Examius

🇺🇸 Medical Council Step exam for International Medical Graduates / ECFMG Certification · subject

Medical Council Step exam for International Medical Graduates / ECFMG Certification USMLE Step 2 CK: Internal Medicine & Subspecialties Syllabus

The USMLE Step 2 CK: Internal Medicine & Subspecialties syllabus for Medical Council Step exam for International Medical Graduates / ECFMG Certification in full: 4 chapters and 20 topics, every one listed below, plus 56 USMLE Step 2 CK: Internal Medicine & Subspecialties flashcards with answers.

4Chapters
20Topics
56Flashcards

USMLE Step 2 CK: Internal Medicine & Subspecialties syllabus: all 4 chapters

Expand any chapter to see its topics and sub-topics.

  1. Cardiology & Pulmonology Management

     5 topics
    • Acute coronary syndrome diagnosis and management
    • Heart failure staging and guideline-directed therapy
    • Arrhythmia and anticoagulation management
    • COPD/asthma exacerbation management
    • Pneumonia, sepsis, and critical care basics

  2. Gastroenterology, Nephrology & Endocrinology

     5 topics
    • GI bleeding and acute abdomen workup
    • Liver disease and hepatitis management
    • Electrolyte emergencies and AKI/CKD management
    • Diabetes management and DKA/HHS
    • Thyroid and adrenal disorder treatment

  3. Infectious Disease & Rheumatology

     5 topics
    • HIV/AIDS diagnosis and antiretroviral therapy
    • Antimicrobial selection and stewardship
    • Sepsis recognition and management
    • Autoimmune and inflammatory arthropathies
    • Vasculitis and systemic rheumatic disease

  4. Hematology-Oncology & Geriatrics

     5 topics
    • Anemia and cytopenia workup
    • Oncologic emergencies and chemotherapy toxicity
    • Cancer screening guidelines
    • Geriatric assessment, polypharmacy, falls
    • Palliative and end-of-life care

Medical Council Step exam for International Medical Graduates / ECFMG Certification USMLE Step 2 CK: Internal Medicine & Subspecialties flashcards — 56 questions with answers

  1. What ECG finding distinguishes STEMI from NSTEMI/unstable angina, and what is the immediate reperfusion goal for STEMI?

    STEMI shows new ST-segment elevation (or new LBBB); NSTEMI/UA have ST depression or T-wave inversion without ST elevation. Goal: primary PCI within 90 minutes of first medical contact (or fibrinolytics within 30 min if PCI unavailable >120 min).

  2. What is the initial medical bundle ('MONA-BASH') for acute coronary syndrome?

    Aspirin (chewed, 162-325 mg) plus a P2Y12 inhibitor, anticoagulation (heparin), high-intensity statin, beta-blocker (if no contraindication), nitrates for pain, and oxygen only if SpO2 <90%. Morphine for refractory pain.

  3. Which cardiac biomarker is most sensitive/specific for MI, and what is its time course?

    Troponin (I or T): rises 3-6 hours after injury, peaks at 24 hours, stays elevated 7-10 days. High-sensitivity troponin allows detection within 1-3 hours; serial measurements detect a rise/fall pattern.

  4. How are the four NYHA functional classes of heart failure defined?

    Class I: no symptoms with ordinary activity. Class II: symptoms with ordinary activity. Class III: symptoms with less-than-ordinary activity. Class IV: symptoms at rest.

  5. What are the four pillars of guideline-directed medical therapy (GDMT) for HFrEF?

    (1) ARNI (or ACEi/ARB), (2) beta-blocker (carvedilol, metoprolol succinate, or bisoprolol), (3) mineralocorticoid receptor antagonist (spironolactone/eplerenone), and (4) SGLT2 inhibitor (dapagliflozin/empagliflozin).

  6. Define the ACC/AHA stages A-D of heart failure.

    Stage A: at risk, no structural disease/symptoms. Stage B: structural disease, no symptoms. Stage C: structural disease with current/prior symptoms. Stage D: refractory, advanced HF requiring specialized interventions.

  7. What is the CHA2DS2-VASc score and when should anticoagulation be started in atrial fibrillation?

    CHF, HTN, Age >=75 (2), Diabetes, Stroke/TIA (2), Vascular disease, Age 65-74, Sex (female). Anticoagulate if score >=2 in men or >=3 in women; consider if 1 (men)/2 (women).

  8. In atrial fibrillation, when is rate control preferred over rhythm control, and what agents are first-line for rate control?

    Rate control is preferred for most stable, older patients with persistent AF. First-line: beta-blockers or non-dihydropyridine calcium channel blockers (diltiazem/verapamil); digoxin as adjunct in HF/hypotension.

  9. What is the immediate management of unstable atrial fibrillation with hemodynamic compromise?

    Synchronized electrical cardioversion. 'Unstable' = hypotension, chest pain/ischemia, acute heart failure, or altered mental status.

  10. How do DOACs compare to warfarin for nonvalvular AF, and which patients still require warfarin?

    DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are preferred: no INR monitoring, fewer interactions, less intracranial bleeding. Warfarin is required for mechanical heart valves and moderate-severe mitral stenosis.

  11. What defines a COPD exacerbation and what are the cornerstone treatments?

    Acute worsening of dyspnea, cough, and/or sputum (volume/purulence). Treat with inhaled short-acting bronchodilators (SABA +/- SAMA), systemic corticosteroids (prednisone ~40 mg x5 days), and antibiotics if increased purulence.

  12. When is noninvasive positive pressure ventilation (BiPAP) indicated in a COPD exacerbation?

    For respiratory acidosis (pH <=7.35 with PaCO2 >=45), severe dyspnea with signs of respiratory muscle fatigue, or persistent hypoxemia despite oxygen. It reduces intubation and mortality.

  13. How is the severity of an asthma exacerbation assessed and treated in the ED?

    Assess with peak flow/FEV1, SpO2, and work of breathing. Treat with oxygen, repeated/continuous SABA (albuterol) plus ipratropium, systemic corticosteroids, and IV magnesium sulfate for severe cases. Rising PaCO2 signals impending respiratory failure.

  14. What CURB-65 criteria guide pneumonia disposition, and what does the score indicate?

    Confusion, Urea >19 mg/dL (BUN), Respiratory rate >=30, Blood pressure <90/60, age >=65. Score 0-1: outpatient; 2: consider admission; >=3: admit, consider ICU.

  15. What is the empiric outpatient antibiotic regimen for community-acquired pneumonia in a previously healthy adult?

    Amoxicillin (high-dose) or doxycycline, or a macrolide where pneumococcal resistance is low. With comorbidities: respiratory fluoroquinolone (levofloxacin) OR beta-lactam plus macrolide.

  16. State the Sepsis-3 definition of sepsis and septic shock.

    Sepsis = life-threatening organ dysfunction (SOFA increase >=2) from a dysregulated host response to infection. Septic shock = sepsis with vasopressors needed to keep MAP >=65 plus lactate >2 despite adequate fluid resuscitation.

  17. What are the key elements of the Surviving Sepsis 'Hour-1 bundle'?

    Measure lactate, obtain blood cultures before antibiotics, give broad-spectrum antibiotics, begin 30 mL/kg crystalloid for hypotension or lactate >=4, and start vasopressors (norepinephrine first-line) to keep MAP >=65 if fluid-refractory.

  18. What is the initial diagnostic and resuscitation approach to acute upper GI bleeding?

    Two large-bore IVs, fluid/blood resuscitation (transfuse to Hgb >=7), IV PPI, and urgent upper endoscopy within 24 hours. Add octreotide and ceftriaxone if variceal bleed is suspected in cirrhosis.

  19. How do you distinguish upper from lower GI bleeding clinically?

    Upper GI bleed (proximal to ligament of Treitz): hematemesis, melena, elevated BUN/creatinine ratio. Lower GI bleed: hematochezia (though brisk upper bleeds can also cause it). NG lavage or endoscopy confirms source.

  20. What signs suggest peritonitis/acute abdomen requiring urgent surgical evaluation?

    Rigid abdomen, rebound tenderness, guarding, absent bowel sounds, and pain out of proportion. Free air on upright X-ray/CT indicates perforation; suspect mesenteric ischemia with severe pain plus lactic acidosis.

Show the other 36 USMLE Step 2 CK: Internal Medicine & Subspecialties flashcards

  1. What is the workup for suspected cirrhosis with ascites, and what does SAAG indicate?

    Diagnostic paracentesis with serum-ascites albumin gradient (SAAG). SAAG >=1.1 g/dL indicates portal hypertension (cirrhosis, HF); SAAG <1.1 suggests non-portal causes (peritoneal carcinomatosis, TB, nephrotic).

  2. How is spontaneous bacterial peritonitis (SBP) diagnosed and treated?

    Ascitic fluid PMN count >=250 cells/mm3. Treat with IV third-generation cephalosporin (cefotaxime/ceftriaxone) plus IV albumin to reduce hepatorenal syndrome. Prophylax high-risk patients with a fluoroquinolone.

  3. Compare hepatitis B serologies: acute infection, chronic infection, resolved infection, and vaccination.

    Acute: HBsAg+, IgM anti-HBc+. Chronic: HBsAg+ >6 months, IgG anti-HBc+, anti-HBs-. Resolved: anti-HBs+, anti-HBc+ (total), HBsAg-. Vaccinated: anti-HBs+ only (no anti-HBc).

  4. What is the treatment goal and regimen for hepatitis C?

    Cure (sustained virologic response, SVR) with 8-12 weeks of direct-acting antivirals (e.g., sofosbuvir/velpatasvir, glecaprevir/pibrentasvir). Cure rates exceed 95% regardless of genotype.

  5. List the components and interpretation of the MELD-Na score.

    Uses bilirubin, INR, creatinine, and sodium to predict 90-day mortality in cirrhosis and prioritize liver transplant. Higher scores indicate worse prognosis and higher transplant priority.

  6. What ECG changes and treatment correspond to severe hyperkalemia?

    Peaked T waves, widened QRS, loss of P waves, sine wave. Treatment: IV calcium gluconate (membrane stabilization), then insulin+glucose, beta-agonists, bicarbonate (shift K intracellularly), and removal via diuretics, kayexalate/patiromer, or dialysis.

  7. What is the danger of correcting hyponatremia too rapidly, and what is the safe rate?

    Rapid correction risks osmotic demyelination syndrome (central pontine myelinolysis). Limit correction to <=8 mEq/L per 24 hours (10-12 max). Use hypertonic saline only for severe symptomatic hyponatremia (seizures, coma).

  8. How are prerenal, intrinsic, and postrenal AKI distinguished by FENa and urine findings?

    Prerenal: FENa <1%, BUN/Cr >20, bland sediment. Intrinsic (ATN): FENa >2%, muddy brown casts. Postrenal: obstruction on imaging (hydronephrosis). FENa is unreliable with diuretic use (use FEUrea <35%).

  9. What are the indications for urgent/emergent dialysis (AEIOU)?

    Acidosis (refractory metabolic), Electrolytes (refractory hyperkalemia), Intoxications (e.g., salicylates, lithium, methanol), Overload (refractory volume overload/pulmonary edema), Uremia (pericarditis, encephalopathy, bleeding).

  10. What are the diagnostic criteria for diabetes mellitus?

    Any of: HbA1c >=6.5%, fasting glucose >=126 mg/dL, 2-hour OGTT glucose >=200 mg/dL, or random glucose >=200 with classic symptoms. Confirm with repeat testing unless unequivocal hyperglycemia.

  11. How is diabetic ketoacidosis (DKA) managed?

    IV fluids (normal saline), IV insulin infusion, and potassium repletion (start when K <5.2; hold insulin if K <3.3). Monitor anion gap closure; add dextrose when glucose <200; treat precipitant. Bridge to subcutaneous insulin when gap closes and patient is eating.

  12. Compare DKA and hyperosmolar hyperglycemic state (HHS).

    DKA (often type 1): glucose >250, pH <7.3, ketones+, anion gap acidosis, develops rapidly. HHS (type 2): glucose >600, pH >7.3, minimal ketones, profound hyperosmolarity/dehydration, altered mental status, develops over days; higher mortality.

  13. What is the first-line pharmacologic therapy for type 2 diabetes and which agents have cardiovascular/renal benefit?

    Metformin is first-line. SGLT2 inhibitors and GLP-1 receptor agonists provide cardiovascular and renal benefit and are preferred add-ons (or first-line) in patients with ASCVD, heart failure, or CKD.

  14. How are primary hypothyroidism and hyperthyroidism distinguished by TSH/T4, and what are first-line treatments?

    Primary hypothyroidism: high TSH, low free T4 -> levothyroxine. Hyperthyroidism: low TSH, high free T4/T3 -> methimazole (PTU in first trimester/thyroid storm), beta-blocker for symptoms, +/- radioactive iodine.

  15. What are the features and management of thyroid storm?

    Fever, tachyarrhythmia, agitation/delirium, GI symptoms (Burch-Wartofsky score). Treat with beta-blocker (propranolol), PTU/methimazole, then iodine (>=1 hour after thionamide), and glucocorticoids; supportive cooling and fluids.

  16. How is primary adrenal insufficiency (Addison disease) diagnosed and treated, including adrenal crisis?

    Low morning cortisol with high ACTH; confirm with cosyntropin stimulation test (inadequate cortisol rise). Treat with hydrocortisone plus fludrocortisone. Adrenal crisis: high-dose IV hydrocortisone, aggressive saline, and treat precipitant.

  17. What is the screening test for Cushing syndrome and the first-line test for primary hyperaldosteronism?

    Cushing: 1 mg overnight dexamethasone suppression test, late-night salivary cortisol, or 24-hr urinary free cortisol. Primary hyperaldosteronism: plasma aldosterone-to-renin ratio (elevated).

  18. What defines AIDS, and when should antiretroviral therapy (ART) be started in HIV?

    AIDS = HIV with CD4 <200 cells/uL or an AIDS-defining illness. ART should be started in ALL HIV-positive patients regardless of CD4 count, as soon as possible after diagnosis.

  19. What is the typical preferred first-line ART regimen for treatment-naive HIV patients?

    An integrase strand transfer inhibitor (INSTI)-based regimen, e.g., bictegravir/tenofovir alafenamide/emtricitabine, or dolutegravir plus 2 NRTIs. INSTI regimens are preferred for efficacy and tolerability.

  20. At what CD4 counts are prophylaxis started for PCP, toxoplasmosis, and MAC in HIV?

    PCP: CD4 <200 -> TMP-SMX. Toxoplasmosis: CD4 <100 with positive IgG -> TMP-SMX. MAC: routine prophylaxis no longer recommended if ART started promptly; historically CD4 <50 -> azithromycin.

  21. What are the core principles of antimicrobial stewardship?

    Use the narrowest effective agent, de-escalate based on culture/sensitivities, use the shortest effective duration, choose the right route, obtain cultures before antibiotics, and reassess at 48-72 hours ('antibiotic time-out').

  22. Which antibiotics cover Pseudomonas aeruginosa, and which cover MRSA?

    Antipseudomonal: piperacillin-tazobactam, cefepime, ceftazidime, meropenem, ciprofloxacin, aztreonam. Anti-MRSA: vancomycin, linezolid, daptomycin (not for pneumonia), ceftaroline, TMP-SMX, doxycycline.

  23. What differentiates rheumatoid arthritis from osteoarthritis clinically?

    RA: symmetric, inflammatory, MCP/PIP and wrist involvement, morning stiffness >1 hour, RF/anti-CCP positive, spares DIP. OA: asymmetric, mechanical, DIP (Heberden) and PIP (Bouchard) nodes, brief morning stiffness, no systemic inflammation.

  24. How are acute gout and pseudogout distinguished on synovial fluid analysis?

    Gout: negatively birefringent, needle-shaped monosodium urate crystals (yellow when parallel to polarizer). Pseudogout (CPPD): positively birefringent, rhomboid calcium pyrophosphate crystals; chondrocalcinosis on X-ray.

  25. What is the first-line treatment for an acute gout flare and for long-term urate-lowering?

    Acute flare: NSAIDs, colchicine, or glucocorticoids. Long-term urate-lowering (for recurrent attacks/tophi/stones): allopurinol or febuxostat, titrated to a serum urate <6 mg/dL; do not stop during an acute flare.

  26. Compare large-, medium-, and small-vessel vasculitis with one classic example of each.

    Large-vessel: giant cell arteritis, Takayasu. Medium-vessel: polyarteritis nodosa, Kawasaki. Small-vessel: granulomatosis with polyangiitis (c-ANCA/PR3), microscopic polyangiitis and eosinophilic GPA (p-ANCA/MPO), IgA vasculitis.

  27. How is giant cell (temporal) arteritis diagnosed and treated, and why is it urgent?

    Older patient with new headache, jaw claudication, vision changes, scalp tenderness, elevated ESR/CRP; confirm with temporal artery biopsy or imaging. Start high-dose glucocorticoids IMMEDIATELY (do not wait for biopsy) to prevent irreversible blindness.

  28. What autoantibodies are associated with SLE, and which is most specific?

    ANA is sensitive (screening) but not specific. Anti-dsDNA (correlates with nephritis/disease activity) and anti-Smith are highly specific. Anti-Ro/La associate with neonatal lupus; antiphospholipid antibodies with thrombosis.

  29. How is anemia classified by MCV, with examples of each category?

    Microcytic (MCV <80): iron deficiency, thalassemia, anemia of chronic disease, sideroblastic. Normocytic (80-100): acute blood loss, hemolysis, chronic disease, renal. Macrocytic (>100): B12/folate deficiency, alcohol, hypothyroidism, drugs, myelodysplasia.

  30. How do iron deficiency and anemia of chronic disease differ on iron studies?

    Iron deficiency: low ferritin, high TIBC, low iron, low transferrin saturation. Anemia of chronic disease: low/normal-to-high ferritin, low TIBC, low iron, normal/low transferrin saturation (iron sequestration).

  31. What are key oncologic emergencies and their initial management?

    Tumor lysis syndrome: hydration, allopurinol/rasburicase, treat electrolytes. Febrile neutropenia: empiric broad-spectrum antibiotics (cefepime) within 1 hour. Spinal cord compression: dexamethasone + emergent MRI + radiation/surgery. Hypercalcemia: IV fluids + bisphosphonate. SVC syndrome.

  32. What are the dose-limiting toxicities of doxorubicin, bleomycin, cisplatin, and vincristine?

    Doxorubicin: cardiotoxicity (dilated cardiomyopathy). Bleomycin: pulmonary fibrosis. Cisplatin: nephrotoxicity and ototoxicity/peripheral neuropathy. Vincristine: peripheral neuropathy.

  33. What are the USPSTF screening recommendations for breast, cervical, and colorectal cancer?

    Breast: biennial mammography ages 40-74. Cervical: Pap every 3 years (21-29), Pap+HPV co-test every 5 years or HPV alone (30-65). Colorectal: begin at age 45 (colonoscopy q10 yr, FIT yearly, or other options) through 75.

  34. What is the lung cancer screening recommendation, and how is prostate cancer screening approached?

    Lung: annual low-dose CT for ages 50-80 with >=20 pack-year history who currently smoke or quit within 15 years. Prostate: shared decision-making for PSA ages 55-69; not routinely recommended >=70.

  35. What are key components of a comprehensive geriatric assessment and the Beers criteria's purpose?

    Assessment covers function (ADLs/IADLs), cognition, mood, gait/falls, nutrition, continence, polypharmacy, and social support. Beers criteria list potentially inappropriate medications in older adults (e.g., benzodiazepines, anticholinergics, first-gen antihistamines).

  36. What are the principles of palliative care and the difference between palliative care and hospice?

    Palliative care: symptom relief and quality of life at any disease stage, alongside curative treatment. Hospice: comfort-focused care for terminal illness with prognosis <=6 months, forgoing curative treatment; both emphasize patient goals.

Medical Council Step exam for International Medical Graduates / ECFMG Certification USMLE Step 2 CK: Internal Medicine & Subspecialties FAQ

What is in the Medical Council Step exam for International Medical Graduates / ECFMG Certification USMLE Step 2 CK: Internal Medicine & Subspecialties syllabus?

Medical Council Step exam for International Medical Graduates / ECFMG Certification USMLE Step 2 CK: Internal Medicine & Subspecialties is split into 4 chapters: Cardiology & Pulmonology Management, Gastroenterology, Nephrology & Endocrinology, Infectious Disease & Rheumatology and Hematology-Oncology & Geriatrics. Together they contain 20 topics.

How many chapters are in Medical Council Step exam for International Medical Graduates / ECFMG Certification USMLE Step 2 CK: Internal Medicine & Subspecialties?

4 chapters, containing 20 topics. The largest chapter is Cardiology & Pulmonology Management, with 5 topics.

Are there flashcards for Medical Council Step exam for International Medical Graduates / ECFMG Certification USMLE Step 2 CK: Internal Medicine & Subspecialties?

Yes — a 56-card USMLE Step 2 CK: Internal Medicine & Subspecialties deck, printed in full in the flashcards section of this page and available in the Examius app with spaced repetition. The free plan covers one exam of your choice, including its flashcards; Examius Pro, a one-time purchase, unlocks every other exam and deck.