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USMLE 185
A 185-concept dependency map for Step 1 — foundational sciences → organ systems → integration. Explore 20 topics and 185 concepts, each with a clear path to mastery.
Topics: 20 | Concepts: 185
Topics in this Roadmap
🧬 Molecular Biology & Genetics
DNA replication, repair mechanisms & mutation types Transcription, RNA processing & splicing Translation & post-translational modification Cell cycle checkpoints & apoptosis pathways Cytoskeleton, organelles & cellular trafficking Autosomal dominant inheritance (Marfan, NF1/NF2, VHL, TSC, HTN spherocytosis) Autosomal recessive inheritance (CF, PKU, sickle cell, hemochromatosis, α1-AT) X-linked recessive/dominant & mitochondrial inheritance Trinucleotide repeat disorders (Huntington, Fragile X, Friedreich ataxia, myotonic dystrophy) Chromosomal disorders (Down, Edwards, Patau, Turner, Klinefelter) Lysosomal storage diseases (Tay-Sachs, Gaucher, Niemann-Pick, Fabry, Hurler/Hunter) Embryology: gastrulation, neural tube & heart development Histology: epithelial, connective, muscle & nerve tissue ID Genetic counseling, pedigree analysis & carrier frequency
🔬 General Pathology
Reversible vs irreversible cell injury Necrosis types (coagulative, liquefactive, caseous, fat, fibrinoid, gangrenous) Acute vs chronic inflammation & mediators Wound healing, granulation tissue & scar formation Neoplasia: hallmarks of cancer, oncogenes vs tumor suppressors Carcinogenesis, tumor grading vs staging (TNM) Hemodynamics: edema, hyperemia/congestion Thrombosis, embolism & infarction (Virchow triad) Shock states (hypovolemic, cardiogenic, septic, anaphylactic, neurogenic) Amyloidosis (AL, AA, ATTR) & Congo red staining Key histologic patterns (granulomas, Reed-Sternberg, Auer rods, psammoma bodies, Call-Exner, Reinke crystals)
🫘 Renal & GU
Nephron physiology & GFR/RBF regulation Acid-base disorders & compensation (Winter's formula) Electrolyte disorders (Na, K, Ca, Mg, PO4) Acute kidney injury (prerenal/intrinsic/postrenal) & ATN Chronic kidney disease & renal osteodystrophy Nephrotic vs nephritic syndromes (MCD, FSGS, membranous, PSGN, IgA, Goodpasture) Renal tubular acidosis subtypes Nephrolithiasis: stone types & management Renal cell carcinoma & GU tumors Diuretic pharmacology (loop, thiazide, K-sparing, osmotic)
🍽️ Gastrointestinal
GI embryology (foregut/midgut/hindgut, rotation anomalies) GI motility, secretion & digestion physiology GI hormones (gastrin, CCK, secretin, somatostatin) Esophageal disease (GERD, achalasia, Barrett esophagus) Peptic ulcer disease & H. pylori IBD: Crohn disease vs ulcerative colitis Acute & chronic pancreatitis Cirrhosis, portal hypertension & viral hepatitis Colorectal cancer & polyposis syndromes (FAP, Lynch/HNPCC) GI pharmacology (PPIs, antiemetics, laxatives, IBD biologics)
🛋️ Psychiatry & Behavioral Science
Psychosocial development (Erikson, Piaget, attachment) Mood disorders (MDD, bipolar I/II, dysthymia) Psychotic disorders (schizophrenia, schizoaffective, brief psychotic) Anxiety & OCD-related disorders Trauma/stressor-related disorders (PTSD, acute stress disorder) Personality disorders (Cluster A/B/C) Substance use disorders & withdrawal syndromes (esp. alcohol, opioids) Eating disorders (anorexia, bulimia, binge-eating) & refeeding syndrome Child psychiatry (ADHD, autism spectrum disorder) Psychopharmacology (antidepressants, antipsychotics, mood stabilizers, anxiolytics)
🌐 Multisystem & Infectious Disease
⚖️ Ethics & Preventive Medicine
Informed consent & decision-making capacity Confidentiality & its exceptions (Tarasoff, reportable diseases) Advance directives & surrogate decision-making End-of-life care & physician-assisted death Cancer screening guidelines (breast, cervical, colorectal, lung, prostate) Cardiometabolic screening (HTN, lipids, diabetes, AAA) Vaccine schedule & contraindications (live vs inactivated) Quality improvement & patient safety principles (PDSA, RCA, just culture)
🛡️ Immunology
Innate immunity: complement pathways, phagocytes, NK cells Adaptive immunity: T-cell & B-cell development/activation MHC I vs MHC II & antigen presentation Hypersensitivity reactions I–IV with classic examples Primary immunodeficiencies (SCID, Bruton, DiGeorge, CGD, CVID, hyper-IgM) Autoimmune disease mechanisms (SLE, RA, Sjögren, MG, Goodpasture) Transplant rejection types (hyperacute, acute, chronic, GVHD) Immunosuppressant mechanisms (calcineurin inhibitors, mycophenolate, biologics) Vaccines: live vs inactivated, contraindications in immunocompromised/pregnancy
💊 General Pharmacology
Pharmacokinetics: absorption, Vd, clearance, half-life Zero-order vs first-order kinetics (phenytoin, ethanol, aspirin) Pharmacodynamics: agonists/antagonists, Emax & potency curves CYP450 induction & inhibition / major drug–drug interactions Autonomic pharmacology: cholinergic & adrenergic agonists/antagonists Toxicology & antidotes (acetaminophen→NAC, opioids→naloxone, benzos→flumazenil, iron→deferoxamine, methanol/ethylene glycol→fomepizole) Adverse drug reactions & hypersensitivity mechanisms FDA clinical trial phases (0–4) & pharmacovigilance
🦠 Microbiology Fundamentals
Bacterial structure, growth curve & genetics (transformation, transduction, conjugation) Gram-positive cocci & rods (Staph, Strep, Clostridium, Listeria, Bacillus, Corynebacterium) Gram-negative cocci & rods (Neisseria, E. coli, Pseudomonas, Enterobacteriaceae) Spirochetes & atypicals (Treponema, Borrelia, Rickettsia, Coxiella, Mycoplasma, Chlamydia) Antibacterial mechanisms & resistance (cell wall, protein synthesis, DNA/folate inhibitors) Virology: structure & replication (DNA vs RNA, + vs − sense, retroviruses) Mycology: dimorphic & opportunistic fungi, antifungal mechanisms Parasitology: protozoa & helminths, antiparasitic drugs HIV/AIDS pathogenesis & opportunistic infections by CD4 count
📊 Biostatistics & Epidemiology
Study designs (case-control, cohort, RCT, cross-sectional, meta-analysis) Sensitivity, specificity, PPV/NPV & effect of prevalence Relative risk, odds ratio, attributable risk, NNT/NNH Bias types (selection, information, confounding, lead-time, length-time) Hypothesis testing: p-values, CIs, Type I/II error, power Choosing statistical tests (t-test, ANOVA, chi-square, regression, Kaplan-Meier) Screening test principles & Wilson-Jungner criteria
🩸 Hematology & Oncology
Hematopoiesis & RBC/WBC/platelet physiology Anemia workup: microcytic, macrocytic, normocytic Hemoglobinopathies (sickle cell disease, α/β-thalassemia) Coagulation cascade & bleeding disorders (hemophilia A/B, vWD, DIC) Leukemias (ALL, AML, CLL, CML) & key cytogenetics Lymphomas: Hodgkin vs Non-Hodgkin (DLBCL, Burkitt, follicular) Multiple myeloma & plasma cell dyscrasias Transfusion reactions & blood product selection Chemotherapy drug classes & mechanisms (alkylators, antimetabolites, anthracyclines, mitotic inhibitors)
❤️ Cardiovascular
Cardiac embryology, fetal circulation & congenital heart defects Cardiac cycle, pressure-volume loops & Frank-Starling mechanism ECG interpretation & arrhythmias (AFib, heart blocks, VT/VF) Ischemic heart disease: angina & MI (STEMI/NSTEMI) + complications Heart failure (HFrEF vs HFpEF) pathophysiology & GDMT Valvular disease (aortic stenosis, MR, MVP, AR) Cardiomyopathies (dilated, hypertrophic, restrictive) Pericardial disease (pericarditis, tamponade, constrictive) Aortic dissection, aneurysms & vasculitides Infective endocarditis & rheumatic fever CV pharmacology (antihypertensives, antiarrhythmics, anticoagulants, statins)
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