Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) Internal Medicine and Medical Subspecialties Syllabus

Internal Medicine and Medical Subspecialties syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Internal Medicine and Medical Subspecialties in Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA), not a summary of it.

1. 1

   Cardiovascular Disorders

   5 topics

   • Ischemic Heart Disease
     • Stable angina and acute coronary syndromes
     • Risk stratification and management
   • Heart Failure and Cardiomyopathies
     • Systolic versus diastolic dysfunction
   • Arrhythmias and Conduction Disorders
     • Atrial fibrillation and supraventricular tachycardia
     • Bradyarrhythmias and heart block
   • Vascular and Hypertensive Disease
     • Hypertension and hypertensive emergencies
     • Peripheral arterial and venous disease
   • Valvular Heart Disease
     • Stenosis and regurgitation murmurs
2. 2

   Pulmonary, Renal, and Endocrine Disorders

   5 topics

   • Obstructive and Restrictive Lung Disease
     • Asthma and COPD
     • Interstitial lung disease
   • Acid-Base and Electrolyte Disorders
     • Metabolic and respiratory disturbances
   • Acute and Chronic Kidney Disease
     • Glomerular and tubular disorders
   • Diabetes and Thyroid Disorders
     • Diabetes mellitus and complications
     • Hyper- and hypothyroidism
   • Adrenal and Pituitary Disease
     • Cushing, Addison, and pituitary axis disorders
3. 3

   Gastroenterology and Hepatology

   4 topics

   • Esophageal and Gastric Disorders
     • GERD and peptic ulcer disease
   • Intestinal Disorders
     • Inflammatory bowel disease
     • Malabsorption and irritable bowel syndrome
   • Hepatobiliary and Pancreatic Disease
     • Hepatitis and cirrhosis
     • Cholelithiasis and pancreatitis
   • GI Bleeding and Emergencies
     • Upper versus lower GI bleed evaluation
4. 4

   Hematology, Oncology, and Rheumatology

   4 topics

   • Anemias and Hemoglobinopathies
     • Micro-, normo-, and macrocytic anemias
   • Coagulation and Bleeding Disorders
     • Thrombophilia and thrombocytopenia
   • Hematologic and Solid Tumor Malignancies
     • Leukemias and lymphomas
     • Oncologic emergencies
   • Autoimmune and Connective Tissue Disease
     • Rheumatoid arthritis and lupus
     • Crystal and seronegative arthropathies
5. 5

   Infectious Disease and Neurology

   4 topics

   • Common Infections by System
     • Respiratory, urinary, and skin infections
     • Sepsis recognition and management
   • HIV and Opportunistic Infections
     • Diagnosis, staging, and antiretroviral therapy
   • Cerebrovascular and Headache Disorders
     • Ischemic and hemorrhagic stroke
     • Migraine and secondary headaches
   • Seizures and Neurodegenerative Disease
     • Epilepsy classification and management
     • Parkinson, dementia, and demyelinating disease

Internal Medicine and Medical Subspecialties flashcards for Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA)

20 of 61 cards from the Internal Medicine and Medical Subspecialties deck — real questions with worked answers.

1. What ECG findings distinguish a STEMI from an NSTEMI?

   STEMI shows ST-segment elevation (>=1 mm in two contiguous limb leads or >=2 mm in precordial leads) or new LBBB with positive troponin; NSTEMI has elevated troponin with ST depression or T-wave inversions but no persistent ST elevation.

2. Which coronary artery occlusion corresponds to ST elevation in leads II, III, and aVF, and what complication should you watch for?

   The right coronary artery (inferior MI). Watch for RV infarction and bradyarrhythmias/AV block; avoid nitrates due to preload-dependence.

3. What is the classic triad of stable angina and how does it differ from unstable angina?

   Stable angina: substernal chest discomfort, provoked by exertion/stress, relieved by rest or nitroglycerin. Unstable angina is new-onset, occurs at rest, or is increasing in frequency/severity, with no troponin rise.

4. By the NYHA functional classification, what defines Class III heart failure?

   Marked limitation of physical activity: comfortable at rest, but less-than-ordinary activity causes symptoms (dyspnea, fatigue, palpitations).

5. What distinguishes HFrEF from HFpEF by ejection fraction, and which is associated with eccentric vs concentric hypertrophy?

   HFrEF: EF <=40%, eccentric (dilated) hypertrophy from volume overload. HFpEF: EF >=50%, concentric hypertrophy with impaired diastolic relaxation.

6. Which heart failure medication classes have proven mortality benefit in HFrEF?

   ACE inhibitors/ARBs or ARNI (sacubitril-valsartan), beta-blockers (carvedilol, metoprolol succinate, bisoprolol), mineralocorticoid receptor antagonists (spironolactone/eplerenone), and SGLT2 inhibitors.

7. Compare the three major cardiomyopathies (dilated, hypertrophic, restrictive) by ventricular geometry and function.

   Dilated: enlarged chambers, systolic dysfunction (low EF). Hypertrophic: thick (often asymmetric septal) walls, diastolic dysfunction +/- LVOT obstruction. Restrictive: stiff, normal-sized walls, diastolic dysfunction with preserved systolic function.

8. How do you distinguish atrial flutter from atrial fibrillation on ECG?

   Atrial flutter shows regular sawtooth flutter (F) waves, often at ~300 bpm with regular ventricular response (e.g., 2:1 -> 150 bpm). Atrial fibrillation has no discrete P waves and an irregularly irregular rhythm.

9. What is the CHA2DS2-VASc score used for and which components score 2 points?

   It estimates stroke risk in atrial fibrillation to guide anticoagulation. Two-point components: Age >=75 and prior Stroke/TIA/thromboembolism.

10. Differentiate Mobitz I (Wenckebach) from Mobitz II second-degree AV block.

    Mobitz I: progressive PR prolongation until a beat is dropped (usually benign, AV node). Mobitz II: constant PR interval with sudden dropped beats (infranodal, high risk of progression to complete block; needs pacemaker).

11. What ECG pattern defines Wolff-Parkinson-White syndrome?

    Short PR interval (<120 ms), a delta wave (slurred QRS upstroke), and widened QRS, due to an accessory pathway (bundle of Kent) pre-exciting the ventricle.

12. What are the blood pressure thresholds defining Stage 1 and Stage 2 hypertension per ACC/AHA 2017?

    Stage 1: systolic 130-139 or diastolic 80-89 mmHg. Stage 2: systolic >=140 or diastolic >=90 mmHg. (Elevated = 120-129/<80; Normal <120/<80.)

13. What is the classic clinical triad of abdominal aortic aneurysm rupture?

    Hypotension, pulsatile abdominal mass, and sudden severe abdominal or flank/back pain.

14. Differentiate the pain of arterial vs venous insufficiency in the lower extremities.

    Arterial (PAD): intermittent claudication, pain worse with elevation/exertion, relieved by dependency; cool, hairless, pale limb with diminished pulses. Venous: dull aching worse with dependency/standing, relieved by elevation; edema, brown hemosiderin staining, medial ankle ulcers.

15. What ankle-brachial index (ABI) value confirms peripheral artery disease?

    An ABI <= 0.90. Values >1.40 suggest noncompressible, calcified vessels (common in diabetes/CKD).

16. How do you distinguish the murmur of aortic stenosis from mitral regurgitation?

    Aortic stenosis: harsh crescendo-decrescendo systolic ejection murmur at the right upper sternal border radiating to the carotids. Mitral regurgitation: holosystolic blowing murmur at the apex radiating to the axilla.

17. Which valvular lesion produces an opening snap followed by a diastolic rumble, and what is its most common cause?

    Mitral stenosis; most commonly caused by rheumatic heart disease. Also causes a loud S1 and is best heard at the apex in the left lateral decubitus position.

18. How does the murmur of hypertrophic cardiomyopathy change with Valsalva versus squatting?

    It increases with Valsalva and standing (decreased preload/afterload, more LVOT obstruction) and decreases with squatting and handgrip (increased preload/afterload). This is opposite to most other murmurs.

19. What spirometry pattern (FEV1/FVC) distinguishes obstructive from restrictive lung disease?

    Obstructive: FEV1/FVC ratio reduced (<0.70). Restrictive: FEV1/FVC normal or increased with reduced FVC and reduced total lung capacity.

20. Contrast emphysema and chronic bronchitis as the two phenotypes of COPD.

    Emphysema ('pink puffer'): alveolar destruction, decreased DLCO, hyperinflation, dyspnea. Chronic bronchitis ('blue bloater'): productive cough >=3 months for >=2 consecutive years, normal DLCO, hypoxemia/cyanosis.

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