Usmle Step 1 Secrets In Color

727 Pages·2017·20.727 MB·English

by  Thomas A. Brown, Sonali J. Bracken

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USMLE STEP 1
SECRETS
IN COLOR
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USMLE STEP 1
SECRETS
IN COLOR
FOURTH EDITION
THOMAS A. BROWN, MD
Medical Director/Owner
Kathy’s Urgent Care of Wethersfield
Wethersfield, Connecticut
SONALI J. BRACKEN
MD/PhD Candidate
University of Connecticut School of Medicine
Farmington, Connecticut
3251 Riverport Lane
St. Louis, Missouri 63043
USMLE STEP 1 SECRETS IN COLOR, FOURTH EDITION ISBN: 978-0-323-39679-0
Copyright © 2017, Elsevier Inc. All rights reserved.
Previous editions copyrighted 2013, 2008, and 2004.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or me-
chanical, including photocopying, recording, or any information storage and retrieval system, without permis-
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permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the
Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other
than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
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To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any lia-
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Library of Congress Cataloging-in-Publication Data
Names: Brown, Thomas A. (Thomas Andrew), 1972- editor. | Bracken, Sonali J.,
editor.
Title: USMLE step 1 secrets in color / [edited by] Thomas A. Brown, MD,
Medical Director/Owner, Kathy’s Urgent Care of Wethersfield, Wethersfield,
Connecticut, Sonali J. Bracken, MD/PhD Candidate, University of
Connecticut School of Medicine, Farmington, Connecticut.
Other titles: USMLE step 1 secrets
Description: Fourth edition. | St. Louis, Missouri : Elsevier, [2017] |
Revison of: USMLE step 1 secrets / Thomas A. Brown, David D. Brown. c2013.
3rd ed.
Identifiers: LCCN 2016037935 | ISBN 9780323396790
Subjects: LCSH: Medical sciences--Outlines, syllabi, etc. |
Physicians--Licenses--United States--Examinations--Study guides.
Classification: LCC R834.5 .B765 2017 | DDC 610.76--dc23 LC record available at https://lccn.loc.gov/2016037935
Content Strategist: James Merritt
Content Development Specialist: Nicole Dicicco
Publishing Services Manager: Hemamalini Rajendrababu
Project Manager: Divya Krishna Kumar
Design Direction: Ryan Cook
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
LIST OF CONTRIBUTORS
Matthew N. Anderson, MD Joravar Dhaliwal
Neurological Surgery Resident University of Connecticut School of Medicine
Brown University Rhode Island Hospital Farmington, Connecticut
Providence, Rhode Island
Andrew J. Duarte
Melissa Argraves, MD University of Connecticut School of Medicine
Resident, Department of Pediatrics Farmington, Connecticut
Children’s Hospital of Philadelphia
Ryan P. Duggan
Philadelphia, Pennsylvania
University of Connecticut School of Medicine
Yetunde Asiedu, MD Farmington, Connecticut
University of Connecticut School of Medicine
Thomas J.S. Durant, MPT, MD
Farmington, Connecticut
Yale School of Medicine
Melina Benson Department of Laboratory Medicine
University of Connecticut School of Medicine New Haven, Connecticut
Farmington, Connecticut
Cory Dwyer
Giana C. Bistany, MD, MS University of Connecticut School of Medicine
University of Connecticut School of Medicine Farmington, Connecticut
Obstetrics and Gynecology
Brian P. Epling
Farmington, Connecticut
University of Connecticut School of Medicine
Martina S. Burn, MD Farmington, Connecticut
Department of Obstetrics, Gynecology and
Patrick A. Field, MD
Reproductive Sciences
University of Connecticut School of Medicine
Yale School of Medicine
Farmington, Connecticut
New Haven, Connecticut
Boston Medical Center Internal Medicine
Samantha Chirunomula Boston, Massachusetts
University of Connecticut School of Medicine
Rebecca Flugrad
Farmington, Connecticut
University of Connecticut School of Medicine
Sarah E. Conway Farmington, Connecticut
NYU School of Medicine
Eric Han, MD
New York, New York
Yale School of Medicine
Sarah Cryer Resident, Department of Obstetrics, Gynecology and
University of Connecticut School of Medicine Reproductive Sciences
Farmington, Connecticut New Haven, Connecticut
Robert D’Angelo, MD Alex M. Hennessey, MD
Harvard Medical School University of Connecticut School of Medicine
Beth Israel Deaconess Hospital Farmington, Connecticut
Boston, Massachusetts
Matthew Howe
Apeksha Dave University of Texas Health Science Center at Houston
University of Connecticut School of Medicine Houston, Texas
Farmington, Connecticut
Liza Karamessinis, MD
Stephanie Davis The Children’s Hospital of Philadelphia
University of Connecticut School of Medicine Philadelphia, Pennsylvania
Farmington, Connecticut
Christopher Del Prete, MD
Dartmouth-Hitchcock Medical Center
Lebanon, New Hampshire
v
vi LIST OF CONTRIBUTORS
Shirin Karimi, MD Nicole J. Rubin, MD
University of Connecticut School of Medicine Resident, Department of Obstetrics and Gynecology
Farmington, Connecticut University of Connecticut School of Medicine
Resident in Internal Medicine at Cambridge Health Farmington, Connecticut
Alliance
Joseph M. Ryan
Clinical Fellow in Medicine at Harvard Medical
University of Connecticut School of Medicine
School
Farmington, Connecticut
Boston, Massachusetts
Neda Shahriari
Adam J.S. Kaye, MD
University of Connecticut School of Medicine
University of Connecticut School of Medicine
Farmington, Connecticut
Farmington, Connecticut
Kelsey Sokol, MD
Andrew Kelsey, MD
University of Connecticut School of Medicine
University of Connecticut School of Medicine
Farmington, Connecticut
John Dempsey Hospital
Farmington, Connecticut Eunice Song, MD
University of Connecticut School of Medicine
Kaitlyn Ryan LaMarche, MD
Farmington, Connecticut
University of Connecticut School of Medicine
Farmington, Connecticut Bryan Stenson
University of Connecticut School of Medicine
Hien Le, MD
Farmington, Connecticut
University of Connecticut School of Medicine
Farmington, Connecticut Margaret Stevenson
University of Connecticut School of Medicine
Aaron Lee, MD
Farmington, Connecticut
University of Connecticut School of Medicine
Farmington, Connecticut Long Tu, MD
University of Connecticut School of Medicine
Deirdre Lewis, MD
Farmington, Connecticut
University of Massachusetts Medical School-Baystate
Springfield, Massachusetts Hollis A. Viray, MD
University of Connecticut School of Medicine
Maritza Montanez, MD
Farmington, Connecticut
University of Connecticut School of Medicine
Farmington, Connecticut Gillian Weston, MD
University of Connecticut
Henry L. Nguyen, MD
Farmington, Connecticut
University of California, San Diego
La Jolla, California David S. Wong
University of Connecticut School of Medicine
Lena M. O’Keefe, MS
Farmington, Connecticut
University of Connecticut School of Medicine
Farmington, Connecticut Kyle T. Wright, MD, PhD
Harvard Medical School
Meaghen Roy-O’Reilly
Brigham and Women’s Hospital
University of Texas Health Science Center at Houston
Boston, Massachusetts
Houston, Texas
PREFACE
Preparing for the United States Medical Licensing Examination (USMLE) Step 1 can be an intimidating and nerve-wracking
experience. For one thing, this score actually counts! Although for many of you the most important goal in taking Step 1 is
passing this exam, we know that is not enough. Earning a spot in a competitive field or residency program requires you to
do more than just pass in order to compete with other high-caliber students. Let us pause right here and take a moment to
introduce ourselves. We are the authors of USMLE Step 1 Secrets, 4th edition, and we have one aim in writing this book: We
are here to help you earn the highest score you possibly can on this exam.
HOW EARLY SHOULD YOU BEGIN STUDYING FOR THE USMLE?
Students frequently ask this question, but unfortunately there is no simple way to answer it. Students commonly allocate
anywhere from 2 to 6 months to study for boards, but some take more time and a rare few may need less. The point is that
each student should begin his or her preparations at a time that makes sense for that particular individual. When planning
your own study schedule, consider how busy you estimate you will be in the months leading up to your exam (do not neglect
your coursework!), how many hours per day you are willing to dedicate to productive study time, and how well you think you
retain information in the short term versus the long term. Most medical students will have figured out which study styles work
best for them long before they even begin to think about boards. Do not change your study habits dramatically for the USMLE
if you have found methods that work well for you. 
HOW WILL THIS BOOK HELP YOU PREPARE FOR STEP 1?
As you may have already figured out, there are hundreds of review books available to help you prepare for this exam. While
the content in these books may overlap quite a bit, the way that material is presented can vary dramatically from resource to
resource. The trick to selecting good review books is to purchase a few that mesh well with your learning style and the actual
format of the USMLE. The more books you have in front of you, the greater the potential for confusion and the less produc-
tive you will feel. In other words, an overabundance of resources eventually will become an impediment to your studying. The
most efficient test takers are the students who consolidate their study materials as time goes by. Start with a fresh copy of
the newest edition of First Aid for the USMLE Step 1. This will be your primary resource for the USMLE Step 1. Our book is
designed to supplement the information that you learn in First Aid and help you place it into clinical context through a mix of
basic-concept and case-based questions. The detailed explanations we provide to our questions will offer you insight into the
way that the USMLE will expect you to think through questions on test day. In addition, our book will provide you with dozens
of valuable study tips (including tips from third- and fourth-year medical students who have earned competitive scores on the
USMLE Step 1) to facilitate your studying.
We begin each chapter with an insider’s guide that will provide you with our best study strategies for that particular subject.
In addition, each chapter includes a number of “Step 1 Secrets” that will point out the highest yield topics to focus on for
boards. It is our mission to offer you the type of valuable information that you can really use to boost your score on test day,
and you will find it exclusively in the fourth edition of USMLE Step 1 Secrets. 
NOW THAT YOU HAVE SELECTED YOUR RESOURCES, HOW SHOULD
YOU GO ABOUT STUDYING FOR THE EXAM?
• Set up a study schedule as early as possible. Determine when you will begin studying, how much time you will
dedicate to the exam each week or month, and when you would like to cover specific subject areas in your review
process. Keep in mind that you will need the last few weeks before boards to review all of the content that you have
studied.
• Make a flexible study schedule, especially early in your preparations. Give yourself some free time every day to enjoy
other activities and relax your mind. This will increase the productivity of your study time.
• Purchase a copy of First Aid for the USMLE Step 1 as soon as possible, and casually review it when studying for your
medical school exams, especially during your second year. There is no need to place your emphasis on studying for
your board exam before you are ready, but at least familiarizing yourself with First Aid in advance will make you feel
much more comfortable when beginning your USMLE studying.
• Annotate your copy of First Aid with notes from USMLE Step 1 Secrets and other high-yield resources. All of your
notes will therefore be in one place in the weeks leading up to your exam date, and you will have a much easier time
getting through all of the material during your final review phase.
vii
viii PREFACE
• Begin using question bank software months before your exam date. Most students use Kaplan Qbank, USMLE World,
USMLE Consult, or USMLERx. If you have the time and budget to do so, we recommend purchasing more than one
product from the aforementioned list. You can use one program casually (tutor mode) and the other program more
intensely (random questions, timed mode) to simulate actual exam conditions. No matter which mode you use, you
will benefit from reading all of the answer explanations at the end. Consider marking questions with great learning
points or excellent diagrams so that you can easily find them again. Keep in mind that you can download question
bank applications for your smartphone.
• The night before your exam, try to put your books away and get a good night’s rest. Half of the battle will be keeping
your focus through an intense, 8-hour exam day. If you feel the need to study the day before or morning of your exam
as a “warm up” or to relieve some anxiety, we recommend going through the high-yield review sections at the end
of First Aid or a few of your own notes. You may also consider answering a couple of practice questions, but be wary
of looking at the answers at this time in case you get them wrong. Avoid cramming any information (new or old) right
before your exam to prevent an anxiety attack.
• Most important, try not to worry too much about your score on Step 1. While your board score will be an important
factor in your residency application, it is not the only factor. (On the other hand, keep in mind that a good Step 1 score
will not make up for poor grades in school.) You would not have gotten into medical school if you were not competent
enough to pass this exam. All you need to do is put in the time and effort. 
WHEN WILL I GET MY SCORE?
Naturally, this is one of the most frequently asked questions among eager examinees who have completed the USMLE Step 1.
Scores are typically made available on the NBME website 3 to 5 weeks after your exam date (lag time is determined by the
number of students who have taken the exam during your window). On the morning that your score will be released, you will
receive an email from NBME alerting you that your score will be made available that afternoon. Your score report will contain
your numerical score and a brief outline of your performance in a broad array of areas. The information provided will be quite
similar to the score report you receive if you elect to take a practice NBME exam through the NBME website. 
TEN THINGS STUDENTS WISH THEY HAD KNOWN BEFORE TAKING
THE USMLE STEP 1
1. Questions on the USMLE Step 1 are often slightly longer than those found in most question bank programs. Most
students finish in time, but keeping on pace will be very important to your success on this exam.
2. Before the start of your exam, you will be given a small whiteboard on which to scribble formulas and perform calcu-
lations during your exam. You may take a few minutes before you actually begin your exam to jot down some notes.
Determine what you will write on your whiteboard during the final week of your review so as not to waste time during
your exam.
3. Anatomy throws many students for a loop on Step 1 because they are often unsure how to prepare for this subject.
Be sure to read our “Insider’s Guide to Clinical Anatomy for the USMLE Step 1” in Chapter 26 of this book.
4. You should expect to have a small percentage of questions on topics that you have never before seen or studied. You
may also get four to five questions on the same topic. If you do not know the answer, take your best guess and move
on. Do not let yourself become flustered or frustrated because you may otherwise miss some easy questions.
5. You are allowed 45 minutes of break time during your exam, but you can gain extra break time by skipping the tuto-
rial (15 minutes; you can watch a similar tutorial on the NBME website before your exam date) or finishing a block
before the allotted time expires. Most students find an hour of break time to be adequate, but you should spend some
time before your exam planning out how you will allot your time. Do not forget that you are expected to include lunch
in your break time.
6. Bring snacks. You will be facing a long day. We suggest that you eat a small lunch and a few snacks in between
blocks rather than one big lunch (some students will otherwise become lethargic during the afternoon). Be wary of
selecting high-sugar snacks (the last thing you need while taking the USMLE is a sugar crash!).
7. While it is no secret that you should dress in comfortable clothing while sitting for your exam, students often do
not know that they should wear as little jewelry and clothing with as few pockets as possible. To prevent the use of
prohibited items, most testing centers will scan you with a metal wand and ask you to turn out your pockets each
time you re-enter the examination room following a break. Not only is this a frustrating process, but also it is a waste
of your break time. You will get through this inspection much more quickly with less jewelry and fewer pockets. Also
remember to bring your ID and locker key with you every time you leave the test center.
8. All NBME forms are different! Do not be fooled by students who tell you that their questions were identical to those in
the USMLE World, Kaplan Qbank, USMLE Consult, or USMLERx. There is no guarantee that your experience will be the
same as theirs. The more questions you do, the better prepared you will be. We recommend that you reserve at least
1000 practice questions to answer in conditions that closely simulate the exam (full blocks, random assortment, and
timed mode).
9. When scheduling your exam date, keep in mind that having more time to study will not necessarily improve your
performance. Every individual has a peak performance window, and trying to study past this window may hurt your