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USMLE test Format | USMLE Course Contents | USMLE Course Outline | USMLE test Syllabus | USMLE test Objectives

Beginning in May 2020- Step 1 examinations will include an increased number of questions that assess communications skills. The tables below provide information on the content weighting for Step 1 examinations administered before and after May 2020.





Table of Contents


- General Principles of Foundational Science


- Immune System


- Blood & Lymphoreticular System


- Behavioral Health


- Nervous System & Special Senses


- Skin & Subcutaneous Tissue


- Musculoskeletal System


- Cardiovascular System


- Respiratory System


- Gastrointestinal System


- Renal & Urinary System


- Pregnancy- Childbirth- & the Puerperium


- Female Reproductive System & Breast


- Male Reproductive System


- Endocrine System


- Multisystem Processes & Disorders


- Biostatistics- Epidemiology/Population Health


- Interpretation of the Medical Literature


- Social Sciences





Biochemistry and molecular biology

Gene expression: DNA structure- replication- exchange- and epigenetics (eg- imprinting- Xactivation- DNA methylation)

Gene expression: transcription

Gene expression: translation- post-translational processing- modifications- and disposition of

proteins (degradation)- including protein/glycoprotein synthesis- intra-extracellular

sorting- and processes/functions related to Golgi complex and rough endoplasmic

reticulum

Structure and function of proteins and enzymes (eg- enzyme kinetics and

structural/regulatory proteins)

Energy metabolism (eg- ATP generation- transport chain)

Biology of cells

Adaptive cell responses and cellular homeostasis (eg- hypertrophy)

Mechanisms of injury and necrosis- including pathologic processes (eg- liquefactive necrosis-

free radical formation)

Apoptosis

Cell cycle and cell cycle regulation (eg- mitosis)

Mechanisms of dysregulation

cell biology of cancer (eg- role of p53- proto-oncogenes)

general principles of invasion and metastasis- including cancer staging

Cell/tissue structure- regulation- and function- including cytoskeleton- organelles-

glycolipids- channels- gap junctions- extracellular matrix- and receptors

Human development and genetics

Principles of pedigree analysis

inheritance patterns

occurrence and recurrence risk determination

Population genetics: Hardy-Weinberg law- founder effects- mutation-selection equilibrium

Principles of gene therapy

Genetic testing and counseling

Genetic mechanisms (eg- penetrance- genetic heterogeneity)

Biology of tissue response to disease

Acute inflammatory responses (patterns of response)

acute inflammation and mediator systems (eg- histamine- prostaglandins- bradykinins-

eosinophilic basic protein- nitric oxide)

vascular response to injury- including mediators

principles of cell adherence and migration (eg- ECAMs- selectins- leukocytic

diapedesis- and rolling)

microbicidal mechanisms and tissue injury (eg- defensins)

clinical manifestations (eg- pain- fever- leukocytosis- leukemoid reaction- chills)

Chronic inflammatory responses (eg- tumor necrosis factor)

Reparative processes

wound healing- repair: thrombosis- granulation tissue- angiogenesis- fibrosis-

scar/keloid formation

regenerative process

Pharmacodynamic and pharmacokinetic processes: general principles

Pharmacokinetics: absorption- distribution- metabolism- excretion- dosage intervals

Mechanisms of drug action- structure-activity relationships (eg- anticancer drugs)

Concentration and dose-effect relationships (eg- efficacy- potency)- types of agonists (eg-

full- partial- inverse) and antagonists and their actions

Individual factors altering pharmacokinetics and pharmacodynamics (eg- age- gender-

disease- tolerance- compliance- body weight- metabolic proficiency-

pharmacogenetics)

Mechanisms of drug adverse effects- overdosage- toxicology

Mechanisms of drug interactions

Signal transduction- including structure/function of all components of signal transduction

pathways such as receptors- ligands (eg- general principles of nitric oxide- autocrine

and paracrine signaling)

Microbial biology

Microbial identification and classification- including principles- microorganism

identification- and non-immunologic laboratory diagnosis

Bacteria

structure (eg- cell walls- composition- appendages- virulence factors- extracellular

products- toxins- mechanism of action of toxins)

processes- replication- and genetics (eg- metabolism- growth- and regulation)

oncogenesis

antibacterial agents (eg- mechanisms of action on organism- toxicity to humans- and

mechanisms of resistance)

Viruses

structure (eg- physical and chemical properties- virulence factors)

processes- replication- and genetics (eg- life cycles- location of virus in latent infection)

oncogenesis

antiviral agents (eg- mechanisms of action on virus- toxicity to humans- and

mechanisms of resistance)

Fungi

structure (eg- cell wall- composition- appendages- virulence factors- extracellular

products- toxins- mechanisms of action of toxins)

processes- replication- and genetics (eg- asexual vs. sexual- metabolism- growth)

antifungal agents (eg- mechanisms of action on fungus- toxicity to humans- and

mechanisms of resistance)

Parasites

structure (eg- appendages- macroscopic features- and virulence factors)

processes- replication- and genetics (eg- life cycles- metabolism- and growth)

oncogenesis

antiparasitic agents (eg- mechanisms of action on parasite- toxicity to humans- and

mechanisms of resistance)

Prions

Normal age-related findings and care of the well patient

Infancy and childhood (0-12 years)

Normal physical changes: linear growth- variations in linear growth- including

constitutional delay; weight; head circumference; micturition- defecation-primary

incontinence/bedwetting; normal physical examination; screening; sleep;

teething syndrome

Developmental stages: motor; speech; cognitive; psychosocial; anticipatory guidance

Lifestyle and routine preventive health care: nutrition; exercise (eg- benefits of

exercise); preventive/travel medicine; risk factors and prevention (eg- guns-

swimming- motor vehicles- car seats); routine vaccinations

Adolescence (13-17 years)

Normal physical changes: linear growth- variations in linear growth including

constitutional delay; weight; puberty; normal physical examination; gynecomastia;

autonomy/self-identity; sleep

Developmental stages: cognitive (eg- abstract thought); psychosocial (eg- autonomy- role

confusion- sexual identity); anticipatory guidance

Lifestyle and routine preventive health care: nutrition; exercise (eg- benefits of

exercise); preventive/travel medicine; risk factors and prevention (eg- risk-taking

behavior- helmets- safe sex- motor vehicles- seat belts- distractions); routine

vaccinations

Adulthood (18-64 years)

Normal physical changes: weight; normal physical examination; screening; sleep

Developmental stages: cognitive; intimacy vs isolation; anticipatory guidance

Lifestyle and routine preventive health care: nutrition; exercise (eg- benefits of

exercise); preventive/travel medicine; risk factors and prevention; routine

vaccinations

Senescence (65 years and older)

Normal physical changes- including normal physical test for age: weight- height

(spinal compression)- skin- bruising; normal physical examination; response to

temperature; micturition- defecation;sleep

Developmental stages: motor; cognitive (eg- benign senescent forgetfulness);

psychosocial; integrity vs despair; retrospection; anticipatory guidance

Lifestyle and routine preventive health care: nutrition; exercise (eg- benefits of exercise);

preventive/travel medicine; risk factors and prevention (eg- falls- general medical

condition; polypharmacy- driving- caregiver stress); routine vaccinations

Immune System

Normal processes

Development of cells of the adaptive immune response- including positive and

negative selection during immune development

Structure- production- and function

granulocytes- natural killer cells- macrophages- mast cells- dendritic cells- cell receptors

(eg- complement receptors and toll-like receptors)- cytokines- chemokines

T lymphocytes- including T-lymphocyte receptors- accessory molecules (eg- CD3- CD4-

CD8- B7)- cell activation and proliferation- cytotoxic T lymphocytes- and memory T

lymphocytes

B lymphocytes and plasma cells- including B-lymphocyte receptors- immunoglobulins- cell

activation and proliferation- including development of antibodies and memory B

lymphocytes

host defense mechanisms- host barriers to infection- mucosal immunity (eg- gutassociated lymphoid tissue and bronchus-associated lymphoid tissue)-

anatomical locations of T and B lymphocytes

Cellular basis of the immune response and immunologic mediators

antigen processing and presentation in the context of MHC I and MHC II molecules (eg-

TAP- beta-2 microglobulin)- intracellular pathways- mechanisms by which MHC is

expressed on the surface; including distribution of MHC I and MHC II on different

cells- mechanisms of MHC I and MHC II deficiencies- and the genetics of MHC

regulation of the adaptive immune response (eg- peripheral tolerance- anergy-

regulatory T lymphocytes- termination of immune response- and B-T

lymphocyte interactions)

activation- function- and molecular biology of complement (eg- anaphylatoxins)

functional and molecular biology of cytokines (eg- IL 1-15)

Basis of immunologic diagnostics (eg- antigen-antibody reactions used for diagnostic

purposes- ELISA- immunoblotting- antigen-antibody changes over time- ABO

typing)

Principles of immunologic protection

vaccine production and mechanisms of vaccine action

biologically active antibodies (eg- monoclonal antibodies- polyclonal antibodies

including IVIG- VZIG- rabies immunoglobulin)

Effect of age on the function of components of the immune system

Abnormal Processes: Health and Health Maintenance- Screening- Diagnosis-

Management- Risks- Prognosis

Disorders associated with immunodeficiency

deficiency primarily of humoral immunity: common variable immunodeficiency;

hyper IgM syndrome; hypogammaglobulinemia/agammaglobulinemia- X-linked

(Bruton); selective immunodeficiency (eg- IgA- IgM- IgE)

deficiency/dysfunction primarily of cell-mediated immunity: adenosine deaminase

deficiency; DiGeorge syndrome; severe combined immunodeficiency disease

(SCID); Wiskott-Aldrich syndrome; granulomatosis; allergic reactions/skin

complement deficiency: alternative pathway component deficiency (C2- C3b- C3bB-

C36B6); classical pathway component deficiency (C1q- C1r- C1-C5); terminal

component deficiency (C5b-C9; terminal complement complex); C1 esterase

inhibitor deficiency- hereditary angioedema; mannose-binding lectin (MBL)

deficiency; membrane attack complex deficiency

deficiency of phagocytic cells and natural killer cells: Chediak-Higashi disease; chronic

granulomatous disease and other disorders of phagocytosis; leukocyte adhesion

deficiency

HIV/AIDS: HIV1 and HIV2; AIDS; AIDS complications (eg- neuropathy- dementia- renal

insufficiency); immunology of AIDS; immune reconstitution syndrome (IRS);

secondary infections; noninfectious complications

Immunologically mediated disorders

hypersensitivity reactions: type 1- 2- 3- including anaphylaxis; type 4; drug reactions;

serum sickness

transplantation: rejection; graft-vs-host disease

Adverse effects of drugs on the immune system: Jarisch-Herxheimer reaction; drugs

affecting the immune system (eg- prednisone- azathioprine- cyclosporine-

methotrexate- monoclonal antibody drugs [eg- abciximab- adalimumab; bevacizumab-

infliximab- omalizumab- rituximab]); vaccine adverse effects

Blood & Lymphoreticular System

Normal Processes

Embryonic development- fetal maturation- and perinatal changes

Organ structure and function

Cell/tissue structure and function

production and function of erythrocytes- including heme and hemoglobin synthesis;

hemoglobin O2 and CO2 transport- transport proteins- erythropoietin

production and function of platelets

production and function of coagulation and fibrinolytic factors; hemostasis

Repair- regeneration- and changes associated with stage of life

Abnormal Processes: Health and Health Maintenance- Screening- Diagnosis-

Management- Risks- Prognosis

Infectious and immunologic

infectious disorders

bacteria

viral: hemorrhagic fever (Ebola virus- Marburg virus); chikungunya; dengue fever;

Zika virus disease

parasitic: malaria (Plasmodium spp); babesiosis (Babesia species)

primary infections of lymphoid tissue: lymphadenitis (viral- bacterial- fungal-

parasitic); lymphangitis; buboes- bubonic plague (Yersinia pestis); cat scratch

disease (Bartonella henselae)

immunologic and inflammatory disorders: cryoglobinemia- essential mixed

cryoglobinemia; autoimmune hemolytic anemia; paroxysmal nocturnal

hemoglobinuria; thrombotic thrombocytopenic purpura; hemolytic uremic

syndrome

Neoplasms: leukemia- acute (ALL- AML); leukemia- chronic (CLL- CML); lymphomas- Hodgkin

disease- non-Hodgkin lymphoma- Burkitt lymphoma- T-cell lymphoma; multiple myeloma-

dysproteinemias- monoclonal gammopathy of unknown significance (MGUS);

myelofibrosis; myelodysplastic syndrome- myelodysplasias; other immunoproliferative

neoplasms (eg- Waldenstrom macroglobulinemia)

Anemia- cytopenias- and polycythemia anemias

decreased production: anemia of chronic disease

hemolysis: glucose-6-phosphate dehydrogenase deficiency; pyruvate kinase deficiency

disorders of hemoglobin- heme- or membrane: disorders of red cell membranes;

hereditary spherocytosis- elliptocytosis; methemoglobinemia- congenital; sickle

cell disease; sideroblastic anemia; thalassemias

other causes of anemia: blood loss- acute and chronic as a cause of anemia

cytopenias: aplastic anemia; leukopenia; neutropenia- cyclic neutropenia-

agranulocytosis; pancytopenia; thrombocytopenia- quantitative; immune

thrombocytopenic purpura (ITP)

cythemias: leukocytosis; polycythemia vera; secondary polycythemia

Coagulation disorders (hypocoagulable and hypercoagulable conditions)

hypocoagulable: disseminated intravascular coagulation; hemophilia- congenital

factor VIII [hemophilia A] and IX [hemophilia B]; hypofibrinogenemia; von

Willebrand disease; platelet dysfunction- qualitative

hypercoagulable: heparin-induced thrombocytopenia; other coagulopathies (eg-

homocysteinemia- hypoplasminogenemia- antithrombin III- protein C/protein S

deficiency- Factor V Leiden- anticardiolipin antibodies- lupus anticoagulant-

prothrombin G20210A mutation)

reactions to blood components: ABO incompatibility/anaphylaxis; Rh

incompatibility/anaphylaxis; hemolysis- delayed; transfusion reaction; transfusion

contaminated with bacteria; transfusion-related acute lung injury (TRALI);

anaphylactoid reaction (IgA deficiency)

Traumatic- mechanical- and vascular disorders: mechanical injury to erythrocytes (eg- cardiac

valve hemolysis); disorders of the spleen; splenic rupture/laceration; splenic infarct;

splenic abscess; effects/complications of splenectomy (eg- sepsis due to encapsulated

bacteria); hypersplenism

Adverse effects of drugs on the hematologic and lymphoreticular systems: antiplatelet drugs-

antithrombin drugs (eg- dabigatran); chemotherapeutic agents; inhibitors of coagulation

factors; methemoglobinemia- acquired; propylthiouracil; tumor lysis syndrome; warfarin

Behavioral Health

Normal Processes

Psychodynamic and behavioral factors- related past experience (eg- transference-

personality traits)

Adaptive behavioral responses to stress and illness (eg- coping mechanisms)

Maladaptive behavioral responses to stress and illness (eg- drug-seeking behavior- sleep

deprivation)

Patient adherence: general adherence; adolescent adherence

Abnormal Processes: Health and Health Maintenance- Screening- Diagnosis-

Management- Risks- Prognosis

Psychotic disorders: brief psychotic disorder; delusional disorder; psychotic disorder due to

another medical condition; schizophrenia; schizoaffective disorder; substance-induced

psychotic disorder

Anxiety disorders: acute stress disorder; anxiety disorders (generalized anxiety disorder-

anxiety due to another medical condition- social phobia); hyperventilation syndrome;

obsessive-compulsive disorder; panic disorder with and without agoraphobia; phobic

disorders; post-traumatic stress disorder; separation anxiety disorder; substance-induced

anxiety disorder- trichotillomania

Mood disorders: major depressive disorder with and without psychotic features- with and

without seasonal pattern; major depressive disorder- postpartum- with and without

psychotic features- including screening; cyclothymic disorder; persistent depressive

disorder (dysthymia); bipolar disorder- manic/depressed/mixed; premenstrual dysphoric

disorder; bipolar and related disorder or depressive disorder due to another medical

condition; substance/medication-induced bipolar and related disorder or depressive

disorder (illegal or prescribed); suicidal ideation/attempt

Somatoform disorders: body dysmorphic disorder; conversion disorder- including psychogenic

seizures; dissociative disorders; illness anxiety disorder (hypochondriasis); malingering;

pain disorder; somatic symptom disorder

Factitious disorders: factitious disorder imposed on self

Eating disorders and impulse control disorders: anorexia nervosa; binge-eating disorder;

bulimia nervosa; eating disorder; disruptive- impulse-control- and conduct disorders (eg-

gambling- kleptomania- pyromania)

Disorders originating in infancy/childhood: reactive attachment disorder; attentiondeficit/hyperactivity disorder; speech sound disorder or language disorder; learning

disorder/dyslexia; intellectual developmental disorder and developmental delay-

undefined- including school problems- fetal alcohol syndrome; oppositional defiant

disorder- conduct disorder; autism spectrum disorder- Rett syndrome; psychoses with

origin specific to childhood; elimination disorders (incontinence- encopresis); tic

disorders/Tourette disorder

Personality disorders: antisocial personality disorder; avoidant personality disorder;

borderline personality disorder; dependent personality disorder; histrionic personality

disorder; narcissistic personality disorder; obsessive-compulsive personality disorder;

paranoid personality disorder; schizoid personality disorder

Psychosocial disorders/behaviors: adjustment disorder; grief response/bereavement- normal

and persistent complex; parent-child relational problems other than physical or emotional

abuse; other psychosocial stress

Sexual and gender identity disorders: gender dysphoria; psychosexual dysfunction

Substance use disorders: alcohol use disorder/intoxication/dependence/withdrawal;

tobacco/nicotine use disorder/dependence/withdrawal; varenicline use; cannabis use

disorder/intoxication/dependence; hallucinogen use

disorder/intoxication/dependence/withdrawal; inhalant use

disorder/intoxication/dependence/withdrawal; opioid- heroin- including prescription drug-

use disorder/intoxication/dependence/withdrawal; sedative- hypnotic- including

benzodiazepine and barbiturate use disorder/intoxication/dependence/withdrawal;

stimulant- cocaine- methamphetamine use

disorder/intoxication/dependence/withdrawal; other drugs of use disorders (eg- ecstasy-

PCP- bath salts)/intoxication/dependence/withdrawal; polysubstance use

disorder/intoxication/dependence/withdrawal

Nervous System & Special Senses

Normal Processes

Embryonic development- fetal maturation- and perinatal changes- including neural tube

derivatives- cerebral ventricles- and neural crest derivatives

Organ structure and function

spinal cord

gross anatomy and blood supply

spinal reflexes

brain stem (eg- cranial nerves and nuclei- reticular formation- anatomy and blood

supply- control of eye movements)

brain

gross anatomy and blood supply

higher function: cognition- language- memory- executive function

hypothalamic function

limbic system and emotional behavior

circadian rhythm sleep-wake disorder

sensory systems

general sensory modalities- including sharp- dull- temperature- vibratory- and

proprioception

special sensory modalities- including vision- hearing- taste- olfaction- and balance

motor systems

brain and spinal cord (upper motoneuron)

basal ganglia and cerebellum

autonomic nervous system

peripheral nerves

Cell/tissue structure and function- including neuronal cellular and molecular

biology

axonal transport

excitable properties of neurons- axons- and dendrites- including channels

synthesis- storage- release- reuptake- and degradation of neurotransmitters and

neuromodulators

presynaptic and postsynaptic receptor interactions- trophic and growth factors

brain metabolism

glia- myelin

brain homeostasis: blood-brain barrier- cerebrospinal fluid formation and flow-

choroid plexus

Repair- regeneration- and changes associated with stage of life

Abnormal Processes: Health and Health Maintenance- Screening-

Diagnosis- Management- Risks- Prognosis

Infectious- immunologic- and inflammatory disorders

infectious disorders: meningitis: bacterial (Actinomyces israelii; Haemophilus influenzae;

Listeria monocytogenes; Mycobacterium tuberculosis; Neisseria meningitidis;

Staphylococcus aureus- epidermidis; Streptococcus agalactiae; Streptococcus

pneumoniae); viral (adenovirus- arboviruses- echovirus and coxsackie A & B viruses-

polioviruses- herpes simplex virus- varicella zoster- human immunodeficiency virus-

lymphocytic choriomeningitis virus- measles virus- mumps virus- St. Louis encephalitis

virus- California encephalitis virus- Western equine encephalitis virus); fungal

(Blastomycosis dermatitidis- Cryptococcus neoformans/gattii); spirochetal (Borrelia

burgdorferi; Leptospira; Treponema pallidum- including neurosyphilis);

protozoal/helminths (Acanthamoeba- Naegleria fowleri- Strongyloides stercoralis-

Angiostrongylus cantonensis- Baylisascaris procyonis); encephalitis (herpesvirus [HSVI]- varicella-zoster virus- Epstein-Barr virus- cytomegalovirus- mumps virus-

enterovirus- West Nile virus- St. Louis encephalitis virus- rabies virus- Eastern and

Western equine encephalitis virus- poliovirus- Taenia- Toxoplasma gondii); prion

disease (eg- Creutzfeldt-Jakob disease); botulism (Clostridium botulinum)- tetanus

(Clostridium tetani); CNS disorders associated with AIDS (eg- progressive multifocal

leukoencephalopathy)

immunologic and inflammatory disorders: myasthenia gravis- including thymoma;

multiple sclerosis; transverse myelitis

Neoplasms (cerebral- spinal- and peripheral): benign (meningioma- neurofibromatosis);

malignant (glioblastoma multiforme- astrocytoma- medulloblastoma- primary CNS

lymphoma); metastatic (eg- breast- lung- pancreatic- testicular- melanoma)

Cerebrovascular disease: arteriovenous malformations- ectatic cerebral vessels; transient

ischemic attack; stroke- thrombotic: cerebral artery occlusion/cerebral infarction;

stroke- embolic: cerebral embolism; stroke: intracerebral hemorrhage- including

subarachnoid hemorrhage- traumatic intracranial hemorrhage; cerebral artery

aneurysm; carotid artery stenosis/atherosclerosis/occlusion/dissection; vertebral artery

deficiency/dissection; subclavian steal syndrome; vascular dementia; hypertensive

encephalopathy; posterior reversible encephalopathy syndrome; venous sinus

thrombosis

Disorders relating to the spine- spinal cord- and spinal nerve roots: cauda equina syndrome;

spinal artery thrombosis/embolus/infarct; spinal cord compression; spinal cord

transection- paraplegia and quadriplegia- acute and chronic effects (eg- autonomic

dysreflexia); spinal stenosis (cervical- lumbar); syringomyelia

Cranial and peripheral nerve disorders

cranial nerve injury/disorders: cranial nerve injury; Bell palsy; anisocoria- miosis-

mydriasis; internuclear ophthalmoplegia; nystagmus and other irregular eye

movements; vestibular neuritis- labyrinthitis; ptosis of the eyelid; Horner syndrome

peripheral nerve/plexus injury/disorders: peripheral nerve injury- including brachial

plexus; carpal/cubital/tarsal/peroneal tunnel syndrome; mononeuritis- Guillain-Barré

syndrome; Miller Fisher syndrome; neuropathy (eg- Charcot-Marie-Tooth disease);

herpes zoster

Neurologic pain syndromes: complex regional pain syndrome (reflex sympathetic

dystrophy- causalgia); fibromyalgia; postherpetic neuralgia; phantom limb

pain/syndrome; thalamic pain syndrome; trigeminal neuralgia

Degenerative disorders/amnestic syndromes: Alzheimer disease; frontotemporal

dementia- including progressive supranuclear palsy- Lewy body disease; mild

neurocognitive disorder- mild cognitive impairment

Global cerebral dysfunction: altered states of consciousness; delirium; coma/brain death

Neuromuscular disorders: amyotrophic lateral sclerosis/spinal muscular atrophy; muscular

dystrophy (eg- Duchenne- myotonic); muscle channelopathies (eg- hypokalemic period

paralysis)

Movement disorders: acute dystonia; adult tic disease; essential tremor; Huntington

disease; Parkinson disease- including Parkinson dementia

Metabolic disorders: adrenoleukodystrophy; metabolic encephalopathy

Paroxysmal disorders: headache- including migraine- mixed- tension- ice-pick- cluster-

medication withdrawal- caffeine withdrawal; seizure disorders- including generalized

tonic-clonic- partial- absence- febrile

Sleep disorders: cataplexy and narcolepsy; circadian rhythm sleep-wake disorder;

insomnia- primary; sleep terror disorder and sleepwalking; REM sleep behavior

disorder; restless legs syndrome

Traumatic and mechanical disorders and disorders of increased intracranial pressure:

anoxic brain damage- cerebral hypoxia; epidural- subdural hematoma (cerebral and

spinal); intraparenchymal hemorrhage- traumatic subarachnoid hemorrhage; cerebral

edema; pseudotumor cerebri (idiopathic intracranial hypertension); torticollis/cervical

dystonia; hydrocephalus- including normal-pressure; traumatic brain injury

(concussion)/postconcussion syndrome (dementia pugilistica); traumatic brain syndrome

Congenital disorders: Friedreich ataxia; neural tube defects (eg- spina bifida-

holoprosencephaly- anencephaly); microcephaly; Sturge-Weber syndrome; tuberous

sclerosis- von Hippel-Lindau disease; hydrocephalus- obstructive (Arnold-Chiari)

Adverse effects of drugs on the nervous system: acute dystonic reaction; drug-induced

meningitis (eg- NSAIDs- sulfa drugs); drug-induced neuropathy (eg- vincristine-

isoniazid- metronidazole); extrapyramidal adverse effects (eg- akathisia- dystonia-

drug-induced parkinsonism); neuroleptic malignant syndrome; poisoning by

psychotropic agents- including antidepressants; serotonin syndrome; tardive

dyskinesia

Disorders of the eye and eyelid

infectious and inflammatory disorders of the eye: blepharitis/eyelid inflammation;

chalazion; chorioretinitis; conjunctivitis (adenovirus)/keratoconjunctivitis;

dacryocystitis; endophthalmitis; hordeolum; iridocyclitis; optic neuritis; periorbital

cellulitis; uveitis

neoplasms of the eye: melanoma; retinoblastoma

disorders of the eye and eyelid- structural: cataract; glaucoma; lacrimal system

disorders; pterygium; refractive disorders (presbyopia- myopia- hyperopia-

astigmatism)

disorders of the pupil- iris- muscles (extraocular): amblyopia; strabismus

disorders of the retina: hypertensive retinopathy; macular degeneration; papilledema;

retinal detachment; retinitis pigmentosa; vascular disorders affecting the retina-

including central retinal artery embolus- retinal hemorrhage- amaurosis fugax-

embolus- carotid artery stenosis- central retinal vein occlusion; visual

impairment/blindness- night blindness

traumatic and mechanical disorders: black eye; burn of the eye and adnexa; corneal

abrasion- ulcer; dislocated lens; foreign body in eye; hyphema; injury to optic nerve

and pathways; laceration of the eye and eyelid; ocular open wounds; orbital

fracture; subconjunctival hemorrhage

adverse effects of drugs on the eyes: ethambutol; hydroxychloroquine; prednisone

Disorders of the ear

infectious and inflammatory disorders of the ear: chondritis; mastoiditis; otitis-

externa- media- interna- serous- suppurative- malignant otitis externa

neoplasms: acoustic neuroma- neurofibromatosis type 2; cholesteatoma

hearing loss/deafness: hearing loss- including noise-induced; otosclerosis; tinnitus

disorders of balance and spatial orientation: Ménière disease; motion sickness; vertigo-

including benign positional vertigo

traumatic and mechanical disorders: barotrauma; foreign body in ear; impacted

cerumen; laceration- avulsion; perforation of tympanic membrane; eustachian

tube disorders

adverse effects of drugs on the ear: antineoplastic agents- including cisplatin;

aminoglycosides; furosemide; salicylates

Skin & Subcutaneous Tissue

Normal Processes

Embryonic development- fetal maturation- and neonatal changes

Organ structure and function- including barrier function- thermal regulation

Cell/tissue structure and function- eccrine function

Repair- regeneration- and changes associated with stage of life (eg- senile purpura- male

pattern baldness- postmenopausal hair changes)

Skin defense mechanisms and normal flora

Abnormal Processes: Health and Health Maintenance- Screening- Diagnosis-

Management- Risks- Prognosis

Infectious- immunologic- and inflammatory disorders

infectious disorders and infestations

bacterial: cellulitis- erysipelas- impetigo- staphylococcal scalded skin syndrome;

abscess- cutaneous- including septic abscess; anthrax (Bacillus anthracis);

carbuncle; folliculitis; pilonidal cyst- infected; pyoderma gangrenosum; MSSA

and MRSA skin infections; mycobacterial infections (eg- leprosy- draining

sinus); scarlet fever (group A Streptococcus)

viral: herpes simplex type 1 & type 2- herpes zoster- Ramsay-Hunt syndrome;

molluscum contagiosum; hand-foot-and-mouth disease; herpangina;

parvovirus; chickenpox- erythema infectiosum (fifth disease)- rubella- measles-

roseola (exanthema subitum); verrucae vulgaris

fungal (deep and superficial): candidiasis- skin; dermatophytosis- tinea corporis;

dermatomycoses; diaper rash; onychomycosis

parasitic: cutaneous larva migrans; cutaneous leishmaniasis

infestations- nonvenomous bites- stings: scabies; lice; insect bites- including bed

bugs

immunologic and inflammatory disorders

papulosquamous and eczematous dermatoses: psoriasis; lichen planus and

lichenoid dermatoses; allergic/irritant contact dermatitis (eg- nickel);

dermatoses caused by plants (poison ivy- poison oak)

vesiculobullous disorders: epidermolysis bullosa; dermatitis herpetiformis;

pemphigus; pemphigoid

urticaria- erythema- exanthema- and purpura: erythema nodosum; atopic

dermatitis; pityriasis rosea; urticaria; Stevens-Johnson syndrome- erythema

multiforme- toxic epidermal necrolysis

autoimmune disorders: vitiligo

Neoplasms

benign neoplasms- cysts and other skin lesions: actinic keratoses; cysts- including

epidermal; hemangiomas; lipoma; pigmented nevi; seborrheic keratosis;

xanthomas

malignant neoplasms: basal cell carcinoma; squamous cell carcinoma; melanoma-

including genital; Kaposi sarcoma; cutaneous T-cell lymphoma- mycosis fungoides

Adnexal disorders (hair and hair follicles- nails- sweat glands- sebaceous glands- oral

mucous membranes)

disorders of the hair and hair follicles: alopecia; seborrhea capitis/seborrheic dermatitis;

tinea barbae and capitis

disorders of the nails (including ingrowing nail)

disorders of sweat and sebaceous glands: acne vulgaris; hidradenitis suppurativa;

hyperhidrosis; ichthyosis; rosacea

Oral disease: aphthous ulcers (stomatitis- canker sores); leukoplakia

Disorders of pigmentation: albinism; lentigo

Traumatic and mechanical disorders: animal bites (dogs- cats- etc); burns or wounds affecting

the skin or subcutaneous tissue (eg- sunburn- other including blast injuries and burns);

cauliflower ear; effects of ultraviolet light; keloids; tattoo; thermal injury- perniosis-

frostbite; ulcers- decubitus

Congenital disorders: xeroderma pigmentosum; benign lesions in neonates- infants-

children (eg- congenital nevi)

Adverse effects of drugs on skin and subcutaneous tissue: drug reactions- eruptions-

including local reaction to vaccine

Musculoskeletal System

Normal processes

Embryonic development- fetal maturation- and perinatal changes

Organ structure and function

Cell/tissue structure and function

biology of bones- joints- tendons- skeletal muscle- cartilage

exercise and physical conditioning/deconditioning

Repair- regeneration- and changes associated with stage of life

Abnormal Processes: Health and Health Maintenance- Screening- Diagnosis-

Management- Risks- Prognosis

Infectious- inflammatory- and immunologic disorders

infectious disorders: gangrene- dry and wet- clostridial myonecrosis (Clostridium

perfringens); discitis; myositis- infective; necrotizing fasciitis; osteomyelitis; septic

arthritis; spondylitis- tuberculous

immunologic disorders: ankylosing spondylitis; dermatomyositis/polymyositis;

juvenile idiopathic arthritis; rheumatoid arthritis- Felty syndrome; psoriatic

arthropathy

inflammatory disorders: adhesive capsulitis of shoulder (frozen shoulder syndrome);

ankylosis/spondylopathy (inflammatory); bursitis; fasciitis; osteochondritis-

osteochondritis dissecans; tendinitis- supraspinatus syndrome- enthesopathy of spine-

elbow- ankle; temporomandibular joint disorders; fibrositis- myofascial pain

syndrome; synovitis; tenosynovitis; myositis

Neoplasms: benign neoplasms (e.g.- ganglion cyst); malignant neoplasms of bone (eg-

osteosarcoma- sarcoma- leiomyosarcoma- rhabdosarcoma); metastases to bone-

secondary malignant neoplasm of bone

Degenerative and metabolic disorders

degenerative/metabolic disorders of bone- tendon- and cartilage: chondromalacia; disc

degeneration- herniated disc; Legg-Calvé-Perthes disease; Osgood-Schlatter disease;

osteodystrophy; osteomalacia; osteonecrosis (avascular)- bone infarct; osteoporosis;

osteopenia; osteitis deformans (Paget disease of bone); pathologic fracture;

radiculopathies; spondylolisthesis/spondylosis (degenerative)

degenerative/metabolic disorders of joints: gout- gouty arthritis- pseudogout; joint

effusion; osteoarthritis

degenerative/metabolic disorders of muscles- ligaments- fascia: Dupuytren contracture;

muscle calcification and ossification; muscle wasting and diffuse atrophy;

rhabdomyolysis

Traumatic and mechanical disorders: amputation and care of amputees; backache- including

low back pain; blast injuries; compartment syndrome; contractures- hospital-acquired;

contusions; dislocations; fractures; sprains- strains; kyphoscoliosis- scoliosis; rotator cuff

syndrome; slipped capital femoral epiphysis; dislocation of hip

Congenital disorders: achondroplasia/dwarfism; disorders of limb development (HOX gene

mutation- phocomelia); developmental dysplasia of the hip; dislocation of hip in

infantile spinal muscular atrophy; genu valgum or varum; foot deformities (flat foot-

valgus/varus deformities); osteogenesis imperfecta; McArdle disease; mitochondrial

myopathies

Adverse effects of drugs on the musculoskeletal system: drug-induced myopathy (eg-

steroids- statins- cocaine- AZT); malignant hyperthermia

Cardiovascular System

Normal Processes

Embryonic development- fetal maturation- and perinatal transitional changes

Organ structure and function

chambers- valves

cardiac cycle- mechanics- heart sounds- cardiac conduction

hemodynamics- including blood volume and systemic vascular resistance

circulation in specific vascular beds- including pulmonary and coronary

Cell/tissue structure and function

heart muscle- metabolism- oxygen consumption- biochemistry- and secretory function

(eg- atrial natriuretic peptide)

endothelium and secretory function- vascular smooth muscle- microcirculation- and

lymph flow

neural and hormonal regulation of the heart- blood vessels- and blood volume-

including responses to change in posture- exercise- and tissue metabolism- and

autonomic responses

Repair- regeneration- and changes associated with stage of life

Abnormal Processes: Health and Health Maintenance- Screening- Diagnosis-

Management- Risks- Prognosis

Infectious- immunologic- and inflammatory disorders

infectious disorders: bacterial endocarditis- myocarditis

immunologic and inflammatory disorders: atherosclerosis (eg- atherosclerosis of the

aorta)

Neoplasms: myxoma- metastases

Dysrhythmias: premature beats (PACs- PVCs); atrial flutter/fibrillation; multifocal atrial

tachycardia; paroxysmal tachycardias; ventricular tachycardia/fibrillation; wide complex

tachycardia; torsades de pointes; bradycardias; atrioventricular block (first-- second--

third-degree); conduction disorder (LBBB- RBBB); cardiac arrest; sick sinus syndrome;

prolonged QT syndrome; Wolff-Parkinson-White syndrome; carotid sinus hypersensitivity;

pacemaker dysfunction- including failure to sense- capture

Heart failure: chordae tendineae rupture; congestive heart failure; cor pulmonale; diastolic

dysfunction; systolic dysfunction; mitral valve dysfunction; heart failure secondary to

myocardial infarction; high-output heart failure- including thyrotoxicosis-induced-

anemia-induced; tachycardia-induced; cardiogenic pulmonary edema

Ischemic heart disease: acute coronary syndrome- acute myocardial infarction; angina

pectoris- stable and unstable/coronary artery disease/coronary insufficiency;

coronary artery spasm

Diseases of the myocardium: cardiomyopathy- dilated- including alcoholic- viral- takotsubo;

cardiomyopathy- obstructive hypertrophic; cardiomyopathy- familial dilated;

cardiomyopathy- restrictive; hypertensive heart disease- left ventricular hypertrophy-

right ventricular hypertrophy; complications of myocardial infarction; nontraumatic

tamponade post-myocardial infarction; papillary muscle rupture/dysfunction; ventricular

free wall rupture; myocarditis

Diseases of the pericardium: chronic constrictive pericarditis; pericardial effusion; pericardial

tamponade; acute pericarditis; pericarditis- following myocardial infarction- surgery-

trauma

Valvular heart disease: valve disorders- mitral/aortic/tricuspid- pulmonic (eg-

regurgitation- stenosis- prolapse- insufficiency- vegetation); functional murmurs;

rheumatic heart disease; complications of artificial valves

Hypotension: orthostatic hypotension

Hypertension: elevated blood pressure practicing without diagnosis of hypertension; essential

hypertension; malignant hypertension; secondary hypertension

Dyslipidemia: hypercholesterolemia; hyperlipidemia; hypertriglyceridemia;

lipoproteins/lipoprotein lipase deficiency

Vascular disorders

disorders of the great vessels: aneurysm- aortic (abdominal/thoracic)- dissection-

ruptured; aneurysm- iliac- other peripheral vascular- ruptured; aortoiliac disease

peripheral arterial vascular disease: arterial embolus/thrombosis; arteriovenous

fistula; atheroembolic disease; claudication; cholesterol emboli; hypertensive

vascular disease; peripheral arterial disease; thromboangiitis obliterans

diseases of the veins: deep venous thrombosis- venous thromboembolism;

phlebitis/thrombophlebitis; varicose veins; venous insufficiency; stasis ulcers-

stasis dermatitis

Traumatic and mechanical disorders: ventricular puncture; myocardial contusion;

myocardial rupture; traumatic aortic dissection; traumatic tamponade

Congenital disorders- including disease in adults: anomalous left coronary artery; atrial

septal defect; coarctation of the aorta; endocardial cushion defect; patent foramen

ovale; patent ductus arteriosus; tetralogy of Fallot; transposition of the great vessels;

ventricular septal defect

Adverse effects of drugs on the cardiovascular system: adriamycin; cocaine- amphetamine-

PCP; ACE inhibitors- calcium channel blockers- alpha blockers- minoxidil

Respiratory System

Normal Processes

Embryonic development- fetal maturation- and perinatal changes

Organ structure and function

airways- including mechanics and regulation of breathing

lung parenchyma- including ventilation- perfusion- gas exchange

pleura

nasopharynx- sinuses

Cell/tissue structure and function- including surfactant formation- and alveolar structure

Repair- regeneration- and changes associated with stage of life

Pulmonary defense mechanisms and normal flora

Abnormal Processes: Health and Health Maintenance- Screening- Diagnosis-

Management- Risks- Prognosis

Infectious- immunologic- and inflammatory disorders

infectious- immunologic- and inflammatory disorders of the upper airways: acute

upper respiratory infection; viral infections (adenovirus- coronaviruses-

coxsackievirus- influenza virus- parainfluenza virus- rhinoviruses); sinusitis;

nasopharyngitis; epiglottitis; Bordetella pertussis pneumonia; croup; acute

laryngitis; acute laryngotracheitis; tracheitis; pharyngitis; streptococcal throat

infections; tonsillitis; peritonsillar abscess; rhinitis- allergic- chronic; ulcers of nasal

cavity/sinuses

infectious- immunologic- and inflammatory disorders of the lower airways: hospitalacquired pneumonia; ventilator-associated pneumonia- community-acquired

pneumonia- acute bronchiolitis; bronchiolitis obliterans with organizing pneumonia

(BOOP); anthrax- pulmonary (Bacillus anthracis); aspiration pneumonia- pneumonitis;

bronchitis- acute; bronchopneumonia; pneumonia (Burkholderia pseudomallei-

Chlamydophila pneumoniae- Coxiella burnetii- Francisella tularensis- Haemophilus

influenzae- Klebsiella pneumoniae- Legionella- Moraxella catarrhalis- Mycoplasma

pneumoniae- Pseudomonas aeruginosa- Streptococcus- MSSA- MRSA- other

gram‐negative bacteria); viral infection (eg- influenza A- B- adenovirus- H1N1-

respiratory syncytial virus- parainfluenza virus); fungal infection (aspergillosis- including

allergic bronchopulmonary aspergillosis and aspergilloma- histoplasmosis-

coccidioidomycosis- Pneumocystis jirovecii); pulmonary tuberculosis; lung abscess;

viral infection (eg- influenza A- B- adenovirus- respiratory syncytial virus-

parainfluenza virus- avian influenza virus); fungal infection (aspergillosis- including

allergic bronchopulmonary aspergillosis and aspergilloma- histoplasmosis-

coccidioidomycosis- Pneumocystis jirovecii)

Neoplasms

benign neoplasms: upper airways (eg- vocal cord polyps- nasal polyps- juvenile

papillomatosis); lungs and pleura (eg- solitary pulmonary nodule- bronchial

carcinoid tumors)

malignant neoplasms

upper airways: lip- oral cavity- and pharynx; head and neck cancer; larynx;

trachea

lower airways and pleura: malignant neoplasms of bronchus and/or lung (squamous

cell- adenocarcinoma- large cell- small cell); malignant neoplasms of pleura

(mesothelioma); secondary malignant neoplasms of lung; secondary malignant

neoplasms of pleura

metastatic neoplasms including pleural

Obstructive airway disease: asthma- reactive airway disease; bronchiectasis; chronic airway

obstruction; chronic obstructive pulmonary disease (COPD)- chronic bronchitis-

emphysema

Pneumoconiosis/fibrosing/restrictive pulmonary disorders/interstitial lung disease:

pneumoconiosis; asbestosis; silicosis; silo-filler's lung- byssinosis- bagassosis-

berylliosis; hypersensitivity pneumonitis; hypereosinophilic syndromes- Loeffler

syndrome; interstitial pneumonia- usual (UIP)- desquamative (DIP)- nonspecific

Respiratory failure/respiratory arrest and pulmonary vascular disorders: acute respiratory

distress syndrome (ARDS); pulmonary hypertension; pulmonary vascular disorders-

arteriovenous fistula; pulmonary edema- pulmonary cause and unspecified; pulmonary

embolism; air and fat embolism; respiratory failure due to enteral feeding

Metabolic- regulatory- and structural disorders: disorders of gas exchange; hypoventilation;

hypoxia; pulmonary alveolar proteinosis; ventilation-perfusion imbalance

Disorders of the pleura- mediastinum- and chest wall: chylothorax; costochondritis;

empyema; hemothorax; mediastinitis; pleural effusion; pleuritis;

pneumomediastinum; pneumothorax

Traumatic and mechanical disorders

upper airways: epistaxis; barotrauma- sinus; laryngeal/pharyngeal obstruction;

tracheoesophageal fistula; tracheal stenosis; tracheomalacia; trauma (eg- tracheal

injury); foreign body (nose- pharynx- larynx- trachea); traumatic/mechanical

disorders of the nasal cavity/sinuses (eg- septal perforation)

lower airways and pleura: atelectasis; diaphragm/chest wall injury; drowning and neardrowning; foreign body- upper and lower respiratory tract; penetrating chest wounds;

pulmonary contusion; sleep apnea- obstructive and central; hypoventilation

syndrome- obesity-hypoventilation syndrome

Congenital disorders: bronchogenic cysts; congenital cysts; congenital diaphragmatic

hernia; pulmonary sequestration; immotile cilia syndrome

Adverse effects of drugs on the respiratory system: bleomycin- amiodarone; adverse

effects of 100% oxygen; acute effects of tobacco/nicotine- inhalants- cocaine

Gastrointestinal System

Normal Processes

Embryonic development- fetal maturation- and perinatal changes

Organ structure and function

anatomy of the alimentary canal- including mouth- pharynx- esophagus- stomach- small

intestine- large intestine- anus- peritoneal cavity

liver and biliary system- including enterohepatic circulation

salivary glands and exocrine pancreas

gastrointestinal motility- including defecation digestion and absorption

Cell/tissue structure and function

endocrine and neural regulatory functions- including GI hormones (eg- gastrin)

salivary- gastrointestinal- pancreatic- hepatic secretory products- including enzymes-

proteins- bile salts- and processes

synthetic and metabolic functions of hepatocytes

Repair- regeneration- and changes associated with stage of life

Gastrointestinal defense mechanisms and normal flora

Abnormal Processes: Health and Health Maintenance- Screening- Diagnosis-

Management- Risks- Prognosis

Infectious- immunologic- and inflammatory disorders

infectious disorders

bacterial: pseudomembranous colitis (Clostridium difficile); enteritis/enteric infections

(includes gastroenteritis) (eg- Staphylococcus aureus- Escherichia coli- Listeria

monocytogenes- Yersinia enterocolitica- Campylobacter species- Vibrio cholerae-

Salmonella species- Shigella species- traveler's/infectious diarrhea); hepatic

abscess- subhepatic abscess- subphrenic abscess; peritonitis- primary and

secondary; Whipple disease

viral: infectious esophagitis (eg- CMV- herpes); hepatitis A- B- C- D- E; coxsackievirus

enteritis/colitis; Echovirus enteritis/colitis; rotavirus enteritis; mumps;

gingivostomatitis- herpetic

fungal: thrush

parasitic: Cryptosporidium- Cyclospora- Entamoeba histolytica- Giardia- Isospora belli-

Strongyloides stercoralis

immunologic and inflammatory disorders: autoimmune hepatitis; celiac disease;

eosinophilic esophagitis; granulomatous enteritis; inflammatory bowel disease-

including Crohn disease- regional enteritis- microscopic colitis (collagenous and

lymphocytic colitis)- ulcerative colitis- toxic megacolon

Neoplasms

benign neoplasms- including polyps- cysts: stomach; small intestine; colon- rectum- and

anus- including polyps

malignant neoplasms and pre-malignant conditions: oral cancer (eg- lips- mouth- tongue-

salivary glands); esophageal- squamous and adenocarcinoma; Barrett esophagus;

gastrinoma- Zollinger-Ellison syndrome; gastrointestinal carcinoid tumors;

gastrointestinal stromal tumors; small intestine; stomach- adenocarcinoma-

lymphoma- MALT; colon- rectum- anus; hereditary colon cancer syndromes- familial

adenomatous polyposis (eg- Peutz-Jeghers syndrome- Gardner syndrome- Turcot

syndrome- ); MUTYH-associated polyposis; gallbladder- cholangiocarcinoma-

adenocarcinoma of the ampulla of Vater; liver- including hepatoma; peritoneal

cancer- including metastatic studding with cancer; pancreas

metastatic neoplasms

Signs- symptoms- and ill-defined disorders: upper gastrointestinal bleeding; lower

gastrointestinal bleeding; constipation; diarrhea; hematochezia; bright red rectal

bleeding; melena; nausea- vomiting- rumination

Disorders of the oral cavity- salivary glands- and esophagus

oral cavity and salivary glands: abscessed tooth; dental caries; malocclusion;

disorders of the salivary glands (eg- stones- sialadenitis- parotitis)

esophagus: achalasia and cardiospasm; dysphagia; diverticulum (eg- Zenker);

esophageal periapical abscess without sinus; esophagitis/esophageal reflux

(GERD); esophagitis- pill; Mallory-Weiss syndrome; paraesophageal (hiatal) hernia;

stricture and stenosis of esophagus

Disorders of the stomach- small intestine- colon- rectum- anus

stomach: dyspepsia/hyperacidity; gastric ulcer; gastritis; peptic ulcer; peptic ulcer

perforation; gastroparesis

small intestine- colon: appendicitis; angiodysplasia; diverticula- diverticulitis-

diverticulosis; duodenitis- duodenal ulcer- peptic ulcer; gastroenteritis and colitis

(noninfectious); granulomatous enterocolitis; Hirschsprung disease; impaction of

intestine; intestinal obstruction/stricture; intussusception; irritable colon/irritable

bowel syndrome; mesenteric ischemia/ischemic bowel/ischemic colitis; necrotizing

enterocolitis; paralytic ileus; volvulus; malnutrition and malabsorption- including

lactose intolerance- short bowel syndrome

rectum and anus: abscess of anal and rectal regions; anal fissure; anal fistula; ulcer;

fecal incontinence; hemorrhage (rectum- anus); proctitis; hemorrhoids; rectal

prolapse

Disorders of the liver and biliary system- noninfectious

liver: cirrhosis; Dubin-Johnson- Rotor syndromes; end-stage liver disease- including

indications for transplantation; Gilbert syndrome- Crigler-Najjar syndrome; hepatic

coma/hepatic encephalopathy; hepatitis- noninfectious; hepatitis- fatty liver-

alcoholic; hepatorenal syndrome; hepatopulmonary syndrome; jaundice; nonalcoholic fatty liver disease; portal hypertension/esophageal varices

biliary system: bile duct obstruction/cholestasis; cholangitis- including ascending;

choledocholithiasis; cholelithiasis/cholecystitis; cholestasis due to parenteral

nutrition; gallstone ileus; Mirizzi syndrome; primary biliary cirrhosis; primary

sclerosing cholangitis

Disorders of the pancreas: pancreatitis- acute; pancreatitis- chronic; pancreatitis-

hereditary; pancreatic cyst/pseudocyst; pancreatic duct obstruction; pancreatic

insufficiency

Disorders of the peritoneal cavity: ascites

Traumatic and mechanical disorders: abdominal wall defects; adhesions- postsurgical;

digestive system complications of surgery; post-gastric surgery syndromes (eg- blind loop

syndrome- adhesions); duodenal tear; foreign body in digestive system; inguinal- femoral-

and abdominal wall hernias; open wound- abdominal; perforation of hollow viscus and

blunt trauma; perforation/rupture of esophagus (Boerhaave syndrome); umbilical hernia

Congenital disorders: annular pancreas- biliary atresia- cleft lip and palate- esophageal

atresia- malrotation without volvulus- Meckel diverticulum- pyloric stenosis-

tracheoesophageal fistula

Adverse effects of drugs on the gastrointestinal system: drug-induced changes in motility

(chronic laxative abuse- opioids); drug-induced gastritis- duodenitis- peptic ulcer disease

(NSAIDs); drug-induced hepatitis (eg- acetaminophen- isoniazid); drug-induced

pancreatitis (eg- thiazide diuretics)

Renal & Urinary System

Normal Processes

Embryonic development- fetal maturation- and perinatal changes

Organ structure and function

kidneys- ureters- bladder- urethra

glomerular filtration and hemodynamics

urine concentration and dilution

renal mechanisms in acid-base balance

renal mechanisms in body fluid homeostasis

micturition

Cell/tissue structure and function

renal metabolism and oxygen consumption

tubular reabsorption and secretion- including transport processes and proteins

hormones produced by or acting on the kidney (eg- renin- aldosterone- angiotensin II-

vasopressin)

Repair- regeneration- and changes associated with stage of life

Abnormal Processes: Health and Health Maintenance- Screening- Diagnosis-

Management- Risks- Prognosis

Infectious- immunologic- and inflammatory disorders

infectious disorders

upper urinary tract: granulomatous pyelonephritis; perinephric abscess;

pyelonephritis; pyonephrosis; renal abscess; renal tuberculosis

lower urinary tract and urinary tract infections of unspecified location: cystitis;

chlamydial and nonchlamydial

immunologic and inflammatory disorders

upper urinary tract

glomerular disorders: Alport syndrome; glomerular disease due to hepatitis

B- C; glomerulonephritis- including poststreptococcal; IgA nephropathy;

lupus nephritis; minimal change disease; nephrotic syndrome; thin

basement membrane disease

tubular interstitial disease: acute tubular necrosis (ATN); acute

interstitial nephritis; papillary necrosis; HIV nephropathy

lower urinary tract: interstitial cystitis

Neoplasms

benign neoplasms and cysts: polycystic kidney disease

malignant neoplasms: renal (eg- Wilms tumor/nephroblastoma- renal cell carcinoma-

renal tumors associated with congenital/hereditary conditions); urinary bladder and

collecting system

Signs- symptoms- and ill-defined disorders: dysuria; hematuria; oliguria- anuria; proteinuria

Metabolic and regulatory disorders: acute kidney injury; renal insufficiency; azotemia-

uremic syndrome; chronic kidney disease- including end-stage renal disease;

cystinuria; Fanconi syndrome; hypertensive renal disease (renal complications of

hypertension); renal calculi- ureteral calculi- nephrolithiasis; renal tubular acidosis

Vascular disorders: renal artery stenosis (atherosclerosis- fibromuscular dysplasia-

nephrosclerosis); renal vein thrombosis; renal infarction

Traumatic and mechanical disorders: bladder rupture; neurogenic bladder; obstructive

uropathy; posterior urethral valves; renal laceration; renal vascular injury; ureteral

laceration/avulsion/disruption; urethral diverticulum; urethral/ureteral

obstruction/stricture/prolapse; urinary incontinence- including secondary enuresis;

vesicoureteral reflux

Congenital disorders: double ureters/ureteral duplication/double collecting system;

horseshoe kidney; hydronephrosis/reflux; renal agenesis- renal hypoplasia- renal

dysplasia; single kidney

Adverse effects of drugs on the renal and urinary system: ACE inhibitors; aminoglycosides;

amphotericin B; cisplatin; furosemide; gadolinium (nephrogenic systemic fibrosis);

heroin; iodinated contrast dye; lithium; NSAIDs; penicillins; sulfa drugs; tenofovir; drug -

induced urinary retention

Pregnancy- Childbirth- & the Puerperium

Normal Processes

Organ structure and function: pregnancy- including fertilization- implantation- development

of embryo- labor and delivery- the puerperium- lactation- gestational uterus- placenta

Abnormal Processes: Health and Health Maintenance- Screening- Diagnosis-

Management- Risks- Prognosis

Prenatal care

preconception counseling and care: folate deficiency prevention; immunizations;

nutritional exam- including vitamins; Rh screening

prenatal risk exam/prevention: adolescent pregnancy; antepartum fetal

evaluation- including biophysical profile; genetic screening; α-fetoprotein; diabetes

mellitus; neural tube defects; Rh isoimmunization

supervision of normal pregnancy: test of gestational age; iron deficiency

prevention; nutrition- including weight management; surveillance- including

ultrasonography and test of fetal growth; vitamin deficiency prevention;

infections- maternal- fetal- newborn (focus on prevention and screening):

cytomegalovirus- coxsackievirus- hepatitis B virus- herpes simplex viruses- HIV-

influenza virus- parvovirus B19 virus- rubella virus- varicella-zoster virus- Chlamydia

trachomatis- Treponema pallidum- Streptococcus agalactiae- Toxoplasma gondii-

amnionitis; asymptomatic urinary tract infection

Obstetric complications: abortion- induced- septic- missed- spontaneous- threatened; acute

fatty liver of pregnancy; anemia of pregnancy- sickle cell disease- thalassemia in

pregnancy; antepartum hemorrhage- including third-trimester bleeding; cardiomyopathy

of pregnancy; cervical incompetence- cervical shortening; cholestasis of pregnancy-

intrahepatic; congenital abnormalities- maternal (eg- bicornuate uterus); ectopic

pregnancy; fetal abnormality affecting management of mother (eg- hydrocephalus- spina

bifida); fetal growth restriction; gestational diabetes; maternal mortality; multiple

gestation; placental abnormalities (abruptio placentae- placenta previa- premature

separation of placenta); polyhydramnios- oligohydramnios; preeclampsia- eclampsia-

HELLP syndrome- gestational hypertension; prolonged pregnancy; Rh isoimmunization

affecting management of mother; vomiting in pregnancy (morning sickness- hyperemesis

gravidarum); trauma in pregnancy; infections complicating pregnancy

Labor and delivery: labor and delivery- uncomplicated; labor and delivery- complicated-

including shoulder dystocia; cesarean delivery- including complications; cord

compression- cord prolapse; fetal malpresentations (eg- breech); intrapartum fetal

evaluation- including fetal heart tones; intrapartum prophylaxis (eg- HIV- Chlamydia-

gonococcal prophylaxis); premature rupture of membranes; preterm (before 37 weeks'

gestation) and postdates labor and delivery; threatened preterm labor

Puerperium- including complications: lactation problems; breast-feeding problems; lochia;

postpartum cardiomyopathy; postpartum blues; postpartum hemorrhage; postpartum

sepsis; retained placenta- products of conception (eg- placenta accreta); uterine atony

Newborn (birth to 4 weeks of age)

normal newborn

examination of liveborn at admission to hospital

screening- newborn

disorders of the newborn: screening- newborn; ABO incompatibility in newborn;

hemolytic disease due to Rh incompatibility; birth asphyxia syndrome (liveborn

neonate); birth trauma (eg- cord compression- brachial palsy- lacerations); drug

withdrawal syndrome in newborn; feeding problems in newborn; fetal growth and

development abnormalities- including fetal growth restriction; gastrointestinal

obstruction; hypocalcemia of newborn; infections- congenital or peripartum

(cytomegalovirus- herpes simplex viruses- HIV- hepatitis B- rubella virus- parvovirus

B19 virus- varicella zoster virus- Chlamydia trachomatis- Streptococcus agalactiae-

Treponema pallidum- Toxoplasma gondii); intrapartum fetal distress/death

including stillborn; jaundice- fetal/neonatal/perinatal; laryngomalacia; macrosomia

(large for gestational age); meconium aspiration syndrome; neonatal acne; neonatal

Candida infection (thrush); neonatal hypoglycemia; neonatal conjunctivitis and

dacryocystitis; ophthalmic gonorrhea; phenylketonuria; premature infant; postterm infant; pseudomembranous colitis of infancy; respiratory distress syndrome

(hyaline membrane disease); respiratory problems after birth (eg-

bronchopulmonary dysplasia- tracheomalacia; tracheoesophageal fistula in

neonates); retinitis of prematurity; seizures in newborn; sudden infant death

syndrome (SIDS)- apparent life-threatening event (ALTE); tetanus neonatorum

Congenital disorders- neonatal: congenital malformations and anomalies; neonatal

hydrocele

Adverse effects of drugs on pregnancy- childbirth- and the puerperium: alcohol- tobacco-

and other drugs (ATOD); prenatal radiation exposure; teratology (eg- ACE inhibitors-

SSRIs- warfarin- infections- toxins)

Systemic disorders affecting pregnancy- labor and delivery- and puerperium:

appendicitis; asthma; carpal tunnel syndrome in pregnancy; cirrhosis; deep venous

thrombosis (DVT); diabetes mellitus; heart failure- valvular heart disease;hypertension;

myasthenia gravis; obesity; pancreatitis; psychiatric disorders; renal calculus/calculi;

renal failure/renal disease- including SLE; seizure disorders; thyroid disorders-

hypothyroidism- hyperthyroidism

Female Reproductive System & Breast

Normal Processes

Embryonic development- fetal maturation- and perinatal changes- gametogenesis

Organ structure and function

female structure- including breast

female function (eg- ovulation- menstrual cycle- puberty)

intercourse- sexual response

Cell/tissue structure and function: hypothalamic-pituitary-gonadal axis- sex steroids-

and gestational hormones

Reproductive system defense mechanisms and normal flora

Repair- regeneration- and changes associated with stage of life

Abnormal Processes: Health and Health Maintenance- Screening- Diagnosis-

Management- Risks- Prognosis

Breast

infectious- immunologic- and inflammatory disorders: breast abscess; inflammatory

disease of breast- fat necrosis; mastitis; nipple discharge

neoplasms

benign and undefined neoplasms: breast cyst- solitary; fibrocystic changes;

fibroadenoma; hypertrophy of breast; intraductal papilloma

malignant neoplasms (including screening): breast cancer; intraductal carcinoma;

Paget disease of breast; phyllodes tumors

Female reproductive system

infectious- immunologic- and inflammatory disorders: bacterial vaginosis; Bartholin gland

abscess; cellulitis- pelvic; candidiasis of the vulva or vagina; lichen sclerosus; sexually

transmitted infections and exposure; cervicitis and endocervicitis; chancroid

(Haemophilus ducreyi); genital herpes; gonorrhea (Neisseria gonorrhoeae); human

papillomavirus infection- genital/venereal/anal warts- condylomata acuminata;

lymphogranuloma venereum (Chlamydia trachomatis)- non-lymphogranuloma

venereum; pelvic inflammatory disease; Fitz-Hugh–Curtis syndrome; salpingitis and

oophoritis; syphilis (Treponema pallidum); trichomoniasis (Trichomonas vaginalis);

urethritis; vaginitis; vulvovaginitis

Neoplasms of the cervix- ovary- uterus- vagina- and vulva

benign neoplasms and cysts: abnormal Pap smear; benign neoplasm of ovary;

endocervical and endometrial polyps; leiomyomata uteri; ovarian cyst

malignant and precancerous neoplasms: cervical cancer; HPV causing cancer; cervical

dysplasia- HPV causing dysplasia; endometrial hyperplasia; endometrial/uterine

cancer; gestational trophoblastic disease (hydatidiform mole); ovarian cancer;

vulvar dysplasia and cancer

Fertility and infertility: assisted reproductive techniques (ART); contraception (eg- oral

contraceptives- IUD- vaginal cap- cervical sponge- diaphragm- implant- morning-after

pill- male and female condoms); female infertility; gonadal dysgenesis 45-X (Turner

syndrome); sterilization; tubal factors; infertility

Menopause: ovarian failure- premature menopause; perimenopause; premenopausal

menorrhagia; postmenopausal atrophic vaginitis (vaginal atrophy); postmenopausal

bleeding; vasomotor symptoms

Menstrual and endocrine disorders: abnormal uterine bleeding- including

perimenopausal; absence of menstruation (primary amenorrhea- secondary

amenorrhea including undiagnosed pregnancy); anovulation; dysmenorrhea;

endometriosis; hirsutism- virilization; mittelschmerz; pelvic pain; polycystic ovarian

syndrome; postcoital bleeding; premenstrual syndrome

Sexual dysfunction: dyspareunia; orgasmic dysfunction; sexual desire/arousal

syndrome; vaginismus

Traumatic and mechanical disorders: Asherman syndrome; chronic inversion of uterus;

chronic pelvic pain syndrome; cystocele; imperforate hymen; injuries- wounds- and burns

affecting the female reproductive system and injuries- wounds- burns- and blast injuries;

ovarian torsion; pelvic relaxation; prolapse- vaginal walls- uterine- uterovaginal; rectocele;

urethrocele

Congenital disorders: müllerian agenesis; uterus didelphys- bicornuate uterus; short cervix

Adverse effects of drugs on the female reproductive system and breast: antihistamines-

H2-receptor blockers; benzodiazepines; beta-adrenergic blockers; hormone

replacement; opioids; spironolactone; selective serotonin reuptake inhibitors;

tricyclic antidepressants

Male Reproductive System

Normal Processes

Embryonic development- fetal maturation- and neonatal changes- gametogenesis

Organ structure and function

structure- male genitalia and prostate

function- male genitalia and prostate (eg- spermatogenesis- puberty)

intercourse- orgasm- erection

Cell/tissue structure and function- including hypothalamic-pituitary-gonadal axis- sex

steroids- and gestational hormones

Reproductive system defense mechanisms and normal flora

Repair- regeneration- and changes associated with stage of life

Abnormal Processes: Health and Health Maintenance- Screening- Diagnosis-

Management- Risks- Prognosis

Infectious- immunologic- and inflammatory disorders

infectious disorders: balan

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