First Aid for the USMLE Step 1 2020, 30th Edition (2020)
First Aid for the USMLE Step 1 2020, 30th Edition (2020) is your essential resource for acing certification exams with confidence.
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FOR
THE®
New York / Chicago / San Francisco / Athens / London / Madrid / Mexico City
Milan / New Delhi / Singapore / Sydney / Toronto
USMLE
STEP 1
2020
FIRST AID
TAO LE, MD, MHS
Founder, ScholarRx
Associate Clinical Professor, Department of Medicine
University of Louisville School of Medicine
VIKAS BHUSHAN, MD
Boracay
MATTHEW SOCHAT, MD
Fellow, Department of Hematology/Oncology
St. Louis University School of Medicine
SARAH SCHIMANSKY, MB BCh BAO
Resident, Department of Ophthalmology
Royal United Hospitals Bath
KIMBERLY KALLIANOS, MD
Assistant Professor, Department of Radiology and Biomedical Imaging
University of California, San Francisco School of Medicine
VAISHNAVI VAIDYANATHAN, MD
Resident, Department of Pediatric Neurology
Barrow Neurological Institute at Phoenix Children’s Hospital
JORDAN ABRAMS
St. George’s University School of Medicine
Class of 2020
THE®
New York / Chicago / San Francisco / Athens / London / Madrid / Mexico City
Milan / New Delhi / Singapore / Sydney / Toronto
USMLE
STEP 1
2020
FIRST AID
TAO LE, MD, MHS
Founder, ScholarRx
Associate Clinical Professor, Department of Medicine
University of Louisville School of Medicine
VIKAS BHUSHAN, MD
Boracay
MATTHEW SOCHAT, MD
Fellow, Department of Hematology/Oncology
St. Louis University School of Medicine
SARAH SCHIMANSKY, MB BCh BAO
Resident, Department of Ophthalmology
Royal United Hospitals Bath
KIMBERLY KALLIANOS, MD
Assistant Professor, Department of Radiology and Biomedical Imaging
University of California, San Francisco School of Medicine
VAISHNAVI VAIDYANATHAN, MD
Resident, Department of Pediatric Neurology
Barrow Neurological Institute at Phoenix Children’s Hospital
JORDAN ABRAMS
St. George’s University School of Medicine
Class of 2020
Copyright © 2020 by Tao Le and Vikas Bhushan. All rights reserved. Except as permitted under the United States Copyright Act of 1976,
no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system,
without the prior written permission of the publisher.
ISBN: 978-1-26-046205-0
MHID: 1-26-046205-6
The material in this eBook also appears in the print version of this title: ISBN: 978-1-26-046204-3,
MHID: 1-26-046204-8.
eBook conversion by codeMantra
Version 1.0
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked
name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the
trademark. Where such designations appear in this book, they have been printed with initial caps.
McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions or for use in corpo-
rate training programs. To contact a representative, please visit the Contact Us page at www.mhprofessional.com.
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug
therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to
provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view
of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been
involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or com-
plete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in
this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers
are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the
information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications
for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.
TERMS OF USE
This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the work. Use of this work is subject
to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may
not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate,
sell, publish or sublicense the work or any part of it without McGraw-Hill Education’s prior consent. You may use the work for your
own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if
you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WAR-
RANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING
THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR
OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED
TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill Education
and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its opera-
tion will be uninterrupted or error free. Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any
inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill Education has no
responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill Education and/
or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or
inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply
to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.
no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system,
without the prior written permission of the publisher.
ISBN: 978-1-26-046205-0
MHID: 1-26-046205-6
The material in this eBook also appears in the print version of this title: ISBN: 978-1-26-046204-3,
MHID: 1-26-046204-8.
eBook conversion by codeMantra
Version 1.0
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked
name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the
trademark. Where such designations appear in this book, they have been printed with initial caps.
McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions or for use in corpo-
rate training programs. To contact a representative, please visit the Contact Us page at www.mhprofessional.com.
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug
therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to
provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view
of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been
involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or com-
plete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in
this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers
are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the
information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications
for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.
TERMS OF USE
This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the work. Use of this work is subject
to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may
not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate,
sell, publish or sublicense the work or any part of it without McGraw-Hill Education’s prior consent. You may use the work for your
own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if
you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WAR-
RANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING
THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR
OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED
TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill Education
and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its opera-
tion will be uninterrupted or error free. Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any
inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill Education has no
responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill Education and/
or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or
inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply
to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.
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Dedication
To the contributors to this and past editions, who took
time to share their knowledge, insight, and humor for the
benefit of students and physicians everywhere.
To the contributors to this and past editions, who took
time to share their knowledge, insight, and humor for the
benefit of students and physicians everywhere.
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v
Contents
Contributing Authors vii
Associate Authors viii
Faculty Advisors ix
Thirtieth Anniversary Foreword xi
Preface xiii
Special Acknowledgments xiv
General Acknowledgments xv
How to Contribute xvii
How to Use This Book xix
Selected USMLE Laboratory Values xx
First Aid Checklist for the USMLE Step 1 xxii
`` S E C T I O N I G U I D E TO E F F I C I E N T E X A M P R E PA R AT I O N 1
Introduction 2
USMLE Step 1—The Basics 2
Defining Your Goal 12
Learning Strategies 13
Timeline for Study 16
Study Materials 20
Test-Taking Strategies 22
Clinical Vignette Strategies 23
If You Think You Failed 24
Testing Agencies 24
References 25
`` S E C T I O N I S U P P L E M E N T S P E C I A L S I T UAT I O N S 27
`` S E C T I O N I I H I G H - Y I E L D G E N E R A L P R I N C I P L E S 29
How to Use the Database 30
Biochemistry 33
Immunology 95
Microbiology 123
Pathology 205
Pharmacology 229
Public Health Sciences 255
Contents
Contributing Authors vii
Associate Authors viii
Faculty Advisors ix
Thirtieth Anniversary Foreword xi
Preface xiii
Special Acknowledgments xiv
General Acknowledgments xv
How to Contribute xvii
How to Use This Book xix
Selected USMLE Laboratory Values xx
First Aid Checklist for the USMLE Step 1 xxii
`` S E C T I O N I G U I D E TO E F F I C I E N T E X A M P R E PA R AT I O N 1
Introduction 2
USMLE Step 1—The Basics 2
Defining Your Goal 12
Learning Strategies 13
Timeline for Study 16
Study Materials 20
Test-Taking Strategies 22
Clinical Vignette Strategies 23
If You Think You Failed 24
Testing Agencies 24
References 25
`` S E C T I O N I S U P P L E M E N T S P E C I A L S I T UAT I O N S 27
`` S E C T I O N I I H I G H - Y I E L D G E N E R A L P R I N C I P L E S 29
How to Use the Database 30
Biochemistry 33
Immunology 95
Microbiology 123
Pathology 205
Pharmacology 229
Public Health Sciences 255
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vi
`` S E C T I O N I I I H I G H - Y I E L D O R G A N S YS T E M S 275
Approaching the Organ Systems 276
Cardiovascular 279
Endocrine 325
Gastrointestinal 357
Hematology and Oncology 403
Musculoskeletal, Skin, and Connective Tissue 445
Neurology and Special Senses 489
Psychiatry 553
Renal 577
Reproductive 611
Respiratory 659
Rapid Review 689
`` S E C T I O N I V TO P - R AT E D R E V I E W R E S O U R C E S 711
How to Use the Database 712
Question Banks and Books 714
Web and Mobile Apps 714
Comprehensive 715
Anatomy, Embryology, and Neuroscience 715
Behavioral Science 716
Biochemistry 716
Cell Biology and Histology 716
Microbiology and Immunology 717
Pathology 717
Pharmacology 718
Physiology 718
``
Abbreviations and Symbols 719
Image Acknowledgments 727
Index 749
About the Editors 808
`` S E C T I O N I I I H I G H - Y I E L D O R G A N S YS T E M S 275
Approaching the Organ Systems 276
Cardiovascular 279
Endocrine 325
Gastrointestinal 357
Hematology and Oncology 403
Musculoskeletal, Skin, and Connective Tissue 445
Neurology and Special Senses 489
Psychiatry 553
Renal 577
Reproductive 611
Respiratory 659
Rapid Review 689
`` S E C T I O N I V TO P - R AT E D R E V I E W R E S O U R C E S 711
How to Use the Database 712
Question Banks and Books 714
Web and Mobile Apps 714
Comprehensive 715
Anatomy, Embryology, and Neuroscience 715
Behavioral Science 716
Biochemistry 716
Cell Biology and Histology 716
Microbiology and Immunology 717
Pathology 717
Pharmacology 718
Physiology 718
``
Abbreviations and Symbols 719
Image Acknowledgments 727
Index 749
About the Editors 808
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vii
Contributing Authors
MAJED H. ALGHAMDI, MBBS
Resident, Joint Program of Preventive Medicine
Jeddah, Saudi Arabia
LILIT ASLANYAN
New York Institute of Technology College of Osteopathic Medicine
Class of 2020
HUMOOD BOQAMBAR, MB BCh BAO
Assistant Registrar, Department of Orthopaedic Surgery
Farwaniya Hospital
WEELIC CHONG
Sidney Kimmel Medical College at Thomas Jefferson University
MD/PhD Candidate
KRISTINA DAMISCH
University of Iowa Carver College of Medicine
Class of 2020
YUMI KOVIC, MD
Resident, Department of Psychiatry
University of Massachusetts Medical School
KAITLYN MELNICK, MD
Resident, Department of Neurological Surgery
University of Florida College of Medicine, Gainesville
MARY KATHERINE MONTES de OCA, MD
Resident, Department of Obstetrics and Gynecology
Duke University Hospital
SCOTT MOORE, DO
Assistant Professor of Medical Laboratory Sciences
Weber State University
VASILY OVECHKO, MD
Resident, Department of Surgery
Russian Medical Academy of Continuous Professional Education
VIVEK PODDER
MBBS Student
Tairunnessa Memorial Medical College and Hospital, Bangladesh
CONNIE QIU
Lewis Katz School of Medicine at Temple University
MD/PhD Candidate
Image and IllustratIon team
CAROLINE COLEMAN
Emory University School of Medicine
Class of 2020
MATTHEW HO ZHI GUANG
University College Dublin (MD), DFCI (PhD)
MD/PhD Candidate
VICTOR JOSE MARTINEZ LEON, MD
Central University of Venezuela
ALIREZA ZANDIFAR, MD
Research Fellow
Isfahan University of Medical Sciences, Iran
Contributing Authors
MAJED H. ALGHAMDI, MBBS
Resident, Joint Program of Preventive Medicine
Jeddah, Saudi Arabia
LILIT ASLANYAN
New York Institute of Technology College of Osteopathic Medicine
Class of 2020
HUMOOD BOQAMBAR, MB BCh BAO
Assistant Registrar, Department of Orthopaedic Surgery
Farwaniya Hospital
WEELIC CHONG
Sidney Kimmel Medical College at Thomas Jefferson University
MD/PhD Candidate
KRISTINA DAMISCH
University of Iowa Carver College of Medicine
Class of 2020
YUMI KOVIC, MD
Resident, Department of Psychiatry
University of Massachusetts Medical School
KAITLYN MELNICK, MD
Resident, Department of Neurological Surgery
University of Florida College of Medicine, Gainesville
MARY KATHERINE MONTES de OCA, MD
Resident, Department of Obstetrics and Gynecology
Duke University Hospital
SCOTT MOORE, DO
Assistant Professor of Medical Laboratory Sciences
Weber State University
VASILY OVECHKO, MD
Resident, Department of Surgery
Russian Medical Academy of Continuous Professional Education
VIVEK PODDER
MBBS Student
Tairunnessa Memorial Medical College and Hospital, Bangladesh
CONNIE QIU
Lewis Katz School of Medicine at Temple University
MD/PhD Candidate
Image and IllustratIon team
CAROLINE COLEMAN
Emory University School of Medicine
Class of 2020
MATTHEW HO ZHI GUANG
University College Dublin (MD), DFCI (PhD)
MD/PhD Candidate
VICTOR JOSE MARTINEZ LEON, MD
Central University of Venezuela
ALIREZA ZANDIFAR, MD
Research Fellow
Isfahan University of Medical Sciences, Iran
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viii
Associate Authors
HUZAIFA AHMAD, MD
Resident, Department of Medicine
Georgetown University Hospital/MedStar Washington Hospital Center
ALEXANDER R. ASLESEN
Kirksville College of Osteopathic Medicine
Class of 2020
ANUP K. BHATTACHARYA, MD
Resident, Mallinckrodt Institute of Radiology
Washington University School of Medicine
ANUP CHALISE, MBBS
Resident, Department of General Surgery
Nepal Medical College and Teaching Hospital
ASHTEN R. DUNCAN, MPH
University of Oklahoma-Tulsa School of Community Medicine
Class of 2021
SARINA KOILPILLAI
St. George’s University School of Medicine
Class of 2020
LAUREN N. LESSOR, MPH, MD
Resident, Department of Pediatrics
Mercy Health – St. Vincent Medical Center
ROHAN BIR SINGH, MD
Fellow, Department of Ophthalmology
Massachusetts Eye and Ear
Harvard Medical School
YAMNA JADOON, MD
Research Associate
Aga Khan University
DANA M. JORGENSON
Chicago College of Osteopathic Medicine
Class of 2020
MITCHELL A. KATONA
University of Texas Health Science Center, Long School of Medicine
Class of 2020
TAYLOR MANEY, MD
Resident, Department of Anesthesiology
Brigham and Women’s Hospital
Image and IllustratIon team
Associate Authors
HUZAIFA AHMAD, MD
Resident, Department of Medicine
Georgetown University Hospital/MedStar Washington Hospital Center
ALEXANDER R. ASLESEN
Kirksville College of Osteopathic Medicine
Class of 2020
ANUP K. BHATTACHARYA, MD
Resident, Mallinckrodt Institute of Radiology
Washington University School of Medicine
ANUP CHALISE, MBBS
Resident, Department of General Surgery
Nepal Medical College and Teaching Hospital
ASHTEN R. DUNCAN, MPH
University of Oklahoma-Tulsa School of Community Medicine
Class of 2021
SARINA KOILPILLAI
St. George’s University School of Medicine
Class of 2020
LAUREN N. LESSOR, MPH, MD
Resident, Department of Pediatrics
Mercy Health – St. Vincent Medical Center
ROHAN BIR SINGH, MD
Fellow, Department of Ophthalmology
Massachusetts Eye and Ear
Harvard Medical School
YAMNA JADOON, MD
Research Associate
Aga Khan University
DANA M. JORGENSON
Chicago College of Osteopathic Medicine
Class of 2020
MITCHELL A. KATONA
University of Texas Health Science Center, Long School of Medicine
Class of 2020
TAYLOR MANEY, MD
Resident, Department of Anesthesiology
Brigham and Women’s Hospital
Image and IllustratIon team
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ix
Faculty Advisors
DIANA ALBA, MD
Clinical Instructor
University of California, San Francisco School of Medicine
MARK A.W. ANDREWS, PhD
Professor of Physiology
Lake Erie College of Osteopathic Medicine at Seton Hill
MARIA ANTONELLI, MD
Assistant Professor, Division of Rheumatology
MetroHealth Medical Center, Case Western Reserve University
HERMAN SINGH BAGGA, MD
Urologist, Allegheny Health Network
University of Pittsburgh Medical Center Passavant
SHIN C. BEH, MD
Assistant Professor, Department of Neurology & Neurotherapeutics
UT Southwestern Medical Center at Dallas
JOHN R. BUTTERLY, MD
Professor of Medicine
Dartmouth Geisel School of Medicine
SHELDON CAMPBELL, MD, PhD
Professor of Laboratory Medicine
Yale School of Medicine
BROOKS D. CASH, MD
Professor of Medicine, Division of Gastroenterology
University of South Alabama School of Medicine
SHIVANI VERMA CHMURA, MD
Adjunct Clinical Faculty, Department of Psychiatry
Stanford University School of Medicine
BRADLEY COLE, MD
Assistant Professor of Basic Sciences
Loma Linda University School of Medicine
LINDA S. COSTANZO, PhD
Professor, Physiology & Biophysics
Virginia Commonwealth University School of Medicine
MANAS DAS, MD, MS
Director, Clinical Anatomy, Embryology, and Histology
University of Massachusetts Medical School
ANTHONY L. DeFRANCO, PhD
Professor, Department of Microbiology and Immunology
University of California, San Francisco School of Medicine
CHARLES S. DELA CRUZ, MD, PhD
Associate Professor, Department of Pulmonary and Critical Care Medicine
Yale School of Medicine
SAKINA FARHAT, MD
Consulting Gastroenterologist
State University of New York Downstate Medical Center
CONRAD FISCHER, MD
Associate Professor, Medicine, Physiology, and Pharmacology
Touro College of Medicine
RAYUDU GOPALAKRISHNA, PhD
Associate Professor, Department of Integrative Anatomical Sciences
Keck School of Medicine of University of Southern California
RYAN C.W. HALL, MD
Assistant Professor, Department of Psychiatry
University of South Florida School of Medicine
LOUISE HAWLEY, PhD
Immediate Past Professor and Chair, Department of Microbiology
Ross University School of Medicine
JEFFREY W. HOFMANN, MD, PhD
Resident, Department of Pathology
University of California, San Francisco School of Medicine
CLARK KEBODEAUX, PharmD
Clinical Assistant Professor, Pharmacy Practice and Science
University of Kentucky College of Pharmacy
KRISTINE KRAFTS, MD
Assistant Professor, Department of Basic Sciences
University of Minnesota School of Medicine
MATTHEW KRAYBILL, PhD
Clinical Neuropsychologist
Cottage Health, Santa Barbara, California
GERALD LEE, MD
Assistant Professor, Departments of Pediatrics and Medicine
Emory University School of Medicine
Faculty Advisors
DIANA ALBA, MD
Clinical Instructor
University of California, San Francisco School of Medicine
MARK A.W. ANDREWS, PhD
Professor of Physiology
Lake Erie College of Osteopathic Medicine at Seton Hill
MARIA ANTONELLI, MD
Assistant Professor, Division of Rheumatology
MetroHealth Medical Center, Case Western Reserve University
HERMAN SINGH BAGGA, MD
Urologist, Allegheny Health Network
University of Pittsburgh Medical Center Passavant
SHIN C. BEH, MD
Assistant Professor, Department of Neurology & Neurotherapeutics
UT Southwestern Medical Center at Dallas
JOHN R. BUTTERLY, MD
Professor of Medicine
Dartmouth Geisel School of Medicine
SHELDON CAMPBELL, MD, PhD
Professor of Laboratory Medicine
Yale School of Medicine
BROOKS D. CASH, MD
Professor of Medicine, Division of Gastroenterology
University of South Alabama School of Medicine
SHIVANI VERMA CHMURA, MD
Adjunct Clinical Faculty, Department of Psychiatry
Stanford University School of Medicine
BRADLEY COLE, MD
Assistant Professor of Basic Sciences
Loma Linda University School of Medicine
LINDA S. COSTANZO, PhD
Professor, Physiology & Biophysics
Virginia Commonwealth University School of Medicine
MANAS DAS, MD, MS
Director, Clinical Anatomy, Embryology, and Histology
University of Massachusetts Medical School
ANTHONY L. DeFRANCO, PhD
Professor, Department of Microbiology and Immunology
University of California, San Francisco School of Medicine
CHARLES S. DELA CRUZ, MD, PhD
Associate Professor, Department of Pulmonary and Critical Care Medicine
Yale School of Medicine
SAKINA FARHAT, MD
Consulting Gastroenterologist
State University of New York Downstate Medical Center
CONRAD FISCHER, MD
Associate Professor, Medicine, Physiology, and Pharmacology
Touro College of Medicine
RAYUDU GOPALAKRISHNA, PhD
Associate Professor, Department of Integrative Anatomical Sciences
Keck School of Medicine of University of Southern California
RYAN C.W. HALL, MD
Assistant Professor, Department of Psychiatry
University of South Florida School of Medicine
LOUISE HAWLEY, PhD
Immediate Past Professor and Chair, Department of Microbiology
Ross University School of Medicine
JEFFREY W. HOFMANN, MD, PhD
Resident, Department of Pathology
University of California, San Francisco School of Medicine
CLARK KEBODEAUX, PharmD
Clinical Assistant Professor, Pharmacy Practice and Science
University of Kentucky College of Pharmacy
KRISTINE KRAFTS, MD
Assistant Professor, Department of Basic Sciences
University of Minnesota School of Medicine
MATTHEW KRAYBILL, PhD
Clinical Neuropsychologist
Cottage Health, Santa Barbara, California
GERALD LEE, MD
Assistant Professor, Departments of Pediatrics and Medicine
Emory University School of Medicine
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x
KACHIU C. LEE, MD, MPH
Assistant Clinical Professor, Department of Dermatology
The Warren Alpert Medical School of Brown University
WARREN LEVINSON, MD, PhD
Professor, Department of Microbiology and Immunology
University of California, San Francisco School of Medicine
JAMES LYONS, MD
Professor of Pathology and Family Medicine
Alabama College of Osteopathic Medicine
PETER MARKS, MD, PhD
Center for Biologics Evaluation and Research
US Food and Drug Administration
DOUGLAS A. MATA, MD, MPH
Brigham Education Institute and Brigham and Women’s Hospital
Harvard Medical School
VICKI M. PARK, PhD, MS
Assistant Dean
University of Tennessee College of Medicine
SOROUSH RAIS-BAHRAMI, MD
Assistant Professor, Departments of Urology and Radiology
University of Alabama at Birmingham School of Medicine
SASAN SAKIANI, MD
Fellow, Transplant Hepatology
Cleveland Clinic
MELANIE SCHORR, MD
Assistant in Medicine
Massachusetts General Hospital
SHIREEN MADANI SIMS, MD
Chief, Division of Gynecology, Gynecologic Surgery, and Obstetrics
University of Florida School of Medicine
NATHAN W. SKELLEY, MD
Assistant Professor, Department of Orthopaedic Surgery
University of Missouri, The Missouri Orthopaedic Institute
HOWARD M. STEINMAN, PhD
Assistant Dean, Biomedical Science Education
Albert Einstein College of Medicine
SUPORN SUKPRAPRUT-BRAATEN, PhD
Director of Research, Graduate Medical Education
Unity Health, Searcy, Arkansas
RICHARD P. USATINE, MD
Professor, Dermatology and Cutaneous Surgery
University of Texas Health Science Center San Antonio
J. MATTHEW VELKEY, PhD
Assistant Dean, Basic Science Education
Duke University School of Medicine
TISHA WANG, MD
Associate Clinical Professor, Department of Medicine
David Geffen School of Medicine at UCLA
SYLVIA WASSERTHEIL-SMOLLER, PhD
Professor Emerita, Department of Epidemiology and Population Health
Albert Einstein College of Medicine
ADAM WEINSTEIN, MD
Assistant Professor, Pediatric Nephrology and Medical Education
Geisel School of Medicine at Dartmouth
ABHISHEK YADAV, MBBS, MSc
Associate Professor of Anatomy
Geisinger Commonwealth School of Medicine
KRISTAL YOUNG, MD
Clinical Instructor, Department of Cardiology
Huntington Hospital, Pasadena, California
KACHIU C. LEE, MD, MPH
Assistant Clinical Professor, Department of Dermatology
The Warren Alpert Medical School of Brown University
WARREN LEVINSON, MD, PhD
Professor, Department of Microbiology and Immunology
University of California, San Francisco School of Medicine
JAMES LYONS, MD
Professor of Pathology and Family Medicine
Alabama College of Osteopathic Medicine
PETER MARKS, MD, PhD
Center for Biologics Evaluation and Research
US Food and Drug Administration
DOUGLAS A. MATA, MD, MPH
Brigham Education Institute and Brigham and Women’s Hospital
Harvard Medical School
VICKI M. PARK, PhD, MS
Assistant Dean
University of Tennessee College of Medicine
SOROUSH RAIS-BAHRAMI, MD
Assistant Professor, Departments of Urology and Radiology
University of Alabama at Birmingham School of Medicine
SASAN SAKIANI, MD
Fellow, Transplant Hepatology
Cleveland Clinic
MELANIE SCHORR, MD
Assistant in Medicine
Massachusetts General Hospital
SHIREEN MADANI SIMS, MD
Chief, Division of Gynecology, Gynecologic Surgery, and Obstetrics
University of Florida School of Medicine
NATHAN W. SKELLEY, MD
Assistant Professor, Department of Orthopaedic Surgery
University of Missouri, The Missouri Orthopaedic Institute
HOWARD M. STEINMAN, PhD
Assistant Dean, Biomedical Science Education
Albert Einstein College of Medicine
SUPORN SUKPRAPRUT-BRAATEN, PhD
Director of Research, Graduate Medical Education
Unity Health, Searcy, Arkansas
RICHARD P. USATINE, MD
Professor, Dermatology and Cutaneous Surgery
University of Texas Health Science Center San Antonio
J. MATTHEW VELKEY, PhD
Assistant Dean, Basic Science Education
Duke University School of Medicine
TISHA WANG, MD
Associate Clinical Professor, Department of Medicine
David Geffen School of Medicine at UCLA
SYLVIA WASSERTHEIL-SMOLLER, PhD
Professor Emerita, Department of Epidemiology and Population Health
Albert Einstein College of Medicine
ADAM WEINSTEIN, MD
Assistant Professor, Pediatric Nephrology and Medical Education
Geisel School of Medicine at Dartmouth
ABHISHEK YADAV, MBBS, MSc
Associate Professor of Anatomy
Geisinger Commonwealth School of Medicine
KRISTAL YOUNG, MD
Clinical Instructor, Department of Cardiology
Huntington Hospital, Pasadena, California
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xi
Thirtieth Anniversary Foreword
Our exam experiences remain vivid in our minds to this day as we reflect on 30 years of First Aid. In 1989, our
big idea was to cobble together a “quick and dirty” study guide so that we would never again have to deal with the
USMLE Step 1. We passed, but in a Faustian twist, we now relive the exam yearly while preparing each new edition.
Like all students before us, we noticed that certain topics tended to appear frequently on examinations. So we
compulsively bought and rated review books and pored through a mind-numbing number of “recall” questions,
distilling each into short facts. We had a love-hate relationship with mnemonics. They went against our purist desires
for conceptual knowledge, but remained the best way to absorb the vocabulary and near-random associations that
unlocked questions and eponyms.
To pull it all together, we used a then “state-of-the-art” computer database (Paradox/MS DOS 4) that fortuitously
limited our entries to 256 characters. That length constraint (which predated Twitter by nearly two decades) imposed
extreme brevity. The three-column layout created structure—and this was the blueprint upon which First Aid was
founded.
The printed, three-column database was first distributed in 1989 at the University of California, San Francisco.
The next year, the official first edition was self-published under the title High-Yield Basic Science Boards Review: A
Student-to-Student Guide. The following year, our new publisher dismissed the High-Yield title as too confusing and
came up with First Aid for the Boards. We thought the name was a bit cheesy, but it proved memorable. Interestingly,
our “High-Yield” name resurfaced years later as the title of a competing board review series.
We lived in San Francisco and Los Angeles during medical school and residency. It was before the Web, and
before med students could afford cell phones and laptops, so we relied on AOL e-mail and bulky desktops. One of
us would drive down to the other person’s place for multiple weekends of frenetic revisions fueled by triple-Swiss
white chocolate lattes from the Coffee Bean & Tea Leaf, with R.E.M. and the Nusrat Fateh Ali Khan playing in the
background. Everything was marked up on 11- by 17-inch “tearsheets,” and at the end of the marathon weekend
we would converge at the local 24-hour Kinko’s followed by the FedEx box near LAX (10 years before these two
great institutions merged). These days we work with our online collaborative platform A.nnotate, GoToMeeting, and
ubiquitous broadband Internet, and sadly, we rarely get to see each other.
What hasn’t changed, however, is the collaborative nature of the book. Thousands of authors, editors, and
contributors have enriched our lives and made this book possible. Most helped for a year or two and moved on, but
a few, like Ted Hon, Chirag Amin, and Andi Fellows, made lasting contributions. Like the very first edition, the team
is always led by student authors who live and breathe (and fear) the exam, not professors years away from that reality.
We’re proud of the precedent that First Aid set for the many excellent student-to-student publications that followed.
More importantly, First Aid itself owes its success to the global community of medical students and international
medical graduates (IMGs) who each year contribute ideas, suggestions, and new content. In the early days, we
used book coupons and tear-out business reply mail forms. These days, we get many thousands of comments and
suggestions each year via our blog FirstAidTeam.com and A.nnotate.
Thirtieth Anniversary Foreword
Our exam experiences remain vivid in our minds to this day as we reflect on 30 years of First Aid. In 1989, our
big idea was to cobble together a “quick and dirty” study guide so that we would never again have to deal with the
USMLE Step 1. We passed, but in a Faustian twist, we now relive the exam yearly while preparing each new edition.
Like all students before us, we noticed that certain topics tended to appear frequently on examinations. So we
compulsively bought and rated review books and pored through a mind-numbing number of “recall” questions,
distilling each into short facts. We had a love-hate relationship with mnemonics. They went against our purist desires
for conceptual knowledge, but remained the best way to absorb the vocabulary and near-random associations that
unlocked questions and eponyms.
To pull it all together, we used a then “state-of-the-art” computer database (Paradox/MS DOS 4) that fortuitously
limited our entries to 256 characters. That length constraint (which predated Twitter by nearly two decades) imposed
extreme brevity. The three-column layout created structure—and this was the blueprint upon which First Aid was
founded.
The printed, three-column database was first distributed in 1989 at the University of California, San Francisco.
The next year, the official first edition was self-published under the title High-Yield Basic Science Boards Review: A
Student-to-Student Guide. The following year, our new publisher dismissed the High-Yield title as too confusing and
came up with First Aid for the Boards. We thought the name was a bit cheesy, but it proved memorable. Interestingly,
our “High-Yield” name resurfaced years later as the title of a competing board review series.
We lived in San Francisco and Los Angeles during medical school and residency. It was before the Web, and
before med students could afford cell phones and laptops, so we relied on AOL e-mail and bulky desktops. One of
us would drive down to the other person’s place for multiple weekends of frenetic revisions fueled by triple-Swiss
white chocolate lattes from the Coffee Bean & Tea Leaf, with R.E.M. and the Nusrat Fateh Ali Khan playing in the
background. Everything was marked up on 11- by 17-inch “tearsheets,” and at the end of the marathon weekend
we would converge at the local 24-hour Kinko’s followed by the FedEx box near LAX (10 years before these two
great institutions merged). These days we work with our online collaborative platform A.nnotate, GoToMeeting, and
ubiquitous broadband Internet, and sadly, we rarely get to see each other.
What hasn’t changed, however, is the collaborative nature of the book. Thousands of authors, editors, and
contributors have enriched our lives and made this book possible. Most helped for a year or two and moved on, but
a few, like Ted Hon, Chirag Amin, and Andi Fellows, made lasting contributions. Like the very first edition, the team
is always led by student authors who live and breathe (and fear) the exam, not professors years away from that reality.
We’re proud of the precedent that First Aid set for the many excellent student-to-student publications that followed.
More importantly, First Aid itself owes its success to the global community of medical students and international
medical graduates (IMGs) who each year contribute ideas, suggestions, and new content. In the early days, we
used book coupons and tear-out business reply mail forms. These days, we get many thousands of comments and
suggestions each year via our blog FirstAidTeam.com and A.nnotate.
Loading page 13...
xii
At the end of the day, we don’t take any of this for granted. Students are expected to synthesize an ever increasing
amount of information, and we have a bigger challenge ahead of us to try to keep First Aid indispensable to students
and IMGs. We want and need your participation in the First Aid community. (See How to Contribute, p. xvii.) With
your help, we hope editing First Aid will continue to be just as fun and rewarding as the past 30 years have been.
Louisville Tao Le
Boracay Vikas Bhushan
First Aid for the USMLE Step 1 Through the Years
At the end of the day, we don’t take any of this for granted. Students are expected to synthesize an ever increasing
amount of information, and we have a bigger challenge ahead of us to try to keep First Aid indispensable to students
and IMGs. We want and need your participation in the First Aid community. (See How to Contribute, p. xvii.) With
your help, we hope editing First Aid will continue to be just as fun and rewarding as the past 30 years have been.
Louisville Tao Le
Boracay Vikas Bhushan
First Aid for the USMLE Step 1 Through the Years
Loading page 14...
xiii
Preface
With the 30th edition of First Aid for the USMLE Step 1, we continue our commitment to providing students with
the most useful and up-to-date preparation guide for the USMLE Step 1. This edition represents an outstanding
revision in many ways, including:
50 entirely new or heavily revised high-yield topics reflecting evolving trends in the USMLE Step 1.
Reorganization of high-yield topics in Pharmacology, Endocrine, and Reproductive chapters for improved study.
Extensive text revisions, new mnemonics, clarifications, and corrections curated by a team of more than 30
medical student and resident physician authors who excelled on their Step 1 examinations and verified by a team
of expert faculty advisors and nationally recognized USMLE instructors.
Updated with 178 new and revised diagrams and illustrations as part of our ongoing collaboration with
USMLE-Rx and ScholarRx (MedIQ Learning, LLC).
Updated with 75 new and revised photos to help visualize various disorders, descriptive findings, and basic
science concepts. Additionally, revised imaging photos have been labeled and optimized to show both normal
anatomy and pathologic findings.
Updated study tips on the opening page of each chapter.
Improved integration of clinical images and illustrations to better reinforce and learn key anatomic concepts.
Improved organization and integration of text, illustrations, clinical images, and tables throughout for focused
review of high-yield topics.
Revised and expanded ratings of current, high-yield review resources, with clear explanations of their relevance
to USMLE review.
Real-time Step 1 updates and corrections can be found exclusively on our blog, www.firstaidteam.com.
We invite students and faculty to share their thoughts and ideas to help us continually improve First Aid for the
USMLE Step 1 through our blog and collaborative editorial platform. (See How to Contribute, p. xvii.)
Louisville Tao Le
Boracay Vikas Bhushan
St. Louis Matthew Sochat
Phoenix Vaishnavi Vaidyanathan
Bristol Sarah Schimansky
New York City Jordan Abrams
San Francisco Kimberly Kallianos
Preface
With the 30th edition of First Aid for the USMLE Step 1, we continue our commitment to providing students with
the most useful and up-to-date preparation guide for the USMLE Step 1. This edition represents an outstanding
revision in many ways, including:
50 entirely new or heavily revised high-yield topics reflecting evolving trends in the USMLE Step 1.
Reorganization of high-yield topics in Pharmacology, Endocrine, and Reproductive chapters for improved study.
Extensive text revisions, new mnemonics, clarifications, and corrections curated by a team of more than 30
medical student and resident physician authors who excelled on their Step 1 examinations and verified by a team
of expert faculty advisors and nationally recognized USMLE instructors.
Updated with 178 new and revised diagrams and illustrations as part of our ongoing collaboration with
USMLE-Rx and ScholarRx (MedIQ Learning, LLC).
Updated with 75 new and revised photos to help visualize various disorders, descriptive findings, and basic
science concepts. Additionally, revised imaging photos have been labeled and optimized to show both normal
anatomy and pathologic findings.
Updated study tips on the opening page of each chapter.
Improved integration of clinical images and illustrations to better reinforce and learn key anatomic concepts.
Improved organization and integration of text, illustrations, clinical images, and tables throughout for focused
review of high-yield topics.
Revised and expanded ratings of current, high-yield review resources, with clear explanations of their relevance
to USMLE review.
Real-time Step 1 updates and corrections can be found exclusively on our blog, www.firstaidteam.com.
We invite students and faculty to share their thoughts and ideas to help us continually improve First Aid for the
USMLE Step 1 through our blog and collaborative editorial platform. (See How to Contribute, p. xvii.)
Louisville Tao Le
Boracay Vikas Bhushan
St. Louis Matthew Sochat
Phoenix Vaishnavi Vaidyanathan
Bristol Sarah Schimansky
New York City Jordan Abrams
San Francisco Kimberly Kallianos
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xiv
Special Acknowledgments
This has been a collaborative project from the start. We gratefully acknowledge the thousands of thoughtful
comments, corrections, and advice of the many medical students, international medical graduates, and faculty who
have supported the authors in our continuing development of First Aid for the USMLE Step 1.
For support and encouragement throughout the process, we are grateful to Thao Pham, Jinky Flang, and Jonathan
Kirsch, Esq. Thanks to Louise Petersen for organizing and supporting the project. Thanks to our publisher, McGraw-
Hill, for the valuable assistance of its staff, including Bob Boehringer, Jeffrey Herzich, and Christina Thomas.
We are also very grateful to Dr. Fred Howell and Dr. Robert Cannon of Textensor Ltd for providing us extensive
customization and support for their powerful Annotate.co collaborative editing platform (www.annotate.co), which
allows us to efficiently manage thousands of contributions. Thanks to Dr. Richard Usatine and Dr. Kristine Krafts
for their outstanding image contributions. Thanks also to Jean-Christophe Fournet (www.humpath.com), Dr. Ed
Uthman, and Dr. Frank Gaillard (www.radiopaedia.org) for generously allowing us to access some of their striking
photographs.
For exceptional editorial leadership, enormous thanks to Kathleen Naylor, Christine Diedrich and Emma
Underdown. Thank you to our USMLE-Rx/ScholarRx team of editors, Jessie Schanzle, Ruth Kaufman, Janene
Matragrano, Susan Mazik, Isabel Nogueira, Sharon Prevost, Jen Shimony, and Hannah Warnshuis. Special thanks to
our indexer Dr. Anne Fifer. We are also grateful to our medical illustrator, Hans Neuhart, for his creative work on the
new and updated illustrations. Lastly, tremendous thanks to Graphic World, especially Anne Banning, Sandy Brown,
Gary Clark, and Cindy Geiss.
Louisville Tao Le
Boracay Vikas Bhushan
St. Louis Matthew Sochat
Phoenix Vaishnavi Vaidyanathan
Bristol Sarah Schimansky
New York City Jordan Abrams
San Francisco Kimberly Kallianos
Special Acknowledgments
This has been a collaborative project from the start. We gratefully acknowledge the thousands of thoughtful
comments, corrections, and advice of the many medical students, international medical graduates, and faculty who
have supported the authors in our continuing development of First Aid for the USMLE Step 1.
For support and encouragement throughout the process, we are grateful to Thao Pham, Jinky Flang, and Jonathan
Kirsch, Esq. Thanks to Louise Petersen for organizing and supporting the project. Thanks to our publisher, McGraw-
Hill, for the valuable assistance of its staff, including Bob Boehringer, Jeffrey Herzich, and Christina Thomas.
We are also very grateful to Dr. Fred Howell and Dr. Robert Cannon of Textensor Ltd for providing us extensive
customization and support for their powerful Annotate.co collaborative editing platform (www.annotate.co), which
allows us to efficiently manage thousands of contributions. Thanks to Dr. Richard Usatine and Dr. Kristine Krafts
for their outstanding image contributions. Thanks also to Jean-Christophe Fournet (www.humpath.com), Dr. Ed
Uthman, and Dr. Frank Gaillard (www.radiopaedia.org) for generously allowing us to access some of their striking
photographs.
For exceptional editorial leadership, enormous thanks to Kathleen Naylor, Christine Diedrich and Emma
Underdown. Thank you to our USMLE-Rx/ScholarRx team of editors, Jessie Schanzle, Ruth Kaufman, Janene
Matragrano, Susan Mazik, Isabel Nogueira, Sharon Prevost, Jen Shimony, and Hannah Warnshuis. Special thanks to
our indexer Dr. Anne Fifer. We are also grateful to our medical illustrator, Hans Neuhart, for his creative work on the
new and updated illustrations. Lastly, tremendous thanks to Graphic World, especially Anne Banning, Sandy Brown,
Gary Clark, and Cindy Geiss.
Louisville Tao Le
Boracay Vikas Bhushan
St. Louis Matthew Sochat
Phoenix Vaishnavi Vaidyanathan
Bristol Sarah Schimansky
New York City Jordan Abrams
San Francisco Kimberly Kallianos
Loading page 16...
xv
Each year we are fortunate to receive the input of thousands of medical students and graduates who provide new
material, clarifications, and potential corrections through our website and our collaborative editing platform.
This has been a tremendous help in clarifying difficult concepts, correcting errata from the previous edition, and
minimizing new errata during the revision of the current edition. This reflects our long-standing vision of a true,
student-to-student publication. We have done our best to thank each person individually below, but we recognize
that errors and omissions are likely. Therefore, we will post an updated list of acknowledgments at our website, www.
firstaidteam.com/bonus/. We will gladly make corrections if they are brought to our attention.
For submitting contributions and corrections, many thanks to Raed Ababneh, Antara Afrin, Rasim Agaev, Vanya
Aggarwal, Ataa Ahmed, Hasan Alarouri, Basim Ali, Muhammad Faizan Ali, Moatasem Al-Janabi, Mohamed
Almahmodi, Chima Amadi, Arman Amin, Jacqueline Aredo, Ranya Baddourah, Daniel Badin, Nida Bajwa, Dileni
Bandarage, Jerrin Bawa, Esra Bayram, Craig Beavers, Jacqueline Bekhit, Matthias Bergmann, Stephanie Biecker,
Aaron Birnbaum, Prateek Bommu, Nathaniel Borochov, Susan Brands, Olivia W. Brooks, Meghan Brown, Stanley
Budzinski, Kevin Budziszewski, Pavel Burski, Elisa M. Cairns, Sergio Camba, Katie Carsky, Esteban Casasola,
Marielys Castro, Jesse Chait, Bliss Chang, Santosh Cherian, Heewon Choi, Charilaos Chourpiliadis, Maruf
Chowdhury, Matthew J. Christensen, Matthew Yat Hon Chung, Alexander Ciaramella, Dillon Clancy, Sofija Conic,
M. Marwan Dabbagh, Parag Das, Ketan Dayma, Elmer De Camps, Charles de Leeuw, Xavier De Pena, Christopher
DeAngelo, Elliott Delgado, Anthony DeMarinis, Stacy Diaz, Evan Dishion, Nicola Helen Duzak, Emily Edwards,
Alec Egan, Mohamed Elashwal, Osama El-Gabalawy, Matthew Eli, Awab Elnaeem, Sally El Sammak, Dylan Erwin,
Stephanie Estevez-Marin, Gray Evans, Najat Fadlallah, Aria Fariborzi, Richard Ferro, Adam Fletcher, Kimberly A.
Foley, Kyle Fratta, Samantha Friday, Nikhila Gandrakota, Siva Garapati, Nicolas Curi Gawlinski, Joanna Georgakas,
Beth Anne George, Ashley Ghaemi, E. Sophia Gonzalez, Justin Graff, Gabriel Graham, Donovan Griggs, David
Gruen, Gursewak Hadday, Jacqueline Hairston, Hunter Harrison, Gull Shahmir Hasnat, Maximillan Hawkins,
Grecia Haymee, Briana Hernandez, Robin Hilder, Tammy Hua, Derrek Humphries, Audrey Hunt, Nanki Hura,
Danny Ibrahim, Jyothik Varun Inampudi, Hnin Ingyin, Maham Irfan, Mina Iskandar, Kritika Iyer, Christina Jacobs,
Arpit Jain, Neil K. Jain, Ala Jamal, Natalie Jansen, Jordan Jay, Mohammad Jmasi, Colton Junod, Talia Kamdjou,
Filip Kaniski, Lydia Kaoutzani, Panagiotis Kaparaliotis, Srikrishna Karnatapu, Patrick Keller, Olivia Keller-Baruch,
Cameron Kerl, Ahmed Ali Khan, Sara Khan, Shaima Khandaker, Samir Khouzam, Sonya Klein, Elana Kleinman,
Andrew Ko, Soheil Kooraki, Anna Kukharchuk, Dennis Vu Kulp, Anil A. Kumar, Julie Kurek, Chloe Lahoud,
Mike Lawandy, Ramy Lawandy, Jessica Lazar, Andrea Leal-Lopez, Lynda Lee, Chime Lhatso, Christine Lin,
Benjamin Lodge, Soon Khai Low, Estefanía Henríquez Luthje, Lisa-Qiao MacDonald, Divya Madhavarapu, Mahir
Mameledzija, Keerer Mann, Rajver Mann, Nadeen Mansour, Yusra Mansour, Bridget Martinez, Ahmad Mashlah,
Rick Mathews, Amy McGregor, Alexandra & Joshua Medeiros & Fowler, Viviana Medina, Areeka Memon, Pedro
G. R. Menicucci, Ben Meyers, Stephan A. Miller, Fatima Mirza, Murli Mishra, Elana Molcho, Guarina Molina,
John Moon, Nayla Mroueh, Neha Mylarapu, Behnam Nabavizadeh, Moeko Nagatsuka, Ghazal Naghibzadeh, Alice
Nassar, Nadya Nee, Lucas Nelson, Zach Nelson, Monica Nemat, Kenneth Nguyen, Michael Nguyen, Christian
General Acknowledgments
Each year we are fortunate to receive the input of thousands of medical students and graduates who provide new
material, clarifications, and potential corrections through our website and our collaborative editing platform.
This has been a tremendous help in clarifying difficult concepts, correcting errata from the previous edition, and
minimizing new errata during the revision of the current edition. This reflects our long-standing vision of a true,
student-to-student publication. We have done our best to thank each person individually below, but we recognize
that errors and omissions are likely. Therefore, we will post an updated list of acknowledgments at our website, www.
firstaidteam.com/bonus/. We will gladly make corrections if they are brought to our attention.
For submitting contributions and corrections, many thanks to Raed Ababneh, Antara Afrin, Rasim Agaev, Vanya
Aggarwal, Ataa Ahmed, Hasan Alarouri, Basim Ali, Muhammad Faizan Ali, Moatasem Al-Janabi, Mohamed
Almahmodi, Chima Amadi, Arman Amin, Jacqueline Aredo, Ranya Baddourah, Daniel Badin, Nida Bajwa, Dileni
Bandarage, Jerrin Bawa, Esra Bayram, Craig Beavers, Jacqueline Bekhit, Matthias Bergmann, Stephanie Biecker,
Aaron Birnbaum, Prateek Bommu, Nathaniel Borochov, Susan Brands, Olivia W. Brooks, Meghan Brown, Stanley
Budzinski, Kevin Budziszewski, Pavel Burski, Elisa M. Cairns, Sergio Camba, Katie Carsky, Esteban Casasola,
Marielys Castro, Jesse Chait, Bliss Chang, Santosh Cherian, Heewon Choi, Charilaos Chourpiliadis, Maruf
Chowdhury, Matthew J. Christensen, Matthew Yat Hon Chung, Alexander Ciaramella, Dillon Clancy, Sofija Conic,
M. Marwan Dabbagh, Parag Das, Ketan Dayma, Elmer De Camps, Charles de Leeuw, Xavier De Pena, Christopher
DeAngelo, Elliott Delgado, Anthony DeMarinis, Stacy Diaz, Evan Dishion, Nicola Helen Duzak, Emily Edwards,
Alec Egan, Mohamed Elashwal, Osama El-Gabalawy, Matthew Eli, Awab Elnaeem, Sally El Sammak, Dylan Erwin,
Stephanie Estevez-Marin, Gray Evans, Najat Fadlallah, Aria Fariborzi, Richard Ferro, Adam Fletcher, Kimberly A.
Foley, Kyle Fratta, Samantha Friday, Nikhila Gandrakota, Siva Garapati, Nicolas Curi Gawlinski, Joanna Georgakas,
Beth Anne George, Ashley Ghaemi, E. Sophia Gonzalez, Justin Graff, Gabriel Graham, Donovan Griggs, David
Gruen, Gursewak Hadday, Jacqueline Hairston, Hunter Harrison, Gull Shahmir Hasnat, Maximillan Hawkins,
Grecia Haymee, Briana Hernandez, Robin Hilder, Tammy Hua, Derrek Humphries, Audrey Hunt, Nanki Hura,
Danny Ibrahim, Jyothik Varun Inampudi, Hnin Ingyin, Maham Irfan, Mina Iskandar, Kritika Iyer, Christina Jacobs,
Arpit Jain, Neil K. Jain, Ala Jamal, Natalie Jansen, Jordan Jay, Mohammad Jmasi, Colton Junod, Talia Kamdjou,
Filip Kaniski, Lydia Kaoutzani, Panagiotis Kaparaliotis, Srikrishna Karnatapu, Patrick Keller, Olivia Keller-Baruch,
Cameron Kerl, Ahmed Ali Khan, Sara Khan, Shaima Khandaker, Samir Khouzam, Sonya Klein, Elana Kleinman,
Andrew Ko, Soheil Kooraki, Anna Kukharchuk, Dennis Vu Kulp, Anil A. Kumar, Julie Kurek, Chloe Lahoud,
Mike Lawandy, Ramy Lawandy, Jessica Lazar, Andrea Leal-Lopez, Lynda Lee, Chime Lhatso, Christine Lin,
Benjamin Lodge, Soon Khai Low, Estefanía Henríquez Luthje, Lisa-Qiao MacDonald, Divya Madhavarapu, Mahir
Mameledzija, Keerer Mann, Rajver Mann, Nadeen Mansour, Yusra Mansour, Bridget Martinez, Ahmad Mashlah,
Rick Mathews, Amy McGregor, Alexandra & Joshua Medeiros & Fowler, Viviana Medina, Areeka Memon, Pedro
G. R. Menicucci, Ben Meyers, Stephan A. Miller, Fatima Mirza, Murli Mishra, Elana Molcho, Guarina Molina,
John Moon, Nayla Mroueh, Neha Mylarapu, Behnam Nabavizadeh, Moeko Nagatsuka, Ghazal Naghibzadeh, Alice
Nassar, Nadya Nee, Lucas Nelson, Zach Nelson, Monica Nemat, Kenneth Nguyen, Michael Nguyen, Christian
General Acknowledgments
Loading page 17...
xvi
Nieves, Nyia Njamfa, Ahmed Noor, Kyle Nyugen, Ahamd Obeidat, Gerald Olayan, Anndres Olson, Hasaan Omar,
Daniel Ortiz, Michael O’Shea, Zonghao Pan, Vasilis Sebastian Paraschos, Christopher Parrino, Janak Patel, Vanisha
Patel, Cyril Patra, Rita Paulis, Dmytro Pavlenko, Nancy A. Pina, Alexander Polyak, Jackeline Porto, Shannon D.
Powell, Jacob Pruett, Laith Rahabneh, Kamleshun Ramphul, Janhvi Rana, Nidaa Rasheed, Abdul Sattar Raslan,
Tomas Ream, Rashelle Ripa, Amanda Michelle Ritchie, Helio Manuel Grullón Rodríguez, Sarah Rohrig, Gessel
Romero, Alexander Rose, Rachel Rose, Erica Rubin, Areesha Saati, Jeffrey Sackey, Raza H. Sagarwala, Chhavi Saini,
Sergii Sakhno, Allie Sakowicz, Shadia Saleh, Roshun Sangani, Dhruv Sarwal, Abeer Sarwar, M. Sathyanarayanan,
Neetu Scariya, Tonio Felix Schaffert, Melissa Schechter, Kathryn Scheinberg, Emma Schnuckle, Emma Schulte,
Taylor Schweigert, Lee Seifert, Sheila Serin, Deeksha Seth, Omid Shafaat, Nirav Shah, Samir K. Shah, Wasif
Nauman Shah, Muhanad Shaib, Ahmed Shakir, Purnima Sharma, Tina Sharma, Kayla Sheehan, Dr. Priya
Shenwai, Sami Shoura, Kris Sifeldeen, Akhand Singh, Manik Inder Singh, Ramzi Y. Skaik, Samantha A. Smith,
Timothy Smith, Emilie Song, Hang Song, Shichen Song, Luke Sorensen, Charles Starling, Jonathan Andrew
Stone, Nathan Stumpf, Johnny Su, Bahaa Eddine Succar, Saranya Sundaram, Steven Svoboda, Clara Sze, Olive
Tang, Brian Tanksley, Omar Tayh, Joshua Taylor, Valerie Teano, Warren Teltser, Steffanie Camilo Tertulien, Roger
Torres, Michael Trainer, Andrew Trinh, Aalap K. Trivedi, Georgeanna Tsoumas, Elizabeth Tsui, Cem Turam,
Methma Udawatta, Daramfon Udofia, Adaku Ume, Rio Varghese, Judith Vásquez, Earl Vialpando, Sagar Vinayak,
Phuong Vo, Habiba Wada, Jason Wang, Tiffany Wang, Zoe Warczak, Mitchell Waters, Rachel Watson, Elizabeth
Douglas Weigel, Rabbi Michael Weingarten, Kaystin Weisenberger, Aidan Woodthorpe, Mattia Wruble, Angela Wu,
Catherine Xie, Rebecca Xu, Nicholas Yeisley, Sammy Yeroushalmi, Melissas Yuan, Sahil Zaveri, and Yolanda Zhang.
Nieves, Nyia Njamfa, Ahmed Noor, Kyle Nyugen, Ahamd Obeidat, Gerald Olayan, Anndres Olson, Hasaan Omar,
Daniel Ortiz, Michael O’Shea, Zonghao Pan, Vasilis Sebastian Paraschos, Christopher Parrino, Janak Patel, Vanisha
Patel, Cyril Patra, Rita Paulis, Dmytro Pavlenko, Nancy A. Pina, Alexander Polyak, Jackeline Porto, Shannon D.
Powell, Jacob Pruett, Laith Rahabneh, Kamleshun Ramphul, Janhvi Rana, Nidaa Rasheed, Abdul Sattar Raslan,
Tomas Ream, Rashelle Ripa, Amanda Michelle Ritchie, Helio Manuel Grullón Rodríguez, Sarah Rohrig, Gessel
Romero, Alexander Rose, Rachel Rose, Erica Rubin, Areesha Saati, Jeffrey Sackey, Raza H. Sagarwala, Chhavi Saini,
Sergii Sakhno, Allie Sakowicz, Shadia Saleh, Roshun Sangani, Dhruv Sarwal, Abeer Sarwar, M. Sathyanarayanan,
Neetu Scariya, Tonio Felix Schaffert, Melissa Schechter, Kathryn Scheinberg, Emma Schnuckle, Emma Schulte,
Taylor Schweigert, Lee Seifert, Sheila Serin, Deeksha Seth, Omid Shafaat, Nirav Shah, Samir K. Shah, Wasif
Nauman Shah, Muhanad Shaib, Ahmed Shakir, Purnima Sharma, Tina Sharma, Kayla Sheehan, Dr. Priya
Shenwai, Sami Shoura, Kris Sifeldeen, Akhand Singh, Manik Inder Singh, Ramzi Y. Skaik, Samantha A. Smith,
Timothy Smith, Emilie Song, Hang Song, Shichen Song, Luke Sorensen, Charles Starling, Jonathan Andrew
Stone, Nathan Stumpf, Johnny Su, Bahaa Eddine Succar, Saranya Sundaram, Steven Svoboda, Clara Sze, Olive
Tang, Brian Tanksley, Omar Tayh, Joshua Taylor, Valerie Teano, Warren Teltser, Steffanie Camilo Tertulien, Roger
Torres, Michael Trainer, Andrew Trinh, Aalap K. Trivedi, Georgeanna Tsoumas, Elizabeth Tsui, Cem Turam,
Methma Udawatta, Daramfon Udofia, Adaku Ume, Rio Varghese, Judith Vásquez, Earl Vialpando, Sagar Vinayak,
Phuong Vo, Habiba Wada, Jason Wang, Tiffany Wang, Zoe Warczak, Mitchell Waters, Rachel Watson, Elizabeth
Douglas Weigel, Rabbi Michael Weingarten, Kaystin Weisenberger, Aidan Woodthorpe, Mattia Wruble, Angela Wu,
Catherine Xie, Rebecca Xu, Nicholas Yeisley, Sammy Yeroushalmi, Melissas Yuan, Sahil Zaveri, and Yolanda Zhang.
Loading page 18...
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xviii
`` NOTE TO CONTRIBUTORS
All contributions become property of the authors and are subject to editing and reviewing. Please verify all data and
spellings carefully. Contributions should be supported by at least two high-quality references.
Check our website first to avoid duplicate submissions. In the event that similar or duplicate entries are received,
only the first complete entry received with valid, authoritative references will be credited. Please follow the style,
punctuation, and format of this edition as much as possible.
`` JOIN THE FIRST AID TEAM
The First Aid author team is pleased to offer part-time and full-time paid internships in medical education and
publishing to motivated medical students and physicians. Internships range from a few months (eg, a summer) up
to a full year. Participants will have an opportunity to author, edit, and earn academic credit on a wide variety of
projects, including the popular First Aid series.
For 2020, we are actively seeking passionate medical students and graduates with a specific interest in improving our
medical illustrations, expanding our database of medical photographs, and developing the software that supports our
crowdsourcing platform. We welcome people with prior experience and talent in these areas. Relevant skills include
clinical imaging, digital photography, digital asset management, information design, medical illustration, graphic
design, tutoring, and software development.
Please email us at firstaid@scholarrx.com with a CV and summary of your interest or sample work.
`` NOTE TO CONTRIBUTORS
All contributions become property of the authors and are subject to editing and reviewing. Please verify all data and
spellings carefully. Contributions should be supported by at least two high-quality references.
Check our website first to avoid duplicate submissions. In the event that similar or duplicate entries are received,
only the first complete entry received with valid, authoritative references will be credited. Please follow the style,
punctuation, and format of this edition as much as possible.
`` JOIN THE FIRST AID TEAM
The First Aid author team is pleased to offer part-time and full-time paid internships in medical education and
publishing to motivated medical students and physicians. Internships range from a few months (eg, a summer) up
to a full year. Participants will have an opportunity to author, edit, and earn academic credit on a wide variety of
projects, including the popular First Aid series.
For 2020, we are actively seeking passionate medical students and graduates with a specific interest in improving our
medical illustrations, expanding our database of medical photographs, and developing the software that supports our
crowdsourcing platform. We welcome people with prior experience and talent in these areas. Relevant skills include
clinical imaging, digital photography, digital asset management, information design, medical illustration, graphic
design, tutoring, and software development.
Please email us at firstaid@scholarrx.com with a CV and summary of your interest or sample work.
Loading page 20...
xix
How to Use This Book
CONGRATULATIONS: You now possess the book that has guided nearly two million students to USMLE success
for 30 years. With appropriate care, the binding should last the useful life of the book. Keep in mind that putting
excessive flattening pressure on any binding will accelerate its failure. If you purchased a book that you believe
is defective, please immediately return it to the place of purchase. If you encounter ongoing issues, you can also
contact Customer Service at our publisher, McGraw-Hill Education, at https://www.mheducation.com/contact.html.
START EARLY: Use this book as early as possible while learning the basic medical sciences. The first semester of
your first year is not too early! Devise a study plan by reading Section I: Guide to Efficient Exam Preparation, and
make an early decision on resources to use by checking Section IV: Top-Rated Review Resources. Note that First Aid
is neither a textbook nor a comprehensive review book, and it is not a panacea for inadequate preparation.
CONSIDER FIRST AID YOUR ANNOTATION HUB: Annotate material from other resources, such as class
notes or comprehensive textbooks, into your book. This will keep all the high-yield information you need in one
place. Other tips on keeping yourself organized:
For best results, use fine-tipped ballpoint pens (eg, BIC Pro+, Uni-Ball Jetstream Sports, Pilot Drawing Pen,
Zebra F-301). If you like gel pens, try Pentel Slicci, and for markers that dry almost immediately, consider
Staedtler Triplus Fineliner, Pilot Drawing Pen, and Sharpies.
Consider using pens with different colors of ink to indicate different sources of information (eg, blue for
USMLE-Rx Step 1 Qmax, green for UWorld Step 1 Qbank).
Choose highlighters that are bright and dry quickly to minimize smudging and bleeding through the page
(eg, Tombow Kei Coat, Sharpie Gel).
Many students de-spine their book and get it 3-hole-punched. This will allow you to insert materials from other
sources, including curricular materials.
INTEGRATE STUDY WITH CASES, FLASH CARDS, AND QUESTIONS: To broaden your learning strategy,
consider integrating your First Aid study with case-based reviews (eg, First Aid Cases for the USMLE Step 1), flash
cards (eg, First Aid Flash Facts), and practice questions (eg, the USMLE-Rx Step 1 Qmax). Read the chapter in the
book, then test your comprehension by using cases, flash cards, and questions that cover the same topics. Maintain
access to more comprehensive resources (eg, First Aid for the Basic Sciences: General Principles and Organ Systems
and First Aid Express videos) for deeper review as needed.
PRIME YOUR MEMORY: Return to your annotated Sections II and III several days before taking the USMLE
Step 1. The book can serve as a useful way of retaining key associations and keeping high-yield facts fresh in your
memory just prior to the exam. The Rapid Review section includes high-yield topics to help guide your studying.
CONTRIBUTE TO FIRST AID: Reviewing the book immediately after your exam can help us improve the next
edition. Decide what was truly high and low yield and send us your comments. Feel free to send us scanned images
from your annotated First Aid book as additional support. Of course, always remember that all examinees are under
agreement with the NBME to not disclose the specific details of copyrighted test material.
How to Use This Book
CONGRATULATIONS: You now possess the book that has guided nearly two million students to USMLE success
for 30 years. With appropriate care, the binding should last the useful life of the book. Keep in mind that putting
excessive flattening pressure on any binding will accelerate its failure. If you purchased a book that you believe
is defective, please immediately return it to the place of purchase. If you encounter ongoing issues, you can also
contact Customer Service at our publisher, McGraw-Hill Education, at https://www.mheducation.com/contact.html.
START EARLY: Use this book as early as possible while learning the basic medical sciences. The first semester of
your first year is not too early! Devise a study plan by reading Section I: Guide to Efficient Exam Preparation, and
make an early decision on resources to use by checking Section IV: Top-Rated Review Resources. Note that First Aid
is neither a textbook nor a comprehensive review book, and it is not a panacea for inadequate preparation.
CONSIDER FIRST AID YOUR ANNOTATION HUB: Annotate material from other resources, such as class
notes or comprehensive textbooks, into your book. This will keep all the high-yield information you need in one
place. Other tips on keeping yourself organized:
For best results, use fine-tipped ballpoint pens (eg, BIC Pro+, Uni-Ball Jetstream Sports, Pilot Drawing Pen,
Zebra F-301). If you like gel pens, try Pentel Slicci, and for markers that dry almost immediately, consider
Staedtler Triplus Fineliner, Pilot Drawing Pen, and Sharpies.
Consider using pens with different colors of ink to indicate different sources of information (eg, blue for
USMLE-Rx Step 1 Qmax, green for UWorld Step 1 Qbank).
Choose highlighters that are bright and dry quickly to minimize smudging and bleeding through the page
(eg, Tombow Kei Coat, Sharpie Gel).
Many students de-spine their book and get it 3-hole-punched. This will allow you to insert materials from other
sources, including curricular materials.
INTEGRATE STUDY WITH CASES, FLASH CARDS, AND QUESTIONS: To broaden your learning strategy,
consider integrating your First Aid study with case-based reviews (eg, First Aid Cases for the USMLE Step 1), flash
cards (eg, First Aid Flash Facts), and practice questions (eg, the USMLE-Rx Step 1 Qmax). Read the chapter in the
book, then test your comprehension by using cases, flash cards, and questions that cover the same topics. Maintain
access to more comprehensive resources (eg, First Aid for the Basic Sciences: General Principles and Organ Systems
and First Aid Express videos) for deeper review as needed.
PRIME YOUR MEMORY: Return to your annotated Sections II and III several days before taking the USMLE
Step 1. The book can serve as a useful way of retaining key associations and keeping high-yield facts fresh in your
memory just prior to the exam. The Rapid Review section includes high-yield topics to help guide your studying.
CONTRIBUTE TO FIRST AID: Reviewing the book immediately after your exam can help us improve the next
edition. Decide what was truly high and low yield and send us your comments. Feel free to send us scanned images
from your annotated First Aid book as additional support. Of course, always remember that all examinees are under
agreement with the NBME to not disclose the specific details of copyrighted test material.
Loading page 21...
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xxii
First Aid Checklist for the USMLE Step 1
This is an example of how you might use the information in Section I to prepare for the USMLE Step 1.
Refer to corresponding topics in Section I for more details.
Years Prior
Months Prior
Weeks Prior
One Week Prior
One Day Prior
Day of Exam
After Exam
Use top-rated review resources for first-year medical school courses.
Ask for advice from those who have recently taken the USMLE Step 1.
Review computer test format and registration information.
Register six months in advance.
Carefully verify name and address printed on scheduling permit. Make sure
the name on scheduling permit matches the name printed on your photo ID.
Go online for test date ASAP.
Define your exam goals (pass comfortably, beat the mean, ace the test)
Set up a realistic timeline for study. Cover less crammable subjects first.
Evaluate and choose study materials (review books, question banks).
Use a question bank to simulate the USMLE Step 1 to pinpoint strengths and
weaknesses in knowledge and test-taking skills.
Do another test simulation in a question bank.
Assess how close you are to your goal.
Pinpoint remaining weaknesses. Stay healthy (exercise, sleep).
Verify information on admission ticket (eg, location, date).
Remember comfort measures (loose clothing, earplugs, etc).
Work out test site logistics (eg, location, transportation, parking, lunch).
Print or download your Scheduling Permit and Scheduling Confirmation
to your phone.
Relax.
Lightly review short-term material if necessary. Skim high-yield facts.
Get a good night’s sleep.
Relax.
Eat breakfast.
Minimize bathroom breaks during exam by avoiding excessive morning
caffeine.
Celebrate, regardless of how well you feel you did.
Send feedback to us on our website at www.firstaidteam.com.
First Aid Checklist for the USMLE Step 1
This is an example of how you might use the information in Section I to prepare for the USMLE
Step 1. Refer to corresponding topics in Section I for more details.
First Aid Checklist for the USMLE Step 1
This is an example of how you might use the information in Section I to prepare for the USMLE Step 1.
Refer to corresponding topics in Section I for more details.
Years Prior
Months Prior
Weeks Prior
One Week Prior
One Day Prior
Day of Exam
After Exam
Use top-rated review resources for first-year medical school courses.
Ask for advice from those who have recently taken the USMLE Step 1.
Review computer test format and registration information.
Register six months in advance.
Carefully verify name and address printed on scheduling permit. Make sure
the name on scheduling permit matches the name printed on your photo ID.
Go online for test date ASAP.
Define your exam goals (pass comfortably, beat the mean, ace the test)
Set up a realistic timeline for study. Cover less crammable subjects first.
Evaluate and choose study materials (review books, question banks).
Use a question bank to simulate the USMLE Step 1 to pinpoint strengths and
weaknesses in knowledge and test-taking skills.
Do another test simulation in a question bank.
Assess how close you are to your goal.
Pinpoint remaining weaknesses. Stay healthy (exercise, sleep).
Verify information on admission ticket (eg, location, date).
Remember comfort measures (loose clothing, earplugs, etc).
Work out test site logistics (eg, location, transportation, parking, lunch).
Print or download your Scheduling Permit and Scheduling Confirmation
to your phone.
Relax.
Lightly review short-term material if necessary. Skim high-yield facts.
Get a good night’s sleep.
Relax.
Eat breakfast.
Minimize bathroom breaks during exam by avoiding excessive morning
caffeine.
Celebrate, regardless of how well you feel you did.
Send feedback to us on our website at www.firstaidteam.com.
First Aid Checklist for the USMLE Step 1
This is an example of how you might use the information in Section I to prepare for the USMLE
Step 1. Refer to corresponding topics in Section I for more details.
Loading page 24...
1
` Introduction 2
` USMLE Step 1—The
Basics 2
` Defining Your Goal 12
` Learning Strategies 13
` Timeline for Study 16
` Study Materials 20
` Test-Taking
Strategies 22
` Clinical Vignette
Strategies 23
` If You Think You
Failed 24
` Testing Agencies 24
` Introduction 2
` USMLE Step 1—The
Basics 2
` Defining Your Goal 12
` Learning Strategies 13
` Timeline for Study 16
` Study Materials 20
` Test-Taking
Strategies 22
` Clinical Vignette
Strategies 23
` If You Think You
Failed 24
` Testing Agencies 24
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Guide to efficient exam PreParationSec tion i6
Once you receive your scheduling permit, you may access the Prometric
website or call Prometric’s toll-free number to arrange a time to take the
exam. You may contact Prometric two weeks before the test date if you
want to confirm identification requirements. Although requests for taking
the exam may be completed more than six months before the test date,
examinees will not receive their scheduling permits earlier than six months
before the eligibility period. The eligibility period is the three-month period
you have chosen to take the exam. Most medical students choose the April–
June or June–August period. Because exams are scheduled on a “first-come,
first-served” basis, it is recommended that you book an exam date on the
Prometric website as soon as you receive your permit. Prometric will provide
appointment confirmation on a print-out and by email. Be sure to read the
latest USMLE Bulletin of Information for further details.
What If I Need to Reschedule the Exam?
You can change your test date and/or center by contacting Prometric at
1-800-MED-EXAM (1-800-633-3926) or www.prometric.com. Make sure to
have your CIN when rescheduling. If you are rescheduling by phone, you
must speak with a Prometric representative; leaving a voicemail message will
not suffice. To avoid a rescheduling fee, you will need to request a change
at least 31 calendar days before your appointment. Please note that your
rescheduled test date must fall within your assigned three-month eligibility
period.
When Should I Register for the Exam?
You should plan to register as far in advance as possible ahead of your
desired test date (eg, six months), but, depending on your particular test
center, new dates and times may open closer to the date. Scheduling early
will guarantee that you will get either your test center of choice or one
within a 50-mile radius of your first choice. For most US medical students,
the desired testing window is in June, since most medical school curricula
for the second year end in May or June. Thus, US medical students should
plan to register before January in anticipation of a June test date. The timing
of the exam is more flexible for IMGs, as it is related only to when they
finish exam preparation. Talk with upperclassmen who have already taken
the test so you have real-life experience from students who went through a
similar curriculum, then formulate your own strategy.
Where Can I Take the Exam?
Your testing location is arranged with Prometric when you book your test
date (after you receive your scheduling permit). For a list of Prometric
locations nearest you, visit www.prometric.com.
` The confirmation emails that Prometric
and NBME send are not the same as the
scheduling permit.
` Test scheduling is done on a “first-come,
first-served” basis. It’s important to schedule
an exam date as soon as you receive your
scheduling permit.
` Register six months in advance for seating
and scheduling preference.
Once you receive your scheduling permit, you may access the Prometric
website or call Prometric’s toll-free number to arrange a time to take the
exam. You may contact Prometric two weeks before the test date if you
want to confirm identification requirements. Although requests for taking
the exam may be completed more than six months before the test date,
examinees will not receive their scheduling permits earlier than six months
before the eligibility period. The eligibility period is the three-month period
you have chosen to take the exam. Most medical students choose the April–
June or June–August period. Because exams are scheduled on a “first-come,
first-served” basis, it is recommended that you book an exam date on the
Prometric website as soon as you receive your permit. Prometric will provide
appointment confirmation on a print-out and by email. Be sure to read the
latest USMLE Bulletin of Information for further details.
What If I Need to Reschedule the Exam?
You can change your test date and/or center by contacting Prometric at
1-800-MED-EXAM (1-800-633-3926) or www.prometric.com. Make sure to
have your CIN when rescheduling. If you are rescheduling by phone, you
must speak with a Prometric representative; leaving a voicemail message will
not suffice. To avoid a rescheduling fee, you will need to request a change
at least 31 calendar days before your appointment. Please note that your
rescheduled test date must fall within your assigned three-month eligibility
period.
When Should I Register for the Exam?
You should plan to register as far in advance as possible ahead of your
desired test date (eg, six months), but, depending on your particular test
center, new dates and times may open closer to the date. Scheduling early
will guarantee that you will get either your test center of choice or one
within a 50-mile radius of your first choice. For most US medical students,
the desired testing window is in June, since most medical school curricula
for the second year end in May or June. Thus, US medical students should
plan to register before January in anticipation of a June test date. The timing
of the exam is more flexible for IMGs, as it is related only to when they
finish exam preparation. Talk with upperclassmen who have already taken
the test so you have real-life experience from students who went through a
similar curriculum, then formulate your own strategy.
Where Can I Take the Exam?
Your testing location is arranged with Prometric when you book your test
date (after you receive your scheduling permit). For a list of Prometric
locations nearest you, visit www.prometric.com.
` The confirmation emails that Prometric
and NBME send are not the same as the
scheduling permit.
` Test scheduling is done on a “first-come,
first-served” basis. It’s important to schedule
an exam date as soon as you receive your
scheduling permit.
` Register six months in advance for seating
and scheduling preference.
Loading page 30...
Guide to efficient exam PreParation Sec tion i 7
How Long Will I Have to Wait Before I Get My Scores?
The USMLE reports scores in three to four weeks, unless there are delays
in score processing. Examinees will be notified via email when their scores
are available. By following the online instructions, examinees will be able to
view, download, and print their score report online for ~120 days after score
notification, after which scores can only be obtained through requesting an
official USMLE transcript. Additional information about score timetables
and accessibility is available on the official USMLE website.
What About Time?
Time is of special interest on the CBT exam. Here’s a breakdown of the
exam schedule:
15 minutes Tutorial (skip if familiar with test format and features)
7 hours Seven 60-minute question blocks
45 minutes Break time (includes time for lunch)
The computer will keep track of how much time has elapsed on the exam.
However, the computer will show you only how much time you have
remaining in a given block. Therefore, it is up to you to determine if you
are pacing yourself properly (at a rate of approximately one question per 90
seconds).
The computer does not warn you if you are spending more than your
allotted time for a break. You should therefore budget your time so that
you can take a short break when you need one and have time to eat. You
must be especially careful not to spend too much time in between blocks
(you should keep track of how much time elapses from the time you finish a
block of questions to the time you start the next block). After you finish one
question block, you’ll need to click to proceed to the next block of questions.
If you do not click within 30 seconds, you will automatically be entered into
a break period.
Break time for the day is 45 minutes, but you are not required to use all of
it, nor are you required to use any of it. You can gain extra break time (but
not extra time for the question blocks) by skipping the tutorial or by finishing
a block ahead of the allotted time. Any time remaining on the clock when
you finish a block gets added to your remaining break time. Once a new
question block has been started, you may not take a break until you have
reached the end of that block. If you do so, this will be recorded as an
“unauthorized break” and will be reported on your final score report.
Finally, be aware that it may take a few minutes of your break time to “check
out” of the secure resting room and then “check in” again to resume testing,
so plan accordingly. The “check-in” process may include
How Long Will I Have to Wait Before I Get My Scores?
The USMLE reports scores in three to four weeks, unless there are delays
in score processing. Examinees will be notified via email when their scores
are available. By following the online instructions, examinees will be able to
view, download, and print their score report online for ~120 days after score
notification, after which scores can only be obtained through requesting an
official USMLE transcript. Additional information about score timetables
and accessibility is available on the official USMLE website.
What About Time?
Time is of special interest on the CBT exam. Here’s a breakdown of the
exam schedule:
15 minutes Tutorial (skip if familiar with test format and features)
7 hours Seven 60-minute question blocks
45 minutes Break time (includes time for lunch)
The computer will keep track of how much time has elapsed on the exam.
However, the computer will show you only how much time you have
remaining in a given block. Therefore, it is up to you to determine if you
are pacing yourself properly (at a rate of approximately one question per 90
seconds).
The computer does not warn you if you are spending more than your
allotted time for a break. You should therefore budget your time so that
you can take a short break when you need one and have time to eat. You
must be especially careful not to spend too much time in between blocks
(you should keep track of how much time elapses from the time you finish a
block of questions to the time you start the next block). After you finish one
question block, you’ll need to click to proceed to the next block of questions.
If you do not click within 30 seconds, you will automatically be entered into
a break period.
Break time for the day is 45 minutes, but you are not required to use all of
it, nor are you required to use any of it. You can gain extra break time (but
not extra time for the question blocks) by skipping the tutorial or by finishing
a block ahead of the allotted time. Any time remaining on the clock when
you finish a block gets added to your remaining break time. Once a new
question block has been started, you may not take a break until you have
reached the end of that block. If you do so, this will be recorded as an
“unauthorized break” and will be reported on your final score report.
Finally, be aware that it may take a few minutes of your break time to “check
out” of the secure resting room and then “check in” again to resume testing,
so plan accordingly. The “check-in” process may include
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Subject
United States Medical Licensing Examination