This lecture is a brief overview of the pathology of nutrition. The truth is, most of you will not encounter the diseases of kwashiorkor or marasmus, except on Step 1. Therefore, I would suggest this lecture as a critical one to review just prior to taking the exam, mainly to reacquaint yourself with the names of the vitamins and their various deficiency states. Why does the USMLE insist on asking questions about diseases you will probably never see? I don’t know, for sure, but I suspect it is because the diseases of protein and calorie malnutrition and the hypovitaminoses cause the death or suffering of millions of people worldwide, mainly children, every year, probably since the beginning of our time on earth. The people writing the USMLE exam expect that medical students should care about these social issues, and (they think) by putting them on your licensing exam, you will gain some valuable perspective that you would not otherwise have, unless you have had the enlightening experience of living in a developing country (which I highly recommend). As always, I have tried to follow Robbins, Cotran and Kumar, 7 th Edition, 2005, in my lecture outline, and have included selected portions of the text in my notes.
Nutritional Pathology James L. Fishback, M.D. Associate Professor University of Kansas School of Medicine