A STUDENT-TO-STUDENT GUIDE • 1,300+ frequently tested facts and mnemonics • • High-yield updates throughout with reorganized neurology chapter • • 100+ new and revised color illustrations and photos • • Student-proven exam tips and strategies • • Revised resource guide with web and mobile apps • FIRST AID FOR THE® USMLE STEP 1 2017 TAO LE, MD, MHS VIKAS BHUSHAN, MD Associate Clinical Professor Boracay Chief, Section of Allergy and Immunology Department of Medicine University of Louisville School of Medicine MATTHEW SOCHAT, MD KIMBERLY KALLIANOS, MD Resident, Department of Internal Medicine Resident, Department of Radiology and Biomedical Imaging Temple University Hospital University of California, San Francisco School of Medicine YASH CHAVDA, DO ANDREW ZUREICK Resident, Department of Emergency Medicine University of Michigan Medical School St. Barnabas Hospital, Bronx Class of 2018 MEHBOOB KALANI, MD Resident, Department of Internal Medicine Allegheny Health Network Medical Education Consortium New York / Chicago / San Francisco / Athens / London / Madrid / Mexico City Milan / New Delhi / Singapore / Sydney / Toronto Copyright © 2017 by McGraw-Hill Education. 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Contents Contributing Authors vii General Acknowledgments xiii Associate Authors viii How to Contribute xvii Faculty Advisors ix How to Use This Book xix Preface xi Selected USMLE Laboratory Values xx Special Acknowledgments xii First Aid Checklist for the USMLE Step 1 xxii (cid:96)(cid:3)SECTION I GUIDE TO EFFICIENT EXAM PREPARATION 1 Introduction 2 Test-Taking Strategies 20 USMLE Step 1—The Basics 2 Clinical Vignette Strategies 21 Defining Your Goal 12 If You Think You Failed 22 Excelling in the Preclinical Years 13 Testing Agencies 22 Timeline for Study 14 References 23 Study Materials 18 (cid:96)(cid:3)SECTION I SUPPLEMENT SPECIAL SITUATIONS 25 (cid:96)(cid:3)SECTION II HIGH-YIELD GENERAL PRINCIPLES 27 How to Use the Database 28 Pathology 203 Biochemistry 31 Pharmacology 223 Immunology 91 Public Health Sciences 245 Microbiology 119 v (cid:96)(cid:3)SECTION III HIGH-YIELD ORGAN SYSTEMS 263 Approaching the Organ Systems 264 Neurology and Special Senses 459 Cardiovascular 267 Psychiatry 523 Endocrine 311 Renal 547 Gastrointestinal 343 Reproductive 579 Hematology and Oncology 385 Respiratory 625 Musculoskeletal, Skin, and Connective Tissue 423 Rapid Review 651 (cid:96)(cid:3)SECTION IV TOP-RATED REVIEW RESOURCES 671 How to Use the Database 672 Cell Biology and Histology 677 Question Banks 674 Microbiology and Immunology 677 Question Books 674 Pathology 677 Web and Mobile Apps 674 Pharmacology 678 Comprehensive 675 Physiology 679 Anatomy, Embryology, and Neuroscience 675 Abbreviations and Symbols 681 Behavioral Science 676 Image Acknowledgments 689 Biochemistry 676 (cid:96)(cid:3) Index 711 About the Editors 777 vi Contributing Authors MARINA BOUSHRA, MD M. SCOTT MOORE, DO Resident, Department of Emergency Medicine Research Fellow East Carolina University/Vidant Medical Center Affiliated Dermatology THEODORE CRISOSTOMO-WYNNE JUN YEN NG, MD F. Edward Hébert School of Medicine Intern Class of 2017 Central Queensland Hospital and Health Services MATTHEW S. DELFINER SATYAJIT REDDY, MD New York Institute of Technology College of Osteopathic Medicine Resident, Department of Internal Medicine Class of 2017 Temple University Hospital ANGELA GAUTHIER VADIM ROSIN Yale School of Medicine University of Michigan Medical School Class of 2018 Class of 2017 BENJAMIN GOUGH, DO SARAH SCHIMANSKY, MB BCh BAO Resident, Department of General Surgery Academic Foundation Doctor Christiana Care Health System North Bristol NHS Trust JAN ANDRE GRAUMAN, MD, MA ZACHARY G. SCHWAM, MD Family Medicine Resident, Northern Remote Stream Resident, Department of Otolaryngology University of Manitoba Icahn School of Medicine at Mount Sinai JESSICA F. JOHNSTON, MSc NINO SIKHARULIDZE, MD Yale School of Medicine Department of Endocrinology MD/PhD Candidate Tbilisi State Medical University JAMES N. McCOY VAISHNAVI VAIDYANATHAN Texas A&M Health Science Center University of Missouri-Kansas City School of Medicine Class of 2017 Class of 2018 I I T MAGE AND LLUSTRATION EAM RYAN W. HADDEN RENATA VELAPATIÑO University of Alabama School of Medicine San Martín de Porres University Class of 2017 School of Medicine vii Associate Authors JAMES E. BATES, MD JESSE D. SENGILLO Resident, Department of Radiation Oncology SUNY Downstate College of Medicine University of Florida School of Medicine Class of 2018 REED GILBOW, MD WENHUI ZHOU Resident, Department of Otolaryngology–Head and Neck Surgery Tufts University School of Medicine University of Virginia School of Medicine MD/PhD Candidate RYAN KELSCH Midwestern University Chicago College of Osteopathic Medicine Class of 2017 I I T MAGE AND LLUSTRATION EAM NAKEYA KHOZEMA DEWASWALA Lokmanya Tilak Municipal Medical College Class of 2016 viii Faculty Advisors MARK A.W. ANDREWS, PhD CHARLES S. DELA CRUZ, MD, PhD Lake Erie College of Osteopathic Medicine at Seton Hill Assistant Professor, Department of Pulmonary and Critical Care Medicine Greensburg, PA Yale School of Medicine MARIA ANTONELLI, MD CONRAD FISCHER, MD Clinical Faculty, Division of Rheumatology Associate Professor, Medicine, Physiology, and Pharmacology Case Western Reserve University School of Medicine Touro College of Medicine HERMAN SINGH BAGGA, MD JEFFREY J. GOLD, MD Urologist, Allegheny Health Network Associate Professor, Department of Neurology University of Pittsburgh Medical Center Assistant Professor, University of California, San Diego School of Medicine ADITYA BARDIA, MBBS, MPH RAYUDU GOPALAKRISHNA, PhD Attending Physician, Massachusetts General Hospital Associate Professor, Department of Cell and Neurobiology Harvard Medical School Keck School of Medicine of University of Southern California PAULETTE BERND, PhD RYAN C.W. HALL, MD Professor, Department of Pathology and Cell Biology Assistant Professor, Department of Psychiatry Columbia University College of Physicians and Surgeons University of South Florida SHELDON CAMPBELL, MD, PhD LOUISE HAWLEY, PhD Associate Professor of Laboratory Medicine Immediate Past Professor and Chair, Department of Microbiology Yale School of Medicine Ross University School of Medicine BROOKS D. CASH, MD MARGARET M. HAYES, MD Professor of Medicine, Division of Gastroenterology Instructor of Medicine University of South Alabama School of Medicine Harvard Medical School SHIVANI VERMA CHMURA, MD JEFFREY W. HOFMANN, MD, PhD Adjunct Clinical Faculty, Department of Psychiatry Resident, Department of Pathology Stanford University School of Medicine University of California, San Francisco School of Medicine PETER V. CHIN-HONG, MD BRIAN C. JENSEN, MD Professor, Department of Medicine Assistant Professor of Medicine and Pharmacology University of California, San Francisco School of Medicine University of North Carolina Health Care CHRISTINA E. CIACCIO, MD, MSc CLARK KEBODEAUX, PharmD Assistant Professor, Departments of Pediatrics and Medicine Clinical Assistant Professor, Pharmacy Practice and Science The University of Chicago Pritzker School of Medicine University of Kentucky College of Pharmacy LINDA S. COSTANZO, PhD MICHAEL R. KING, MD Professor, Physiology & Biophysics Instructor, Department of Pediatric Anesthesiology Virginia Commonwealth University School of Medicine Northwestern University Feinberg School of Medicine ANTHONY L. DeFRANCO, PhD KRISTINE KRAFTS, MD Professor, Department of Microbiology and Immunology Assistant Professor, Department of Basic Sciences University of California, San Francisco School of Medicine University of Minnesota School of Medicine ix GERALD LEE, MD MELANIE SCHORR, MD Assistant Professor, Department of Pediatrics Research Fellow, Department of Medicine University of Louisville School of Medicine Massachusetts General Hospital KACHIU C. LEE, MD, MPH NATHAN W. SKELLEY, MD Assistant Clinical Professor, Department of Dermatology Assistant Professor, Department of Orthopaedic Surgery Brown University, Providence, Rhode Island University of Missouri, The Missouri Orthopaedic Institute WARREN LEVINSON, MD, PhD SHEENA STANARD, MD, MHS Professor, Department of Microbiology and Immunology Hospitalist University of California, San Francisco School of Medicine State University of New York Upstate Hospital PETER MARKS, MD, PhD HOWARD M. STEINMAN, PhD Center for Biologics Evaluation and Research Assistant Dean, Biomedical Science Education US Food and Drug Administration Albert Einstein College of Medicine J. RYAN MARTIN, MD STEPHEN F. THUNG, MD Assistant Professor of Obstetrics, Gynecology, and Reproductive Sciences Associate Professor, Department of Obstetrics and Gynecology Yale School of Medicine The Ohio State University College of Medicine DOUGLAS A. MATA, MD, MPH RICHARD P. USATINE, MD Brigham and Women’s Hospital Professor, Dermatology and Cutaneous Surgery Harvard Medical School University of Texas Health Science Center San Antonio VICKI PARK, PhD PRASHANT VAISHNAVA, MD Associate Professor, Pediatrics and Medical Education Assistant Professor, Department of Medicine University of Tennessee Health Science Center Mount Sinai Hospital and Icahn School of Medicine JEANNINE RAHIMIAN, MD, MBA J. MATTHEW VELKEY, PhD Associate Professor, Obstetrics and Gynecology Assistant Dean, Basic Science Education David Geffen School of Medicine at UCLA Duke University School of Medicine SOROUSH RAIS-BAHRAMI, MD BRIAN WALCOTT, MD Assistant Professor, Urology and Radiology Clinical Instructor, Department of Neurological Surgery The University of Alabama at Birmingham School of Medicine University of California, San Francisco SASAN SAKIANI, MD TISHA WANG, MD Assistant Professor, Department of Medicine Associate Clinical Professor, Department of Medicine Case Western Reserve University School of Medicine David Geffen School of Medicine at UCLA ROBERT A. SASSO, MD SYLVIA WASSERTHEIL-SMOLLER, PhD Professor of Clinical Medicine Professor Emerita, Department of Epidemiology and Population Health Ross University School of Medicine Albert Einstein College of Medicine JOSEPH L. SCHINDLER, MD ADAM WEINSTEIN, MD Assistant Professor, Neurology and Neurosurgery Assistant Professor, Pediatric Nephrology and Medical Education Yale School of Medicine Geisel School of Medicine at Dartmouth x