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USMLE | Multisystem Processes & Disorders

Normal Processes

Principles of nutrition

    • generation, expenditure, and storage of energy at the whole-body level functions of nutrients (eg, essential, trans-fatty acids, cholesterol)

Electrolyte and water metabolism

    • electrolyte metabolism (calcium, potassium, phosphorus)
    • water metabolism

Intracellular accumulations (eg, pigments, fats, proteins, carbohydrates, minerals, inclusions, vacuoles, lysosomal/glycogen storage disease and structures related to

storage diseases, glycogen phosphorylase deficiency, Zellweger syndrome)

Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis

Infectious, immunologic, and inflammatory disorders

infectious disorders

    • bacterial: brucellosis (Brucella spp); leptospirosis (Leptospira interrogans); Lyme disease (Borrelia burgdorferi); melioidosis (Burkholderia pseudomallei); miliary (disseminated) tuberculosis (Mycobacterium tuberculosis); tularemia (Francisella tularensis); toxic shock syndrome; Q fever (Coxiella burnetii ); anaplasmosis and ehrlichiosis (Anaplasma and Ehrlichia species); rickettsiosis (Rocky Mountain spotted fever [Rickettsia rickettsii])
    • viral: infectious mononucleosis (Epstein-Barr virus); cytomegalovirus infection; yellow fever; human herpesvirus 8 (HHV-8)
    • fungal: blastomycosis (Blastomyces dermatitidis); candidiasis (Candida albicans); coccidioidomycosis (Coccidioides immitis/posadasii); histoplasmosis (Histoplasma capsulatum)
    • parasitic: schistosomiasis (Schistosoma); leishmaniasis (Leishmania spp), visceral (kala- azar); trypanosomiasis/Chagas disease, acute and chronic (Trypanosoma)
    • immunologic and inflammatory disorders: acute rheumatic fever; autoimmune arteritis/vasculitis; Behçet syndrome; Churg-Strauss syndrome; eosinophilic granuloma, histiocytosis, Langerhans cell histiocytosis; Goodpasture syndrome; Henoch-Schönlein purpura; Kawasaki disease; mixed connective tissue disease; polyangiitis; polyarteritis nodosa; polymyalgia rheumatica, temporal arteritis; Raynaud disease/Raynaud syndrome; reactive arthritis, formerly Reiter disease, including Reiter arthritis; scleroderma (systemic sclerosis); Sjögren syndrome; systemic lupus erythematosus; Takayasu arteritis; Wegener granulomatosis; familial Mediterranean fever; sarcoidosis, Lofgren syndrome

Neoplasms and related disorders

  • paraneoplastic syndromes: endocrine (eg, SIADH, Cushing syndrome, hypercalcemia of malignancy [PTHrP]); hematologic (polycythemia, nonbacterial thrombotic endocarditis); neurologic (myasthenic syndrome, paraneoplastic cerebellar degeneration, limbic encephalitis, pure sensory neuropathy); mucocutaneous (eg, acanthosis nigricans); musculoskeletal (eg, pulmonary osteoarthropathy, polymyositis); other (membranous glomerulonephritis)
  • inherited cancer syndromes: DNA repair abnormalities (eg, Fanconi anemia); Lynch syndrome (gastrointestinal and female reproductive)

Signs, symptoms, and ill-defined disorders: arthralgias; abdominal pain; chest pain; cough; dizziness, light-headedness, syncope, including breath-holding spells with syncope; dyspnea, shortness of breath; edema, anasarca; fatigue; fever of unknown origin; Gulf War syndrome; hemoptysis; joint pain; palpitations; pruritus; unexpected weight gain/weight loss


    • protein-calorie malnutrition (kwashiorkor, marasmus)
    • vitamin deficiencies and/or toxicities: vitamin A; vitamin B; vitamin B1, thiamine (eg, Wernicke- Korsakoff syndrome, beriberi); vitamin B3, niacin; vitamin B6, pyridoxine; vitamin B9, folic acid; vitamin B12, cobalamins (pernicious anemia); vitamin C (scurvy); vitamin D (rickets); vitamin E; vitamin K
    • mineral deficiencies and/or toxicities obesity
    • enteral/parenteral nutrition (TPN)

Toxins and environmental extremes

    • physical and associated disorders
      • temperature (eg, hypothermia, hyperthermia, heat stroke) radiation (eg, radon, uranium mining, imaging studies) thermal injury, burns, electrocution, lightning
      • decreased atmospheric pressure, high-altitude sickness increased water pressure
    • chemical including Gulf War illness/syndrome gases, vapors, smoke inhalation
    • agricultural hazards (eg, pesticides, green tobacco poisoning, anhydrous ammonia, Agent Orange)
    • volatile organic solvents heavy metals
    • other chemical agents (eg, ethylene glycol, carbon tetrachloride, methanol; BPA)
    • principles of poisoning and therapy (eg, ASA, acetaminophen)

Venomous bites and stings: hymenoptera bites and stings; scorpion bites; snake bites; spider bites; jellyfish stings

Fluid, electrolyte, and acid-base balance disorders

    • fluid volume and electrolyte/ion disorders: fluid volume disorders; dehydration; hypovolemia; volume overload; electrolyte disorders; hyponatremia, hypernatremia; hypokalemia, hyperkalemia; hypocalcemia, hypercalcemia; hypophosphatemia, hyperphosphatemia; hypomagnesemia
    • acid-base disorders: metabolic acidosis; metabolic alkalosis; respiratory acidosis; respiratory alkalosis; mixed acid-base disturbances


    • child, nonaccidental trauma/inflicted head trauma/factitious disorder by proxy intimate partner abuse, sexual, emotional, and physical including injuries (eg, rib
    • fractures) related to abuse
    • elder abuse, sexual, emotional, and physical including injuries (eg, rib fractures)
    • related to abuse sexual assault

Multiple trauma (eg, prioritization, blast injury involving more than one organ system)

Shock, cardiogenic, hypovolemic, neurogenic, septic, sepsis, bacteremia, systemic

    • inflammatory response syndrome (SIRS), refractory, multiorgan dysfunction syndrome: meningococcemia

Genetic metabolic and developmental disorders

    • multifactorial: VATER syndrome, association syndromes
    • large genomic changes: Beckwith-Wiedemann syndrome; Down syndrome; Prader-Willi syndrome
    • enzymatic/metabolic: alpha-1 antitrypsin deficiency; porphyria; inborn errors of metabolism (eg, maple syrup urine disease, diseases involving urea cycle); storage diseases (eg, Fabry disease, Tay-Sachs disease, glycogen storage disease, mucopolysaccharidoses)
    • structural protein disorders: amyloidosis; Ehlers-Danlos syndrome; immotile cilia syndrome (Kartagener syndrome; primary ciliary dyskinesia); Marfan syndrome
    • intracellular/extracellular transport receptors: cystic fibrosis; hemochromatosis; Wilson disease
    • triplet repeat/RNA disorders: fragile X syndrome

Adverse effects of drugs on multisystem disorders: drug-induced electrolyte abnormalities and acid base-disorders (eg, albuterol, prednisone, diuretics, alcohol)

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