2011 First Aid for the USMLE Step 1

Official Updates, Corrections, and Clarifications

Updated March 1, 2011

Despite our best efforts, errors do occur during the revision. If you see a verifiable error not on this list, please report it to
our blog at www.firstaidteam.com. If you are the first to report the error, you will receive a $10 gift certificate. In order
to identify and correct every possible error, we review every single submission, as well as search other websites and
blogs that claim to have a comprehensive listing of errors in First Aid 2011. If you find that our material conflicts with a
source that you’re reviewing, please point us toward it with a corroborating reference. As always, we will check every
submission against primary references to ensure the most accurate, high-yield study guide available. If you submitted an
erratum and it does not appear in an update, then either it does not agree with the primary literature in the field or we
consider it a detail beyond the scope of the book.

Please note that we will not list simple typos or, unless egregious, omitted material; our goal is to provide a high-yield
framework for studying and not a comprehensive textbook. The list below reflects content errors and typos that may
create confusion that were submitted before February 8, 2011. As always, updates are available at
www.firstaidteam.com. Good luck with your studies!

–The First Aid/USMLERx Team

Page # Entry Title Correction/Clarification

In the second full paragraph, change "To avoid a rescheduling fee,
you will need to request a change before noon EST at least five
business days before your appointment" to "No fee is charged for
changing your testing appointment 31 or more calendar days prior
6 Rescheduling an exam to the first day of the scheduled test."
Shift the reference to “sleep spindle” in the figure slightly to the
62 Sleep stages left.
Note that the figure should illustrate the phosphodiester linkage
between the top two deoxyribonucleotides which is an important
DNA/RNA/Protein synthesis component of the DNA backbone, and also crucial for binding of
71 direction phosphodiesterases.
”The 2 C’s” entry in column 3 should align with the entry for
91 VitaminB2 (riboflavin) Deficiency.
(1) The arrows for dihydropterin reductase reaction are both
pointing the wrong direction. The enzyme should recover THB
from DHB and make NADP+ from NADPH. Reverse the arrows.
107 Catecholamine synthesis (2) Change “Dopamine ß-hydroxylase” to “Dopamine.”
Change the entry for "Primitive ventricle" to "Trabeculated parts of
123 Heart embryology right and left ventricles.”
Posterior fossa
127 malformations Change Chiari II to Chiari I.
The list of muscles of pharyngeal arch 1 includes the anterior 2/3
of the tongue. While it is true that CN V supplies somatic sensation
to the mucosa of the tongue via the lingual nerve, it does not
innervate any of the muscles of the tongue. All of the muscles of
the tongue are innervated by CN XII, with the exception of CN X's
128 Branchial arch derivatives contribution by innervating the palatoglossus.

132 Kidney embryology In the last line of text, change “uteropelvic” to “ureteropelvic.”
Change the media used for isolation for Legionella to include iron
138 Special culture requirements in addition to cysteine.
Note that tuberculoid disease is the result of high cell-mediated
immunity with a largely Th1-type immune response, and
lepromatous leprosy is characterized by low cell-mediated
149 Leprosy (Hansen’s disease) immunity with a humoral Th2 response.
Include a third, and newest, triple therapy for H. pylori, (3) proton
pump inhibitor, clarithromycin, and either amoxicillin or
152 Helicobacter pylori metronidazole.
 In the entry for Reoviruses, note that coltivirus (not reovirus) is the
168 RNA viruses cause of Colorado tick fever.

180 Red rashes of childhood Revise the clinical presentation of Mumps virus to include rash.
Sexually transmitted In the entry for bacterial vaginosis, note that it can be sexually
181 diseases transmitted, but it is not exclusively an STD.
Change the statement "C. trachomatis --the most common STD in
the United States" to "C. trachomatis -- the most common bacterial
181 Pelvic inflammatory disease STD in the United States."
In item 6 under “Area of body,” change “Anal canal below” to “Anal
canal below pectinate line" with “primary lymph drainage to the
200 Lymph drainage superficial inguinal nodes.”
Change the classical pathway convertase for C3 from C4b,2b to
207 Complement C4b2a.
Under Bruton's agammaglobulinemia, in the Defect column,
change “blocks B-cell differentiation/maturation” to “blocks pro-B
213 Immune deficiencies cell from forming pre-B cell.”

216 Sirolimus (rapamycin) Note that sirolimus inhibits (not binds to) mTOR.

220 Necrosis In item 5, change “Fibroid” to “Fibrinoid.”

222 Free radical injury In item 3, change “CCi4” to “CCl4” (carbon tetrachloride).

229 Oncogenic microbes Under EBV, add Hodgkin’s lymphoma.

Under “Neoplasm,” change “Renal cell carcinoma,
hemangioblastoma” to read “Renal cell carcinoma,
Paraneoplastic effects of hemangioblastoma, hepatocellular carcinoma,
229 tumors pheochromocytoma.
Change text in first paragraph to “”conversion of lactate to
246 Alcohol toxicity pyruvate…”
Change the entry under Subendocardial infarcts to
"Subendocardium especailly vulnerable to ischemia due to fewer
272 Types of infarcts collaterals, higher pressure." (all on one line.)
Change the title of the Fact from “Rheumatic heart disease” to
276 Rheumatic heart disease “Rheumatic fever.”

305 Propylthiouracil, methimazole Propylthiouracil can also cause hepatotoxicity.

In the diagram, change “Mucularis mucosae” to "Mucularis
310 Digestive tract anatomy mucosa."

313 Portosystemic anastomoses Delete the number “4” from the diagram.
Change the text under Pepsin regulation, third column,to
318 GI secretory products “…stimulation and local…”
Move the reference to “Gastric lumen” to the other side of the
319 Gastric parietal cell diagram under “Gastric parietal cell.”

320 Carbohydrate digestion Under “Salivary amylase,” change “dextrans” to “dextrins.”

Change “Dx: Pertechnetate. Study for ectopic uptake.” to “Dx:
327 Meckel’s diverticulum Pertechnetate study for ectopic uptake.”
Wilson’s disease (1) Remove "Choreiform movements" from the list of
(hepatolenticular characteristic features.
333 degeneration) (2) Next to "Dementia," add dyskinesia and dysarthria.
In reference to biliary colic, remove the phrase that states, "...
cause bile duct obstruction which results in bile duct contraction."
335 Gallstones (cholelithiasis) It is a repeat of the previous sentence.
Change the Adhesion box entry to “Platelets bind vWF via GpIb
346 Platelet plug formation receptor at the site [not side] of injury only (specific).”
Normocytic, normochromic Remove G6PD deficiency from extravascular hemolysis and
350 anemia include under intravascular hemolysis.
 Intrinsic hemolytic normocytic Note that the text “synthesis of GPI anchor” appears twice near
352 anemia the bottom of the page. Delete one occurrence of this text.
Note that the M protein in multiple myeloma is most commonly IgA
or IgG. Multiple myeloma cells produce excessive monoclonal
proteins, called M proteins, and are recognized as IgA, IgD, IgG,
358 Multiple myeloma IgE, IgM. The M protein level is referred to as the M-spike.
Change the CML Comments to "Responds to imatinib (a small
molecule inhibitor of the bcr-abl tyrosine kinase).” Imatinib is not
359 Leukemias an antibody.
Chronic myeloproliferative Shift the second CML label down one line so that it aligns with
361 disorders "bcr-abl transformation leads to..."
(1) Note that RCC, Wilms' tumor, cyst, HCC, and hydronephrosis
are associated diseases of inappropriate absolute polycythemia
due to ectopic erythropoietin.
(2) Note that EPO is increased (not decreased) in polycythemia
361 Polycythemia vera.
Note that the "decrease" sign in the first sentence refers to both
362 Heparin thrombin and Xa levels.
(1) Change “Median (C6-C8, T1)” to “Median (C5-C8, T1).”
(2) In the third column, the “ape hand” description should indicate
that a distal median nerve lesion can also cause “ape hand.”
(3) The median motor deficits are transposed. Switch the positions
374 Upper extremity nerves of “Lateral finger flexion/wrist flexion” and “Opposition of thumb.”
There is no perifascicular inflammation in polymyositis. In
386 Polymyositis/dermatomyositis dermatomyositis, perifascicular atrophy is sufficient for diagnosis.
Include a reference to image 66 in the description of acanthosis
389 Skin disorders (continued) nigricans.

397 Neurotransmitters Note that Ach in REM sleep is increased, not decreased.
(1) Change the VPL reference from "position and proprioception”
to “pressure, touch, vibration, and proprioception."
(2) Note that the input of the MGH is the superior olive and inferior
399 Thalamus collculus of tectum [not pons].
Cranial nerve III in cross- Note that the output to ocular muscles is due to decreased [not
423 section increased] diffusion to interior.
In item 7, central scotoma, change the image of the left eye to
show a dark circle in the middle as opposed to being completely
423 Visual field defects shaded in.
Note that partial seizures most commonly originate in the medial
426 Seizures [not mesial] temporal lobe.
429 Herniation syndromes Redirect arrow 3 from the uncus through the tentorium cerebelli.
Neurotransmitter changes
442 with disease Under Huntington’s disease, add “↑ dopamine.”
Signs and symptoms of Under “alcohol,” add a period after "Serum
450 substance abuse γ-glutamyltransferase (GGT) - sensitive indication of alcohol use"
The top of page 451 is a continuation of Signs and symptoms of
substance abuse from page 450. The top of page 451 should be
Signs and symptoms of changed to include the title, “Signs and symptoms of substance
451 substance abuse abuse (continued).”
(1) In the upper left drawing, within the proximal convoluted
+ - +
tubule, show that H2CO3 splits into H and HCO3 and the H then
goes into the lumen and the HCO3 goes into the interstitium.
(2) In the lower right drawing, change the label from “Distal
461 Nephron physiology convoluted tubule” to “Collecting tube transport.”
For Alport’s syndrome, change “deafness X-linked dominant” to
“deafness X-linked.” Transmission of Alport's syndrome can be X-
467 Nephritic syndrome linked, autosomal recessive, or autosomal dominant.
Note that focal segmental glomerulosclerosis, not membranous
glomerulonephritis, is the most common cause of adult nephrotic
468 Nephrotic syndrome syndrome.
 Under Ammonium magnesium phosphate, in the Notes column,
delete “magnesium”; these stones are caused by infection with
469 Kidney stones urease-positive or radiolucent bugs.
In the right column, insert a comma between “Smoking” and
470 Transitional cell carcinoma “Aniline dyes.”
Note that some text is repeated: "and flagellum (tail) from one of
479 Derivation of sperm parts the centrioles" and "Tail forms from centrioles."
In the diagnosis/disease associated with “hypertension,
hypokalemia, metabolic acidosis,” delete the “1°
519 Classic presentations hyperaldosteronism” in parentheses.
(1) In the diagnosis/disease associated with “Hair-on-end (crew-
cut) appearance on x-ray,” change extramedullary hematopoiesis
to marrow expansion.
(2) Hilar lymphadenopathy, peripheral granulomatous lesions in
middle or lower lung lobes” is associatd with a Ghon complex (not
524 Classic labs/findings a Ghon focus).
Add these pages to the index entry:
275, bacterial endocarditis
604 Endocarditis 275, Libman-Sacks endocarditis

I-21 Image 86A Change “hyercellularity” to “hypercellularity.”