寒くなってきましたね。
あまり時間はとれませんが、少しずつ。
1.The palmoplantar (glabrous) skin of the palms and soles contain an additional epidermal layer that is known as the stratum lucidum.
2.褐色細胞腫と合併する甲状腺疾患は？→medullary thyroid carcinoma
3.シャーガス病はT cruzi。intracellular protozoan parasites transmitted by reduviid bugs.
4.フェニレフリンはα1刺激薬→末梢血管しめる。
5.Milrinoneはinhibiting PDE-3。心筋に作用し収縮力を強め、末梢の血管平滑筋は弛緩させる。cAMPが上昇するため。
6.気管食道瘻Tracheoesophageal fistulaの合併症に鎖肛、肋骨欠損あり。その他合併症はvertebral anomalies, anal atresia, cardiac defects, tracheoesophageal fistulas, renal/genitourinary anomalies, and limb defects.
7.All benzodiazepines have a relatively high potential for causing dependency.
Shorter-acting agents such as oxazepam and alprazolam are particularly likely to cause dependency.
8.Ascending cholangitis is an infection of the gallbladder that results from biliary stasis and bacterial overgrowth secondary to obstruction of the biliary tract. The classic symptoms are known as the Charcot triad: right upper quadrant pain, fever, and jaundice. 胆管炎は黄疸あり。胆嚢炎との違い。
9.Li-Fraumeni syndromeの遺伝子異常はTP53 tumor suppressor gene
10.Buffered charcoal yeast extract agarBCYE培地はグラム陰性。
particularly Legionella species.
11.Cystic hygromas, which are associated with Down syndrome and Turner syndrome, present as fluid-filled cysts on the neck of neonates.
膿疱性ヒグローマはダウン症やターナー症候群を伴う頻度が高い。
12.Angelman syndrome typically arises de novo from a maternally derived microdeletion on chromosome 15.
Fragile X syndrome is an X-linked dominant disorder.
Homocystinuria is an autosomal recessive disorder.
13.神経線維腫症とリンチ症候群は常染色体優性遺伝。
リンチ症候群はmismatch repair proteins
14.サルファ剤で溶血性貧血→G6PD;oxidized glutathioneグルタチオンが上昇
15. 腹膜透析中のカテ感染→S.epidermidis
16.Lipofuscin is a nondegradable pigment composed of oxidized and polymerized membrane lipids formed from organelles autophagocytosed by lysosomes.
リポフスチンは分解されない→剖検で認められる茶色い物質
17.喫煙者、コカイン使用者などは早剥のリスクが高く、DICリスクも高い。
18.DiGeorge→Third and fourth pharyngeal pouches←甲状腺形成。3が下、4が上。
pouchは甲状腺！
cleftは外耳道
20.腎盂腎炎で結石あり。尿所見でpHアルカリ→プロテウスかクレブシエラ→結石の種類はammonium magnesium phosphate stones
結石で一番多いのはCalcium oxalate stones。
リン酸カルシウム結石Calcium phosphate stonesの原因はhypercalciuria, dehydration, or hyperparathyroidism.
21.Iron is absorbed via apoferritin-mediated transport.
Vitamin B12 is absorbed via intrinsic factor–mediated transport.
Sodium-dependent cotransport is the mechanism of absorption of vitamin C, biotin (B7), and pantothenic acid (B5).
鉄の輸送はアポフェリチン、ビタミンB12は内因子、ビタミンC・B7・B5はナトリウム共輸送体
22.Tryptophan is a precursor of niacin, serotonin, and melatonin
トリプトファンはナイアシン、セロトニン、メラトニンの前駆体。
ペラグラの問題で聞かれる。
Thyroid hormone is made from tyrosine, and the amino acid phenylalanine is a precursor to tyrosine.
甲状腺ホルモン：フェニルアラニンからチロシン
23.Horizontal nystagmus with fast phase to the right (the unaffected side) is characteristic of left vestibular neuritis.
ヘッドインパルステスト。左にふったときに陽性→左の前庭神経炎
眼振は健側に素早く認める。
24.Zollinger-Ellison syndrome is a rare ulcer disease manifested by abdominal pain, resistance to treatment, ulcers distal to the typical gastric locations, and a high serum gastrin level.
Zollinger-Ellison syndrome is a rare neoplasm of the pancreas or duodenum, specifically a gastrin-secreting tumor.
ゾリンジャー・エリソン症候群はPPI不耐。MENを想起する。
25.HIVの人の眼症状→CMV感染疑い→処方→腎機能障害→処方した薬の機序は？→Ganciclovir：inhibiting the incorporation of dGTP into replicating viral DNA
26.stable anginaとunstable anginaの違い
毎回起こるのが安定狭心症。
27.カルシトニン高値の甲状腺腫瘍は？
Medullary thyroid cancer causes high serum calcitonin.
MTC is associated with RET gene mutations and sometimes with MEN2A and MEN2B.
28.百日咳→gram-negative coccobacillus Bordetella pertussis→Bordet-Gengou agar
MacConkey agar→Enterobacteriaceae.
Chocolate agar→Haemophilus influenzae.
Löffler agar→Corynebacterium diphtheriae.
29.cold AIHA→IgM
30.GPIIb/IIIa receptor → Glanzmann thrombasthenia
ristocetin assayで凝集
31.Bernard-Soulier disease ← platelet membrane protein complex GPIb.
ベルナールはPT/APTT正常
32.Lipoprotein lipase deficiency is seen in type I familial dyslipidemia, which presents with increased chylomicrons in the circulation and elevated total cholesterol and triglyceride levels.
リポプロテインリパーゼ異常は1型家族性脂質異常症。
コレステロールと中性脂肪が高値。
33.糖尿病薬内服中に飲酒で複視、嘔吐、低血圧、顔面紅潮→ジスルフィラム様反応。内服していた薬はtolbutamide（第一世代SU薬）
Headache, blurry vision, vomiting, hypotension, and facial flushing after consumption of alcohol suggest a disulfiramlike reaction.
34.Hepatitis E virus is a nonenveloped, single-stranded RNA virus.
E肝は一本鎖RNA
・Small defective circular RNA virusはD肝ウイルスhepatitis D virus
問題文で海外で屋台の食事をしたらA肝かE肝。
35.Ingestions that can lead to an elevated anion gap metabolic acidosis include methanol, ethylene, or propylene glycol, as well as drugs such as aspirin, isoniazid (INH), and metformin, which may lead to lactic acidosis.
アニオンギャップ開大アシドーシスの原因GOLDMARK
メタノール、INH、メトホルミン
36.NSAIDは輸入細動脈を締める→腎機能低下
Inhibition of prostaglandin production increases afferent arterial tone
ACE-Iは両方緩めるが、特に輸出細動脈を緩める→濾過率低下
37.Hypomagnesemia can be seen in patients with heavy alcohol intake. It may cause hypokalemia due to renal potassium wasting.
低Mg血症はアルコール多飲の人にみられる。
腎集合管でのカリウム分泌を促し、低カリウム血症を引き起こす。
低マグネシウム血症の原因はアルコールだけではなく、下痢、嘔吐、急性膵炎、利尿薬、PPIなど。
38.Lead inhibits δ-aminolevulinic acid dehydratase, preventing porphobilinogen formation. Lead also inhibits ferrochelatase
鉛中毒で小球性貧血。
39.尿osmolality 50-1200 mOsmol/kg H20
hyponatremia with very dilute urine (low urine osmolarity <100 mOsm/kg), suggesting a diagnosis of psychogenic (primary) polydipsia.
尿浸透圧が100以下→心因性多飲
40.Myopia近視 is blurred distance vision, and visual acuity would be decreased when doing the Snellen test
41.プリマキン内服で黄疸と褐色尿→G6PD deficiencyのため溶血。
G6PDはHMPシャントに関与、NADP+を減らす。X連鎖性疾患
42.Barbiturates are central nervous system depressants. Intoxication may be evidenced by dilated pupils, confusion, hypotension, and poor coordination. The most feared result of intoxication is respiratory depression.
バルビツールはCNS低下。瞳孔拡大、低血圧、混乱。呼吸抑制。
43.Intoxication from stimulants such as cocaine manifests with sweating, tachycardia, hypertension, and hyperactivity. Withdrawal is characterized by hypersomnolence and irritability and may be associated with severe depressive episodes.
コカインは興奮。翌日うつ症状。
Heroin is associated with a brief rush of euphoria. Signs of intoxication include nausea, vomiting, pupillary constriction, seizure, and CNS depression. Withdrawal is associated with flulike symptoms, sweating, insomnia, and anorexia.
ヘロインは多幸感。縮瞳、CNS低下。離脱症状に感冒様症状、発汗、不眠、アノレキ
44.Abortive tubules and glomeruli are the pathological characteristics of a Wilms tumor, the most common renal tumor in childhood.
ウィルムス腫瘍に特有の腎障害。
45.結節性硬化症の皮膚組織の病理所見
Angiomyolipomas血管筋脂肪腫, frequently seen with tuberous sclerosis, are benign neoplasms that typically contain smooth muscle cells, fat cells, and many thick-walled blood vessels.
46.A positive PPD test is an example of a type IV HSR in which previously sensitized T cells are activated to trigger cytokine release. Erythema nodosum has a similar pathogenesis.
PPDテストは4型アレルギー。結節性紅斑も。
47.Hemiballismus may arise from an acute lacunar infarct of the subthalamic nucleus.
Normally, the subthalamic nucleus directly excites the internal segment of the globus pallidus.
ヘミバリズムはラクナ梗塞で起こりがち。視床下核が直接的に淡蒼球を刺激。
48.Biotin (vitamin B7) deficiency causes dermatitis, alopecia, and/or enteritis without mental status changes.
ビオチン欠乏は皮膚炎と脱毛。精神症状の変化なし。
Deficiency of pantothenic acid (vitamin B5) causes dermatitis, enteritis, and/or alopecia, with adrenal insufficiency as an important distinguishing feature.
ビタミンB5は副腎不全あり。これが鑑別。
亜鉛欠乏は傷の治りが遅い。低性腺機能症、毛が薄い。
49.先端巨大症のホルモンはIGF-1。チロシンキナーゼ受容体に結合しシグナル伝達。
50.急性膵炎でトリプシノーゲンからトリプシンへの変換による自己融解が腹痛を引き起こしている。
USMLEに興味がある方はまずこれから始めてみて下さい。
アマゾンでは2022年度版が予約できます。
