2025 FA Step 1 Proposed Errata & Suggestions
Page #ChapterSectionFact NameSupporting Reference(s)Main CommentSubmission type
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136BiochemistryMolecularDNA replicationNot neededThe Eukaryotic Topoisomerase 2 inhibitors(Etoposide, Teniposide) can be remembered by the mnemonic "There are (always) 2 sides to a story" The 2 for Topoisomerase 2 and the sides for the suffix of the drugMnemonic
236BiochemistryMolecularTopoisomerase inhibitorshttps://www.uptodate.com/contents/basic-genetics-concepts-chromosomes-and-cell-division?search=topoisomerase%20inhibitors&source=search_result&selectedTitle=7%7E59&usage_type=default&display_rank=7"first pour the tea can, then set it aside" topoisomerase I inhibitors: -tecan and topoisomerase II inhibitors: -sideMnemonic
337BiochemistryMolecularDNA repairNAFor figure in the Base excision repair of Single strand, the "Glycosylase removes base" part should keep the backbone segment. The next step "Endonuclease and lyase remove backbone segment", then we can remove the backbone. Otherwise, these two figures of the step look almost the same except one wrote "AP site"."Minor erratum
450BiochemistryLaboratory Techniquesα1-antitrypsin deficiencyHarper's Illustrated Biochemistryα1-Antitrypsin deficiency leads to unopposed elastase activity, which primarily causes emphysema, a type of chronic obstructive pulmonary disease (COPD), but not all COPD is caused by α1-antitrypsin deficiency. It should be clarified so that students do not confuse that all COPD is caused by the α1-Antitrypsin deficiency.Clarification to current text
551BiochemistryLaboratory TechniquesNEW FACThttps://pubmed.ncbi.nlm.nih.gov/18193021/In the section for blotting procedures, USMLE lists Southwestern blotting as something that should be understood. I suggest a note be added on Southwestern blots. Southwestern blots use double-stranded DNA probes to detect DNA-binding molecules (ie transcription factors). Uworld has a question on this.High-yield addition to next year
658BiochemistryPharmacologyCystic fibrosisnot neededThe corrector drugs have the CFTR letters highlighted in red to show their relationship to the CFTR protein, even though this is not specific to the corrector drugs since the potentiator drug listed (ivacaftor) also has CFTR letters at the end, which might lead to confusion when distinguishing between the two drug types. Since the potentiator drugs hold the CFTR channel open for chloride ions to flow through the cell membrane, I would like to suggest using "ivacuate" as a mnemonic for ivacaftor. This term, inspired by "evacuation," reflects its mechanism of action—the "evacuation" of chloride ions through the channel that is held open by the drug—making it a more specific and memorable aid for students.Mnemonic
758BiochemistryGeneticsCystic fibrosishttps://www.uptodate.com/contents/cystic-fibrosis-clinical-manifestations-and-diagnosis"Chloride normally goes IN the skIN" (as opposed to secreted in the lungs)Mnemonic
862BiochemistryGeneticsNEW FACThttps://emedicine.medscape.com/article/950480-overview?form=fpfGenetic Disorder by chromosome. Chromosome 4p deletion for wolf hirschhorn syndrome. Very high yield and not mentioned in the selected examples.High-yield addition to next year
962BiochemistryGeneticsNEW FACThttps://www.uptodate.com/contents/ataxia-telangiectasia#H564078596Chromosome 11: Ataxia Telengiectasia (ATM gene mutation)High-yield addition to next year
1069BiochemistryNutritionNEW FACT(https://www.ncbi.nlm.nih.gov/books/NBK507876/) (https://doi.org/10.1210/jcem-31-3-312)In page 69 (Biochemistry - Nutrition section), It states that the edema in Kwashiorkor disease is due to decrease in plasma oncotic pressure which arises from decreased albumin and decreased Antidiuretic hormone. The correction here should be made to the Antidiuretic hormone: it should be increased not decreased. ADH levels are typically increased as part of the body’s response to maintain blood pressure and circulating volume during hypovolemia.Minor erratum
1169BiochemistryNutritionNEW FACThttps://www.ncbi.nlm.nih.gov/books/NBK507876/#:~:text=Children%20with%20kwashiorkor%20were%20found,responds%20aggressively%2C%20causing%20sodium%20retention.A decrease in antidiuretic hormone cannot lower intravascular oncotic pressure, and Kwashiorkor is characterized by elevated ADH levels.Major erratum
1272BiochemistryMetabolismSummary of pathwayshttps://www.amboss.com/us/knowledge/carbohydratesOn page 72 is the summary of pathways with the enzymes listed to the left. One of the pathways shown is fructose metabolism. On page 78, disorders of fructose metabolism are mentioned with a diagram listing the enzymes involved. Different enzymes have been mentioned on pages 72 and 78, namely between Glyceraldehyde to Glyceraldehyde-3-P (should be triose kinase as shown on page 78 NOT triose phosphate isomerase as previously mentioned on page 72) and Dihydroxyacetone-P to Glyceraldehyde-3-P (should be triose phosphate isomerase as shown on page 78 NOT Aldolase B/A as previously mentioned on page 72).Major erratum
1373BiochemistryMetabolismHexokinase vs glucokinasehttps://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/monogenic-neonatal-mellitus-mody&ved=2ahUKEwjX89rE8ryMAxU1yqACHZ2uIdoQFnoECBgQAQ&usg=AOvVaw1TgI7h0DYdeiUcs80Avz9LMODY (maturity onset diabetes of the young) is now called monogenic diabetes. This has been mentioned in UWorld Step II Bank as well.Clarification to current text
1477BiochemistryMetabolismPentose phosphate pathwayhttps://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/pentose-phosphate-pathway#chapters-articlesThe pentose phosphate pathway (PPP), also known as the hexose monophosphate (HMP) shunt, occurs in the cytoplasm of all cells. However, it is especially active in tissues with high demands for NADPH or nucleotide synthesis. These include the liver, adrenal cortex, lactating mammary glands, and red blood cells (RBCs) — due to their roles in fatty acid synthesis, steroid hormone production, and oxidative stress defense. Emphasizing only these sites as the exclusive locations of the pathway is misleading, as PPP is a ubiquitous metabolic process, though its activity level varies depending on tissue-specific needs.Clarification to current text
1584BiochemistryMetabolismGluconeogenesis, irreversible enzymeshttps://www.uptodate.com/contents/glucose-6-phosphatase-deficiency-glycogen-storage-disease-i-von-gierke-disease?search=Glucose-6-phosphatase%20deficiency%20%28glycogen%20storage%20disease%20I%2C%20von%20Gierke%20disease%29&source=search_result&selectedTitle=1%7E88&usage_type=default&display_rank=1On page 72 ("summary of pathways") and page 84 ("glycogen"), there seems to be an issue within the "Gluconeogenesis" pictures. Specifically regarding the direction in which the arrows point between Glucose and Glucose-6-Phosphate. For example, on page 72, Gluconeogenesis depicts Glucose-6-Phosphate --> Glucose. On page 84, Gluconeogenesis depicts Glucose --> Glucose-6-Phosphate. It seems as though the arrows have been flipped on these two pages which could make students like myself confused about the true orientation.Major erratum
1686BiochemistryMetabolismLysosomal storage diseasesN/ADiseases that have "cherry-red spot": Niemann-Pick, Tay-Sachs → Pick cherries and put them in a sac.Mnemonic
1786BiochemistryMetabolismLysosomal storage diseaseshttps://www.uptodate.com/contents/overview-of-acid-sphingomyelinase-deficiency-and-niemann-pick-disease-type-c"NO MAN don't PICK the SPHINx" as a pneumonic for Niemann-Pick disease and sphingomyelinase, think of a vandal destroying the Egyptian Sphinx (no sphingomyelinase) by picking (Niemann-Pick) at itMnemonic
1891BiochemistryMetabolismMajor apolipoproteinsNAFor B100, " (I hope I live to Be 100)". The word in red should be "live" instead of just "ive".Spelling/formatting
1992BiochemistryMetabolismAbetalipoproteinemia1. https://my.clevelandclinic.org/health/diseases/abetalipoproteinemia#management-and-treatment 2. https://www.uptodate.com/contents/neuroacanthocytosis#H1982943Abetalipoproteinemia is also managed with medium-chain triglyceride (MCT) supplementation, which is not mentioned.High-yield addition to next year
2092BiochemistryMetabolismFamilial dyslipidemiasUpToDateIn type III dysbetalipoproteinemeia Chylomicrons VLDL are not elevated instead, Chylomicrons and VLDL remnants are elevated.Minor erratum
21108ImmunologyImmune ResponsesT cells1. https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01499-1#:~:text=Lymphocyte%20activation%20gene%2D3%20(LAG,the%20treatment%20of%20solid%20tumors 2. https://pmc.ncbi.nlm.nih.gov/articles/PMC4942846/ 3. https://www.sciencedirect.com/science/article/pii/S1074761324000359The T cell section (Page 108) lists classic markers like CD3, CD28, etc., but doesn’t mention checkpoint inhibitors like LAG-3 or TIGIT or TIM-3, which are increasingly relevant in clinical oncology and immunotherapy practice.High-yield addition to next year
22133MicrobiologyClinical BacteriologyStaphylococcus aureusAmbossStaphylococcus aureus ferments Mannitol Salt Agar (turns yellow)Clarification to current text
23134MicrobiologyClinical BacteriologyStreptococcus pyogenes (group A streptococci)AmbossPharyngitis can lead to rheumatic fever due to molecular mimicry. Therefore, the first mnemonic can simply state, "Pharyngitis causes Rheumatic Phever." In contrast, all pyogenic strains responsible for both pharyngitis and skin (superficial) infections can cause post-streptococcal glomerulonephritis (PSGN) through immune complex deposition. Thus, the second sentence can state, "Pyogenic strains lead to PSGN."Mnemonic
24137MicrobiologyClinical BacteriologyListeria monocytogeneshttps://www.cdc.gov/listeria/outbreaks/index.html(Listeria Transmission Missing New CDC Advisory); Doesn’t highlight recent CDC warnings about Listeria monocytogenes outbreaks via refrigerated cheeses and ready-to-eat seafood.Add “recent outbreaks linked to smoked seafood and soft cheeses".High-yield addition to next year
25142MicrobiologyClinical BacteriologySalmonella vs ShigellaReview of Medical Microbiology & Immunology by Warren Levinson, Mc Graw HillThe virulence factors of shigella is "EXOTOXIN". But book mentioned it as "Endotoxin". So the "Endotoxin" should be corrected to "Exotoxin"..Major erratum
26146MicrobiologyClinical BacteriologyChlamydia trachomatis serotypesUpToDatePID due to Chlamydia can result in scarring of the fallopian tubes, which can lead to ectopic pregnancy or infertility.Minor erratum
27146MicrobiologyClinical BacteriologyChlamydia trachomatis serotypesUpToDateTypes D–K doesnot causes ectopic pregnancy but PID due to Chlamydia can result in scarring of the fallopian tubes, which can lead to ectopic pregnancy or infertility.Minor erratum
28166MicrobiologyVirologyInfluenza viruseshttps://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/influenza-b-virusImage shows Virus B goes through Antigenic Shift but that is only for Virus A. Virus B and C only go through antigenic drift.Major erratum
29168MicrobiologyVirologyArboviruses transmitted by Aedes mosquitoesCDC; https://www.cdc.gov/dengue/hcp/diagnosis-testing/index.html. https://www.cdc.gov/dengue/hcp/diagnosis-testing/serologic-tests-for-dengue-virus.html. Accessmedicine; https://accessmedicine.mhmedical.com/content.aspx?bookid=3516&sectionid=289629118Diagnosis of dengue can be made by NS1 ELISA and IgM detection for <5 days and MAC-ELISA for _>5 days. The presence of the dengue virus non-structural protein 1 (NS1) in blood (serum) during the first 7 days of illness is indicative of a current or recent dengue virus infection. The dengue MAC-ELISA is used for the qualitative detection of IgM antibodies against dengue virus.High-yield addition to next year
30169MicrobiologyVirologyRabies virusRabies. In: Papadakis MA, McPhee SJ. eds. Quick Medical Diagnosis & Treatment 2023. McGraw-Hill Education; 2023; https://accessmedicine.mhmedical.com/content.aspx?bookid=3241&sectionid=271758716 Cleveland; https://my.clevelandclinic.org/health/diseases/13848-rabies. WHO; https://www.who.int/news-room/fact-sheets/detail/rabies. https://pmc.ncbi.nlm.nih.gov/articles/PMC9274529/FA states symptoms and progression of rabies as agitation, photophobia, hydrophobia, but it does not explain why this happens. AEROPHOBIA is not mentioned. Swallowing or inspiration causes painful spasms leading to hydrophobia, dysphagia and also aerophobia. Aerophobia is quite evident in rabies and should be included as well.High-yield addition to next year
31171MicrobiologyVirologyHepatitis serologic markershttps://emedicine.medscape.com/article/2109144-overview#a2in recovery, there is (+) IgG and ( -) IgM anti-HBcMinor erratum
32172MicrobiologyVirologyHepatitis serologic markershttps://www.uptodate.com/contents/hepatitis-b-virus-screening-and-diagnosis-in-adults?search=hepatitis%20b%20serology%20interpretation&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1#H5I am writing to bring to your attention a discrepancy regarding the interpretation of Hepatitis B serologic markers in the 2024 edition of First Aid for the USMLE Step 1. It is noted in the current edition that Anti-HBc is positive for IgM in patients during the recovery period. However, after reviewing multiple resources, including UpToDate, I found that Anti-HBc is typically IgG in these patients. In certain cases, Anti-HBc IgM may remain detectable in the bloodstream for up to two years, which could result in a positive test in patients who are in the recovery phase. Given this, I kindly request that in future editions of the book, this nuance be more clearly addressed. The current version suggests that Anti-HBc is exclusively IgM in the recovery period, which may lead to confusion for readers. Thank you for considering this clarification for future revisions. I appreciate your attention to this matter and your ongoing efforts to maintain the accuracy of this valuable resource.Clarification to current text
33185MicrobiologyAntimicrobialsCephalosporinshttps://www.uptodate.com/contents/cephalosporins?search=cephalosporins&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1#H93rd generation cephalosporins - "Don't tri me"for ceftriaxone, cefpodoxime, ceftazidime, cefiximeMnemonic
34197MicrobiologyAntimicrobialsHIV therapyUWorldProtease inhibitors are associated with lipodystrophy syndrome, which is characterized by fat accumulation in the trunk and dorsocervical region, breast enlargement, and peripheral fat loss, leading to hollowed cheeks and limb atrophy. Additionally, Protease inhibitors can cause metabolic disturbances, including dyslipidemia, which results in elevated levels of LDL, total cholesterol, and triglycerides, as well as insulin resistance, increasing the risk of developing diabetes mellitus.High-yield addition to next year
35214PathologyInflammationCollagenhttps://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/influenza-b-virusTable states that there is an increase in type III collagen in the hypertrophic scar. In reality, there is an increase in the ratio of collagen I/III, with type I being higher. Same applies to the keloid scar. A clarification for this table would be necessary,Clarification to current text
36237PharmacologyAutonomic DrugsG-protein–linked second messengersUSMLERx, Self-studyMnemonic for remembering the association between the G-protein class and the receptor- 'Gq' models can only 'HAV 1 M&M', '2MAD' they 'i'nhibit themselvesMnemonic
37237PharmacologyAutonomic DrugsG-protein–linked second messengersSelf-Study2 should be in subscriptSpelling/formatting
38240PharmacologyAutonomic DrugsAtropinehttps://www.uptodate.com/contents/organophosphate-and-carbamate-poisoning?search=atropine&source=search_result&selectedTitle=2%7E150&usage_type=default&display_rank=2#H12Atropine is a muscarinic antagonist - think "atrophy - atropine; *antagonizing* muscle (muscarinic) will result in atrophy (atropine)Mnemonic
39241PharmacologyAutonomic DrugsSympathomimeticsSelf-StudyNumbers alongwith the receptors can be in subscriptSpelling/formatting
40246PharmacologyPharmacologyNEW FACTNADrugs Acting on 5-HT (Serotonin) ReceptorsSpelling/formatting
41246PharmacologyPharmacologyNEW FACTNADrugs Acting on 5-HT (Serotonin) Receptors (edited)High-yield addition to next year
42263Public Health SciencesEpidemiology & BiostatisticsConfounding vs effect modificationhttps://pmc.ncbi.nlm.nih.gov/articles/PMC4249691/#:~:text=Confounding%20depends%20on%20how%20treatment,however%20relative%20to%20a%20population.The diagram for both confounding and effect modification show the same thing (the arrows are identical for both cases). I assume there should be two "weak/no association" arrows under the confounding section when stratified analysis is done.Minor erratum
43263Public Health SciencesEpidemiology & BiostatisticsConfounding vs effect modificationNAThe association in the image on this page I believe does not accurately represent the concept.Clarification to current text
44284CardiovascularEmbryologyHeart morphogenesisNo needIn pictures number 4 and 5, it’s written that remaining portion of septum primum forms a one way valve, but for it to be so, it needs to be long enough to close seal the opening (drawn in yellow)Minor erratum
45284CardiovascularEmbryologyHeart morphogenesis1. https://www.mdpi.com/2308-3425/9/6/187 2. https://my.clevelandclinic.org/health/articles/7247-fetal-development-stages-of-growth 3. https://www.medicalnewstoday.com/articles/when-does-a-fetus-have-a-heartbeat----Under Summary and Conclusions: " In this study, regular electrical activity was already recorded in the heart specimens from embryos at a gestational age of 5 weeks"The statement “beats spontaneously by week 4 of development” appears to be inaccurate. Current embryological evidence suggests that regular electrical activity in the embryonic heart is typically observed beginning around 5–6 weeks of gestation. Therefore, the timing for the onset of spontaneous cardiac activity should be updated for accuracy.Major erratum
46285CardiovascularEmbryologyNEW FACThttps://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-atrioventricular-av-canal-defects?search=partial%20atrioventricular%20septal%20defect&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1 ) and https://www.ncbi.nlm.nih.gov/books/NBK562194/) and ( https://www.cdc.gov/heart-defects/about/atrioventricular-septal-defect.html)As shown in the attached image, the book states the following: “Atrioventricular septal defect (AVSD)—also known as endocardial cushion or AV canal defect. Acyanotic congenital heart defect with single common AV valve plus either ASD alone (partial AVSD) or both ASD and VSD (complete AVSD).” However, according to current scientific understanding and established medical sources, the more accurate description should be: “Atrioventricular septal defect (AVSD)—also known as endocardial cushion or AV canal defect. Acyanotic congenital heart defect with a single common AV valve plus both ASD and VSD (complete AVSD), or a partial form characterized by a common atrioventricular junction and an ostium primum ASD with separate right and left AV valve orifices.” To elaborate further, based on verified academic and clinical sources: “A partial atrioventricular septal defect is characterized by an ostium primum atrial septal defect, separate atrioventricular valves with a common junction, an inlet ventricular septal defect, and a cleft mitral valve. In contrast, a complete AVSD is characterized by a common atrioventricular valve with an ostium primum atrial septal defect and an unrestricted ventricular septal defect of the inlet type.” Alternatively, as some references describe: “A partial or incomplete AVSD occurs when the heart has some, but not all, of the features of a complete AVSD. There is typically a hole in the atrial wall or the ventricular wall near the center of the heart. Partial AVSD usually presents with both mitral and tricuspid valves, though one (most often the mitral valve) may not close completely, resulting in regurgitation.”Minor erratum
47286CardiovascularEmbryologyFetal-postnatal derivativeshttps://radiopaedia.org/articles/umbilical-artery-1#:~:text=The%20umbilical%20artery%20gives%20rise,is%20the%20superior%20vesical%20artery.umbilical arteries remnant is given as medial umbilical ligament, its true but its the distal umbilical artery which becomes medial umbilical ligamnet, the proximal umbilical arteries remains as superior vesical artery .High-yield addition to next year
48292CardiovascularPhysiologyPressure-volume loops and cardiac cyclehttps://link.springer.com/article/10.1038/s41598-020-60317-7?fromPaywallRec=true#citeas"Right atrial pressure curve (JVP)" is improperly aligned to the cardiac cycle. The a wave should appear just earlier than illustrated because it signifies pressure felt from the right atrial contraction, which takes place just before the QRS complex/ventricular contraction.Minor erratum
49298CardiovascularPhysiologyElectrocardiogramNo needHere’s the corrected sentence with proper grammar: “You added ‘(which divides into left anterior and posterior fascicles)’ in the new addition, but you forgot to remove ‘left bundle branch divides into left anterior and posterior fascicles’ at the end of the paragraph (it’s written twice).”Spelling/formatting
50299CardiovascularPhysiologyBaroreceptors and chemoreceptorshttps://www-uptodate-com.lecomlrc.lecom.edu/contents/carotid-sinus-hypersensitivity-and-carotid-sinus-syndrome?search=carotid%20sinus%20hypersensitivity&source=search_result&selectedTitle=1%7E26&usage_type=default&display_rank=1#H3511079809The Baroreceptors and Chemoreceptors page on First Aid Forward, when talking about Carotid Sinus Hypersensitivity, says that increased baroreceptor firing increases AV node refractory period which increases HR and increases CO. This should be the opposite; increasing AV node refractory period should DECREASE HR and CO, and that's what causes the syncope. I have attached a screenshot of how it appears on First Aid Forward with the specific error highlighted, and I've also attached a link to the Uptodate page for Carotid Sinus Hypersensitivity as the condition is defined as a drop in HR or blood pressure in response to stimulation of carotid baroreceptors.Major erratum
51310CardiovascularPathologyDiagnosis of myocardial infarctionhttps://myadlm.org/advocacy-and-outreach/optimal-testing-guide-to-lab-test-utilization/a-f/ckmb#:~:text=Troponin%20T%20or%20I%20are,removed%20from%20routine%20order%20sets.In the book, it states that CK-MB is a useful marker for the diagnosis of reinfarction. However, upon further review of multiple resources (question banks, articles), it becomes clear that Troponin I is instead newly used for the monitoring and diagnosis of reinfarction. Students who read the current version as is are quite likely to incorrectly answer related questions on question banks/ the real exam.Major erratum
52310CardiovascularPathologyECG localization of STEMIhttps://www.ncbi.nlm.nih.gov/books/NBK470572/For the location of the inferior infarct, the text has RCA which is correct in most scenarios BUT it isn't the only. Since PDA can be supplied by LCX, text needs to clarify that Inferior Infarct isn't only from RCA.Clarification to current text
53312CardiovascularPathologyHereditary channelopathiesMedscape: “ https://emedicine.medscape.com/article/163751-overview?form=fpf”; Amboss: “ https://next.amboss.com/us/article/pl0LBT?q=brugada%20syndrome#ZWcZPY0” ; StatPearls: “https://www.ncbi.nlm.nih.gov/books/NBK519568/“According to FA: Brugada Syndrome causes “elevations in leads V1–V2”. There is no mention of V3. While Amboss says “Brugada pattern: pseudo-RBBB with ST elevation in leads V1–V3”; StatPearl says “The syndrome is characterized by the ECG findings of a right bundle branch block and ST-segment elevations in the right precordial leads (V1-V3).” and Medscape writes “Asymptomatic, but routine ECG shows ST-segment elevation in leads V1-V3”.Major erratum
54314CardiovascularPathologyMyocardial infarction complicationsUWorldprevious MI does NOT protect against free wall rupture. Instead, patients with a history of MI are at increased risk due to ventricular remodeling and the potential for reinfarction.Major erratum
55315CardiovascularPathologyCardiomyopathiesNot needed"Titin Too Loose, Myosin Too Much" = how to remember the mutated proteins in familial cardiomyopathies (i.e., familial dilated ["loose", overstretched] CM is titin, familial hypertrophic ["too much", thickened] CM is myosin)Mnemonic
56316CardiovascularPathologyHeart failurehttps://cvphysiology.com/heart-failure/hf006#:~:text=HFpEF%20most%20commonly%20results%20from,%2Ddiastolic%20pressure%20(EDP).The HFpEF graph shows that EDV is higher than it is in normal, but actually it’s normal or decreasedMajor erratum
57316CardiovascularPathologyHeart failureUpToDateSGLT2 inhibitors improve symptoms and mortality in all patients with HFrEF. The text here says in select patients only.Minor erratum
58317CardiovascularPathologyShockuworldPrimary disturbance for hypovolemic shock is volume depletion so there should be a decrease in CVP not PCWPMinor erratum
59320CardiovascularPathologyMyocarditisSelf explanatory. https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-treatment-of-diphtheria?search=diphtheria&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1Corynebacterium diptheriae is mentioned under the “Bacterial” but myocarditis in diptheria is toxin mediated and I think it will be more appropriate to mention it under the heading “Toxins”. Keep in Corynebacterium under bacterial heading may falsely imply direct bacterial invasion.Clarification to current text
60321CardiovascularPathologyDeep venous thrombosisUWorld→ Proximal DVT (femoral, iliac, popliteal) = MCC of PE → Distal (calf) DVTs less likely to embolize; often resolve spontaneouslyHigh-yield addition to next year
61335EndocrineAnatomy and PhysiologyNEW FACThttps://emedicine.medscape.com/article/118651-overview#a5I wanted to clarify a statement in First Aid 2024, Endocrine Physiology (Page 335) regarding reverse T3 (rT3) regulation. The book states: "Reverse T3 (rT3) production is increased by growth hormone and glucocorticoids." From my understanding: Glucocorticoids (at high doses) increase rT3 by inhibiting 5’-deiodinase, shifting T4 conversion toward rT3. Growth hormone (GH) actually decreases rT3, as it enhances T4-to-T3 conversion via 5’-deiodinase (D1, D2) while suppressing Type 3 deiodinase (D3), which generates rT3.Clarification to current text
62335EndocrinePhysiologyNEW FACTRobbins and Cotran Pathologic Basis of Disease (10th Edition), Chapter on Thyroid Disorders.The statement that "T3 and T4 are the only lipophilic hormones with charged amino acids" is incorrect. Steroid hormones (e.g., cortisol, estrogen) are also lipophilic and require carrier proteins for transport in the blood.Major erratum
63335EndocrinePhysiologyThyroid hormoneshttps://www.amboss.com/us/knowledge/thyroid-gland-and-parathyroid-glandsI recommend adding liver disease (including liver failure) as a significant cause of decreased thyroxine-binding globulin (TBG) levels, TBG is synthesized in the liver, and hepatic disorders directly impair its production. As a result, patients with liver disease frequently exhibit reduced total T3 and T4 levels, despite maintaining normal free hormone concentrations. Including this information would enhance the clinical relevance of the section and provide students with a more comprehensive understanding of thyroid function assessment, particularly in patients with underlying liver conditions.High-yield addition to next year
64339EndocrinePhysiologyAdrenal steroids and congenital adrenal hyperplasiasNo needIt is incorrectly stated that in 17a-hydroxylase deficiency, aldosterone levels decrease, when in fact they increase. This error is not present in older versions. I will attach below the incorrect version in this year's edition first and the correct version in the 2023 edition after.Major erratum
65339EndocrinePhysiologyAdrenal steroids and congenital adrenal hyperplasiashttps://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323597128000783?scrollTo=hl0000683 Guyton and Hall Textbook of Medical Physiology 14th Edition Page 969In the footnote, hyperpigmentation in human should be mainly caused by ACTH not MSH in human because the quantities of pure MSH secreted in humans are extremely small, whereas those of ACTH are large, it is likely that ACTH is normally more important than MSH in determining the amount of melanin in the skinMinor erratum
66339EndocrinePhysiologyAdrenal steroids and congenital adrenal hyperplasiasOld edition of first aid and GytonUnder the topic of 17α-hydroxylase deficiency, it says aldosterone decreases, but this seems incorrect. The correct statement should be “aldosterone increases.”Major erratum
67349EndocrinePathologyFamilial hypocalciuric hypercalcemiaUpToDateLabs: normal or high PTH, high serum calcium, normal or low serum phosphate and low urinary calciumHigh-yield addition to next year
68355EndocrinePathologyPheochromocytomaUpToDateInstead of Irreversible alpha-antagonists (e.g. phenoxybenzamine) followed by beta-blockers prior to tumor resection, I suggest Medical therapy includes selective alpha-1 blockers (prazosin, terazosin) or non selective alpha blockers (phenoxybenzamine) prior to non-selective beta blockers (propranolol) or selective beta blockers (atenolol, metoprolol) prior to the tumor resection.Clarification to current text
69355EndocrinePathologyPheochromocytomaUpToDateepisodic hyperglycemia may be an uncommon finding; i think i must be episodic hyperglycemia may be an common finding.Minor erratum
70359EndocrinePharmacologyNEW FACTUp To Date"Metformin also activates the enzyme AMP-activated protein kinase (AMPK) in hepatocytes, which appears to be the mechanism by which metformin lowers serum lipid concentrations." This is also highly tested mechanism of action of metformin.High-yield addition to next year
71364GastrointestinalEmbryologyTongue developmenthttps://usmle-rx.scholarrx.com/video-player;playlist=quick-play-express-6d18a870-162c-11f0-8b94-f97e29b232221st AND 2ND pharyngeal arch forms the ant 2/3 of tongue.Clarification to current text
72366GastrointestinalEmbryologyHypertrophic pyloric stenosishttps://radiopaedia.org/articles/pyloric-stenosis-1?lang=usIn hypertrophic pyloric stenosis, ultrasound is the modality of choice in the clinical settings. Sonographic signs are antral nipple sign, cervix sign and target sign.High-yield addition to next year
73366GastrointestinalEmbryologyHypertrophic pyloric stenosisnot needed3P's in Pyloric Stenosis --->. Palpable Olive Mass, Peristalsis visible, Postprandial non-bilious Projective vomitingMnemonic
74367GastrointestinalAnatomyRetroperitoneal structureshttps://emedicine.medscape.com/article/1948973-overviewit is mentioned that thoracic part of esophagus is retroperitonela which gives a idea that other parts of esophagus that is cervical and abdominal is peritoneal whereas cervical part of esophagus is also retroperitonealMajor erratum
75369GastrointestinalAnatomyNEW FACTno need@LOCI for location of gut muscle( Longitudinal Outer, Circular Inner layer )of gut muscleMnemonic
76385GastrointestinalPathologyEsophageal cancerhttps://radiopaedia.org/articles/rats-tail-sign-oesophagusunlike in achalasia cardia, rat tail appearance is seen in barium swallow of esophagus cancerHigh-yield addition to next year
77386GastrointestinalPathologyNEW FACThttps://www.ncbi.nlm.nih.gov/books/NBK563154/#:~:text=Menetrier%20disease%20is%20a%20rare,giant%20hypertrophic%20gastritis.%5B1%5D , Robbins & Cotran Pathologic Basis of Disease 10 edition with south asia content, page no 772In Ménétrier disease, first aid 2025 says there is hyperplasia of gastric mucosa and hypertrophied rugae, but it does not clarify on location on stomach. It can give a false sense on entire parts of stomach. Hypertrophied rugae are present in present in body and fundus, and antrum is spared.Clarification to current text
78390GastrointestinalPathologyDiverticula of the GI tractno needIn the definition of a false diverticulum, Zenker's diverticulum is mentioned as an example. However, its position in the sentence following "occurs especially where vasa recta penetrate the muscularis externa layer" is misleading, as it makes it seem like this is the cause of Zenker's diverticulum. In reality, Zenker's diverticulum is caused by weakness in Killian's triangle.Minor erratum
79394GastrointestinalPathologyColonic polypsup to date:https://www.uptodate.com/contents/overview-of-colon-polyps?search=hyperplastic%20polyp&source=search_result&selectedTitle=1%7E31&usage_type=default&display_rank=1#H695577522 Sternberg’s Diagnostic Surgical Pathology (6th ed.): "The sawtooth (serrated) pattern is the hallmark of hyperplastic polyps."the book mentions that hyperplastic polyps "occasionally evolve into serrated polyps and more evolved lesions" however pathology sources and up to date state that all hyperplastic polyps are serrated. the quoted sentence implies that it evolves into a serrated form rather than being serrated, which may cause confusion.Major erratum
80396GastrointestinalPathologyCirrhosis and portal hypertension[1] UWorld #1701. [2] https://www.uptodate.com/contents/pathogenesis-of-ascites-in-patients-with-cirrhosisYou mentioned that portal vein thrombosis causes ascites. However, ascites is uncommon with portal vein thrombosis since sinusoidal hypertension does not develop [1]. Sinusoidal hypertension appears to be required for fluid retention to occur; presinusoidal portal hypertension, as in portal vein thrombosis, does not result in ascites formation in the absence of another predisposing factor [2].High-yield addition to next year
81398GastrointestinalPathologySteatotic liver diseaseNo needMASLD is written twiceSpelling/formatting
82403GastrointestinalPathologyCholelithiasis and related pathologieshttps://www.uptodate.com/contents/gallstones-epidemiology-risk-factors-and-prevention?search=cholelithiasis%20risk%20factors&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1#H2608614826 , https://pubmed.ncbi.nlm.nih.gov/6429363/Total parenteral nutrition (TPN) is associated with cholesterol stones, not pigmented stones as mentioned in the book. TPN leads to gallbladder hypomotility due to reduced cholecystokinin (CCK) secretion, resulting in gallbladder stasisMajor erratum
83408GastrointestinalPharmacologyAnticonstipation drugshttps://www.uptodate.com/contents/prevention-and-management-of-side-effects-in-patients-receiving-opioids-for-chronic-pain#H372619437Methylnaltrexone should be included in the anti-constipation drugs section under a new category, Peripherally Acting Opioid Antagonists, as it is specifically used for opioid-induced constipation (OIC) without affecting analgesia. Currently, it is only mentioned under opioid antagonists, but its role in treating constipation is not highlighted. Since Step 1 often tests opioid side effects and their management, methylnaltrexone is relevant as a peripherally acting μ-opioid receptor antagonist that does not cross the blood-brain barrier. Its inclusion would help clarify the distinction between central opioid antagonists (e.g., naloxone, naltrexone) used for overdose and peripheral antagonists like methylnaltrexone used for constipation. Adverse effects include diarrhea, abdominal pain, and nausea. Adding this drug would improve clarity on OIC treatment and align with other medications already included in the anti-constipation section. If needed, it can instead be added as a NEW FACT. Given that loperamide and diphenoxylate are separated for their role in diarrhea, a similar approach can be taken for methylnaltrexone and other peripherally acting opioid antagonists (e.g., naloxegol, naldemedine) due to their distinct mechanism and clinical relevance in Step 1.High-yield addition to next year
84419Hematology and OncologyPhysiologyVitamin K–dependent coagulationno needI think since you corrected the first line from "synthesis" to carboxylation and maturation, you should correct the 7th line (synthesis).Minor erratum
85427Hematology and OncologyPathologyNonhemolytic, normocytic anemias1.first aid page 422. 2.RAPID REVIEW PATHOLOGY EDWARD F. GOLJAN (fifth edition) (i will provide photo from the books in the file attachements section )Anemia of chronic disease is microcytic, not normocyticMajor erratum
86427Hematology and OncologyPathologyNonhemolytic, normocytic anemias1.first aid page 422. 2.RAPID REVIEW PATHOLOGY EDWARD F. GOLJAN (fifth edition) (i will provide photo from the books in the file attachements section )Anemia of chronic disease is microcytic, not normocyticMajor erratum
87428Hematology and OncologyPathologyIntrinsic hemolytic anemiashttps://academic.oup.com/labmed/article/46/3/e79/2657964In Hb electrophoresis in sickle cell disease patients should be no HbA1 at all not decreasing in amount because the mutation in sickle cell disease in both beta globin so it would me no HbA1 at all( which composes of 2beta and 2alpha). Hb electrophoresis then ( HbS,HbF,HbA2 ).Minor erratum
88429Hematology and OncologyPathologyExtrinsic hemolytic anemiashttps://pmc.ncbi.nlm.nih.gov/articles/PMC9821124/ -- In the Introduction session, last sentence of the first paragraph -- "Terminal complement is activated in the vasculature, leading to intravascular hemolysis." Also NBME Self-Assessment Practice question also categorized cold AIHA as intravascular hemolysis.In the "Autoimmune hemolytic anemia" block, "Cold AIHA" bullet - "IgM + complement cause RBC agglutination and extravascular hemolysis upon exposure to cold", should be intravascular hemolysisClarification to current text
89432Hematology and OncologyPathologyPlatelet disordersno needIn the lab findings for Bernard-Soulier syndrome, the book states "decreased platelet aggregation". However, this may be misleading, as the primary defect in Bernard-Soulier is in platelet adhesion due to defective GpIb, not in true aggregation. The reduced aggregation is observed specifically in the ristocetin-induced platelet aggregation test, which evaluates vWF-GpIb–mediated adhesion. To avoid confusion, I suggest rephrasing it as: "Decreased platelet aggregation with ristocetin." I understand that the book doesn’t intend to imply a primary aggregation defect, but the current wording may give that impression.Clarification to current text
90432Hematology and OncologyPathologyThrombotic microangiopathiesUWorldPathophysiology: Predominately caused by Shiga toxin–producing Escherichia coli (STEC) infection (serotype O157:H7), which causes profound endothelial dysfunction → capillary microthrombi → renal vascular occlusion (afferent arteriole, glomerular capillaries).High-yield addition to next year
91433Hematology and OncologyPathologyMixed platelet and coagulation disordersLevi M, Toh CH, Thachil J, Watson HG. Guidelines for the Diagnosis and Management of DICDIC is not limited to Gram-negative sepsis; Gram-positive sepsis can also trigger DIC via endotoxin and cytokine activation. The text should be more inclusive.Minor erratum
92434Hematology and OncologyPathologyBlood transfusion therapyhttps://www.uptodate.com/contents/platelet-transfusion-indications-ordering-and-associated-risks?search=platelet%20transfusion%20unit&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1#H382870481Please revise the platelet transfusion section: “1 unit increases platelet count by ~30,000/µL” is incorrect. Correct version: “1 random donor unit increases platelet count by ~5,000 µL; 6 units (or 1 apheresis unit) increase by ~30,000 µL.”Minor erratum
93434Hematology and OncologyPathologyHodgkin lymphomaUpToDateReed sternberg cells (i.e. large B cells with multilobed nuclei and prominent nucleoli i.e. owl-eyed nuclei).Clarification to current text
94434Hematology and OncologyPathologyHodgkin lymphomaUSMLERxThe mnemonic for best vs worst prognosis can simply be- the 'rich' have it 'better'; the 'poor' have it 'worse'Mnemonic
95436Hematology and OncologyPathologyNEW FACThttps://www.pathologyoutlines.com/topic/stainskappa.html \ https://www.pathologyjournal.rcpa.edu.au/article/S0031-3025(24)00098-9/fulltextFree Light Chain Ratio: unbound (free) kappa and lambda light chains in the serum.Very sensitive test for detecting monoclonal plasma cell disorders.determine clonal status of lymphocytes and plasma cells if expansion happens that mean increase either kappa or lambda also used for differentiating monoclonal vs. polyclonal gammopathies. in renal failure both kappa and lambda is high so the final ratio is normal.the updated κ:λ free light chain ratio range (0.26–1.65) with Freelite on BN II/Optilite ensures accurate diagnosis and monitoring of plasma cell disorders like multiple myeloma.High-yield addition to next year
96436Hematology and OncologyPathologyPlasma cell dyscrasiasnot neededAttached is an improved table format summarizing plasma cell dyscrasiasHigh-yield addition to next year
97437Hematology and OncologyPathologyLeukemiasnot neededAttached is an improved table format summarizing leukemiasHigh-yield addition to next year
98441Hematology and OncologyPharmacologyWarfarin1)https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2020/12/16/22/01/2020-ACC-AHA-VHD-GL-Pt-3-GL-VHD 2)https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923 (i will provide photo from the guidlines)add to clinical use that: warfarin is class 1 (the only anticoagulant) in patients with mechanical heart valves, or ventricular assist devices, there is no other anticoagulant indicated in these casesHigh-yield addition to next year
99444Hematology and OncologyPharmacologyAntimetabolitesSelf-Study, USMLERxDrugs that inhibit folate synthesis or folate-dependent pathways, such as those involved in DNA synthesis, can lead to megaloblastic anemia. This common adverse effect is associated with medications like 5-Fluorouracil, Hydroxyurea, and Methotrexate. However, at present, megaloblastic anemia is only noted as an adverse effect for Hydroxyurea.Clarification to current text
100444Hematology and OncologyPharmacologyAntitumor antibioticsInfo already in First AidThe adverse effect of Bleomycin being Pulmonary Fibrosis can be remembered by the memory device "Bleomycin bleows(blows) up the lungs". This is further validated by a similar accepted memory device "Vinblastine blasts the marrow"" on Page 445Mnemonic
101444Hematology and OncologyPharmacologyAntitumor antibioticsInfo already in First AidThe adverse effect of Bleomycin being Pulmonary Fibrosis can be remembered by the memory device "Bleomycin bleows(blows) up the lungs". This is further validated by a similar accepted memory device "Vinblastine blasts the marrow"" on Page 445Mnemonic
102445Hematology and OncologyPharmacologyAlkylating agentshttps://bmccancer.biomedcentral.com/articles/10.1186/s12885-025-13757-1#:~:text=The%20role%20of%20temozolomide%20as%20adjuvant%20therapy%20in,25%2C%20Article%20number%3A%20399%20%282025%29%20Cite%20this%20articleAttached is the updated table of alkylating agents, with the addition of temozolomide including its mechanism, clinical use, and adverse effects, to reflect its current importance in the treatment of brain tumors.High-yield addition to next year
103446Hematology and OncologyPharmacologyTamoxifenSelf-StudyInformation on Tamoxifen is mentioned twice, once in Hematology and another time with the SERMs in the Reproductive chapterClarification to current text
104450Musculoskeletal, Skin, and Connective TissueAnatomy and PhysiologyUpper extremity nerveshttps://www.ncbi.nlm.nih.gov/books/NBK554514/Musculocutaneous (C5-C7) Upper trunk compression Loss of sensation over lateral forearm not dorsal (wrongly mentioned in the book) as dorsal forearm is supplied by posterior cutaneous branches;posterior interosseous nerve (PIN) of radial nerve not musculocutaneous nerve.Major erratum
105452Musculoskeletal, Skin, and Connective TissueAnatomy and PhysiologyBrachial plexus lesionshttps://www.uptodate.com/contents/neonatal-brachial-plexus-palsy?search=klumpke%20palsy&sectionRank=1&usage_type=default&anchor=H774209207&source=machineLearning&selectedTitle=1%7E4&display_rank=1#H774209207in klumpke palsy , the features mentions about claw hand deformity which is a common manifestation, but addition of horner syndrome which can be seen in klumpke palsy due to t1 getting effected would be a high yieldHigh-yield addition to next year
106456Musculoskeletal, Skin, and Connective TissueAnatomy and PhysiologyLower extremity nervesUWorldThe lower extremity nerves section can include the Ilioinguinal nerve (L1), which is significant for its sensory innervation of the upper medial thigh, the base of the penis, and the anterior scrotum or labia majora. Additionally, it's worth noting that the Ilioinguinal nerve is at risk of injury during abdominal surgery/inguinal hernia repair due to its proximity to the inguinal canal.High-yield addition to next year
107464Musculoskeletal, Skin, and Connective TissuePathologyNEW FACTDiagram inconsistencySmall diagram of knee is inconsistent with large diagram. Hip is on the wrong side. The valgus force described in the image is directed laterally (onto the medial cruciate ligament), but the large image is directed medially (onto the lateral cruciate ligament).Minor erratum
108466Musculoskeletal, Skin, and Connective TissuePathologyChildhood musculoskeletal conditionshttps://reference.medscape.com/article/1248422-overview?_gl=1*yk180g*_gcl_au*MTk2MDI1NTkxLjE3NDIwODcxODI.In slipped capital femoral epiphysis disease the book mentions that its epiphysis displaces relative to femoral neck , but in fact the correct definition is it is slippage of metaphase relative to epiphysisMajor erratum
109466Musculoskeletal, Skin, and Connective TissuePathologyChildhood musculoskeletal conditionshttps://reference.medscape.com/article/1248422-overview?_In slipped capital femoral epiphysis disease the book mentions that its epiphysis displaces relative to femoral neck, but in fact the correct definition is it is slippage of metaphysis relative to epiphysis(SCFE is actually a misnomer, because the epiphysis is held in the acetabulum by the ligamentum teres; thus, the metaphysis actually moves proximally and anteriorly while the epiphysis remains in the acetabulum.Major erratum
110467Musculoskeletal, Skin, and Connective TissuePathologyOsteoporosishttps://pmc.ncbi.nlm.nih.gov/articles/PMC9504265/#sec9-ijms-23-10733. https://accessmedicine.mhmedical.com/content.aspx?bookid=3388&sectionid=282405631&utm.long-term PPi therapy can lead to 2° osteoporosis.Clarification to current text
111470Musculoskeletal, Skin, and Connective TissuePathologyPrimary bone tumorshttps://radiopaedia.org/articles/giant-cell-tumour-of-boneIn the Giant Cell Tumor entry in the Primary Bone Tumors table, it states the “radiographic epicenter is metaphysis,” which contradicts the same row stating the tumor is epiphyseal in location. While large tumors may extend into the metaphysis, the classic and Step 1-relevant location is epiphysis , especially in skeletally mature individuals. This discrepancy is confusing and should be clarified.Major erratum
112476Musculoskeletal, Skin, and Connective TissuePathologySystemic lupus erythematosushttps://www.sciencedirect.com/science/article/pii/S0953620523000377?utm_source=chatgpt.comThe current edition does not mention the most common cause of death in patients with SLE. Please consider adding that cardiovascular disease (CVD) is the most common cause of death in patients with SLEHigh-yield addition to next year
113477Musculoskeletal, Skin, and Connective TissuePathologyPolymyositis/dermatomyositisnot neededIn the dermatomyositis paragraph, there's an issue where a parenthesis is opened at '(thickening' but never closed.Spelling/formatting
114479Musculoskeletal, Skin, and Connective TissuePathologyVasculitideshttps://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-behcet-syndrome?search=behcet%20disease%20adult&source=search_result&selectedTitle=1%7E139&usage_type=default&display_rank=1#H265677260behcet syndrome can be diagnosed if recurrent oral ulcer is present for at least 3 times in 12 months.High-yield addition to next year
115479Musculoskeletal, Skin, and Connective TissuePathologyVasculitidesnot neededIn the Immunoglobulin A vasculitis presentation/pathophysiology section, there's an issue where a parenthesis is opened at '(abdominal pain' but never closed.Spelling/formatting
116483Musculoskeletal, Skin, and Connective TissueDermatologyDermatologic macroscopic termshttps://www.uptodate.com/contents/approach-to-the-clinical-dermatologic-diagnosis?search=erosion&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1#H5erosion due to GERD is not an example of dermatologic lesionMinor erratum
117489Musculoskeletal, Skin, and Connective TissueDermatologyAutoimmune blistering skin disordershttps://www.uptodate.com/contents/pathogenesis-clinical-manifestations-and-diagnosis-of-pemphigus?search=Pemphigus%20vulgaris&source=search_result&selectedTitle=2%7E40&usage_type=default&display_rank=2#H181679704Disrupted desmosomes rather than hemidesmosomes under Pemphigus vulgaris in the pictureMinor erratum
118489Musculoskeletal, Skin, and Connective TissueDermatologyAutoimmune blistering skin disordersNo needIn the diagram at the bottom of the page, on the left side (under Pemphigus Vulgaris) the arrow pointing at the connections between the keratinocytes says "disrupted hemidesmosomes" when it should just say "disrupted DESMOSOMES" because the former applies to Bullous Pemphigoid, which is annotated correctly on the right, but not Pemphigus Vulgaris.Minor erratum
119490Musculoskeletal, Skin, and Connective TissueDermatologyOther blistering skin disordershttps://emedicine.medscape.com/article/1122915-overview#a2infections of erythema multiforme has been written as m. pneumoniae and hsv which may give a impression that m. pneumoniae is a common cause whereas its the opposite hsv is the common causeMinor erratum
120501Neurology and Special SensesEmbryologyNeural tube defectshttps://www.ninds.nih.gov/health-information/disorders/spina-bifidaIn the Spinal dysraphism section, explaining the spina bifida occulta, it says “Failure of caudal neural tube to close” which is misleading. As in spina bifida occulta, what happens is that the neural tube closes properly but the issue is the failure of the vertebral arch to form over the closed neural tube! You can see in the NIH supporting reference I included, in the occulta section, it happens when one or more bones in the spinal column “vertebrae”. So saying it as in the first aid book, “Closed NTD. Failure of caudal neural tube to close” is misleading and contrary.Clarification to current text
121502Neurology and Special SensesNeuropathologySyringomyeliahttps://emedicine.medscape.com/article/1151685-clinicalWhen the syrinx cavity expands to involve the posterior columns, there is a loss of position and vibration senses in the feet, and astereognosis may be observed in the hands. This concept is also assessed in the UWorld question bank under Question ID No. 1904. A screenshot of the question is attached below for reference.High-yield addition to next year
122504Neurology and Special SensesAnatomy and PhysiologySensory receptorshttps://www.griffinot.com/touch-sense-sensory-processing/"Deep touch" is equivalent to pressure in the context of "Merkel discs".Clarification to current text
123505Neurology and Special SensesAnatomy and PhysiologyNeuronal response to axonal injuryGrammar"In effort to" is grammatically incorrect and should be changed to "in an effort to".Spelling/formatting
124505Neurology and Special SensesAnatomy and PhysiologyNeurotransmitter changes with diseasehttps://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2019.00340/fullThe "tuberomammillary nucleus" (TMN) is a "histaminergic" nucleus located within the posterior third of the hypothalamus, and it should be added to complete the table. Also, the attached figure summarizes the contents in one image.High-yield addition to next year
125505Neurology and Special SensesAnatomy and PhysiologyPeripheral nervehttps://brainly.com/question/33041467"Ecto-" means outer not "Epi-". Epi- means upon.Minor erratum
126505Neurology and Special SensesAnatomy and PhysiologyPeripheral nervehttps://www.sciencedirect.com/topics/neuroscience/endoneurium#:~:text=The%20endoneurium%20refers%20to%20the,protecting%20and%20repairing%20injured%20axonsThe "endoneurium" refers to the fibrous tissue that surrounds myelinated and unmyelinated axons in the peripheral nerves. So, it would be better to be added "unmyelinated" after "individual myelinated".Clarification to current text
127506Neurology and Special SensesAnatomy and PhysiologyBlood-brain barrierhttps://en.m.wikipedia.org/wiki/Vascular_organ_of_lamina_terminalis"OVLT" stands for organum vasculosum of the lamina terminalis. So, "of the" should be added after "vasculosum".Spelling/formatting
128506Neurology and Special SensesAnatomy and PhysiologyVomiting centerMnemonicTo aid in remembering, we can highlight and bold the "H" in "H1 antagonists" and "Hyperemesis gravidarum".Mnemonic
129506Neurology and Special SensesAnatomy and PhysiologyVomiting centerMnemonicTo aid in remembering, we can use "H&M" for "H1 and M1 antagonists", drawing on the similarity with the brand.Mnemonic
130507Neurology and Special SensesAnatomy and PhysiologySleep physiologyGrammar"Rapid-eye movement" is incorrect and should be changed to "Rapid eye movement".Spelling/formatting
131507Neurology and Special SensesAnatomy and PhysiologySleep physiologyhttps://en.m.wikipedia.org/wiki/Gaze_(physiology)For precision and clarification, it would be better if "horizontal" were added before "conjugate gaze center" when referring to the PPRF.Clarification to current text
132508Neurology and Special SensesAnatomy and PhysiologyHypothalamusGrammarFor clarification, it would be better to be added "via the" before "release of hormones" in the hypothalamus section.Clarification to current text
133510Neurology and Special SensesAnatomy and PhysiologyCerebellumhttps://en.m.wikipedia.org/wiki/Anatomy_of_the_cerebellumThe "paravermal zone" controls distal movements, not the "hemispheres", which contribute to the planning and timing. Therefore, "ie, hemisphere" should be changed to "ie, paravermal zone".Major erratum
134512Neurology and Special SensesAnatomy and PhysiologyCerebral perfusionhttps://en.m.wikipedia.org/wiki/Brain_death"Coma" is different from "brain death"; therefore, it should be deleted.Minor erratum
135512Neurology and Special SensesAnatomy and PhysiologyCerebral perfusionAccording to the content"CPP" is different from "CBF". As the figure shows, CBF is associated with hypoxemia, so "CPP" should be replaced with "CBF".Minor erratum
136512Neurology and Special SensesAnatomy and PhysiologyCerebral perfusionhttps://derangedphysiology.com/main/cicm-primary-exam/cardiovascular-system/Chapter-474/cerebral-blood-flow-autoregulationAs the figure shows, CBF is correlated with PCO2 until it is 90 or less. Therefore, in the sentence "CPP is directly proportional to PCO2 until PCO2 > 90", the ">" sign should be changed to "<".Major erratum
137513Neurology and Special SensesAnatomy and PhysiologyCerebral arteries—cortical distributionhttps://www.ncbi.nlm.nih.gov/books/NBK559186/In "man in a barrel syndrome", the lower extremities are intact.Clarification to current text
138513Neurology and Special SensesAnatomy and PhysiologyHomunculushttps://learnsomatics.ie/how-your-brain-sees-your-body/The "face" label in the motor homunculus is missing the area between the eyes and lips; it should be included.Clarification to current text
139515Neurology and Special SensesAnatomy and PhysiologyBrainstem—dorsal view (cerebellum removed)https://en.m.wikipedia.org/wiki/Inferior_cerebellar_peduncleSince the "inferior cerebellar peduncle" attaches to the medulla, it should have the same color as the medulla.Spelling/formatting
140515Neurology and Special SensesAnatomy and PhysiologyBrainstem—ventral viewGrammarThe phrase "exit in the medulla" shown in the figure is incorrect; it should be revised to "exit from the medulla".Spelling/formatting
141515Neurology and Special SensesAnatomy and PhysiologyBrainstem—ventral viewhttps://en.m.wikipedia.org/wiki/Trochlear_nerveThe "trochlear nerve" decussates "within the brainstem" before emerging on the contralateral side of the brainstem.Clarification to current text
142515Neurology and Special SensesAnatomy and PhysiologyBrainstem—ventral viewhttps://pubmed.ncbi.nlm.nih.gov/15836511/Hi, I really like the diagram of the brainstem from the ventral view on page 515. I think it could be expanded slightly to include the rule of 4s. The rule of 4s is referenced in the mnemonic but it is not shown directly and it loses out showing visually medial vs lateral nerve origin points, and it doesn't show blood flow. There is also the mnemonic that all midline (medial) structures start with M and all side (lateral) structures start with S. Side = Sympathetics, Spinothalamic, Sensory, Spinocerebellar. Midline = Motor nucleus, (Motor) Corticospinal, MLF, and Medial lemniscus (DC). -- I think with the room provided, a diagram of the rule of 4s could be included under the text. I used the rule of 4s many times both in studies and exams. Attached is my hand written rule of 4s as well as a diagram for references. I wrote mine on page 521 since there was a lot of room.High-yield addition to next year
143515Neurology and Special SensesAnatomy and PhysiologyVentricular systemhttps://en.m.wikipedia.org/wiki/Ventricular_systemSince CSF flow ends either in the subarachnoid space or the central canal of the spinal cord, the direction should be indicated as "1 → 6/7" instead of "1 → 7", as CSF cannot proceed to 7 once it reaches 6.Minor erratum
144515Neurology and Special SensesAnatomy and PhysiologyVentricular systemhttps://en.m.wikipedia.org/wiki/Fourth_ventricleThe foramina of the fourth ventricle are imprecisely indicated, and the foramen of Magendie is incorrectly shown at the fastigium.Minor erratum
145516Neurology and Special SensesAnatomy and PhysiologyBrainstem cross sectionshttps://en.m.wikipedia.org/wiki/Cerebral_crus#:~:text=The%20cerebral%20crus%20The "cerebral crus" s the anterior portion of the "cerebral peduncle"; therefore, the label should be changed accordingly.Minor erratum
146516Neurology and Special SensesAnatomy and PhysiologyCranial nerve nucleihttps://www.kenhub.com/en/library/anatomy/the-accessory-nerve"Cranial nerve XI" consists of two parts, and it would be more appropriate to include the cranial portion in the medulla section.Clarification to current text
147516Neurology and Special SensesAnatomy and PhysiologyVagal nucleihttps://emedicine.medscape.com/article/1923077-overview#a1The "nucleus ambiguus" also sends parasympathetic fibers to the heart (more so than the dorsal motor nucleus).Minor erratum
148517Neurology and Special SensesAnatomy and PhysiologyBrainstem cross sectionshttps://teachmeanatomy.info/neuroanatomy/brainstem/medulla-oblongata/The "tectospinal tract" is located between the MLF and the medial lemniscus in the medulla, and it would be better to include it as well.Clarification to current text
149518Neurology and Special SensesAnatomy and PhysiologyCranial nerves and arteriesThis was correct on the 2024 version of First Aid but incorrect on the 2025 version.The arrows pointing to anterior inferior cerebellar artery and labyrinthine artery are switched on the diagram.Minor erratum
150518Neurology and Special SensesAnatomyCranial nerves and arteriesFirst aid page 526, https://radiopaedia.org/articles/labyrinthine-artery , K Zhang et al "Anatomic investigation of the labyrinthine artery" Zhonghua Er Bi Yan Hou Ke Za Zhi. 2002 Apr;37(2):103-5. PMID: 12768717The Labyrinthine artery is a BRANCH of AICA (Anterior Inferior Cerebellar Artery) in ~90% of cases. Variant: can arise directly from basilar artery (~10%). In the diagram it’s depicted as the less common variant, which is that it arises from the basilar artery. This is clinically relevant, and even in page 526, “Effects of strokes”, “Posterior circulation”, “Anterior inferior cerebellar artery” we can see the note “Supplied by labyrinthine artery, a branch of AICA”Clarification to current text
151518Neurology and Special SensesAnatomy and PhysiologyCranial nerves and arterieshttps://en.m.wikipedia.org/wiki/MidbrainThe "midbrain" is supplied by the following arteries: the "superior cerebellar artery", "basilar artery", and "posterior cerebral artery".Major erratum
152518Neurology and Special SensesAnatomy and PhysiologyCranial nerves and arterieshttps://en.m.wikipedia.org/wiki/PonsThe blood supply of the "pons" is provided by the pontine arteries (branches of the basilar artery), the anterior inferior cerebellar artery, and the superior cerebellar artery. Therefore, the "labyrinthine" artery, which supplies the inner ear, should be excluded.Major erratum
153518Neurology and Special SensesAnatomy and PhysiologyCranial nerves and vessel pathwayshttps://en.m.wikipedia.org/wiki/Jugular_foramenThe "sigmoid sinus" in the posterior cranial fossa becomes the "internal jugular vein" after passing through the jugular foramen; therefore, it would be better written as "sigmoid sinus (internal jugular vein)".Clarification to current text
154519Neurology and Special SensesAnatomy and PhysiologyCranial nerve reflexesUSMLERxThe vestibulo-ocular reflex (VOR) uses input from the vestibular apparatus (CN VIII) to detect head rotation. This signal is processed and relayed via the medial longitudinal fasciculus (MLF) to coordinate the actions of CN III (oculomotor), CN IV (trochlear), and CN VI (abducens), producing eye movements opposite to head motion to stabilize vision during movement.Clarification to current text
155519Neurology and Special SensesAnatomy and PhysiologyCranial nerveshttps://en.m.wikipedia.org/wiki/Chorda_tympaniThe "chorda tympani" has afferent fibers for taste sensation and efferent fibers for salivation; therefore, it would be better to be added "(chorda tympani)" after "by CN seven".Clarification to current text
156519Neurology and Special SensesAnatomy and PhysiologyCranial nerveshttps://en.m.wikipedia.org/wiki/Trigeminal_nerveThe mandibular branch of the "trigeminal nerve" innervates four muscles: the "tensor veli palatini", the "mylohyoid", the "anterior belly of the digastric", and the tensor tympani, in addition to the muscles of mastication.Clarification to current text
157519Neurology and Special SensesAnatomy and PhysiologyCranial nervesMnemonicTo aid in remembering, we can bold and highlight the "T" in "Trigeminal" and "Tensor tympani" & "Tensor veli palatini".Mnemonic
158520Neurology and Special SensesAnatomy and PhysiologyMastication muscleshttps://en.m.wikipedia.org/wiki/Lateral_pterygoid_muscleThe most important function of the "lateral pterygoid" is opening the jaw, and it is the only muscle responsible for this action; therefore, it should be mentioned.Clarification to current text
159520Neurology and Special SensesAnatomy and PhysiologySpinal cord—lower extentMy brainSilly Fat Surgeons Inject Large Epidurals During Awkward Surgeries can be a fun way to remember the needle passage to obtain CSFMnemonic
160520Neurology and Special SensesAnatomy and PhysiologySpinal cord—lower extenthttps://en.m.wikipedia.org/wiki/Dura_materThe "spinal dura mater", unlike the cranial dura mater, is single-layered; therefore, it should be shown in the figure as a "single layer", not two layers.Minor erratum
161522Neurology and Special SensesAnatomy and PhysiologySpinal tract anatomy and functionshttps://en.m.wikipedia.org/wiki/Spinothalamic_tractSince the anterior spinothalamic tract carries information about crude touch, "crude touch" should be included in the "spinothalamic" section.Clarification to current text
162522Neurology and Special SensesAnatomy and PhysiologySpinal tract anatomy and functionshttps://en.m.wikipedia.org/wiki/Spinothalamic_tractThe anterior spinothalamic tract transmits pressure; therefore, "pressure" should be included in the "spinothalamic" tract, not the dorsal column.Major erratum
163522Neurology and Special SensesAnatomy and PhysiologySpinal tract anatomy and functionsFormattingThe fibers passing through the medulla from underneath would be better shown as a "dashed line", like the corticospinal tract.Spelling/formatting
164524Neurology and Special SensesPathologyAbnormal motor posturinghttps://www.ncbi.nlm.nih.gov/books/NBK559135/"People like to FLEX their DECOR" to help remember that flexor posturing is also known as decorticate posturingMnemonic
165527Neurology and Special SensesPathologyExtracranial injuriesself understoodblood accumulation between periosteum and *gala aponeurosis*; replace with blood accumulation between periosteum and (galea aponeurotica or epicranial aponeurosis).Minor erratum
166537Neurology and Special SensesPathologyMultiple sclerosishttps://www.amboss.com/us/knowledge/multiple-sclerosisMultiple Sclerosis: Charcot neurological triad: scanning speech, nystagmus, and intention tremors ; Also, scanning speech is type of ataxic dysarthria; we can omit one among them.High-yield addition to next year
167571PsychiatryPsychologyEgo defensesself understanding and https://en.wikipedia.org/wiki/Regression_(psychology)the example that is given of fixation is more appropriate for the regression and does not seems to be well acquainted with what fixation meansMajor erratum
168575PsychiatryPathologyDissociative disordersFirst Aid 2025, pg. number 18 under Section I, Guide to Efficient Exam Preparation, Apps. https://www.grammarly.com/blog/commonly-confused-words/traveling/It is printed "travelling". It should be "traveling" instead, with a single 'L' as of American english. This creates confusion whether english is followed in the British Style or American.Spelling/formatting
169577PsychiatryPathologySchizophrenia spectrum disordersUWorld, USMLERxA better prognosis in schizophrenia is associated with female gender, rapid and later onset with predominantly positive symptoms.High-yield addition to next year
170578PsychiatryPathologyNEW FACThttps://www.federalregister.gov/documents/2013/08/01/2013-18552/change-in-terminology-mental-retardation-to-intellectual-disabilityGood morning! I am reaching out about the use of "retardation" in the USMLE First Aid textbook. As this terminology has changed and is outdated I wanted to draw this to your attention to be updated for the 2026 model. Thank you so much for your help!Major erratum
171586PsychiatryPathologyEating disordershttps://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t16/The current description of Bulimia Nervosa states, "Recurring episodes of binge eating with compensatory purging behaviors at least weekly over the last 3 months.” However, it should state, “Recurring episodes of binge eating with inappropriate compensatory behaviors, such as purging, fasting, excessive exercise, or misuse of medications, at least weekly over the last 3 months.” The current definition being limited to compensatory purging will mistakenly cause the selection of “binge-eating disorder” for vignettes that instead use “fasting, exercise, or medication use” for the compensatory behavior.High-yield addition to next year
172588PsychiatryPathologyPsychoactive drug intoxication and withdrawalhttps://pmc.ncbi.nlm.nih.gov/articles/PMC5027896/Under the stimulant section of the table for the amphetamine row, under the "withdrawal" column based on the header from the top of the page, "meth mites" is listed. This makes it look like tactile hallucinations prevail during withdrawal. This is incorrect as tactile hallucinations occur with intoxication, it should be moved to the prior column.Minor erratum
173601RenalPhysiologyFiltrationhttps://pmc.ncbi.nlm.nih.gov/articles/PMC1282204/"NSAIDs and ACE inhibitors should not be given toegether -> constriction of afferent and efferent arterioles" is the statement made in the book, but it should have been "constriction of afferent and dilation of efferent arterioles" because Angiotensin II constricts efferent arterioles and ACE inhibitors will dilate them.Minor erratum
174601RenalPhysiologyFiltrationhttps://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/ace-inhibitors/art-20047480New addition for this year states "NASIDS ad ACE inhibitors should not be given together>constriction of afferent and efferent arterioles" But ACE inhibitors dilate efferent arterioles so at face value this is confounding. Suggest rephrasing. I believe that this issue is that NSAIDs can antagonize ACEi action.Major erratum
175602RenalPhysiologyNEW FACThttps://www.sciencedirect.com/topics/medicine-and-dentistry/nephronHi, I think it would be extremely high-yield and helpful to include a diagram of osmolarity along the nephron. This is something that comes up multiple times on Uworld and other resources. I hand wrote a diagram into my 2024 First Aid, but I think having it printed would be helpful for future copies. Alternatively, osmolarity could be added to the diagrams on page 608 or page 625.High-yield addition to next year
176610RenalPhysiologyAcidosis and alkalosisNot requiredUnder Respiratory Alkalosis: Hyperventilation: Mnemonic: AH STOP hyperventilating! A= Anxiety, H = Hypoxemia (high altitudes), S = Salicylates (early), T = Tumor, O = PulmOnary embOlism, P = PregnancyMnemonic
177610RenalAnatomy and PhysiologyAcidosis and alkalosishttps://emedicine.medscape.com/article/238670-treatment?form=fpfIts written that in metabolic alkalosis after checking urine cl- if its more than 20 mEq/L then this is a saline-resistant cause such as: Hyperaldosteronism, Bartter syndrome, Gitelman syndrome, and current loop/thiazide diuretics. But after long researching i found that in Bartter syndrome its better to give patient saline, and the patient is considered as saline-responsive which is the opposite of what is written in the book.Minor erratum
178611RenalPhysiologyRenal tubular acidosisNACauses of RTA1= 4 As (A is the 1st alphabet letter)= Amphotericin B toxicity, Analgesic nephropathy, congenital Anomalies (obstruction) of urinary tract, Autoimmune diseases (eg, SLE)Mnemonic
179614RenalPathologyNephritic syndromehttps://www.uptodate.com/contents/thromboangiitis-obliterans-buerger-diseaseUnder "IgA nephropathy", it has "Berger disease" in parentheses. It should be spelled with a u, as in "Buerger disease"Spelling/formatting
180615RenalPathologyNephritic syndromehttps://www.sciencedirect.com/science/article/pii/S0031302516311308#:~:text=MPGN%20is%20divided%20into%20immune,I%2C%20type%20III%20and%20secondary.i think it's better to use the other classification for the MPGN ( membrane proliferative glomerulonephritis ) the one that depends on the complement levels , as the one written in the book shoes that C3 glomeurlopathies cause only DDD , while it may result in c3 DDD or c3 GP and also there is C4 GP that was not mentioned . so a better classification is the one that divides them into IC , complement , neither bothClarification to current text
181617RenalPathologyKidney stonesI donThis photo contains: • Green highlights indicate a mnemonic. • Red text in bold font represents a common case. • An “X” inside a box means the shape is like an envelope.Mnemonic
182618RenalPathologyUrinary incontinenceUSMLERxHello! Impaired neural control of the bladder, leading to 'neurogenic bladder,' is a key association of overflow incontinence. While spinal cord injury is mentioned in the text, other conditions such as multiple sclerosis, diabetic neuropathy, and stroke can also cause it.Clarification to current text
183621RenalPathologyAcute tubular necrosisContains all mentioned instances in FA 2025CARL HUMs (Cisplatin, Acute Pyelonephritis, Radiocontrast Dyes, Lead, Hemoglobin, Uric Acid, MyoglobinMnemonic
184624RenalPathologyNEW FACThttps://my.clevelandclinic.org/health/diseases/22415-angiomyolipoma-of-the-kidneyRenal Angiomyolipoma (AML): The most common benign kidney tumors, more frequent in females. Composed of blood vessels, smooth muscle, and fat. Asymptomatic or cause pain, hematuria, or bleeding. Associated with tuberous sclerosis. Treated by surgery or embolization.High-yield addition to next year
185625RenalPharmacologyDiuretics: effects on electrolyte excretionSame page, under Blood pH see alkalemia, it explains why HCO3- is reabsorbed and not excreted more when thiazide diuretics are usedFor Thiazide diuretics, under HCO3- it should be decreased (downward arrow) and not increased (upward arrow)Minor erratum
186634ReproductiveEmbryologyAmniotic fluidhttps://www.uptodate.com/contents/polyhydramnios-etiology-diagnosis-and-management-in-singleton-gestationsCould add a brief section under polyhydramnios and add the simple mnemonic "SWALLYhydramnios" to help students remember that defects in amniotic fluid swallowing are predominant in polyhydramniosMnemonic
187640ReproductiveEmbryologySexual differentiationhttps://www.uptodate.com/contents/image?imageKey=PI/65675In the figure, it showed Prostate belongs to "External male genitalia". In fact, prostate is internal male genitalia.Minor erratum
188640ReproductiveEmbryologyUterine (M¸llerian duct) anomaliesNo needIn the older First Aid versions, Bicornuate and Septate uterus are correctly represented in the corresponding images. However, in this latest version, I found it very confusing how the images are attributed to the other uterine anomaly. To clarify, the supposed hysterosalpingography image for Sepate uterus labeled 'A' is actually that of a Bicornuate uterus. Likewise, the supposed hysterosalpingography for Bicornuate uterus labeled 'B' is actually that of a Septate uterus. They are just switched the opposite way around. The fix is pretty easy. Switch the letters and the images around. So put the second image first and give it the letter 'A' to correctly represent a Septate uterus. Then, but the first image second and give it the letter 'B' to correctly represent a Bicornuate uterus. I will provide below a snapshot of this section in the latest FA edition (2025) which is faulty as opposed to the correct form in FA 2023 in the second picture. Thank you.Minor erratum
189640ReproductiveEmbryologyUterine (M¸llerian duct) anomalieshttps://www.uptodate.com/contents/congenital-anomalies-epidemiology-types-and-patterns?search=septate%20uterus&source=search_result&selectedTitle=5%7E15&usage_type=default&display_rank=5I was reviewing USMLE Rx First Aid online and noticed that the pictures for the Septate uterus and Bicornuate uterus were switched around. I compared these images to my 2024 edition of First Aid, and the picture used for the Bicornuate uterus is now used to describe the Septate uterus in the 2025 online edition.Minor erratum
190651ReproductivePhysiologyPhysiologic changes in pregnancyN/AUnder the Endocrine box it is written "insulin resitance" missing an s after "resi" in resistanceSpelling/formatting
191651ReproductivePhysiologyPhysiologic changes in pregnancyhttps://www.merriam-webster.com/dictionary/resistanceThe diagram has a spelling error. Under the "Endocrine" subsection of the diagram, resistance is spelled incorrectly as "resitance"Minor erratum
192651ReproductivePhysiologyPregnancyhttps://www.acog.org/practice-management/health-it-and-clinical-informatics/revitalize-obstetrics-data-definitionsParity: The number of pregnancies reaching 20 weeks and 0 days of gestation or beyond, regardless of the number of fetuses or outcomesMinor erratum
193652ReproductivePhysiologyNeonatal birth weightACOG Practice Bulletin No. 216: Macrosomia https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/01/macrosomia. Also refer to: Rahimian, Jeannine. "Disproportionate Fetal Growth." CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 12e Eds. Alan H. DeCherney, et al. McGraw-Hill Education, 2019: https://accessmedicine.mhmedical.com/content.aspx?sectionid=206959761&bookid=2559#206959863The current text in FA-2025 defines macrosomia >4000g. Newer guidelines laid by the American College of Obstetricians and Gynecologists (ACOG) defines fetal macrosomia as a birth weight exceeding 4,500 grams (approximately 9 lbs, 15 oz)Major erratum
194652ReproductiveAnatomy and PhysiologyNeonatal birth weighthttps://accessmedicine.mhmedical.com/content.aspx?sectionid=206959761&bookid=2559#206959863. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/01/macrosomiaMacrosomia is defined as birth weight >4500grams, as per latest guidelines laid by ACOG and published in books. Or at least it should be ≥ 4000grams.Minor erratum
195663ReproductivePathologyOvarian cystshttps://pmc.ncbi.nlm.nih.gov/articles/PMC4402440/I would like to suggest adding the following high-yield information to this topic as it appears in NIH literature, without modification: 'The most common pregnancy-associated ovarian masses are functional cysts like the corpus luteum of pregnancy and theca-lutein cysts. Most of these cysts will resolve after the first 14–16 weeks of gestation, but some, like the theca lutein cysts, can persist until after delivery'.High-yield addition to next year
196664ReproductivePathologyOvarian tumorsKumar V, Abbas Ak, Aster JC. Robbins & Cortana Pathologic Basis of Diseases. 10th edition; 2021. p1020. https://www.uptodate.com/contents/epithelial-carcinoma-of-the-ovary-fallopian-tube-and-peritoneum-histopathology?search=epithelial%20ovarian%20cancer&source=search_result&selectedTitle=10%7E150&usage_type=default&display_rank=10#H1295683671It says in the bracket that mucinous epidermal tumors are lined by mucinous epithelium natively found in cervix. But as per Robbin’s and Cortana Pathologic Basis of Diseases, the mucinous epithelium is commonly gastric or intestinal type and uncommonly cervical type. Even UpToDate mentions the same.Major erratum
197666ReproductivePathologyUterine conditionshttps://www.amboss.com/us/knowledge/uterine-leiomyomaAdenomyosis: Histopathology; Irregular distribution of smooth cells and endometrial glandular tissue in the myometriumHigh-yield addition to next year
198666ReproductivePathologyUterine conditionsNot neededAdenomyosis; On Palpation : Tenderness( +)High-yield addition to next year
199666ReproductivePathologyUterine conditionshttps://pmc.ncbi.nlm.nih.gov/articles/PMC7987203/#F2 (Fig 2e,f)Presence of irregularly shaped islands of endometrial glands and stroma within the myometrium. The architecture of adenomyosis is distinct from that of the functional endometrium, in which the glands are solitary, nonbranching, and longitudinally arranged. this makes itClarification to current text
200666ReproductivePathologyUterine conditionshttps://pmc.ncbi.nlm.nih.gov/articles/PMC7932680/adenomyosis is an estrogen-dependent gynecological disorder resulting from one of several mechanisms: invasion of the endometrial basalis into the myometrium induced by enhanced cell survival, EMT, and cell migration; continuous auto-microtrauma of the junctional zone; de novo metaplasia from adult stem cells and embryonic Mullerian remnants; and “from outside to inside invasion.”Clarification to current text
201666ReproductivePathologyUterine conditionshttps://www.ncbi.nlm.nih.gov/books/NBK538273/Under Leiomyoma, "Irregularly-shaped" should be added prior to "Enlarged uterus with nodular contour on exam" which helps to differentiate it from Adenomyosis.High-yield addition to next year
202675ReproductivePharmacologyContraceptionhttps://www.uptodate.com/contents/heavy-periods-beyond-the-basics/printProgestin IUDs are FDA-approved and indicated for the treatment of heavy menstrual bleeding; only copper IUDs are contraindicated in heavy menstrual bleeding.Major erratum
203686RespiratoryPhysiologyCarbon dioxide transporthttps://www.uptodate.com/contents/red-blood-cell-membrane-structure-and-dynamics#H3785284454THE CONVERSION OF HCO3- AND H+ IS TRANSFERRED OUT OF RBCs into the plasma via *BAND 3 PROTEIN * (ADD EITHER ON THE IMAGE OR A TEXT, BAND 3 PROTEIN) IN EXCHANGE FOR CHLORIDE IONS (CL-) TO MAINTAIN ELECTRICAL NEUTRALITY. THIS EXCHANGE IS KNOWN AS ''CHLORIDE SHIFT '' WHICH IS THE PRINCIPAL CAUSE OF HIGH RBC CHLORIDE CONTENT IN VENOUS BLOOD.High-yield addition to next year
204687RespiratoryPhysiologyOxyhemoglobin dissociation curveNot neededIt would be clearer to distinguish between maternal and fetal blood to avoid confusion. Instead of broadly stating that pregnancy causes a left shift, it is more accurate to specify that pregnancy causes a right shift duo to increased 2,3-BPG in maternal hemoglobin, while the fetal curve is left shifted, because fetal hemoglobin has low affinity for 2,3 BPG.Clarification to current text
205689RespiratoryPhysiologyCyanide vs carbon monoxide poisoningSelf-StudyFor O2 mentioned in the row of 'effect on oxygen-hemoglobin curve', '2' should be in subscriptSpelling/formatting
206693RespiratoryPathologyNEW FACTEncyclopedia of PathologyThe statement regarding "Curschmann spirals and Charcot-Leyden crystals" seen in asthma is confusing making it seem that they are pathognomonic to asthma. The text needs more clarification for students to not think they are pathognomonic findings for asthma. They are not pathognomonic for asthma and can be seen in other conditions like chronic bronchitis and bronchiectasis.Clarification to current text
207704RespiratoryPharmacologyAsthma drugsAmbossSince IL-13 directly affects smooth muscle cells by inducing airway smooth muscle contraction, increasing mucus production, and promoting airway remodeling, it contributes to bronchoconstriction, airway obstruction, and long-term structural changes in the airways. Therefore, adding IL-13 in the pathway between Th2 cells and smooth muscle cells would enhance the clarity of the diagram by illustrating its critical role in asthma pathophysiology. Additionally, as the diagram already mentions dupilumab, a monoclonal antibody that targets IL-4Rα, a receptor subunit shared by both IL-4 and IL-13, thereby blocking their signaling.Clarification to current text
208705RespiratoryPharmacologyH1-blockershttps://www.rxlist.com/antihistamines_secondgeneration/drug-class.htmAdverse effects section lists "far less sedating than 1st generation ..." as an adverse effect, but this is more of an advantage and less of an adverse effect. An adverse effect entry may be better stated as "adverse effects are much more rare, but may appear similar to those of 1st generation antihistamines"High-yield addition to next year
209708Rapid ReviewRapid ReviewCystic fibrosishttps://en.wikipedia.org/wiki/Ligature_(writing)Every instance of the words "cystic fibrosis" (but not "fibrosis" alone) in the text uses a ligature combining the letters "fi" making it impossible to ctrl+f search for the term, even if you attempt to paste in the unicode character, as ligatures are not supported by the search text box. The normal characters fi should be used to make the PDF properly searchable.Spelling/formatting
210712Rapid ReviewRapid ReviewWilson diseasehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9768184/ https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-022-02186-0 https://www.mdpi.com/2227-9059/11/2/420The current text incorrectly says that serum ceruloplasmin increases, whereas it should decrease due to defective copper incorporation into apoceruloplasmin.Major erratum
211712Rapid ReviewRapid ReviewWilson diseasehttps://www.uptodate.com/contents/wilson-disease-clinical-manifestations-diagnosis-and-natural-history#H1327623524Text states Wilson Disease causes an increase in serum ceruloplasmin when it should indicate a decrease in ceruloplasminMajor erratum
212713Rapid ReviewRapid ReviewHypothyroidismWinsz-Szczotka K, Komosińska-Vassev K, Olczyk K. Metabolizm glikozoaminoglikanów w przebiegu choroby Gravesa-Basedowa [The metabolism of glycosaminoglycans in the course of Graves' disease]. Postepy Hig Med Dosw (Online). 2006;60:184-91. Polish. PMID: 16618989.This is in reference to the 2023 version, and was not mentioned in the 2023 Errata nor the 2024 errata. On page 713 of the 2023 version in relation to "myxedema in hypothyroidism" the page has the error of an increase in "CAGs in interstitial space" when it should be "GAGs in interstitial space".Minor erratum
213720Rapid ReviewRapid ReviewHomocystinuriahttps://www.uptodate.com/contents/overview-of-homocysteineI believe that it would be useful to add "developmental delay" and "thromboembolic disease" to the high-yield homocystinuria facts and help further differentiate it from Marfan syndrome. This may also be useful to further emphasize on page 50High-yield addition to next year
214734Rapid ReviewRapid ReviewNEW FACT-Mammillary is misspelled as "mamillary" under "Bilateral mamillary [sic] body lesions with thiamine deficiency"Spelling/formatting
215766Photo AcknowledgmentsPhoto AcknowledgmentsPhoto AcknowledgmentsAccording to the contentThe figure on page 513 shows both cortical and internal watershed zones; therefore, the word "cortical" should be deleted.Minor erratum
216138MicrobiologyClinical BacteriologyTuberculosisUWorld, USMLERxA positive PPD test result may be observed in: current infection, previous exposure, and BCG vaccination. While BCG vaccination is not listed as a cause of PPD positivity here, the text further down implies this by noting that the interferon-γ release assay (IGRA) has fewer false positives from BCG.Clarification to current text
217104ImmunologyImmune ResponsesComplementhttps://www.uptodate.com/contents/complement-pathwaysThe Complement System pathways image makes it seem like C3 convertase is always made up of C3b, Bb, C4b and C2b when in fact, there are two types of C3 convertases: That which is formed via the Alternative pathway (made up of C3b, Bb and P [i.e. the C3 convertase C3bBbP]; after the action of serine protease D (factor D)), as well as that which is formed in either the Classic or Lectin pathways (the C3 convertase being made up of C4b and C2b [i.e. the C3 convertase C4bC2b]). I've found 2 Biorender template figures (that can be simplified and adapted to the First Aid style) that together show a more correct way of presenting these pathways, but which, however, are incomplete on their own (while also both failing to mention P (properdin), essential in the Alternative Pathway): https://app.biorender.com/biorender-templates/figures/all/t-5e5acf667701b8008996062e-complement-pathways and https://app.biorender.com/biorender-templates/details/t-5f5b7cfc14d40300aa942bdb-three-pathways-of-complement-activationMajor erratum
21834BiochemistryMolecularDe novo pyrimidine and purine synthesishttps://en.wikipedia.org/wiki/Azathioprine#Mechanism_of_action6-mercaptopurine and its prodrug azathioprine inhibit de novo purine synthesis by inhibiting "glutamine phosphoribosyl pyrophosphate aminotransferase" and not "guanine phosphoribosyl transferase" as mentioned in book.Minor erratum
219601RenalPhysiologyChanges in glomerular dynamicshttps://www.uptodate.com/contents/antihypertensive-therapy-and-progression-of-chronic-kidney-disease-experimental-studies/print?utm_source=chatgpt.comAt the right of top of the page it is mentioned that NSAID and ACE inhibitors should not be given together because they lead to constriction of afferent and efferent arterioles. which is wriong because ACE inhibitors lead to efferent arteriol dilation.Minor erratum
220546Neurology and Special SensesPathologyCommon cranial nerve lesionshttps://www.ncbi.nlm.nih.gov/books/NBK532869/Addition to CNXII Lesion - UMN results in tongue pointing away from lesion (Can update mnemonic to highlight "Lick your wounds" starting with an L for LMN specifically)High-yield addition to next year
221140MicrobiologyClinical BacteriologyNeisseriaSelf-StudyThe information on Neisseria currently states that it "metabolize glucose and produce IgA proteases." This phrasing may imply a causal link between glucose metabolism and immune evasion. To enhance clarity and improve the flow, it would be beneficial to separate the statement into two sentences: "Metabolizes glucose. Produces IgA proteases."Clarification to current text
222351EndocrinePathologyNEW FACThttps://diabetesjournals.org/care/article/47/Supplement_1/S20/153954/2-Diagnosis-and-Classification-of-DiabetesMaturity-onset diabetes of the young (MODY) Autosomal dominant inheritance of a single gene defect; early onset of hyperglycemia typically age <25 years due to insulin secretion dysfunction without insulin resistance. It is commonly misdiagnosed as type 1 diabetes due to onset age, but MODY has absent autoantibodies and normal C-peptide. Most common subtypes are GCK-MODY and HNF1A-MODY. GCK-MODY typically manifests during pregnancy.1,2 Diagnosis: clinical (eg, absent autoantibodies, normal C-peptide, normal BMI), confirmed by genetic testing Treatment: sulfonylureasHigh-yield addition to next year
223378GastrointestinalPhysiologyNEW FACThttps://journals.physiology.org/doi/full/10.1152/ajpgi.00442.2015Enkephalins - endogenous opioid peptides found predominantly in the gastrointestinal and nervous system. They are released by neurones of the enteric nerve plexuses throughout the GI tract. They bind to the receptors δ, μ and κ in the GI tract.Its function is to inhibit peristalsis (decrease GI motility) and reduce intestinal water and electrolyte secretion (opposes VIP).Enkephalin release is increased with increase in sympathetic tone and stretching of the intestinal wall.High-yield addition to next year
224609RenalPhysiologyNEW FACThttps://linkinghub.elsevier.com/retrieve/pii/B978032308500700045XHypomagnesemia related hypokalemia - (decreased serum Mg2+ decreases serum K+ ). Mg2+ inhibits a secretion channel in the collecting duct of the nephron called ROMK. This channel secretes K+ into the urine and when left uninhibited can lead to hypokalemia. To correct this type of hypokalemia, serum Mg2+ should be corrected first and then serum K+. (ROMK – Renal outer medullary potassium channel)Clarification to current text
22598ImmunologyCellularNEW FACThttps://rarediseases.info.nih.gov/diseases/9548/mhc-class-i-deficiency AND https://rarediseases.info.nih.gov/diseases/824/mhc-class-ii-deficiencyBare Lymphocyte syndrome - Type 1 (BLS I): A mutation in TAP genes results in an absent MHC I, which leads to impaired CD8+ T-cell activity. Results in necrotizing granulomatous skin lesions (eg pyoderma gangrenosum), vasculitis and frequent respiratory infections in the presence of normal serum immunoglobulins and normal lymphocyte count except CD8+. Autosomal recessive. Type 2 (BLS II): mutations in regulatory genes for MHC II results in an absent MHC II, which leads to impaired CD4+ T-cell activity as well as impaired B-cell and antigen presenting cell (APC) activity. Results in severe SCID-like manifestations including recurrent bacterial, fungal, viral, and protozoal infections. Serum immunoglobulins is decreased. Autosomal recessive.High-yield addition to next year
226112ImmunologyImmune ResponsesNEW FACThttps://pmc.ncbi.nlm.nih.gov/articles/PMC9843350/#:~:text=The%20pathophysiological%20mechanisms%20of%20FNHTR,from%20blood%20products%20during%20storage.Febrile non-hemolytic transfusion reaction - Second mechanism (immune pathway): Recipient anti-HLA antibodies attack the HLA on donor white blood cells (WBCs), stimulating cytokine release from the donor WBCs.High-yield addition to next year
227339EndocrinePhysiologyAdrenal steroids and congenital adrenal hyperplasiashttps://www.ncbi.nlm.nih.gov/gene/1586?; https://www.sciencedirect.com/science/article/abs/pii/B9780128181249000139; https://www.sciencedirect.com/science/article/pii/S0083672908611474; https://www.sciencedirect.com/science/article/abs/pii/B9781455748587000226The enzyme CYP17A1 (also known as P450c17) can have both 17alpha-hydroxylas activity in the case of the converstion of pregnenolone to 17alpha-hydroxypregnenolone, or it can have 17,20-lyase activity in the case of 17alpha-hydroxypregnenolone conversion to DHEA. In the diagram, 17alpha-hydroxylase is erroenously listed for the latter conversion rather than 17,20-lyase. This is also true in the conversion of 17-hydroxyprogesterone to androstenedione - this should be listed as 17,20-lyase. The 2024 First Aid had the correct listing of 17,20-lyase. These activities are distinct and should remain distinct in the text. I've attached a screenshot of the 2024 version which was correct, as well as linked various reputable sources that confirm.Major erratum
228348EndocrinePathologyLab values in hypocalcemia disordershttps://emedicine.medscape.com/article/128762-overview?st=fpf&scode=msp&socialSite=google&form=fpf&icd=login_success_gg_mismatch_fpfIn Vitamin D deficiency, it is supposed to have 1,25(OH)2 Vit. D decreased, not -/increased, also 25(OH) vit. D should be normal unless it's also a cause of vitamin D deficiency as a precursor to active Vitamin DMinor erratum
229666ReproductivePathologyUterine conditionshttps://pmc.ncbi.nlm.nih.gov/articles/PMC3859152/Adenomyosis: RF: Multipara, D&C, CS. Tender on examHigh-yield addition to next year
230666ReproductivePathologyUterine conditionshttps://www.nichd.nih.gov/health/topics/uterine/conditioninfo/people-affectedLeiomyoma: RF: nullipara, obesity, black. Nontender on examHigh-yield addition to next year
231651ReproductivePhysiologyAbnormal uterine bleedinghttps://www.ncbi.nlm.nih.gov/books/NBK532913/Localizing Clues by Bleeding Pattern: Postcoital bleeding: Cervical pathology: Cervical cancer, cervical ectropion, cervicitis. Intermenstrual bleeding: Endometrial pathology: Endometrial polyp, hyperplasia, cancer. Heavy regular menstrual bleeding (menorrhagia): Myometrial pathology: Fibroids (leiomyoma), adenomyosis. Irregular heavy bleeding: Ovulatory dysfunction or endometrial cause: PCOS, anovulation, endometrial hyperplasia. Postmenopausal bleeding: Endometrial or vaginal atrophy / malignancy: Endometrial cancer, atrophic endometritisHigh-yield addition to next year
232603RenalPhysiologyNephron transport physiologyhttps://www.sciencedirect.com/science/article/pii/S0098299712001379#s0030urea enters the principal cell via UT-A1/3 transporters not a UT1 receptorMinor erratum
233487Musculoskeletal, Skin, and Connective TissueDermatologySkin infectionsSelf explanatory; https://doi.org/10.1016/j.amjsurg.2007.08.076In necrotizing fasciitis, the fascia becomes pale and friable instead of normal glistening and doesn’t bleed to touch. I have encountered this concept multiple times throughout UWORLD where they give a picture of skin infection and the surgeon decides to explore and finds this characteristic feature. I think this characteristic finding should also be included.High-yield addition to next year
234476Musculoskeletal, Skin, and Connective TissuePathologySystemic lupus erythematosushttps://pmc.ncbi.nlm.nih.gov/articles/PMC9797422/you used to write the most common of death to be renal , actually the most common cause of death is cardiovascular according to the newest studiesMajor erratum
235656ReproductivePathologyNEW FACThttps://pubmed.ncbi.nlm.nih.gov/32310493/attaches is a table showing -Causes of Female Infertility-High-yield addition to next year
236686RespiratoryPhysiologyVentilation/perfusion mismatchMedscape: https://emedicine.medscape.com/article/300901-overview#a4 “Pulmonary embolism causes areas of the lung to be ventilated but not perfused, producing physiologic dead space.”Page 686 – V/Q mismatch section: Pulmonary embolism is listed under conditions with “↓ ventilation.” However, pulmonary embolism actually has normal ventilation but zero perfusion, making it a classic case of dead space ventilation (V/Q = ∞) — not a low V/Q mismatch. This is a key concept in respiratory physiology and frequently tested in USMLE exams. Suggested correction: Remove pulmonary embolism from this list and consider adding a note that it represents increased V/Q or dead space physiology due to absent perfusion.Major erratum
237608RenalPhysiologyPotassium shiftshttps://pmc.ncbi.nlm.nih.gov/articles/PMC3231780/The reversible H-K exchange activity is not mediated by an H-K exchanger as depicted, there is no such protein in the plasma membranes of cells. This apparent activity is mediiated by Na/K-ATPase inhibition by acidosis and activation in alkalosis.Major erratum
238603RenalPhysiologyNephron transport physiologyhttps://www.uptodate.com/contents/overview-of-the-renin-angiotensin-system#H7496555Angiotensin II is represented as acting directly on NHE, rather than as a hormone acting via a specific receptor as shown for other hormones in this section.Minor erratum
239603RenalPhysiologyNephron transport physiologyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC5198284/In all cells models, channels are depicted as two parallel lines with an ion traveling between EXCEPT for the basolateral Cl channel in the early DCT which is depicted as a snigel arrow labeled 'Cl channel diffusion'. Not clear why this is depicted differently.Clarification to current text
240601RenalPhysiologyFiltrationhttps://doi.org/10.1161/hc4101.096153A sentence in this section states that "NSAIDS and ACE inhibitors should not be given together" because they will cause CONSTRICTION of afferent and efferent arterioles. I don't think this is accurate. NSAIDs would cause vasoconstriction of afferent arterioles, but ACE inhibitors would cause VASODILATION of efferent arterioles. The simultaneous vasoconstriction of blood flow into the glomerulus, coupled with vasodilation of exiting blood flow, would cause a big drop in GFR. (reference the highlighted part of the attached image)Minor erratum
241417Hematology and OncologyPhysiologyNEW FACTFirst aidFormation of insoluble fibrin mesh. Aspirin irreversibly inhibits cyclooxygenase, thereby inhibiting TXA2 synthesis. Clopidogrel, prasugrel, and ticagrelor inhibit ADP-induced expression of GpIIb/IIIa by blocking P2Y12 receptor. Eptifibatide and tirofiban inhibit GpIIb/IIIa (fibrinogen receptor) directly. Ristocetin activates vWF to bind GpIb. Failure of aggregation with ristocetin assay occurs in von Willebrand disease and Bernard-Soulier syndrome. Desmopressin promotes the release of vWF and factor VIII from endothelial cells. vWF carries/protects factor VIII; volksWagen Factories make gr8 cars.Clarification to current text
2422024 Edition 703RespiratoryPathologyLung cancerAs referenced in USMLE First Aid 2024Small cell carcinoma (S emphasized) and Squamous cell carcinoma (S emphasized) are both "S"entral (central) located.Mnemonic
24365BiochemistryNutritionVitamin B5Self explanatoryUnder the section- Deficiency, I believe a comma is missing after “adrenal insufficiency”, which is falsely giving an impression that adrenal insufficiency may lead to burning feet syndrome in vitamin b5 deficiency.Spelling/formatting
244663ReproductivePathologyOvarian cystsnot neededattached is a table of ovarian cysts (better formulated)Spelling/formatting
245664-665ReproductivePathologyOvarian tumorsnot neededattached is a table of ovarian tumors (better formulated)Spelling/formatting
246591PsychiatryPharmacologyNEW FACThttps://www.uptodate.com/contents/second-generation-and-other-antipsychotic-medications-pharmacology-administration-and-side-effectsThere is a recently added antipsychotic dual medication called “Xanomeline and Trospium chloride” that is used to treat Schizophrenia and has been recently US FDA approved by the end of 2024. It’s mechanism of action is uniquely different from other typical and atypical antipsychotics. Through the duality actions of the combined medication, the first medication Xanomeline works as a muscarinic agonist in the central nervous system through M1 and m4 agonism, while the other medication Trospium works as a muscarinic antagonist in the peripheral nervous system. Obviously, this medication is novel and unique. Its side effect is mainly anticholinergic side effects such as urinary retention and tachycardia for example. And it is contradicted in patients with narrow angle glaucoma or impairment in hepatic and renal system. This will definitely be a hot topic by the next foreseeable future because of the high yield pharmacological mechanism of action and because uniqueness as an antipsychotic working on different receptors other than dopamine and serotonin.High-yield addition to next year
247207PathologyPathologyPsammoma bodiesnot neededattached is a photo of psammoma bodies causes (better formulated)Mnemonic
248114ImmunologyImmune ResponsesNEW FACT1.https://www.uptodate.com/contents/chronic-mucocutaneous-candidiasis?search=APECED&source=search_result&selectedTitle=1~40&usage_type=default&display_rank=1#H571998. 2. UWORLD STEP 3 Question bankAutoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) caused by AIRE gene deficiency.Associated Polyendocrinopathy: * Hypoparathyroidism (↓ calcium → tetany, seizures) * Adrenal insufficiency * Type 1 diabetes mellitus * Thyroiditis [ Mnemonic to Remember: PArTyD with Candy P- Hypoparathyroidism ,Ar- Adrenal Insufficiency ,T- Thyroiditis,TyD- Type 1 DM,Candy- Candidiasis ]Mnemonic
249656ReproductivePathologyNEW FACTnot neededattached is a table of XY DSD syndromesHigh-yield addition to next year
250141MicrobiologyClinical BacteriologyPseudomonas aeruginosahttps://www.uptodate.com/contents/principles-of-antimicrobial-therapy-of-pseudomonas-aeruginosa-infectionsUnder the section treatments, I think that the current text might give false implications. Like, not all 3rd and 4th generation cephalosporins have anti pseudomonal property. Cefepime, ceftazidime and cefoperazone are only (also a new agent Cefiderocol) cephalosporins having antipseudomonal activity and this should be mentioned specifically. Similarly only ciprofloxacin and levofloxacin (also a new agent delafloxacin) have antipseudomonal property and just mentioning fluroquinolones, like in current text, might mislead readers to falsely think that other fluroquinolones can be also be used. I think it would make it more clear to specify specific antibiotics that are active against pseudomonas instead of a general class of antibiotics.Clarification to current text
251601RenalPhysiologyAngiotensin-converting enzyme inhibitorshttps://pubmed.ncbi.nlm.nih.gov/32212310/NSAIDs and ACE inhibitors should not be given together —> constriction of afferent and efferent arterioles. ( NSAIDs do cause constriction of afferent arterioles but ACE inhibitors cause Dilation of efferent arterioles, and they might be used together in a procedure called “Medical Nephrectomy” in patients with Nephrotic Syndrome, in which the NSAIDs induced constriction of the afferent arterioles along with the ACE inhibitors should Dilation of efferent arterioles causes a great decrease in GFR thus decreasing the protein loss that happens in severe Nephrotic SyndromeMajor erratum
252394GastrointestinalPathologyNEW FACTRobbins and cotran pathologic Basis of diseasePeutz jegher syndrome : Arborising pattern of smooth muscle (Christmas tree apperance). Associated with 100% risk of pancreatic cancer)High-yield addition to next year
253388GastrointestinalPathologyNEW FACTNAGluten protein found in barley rye oat and wheat . Mnemonic : BROWMnemonic
254445Hematology and OncologyPharmacologyNEW FACTNAAlkylating agents : ifosfamide , busulfan , nitroureas , procarbazine , cyclophosphamide. Mnemonic : IF BUS NOT PRESENT take CYCLEMnemonic
255248PathologyToxicities and Side EffectsNEW FACTNAGynecomastia drugs : GnRH analogs/antagonists , DIgoxin , Spironolactone , Cimetidine , Ketoconazole , Oestrogen , Androgen receptor inhibitor , Finasteride . MNEMONIC : Great DISCKO And Fun.Mnemonic
256248PharmacologyToxicities and Side EffectsNEW FACTNAHepatitis causing drugs : isoniazid , Rifampin , pyrazinamide , statins , fibrates . MNEMONIC : I Referred Patient Serum(AST, ALT) For HepatitisMnemonic
257390GastrointestinalPathologyNEW FACThttps://theromefoundation.org/rome-iv/rome-iv-criteria/IRRITABLE BOWEL DISEASE : Recurrent abdominal pain on average at least 1 day/week in the last 3 months, associated with two or more of three criteria: (1). related to defecation; (2). associated with a change in the frequency of stool and (3). associated with a change in the form (appearance) of stool. These criteria should be fulflled for the last 3 months with symptom onset at least 6 months prior to diagnosis.Clarification to current text
258450Musculoskeletal, Skin, and Connective TissueAnatomy and PhysiologyUpper extremity nerveshttps://emedicine.medscape.com/article/1242387-overview#a12median nerve injury causes loss of sensation over (nail beds) of dorsal 3 1/2 fingersClarification to current text
259529Neurology and Special SensesPathologyAphasiaHarrison principle of internal medicine 22 edition chapter 32 aphasia memory loss and other cognitive disorderTypes of aphasia : addition of high yield images for aphasia and its types . Images is attached belowHigh-yield addition to next year
260172MicrobiologyVirologyHepatitis serologic markersCurrent medical diagnosis and treatment 2025 : pg no 672 Table 18-5Recovery phase : Anti HBc (IgG) should be positive rather than Anti HBc(IgM)Clarification to current text
261620RenalPathologyAcute kidney injuryCurrent medical diagnosis and treatment 2025 pg no 898 table 24-3Urine osmolarity in postrenal azotemia should be > 400 ; serum BUN/CR should be > 20 % in post renal azotemia . FeNA should be > 1% in intrinsic renal failureMajor erratum
262511Neurology and Special SensesPathologyBasal gangliaFirst aid USMLE step 1Dopamine from SNc stimulate direct pathway (by binding to D1 receptor) . In image green arrow shows stimulatory pathway and dark pink show inhibitory. Below D1 receptor in image is dark pink arrow which should be changed to green arrowMinor erratum
263511Neurology and Special SensesAnatomy and PhysiologyBasal gangliaFIRST AID USMLE STEP 1Dopamine from SNc stimulates the direct pathway . In image green arrow represent stimulatory and dark pink show inhibitory. Dark pink arrow below the D1 receptor should be changed to green arrowClarification to current text
264339EndocrinePhysiologyAdrenal steroids and congenital adrenal hyperplasiasCheck first aid 2024, 202317 alpha hydroxylase, under mineralocorticoids, there should be an upwards arrow only without any text. Low aldosterone and high 11-deoxycorticosterone is wrong as both will be high. Previous first aid had this right.Major erratum
26538BiochemistryMolecularCystic fibrosishttps://www.rarediseaseadvisor.com/hcp-resource/cystic-fibrosis-pathophysiology/there is a mistake in the frameshift mutation examples( the cystic fibrosis), the most common cause of cystic fibrosis is the ΔF508 mutation in the CFTR gene. This mutation is a deletion of three nucleotides (CTT), removing phenylalanine at position 508. It is classified as an in-frame deletion (does not shift the reading frame). This leads to a Class II mutation, causing defective protein processing. In contrast: Frameshift mutations delete or insert nucleotides not in multiples of three, altering the reading frame. These are Class I mutations, resulting in defective protein synthesis, also in the page 58 (biochemistry genetics) there is mention that cystic fibrosis is deletion ΔF508 mutation in the CFTR gene, This mutation is a deletion of three nucleotides (CTT), removing phenylalanine at position 508.Minor erratum
26638BiochemistryMolecularCystic fibrosishttps://www.rarediseaseadvisor.com/hcp-resource/cystic-fibrosis-pathophysiology/in the first aid for the usmle step 1 book 2025 (a student to student guide) there is a mistake in the frameshift mutation examples( the cystic fibrosis), the most common cause of cystic fibrosis is the ΔF508 mutation in the CFTR gene. This mutation is a deletion of three nucleotides (CTT), removing phenylalanine at position 508. It is classified as an in-frame deletion (does not shift the reading frame). This leads to a Class II mutation, causing defective protein processing. In contrast: Frameshift mutations delete or insert nucleotides not in multiples of three, altering the reading frame. These are Class I mutations, resulting in defective protein synthesis, also in the page 58 (biochemistry genetics) there is mention that cystic fibrosis is deletion ΔF508 mutation in the CFTR gene, This mutation is a deletion of three nucleotides (CTT), removing phenylalanine at position 508.Minor erratum
267712Rapid ReviewRapid ReviewWilson diseasehttps://www.uptodate.com/contents/wilson-disease-clinical-manifestations-diagnosis-and-natural-history"copper incorporation into apoceruloplasmin, excretion into bile increase serum ceruloplasmin, copper in tissues and urine". It should be "decrease serum ceruloplasmin, increase copper in tissue and urine."Minor erratum
268263Public Health SciencesEpidemiology & BiostatisticsConfounding vs effect modificationJekel's Epidemiology, Biostatistics, Preventive Medicine, and Public Health, 5th EditionThe diagrams for confounding and effect modification after stratification are visually almost identical. This can make it difficult for readers to distinguish between the two concepts. Confounding is present when the association between exposure and outcome is eliminated (or substantially reduced) after stratification by the confounder, whereas effect modification is present when the association differs in magnitude between strata. Other educational resources, such as UWorld Step 1 QBank explanations, also clarify this distinction using stratified 2x2 tables with relative risks or odds ratios, making the effect of stratification explicit.Major erratum
269451Musculoskeletal, Skin, and Connective TissueAnatomy and PhysiologyRotator cuff musclesN/ARotator Cuff Muscle (SItS) Injury Causes "ABnormal EXercise ADDing INjury" Supraspinatus - ABduct, Infraspinatus - EXternal Rotation, teres minor - ADDuction, Subscapularis - INternal RotationMnemonic
27075BiochemistryMetabolismTCA cyclehttps://www.ncbi.nlm.nih.gov/books/NBK541072/To remember the steps of the TCA cycle that yield NADH, using the following substrates: Isocitrate, alfa-Ketoglutarate and Malate. The pnemonic would be as follows: (I) (K)now (M)etabolism makes NADH. (I) for Isocitrate to alfa-ketoglutarate. (K) for alfa-Ketoglutarate to succinyl-CoA. (M) for Malate to oxaloacetate.Mnemonic
27163BiochemistryNutritionVitamins: water solublenot neededmnemonic for remembering B vitamins names: “The Real Nerd Plays Poker Better For Cash." the initial of each word is same as the initial of the B vitamins respectively.Mnemonic
272340EndocrinePhysiologyCortisolUworld + https://pubmed.ncbi.nlm.nih.gov/19503019/Cortisol increases the conversion of norepinephrine to epinephrine in the adrenal medulla by increasing the expression of phenylethanolamine-N-methyltransferase.High-yield addition to next year
273478, 479Musculoskeletal, Skin, and Connective TissuePathologyVasculitideshttps://www.uptodate.com/contents/granulomatosis-with-polyangiitis-and-microscopic-polyangiitis-clinical-manifestations-and-diagnosis?search=GPA&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H3058031351"GPA and MPA most commonly occur in older adults". According to First aid ,Granulomatosis with polyangiitis (GPA) and Microscopic Polyangiitis (MPA) are described as commonly occuring middle-aged adults. However, based on epidemiological data and clinical source such as UpToDate, these conditions are more commonly diagnosed in older adults.Major erratum
274478, 479Musculoskeletal, Skin, and Connective TissuePathologyVasculitideshttps://www.uptodate.com/contents/granulomatosis-with-polyangiitis-and-microscopic-polyangiitis-clinical-manifestations-and-diagnosis?search=GPA&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H3058031351I would like to suggest a minor but important addition to the section on Granulomatosis with Polyangiitis (GPA) and Microscopic Polyangiitis (MPA) in First Aid for the USMLE Step 1. According to UpToDate, approximately 30–50% of patients with GPA or MPA develop cutaneous vasculitis, most commonly presenting as palpable purpura on the lower extremities, sometimes with focal necrosis or ulceration. These skin findings are not currently highlighted in First Aid but are clinically significant and have been featured in several UWorld Qbank questions. Including a brief mention of cutaneous manifestations would not only improve clinical accuracy but also better equip students for board-style questions that test these findings.Suggested: Cutaneous vasculitis (e.g., palpable purpura on lower extremities, ulcers)High-yield addition to next year
275429Hematology and OncologyPathologyNEW FACThttps://www.ncbi.nlm.nih.gov/books/NBK563146/attached is a file of pancytopeniaHigh-yield addition to next year
276126ImmunologyImmune ResponsesNEW FACThttps://emcrit.org/ibcc/angioedema/attached is a file showing angioedema with vs without hives (allergic vs non-allergic) (causes, s/s, pp, tx)Clarification to current text
277388GastrointestinalPathologyMalabsorption syndromeshttps://www.uptodate.com/contents/selective-iga-deficiency?search=selective%20iga%20deficiency&source=search_result&selectedTitle=1~96&usage_type=default&display_rank=1#H20I’d like to suggest a high-yield clarification that should be included in both the Selective IgA Deficiency and Celiac Disease sections of the next edition:“When screening for celiac disease in patients with selective IgA deficiency (sIgAD), IgG-antigliadin antibodies or an IgG-based test for tissue transglutaminase is preferable to IgA-based assays, as the latter may be falsely negative.”This point is supported by UpToDate and reflects a clinically important testing consideration. While it is briefly alluded to in the Selective IgA Deficiency section, it deserves clearer and more prominent mention, particularly in the Celiac Disease section, where readers are directly learning about diagnostic testing. Also, in Selective IgA deficiency section it would be helpful to specify that false-negative celiac tests occur only when IgA-based assays are used.High-yield addition to next year
278114ImmunologyImmune ResponsesImmunodeficiencieshttps://www.uptodate.com/contents/selective-iga-deficiency?search=selective%20iga%20deficiency&source=search_result&selectedTitle=1~96&usage_type=default&display_rank=1#H20I’d like to suggest adding this high-yield point that , “Celiac disease is reported in approximately 6–7% of patients with selective IgA deficiency.” “Concomitant autoimmune disorders (eg, celiac disease) are also common with selective IgA deficiency” .Also supported by UpToDate and tested in UWorld.High-yield addition to next year
279698RespiratoryPathologyDigital clubbinghttps://www.uptodate.com/contents/overview-of-nail-disorders?search=digital%20clubbing&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H176463837I’d like to suggest adding a few important causes of digital clubbing, based on UpToDate and commonly tested concepts: * Congestive heart failure (CHF) * Infective endocarditis * Liver cirrhosis These are not currently emphasized in First Aid but are clinically relevant and may appear on exams. Thanks for your great workHigh-yield addition to next year
280320CardiovascularPathologyHereditary hemorrhagic telangiectasiahttps://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-hereditary-hemorrhagic-telangiectasia-osler-weber-rendu-syndrome?search=Hereditary%20hemorrhagic%20telangiectasia&source=search_result&selectedTitle=1~76&usage_type=default&display_rank=1I’d like to suggest adding iron deficiency anemia as a characteristic clinical finding in hereditary hemorrhagic telangiectasia. According to UpToDate, it is the most common laboratory abnormality due to chronic blood loss from Epistaxis and GI bleeding.High-yield addition to next year
281694RespiratoryPathologyHypersensitivity pneumonitishttps://www.uptodate.com/contents/hypersensitivity-pneumonitis-extrinsic-allergic-alveolitis-epidemiology-causes-and-pathogenesis?search=hypersensitivity%20pneumonitis&source=search_result&selectedTitle=1~113&usage_type=default&display_rank=1I’d like to suggest expanding the explanation under Hypersensitivity Pneumonitis (HP) , particularly in reference to environmental exposures. Currently, it mentions: “Often seen in farmers and bird-fanciers.” However, according to UpToDate and UWorld explanations (e.g., questions discussing hot tub lung), additional sources of exposure should be included to reflect the full clinical picture. I suggest adding: “ Ventilation and water-related contamination — HP can result from exposure to antigens in humidifiers, hot tubs, spas, pools, water-damaged surfaces, forced-air systems, and metalworking aerosols." Also the fact about “ Hot-tub lung (mists; mold on ceiling and around tub)”Clarification to current text
282694RespiratoryPathologyHypersensitivity pneumonitishttps://www.uptodate.com/contents/hypersensitivity-pneumonitis-extrinsic-allergic-alveolitis-epidemiology-causes-and-pathogenesis?search=type%203%20hypersensitivity%20pneumonitis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1According to Uptodate " Cigarette smoking is associated with a decreased risk of Hypersensitivity Pneumonitis"High-yield addition to next year
283351EndocrinePathologyNEW FACThttps://www.researchgate.net/publication/343083990_Tumor_Necrosis_Factor_Alpha_Role_in_the_Development_of_Obesity_and_Diabetes_Mellitusin the table of type 1 vs type 2 dm, dm-2 pp: ↑ Insulin resistance and β-cell failure from high FFAs and cytokines (TNF-α, IL-6, IL-1β). cytokines must be added as they were asked about beforeHigh-yield addition to next year
28487BiochemistryMetabolismNEW FACThttps://ispub.com/IJA/21/1/12811attached is a table comparing Ketotic Hypoglycemia vs Non-Ketotic Hypoglycemia. It is important as it shows the difference between hypoglycemia seen in fatty acid metabolism disorders and insulinoma vs GSD and organic acidemiasHigh-yield addition to next year
285168MicrobiologyVirologyArboviruses transmitted by Aedes mosquitoes1. https://www.cdc.gov/chikungunya/vaccines/index.html 2. https://www.cdc.gov/chikungunya/hcp/vaccines/index.html 3. https://www.uptodate.com/contents/immunizations-for-travel?search=chikungunya%20vaccine&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H672765528The statement that “No vaccine currently available” for prevention of chikungunya is no longer accurate. As of late 2023 and early 2025, effective chikungunya vaccines (e.g., IXCHIQ, VIMKUNYA) have been approved and are available in several regions, including the USA and Europe. There are 2 available and approved chikungunya vaccine in USA: 1. Recombinant virus-like particle vaccine (VIMKUNYA) was recently approved by FDA in February 14 2025 for individuals 12 years of age and older. 2. Live-attenuated virus vaccine (IXCHIQ) which was approved by FDA in Nov 9 2023 which is a live attenuated vaccine for individuals 18 years of age and older. This update would provide a more complete and accurate picture of managing chikungunya risk. Thank you for your consideration.Major erratum
286202PathologyCellularBarrett esophagushttps://www.uptodate.com/contents/barretts-esophagus-surveillance-and-managementMetaplasia in Barrett esophagus should be stratified squamous epithelium replaced by metaplastic columnar epithelium. (not the other way around)Major erratum
287688RespiratoryPhysiologyMethemoglobinhttps://www.uptodate.com/contents/methemoglobinemiaAlong with reduced total oxygen concentration of oxygen in blood, another reason for tissue hypoxia in methemoglobinemia is increased affinity and thus tight binding of remaining ferrous iron in hemoglobin to oxygen. Ferric iron doesn’t bind to oxygen but increases affinity of remaining ferrous iron in tetramer to oxygen thus compromising effective oxygen release at tissues. I have shared the link to UpToDate topic as well as the screenshot of the text.Clarification to current text
288123MicrobiologyBasic BacteriologyStainsNA- All are found in the book but not put together in the table (the table only put Whipple)pas positive conditions: Stains glycogen, mucopolysaccharides; used to diagnose Whipple disease (Tropheryma whipplei B), Glycogen storage disease, alpha1 antitrypsin deficiency, fungal infectionsClarification to current text
289226PathologyPathologyNEW FACTnot needed- just reformatting histopathological findings of most important disorders scattered all over the bookHIGH YEILD!!! Attached is a file of summary Tables of Important Histological Findings in Key Diseases (Grouped by System)Spelling/formatting
290523Neurology and Special SensesAnatomy and PhysiologyClinical reflexesGrammar"Reflexes count up in order" is incorrect grammatically and it should be changed to "reflexes are counted up".Spelling/formatting
291523Neurology and Special SensesAnatomy and PhysiologyClinical reflexeshttps://www.lecturio.com/nursing/free-cheat-sheet/deep-tendon-reflexes-scale-arcs/C5 is the main nerve root for the biceps reflex, whereas "C6", not C5, is the main root for the "brachioradialis" reflex.Minor erratum
292523Neurology and Special SensesAnatomy and PhysiologyClinical reflexeshttps://m.youtube.com/watch?v=Otf4_UEvnQ8To respect the original rhyme, "kick the door" would be better changed to "shut the door".Spelling/formatting
293704RespiratoryPathologySuperior vena cava syndromeSelf understood.The topic is about superior venacava syndrome but the obstruction in the figure, indicated by red, is placed in the right brachiocephalic vein and before the right meets left brachiocevein. Superior venacava starts after right and left venacava joins.Minor erratum
294704RespiratoryPathologySuperior vena cava syndromeSelf understood.The topic is about superior venacava syndrome but the obstruction in the figure, indicated by red, is placed in the right brachiocephalic vein and before right meets left brachiocephalic vein. Superior venacava begins after right and left venacava joins.Minor erratum
295704RespiratoryPathologySuperior vena cava syndromeSelf understood.The topic is about superior venacava syndrome but the obstruction in the figure, indicated by red, is placed in the right brachiocephalic vein and before right meets left brachiocephalic vein. Superior venacava begins after right and left brachiocephalic vein joins.Minor erratum
296601RenalPhysiologyAngiotensin-converting enzyme inhibitorshttps://www.uptodate.com/contents/kidney-effects-of-ace-inhibitors-and-arbs-in-hypertension ,https://emedicine.medscape.com/article/239392-medicationit is written ACEI constrict efferent but it dilate efferentMinor erratum
297328CardiovascularPharmacologyAntiarrhythmics—calcium channel blockers (class IV)https://www.uptodate.com/contents/calcium-channel-blocker-poisoning?search=calcium%20channel%20blocker%20overdose&source=search_result&selectedTitle=1~15&usage_type=default&display_rank=1Thank you for your excellent work on the 2025 edition of First Aid for the USMLE Step 1. I noticed that calcium channel blocker (CCB) overdose is not currently covered in the text. Given its importance in emergency medicine and its distinct treatment approach, I believe it warrants inclusion in the Cardiovascular pharmacology section. Management of CCB overdose involves: 1. IV bolus of isotonic crystalloid (500–1000 mL) for hypotension, repeated as needed 2. IV atropine (1 mg, up to 3 doses) for bradycardia 3. IV calcium salts, IV glucagon, high-dose insulin with dextrose, vasopressors, and IV lipid emulsion Including even a brief summary of these interventions would add meaningful clinical value and help students better prepare for exams and real-world scenarios. Thank you for considering this suggestion.High-yield addition to next year
298480Musculoskeletal, Skin, and Connective TissuePathologyRaynaud phenomenonhttps://www.uptodate.com/contents/treatment-of-raynaud-phenomenon-initial-management480?search=raynauds&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H188847417Currently, the text states “Treat with calcium channel blockers,” but it would be helpful to clarify which agents are commonly used , long-acting dihydropyridine CCBs are preferred over short acting CCBs. Commonly used long-acting dihydropyridine CCBs include Amlodipine and Nifedipine.Clarification to current text
299480Musculoskeletal, Skin, and Connective TissuePathologyNeuromuscular junction diseaseshttp://uptodate.com/contents/lambert-eaton-myasthenic-syndrome-treatment-and-prognosis?search=lambert%20eaton%20myasthenic%20syndrome&source=search_result&selectedTitle=2~33&usage_type=default&display_rank=2#H1273903380I’d like to suggest expanding the section on Lambert-Eaton Myasthenic Syndrome (LEMS). Specifically, it would be helpful to include: * Amifampridine (3,4-diaminopyridine) as the first-line symptomatic treatment * “ Its mechanism involves potassium channel blockade, which significantly prolongs presynaptic nerve terminal depolarization, enhances calcium influx, and improves acetylcholine release.” This would offer a more complete picture of LEMS, especially given its clinical relevance and differences from myasthenia gravis.High-yield addition to next year
300482Musculoskeletal, Skin, and Connective TissueDermatologyExocrine glandshttps://www.uptodate.com/contents/bromhidrosis https://www.mayoclinic.org/diseases-conditions/hyperhidrosis/multimedia/sweat-glands/img-20007980. https://www.ncbi.nlm.nih.gov/books/NBK482278/?utAreas like axilla and groin can also have apocrine sweat glands. Apocrine sweat glands in contrast to merocrine sweat glands produce sweat with more lipids and pheromones. These lipids when degraded by various bacteria produces malodor which when excess can cause localized bromhidrosis. Also, apocrine sweat glands start functioning at puberty under influence of sex hormones. Similarly while merocrine sweat glands open directly into the skin but apocrine glands open into the hair follicle.Clarification to current text
301114ImmunologyImmune ResponsesNEW FACThttps://pubmed.ncbi.nlm.nih.gov/39206195/B-cell disorders: Feature Description Defect Decreased levels of one or more IgG subclasses (IgG1, IgG2, IgG3, or IgG4) despite normal total IgG levels Most common subtype IgG2 deficiency (especially in children) Pathophysiology Impaired antibody response to polysaccharide antigens (e.g., encapsulated bacteria) Age group Typically identified in children or young adults Clinical presentation - Recurrent sinopulmonary infections (e.g., otitis media, sinusitis, pneumonia) - May present after routine vaccinations (e.g., PCV) fail to protect - Some may be asymptomatic Associated conditions - Atopy (e.g., allergic rhinitis) - Asthma - Occasionally found with autoimmune diseases Investigations - Normal total IgG, IgA, IgM - Decreased one or more IgG subclasses - Normal B- and T-cell counts - Poor response to polysaccharide vaccines (e.g., pneumococcal vaccine) Diagnosis confirmed by - Serum quantitative IgG subclasses - Functional antibody testing (pre- and post-vaccine titers) Management - Observation if mild - Prophylactic antibiotics - Immunoglobulin replacement therapy if severeHigh-yield addition to next year
30278BiochemistryMetabolismDisorders of fructose metabolismhttps://pmc.ncbi.nlm.nih.gov/articles/PMC5409695/Essential fructosuria pathophysiology is Fructose is not trapped into cells. Hexokinase becomes 1° pathway for converting fructose to fructose-6-phosphate not to fructose-1-phosphate (it is completely different as one is metabolized directly by aldolase b while the other is converted to fructose 1 6 bisphosphonate then metabolized by aldolase b in glycolysis)Major erratum
303441Hematology and OncologyPharmacologyWarfarinSelf study, First Aid CasesWEPT = Warfarin affects the Extrinsic pathway, increasing PT.Mnemonic
304217PathologyNeoplasiaHallmarks of cancerChapter 2 The nature of cancer in The Biology of Cancer by Robert A. Weinberg See also https://www.medscape.com/s/viewarticle/719423?_gl=1*syicom*_gcl_au*MTc1NjUwMzk0NC4xNzUwMTE1ODEy"Warburg effect : Shift of glucose metabolism away from mitochondrial oxidative phosphorylation toward glycolysis, even in the presence of oxygen. Aerobic glycolysis provides rapidly dividing cancer cells with the carbon needed for synthesis of cellular structures, leading to increased lactic acid."...this is from FirstAid "In cancer cells, including those with access to ample oxygen, the GLUT1 glucose transporter imports large amounts of glucose into the cytosol, where it is processed by glycolysis. However, as the last step of glycolysis, pyruvate kinase M2 (PK-M2) causes its pyruvate product to be diverted to lactate dehydrogenase (LDH-A), yielding the lactate that is secreted in abundance by cancer cells. Because relatively little of the initially imported glucose is metabolized by the mitochondria, as few as 2 ATPs are generated per glucose molecule"...this is from the textbook referenced below. I feel this clarification is needed because even in the explanation for UWorld QID: 22845, the excessive production of lactate in the cancer cells compared to normal cells bears the presentation of anaerobic glycolysis but this is not the case as there is oxygen present and so an acknowledgement of this PK-M2 step is necessary.Clarification to current text
305105ImmunologyImmune ResponsesComplement disordershttps://www.uptodate.com/contents/pathogenesis-of-paroxysmal-nocturnal-hemoglobinuria https://www.uptodate.com/contents/paroxysmal-nocturnal-hemoglobinuria-treatment-and-prognosisIn the topic “Paroxysmal nocturnal hemolysis”, it says that the hemolysis is complement mediated intravascular hemolysis. But in fact the hemolysis is both intravascular and extravascular, and the mechanism of hemolysis depicts the different roles of CD55 and CD59. Intravascular hemolysis is due to MAC and is inhibited by CD 59, in normal RBCs, and by eculizumab which is a C5 inhibitor. On the other hand, extravascular hemolysis is prevented by CD 55/DAF which inhibits C3 convertase and prevents C3b opsonisation of the RBC. These RBCs that are opsonised by C3b are removed by reticulo endothelial system and results in extravascular hemolysis. The importance of this extravascular hemolysis is that breakthrough hemolysis can occur in patients treated with eculizumab which only blocks MAC formation by blocking C5 but has no effect upstream of MAC formation. There are inhibitors of various upstream mediators of complement cascade that are used therapeutically to tackle this same problem of extravascular hemolysis. I have shared a link to UpToDate topic on PNH as well as the figure in UpToDate that provides a clear illustration.Major erratum
306122MicrobiologyBasic BacteriologyCell envelopeSelf explanatoryUnder the sub-heading “Cytoplasmic membrane”, the bracket has included just “gram positive” but I think the correct grammar is that the bracket should also include “only” making the correct sentence as “Lipoteichoic acids (gram positive only) extends from membrane to exterior”.Spelling/formatting
307505Neurology and Special SensesAnatomy and PhysiologyNeurotransmitter changes with diseasehttps://emedicine.medscape.com/article/286759-overview#a2Neurotransmitters Decreased by Sadness (depression) N: norepinephrine D: dopamine S : serotoninMnemonic
308620RenalPathologyNEW FACThttps://pubmed.ncbi.nlm.nih.gov/20370459/attached is a table: Indications for Dialysis in AKI AEOIUHigh-yield addition to next year
309103ImmunologyImmune ResponsesImmunoglobulin isotypeshttps://teachmephysiology.com/immune-system/adaptive-immune-system/antibodies/The image of each immunoglobulin suggests that immunoglobulins are very similar to each other(IgE,IgG,IgD), but this is not entirely accurate, For example, the Fc region of Immunoglobulin E (IgE) contains more immunoglobulin folds compared to other isotypes, highlighting structural differences ,Immunoglobulins differ from each other structurally in many ways, including variations in their Fc regions. The Fc region, which is part of the constant region of the heavy chains, determines the immunoglobulin isotype and influences its specific functions,, I've found 2 template figures (that can be simplified and like to the First Aid style), https://www.researchgate.net/figure/Structure-of-antibodies-isotypes-and-IgG-subclasses-A-Antibodies-are-dimeric_fig1_380267023, https://www.news-medical.net/life-sciences/Types-of-Antibodies.aspxMajor erratum
310176MicrobiologySystemsNEW FACThttps://pmc.ncbi.nlm.nih.gov/articles/PMC7522803/in Common causes of meningitis table: add VP shunt associated meningitis=S. epidermisClarification to current text
311xviiiSection IAbbreviations and SymbolsNEW FACThttps://emedicine.medscape.com/article/2073979-overviewCurrent text: In the Selected USMLE Laboratory Values table, the normal range for urea nitrogen (serum BUN) is listed as 7 – 18 mg/dL, 25 – 64 nmol/L. Problem: The SI-unit entry is incorrect and uses the wrong prefix. It should be reported in mmol/L, not nmol/L. A quick calculation shows that 25 – 64 nmol/L equals 0.000025 – 0.000064 mmol/L it's about 100,000 times lower than the true physiologic range. Correct text: Urea nitrogen, serum (BUN): 7 – 18 mg/dL (3.6 – 7.1 mmol/L)Spelling/formatting
312738Rapid ReviewRapid ReviewTricyclic antidepressantshttps://www.accessdata.fda.gov/drugsatfda_docs/label/2014/016798s056,017516s025lbl.pdfPage No. 738 — Rapid Review ➜ Easily Confused Medications Current text: Doxepin — Depression, anxiety, bipolar disorder (tricyclic antidepressant) Problem: Doxepin is not approved for bipolar disorder; tricyclics can precipitate mania or rapid cycling in susceptible patients. Correct text: Doxepin — Depression, anxiety (off-label: insomnia). Not approved for bipolar disorder; use may trigger manic switching.Minor erratum
313676ReproductivePharmacologyAndrogenshttps://pmc.ncbi.nlm.nih.gov/articles/PMC4219622/Current text: Testosterone, methyltestosterone — adverse effects: ↑ LDL, ↑ HDL Problem: Exogenous androgens increase LDL but lower HDL. Multiple studies confirm a decrease in HDL with testosterone therapy. Correct text: … adverse effects: ↑ erythrocytosis, ↑ LDL, ↓ HDLMinor erratum
314567Neurology and Special SensesPharmacologyOpioid analgesicshttps://reference.medscape.com/drug/demerol-meperidine-343315Current text: meperidine (long-acting) Problem: Meperidine (pethidine) is a short-acting opioid; analgesia lasts ~2–4 h. Correct text: meperidine (short-acting)Minor erratum
315366GastrointestinalEmbryologyTracheoesophageal anomalieshttps://www.ncbi.nlm.nih.gov/books/NBK560848/#:~:text=EA%20is%20typically%20diagnosed%20with%20failure%20to,into%20the%20orogastric%20tube%20under%20fluoroscopic%20guidance.In the pure esophageal atresia picture , the book mentioned that there is a stenosis in the esophagus while the trusted sources tell us that is an ended pouch which separates 2 parts of the esophagusMinor erratum
316601RenalPhysiologyAngiotensin-converting enzyme inhibitorshttps://pubmed.ncbi.nlm.nih.gov/2490816/“NSAIDs and ACE inhibitors should not be given together constriction of afferent and efferent arterioles.” the statement is physiologically incorrect: • NSAIDs constrict the afferent arteriole by inhibiting prostaglandin synthesis. • ACE inhibitors dilate the efferent arteriole by reducing angiotensin II levels.Major erratum
317298CardiovascularPhysiologyElectrocardiogram-This sentence is written twice: left bundle branch divides into left anterior and posterior fascicles.Minor erratum
318300CardiovascularPhysiologyNormal resting cardiac pressures-“ Pulmonary capillary wedge pressure (PCWP; in mm Hg) is a good approximation of left atrial pressure, except in mitral stenosis when PCWP > LV end diastolic pressure. PCWP is measured with pulmonary artery catheter (Swan-Ganz catheter).” LVEDP is not introduced in the first part of the sentence. Better to say in the first part Pulmonary capillary wedge pressure (PCWP) is commonly used to estimate left atrial pressure, and by extension, the left ventricular end-diastolic pressure (LVEDP).Clarification to current text
319613RenalPathologyNephrotic syndromeNoneMnemonic to remember nephrotic syndrome characteristics "LEACI Protein" pronounced "leaky" protein. Lipiduria, Edema, Albumin decreased, blood Clots, Infection risk increased, and PROTEINuriaMnemonic
320439Hematology and OncologyPathologyLangerhans cell histiocytosishttps://pubmed.ncbi.nlm.nih.gov/26400031/attaches is a table comparing MAS vs LCHClarification to current text
321123MicrobiologyBasic BacteriologyStainsnot needed- just reformattingPeriodic acid–Schiff stain: Stains glycogen, mucopolysaccharides; used to diagnose Whipple disease (Tropheryma whipplei B), glycogen storage disease, alpha1 antitrypsin deficiency, and fungal infections (Mycobacterium avium complex)Clarification to current text
322367GastrointestinalEmbryologyPancreas and spleen embryologyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC6872911/In the Pancreas divisum , the text didn’t clarify if the problem in the buds or the ducts , so it should be “ventral and dorsal (ducts )fail to fuse at 7 weeks of development” instead of “ ventral and dorsal parts fail to fuse at 7 weeks of development.“Clarification to current text
323333Hematology and OncologyPhysiologyAntidiuretic hormoneFirstAidDesmopressin is a medication primarily known for treating central diabetes insipidus and nocturnal enuresis (bedwetting) due to its antidiuretic effect. However, it's also a valuable treatment for von Willebrand disease and mild hemophilia A because it stimulates the release of von Willebrand factor and factor VIII from endothelial cells. These factors are crucial for blood clotting, and their release helps control bleeding in these conditions.Clarification to current text
32439BiochemistryMolecularLac operonRobeva, R. S., Kirkwood, J. R., & Davies, R. A. (2012). Chapter 1. Mechanisms of Gene Regulation: Boolean Network Models of the Lactose Operon in Escherichia coli. In Mathematical Concepts and Methods in Modern Biology (pp. 3-30). Academic Press.Current: "Low glucose and lactose available" Correction: "Low glucose AND lactose available" “See attached screenshot for reference” Rationale: The lac operon follows Boolean AND logic - both conditions must be true for strong expression. Capitalizing "AND" would: 1. Clarify this is a logical AND operation (both inputs required), not just a grammatical conjunction 2. Help students recognize the Boolean logic inherent in gene regulation 3. Emphasize that BOTH conditions must be satisfied simultaneously for lac gene activation The right side of your diagram effectively shows a truth table with four states. Only when both conditions are met (low glucose AND lactose available) do we get strong expression. The capitalization would reinforce this all-or-nothing logic that many students miss.Clarification to current text
3258Section ISection INEW FACTI do not have a hyperlink. I noticed numbers in a chart in Section 1 of the book and did not know if it was correct or not.Section 1: Guide to Efficient Exam Preparation in Table 2: Passing Rates for the 2022-2023 USMLE Step 1. In the 2025 version I have the number for Allopathic total passing percentage in 2023 says 9% and did not know if that was meant to say 89%.Minor erratum
326115ImmunologyImmune ResponsesImmunodeficiencies1. https://www.uptodate.com/contents/ataxia-telangiectasia?search=ataxia%20telangiectasia&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H7. 2. https://www.ncbi.nlm.nih.gov/books/NBK519542/I would like to suggest a correction and clarification in the section on Ataxia-Telangiectasia. The current triad mentions “spider angiomas (telangiectasia),” but spider angiomas are not a characteristic feature of A-T. Instead, the condition is classically associated with oculocutaneous telangiectasia, particularly involving the bulbar conjunctiva. Additionally, most editions include an image of cutaneous telangiectasia. Since ocular involvement is often more striking and specific to the diagnosis, I’ve attached a representative image of ocular telangiectasia seen in A-T, which may serve as a better visual aid.Thank you for considering this suggestion and for your excellent work in supporting medical students.Major erratum
327617RenalPathologyKidney stonesno needThe urine crystal shape "wedge-shaped prism" for calcium phosphate ==> you can make the P's in red to make it easier (Prism, Phosphate)Mnemonic
328319CardiovascularPathologyConstrictive pericarditishttps://onlinejase.com/article/S0894-7317(13)00533-6/fulltextIn the Cardiovascular Pathology section, under "Constrictive Pericarditis" (Page 319, 2025 edition), First Aid incorrectly lists pulsus paradoxus as a clinical feature. Pulsus paradoxus is a classic finding in cardiac tamponade, not constrictive pericarditis. Major sources including UpToDate and StatPearls confirm that pulsus paradoxus is usually constrictive pericarditi, .absent in constrictive pericarditis, and when present, it is not a reliable or consistent feature. The American Society of Echocardiography, in its clinical recommendations, explicitly distinguishes the hemodynamics of constrictive pericarditis from those of cardiac tamponade, noting that while both conditions involve a noncompliant pericardial space, the dissociation of intrathoracic and intracardiac pressures in constrictive pericarditis blunts the inspiratory decrease in left ventricular filling, and thus pulsus paradoxus is not a prominent feature in classic constrictive pericarditis. Kindly consider this for correction and possible acknowledgment.Major erratum
329656ReproductivePathology5α-reductase deficiencyhttps://www.uptodate.com/contents/steroid-5-alpha-reductase-2-deficiency/It’s written that Testosterone levels are normal but I think it’s better to write normal to high due to impaired conversion.High-yield addition to next year
330648ReproductivePhysiologyEstrogenhttps://pubmed.ncbi.nlm.nih.gov/3595517/function listed as "stimulation of prolactin secretion, decreased prolactin action on breasts", but is confusing (especially with the same wording for the "progesterone" entry below) & should be clarified "stimulation of prolactin secretion IN ANTERIOR PITUITARY; HIGH ESTROGEN --> DOWNSTREAM prolactin ANTAGONISM INHIBITS LACTATION"Clarification to current text
331502Neurology and Special SensesEmbryologyPosterior fossa malformationsnot neededChiari I malformationMnemonic: CHIA-RI C = Cerebellar tonsillar herniation H = Headache IA = In Adulthood ( RI = syRIngomyelia Chiari II malformationMnemonic: Chiari II → "II M" → 2 Ms → MM = MyeloMeningocele + Malformed CSF flow * MyeloMeningocele * Causes non-communicating hydrocephalusMnemonic
332402GastrointestinalPathologyHemochromatosishttps://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-hereditary-hemochromatosisI think it would be better to mention “secondary hypogonadism” instead of just hypogonadism so as to clarify that unlike diabetes which is due to deposition of iron in pancreas, hypogonadism and hypothyroidism is due to decreased trophic hormone secretion resulting from pituitary iron deposition.Clarification to current text
333402GastrointestinalPathologyHemochromatosishttps://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-hereditary-hemochromatosisPatients with hemochromatosis are at increased risk of infection with Vibrio vulnificans and Yersinia enterocolitica. It’s a high yield question topic. Increased risk with vibrio vulnificans is mentioned in the microbiology section as well. But I think it would be helpful if this is mentioned in this section as well so as to get a more complete picture.High-yield addition to next year
334355EndocrinePathologyPheochromocytomaSelf explanatoryFor remembering the association of pheochromocytoma with gene mutations, we can remember the disease those mutations cause by Mneumonic 1-2-3 i.e. 1- [NF 1] 2- [MEN 2] 3-[VHL- 3 letters]Mnemonic
335196MicrobiologyAntimicrobialsBaloxavirhttps://pubmed.ncbi.nlm.nih.gov/32122918/ https://doi.org/10.1093/cid/ciaa107 https://www.uptodate.com/contents/antiviral-drugs-for-influenza-pharmacology-and-resistanceIn the mechanism, it says “transfer of 5’ cap of host mRNA onto viral mRNA”. I think it’s misleading as cap snatching accurately refers to cleavage of 5’ cap of host mRNA to be used as a primer for initiation of viral mRNA synthesis by viral Rna polymerase. It is not the transfer of 5’ cap but using the 5’ cap as a primer for viral mRNA synthesis. Saying transfer of 5’ cap from host to viral mRNA is misleading as may wrongly imply that viral mRNA synthesis and cap snatching happens at random sequence when in fact cap snatching provides primer for synthesis of viral mRNA. In this regard baloxavir inhibits the initiation of mRNA synthesis.Clarification to current text
336p. 297CardiovascularPhysiologyPacemaker action potentialhttps://www.ahajournals.org/doi/10.1161/CIRCRESAHA.109.208041 and https://doi.org/10.1152/physrev.00029.2008In the bottom image of the page, regarding phase 4 of the action potential, the illustration representing the funny current indicates that both sodium and potassium enter the cell; however, potassium should actually exit, even though the net ionic flow is inward.Minor erratum
33737BiochemistryMolecularDNA repairUWorldBase excision repair is responsible for repairing various non-bulky DNA base alterations, including depurination, alkylation, oxidation, and deamination.Clarification to current text
338512Neurology and Special SensesAnatomy and PhysiologyCerebral perfusionSpelling error doesn’t require hyperlink.The second line of the page 512, in the Cerebral Perfusion topic, misspelled ‘perfusion’ as ‘perfursion’.Spelling/formatting
339615RenalPathologyNephritic syndromehttps://www.uptodate.com/contents/genetics-pathogenesis-and-pathology-of-alport-syndrome-hereditary-nephritisIt says that it is X-linked dominant. There are a good proportion of (15%) that are autosomal recessive, which the book completely ignores. There are also potentially 5% that are autosomal dominant, although the literature is less certain about this. Perhaps a X-linked dominant (85%), autosomal (15%) would be more accurate than "mostly x-linked". I have attached an uptodate link as well as a review article regarding this.Clarification to current text
340162MicrobiologyVirologyHerpesviruseshttps://www.uptodate.com/contents/human-herpesvirus-8-infectionUnder the heading Human herpesviurs 8, it mentions the route of transmission as sexual contact. But multiple sources including UpToDate mentions that transmission through saliva is the primary means of transmission. It also mentions that the transmission through saliva during intercourse is the primary mode of transmission during sexual contact. Prevalence is also more in men having sex with men though seminal fluid being a much less important in transmission. Organ transplant is another potential source of transmission.Major erratum
341433Hematology and OncologyPathologyNEW FACTAVPR2 on vascular endothelium can modulate the release of factor VIII and von Willebrand factor. https://www.uptodate.com/contents/desmopressin-ddavp-stimulation-testIn the treatment of vWD, desmopressin(releases vWF stored in endothelium) should be changed to desmopressin(releases both vWF and Factor VIII stored in endothelium) because both vWF and Factor VIII are implicated in the disease and desmopressin does increase both. That's also one of the reasons why it is used in Hemophilia AHigh-yield addition to next year
342286CardiovascularEmbryologyHeart embryologySadler TW. Langman's medical embryology. 14th ed. Philadelphia: Wolters Kluwer; 2019. p. 181.It mentions that the primitive ventricle gives rise to trabeculated portion of both right and left ventricles which is inaccurate. The primitive ventricle gives rise to only trabeculated portion of left ventricle while it is the proximal one-third portion of bulbous cord is that gives rise to trabeculated portion of right ventricle. I have provided the reference as well a screenshot of the chapter from Langman’s Medical embryology textbook.Major erratum
343646ReproductiveAnatomySeminiferous tubulesnot needed- just reformattingrearranged into tableSpelling/formatting
34481BiochemistryMetabolismPhenylketonuriaUWorldDisorders involving impaired tetrahydrobiopterin (BH4) levels, the most common being dihydrobiopterin reductase deficiency, account for 2% of phenylketonuria cases. BH4 is an important cofactor for both phenylalanine hydroxylase and tyrosine hydroxylase. Although phenylalanine levels can be corrected with dietary restriction, downstream deficiencies of dopamine (elevated prolactin), norepinephrine, epinephrine, and serotonin lead to progressive neurologic deterioration.Clarification to current text
345423Hematology and OncologyPathologyReticulocyte production indexhttps://www.uptodate.com/contents/approach-to-the-child-with-anemia?utm_source=chatgpt.com#H3419817456 https://www.uptodate.com/contents/diagnostic-approach-to-anemia-in-adults?search=reticulocyte%20production%20index&sectionRank=1&usage_type=default&anchor=H1722635667&source=machineLearning&selectedTitle=2~3&display_rank=2#H1722635667Reticulocyte Production Index isn't the same as corrected reticulocyte count. 1. Corrected retic count accounts for the fact that a lower red cell mass artificially inflates the reticulocyte % 2. RPI builds on the corrected count by further adjusting for prolonged circulation time of reticulocytes released early in response to anemia. Both the formulae are also different . So, all in all, "also called corrected reticulocyte count" must be improvised.Major erratum
346352EndocrineSystemsCushing syndromehttps://pubmed.ncbi.nlm.nih.gov/14671138/According to new guidelines (and there is an AMBOSS question in the High Yield study plans for it), since Cushing's disease is way more common than Ectopic ATCH secretion - we now do a Brain MRI to check for Cushing's disease, which if negative is proceeded by CRH stimulation test or inferior petrosal sinus sampling.Major erratum
347546Neurology and Special SensesNeuropathologyFacial nerve lesionshttps://medizzy.com/feed/40335258 and https://i.pinimg.com/564x/49/77/c6/4977c61d700fe70478d29cd2dae11841.jpgThe upper motor neuron (UMN) lesion affects the contralateral side because the corticobulbar tract crosses over. For example, a lesion in the right motor cortex causes weakness in the left lower half of the face. On the other hand, the lower motor neuron (LMN) lesion affects the ipsilateral side since it involves the facial nerve after it has left the brainstem. So, a lesion in the left facial nerve results in weakness of the entire left side of the face. The images can be confusing because they don’t clearly differentiate between ipsilateral and contralateral sides. For clarity, the photo showing the LMN lesion should be on the opposite side from the right motor cortex, or it should clearly state that the lesion is in the left facial nerve to avoid confusion, Here is a photo from Amboss and another websites that clearly illustrates the difference between upper and lower motor neuron lesions, https://medizzy.com/feed/40335258 and https://i.pinimg.com/564x/49/77/c6/4977c61d700fe70478d29cd2dae11841.jpgClarification to current text
348108ImmunologyImmune ResponsesCell surface proteinsFirst aid book (Page 100)The regulatory cell surface protein is also FOXP3. Because of its importance in IPEX syndrome, it's important to include FOXP3 when discussing regulatory T cells cell surface proteins, as mentioned on the first aid book page 100(regulatory T cells).Minor erratum
34982BiochemistryMetabolismPhenylketonuriaUWorldPhenylketonuria not only presents with hypopigemented skin, hair and eyes; it also presents with hypopigmentation of the catecholaminergic brain nuclei (substantia nigra, locus ceruleus, vagal nucleus dorsalis) due to the disruption of catecholamine synthesis.Clarification to current text
350529Neurology and Special SensesNeuropathologyAphasianot neededConduction aphasia: can be caused by damage to the Connection(Con highlighted with red like the Conduction word) between Broca’s and Wernicke’s areas(arCuate fasciculus).Mnemonic
351651ReproductivePhysiologyPregnancyhttps://en.wikipedia.org/wiki/Gravidity_and_parityGravida Number of times a woman has been pregnant, regardless of the outcome (includes live birth, miscarriage, abortion, ectopic, etc.) vs Para Number of pregnancies reaching ≥20 weeks gestation, regardless of outcome (live birth or stillbirth) — not number of live babies aloneMinor erratum
352656ReproductivePathologyDiagnosing disorders by sex hormonesnot needed just reformatting for better clarityreformatting of the table with addition of other disorders, genotype and phenotypeSpelling/formatting
353211PathologyInflammationLeukocyte extravasationhttps://www.sciencedirect.com/science/article/abs/pii/S1359610198000240 and https://en.wikipedia.org/wiki/Selectin#:~:text=During%20an%20inflammatory%20response%2C%20P,the%20delay%20of%20several%20hours. and https://accessmedicine.mhmedical.com/content.aspx?sectionid=210416005&bookid=2570#210416132 and https://pmc.ncbi.nlm.nih.gov/articles/PMC11232095/ and first aid page 417.In the leukocyte extravasation image(the image of 4 steps), E-selectin is shown before P-selectin, and also in the step 1 table, E-selectin is written first before P-selectin,This can be confusing because it's not accurate — P-selectin comes before E-selectin, P-selectin is released within minutes, while E-selectin appears later. This makes sense because P-selectin is pre-formed and stored in Weibel-Palade bodies, ready for immediate release. In contrast, E-selectin is newly expressed in response to cytokines, Even the name helps as a mnemonic: P-selectin = from weibel- Palade bodies (pre-formed), E-selectin = expressed , This is also supported by First Aid (Hematology, p. 417), the image which shows that P-selectin is stored in Weibel-Palade bodies and released early — before other steps.Clarification to current text
354686RespiratoryPhysiologyHypoxia and hypoxemiaFirst Aid 2025 and common senseReplace 5 Right-to-left shunt (the extreme of V/Q mismatch) Normal perfusion in areas of no ventilation. Can be anatomic (eg, intracardiac shunt) or physiologic (eg, perfusion of nonventilated alveoli in ARDS); With: 5 Right-to-left shunt (the extreme of V/Q mismatch) Occurs when deoxygenated blood enters the systemic circulation without being oxygenated in the lungs. Can be anatomic (eg, an intracardiac shunt, where blood bypasses the lungs entirely despite normal ventilation) or physiologic (eg, perfusion of nonventilated alveoli in ARDS)Major erratum
35578BiochemistryMetabolismDisorders of galactose metabolismSelf-StudyGalactitolSpelling/formatting
356506Neurology and Special SensesAnatomy and PhysiologyMeningesnot neededThe Brain DAPs You in Layers ,D( DURA), A(ARACHNOID) P(PIA).Mnemonic
357675ReproductivePharmacologyProgestinshttps://bjgp.org/content/71/712/522vs COCPs: Suitable for breastfeeding women, or those with estrogen risks (history of DVT, migraines with aura, >35 smoker)High-yield addition to next year
358144MicrobiologyClinical BacteriologyHelicobacter pylorihttps://www.uptodate.com/contents/treatment-of-helicobacter-pylori-infection-in-adults?search=h.pylori%20quad%20therapy&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2Hello! Quad therapy for h.pylori should include tetracycline 500mg, and not clarithromycin, as macrolides have increased resistance world wide, per UptoDate.Major erratum
359671ReproductivePathologyEpididymitis and orchitisnot needed just reformatting for better clarityMost common causes: C trachomatis and N gonorrhoeae (young males): -ve culture E coli and Pseudomonas (older males, associated with UTI and BPH): +ve culture Mumps orchitis: follow parotidis, cause infertility, RF is no childhood vaccination Autoimmune (eg, granulomas involving seminiferous tubules)Clarification to current text
360638ReproductiveEmbryologyPharyngeal arch derivativesUWorldAortic & Pharyngeal arch association, being questioned in UWorldHigh-yield addition to next year
36178BiochemistryMetabolismDisorders of fructose metabolismhttps://doi.org/10.1111/j.0954-6820.1972.tb05317.x https://doi.org/10.3390/nu9040356In essential fructosuria, it says that hexokinase becomes the primary pathway that converts fructose to fructose-1-phosphate. But actually hexokinase converts fructose into fructose-6-phosphate which then enters glycolysis pathway.Major erratum
36288BiochemistryMetabolismKetone bodiesSelf understood. Chapter from biochemistry section "Ethanol metabolism" from First Aid Step 1 2025 page no 70 itself.It says that chronic alcoholism leads to a high NADH state that leads to accumulation of OAA. I think this statement might be confusing. It's better to state, "With chronic alcohol overuse, high NADH state leads to shunting of OAA to malate downregulating TCA cycle." Because of shunting, OAA levels depletes in chronic alcohol overuse.Clarification to current text
363669ReproductivePathologyNEW FACThttps://my.clevelandclinic.org/health/diseases/10035-erectile-dysfunctionattached is a pdf file for erectile dysfunction as a penile pathology which is high yield and frequently asked aboutHigh-yield addition to next year
364672ReproductivePathologyBenign prostatic hyperplasiahttps://www.auajournals.org/doi/10.1097/JU.0000000000003698The dynamic component (stromal smooth muscle) responds rapidly to α-adrenergic blockers, which relax prostatic smooth muscle. The static component (epithelial hyperplasia) responds to 5α-reductase inhibitors, which gradually reduce prostate size over several months. The fibrous/collagen-predominant component is drug-resistant and requires surgical intervention (e.g., TURP).Clarification to current text
36598ImmunologyCellularMajor histocompatibility complex I and IIhttps://www.uptodate.com/contents/pathogenesis-of-food-allergy/abstract/36Antigen loaded following release of invariant chain in an acidified Lysosome not EndosomeMajor erratum
366357EndocrinePathologyZollinger-Ellison syndromehttps://www.uptodate.com/contents/management-and-prognosis-of-gastrinoma-zollinger-ellison-syndromeIt says that the ulcers are often refractory to proton pump inhibitors. But the statement is incorrect as PPIs are the cornerstone in management of Zollinger Ellison syndrome. The caveat is that the dose is higher. So the accurate statement would be “recurrent ulcers often refractory to STANDARD DOSES of proton pump inhibitors”. The introduction of PPIs has drastically reduced the morbidity and mortality in ZE syndrome solidifying PPIs efficacy in this condition.Clarification to current text
367633ReproductiveEmbryologyTypes of errors in morphogenesishttps://pediatriceducation.org/2018/02/05/what-is-the-difference-between-an-association-and-a-syndrome/Syndrome: multiple anomalies with a known single cause (e.g., Down syndrome – trisomy 21). Association: anomalies that occur together more frequently than would be expected by chance, but without a known genetic or environmenta cause (e.g., VACTERL Association ).High-yield addition to next year
3688Section ISection INEW FACThttps://www.usmle.org/performance-dataTable 2 shows that in 2023 only 9% of total allopathic students pass the USMLE step 1 exam which is clerical error.Clarification to current text
369467Musculoskeletal, Skin, and Connective TissuePathologyOsteoporosishttps://pmc.ncbi.nlm.nih.gov/articles/PMC4613168/Glucocorticoid therapy can result in osteoporosis following prolonged use.Clarification to current text
370365GastrointestinalEmbryologyVentral wall defectshttps://emedicine.medscape.com/article/975583-overview#a5 , https://pubmed.ncbi.nlm.nih.gov/36446303/Ventral wall defects should be clarified because I was asked about the specific embryologic causes. Omphalocele results from a failure of the midgut to return to the abdominal cavity, whereas gastroschisis arises from a failure of lateral wall folding. However, First Aid 2025 states that both result from failure of abdominal wall closure, which may cause confusion. This distinction should be clarified, as it can be tested in practice questions, Step 1, and COMLEX.Clarification to current text
371631ReproductiveEmbryologyEmbryologic derivativeshttps://pmc.ncbi.nlm.nih.gov/articles/PMC4369764/S100 is expressed in neural crest-derived cells. Its expression is used in diagnosing tumors of neural crest origin such as melanoma, schwannoma, neurofibroma, and Langerhans cell histiocytosis.High-yield addition to next year
372547Neurology and Special SensesOtologyAuditory anatomy and physiologyhttps://www.ncbi.nlm.nih.gov/books/NBK532284/?utm_source and https://teachmeanatomy.info/head/organs/ear/eustachian-tube// and first aid page 547The image of the ear anatomy looks like the pharyngotympanic (Eustachian) tube is part of the inner ear, but this is not true. The Eustachian tube is part of the middle ear, connects the middle ear to the back of the throat (nasopharynx), also this is supported and mentioned on the same page about otitis media (inflammation of the middle ear), which is associated with Eustachian tube dysfunction, I found an image on BioRender that clearly shows the different parts of the ear (external, middle, and inner), especially the middle ear, where you can see the Eustachian tube and the ossicles, but the image doesn't show the innervation of the external ear. https://app.biorender.com/biorender-templates/details/t-6047c2c8a8c77426b7976515-middle-and-inner-ear-anatomy/?source=galleryMajor erratum
373545Neurology and Special SensesNeuropathologyBrown-SÈquard syndromehttps://www.healthcentral.com/condition/spinal-cord-injury/complications-after-traumatic-spinal-cord-injuryAttached is a table of spinal cord syndromes with features and causes of each which are high yeild and frequently asked aboutHigh-yield addition to next year
374547Neurology and Special SensesOtologyOtitis mediaNAIt's written as "Most commonly due to nontypeable Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis." But there is no MO called nontypeable Streptococcus pneumoniae, so the true version is "Most commonly due to Streptococcus pneumoniae, nontypeable Haemophilus influenzae, Moraxella catarrhalis."Minor erratum
375554Neurology and Special SensesOphthalmologyNEW FACThttps://eyewiki.org/Argyll_Robertson_PupilsArgyll Robertson Pupil A light-near dissociation pathology where pupils constrict during accommodation but not to light, caused by selective pretectal pathway disruption (classically from neurosyphilis, pineal tumors compressing the pretectal area, or dorsal midbrain lesions). These small, irregular pupils demonstrate intact efferent parasympathetic function via preserved accommodation circuits from the visual cortex, while the retinotectal afferent pathway is impaired. Unlike tonic pupils, they are typically bilateral, show no delayed redilation, and often accompany dorsal midbrain signs like vertical gaze palsy (Parinaud's syndrome with pineal tumors).High-yield addition to next year
376558Neurology and Special SensesOphthalmologyNEW FACThttps://www.sciencedirect.com/topics/veterinary-science-and-veterinary-medicine/paramedian-pontine-reticular-formationParamedian Pontine Reticular Formation (PPRF) The PPRF is the horizontal gaze center in the dorsal pons. Lesions cause ipsilateral gaze palsy (eyes can't look toward lesion side). Unlike INO (impaired adduction with nystagmus), PPRF damage affects all horizontal movements. It connects to the ipsilateral abducens nucleus and contralateral oculomotor nucleus via MLF. One-and-a-half syndrome occurs when a lesion affects both PPRF and MLF: ipsilateral gaze palsy plus contralateral adduction failure (only abduction remains). Seven-and-a-half syndrome adds an ipsilateral facial nerve palsy to one-and-a-half syndrome. These patterns localize to pontine tegmentum, often from stroke or MS. Vertical gaze remains intact, distinguishing from midbrain lesions.High-yield addition to next year
37778BiochemistryMetabolismDisorders of fructose metabolismUptodate / amboss / uworldIn essential fructosuria, the deficiency of the enzyme fructokinase means that fructose cannot be converted to fructose-1-phosphate. Since the main pathway is non-functional, a secondary, or "backup," pathway takes over. This alternative pathway involves hexokinase, which is an enzyme that has a high affinity for glucose but can also phosphorylate other hexoses like fructose. When it acts on fructose, it produces fructose-6-phosphate, not fructose-1-phosphateMinor erratum
37846BiochemistryCellularPeroxisomehttps://doi.org/10.1212/WNL.0b013e3182929f8e https://doi.org/10.1016/j.bbamcr.2006.09.010 https://doi.org/10.1016/j.ymgme.2015.12.009Zellweger syndrome (ZS) is a peroxisome biosynthesis defect (PBD). So there is impaired oxidation of very long chain fatty acid (VLCFA) including pipecolic acid. PEX gene (encoding for peroxin) is responsible for peroxisome assembly. Its defects is responsible for PBD in ZS. So MOSTLY PEROXISOMES ARE NOT FORMED (and even if did there the function is severely compromised) leading to increased INTRACELLULAR accumulation of VLCFA (can be demonstrated by skin fibroblast culture method) and PIPECOLIC ACID, which spill into PLASMA (can be measured in plasma and used as a diagnostic tool) and not withinin the PEROXISOMES (as the text in FA mentions). So in ZS, due to PBD, I think it is inappropriate to say that pipecolic acid levels accumulate in peroxisomes; and instead it is more appropriate to say that there is ACCUMULATION OF PIPECOLIC ACID IN PLASMA.Major erratum
379104ImmunologyImmune ResponsesComplementhttps://www.uptodate.com/contents/complement-pathways https://pubmed.ncbi.nlm.nih.gov/26043382/In the figure of complement activation, I think it would be better to clarify that C5 convertase is different for different complement activation pathways. For Classic and Lectin pathway, C5 convertase is C4bC2bC3b (although there is controversy in nomenclature of C2a and C2b which was acknowledged by previous edition of FA). While for Alternative pathway, C5 convertase is C3bBbC3b. The figure provided in FA 2025 doesn’t make this distinction and may create a false impression that C5 convertase is same for all pathways of complement activation.Major erratum
380105ImmunologyImmune ResponsesComplement disordershttps://www.uptodate.com/contents/overview-and-clinical-assessment-of-the-complement-systemAH50 and CH50 test is used to screen for deficiency of alternative and classical pathways respectively. The combination of results of these two tests are frequently tested in UWORLD. I think it’s super high yield. Surprisingly, FA 2025 doesn’t mention about AH50 although CH50 is mentioned briefly. I have provided a table screenshot to help clarify the utility of these tests.High-yield addition to next year
381105ImmunologyImmune ResponsesComplement disordershttps://www.uptodate.com/contents/overview-and-clinical-assessment-of-the-complement-systemAH50 and CH50 test is used to screen for activity of alternative and classical pathway respectively. The combination of results of these two tests are frequently tested in UWORLD. I think it’s super high yield. Surprisingly, FA 2025 doesn’t mention about AH50 although CH50 is mentioned briefly. I have provided a table screenshot to help clarify the utility of these tests. In classical pathway deficiency: CH50 low and AH50 normal; In alternative pathway deficiency: AH50 low and CH50 normal; In terminal complement deficiency: both AH50 and CH50 low.High-yield addition to next year
38260BiochemistryGeneticsFragile X syndromenot neededFragile X syndrome involves trinucleotide repeat expansion [(CGG)n] which occurs during oogenesis. The mnemonic EGG can be used- which resembles CGG repeats, and also reminds you that this happens during oogenesis.Mnemonic
383359EndocrinePharmacologyDiabetes mellitus therapyFrom UW: “ When hypoglycemia is due to excessive endogenous insulin production (eg, sulfonylureas, meglitinides, insulinoma), C-peptide levels are elevated. In contrast, exogenous insulin and insulin analogues (ie, insulin-like polypeptides with structural alterations to optimize pharmacokinetic properties) do not contain C-peptide. When hypoglycemia is induced by these agents, endogenous insulin secretion is suppressed and C-peptide levels are low”C-peptide increase should be added to the notes in drugs that increase insulin secretion as there are many questions on it on both step 1 & 2.High-yield addition to next year
384375GastrointestinalAnatomyNEW FACThttps://www.ncbi.nlm.nih.gov/books/NBK532889/On page 375, in the diagram of the femoral region, the muscle labeled as "Satorius" is incorrectly spelled. The correct anatomical term is "Sartorius", which refers to the longest muscle in the human body located in the anterior compartment of the thigh. Accurate spelling is important for anatomical clarity and should be corrected in future editions.Spelling/formatting
385529Neurology and Special SensesPathologyThalamic pain syndromehttps://next.amboss.com/us/article/UR0bmf?q=overview+of+stroke (amboss article on stroke)the text states that thalamic pain syndrome may be due to occlusion of a lenticulostriate artey. These are branches of MCA. However, the thalamus is majorly supplied by branches from the PCA, thus making a PCA infarct or an infarct of its branches more likely to cause said syndrome.Minor erratum
386528Neurology and Special SensesPathologyIntracranial hemorrhagenot neededcan add this fact :focal neurologic deficits are not the norm in SAH due to the diffuse flow of blood in the subarachnoid space is rare and occurs mainly as a complication such as mass effect of saccular aneurysm, or vasospasm days after bleedHigh-yield addition to next year
387451Musculoskeletal, Skin, and Connective TissueAnatomy and PhysiologyNEW FACThttps://teachmeanatomy.info/upper-limb/nerves/many pyqs including questions that supposed students to know the course of upper extremity nerves, so: the major nerves of the upper extremity and their courses: Musculocutaneous nerve (C5–C7): Pierces coracobrachialis → runs between biceps brachii and brachialis → continues as lateral cutaneous nerve of forearm. Median nerve (C5–T1): Runs with brachial artery in arm (medial side) → passes through cubital fossa medial to brachial artery → travels between flexor digitorum superficialis & profundus → passes through carpal tunnel → into hand. Ulnar nerve (C8–T1): Runs medial in arm → passes posterior to medial epicondyle (funny bone) → enters forearm between flexor carpi ulnaris heads → travels with ulnar artery → passes superficial to flexor retinaculum (Guyon’s canal) into hand. Radial nerve (C5–T1): Spirals around humerus in radial groove with profunda brachii artery → enters anterior arm near lateral epicondyle → divides into superficial branch (sensory, runs with radial artery) and deep branch (posterior interosseous, motor to extensors). Axillary nerve (C5–C6): Passes through quadrangular space with posterior circumflex humeral artery → wraps around surgical neck of humerus → supplies deltoid & teres minor.High-yield addition to next year
388689RespiratoryPhysiologyCyanide vs carbon monoxide poisoningSelf understood. Same section in FA step 1 where it discusses how nitrites helps in cyanide poisoning.At the last sentences, it says, “…. rather than nitrates or sodium thiosulfate, to avoid increasing methylglobin”. It should be METHEMOGLOBIN instead of METHYLGLOBIN. There is no such term as methylglobin.Spelling/formatting
389339EndocrinePhysiologyAdrenal steroids and congenital adrenal hyperplasiasCheck the older version of first aid 2022 that I have attachedIn the flowchart given in page 339 it’s been wrongly mentioned that 17alpha hydroxylase enzyme is required for the coveraion of 17 hydroxypregnelone to DHEA and similarly mentioned wronged just below too. It should be 17,20 lyase.Major erratum
390689RespiratoryPhysiologyCyanide vs carbon monoxide poisoninghttps://www.uptodate.com/contents/cyanide-poisoningAt the last sentences, it says, “…. rather than nitrites or sodium thiosulfate, to avoid increasing methylglobin”. In fact, sodium thiosulfate doesn’t induce methemoglobinemia, only nitrites do. Usually hydroxocobalamin is preferred in cyanide poisoning; but if unavailable and no contraindications to nitrites/sodium thiosulfate, combination of nitrite+sodium thiosulfate is used. But if nitrite is contraindicated (e.g during smoke when carboxyhemoglobin levels pending) and hydroxocobalim is unavailable, then sodium thiosulfate is used. I think the misinformation in the FA arose from the fact that usually nitrites and sodium thiosulfate are used in combination. But only nitrites are contraindicated in smoke victims and not sodium thiosulfate as nitrites induces methemoglobinemia and sodium thiosulfate doesn’t. I have shared the link to UpToDate content and a screenshot.Major erratum
391689RespiratoryPhysiologyCyanide vs carbon monoxide poisoninghttps://www.uptodate.com/contents/cyanide-poisoningAt the last sentences, it says, “…. rather than nitrites or sodiumthiosulfate, to avoid increasing methylglobin”. In fact, sodium thiosulfatedoesn’t induce methemoglobinemia, only nitrites do. Usually hydroxocobalamin is preferred in cyanide poisoning; but if unavailable and no contraindications to nitrites/sodium thiosulfate, combination ofnitrite+sodium thiosulfate is used. But if nitrite is contraindicated (e.g in a smoke victim when carboxyhemoglobin levels pending) and hydroxocobalin is unavailable, then sodium thiosulfate is used. I think the misinformation in the FA arose from the fact that usually nitrites and sodium thiosulfate are used in combination. But only nitrites are contraindicated in smoke victims and not sodium thiosulfate as nitrites induces methemoglobinemia and sodium thiosulfate doesn’t. So the appropriate statement is, “IF CONCURRENT CO AND CYANIDE POISONING ARE SUSPECTED (E.G. IN VICTIMS OF FIRE), GIVE HYDROXOCOBALAMIN (OR SODIUM THIOSULFATE IF HYDROXOCOBALAMIN UNAVAILABLE), RATHER THAN NITRITES, TO AVOID INCREASING METHEMOGLOBINEMIA”. I have shared the link to UpToDate content and a screenshot.Major erratum
392339EndocrinePhysiologyAdrenal steroids and congenital adrenal hyperplasiasamboss, uworld↓aldosterone is given in 17 alpha OH deficiency however, the substrates are shunted towards aldosterone production thus ↑aldosteroneMajor erratum
39333BiochemistryMolecularNucleotidesnot neededThe statement: “Nucleoside = Base + (deoxy)ribose (sugar), Nucleotide = Base + (deoxy)ribose + phosphate” is not fully accurate and maybe confusing , because RNA is ribonucleic acid, and it contains ribose, not deoxyribose, It’s more comprehensive to write: Nucleoside = Base + Sugar (ribose or deoxyribose), Nucleotide = Base + Sugar (ribose or deoxyribose) + Phosphate, This form clearly includes both DNA and RNA nucleotides.Minor erratum
39444BiochemistryCellularTumor suppressor genesfirst aid page 341, UWorldThe statement in the tumor suppressors: “Growth factors (e.g., insulin, PDGF, EPO, EGF) bind tyrosine kinase receptors to transition the cell from G1 to S phase” is not entirely accurate, because EPO (erythropoietin) binds a non–tyrosine kinase receptor,EPO activates the JAK-STAT pathway through a non-receptor tyrosine kinase, not an intrinsic tyrosine kinase receptor like insulin or EGF, This is also mentioned in the Endocrine chapter, page 341, under the section “non–receptor tyrosine kinase”, This distinction is important, as NBME and Qbanks frequently test receptor types and signaling pathways.Minor erratum
39561BiochemistryGeneticsSex chromosome disordersUWorld, https://opened.cuny.edu/courseware/lesson/667/student/?section=3There is an error in the image illustrating nondisjunction in Meiosis I and Meiosis II, as it shows the extra chromosome the trisomy (n+1) in both cases as identical in the content, This is incorrect and may cause confusion in comprehension, In reality, the extra chromosome(n+1) in Meiosis I nondisjunction consists of two different homologs chromosomes (heterodisomy), while in Meiosis II nondisjunction, it consists of two identical sister chromatids (isodisomy), This distinction is important , This concept is frequently tested in question banks, especially UWorld, I found an image that clearly shows the difference between Meiosis I and II nondisjunction, particularly highlighting the distinct genetic content of the trisomic (n+1) gametes. https://opened.cuny.edu/courseware/lesson/667/student/?section=3Major erratum
39636BiochemistryPharmacologyTopoisomerase inhibitorsnot neededlook, -teCAN sounds like ONE so it's topoisomerase 1 inhibitor, whereas eTOposide sounds like two so its topoisomerase 2 inhibitorMnemonic
397257Public Health SciencesEpidemiology & BiostatisticsClinical therapeutic trialhttps://pmc.ncbi.nlm.nih.gov/articles/PMC10023071/0= micrOdOsing 1=FirST (Safety, Tolerable dose) 3= C= confirmatory,comparison 4= FOUR=pour= post marketingMnemonic
398257Public Health SciencesEpidemiology & BiostatisticsClinical therapeutic trialKD Tripathy pharmacologyanother name for different phases of clinical trial Phase 0: Microdosing study Phase I: Human pharmacology and safety Phase II: Therapeutic exploration and dose ranging Phase III: Therapeutic confirmation/comparison Phase IV: Postmarketing surveillance/ studiesClarification to current text
399257Public Health SciencesEpidemiology & BiostatisticsBradford Hill criterianot neededA B C₂ (D) E P S₂ T :: A → Analogy B → Biological gradient C₂ → Consistency + Coherence (two C’s) D → nothing E → Experimental evidence P → Plausibility S₂ → Strength + Specificity (two S’s) T → TemporalityMnemonic
400245PharmacologyAutonomic DrugsPhosphodiesterase inhibitorsnot neededPDE-4 : RoFLUmilast (RoFOURlumilast) PDE-3 Milrinone M looks like 3Mnemonic
401245PharmacologyAutonomic DrugsPhosphodiesterase inhibitorsGodman and gillman pharmacologyDuring pharmacologic stress testing, dipyridamole induces the coronary steal phenomenon, where vasodilation of healthy coronaries diverts blood from ischemic regions, worsening ischemia and causing chest pain with ST depression in CAD—also called the reverse Robin Hood phenomenon.High-yield addition to next year
402244PharmacologyAutonomic Drugsβ-blockersGodman and gillman pharmacologyDissecting Aortic aneurysm : action :beta blocker reduces both heart rate and force of contraction (dP/dt), which lowers shear stress on the aortic wall and slows propagation of the dissection. example : esmolol, labetalolHigh-yield addition to next year
403246PharmacologyToxicities and Side EffectsIngested seafood toxinshttps://pubmed.ncbi.nlm.nih.gov/39239017/Wild honey poisoning is caused by grayanotoxin, produced from nectar of Rhododendron species (especially in Himalayan regions), which binds voltage-gated sodium channels causing prolonged depolarization and increased vagal tone, leading to bradycardia, hypotension, nausea, and vomiting, and is treatment is supportive.High-yield addition to next year
404247PharmacologyToxicities and Side EffectsSpecific toxicity treatmentsKD Tripathy pharmacologyCO poisoning - antidote is 100% O2 via non re-breathing maskHigh-yield addition to next year
405247PharmacologyToxicities and Side EffectsSpecific toxicity treatmentsKD Tripathy pharmacologymethanol poisoning antidote is foMEpizoleMnemonic
406247PharmacologyToxicities and Side EffectsDrug reactions—cardiovascularKD Tripathy pharmacologyDilated cardiomyopathy is also seen in chronic cocaine users due to persistently increased catecholamine causing myocardial ischemia and necrosis causing DCMHigh-yield addition to next year
407248PharmacologyToxicities and Side EffectsDrug reactions—endocrine/reproductiveDavison textbook of medicineHypothyroidism is also caused by EthionamideHigh-yield addition to next year
408248PharmacologyToxicities and Side EffectsDrug reactions—endocrine/reproductiveKD Tripathy pharmacologyAmiloride is used for treatment of lithium induced diabetes insipidusHigh-yield addition to next year
409248PharmacologyToxicities and Side EffectsDrug reactions—gastrointestinalDavison textbook of medicineacute cholestatic jaundice also caused by chlorpropamide, pancreatitis causes by didanosine, stavudine. PPI cause SIBO( small intestinal bacterial overgrowth) by suppressing gastric acidHigh-yield addition to next year
410248PharmacologyToxicities and Side EffectsDrug reactions—musculoskeletal/skin/connective tissueKD Tripathy pharmacologymalignant hyperthermia is also caused by succinylcholineHigh-yield addition to next year
411248PharmacologyToxicities and Side EffectsDrug reactions—neurologicGodman and gillman pharmacologyperipheral neuropathy also caused by ciprofloxacin, Vitamin A causes Pseudotumor cerebri, seizures caused by SSRI overdose, lithium overdose, Ciprofloxacin when combined with NSAIDHigh-yield addition to next year
412248PharmacologyToxicities and Side EffectsDrug reactions—neurologichttps://bmjophth.bmj.com/content/7/1/e000943vigabatrin causes constriction of visual field, amiodarone causes corneal deposits and optic neuropathy, chlorpromazine causes corneal deposits causing white-grey opacities causing vortex keratopathy(cornea verticillata)High-yield addition to next year
413588PsychiatryPathologyPsychoactive drug intoxication and withdrawalhttps://www.uptodate.com/contents/benzodiazepine-withdrawal"Depression" is listed as a symptom under the "Withdrawal" column for benzodiazepines. This should be listed as anxiety or panic attacks. Chronic use of benzodiazepines is strongly associated with depression, including treatment-resistant depression. However, withdrawal from benzodiazepines is nearly always maked by anxious (not depressive) symptoms.Minor erratum
414430Hematology and OncologyPathologyHeme synthesis, porphyrias, and lead poisoninghttps://pubmed.ncbi.nlm.nih.gov/35806474/#&gid=article-figures&pid=figure-2-uid-1In Figure of heme synthesis pathway, After coproporphyrinogen III there should have been Protoporphyrinogen IX then it crosses mitochondria producing Protoporphyrinogen III then finally to protoporphyrin.Major erratum
415430Hematology and OncologyPathologyHeme synthesis, porphyrias, and lead poisoninghttps://pubmed.ncbi.nlm.nih.gov/35806474/#&gid=article-figures&pid=figure-2-uid-1Porphyria Cutanea TARda= uroporphyrinogen deCARboxylase @Tar sounds like CarMnemonic
416430Hematology and OncologyPathologyHeme synthesis, porphyrias, and lead poisoninghttps://pubmed.ncbi.nlm.nih.gov/35806474/#&gid=article-figures&pid=figure-2-uid-1Porphobilinogen deaminase is aka hydroxymethyl bilane synthaseClarification to current text
417430Hematology and OncologyPathologyHeme synthesis, porphyrias, and lead poisoninghttps://pubmed.ncbi.nlm.nih.gov/35806474/#&gid=article-figures&pid=figure-2-uid-1Porphobilinogen deaminase is aka hydroxymethyl bilane synthaseClarification to current text
418430Hematology and OncologyPathologyHeme synthesis, porphyrias, and lead poisoningGautam Biswas Forensic medicineA – Abdominal colic/Anemia/amenorrhea/abortion , B – Basophilic stippling/Burton’s line, C – Constipation/colic/Cognitive impairment, D – Drop wrist/foot, E – Encephalopathy, F – Foot drop, G – Gout( saturnine gout) , H – Hypertension, M – Motor neuropathy, N – neuropathy (periphery) /Nephropathy, O – Osteoblast lead lines, P – Plumbism/Psychological changes.Mnemonic
419430Hematology and OncologyPathologyHeme synthesis, porphyrias, and lead poisoninghttps://pubmed.ncbi.nlm.nih.gov/965496/#:~:text=Abstract,of%20the%20genetically%20determined%20disorder.Lead inhibits pyrimidine 5′-nucleotidase → RNA cannot be degraded → basophilic stippling in RBCs.Clarification to current text
420430Hematology and OncologyPathologyHeme synthesis, porphyrias, and lead poisoningLippincott biochemistrySubstrate buildup before porphobilinogen deaminase (as in AIP) doesn’t cause photosensitivity, but accumulation after it (porphyrins, as in PCT) does.High-yield addition to next year
421425Hematology and OncologyPathologyMicrocytic, hypochromic anemiasLippincott biochemistryRing sideroblasts result from iron accumulation in mitochondria, visible as perinuclear deposits around the nucleus of RBC precursors. vs Basophilic stippling → ribosomal RNA clumps (blue dots in mature RBCs).High-yield addition to next year
422697RespiratoryPathologyAcute respiratory distress syndromeDavidson textbook of medicineplease mention the name of diagnostic criteria as Berlin criteria FOR ARDSHigh-yield addition to next year
423375GastrointestinalAnatomyFemoral regionhttps://dictionary.cambridge.org/dictionary/english/sartorius“Satorius” correct spelling is “Sartorius” in the image.Spelling/formatting
424411Hematology and OncologyEmbryologyBlood groupshttps://www.uptodate.com/contents/red-blood-cell-antigens-and-antibodies?search=blood%20groups&sectionRank=2&usage_type=default&anchor=H3139524982&source=machineLearning&selectedTitle=1~150&display_rank=1#H3139524982The blood type table states that people with the Rhesus negative blood type have anti-D antibodies in their blood. However, this is not the norm, but merely an exception that occurs when these people come into contact with Rhesus positive blood and subsequently become immunized. Normally, therefore, people do NOT have anti-D antibodies in their blood.Major erratum
42568BiochemistryNutritionVitamin Dhttps://pmc.ncbi.nlm.nih.gov/articles/PMC9573796/ and https://pmc.ncbi.nlm.nih.gov/articles/PMC9092099/The text does not mention the role or immunological properties of Vitamin D, Specifically, there is no state that Vitamin D has immune-modulating functions, there is an association between low Vitamin D levels and multiple sclerosis as mention in the neurology chapter (page 537),This is a significant omission in this text , as Vitamin D plays a well-established role in both the innate and adaptive immune systems, Its effects include enhancing innate immunity through the activation of antimicrobial peptides like cathelicidin, and regulating adaptive immunity by suppressing pro-inflammatory T cells (Th1 and Th17) while promoting regulatory and anti-inflammatory T cells (Tregs and Th2), Given the clinical importance of these effects—particularly in autoimmune disease and infection—Vitamin D’s immune function should be clearly addressed.High-yield addition to next year
42657BiochemistryGeneticsModes of inheritancenot neededThe current diagrams illustrating X-linked dominant and X-linked recessive inheritance use a non-standard, color-based system to represent alleles, This approach leads to confusion — especially when distinguishing between heterozygous and homozygous genotypes, Additionally the diagrams use only capital letters, without incorporating a mix of capital and small letters to represent different alleles, This is inconsistent with the autosomal dominant and autosomal recessive diagrams, where capital and lowercase letters are used to clearly distinguish between homozygous and heterozygous genotypes. In the case of X-linked inheritance, the absence of this standard notation makes it difficult to accurately interpret the genetic information presented, Comparing females in X-linked recessive and X-linked dominant inheritance (both daughters and mothers) is difficult due to unclear differentiation in the diagrams,i think it more clearly to write them in this way : X-linked Recessive: Affected male: XᵈY, Carrier female: XᴰXᵈ, Affected female: XᵈXᵈ / X-linked Dominant: Affected male: XᴰY ,Heterozygous affected female: XᴰXᵈ, Homozygous affected female: XᴰXᴰ.Clarification to current text
427601RenalPhysiologyFiltrationhttps://scontent.famm6-1.fna.fbcdn.net/v/t39.30808-6/517065276_730322796429428_2036080678357907248_n.jpg?_nc_cat=106&ccb=1-7&_nc_sid=833d8c&_nc_ohc=XDvRo5EwUzcQ7kNvwEJG5hR&_nc_oc=AdmuvDqv4pHamUbxoX3Y0dHZCoTWfV1Hrn7CtJhOGZVPaUdPaK2zczQ8hqUY65F6N_SoU30fEC-TlQ_kG8jCyGCX&_nc_zt=23&_nc_ht=scontent.famm6-1.fna&_nc_gid=fsktF1P6Je-l1IrSvmH0AQ&oh=00_AfXddsTDt8Mq6cn_S4CXxfgnygW6ZJZUVVCbcrvVoxzdQg&oe=68BCD1B8FA said: "Prostaglandins Dilate Afferent arteriole (PDA). Angiotensin II Constricts Efferent arteriole (ACE). RPF is best estimated with PAH clearance. NSAIDs and ACE inhibitors should not be given together --> constriction of afferent and efferent arterioles." It should be better phrased as: "Prostaglandins dilate afferent arteriole (PDA). Ang II constricts efferent arteriole (ACE). NSAIDs → afferent constriction ↓GFR. ACE inhibitors → efferent dilation ↓GFR. NSAIDs + ACEi → afferent constriction + efferent dilation → marked ↓GFR → risk AKI"Minor erratum
428p.601RenalPhysiologyFiltrationhttps://www-uptodate-com.neomed.idm.oclc.org/contents/renin-angiotensin-system-inhibition-in-the-treatment-of-hypertension?search=ace%20inhibitors&topicRef=3816&source=see_link#H1The book says that NSAIDs/ACE inhibitors should not be given together because that would cause both constriction of efferent and afferent. However, ACE inhibitors work by inhibiting AT2 action (which typically causes efferent constriction), therefore the more accurate description would be that ACE inhibitors and NSAIDs should not be taken together because they cause constriction of afferent and dilation of efferent.Minor erratum
429426Hematology and OncologyPathologyMacrocytic anemiashttps://pubmed.ncbi.nlm.nih.gov/26900641/Metformin-induced vitamin B₁₂ deficiency is mentioned in the biochemistry section but not under “Causes of B₁₂ deficiency.” I suggest adding “Long-term metformin therapy” to this list, as it is clinically relevant and high-yield for USMLE Step 1.High-yield addition to next year
430339EndocrinePhysiologyAdrenal steroids and congenital adrenal hyperplasiashttps://www.sciencedirect.com/science/article/pii/S2376060520302467The aldosterone level increases in 17a-hdroxylase deficiency unlike what the table chart states that it decreases.Major erratum
431165MicrobiologyVirologyRotavirushttps://www.ncbi.nlm.nih.gov/books/NBK558951/#:~:text=Etiology,those%20of%20high%2Dincome%20countries.Rotavirus has a wheel-like appearance on electron microscopy: Rotate a wheel. Rota in Rotate is already in red text colour, which makes this addition even more convenientMnemonic
432NAGastrointestinalPharmacologyBileN.A.I’d like to suggest adding a brief pharmacology entry for ursodiol (ursodeoxycholic acid) in the GI pharmacology section. Currently, it is mentioned only as a treatment for primary biliary cholangitis. However, students often confuse it with bile acid sequestrants, since both deal with bile salts but have opposite mechanisms. A concise entry could help clarify: Mechanism: Increases bile secretion, decreases cholesterol secretion and reabsorption. Uses: Gallstone dissolution, primary biliary cholangitis. Note: Do not confuse with bile acid sequestrants (which bind bile acids in the gut). This addition would be high yield, since ursodiol appears on NBME practice exams and its distinction from bile acid resins is clinically and test-relevant.High-yield addition to next year
433601RenalPhysiologyFiltrationThe increased AKI risk: https://www.sciencedirect.com/science/article/pii/S2157171615321638 , The increased risk in hyperkalemia: https://www.uptodate.com/contents/nsaids-therapeutic-use-and-variability-of-response-in-adultsThe current text states: “NSAIDs and ACE inhibitors should not be given together → constriction of afferent and efferent arterioles.” This description is physiologically inaccurate for the efferent arteriole and may be confusing for learners. NSAIDs act by inhibiting prostaglandin synthesis, which results in constriction of the afferent arteriole, while ACE inhibitors decrease angiotensin II, leading instead to dilation of the efferent arteriole. The combined effect(afferent constriction together with efferent dilation) lowers intraglomerular pressure and reduces GFR, thereby increasing the risk of acute kidney injury. Furthermore, the use of NSAIDs alongside ACE inhibitors potentiates the risk of hyperkalemia.Minor erratum
434575PsychiatryPathologyNEW FACTN.A.I would like to report a possible correction in the section on Korsakoff syndrome. The current text states: “…especially mammillary bodies and anterior thalamus.” However, the lesion classically involves the dorsomedial nucleus of the thalamus, along with the mammillary bodies. The anterior nucleus is not typically implicated in Korsakoff syndrome. Proposed correction: “…especially mammillary bodies and dorsomedial thalamus.”Major erratum
435574PsychiatryPathologyNEW FACThttps://www.uptodate.com/contents/intellectual-disability-id-in-children-evaluation-for-a-cause?search=intellectual%20disability&topicRef=6172&source=see_link#H167152337Under Intellectual Disability, it is important to note that the most common genetic cause is Down syndrome, while the most common inherited cause is Fragile X syndrome. This distinction is frequently tested, particularly in questions asking about the most common genetic etiologyHigh-yield addition to next year
436422Hematology and OncologyPathologyNonhemolytic, normocytic anemiashttps://doi.org/10.3389/fimmu.2023.1286632;https://accessmedicine.mhmedical.com/content.aspx?bookid=3541&sectionid=293335228Acute Blood Loss (hemorrhage) is listed in non-hemolytic box which contains a "(low reticular index)" indication. Blood loss should probably have some kind of clarification associated with it because it is typically associated with compensatory high reticulocyte index. Some sources vary, notably up to date, but majority of sources support this and in clinical practice a known large bleed wont use test reticular index, and for chronic bleeds like GI ulcer reticular index will usually be elevated until iron depleted over a long time.Minor erratum
437237PharmacologyAutonomic DrugsG-protein–linked second messengersNAkiss kick sick six= q i s / q i q / s i q / s q s= alpha1,2 beta1,2,3 d1,2 h1,2 v1,2Mnemonic
438149MicrobiologyMycologySystemic mycosesno needfor Coccidioidomycosis " Cocci crowds with spherules in California " as coccidiomycosis is crowded with spherules, found in CaliforniaMnemonic
439309CardiovascularPathologyEvolution of myocardial infarctionUWorldUWorld states that the first four hours after an MI appear as 'normal myocardium' with minimal change, and wavy fibers are observed after that time.Clarification to current text
440325CardiovascularPharmacologyLipid-lowering agentshttps://www.mdpi.com/2073-4409/11/19/2972?utm_source=chatgpt.comyou mentioned that evolocumab is a PCSK9 inhibitors but according to new guidelines it's now called PCSK9 monoclonal antibody while the PCSK9 inhibitor is now inclisiran ( through RNA interference ) it's important to point out this differenceMajor erratum
44134BiochemistryMolecularDe novo pyrimidine and purine synthesisUWorld , FIRST AID STEP1 2025 page 35(salvage pathway)6-mercaptopurine mimics guanine and hypoxanthine inhibiting HGPRT that inhibits salvage pathway synthesis not de novo purine synthesis as mentionedMinor erratum
442104ImmunologyImmune ResponsesComplement1) https://pmc.ncbi.nlm.nih.gov/articles/PMC358203/?page=24 2)https://www.jacionline.org/article/S0091-6749(04)00975-3/fulltextTheoritically MAC defends against gram -ve bacteria because of the presence of outer membrane, however clinically only few gram -ves are almost solely dependendant on MAC degradation among those is Neisseria meningitidis (MC), thats why it is the most commonly found in MAC defeciencies, the reason behind this is due to the structural formation of different bacterias;(1) Neisseria has an outer membrane composition (lipooligosaccharide instead of long-chain LPS) that allows easier C5b-9 insertion. (2) Many Gram-negative pathogens (e.g., E. coli, Klebsiella, Pseudomonas) are efficiently opsonized by C3b and IgG, enabling neutrophil phagocytosis. Neisseria meningitidis has a polysaccharide capsule and surface proteins that hinder opsonophagocytosis, so MAC-mediated lysis is essential for rapid clearanceClarification to current text
443601RenalPhysiologyAngiotensin-converting enzyme inhibitorshttps://www.uptodate.com/contents/major-side-effects-of-angiotensin-converting-enzyme-inhibitors-and-angiotensin-ii-receptor-blockers?search=ace%20inhibitors%20dilates%20efferent%20arteriole&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1In the text it says "Angiotensin II Constricts Efferent arteriole (ACE)... NSAIDs and ACE inhibitors should not be given together -> constriction of afferent and efferent arterioles." However, ACE inhibitors do not cause constriction of the efferent arteriole, they cause dilation of the efferent arteriole. Thus, the combination of NSAIDS and ACE inhibitors causes afferent arteriole constriction and efferent arteriole dilation.Clarification to current text
444543Neurology and Special SensesPathologyHerniation syndromeshttps://pubmed.ncbi.nlm.nih.gov/32282365/ ; Amboss etc.In the Uncal transtentorial herniation section, the description of Kernohan phenomenon is confusing. The text currently suggests that Kernohan phenomenon may involve a “contralateral blown pupil.” While UpToDate does list contralateral pupillary dilation in some cases, most authoritative resources (peer-reviewed literature, Amboss, UWorld, neurology texts) describe Kernohan phenomenon as a false localizing sign producing ipsilateral hemiparesis due to contralateral cerebral peduncle compression, with the pupil dilation classically remaining ipsilateral to the herniation from CN III compression. For Step exam purposes, it would be less confusing if the entry emphasized that the false localizing feature is the motor deficit, not the pupillary finding. Thank you!Clarification to current text
445339EndocrinePhysiologyAdrenal steroids and congenital adrenal hyperplasiasPathoma book page 171, it says: D. 17-hydroxylase deficiency leads to decreased cortisol and androgens. 1. Weak mineralocorticoids (DOC) are increased leading to HTN with mild hypokalemia; renin and aldosterone are low. 2. Decreased androgens lead to primary amenorrhea and lack of pubic hair (females) or ambiguous genitalia with undescended testes (males).I noticed that in the section on 17α-hydroxylase deficiency, it mentions “increased mineralocorticoids”. In the section on 11β-hydroxylase deficiency, it clearly explains that DOC is increased but aldosterone is decreased due to suppression of renin by DOC’s mineralocorticoid effect. I suggest clarifying that in 17α-hydroxylase deficiency, although DOC and corticosterone accumulate causing mineralocorticoid effects, aldosterone itself is actually decreased because of renin suppressionClarification to current text
446339EndocrinePhysiologyAdrenal steroids and congenital adrenal hyperplasiasPathoma book page 171: it says: D. 17-hydroxylase deficiency leads to decreased cortisol and androgens. 1. Weak mineralocorticoids (DOC) are increased leading to HTN with mild hypokalemia; renin and aldosterone are low. 2. Decreased androgens lead to primary amenorrhea and lack of pubic hair (females) or ambiguous genitalia with undescended testes (males). AccessMedicine: https://accessmedicine.mhmedical.com/updatesContent.aspx?gbosid=569716I noticed that in the section on 17a-hydroxylase deficiency, it mentions "increased mineralocorticoids". In the section on 11ß-hydroxylase deficiency, it clearly explains that DOC is increased but aldosterone is decreased due to suppression of renin by DOC's mineralocorticoid effect. I suggest clarifying that in 17a-hydroxylase deficiency, although DOC and corticosterone accumulate causing mineralocorticoid effects, aldosterone itself is actually decreased because of renin suppressionClarification to current text
44796ImmunologyLymphoid StructuresThymushttps://pmc.ncbi.nlm.nih.gov/articles/PMC9381902/ and https://pubmed.ncbi.nlm.nih.gov/37659170/ and https://pubmed.ncbi.nlm.nih.gov/35822239/The thymus decreases in both size and function with age, a key point often tested in UWorld and NBME Step 1/2. This process, called thymic involution, leads to decrase naïve T cell production and contributes to the age-related decline in immune function. It’s important to mention that the size decrease , since that detail is commonly asked.High-yield addition to next year
448101ImmunologyCellularT- and B-cell activationfirst aid book page 101, and https://pubmed.ncbi.nlm.nih.gov/19388527/ and https://pubmed.ncbi.nlm.nih.gov/23246038/In the first line, antigen-presenting cells (APCs) are listed as B cells, dendritic cells, Langerhans cells, and macrophages, which can be confusing when identifying the most dominant APC, Dendritic cells are the primary and most important APCs, so they should be mentioned first and clearly highlighted as (most important), Additionally, on the same page in the T cell activation section (step 3), it states that Signal 2 involves the interaction between B7 on dendritic cells and CD28 on naïve T cells—not B cells, This distinction should be clarified to avoid misunderstanding, also Langerhans cells are mentioned separately, which can be confusing, In fact, they are a specialized type of dendritic cell found in the skin and not another type of cells ,Highlighting this helps clarify that Langerhans cells share the same antigen-presenting functions as other dendritic cells.Clarification to current text
449109ImmunologyImmune ResponsesVaccinationfirst aid book page 103, first aid book page 125, and https://pubmed.ncbi.nlm.nih.gov/35921476/in the discussion of subunit, recombinant, polysaccharide, and conjugate vaccines examples, the text inaccurately states that “PCV13, PCV15, and PCV20 polysaccharide produce a T-cell-dependent response.” This is misleading, as polysaccharide antigens alone cannot be presented to T cells and therefore do not elicit a T-cell-dependent immune response, Instead, it is the conjugation of the polysaccharide to a protein carrier that enables the antigen to be recognized and processed in a T-cell-dependent manner, This concept is supported by the Immunology chapter (page 103) in thymus- dependent antigen , which explains that thymus-dependent antigens must contain a protein component in order to activate T cells, Further evidence is found in the Microbiology chapter (page 125) in the encpsulted bacteria," A polysaccharide antigen alone cannot be peresented to T cells, immunogenicity can be enhanced by conjugating capsule antigen to a carrier protein", Therefore, the statement would be more accurate if rephrased as: “A polysaccharide conjugated to a carrier protein produces a T-cell-dependent response.”Major erratum
450562Neurology and Special SensesPharmacologyBenzodiazepinesusmle Rx q bank, and https://www.ncbi.nlm.nih.gov/books/NBK544349The text states that alprazolam, triazolam, oxazepam, and midazolam are short-acting benzodiazepines with a higher addictive potential, However, this is true for all except oxazepam, which actually has a lower addictive potential and is not considered highly addictive, Notably, oxazepam is not included in the list of highly addictive short-acting benzodiazepines in the USMLE-Rx question bank, unlike alprazolam and midazolam, its included in the low potency short acting list, For greater accuracy, it would be better to specify oxazepam as having a low addictive potential when discussing short-acting benzodiazepines, This distinction is important because the concepts of addiction potential and half-life (short vs. long) are frequently tested in various question banks.Minor erratum
451368GastrointestinalAnatomyImportant gastrointestinal ligamentshttps://pmc.ncbi.nlm.nih.gov/articles/PMC8084047 and https://pubmed.ncbi.nlm.nih.gov/26330237/ and https://pubmed.ncbi.nlm.nih.gov/37889837/in the splenorenal ligament, the tail of the pancreas is rich in islets of Langerhans, which contain insulin-producing β-cells, During distal pancreatectomy or surgical procedures involving the splenorenal ligament, the tail may be resected or injured, This can significantly reduce endocrine function and increase the risk of developing new-onset diabetes,These two points are clinically significant and can be added to the text.High-yield addition to next year
452225PathologyAgingNormal aginghttps://pmc.ncbi.nlm.nih.gov/articles/PMC9381902/ and https://pubmed.ncbi.nlm.nih.gov/37659170/ and https://pubmed.ncbi.nlm.nih.gov/35822239/in the immune context, The thymus decreases in both size and function with age, a key point often tested in UWorld and NBME Step 1/2, This process, called thymic involution, leads to decrase naïve T cell production and contributes to the age-related decline in immune function. It’s important to mention that the size decrease , since that detail is commonly askedHigh-yield addition to next year
453207PathologyCellularIonizing radiation toxicityhttps://pmc.ncbi.nlm.nih.gov/articles/PMC4906114/Here is addition to this topic which was previously asked about in the exam: Radiation dermatitis is skin damage from ionizing radiation. Acute (<3 months) shows erythema, peeling, pain, and itching. Chronic (>3 months) includes atrophy, pigmentation changes, telangiectasia, and fibrosis driven by high TGF-β, with histology showing dense collagen deposition, fibroblast proliferation, and loss of adnexal structures.High-yield addition to next year
454366GastrointestinalEmbryologyNEW FACThttps://pmc.ncbi.nlm.nih.gov/articles/PMC3841386/I am writing to respectfully suggest a revision in the section on Hypertrophic Pyloric Stenosis (Page 366). The current edition describes the biochemical abnormality as “hypokalemic hypochloremic metabolic acidosis.” However, this is incomplete. The typical disturbance is actually hypokalemic, hypochloremic metabolic alkalosis, and in prolonged or severe cases, paradoxical aciduria may develop due to renal adaptation. This finding is well documented in standard pediatric surgery texts and supported by multiple journal articles. For accuracy and completeness, it may be beneficial to amend the section to read: “Results in hypokalemic, hypochloraemic, metabolic alkalosis. In late or severe cases, paradoxical aciduria may also occur.”High-yield addition to next year
455302CardiovascularPathologyCongenital heart diseaseshttps://www.utmb.edu/pedi_ed/CoreV2/CardiologyPart1/CardiologyPart13.htmlFor persistent truncus arteriosis, it is the failure of neural crest cells to migrate that causes failure of the ap septum formationMinor erratum
456395GastrointestinalPathologyLynch syndromehttps://pmc.ncbi.nlm.nih.gov/articles/PMC3423888/Lynch Syndrome (Page 395). The current text mentions that Lynch Syndrome is associated with endometrial, ovarian, and skin cancers, and provides the mnemonic: “Merrill Lynch has CEOS.” However, based on epidemiological data, stomach cancer is a more relevant and frequent association with Lynch Syndrome than skin cancer. Including stomach cancer in place of skin cancer would be both clinically accurate and better aligned with the mnemonic, as: • C = Colon • E = Endometrial • O = Ovarian • S = StomachHigh-yield addition to next year
457366GastrointestinalEmbryologyHypertrophic pyloric stenosishttps://pmc.ncbi.nlm.nih.gov/articles/PMC3841386/Hypertrophic Pyloric Stenosis (Page 366). The current edition describes the biochemical abnormality as “hypokalemic hypochloremic metabolic alkalosis.” However, this is incomplete. The typical disturbance is actually hypokalemic, hypochloremic metabolic alkalosis, and in prolonged or severe cases, paradoxical aciduria may develop due to renal adaptation. This finding is well documented in standard pediatric surgery texts and supported by multiple journal articles.High-yield addition to next year
458246PharmacologyToxicities and Side EffectsNEW FACTNot needed, all present in past papers or in the book in other chaptersAttached is table of different pharmacokinetics changes in different conditions (age was the only condition discussed even though the past papers included questions asking about the effect of multiple conditions)High-yield addition to next year
459538Neurology and Special SensesPathologyNEW FACT[UptoDate](https://www.uptodate.com/contents/neuromuscular-weakness-related-to-critical-illness?search=critical%20illness%20polyneuropathy&source=search_result&selectedTitle=1~10&usage_type=default&display_rank=1#H2034067156) [StatPearls](https://www.ncbi.nlm.nih.gov/books/NBK562270/)Criticall illness polyneuropathy is more prominent distally not proximally! it is the other way around. CIM on the other hand is more prominent proximally although they commonly overlap. Distal prominence is more consistent with the pathophysiology of the disease. StatPearls states this very clearly and so does every publication i have found on CIP. UpToDate does imply it in the pathophysiology section.Major erratum
460538Neurology and Special SensesPathologyOther demyelinating and dysmyelinating disordersThe Sick and the Weak: Neuropathies/Myopathies in the Critically Ill https://pubmed.ncbi.nlm.nih.gov/26133937/. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis https://www.sciencedirect.com/science/article/abs/pii/S1474442211701788 Or https://doi.org/10.1016/S1474-4422(11)70178-8 ICU-acquired weakness: Critical illness myopathy and polyneuropathy https://www.sciencedirect.com/science/article/abs/pii/S0883944125000619 Or https://doi.org/10.1016/j.jcrc.2025.155074Critical illness polyneuropathy presents mainly with distal weakness more than proximal weakness (unlike critical illness myopathy)High-yield addition to next year
461538Neurology and Special SensesPathologyOther demyelinating and dysmyelinating disordersThe Sick and the Weak: Neuropathies/Myopathies in the Critically Ill https://pubmed.ncbi.nlm.nih.gov/26133937/ Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis https://www.sciencedirect.com/science/article/abs/pii/S1474442211701788 / https://doi.org/10.1016/S1474-4422(11)70178-8 ICU-acquired weakness: Critical illness myopathy and polyneuropathy https://www.sciencedirect.com/science/article/abs/pii/S0883944125000619 / https://doi.org/10.1016/j.jcrc.2025.155074Critical illness polyneuropathy presents mainly with distal weakness more than proximal weakness (unlike critical illness myopathy)Minor erratum
462570PsychiatryPsychologyOperant conditioningNo needOperant conditioning is increasing or decreasing the likelihood of a particular behavior based on its consequences, its not eliciting an action because it produces a (punishment?)! a punishment applied means less likelihood of that specific behavior to happen next time, that is the opposite of eliciting the behavior. You can just replace “elicited” with “modified”Minor erratum
463687RespiratoryPhysiologyHemoglobinNot neededO₂ → Heme Fe²⁺ (transports oxygen, cooperative binding) CO₂ → N-terminal amino groups of globin (forms carbaminohemoglobin, Haldane effect) H⁺ → Histidine/basic residues of globin (Bohr effect, buffers pH) 2,3-BPG → Central cavity between β chains (stabilizes T state, promotes O₂ release)Clarification to current text
464413Hematology and OncologyAnatomyThrombocytes (platelets)Mnemonic, No reference it's created by myselfFibrinogen receptor: GpIIb/IIIa, New mnemonic is (Fibrinogen needs ‘to be IIIa’), I always get confused between 2b3a and 3b2a, unfortunately, I made a mistake in my university exam then I created this mnemonic to make it easy to remember, I highly recommend adding this nice addition to the First Aid 2026Mnemonic
465690RespiratoryPathologyEpistaxishttps://radiopaedia.org/articles/kiesselbach-plexusposterior Ethmoidal arteries are not part of Kiesselbach plexusMinor erratum
466690RespiratoryPathologyRhinosinusitishttps://my.clevelandclinic.org/health/body/sphenoid-sinussphenoid sinuses drains into the sphenoethmoidal recess.Clarification to current text
467571PsychiatryPsychologyEgo defenseshttps://www.uptodate.com/contents/psychological-factors-affecting-other-medical-conditions-clinical-features-assessment-and-diagnosisIn the example describing a college student who continues to suck her thumb when studying for stressful exams, you labeled the defense mechanism as fixation. However, because the description doesn’t specify whether this behavior has persisted since childhood or reappeared under stress, it’s difficult to determine whether it truly represents fixation or regression. Regression is: A partial or total return to earlier patterns of adaptation or behavior (Uptodate) To illustrate fixation more clearly, you might consider revising the example to something like: “A college student who has continued to suck her thumb since childhood, finding it comfortable to suck her thumb when studying for stressful exams”Clarification to current text
468584PsychiatryPathologyEating disordershttps://www.uptodate.com/contents/functional-hypothalamic-amenorrhea-pathophysiology-and-clinical-manifestationsin addition to low leptin, other hormonal factors such as elevated cortisol (hypercortisolism) and increased ghrelin levels also contribute to the suppression of the hypothalamic–pituitary–gonadal axis and the development of functional hypothalamic amenorrhea. Conditions of low energy availability (either from decreased caloric intake and/or excessive exercise) are associated with relative hypercortisolemia and higher 24-hour urinary free cortisol levels, These relatively high levels of cortisol can adversely impact GnRH secretion. Furthermore, Ghrelin administration in both animals and humans impairs FSH and LH secretion, suggesting that these high ghrelin levels may also have a part in all this pathway causing amenorrheaHigh-yield addition to next year
469204PathologyPathologyNEW FACT(https://pmc.ncbi.nlm.nih.gov/articles/PMC2316949/) (https://pubmed.ncbi.nlm.nih.gov/16676004/)BAX and BAK form pores in the OUTER mitochondrial membrane resulting in release of cytochrome C from INTER mitochondrial membrane space into the cytoplasm thus activating caspases.Major erratum
470703RespiratoryPathologyLung cancerNAattached is the topic reformulated into a comparison table for better understanding and easier memorizationSpelling/formatting
471705RespiratoryPharmacologyH1-blockersnot needed as this information is already in the psychiatry chapter (antipsychotics)clinical uses of h1 blockers: add to them extrapyramidal symptoms (acute dystonia)Clarification to current text
472123MicrobiologyBasic BacteriologyStainsTortora, G.J., Funke, B.R., Case, C.L. (2023). Microbiology: An Introduction, 14th Edition. Pearson. Section on “The Gram Stain” details how the alcohol dissolves the outer membrane of Gram-negative cells, allowing crystal violet to wash out and safranin to be absorbed."...bacteria with thin peptidoglycan layer turn red or pink (gram -) with counterstain." This is misleading, bacuase staining with the counterstain is not due to the peptidoglycan layer being thin, but due to the presence of the outer membrane, which binds crystal violet in G- and is washed away by alcohol, allowing safranin to bind to the peptidoglycan.Major erratum
473692RespiratoryPathologyNEW FACThttps://www.ncbi.nlm.nih.gov/books/NBK430762/attached is a table about bronchoalveolar lavage findings ddx which has been asked about in many mcqs in past papersHigh-yield addition to next year
474331EndocrineAnatomyAdrenal cortex and medullaNo reference required."Adrenal cortex is derived from mesoderm; adrenal medulla is derived from neural crest." No need for parenthesis.Spelling/formatting
475233PharmacologyPharmacokinetics & PharmacodynamicsReceptor bindingGoodman & Gilman’s The Pharmacological Basis of Therapeutics, 14th Edition (2022) — Chapter 3: Pharmacodynamics: Molecular Mechanisms of Drug Action. “Inverse agonists possess negative intrinsic efficacy and decrease receptor activity below the basal level observed in the absence of ligand.”Inverse agonists reduce efficacy to below 0, i.e. the baseline constitutive activity (negative efficacy). "Independent" change in efficacy does not make sense and is confusing. Thus, replace the word "Independent" with "Negative".Clarification to current text
476197MicrobiologyAntimicrobialsHIV therapyhttps://www.uptodate.com/contents/when-to-initiate-antiretroviral-therapy-in-persons-with-hivAll individuals with HIV infection, regardless of CD4 count, should begin antiretroviral therapy (ART) as soon as possible. The text mentions "Strongest indication for use with patients presenting with AIDS-defining illness, low CD4+ cell counts (< 500 cells/mm3), or high viral load". However, Early treatment is particularly critical in patients with a low CD4 count (< 350 cells/mm3), high viral load, or an AIDS-defining illness. The ABSOLUTE INDICATION OF INITIATION OF ART IS HIV POSITIVE STATUS, regardless of viral load and CD4 status.Major erratum
477198MicrobiologyAntimicrobialsHIV therapyhttps://www.uptodate.com/contents/kidney-stones-in-adults-diagnosis-and-acute-management-of-suspected-nephrolithiasisAdd side effects of protease inhibitors : Nephrolithiasis, crystal-induced nephropathy, and hematuriaClarification to current text
478304CardiovascularPathologyHypertensionhttps://www.uptodate.com/contents/management-of-severe-asymptomatic-hypertension-hypertensive-urgencies-in-adultsSevere hypertension in adults (often defined as systolic blood pressure ≥180 mmHg and/or diastolic blood pressure ≥120 mmHg. Mention Systolic ≥ 180mmHg and/or Diastolic ≥120 mmHg.Clarification to current text
479328CardiovascularPharmacologyOther antiarrhythmicshttps://www.uptodate.com/contents/etiology-of-atrioventricular-blockIn the section of adenosine, include adenosine is contraindicated in a) preexcitation syndromes *Antidromic AVRT, WPW b) AV Block c) Reactive airway disease.High-yield addition to next year
480467Musculoskeletal, Skin, and Connective TissuePathologyOsteoporosishttps://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screeningIn the section of screening for osteoporosis also include: Postmenopausal women < 65 years of age with ≥ 1 risk factor for osteoporosisClarification to current text
481276Public Health SciencesHealthcare DeliveryMedicare and Medicaidhttps://web.archive.org/web/20240530230039/https://www.cms.gov/medicare/enrollment-renewal/health-plans/original-part-a-bIn the section of medicare eligibility, add Amyotrophic lateral sclerosis in addition to End-stage renal failure on dialysis or with a kidney transplant and Permanent disabilities.Clarification to current text
482324CardiovascularPharmacologySacubitrilhttps://www.uptodate.com/contents/overview-of-the-management-of-heart-failure-with-reduced-ejection-fraction-in-adultsThe current description of Sacubitril’s mechanism is somewhat misleading. It states that neprilysin inhibition prevents the degradation of bradykinin, natriuretic peptides, angiotensin II, and substance P, leading to vasodilation and reduced ECF volume. However, inhibition of neprilysin actually increases angiotensin II levels, because neprilysin normally breaks down angiotensin II. Therefore, Sacubitril alone would raise angiotensin II activity, which could counteract its beneficial effects. This is why Sacubitril is always combined with Valsartan (an ARB); to block angiotensin II receptor activation and prevent vasoconstriction and sodium retention.Major erratum
483174MicrobiologySystemsNEW FACThttps://www.uptodate.com/contents/sepsis-syndromes-in-adults-epidemiology-definitions-clinical-presentation-diagnosis-and-prognosisAdd an introductory lines to sepsis, Sepsis: a severe, life-threatening condition that results from a dysregulation of the patient's response to an infection, causing tissue and organ damage and subsequent organ dysfunction. Septic shock: a sepsis syndrome accompanied by circulatory and metabolic abnormalities that leads to persistent hypotension requiring vasopressors to maintain mean arterial pressure (MAP) ≥ 65 mm Hg and Persistent lactic acidosis with lactate > 2 mmol/L (18 mg/dL) despite adequate fluid resuscitation. * Bacteremia: the presence of viable bacteria in the bloodstream, with or without clinical signs of infection. * Systemic inflammatory response syndrome (SIRS) is a group of physiological and immune-mediated reactions that are triggered in response to an infectious or noninfectious insult. Diagnosis requires ≥ 2 of the following 4 criteria a) Temperature: > 38°C or < 36° b) Heart rate > 90/min c) Respiratory rate: > 20/min or PaCO2 < 32 mm Hg d) White blood cell count: > 12,000/mm3, < 4000/mm3, and/or > 10% band cells. Sepsis: ≥ 2 SIRS criteria PLUS a suspected or confirmed underlying infection. Severe sepsis: sepsis PLUS dysfunction of at least one organ or system.High-yield addition to next year
484170MicrobiologyVirologyHepatitis viruseshttps://www.sciencedirect.com/science/article/abs/pii/B9781437708813000036Remove the eponyms Councilman bodies from liver biopsy findings in Hep A with “ACIDOPHIL BODIES”. Robbins pathology 11th edition 2026 says: Apoptotic hepatocytes were first clearly described in yellow fever by William Thomas Coun- cilman and therefore have been referred to as Councilman bodies; while apoptosis occurs in many forms of liver disease, by convention this eponym is restricted to that disease. In other settings in which apoptotic hepatocytes are seen (e.g., acute and chronic hepatitis), the term acidophil bodies is used.”Minor erratum
485263Public Health SciencesEpidemiology & BiostatisticsConfounding vs effect modificationlogically i think , did not find up to date linkHi, I hope everyone is doing well. In the figure explaining confounding and effect modification, the illustration appears to blur the distinction between the two concepts. Specifically, after stratification in the confounding example, the association should disappear. Therefore, the figure should depict no association/weak association (the arrows should dotted) rather than indicating a continued strong association in subgroup of smokers and cofee drinker.Correct me if i am wrong. ThanksClarification to current text
486577PsychiatryPathologySchizophrenia spectrum disordersDSM-5the diagnostic criteria for schizophreniform and brief psychotic disorder, the text did not mention that At least one of the symptoms must be (1), (2), or (3): 1. Delusions. 2. Hallucinations. 3. Disorganized speechMajor erratum
487689RespiratoryPhysiologyCyanide vs carbon monoxide poisoninghttps://www.uptodate.com/contents/carbon-monoxide-poisoning?utm_source=chatgpt.com, https://pubmed.ncbi.nlm.nih.gov/12969439/,At the top of the page, it states that cyanide (CN) and carbon monoxide (CO) poisoning both inhibit aerobic metabolism by blocking complex IV of the electron transport chain (ETC), specifically cytochrome c oxidase. This leads to hypoxia that does not fully resolve with supplemental oxygen and results in increased anaerobic metabolism. However, this statement is not entirely accurate because the primary mechanism of hypoxia in CO poisoning is via decreased oxygen unloading in tissues and tissue hypoxia, which responds well to treatment with 100% oxygen as well as hyperbaric oxygen therapy. CO binds competitively to hemoglobin with more than 200 times greater affinity than O2, forming carboxyhemoglobin, which significantly reduces the oxygen saturation of hemoglobin. This is supported by the left shift observed in the oxygen dissociation curve (ODC), indicating increased oxygen affinity. In summary: The primary source for CO poisoning, UpToDate, focuses on hemoglobin binding as the main mechanism but also acknowledges mitochondrial and cytochrome interactions. https://www.uptodate.com/contents/carbon-monoxide-poisoning?utm_source=chatgpt.com The peer-reviewed article by Alonso et al. confirms that CO can inhibit Complex IV, although this is viewed as a secondary effect. https://pubmed.ncbi.nlm.nih.gov/12969439/ For CN poisoning, the main mechanism of toxicity is inhibition of Complex IV of the ETC. Cyanide’s direct inhibition of Complex IV is well supported by sources like eMedicine/Medscape. https://pubmed.ncbi.nlm.nih.gov/12969439/Major erratum
488256Public Health SciencesEpidemiology & BiostatisticsObservational studiesnot required"Second-to-last letter tells what you measure!" Case-Contr"O"l → "O"dds Ratio; Coho"R"t → "R"elative RiskMnemonic
489256Public Health SciencesEpidemiology & BiostatisticsObservational studiesnot requiredIn the heading of observational study add "Observational studies except case-series/case-report establish the degree of association between exposure and outcome, but they cannot establish causality." remove the statement :"Can show risk factor association with disease, but does not establish causality." from cross-sectional study because the statement is valid not just for cross sectional but all observational studies except case-report and case control study.Clarification to current text
490404GastrointestinalPathologyPancreatitishttps://journals.lww.com/ctg/fulltext/2023/08000/drug_induced_acute_pancreatitis__an_evidence_based.8.aspxIn the section of acute pancreatitis, include "Glucocorticoids, Valproate and Azathioprine" to the etiology under "Drugs"Clarification to current text
491366GastrointestinalEmbryologyHypertrophic pyloric stenosishttps://www.uptodate.com/contents/infantile-hypertrophic-pyloric-stenosis#H2290075917In the etiology of IHPSS, also include "Environmental factors (Exposure to nicotine during pregnancy, Bottle feeding)"Clarification to current text
492347EndocrinePathologyThyroid cancerno needFor follicular thyroid cancer mnemonic ==> "FOLLows the blood" as in metastasizes hematogenouslyMnemonic
493338EndocrinePhysiologyInsulinNo additionalIn my opinion the numbering of the diagram is confusing and makes it seem like the insulin dependent glucose-uptake (labeled #1-2) occurs prior to the release of the insulin by the beta cells (labeled #3-8 on the diagram). Reordering the sections so that the Regulation section is before the Function section to have the diagram be numbered in logical order of what actually occurs would be helpful and improve clarity, in my opinion!Clarification to current text
494610RenalPhysiologyAcid-base physiologyhttps://emcrit.org/ibcc/agma/Attached is a table comparing serum and urine changes in HAGMA vs NAGMA which is of high yield and frequently asked aboutHigh-yield addition to next year
495610RenalPhysiologyAcidosis and alkalosisNot requiredIn the section of metabolic alkalosis with low urinary chloride, mention remote use of diuretics instead of recent use.Clarification to current text
496459Musculoskeletal, Skin, and Connective TissueAnatomy and PhysiologyMotor neuron action potential to muscle contractionGuyton and Hall Textbook of Medical Physiology, 15 edition, page 80-83In the diagram showing the organization of proteins in the sarcomere, myosin should be tethered to the Z-disc by titin, but it is completely missing in the diagram.Major erratum
497370GastrointestinalAnatomySuperior mesenteric artery syndromeno needadd mnemonic: "Skinny SMA squeezes 3rd D-part" where skinny=loss of fat; 3rd D-part = 3rd part of duodenumMnemonic
498263Public Health SciencesEpidemiology & BiostatisticsConfounding vs effect modificationhttps://pubmed.ncbi.nlm.nih.gov/20335814/, https://onlinelibrary.wiley.com/doi/epdf/10.1002/jrsm.1544In the figure shown at the bottom of the page, it suggests that after eliminating confounding bias by stratification that a strong association would persist in one of the subgroups (bold arrow). In a stratified analysis of a real confounding bias, no association would be seen between either subgroups.Minor erratum
499528Neurology and Special SensesPathologyIntracranial hemorrhageUptoDate: https://www.uptodate.com/contents/aneurysmal-subarachnoid-hemorrhage-treatment-and-prognosis#H28753187 eMedicine : https://emedicine.medscape.com/article/1164341-treatment#d12Nimodipine's effect on reducing vasospasm is unproven. Its mechanism of enhancing outcomes in patients post subarachnoid hemorrhage are mainly attributed to it's neuroprotective effects (rather than reducing vasospasm) by preventing calcium entry intro neurons during ischemia and thus maintiaining intracellular calcium levels. There are studies attributing its effects at the level of the microcirculation of the neurons but none to reductions in main vessel vasospasm. In fact many studies have demonstrated better clinical outcomes without any significant reductions in vasospasms on angiograms. eMedicine and UpToDate both state this very clearly and a well known fact among neurosurgeons. This need to be fixed in the next edition or at least elaborated.Major erratum
500307CardiovascularPathologyAortic dissectionhttps://www.uptodate.com/contents/overview-of-acute-aortic-dissection-and-other-acute-aortic-syndromes?search=proximal%20propagation%20of%20type%20b%20aortic%20dissection&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1Current text: “Stanford type B (distal): involves only descending aorta (Below left subclavian artery).” Issue: That statement is not entirely true, as proximal propagation of a type B dissection into the aortic arch—and the resulting clinical manifestations—is a possible complication, which students could be tested on. Type A dissections include any involvement of the ascending aorta. If the ascending aorta is not involved—even in cases affecting the aortic arch—the dissection is classified as type B. Stating that it “involves only descending aorta” could mislead the students into overlooking the manifestations that arise from aortic arch involvement. UpToDate: "The Daily (Stanford) system classifies aortic dissections that involve the ascending aorta as type A, regardless of the site of the primary intimal tear, and all other dissections as type B [2,5,37,38]." This statement proves that type B aortic dissection could have aortic arch involvement.Major erratum
501434Hematology and OncologyPathologyHodgkin vs non-Hodgkin lymphomahttps://click.smartsheet.com/f/a/maoEFiJh1aJWae7KvpoleA~~/AARF7wA~/RgRokaJYP0TeaHR0cHM6Ly93d3cudXB0b2RhdGUuY29tL2NvbnRlbnRzL2NsaW5pY2FsLXByZXNlbnRhdGlvbi1hbmQtZGlhZ25vc2lzLW9mLWNsYXNzaWMtaG9kZ2tpbi1seW1waG9tYS1pbi1hZHVsdHM_c2VhcmNoPWhvZGdraW4lMjBseW1waG9tYSZzb3VyY2U9c2VhcmNoX3Jlc3VsdCZzZWxlY3RlZFRpdGxlPTElN0UxNTAmdXNhZ2VfdHlwZT1kZWZhdWx0JmRpc3BsYXlfcmFuaz0xI0gyNTcxMzY4NTE1VwNzcGNCCmarWB2vZq22QFtSGGFuZWxpdGVrYXJ1bjk5QGdtYWlsLmNvbVgEAAAAAA~~Both "Present with Indolent course of painless lymphadenopathy, Mediastinal mass and Hepatosplenomegaly" in clinical signs and symptoms. Additionally, for Hodgkin's lymphoma add " Pel-Ebstein fever, Alcohol induced pain at the affected Lymph Nodes and Pruritus (d/t cytokines IL-2, Il-6)Clarification to current text
502318CardiovascularPathologyInfective endocarditishttps://www.sciencedirect.com/science/article/pii/S2405844024159245Mitral valve prolapse (MVP) is the most common underlying valvular disease predisposing to the development of IE in developed countries, particularly when it is associated with coexistent mitral regurgitation. In developing countries, the most common acquired heart disease leading to IE development is rheumatic heart disease (RHD).High-yield addition to next year
503432Hematology and OncologyPathologyPlatelet disordershttps://emedicine.medscape.com/article/954877-overview#a7?form=fpfAs for Bernard-Soulier syndrome it is being stated on first aid that there is decreased Platelet Aggregation. I believe it is a bit misleading! Here is my suggestion: Bernard-Soulier syndrome → Autosomal recessive defect in platelet adhesion. ↓ GPIb → ↓ platelet-to-vWF adhesion at sites of vascular injury. → GPIb also involved in platelet production → thrombocytopenia with giant platelets. Labs: • Normal or ↓ platelet count • ↑ bleeding time • ↓ ristocetin-induced aggregation (secondary to defective adhesion) • Large plateletsClarification to current text
50478BiochemistryMetabolismDisorders of fructose metabolismhttps://www.ncbi.nlm.nih.gov/books/NBK576428/, https://pmc.ncbi.nlm.nih.gov/articles/PMC5409695/For the pathophysiology of essential fructosuria, in the case of lack of fructokinase, hexokinase converts fructose to fructose-6-phosphate, not fructose-1-phosphateMajor erratum
505296CardiovascularPhysiologyHeart murmursin page 357: carcinoid syndrome—episodic flushing, diarrhea, wheezing, right-sided valvular heart disease (eg, tricuspid regurgitation, pulmonic stenosis), q urinary 5-HIAA. Excess 5-HT production depletes tryptophan stores, leading to niacin deficiency (pellagra).Causes of TR: add carcinoid syndromeHigh-yield addition to next year
506456Musculoskeletal, Skin, and Connective TissueAnatomy and PhysiologyLower extremity nerveshttps://www.uptodate.com/contents/sciatic-blocks-procedure-guide#H911661244 / https://www.ncbi.nlm.nih.gov/books/NBK482431/The sensory innervation of the sciatic nerve does not include the posterior thigh, as mentioned in the book. this area is actually supplied by the posterior femoral cutaneous nerve. From Uptodate “ The sciatic nerve provides sensory innervation to the skin of the leg and foot below the level of the knee, with the exception of a medial strip innervated by the saphenous nerve. The skin of the posterior thigh is innervated by the posterior femoral cutaneous nerve (PFCN) which derives from the sacral plexus and is separated from, but close to, the sciatic nerve along most of its course. “Major erratum