2016FirstAidfortheUSMLEStep1

OfficialUpdates,Corrections,andClarifications
March31,2016

Despiteourbestefforts,errorsdooccurduringarevision.Thislistaddressescontenterrorsthatmay
createconfusion.Ifyouarethefirstindividualtosubmitareferencedcorrectionorclarificationtousat
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TheFirstAid/USMLERxTeam

CATEGORIESOFUPDATES

MajorCorrections

Factualerrorsthatcouldinterferewithcomprehension

MinorCorrections

Lesssignificanterrorsthatmaycauseconfusion

Clarifications

Thetextisaccurate,butcouldbewrittenmoreclearly
Minorformattingissues(misalignments,indents,etc)thatmayconfuse

MAJORCORRECTIONS

Page

FactName

Revision

203

Vaccination

Replace"MMRistheonlyliveattenuatedvaccinegiventopersonswith
HIV."with"MMRandvaricellaarelivevaccinesthatcanbegivento
patientswithHIVwhohaveCD4>200."

268

Resistance,
pressure,flow

Remove"Removaloforgansinparallelarrangement(eg,nephrectomy)
TPRandCO."fromthethirdcolumn.

375

Misoprostol

FromtheCLINICALUSErow,remove"maintenanceofaPDA."The
drugofchoiceforthisindicationisalprostadil.

384

Coagulation
cascade
components

Intheflowchartfor"Procoagulation,"replace"glutamyltransferase"with
"glutamylcarboxylase."

390

Macrocytic(MCV
>100fL)anemia

DiamondBlackfanshouldbelistedunderNonmegaloblasticanemia,not
Megaloblasticanemia.

405

Directthrombin
inhibitors

IntheADVERSEEFFECTSrow,tranexamicacidisanantifibrinolytic
agent,notfibrinolyticasthetextstates.

455

Neuro
transmitters

Serotoninlevelsaredecreased()inParkinsondisease,notincreased().

478

Cranialnerve
andvessel
pathways

TheimageshouldshowcranialnerveV1travelingthroughthesuperior
orbitalfissure,nottheforamenrotundum.Notethatthisiscorrectlystated
intheaccompanyingtable.

593

Ovarian
neoplasms
(continued)

UnderImmatureteratoma,replace"Commonlydiagnosedafter
menopause."with"Commonlydiagnosedbeforeage20."

606

Congenitallung
malformations

InthePulmonaryhypoplasiarow,delete"usuallyinvolvingrightlung"from
theendofthefirstsentence.

MINORCORRECTIONS

Page

FactName

Revision

60

Ciliastructure

Replace"Resultsinmaleandfemaleinfertilitydueto"with"Resultsin
maleandfemalefertilitydueto"

145

Ectoparasites

IntheScabies(Sarcoptesscabiei)row,replace"transmissionthrough
fomites."with"transmissionthroughskintoskincontact(mostcommon)
orviafomites."

204

Hypersensitivity
types

IntheTypeIIrow,removePerniciousanemiafromthebulletedlistinthe
thirdcolumn(itisbetterclassifiedasatypeIVhypersensitivityreaction).

216

Apoptosis

IntheExtrinsic(deathreceptor)pathwayrow,firstbullet,replace"or
TNFbindingtoTNF)"with"orTNFbindingtoitsreceptor)."

315

Thyroid
hormones(T3/T4)

Pleasenotethattheorganificationofiodinetothyroglobulinandthe
subsequentcouplingreactionwiththyroidperoxidasetoT3/T4andMIT/DIT
occurpriortoendocytosisfromthefollicularlumenintothethyroid
follicularepithelialcell.

352

Bile

Inthethirdbullet,replace(bodysonlymeansofeliminatingcholesterol)
with(bodysprimarymeansofeliminatingcholesterol).

367

Hepatic
encephalopathy

UnderTreatment,replace"(NH4+producinggutbacteria)."with"(NH3
producinggutbacteria)."

416

Kneeexam

IntheimageforAbnormalpassiveabduction,replace"Externalrotation"
with"Abduction(valgus)force."IntheimageforAbnormalpassive
adduction,replace"Internalrotation"with"Adduction(varus)force."

430

Osteoarthritis
andrheumatoid
arthritis

Inthediagramforrheumatoidarthritis,the"Pannusformation"labelshould
bepulledbackslightlytoindicatethedarkerblueareabetweenthelight
bluejointcapsule/synovialliningandthebone.

471

Idiopathic
intracranial
hypertension
(pseudotumor
cerebri)

Replace"opticnervefenestrationsurgery)."with"opticnervesheath
fenestrationsurgery).

504

Parkinson
diseasedrugs

Intheimageofdopaminemetabolism,withinthePRESYNAPTIC
TERMINALFROMTHESUBSTANTIANIGRAbracket,notethatCOMT
convertsdopamineinto3methoxytyramine(3MT),not3Omethyldopa
(3OMD).Theconversionofdopamineto3OMDviaCOMTonlyoccursin
theperiphery.

562

Earlyfetal
development

IntheEarlyembryonicdevelopmentimage,replacethelabel2oocyte
(1N1C)with2oocyte(1N2C).

571

Genital
embryology

Inthelowerimage,replacethelabelMesonephrickidneywith
Metanephrickidney.

619

Restrictivelung
diseases

InthebulletedlistofInterstitiallungdiseases,deleteGoodpasture
syndrome.

CLARIFICATIONS

Page

FactName

Revision

70

Modesof
inheritance

IntheXlinkeddominantrow,remove"Rettsyndrome"fromthelistof
examples.WhilethisconditiondoesbehaveinanXlinkeddominant
fashion,itisalmostalwayssporadic,andaffectedindividualstendnotto
reproduce.

133

Rickettsial
diseasesand
vectorborne
illnesses

IntheQfeverrow,replace"Mostcommoncauseofculture
endocarditis."with"Commoncauseofcultureendocarditis."

160

Common
diseasesof
HIVpositive
adults

NotethatwhileinfectionwithCryptosporidiumsppcanoccurwitha
CD4+cellcountof500/mm3orbelow,diseaseismuchmorelikelyto
arisewhentheCD4+cellcountisbelow100/mm3.

238

UrinepHand
drugelimination

ForTCAs,notethatammoniumchlorideadministrationonlyservesto
increaseurinaryexcretionofthedrugviaurineacidification,whichis
rarelydoneclinically,butisthemainteachingpointofthisfact.Themore
commonlyseentreatmentofTCAoverdosewithsodiumbicarbonatehas
adifferentmechanism,namelypromotingtheunbindingofTCAsfrom
sodiumchannelstoreducetheirtoxiceffects.Insummary,bothmaybe
usedasantidotes.Eachantidotesimplyactsdifferently,andsodium
bicarbonateismuchmorecommonlyused.

291

Cardio
myopathies

IntheHypertrophiccardiomyopathyrow,replace"(commonlyamyosin
heavychainmutation)."with(mostcommonlyduetomutationsingenes
encodingsarcomericproteins,suchasmyosinbindingproteinCand
myosinheavychain).

339

Pancreasand
spleen
embryology

InAnnularpancreas,replaceandnonbiliousvomiting.withand
vomiting.

385

Thrombogenesis

Inthefifthparagraph,replaceFailureofagglutinationwithFailureof
aggregation.

391

Normocytic,
normochromic
anemia

Notethatspherocytes,whiletheycanbeseeninmanyformsof
extravascularhemolysis,aremoststronglyassociatedwithhereditary
spherocytosisandautoimmunehemolyticanemias.

407

Cilostazol,
dipyridamole

IntheMECHANISMrow,replacePhosphodiesteraseIIIinhibitorwith
Phosphodiesteraseinhibitorsasthesedrugsactondifferent
phosphodiesterasesubtypes.

471

Idiopathic
intracranial
hypertension
(pseudotumor
cerebri)

Addobesitytothelistofriskfactorsinthefirstparagraph.

487

Hornersyndrome NotethataPancoasttumorisbetterclassifiedasafindingoutsideofthe
spinalcordittypicallycausesaHornersyndromebycompromisingthe
stellateganglionfoundalongside,butnotwithin,thespinalcord.

498

Glaucomadrugs

Intheagonistsrow,notethatepinephrineactson1receptorsand
decreasesaqueoushumorproductionviavasoconstriction,whereas
brimonidinedirectlydecreasesproductionvia2receptors.

515

Majordepressive
disorder

Delete"usuallylasting612months."fromtheendofthefirstsentence
inthesecondcolumn.

517

Specificphobia

ForAgoraphobia,deleteMAOinhibitorsfromtheTreatmentlist.

522

Psychoactive
drugintoxication
andwithdrawal

IntheOpioidsrow,undertheINTOXICATIONcolumn,deletenaltrexone
fromtheTreatmentlist.

607

Neonatal
respiratory
distress
syndrome

IntheComplicationsparagraph,deletemetabolicacidosis.

621

Sleepapnea

IntheObesityhypoventilationsyndromerow,delete(respiratoryrate).

625

Pancoasttumor
(superiorsulcus
tumor)

Inthesecondbullet,replace"Superiorcervicalganglion"with"Stellate
ganglion."