1.Lepirudin and bivalirudin are anticoagulants that work by directly inhibiting thrombin (factor II). These medications are used as alternatives to heparin when the patient is at risk for heparin-induced thrombocytopenia.
HITのときはlepirudin。
2.Meckel diverticulum, a true diverticulum typically composed of normal intestinal mucosa or ectopic gastric tissue, presents with bloody stools without diarrhea, abdominal pain, or other symptoms of irritable bowel disease.
Meckel憩室は鮮血便がでるが、その他症状なし。
3.T-cell acute lymphoblastic lymphoma may present with signs and symptoms of anemia, thrombocytopenia, leukocytosis, and mediastinal mass.
Biopsy of the mass would show cells with light-blue, scanty, and nongranular cytoplasm, which represents lymphoblasts.
T細胞性急性リンパ芽球性リンパ腫は縦隔腫瘍が特徴。生検所見が選択肢の出題あり。
4.tinea orporisの治療薬と機序は？
Griseofulvin(α/β-tubulin dimers)
5.inactivates elongation factor-2 by adenosine diphosphate ribosylation→diphtheriae
EF-2不活化でタンパク合成阻害。
6.裸足での作業エピソードからのmuscle spasms→C.tetanus。機序は？
→Tetanus toxin blocks release of glycine and γ-aminobutyric acid from inhibitory interneurons in the spinal cord
グリシン、GABAの放出阻害
7.高血圧治療、第一選択薬はthiazide、ACE-I、ARB。
脂質異常症がある場合にはthiazideは避ける。
8.TCAs like doxepin and SSRIs like escitalopram inhibit serotonin reuptake.
・Lithium increases serotonin receptors.
・EscitalopramはSSRI
・Mirtazapine increases serotonin release. ミルタザピンはα2-antagonist (increases the release of norepinephrine and serotonin) and a potent antagonist of histamine H1 and serotonin 5-HT2 and 5-HT3 receptors.
TCAもセロトニン再吸収阻害作用あり。
セロトニン症候群を引き起こす可能性の低いBupropion。ノルアド・ドパミン再吸収阻害。
Bupropionはうつの治療薬、禁煙治療薬。
9.高血圧とBPHに対して処方→ふらつき。薬剤名は？
→Prazosin (a selective α1-receptor antagonist) may produce first-dose orthostatic hypotension, syncope, and headache.
プラゾシンは起立性低血圧を引き起こす。
phenylephrineはα1agonist(α1>α2)エピネフリンと同じ。
clonidineはα2agonist
10.Carbachol is an agonist at parasympathetic muscarinic M3 receptors.
カルバコールはM3 agonist。縮瞳。
physostigmine(AchE-I→コリン作用↑)、pilocarpineも縮瞳。
11.Hypopigmented, asensate skin patches are seen in leprosy
12.Classic galactosemia presents in the first days of life with vomiting, diarrhea, hepatomegaly, jaundice, cataracts, and E coli sepsis.
出生後すぐの嘔吐、下痢、肝腫大、黄疸、白内障、大腸菌感染→ガラクトース血症
13.Hereditary deficiency of galactokinase may present as a failure to track objects or to develop a social smile due to infantile cataracts.
ガラクトキナーゼ欠損症では目で対象物を追わない、笑わない←白内障。
14.Deficiencies of aldolase B would only present after fructose has been introduced into the diet at age 6 months.
アルドース欠損は離乳食開始の6ヶ月ごろに認められる。
15.Congenital lactase deficiency is an extremely rare autosomal recessive disorder that can cause malabsorption of lactose in breast milk and formula.
ラクトース不耐症はAR。
16.Unconjugated bilirubin is a major component of pigmented gallstones, which are radiopaque on x-ray.
レントゲンに映る胆嚢結石はunconjugated。
(conjugated bilirubinは水溶性)
17.Progressive multifocal leukoencephalopathy causes disseminated nonenhancing lesions, seen on MRI, and focal neurologic deficits.
HIV脳症ではMRIでびまん性の萎縮がみられる。PMLではエンハンスされないびまん性病変。
18.Furosemide is a potent diuretic used to treat heart failure. It causes metabolic alkalosis and increases urine calcium excretion.
フロセミドで代謝性アルカローシス・カルシウム排泄亢進
・ループ利尿薬は，Na＋/K＋/2Cl－
cotransporter（NKCC2）を阻害することにより，renal outer medullary potassium（ROMK）による管腔側の陽性荷電がなくなり，Ca，Mg の再吸収も低下する。
・サイアザイドは尿中カルシウム排泄低下が起こる。近位尿細管での Na の吸収に伴うCa 吸収亢進と遠位尿細管での Ca 吸収亢進のため。
19.cryptococcal meningitisの治療薬でamphotericin Bに追加する薬は？
→Flucytosine：a pyrimidine antimetabolite that works by inhibiting nucleic acid synthesis.
20.糖尿病腎症のフォロー：ratio of urine albumin to creatinine
21.sleep terrors夜驚症は覚えていない。
scream and autonomic signs(flushed face, tachycadia)
Parasomnias—abnormal behavior associated with sleep—can be associated with non-rapid eye movement (non-REM) sleep or REM sleep.
REM睡眠行動障害はsecond half of the night。
22.Nightmare disorder presents in the second half of the night with waking from a dream and experiencing feelings of fear, anxiety, and/or anger.
Patients with this disorder are alert and recall the dream.
悪夢障害は睡眠後半に起こる。夢を覚えている！つらい。
23.The glucagon receptor is a G-protein–coupled receptor that activates adenylyl cyclase to produce an increase in intracellular cAMP.
飢餓時に出るグルカゴン。cAMP上げる。
インスリンはチロシンキナーゼ受容体。
24.Clinical presentation of OTC deficiency includes episodes of vomiting, lethargy, and fever with decreased growth and cognitive impairment. OTC deficiency is characterized by hyperammonemia and elevated orotic acid levels.
15歳の男の子が肉を食べて寒気・感冒症状！？発達の遅れあり。
アンモニア高値。
25.Duchenne muscular dystrophyはX-linked recessive.
26.Arterial cystic medial degeneration occurs in connective tissue disorders, such as Marfan syndrome.
マルファン。
動脈瘤は動脈硬化による。機序の違い。
27.The pathogenesis of primary dysmenorrhea is myometrial stimulation via prostaglandin release at menses, which causes vasoconstriction, ischemia, and high-frequency myometrial contraction.
一次無月経について。
28.LSD intoxication causes visual illusions, anxiety or depression, delusions, nausea, weakness, paresthesias, and dilated pupils. Vital signs typically remain normal, which helps distinguish LSD intoxication from other forms of drug abuse.
LSDはバイタル安定。幻視、散瞳、不安。
29.Renal tubular acidosis is one of several tubular disorders that leads to inadequate renal excretion of acid.
Renal tubular acidosis may be a complication of chronic renal (interstitial) disease, low renin states (type IV), multiple myeloma (type II), and several drugs like amphotericin (type I).
尿細管性アシドーシス。
30.Pooling of abnormal circulating RBCs in the spleen is the mechanism of splenic sequestration crisis seen in sickle cell disease.
31.Muffled heart sounds occur when excess fat or fluid lies between the stethoscope and the heart and is seen in patients with morbid obesity or cardiac tamponade.
うーん。
32.Pulsus paradoxus is a drop in amplitude of systolic blood pressure by ≥10 mm Hg during inspiration and is seen in patients with cardiac tamponade, asthma, obstructive sleep apnea, constrictive pericarditis, or croup.
33.the mechanism of action for the virulence of Tb→Activates macrophages and induces the release of tumor necrosis factor-α
マクロファージ活性とTNFα誘導
Part of the virulence of M tuberculosis is related to a major glycolipid in the mycobacterial cell wall called “cord factor.”
・Protein A binds to the Fc region of IgG
→a surface protein of S.aureus.
・IgA protease cleaves IgA and is produced by Streptococcus pneumoniae, Haemophilus influenzae type B, and Neisseria species.
IgAプロテアーゼは肺炎球菌、インフルエンザ桿菌、ナイセリアで産生。
・M protein is associated with molecular mimicry. It is produced by Streptococcus pyogenes, which is a cause of pharyngitis, cellulitis, and erysipelas, and is associated with the autoimmune response seen in rheumatic fever.
・Lipid A is a component of endotoxin in the outer membrane of gram-negative organisms and induces an inflammatory response, which is responsible for the manifestations of septic shock.
グラム陰性のエンドトキシンの構成要素。敗血症性ショック。
34.Cori disease results from mutations in the gene encoding the glycogen debranching enzyme, which liberates glucose specifically from glycogen branchpoints.
The inability to fully break down glycogen also leads to hepatomegaly (due to glycogen accumulation), hypoglycemia (due to decreased glucose liberation from liver glycogen) during postabsorptive periods (typically, 3 to 5 hours after a meal has been digested and absorbed), and elevated creatinine kinase (due to decreased glucose liberation from muscle glycogen leading to muscle cell damage).
コリ病は脱分枝酵素の障害→グリコーゲン分解できないので細胞内にデキストリン様構造蓄積→グリコーゲン蓄積で肝腫大、低血糖、CK上昇。
・フォンギールケはG6P欠損→肝腫大、低血糖、ラクテート、トリグリセリド、尿酸高値。
Glucose-6-phosphatase deficiency leads to Von Gierke disease (GSD type I), which presents in infancy with severe fasting hypoglycemia and increased blood levels of lactate, triglycerides, and uric acid.
・マッカードルはミログロビン尿症
Myophosphorylase deficiency leads to McArdle disease (GSD type V), which presents with muscle cramps, fatigue, and myoglobinuria with strenuous exercise.
35.H pylori–associated gastric ulcers typically show small, solitary, punched-out lesions with sharply demarcated edges and inflammatory infiltrate.
36.an autosomal recessive disorder that predisposes to bronchiectasis and recurrent respiratory infections.
気管支拡張と反復性の呼吸器感染→CF
膵炎リスク
37.renal artery stenosis will have increased renin, activating the renin-angiotensin-aldosterone system. However, the serum sodium concentration is most commonly normal, because water reabsorption accompanies the sodium reabsorption.
腎動脈狭窄でRAA系亢進するもナトリウム値は正常
38.Norovirus is a member of the Caliciviridae family and has a similar genome to that of poliovirus: positive-sense, nonsegmented, single-stranded RNA.
Poliovirus is part of the Picornaviridae family.
覚えきれん。ノロウイルスはカリシウイルス科。ポリオはピコルナウイルス科
39.The cross-linking of IgE present on the immunoglobulin surface receptors on both mast cells and basophils leads to the release of vasoactive compounds, which then leads to anaphylactic shock.
40.A common cause of peptic ulcer disease is H. pylori infection, which causes mucosal damage through the production of ammonia, neutralizes stomach acid, and increases the pH of the environment.
呼気試験しますねー。
41.Focal segmental glomerulosclerosis (FSGS) is now the most common primary glomerular disease in ths USA (diabetic renal disease is the most common overall cause of glomerular disease)
Focal segmental glomerulosclerosis is associated with HIV infection (more common with injectable drug use), heroin use, severe obesity, or unilateral renal agenesis.
FSGSの原因は糖尿病がメイン。その他薬物使用によるHIV、ヘロイン、肥満、片腎と関連。
42.Hox genes are important in the developing embryo, and syndactyly is commonly associated with Hox gene mutations.
Hox遺伝子は指趾癒合と関連。
43.The lactose (lac) operon is an example of an inducible operon.
lacオペロン。E.coliはlactoseが使える環境でlac operon発現！
44.Gastric distention promotes the release of gastrin by G cells in the antrum and promotes acid.
胃が拡張するとのG細胞からガストリン分泌。
45.Secretin stimulates bicarbonate secretion and is released in response to increased acid and fatty acids in the duodenal lumen.
セクレチンは重炭酸塩分泌。
46.日光過敏鑑別
・Bloom syndrome presents with redness of the cheeks and face after sun exposure but is also characterized by short stature and café-au-lait spots.
・Porphyria cutanea tarda presents in individuals aged 40 to 70 years and presents with hypertrichosis, hyperpigmentation, increased photosensitivity, and tea-colored urine.
・Albinism typically presents with decreased or absent melanin production in the skin, hair, or eyes of patients.
・Hartnup disease results in decreased absorption of tryptophan and subsequent deficiency of vitamin B3. In addition to photosensitive dermatitis, it presents with glossitis, diarrhea, and dementia.
XPが国試的には有名ですが、見たことないです。
PCTは年齢で鑑別できそうですね。SLEも。
Bloom syndromeは低身長。
Albinismは目や髪の所見があるはず。
Hartnup diseaseはトリプトファンの吸収障害。舌炎、下痢、認知症があると。
47.During the latent phase, HSV-1 viral genetic material is preserved as an episomal circular, dsDNA that is not integrated into the host chromosome.
ウイルス潜伏期での状態。
48.Adverse effects of Hydrochlorothiazide (HCTZ) include hyponatremia, hyperglycemia, hyperuricemia, hyperlipidemia, and hypercalcemia.
副作用の頻度はどうなんですかね。
49.SJS is a serious potential adverse reaction to lamotrigine, used for treatment of bipolar disorder.
ラモトリギンは双極性障害の治療薬としてコモン。
ターゲット斑→Stevens-Johnson Syndrome (SJS) or toxic epidermal necrolysis
双極性障害の治療薬にClozapine, lithium, quetiapine, and valproic acidは使うがSJSは引き起こさない。
50.Trichomonas vaginalisの治療薬とその機序は？
Metronidazole works by forming free radical metabolites that damage bacterial or protozoan DNA.
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。
