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 practicing without diagnosis of hypertension; essential hypertension; malignant hypertension; secondary hypertension Dyslipidemia: hypercholesterolemia; hyperlipidemia; hypertriglyceridemia; lipoproteins/lipoprotein lipase deficiency Vascular disorders disorders of the great vessels: aneurysm, aortic (abdominal/thoracic), dissection, ruptured; aneurysm, iliac, other peripheral vascular, ruptured; aortoiliac disease peripheral arterial vascular disease: arterial embolus/thrombosis; arteriovenous fistula; atheroembolic disease; claudication; cholesterol emboli; hypertensive vascular disease; peripheral arterial disease; thromboangiitis obliterans diseases of the veins: deep venous thrombosis, venous thromboembolism; phlebitis/thrombophlebitis; varicose veins; venous insufficiency; stasis ulcers, stasis dermatitis Traumatic and mechanical disorders: ventricular puncture; myocardial contusion; myocardial rupture; traumatic aortic dissection; traumatic tamponade Congenital disorders, including disease in adults: anomalous left coronary artery; atrial septal defect; coarctation of the aorta; endocardial cushion defect; patent foramen ovale; patent ductus arteriosus; tetralogy of Fallot; transposition of the great vessels; ventricular septal defect Adverse effects of drugs on the cardiovascular system: adriamycin; cocaine, amphetamine, PCP; ACE inhibitors, calcium channel blockers, alpha blockers, minoxidil Respiratory System Normal Processes Embryonic development, fetal maturation, and perinatal changes Organ structure and function airways, including mechanics and regulation of breathing lung parenchyma, including ventilation, perfusion, gas exchange pleura nasopharynx, sinuses Cell/tissue structure and function, including surfactant formation, and alveolar structure Repair, regeneration, and changes associated with stage of life Pulmonary defense mechanisms and normal flora Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, immunologic, and inflammatory disorders infectious, immunologic, and inflammatory disorders of the upper airways: acute upper respiratory infection; viral infections (adenovirus, coronaviruses, coxsackievirus, influenza virus, parainfluenza virus, rhinoviruses); sinusitis; nasopharyngitis; epiglottitis; Bordetella pertussis pneumonia; croup; acute laryngitis; acute laryngotracheitis; tracheitis; pharyngitis; streptococcal throat infections; tonsillitis; peritonsillar abscess; rhinitis, allergic, chronic; ulcers of nasal cavity/sinuses infectious, immunologic, and inflammatory disorders of the lower airways: hospitalacquired pneumonia; ventilator-associated pneumonia, community-acquired pneumonia, acute bronchiolitis; bronchiolitis obliterans with organizing pneumonia (BOOP); anthrax, pulmonary (Bacillus anthracis); aspiration pneumonia, pneumonitis; bronchitis, acute; bronchopneumonia; pneumonia (Burkholderia pseudomallei, Chlamydophila pneumoniae, Coxiella burnetii, Francisella tularensis, Haemophilus influenzae, Klebsiella pneumoniae, Legionella, Moraxella catarrhalis, Mycoplasma pneumoniae, Pseudomonas aeruginosa, Streptococcus, MSSA, MRSA, other gram‐negative bacteria); viral infection (eg, influenza A, B, adenovirus, H1N1, respiratory syncytial virus, parainfluenza virus); fungal infection (aspergillosis, including allergic bronchopulmonary aspergillosis and aspergilloma, histoplasmosis, coccidioidomycosis, Pneumocystis jirovecii); pulmonary tuberculosis; lung abscess; viral infection (eg, influenza A, B, adenovirus, respiratory syncytial virus, parainfluenza virus, avian influenza virus); fungal infection (aspergillosis, including allergic bronchopulmonary aspergillosis and aspergilloma, histoplasmosis, coccidioidomycosis, Pneumocystis jirovecii) Neoplasms benign neoplasms: upper airways (eg, vocal cord polyps, nasal polyps, juvenile papillomatosis); lungs and pleura (eg, solitary pulmonary nodule, bronchial carcinoid tumors) malignant neoplasms upper airways: lip, oral cavity, and pharynx; head and neck cancer; larynx; trachea lower airways and pleura: malignant neoplasms of bronchus and/or lung (squamous cell, adenocarcinoma, large cell, small cell); malignant neoplasms of pleura (mesothelioma); secondary malignant neoplasms of lung; secondary malignant neoplasms of pleura metastatic neoplasms including pleural Obstructive airway disease: asthma, reactive airway disease; bronchiectasis; chronic airway obstruction; chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema Pneumoconiosis/fibrosing/restrictive pulmonary disorders/interstitial lung disease: pneumoconiosis; asbestosis; silicosis; silo-filler's lung, byssinosis, bagassosis, berylliosis; hypersensitivity pneumonitis; hypereosinophilic syndromes, Loeffler syndrome; interstitial pneumonia, usual (UIP), desquamative (DIP), nonspecific Respiratory failure/respiratory arrest and pulmonary vascular disorders: acute respiratory distress syndrome (ARDS); pulmonary hypertension; pulmonary vascular disorders, arteriovenous fistula; pulmonary edema, pulmonary cause and unspecified; pulmonary embolism; air and fat embolism; respiratory failure due to enteral feeding Metabolic, regulatory, and structural disorders: disorders of gas exchange; hypoventilation; hypoxia; pulmonary alveolar proteinosis; ventilation-perfusion imbalance Disorders of the pleura, mediastinum, and chest wall: chylothorax; costochondritis; empyema; hemothorax; mediastinitis; pleural effusion; pleuritis; pneumomediastinum; pneumothorax Traumatic and mechanical disorders upper airways: epistaxis; barotrauma, sinus; laryngeal/pharyngeal obstruction; tracheoesophageal fistula; tracheal stenosis; tracheomalacia; trauma (eg, tracheal injury); foreign body (nose, pharynx, larynx, trachea); traumatic/mechanical disorders of the nasal cavity/sinuses (eg, septal perforation) lower airways and pleura: atelectasis; diaphragm/chest wall injury; drowning and neardrowning; foreign body, upper and lower respiratory tract; penetrating chest wounds; pulmonary contusion; sleep apnea, obstructive and central; hypoventilation syndrome, obesity-hypoventilation syndrome Congenital disorders: bronchogenic cysts; congenital cysts; congenital diaphragmatic hernia; pulmonary sequestration; immotile cilia syndrome Adverse effects of drugs on the respiratory system: bleomycin, amiodarone; adverse effects of 100% oxygen; acute effects of tobacco/nicotine, inhalants, cocaine Gastrointestinal System Normal Processes Embryonic development, fetal maturation, and perinatal changes Organ structure and function anatomy of the alimentary canal, including mouth, pharynx, esophagus, stomach, small intestine, large intestine, anus, peritoneal cavity liver and biliary system, including enterohepatic circulation salivary glands and exocrine pancreas gastrointestinal motility, including defecation digestion and absorption Cell/tissue structure and function endocrine and neural regulatory functions, including GI hormones (eg, gastrin) salivary, gastrointestinal, pancreatic, hepatic secretory products, including enzymes, proteins, bile salts, and processes synthetic and metabolic functions of hepatocytes Repair, regeneration, and changes associated with stage of life Gastrointestinal defense mechanisms and normal flora Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, immunologic, and inflammatory disorders infectious disorders bacterial: pseudomembranous colitis (Clostridium difficile); enteritis/enteric infections (includes gastroenteritis) (eg, Staphylococcus aureus, Escherichia coli, Listeria monocytogenes, Yersinia enterocolitica, Campylobacter species, Vibrio cholerae, Salmonella species, Shigella species, traveler's/infectious diarrhea); hepatic abscess, subhepatic abscess, subphrenic abscess; peritonitis, primary and secondary; Whipple disease viral: infectious esophagitis (eg, CMV, herpes); hepatitis A, B, C, D, E; coxsackievirus enteritis/colitis; Echovirus enteritis/colitis; rotavirus enteritis; mumps; gingivostomatitis, herpetic fungal: thrush parasitic: Cryptosporidium, Cyclospora, Entamoeba histolytica, Giardia, Isospora belli, Strongyloides stercoralis immunologic and inflammatory disorders: autoimmune hepatitis; celiac disease; eosinophilic esophagitis; granulomatous enteritis; inflammatory bowel disease, including Crohn disease, regional enteritis, microscopic colitis (collagenous and lymphocytic colitis), ulcerative colitis, toxic megacolon Neoplasms benign neoplasms, including polyps, cysts: stomach; small intestine; colon, rectum, and anus, including polyps malignant neoplasms and pre-malignant conditions: oral cancer (eg, lips, mouth, tongue, salivary glands); esophageal, squamous and adenocarcinoma; Barrett esophagus; gastrinoma, Zollinger-Ellison syndrome; gastrointestinal carcinoid tumors; gastrointestinal stromal tumors; small intestine; stomach, adenocarcinoma, lymphoma, MALT; colon, rectum, anus; hereditary colon cancer syndromes, familial adenomatous polyposis (eg, Peutz-Jeghers syndrome, Gardner syndrome, Turcot syndrome, ); MUTYH-associated polyposis; gallbladder, cholangiocarcinoma, adenocarcinoma of the ampulla of Vater; liver, including hepatoma; peritoneal cancer, including metastatic studding with cancer; pancreas metastatic neoplasms Signs, symptoms, and ill-defined disorders: upper gastrointestinal bleeding; lower gastrointestinal bleeding; constipation; diarrhea; hematochezia; bright red rectal bleeding; melena; nausea, vomiting, rumination Disorders of the oral cavity, salivary glands, and esophagus oral cavity and salivary glands: abscessed tooth; dental caries; malocclusion; disorders of the salivary glands (eg, stones, sialadenitis, parotitis) esophagus: achalasia and cardiospasm; dysphagia; diverticulum (eg, Zenker); esophageal periapical abscess without sinus; esophagitis/esophageal reflux (GERD); esophagitis, pill; Mallory-Weiss syndrome; paraesophageal (hiatal) hernia; stricture and stenosis of esophagus Disorders of the stomach, small intestine, colon, rectum, anus stomach: dyspepsia/hyperacidity; gastric ulcer; gastritis; peptic ulcer; peptic ulcer perforation; gastroparesis small intestine, colon: appendicitis; angiodysplasia; diverticula, diverticulitis, diverticulosis; duodenitis, duodenal ulcer, peptic ulcer; gastroenteritis and colitis (noninfectious); granulomatous enterocolitis; Hirschsprung disease; impaction of intestine; intestinal obstruction/stricture; intussusception; irritable colon/irritable bowel syndrome; mesenteric ischemia/ischemic bowel/ischemic colitis; necrotizing enterocolitis; paralytic ileus; volvulus; malnutrition and malabsorption, including lactose intolerance, short bowel syndrome rectum and anus: abscess of anal and rectal regions; anal fissure; anal fistula; ulcer; fecal incontinence; hemorrhage (rectum, anus); proctitis; hemorrhoids; rectal prolapse Disorders of the liver and biliary system, noninfectious liver: cirrhosis; Dubin-Johnson, Rotor syndromes; end-stage liver disease, including indications for transplantation; Gilbert syndrome, Crigler-Najjar syndrome; hepatic coma/hepatic encephalopathy; hepatitis, noninfectious; hepatitis, fatty liver, alcoholic; hepatorenal syndrome; hepatopulmonary syndrome; jaundice; nonalcoholic fatty liver disease; portal hypertension/esophageal varices biliary system: bile duct obstruction/cholestasis; cholangitis, including ascending; choledocholithiasis; cholelithiasis/cholecystitis; cholestasis due to parenteral nutrition; gallstone ileus; Mirizzi syndrome; primary biliary cirrhosis; primary sclerosing cholangitis Disorders of the pancreas: pancreatitis, acute; pancreatitis, chronic; pancreatitis, hereditary; pancreatic cyst/pseudocyst; pancreatic duct obstruction; pancreatic insufficiency Disorders of the peritoneal cavity: ascites Traumatic and mechanical disorders: abdominal wall defects; adhesions, postsurgical; digestive system complications of surgery; post-gastric surgery syndromes (eg, blind loop syndrome, adhesions); duodenal tear; foreign body in digestive system; inguinal, femoral, and abdominal wall hernias; open wound, abdominal; perforation of hollow viscus and blunt trauma; perforation/rupture of esophagus (Boerhaave syndrome); umbilical hernia Congenital disorders: annular pancreas, biliary atresia, cleft lip and palate, esophageal atresia, malrotation without volvulus, Meckel diverticulum, pyloric stenosis, tracheoesophageal fistula Adverse effects of drugs on the gastrointestinal system: drug-induced changes in motility (chronic laxative abuse, opioids); drug-induced gastritis, duodenitis, peptic ulcer disease (NSAIDs); drug-induced hepatitis (eg, acetaminophen, isoniazid); drug-induced pancreatitis (eg, thiazide diuretics) Renal & Urinary System Normal Processes Embryonic development, fetal maturation, and perinatal changes Organ structure and function kidneys, ureters, bladder, urethra glomerular filtration and hemodynamics urine concentration and dilution renal mechanisms in acid-base balance renal mechanisms in body fluid homeostasis micturition Cell/tissue structure and function renal metabolism and oxygen consumption tubular reabsorption and secretion, including transport processes and proteins hormones produced by or acting on the kidney (eg, renin, aldosterone, angiotensin II, vasopressin) Repair, regeneration, and changes associated with stage of life Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, immunologic, and inflammatory disorders infectious disorders upper urinary tract: granulomatous pyelonephritis; perinephric abscess; pyelonephritis; pyonephrosis; renal abscess; renal tuberculosis lower urinary tract and urinary tract infections of unspecified location: cystitis; chlamydial and nonchlamydial immunologic and inflammatory disorders upper urinary tract glomerular disorders: Alport syndrome; glomerular disease due to hepatitis B, C; glomerulonephritis, including poststreptococcal; IgA nephropathy; lupus nephritis; minimal change disease; nephrotic syndrome; thin basement membrane disease tubular interstitial disease: acute tubular necrosis (ATN); acute interstitial nephritis; papillary necrosis; HIV nephropathy lower urinary tract: interstitial cystitis Neoplasms benign neoplasms and cysts: polycystic kidney disease malignant neoplasms: renal (eg, Wilms tumor/nephroblastoma, renal cell carcinoma, renal tumors associated with congenital/hereditary conditions); urinary bladder and collecting system Signs, symptoms, and ill-defined disorders: dysuria; hematuria; oliguria, anuria; proteinuria Metabolic and regulatory disorders: acute kidney injury; renal insufficiency; azotemia, uremic syndrome; chronic kidney disease, including end-stage renal disease; cystinuria; Fanconi syndrome; hypertensive renal disease (renal complications of hypertension); renal calculi, ureteral calculi, nephrolithiasis; renal tubular acidosis Vascular disorders: renal artery stenosis (atherosclerosis, fibromuscular dysplasia, nephrosclerosis); renal vein thrombosis; renal infarction Traumatic and mechanical disorders: bladder rupture; neurogenic bladder; obstructive uropathy; posterior urethral valves; renal laceration; renal vascular injury; ureteral laceration/avulsion/disruption; urethral diverticulum; urethral/ureteral obstruction/stricture/prolapse; urinary incontinence, including secondary enuresis; vesicoureteral reflux Congenital disorders: double ureters/ureteral duplication/double collecting system; horseshoe kidney; hydronephrosis/reflux; renal agenesis, renal hypoplasia, renal dysplasia; single kidney Adverse effects of drugs on the renal and urinary system: ACE inhibitors; aminoglycosides; amphotericin B; cisplatin; furosemide; gadolinium (nephrogenic systemic fibrosis); heroin; iodinated contrast dye; lithium; NSAIDs; penicillins; sulfa drugs; tenofovir; drug - induced urinary retention Pregnancy, Childbirth, & the Puerperium Normal Processes Organ structure and function: pregnancy, including fertilization, implantation, development of embryo, labor and delivery, the puerperium, lactation, gestational uterus, placenta Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Prenatal care preconception counseling and care: folate deficiency prevention; immunizations; nutritional exam, including vitamins; Rh screening prenatal risk exam/prevention: adolescent pregnancy; antepartum fetal evaluation, including biophysical profile; genetic screening; α-fetoprotein; diabetes mellitus; neural tube defects; Rh isoimmunization supervision of normal pregnancy: test of gestational age; iron deficiency prevention; nutrition, including weight management; surveillance, including ultrasonography and test of fetal growth; vitamin deficiency prevention; infections, maternal, fetal, newborn (focus on prevention and screening): cytomegalovirus, coxsackievirus, hepatitis B virus, herpes simplex viruses, HIV, influenza virus, parvovirus B19 virus, rubella virus, varicella-zoster virus, Chlamydia trachomatis, Treponema pallidum, Streptococcus agalactiae, Toxoplasma gondii, amnionitis; asymptomatic urinary tract infection Obstetric complications: abortion, induced, septic, missed, spontaneous, threatened; acute fatty liver of pregnancy; anemia of pregnancy, sickle cell disease, thalassemia in pregnancy; antepartum hemorrhage, including third-trimester bleeding; cardiomyopathy of pregnancy; cervical incompetence, cervical shortening; cholestasis of pregnancy, intrahepatic; congenital abnormalities, maternal (eg, bicornuate uterus); ectopic pregnancy; fetal abnormality affecting management of mother (eg, hydrocephalus, spina bifida); fetal growth restriction; gestational diabetes; maternal mortality; multiple gestation; placental abnormalities (abruptio placentae, placenta previa, premature separation of placenta); polyhydramnios, oligohydramnios; preeclampsia, eclampsia, HELLP syndrome, gestational hypertension; prolonged pregnancy; Rh isoimmunization affecting management of mother; vomiting in pregnancy (morning sickness, hyperemesis gravidarum); trauma in pregnancy; infections complicating pregnancy Labor and delivery: labor and delivery, uncomplicated; labor and delivery, complicated, including shoulder dystocia; cesarean delivery, including complications; cord compression, cord prolapse; fetal malpresentations (eg, breech); intrapartum fetal evaluation, including fetal heart tones; intrapartum prophylaxis (eg, HIV, Chlamydia, gonococcal prophylaxis); premature rupture of membranes; preterm (before 37 weeks' gestation) and postdates labor and delivery; threatened preterm labor Puerperium, including complications: lactation problems; breast-feeding problems; lochia; postpartum cardiomyopathy; postpartum blues; postpartum hemorrhage; postpartum sepsis; retained placenta, products of conception (eg, placenta accreta); uterine atony Newborn (birth to 4 weeks of age) normal newborn examination of liveborn at admission to hospital screening, newborn disorders of the newborn: screening, newborn; ABO incompatibility in newborn; hemolytic disease due to Rh incompatibility; birth asphyxia syndrome (liveborn neonate); birth trauma (eg, cord compression, brachial palsy, lacerations); drug withdrawal syndrome in newborn; feeding problems in newborn; fetal growth and development abnormalities, including fetal growth restriction; gastrointestinal obstruction; hypocalcemia of newborn; infections, congenital or peripartum (cytomegalovirus, herpes simplex viruses, HIV, hepatitis B, rubella virus, parvovirus B19 virus, varicella zoster virus, Chlamydia trachomatis, Streptococcus agalactiae, Treponema pallidum, Toxoplasma gondii); intrapartum fetal distress/death including stillborn; jaundice, fetal/neonatal/perinatal; laryngomalacia; macrosomia (large for gestational age); meconium aspiration syndrome; neonatal acne; neonatal Candida infection (thrush); neonatal hypoglycemia; neonatal conjunctivitis and dacryocystitis; ophthalmic gonorrhea; phenylketonuria; premature infant; postterm infant; pseudomembranous colitis of infancy; respiratory distress syndrome (hyaline membrane disease); respiratory problems after birth (eg, bronchopulmonary dysplasia, tracheomalacia; tracheoesophageal fistula in neonates); retinitis of prematurity; seizures in newborn; sudden infant death syndrome (SIDS), apparent life-threatening event (ALTE); tetanus neonatorum Congenital disorders, neonatal: congenital malformations and anomalies; neonatal hydrocele Adverse effects of drugs on pregnancy, childbirth, and the puerperium: alcohol, tobacco, and other drugs (ATOD); prenatal radiation exposure; teratology (eg, ACE inhibitors, SSRIs, warfarin, infections, toxins) Systemic disorders affecting pregnancy, labor and delivery, and puerperium: appendicitis; asthma; carpal tunnel syndrome in pregnancy; cirrhosis; deep venous thrombosis (DVT); diabetes mellitus; heart failure, valvular heart disease;hypertension; myasthenia gravis; obesity; pancreatitis; psychiatric disorders; renal calculus/calculi; renal failure/renal disease, including SLE; seizure disorders; thyroid disorders, hypothyroidism, hyperthyroidism Female Reproductive System & Breast Normal Processes Embryonic development, fetal maturation, and perinatal changes, gametogenesis Organ structure and function female structure, including breast female function (eg, ovulation, menstrual cycle, puberty) intercourse, sexual response Cell/tissue structure and function: hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones Reproductive system defense mechanisms and normal flora Repair, regeneration, and changes associated with stage of life Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Breast infectious, immunologic, and inflammatory disorders: breast abscess; inflammatory disease of breast, fat necrosis; mastitis; nipple discharge neoplasms benign and undefined neoplasms: breast cyst, solitary; fibrocystic changes; fibroadenoma; hypertrophy of breast; intraductal papilloma malignant neoplasms (including screening): breast cancer; intraductal carcinoma; Paget disease of breast; phyllodes tumors Female reproductive system infectious, immunologic, and inflammatory disorders: bacterial vaginosis; Bartholin gland abscess; cellulitis, pelvic; candidiasis of the vulva or vagina; lichen sclerosus; sexually transmitted infections and exposure; cervicitis and endocervicitis; chancroid (Haemophilus ducreyi); genital herpes; gonorrhea (Neisseria gonorrhoeae); human papillomavirus infection, genital/venereal/anal warts, condylomata acuminata; lymphogranuloma venereum (Chlamydia trachomatis), non-lymphogranuloma venereum; pelvic inflammatory disease; Fitz-Hugh–Curtis syndrome; salpingitis and oophoritis; syphilis (Treponema pallidum); trichomoniasis (Trichomonas vaginalis); urethritis; vaginitis; vulvovaginitis Neoplasms of the cervix, ovary, uterus, vagina, and vulva benign neoplasms and cysts: abnormal Pap smear; benign neoplasm of ovary; endocervical and endometrial polyps; leiomyomata uteri; ovarian cyst malignant and precancerous neoplasms: cervical cancer; HPV causing cancer; cervical dysplasia, HPV causing dysplasia; endometrial hyperplasia; endometrial/uterine cancer; gestational trophoblastic disease (hydatidiform mole); ovarian cancer; vulvar dysplasia and cancer Fertility and infertility: assisted reproductive techniques (ART); contraception (eg, oral contraceptives, IUD, vaginal cap, cervical sponge, diaphragm, implant, morning-after pill, male and female condoms); female infertility; gonadal dysgenesis 45,X (Turner syndrome); sterilization; tubal factors; infertility Menopause: ovarian failure, premature menopause; perimenopause; premenopausal menorrhagia; postmenopausal atrophic vaginitis (vaginal atrophy); postmenopausal bleeding; vasomotor symptoms Menstrual and endocrine disorders: abnormal uterine bleeding, including perimenopausal; absence of menstruation (primary amenorrhea, secondary amenorrhea including undiagnosed pregnancy); anovulation; dysmenorrhea; endometriosis; hirsutism, virilization; mittelschmerz; pelvic pain; polycystic ovarian syndrome; postcoital bleeding; premenstrual syndrome Sexual dysfunction: dyspareunia; orgasmic dysfunction; sexual desire/arousal syndrome; vaginismus Traumatic and mechanical disorders: Asherman syndrome; chronic inversion of uterus; chronic pelvic pain syndrome; cystocele; imperforate hymen; injuries, wounds, and burns affecting the female reproductive system and injuries, wounds, burns, and blast injuries; ovarian torsion; pelvic relaxation; prolapse, vaginal walls, uterine, uterovaginal; rectocele; urethrocele Congenital disorders: müllerian agenesis; uterus didelphys, bicornuate uterus; short cervix Adverse effects of drugs on the female reproductive system and breast: antihistamines, H2-receptor blockers; benzodiazepines; beta-adrenergic blockers; hormone replacement; opioids; spironolactone; selective serotonin reuptake inhibitors; tricyclic antidepressants Male Reproductive System Normal Processes Embryonic development, fetal maturation, and neonatal changes, gametogenesis Organ structure and function structure, male genitalia and prostate function, male genitalia and prostate (eg, spermatogenesis, puberty) intercourse, orgasm, erection Cell/tissue structure and function, including hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones Reproductive system defense mechanisms and normal flora Repair, regeneration, and changes associated with stage of life Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, immunologic, and inflammatory disorders infectious disorders: balan



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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