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First_Aid_Step1. Restricted lung expansion causes  lung volumes ( FVC and TLC). PFTs:  FEV1/FVC ratio. Patient presents with short, shallow breaths. Types: Poor breathing mechanics (extrapulmonary, normal DLCO, normal A-a gradient): Poor muscular effort—polio, myasthenia gravis, Guillain-Barré syndrome Poor structural apparatus—scoliosis, morbid obesity Interstitial lung diseases (pulmonary,  DLCO,  A-a gradient): Pneumoconioses (eg, coal workers’ pneumoconiosis, silicosis, asbestosis) Sarcoidosis: bilateral hilar lymphadenopathy, noncaseating granulomas;  ACE and Ca2+ Idiopathic pulmonary fibrosis (repeated cycles of lung injury and wound healing with  collagen deposition, “honeycomb” lung appearance [red arrows in A ], traction bronchiectasis [blue arrow in A ] and digital clubbing). Granulomatosis with polyangiitis (Wegener) Drug toxicity (eg, bleomycin, busulfan, amiodarone, methotrexate)


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First_Aid_Step1. Granulomatosis with polyangiitis (Wegener) Drug toxicity (eg, bleomycin, busulfan, amiodarone, methotrexate) Hypersensitivity pneumonitis—mixed type III/IV hypersensitivity reaction to environmental antigen. Causes dyspnea, cough, chest tightness, fever, headache. Often seen in farmers and those exposed to birds. Reversible in early stages if stimulus is avoided.


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First_Aid_Step1. Sarcoidosis Characterized by immune-mediated, widespread noncaseating granulomas A , elevated serum ACE levels, and elevated CD4/CD8 ratio in bronchoalveolar lavage fluid. More common in African-American females. Often asymptomatic except for enlarged lymph nodes. CXR shows bilateral adenopathy and coarse reticular opacities B ; CT of the chest better demonstrates the extensive hilar and mediastinal adenopathy C . Associated with Bell palsy, Uveitis, Granulomas (noncaseating epithelioid, containing microscopic Schaumann and asteroid bodies), Lupus pernio (skin lesions on face resembling lupus), Interstitial fibrosis (restrictive lung disease), Erythema nodosum, Rheumatoid arthritis-like arthropathy, hypercalcemia (due to  1α-hydroxylase–mediated vitamin D activation in macrophages). A facial droop is UGLIER. Treatment: steroids (if symptomatic).


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First_Aid_Step1. Complication of inhalation of noxious stimuli (eg, smoke). Caused by heat, particulates (< 1 µm diameter), or irritants (eg, NH3)  chemical tracheobronchitis, edema, pneumonia, ARDS. Many patients present 2° to burns, CO inhalation, cyanide poisoning, or arsenic poisoning. Singed nasal hairs or soot in oropharynx common on exam. Bronchoscopy shows severe edema, congestion of bronchus, and soot deposition ( A , 18 hours after inhalation injury; B , resolution at 11 days after injury). Pneumoconioses Asbestos is from the roof (was common in insulation), but affects the base (lower lobes). Silica and coal are from the base (earth), but affect the roof (upper lobes). Asbestosis Associated with shipbuilding, roofing, plumbing. “Ivory white,” calcified, supradiaphragmatic A and pleural B plaques are pathognomonic of asbestosis. Risk of bronchogenic carcinoma > risk of mesothelioma.  risk of Caplan syndrome (rheumatoid arthritis and pneumoconioses with intrapulmonary nodules).


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First_Aid_Step1. Affects lower lobes. Asbestos (ferruginous) bodies are golden-brown fusiform rods resembling dumbbells C , found in alveolar sputum sample, visualized using Prussian blue stain, often obtained by bronchoalveolar lavage.  risk of pleural effusions. Berylliosis Associated with exposure to beryllium in Affects upper lobes. aerospace and manufacturing industries. Granulomatous (noncaseating) D on histology and therefore occasionally responsive to steroids.  risk of cancer and cor pulmonale. Mesothelioma Malignancy of the pleura associated with Psammoma bodies seen on histology. asbestosis. May result in hemorrhagic pleural Calretinin and cytokeratin 5/6 ⊕ in almost all effusion (exudative), pleural thickening A . mesotheliomas, ⊝ in most carcinomas. Smoking not a risk factor.


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First_Aid_Step1. PAThOPhYSIOlOgY Alveolar insult  release of pro-inflammatory cytokines  neutrophil recruitment, activation, and release of toxic mediators (eg, reactive oxygen species, proteases, etc)  capillary endothelial damage and  vessel permeability  leakage of protein-rich fluid into alveoli • formation of intra-alveolar hyaline membranes (arrows in A ) and noncardiogenic pulmonary edema (normal PCWP). Loss of surfactant also contributes to alveolar collapse. CAUSES Sepsis (most common), aspiration, pneumonia, trauma, pancreatitis. DIAgNOSIS Diagnosis of exclusion with the following criteria (ARDS): Respiratory failure within 1 week of alveolar insult Decreased Pao2/Fio2 (ratio < 300, hypoxemia due to  intrapulmonary shunting and diffusion abnormalities) Symptoms of respiratory failure are not due to HF/fluid overload CONSEQUENCES Impaired gas exchange,  lung compliance; pulmonary hypertension.


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First_Aid_Step1. Symptoms of respiratory failure are not due to HF/fluid overload CONSEQUENCES Impaired gas exchange,  lung compliance; pulmonary hypertension. mANAgEmENT Treat the underlying cause. Mechanical ventilation:  tidal volume, • PEEP. Sleep apnea Repeated cessation of breathing > 10 seconds during sleep  disrupted sleep  daytime somnolence. Diagnosis confirmed by sleep study. Nocturnal hypoxia • systemic/pulmonary hypertension, arrhythmias (atrial fibrillation/flutter), sudden death. Hypoxia  EPO release  erythropoiesis. Central sleep apnea Impaired respiratory effort due to CNS injury/toxicity, HF, opioids. May be associated with Cheyne-Stokes respirations (oscillations between apnea and hyperpnea). Think 3 C’s: Congestive HF, CNS toxicity, Cheyne-Stokes respirations. Treat with positive airway pressure.


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First_Aid_Step1. Obesity Obesity (BMI ≥ 30 kg/m2)  hypoventilation • Paco2 during waking hours (retention); • Pao2 hypoventilation and • Paco2 during sleep. Also known as Pickwickian syndrome. syndrome Normal mean pulmonary artery pressure = 10–14 mm Hg; pulmonary hypertension ≥ 25 mm Hg at rest. Results in arteriosclerosis, medial hypertrophy, intimal fibrosis of pulmonary arteries, plexiform lesions. Course: severe respiratory distress • cyanosis and RVH • death from decompensated cor pulmonale. Pleural effusion • Dull • None if small Away from side of lesion if large Atelectasis • Dull • Toward side of lesion Tension • Hyperresonant • Away from side of lesion pneumothorax Atelectasis Alveolar collapse (right upper lobe collapse against mediastinum in A ). Multiple causes: Obstructive—airway obstruction prevents new air from reaching distal airways, old air is resorbed (eg, foreign body, mucous plug, tumor)


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First_Aid_Step1. Obstructive—airway obstruction prevents new air from reaching distal airways, old air is resorbed (eg, foreign body, mucous plug, tumor) Compressive—external compression on lung decreases lung volumes (eg, space-occupying lesion, pleural effusion) Contraction (cicatrization)—scarring of lung parenchyma that distorts alveoli (eg, sarcoidosis) Adhesive—due to lack of surfactant (eg, NRDS in premature babies) Pleural e˜usion, Scarring air, tumor Pleural effusions Excess accumulation of fluid A between pleural layers  restricted lung expansion during inspiration. Can be treated with thoracentesis to remove/reduce fluid B . Lymphatic Also known as chylothorax. Due to thoracic duct injury from trauma or malignancy. Milkyappearing fluid;  triglycerides.


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First_Aid_Step1. Lymphatic Also known as chylothorax. Due to thoracic duct injury from trauma or malignancy. Milkyappearing fluid;  triglycerides. Exudate  protein content (> 2.9 g/dL), cloudy (cellular). Due to malignancy, inflammation/infection (eg, pneumonia, collagen vascular disease), trauma (occurs in states of  vascular permeability). Must be drained due to risk of infection. Transudate  protein content (< 2.5 g/dL), clear (hypocellular). Due to  hydrostatic pressure (eg, HF, Na+ retention) or  oncotic pressure (eg, nephrotic syndrome, cirrhosis). Pneumothorax Accumulation of air in pleural space A . Dyspnea, uneven chest expansion. Chest pain,  tactile fremitus, hyperresonance, and diminished breath sounds, all on the affected side. Primary spontaneous Due to rupture of apical subpleural bleb or cysts. Occurs most frequently in tall, thin, young males pneumothorax and smokers.


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First_Aid_Step1. Primary spontaneous Due to rupture of apical subpleural bleb or cysts. Occurs most frequently in tall, thin, young males pneumothorax and smokers. Traumatic Caused by blunt (eg, rib fracture), penetrating (eg, gunshot), or iatrogenic (eg, central line pneumothorax placement, lung biopsy, barotrauma due to mechanical ventilation) trauma. Can be from any of the above. Air enters pleural space but cannot exit. Increasing trapped air • tension pneumothorax. Trachea deviates away from affected lung B . May lead to increased intrathoracic pressure • mediastinal displacement  kinking of IVC  venous return  cardiac output. Needs immediate needle decompression and chest tube placement. Lobar pneumonia S pneumoniae most frequently, also Legionella, Intra-alveolar exudate • consolidation A ; may Klebsiella involve entire lobe B or the whole lung.


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First_Aid_Step1. Lobar pneumonia S pneumoniae most frequently, also Legionella, Intra-alveolar exudate • consolidation A ; may Klebsiella involve entire lobe B or the whole lung. Etiology unknown. Secondary organizing pneumonia is caused by chronic inflammatory diseases (eg, rheumatoid arthritis) or medication side effects (eg, amiodarone). ⊝ sputum and blood cultures, often responds to steroids but not to antibiotics. Formerly known as bronchiolitis obliterans organizing pneumonia (BOOP). Noninfectious pneumonia characterized by inflammation of bronchioles and surrounding structure. Natural history of lobar pneumonia


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First_Aid_Step1. Natural history of lobar pneumonia Lung cancer Leading cause of cancer death. Presentation: cough, hemoptysis, bronchial obstruction, wheezing, pneumonic “coin” lesion on CXR or noncalcified nodule on CT. Sites of metastases from lung cancer: Liver (jaundice, hepatomegaly), Adrenals, Bone (pathologic fracture), Brain; “Lung ‘mets’ Love Affective Boneheads and Brainiacs.” In the lung, metastases (usually multiple lesions) are more common than 1° neoplasms. Most often from breast, colon, prostate, and bladder cancer. SPHERE of complications: Superior vena cava/thoracic outlet syndromes Pancoast tumor Horner syndrome Endocrine (paraneoplastic) Recurrent laryngeal nerve compression Risk factors include smoking, secondhand smoke, radon, asbestos, family history. Squamous and Small cell carcinomas are Sentral (central) and often caused by Smoking.


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First_Aid_Step1. Risk factors include smoking, secondhand smoke, radon, asbestos, family history. Squamous and Small cell carcinomas are Sentral (central) and often caused by Smoking. TYPE lOCATION ChARACTERISTICS hISTOlOgY Small cell Small cell (oat cell) carcinoma Central Undifferentiated  very aggressive. May produce ACTH (Cushing syndrome), ADH (SIADH), or Antibodies against presynaptic Ca2+ channels (Lambert-Eaton myasthenic syndrome) or neurons (paraneoplastic myelitis, encephalitis, subacute cerebellar degeneration). Amplification of myc oncogenes common. Managed with chemotherapy +/– radiation. Neoplasm of neuroendocrine Kulchitsky cells  small dark blue cells A . Chromogranin A ⊕, neuron-specific enolase ⊕, synaptophysin ⊕. Non-small cell


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First_Aid_Step1. Adenocarcinoma Peripheral Most common 1° lung cancer. More common in women than men, most likely to arise in nonsmokers. Activating mutations include KRAS, EGFR, and ALK. Associated with hypertrophic osteoarthropathy (clubbing). Bronchioloalveolar subtype (adenocarcinoma in situ): CXR often shows hazy infiltrates similar to pneumonia; better prognosis. Glandular pattern on histology, often stains mucin ⊕ B . Bronchioloalveolar subtype: grows along alveolar septa  apparent “thickening” of alveolar walls. Tall, columnar cells containing mucus. Squamous cell carcinoma Central Hilar mass C arising from bronchus; Cavitation; Cigarettes; hyperCalcemia (produces PTHrP). Keratin pearls D and intercellular bridges. Large cell carcinoma Peripheral Highly anaplastic undifferentiated tumor; poor prognosis. Less responsive to chemotherapy; removed surgically. Strong association with smoking. Pleomorphic giant cells E . Localized collection of pus within parenchyma


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First_Aid_Step1. Localized collection of pus within parenchyma A . Caused by aspiration of oropharyngeal contents (especially in patients predisposed to loss of consciousness [eg, alcoholics, epileptics]) or bronchial obstruction (eg, cancer). B often seen on CXR; presence suggests cavitation. Due to anaerobes (eg, Bacteroides, Fusobacterium, Peptostreptococcus) or S aureus. Treatment: antibiotics, drainage, or surgery. Lung abscess 2° to aspiration is most often found in right lung. Location depends on patient’s position during aspiration: RLL if upright, RUL or RML if recumbent. Pancoast tumor Also known as superior sulcus tumor. Carcinoma that occurs in the apex of lung A may cause Pancoast syndrome by invading/compressing local structures. Compression of locoregional structures may cause array of findings: Stellate ganglion • Horner syndrome (ipsilateral ptosis, miosis, anhidrosis)


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First_Aid_Step1. Stellate ganglion • Horner syndrome (ipsilateral ptosis, miosis, anhidrosis) An obstruction of the SVC that impairs blood drainage from the head (“facial plethora”; note blanching after fingertip pressure in A ), neck (jugular venous distention), and upper extremities (edema). Commonly caused by malignancy (eg, mediastinal mass, Pancoast tumor) and thrombosis from indwelling catheters B . Medical emergency. Can raise intracranial pressure (if obstruction is severe) • headaches, dizziness,  risk of aneurysm/ rupture of intracranial arteries. Histamine-1 blockers Reversible inhibitors of H1 histamine receptors. First generation Diphenhydramine, dimenhydrinate, Names usually contain “-en/-ine” or “-en/-ate.” chlorpheniramine, doxylamine. ClINICAl USE Allergy, motion sickness, sleep aid. ADVERSE EFFECTS Sedation, antimuscarinic, anti-α-adrenergic. Second generation Loratadine, fexofenadine, desloratadine, Names usually end in “-adine.” cetirizine. ClINICAl USE Allergy.


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First_Aid_Step1. ADVERSE EFFECTS Sedation, antimuscarinic, anti-α-adrenergic. Second generation Loratadine, fexofenadine, desloratadine, Names usually end in “-adine.” cetirizine. ClINICAl USE Allergy. ADVERSE EFFECTS Far less sedating than 1st generation because of  entry into CNS. Guaifenesin Expectorant—thins respiratory secretions; does not suppress cough reflex. N-acetylcysteine Mucolytic—liquifies mucus in chronic bronchopulmonary diseases (eg, COPD, CF) by disrupting disulfide bonds. Also used as an antidote for acetaminophen overdose. Dextromethorphan Antitussive (antagonizes NMDA glutamate receptors). Synthetic codeine analog. Has mild opioid effect when used in excess. Naloxone can be given for overdose. Mild abuse potential. May cause serotonin syndrome if combined with other serotonergic agents. Pseudoephedrine, phenylephrine mEChANISm α-adrenergic agonists. ClINICAl USE Reduce hyperemia, edema (used as nasal decongestants); open obstructed eustachian tubes.


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First_Aid_Step1. Pseudoephedrine, phenylephrine mEChANISm α-adrenergic agonists. ClINICAl USE Reduce hyperemia, edema (used as nasal decongestants); open obstructed eustachian tubes. ADVERSE EFFECTS Hypertension. Rebound congestion if used more than 4–6 days. Can also cause CNS stimulation/ anxiety (pseudoephedrine). therapy IgE and blocks binding to FcεRI. Used in allergic asthma with  IgE levels resistant to inhaled steroids and long-acting β2-agonists. (leukotrienes, histamine, interleukins, etc) due to  cAMP hydrolysis. Limited use due to narrow therapeutic index (cardiotoxicity, neurotoxicity); metabolized by cytochrome ˜-agonists P-450. Blocks actions of adenosine. Muscarinic Chromones Cromolyn—prevents mast cell degranulation. antagonists Prevents acute asthma symptoms. Rarely used.


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First_Aid_Step1. P-450. Blocks actions of adenosine. Muscarinic Chromones Cromolyn—prevents mast cell degranulation. antagonists Prevents acute asthma symptoms. Rarely used. Anti-IL-5 monoclonal Prevents eosinophil differentiation, maturation, therapy activation, and survival mediated by IL-5 Early response: Late response: stimulation. For maintenance therapy in severe eosinophilic asthma. Mepolizumab, reslizumab—against IL-5. Benralizumab—against IL-5 receptor α. “Study without thought is vain: thought without study is dangerous.” “It is better, of course, to know useless things than to know nothing.” “For every complex problem there is an answer that is clear, simple, and wrong.” —H. L. Mencken The following tables represent a collection of high-yield associations between diseases and their clinical findings, treatments, and key associations. They can be quickly reviewed in the days before the exam.


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First_Aid_Step1. Gout, intellectual disability, self-mutilating behavior in a Lesch-Nyhan syndrome (HGPRT deficiency, X-linked 37 boy recessive) Arachnodactyly, lens dislocation (upward and temporal), Marfan syndrome (fibrillin defect) 52 aortic dissection, hyperflexible joints Calf pseudohypertrophy Muscular dystrophy (most commonly Duchenne, due to 61 X-linked recessive frameshift mutation of dystrophin gene) Child uses arms to stand up from squat Duchenne muscular dystrophy (Gowers sign) 61 Slow, progressive muscle weakness in boys Becker muscular dystrophy (X-linked non-frameshift 61 deletions in dystrophin; less severe than Duchenne) Infant with cleft lip/palate, microcephaly or Patau syndrome (trisomy 13) 63 holoprosencephaly, polydactyly, cutis aplasia Infant with microcephaly, rocker-bottom feet, clenched Edwards syndrome (trisomy 18) 63 hands, and structural heart defect Dilated cardiomyopathy, edema, alcoholism or Wet beriberi (thiamine [vitamin B1] deficiency) 66 malnutrition


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First_Aid_Step1. Dilated cardiomyopathy, edema, alcoholism or Wet beriberi (thiamine [vitamin B1] deficiency) 66 malnutrition Dermatitis, dementia, diarrhea Pellagra (niacin [vitamin B3] deficiency) 67 Swollen gums, mucosal bleeding, poor wound healing, Scurvy (vitamin C deficiency: can’t hydroxylate proline/ 69 petechiae lysine for collagen synthesis) Chronic exercise intolerance with myalgia, fatigue, McArdle disease (skeletal muscle glycogen phosphorylase 87 painful cramps, myoglobinuria deficiency) Infant with hypoglycemia, hepatomegaly Cori disease (debranching enzyme deficiency) or Von 87 Gierke disease (glucose-6-phosphatase deficiency, more severe) Myopathy (infantile hypertrophic cardiomyopathy), Pompe disease (lysosomal α-1,4-glucosidase deficiency) 88 (sphingomyelin accumulation), central retinal artery occlusion Hepatosplenomegaly, pancytopenia, osteoporosis, Gaucher disease (glucocerebrosidase [β-glucosidase] avascular necrosis of femoral head, bone crises deficiency)


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First_Aid_Step1. Hepatosplenomegaly, pancytopenia, osteoporosis, Gaucher disease (glucocerebrosidase [β-glucosidase] avascular necrosis of femoral head, bone crises deficiency) Male child, recurrent infections, no mature B cells Bruton disease (X-linked agammaglobulinemia) Recurrent cold (noninflamed) abscesses, eczema, high Hyper-IgE syndrome (Job syndrome: neutrophil 116 serum IgE,  eosinophils chemotaxis abnormality) “Strawberry tongue” Scarlet fever 136, Kawasaki disease 314 Abdominal pain, diarrhea, leukocytosis, recent antibiotic Clostridium difficile infection Back pain, fever, night sweats Pott disease (vertebral TB) Adrenal hemorrhage, hypotension, DIC Waterhouse-Friderichsen syndrome (meningococcemia) 142, 349 Large rash with bull’s-eye appearance Erythema migrans from Ixodes tick bite (Lyme disease: 146 Borrelia) Ulcerated genital lesion Nonpainful, indurated: chancre (1° syphilis, Treponema 147, pallidum) 184 Painful, with exudate: chancroid (Haemophilus ducreyi)


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First_Aid_Step1. Ulcerated genital lesion Nonpainful, indurated: chancre (1° syphilis, Treponema 147, pallidum) 184 Painful, with exudate: chancroid (Haemophilus ducreyi) Smooth, moist, painless, wart-like white lesions on Condylomata lata (2° syphilis) 147 genitals Fever, chills, headache, myalgia following antibiotic Jarisch-Herxheimer reaction (rapid lysis of spirochetes 148 treatment for syphilis results in endotoxin-like release) Dog or cat bite resulting in infection Pasteurella multocida (cellulitis at inoculation site) 149 Rash on palms and soles Coxsackie A, 2° syphilis, Rocky Mountain spotted fever 150 Black eschar on face of patient with diabetic ketoacidosis Mucor or Rhizopus fungal infection 153 Chorioretinitis, hydrocephalus, intracranial calcifications Congenital toxoplasmosis 156 Child with fever later develops red rash on face that Erythema infectiosum/fifth disease (“slapped cheeks” 164 spreads to body appearance, caused by parvovirus B19)


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First_Aid_Step1. Child with fever later develops red rash on face that Erythema infectiosum/fifth disease (“slapped cheeks” 164 spreads to body appearance, caused by parvovirus B19) Fever, cough, conjunctivitis, coryza, diffuse rash Measles 170 Small, irregular red spots on buccal/lingual mucosa with Koplik spots (measles [rubeola] virus) 170 blue-white centers Bounding pulses, wide pulse pressure, diastolic heart Aortic regurgitation 291 murmur, head bobbing Continuous “machine-like” heart murmur PDA (close with indomethacin; keep open with PGE Chest pain on exertion Angina (stable: with moderate exertion; unstable: with 304 Chest pain, pericardial effusion/friction rub, persistent Dressler syndrome (autoimmune-mediated post-MI Chest pain with ST depressions on ECG Angina (⊝ troponins) or NSTEMI (⊕ troponins) 307 fever following MI fibrinous pericarditis, 2 weeks to several months after acute episode)


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First_Aid_Step1. Chest pain with ST depressions on ECG Angina (⊝ troponins) or NSTEMI (⊕ troponins) 307 fever following MI fibrinous pericarditis, 2 weeks to several months after acute episode) Painful, raised red lesions on pads of fingers/toes Osler nodes (infective endocarditis, immune complex Painless erythematous lesions on palms and soles Janeway lesions (infective endocarditis, septic emboli/ 311 microabscesses) Retinal hemorrhages with pale centers Roth spots (bacterial endocarditis) Distant heart sounds, distended neck veins, hypotension Beck triad of cardiac tamponade Cervical lymphadenopathy, desquamating rash, coronary Kawasaki disease (mucocutaneous lymph node syndrome, 314 aneurysms, red conjunctivae and tongue, hand-foot treat with IVIG and aspirin) changes Palpable purpura on buttocks/legs, joint pain, abdominal Immunoglobulin A vasculitis (Henoch-Schönlein 315 pain (child), hematuria purpura, affects skin and kidneys)


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First_Aid_Step1. Palpable purpura on buttocks/legs, joint pain, abdominal Immunoglobulin A vasculitis (Henoch-Schönlein 315 pain (child), hematuria purpura, affects skin and kidneys) Telangiectasias, recurrent epistaxis, skin discoloration, Hereditary hemorrhagic telangiectasia (Osler-Weber-316 arteriovenous malformations, GI bleeding, hematuria Rendu syndrome) Skin hyperpigmentation, hypotension, fatigue 1° adrenocortical insufficiency  ACTH, • α-MSH (eg, 349 Addison disease) Cutaneous flushing, diarrhea, bronchospasm Carcinoid syndrome (right-sided cardiac valvular lesions, 352 • 5-HIAA) Cold intolerance, weight gain, brittle hair Hypothyroidism 341 Cutaneous/dermal edema due to deposition of Myxedema (caused by hypothyroidism, Graves disease 340 mucopolysaccharides in connective tissue [pretibial]) No lactation postpartum, absent menstruation, cold Sheehan syndrome (postpartum hemorrhage leading to 339 intolerance pituitary infarction)


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First_Aid_Step1. No lactation postpartum, absent menstruation, cold Sheehan syndrome (postpartum hemorrhage leading to 339 intolerance pituitary infarction) Deep, labored breathing/hyperventilation Diabetic ketoacidosis (Kussmaul respirations) 347 Pancreatic, pituitary, parathyroid tumors MEN 1 (autosomal dominant) 351 Thyroid tumors, pheochromocytoma, MEN 2B (autosomal dominant RET mutation) 351 ganglioneuromatosis, Marfanoid habitus Thyroid and parathyroid tumors, pheochromocytoma MEN 2A (autosomal dominant RET mutation) 351 Jaundice, palpable distended non-tender gallbladder Courvoisier sign (distal malignant obstruction of biliary 398 tree) Vomiting blood following gastroesophageal lacerations Mallory-Weiss syndrome (alcoholic and bulimic patients) 377 Dysphagia (esophageal webs), glossitis, iron deficiency Plummer-Vinson syndrome (may progress to esophageal 377 anemia squamous cell carcinoma) Enlarged, hard left supraclavicular node Virchow node (abdominal metastasis) 379


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First_Aid_Step1. Enlarged, hard left supraclavicular node Virchow node (abdominal metastasis) 379 Arthralgias, adenopathy, cardiac and neurological Whipple disease (Tropheryma whipplei) symptoms, diarrhea Severe RLQ pain with palpation of LLQ Rovsing sign (acute appendicitis) Severe RLQ pain with deep tenderness McBurney sign (acute appendicitis) Hamartomatous GI polyps, hyperpigmented macules on Peutz-Jeghers syndrome (inherited, benign polyposis can 387 mouth, feet, hands, genitalia cause bowel obstruction;  cancer risk, mainly GI) Multiple colon polyps, osteomas/soft tissue tumors, Gardner syndrome (subtype of FAP) Abdominal pain, ascites, hepatomegaly Budd-Chiari syndrome (posthepatic venous thrombosis) 392 Hyperphagia, hypersexuality, hyperorality Klüver-Bucy syndrome (bilateral amygdala lesion) Resting tremor, athetosis, chorea Basal ganglia lesion “Worst headache of my life” Subarachnoid hemorrhage


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First_Aid_Step1. Hyperphagia, hypersexuality, hyperorality Klüver-Bucy syndrome (bilateral amygdala lesion) Resting tremor, athetosis, chorea Basal ganglia lesion “Worst headache of my life” Subarachnoid hemorrhage Resting tremor, rigidity, akinesia, postural instability, Parkinson disease (loss of dopaminergic neurons in Chorea, dementia, caudate degeneration Huntington disease (autosomal dominant CAG repeat 520 expansion) Nystagmus, intention tremor, scanning speech, bilateral Multiple sclerosis 523 internuclear ophthalmoplegia Café-au-lait spots, Lisch nodules (iris hamartoma), Neurofibromatosis type I 525 cutaneous neurofibromas, pheochromocytomas, optic gliomas Vascular birthmark (port-wine stain) of the face Nevus flammeus (benign, but associated with Sturge-525 Weber syndrome) Renal cell carcinoma (bilateral), hemangioblastomas, von Hippel-Lindau disease (dominant tumor suppressor 525 angiomatosis, pheochromocytoma gene mutation)


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First_Aid_Step1. Renal cell carcinoma (bilateral), hemangioblastomas, von Hippel-Lindau disease (dominant tumor suppressor 525 angiomatosis, pheochromocytoma gene mutation) Hyperreflexia, hypertonia, Babinski sign present UMN damage 529 Hyporeflexia, hypotonia, atrophy, fasciculations LMN damage 529 Spastic weakness, sensory loss, bowel/bladder dysfunction Spinal cord lesion 530 Unilateral facial drooping involving forehead LMN facial nerve (CN VII) palsy; UMN lesions spare the 532 forehead Episodic vertigo, tinnitus, hearing loss Ménière disease 534 Ptosis, miosis, anhidrosis Horner syndrome (sympathetic chain lesion) 540 Conjugate horizontal gaze palsy, horizontal diplopia Internuclear ophthalmoplegia (damage to MLF; may be 543 unilateral or bilateral) Polyuria, renal tubular acidosis type II, growth failure, Fanconi syndrome (multiple combined dysfunction of the 586 electrolyte imbalances, hypophosphatemic rickets proximal convoluted tubule)


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First_Aid_Step1. Polyuria, renal tubular acidosis type II, growth failure, Fanconi syndrome (multiple combined dysfunction of the 586 electrolyte imbalances, hypophosphatemic rickets proximal convoluted tubule) Athlete with polycythemia 2° to erythropoietin injection Periorbital and/or peripheral edema, proteinuria (> 3.5g/ Nephrotic syndrome day), hypoalbuminemia, hypercholesterolemia Hereditary nephritis, sensorineural hearing loss, Alport syndrome (mutation in collagen IV) retinopathy, lens dislocation Streak ovaries, congenital heart disease, horseshoe kidney, Turner syndrome (45,XO) 638 cystic hygroma at birth, short stature, webbed neck, lymphedema Red, itchy, swollen rash of nipple/areola Paget disease of the breast (sign of underlying neoplasm) 650 Fibrous plaques in tunica albuginea of penis with Peyronie disease (connective tissue disorder) 651 abnormal curvature Hypoxemia, polycythemia, hypercapnia Chronic bronchitis (hyperplasia of mucous cells, “blue


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First_Aid_Step1. Hypoxemia, polycythemia, hypercapnia Chronic bronchitis (hyperplasia of mucous cells, “blue Pink complexion, dyspnea, hyperventilation Emphysema (“pink puffer,” centriacinar [smoking] or Bilateral hilar adenopathy, uveitis Sarcoidosis (noncaseating granulomas)  AFP in amniotic fluid/maternal serum Down syndrome, Edwards syndrome 63 Large granules in phagocytes, immunodeficiency Chédiak-Higashi disease (congenital failure of 117 phagolysosome formation) Recurrent infections, eczema, thrombocytopenia Wiskott-Aldrich syndrome 117 Optochin sensitivity Sensitive: S pneumoniae; resistant: viridans streptococci 134 (S mutans, S sanguis) Novobiocin response Sensitive: S epidermidis; resistant: S saprophyticus 134 Bacitracin response Sensitive: S pyogenes (group A); resistant: S agalactiae 134 (group B) Branching gram ⊕ rods with sulfur granules Actinomyces israelii 139


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First_Aid_Step1. Branching gram ⊕ rods with sulfur granules Actinomyces israelii 139 Hilar lymphadenopathy, peripheral granulomatous lesion Ghon complex (1° TB: Mycobacterium bacilli) 140 in middle or lower lung lobes (can calcify) Cardiomegaly with apical atrophy Chagas disease (Trypanosoma cruzi) 158 Enlarged cells with intranuclear inclusion bodies “Owl eye” appearance of CMV 165 Eosinophilic globule in liver Councilman body (viral hepatitis, yellow fever), represents 168 hepatocyte undergoing apoptosis Eosinophilic inclusion bodies in cytoplasm of Negri bodies of rabies Ring-enhancing brain lesion on CT/MRI in AIDS Toxoplasma gondii, CNS lymphoma Psammoma bodies Meningiomas, papillary thyroid carcinoma, 211 mesothelioma, papillary serous carcinoma of the


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First_Aid_Step1. Ring-enhancing brain lesion on CT/MRI in AIDS Toxoplasma gondii, CNS lymphoma Psammoma bodies Meningiomas, papillary thyroid carcinoma, 211 mesothelioma, papillary serous carcinoma of the Sheets of medium-sized lymphoid cells with scattered Burkitt lymphoma (t[8:14] c-myc activation, associated 430 pale, tingible body–laden macrophages (“starry sky” with EBV; “starry sky” made up of malignant cells) histology) • Monoclonal gammopathy of undetermined significance (MGUS consequence of aging) Stacks of RBCs Rouleaux formation (high ESR, multiple myeloma) 423 Azurophilic peroxidase ⊕ granular inclusions in Auer rods (AML, especially the promyelocytic [M3] type) 432 granulocytes and myeloblasts “Brown” tumor of bone Hyperparathyroidism or osteitis fibrosa cystica (deposited 464 hemosiderin from hemorrhage gives brown color) “Soap bubble” in femur or tibia on x-ray Giant cell tumor of bone (generally benign) 464


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First_Aid_Step1. Raised periosteum (creating a “Codman triangle”) Aggressive bone lesion (eg, osteosarcoma, Ewing 465 sarcoma, osteomyelitis) “Onion skin” periosteal reaction Ewing sarcoma (malignant small blue cell tumor) 465 Anti-IgG antibodies Rheumatoid arthritis (systemic inflammation, joint 466 pannus, boutonniere and swan neck deformities) Rhomboid crystals, ⊕ birefringent Pseudogout (calcium pyrophosphate dihydrate crystals) 467 Needle-shaped, ⊝ birefringent crystals Gout (monosodium urate crystals) 467  uric acid levels Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, 467 loop and thiazide diuretics “Bamboo spine” on x-ray Ankylosing spondylitis (chronic inflammatory arthritis: 469 HLA-B27) Antinuclear antibodies (ANAs: anti-Smith and anti-SLE (type III hypersensitivity) 470 dsDNA) Anti-histone antibodies Drug-induced SLE (eg, hydralazine, isoniazid, 250 phenytoin, procainamide)


First_Aid_Step1

First_Aid_Step1. Antinuclear antibodies (ANAs: anti-Smith and anti-SLE (type III hypersensitivity) 470 dsDNA) Anti-histone antibodies Drug-induced SLE (eg, hydralazine, isoniazid, 250 phenytoin, procainamide) Bloody or yellow tap on lumbar puncture Xanthochromia (due to subarachnoid hemorrhage) 513 Eosinophilic cytoplasmic inclusion in neuron Lewy body (Parkinson disease and Lewy body dementia) 520 Extracellular amyloid deposition in gray matter of brain Senile plaques (Alzheimer disease) Depigmentation of neurons in substantia nigra Parkinson disease (basal ganglia disorder: rigidity, resting 520 tremor, bradykinesia) Silver-staining spherical aggregation of tau proteins in Pick bodies (Pick disease: progressive dementia, changes 520 neurons in personality) Streptococcus pneumoniae Penicillin/cephalosporin (systemic infection, pneumonia), 187, vancomycin (meningitis) 190


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First_Aid_Step1. Streptococcus pneumoniae Penicillin/cephalosporin (systemic infection, pneumonia), 187, vancomycin (meningitis) 190 Staphylococcus aureus MSSA: nafcillin, oxacillin, dicloxacillin 188, (antistaphylococcal penicillins); MRSA: vancomycin, 190, daptomycin, linezolid, ceftaroline 195 Enterococci Vancomycin, aminopenicillins/cephalosporins 189, 190 Rickettsia rickettsii Doxycycline, chloramphenicol 192 Clostridium difficile Oral metronidazole; if refractory, oral vancomycin 190, 195 Mycobacterium tuberculosis RIPE (rifampin, isoniazid, pyrazinamide, ethambutol) 196 Influenza Oseltamivir, zanamivir 201 CMV Ganciclovir, foscarnet, cidofovir 202 Patent ductus arteriosus Close with indomethacin; keep open with PGE analogs 282 Stable angina Sublingual nitroglycerin 304 Kawasaki disease IVIG, aspirin 314 Granulomatosis with polyangiitis (Wegener) Cyclophosphamide, corticosteroids 315


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First_Aid_Step1. Kawasaki disease IVIG, aspirin 314 Granulomatosis with polyangiitis (Wegener) Cyclophosphamide, corticosteroids 315 Arrhythmia in damaged cardiac tissue Class IB antiarrhythmic (lidocaine, mexiletine) 322 Prolactinoma Cabergoline/bromocriptine (dopamine agonists) 330 Diabetes insipidus Desmopressin (central); hydrochlorothiazide, 338 indomethacin, amiloride (nephrogenic) SIADH Fluid restriction, IV hypertonic saline, conivaptan/ 338 tolvaptan, demeclocycline Diabetic ketoacidosis Fluids, insulin, K+ 347 Diabetes mellitus type 2 Dietary intervention, oral hypoglycemics, and insulin (if 347 refractory) Pheochromocytoma α-antagonists (eg, phenoxybenzamine) Crohn disease Corticosteroids, infliximab, azathioprine Ulcerative colitis 5-ASA preparations (eg, mesalamine), 6-mercaptopurine, 382 infliximab, colectomy Acute promyelocytic leukemia (M3) All-trans retinoic acid, arsenic trioxide Drug of choice for anticoagulation in pregnancy or renal Low-molecular-weight heparin


First_Aid_Step1

First_Aid_Step1. Acute promyelocytic leukemia (M3) All-trans retinoic acid, arsenic trioxide Drug of choice for anticoagulation in pregnancy or renal Low-molecular-weight heparin Long-term anticoagulation Warfarin, dabigatran, rivaroxaban and apixaban 436, 437 Warfarin reversal Fresh frozen plasma (acute), vitamin K (non-acute) 436 Osteoporosis Calcium/vitamin D supplementation (prophylaxis); 462 bisphosphonates, PTH analogs, SERMs, calcitonin, denosumab (treatment) Chronic gout Xanthine oxidase inhibitors (eg, allopurinol, febuxostat); 467 pegloticase; probenecid Acute gout attack NSAIDs, colchicine, glucocorticoids 467 Migraine Abortive therapies (eg, sumatriptan, NSAIDs); prophylaxis 518 (eg, propranolol, topiramate, CCBs, amitriptyline) Multiple sclerosis Disease-modifying therapies (eg, β-interferon, 523 natalizumab); for acute flares, use IV steroids Tonic-clonic seizures Levetiracetam, phenytoin, valproate, carbamazepine 544 Anorexia Nutrition, psychotherapy, SSRIs 567


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First_Aid_Step1. Tonic-clonic seizures Levetiracetam, phenytoin, valproate, carbamazepine 544 Anorexia Nutrition, psychotherapy, SSRIs 567 Alcoholism Disulfiram, acamprosate, naltrexone, supportive care 571 ADHD Methylphenidate, amphetamines, CBT, atomoxetine, guanfacine, clonidine Bipolar disorder Mood stabilizers (eg, lithium, valproic acid, carbamazepine), atypical antipsychotics Generalized anxiety disorder SSRIs, SNRIs (first line); buspirone (second line) Benign prostatic hyperplasia α1-antagonists, 5α-reductase inhibitors, PDE-5 inhibitors 654 Infertility Leuprolide, GnRH (pulsatile), clomiphene Prostate adenocarcinoma/uterine fibroids Leuprolide, GnRH (continuous) Erectile dysfunction Sildenafil, tadalafil, vardenafil 686 Pulmonary arterial hypertension (idiopathic) Sildenafil, bosentan, epoprostenol 686 Mitochondrial inheritance Disease occurs in both males and females, inherited 59 through females only Intellectual disability Down syndrome, fragile X syndrome 62, 63


First_Aid_Step1

First_Aid_Step1. Mitochondrial inheritance Disease occurs in both males and females, inherited 59 through females only Intellectual disability Down syndrome, fragile X syndrome 62, 63 Vitamin deficiency (USA) Folate (pregnant women are at high risk; body stores only 68 3to 4-month supply; prevents neural tube defects) Bacterial meningitis (newborns and kids) Group B streptococcus/E coli/Listeria monocytogenes 180 (newborns), S pneumoniae/N meningitidis (kids/teens) HLA-DR3 Diabetes mellitus type 1, SLE, Graves disease, Hashimoto 100 thyroiditis (also associated with HLA-DR5), Addison disease HLA-DR4 Diabetes mellitus type 1, rheumatoid arthritis, Addison 100 disease Bacteria associated with gastritis, peptic ulcer disease, and H pylori 146 gastric malignancies (eg, adenocarcinoma, MALToma) Infection 2° to blood transfusion Hepatitis C Food poisoning (exotoxin mediated) S aureus, B cereus Osteomyelitis with IV drug use Pseudomonas, Candida, S aureus


First_Aid_Step1

First_Aid_Step1. Infection 2° to blood transfusion Hepatitis C Food poisoning (exotoxin mediated) S aureus, B cereus Osteomyelitis with IV drug use Pseudomonas, Candida, S aureus UTI E coli, Staphylococcus saprophyticus (young women) 181 Sexually transmitted disease C trachomatis (usually coinfected with N gonorrhoeae) Nosocomial pneumonia S aureus, Pseudomonas, other enteric gram ⊝ rods Pelvic inflammatory disease C trachomatis, N gonorrhoeae Infections in chronic granulomatous disease S aureus, E coli, Aspergillus (catalase ⊕) Metastases to bone Prostate, breast > kidney, thyroid, lung Metastases to brain Lung > breast > melanoma, colon, kidney Metastases to liver Colon >> stomach > pancreas 223 S3 heart sound  ventricular filling pressure (eg, mitral regurgitation, 287 HF), common in dilated ventricles S4 heart sound Stiff/hypertrophic ventricle (aortic stenosis, restrictive 287 cardiomyopathy)


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First_Aid_Step1. S4 heart sound Stiff/hypertrophic ventricle (aortic stenosis, restrictive 287 cardiomyopathy) Constrictive pericarditis TB (developing world); idiopathic, viral illness (developed 287 world) Holosystolic murmur VSD, tricuspid regurgitation, mitral regurgitation 291 Heart murmur, congenital Mitral valve prolapse 291 Chronic arrhythmia Atrial fibrillation (associated with high risk of emboli) 295 Cyanosis (early; less common) Tetralogy of Fallot, transposition of great vessels, truncus 298 arteriosus, total anomalous pulmonary venous return, tricuspid atresia Late cyanotic shunt (uncorrected left to right becomes Eisenmenger syndrome (caused by ASD, VSD, PDA; 299 right to left) results in pulmonary hypertension/polycythemia) Hypertension, 2° Renal artery stenosis, chronic kidney disease (eg, 300 polycystic kidney disease, diabetic nephropathy),


First_Aid_Step1

First_Aid_Step1. Hypertension, 2° Renal artery stenosis, chronic kidney disease (eg, 300 polycystic kidney disease, diabetic nephropathy), Aortic aneurysm, thoracic Marfan syndrome (idiopathic cystic medial degeneration) 302 Aortic aneurysm, abdominal Atherosclerosis, smoking is major risk factor 302 Aortic aneurysm, ascending or arch 3° syphilis (syphilitic aortitis), vasa vasorum destruction 303 Sites of atherosclerosis Abdominal aorta > coronary artery > popliteal artery Right heart failure due to a pulmonary cause Cor pulmonale Heart valve in bacterial endocarditis Mitral > aortic (rheumatic fever), tricuspid (IV drug abuse) 310 Endocarditis presentation associated with bacterium S aureus (acute, IVDA, tricuspid valve), viridans 310 streptococci (subacute, dental procedure), S bovis (colon cancer), culture negative (Coxiella, Bartonella, HACEK) Temporal arteritis Risk of ipsilateral blindness due to occlusion of


First_Aid_Step1

First_Aid_Step1. Temporal arteritis Risk of ipsilateral blindness due to occlusion of Recurrent inflammation/thrombosis of small/medium Buerger disease (strongly associated with tobacco) 314 vessels in extremities Cardiac 1° tumor (kids) Rhabdomyoma, often seen in tuberous sclerosis Cardiac tumor (adults) Metastasis, myxoma (90% in left atrium; “ball valve”) Congenital adrenal hyperplasia, hypotension 21-hydroxylase deficiency 1° hyperparathyroidism Adenomas, hyperplasia, carcinoma 345 2° hyperparathyroidism Hypocalcemia of chronic kidney disease 345 • Paraneoplastic (due to ACTH secretion by tumors) Tumor of the adrenal medulla (kids) Neuroblastoma (malignant) 350 Tumor of the adrenal medulla (adults) Pheochromocytoma (usually benign) 350 Refractory peptic ulcers and high gastrin levels Zollinger-Ellison syndrome (gastrinoma of duodenum or 351, pancreas), associated with MEN1 352


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First_Aid_Step1. Refractory peptic ulcers and high gastrin levels Zollinger-Ellison syndrome (gastrinoma of duodenum or 351, pancreas), associated with MEN1 352 Acute gastric ulcer associated with CNS injury Cushing ulcer ( intracranial pressure stimulates vagal 379 gastric H+ secretion) Acute gastric ulcer associated with severe burns Curling ulcer (greatly reduced plasma volume results in 379 sloughing of gastric mucosa) Bilateral ovarian metastases from gastric carcinoma Krukenberg tumor (mucin-secreting signet ring cells) 379 Chronic atrophic gastritis (autoimmune) Predisposition to gastric carcinoma (can also cause 379 pernicious anemia) Alternating areas of transmural inflammation and normal Skip lesions (Crohn disease) 382 colon Site of diverticula Sigmoid colon 383


First_Aid_Step1

First_Aid_Step1. Alternating areas of transmural inflammation and normal Skip lesions (Crohn disease) 382 colon Site of diverticula Sigmoid colon 383 Hepatocellular carcinoma Cirrhotic liver (associated with hepatitis B and C, alcoholism, and hemochromatosis) 1° liver cancer Hepatocellular carcinoma (chronic hepatitis, cirrhosis, 392 hemochromatosis, α1-antitrypsin deficiency, Wilson disease) Congenital conjugated hyperbilirubinemia (black liver) Dubin-Johnson syndrome (inability of hepatocytes to Hemochromatosis Multiple blood transfusions or hereditary HFE mutation 395 (can result in heart failure, “bronze diabetes,” and  risk of hepatocellular carcinoma) Pancreatitis (acute) Gallstones, alcohol Pancreatitis (chronic) Alcohol (adults), cystic fibrosis (kids) Bleeding disorder with GpIb deficiency Bernard-Soulier syndrome (defect in platelet adhesion to 427 von Willebrand factor) DIC Severe sepsis, obstetric complications, cancer, burns, 428 trauma, major surgery, acute pancreatitis, APL


First_Aid_Step1

First_Aid_Step1. DIC Severe sepsis, obstetric complications, cancer, burns, 428 trauma, major surgery, acute pancreatitis, APL Malignancy associated with noninfectious fever Hodgkin lymphoma 429 Type of Hodgkin lymphoma Nodular sclerosis (vs mixed cellularity, lymphocytic 429 predominance, lymphocytic depletion) t(14;18) Follicular lymphomas (BCL-2 activation, anti-apoptotic 430 oncogene) t(8;14) Burkitt lymphoma (c-myc fusion, transcription factor 430 oncogene) Type of non-Hodgkin lymphoma Diffuse large B-cell lymphoma 430 Age ranges for patient with ALL/CLL/AML/CML ALL: child, CLL: adult > 60, AML: adult ∼ 65, CML: 432, adult 45–85 433 Malignancy (kids) Leukemia, brain tumors 432, 526 t(9;22) Philadelphia chromosome, CML (BCR-ABL oncogene, 434 tyrosine kinase activation), more rarely associated with ALL Vertebral compression fracture Osteoporosis (type I: postmenopausal woman; type II: 462 elderly man or woman)


First_Aid_Step1

First_Aid_Step1. Vertebral compression fracture Osteoporosis (type I: postmenopausal woman; type II: 462 elderly man or woman) HLA-B27 Psoriatic arthritis, ankylosing spondylitis, IBD-associated 469 arthritis, reactive arthritis (formerly Reiter syndrome) Tumor of infancy Strawberry hemangioma (grows rapidly and regresses Actinic (solar) keratosis Precursor to squamous cell carcinoma Atrophy of the mammillary bodies Wernicke encephalopathy (thiamine deficiency causing ataxia, ophthalmoplegia, and confusion) “Some books are to be tasted, others to be swallowed, and some few to be chewed and digested.” “Always read something that will make you look good if you die in the middle of it.” —P.J. O’Rourke “So many books, so little time.” “If one cannot enjoy reading a book over and over again, there is no use in reading it at all.” to Use the Database 712 `Anatomy, Embryology, and Neuroscience 715


First_Aid_Step1

First_Aid_Step1. Embryology, and Neuroscience 715 This section is a database of top-rated basic science review books, sample examination books, software, websites, and apps that have been marketed to medical students studying for the USMLE Step 1. For each recommended resource, we list (where applicable) the Title, the First Author (or editor), the Current Publisher, the Copyright Year, the Number of Pages, the Approximate List Price, the Format of the resource, and the Number of Test Questions. Finally, each recommended resource receives a Rating. Within each section, resources are arranged first by Rating and then alphabetically by the first author within each Rating group. For a complete list of resources, including summaries that describe their overall style and utility, go to www.firstaidteam.com/bonus A letter rating scale with six different grades reflects the detailed student evaluations for Rated Resources. Each rated resource receives a rating as follows:


First_Aid_Step1

First_Aid_Step1. A letter rating scale with six different grades reflects the detailed student evaluations for Rated Resources. Each rated resource receives a rating as follows: The Rating is meant to reflect the overall usefulness of the resource in helping medical students prepare for the USMLE Step 1. This is based on a number of factors, including: The cost The readability of the text or usability of the app The appropriateness and accuracy of the material The quality and number of sample questions The quality of written answers to sample questions The quality and appropriateness of the illustrations (eg, graphs, diagrams, photographs) The length of the text (longer is not necessarily better) The quality and number of other resources available in the same discipline The importance of the discipline for the USMLE Step 1


First_Aid_Step1

First_Aid_Step1. The length of the text (longer is not necessarily better) The quality and number of other resources available in the same discipline The importance of the discipline for the USMLE Step 1 Please note that ratings do not reflect the quality of the resources for purposes other than reviewing for the USMLE Step 1. Many books with lower ratings are well written and informative but are not ideal for boards preparation. We have not listed or commented on general textbooks available in the basic sciences. Evaluations are based on the cumulative results of formal and informal surveys of thousands of medical students at many medical schools across the country. The ratings represent a consensus opinion, but there may have been a broad range of opinion or limited student feedback on any particular resource. Please note that the data listed are subject to change in that: Publishers’ prices change frequently. Bookstores often charge an additional markup.


First_Aid_Step1

First_Aid_Step1. Please note that the data listed are subject to change in that: Publishers’ prices change frequently. Bookstores often charge an additional markup. New editions come out frequently, and the quality of updating varies. The same book may be reissued through another publisher. We actively encourage medical students and faculty to submit their opinions and ratings of these basic science review materials so that we may update our database. (See p. xvii, How to Contribute.) In addition, we ask that publishers and authors submit for evaluation review copies of basic science review books, including new editions and books not included in our database. We also solicit reviews of new books or suggestions for alternate modes of study that may be useful in preparing for the examination, such as flash cards, computer software, commercial review courses, apps, and websites. Disclaimer/Conflict of Interest Statement


First_Aid_Step1

First_Aid_Step1. Disclaimer/Conflict of Interest Statement No material in this book, including the ratings, reflects the opinion or influence of the publisher. All errors and omissions will gladly be corrected if brought to the attention of the authors through our blog at www.firstaidteam.com. Please note that USMLE-Rx and the entire First Aid for the USMLE series are publications by certain authors of this book; the following ratings are based solely on recommendations from the student authors of this book as well as data from the student survey and feedback forms. UWorld Qbank UWorld www.uworld.com Test/2400 q $249–$749 A NBME Practice Exams National Board of Medical Examiners www.nbme.org/students/sas/ Comprehensive.html AMBOSS Amboss www.amboss.com Test/3500 USMLE-Rx Qmax USMLE-Rx www.usmle-rx.com Test/2300 Qbank Kaplan www.kaptest.com Test/2100 BoardVitals www.boardvitals.com Test/1750 q $59–$179 B Kaplan USMLE Step 1 Qbook Kaplan Kaplan, 2017, 468 pages Test/850 q $50 B


First_Aid_Step1

First_Aid_Step1. Qbank Kaplan www.kaptest.com Test/2100 BoardVitals www.boardvitals.com Test/1750 q $59–$179 B Kaplan USMLE Step 1 Qbook Kaplan Kaplan, 2017, 468 pages Test/850 q $50 B Pastest www.pastest.com Test/2100 Review www.truelearn.com Test/2200 Anki www.ankisrs.net Flash www.boardsbeyond.com Review/ Physeo www.physeo.com Review $30–$150 SketchyMedical www.sketchymedical.com Review $99–$369 Fighter www.cramfighter.com Study www.usmle-rx.com Review/Test $69–$299 Facts www.usmle-rx.com Flash Medbullets www.medbullets.com Review/ Pathology www.medicalschoolpathology.com Review Free www.onlinemeded.org Review Free www.osmosis.org Mastery builtbyhlt.com/medical/usmle-step- 1-mastery Test/1400 q $2–$10 B+ WebPath: The Internet Pathology Laboratory webpath.med.utah.edu Review/ Test/1300 q Free B Blue Histology www.lab.anhb.uwa.edu.au/mb140 Review/Test Free B Digital Anatomist Project: Interactive Atlases University of Washington da.si.washington.edu/da.html Review Free


First_Aid_Step1

First_Aid_Step1. B Digital Anatomist Project: Interactive Atlases University of Washington da.si.washington.edu/da.html Review Free Dr. Najeeb Lectures www.drnajeeblectures.com Review $99 B Firecracker Firecracker Inc. firecracker.lww.com Review/ Test/2800 q $39–$660 B KISSPrep www.kissprep.com Review $99–$135 www.lecturio.com Review/ Inc. www.memorangapp.com Flash Picmonic www.picmonic.com Review $25–$480 Radiopaedia.org www.radiopaedia.org Cases/Test Free B– The Pathology Guy Friedlander www.pathguy.com Review Free


First_Aid_Step1

First_Aid_Step1. A First Aid for the Basic Sciences: General Principles Le McGraw-Hill, 2017, 528 pages Review $55 A First Aid Cases for the USMLE Step 1 Le McGraw-Hill, 2018, 496 pages Cases $50 A– First Aid for the Basic Sciences: Organ Systems Le McGraw-Hill, 2017, 912 pages Review $72 A– Crush Step 1: The Ultimate USMLE Step 1 Review O’Connell Elsevier, 2017, 704 pages Review $45 A– Cracking the USMLE Step 1 Princeton Review Princeton Review, 2013, 832 pages Review $45 B+ USMLE Step 1 Secrets in Color Brown Elsevier, 2016, 800 pages, ISBN 9780323396790 Review $43 B+ Step-Up to USMLE Step 1 2015 Jenkins Lippincott Williams & Wilkins, 2014, 528 pages Review $50 B+ USMLE Step 1 Lecture Notes 2018 Kaplan Kaplan Medical, 2018, ~2700 pages Review $330 B+ USMLE Images for the Boards: A Comprehensive Image-Based Review Tully Elsevier, 2012, 296 pages Review $42 B USMLE Step 1 Made Ridiculously Simple Carl MedMaster, 2017, 416 pages, Review/Test 1000 q $30 B medEssentials for the USMLE Step 1 Manley


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First_Aid_Step1. Review Tully Elsevier, 2012, 296 pages Review $42 B USMLE Step 1 Made Ridiculously Simple Carl MedMaster, 2017, 416 pages, Review/Test 1000 q $30 B medEssentials for the USMLE Step 1 Manley Kaplan, 2012, 588 pages Review $55


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First_Aid_Step1. Anatomy, Embryology, and Neuroscience A– High-Yield Gross Anatomy Dudek Lippincott Williams & Wilkins, 2014, 320 pages Review $43 A– Clinical Anatomy Made Ridiculously Simple Goldberg MedMaster, 2016, 175 pages Review $30 B+ High-Yield Embryology Dudek Lippincott Williams & Wilkins, 2013, 176 pages Review $56 B+ High-Yield Neuroanatomy Fix Lippincott Williams & Wilkins, 2015, 208 pages Review/ Test/50 q $40 Anatomy, Embryology, and Neuroscience (continued)


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First_Aid_Step1. Anatomy, Embryology, and Neuroscience (continued) B+ Anatomy—An Essential Textbook Gilroy Thieme, 2017, 528 pages Text/ Test/400 q $48 B+ Netter’s Anatomy Flash Cards Hansen Saunders, 2018, 688 flash cards Flash cards $40 B+ Crash Course: Anatomy Stenhouse Elsevier, 2015, 288 pages Review $45 B BRS Embryology Dudek Lippincott Williams & Wilkins, 2014, 336 pages Review/ Test/220 q $56 B Anatomy Flash Cards: Anatomy on the Go Gilroy Thieme, 2013, 752 flash cards Flash cards $60 B Clinical Neuroanatomy Made Ridiculously Simple Goldberg MedMaster, 2014, 90 pages + CD-ROM Review/Test/ Few q $26 B Netter’s Anatomy Coloring Book Hansen Elsevier, 2018, 392 pages Review $20 B Case Files: Anatomy Toy McGraw-Hill, 2014, 416 pages Cases $35 B– Case Files: Neuroscience Toy McGraw-Hill, 2014, 432 pages Cases $35 A– BRS Behavioral Science Fadem Lippincott Williams & Wilkins, 2016, 384 pages Review/ Test/700 q $52 B+


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First_Aid_Step1. A– BRS Behavioral Science Fadem Lippincott Williams & Wilkins, 2016, 384 pages Review/ Test/700 q $52 B+ High-Yield Biostatistics, Epidemiology, Glaser Lippincott Williams & Wilkins, 2013, Review $43 and Public Health 168 pages Pixorize www.pixorize.com Review $100–$130 B+ Medical Biochemistry—An Illustrated Review Panini Thieme, 2013, 441 pages Review/ Test/400 q $40 B Lange Flash Cards Biochemistry and Genetics Baron McGraw-Hill, 2017, 196 flash cards Flash cards $40 B Lippincott Illustrated Reviews: Biochemistry Ferrier Lippincott Williams & Wilkins, 2017, 560 pages Review/ Test/200 q $78 B BRS Biochemistry, Molecular Biology, and Genetics Lieberman Lippincott Williams & Wilkins, 2013, 432 pages Review/Test $54 B Case Files: Biochemistry Toy McGraw-Hill, 2014, 480 pages Cases $35 B PreTest Biochemistry and Genetics Wilson McGraw-Hill, 2017, 592 pages Test/500 q $38


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First_Aid_Step1. B+ BRS Cell Biology and Histology Gartner Lippincott Williams & Wilkins, 2018, 448 pages Review/ Test/320 q $54 B+ Crash Course: Cell Biology and Genetics Stubbs Elsevier, 2015, 216 pages Review/Print + online $47 B Wheater’s Functional Histology Young Elsevier, 2013, 464 pages Text $83


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First_Aid_Step1. A– Basic Immunology Abbas Elsevier, 2019, 336 pages Review $70 A– Clinical Microbiology Made Ridiculously Simple Gladwin MedMaster, 2019, 418 pages Review $38 A– Medical Microbiology and Immunology Flash Cards Rosenthal Elsevier, 2016, 192 flash cards Flash cards $40 B+ Lippincott Illustrated Reviews: Immunology Doan Lippincott Williams & Wilkins, 2012, 384 pages Reference/ Test/Few q $75 B+ Microcards: Microbiology Flash Cards Harpavat Lippincott Williams & Wilkins, 2015, 312 flash cards Flash cards $53 B+ Review of Medical Microbiology and Immunology Levinson McGraw-Hill, 2018, 832 pages Review/ Test/654 q $63 B+ How the Immune System Works Sompayrac Wiley-Blackwell, 2019, 168 pages Review $50 B Case Studies in Immunology: Clinical Companion Geha W. W. Norton & Company, 2016, 384 pages Cases $62 B Pretest: Microbiology Kettering McGraw-Hill, 2013, 480 pages Test/500 q $38 B Case Files: Microbiology Toy McGraw-Hill, 2014, 416 pages Cases $36 B Lange Microbiology and Infectious


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First_Aid_Step1. pages Cases $62 B Pretest: Microbiology Kettering McGraw-Hill, 2013, 480 pages Test/500 q $38 B Case Files: Microbiology Toy McGraw-Hill, 2014, 416 pages Cases $36 B Lange Microbiology and Infectious Diseases Flash Cards, 3e Somers McGraw-Hill Education, 2017, 358 pages Flash cards $46 B– Lippincott Illustrated Reviews: Microbiology Cornelissen Lippincott Williams & Wilkins, 2019, 448 pages Review/Test/ Few q $73


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First_Aid_Step1. A+ Pathoma: Fundamentals of Pathology Sattar Pathoma, 2019, 218 pages Review/ Lecture $85–$120 A– Rapid Review: Pathology Goljan Elsevier, 2018, 864 pages Review/ Test/500 q $65 A– Robbins and Cotran Review of Pathology Klatt Elsevier, 2014, 504 pages Test/1100 q $55 A– Crash Course: Pathology Xiu Elsevier, 2019, 438 pages Review $40 B High-Yield Histopathology Dudek Lippincott Williams & Wilkins, 2017, 320 pages Review $36 B Pathophysiology of Disease: Introduction to Clinical Medicine Hammer McGraw-Hill, 2018, 832 pages Text $90 B Haematology at a Glance Mehta Blackwell Science, 2014, 136 pages Review $49 B Pocket Companion to Robbins and Cotran Pathologic Basis of Disease Mitchell Elsevier, 2016, 896 pages Review $40 B BRS Pathology Schneider Lippincott Williams & Wilkins, 2013, 480 pages Review/ Test/450 q $54


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First_Aid_Step1. B+ Crash Course: Pharmacology Battista Elsevier, 2019, 336 pages Review $40 B+ Master the Boards USMLE Step 1 Pharmacology Flashcards Fischer Kaplan, 2015, 200 flash cards Flash cards $55 B+ BRS Pharmacology Rosenfeld Lippincott Williams & Wilkins, 2019, 384 pages Review/ Test/200 q $55 B Lange Pharmacology Flash Cards Baron McGraw-Hill, 2017, 266 flash cards Flash cards $39 B Pharmacology Flash Cards Brenner Elsevier, 2017, 230 flash cards Flash cards $45 B Katzung & Trevor’s Pharmacology: Examination and Board Review Trevor McGraw-Hill, 2018, 592 pages Review/ Test/800 q $54 B Lippincott Illustrated Reviews: Pharmacology Whalen Lippincott Williams & Wilkins, 2018, 576 pages Review/ Test/380 q $75


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First_Aid_Step1. A– BRS Physiology Costanzo Lippincott Williams & Wilkins, 2018, 304 pages Review/ Test/350 q $54 A– Pathophysiology of Heart Disease Lilly Lippincott Williams & Williams, 2015, 480 pages Review $57 A– PreTest Physiology Metting McGraw-Hill, 2013, 528 pages Test/500 q $38 A– Color Atlas of Physiology Silbernagl Thieme, 2015, 472 pages Review $50 B+ BRS Physiology Cases and Problems Costanzo Lippincott Williams & Wilkins, 2012, 368 pages Cases $58 B+ Physiology Costanzo Saunders, 2017, 528 pages Text $60 B+ Vander’s Renal Physiology Eaton McGraw-Hill, 2018, 224 pages Text $49 B+ Acid-Base, Fluids, and Electrolytes Made Ridiculously Simple Preston MedMaster, 2017, 166 pages Review $24 B+ Pulmonary Pathophysiology: The Essentials West Lippincott Williams & Wilkins, 2017, 264 pages Review/ Test/75 q $57 B Rapid Review: Physiology Brown Elsevier, 2011, 384 pages Test/350 q $39 B Endocrine Physiology Molina McGraw-Hill, 2018, 320 pages Review $59 B– Netter’s Physiology Flash Cards Mulroney


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First_Aid_Step1. q $57 B Rapid Review: Physiology Brown Elsevier, 2011, 384 pages Test/350 q $39 B Endocrine Physiology Molina McGraw-Hill, 2018, 320 pages Review $59 B– Netter’s Physiology Flash Cards Mulroney Saunders, 2015, 450 flash cards Flash cards $40 calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerosis, and telangiectasias [syndrome] left, liver


First_Aid_Step1

First_Aid_Step1. LA left atrial, left atrium LM lateral meniscus, left main coronary artery, light microscopy LT labile toxin, leukotriene LV left ventricle, left ventricular MAC membrane attack complex, minimum alveolar concentration MAP mean arterial pressure, mitogen-activated protein Med cond* medial condyle MELAS mitochondrial encephalopathy, lactic acidosis, and stroke-syndrome like episodes MGUS monoclonal gammopathy of undetermined significance MHC major histocompatibility complex MIRL membrane inhibitor of reactive lysis MMR measles, mumps, rubella [vaccine] MR medial rectus [muscle], mitral regurgitation NPH neutral protamine Hagedorn, normal pressure hydrocephalus 1,25-OH D3 calcitriol (active form of vitamin D) 25-OH D3 storage form of vitamin D OVLT organum vasculosum of the lamina terminalis P-450 cytochrome P-450 family of enzymes PA posteroanterior, pulmonary artery Pao2 partial pressure of oxygen in arterial blood Pao2 partial pressure of oxygen in alveolar blood


First_Aid_Step1

First_Aid_Step1. P-450 cytochrome P-450 family of enzymes PA posteroanterior, pulmonary artery Pao2 partial pressure of oxygen in arterial blood Pao2 partial pressure of oxygen in alveolar blood PAP Papanicolaou [smear], prostatic acid phosphatase PC platelet count, pyruvate carboxylase Pco2 partial pressure of carbon dioxide PCP phencyclidine hydrochloride, Pneumocystis jirovecii pneumonia PDA patent ductus arteriosus, posterior descending artery Pi plasma interstitial osmotic pressure, inorganic phosphate PICA posterior inferior cerebellar artery PIP2 phosphatidylinositol 4,5-bisphosphate PIP3 phosphatidylinositol 3,4,5-bisphosphate Po2 partial pressure of oxygen PV plasma volume, venous pressure R correlation coefficient, right, R variable [group] R3 Registration, Ranking, & Results [system] RANK-L receptor activator of nuclear factor-κ B ligand RR relative risk, respiratory rate RV residual volume, right ventricle, right ventricular SE standard error [of the mean]


First_Aid_Step1

First_Aid_Step1. RANK-L receptor activator of nuclear factor-κ B ligand RR relative risk, respiratory rate RV residual volume, right ventricle, right ventricular SE standard error [of the mean] SIADH syndrome of inappropriate [secretion of] antidiuretic hormone SV splenic vein, stroke volume TCA tricarboxylic acid [cycle], tricyclic antidepressant V1, V2 vasopressin receptors Vd volume of distribution V(D)J variable, (diversity), joining gene segments rearranged to form Ig genes VH variable region, heavy chain [antibody] VL variable region, light chain [antibody] VPL ventral posterior nucleus, lateral VPM ventral posterior nucleus, medial VPN vancomycin, polymyxin, nystatin [media] V˙ /Q˙ ventilation/perfusion [ratio] XR X-linked recessive XX/XY normal complement of sex chromosomes for female/male ZDV zidovudine [formerly AZT]