Step 1, from the mechanism up.
Original notes that teach why things happen, a question bank that explains every option, and flashcards that schedule themselves. Written by a final-year medical student.
- 1,045 questions
- 39 chapters of notes
- First Aid 2026 page on every topic
A 68-year-old man with stage 4 chronic kidney disease is brought to the emergency department because of generalized weakness for 1 day. His medications are lisinopril, spironolactone, and furosemide. His pulse is 48/min, and blood pressure is 112/68 mm Hg. Serum potassium concentration is 7.6 mEq/L. An ECG shows tall, narrow, peaked T waves, absent P waves, and a QRS duration of 150 msec.
Which of the following is the most appropriate initial pharmacotherapy?
Severe hyperkalemia with ECG changes is treated first with intravenous calcium, which stabilizes the cardiac membrane without lowering potassium; drugs that shift potassium into cells and drugs that remove it follow.
- 1,045exam-style questions, with more added every week
- 39chapters of original notes, mechanism first
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Everything for Step 1 in one place
Read a topic, test it, then keep it with spaced repetition. Each part links to the others.
- Notes39 chapters that start from normal function and build to the exam pattern and the traps.
- Question bank1,045 questions in tutor or exam mode, timed or untimed, with a reason for every option.
- FlashcardsDecks written from the notes, scheduled so you review each card just before you forget it.
- Quick referenceFormulas, lab values, drug tables and side-by-side comparisons for the last week.
- First Aid 2026 pagesEvery topic shows the matching page, so your book and the notes stay in step.
Organ systems › Renal › Nephrotic syndrome
Diabetic nephropathy
The earliest change is not damage but hyperfiltration. Glycation stiffens the efferent arteriole more than the afferent, so pressure inside the glomerulus rises before the GFR starts to fall. FA 616
Mechanism
- Hyperglycemia
- Efferent hyalinosis
- High glomerular pressure
- Mesangial expansion
- Nodular sclerosis
High-yield
ACE inhibitors, ARBs and SGLT2 inhibitors all lower glomerular pressure; SGLT2 inhibitors do it through tubuloglomerular feedback on the afferent arteriole.
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Who wrote this
I'm a final-year medical student. I wrote these notes for my own Step 1 preparation because I wanted one source that explained the mechanism first and the facts second.
Every chapter, question and flashcard is original. First Aid page numbers are there so you can cross-check, not because anything is copied from it.
Questions
What's included?
The full notes (39 chapters and the quick-reference pages), the whole question bank with new questions each week, flashcards with spaced repetition and your progress across all three.
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First Aid for the USMLE Step 1, 2026. Page numbers are references only; nothing is copied from the book.
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