2025 FA Step 1 Proposed Errata & Suggestions
Page #ChapterSectionFact NameSupporting Reference(s)Main CommentSubmission type
 Collaboration powered by Smartsheet   |   Report Abuse
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.Major 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
286223PathologyCellularBarrett 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
318298CardiovascularPhysiologyNormal 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
323333EndocrinePhysiologyAntidiuretic 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