: Panic disorder; generalized anxiety disorder; somatic symptom disorder; lithium toxicity triggered by dehydration/exercise.
  • Patient Safety, Ethics & QI: Surrogate decision‑making (health care proxies); handoff & communication errors; preventing wrong‑site surgery (consent & marking); systems‑based interventions (standardized orders, diagnosis‑driven reminders); C. difficile contact precautions; duty to report an impaired physician.
  • Biostatistics & Medical Literature: Interpreting abstracts for opioid use disorder treatments (buprenorphine vs. methadone); absolute risk reduction calculations; interpreting Kaplan‑Meier survival curves.
STEP 3

Patient Management

  • Critical Care & Emergency Medicine: Acute COPD exacerbation with ventilation refusal (advance directives); pneumococcal pneumonia matching perfusion/positioning; septic shock from Vibrio vulnificus; acetaminophen and alcohol overdose prognosis; severe DKA with cerebral edema (mannitol therapy).
  • General Internal Medicine: Outpatient CAD management (adding lisinopril post‑MI); atypical femur fractures (bisphosphonates); thyrotoxicosis; amaurosis fugax & TIA (carotid ultrasonography).
  • Infectious Disease: Postpartum mastitis progressing to abscess; doxycycline‑induced Jarisch‑Herxheimer reaction in Lyme disease; Rocky Mountain spotted fever (tick vector); HIV perinatal transmission risk factors; methimazole‑induced agranulocytosis.
  • Neurology & Psychiatry: Psychogenic non‑epileptic seizures (video EEG monitoring); adjustment disorder with anxiety; neuroleptic malignant syndrome (haloperidol discontinuation).
  • Surgery, Orthopedics & Rehab: Colon cancer metastasis surveillance; scaphoid fracture casting; postoperative pain management in sleep apnea (bupivacaine nerve block); lower extremity amputation prosthetic hindrance (hip flexion contractures).
  • Pediatrics & OB/GYN: SIDS risk factors (maternal smoking); supporting breastfeeding when returning to work; methadone maintenance during pregnancy; PCOS (uterine cancer risk counseling); HPV vaccine anticipatory guidance.
  • Biostatistics, Safety & Systems‑Based Practice: Interpreting pharmaceutical ads for ADHD medications; analyzing ROC curves for rapid flu tests; managing polypharmacy without records; ICU team communication & common mental models.

Mapping methodology & references

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