Preface

The purpose of this course is to prepare the osteopathic student studying for the COMAT Internal Medicine Examination. Internal medicine is the study of common and uncommon adult diseases of the major organ systems of the body. The osteopathic student has the dual obligation to understand these disorders from an osteopathic and allopathic perspective so the course addresses these dualities as part of what you’ll need to learn and understand.

The different organ systems in this course include the cardiovascular system, the respiratory system, the gastrointestinal system, the nervous system, the musculoskeletal system, and the endocrine system, among others. We will talk about the major diseases of these body areas that you will encounter as part of a typical osteopathic practice. These are things you probably have encountered to some degree as part of your classroom education and student clinical experiences. The course itself is designed to put these two things together in a meaningful way so you can pass the exam with confidence, based on the commonly accepted ways to manage these health conditions in a clinical setting.

The focus of chapter one in the course is the different cardiovascular diseases you will encounter in a typical internal medicine practice. It includes conditions like angina, acute coronary syndromes, and arrhythmias as well as congestive heart failure, aortic dissection, valvular heart disease, and peripheral vascular disease. Inflammatory conditions affecting the heart, such as endocarditis and pericarditis, are less common but may still be seen and managed by you in an internal medicine practice. These are also covered in this chapter.

Chapter two involves a discussion of the different endocrine disorders you might encounter in an internal medicine setting. These include disorders of weight loss or weight gain, diabetes mellitus, diseases of the parathyroid glands, thyroid disorders, endocrine diseases of pituitary origin, adrenal gland disorders, and the different male and female gonadal diseases related to the endocrine system. As you will see in this

chapter, the symptoms can overlap or can be vague, requiring astute observation and laboratory measurements in order make a diagnosis and treat the different diseases.

Chapter three in the course introduces the different gastrointestinal diseases you would encounter in a general internal medicine setting. Things we talk about in this chapter include esophageal and stomach disorders, malabsorption, common bowel disorders like constipation and diarrhea, and inflammatory bowel disease. Diseases unrelated to the alimentary canal itself are also covered, including liver disease, pancreatic diseases, and gallbladder disorders. Common GI cancers are also covered in this chapter.

The focuses of chapter four are hematological conditions and oncological disorders. Hematological disorders discussed in the chapter include anemias, coagulation disorders, and blood-related malignancies. The general management of cancer including the recommended cancer screening tests in the US are also covered as part of this chapter.

Chapter five in the course talks about the different infectious diseases a person can have, including viral infections, bacterial infections, fungal infections, and parasitic infections. Certain types of infectious disease situations are discussed specifically, such as HIV disease. Issues related to bioterrorism and infectious disease prevention are also covered in this chapter.

Chapter six involves a thorough discussion of musculoskeletal conditions as they are approached in both internal medicine and osteopathy. These include coverage of somatic dysfunctions and viscerosomatic relationships in musculoskeletal diseases. Other common disorders covered in this chapter include osteoporosis, rheumatic diseases, vasculitis, and several of the more common muscle disorders in human disease states.

The focus of chapter seven in the course is the different neurological conditions you might expect to see an internal medicine practice. Common disorders discussed in the chapter include the different types of stroke, the different types of dementia, and delirium. Less commonly seen disorders are those that affect the spinal cord, peripheral nerves, and the autonomic nervous system. You should be able to recognize and treat

these disorders; this is why they are covered thoroughly in the chapter from discussing presentation to diagnostic testing to treatment of these challenging disorders.

Chapter eight in the course focuses on kidney diseases and hypertension. Kidney diseases can cause electrolyte disturbances or can simply be how the body responds to electrolyte disturbances caused by other dysfunctions in the body. Diseases discussed in this chapter include acute kidney injury, chronic kidney disease, kidney stones, obstructive uropathy, and intrinsic kidney diseases. While hypertension is not always related to the kidneys, much of the treatment of hypertension focuses on the kidneys, so this is covered in this chapter.

Chapter nine talks about the different respiratory diseases seen in internal medicine. Some of the diseases talked about are acute diseases like asthma, pneumonia, respiratory failure, or pulmonary embolisms. Others are chronic diseases managed in internal medicine, such as COPD and interstitial lung disease. Also covered in the chapter are some of the major respiratory tract cancers, including the two main types of lung cancer.

Chapter ten in the course talks about the different allergy and skin-related diseases seen in clinical practice. Allergic diseases can involve systemic or respiratory symptoms as well as skin-related symptoms due to exposure to environmental allergens. There are several skin diseases discussed in this chapter, including skin rashes, benign skin lesions, and skin cancers, which have increased in incidence in recent years.