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USMLE Exam Format | USMLE Course Contents | USMLE Course Outline | USMLE Exam Syllabus | USMLE Exam 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 exam 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 reading 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: exam of gestational age; iron deficiency

prevention; nutrition, including weight management; surveillance, including

ultrasonography and exam 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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