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First Aid for the USMLE Step 1 2024: A Student-to-Student Guide (2024)

Master every section of your certification exam with First Aid for the USMLE Step 1 2024: A Student-to-Student Guide (2024), a detailed and structured guide.

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    FIRST AID USMLE STEP 2024 FOR THE ® ® A STUDENT - TO - STUDENT GUIDE THE most recommended content resource for USMLE prep Over 1 , 300 must - know concepts with many new high - yield facts Enhanced tables and mnemonics for rapid learning and high retention Exceptional illustrations and images help you visualize key concepts Tao Le Vikas Bhushan Connie Qiu Anup Chalise Panagiotis Kaparaliotis Boards & Beyond IS NOW PART OF THE McGRAW HILL FAMILY L E A R N M O R E Mc Gra w Hill

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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 2024 FIRST AID TAO LE, MD, MHS Founder, ScholarRx Associate Clinical Professor, Department of Medicine University of Louisville School of Medicine VIKAS BHUSHAN, MD Founder, First Aid for the USMLE Step 1 Boracay, Philippines CONNIE QIU, MD, PhD Resident, Department of Dermatology Johns Hopkins Hospital PANAGIOTIS KAPARALIOTIS, MD University of Athens Medical School, Greece KIMBERLY KALLIANOS, MD Assistant Professor, Department of Radiology and Biomedical Imaging University of California, San Francisco School of Medicine ANUP CHALISE, MBBS, MS, MRCSEd Registrar, General and Colorectal Surgery North Middlesex University Hospital, London CAROLINE COLEMAN, MD Assistant Professor, Department of Medicine Emory University School of Medicine SEAN EVANS, MD Resident, Department of Medicine Emory University School of Medicine

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    First Aid for the® USMLE Step 1 2024: A Student-to-Student Guide Copyright © 2024 by Tao Le and Vikas Bhushan. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distrib- uted in any form or by any means, or stored in a data base or retrieval system, without the prior written permission of the publisher. Previous editions copyright © 1991 through 2023 by Tao Le and Vikas Bhushan. First edition copyright © 1990, 1989 by Vikas Bhushan, Jeffrey Hansen, and Edward Hon. Photo and line art credits for this book begin on page 755 and are considered an extension of this copyright page. Portions of this book identified with the symbol are copyright © USMLE-Rx.com (MedIQ Learning, LLC). Portions of this book identified with the symbol are copyright © Dr. Richard Usatine. Portions of this book identified with the symbol are under license from other third parties. Please refer to page 755 for a complete list of those image source attribution notices. First Aid for the® is a registered trademark of McGraw Hill. 1 2 3 4 5 6 7 8 9 LMN 27 26 25 24 23 22 ISBN 978-1-266-07720-3 MHID 1-266-07720-0 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 complete, 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 recom- mended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. This book was set in Electra LT Std by GW Inc. The editors were Bob Boehringer and Christina M. Thomas. Project management was provided by GW Inc. The production supervisor was Jeffrey Herzich. LSC Communications was printer and binder. This book is printed on acid-free paper. Copyright © 2024. Exclusive rights by McGraw Hill for manufacture and export. This book cannot be re exported from the country to which it is consigned by McGraw Hill. The International Edition is not available in North America. McGraw Hill books are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. To contact a representative please visit the Contact Us pages at www.mhprofessional.com.

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    Dedication To medical students and physicians worldwide for collaborating to improve medical education and practice.

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    v Contents Contributing Authors vii Associate Authors viii Faculty Advisors ix Preface xi Special Acknowledgments xii General Acknowledgments xiii How to Contribute xv How to Use This Book xvii Selected USMLE Laboratory Values xviii First Aid Checklist for the USMLE Step 1 xx ` 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 Learning Strategies 10 Timeline for Study 14 Study Materials 17 Test-Taking Strategies 20 Clinical Vignette Strategies 21 If You Think You Failed 22 Testing Agencies 23 References 23 ` 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 25 ` 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 27 How to Use the Database 28 Biochemistry 31 Immunology 93 Microbiology 121 Pathology 201 Pharmacology 227 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 279 Approaching the Organ Systems 280 Cardiovascular 283 Endocrine 329 Gastrointestinal 363 Hematology and Oncology 409 Musculoskeletal, Skin, and Connective Tissue 449 Neurology and Special Senses 499 Psychiatry 569 Renal 595 Reproductive 629 Respiratory 677 Rapid Review 707 ` 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 739 How to Use the Database 740 Question Banks 742 Web and Mobile Apps 742 Comprehensive 743 Anatomy, Embryology, and Neuroscience 743 Behavioral Science 744 Biochemistry 744 Cell Biology and Histology 744 Microbiology and Immunology 744 Pathology 745 Pharmacology 745 Physiology 746 ` Abbreviations and Symbols 747 Image Acknowledgments 755 Index 773 About the Editors 828

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    vii Contributing Authors CHRISTIAN FAABORG-ANDERSEN, MD Resident, Department of Medicine Massachusetts General Hospital MORGAN BUCHANAN, MPH Emory University School of Medicine Class of 2025 ANTHONY G. CHESEBRO Renaissance School of Medicine, Stony Brook University MD/PhD candidate EMILY HAND St. George’s University School of Medicine, Grenada Class of 2024 KATHERINE LEBLANC, MSc University of Washington School of Medicine MD/PhD Candidate ANNA LIGOCKI, MD, MS Resident, Department of Medicine Ascension Saint Agnes Hospital FAATEH AHMAD RAUF, MBBS Resident, Department of Medicine ISMMS NYC Health+Hospitals/Queens CAROLINA CABAN RIVERA Lewis Katz School of Medicine at Temple University Class of 2025 JAIMIE LYNN ROGNER, MD, MPH Resident, Departments of Medicine and Pediatrics University of Rochester Medical Center GEORGIOS M. STERGIOPOULOS, MD Research Fellow, Department of Molecular Medicine Mayo Clinic, Minnesota I mage and I llustrat I on t eam YOOREE GRACE CHUNG Emory University School of Medicine MD/PhD Candidate TANYA KONDOLAY, MPH Aureus University School of Medicine MD Candidate NOAH NEWMAN, MD Resident, Department of Internal Medicine Emory University School of Medicine

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    viii Associate Authors MAKENNA ASH Emory University School of Medicine Class of 2025 MARGARET GINOZA, MD, MPH Resident, Internal Medicine–Pediatrics Baylor College of Medicine TALEAH KHAN, MBBS CMH Lahore Medical College and Institute of Dentistry, Pakistan PRABHAT POUDEL, MBBS Nepal Medical College Teaching Hospital, Nepal DANUSHA SANCHEZ, MD Resident, Department of Emergency Medicine Poznań University of Medical Sciences, Poland ADITYA SINGH, MBBS All India Institute of Medical Sciences, Raipur, India ANNABEL LU Emory University School of Medicine Class of 2024 I mage and I llustrat I on t eam AUBREY REED Emory University School of Medicine MD/PhD Candidate

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    ix Faculty Advisors RITU AMATYA FHI 360, Nepal MARK A.W. ANDREWS, PhD Professor and Founding Chairman, Department of Physiology Duquesne University College of Osteopathic Medicine MARIA ANTONELLI, MD Assistant Professor, Division of Rheumatology Case Western Reserve University at MetroHealth Medical Center, Cleveland SAMAN BENTOTA, MD Physician and Microbiologist Sri Lanka JOE B. BLUMER, PhD Associate Professor, Department of Pharmacology Medical University of South Carolina College of Medicine BRADLEY J. BRUGGEMAN, MD Assistant Professor, Obstetrics and Gynecology University of Florida College of Medicine CHRISTOPHER M. BURNS, PhD Professor of Basic Medical Sciences University of Arizona College of Medicine, Phoenix BROOKS D. CASH, MD Chief, Gastroenterology, Hepatology, and Nutrition University of Texas Health Science Center at Houston DIMITRI CASSIMATIS, MD Associate Professor, Department of Medicine Emory University School of Medicine CATHERINE CHILES, MD Associate Clinical Professor of Psychiatry Yale School of Medicine BRADLEY COLE, MD Assistant Professor of Neurology Loma Linda University School of Medicine CAROLINE COLEMAN, MD Assistant Professor, Department of Medicine Emory University School of Medicine MARTHA FANER, PhD Associate Professor of Biochemistry and Molecular Biology Michigan State University College of Osteopathic Medicine CONRAD FISCHER, MD Associate Professor, Medicine, Physiology, and Pharmacology Touro College of Medicine AYAKO WENDY FUJITA, MD Fellow, Division of Infectious Diseases Emory University School of Medicine RAYUDU GOPALAKRISHNA, PhD Professor, Department of Integrative Anatomical Sciences Keck School of Medicine of University of Southern California MEREDITH K. GREER, MD Assistant Professor, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine Emory University School of Medicine AMBER J. HECK, PhD Associate Professor, Department of Microbiology, Immunology, and Genetics University of North Texas Health Science Center, Fort Worth VASUDEVA G. KAMATH, MSc, PhD Assistant Professor of Biochemistry The University of Arizona College of Medicine, Phoenix CLARK KEBODEAUX, PharmD Clinical Associate Professor, Pharmacy Practice and Science University of Kentucky College of Pharmacy MATTHEW KRAYBILL, PhD Clinical Neuropsychologist Cottage Health, Santa Barbara, California GERALD LEE, MD Associate Professor, Departments of Pediatrics and Medicine Emory University School of Medicine KACHIU C. LEE, MD, MPH Assistant Professor (Adjunct), Department of Dermatology Lewis Katz School of Medicine at Temple University

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    x JAMES LYONS, MD Associate Dean, Professor of Pathology and Family Medicine Alabama College of Osteopathic Medicine NILADRI KUMAR MAHATO, MBBS, MS, PhD Assistant Professor of Anatomy Marian University College of Osteopathic Medicine, Indianapolis CARL MARFURT, PhD Professor Emeritus, Department of Anatomy, Cell Biology and Physiology Indiana University School of Medicine–Northwest, Gary PETER MARKS, MD, PhD Center for Biologics Evaluation and Research US Food and Drug Administration DOUGLAS A. MATA, MD, MPH Director of Molecular Pathology Foundation Medicine, Cambridge, Massachusetts SOROUSH RAIS-BAHRAMI, MD, MBA Professor of Urology and Radiology University of Alabama at Birmingham Heersink School of Medicine RICHARD P. RAMONELL, MD Assistant Professor of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine University of Pittsburgh School of Medicine KEISHA RAY, PhD Associate Professor, McGovern Center for Humanities and Ethics University of Texas Health Science Center at Houston SASAN SAKIANI, MD Assistant Professor of Medicine, Department of Medicine University of Maryland School of Medicine SARAH SCHIMANSKY, MB BCh BAO Resident, Department of Ophthalmology Bristol Eye Hospital NATHAN WM. SKELLEY, MD Associate Professor, Medical Director of Orthopaedic Surgery Sanford Health–University of South Dakota School of Medicine TONY SLIEMAN, PhD, MSc Associate Professor, Department of Basic Sciences New York Institute of Technology College of Osteopathic Medicine at Arkansas State University MATTHEW SOCHAT, MD Physician, Hematology/Oncology Southeastern Medical Oncology Center HOWARD M. STEINMAN, PhD Assistant Dean, Biomedical Science Education Albert Einstein College of Medicine JACQUELINE TRUONG, DPM, MPH Associate Professor, College of Podiatric Medicine Western University of Health Sciences RICHARD P. USATINE, MD Professor, Dermatology and Cutaneous Surgery University of Texas Health Science Center San Antonio SYLVIA WASSERTHEIL-SMOLLER, PhD Professor Emerita, Department of Epidemiology and Population Health Albert Einstein College of Medicine ADAM WEINSTEIN, MD Associate Professor of Medical Sciences and Pediatrics Frank H. Netter MD School of Medicine at Quinnipiac University ABHISHEK YADAV, MBBS, MSc Associate Professor, Department of Medicine Rutgers New Jersey Medical School KRISTAL YOUNG, MD Clinical Instructor, Department of Cardiology Huntington Hospital, Pasadena, California

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    xi Preface With the 34th 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 this exam. This edition represents an outstanding revision in many ways, including: ƒ 22 entirely new or heavily revised high-yield topics reflecting evolving trends in the USMLE Step 1. ƒ Extensive text revisions, new mnemonics, clarifications, and corrections curated by a team of 16 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. ƒ Updated with 81 new and revised diagrams and illustrations as part of our ongoing collaboration with USMLE-Rx and ScholarRx (MedIQ Learning, LLC). ƒ Updated with 21 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. ƒ Updated exam preparation advice, tailored for the current pass/fail scoring system and Step 1 blueprint changes. ƒ New advice on how to utilize emerging AI tools to increase studying efficiency. ƒ Updated photos of patients and pathologies to include a variety of skin colors to better depict real-world presentations. ƒ Improved organization and integration of text, illustrations, clinical images, and tables throughout for focused review of high-yield topics. ƒ Revised ratings of current, high-yield review resources, with clear explanations of their relevance to USMLE review. Replaced outdated resources with new ones recommended by Step takers. ƒ 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. xv.) Louisville Tao Le Boracay Vikas Bhushan Baltimore Connie Qiu London Anup Chalise Athens Panagiotis Kaparaliotis Atlanta Caroline Coleman Atlanta Sean Evans San Francisco Kimberly Kallianos

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    xii 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 . We provide special acknowledgment and thanks to the following individuals who made exemplary contributions to this edition through our voting, proofreading, and crowdsourcing platform: Yazmin Allegretti, Athanasios Angistriotis, and Nikitha Crasta. 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, Christina Thomas, Kristian Sanford, and Don Goyette. 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 Megan Chandler. Special thanks to our indexer, Dr. Anne Fifer. We are also grateful to our art manager, Susan Mazik, and illustrators, Stephanie Jones and Rachael Joy, for their creative work on the new and updated illustrations. Lastly, tremendous thanks to our compositor, GW Inc., especially Anne Banning, Gary Clark, Cindy Geiss, Denise Smith, Debra Clark, and Gabby Sullivan. Louisville Tao Le Boracay Vikas Bhushan Baltimore Connie Qiu London Anup Chalise Athens Panagiotis Kaparaliotis Atlanta Caroline Coleman Atlanta Sean Evans San Francisco Kimberly Kallianos

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    xiii 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 Ehsen Abdul-Kabir, Suleiman Jamal Abou Ramadan, Ghaith Abu-Hassan, Raghed Abu Jabeh, Ruby Abu Nassar, Suhaib Abusara, Rochana Acharya, Biplov Adhikari, Sumera Afzal-Tohid, Marium Aisha, Wahid Aloweiwi, Sajjad Altmimi, Mohammad Arabi, Laila Ashkar, Nabil Askar, Emily Babcock, Abdulrahman Bani-Yassin, Angelina Bania, Gabriella Barr, Shreya Bavishi, Heather Beyea, Karun Bhattarai, Pratik Bhattarai, Suzit Bhusal, Iuliia Bochinina, Stephanie Brown, Nicholas Buehler, Jack Carey, Paola Del Cueto, Amy Cunningham, Suyash Dawadi, Molly Dexter, Jeevan Divakaran, Manasa Dutta, Prabin Duwadee, Gian Ferrando, Talia Fradkin, Louna Ftouni, Aaron Goldman-Henley, Priyanka Goswami, Jackson Green, Ishan Gupta, Fariah Asha Haque Haque, Mariam Hassan, Shelly Colleen Heredia, Hung Ho, Rachel Holmes, Kaitlyn Hoyt, Samkit Jain, Subhah Jalil, Abdelrhman Muwafaq Janem, Julia Katcher, Avneet Kaur, Nadim Khutaba, Sourabh Kumar, Nery y Mara Lamothe, Guilherme Leite, Anna Marmalidou, Tanya Mateo, Juliana Maya, Nathan McDermott, Jose Antonio Meade, Shivani Mehta, Muhammed Mikaeel, Dylan Mittauer, Andrew Mohama, Gamble Morrison, Andrew Moya, Alexandra Jan Mrani, Waneeza Mughees, Ziad Nabil, Ezra Nadler, Shamsun Nahar, Sajjad Nazar Majeed, Antony Nemr, Hyder Nizamani, Sophie O’Hare, Charis Osiadi, Fahreddin Palaz, Sharon Pan, Archana Pandey, Abigail Poe, Emily Pompeo, Zoe Pujadas, Yochitha Pulipati, Nicholas Purvis, Denise Qyqja, Parul Rai, Yoshita Rao, Liran Raz, Eva Rest, Carol Sánchez Jiménez, Ridha Saad, Luke Schroeder, Sirous Seifirad, Muhammad Shahzaib, Amir Hossein Shams, Naimatullah Sharifi, Ajay Ajit Pal Singh, Ramzi Skaik, Swati Srivastava, Zargham Abbas Syed, Miranda Teixeira, Grayson Tishko, Hirak Trivedi, Ana Tsiklauri, Luis Vilatuna, Amanjot Virk, Stefani Wren, Richard Wu, and Hsinyu Yin. General Acknowledgments

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    xv This edition of First Aid for the USMLE Step 1 incorporates thousands of contributions and improvements suggested by student and faculty advisors. We invite you to participate in this process. Please send us your suggestions for: ƒ Study and test-taking strategies for the USMLE Step 1 ƒ New facts, mnemonics, diagrams, and clinical images ƒ High-yield topics that may appear on future Step 1 exams ƒ Personal ratings and comments on review books, question banks, apps, videos, and courses ƒ Pathology and radiology images (high resolution) relevant to the facts in the book For each new entry incorporated into the next edition, you will receive up to a $20 Amazon.com gift card as well as personal acknowledgment in the next edition. Significant contributions will be compensated at the discretion of the authors. Also, let us know about material in this edition that you feel is low yield and should be deleted. All submissions including potential errata should ideally be supported with hyperlinks to a dynamically updated Web resource such as UpToDate, AccessMedicine, and ClinicalKey . We welcome potential errata on grammar and style if the change improves readability. Please note that First Aid style is somewhat unique; for example, we have fully adopted the AMA Manual of Style recommendations on eponyms (“We recommend that the possessive form be omitted in eponymous terms”) and on abbreviations (no periods with eg, ie, etc). We also avoid periods in tables unless required for full sentences. Kindly refrain from submitting “style errata” unless you find specific inconsistencies with the AMA Manual of Style . The preferred way to submit new entries, clarifications, mnemonics, or potential corrections with a valid, authoritative reference is via our website: www.firstaidteam.com . This website will be continuously updated with validated errata, new high-yield content, and a new online platform to contribute suggestions, mnemonics, diagrams, clinical images, and potential errata. Alternatively, you can email us at: firstaid@scholarrx.com. Contributions submitted by May 15, 2024 , receive priority consideration for the 2025 edition of First Aid for the USMLE Step 1 . We thank you for taking the time to share your experience and apologize in advance that we cannot individually respond to all contributors as we receive thousands of contributions each year. How to Contribute

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    xvi ` 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 /ScholarRx team is pleased to offer paid editorial and coaching positions. We are looking for passionate, experienced, and dedicated medical students and recent graduates. Participants will have an opportunity to work on a wide variety of projects, including the popular First Aid series and the growing line of USMLE-Rx/ScholarRx products, including Rx Bricks. Please use our webform at https://www.usmle-rx.com/join-the-first-aid-team/ to apply, and include a CV and writing examples. For 2024, we are actively seeking passionate medical students and graduates with a specific interest in improving our medical illustrations, expanding our database of photographs (including clinical images depicting diverse skin types), 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.

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