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Core Advanced Internal Medicine Core Pathway ### Basic Sciences 2,168 questions #### Anatomy for anesthesia (airway, neuraxial, vascular, regional) 50 - Neuraxial anatomy and dermatomes - Dermatome and block height assessment 4 - Meninges and CSF spaces 4 - Vertebral column and ligamentous structures 4 - Peripheral nerve anatomy (regional anesthesia essentials) - Brachial plexus overview 5 - Lower limb plexuses 5 - Truncal blocks anatomy 5 - Upper airway anatomy and airway assessment landmarks - Airway examination correlates 5 - Nasal and oral cavity anatomy 4 - Pharynx and larynx anatomy 5 - Vascular access anatomy - Arterial access anatomy 4 - Central venous anatomy 5 #### Anatomy, Surgical Anatomy & Pelvic Support 70 Gross and applied anatomy relevant to obstetrics, gynecology, pelvic surgery, continence/prolapse, a... - Adnexa and tubo-ovarian anatomy - Broad ligament spaces and adnexal torsion anatomy 2 - Fallopian tube segments and function 3 - Ovary—blood supply and surgical implications 2 - Parametrium and ureteric course 2 - Pelvic sidewall landmarks 3 - Bony pelvis, pelvic diameters, and obstetric biomechanics - Anatomy relevant to operative vaginal birth 3 - Maternal pelvis shapes and relevance 3 - Mechanisms of labor and fetal head molding 3 - Pelvic floor interaction with birth 3 - Pelvimetry concepts and clinical utility 2 - Breast anatomy and lactation-relevant structures - Breast ducts, lobules, and lymphatics 3 - Breast imaging anatomy correlation 2 - Nipple–areolar complex anatomy 3 - Physiology-anatomy interface in lactation 3 - Surgical anatomy (duct excision, abscess drainage) basics 3 - Pelvic floor, continence mechanisms and anorectal anatomy - Anal sphincter complex 4 - Levator ani and fascial supports 3 - Lower urinary tract anatomy 2 - Neurovascular anatomy relevant to pelvic pain 3 - Perineum and episiotomy landmarks 3 - Uterus, cervix, vagina and vulva—applied anatomy - Cervical anatomy and transformation zone 2 - Lymphatic drainage of lower genital tract 3 - Uterine layers and supporting ligaments 3 - Vaginal anatomy and fornices 3 - Vulvar anatomy 4 #### Applied Anatomy for Emergency Care 117 Regional anatomy relevant to resuscitation, procedures, and time-critical diagnosis. - Abdominal and pelvic anatomy for acute abdomen - Appendix, bowel, mesentery 5 - Genitourinary anatomy 5 - Hepatobiliary and pancreatic anatomy 5 - Pelvic anatomy and hemorrhage 3 - Peritoneal spaces and referred pain 5 - Airway, neck, and upper aerodigestive anatomy - Airway edema/obstruction implications 5 - Larynx and trachea 4 - Neck vascular/nerve structures 4 - Surgical airway anatomy (foundational) 4 - Upper airway landmarks 5 - Musculoskeletal compartments and vascular anatomy - Compartment syndrome anatomy 4 - Fracture patterns and growth plates (intro) 5 - Major joints: stability and reduction basics 5 - Ultrasound-relevant vascular anatomy 5 - Vascular anatomy for hemorrhage control 5 - Neuroanatomy and spinal anatomy for EM - Cerebral vascular territories (exam-relevant) 5 - Intracranial compartments and herniation 4 - Ocular and orbital anatomy 5 - Peripheral nerve anatomy for injuries/blocks 5 - Spinal cord/nerve root anatomy 5 - Thoracic anatomy and pleura - Chest wall, ribs, diaphragm 5 - Mediastinum and great vessels 6 - Pericardium and cardiac anatomy basics 5 - Pleural spaces and lung lobes 5 - Procedural anatomy (thoracic) 3 #### Biochemistry, Metabolism & Nutrition 37 Core metabolic pathways, organ metabolism, and clinically important deficiencies/excesses. - Carbohydrate and lipid metabolism (clinically applied) - Glycolysis/gluconeogenesis concepts 3 - Inborn errors (overview) 4 - Lipid metabolism 3 - Obesity and insulin resistance 2 - Micronutrients and deficiency syndromes - Fat-soluble vitamins 3 - Refeeding syndrome 3 - Trace elements 3 - Water-soluble vitamins 3 - Protein metabolism and liver synthetic function - Albumin and oncotic pressure 4 - Amino acid metabolism 4 - Bilirubin metabolism 3 - Coagulation factors synthesis 2 #### Cardiovascular physiology and measurement 71 - Cardiac electrophysiology and ECG basics - Arrhythmia mechanisms (exam core) 5 - Cardiac action potentials 4 - Conduction system anatomy/physiology 5 - Defibrillation/cardioversion principles 5 - ECG interpretation for anesthesia 5 - Cardiac pump function and determinants of CO - Autonomic control of circulation 5 - Determinants of SVR and MAP 4 - Frank–Starling physiology 5 - Myocardial oxygen supply/demand 5 - Pressure–volume concepts 6 - Shock physiology (core principles) 5 - Oxygen transport and hemodynamic oxygenation metrics - Hemoglobin–oxygen dissociation curve 4 - Microcirculation basics 5 - Oxygen consumption and extraction 4 - Oxygen content and delivery 4 #### Cellular & Molecular Biology 43 Core cellular structure/function and signaling relevant to disease mechanisms and therapeutics. - Cell structure, organelles, and trafficking - Cell cycle, apoptosis, necrosis 3 - Cell–cell junctions and extracellular matrix 4 - Membrane structure & transport 4 - Organelles and key functions 4 - Oncogenesis fundamentals - Cancer immunology (intro) 3 - Carcinogenesis & exposures 3 - Hallmarks of cancer (board-level) 3 - Tumor suppressors and oncogenes 4 - Signal transduction & second messengers - Inflammation signaling 4 - Pharmacologic implications 3 - Receptor classes 4 - Second messengers 4 #### Clinical epidemiology, biostatistics, and evidence-based practice 55 Board-relevant study design, diagnostic testing performance, screening, clinical decision-making, an... - Basic statistics interpretation (board level) - Confidence intervals 3 - Hypothesis testing and p-values 3 - Inter-rater reliability and kappa 2 - Measures of central tendency and spread 3 - Regression basics (conceptual) 3 - Diagnostic test characteristics - Decision rules (e.g., PECARN concept) 3 - Interpreting lab reference ranges in pediatrics 3 - Likelihood ratios and post-test probability 2 - ROC curves and thresholds (conceptual) 2 - Sensitivity, specificity, predictive values 3 - Screening principles and prevention evidence - Clinical practice guidelines (CPGs) 3 - Criteria for screening programs 4 - Ethics in evidence application 3 - Number needed to treat/harm 3 - Public health measures and outbreak basics 2 - Study designs and hierarchy of evidence - Diagnostic test studies 3 - Interventional studies (RCTs) 3 - Observational studies (cohort, case-control, cross-sectional) 2 - Quality improvement vs research (distinction) 3 - Systematic reviews and meta-analyses 2 #### Clinical pharmacology and therapeutics (core) 76 Weight-based dosing, pediatric pharmacokinetics/dynamics, antimicrobial fundamentals, common drug cl... - Analgesia, sedation, and peri-procedural medications - Common agents and adverse effects 4 - Local anesthetics and toxicity 4 - Non-opioid analgesics 3 - Opioids and respiratory depression risk 3 - Procedural sedation core concepts 4 - Antimicrobial classes and selection (foundational) - Aminoglycosides and nephro/ototoxicity 2 - Antiviral/antifungal overview (core) 3 - Beta-lactams and cephalosporins 4 - Macrolides and atypical coverage 3 - MRSA agents (clindamycin, TMP-SMX, vancomycin, linezolid) 2 - Common pediatric chronic medication classes (core board level) - Antiepileptic drugs overview 3 - Asthma/allergy pharmacotherapy basics 4 - Cardiac medications basics 3 - Endocrine medications basics 3 - Psychotropic basics (overview) 3 - Pediatric dosing principles and medication safety - Adverse drug reaction types 3 - Medication reconciliation and error prevention 3 - Routes of administration and bioavailability 3 - Therapeutic drug monitoring (TDM) basics 3 - Weight-based dosing and dose limits 2 - Pediatric pharmacokinetics and pharmacodynamics - Absorption differences by age 3 - Distribution (body water/fat, protein binding) 3 - Elimination (renal maturation) 3 - Metabolism (hepatic enzymes) 2 - Pharmacogenomics basics (board overview) 3 #### Core anesthesia pharmacology (drug classes) 95 - Cardiovascular drugs commonly used in anesthesia - Antiarrhythmics (core familiarity) 4 - Antihypertensives and antianginals 5 - Vasopressors and inotropes 6 - Inhalational anesthetics - MAC and factors affecting MAC 6 - Organ effects and toxicity 6 - Special phenomena 5 - Uptake and distribution 4 - Intravenous induction agents and sedatives - Benzodiazepines 4 - Dexmedetomidine and alpha-2 agonists 4 - Etomidate 4 - Ketamine 5 - Propofol 5 - Neuromuscular blockers and reversal agents - Depolarizing blockade (succinylcholine) 4 - Monitoring and reversal 4 - NMJ physiology relevant to blockade 5 - Nondepolarizing blockade 4 - Opioids and adjunct analgesics - Adjuvant analgesics (exam-relevant) 4 - Common IV opioids in anesthesia 5 - Non-opioid analgesics (core) 5 - Opioid receptor pharmacology 6 #### Core Physiology and Pathophysiology 147 High-yield physiologic principles that underpin ED presentation patterns and first-line therapy. - Acid–base physiology and interpretation - Metabolic acidosis 4 - Metabolic alkalosis 5 - Osmolar gap and toxin clues 4 - Respiratory acidosis/alkalosis 5 - Systematic interpretation approach 5 - Inflammation, immunity, and sepsis pathobiology - Anaphylaxis physiology 5 - Coagulation-inflammation interface 5 - Fever physiology 4 - Host response to infection 6 - Vaccines, immunization status, and ED relevance 5 - Neurophysiology of consciousness, seizure, and delirium - Delirium and encephalopathy mechanisms 3 - Raised ICP physiology 4 - Reticular activating system and coma basics 6 - Seizure generation and termination (conceptual) 4 - Temperature and CNS function 5 - Oxygen delivery, shock physiology, and perfusion - Determinants of oxygen delivery 4 - Fluid responsiveness and endpoints 5 - Reperfusion and resuscitation complications 5 - Shock classification and physiology 6 - Vasopressors/inotropes physiology 6 - Renal physiology and electrolyte homeostasis - Acute kidney injury pathophysiology 6 - Calcium, magnesium, phosphate physiology 6 - Diuretics and renal pharmacodynamics (intro) 5 - Potassium physiology and membrane excitability 6 - Sodium and water balance 5 - Respiratory mechanics and gas exchange - Acid-base interplay in respiratory disease 4 - Hypoxemia mechanisms 5 - Ventilation strategy principles (intro) 5 - Ventilation vs oxygenation concepts 5 - Work of breathing and fatigue 4 #### Developmental physiology and anatomy 103 Age-dependent structure and function across fetal, neonatal, infant, child, and adolescent stages re... - GI, hepatic, and pancreatic developmental physiology - Bilirubin metabolism 2 - Feeding physiology and gastric emptying 4 - Gut microbiome concepts (board-relevant) 3 - Liver synthetic function and vitamin K 3 - Pancreatic function maturation 2 - Neurodevelopmental physiology (foundation) - Brain development timing and vulnerability 3 - Intracranial pressure basics 3 - Pain pathways and developmental differences 3 - Seizure physiology overview 3 - Sleep physiology across development 3 - Fetal-to-neonatal transition physiology - Cardiovascular transition and shunts 3 - Neonatal glucose homeostasis 3 - Placental to pulmonary gas exchange transition 3 - Respiratory adaptation 3 - Thermoregulation at birth 3 - Hematopoiesis and pediatric hemostasis basics - Age-based CBC norms 3 - Coagulation and bleeding evaluation foundations 3 - Hemoglobin switching and oxygen affinity 3 - Iron metabolism and erythropoiesis 3 - Transfusion medicine basics 4 - Pediatric cardiovascular physiology basics - Blood pressure norms and perfusion 3 - Cardiac output determinants by age 2 - Congenital heart physiology patterns 3 - Oxygen delivery and consumption 2 - Shock physiology overview 3 - Pediatric respiratory mechanics basics - Age-dependent airway anatomy 3 - Basic blood gas interpretation 4 - Pulmonary defense mechanisms 3 - Ventilation-perfusion relationships 3 - Work of breathing and fatigue 2 - Renal maturation and fluid homeostasis - Acid handling and bicarbonate physiology 3 - Neonatal electrolyte vulnerabilities 3 - Neonatal renal function and GFR maturation 3 - Urine output norms and interpretation 3 - Water balance regulation 3 #### Embryology, Fetal Development & Congenital Anomalies 42 Embryology and developmental physiology underpinning congenital anomalies and reproductive tract dis... - Gametogenesis, fertilization, implantation and early placentation - Amniotic fluid development and regulation 3 - Fertilization and early embryo development 2 - Implantation physiology and abnormal implantation 3 - Oogenesis and spermatogenesis essentials 3 - Placental development and cord formation 3 - Müllerian development and reproductive tract anomalies - Cervical insufficiency developmental considerations 2 - Congenital anomalies—screening principles 3 - Müllerian duct fusion and canalization 3 - Ovarian and testicular differentiation 3 - Urogenital sinus development 2 - Organogenesis and teratology timing - Common teratogens and patterns 5 - Congenital infection pathogenesis (TORCH concept) 3 - Critical periods of development 2 - Fetal growth regulation 2 - Placental transfer and fetal drug exposure 3 #### Emergency Pharmacology and Therapeutics 117 PK/PD and emergency drug classes frequently tested and used in ED resuscitation and symptom control. - Analgesia in emergency medicine - Ketamine for analgesia 3 - Non-opioid analgesics 5 - Opioid pharmacology and safe prescribing 6 - Pain syndromes and multimodal strategy 4 - Regional anesthesia principles (intro) 5 - Antimicrobials and stewardship essentials - Allergy, anaphylaxis, and cross-reactivity 5 - Antibiotic adverse effects 5 - Antiviral/antifungal (board-level) 5 - Empiric antibiotic selection principles 4 - High-yield ED syndromes (empiric) 4 - Cardiovascular and vasoactive medications - Antiarrhythmics and rate control 5 - Antihypertensives in emergencies 5 - Antithrombotics and reperfusion adjuncts 6 - Reversal agents (core overview) 5 - Vasopressors/inotropes 5 - Pharmacokinetics/pharmacodynamics in the ED - Absorption, distribution, metabolism, elimination 4 - Drug interactions and adverse drug events 5 - Medication safety principles 5 - Onset/offset and context-sensitive half-time 5 - Pharmacogenomics and variability (board-level) 3 - Sedation, induction agents, and anxiolysis - Benzodiazepines 5 - Dexmedetomidine (board-level overview) 4 - Ketamine dissociation 4 - Procedural sedation safety 5 - Propofol and etomidate basics 5 #### Epidemiology, Biostatistics & Evidence-Based Medicine 45 Study design, bias, test performance, causality, and applying evidence to patient care. - Clinical guidelines and evidence synthesis - Ethics in research 3 - GRADE and strength of recommendation 3 - Implementation and de-implementation 3 - Systematic reviews/meta-analyses 3 - Diagnostic test interpretation - Bayesian reasoning 2 - Core measures 3 - ROC curves and thresholds 2 - Screening principles 3 - Study design and validity - Bias and confounding 3 - Causality and inference 3 - Interventional trials 3 - Observational designs 4 - Treatment effects and risk - Decision analysis basics 3 - Effect size measures 2 - Heterogeneity and subgroup analyses 3 - Time-to-event analysis 2 #### Fluids, electrolytes, and acid–base 83 Core calculations and physiologic reasoning for pediatric fluid management, electrolyte abnormalitie... - Calcium, magnesium, and phosphate disorders - Hypercalcemia differential and initial workup 2 - Hypomagnesemia and refractory hypokalemia/hypocalcemia 2 - Neonatal hypocalcemia (early/late) 3 - Phosphate abnormalities (refeeding, DKA) 3 - QT prolongation and electrolyte-related arrhythmias 3 - Acid–base disorders and interpretation - Bicarbonate therapy: indications and risks 4 - Metabolic acidosis differential (high vs normal anion gap) 4 - Metabolic alkalosis differential 3 - Respiratory acidosis/alkalosis scenarios 3 - Stepwise blood gas interpretation 3 - Hypernatremia in children - Central diabetes insipidus management 3 - Correction strategy and monitoring 3 - Etiologies and diagnostic approach 3 - Nephrogenic diabetes insipidus basics 2 - Neurologic complications of dysnatremias 2 - Hyponatremia in children - Acute symptomatic hyponatremia management 3 - Classification by volume status 3 - Osmotic demyelination risk 2 - Pseudohyponatremia and lab pitfalls 3 - SIADH approach 3 - Maintenance fluids and dehydration management - Assessment of dehydration severity 3 - Hypernatremic dehydration 2 - IV fluid bolus and deficit replacement 3 - Maintenance fluid calculation and composition 3 - Oral rehydration therapy (ORT) 2 - Potassium disorders (hypo/hyperkalemia) - Hyperkalemia emergency management 3 - Hyperkalemia recognition and ECG changes 3 - Hypokalemia causes and evaluation 2 - Renal tubular disorders related to potassium 3 - Replacement strategies and safety 2 #### Genetics & Genomics 31 Mendelian and complex genetics, genomic medicine, and clinically actionable variants. - Complex traits and gene–environment interaction - Epigenetics 3 - Microbiome (board-level concepts) 2 - Polygenic risk concepts 3 - Somatic mosaicism & clonal hematopoiesis 2 - Genomic testing in clinical practice - Ethical issues 2 - Pharmacogenomics 3 - Testing modalities 2 - Variant interpretation 3 - Mendelian inheritance and risk - Autosomal dominant patterns 3 - Autosomal recessive patterns 3 - Mitochondrial inheritance 2 - X-linked inheritance 3 #### Genetics and metabolism (introductory) 57 Foundations of inheritance, genetic testing, dysmorphology approach, and introductory inborn error r... - Dysmorphology and congenital anomaly approach - Approach to a dysmorphic child 3 - Common genetic syndromes (core list) 3 - Referral and multidisciplinary care 2 - Syndromic vs sequence vs association concepts 3 - Teratology basics 4 - Inborn errors: pattern recognition (intro) - Hypoglycemia patterns and ketones 3 - Lactic acidosis and mitochondrial disease overview 2 - Metabolic acidosis and hyperammonemia patterns 3 - Newborn with lethargy/vomiting after feeds 3 - Recurrent rhabdomyolysis and exercise intolerance 2 - Genetic testing modalities and indications - Ethical considerations in pediatric genetics 2 - Karyotype, microarray, and targeted panels 3 - Newborn screening follow-up basics 3 - Prenatal testing concepts (board-level) 2 - Single-gene sequencing and exome/genome sequencing 3 - Patterns of inheritance and pedigree interpretation - Autosomal dominant/recessive patterns 3 - Chromosomal abnormalities overview 4 - De novo variants and recurrence risk 3 - Multifactorial inheritance and risk 3 - X-linked and mitochondrial inheritance 3 #### Genetics, Immunology, Hematology & Teratology 65 Genetic principles, prenatal screening/diagnosis frameworks, immunohematology (Rh), and teratology r... - Genetic inheritance and counseling fundamentals - Carrier screening concepts 4 - Chromosomal abnormalities and mechanisms 4 - Consanguinity and risk quantification basics 2 - Genetic test ethics and informed consent 3 - Patterns of inheritance 4 - Immunohematology and alloimmunization - Fetal anemia assessment principles 2 - Non-D antibodies and clinical relevance 3 - RhD immunization prevention 3 - Thrombophilia concepts 3 - Transfusion medicine basics in OB 4 - Prenatal screening and diagnostic testing - Aneuploidy screening modalities 3 - Diagnostic procedures principles 3 - Neural tube defect screening and diagnosis 4 - Non-immune hydrops framework 3 - Screening test performance interpretation 3 - Teratology and environmental exposures - Infections as teratogens (TORCH) 4 - Medication risk frameworks 3 - Occupational/environmental hazards 4 - Radiation exposure in pregnancy 3 - Substance use and fetal effects 3 #### Hematology, Transfusion, and Evidence-Based Medicine 94 Coagulation, transfusion science, and biostatistics/EBM essentials commonly assessed in EM training... - EBM in practice: guidelines, pathways, and stewardship - Antimicrobial and imaging stewardship 4 - Applying guidelines safely 3 - Critical incident literature appraisal (M&M style) 4 - Quality metrics vs patient-centered outcomes 4 - Screening and prevention in ED context 5 - Biostatistics and clinical epidemiology for EM - Bias, confounding, and validity 4 - Clinical prediction rules and implementation 6 - Diagnostic test performance 5 - Measures of effect and uncertainty 4 - Study designs and hierarchy of evidence 5 - Hemostasis and coagulation fundamentals - Bleeding risk stratification (conceptual) 4 - Coagulopathies in the ED 6 - Heparin/DOAC physiology and lab interpretation 5 - Primary vs secondary hemostasis 6 - Thrombosis physiology 5 - Transfusion medicine and massive hemorrhage basics - Blood products and indications 5 - Hemolysis and anemia emergencies 5 - Massive transfusion principles 5 - Rh/alloimmunization principles (ED-relevant) 4 - Transfusion reactions 5 #### Immunology & Inflammation 36 Innate/adaptive immunity, hypersensitivity, autoimmunity, immunodeficiency, and transplant fundament... - Adaptive immunity - B cell biology and antibodies 4 - Hypersensitivity reactions 3 - T cell biology 3 - Vaccinology principles 2 - Autoimmunity and tolerance - Central and peripheral tolerance 3 - Immunodeficiency overview 3 - Systemic autoimmune disease mechanisms 3 - Transplant immunology (intro) 3 - Innate immunity and inflammation - Complement system 3 - Inflammation resolution 3 - Pattern recognition and cytokines 3 - Phagocytes and granulomatous inflammation 3 #### Immunology, inflammation, and allergy foundations 84 Fundamental immune mechanisms, hypersensitivity, primary immunodeficiency red flags, and vaccine imm... - Autoimmunity and immune dysregulation fundamentals - Autoantibodies and immune tolerance concepts 3 - Autoinflammatory syndromes (intro) 4 - Cytokine storm/HLH conceptual bridge 3 - Cytopenias and autoimmune disease links 3 - Immune-mediated kidney and skin disease examples 3 - Hypersensitivity and allergic disease mechanisms - Atopic disease spectrum 4 - Drug allergy vs intolerance 3 - Food allergy mechanisms and tolerance 4 - Type I (IgE-mediated) reactions 4 - Type II/III/IV hypersensitivity examples 4 - Innate and adaptive immune system basics - Adaptive immunity components 4 - Complement system basics 3 - Inflammation resolution and chronic inflammation 3 - Innate immunity components 4 - Mucosal immunity and IgA 3 - Primary immunodeficiency (PID) overview and red flags - Basic lab evaluation of immune function 3 - Clinical warning signs and patterns 3 - Immunization considerations in immunocompromise 3 - Secondary immunodeficiency causes 3 - T-cell vs B-cell vs phagocyte vs complement defects 4 - Vaccine immunology foundations - Active vs passive immunity principles 3 - Adjuvants and immunogenicity 3 - Herd immunity and population impact (exam framing) 4 - Live attenuated vs inactivated vaccines 3 - Vaccine adverse events and safety systems 3 #### Maternal–Fetal Physiology, Placenta & Parturition 55 Pregnancy adaptations, uteroplacental unit physiology, and labor physiology essential for safe obste... - Maternal cardiovascular and hemodynamic adaptations - Blood pressure physiology across trimesters 3 - Changes in blood volume, CO, SVR 3 - Coagulation physiology (hypercoagulability) 2 - Postpartum hemodynamic shifts 3 - Uterine blood flow physiology 2 - Placental function, transport, and endocrine activity - Amniotic fluid dynamics 3 - Maternal–fetal immunology 2 - Placental endocrine hormones 3 - Placental transport mechanisms 3 - Umbilical and fetal circulation physiology 3 - Respiratory, renal, and acid–base physiology in pregnancy - GI/hepatic adaptations 3 - Hematologic adaptations beyond coagulation 3 - Renal changes and lab interpretation 3 - Thermoregulation and skin changes 3 - Ventilatory changes and ABG interpretation 2 - Uterine contractility and cervical remodeling - Cervical ripening mechanisms 3 - Lactation physiology 3 - Myometrial excitation–contraction coupling 2 - Postpartum uterine involution 2 - Stages of labor physiology 4 #### Neurophysiology, autonomics, and thermoregulation 43 - Autonomic nervous system and reflexes - Autonomic failure and dysautonomia 6 - Key perioperative reflexes 5 - Sympathetic vs parasympathetic physiology 5 - Cerebral blood flow and intracranial dynamics - CBF regulation 5 - CSF production and drainage 4 - ICP physiology 4 - Thermoregulation and perioperative hypothermia - Anesthesia effects on temperature 5 - Complications of hypothermia 4 - Normal thermoregulatory control 5 #### Nutrition, growth biology, and metabolic fundamentals 76 Core pediatric nutrition and metabolism including breastfeeding, micronutrients, malnutrition, obesi... - Energy metabolism and common IEM overview (intro) - Acute metabolic decompensation first steps 2 - Basic pathways (glycogen, FAO, urea cycle) 4 - Hypoglycemia differential by age 3 - Newborn screen concept and limitations 2 - When to refer for metabolic/genetic evaluation 3 - Failure to thrive (FTT) and malnutrition - Definitions and anthropometric assessment 3 - Differential diagnosis framework 3 - Initial evaluation and targeted testing 3 - Multidisciplinary management and safeguarding interface 3 - Nutritional rehabilitation 3 - Infant feeding (breastfeeding and formula) - Breast milk composition and benefits (exam framing) 2 - Complementary feeding and allergen introduction 4 - Feeding difficulties and red flags 3 - Formula types and indications 4 - Lactation management basics 3 - Micronutrients and deficiency states - Iodine and thyroid development 3 - Iron deficiency and anemia prevention 2 - Vitamin A, E, K deficiencies (board-relevant) 4 - Vitamin D and calcium 4 - Zinc and trace elements 3 - Pediatric obesity and metabolic risk - BMI classification and staging 4 - Lifestyle intervention fundamentals 2 - Metabolic syndrome and NAFLD overview 3 - Obesity pharmacotherapy and bariatric basics (board overview) 3 - Weight stigma and counseling skills 3 #### Pathology & General Pathophysiology 35 General injury, repair, vascular pathology, thrombosis, and systemic responses to illness. - Cell injury and adaptation - Amyloidosis (overview) 3 - Edema and effusions pathophysiology 3 - Inflammation and repair 3 - Reversible vs irreversible injury 3 - Fever, SIRS, and sepsis biology - Biomarkers (concepts) 3 - Cytokine-mediated shock 3 - Organ dysfunction mechanisms 3 - Stress response and endocrine changes 3 - Hemostasis and thrombosis (mechanisms) - Atherosclerosis & aneurysm pathophysiology 3 - Coagulation cascade (clinical interpretation) 3 - Platelet biology 2 - Thrombosis and embolism 3 #### Pathology, Neoplasia, and Breast Pathology Foundations 73 Core gynecologic and obstetric pathology and tumor biology underpinning screening, diagnosis, and in... - Inflammation, infection, and tissue response basics - Acute vs chronic inflammation patterns 2 - Necrosis patterns relevant to OB-GYN 3 - Pathology specimen handling basics 3 - Thrombosis and embolism concepts 3 - Wound healing and scar formation 3 - Breast pathology foundations for OB-GYN - Benign breast disease 3 - Breast cancer basics for generalists 3 - Breast screening and pathology correlation 4 - High-risk lesions overview 3 - Lactation-related breast conditions 3 - Cervical pathology and HPV-mediated disease - CIN/HSIL/LSIL pathologic correlates 3 - Cytology and histology interpretation basics 3 - HPV biology and carcinogenesis 3 - Invasive cervical cancer—histology overview 3 - Vaginal/vulvar intraepithelial lesions basics 3 - Endometrial pathology and AUB foundations - Benign uterine pathology 3 - Endometrial carcinoma basics (Type 1 vs Type 2) 3 - Endometrial hyperplasia classification concepts 2 - Gestational endometrium and retained products concepts 3 - Uterine sarcomas overview 3 - Ovarian, tubal, and peritoneal tumors—foundations - Borderline tumors concepts 2 - Fallopian tube origin hypothesis for HGSC 3 - GTD pathology overview 3 - Ovarian tumor classification overview 3 - Tumor markers basics 3 #### Pharmacology fundamentals (PK/PD and drug handling) 61 - Pharmacodynamics and receptor theory - Dose–response relationships 4 - Drug interactions 5 - Pharmacogenomics (core testables) 5 - Receptor types and signaling 5 - Pharmacokinetics core concepts - Bioavailability and first-pass metabolism 5 - Compartment models and parameters 6 - Organ failure effects on PK 5 - Redistribution and tissue uptake 4 - Special populations 5 - Toxicology and adverse drug reactions - Dose-related vs idiosyncratic reactions 4 - Local anesthetic systemic toxicity (principles) 5 - Methemoglobinemia and CO toxicity (periop) 4 - Opioid toxicity and reversal 4 #### Pharmacology, Microbiology & Diagnostic Science (Core) 83 High-yield medication classes, antimicrobial principles, vaccination and infection concepts, plus di... - Diagnostic test interpretation and screening science - Bias and confounding in diagnostic studies 3 - Critical values and escalation thresholds 3 - Reference ranges and pregnancy-adjusted labs 3 - Screening program principles 3 - Test characteristics and Bayes theorem intuition 3 - Gynecologic pharmacology and contraception hormones - Antibiotics/antifungals commonly used in GYN 4 - Combined hormonal contraception (CHC) pharmacology 3 - Emergency contraception 2 - Menopause therapies 3 - Progestin-only methods 4 - Medication safety in pregnancy and lactation - Medication safety in breastfeeding 3 - Peripartum anesthesia/analgesia pharmacology basics 4 - Pharmacovigilance and counseling resources 4 - Principles of prescribing in pregnancy 3 - Teratogenic medication classes (core list) 4 - Microbiology, immunology and infection prevention - Immunization principles for OB-GYN 3 - Postoperative and postpartum infections 5 - Pregnancy infections 3 - STI microbiology essentials 3 - Vaginal microbiome and common vaginitis 4 - Obstetric medication classes - Diabetes medications in pregnancy 3 - Hypertension medications in pregnancy 3 - Thromboprophylaxis and anticoagulants 3 - Tocolytics and preterm birth meds 4 - Uterotonics and postpartum hemorrhage meds 3 #### Physics, measurement, mathematics, statistics (foundations) 56 - Radiation, MRI, and ultrasound physics (foundations) - Ionizing radiation basics 3 - MRI environment hazards 4 - Ultrasound fundamentals 4 - Electrical safety and basic electronics - Electrical hazards in OR 5 - Ohm’s law and power 5 - Flow, pressure, and resistance - Laminar vs turbulent flow 5 - Poiseuille and Bernoulli principles 5 - Gas laws and vapors relevant to anesthesia - Core gas laws 5 - Humidity and airway gas conditioning 5 - Vaporization concepts 5 - Mathematics, dosing, and basic statistics - Data interpretation basics 5 - Unit conversions and drug calculations 5 #### Physiology & Homeostasis 50 System physiology emphasizing integration and mechanisms behind common clinical syndromes. - Cardiovascular physiology - ECG electrophysiology basics 4 - Exercise physiology 3 - Hemodynamics and cardiac output 3 - Vascular biology 3 - Endocrine physiology - Calcium and bone metabolism 4 - Glucose homeostasis 4 - Hypothalamic–pituitary axes 3 - Thyroid hormone action 3 - Renal physiology & volume regulation - Acid–base renal handling 3 - Glomerular filtration and hemodynamics 3 - Tubular handling of electrolytes 3 - Water balance 3 - Respiratory physiology - Acid–base and respiratory compensation 3 - Hypoxic pulmonary vasoconstriction 2 - Lung mechanics 3 - Ventilation/perfusion and gas exchange 3 #### Reproductive Endocrinology & Menstrual Cycle Physiology 45 Hormonal regulation across lifespan: puberty, cycle, pregnancy, lactation, menopause; core board phy... - Hypothalamic–pituitary–ovarian (HPO) axis regulation - Endometrial cycle and histology 3 - FSH/LH actions and ovarian steroidogenesis 3 - GnRH pulsatility and feedback loops 4 - Ovulation physiology and luteal phase 3 - Puberty physiology and normal variants 3 - Menopause and perimenopause physiology - Cardiometabolic changes around menopause 3 - Hormone therapy physiologic rationale and risks 4 - Ovarian aging and follicular depletion 3 - Premature ovarian insufficiency (POI) physiology 2 - Urogenital atrophy (GSM) pathophysiology 3 - Pregnancy endocrine physiology - Calcium/vitamin D and bone metabolism 3 - hCG, corpus luteum rescue, and placental takeover 2 - Insulin resistance and metabolic adaptations 3 - Postpartum endocrine changes 3 - Thyroid physiology in pregnancy 3 #### Respiratory physiology and acid–base 73 - Acid–base and electrolytes (physiology foundations) - Anion gap and lactate interpretation 4 - Henderson–Hasselbalch and bicarbonate buffering 5 - Key electrolytes for anesthesia 5 - Stewart/strong ion approach (conceptual) 5 - Control of breathing and perioperative respiratory depression - Central and peripheral chemoreceptors 5 - Neuromuscular weakness and ventilation 4 - Ventilatory responses to anesthesia and opioids 4 - Gas exchange: diffusion, V/Q, shunt - Alveolar gas equation and A–a gradient 5 - CO2 transport and elimination 5 - Hypoxic pulmonary vasoconstriction (HPV) 4 - V/Q mismatch vs shunt vs diffusion limitation 5 - Lung volumes, compliance, resistance, and work of breathing - Airway resistance and flow 4 - Closing capacity and FRC 4 - PFT patterns for anesthesia 5 - Static and dynamic compliance 6 - Ventilation distribution and time constants 3 ### Cardiopulmonary Medicine 191 questions #### Cardiology: Ischemia, Heart Failure, Valves, Rhythm 68 Core cardiovascular syndromes and guideline-informed management principles. - Pericardial and myocardial disease - Cardiomyopathies (overview) 3 - Myocarditis 3 - Pericarditis and effusion 3 - Pulmonary embolism strain vs MI differentiation 3 - Acute coronary syndromes - ACS complications 3 - Diagnosis and initial management 2 - Reperfusion strategies 2 - Secondary prevention 2 - Arrhythmias and conduction disorders - Atrial fibrillation/flutter 3 - Bradyarrhythmias and blocks 3 - Supraventricular tachycardias 3 - Ventricular arrhythmias 3 - Heart failure (acute and chronic) - Acute decompensated HF management 3 - Advanced therapies and devices (overview) 3 - Classification and etiologies 3 - Guideline-directed medical therapy (GDMT) concepts 4 - Stable ischemic heart disease and angina - Diagnostic evaluation 2 - Medical therapy 3 - Pathophysiology and symptom patterns 2 - Revascularization concepts 3 - Valvular heart disease - Aortic regurgitation and mitral stenosis 3 - Aortic stenosis 3 - Endocarditis-related valvular issues (interface) 3 - Mitral regurgitation 3 #### Pulmonology: Airways, Parenchyma, Pleura, Critical Respiratory 74 Common respiratory disorders and initial stabilization of respiratory failure. - Interstitial lung disease (ILD) and pulmonary fibrosis - Acute exacerbation of ILD 3 - Diagnostic workup 3 - ILD pattern approach 4 - Management concepts 3 - Asthma - Acute exacerbation management 3 - Chronic management 3 - Complications and mimics 3 - Diagnosis and phenotypes 3 - COPD - Acute exacerbations 3 - Complications 3 - Diagnosis and staging 3 - Stable management 3 - Pleural disease - Empyema and complicated parapneumonic effusion 3 - Malignant pleural effusion 3 - Pleural effusion evaluation 3 - Pneumothorax 3 - Pneumonia and lower respiratory infections - Aspiration syndromes 3 - Community-acquired pneumonia 4 - Hospital-acquired and ventilator-associated pneumonia 4 - Opportunistic pneumonias (overview) 3 - Respiratory failure and ventilatory support (intro) - Hypercapnic respiratory failure 3 - Hypoxemic respiratory failure 3 - Noninvasive ventilation basics 2 - Sleep-disordered breathing (overview) 3 #### Vascular Medicine & Hypertension 49 Systemic vascular disease, hypertensive syndromes, and thromboembolic disease. - Pulmonary hypertension and RV failure (interface) - PH classification overview 3 - PH diagnostic tests (overview) 2 - RV failure physiology and treatment principles 3 - Targeted therapies (overview) 2 - Aortic disease - Acute aortic syndromes overview 4 - Aneurysms 3 - Aortic dissection 3 - Peripheral arterial disease 3 - Hypertension (diagnosis and management) - Accurate measurement and diagnosis 4 - First-line therapies and combinations 3 - Hypertensive emergencies/urgencies 4 - Secondary hypertension causes 3 - Venous thromboembolism - Complications and recurrence prevention 3 - DVT diagnosis and treatment 3 - Pulmonary embolism 3 - Thrombophilia and special situations 3 ### Clinical Pharmacology 166 questions #### Core Principles of Clinical Pharmacology 88 PK/PD, prescribing safety, therapeutic monitoring, interactions, special populations. - Adverse drug reactions (ADRs) and safety - ADR classification and recognition 3 - Medication errors and reconciliation 3 - Organ-specific toxicities 3 - Pregnancy/lactation and teratogenicity 3 - Clinical toxicology and overdose - Alcohols and gases 3 - Cardiotoxic ingestions 4 - Common high-yield overdoses 3 - Initial approach to poisoning 3 - Dosing in renal/hepatic impairment - Assessing kidney function for dosing 2 - Hepatic impairment dosing 3 - Obesity and underweight dosing 4 - Renal dose adjustments (principles) 2 - Drug–drug and drug–food interactions - CYP-mediated interactions 4 - Herbals and supplements 3 - Pharmacodynamic interactions 3 - Transporters and chelation 3 - Pharmacodynamics (PD) - Dose–response relationships 4 - Population variability 4 - Receptor pharmacology 3 - Time-dependent effects 3 - Pharmacokinetics (PK) - Absorption and bioavailability 3 - Distribution 3 - Elimination 3 - Metabolism 4 - Therapeutic drug monitoring (TDM) - Indications for TDM 2 - Key monitored drugs 4 - Sampling and interpretation 3 - TDM in special populations 3 #### Major Therapeutic Classes in Internal Medicine 78 Drug classes commonly tested across IM boards with key indications, contraindications, interactions,... - Immunomodulators and rheumatologic drugs - Biologics and targeted therapies (overview) 3 - DMARDs (conventional) 3 - Transplant immunosuppression (overview) 3 - Vaccination and prophylaxis on immunosuppression 3 - Anticoagulants and antiplatelets - Antiplatelet therapy 4 - DOACs 3 - Heparins and fondaparinux 5 - Warfarin 2 - Antimicrobials (overview for safe prescribing) - Antifungals/antivirals 3 - Glycopeptides and lipopeptides 4 - Macrolides/fluoroquinolones/tetracyclines 3 - β-lactams 3 - Cardiovascular drugs - Antianginal agents 4 - Antiarrhythmics 3 - Antihypertensives 2 - Heart failure therapies (foundational) 3 - CNS and pain medications - Antidepressants/antipsychotics 3 - Antiepileptics 3 - Opioids and analgesic ladder 3 - Sedatives and hypnotics 3 - Endocrine and metabolic drugs - Diabetes therapies 3 - Lipid-lowering therapies 3 - Steroids and adrenal drugs 5 - Thyroid therapies 4 ### Diagnostic Reasoning 133 questions #### Clinical Reasoning Foundations 61 From complaint to differential using structured thinking, probability, and safety-focused decision-m... - Diagnostic error and safety - Cognitive biases 2 - Safety nets 3 - Second opinions and escalation 3 - System factors 3 - Differential diagnosis building - Illness scripts and pattern recognition 3 - Problem representation 2 - Red flags and must-not-miss diagnoses 4 - Systematic differentials 3 - History-taking for diagnosis - Bias awareness in history 3 - Contextual history 3 - Functional and psychosocial assessment 2 - Symptom analysis frameworks 4 - Physical examination for decision-making - Abdominal exam and acute abdomen screening 3 - Cardiopulmonary exam high-yield findings 3 - Neurologic screening and localization 3 - Vital signs and physiologic interpretation 3 - Probability and Bayesian reasoning at bedside - Clinical prediction rules 5 - Decision thresholds 3 - Estimating pretest probability 3 - Using likelihood ratios 3 #### Test Selection, Interpretation & Diagnostic Stewardship 72 Ordering and interpreting core investigations used in IM boards and practice. - Chest imaging (CXR/CT basics) - Common CT patterns 3 - CT indications and contrast considerations 2 - Diagnostic stewardship in imaging 3 - Systematic CXR approach 4 - ECG interpretation (core board patterns) - Arrhythmia recognition 3 - Conduction and structural clues 3 - Electrolyte/drug effects 3 - Ischemia and infarction patterns 3 - Laboratory medicine fundamentals - CBC interpretation 3 - Chemistry panels and liver tests 3 - Inflammatory and cardiac biomarkers 3 - Pre-analytical and analytical errors 3 - Microbiology diagnostics - Blood cultures and contamination 3 - CSF interpretation 3 - Respiratory diagnostics 3 - Serology and immunologic tests pitfalls 3 - Pulmonary function tests and oxygenation - ABG interpretation 3 - DLCO interpretation 3 - Pulse oximetry limitations 3 - Spirometry patterns 3 - Urinalysis and kidney diagnostics - Dipstick and microscopy 4 - Imaging and biopsy indications (overview) 3 - Protein quantification 2 - Urine electrolytes 3 ### Gastrointestinal Medicine 191 questions #### Esophagus, Stomach, and Upper GI Bleeding 39 High-yield luminal GI disorders and emergencies. - Dysphagia and odynophagia - Alarm features and cancer risk 3 - Initial diagnostic approach 3 - Mechanical obstruction vs motility disorder 4 - Oropharyngeal vs esophageal dysphagia 5 - GERD and peptic disorders - Barrett esophagus 2 - Functional dyspepsia 3 - GERD diagnosis and management 3 - Peptic ulcer disease and H. pylori 3 - Upper GI bleeding - Initial stabilization and risk stratification 3 - Non-variceal bleeding causes and management 4 - Special scenarios 3 - Variceal bleeding 3 #### GI Oncology & Miscellaneous High-Yield Disorders 47 Common GI cancers, acute surgical GI issues, and board-relevant rarer entities. - Motility and functional disorders (select) - Acute intermittent porphyria (overview) 3 - Carcinoid syndrome (overview) 3 - Chronic nausea/vomiting differential 3 - Gastroparesis 3 - Pancreatic and hepatobiliary cancers (overview) - Cancer-associated symptoms 3 - Cholangiocarcinoma and gallbladder cancer 3 - Hepatocellular carcinoma (HCC) 3 - Pancreatic adenocarcinoma 3 - Acute abdominal pain and surgical GI emergencies (overview) - Appendicitis and diverticulitis 3 - Bowel obstruction 3 - GI perforation and peritonitis 2 - Mesenteric ischemia 2 - Colorectal cancer and polyposis syndromes (overview) - Cancer prevention links 3 - Hereditary syndromes 3 - Presentation and workup 3 - Treatment concepts 4 #### Hepatobiliary, Pancreas, and Liver Failure 61 Approach to abnormal liver tests, hepatitis, cirrhosis complications, and biliary/pancreatic emergen... - Acute hepatitis and acute liver failure - Acute liver failure management principles 2 - Fulminant infections in liver disease 3 - Toxic and ischemic hepatitis 4 - Viral hepatitis (A, B, C, E) overview 3 - Approach to abnormal liver chemistries - Autoimmune and metabolic liver disease workup 3 - Drug-induced liver injury (DILI) 3 - Initial evaluation 3 - Pattern recognition 4 - Biliary disease - Cholangitis 3 - Cholelithiasis and cholecystitis 3 - Cholestatic chronic diseases 3 - Gallstone pancreatitis interface 2 - Cirrhosis and portal hypertension - Ascites and SBP 3 - Hepatic encephalopathy 3 - Hepatorenal syndrome (HRS) 3 - Varices and portal hypertensive bleeding prevention 4 - Pancreatitis and pancreatic disorders - Acute pancreatitis diagnosis and severity 3 - Chronic pancreatitis 3 - Complications 3 - Initial management 3 #### Small and Large Intestine: Diarrhea, IBD, Malabsorption 44 Approach to diarrhea/constipation, inflammatory bowel disease, and malabsorption syndromes. - Acute diarrhea - Clinical evaluation and dehydration severity 3 - Complications 3 - Infectious etiologies and testing 4 - Treatment principles 2 - Chronic diarrhea and malabsorption - Categorization approach 3 - Celiac disease 3 - Microscopic colitis and bile acid diarrhea 2 - Pancreatic exocrine insufficiency 3 - Constipation and IBS - Constipation evaluation 3 - Defecatory disorders 2 - IBS subtypes and diagnosis 3 - Treatment strategies 3 - Inflammatory bowel disease (IBD) - Acute severe colitis and toxic megacolon 3 - Diagnosis and monitoring 3 - Therapy overview 2 - UC vs Crohn differentiation 2 ### General Internal Medicine 158 questions #### Perioperative & Consultative Medicine 47 Risk assessment, medication management, and common perioperative medical issues. - Perioperative medication management - Anticoagulants/antiplatelets 3 - Antihypertensives and cardiac meds 3 - Diabetes medications 3 - Steroids and immunosuppression 3 - Perioperative pulmonary evaluation - Postoperative pulmonary complications 4 - Pulmonary testing 2 - Risk assessment and optimization 3 - Ventilation/oxygenation issues post-op 2 - Postoperative medical complications - AKI and fluid/electrolyte disorders 3 - Delirium prevention and management 2 - Fever and infection workup post-op 3 - VTE prophylaxis 3 - Preoperative cardiovascular evaluation - Arrhythmias and devices 3 - Functional capacity and risk stratification 3 - Heart failure and valvular disease periop issues 4 - Management of ischemic heart disease 3 #### Prevention, Screening & Health Maintenance 47 Evidence-based prevention across age groups and risk strata. - Infectious disease prevention counseling - Hepatitis screening 2 - STI screening and prevention 2 - TB screening (risk-based) 2 - Travel health basics 3 - Adult immunizations - Age- and risk-based vaccines 3 - Routine adult vaccines 5 - Vaccine contraindications and adverse events 3 - Vaccines in special populations 3 - Cancer screening (board-level principles) - Breast and cervical screening 3 - Colorectal cancer screening 3 - Lung cancer screening 3 - Prostate cancer screening 3 - Cardiometabolic prevention - ASCVD risk estimation and statins 3 - Aspirin in prevention (principles) 3 - Diabetes prevention and screening 3 - Hypertension screening and prevention 3 #### Transitions of Care, Patient Safety & Cross-cutting Skills 64 Safe discharge, chronic disease coordination, and common generalist competencies. - Occupational and environmental medicine (intro) - Fitness for duty and return-to-work 2 - Reporting and public health coordination 3 - Toxins and exposures 3 - Work-related lung disease 4 - Medication reconciliation and deprescribing - Adherence and access barriers 3 - High-risk medications 3 - Polypharmacy management 3 - Transitions and communication 3 - Nutrition and obesity (generalist) - Dietary patterns in chronic disease 4 - Enteral and parenteral nutrition (principles) 4 - Malnutrition assessment 4 - Obesity management overview 2 - Palliative care fundamentals - Ethics at end-of-life (overview) 3 - Goals-of-care and advance care planning 4 - Hospice eligibility concepts 3 - Symptom management 4 - Substance use disorders (generalist approach) - Alcohol use disorder 3 - Opioid use disorder 3 - Stimulants and other substances 3 - Tobacco and vaping 3 ### Hematology And Oncology 192 questions #### Hematologic Malignancies & Solid Tumor Principles 50 Recognition, initial workup, emergencies, and complications of cancer therapy. - Leukemias (acute and chronic) overview - Acute leukemia recognition 3 - Chronic leukemias basics 3 - Supportive care 3 - Treatment complications 3 - Lymphoma (Hodgkin and non-Hodgkin) overview - Clinical presentation and staging basics 3 - Complications 4 - Diagnostic approach 3 - Treatment concepts 4 - Plasma cell disorders - Amyloidosis (clinical) 3 - MGUS vs smoldering vs multiple myeloma 3 - Myeloma complications 2 - Treatment overview 4 - Solid tumors: general principles - Cancer screening and early detection integration 3 - Cancer-associated thrombosis 3 - Oncologic pain and symptom control 3 - Staging and performance status (overview) 3 #### Oncologic Emergencies & Treatment Toxicities 52 Time-critical cancer complications and adverse effects of systemic therapies. - Immune- and targeted-therapy toxicities (overview) - CAR-T and bispecific toxicities (overview) 2 - Checkpoint inhibitor immune-related adverse events 3 - Chemotherapy organ toxicities (select) 3 - Radiation-related complications (overview) 2 - Febrile neutropenia - Empiric antibiotic choices (principles) 3 - Growth factors and prophylaxis concepts 3 - Risk stratification and initial steps 2 - Source control and complications 3 - Hypercalcemia of malignancy - Acute management 3 - Diagnostic approach 2 - Mechanisms 3 - Prevention of recurrence 3 - Spinal cord compression and brain metastasis (overview) - Complications 2 - Immediate management 3 - Leptomeningeal disease (overview) 3 - Recognition 3 - Tumor lysis syndrome (TLS) - Diagnosis and labs 2 - Prevention 3 - Risk assessment 2 - Treatment 2 #### Red Cell Disorders & Anemia 45 Approach to anemia by indices/reticulocytes, hemolysis, and common etiologies. - Approach to anemia - Iron studies interpretation 2 - MCV-based framework 3 - Reticulocyte index and marrow response 2 - When to refer/urgent evaluation 2 - Hemolytic anemia - Confirming hemolysis 3 - Immune hemolysis 3 - Inherited and acquired non-immune hemolysis (overview) 4 - Microangiopathic hemolysis (MAHA) 3 - Iron deficiency anemia - Complications 3 - Etiologies by demographic 3 - Refractory/complex cases 3 - Treatment 3 - Macrocytic anemia and B12/folate disorders - Megaloblastic anemia 4 - Non-megaloblastic macrocytosis 3 - Transfusion principles in anemia 2 - Treatment and safety 2 #### White Cell Disorders, Platelets, Coagulation & Transfusion 45 Leukocytosis/cytopenias, platelet disorders, bleeding/thrombosis, and transfusion medicine. - Coagulation disorders and bleeding - Anticoagulant-associated bleeding 3 - Approach to abnormal PT/aPTT 3 - DIC 3 - Hemophilia and vWD (overview) 3 - Leukocytosis and leukopenia - Eosinophilia approach 2 - Lymphocytosis differential 2 - Neutropenia approach 3 - Neutrophilia differential 3 - Thrombocytopenia and platelet disorders - Approach to thrombocytopenia 3 - HIT 3 - ITP 3 - Platelet function disorders (overview) 3 - Transfusion medicine - Blood components and indications 2 - Patient blood management 3 - Special transfusion scenarios 3 - Transfusion reactions 3 ### Infection And Immunity 198 questions #### Antimicrobial Stewardship & Resistance 39 Choosing appropriate agents, duration, and prevention of resistance and complications. - Infection prevention and control - Antimicrobial prophylaxis (select) 4 - Healthcare-associated infection prevention 3 - Post-exposure prophylaxis (overview) 3 - Standard and transmission-based precautions 4 - Principles of empiric therapy - Duration and follow-up 3 - Host and site considerations 3 - Local resistance patterns 3 - Narrowing therapy 3 - Resistant organisms (overview) - C. difficile prevention and recurrence 3 - ESBL/AmpC and CRE 3 - MRSA 3 - Pseudomonas and nonfermenters 4 #### Core Infectious Syndromes & Sepsis 49 Common infections, sepsis recognition, empiric therapy principles, and source control. - CNS infections (overview) - Bacterial meningitis 3 - Brain abscess 3 - Encephalitis 4 - TB/fungal meningitis (overview) 3 - Community-acquired infections (syndrome-based) - Bacteremia of unclear source 2 - Pneumonia 3 - Skin and soft tissue infections 2 - UTI and pyelonephritis 3 - Endocarditis and intravascular infections - Complications 3 - Device and line infections 4 - Diagnosis 4 - Empiric and targeted therapy concepts 3 - Sepsis and septic shock - Adjunctive care 3 - Early antimicrobial therapy 3 - Recognition and initial resuscitation 3 - Source control 3 #### Immunity, Rheumatology & Vasculitis (Board-Level) 62 Autoimmune disease recognition, inflammatory syndromes, and distinguishing infection vs inflammation... - Immunodeficiency and allergy (overview) - Anaphylaxis and severe allergy 2 - Angioedema 3 - Primary immunodeficiency red flags 3 - Secondary immunodeficiency 5 - Rheumatoid arthritis and spondyloarthropathies (overview) - Crystal arthropathies vs infection 3 - DMARDs/biologics safety (interface) 3 - RA diagnosis and extra-articular disease 3 - Spondyloarthritis 4 - Approach to fever and inflammation of unclear source - Adult-onset Still disease and HLH (overview) 3 - FUO framework 3 - Inflammatory markers interpretation 3 - Temporal arteritis and PMR 3 - Systemic lupus erythematosus (SLE) - Clinical patterns and serologies 3 - Major organ involvement 3 - Pregnancy considerations (overview) 3 - Treatment principles 3 - Vasculitis syndromes (overview) - ANCA-associated vasculitis 2 - Immune complex vasculitis 4 - Large-vessel vasculitis 3 - Vasculitis mimics and infection overlap 3 #### Special Pathogens & Host States 48 HIV, TB, viral hepatitis interface, travel medicine basics, and infections in immunocompromised host... - Travel and zoonoses (select) - Arboviruses 4 - Malaria 3 - Rabies and animal bites 3 - Tick-borne diseases (US-focused overview) 3 - Fungal infections (overview) - Candidemia 3 - Cryptococcosis 3 - Endemic mycoses 3 - Invasive aspergillosis and mucormycosis 3 - HIV medicine (core IM level) - Antiretroviral therapy principles 3 - Diagnosis and monitoring 3 - Opportunistic infections (recognize and prevent) 3 - Preventive care in HIV 2 - Tuberculosis and NTM (overview) - Active TB 3 - Extrapulmonary TB (overview) 3 - Latent TB infection (LTBI) 3 - Nontuberculous mycobacteria 3 ### Metabolic And Renal Medicine 204 questions #### Diabetes & Metabolic Disorders 48 Diabetes, dyslipidemia, obesity, and metabolic syndrome—high-frequency board content. - Diabetic emergencies - DKA vs HHS differentiation 2 - Euglycemic DKA 2 - Hypoglycemia 3 - Treatment protocols (principles) 4 - Dyslipidemia and ASCVD prevention - Hypertriglyceridemia 4 - Primary and secondary prevention frameworks 3 - Secondary dyslipidemias 3 - Statin intolerance and adverse effects 3 - Obesity medicine (metabolic focus) - Anti-obesity pharmacotherapy overview 2 - Assessment and complications 4 - Bariatric surgery overview 3 - Lifestyle interventions 3 - Type 2 diabetes mellitus - Diagnosis and targets 3 - Initial therapy and escalation 4 - Macrovascular risk reduction 2 - Microvascular complications 3 #### Fluids, Electrolytes & Acid–Base 41 High-yield interpretation and management of common hospital syndromes. - Acid–base disorders - Bicarbonate therapy indications (limited) 2 - Metabolic acidosis 3 - Metabolic alkalosis 2 - Respiratory acidosis/alkalosis 3 - Hypernatremia - Diabetes insipidus management (overview) 2 - Etiologies and diagnosis 3 - Special scenarios 3 - Treatment principles 2 - Hyponatremia - Correction safety 3 - Hypovolemic hyponatremia 2 - SIADH 3 - Tonicity and initial approach 3 - Potassium disorders - Acid–base linkages 3 - Hyperkalemia 3 - Hypokalemia 2 - Periodic paralysis (overview) 2 #### Nephrology & Urology Core 66 AKI/CKD, glomerular disease, nephrotic/nephritic syndromes, and obstructive uropathy. - Acute kidney injury (AKI) - AKI management principles 3 - Classification and initial evaluation 3 - Common intrinsic causes 4 - Postrenal AKI 4 - Chronic kidney disease (CKD) - CKD complications 3 - Medication considerations 4 - Renal replacement planning 3 - Staging and progression risk 3 - Glomerular diseases (overview) - Common primary GN patterns 3 - Nephritic syndrome and RPGN 3 - Nephrotic syndrome 2 - Systemic disease GN 3 - Hematuria and proteinuria evaluation - Hereditary kidney disease (overview) 4 - Microscopic hematuria approach 4 - Proteinuria approach 3 - Renal tubular disorders (overview) 4 - Nephrolithiasis and obstruction - Acute management 3 - Obstructive uropathy 3 - Prevention 2 - Stone types and evaluation 5 #### Thyroid, Adrenal, Pituitary & Calcium/Bone 49 Core endocrine disorders and metabolic bone disease commonly tested on boards. - Pituitary disorders - Acromegaly (overview) 2 - Central diabetes insipidus and SIADH (interface) 4 - Hyperprolactinemia 3 - Hypopituitarism 3 - Adrenal disorders - Adrenal insufficiency 3 - Cushing syndrome (overview) 3 - Pheochromocytoma/paraganglioma 3 - Primary aldosteronism 3 - Calcium, parathyroid, and metabolic bone disease - Hypercalcemia evaluation and acute management 3 - Hypocalcemia and tetany 3 - Osteoporosis 3 - Paget disease and osteomalacia (overview) 3 - Hypothyroidism and hyperthyroidism - Amiodarone and iodine effects 3 - Hypothyroidism evaluation and treatment 4 - Thyroid nodules and cancer (overview) 3 - Thyrotoxicosis and Graves disease 3 ### Neurobehavioral Medicine 150 questions #### Chronic Neurology & Cognitive Disorders 46 Common outpatient and inpatient chronic neuro and neurocognitive conditions relevant to IM practice. - Multiple sclerosis and demyelinating disease (overview) - Acute relapse management 2 - Diagnosis concepts 3 - Disease-modifying therapy overview 3 - Typical presentations 4 - Parkinsonism and movement disorders (overview) - Ataxia and gait disorders (overview) 3 - Drug-induced parkinsonism 2 - Essential tremor 3 - Parkinson disease basics 3 - Dementia and mild cognitive impairment - Alzheimer disease and mixed dementia 3 - Evaluation 3 - Lewy body and frontotemporal dementia (overview) 2 - Vascular dementia 3 - Peripheral neuropathy and radiculopathy - Common causes 3 - Diagnostic testing 3 - Neuropathic pain management 3 - Pattern-based approach 3 #### Neurologic Emergencies and Core Syndromes 58 Time-critical neurology plus common inpatient neuro problems seen in IM boards. - Acute headache syndromes - Meningitis/encephalitis vs migraine differentiation 3 - Primary headaches (overview) 3 - Subarachnoid hemorrhage and thunderclap headache 2 - Temporal arteritis 3 - Altered mental status and encephalopathy - Delirium recognition and initial workup 3 - Hepatic and uremic encephalopathy 3 - Nonconvulsive status epilepticus (overview) 3 - Wernicke encephalopathy 2 - Neuromuscular weakness and spinal cord syndromes - Acute myelopathy and cord compression 3 - Critical illness neuromyopathy (overview) 3 - Guillain–Barré syndrome 4 - Myasthenia gravis and crisis 2 - Seizures and status epilepticus - Antiepileptic drug adverse effects (overview) 3 - Common seizure mimics 3 - First seizure evaluation 3 - Status epilepticus management 3 - Stroke and TIA - Acute ischemic stroke treatment principles 3 - Hemorrhagic stroke basics 3 - Initial assessment and imaging 3 - Secondary prevention 3 #### Psychiatry, Substance-Related Presentations & Sleep 46 Common psychiatric conditions in IM, medication effects, and medically relevant behavioral syndromes... - Sleep disorders (overview) - Insomnia 3 - Obstructive sleep apnea 3 - Parasomnias and circadian disorders (overview) 3 - Restless legs syndrome 2 - Depression and anxiety in medical illness - Depression in chronic disease (overview) 3 - Diagnosis and screening 3 - Medication interactions and side effects 3 - Treatment options 3 - Psychosis, agitation, and behavioral emergencies - Agitation management (medical setting) 3 - Catatonia (overview) 3 - Differential diagnosis of acute psychosis 3 - Neuroleptic malignant syndrome and serotonin syndrome 4 - Substance-related syndromes - Alcohol withdrawal and complications 3 - Opioid intoxication and withdrawal 2 - Sedative-hypnotic withdrawal 2 - Stimulant toxicity 3 Internal Medicine Advanced Pathway ### Acute And Critical Care 50 questions #### Emergency Stabilization & Resuscitation 50 ABCs, shock, sepsis, airway, rapid deterioration, and immediate management algorithms. - Airway management basics for internists - Indications and risk assessment 4 - Post-intubation ventilator setup (principles) 3 - Pre-oxygenation and RSI principles 4 - Special airways 4 - Approach to the crashing patient - Early critical investigations 3 - Early escalation and teamwork 3 - Primary survey (ABCDE) 3 - Rapid differential by physiology 3 - ICU Complications & Organ Support - Acute kidney injury in ICU 2 - ARDS and severe hypoxemia 3 - Delirium, immobility, and ICU-acquired weakness 2 - Nosocomial infections and prevention 3 - Shock: advanced management - Cardiogenic shock 3 - Distributive shock nuances 3 - Hemorrhagic shock and massive transfusion 3 - Obstructive shock 4 ### Advanced Clinical Medicine 650 questions #### Acute and Critical Care 95 Time-sensitive stabilization, escalation, and ICU-level principles. - Acute kidney injury and renal replacement in ICU (overview) - Complications of RRT 3 - CRRT vs intermittent HD concepts 2 - Drug dosing on RRT 3 - Indications and timing debates 2 - ICU sedation, analgesia, delirium, and nutrition - Analgesia-first sedation and monitoring 3 - Delirium prevention and management bundle 3 - ICU nutrition concepts 3 - Stress ulcer and DVT prophylaxis 3 - Acute coronary syndromes and malignant arrhythmias (critical care) - Bradycardia and AV block emergencies 3 - Post-cardiac arrest care 4 - STEMI/NSTEMI time-critical pathways 3 - Tachyarrhythmias instability management 3 - Acute GI bleeding and massive hemorrhage - Bleeding in liver disease/uremia 3 - Lower GI bleed and ischemic colitis 3 - Resuscitation and hemostatic strategy 3 - Variceal bleeding protocol 2 - Acute respiratory failure and ventilation basics - ARDS management fundamentals 4 - Intubation decision-making 3 - Noninvasive support 2 - Weaning and extubation 3 - Sepsis bundles and ICU escalation - Adjuncts and controversies 3 - Organ support 3 - Sepsis in special hosts 3 - Time-critical actions 3 - Severe electrolyte and acid–base emergencies - Severe acidosis and toxic ingestions 5 - Severe hypercalcemia and hypocalcemia 3 - Severe hyperkalemia 3 - Severe hyponatremia with symptoms 2 - Shock (all types) - Fluid resuscitation strategies 3 - Initial recognition and classification 3 - Monitoring and endpoints 3 - Vasopressors and inotropes 3 #### Advanced Therapeutics 59 High-complexity therapeutics, monitoring plans, toxicity mitigation, and guideline edge-cases. - Advanced endocrine therapeutics - Complex insulin management 3 - Diabetes drugs in comorbidities 3 - Osteoporosis pharmacotherapy sequencing (overview) 3 - Thyroid disease in special contexts 3 - Oncologic supportive care and toxicity management (advanced) - Antiemetic regimens (overview) 3 - Cancer pain and palliative therapeutics 3 - Hematopoietic growth factors and transfusions 2 - Immunotherapy and cellular therapy toxicities (overview) 3 - Biologics, immunosuppression, and infection prophylaxis - Managing immune-related adverse events 3 - Monitoring and toxicity mitigation 3 - Pre-therapy screening 3 - Transplant-specific therapeutics overview 3 - Complex anticoagulation and antithrombotic management - Antiplatelet therapy in complex CAD 3 - Bleeding management and reversal 4 - DOAC selection in complex patients 2 - Mechanical valves and high-risk thrombosis 3 - Complex antimicrobial therapy and stewardship (advanced) - Endocarditis and osteomyelitis stewardship 4 - OPAT and IV-to-PO transitions 3 - Resistant Gram-negative infections 3 - Serious MRSA infections 2 #### Complex Diagnostics 55 Advanced interpretation of tests and diagnostic strategies for challenging problems. - Advanced echocardiography concepts (board-relevant) - Diastolic dysfunction and HFpEF 3 - Endocarditis imaging 2 - Shock POCUS integration 2 - Valvular quantification 3 - Advanced imaging interpretation and incidentalomas - Incidental adrenal nodule workup (overview) 2 - Pulmonary nodules (overview) 2 - Renal masses and cysts (overview) 3 - Thyroid nodules (overview) 4 - Advanced pulmonary diagnostics - Bronchoscopy and BAL interpretation (overview) 3 - Complex PFT interpretation 3 - Sleep study interpretation basics (overview) 3 - V/Q, CTPA, and CTEPH workup 2 - Advanced ECG and rhythm analysis - Brugada, long QT, and inherited arrhythmia syndromes (overview) 3 - Electrolyte/drug-induced ECG nuances 3 - Pacemaker/ICD ECG basics 3 - Wide complex tachycardia differentiation 3 - Advanced hematologic and immunologic diagnostics - Autoantibodies and complement patterns 2 - Hemolysis and smear interpretation 3 - Interpreting abnormal coagulation tests 3 - Monoclonal gammopathy evaluation 3 #### Complex Multisystem Presentations 57 Advanced integration of comorbidities, atypical presentations, and diagnostic/therapeutic tradeoffs. - Complex liver–kidney–heart interactions - Cardiorenal syndromes 3 - Congestive hepatopathy 2 - Hepatorenal and cirrhotic cardiomyopathy 4 - Pulmonary-renal syndromes 3 - Fever of unknown origin and hyperinflammatory syndromes - Advanced diagnostics 3 - Advanced differential and prioritization 2 - Empiric therapy risks 3 - High-yield rare entities 3 - Syncope and unexplained falls (advanced) - Autonomic and orthostatic syndromes 3 - Cardiac causes 3 - Neurologic mimics 3 - Risk stratification and disposition 3 - Undifferentiated dyspnea with multimorbidity - Cardiac vs pulmonary vs anemia vs metabolic causes 2 - Complex diagnostic strategy 3 - Disposition decisions 3 - Management tradeoffs 3 - Unexplained weight loss and constitutional symptoms - Cancer-focused evaluation 2 - Endocrine and metabolic causes 3 - Infectious causes 3 - Psychiatric and social causes 3 #### Multimorbidity and Frailty 52 Geriatric syndromes, chronic disease complexity, functional outcomes, and transitions of care. - Special Populations - Adults with disabilities and complex care needs 3 - Cultural and language equity in complex care 2 - Homelessness and housing insecurity 3 - Post-ICU syndrome (overview) 3 - Frailty assessment and prognostication - De-intensification of care 2 - Frailty identification tools 3 - Prognostic communication 2 - Sarcopenia and malnutrition 2 - Geriatric syndromes - Delirium 3 - Falls and syncope in older adults 3 - Incontinence 3 - Pressure injuries and skin care 3 - Polypharmacy and complex medication management - Adherence and regimen simplification 2 - Deprescribing high-risk meds 2 - Medication prioritization with multimorbidity 2 - Renal/hepatic dosing in older adults 3 - Transitions of care and post-acute planning - Hospital readmissions and high-risk patients 2 - Palliative and hospice transitions 3 - Safe discharge planning 3 - Skilled nursing, rehab, home health selection 3 #### Procedural and Perioperative Care 78 Common IM procedures, complication awareness, consent, and periop optimization. - Vascular access (peripheral and central) overview - Indications for central venous access 2 - Line complications 3 - Midlines and PICCs (selection concepts) 3 - Ultrasound guidance principles 2 - Arthrocentesis and injection (overview) - Complications and contraindications 3 - Indications 3 - Synovial fluid analysis 3 - When to consult orthopedics/rheumatology 2 - Lumbar puncture - Complications 3 - CSF collection and handling 3 - CSF interpretation (advanced patterns) 3 - Indications and contraindications 2 - Paracentesis - Ascitic fluid interpretation 3 - Complications and management 3 - Indications and contraindications 3 - Technique and ultrasound guidance 2 - Perioperative medicine (advanced integration) - Cardiac risk in complex patients 3 - Periop anticoagulation for high thrombotic risk 3 - Periop management of chronic meds 3 - Postop complications prevention 3 - Procedure fundamentals - Aseptic technique and infection prevention 2 - Informed consent and capacity 3 - Periprocedural anticoagulation management 3 - Sedation and analgesia principles (overview) 3 - Thoracentesis - Complications 3 - Indications and pre-procedure evaluation 3 - Next steps after thoracentesis 3 - Pleural fluid studies 3 #### Professionalism and Ethics 52 Ethical/legal standards, complex communication, consent, confidentiality, and error disclosure. - Capacity, consent, and surrogate decision-making - Advance directives and POLST/MOLST concepts 2 - Capacity assessment 2 - Informed consent in complex care 3 - Surrogates and substituted judgment 3 - Confidentiality, privacy, and mandatory reporting (principles) - Adolescent confidentiality (overview) 2 - Confidentiality in routine care 4 - Exceptions to confidentiality (overview) 3 - Subpoenas, documentation, and medicolegal basics 3 - End-of-life ethics and high-stakes decisions - DNR/DNI and code status discussions 2 - Organ donation and donation after circulatory death (overview) 2 - Palliative sedation (overview) 3 - Withholding vs withdrawing life-sustaining treatment 2 - Error disclosure and communication in adverse events - Documentation after adverse events 2 - Duty of candor principles 2 - Root cause analysis participation 3 - Second victim phenomenon 2 - Professional conduct, conflict of interest, and boundaries - Conflict of interest in prescribing and research 3 - Cultural humility and respectful care 3 - Fitness to practice and impairment 3 - Professional boundaries 3 #### Rare and Niche-but-Testable Diseases 44 Board-relevant uncommon conditions and masqueraders. - Porphyria and other metabolic masqueraders (overview) - A1AT deficiency 3 - Acute intermittent porphyria 3 - Hereditary hemochromatosis 3 - Wilson disease 2 - Amyloidosis (systemic) - Clinical phenotypes 3 - Diagnostic strategy 3 - Red flags 2 - Types and treatment overview 3 - Sarcoidosis - Diagnosis and mimics 3 - Hypercalcemia mechanism 2 - Organ involvement patterns 4 - Treatment principles 2 - Endocrine emergencies (advanced) - Adrenal crisis 2 - Hypercalcemic crisis 2 - Pituitary apoplexy 3 - Thyroid storm and myxedema coma 4 #### Scholarship and Education 46 Advanced appraisal, guideline literacy, teaching and supervision, feedback, reflective practice, and... - Scholarly activity and research literacy - Ethics and IRB basics 4 - Formulating clinical questions 3 - Presentation and dissemination skills 2 - Quality improvement scholarship 3 - Critical appraisal and statistics (advanced applied) - Clinical prediction models and AI (overview) 3 - Diagnostic studies 3 - Interpreting RCTs and pragmatic trials 3 - Systematic reviews and guidelines 3 - Reflective practice and lifelong learning - Clinical reasoning reflection and calibration 2 - Continuing professional development (CPD) planning 2 - Professional development and leadership learning 4 - Well-being and burnout prevention 2 - Teaching, supervision, and bedside education - Clinical teaching frameworks 3 - Feedback and assessment 3 - Remediation and coaching (overview) 4 - Supervision and entrustment 2 #### Special Populations 57 Distinct physiology/risk groups: pregnancy interfaces, immunocompromised hosts, adolescents, occupat... - Adolescent transition to adult care - Adolescent mental health and substance risk 3 - Congenital heart disease in adults (overview) 1 - Cystic fibrosis and chronic childhood diseases (overview) 3 - Transition planning 2 - Occupational, travel, and environmental illness (advanced) - Altitude and diving medicine (overview) 3 - Heat illness and exertional syndromes 3 - Toxic exposures 4 - Travel fever evaluation 3 - Pregnancy interfaces for internists - Diabetes in pregnancy (overview) 3 - Hypertensive disorders of pregnancy (overview) 3 - Medication safety counseling 3 - Thromboembolism in pregnancy (overview) 2 - Health equity in special populations - Bias mitigation in clinical decisions 3 - Language, disability, and communication access 3 - Population health approaches (overview) 3 - Structural determinants and outcomes 3 - Immunocompromised host (non-transplant and transplant interfaces) - Drug interactions 3 - Fever in immunocompromised patient 3 - Prophylaxis concepts 3 - Vaccination strategies 3 #### Systems Leadership and Quality 55 Safety science, QI methods, service management, and population health framing. - Population health and service management (overview) - Care for high-utilizer populations 2 - Clinical operations basics 3 - Ethical resource allocation 3 - Public health collaboration 2 - Clinical governance and stewardship - Antimicrobial stewardship 3 - Clinical pathways and standard work 3 - Diagnostic stewardship 3 - Resource utilization and cost awareness 3 - Handoffs, escalation, and team leadership - Interprofessional teamwork and conflict management 3 - Leadership in crisis 2 - Rapid response and deterioration management 3 - Safe handoff practices 3 - Patient safety fundamentals - High reliability principles 3 - Human factors and ergonomics 3 - Safety event reporting and learning systems 2 - Types of harm and error 3 - Quality improvement methodology - Equity in QI 3 - Implementation science basics 2 - Measuring quality 3 - QI tools and frameworks 3 ### Advanced Therapeutics 209 questions #### High-Risk Medication Management & Monitoring 46 Therapeutic reasoning under complexity, toxicity mitigation, and balancing benefit/harm. - Biologic therapies (deep safety) - Infusion reactions and hypersensitivity 3 - Long-term monitoring 3 - Managing serious infections on biologics 3 - Pre-treatment evaluation and vaccination 3 - Complex heart failure therapeutics - Advanced devices and palliative transitions 3 - Atrial fibrillation in HF 2 - Diuretic resistance 3 - GDMT optimization under constraints 3 - Multimorbidity and competing guideline targets - Benefit–harm assessment 3 - Deprescribing and simplification at scale 3 - High-risk transitions (hospital to home) 3 - Therapeutic monitoring plans 3 - Therapeutics in advanced CKD and dialysis - Antibiotic dosing on RRT 3 - Anticoagulation in CKD/ESRD 2 - Diabetes management in CKD 3 - Pain and sedation in CKD 3 #### Multimorbidity and Frailty 34 Complex chronic disease trajectories, geriatric syndromes, polypharmacy, and goals-of-care integrati... - Special Populations - Caregiver burden and social support 2 - Dementia and medical decision-making 3 - Geriatric oncology (overview) 4 - Palliative integration for chronic organ failure 4 - Complex chronic disease clustering - Cancer survivorship with multimorbidity 3 - Cirrhosis + renal dysfunction + malnutrition 3 - COPD + HF + sleep apnea overlap 3 - Diabetes + CKD + HF interplay 2 - Frailty-focused acute care decisions - Avoiding iatrogenesis 2 - Delirium prevention in high-risk patients 3 - Falls prevention programs 2 - ICU admission and escalation decisions 3 #### Procedural and Perioperative Care 23 Procedure competence, periop optimization in complex patients, and complication management. - Advanced perioperative risk management - High-risk cardiac conditions 4 - Periop anticoagulation in high thrombotic risk 3 - Periop diabetes and obesity considerations 2 - Pulmonary hypertension and right heart failure periop 2 - Complication-aware procedural practice - Arterial blood gas and arterial line basics (overview) 3 - Lumbar puncture and anticoagulation management 3 - Thoracentesis/paracentesis complications management 3 - Ultrasound-guided procedures (POCUS integration) 3 #### Professionalism and Ethics 21 High-stakes communication, medico-legal principles, and ethical complexity in advanced practice. - Complex goals-of-care conversations - Managing conflict with families 2 - Moral distress and clinician support 3 - Serious illness communication 3 - Time-limited trials and ICU decisions 3 - Consent and capacity in high-risk settings - Advance directives interpretation under uncertainty 2 - Cultural and language barriers 3 - Emergency exceptions to consent 2 - Refusal of care 3 #### Scholarship and Education 20 Advanced teaching and scholarship integrated into clinical leadership roles. - Designing curricula and assessments - Assessment methods 3 - Feedback systems at program level 3 - Learning objectives and alignment 2 - Standard setting concepts (overview) 2 - Clinical scholarship and guideline implementation - Academic integrity and authorship 3 - Guideline interpretation and local adaptation 2 - Journal club leadership 2 - Teaching diagnostic reasoning 3 #### Special Populations 43 Physiology/risk-specific care: pregnancy interfaces, immunocompromised, adolescents, occupational/tr... - Complex care in pregnancy (IM interface) - Autoimmune disease in pregnancy 3 - Cardiac disease and pregnancy (overview) 3 - Thyroid disease and pregnancy 3 - VTE and thrombophilia 3 - Occupational and travel medicine (advanced) - Mass gathering medicine (overview) 4 - Return-to-work and disability 2 - Tropical medicine red flags 3 - Work-related lung and skin disease 2 - Health equity and culturally safe care - Care for migrants and refugees (overview) 3 - Reducing disparities in chronic disease outcomes 2 - Trauma-informed care and stigma reduction 2 - Working with interpreters and low health literacy 3 - Immunocompromised hosts (advanced) - Biologic therapies and latent infections 3 - HIV with complex comorbidities 2 - Post-transplant infectious syndromes (overview) 2 - Vaccination strategy in immunocompromise 3 #### Systems Leadership and Quality 22 Leading teams, managing services, and delivering high-reliability, high-value care. - Service management and patient flow - Capacity and throughput 3 - Handoffs across services 3 - Resource stewardship 3 - Safety culture and speaking up 2 - Leading QI projects in clinical services - Change management 3 - Choosing an aim and measures 3 - Data interpretation 2 - Spreading improvements 3 ### Complex Diagnostics 35 questions #### Bayesian & Stewardship-Based Diagnostics (Advanced) 35 High-level reasoning, test selection, and diagnostic strategy in complex cases. - Advanced Bayesian reasoning in practice - Calibration and diagnostic confidence 3 - Decision thresholds and shared decisions 2 - Diagnostic timeouts and debiasing 4 - Sequential testing strategy 2 - Advanced imaging and pattern recognition - Abdominal imaging pearls 3 - Complex chest CT patterns 4 - Incidentalomas and overdiagnosis management 3 - Neuroimaging red flags 2 - Complex lab interpretation and pitfalls - Autoimmune serologies pitfalls 3 - Endocrine test pitfalls 3 - Microbiology test interpretation 3 - Spurious results and artifacts 3 ### Multimorbidity And Frailty 30 questions #### Geriatric Medicine at Advanced Level 30 Frailty syndromes, complex prescribing, and geriatric decision-making in acute and longitudinal care... - Advanced polypharmacy in frailty - Adverse drug event prevention 2 - Deprescribing complex regimens 3 - Medication management systems 3 - Renal dosing and monitoring in older adults 3 - Comprehensive geriatric assessment (CGA) - Documentation and communication 2 - Domains of CGA 3 - Frailty and surgical/ICU risk 3 - Using CGA to guide care plans 2 - Symptom control in multimorbidity - Anorexia-cachexia and nutrition 3 - Dyspnea management across diseases 2 - Insomnia and behavioral symptoms 2 - Pain management in frail older adults 2 ### Procedural And Perioperative Care 23 questions #### Advanced Procedural Competence and Perioperative Optimization 23 Integrating risk, consent, anticoagulation, and complications across procedures and periop consults. - Ultrasound-guided bedside procedures (advanced) - Ascites procedures 3 - Pleural procedures 2 - POCUS for diagnosis and guidance 3 - Vascular access 3 - Perioperative care for high-risk medications - Anticoagulants and antiplatelets (advanced) 3 - Diabetes therapies periop 3 - Immunosuppressants periop 3 - Pain and sedation risk reduction 3 ### Professionalism And Ethics 37 questions #### Advanced Ethics in Complex Internal Medicine 23 Difficult cases, interprofessional tensions, and high-risk legal/ethical scenarios. - Ethics consultation triggers and frameworks - Documentation and communication 4 - Ethics in resource limitation 2 - Identifying ethical dilemmas 2 - Structured analysis 3 - Professionalism in difficult interactions - Conflicts of interest in leadership roles 3 - Equity and bias in professionalism 3 - Interprofessional conflict resolution 3 - Managing disruptive behavior 3 #### High-Stakes Professional Practice 14 Category placeholder to maintain structure; see 'Professionalism and Ethics' above for detailed topi... - Professionalism and ethics comprehensive review - Capacity/consent/refusal complex cases 3 - Confidentiality and law enforcement interface 3 - Ethics of resource scarcity and triage 3 - Professional documentation under scrutiny 2 - Restraint and mental health law interfaces 3 ### Scholarship And Education 37 questions #### Advanced Educator and Scholar Competencies 22 Programmatic assessment, learning science, and scholarship dissemination. - Learning science and curriculum design (overview) - Cognitive load and instructional design 2 - Competency-based medical education (CBME) 3 - Faculty development and coaching 3 - Simulation-based education 3 - Scholarly writing and dissemination - Academic career development 3 - Educational scholarship 3 - Presentation skills 3 - Writing for publication 2 #### Scholarship, EBM, Teaching 15 Category placeholder to maintain structure; see 'Scholarship and Education' above for detailed topic... - Scholarship and education comprehensive review - Assessment literacy for orals/OSCE 3 - CPD and lifelong learning 3 - Critical appraisal and EBM application 4 - QI and guideline implementation 2 - Teaching and feedback skills 3 ### Special Populations 396 questions #### Advanced Special Population Integration 14 Category placeholder to maintain structure; see 'Special Populations (Advanced)' domain set above. - Integrated advanced special populations review - Critically ill neonate/child 3 - Geriatric frailty and anticoagulation complications 3 - High-risk pregnancy emergencies 3 - Immunocompromised/oncology emergencies 3 - Palliative and end-of-life care 2 #### Cultural, linguistic, and refugee mental health 17 Culturally safe care, interpreter use, trauma and displacement, and diagnostic adaptations. - Refugee trauma and complex needs - Care coordination with social/legal supports 5 - Pre-, peri-, post-migration stressors 4 - Cultural formulation and culturally bound expressions - Eliciting explanatory models 5 - Interpreter-mediated assessments 3 #### Geriatrics and Frailty (Core) 31 Atypical presentations, falls, delirium, polypharmacy, and disposition safety in older adults. - Atypical presentations and geriatric assessment - Atypical infection/ACS presentations 3 - Delirium recognition 3 - Disposition safety 3 - Frailty and functional assessment 4 - Polypharmacy and adverse drug events 3 - Falls and trauma in older adults - Disposition and safeguarding 3 - Head injury on anticoagulants 3 - Hip and pelvic fractures 4 - Rib fractures and respiratory compromise 2 - Syncope vs mechanical fall differentiation 3 #### High-Risk and Under-Served Groups (Advanced) 34 Clinical care tailored to specific physiologic and social contexts. - Care of patients with advanced cancer and comorbidities - Complications of therapy affecting other organs 4 - Decision-making under limited prognosis 2 - Infection risk management 4 - Transitions to hospice 3 - Patients with serious mental illness - Capacity and adherence challenges 3 - Delirium vs psychiatric symptom overlap 2 - Metabolic monitoring for antipsychotics 2 - Suicide risk in medical illness 3 - Patients with substance use disorders and complex illness - Hospital-based addiction care 3 - Infections related to injection drug use 3 - Pain management with OUD 3 - Trauma-informed care 2 #### Immunocompromised Patients (Core) 26 Oncology, transplant, HIV, and iatrogenic immunosuppression presentations and ED priorities. - Oncologic and therapy-related complications (intro) - Disposition 2 - Immunotherapy adverse events awareness 3 - Spinal cord compression awareness 3 - Thrombosis/PE risk in cancer 3 - Tumor lysis syndrome awareness 2 - Fever in immunocompromised patients - Disposition 2 - HIV and opportunistic infection awareness 3 - Neutropenic fever 2 - Steroid/biologic immunosuppression 3 - Transplant patient infection risk 3 #### Intellectual disability, autism, and communication differences 18 Adapting assessment and treatment for neurodevelopmental and cognitive differences across lifespan. - Challenging behavior and risk management - Positive behavior support planning 4 - Psychotropic use: target symptoms and monitoring 3 - Diagnostic overshadowing and medical contributors - Communication-adapted interviewing 6 - Pain, constipation, seizures, sleep problems 5 #### LGBTQ+ and gender-related mental health care 16 Affirming assessment, minority stress, gender dysphoria-related care principles, and psychiatric com... - Gender dysphoria care principles (within psychiatrist scope) - Assessment and comorbidity evaluation 4 - Collaborative care with gender-affirming services 5 - Minority stress and stigma-related mental health risks - Assessment of discrimination, violence, and support 4 - Suicide risk and protective interventions 3 #### Pediatrics 80 Age-specific assessment, stabilization, and high-risk pediatric presentations. - Febrile infant and pediatric sepsis (foundational) - Disposition 4 - Empiric antibiotics 5 - Initial evaluation 4 - Pitfalls 3 - Risk stratification concepts by age 4 - Pediatric assessment and physiology essentials - Age-adjusted vitals and shock recognition 4 - Fever and serious bacterial infection risk 5 - Pain assessment and analgesia 3 - Pediatric airway differences 4 - Safeguarding basics 5 - Pediatric dehydration and GI illness - Assessment of dehydration 4 - Disposition 3 - Electrolyte derangements awareness 4 - Oral rehydration therapy (ORT) 4 - When to suspect surgical abdomen 5 - Pediatric respiratory distress syndromes - Bronchiolitis 4 - Croup 4 - Disposition and family counseling 3 - Foreign body aspiration 3 - Pediatric asthma 5 #### Perinatal and reproductive psychiatry 16 Assessment and treatment planning around pregnancy, postpartum, lactation, and reproductive transiti... - PMDD and reproductive transitions - Diagnosis and treatment overview 4 - Perinatal mood and anxiety disorders - Medication risk-benefit counseling 4 - Safety planning and mother-infant considerations 3 - Screening and differential diagnosis 5 #### Pregnancy and Gynecologic Emergencies (Core) 86 Physiologic changes, early pregnancy complications, and common OB/GYN emergencies in the ED. - Second/third-trimester bleeding (overview) - Disposition and transfer 4 - Pitfalls 4 - Placenta previa/abruption awareness 5 - Postpartum hemorrhage awareness 5 - Preterm labor awareness 6 - First-trimester bleeding and ectopic pregnancy - Complications and pitfalls 5 - Disposition 4 - Initial evaluation 4 - Management pathways 5 - Ultrasound interpretation (conceptual) 4 - Hypertensive disorders of pregnancy (core) - BP management principles 3 - Disposition 3 - HELLP syndrome awareness 3 - Magnesium sulfate therapy 3 - Preeclampsia/eclampsia recognition 5 - Pregnancy physiology and ED implications - Cardiovascular/respiratory changes 5 - Disposition and follow-up 4 - Laboratory and imaging considerations 6 - Resuscitation modifications 4 - Trauma considerations 4 #### Safeguarding, Social Determinants, and Vulnerable Groups 42 Discharge planning and safety for patients with social vulnerability or safeguarding needs. - Homelessness, substance use, and high-utilization care - Behavioral health comorbidity 4 - Documentation and ethical considerations 2 - Harm reduction in ED 2 - Linkage to care and follow-up 3 - Medical risks and barriers 3 - Patients with disabilities and communication barriers - Capacity and consent considerations 2 - Communication accommodations 2 - Discharge planning 2 - Pitfalls 3 - Safeguarding and abuse risk 2 - Domestic violence and sexual assault (core) - Forensic pathways awareness 3 - Mandatory reporting (contextual) 3 - Medical care essentials 4 - Safety planning and resources 4 - Trauma-informed care 3 #### Severe psychosocial vulnerability and marginalized contexts 16 Homelessness, incarceration, HIV, chronic pain, and other contexts requiring adapted and equitable c... - HIV and neuropsychiatric complications - Depression, cognitive impairment, medication interactions 5 - Incarcerated individuals and reentry planning (overview) - Continuity of care and medication access 3 - Chronic pain and opioid risk - Integrated pain and mental health care 4 - Homelessness and serious mental illness - Engagement and harm reduction 4 ### Systems Leadership And Quality 20 questions #### Advanced Systems Practice and Leadership 20 Operational leadership, safety, reliability, and population-level improvement. - Designing and evaluating care pathways - Clinical pathway creation 3 - High-value care integration 2 - Measuring impact 3 - Sustainability and spread 2 - Leading high-reliability teams - Crisis management and incident command (overview) 3 - Safety culture measurement and improvement 3 - Standardization vs flexibility 2 - Team cognition and situational awareness 2 [ View Internal Medicine ](https://mdster.com/speciality/internal-medicine) [ View pricing ](https://mdster.com/pricing) [ MDster home ](/ "MDster home") Master your medical exams with evidence-based learning. 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