A STUDETN-TO-STUDEGNUTI DE ..,..A dvifcreo smt udewnhtosa cetdh 2e0 1e2x am� ..,..1 200f+r equetnetsltfyea dc atnsd m nemoni� cs ..,..H undreodfhs i gh-ycioelliodmr a gaensd d iagratmhsr oug�h out ..,..S tudernatt ionfgm so rteh a3n0 0r eview pr�o ducts TAOL E,M D,M HS AssociCaltien iPcraolf esosfMo erd iciannedP ediatrics ChieSfe,c tioofAn l leragnydI mmunology DepartmoefnM te dicine UniverosfiL toyu isville VIKABS HUSHANM,D DiagnosRtaidci ologist LosA ngeles VIVETK. K ULKARNI YalSec hooolfM edicine Clasosf2 014 MATTHEWM .S OCHAT WarreAnl peMretd icSaclh ooolfB rowUnn iversity Clasosf2 013 ID Medical NewY orIkC hicaIgS oa nF ranciIsL cios bIoLn o ndoInM adriIdM exicCoi ty MilaInN ewD elhIiS anJ uaInS eouIlS ingapIoS ryed neIyT oronto ThMec Graw·HCiolmlp anies 'ii'll ,,. · ··� FirAsitd fotrh e®US MLES tep1 2013A: S tduent-tod-eSnttGu udie Copyr©i 2g0h1t3b yT aoL ea ndV ikBahsu shAalnrl.i grhetsse rPvreidn.it nte hdUe n itSetda toefAs m eriEcxac.ea pspt e r mittuendd etrhU en itSetda tCeosp yrAicgothf 1t 9 76n,o p arotft hipsu blicmaatybi eor ne prodourcd eidst riibnau ntye d foromrb ya nmye anosrs, t orienad d ata obrra ester siyesvtaelm , twhipetr hiwoorurit tt peenr misosfti hopenu blisher. Previeoduist icoonpysr ©i 1g9h9t1t hro2u0g1h2b yV ikBahsu shaanndT aoL eF.i resdti tcioopny r©i 1g9h9t0 1,9 89b y VikBahsu shJaenf,fH raenys eann,dE dwaHrodn . Phoctroe dfiottrhs bi oso bke goinnp ag6e3 3a nda rceo nsidaener xetde nosfti hocinos p yrpiagghet. FirAsiftdo trh ei®sa r egisttreardeedom faT rhkeM cGraw-Hill Companies, Inc. 1 2 3 4 5 6D O7W / 8D O9W1 401 31 2 ISB9N7 8-0-07-180232-1 MHI0D- 07-180232-0 ISS1N5 32-6020 Notice Mediciisan nee ver-chsacnigeinAncsgne e.w r eseaarncdch l inical experoiuerkn ncoew lebcdrhagongeae,ds e n int reatamneddn rtu tgh eraarpreye quiTrheead u.t haonrdts h peu bliosfth hewiros r hka vceh eckweidts ho urces belietvobe edr eliiantb hleeei ffro rttops r ovide intfhoairtscm oamtpiloaennt dge e nerianal clcyo wridtt hh set an daradcsc epattte hdte i moefp ublicHaotwieovnie.nvr i,e owft hpeo ssiobfih luimtaeynr roorcr h angienms e dical sciennceeistt,hh eaeru thnoortrsh peu blinsoharen roy t hpearr wthyoh abse einn volivnte hdpe r eparoarpt uibon licaotfti howinos r wka rratnhtatsthi en formcaotnitoanhi enreedii sin ne verreys paeccctu roarct oem plaentdte h,e y disclaalrilem s ponsfioabrni eylr irtooyrro sm issoirof notsrh ree sults forbotumas oiefn t ehiden formcaotnitoani ned int hiwso rRke.a dearresen courtaogc eodn ftihriemn formcaotnitoanhi enreedwi into ht hseoru rcFoeres xa.m pel andi np artirceualdaaerrr,aes d vitsoec dh ectkhp er odiuncfto rmsahteiieontnc luidnte hdpe a ckaogfee a cdhr gu thepyl atnoa dminitsobt eec re rttahiatnth i en formcaotnitoanii nnt ehdwi osr iksa ccuraantdte h acth angheasv e nobte emna dei nt hree commenddoesoder i nt hceo ntrainfdioacrda mtiinoinssTt hriartsei coonm.m endiasot fi on partiicmuploarrti ancn ocnen ecwtiitnohen wo ri nfrequuseenddtr luyg s. Thibso owka ss eitnE lecLtHbr yaR ainbGorwa phics. Thee ditwoerrCsea theAr.Ji onhen saonndP etJeB.ro yle. Projmeacnta gemweanspt r ovibdyRe adi nbGorwa phics. Thep roducstuipoenrv wiassJo erff rHeeyr zich. RRD onnewlalsep yr inatnedbr i nder. Thibso oikps rinotnea dc id-pfarpeeer . McGrawb-oHoikalsrla e v ailaatsb pleecq iuaaln dtiistcyo tuoun staess p remiuamnsds alperso motoirfo onurss ,ie n c orpo ratter aipnrionggr amcso.n taTar oce tp resepnlteaatesi-evm eau isal tb [email protected]. Dedication Tot hceo ntritbotu htaionsrdp s a setd itiwohnots o,ot ki mteos hare thekinro wleidngseia,gn hdht u,m ofrot rh bee neoffsi ttu dents. Contents ContribuAtuitnhgo rs vii Howt oC ontribute XVII AssociAautteh ors viii Howt oU seT his Book xix FaculRteyv iewers ix CommonU SMEL LaboratVoarlyu es XXI Preface xi BasiScc ienDcies cipClrionses -Reference Tablfeo Hri gh-YFiaecltds xxiii SpeciAaclk nowledgments xii FirAsitdC hecklfiostrth eU SMEL Ste1p xxiv AcknowledgmfeonOrtn sl iCnoen tributors xiii �SECTIOIN GUIDET O EFFICINET EXAM PREPARATION 1 Introduction 2 CliniVciagln eStttrea tegies 21 USMLSEt e1p- TheB asics 2 IYfo uT hinYko uF ailed 22 DefinYionugGr o al 12 IYfo uF ailed 22 TimelfionSert udy 12 TestiAngge ncies 23 StudMya terials 17 References 23 Test-TaSktirnagt egies 19 �SECTIOINS UPPLEMENT SPECIASLI TUATIONS 25 FirAsitdf otrh eI nternatMieodniacGlar la duate 26 FirAsitdf otrh eP odiatMreidci cSatlu dent 41 FirAsitdf otrh eO steopaMtehdiicc Satlu dent 36 FirAsitdf otrh eS tudewnitt ah D isability 43 �SECTIOINI HIGH-YIELDG ENERAL PRINCIPLES 45 Howt oU set heD atabase 46 Immunology 191 Behavioral Science 49 Pathology 211 Biochemistry 63 Pharmacology 225 Microbiology 117 v �SECTION Ill HIGH-YIELODR GAN SYSTMES 245 Cardiovascular 249 Psychiatry 457 Endocrine 285 Renal 477 Gastrointestinal 307 Reproduc,t ive 503 HematolaongdyO ncology 343 Respiratory 543 MusculoskeSlkeitna,l C,ao nndn ectTiivses ue 377 RapiRde view 565 Neurology 407 �SECTIONI V TOP-RATEDR EVIEWR ESOURCES 583 Howt oU set heD atabase 584 MicrobioalnodIg mym unology 601 IJ QuestiBoann ks 586 Pathology 605 QuestiBoono ks 587 Pharmacology 610 Internet Sites 588 Physiology 614 Comprehensive 589 CommercRieavli eCwo urses 619 AnatomEym,b ryolaongdyN ,e uroscience 591 Publisher Contacts 624 BehavioSrcaile nce 595 AbbreviaatnidoS nysm bols 625 Biochemistry 597 PhotAoc knowledgments 633 CelBli oloagnydH istology 599 Index 641 Aboutth eA uthors 695 VI ContrbiutnigA uthros JACOBB ARANOSKI MAX C.P ETERSEN MedicSacli enTtriasitn ing Program YalSec hoooflM edicine YalSec hoooflM edicine Claosfs2 014 ROBERTS TRETCH VICKZI. J .B ING YalSec hoooflM edicine YalSec hoooflM edicine Claosfs2 014 Claosfs2 014 GARTHS TROHBEHN JEFFRESY.F UTTRELEIB YalSec hoooflM edicine YalSec hoooflM edicine Claosfs2 014 Claosfs2 013 NICHOLATSH EODOSAKIS ABHIJEEGTU MMADAVELLI Medical Scientist Training Program YalSec hoooflM edicine YalSec hoooflM edicine Claosfs2 014 RICHARDP .U SATINEMD, LAURENH IBLER DermatoIlmoaggyeC so ntributor ProfesDseorrm,a toalnodgC yu taneSouursg ery YalSec hoooflM edicine ProfesFsaomria,ln ydC ommuniMteyd icine Claosfs2 014 UniverosfTi etxyaH se alStchi enCceen tSearn A ntonio JEFFREHYO FMANN CAROLINAE. W ALKER WarrAelnp eMretd icSaclh oooflB rowUnn iversity YalSec hoooflM edicine Claosfs2 016 Claosfs2 014 OLGAL AUR SAMANTHAX .Y .W ANG YalSec hoooflM edicine YalSec hoooflM edicine Claosfs2 014 Classo f2 014 WALTER WFI.G GINSP,h D KELSEBY. L OELIGER Editfoirr,s taidteam.com MedicSacli enTtriasitnP irnogg ram WakeF oreSscth oooflM edicine YalSec hoooflM edicine Classo f2 014 GORANM ICEVIC PETERZ HAO MedicSacli enTtriasitnP irnogg ram YalSec hoooflM edicine YalSec hoooflM edicine Classo f2 014 VII AssoctieaA uthors FADYA KLADIOS AMY MORENO MedicUanli verosfti hteAym ericas YalSec hoooflM edicine Claosfs2 013 Claosfs2 014 ADITYBAA RDI,AM D,M PH AYESHAN ZERIBE AttendPihnygs icMiaasns,a chuGseentetrsHa ols piCtaanlc Ceern ter WarrAelnp eMretd icSaclh oooflB rowUnn iversity InstruicntM oerd iciHnaer,v aMredd icSaclh ool Claosfs2 013 MICHELLME. B RAVO KEZIAS PENCE WarrAelnp eMretd icSaclh oooflB rowUnn iversity Claosfs2 013 WarrAelnp eMretd icSaclh oooflB rowUnn iversity Claosfs2 013 RAFAELA .B UERBA YalSec hoooflM edicine RANYWOO Claosfs2 014 YalSec hoooflM edicine Claosfs2 013 JONATHAN FU YalSec hoooflM edicine Claosfs2 013 ANDREW HANOIW U BostUonni verSscihtoyoo flM edicine ALEJANDRROA FAELG ENER Claosfs2 015 UniversCiednatddr eaClla ribe Claosfs2 015 MICHAELX IONG ASHWANIG ORE WarrAelnp eMretd icSaclh oooflB rowUnn iversity Claosfs2 015 StG.e orgUen'isv erSscihtoyoo flM edicine Claosfs2 015 PATRICIZAA DNICK JAMESM . GRAY JohnHso pkiSncsh oooflM edicine UniverCsoiltlyeD gueb lSicnh oooflM edicainndeM edicSacli ence Claosfs2 014 Claosfs2 014 CHRISTINZEE NDER-PRINCETDOON , WILLIALM .H WANG,M Sc ResidPehnyts icLiaakne,l Raengdi oHneaall thcare HealStchi en&cT eesc hnolaongdByi o physics Programs AdjunPcrto fesCsloirn,i cal HarvaUrndi versity/MasIsnascthioutfTsu eetcteht nso logy MichiSgtaanUt nei verCsoiltlyeo gfMe e dicine MD/PhcDa ndidate KATHARINJEO O JINY(UJ ANEZ)H ANG Warren Alpert MeodfBi rcoawlUn n Sicvheorosli ty WarrAelnp eMretd icSaclh oooflB rowUnn iversity Claosfs2 013 Claosfs2 014 VIII Faculty Reviewers SHANTAK APADI,AM D CHARLEDSE LAC RUZ,M D AssisPtraonfte sDseopra,r tmoefPn utl monaanrdyC ritCiacraMele dicine LecturDeerp,a rtmoefSn utr gery YalSec hoooflM edicine YalSec hoooflM edicine EMILYR .E SPOSITPOh,D BERTRAMK ATZUNGM,D ,P hD AssisPtraonfte ssor ProfesEsmoerr itus SulliUvnainv erCsoiltlyeo gfPe h armacy UniverosfCi atlyi foSrannFi raa,n cisco CONRADF ISCHEMRD, GERALDL EEM,D AssociPartoef esofsP ohry siolMoegdyi,c iannedP, h armacology AssisPtraonfte sSseocrt,io ofAn l learngdyI mmunology TourCoo lleogfMe e diciNneew,Y orCki ty DepartmeonfIt n terMneadli cine UniverosfLi otuyi sSvcilhlooeof lM edicine STUARTFL YNN,M D Dean, CoolfMl eedgiec ine WARRENL EVINSONM,D ,P hD TheU niverosfAi rtiyz oPnhao,e nix Professor, DoefpM airctrmoebniaton ldoI gmym unology UniverosfCi atlyi foSrannFi raa,n cisco ANUJG AGGAR,M D Clinical Fellow NICHOLASM AHONEY,M D DepartmoefIn ntf ectDiiosuesa se UniverosfSi atnFy r anciSscchooo oflM edicine AssisPtraonfte sDseopra,r tmoefOn pth thalmology WilmeEry eI nstitutHeo/pJkoihUnnnssi versity MATTHEWG ARABEDIA,NM D DivisoifMo ant ernalM-eFdeitcailn e PETERM ARKS,M D,P hD DepartmoefOn bts tetarnidGc ysn ecology Associate PDreopfaertsmseoonfrIt ,n terMneadli cine SantCal aVraal lMeeyd icCaeln ter YalSec hoooflM edicine ANTHONYG LASERM,D ,P hD PATRICIJA.M ElTINGP,h D Assistant ProfessoofFr a,m iDMleeypd airctimneen t MedicUanli verosfSi otuytC ha rolina ProfesosfPo hry sio&l Pohgayr macoalnodog fyM edicine VicCeh ancealnldoS re niAosrs ociDaetaenf oSrt udeAnffta irs RYANC .W .H ALLM,D TheU niverosfTi otlye Cdool leogfMe e diciannedL ifSec iences AssisPtraonfte sDseopra,r tmoefMn etd icEadlu cation AFSOONM OKTAR,P hD UniverosfCi etnyt rFallo rOirdlaa,n do AffilAisastiesP traonfte sDseopra,r tmoefPn sty chiatry AssisPtraonfte ssor UniverosfSi otuytF hl orTiadmap,a SulliUvnainv erCsoiltlyeo gfPe h armacy RAJESHJ ARIM,D ,M BA ROBERTN OVAK,M D Spine, MeadnidRc eihnaeb,i litation ThePraaiMnpa ineasg-eSmMeAnRtT ChaiDre,p artmoefPn att holaongdLy a boraMteodryi cine WestminasntdWe hri tMea rsMha,r yland AkroCnh ildrHeons'psi tal KURTJ OHNSON,P hD DAVIDP ERR,YP hD ProfesDseopra,r tmoefAn nta toamnyd R egenerBaitoilvaoeng dy DepartmoefOn bts tetarnidGc ysn ecology ProfesDseopra,r tmoefPn hta rmacoalnodPg hyy siology GeorgWea shingUtnoinv erSscihtyo ooflM edicine GeorgWea shingUtnoinv erSscihtoyoo flM edicine IX MICHAESL. R AFI,IM D,P hD HOWARD STEINMANP,h D DirecMteomro,r Dyi sordCelrisn ic ProfesDseopra,r tmoefBn ito chemistry AssisPtraonfte sosfNo eru rosciences AssisDteaanont f B iomediSccaile nEcdeu cation UniverosfCi atyl iifao SrannD iegHoe alStyhs tem AlbeEritn stCeoilnl eogfMe e dicine STEPHENT HUNG,M D DANIEJL. R UBINM,D ,M SC AssociPartoef esDseopra,rt meonfOt b stetrics/Gynecology OhiSot aUtnei versity AssisPtraonfte sosfMo erd iciDniev,i soifEo nnd ocrinology AssociPartoeg rDaimr ecEtnodro,c rinFoellolgoyw ship TemplUen iverSscihtoyoo flM edicine RICHARDP .U SATINMED, ProfesDseorrm,a toalnodgCy u taneSouursg ery ProfesFsaomria,ln ydC ommuniMteyd icine JOSEPHSC HINDLEMRD, UniverosfTi etxyaH se alStchi enCceen tSearnA n tonio AssisPtraonfte sDseopra,r tmoefNn etu rolaongdNy e urosurgery HILARYV ERNON,M D ClinDiicraelc YtaolrNe,e wH aveSnt roPkreo gram YalSec hoooflM edicine AssisPtraonfte sMscoKru,s ick-NInastthiatnousfGt een etMiecd icine JohnHso pkiUnnsi versity SANJISVH AH,M D ADAM WEINSTEIMND, AssisPtraonfte sDsiovri,so ifCo anr diology AssisPtraonfte sSseocrt,io ofPn e diaNterpihcr ology DepartmoefMn etd icine DepartmeonfPt e diatrics NorthwesUtneirvne rsity GeisSeclh oooflM ediciantDe a rtmouth X