Medical Council Step exam for International Medical Graduates / ECFMG Certification USMLE Step 2 CK: Surgery, OB-GYN, Pediatrics & Psychiatry Syllabus

USMLE Step 2 CK: Surgery, OB-GYN, Pediatrics & Psychiatry syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for USMLE Step 2 CK: Surgery, OB-GYN, Pediatrics & Psychiatry in Medical Council Step exam for International Medical Graduates / ECFMG Certification, not a summary of it.

1. 1

   General & Subspecialty Surgery

   5 topics

   • Preoperative evaluation and risk assessment
   • Acute abdomen and surgical emergencies
   • Trauma evaluation and ATLS principles
   • Postoperative complications and wound management
   • Fluids, electrolytes, and surgical nutrition
2. 2

   Obstetrics

   5 topics

   • Prenatal care and routine screening
   • Normal labor, delivery, and intrapartum monitoring
   • High-risk pregnancy and obstetric complications
   • Hypertensive disorders of pregnancy
   • Postpartum care and hemorrhage
3. 3

   Gynecology

   5 topics

   • Menstrual disorders and abnormal uterine bleeding
   • Contraception and family planning
   • Pelvic infections and STIs
   • Gynecologic oncology and screening
   • Menopause and infertility
4. 4

   Pediatrics

   5 topics

   • Neonatal care and APGAR assessment
   • Growth, development, and immunization schedules
   • Common pediatric infectious diseases
   • Congenital and genetic disorders
   • Pediatric emergencies and child abuse recognition
5. 5

   Psychiatry & Behavioral Health

   5 topics

   • Mood and anxiety disorders
   • Psychotic disorders and schizophrenia
   • Substance use disorders
   • Psychopharmacology and adverse effects
   • Suicide risk assessment and psychiatric emergencies

USMLE Step 2 CK: Surgery, OB-GYN, Pediatrics & Psychiatry flashcards for Medical Council Step exam for International Medical Graduates / ECFMG Certification

21 of 50 cards from the USMLE Step 2 CK: Surgery, OB-GYN, Pediatrics & Psychiatry deck — real questions with worked answers.

1. Per the Revised Cardiac Risk Index (RCRI), what are the 6 predictors of major perioperative cardiac complications?

   High-risk surgery (intraperitoneal, intrathoracic, suprainguinal vascular), ischemic heart disease, history of CHF, history of cerebrovascular disease, insulin-dependent diabetes, and preoperative creatinine >2.0 mg/dL.

2. For a patient undergoing elective noncardiac surgery, what functional capacity threshold (in METs) generally allows proceeding without further cardiac testing?

   ≥4 METs (e.g., able to climb a flight of stairs or walk up a hill) without symptoms indicates adequate functional capacity to proceed.

3. What is the classic clinical triad and typical exam finding of acute mesenteric ischemia?

   Pain out of proportion to physical exam findings, in a patient with atrial fibrillation or vascular disease; abdomen is initially soft/benign despite severe pain. Confirmed by CT angiography.

4. Differentiate the pain migration of acute appendicitis from acute cholecystitis.

   Appendicitis: periumbilical pain migrating to RLQ (McBurney's point). Cholecystitis: RUQ pain (often after fatty meals) with a positive Murphy's sign, may radiate to right scapula.

5. In the ATLS primary survey, what does the ABCDE sequence stand for?

   A - Airway with C-spine protection; B - Breathing/ventilation; C - Circulation with hemorrhage control; D - Disability (neurologic/GCS); E - Exposure/environment control.

6. What are the 4 immediately life-threatening thoracic injuries identified during ATLS breathing assessment?

   Tension pneumothorax, open pneumothorax (sucking chest wound), massive hemothorax, and flail chest (with pulmonary contusion). Cardiac tamponade is a circulation threat.

7. What is the most common cause of fever on postoperative days 1–2, and the classic '5 Ws' mnemonic for postop fever timing?

   Atelectasis is classic for POD 1–2. The 5 Ws: Wind (atelectasis/pneumonia, days 1–2), Water (UTI, days 3–5), Walking (DVT/PE, days 4–6), Wound (infection, days 5–7), Wonder drugs/What did we do (drug fever/abscess, day 7+).

8. What is the difference between wound dehiscence and evisceration, and the immediate management of evisceration?

   Dehiscence is separation of fascial layers; evisceration is protrusion of abdominal contents through the wound. Evisceration: cover bowel with sterile saline-soaked gauze and take to OR emergently.

9. What is the maintenance IV fluid calculation using the '4-2-1' rule?

   4 mL/kg/hr for the first 10 kg, plus 2 mL/kg/hr for the next 10 kg, plus 1 mL/kg/hr for each kg above 20 kg.

10. What electrolyte abnormalities define refeeding syndrome, and which is the hallmark?

    Hypophosphatemia (hallmark), hypokalemia, and hypomagnesemia, occurring when nutrition is reintroduced to a malnourished patient due to insulin-driven intracellular shifts.

11. What is the recommended schedule and timing for the routine prenatal glucose challenge test screening for gestational diabetes?

    50 g 1-hour glucose challenge test at 24–28 weeks gestation; if abnormal (≥130–140 mg/dL), confirm with a 100 g 3-hour glucose tolerance test.

12. At what gestational age is the fetal anatomy ultrasound performed, and when is maternal serum alpha-fetoprotein (MSAFP) checked?

    Anatomy ultrasound at 18–20 weeks; MSAFP/quad screen at 15–20 weeks (elevated suggests neural tube defects, low suggests aneuploidy).

13. Define the stages of labor.

    Stage 1: onset of labor to full (10 cm) cervical dilation (latent + active phases). Stage 2: full dilation to delivery of fetus. Stage 3: delivery of fetus to delivery of placenta. Stage 4: first 1–2 hours postpartum.

14. On fetal heart rate monitoring, what do early, variable, and late decelerations each indicate?

    Early decels (mirror contractions) = fetal head compression (benign). Variable decels (abrupt, variable timing) = umbilical cord compression. Late decels (nadir after contraction peak) = uteroplacental insufficiency (concerning for hypoxia).

15. What is the difference between placenta previa and placental abruption in presentation?

    Previa: painless vaginal bleeding (placenta over the os) — avoid digital exam. Abruption: painful vaginal bleeding with a tender, firm uterus (premature placental separation), associated with hypertension/trauma/cocaine.

16. What defines fetal growth restriction (IUGR) and the difference between symmetric and asymmetric types?

    Estimated fetal weight <10th percentile. Symmetric IUGR (early insult, e.g., TORCH, aneuploidy) affects all parameters equally; asymmetric IUGR (late insult, e.g., placental insufficiency) spares the head ('head sparing').

17. Define gestational hypertension, preeclampsia, and the BP/proteinuria criteria.

    Gestational HTN: BP ≥140/90 after 20 weeks without proteinuria. Preeclampsia: BP ≥140/90 after 20 weeks PLUS proteinuria (≥300 mg/24h) OR end-organ dysfunction (thrombocytopenia, renal/hepatic, pulmonary edema, cerebral/visual symptoms).

18. What is the first-line medication to prevent seizures in severe preeclampsia/eclampsia, and what are signs of toxicity?

    Magnesium sulfate. Toxicity progresses with rising levels: loss of deep tendon reflexes, respiratory depression, then cardiac arrest. Treat toxicity with IV calcium gluconate.

19. What are the 4 'T's of postpartum hemorrhage causes, and the most common one?

    Tone (uterine atony — most common), Trauma (lacerations), Tissue (retained placenta), Thrombin (coagulopathy).

20. What is the stepwise uterotonic management of uterine atony causing postpartum hemorrhage?

    Bimanual massage + oxytocin first-line; then methylergonovine (avoid in HTN), carboprost/15-methyl-PGF2alpha (avoid in asthma), and misoprostol. If refractory: balloon tamponade, uterine artery embolization, B-Lynch suture, or hysterectomy.

21. Define abnormal uterine bleeding terms: menorrhagia, metrorrhagia, and oligomenorrhea.

    Menorrhagia = heavy/prolonged bleeding at regular intervals. Metrorrhagia = irregular bleeding between periods. Oligomenorrhea = infrequent menses (cycles >35 days).

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