Table Of Content

General Principles New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto SENIOR EDITORS TAO LE, MD, MHS Assistant Clinical Professor Chief, Section of Allergy and Clinical Immunology Department of Medicine University of Louisville KENDALL KRAUSE, MD Resident Department of Emergency Medicine Harvard Affi liated Emergency Medicine Residency EDITORS ELIZABETH EBY Vanderbilt University School of Medicine Class of 2009 JUSTIN P. FOX, MD Resident Department of Surgery Wright State University DANIELLE GUEZ Yale University School of Medicine Class of 2011 M. KENNEDY HALL Albert Einstein College of Medicine Class of 2009 SANDY MONG Harvard Medical School Class of 2009 KONSTANTINA M. VANEVSKI, MD Senior Fellow Department of Obstetrics and Gynecology F. Edward Hébert School of Medicine Unifomed Services University of the Health Sciences Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. 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The following material was reproduced, with permission, from Le T, et al. First Aid for the USMLE Step 1: 2008, New York: McGraw-Hill, 2008: Figures 1-3, 1-6, 1-7, 1-8, 1-19, 1-20, 1-22, 1-24, 1-25, 1-26, 1-27, 1-28, 1-30, 1-32, 1-33, 3-5, 3-7, 3-8, 3-9, 3-14, 3-15, 3-16, 3-17, 3-25, 3-27, 3-32, 3-34, 3-40, 3-42, 3-44, 3-45, 3-48, 3-49, 3-50, 3-52, 3-59, 3-70, 3-73, 3-101, 3-119, 3-120, 3-121, 3-122, 3-123, 4-3, 4-5, 4-6, 4-11, 4-25, 5-6, 5-7, 5-10, 5-37, 5-38, 5-40, 6-4, 6-5, 6-10, 6-11, 8-1, and 8-2; Tables 1-7, 3-20, 3-28, 4-7, 5-51, 6-6, 6-7, 6-10, and 6-12. Cover images are modified and reproduced, with permission, from the following sources: Chandrasoma P, Taylor CR. Concise Pathology, 3rd ed. Originally published by Appleton & Lange. Copyright © 1998 by The McGraw-Hill Companies, Inc.; and Wolff K, Johnson RA, Suurmond D. Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology, 5th ed. New York: McGraw-Hill, 2005. 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This page intentionally left blank v Contributing Authors . . . . . . . . . . . . . . . . . . . . . . . . . vi Faculty Reviewers . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . xi How to Contribute. . . . . . . . . . . . . . . . . . . . . . . . . . .xiii CHAPTER 1. Anatomy and Histology. . . . . . . . . .1 Cellular Anatomy and Histology . . . . . . . . . . . . . . . . .2 Gross Anatomy and Histology. . . . . . . . . . . . . . . . . 18 CHAPTER 2. Behavioral Science . . . . . . . . . . . . 39 Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Disease Prevention . . . . . . . . . . . . . . . . . . . . . . . . . 49 Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Life Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Psychology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 CHAPTER 3. Biochemistry . . . . . . . . . . . . . . . . . 75 Molecular Biology . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Mutations and DNA Repair . . . . . . . . . . . . . . . . . . . 95 Enzymes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 The Cell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Connective Tissue . . . . . . . . . . . . . . . . . . . . . . . . . 122 Homeostasis and Metabolism . . . . . . . . . . . . . . . 130 Amino Acids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Fed versus Unfed State . . . . . . . . . . . . . . . . . . . . . 175 Laboratory Tests and Techniques. . . . . . . . . . . . . 214 Genetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 CHAPTER 4. Embyology . . . . . . . . . . . . . . . . . . 233 CHAPTER 5. MIcrobiology . . . . . . . . . . . . . . . . 261 Bacteriology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262 Spirochetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326 Mycology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332 Helminths. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344 Zoonotic Bacteria. . . . . . . . . . . . . . . . . . . . . . . . . . 355 Virology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 358 Microbiology: Systems. . . . . . . . . . . . . . . . . . . . . . 408 Antimicrobials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424 CHAPTER 6. Immunology . . . . . . . . . . . . . . . . . 457 Principles of Immunology . . . . . . . . . . . . . . . . . . . 458 Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 478 CHAPTER 7. Pathology . . . . . . . . . . . . . . . . . . . 503 CHAPTER 8. General Pharmacology . . . . . . . 527 Pharmacodynamics . . . . . . . . . . . . . . . . . . . . . . . . 528 Pharmacokinetics. . . . . . . . . . . . . . . . . . . . . . . . . . 531 Toxicology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 534 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 543 About the Editors . . . . . . . . . . . . . . . . . . . . . . . . . 560 Contents vi CONTRIBUTING AUTHORS Kevan M. Akrami Albert Einstein College of Medicine Class of 2009 Ryan Patrick Bayley Vanderbilt University School of Medicine Class of 2008 Johnathan A. Bernard Yale University School of Medicine Harvard School of Public Health Class of 2009 Melissa A Buryk, MD Resident Department of Pediatrics Portsmouth Naval Medical Center Trevor A. Crowell Keck School of Medicine University of Southern California Class of 2008 Beverly (Ye) Du Harvard Medical School Class of 2009 Cicely Anne Dye F. Edward Hérbert School of Medicine Uniformed Services University of the Health Sciences Class of 2009 Elizabeth Eby Vanderbilt University School of Medicine Class of 2009 Matthew C. Egalka, MD Resident Department of Pediatrics Yale-New Haven Children’s Hospital Mary Evans, MD Resident Department of Internal Medicine Boston Medical Center Rolf Graning, MD Uniformed Services University of the Health Sciences Class of 2007 Britney L. Grayson Vanderbilt University School of Medicine Class of 2012 Alison Hanson Vanderbilt University School of Medicine Class of 2012 Nicole M. Hsu F. Edward Hébert School of Medicine Uniformed Services University of the Health Sciences Class of 2009 Sean L. Jersey, MD Flight Surgeon 99th Reconnaissance Squadron Air Force Base, California Serge Kobsa Yale University School of Medicine Class of 2011 Pamela Landsteiner, MD Transitional Resident David Grant USAF Medical Center Travis Air Force Base, California Peter Liang Harvard Medical School Class of 2009 Joel Musee Vanderbilt University School of Medicine Class of 2013 Gregory Nelson, MD, MHS Resident Department of Orthopaedic Surgery Barnes-Jewish Hospital Washington University in St. Louis Scott E. Potenta Harvard Medical School Class of 2011 Sofi e Rahman Vanderbilt University School of Medicine Class of 2009 Rachel Reinert Vanderbilt University School of Medicine Class of 2013 Jakub Sroubek Albert Einstein College of Medicine Class of 2011 Brendon G. Tillman F. Edward Hébert School of Medicine Uniformed Services University of the Health Sciences Class of 2009 Yolanda D. Tseng Harvard Medical School Class of 2009 Joshua Tyler, MD Resident Department of General Surgery Brooke Army Medical Center Eric Vaillant Resident University of California Davis Medical Center Joshua J. Weaver, MD Resident Department of Neurology New York Presbyterian /Weill Cornell Cicely Williams Yale University School of Medicine Class of 2011 David Young Vanderbilt University School of Medicine Class of 2008 vii FACULTY REVIEWERS Ronald Arky, MD Charles S. Davidson Distinguished Professor of Medicine, Brigham and Women’s Hospital Harvard Medical School James B. Atkinson, MD, PhD Professor Department of Pathology Vanderbilt University Medical Center Susan J. Baserga, MD, PhD Professor, Molecular Biophysics and Biochemistry, Genetics, Therapeutic Radiology Yale University School of Medicine Stephen C. Baum, MD Professor of Medicine, Microbiology and Immunology Albert Einstein College of Medicine Douglas A. Berv, MD Lecturer Department of Psychiatry Yale University School of Medicine Jonathan Bogan, MD Assistant Professor of Medicine and Cell Biology Yale University School of Medicine Florence M. Brown, MD Assistant Professor of Medicine Beth Israel-Deaconess Medical Center Harvard Medical School Yung-Chi “Tommy” Cheng, PhD Henry Bronson Professor of Pharmacology Yale University School of Medicine Yoon Andrew Cho-Park, MD Clinical Fellow in Neurology Massachusetts General Hospital/Brigham and Women’s Hospital Harvard Medical School Christoper Cimino, MD Professor of Clinical Neurology Albert Einstein College of Medicine Celena Dancourt, MD Chief Resident Department of Psychiatry Beth Israel Medical Center Albert Einstein College of Medicine Sachin Desai, MD Clinical Fellow Department of Pediatrics Yale University School of Medicine Jorg Dietrich, MD, PhD Chief Resident Department of Neurology Massachusetts General Hospital/Brigham and Women’s Hospital Harvard Medical School Eric Elster, MD Assistant Professor of Surgery Uniformed Services University of the Health Sciences Susan Farrell, MD Assistant Professor of Medicine Brigham and Women’s Hospital Harvard Medical School Dennis Finkielstein, MD Assistant Professor of Medicine Albert Einstein College of Medicine David E. Golan, MD, PhD Professor Department of Biological Chemistry & Molecular Pharmacology Harvard Medical School Attilio V. Granata, MD, MBA Associate Professor Yale School of Medicine and Yale School of Public Health Yvonne Grimm-Jorgensen, PhD Assistant Professor Department of Cell Biology University of Connecticut Health Center Mehrnaz Hojjati, MD Assistant Professor Department of Medicine Medical School at the University of Minnesota Paul D. Holtom, MD Associate Professor of Medicine and Orthopedics Keck School of Medicine of University of Southern California Edmund G. Howe III, MD, JD Professor of Psychiatry Uniformed Services University of the Health Sciences Anand D Jeyasekharan, MD, MBBS Department of Oncology and Hutchison/MRC Research Centre University of Cambridge Shanta Kapadia, MD, MBBS Lecturer Department of Surgery Yale School of Medicine Joel Katz, MD Assistant Professor of Medicine Brigham and Women’s Hospital Harvard Medical School George L. King, MD Professor of Medicine Brigham and Women’s Hospital Harvard Medical School Philip Kingsley, MS Assistant in Biochemistry Vanderbilt University Medical Center Michael Klompus, MD, PhD Instructor Department of Ambulatory Care and Prevention Harvard Medical School Fotios Koumpouras, MD Assistant Professor of Medicine University of Pittsburg School of Medicine viii Patricia Kritek, MD Instructor in Medicine Brigham and Women’s Hospital Harvard Medical School Jayde Kurland, MD Staff Gastroenterologist National Naval Medical Center Joseph D. LaBarbera, PhD Associate Professor Department of Psychiatry Vanderbilt University School of Medicine John McArdle, MD Assistant Professor of Medicine Yale University School of Medicine Cynthia Macri, MD Assistant Professor, Obstetrics and Gynecology Uniformed Services University of the Health Sciences Jason B. Martin, MD Division of Allergy, Pulmonary, and Critical Care Department of Medicine Vanderbilt University School of Medicine Andrew Miller, DO Senior Rheumatology Fellow Vanderbilt University Medical Center Tracey A. Milligan, MD, MS Instructor in Neurology Brigham and Women’s Hospital Harvard Medical School Kenneth L. Muldrew, MD, MPH Winchester Fellow in Clinical Microbiology Department of Laboratory Medicine Yale School of Medicine Michael Parker, MD Assistant Professor of Medicine Beth Israel-Deaconess Hospital Harvard Medical School Jonathan P. Pearl, MD Assistant Professor Department of Surgery Uniformed Services University of the Health Sciences Cathleen C. Pettepher, PhD Professor, Cancer Biology and Cell & Developmental Biology Vanderbilt University School of Medicine Staci E. Pollack, MD Assistant Professor of Reproductive Endocrinology & Infertility Department of Obstetrics, Gynecology & Women’s Health Albert Einstein College of Medicine E. Matthew Ritter, MD Assistant Professor of Surgery Norman M. Rich Department of Surgery Uniformed Services University of the Health Sciences David H. Roberts, MD Assistant Professor of Medicine Beth Israel-Deaconess Medical Center Harvard Medical School Jeffrey J. Schwartz, MD Associate Professor Department of Anesthesiology Yale University School of Medicine Ravi Shah, MD Resident in Internal Medicine Massachusetts General Hospital Keegan Smith, MD Clinical Fellow Division of Allergy, Pulmonary, and Critical Care Medicine Vanderbilt University Medical Center Darko Stefanovski, MSc PhD Graduate Student; PIBBS (Physiology & Biophysics) Keck School of Medicine of University of Southern California Richard S. Stein, MD Professor of Medicine Vanderbilt University Medical Center Howard M. Steinman, MD Professor of Biochemistry Albert Einstein College of Medicine Srinivas Susarla, DMD Clinical Fellow in Oral and Maxillofacial Surgery Massachusetts General Hospital Louise D. Teel, PhD Research Assistant Professor Department of Microbiology and Immunology Uniformed Services University of the Health Sciences Mark Thomas, MD Associate Professor Physical Medicine and Rehabilitation Albert Einstein College of Medicine Joseph I. Wolfsdorf, MB, BCh Professor of Pediatrics Children’s Hospital Harvard Medical School ix Preface With this fi rst edition of First Aid for the Basic Sciences: General Principles, we continue our commitment to providing students with the most useful and up- to-date preparation guides for the USMLE Step 1. Both this text and its com- panion, First Aid for the Basic Sciences: Organ Systems, are designed to fi ll the need for a high-quality, in-depth, conceptually driven study guide for Step 1 of the USMLE. They are designed to be used either alone, or in conjunc- tion with the original First Aid for the USMLE Step 1. In this way, students can tailor their own studying experience, calling on either book, according to their mastery of each subject. These books would not have been possible without the help of the hundreds of students and faculty members who contributed their feedback and suggestions. We invite students and faculty to please share their thoughts and ideas to help us improve First Aid for the Basic Sciences: General Principles. (See How to Contribute, p. xiii.) Tao Le Louisville Kendall Krause Boston This page intentionally left blank xi Acknowledgments This has been a collaborative project from the start. We gratefully acknowl- edge the thoughtful comments and advice of the residents, international medical graduates, and faculty who have supported the editors and authors in the development of First Aid for the Basic Sciences: General Principles. We wish to extend a sincere and heartfelt thanks to our amazing editor, Isabel Nogueira, who truly was the backbone of this project. Without her enthusi- asm and commitment, the publication of this project would not have been possible. For support and encouragement throughout the process, we are grateful to Thao Pham, Louise Petersen, and Selina Franklin. Furthermore, we wish to give credit to our wonderful editors and authors, who worked tirelessly on the manuscript. We never cease to be amazed by their dedication, thoughtfulness, and creativity. Thanks to Catherine Johnson and our publisher, McGraw-Hill, for their assistance and guidance. For outstanding editorial work, we thank Karla Schroeder, Michael Shelton, and Alison Kelley. A special thanks to Rainbow Graphics for remarkable production work. Thanks to Peter Anderson of the Department of Pathology, University of Al- abama at Birmingham, for use of images from the Pathology Education In- structional Resource Digital Library (http://peir.net). We also thank faculty at Uniformed Services University of the Health Sciences (USUHS) for use of their images. 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