Was ist das eigentlich? Cyberrisiken verständlich erklärt

Es wird viel über Cyberrisiken gesprochen. Oftmals fehlt aber das grundsätzliche Verständnis, was Cyberrisiken überhaupt sind. Ohne diese zu verstehen, lässt sich aber auch kein Versicherungsschutz gestalten.

Beinahe alle Aktivitäten des täglichen Lebens können heute über das Internet abgewickelt werden. Online-Shopping und Online-Banking sind im Alltag angekommen. Diese Entwicklung trifft längst nicht nur auf Privatleute, sondern auch auf Firmen zu. Das Schlagwort Industrie 4.0 verheißt bereits eine zunehmende Vernetzung diverser geschäftlicher Vorgänge über das Internet.

Anbieter von Cyberversicherungen für kleinere und mittelständische Unternehmen (KMU) haben Versicherungen die Erfahrung gemacht, dass trotz dieser eindeutigen Entwicklung Cyberrisiken immer noch unterschätzt werden, da sie als etwas Abstraktes wahrgenommen werden. Für KMU kann dies ein gefährlicher Trugschluss sein, da gerade hier Cyberattacken existenzbedrohende Ausmaße annehmen können. So wird noch häufig gefragt, was Cyberrisiken eigentlich sind. Diese Frage ist mehr als verständlich, denn ohne (Cyber-)Risiken bestünde auch kein Bedarf für eine (Cyber-)Versicherung.

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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 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: 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;
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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
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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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USMLE Step PDF Download

 

USMLE (Step 1 and 2) Registration

There are a few different ways that Anki is usually incorporated into Step 1 studying:

Pre-Made decks

Zanki and Anking are two pre-made decks that have been curated over exact years to capture the best and most high yield Step 1 content from almost any and all resources that students find useful, including Pathoma, First Aid, Sketchy, etc. Both decks are very large and extremely comprehensive, sometimes emphasizing information that isn’t always high-yield or testable.

Making your own cards (content)

For some students, taking traditional handwritten or typed notes is cumbersome and disengaging. With that in mind, it’s not uncommon that students will do their “note taking” by taking the material they find in resources like First Aid, Boards and Beyond, etc and creating their own cards to capture the content in whatever way makes the most sense for them.

Making your own cards (missed questions)

Knowing that UWorld offers a wealth of information in the explanation of answer choices and through outlining the educational objectives of different question types, it should be no surprise that a lot of that content can be ideal for Anki. In this approach it’s important to do your best to pinpoint specific and succinct knowledge gaps so that you can make cards that aren’t so dense that they’re not helpful. It’s important to note that if not appropriately focused, this approach can be incredibly time intensive and can sometimes not be the most productive way to use your time, so be thoughtful in how you incorporate this into your overall study strategy.


Essential Resources for the Boards: USMLE Step 1

Editor's Note:

The goal of this column is to provide you with the resources you need to excel in medical school. For more clinical resources, visit Emily Cooper's blog, Med-Source, which she maintains as a "one-stop guide" for med students.

I was planning to expound upon pathology this month, but having just completed Step 1 of the boards (formally known as the US Medical Licensing test or USMLE), it seemed appropriate that I share the pearls that I gleaned while the material was still somewhat fresh in my mind. I studied for just over 5 weeks, which felt like just the right amount of time. Any shorter and I would not have been fully prepared, any longer and I would have started to forget what I learned at the beginning.

From the outset, I would highly recommend creating a study schedule in which you cover all of the material in First Aid during the first 3 1/2 to 4 weeks, doing at least 50 questions each night and then only reviewing questions during the last week.

The highest-yield online sites for the Boards are the question banks. Although pricey, the questions provide the best way to assess your progress and, next to First Aid, were my most valuable study resource.

  • Kaplan Qbank still serves as the industry standard. Your subscription provides access to more than 2000 questions that can be sorted by both discipline and organ system. A 1-month subscription costs $199, a 3-month subscription costs $279, and a 6-month subscription costs $499 (discounts may be available through your medical school). This program allows you to customize tests with your unused and/or incorrect questions, so that you can focus on your weaker areas. Although the interface is not identical to the real exam, it is close enough that the real test will not feel foreign. Kaplan's other strong points are their explanations for the answers. After completing a test, make sure to read the full answers, as a lot of information is packed into explaining why certain choices are incorrect.

  • USMLE World is the steadily growing upstart rival to Kaplan. They have now amassed more than 2000 questions as well, making this q-bank capable of standing on its own as a review source. The format is identical to the FRED format that you will see on the real thing. As with Kaplan, you can track your performance. I found the questions to be slightly more representative of the real test than the Kaplan questions, but the explanations were not as thorough.

  • Practice exams provided by the National Board of Medical Examiners also come highly recommended and are available for $45 each. Other students who have used these exams say that they are the most representative of the real exam, with form 1 being the easiest and form 3 the most difficult.

  • When you register for Step 1, you get access to practice content. The 3 blocks of content are easier than the real exam, but they are a good confidence booster and are worth running through if only to know that you have covered the "official" material. The Kaplan Qbank subscription also comes with a .pdf file of explanations (an answer key without explanations comes with the content).

  • Also, be sure to check out resources offered by your school. At the University of Pennsylvania, they have access to USMLEasy, which provides online question banks for all of the step exams. If you don't have free access, you can check out demo quizzes on Medscape and learn more about the Step 1 q-bank.

  • The volume of print material available to prep for the boards is virtually limitless. Fortunately, First Aid -- along with upperclassmen -- should help you wade through and select the most valuable choices. Below, I listed the top 1 or 2 choices that my colleagues and I chose for each subject. It may be useful to go to your medical bookstore and look through the major series (High Yield, BRS, and Rapid Review) to decide which style works best for you. Also, First Aid has extensive reviews of the subject-based review books in the last section.

  • First Aid for the USMLE Step 1 2008 (Le T, Bhushan V, Rao DA): Treat this book as your Boards bible. Learn it, love it, know it. Take all of your notes in this book so that when you review at the end, you only have to go back to 1 book.

  • Biochemistry: Focus on the key enzymes and clinical consequences. Any one of the following will suffice:

  • Lippincott's Illustrated Reviews: Biochemistry (Champe PC, Harvey RA, Ferrier DR);

  • BRS Biochemistry and Molecular Biology (Swanson TA, Kim SI, Glucksman MJ);

  • High-Yield Biochemistry (Wilcox B).

  • Pharmacology: Focus only on those drugs mentioned in First Aid and master the general pharmacology chapter. I used only the flashcards and felt that they were more than adequate.

  • Pharmacology Flashcards (Barron) -- One side has a clinical vignette and the other has all the key information on the drug;

  • Lippincott's Illustrated Reviews: Pharmacology (Howland RD, Mycek MJ, Harvey RA, et al);

  • Appleton & Lange Review of Pharmacology (Krzanowski JJ).

  • Microbiology: Clinical Microbiology Made Ridiculously Simple (Gladwin M, Trattler B)

  • Immunology: High-Yield Immunology (Johnson AG) or Medical Microbiology and Immunology (Immunology section only) (Levinson WE)

  • Pathology: BRS Pathology (Schneider AS, Szanto PA, Kim SI, et al)

  • Physiology: BRS Physiology (Costanzo LS)

  • Anatomy: High-Yield Gross Anatomy (Dudek RW, Louis TM)

  • Embryology: High-Yield Embryology (Dudek RW) or BRS Embryology (Dudek RW)

  • Neuroanatomy: High-Yield Neuroanatomy (Fix JD) or Clinical Neuroanatomy Made Ridiculously Simple (Goldberg S)

  • Behavioral Science: High-Yield Behavioral Science (Fadem B)

  • Histology: High-Yield Histology (Dudek RW)

  • As indicated above, First Aid is the quintessential source for Boards review. Take all of your notes in this book, writing in it as you go over your q-bank answers.

  • During your review days at the end, go back and reread your annotated copy.

  • Do questions! Each night after studying, answer at least 50 questions on what you studied that day. Towards the end of your studying, complete blocks of 50 random questions to better simulate the real exam.

  • Know the basic pharmacology chapter. The concept of epinephrine reversal will be on your Boards.

  • Study with a friend. You may or may not want to actually study out loud, but at the very least you should have someone you meet everyday and sit with to help get you through. Five weeks is a long time to sit in a room by yourself.

  • Sleep, eat, exercise, go out. Your life doesn't need to stop because you are studying. If you get going before 10 am, you should be done by 8 pm with time to chill out.

  • One last thought: you will be fine. If you feel overwhelmed, channel that energy into doing an extra block of questions rather than freaking out about the exam. Everyone panics a little at some point, but panicking is not productive. Doing questions is. Good luck!


    Will I Limit My Career Path By Pursuing DO Instead Of MD?

    Getting into medical school is not easy. In 2018, only 41% of all applicants were accepted, with a low MCAT score listed as the “biggest application deal-breaker” in the application. For students who are applying to medical school with a lower-than-average GPA or MCAT score, they might be weighing their options to see if there are is another way to earn the title of “doctor.”  

    There are dozens of medical specialties out there and various degrees associated with the medical field. There is more to the name “doctor” then you might realize. However, the terms “doctor” and “MD” are often used as synonyms, but this is not always the case. Licensed physicians can hold either an MD or DO degree. For students who are debating which path into medicine they want to take, they might be wondering why one is right for them and is one better than the other?

    Getty Royalty Free

    MD Vs. DO: Different Approaches

    Both allopathic (MD) and osteopathic (DO) medical schools instruct their students in the necessary scientific foundations to become licensed physicians. However, the approaches the two schools take are very different. To obtain your medical doctor degree (MD), you must attend an allopathic medical school. Allopathic medicine uses science to diagnose and treat any medical conditions.

    Osteopathic medicine is a little less-known and takes a more holistic approach.  Doctors who receive their DO degree study something called osteopathic manipulative treatment (OMT), a method that involves moving muscles and joints to promote healing. When OMT fits within a patient’s treatment plan, it can be used to complement drugs or surgery, adding another dimension to medical care.

    Physicians with both an MD and a DO are licensed in all 50 states to practice medicine, perform surgeries and prescribe medication.

    MD Vs. DO: Education

    There are more than 152 accredited U.S. allopathic colleges, whereas there are just 35 accredited colleges of osteopathic medicine. Naturally, that means that there are more MDs than DOs, with roughly 25% of all doctors receiving their degree from an osteopathic medical school. The National Resident Matching Program surveyed all active medical school students who participated in the 2018 Main Residency Match. The number of seniors who attended allopathic medical school in 2018 numbered at 18,818 whereas the students of osteopathic medical schools numbered at just 4,275.

    There is a stigma surrounding DOs and the level of work and academic success you must have achieved to be accepted. Years ago, it was believed that earning a degree in osteopathic medicine versus allopathic medicine was the more easily-accessible path to becoming a doctor.

    As the gap has lessened, it can be just as difficult to be admitted into a DO program compared to an MD one. The average MCAT score for matriculants into a medical school was a 510.4, on the other hand, the average MCAT scores for matriculants into a college of osteopathic medicine averaged around 502.2.  

    Once they enter into their respective medical schools, the path to becoming a doctor is very similar. Both MDs and DOs have earned bachelor’s degrees and then attend a four-year medical school. While in med school, they both learn the same basic knowledge regarding anatomy, physiology and pharmacology.

    DOs spend an additional 200 hours learning about nerves, muscles, bones and how the connection between them will affect their patients’ overall health. When doctors of osteopathic medicine enter into the workforce, they can incorporate that training into their day-to-day patient interactions if they choose.

    MD Vs. DO: Exams

    The allopathic and osteopathic paths to becoming a doctor begin to split once the students take their licensing exams. Students at allopathic schools take the USMLE series, while osteopathic students often take the COMLEX sequence. Both of these exams are three-step exams and prospective doctors take them between the end of their second year of medical school and their first year of residency.

    However, DOs can take the USMLE test as well as the COMLEX sequence. While it does add considerably to the student’s workload, it is worth it if they are considering a residency program that requires the USMLE.

    These two exams might cover similar topics, but they are a bit different in the testing style. In general, allopathic students are better prepared for taking the USMLE examinations and tend to do better than osteopathic students. The mean USMLE Step 1 Score for all matched U.S. allopathic seniors was 233 while the mean USMLE Step 1 Score for all matched US osteopathic seniors was 227.

    Ultimately, the student needs to assess their own individual goals and interests when deciding if they should take the USMLE. The USMLE will increase the number of programs the student can apply to and will give them greater access to more specialized programs. However, depending on the residencies the student is interested in, the USMLE might not be necessary for an osteopathic student.

    Osteopathic students should be confident that they will do well on the USMLE before committing to taking it. According to the 2018 NRMP (National Resident Matching Program) Program Director, of the 1,333 programs surveyed, only 2% said that the USMLE was not required. Thirty percent of the program directors said they would never admit a student who failed the USMLE on their first attempts, and 58% said they would seldom admit a student who failed.

    Of those schools, 46% of programs said that they do use the COMLEX-USA test when considering which applicants to invite for an interview. Taking the USMLE helps put the students on an even playing field; the directors can compare the students more easily if they have all taken the same exam.  

    MD Vs. DO: Residency

    According to the National Resident Matching Program, allopathic seniors preferred the specialties of radiology, neurological surgery, orthopedic surgery, and plastic surgery. They least preferred to match with a residency in pathology, family medicine, or internal medicine.

    On the other hand, osteopathic medical seniors preferred family medicine, pathology, physical medicine and rehabilitation, and psychiatry more than other specialties. They were less likely to apply for a residency in otolaryngology, plastic surgery, radiation oncology, and orthopedic surgery.

    Overall, 91.8% of US allopathic seniors matched with their preferred specialty. 82.6% of US osteopathic seniors paired with their preferred specialty.

    As of 2019, MD students could only match with programs that were accredited by the Accreditation Council for Graduate Medical Education (ACGME) and DO students could match with residencies that are accredited by either the ACGME or the American Osteopathic Association (AOA). However, this is all about to change. In July of 2020, the accreditation councils will merge to form a single GME Accreditation system, allowing MD and DO students to apply to any residencies.

    The purpose of this merger is to create a more consistent method of evaluating residencies. It will affect both current and future DO students, who no longer will have a safe haven of residencies that only DO students can apply to. That means that allopathic students will have more opportunities open to them, perhaps at the expense of weaker DO students.

    When choosing between DO and MD, you should consider what you want your future specialty to be, as your chances of matching with your desired program can increase depending on if you go to an allopathic or osteopathic medical school. Being a DO does not make you any worse or better of a doctor. Your residency and your action will determine that, not what letters follow your name.

    Research for this article was contributed by Moon Prep college counselor, Lindsey Conger.


     




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    Warum sind Cyberrisiken so schwer greifbar?

    Als mehr oder weniger neuartiges Phänomen stellen Cyberrisiken Unternehmen und Versicherer vor besondere Herausforderungen. Nicht nur die neuen Schadenszenarien sind abstrakter oder noch nicht bekannt. Häufig sind immaterielle Werte durch Cyberrisiken in Gefahr. Diese wertvollen Vermögensgegenstände sind schwer bewertbar.

    Obwohl die Gefahr durchaus wahrgenommen wird, unterschätzen viele Firmen ihr eigenes Risiko. Dies liegt unter anderem auch an den Veröffentlichungen zu Cyberrisiken. In der Presse finden sich unzählige Berichte von Cyberattacken auf namhafte und große Unternehmen. Den Weg in die Presse finden eben nur die spektakulären Fälle. Die dort genannten Schadenszenarien werden dann für das eigene Unternehmen als unrealistisch eingestuft. Die für die KMU nicht minder gefährlichen Cyber­attacken werden nur selten publiziert.

    Aufgrund der fehlenden öffentlichen Meldungen von Sicherheitsvorfällen an Sicherheitsbehörden und wegen der fehlenden Presseberichte fällt es schwer, Fakten und Zahlen zur Risikolage zu erheben. Aber ohne diese Grundlage fällt es schwer, in entsprechende Sicherheitsmaßnahmen zu investieren.

    Erklärungsleitfaden anhand eines Ursache-Wirkungs-Modells

    Häufig nähert man sich dem Thema Cyberrisiko anlass- oder eventbezogen, also wenn sich neue Schaden­szenarien wie die weltweite WannaCry-Attacke entwickeln. Häufig wird auch akteursgebunden beleuchtet, wer Angreifer oder Opfer sein kann. Dadurch begrenzt man sich bei dem Thema häufig zu sehr nur auf die Cyberkriminalität. Um dem Thema Cyberrisiko jedoch gerecht zu werden, müssen auch weitere Ursachen hinzugezogen werden.

    Mit einer Kategorisierung kann das Thema ganzheitlich und nachvollziehbar strukturiert werden. Ebenso hilft eine solche Kategorisierung dabei, eine Abgrenzung vorzunehmen, für welche Gefahren Versicherungsschutz über eine etwaige Cyberversicherung besteht und für welche nicht.

    Die Ursachen sind dabei die Risiken, während finanzielle bzw. nicht finanzielle Verluste die Wirkungen sind. Cyberrisiken werden demnach in zwei Hauptursachen eingeteilt. Auf der einen Seite sind die nicht kriminellen Ursachen und auf der anderen Seite die kriminellen Ursachen zu nennen. Beide Ursachen können dabei in drei Untergruppen unterteilt werden.

    Nicht kriminelle Ursachen

    Höhere Gewalt

    Häufig hat man bei dem Thema Cyberrisiko nur die kriminellen Ursachen vor Augen. Aber auch höhere Gewalt kann zu einem empfindlichen Datenverlust führen oder zumindest die Verfügbarkeit von Daten einschränken, indem Rechenzentren durch Naturkatastrophen wie beispielsweise Überschwemmungen oder Erdbeben zerstört werden. Ebenso sind Stromausfälle denkbar.

    Menschliches Versagen/Fehlverhalten

    Als Cyberrisiken sind auch unbeabsichtigtes und menschliches Fehlverhalten denkbar. Hierunter könnte das versehentliche Veröffentlichen von sensiblen Informationen fallen. Möglich sind eine falsche Adressierung, Wahl einer falschen Faxnummer oder das Hochladen sensibler Daten auf einen öffentlichen Bereich der Homepage.

    Technisches Versagen

    Auch Hardwaredefekte können zu einem herben Datenverlust führen. Neben einem Überhitzen von Rechnern sind Kurzschlüsse in Systemtechnik oder sogenannte Headcrashes von Festplatten denkbare Szenarien.

    Kriminelle Ursachen

    Hackerangriffe

    Hackerangriffe oder Cyberattacken sind in der Regel die Szenarien, die die Presse dominieren. Häufig wird von spektakulären Datendiebstählen auf große Firmen oder von weltweiten Angriffen mit sogenannten Kryptotrojanern berichtet. Opfer kann am Ende aber jeder werden. Ziele, Methoden und auch das Interesse sind vielfältig. Neben dem finanziellen Interesse können Hackerangriffe auch zur Spionage oder Sabotage eingesetzt werden. Mögliche Hackermethoden sind unter anderem: Social Engineering, Trojaner, DoS-Attacken oder Viren.

    Physischer Angriff

    Die Zielsetzung eines physischen Angriffs ist ähnlich dem eines Hacker­angriffs. Dabei wird nicht auf die Tools eines Hackerangriffs zurückgegriffen, sondern durch das physische Eindringen in Unternehmensgebäude das Ziel erreicht. Häufig sind es Mitarbeiter, die vertrauliche Informationen stehlen, da sie bereits den notwendigen Zugang zu den Daten besitzen.

    Erpressung

    Obwohl die Erpressung aufgrund der eingesetzten Methoden auch als Hacker­angriff gewertet werden könnte, ergibt eine Differenzierung Sinn. Erpressungsfälle durch Kryptotrojaner sind eines der häufigsten Schadenszenarien für kleinere und mittelständische Unternehmen. Außerdem sind auch Erpressungsfälle denkbar, bei denen sensible Daten gestohlen wurden und ein Lösegeld gefordert wird, damit sie nicht veröffentlicht oder weiterverkauft werden.

    Ihre Cyberversicherung sollte zumindet folgende Schäden abdecken:

    Cyber-Kosten:

    • Soforthilfe und Forensik-Kosten (Kosten der Ursachenermittlung, Benachrichtigungskosten und Callcenter-Leistung)
    • Krisenkommunikation / PR-Maßnahmen
    • Systemverbesserungen nach einer Cyber-Attacke
    • Aufwendungen vor Eintritt des Versicherungsfalls

    Cyber-Drittschäden (Haftpflicht):

    • Befriedigung oder Abwehr von Ansprüchen Dritter
    • Rechtswidrige elektronische Kommunikation
    • Ansprüche der E-Payment-Serviceprovider
    • Vertragsstrafe wegen der Verletzung von Geheimhaltungspflichten und Datenschutzvereinbarungen
    • Vertragliche Schadenersatzansprüche
    • Vertragliche Haftpflicht bei Datenverarbeitung durch Dritte
    • Rechtsverteidigungskosten

    Cyber-Eigenschäden:

    • Betriebsunterbrechung
    • Betriebsunterbrechung durch Ausfall von Dienstleister (optional)
    • Mehrkosten
    • Wiederherstellung von Daten (auch Entfernen der Schadsoftware)
    • Cyber-Diebstahl: elektronischer Zahlungsverkehr, fehlerhafter Versand von Waren, Telefon-Mehrkosten/erhöhte Nutzungsentgelte
    • Cyber-Erpressung
    • Entschädigung mit Strafcharakter/Bußgeld
    • Ersatz-IT-Hardware
    • Cyber-Betrug