UW終わり。
解答時間は平均90秒とギリギリ。
UW復習とこれまでのまとめノートを毎日少しずつやっています。
毎日80−100問が限界。最低40問としてやってきましたが、そこそこ時間がかかりました。
睡眠時間をあまり削らす、働きながら勉強するとこんなもんかと。
苦手なのは遺伝と生化学と統計ですね。
得点源となる分野からやっていたので当然の結果ですが。
自分の研究に関連する統計知識・今まで診察したことがある遺伝疾患は当然すぐにわかるのですが、
それ以外は全く頭に入ってこないですね。
今日もがんばります。
年内に受けたいな。
UW再開し約1800問
Anki、Rxの復習を含め毎日少しずつやっています。
まら、忘れてますね。
解説すればすぐ思い出すのですが、時間制約の元でやっているとなかなか。
OETの勉強も少し。
オンライン英会話はCamblyで週3、30分です。
相性がよい先生と定期的にやっています。
フリートークとIELTSのスピーキングを適当に。
一旦復習終わり。
871項目。
重複も多々。
見返しつつAnki。
1.Adenosine diphosphate ribosylation of adenyl cyclase and activation of Gs
→Vibrio cholerae toxin："rice-water" diarrhea.
Inhibition of Gi→Bordetella pertussis toxin：flu-like symptoms
2.anemia of chronic disease(ACD)：cytokine-mediated dysregulation of iron metabolism.
ACD is usually normocytic (25% of cases are microcytic).
慢性炎症に伴う貧血は25%で小球性
3.Adverse effects of fibrates include cholesterol gallstones, myositis, and hepatotoxicity.
フィブラートの副作用は筋痛、胆石、肝障害。
4.Digoxin inhibits Na+/K+ ATPase.：uses adenosine triphosphate to extrude three Na+ ions out of the cell for every two K+ ions brought into the cell.
ATPつかってナトリウムイオン3つを細胞外へ、カリウムイオン2つを細胞内へ。
→ジゴキシンで障害されると細胞内のナトリウム濃度上昇→細胞内カルシウムを細胞外へ汲み出すNa+/Ca2+ exchangerの作用低下→→細胞内でのCa2イオン濃度上昇→→cardiac contractility
で心筋収縮力上がると。
5.【Müllerian agenesis】：primary amenorrhea, absent or underdeveloped uterus, and a blind vaginal pouch.
Müllerian agenesis is caused by the absence of the paramesonephric (Müllerian) duct in utero.
Müller管無形成。
6.【Androgen receptor defect】 leading to androgen insensitivity.
2次成長なし
7.【Bloom syndrome】,defective DNA repair
・characterized by a long, narrow face with an underdeveloped malar region, along with redness and telangiectasia in a butterfly distribution on the cheeks and nose, exacerbated by sun exposure.
Patients have short stature, skin hyper- and hypopigmentation, and café-au-lait spots.
・associated with an increased risk for malignancies such as leukemia and lymphoma.
8.【Hartnup disease】deficiency of neutral amino acid transport in the brush-border membrane of the small intestine and the proximal tubule of the kidney
→decreased absorption of tryptophan and subsequent deficiency of vitamin B3.
It presents with glossitis, as well as diarrhea, dementia, and photosensitive dermatitis.
9.【Xeroderma pigmentosum】
photosensitivity and increased lentigines and ephelides.
It is the result of a defect impairing the cell’s ability to repair damage from ultraviolet radiation.
10.Osimertinib： irreversible epidermal growth factor receptor(EGFR)
tyrosine kinase inhibitor that binds to select mutant forms of EGFR common to some tumor cells.
EGFR阻害。
11.Bortezomib inhibits the function of proteasomes, interfering with regulation of protein homeostasis within the cell.
プロテアソーム阻害。
12.Vinblastine binds to tubulin and inhibits microtubule assembly and arrests cells at metaphase.
13.Rituximab is a monoclonal antibody raised against the CD20 antigen on the surface of B lymphocytes. Antigen binding blocks cell cycle initiation and activates complement-dependent B-cell cytotoxicity.
14.Erlotinib reversibly inhibits epidermal growth factor receptor (HER1/EGFR) tyrosine kinase activity, with highest binding to mutant forms common to some tumor cells.
15.Uncal herniation is characterized by CN III palsy and fixed and dilated pupil.
16.Estrogen increases hepatic synthesis of TBG, leading to increased total T3/T4 levels but normal free T3, T4, and TSH, with no thyroid symptoms.
エストロゲンは肝臓に作用してTBG産生。
T3上昇するが、フリーT3、T4、TSHは正常
17.【prolactinomas】
prolactin-induced milk production and hypoestrogenism secondary to prolactin suppression of gonadotropin-releasing hormone.
Women with hypoestrogenism are at increased risk for oligo/amenorrhea, anovulation, decreased bone density and osteoporosis, and vaginal atrophy.
下垂体腫瘍プロラクチノーマ
→乳汁分泌とエストロゲン低下→無月経、骨粗鬆症、膣萎縮
18.Amphetamines such as dextroamphetamine can cause serotonin syndrome.
19.Epinephrine stimulates glucagon secretion and provides energy substrate for the fight-or-flight response.
エピはグルカゴン分泌刺激。
Norepinephrine acts to stimulate glucagon secretion and provides energy substrate for the fight-or-flight response.
ノルエピもグルカゴン刺激。
20.Insulin secretion is stimulated by hyperglycemia, but also by fatty acids and amino acids in the blood, incretins (eg, glucagon-like peptide 1), gastrointestinal inhibitory peptide, and some antidiabetic drugs like sulfonylureas.
Incretins are released from gut enteroendocrine cells after eating and augment islet cell secretion of insulin.
21.poison ivy：type IV hypersensitivity reaction(allergic contact dermatitis)
triggers differentiation of CD4+ T lymphocytes into T-helper type 1 lymphocytes.
4型アレルギーはCD4関与。
つかれました。
手抜き。
ほぼほぼ。
1.Angiotensin II, atrial natriuretic peptide(ANP), insulin, and vasopressin signal through cell-surface receptors.
Aldosterone binds its receptor in the cytosol, after which the receptor-hormone complex transits to the nucleus.
アルドステロンはcytosolの受容体に結合→核へ
2.IL-8 attracts neutrophils
IL-8は好中球遊走
3.高地に適応するのに2,3-bisphosphoglycerateが増える→oxygen-hemoglobin dissociation curve右へ。
4.Hepatitis A virus (HAV) はpicornavirus。
5.TB is caused by Mycobacterium tuberculosis, an acid-fast bacillus.
Part of its virulence is related to a major glycolipid in the mycobacterial cell wall called “cord factor,” which creates a microscopically clumped appearance of the cells, called a “serpentine cord.” Cord factor activates macrophages and induces the release of tumor necrosis factor-α, contributing to the formation of caseating granulomas.
結核：TNFαを分泌させ乾酪性壊死を形成。
6.Protein Aは黄ブ菌。
7.M proteinはS.pyogenes。
8.Lipid Aはグラム陰性菌の外膜にあるendotoxin。炎症、septic shockに関与。
9.Central DI is associated with low urine osmolality, hypernatremia (when patients can’t drink water), and positive free water clearance.
下垂体腫瘍摘出→ADH低下→Central DI→Free water clearance of 2.5 L per day
10.【Invasive ductal carcinoma】
組織)atypical glandular cells that form irregular tubules within a dense connective tissue (desmoplastic) stroma.
Metalloproteinases allow degradation of the basement membrane
→progression from carcinoma in situ to invasive carcinoma.
11.Subepithelial electron dense deposits are seen in other forms of glomerular disease, such as membranous glomerulonephritis
上皮下蓄積→膜性腎症。
12.Mixed cryoglobulinemiaはsmall vessel vasculitis。抗原抗体物質の蓄積antigen-antibody depositionによる。 腎組織でmembranoproliferative glomerulonephritis with glomerular immune complex deposition and subendothelial electron dense deposits.
内皮下
13.【Postpartum blues】：within 2 to 3 days of delivery,
depressive symptoms such as dysphoria, insomnia, fatigue, and impaired concentration.
程度はmildでself-limiting。
・resolving within 2 weeks of onset.
2,3日で症状が出現し、数日でピーク、2週間以内に改善。
14.【Postpartum psychosis】：within 1 month of delivery.
a maniclike episode of agitation, expansive or irritable mood, delusions, hallucinations, and severe lack of sleep for several nights.
マニック！
15.【Postpartum hypothyroidism】
associated with depression 2 to 6 months after having a baby, but this patient has no other symptoms of hypothyroidism (eg, cold intolerance, constipation, or dry skin).
2-6ヶ月のうつ、その他甲状腺症状なし。
産後の精神症状は発症時期で比較的鑑別可能。
16.Pooling of abnormal circulating RBCs in the spleen
←the mechanism of splenic sequestration crisis seen in sickle cell disease.
abnormal RBCs are trapped in the spleen leading to acute splenomegaly and an acute drop in hemoglobin level.
異常RBCが脾臓でトラップ。
17.Risk factors for cataracts in children
・metabolic disorders (classic galactosemia, galactokinase deficiency)
・chromosomal disorders (trisomy 13, 18, 21)
・ToRCHeS infections (eg, rubella)
・genetic disorders (Marfan syndrome, Alport syndrome, myotonic dystrophy, and NF 2).
18.【Maple syrup urine disease】
results in an increase of leucine levels due to deficiency of the branched-chain alpha-ketoacid dehydrogenase complex.
αケト酸。
19.【Hereditary hemochromatosis】
・autosomal-recessive disorder leading to hepatic cirrhosis.
・a disorder of the HFE gene→excess absorption of iron, which leads to elevated saturation of transferrin with iron.
ヘモクロマトーシスは鉄吸収過剰。
20.Purkinje cells transmit cerebellar cortical activity to the deep cerebellar nuclei.
Purkinje cells are inhibitory neurons and use GABA as its neurotransmitter.
21.Acetylcholine and glutamate are excitatory, not inhibitory, neurotransmitters.
Dopamine and glycine are neurotransmitters that can be inhibitory but are not found in the cerebellum.
アセチルコリンとグルタミンは興奮を伝える。
ドーパミンとグリシンは抑制だか小脳には存在しない。
22.Microtubule assembly/disassembly
→ビンクリスチンとパクリタキセル
23.Replicative infectious forms describe the elementary and reticulate bodies of Chlamydia trachomatis, which is not visible on Gram stain.
クラミジアはGram染色じゃみえんよ。
24.A helical shape with two cell membranes and flagella trapped between them is a characteristic of Treponema pallidum. It is visualized with dark-field microscopy, not Gram stain.
梅毒はhelical shape。Gram染色ではみえん。
25.
Neisseria meningitidisはpolysaccharide capsuleをもち、meningitisを引き起こす。
26.Tinea corporis
治療はtopical or oral antifungal therapy（ketoconazole)
ケトコナゾールはfungal cytochrome P-450を阻害することでfungal membrane sterols合成阻害。
27.Transduction involves DNA transfer from infection of a virion packaged with DNA (a so-called lytic phage) from another bacterial cell.
Transformationは周りの環境から新しいDNAを取り込むプロセス。
Translocationは同じ染色体内あるいは別の染色体から別の場所へ移動。
ざっくり。
28.へその緒がなかなか取れない→LAD
LAD type I：decreased expression or function of CD18。
29.Nephrogenic DIはADH resistance(principal cells of the cortical collecting duct).
腎性尿崩症はADHに反応しない。集合管の主細胞が原因。
30.リウマチ熱はGASによる。GASの毒素はM蛋白。
M蛋白の抗体は自己抗原にも反応する→molecular mimicryという。
特に心臓とCNSに蛋白がM蛋白抗体が作用するため雑音やSydenham choreaを引き起こす。
31.Hb Barts diseaseが最もsevere formな α-thalassemia・
all four α-globin genesがないパターン。
→inability to make HbA1, A2, and F.
RBCsは4つのγ-chainsで構成さてる。
●This disease is fatal in utero.
32.HbHはthree of the four α-globin genesがないパターン。
→↓α-chain production、abnormal Hb called HbHが増える。
33.Pericarditisはcoxsackievirus
コクサッキーはRNA virusでPicornaviridae family。
34.
Positive, single-stranded, helical RNA virus→Coronaviridae
コロナはヘリカル。
35.HDV is a deficient virus that utilizes hepatitis B envelope proteins (HBsAg) to release its progeny via a process called complementation. HDV requires coinfection with HBV to infect a host
HDVはHBVがいないと生きていけない。
36.Cannabis intoxication is characterized by altered mental status, increased appetite, conjunctival injection, and slurred speech.
大麻はオランダで勧められた。吸ってはいない。だらっとなる。
37.Antihistamine intoxication presents with findings consistent with anticholinergic toxicity, including elevated pulse, respirations, and blood pressure; mydriasis; decreased bowel sounds; dry skin; and dry mouth.
抗ヒスタミン中毒は抗コリン中毒と似ている。
テンション上がる方のやつ。
38.Amphetamine intoxication presents with findings consistent with sympathomimetic toxicity, including elevated vital signs, mydriasis, decreased bowel signs, wet skin (perspiration), and agitated mood.
アンフェタミンは交感神経上がる系。むーどもあじてーと。
39.Decreased inhibitory neurotransmitter release by toxins such as Tetanospasmin (produced by Clostridium tetani) and decreased stimulatory neurotransmitter release by toxins such as botulinum toxin (produced by Clostridium botulinum) would cause spastic or flaccid paralysis, respectively.
40.Finasteride inhibits 5α-reductase to decrease the synthesis of DHT and can be used for the treatment of benign prostatic hyperplasia.
ふぃなす。
41.Borrelia burgdorferiはspirocheteでLyme diseaseの原因となる。
Ixodes tickが媒介。
42.Central DIはdeficient secretion of ADH
ADHはparaventricular and supraoptic nuclei of the hypothalamusで産生。
→travels down the axon through the infundibulum to the posterior pituitary gland, where it is stored until released into the blood.
43.Diabetic retinopathy is a common cause of vision loss in patients with diabetes mellitus and presents with the slow onset of blurry vision, floaters, dark spots, and loss of night vision.
夜盲...?
44.NF2：increased risk for developing cataracts, causing patients to present with blurry vision.
両側腫瘍2個→NF2
45.Acetaminophen overdose has caused acute liver failure.
Acetaminophen is known to cause centrilobular, or zone 3, necrosis.
46.Macrovesicular steatosis can be caused by alcohol abuse, nonalcoholic fatty liver disease, diabetes mellitus, and, in rare cases, use of drugs such as corticosteroids.
副腎皮質ホルモンでも脂肪肝になるよ。
47.Intermediate zone lesions are seen in patients with yellow fever caused by a RNA virus.
イエローフィーバー。
48.Pulmonary fibrosis is a serious adverse event associated with several pharmaceutical agents, including bleomycin, amiodarone, busulfan, and melphalan.
肺腺腫症をきたす薬剤にメルファラン。
49.Lymphoid aggregates with germinal centers and Hurthle cells (seen in Hashimoto thyroiditis) and tall, crowded follicular epithelial cells with scalloped colloids (seen in Graves disease) would be associated with smooth, nontender goiters.
50.肺炎でaerobic bacillary pathogen
→Legionnaires’ disease, caused by L pneumophila and transmitted via inhalation of water droplets from contaminated water systems, is associated with respiratory symptoms, hyponatremia, and gastrointestinal symptoms.
P aeruginosa usually occurs in hospitalized patients or in immunocompromised community patients. It is an aerobic bacillus but not a common cause of hyponatremia or musculoskeletal symptoms.
緑膿菌とレジオネラとの鑑別はどちらもaerobic bacillusだか、緑膿菌は低ナトや筋骨格系の症状はきたさない。
1.A reversal of drug effect with aminocaproic acid would occur with tissue plasminogen activator (tPA).
tPA使用のリバースはaminocaproic acid
2.Perioral dermatitis presents with clusters of 1- to 2-mm erythematous papules or pustules around the mouth, with sparing of the skin directly around the lips, and is often associated with topical or inhaled steroid use or fluorinated toothpaste.
歯磨き粉注意！！
3.Impetigo：a superficial staphylococcal or streptococcal skin infection.
It usually presents with vesicles and honey-colored crusting. The infection is most common in children.
4.The red nucleusはmotor movementsに関与、特にupper extremity flexion.
The cerebellar pedunclesはafferent and efferent fibersが含まれている→movement, coordination, and balanceに関与。
The subthalamic nucleusはbasal gangliaの一部→initiate and control skeletal muscle movement.筋骨格筋のコントロール。
5.Charcoal yeast extract agar, buffered with iron and cysteine, cultures Legionella pneumophila.
おぼえきれん。
3回以上メモに書いてる。
6.Atropine(muscarinic antagonist)
・mydriasis via inhibition of the pupillary constrictor
・cycloplegia (loss of accommodation) via inhibition of the ciliary muscle.
光を当てても縮瞳しないのは毛様体筋が制御されているから。
7.lithiumのモニタリング項目
・thyroid stimulating hormone
・serum creatinine
・serum calcium.
8.Phosphoribosyl pyrophosphateはribose-5-phosphateとATPで作られる。
ribose-5-phosphateはHMP回路hexose monophosphate pathwayで産生。
9.G6PD-deficient patients may have hemolysis after taking oxidative drugs.
G6PD deficiency lowers the reduced form of glutathione.
G6Pはヘキソキナーゼとグルコキナーゼから作られる。
G6PD欠損ではこれらが増加。
10.Norepinephrine causes increased myocyte contractility via β1-adrenergic receptor stimulation, leading to increased Ca2+ influx into the cells.
低血圧の時にエピ。
β作用で心収縮力上げる。
11.Tetanus toxin blocks release of glycine and γ-aminobutyric acid from inhibitory interneurons in the spinal cord, which results in the classic signs of the disease.
12.大腸癌系。
・Familial adenomatous polyposis：AD
・Gardner syndrome：AD colorectal cancer＋bone and soft tissue tumors.
・Peutz-Jeghers syndrome：AD multiple nonmalignant hamartomas throughout the gastrointestinal tract, along with hyperpigmented macules around the mouth, lips, hands, and genitals.
・Turcot syndrome：hundreds of colonic polyps in addition to malignancies of the central nervous system.
13.Highly spiced foods may cause dyspepsia
辛い食べ物は...
14.Risk factors associated with the worsening of peptic ulcer disease and H pylori–induced ulcers include nonsteroidal antiinflammatory drug use, tobacco use, alcohol use, and genetic predisposition.
食事で寛解。
タバコ、アルコール良くない。
15.なんとか小体。
・Döhle bodies are oval bodies found in the neutrophils of patients with infections, trauma, pregnancy, or cancer.
・Negri bodies：for rabies infection.
・Weibel-Palade bodies store and release von Willebrand factor and P-selectin and are normal components of vascular endothelial cells.
16.E coli can colonize in the urinary system primarily due to its virulence factor, fimbriae.
膀胱炎をきたす細菌の病原性はfimbriae。尿管にくっつくだったかな。
The heat-labile toxin is an enterotoxin produced by the Escherichia coli strain that causes traveler’s diarrhea.
旅行者下痢
The heat-stable toxin is produced in enterotoxigenic Escherichia coli. This allows the bacteria to thrive in environments that are as high as 100°C. It is typically seen in traveler’s diarrhea.
The K-capsule is a virulence factor of the Escherichia coli strain that causes pneumonia and neonatal meningitis. It helps the bacteria to avoid phagocytosis as well as promote biofilm formation.
17.Parvovirus B19 infects and destroys red blood cell precursor cells in the bone marrow, leading to aplastic crisis. It would present result in prolonged, severe anemia.
18.Postinfectious GN and Osler nodes are both caused by immune complex deposition in the tissues.
19.The third aortic arch→common carotid artery as well as the proximal internal carotid artery.
3弓は頚動脈と内頚動脈近位。
The sixth aortic arch→proximal parts of the pulmonary arteries and, on the left, the ductus arteriosus.
6弓は肺動脈とPDA。
20.Metformin inhibits hepatic gluconeogenesis, increases insulin sensitivity in peripheral tissues, and increases peripheral glucose utilization to help lower the blood glucose level.
メトホルミンは肝臓に作用し糖新生阻害。末梢でのインスリン感受性改善。
21.Hemolytic uremic syndrome most often occurs in children with Shiga toxin–producing E coli infections, leading to anemia and acute kidney injury.
Schistocytesが見られる。
22.APS：prolonged PTT that is not corrected by mixing 1:1 with fresh-frozen plasma and can be detected by the presence of specific serum autoantibodies, including anticardiolipin or anti–beta-2-glycoprotein.
23.Primary lactose intolerance：diarrhea and flatulence in the setting of a dairy-rich diet, and acidic stool pH and elevated osmotic gap.
・caused by decreased expression of lactase enzyme, which occurs after weaning and increases with age.
・Lactase normally functions to hydrolyze lactose into galactose and glucose.
24.DKA occurs in patients with type 1 diabetes mellitus and is caused by increased ketone formation leading to acidosis.
・hyperkalemia due to potassium movement out of cells.
DKAでは高カリウム。
細胞外へカリウム移動。
25.Mitral stenosis：unusual in developed countries because it typically results from rheumatic heart disease←group A Streptococcusが原因。
During streptococcal infection, antibody cross-reactivity termed molecular mimicry occurs between the streptococcal antigen and the mitral valve leaflets.
僧帽弁狭窄の原因はリウマチ熱。先進国ではレア。molecular mimicryがポイント。
26.Decreased urinary output can occur as a result of inhibition of muscarinic receptors (detrusor relaxation) or α1-receptor stimulation (contraction of bladder sphincter).
ムスカリン受容体刺激で膀胱弛緩、α1で括約筋締める→頻尿予防。
27.【Propionic acidemia】a disorder of fatty acid metabolism
→seizures, poor feeding, and hypotonia, and metabolic acidosis with increased anion gap.
Propionic acidemia occurs as a result of propionyl-CoA carboxylase deficiency
→elevation of propionic acid, and decrease of methylmalonic acid.
28.The first-generation antipsychotics with high affinity for dopamine D2 receptors
→副作用としてacute dystonic reactions such as torticollis, a painful muscle spasm of the neck, and oculogyric crisis.
第一世代抗精神病薬の副作用：斜頚、スパスムス、眼球がジストニア運動により偏位。
ジストニアはunopposed cholinergic activity in the CNSによる。
The treatment of choice for acute dystonic reactions is an anticholinergic agent such as benztropine or diphenhydramine.
29.Hypertension is the most important risk factor for nontraumatic intracranial hemorrhages due to rupture of Charcot-Bouchard microaneurysms of the deep penetrating arteries of the basal ganglia, thalamus, internal capsule, or cerebellum.
脳出血の原因は高血圧。
30.Hydralazine：useful for treating CHF and refractory hypertension, but it can cause reflex tachycardia→increased myocardial demand and angina in patients with CAD.
ヒドララジンはCHFの治療に有効。難治性の高血圧にも。頻脈になる。
31.【Schizotypal disorder】
strikingly odd, with peculiar notions, ideas of reference, illusions, magical thinking, and derealization.
極端にodd。幻覚幻聴。
【Schizoid personality disorder】
characterized by social withdrawal and avoidance of close relationships. typically viewed by others as reclusive and emotionally cold.
冷たい感じ。
32.Effect Modification交互作用
研究対象要因の効果（Effect）が他の要因の有無によって変わる（Modifyされる），つまりワルファリンは納豆を食べなければ効果があるが，食べると効果がなくなるので，ワルファリンの効果は納豆を食べるか食べないかによって変えられる，すなわち2つの要因は交互作用していると言えます。
igaku-shoin.co.jp/paper/archive/y2011/PA02958_03
33.GPAの抗体：anti-PR3 (c-ANCA) autoantibodies.
PR3はproteinase-3 enzyme。
34.Cholecystokinin is released by the I cells of the duodenum and jejunum.
35.Ethanol intoxication is associated with a high serum osmolality.
NAD+ is converted to NADH during ethanol metabolism. The resulting increased NADH:NAD+ ratio in the liver leads to inhibition of gluconeogenesis and subsequent hypoglycemia.
飲酒＋高尿浸透圧→エタノール中毒疑い
エタノール代謝でNAD+→NADH亢進(NADH/NAD+ ↑↑)→肝臓での糖新生阻害→低血糖。
36.Alprazolam and chlordiazepoxide：benzodiazepines
→increased chloride flux that is inhibited by flumazenil.
アルプラゾラム、クロルジアゼポキシドはベンゾ。フルマゼニルでクロール移動制限される。
37.Thiazide diuretics lower blood pressure by inducing sodium diuresis and by acting as mild vasodilators.
サイアザイドにmildな血管拡張作用あり。作用機序はわかっていないがCNSの受容体を介しているかも。
38.hyperkalemia, a low serum bicarbonate, and a normal anion gap (12 mEq/L)
→hyperkalemic (type 4) renal tubular acidosis (RTA).
高カリウムの時にRTA4鑑別。
39.Physical indicators of lactose intolerance include intermittent postprandial diarrhea, bloating, flatulence, and abdominal pain; an elevated stool osmotic gap essentially confirms the diagnosis.
むずいな。
40.Branching enzyme deficiency leads to Andersen disease (glycogen storage disease type IV)
・presents in infancy with hepatosplenomegaly and failure to thrive.
Children with this disease usually have dilated cardiomyopathy and cirrhosis and die within 5 years.
あんだーそん。4型。幼児、肝脾腫、心肥大、肝硬変。
41.Clozapine：atypical antipsychotic
blocks serotonin receptors and dopamine blockade
汎血球減少を来たす抗精神病薬はclozapine。統合失調症の陽性陰性症状に効果あり。
42.a painless thyroid nodule associated with the RAS oncogene and lung metastases
→follicular thyroid cancer
43.tartrate-resistant acid phosphatase positive
→hairy cell leukemia
・anemia, thrombocytopenia, and leukopenia→symptoms）fatigue, easy bruising, and recurrent infection.
44.Lamotrigine：an anticonvulsant
inhibiting presynaptic sodium channels→preventing the release of glutamate.
・used for focal and generalized seizures, as well as bipolar disorder.
ラモトリギンはナトリウムブロック。
けいれん、双極性障害で処方。
45.Gram-negative facultative intracellular organism
→Salmonella
46.Gram-positive spore-forming anaerobe
→C.difficile
47.The most common form of CGD：X-linked recessive
may manifest in females due to skewed X-chromosome inactivation of the wild-type allele.
女性が多い。
48.Defective STAT3 signaling→ hyper IgE syndrome(AR).
Defective regulation of actin cytoskeleton→hyper IgE syndrome(AR).
49.Anorexia nervosa induces a functional hypogonadal state that results in estrogen deficiency→osteoporosis and increased susceptibility to stress fractures.
アノレキで疲労骨折！
50.Plasma is a blood product containing fibrinogen and clotting factors and may be used to treat coagulation disorders.
凝固疾患に血漿。
