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on July 30, 2005
I actually used the 2004 edition of First Aid, but it doesn't change much from year to year. Here is what you need to know about how to ace the USMLE Step 1:

1. First Aid is your bible. Read it, study it, know it. I honestly believe that if you had this book memorized cover to cover and nothing else, you would do very well on the USMLE Step 1.

2. Use Kaplan QBank. I recommend completing most of it (the regular QBank, not the IV QBank, which I didn't use), but you don't have to finish all of it. Keep a list of your errors and review your list periodically (at least twice per week) before you do more questions.

3. The BRS books are useful for fleshing out your review of physio and path. Use them during your courses if possible.

4. "Clinical Microbiology Made Ridiculously Simple" has great pictures to help you remember micro stuff. It's best if you use it during your micro course, then just skim the stuff you highlighted to help you solidify micro before the boards.

5. First Aid is pretty spotty on anatomy (which includes embryology, gross anatomy and neuroanatomy) but there really is very little anatomy on the USMLE Step 1. It's a subject you can get very bogged down in with pretty low yield (as in a whole book on neuro, embryo and gross for a few questions on the actual exam, and will you even remember the details anyway?), and you won't lose many points by just using First Aid for this subject. I actually ended up reading High Yield Gross, High Yield Embryo, and Clinical Neuro Made Ridiculously Simple, and I think it was mostly a waste of time because of how little I retained. Clinical Neuro Made Ridiculously Simple isn't a bad book to have in general, though--it cleared up a number of clinical points not well-covered in my neuro course.

6. For biochem, behavioral science and pharmacology, First Aid is all you need. I know that may sound blasphemous, but trust me. It's what I did and look at my score. There may be one or two questions that come up during the exam on things you've never heard of, but it's not worth all the extra time you'd put into going through other whole books or overly comprehensive sets of flashcards. And would you remember the obscure things anyway?

So that's all you need. Remember, when it comes to test day it's not what you went over that counts but what you REMEMBER. Repetition with First Aid (and BRS physio and path) will help you more than grazing over several review sources on each subject. Don't waste too much time on anatomy. And if you study like I did, you can still have a life (sort of) while studying for the boards! GOOD LUCK!
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on July 3, 2006
SO i took step 1, two weeks ago...i trusted the advice of my friends and studied mainly from this book! although this book may seem like just a list of facts...USE IT as a guide....for my version of the exam...I was able to answer almost ALL of the questions based on knowledge from this book....there's proabbaly 10% of the test that tested on obscure facts, and i know for sure the first section of my test was the experimental questions (questions nbme uses to try out new questions) the answer choices were all ambiguous and weird!!! at that point i was like HoLY [...] i shoulda studied from more sources...but after that section was over...I started to DO MAJOR damage to that test....90% of the questions were covered in FA, but here's the kicker...the test only covered 25% of FA ( i literally had like 5-7 gout questions)...simply put...if you know this book youll do GREAT! more importantly in order to consolidate this information i suggest doing qbank on RANDOM...do atleast 100 a night...u'll finish in 22 days...refer back to first AID while u do the questions......and take notes from qbank and write it into your first AID...that helped me a lot! learn from qbank...do it in TUTOR mode and read the answer explanations...I also used the pathology robbins review {question book) did all 1000 of them...100 questions a day for 2 weeks...i did this prior to starting qbank...but i forgot most of the information i learned from the book tho...but it did help me refresh a lot of pathology... I Would read the corresponding sections in BRS and do the path questions...and take notes into BRS...that way when i later reviewed BRS all that info would be there for me....and i also read pathophysiology for boards and wards(takes only one day)...which i thought was BETTER than BRS because it gives u more clinical findings than BRS...read both if you can...but there ARE many mistakes in pathophysio for boards and wards...i also read high yield anatomy and embryo...TOTAL Waste of time...all anatomy questions and embryo that I had were answerable using FIRST AID... also DO NOT BELIEVE IT WHEN PEOPLE TELL U the versions don't change from year to year...I owned the 2004 edition...a month before the test i went to the bookstore...and glanced over the 2006 version...THERE IS WAY MORE INFO in the 2006 version...atleast a good 40 pages more...and the font is smaller...so FIRST AID is basically new and improved!!! SO I bought the 2006 version and transfered the notes from the 2004 version i had taken during my coursework into the 2006 version...50% of my notes were already added into the 2006 version!!! get the 2006 version...if you have an old version get rid of it...of course for biochem...i read lippincotts just to make some sense out of all the random facts in first aid...if your doing things like memorizing every pathway in biochem you're wasting your time...memorize the ones given in FIRST AID ESP RATE LIMITING REACTIONS!!!...and make sure they make sense to you....and if it doesn't make sense...save it for "blind memorization" before the exam....but the most important things you can do for yourself is...read FIRST AID from front to back cover...it'll take about 6 days...you have to do this so you know what info is covered...then divide up your days... i did...1 day behavioral(FA only)...1 day biochem(lippincott), 1 day embryo(High Y), 1 day anatomy(high Y),1 day neuro,(use clinical neuro made ridiculously simple and FA's neuro section) 2 days physio (BRS-VERY IMPORTANT BOOK) 2 days pharm (mainly FA,some lippincott) 2 days micro(FA and microbio ridiculously simple CHARTS), 5 days path(BRS+patho board and ward) (if you find yourself using more than 1 day on anatomy or embryo...ur studying way too much... MOVE ON and study wats in first aid!)these study days were 8 hours reading from texts...and 3-4 hours doing questions at night...about 11-12 hrs a day for 5 weeks... the last week i spent rereading first aid twice...reading it once probaably would have been enough...the 2nd time reading it you tend to start glancing over information and not focusing as much...by now all u can fit in your brain...is already in there...so be a man...and take the test!!! don't get bogged down if your first section the questions are harder than qbank...its most likely the experimental...they'll get easier after that...and after the test...u'll hug and kiss your FIRST AID 2006. good luck med students...the journey has just BEGUN!
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on December 20, 2006
I found this in a forum, I won't say anything just read this before you exam:

A bunch of emails have been going around my class with the First Aid 2006 errata..there are tons, and even missing pages!!!

I've copied & pasted what I can find so far, and obviously, use at your own risk but most are obvious... and 2 attachments of 2 PDF files of missing pages - one for micro (Rickettsia) & Cardio drugs.,

age#--correction

72--it should read "Kubler-Ross Dying Stages" (not grief stages)

161--Micro - Most common cause of bacterial meningitis in adults 18-60 is Strep pneumo. N meningitidis is still the most common for 6 - 18 yr olds (from uptodate)

187--the complement cascade show C4b2*b* as classic C3 convertase and C4b2*b as classic C5 convertase. It should be C4b2_*a*_ = classic C3 convertase and C4b2_*a*_3b = classic C5 convertase

208--St. John's Wort is an inducer of CYP (3A4), not an inhibitor. (checked JAMA)

221--EDV and ESV are swapped in the pressure-volume relationship in the cardiovascular section

221--the PV-curve shows what happens with an increase in afterload AND contractility. So put a little "[up-arrow] contractility" next to "[up-arrow] afterload"

259--In "Other hypothalamic/pituitary drugs" GH is somatoTROPIN. Octreotide is the analogue of somatostatin.

274--Barrett's esophagus is replacement of nonkeratinized squamous epithelium with INTESTINAL columnar epithelium in the distal esophagus (not gastric)

275--"Usually squamous cell carcinoma" Actually, squamous cell CA and adenocarcinoma of the esophagus currently have almost equal incidence due to a rapid rise in adenocarcinoma rates in recent decades (from UpToDate, Qbank)

283--Pirenzepine causes TACHYcardia, not bradycardia as a toxicity (from micromedex)

295--Wilm's tumor is a mutation on 11p (not 11q) (according to BRS and emedicine and Miglet) (for both WT1 and WT2)

310--Imatinib (Gleevec) is NOT an antibody or myclonal. But it is a tyrosine kinase inhibitor.

322--Pemphigus vulgaris = intraEPIDERMAL bullae

344--cavernous sinus syndrome should include opthalmoplegia, opthalmic and MAXILLARY sensory loss

345--swap SR with IO at the top, and IR with SO at the bottom

346--pupillary light reflex sends signal via CN2 not CN3

353--Syringomyelia is from damage to crossing SPINOTHALAMIC TRACT FIBERS in the anterior white commissure.

368--the mechanism of ethosuxamide blocks thalamic Ca+2 channels, NOT thalamic Ca+1

385--#5) SLE - in DIFFUSE PROLIFERATIVE form you get wire-loop abnormality with subendothelial immune complex deposits

Color img 48B--is actually a pilocytic astrocytoma, not a glioblastoma (those are Rosenthal fibers)

Color img 104--Sarcoidosis does NOT have caseation

they're the

area immediately posterior to the central sulcus.

pg 346: Pupillary light reflex -> light in either retina sends a signal

via

CN II (NOT III). the pupils contract bilaterally (consensual reflex)

via CN

III (= solid lines)

pg352- diagram on left: F, which is supposed to be pilocytic

astroctoma, is

usually in the posterior fossa but they drew it in the frontal lobe.

pg353- the spinal cord section diagram for syringomelia- corticospinal

should be spinothalamic

pg 357- herniation syndromes- the uncus is mislabelled.

Differences In the definition of cleft lip on page 117 and 124. What

it

says on page 124 is correct and page 117 should read "failure of fusion

of

the maxillary and medial nasal processes leading to cleft lip."

pg 149 it states that Loa Loa (nematode) is transmitted by the deerfly.

this is incorrect. it is transmitted by the bite of a mango fly,

Chrysops.

Pg 63 - Second chart should be disease vs. exposure, not disease vs. test [Annie Garment]

Pg 87 - Pyruvate Kinase is shown as reversible in the diagram. It's

irreversible. [From Mike Su and Christian Song]

Pg 97 - Liver, Fasting State: Amino acids can indeed enter the TCA cycle directly (after deamination) but this is not true for glycerol or lactate. Glycerol enters the glycolytic pathway by being metabolized to Dihydroxyacetone Phosphate (DHAP) while lactate enters the pathway by being metabolized to pyruvate. Therefore, the arrows should be changed accordingly.

Pg 118 - Under the heading "Embryologic Derivatives", surface ectoderm is said

to give rise to the "epithelial linings". This is mostly incorrect. The ectodermal germ layer gives rise to the *sensory* epithelium of the ear, nose, and eye. Epithelial linings of the gut, UG tract, and respiratory tract are derived from the *endodermal* germ layer. [DT Jacobs]

Pg 140 - "Salmonella has an animal reservoir." Not true of Salmonella Typhi, the strain the causes Typhoid fever! (i.e. it's only in humans).

Pg 141 - E. Coli O157:H7 is a subtype of EHEC, not EIEC.

Pg 154 - The process explained is called "Phenotypic Masking" not "Phenotypic Mixing", which is a different process. I verified this with a research paper which describes the process in the journal of Evolution. [from James Toussaint]

Pg 166 (Chart) - Amoxicillin/Ampicillin can be used for E. Coli, as it says on the very next page.

Pg 302 - Follicular Lymphoma: "bcl-2 is involved in apoptosis." Okay, technically this isn't an actual mistake, but at the very least it's HIGHLY misleading. It should really say "bcl-2 is involved in INHIBITION of apoptosis." It's important to realize that this isn't a matter of underexpression of a pro-apoptotic gene, but rather overexpression of an anti-apoptotic gene.

Pg 319 - Osteomalacia/rickets. Vitamin D deficiency causes a DECREASE in serum phosphate (due to increased renal excretion, which, in turn, is due to increased PTH).

Pg 324 - Temporal Arteritis affects medium and LARGE arteries

Pg 325 - Cox-2 inhibitors: the IMPORTANT toxicity is an increased risk of thrombosis (stroke or MI).

Pg 326 - Etanercept: Mechanism - inhibits BOTH TNF-Ü AND TNF-â

Pg 404, Testicular non-germ cell tumors, Leydig cell: "androgen producing leads to gynecomastia in men, precocious puberty in boys." While it is true that Leydig cell tumors are androgen-secreting (at least initially) and it is also true that later in life

they can lead to gynecomastia, it is incorrect to say that these two facts are

related to each other. Not only does this not make any sense, but it turns out

that adults with leydig cell tumors actually have DECREASED levels of androgens.

Pg 485 - ALL is Acute LymphoBLASTIC Leukemia, not "lymphocytic" leukemia
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on May 15, 2005
Note: This is a revision of a prior review, written in the heat of anger and frustration in the midst of board studying.

I would expect that after several editions, First Aid for the USMLE Step 1 would have fewer errors (which are sometimes in previous editions as well) as well as have tons of minor editorial mistakes which make this a poor reference book. Don't get me wrong: if you are taking the USMLE Step 1, you need this book. It has excellent information and sums several big topics up nicely and concisely. While you are reading BRS Pathology for instance, you will notice that the material correlates really well, and First Aid focuses on the details you need to know. The catch: you need to know each and every word of first aid, as my friends and Q bank would have me believe.

Here are the main reasons I am not completely satisfied with First Aid. In the Index, several of the topics listed reference the incorrect pages. Another reviewer noted that this isn't a big problem, but when you like to flip back and forth like I do, and look up terms that look novel or strange, it is more than irritating to have to flip forward or backward 1-2 pages to find what I'm looking for. There are also many cross-referencing problems on the inside-cover (don't worry too much, though; there's an underground cross-referencing page floating around your med schools to correct this). As I understand, these errors are limited to the 2005 edition.

I also believe in an index having utility and being thorough. First Aid's index is not nearly thorough enough to be able to reference important terms. When tricky or odd-looking terms comes up, go to your Stedman's. Don't try to look for what First Aid has to say about a term because a term may be within the book, but it won't always be in the index (e.g. Fanconi syndrome). Also, many times you have to try to decipher where First Aid wants you to look (e.g. "acid-base chemistry" is indexed, but not "arterial blood gas").

There are also some minor errors and oversimplifications throughout the book. You will correct them with your own markings as you study, but don't necessarily trust First Aid entirely. Go to other sources to confirm the information you are reading. And don't always go to other board review books - sometimes the errors float around several books.
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on March 30, 2006
This book is an essential material for step 1, second to none hands down. I was literally blown away while taking the USMLE step 1 test at how many questions I can recall that I saw in the First Aid.

Everyone I know loves this book; Kaplan's best instructors reference this book. In my view if you paid attantion in Med school classes (the material is not brand new to you) for Step 1 exam get this book + questions (lots of questions) from NMS or/and Qbank. That is it, nothing else. But you MUST go over the book material more than once, first review it all, then while studying questions, go over each information from the First Aid book again and again.
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on March 12, 2006
The United States Medical Licensing Examination Step 1 is one of those thests that isn't very hard, but the results are very important. There are several review books out there, and what makes this one special is a fair question.

You will find the answer to that question in the first few pages of the book. Here they ask you the student to use the book, but then to contribut to the next edition by sharing what you remember about the test, what text books you would recommend, and most important, to identiry any errors in this book that you might find.

This kind of feedback is most important. The alternative is to have a book written by a few people that think they know best for what the students need.

After taking three years to write, this book was first issued in 1993. Since then there have been annual editions each year to reflect changes in the test and improvements in the approach.

As for what's in the book, you know already. It's a summary of everything in your text books. It's not a replacement for your texts, it's distilling out what you need for the test. And oh yes, there are lots and lots of specialized words, but I expect that doesn't come as a surprise.
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on September 20, 2006
There is a reason this book is ubiquitous among students studying for USMLE Step 1: it gets results. It contains a section giving advice for studying for the test, high-yield facts and figures for the subjects, and reviews of other resources. It is a great value for the price.

The best way to use this is as a master study-guide. Get it early 2nd year and use it with your courses as you go along. Also, get a long (9-12 month) subscription to Kaplan's QBank (another Step 1 necessity) and do those questions as you go along with your courses. Make notes in your copy and turn it into the perfect resource to use for Step 1, and study it over and over. Ideally, you'll have gone through First Aid a few times and done all the QBank questions by the end of 2nd year. If you can do this, you'll be very well prepared for the test while all your classmates are flipping out.

There are some areas that First Aid needs some first aid of its own. Physiology, being more concepts based, is not suited for quick review with high-yield facts. Path and micro are also too broad for short review. The anatomy (gross, histo, and embryo) is somewhat weaker in first aid, but these subjects are not highly represented on the test anyway. So, for supplementary review, use BRS Physiology and Pathology, and Clinical Microbiology Made Ridiculously Simple. If you have time, you can consider High-Yield Behavioral Science and High-Yield Gross, Histo, or Neuro, but don't get bogged down with anatomy, as it is a small part of the test.

Unfortunately, there are some disciplines in medicine that will be very hard to get into unless you have high board scores, and Step 1 is generally considered to be the more important of the Steps as far as getting a residency goes. If you prepare early and study high-yield material again and again, and practice, practice, practice doing questions, you will ace the exam. Don't try to know everything. I scored a 252/99 on the test, and if you're reading this review, you can do as well or better. Get it now, use it, and ace the test!
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on August 6, 2006
Great book for revision, though not a single source for all you need to know for the exam. Good indication of which concepts are important. I recommend it highly if you have studied from many other sources, and need to put everything together.
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on June 29, 2006
If you plan on taking the USMLE Step 1, forget about trying to read all of those high yield books... there just isn't time. Instead, study this book, and hit up the Kaplan Qbank and you should be in good shape if you've been paying attention in classes for the past two years (if not, it's gonna take a lot more than this to get you through it). It's got very concise and specific info that's great for answering standardized test style questions. It's absolutely essential, and worth the investment. Also, if you have an older version... keep it. All the newer ones really have is a few extra pictures. They dont change much year to year (probably because, go figure, most basic science doesn't change much year to year), but for sure grab one of them because it will save you a lot of time, and can only help your score.
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on September 14, 2006
Having just taken the Step 1, I have to say that I am considerably less enthused with this book than most everyone else. It does do a good job of reviewing the basic points and some of the associated details. However, I found that quite a few items on my test did not appear in First Aid at all, and that overall the level of detail was insufficient. I was also using QBank and BSR and altogether they still failed to include enough material on courses taught in the first year, specifically pharmacology and cellular pathways, which were heavily emphasized on the exam. So while this book is definitely a nice point to jump off from, it could use some heavy updating.
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