1.GLP-1 analogs, such as exenatide and liraglutide, increase glucose-dependent insulin secretion and decrease glucagon secretion.
GLP-1はグルコース依存性にインスリン分泌
Sodium-glucose cotransporter 2 (SGLT2) inhibitors, such as canagliflozin and dapagliflozin, block the reabsorption of glucose in the renal tubules.
SGLTは尿細管での糖再吸収阻害
2.Untreated ischemia results in irreversible cell injury and coagulative necrosis characterized by nuclear changes that include pyknosis, karyorrhexis, and karyolysis.
無治療の虚血で起こる細胞障害所見。
3.Uncal herniation is characterized by CN III palsy and fixed and dilated pupil.
テント切痕ヘルニアでⅢの障害。
・Pinpoint pupils are due to damage to ascending sympathetic fibers from the superior cervical ganglion that travel along the internal carotid artery to reach the eye. Large pontine lesions may lead to compression of these fibers.
4.After direct inoculation, rabies virus binds to nicotinic acetylcholine receptors and travels to the central nervous system via retrograde axonal transport.
狂犬病。
Rabies (Rhabdoviridae) is a single-stranded RNA virus
The virus then travels via retrograde axonal transport, reaching the dorsal root ganglia of the spinal cord and eventually the brain.
5.Upper/Middle/Lower trunk→Lateral/Posterior/Medial cord
6.glucocorticoid-induced hyperglycemia機序は？
→phosphoenolpyruvate(PEP) carboxykinase catalyzes an irreversible step in gluconeogenesis, converting oxaloacetate to phosphoenolpyruvate.
ステロイド内服で高血糖になるのはPEPカルボキシラーゼカタラーゼによって糖新生が起こるため。
7.Cannabis intoxication is characterized by altered mental status, increased appetite, conjunctival injection, and slurred speech.
カンナビノイドはバイタル正常。食欲増加。結膜充血！
・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.
ヒスタミン中毒は抗コリン中毒の所見→頻脈・頻呼吸・高血圧
・Amphetamine intoxication presents with findings consistent with sympathomimetic toxicity, including elevated vital signs, mydriasis, decreased bowel signs, wet skin (perspiration), and agitated mood.
アンフェタミン中毒はバイタルサイン上昇、散瞳、不穏。
8.Sepsis causes ARDS by neutrophil release of cytokines and proteases, increasing the capillary permeability and movement of fluid into alveoli.
敗血症でARDSになる機序。好中球がサイトカイン放出、毛細血管の透過性亢進→血管内から肺胞へ。
9.Tricuspid regurgitation is associated with a “blowing” systolic heart murmur loudest at the left lower sternal border that becomes louder with inspiration.
吸気で雑音増悪→三尖弁逆流。
10.Topiramate is an anticonvulsant that is used to treat and prevent seizures.
トピラメイトは抗けいれん薬。片頭痛にも使うことがある。
Amitriptyline is a tricyclic antidepressant used in migraine prophylaxis.
アミトリプチリンは三環系抗うつ薬。片頭痛予防に使う。
11.The most common form of CGD is inherited in an X-linked recessive manner and may manifest in females due to skewed X-chromosome inactivation of the wild-type allele.
12.The axillary nerve←fracture of the surgical neck or anterior dislocation of the shoulder.
The radial nerve←midshaft humerus fracture.
骨折部位による神経障害。
13.The third aortic arch gives rise to the common carotid artery as well as the proximal internal carotid artery.
第3弓は総頚動脈と内頚動脈近位。
6弓はPDA。
14.Paget disease is a metabolic bone disease leading to increased bone formation with bone pain and bone overgrowth.
Serum alkaline phosphatase is increased as a result of increased osteoblastic activity.
パジェットでは骨増生→ALP上昇。
15.All of the Herpesviridae are double-stranded linear DNA viruses
ヘルペスウイルスはliner DNA
EBVもサイトメガロも
16.anticholinergic activity
・Urinary retention
・Mydriasis
17.Muscarine is a toxin found in certain mushrooms that agonizes muscarinic receptors
→vasodilation, sweating, salivation, increased gastrointestinal motility, and miosis.
きのこ食べてコリン作用で血管拡張、発汗、下痢、縮瞳
→血圧下がる。脈拍呼吸数は正常範囲。
18.Lipolysis is associated with β3-receptor activation, a type of sympathetic receptor.
脂肪分解はβ3受容体刺激による。
19.小児、発熱、腸閉塞→リンパ腫が疑われる場合→Burkitt lymphoma t(8;14)
20.In premature neonates with NRDS, dipalmitoylphosphatidylcholine (the most important component of surfactant) is deficient. Decreased surfactant leads to alveolar collapse from increased surface tension, causing diffuse atelectasis.
サーファクタントが不十分だとNRDS、びまん性無気肺になる。
21.Women with prolactinomas can present with symptoms related to tumor mass effect (ie, 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→高プロラクチン血症→GnRH低下→FSH／LH低下→脂質異常症・骨粗鬆症のリスク。
22.ポルフィリン症で障害されている酵素はcytolasmで作用している。
23.Brucella species enter the body via contaminated milk products or direct contact with contaminated livestock.
汚染されたミルク経由での感染。
24.Acidic stool pH and elevated stool osmotic gap make the diagnosis of primary lactose intolerance most likely.Fermentation by bacteria also produces hydrogen ions, which explains a acidic (pH <6)stool.
便pH正常5.5-6.0
便浸透圧差(290-2×(便Na+便K)；50未満なら分泌型、50以上なら浸透圧性
25.Galactokinase phosphorylates galactose in the process of metabolizing galactose. Deficiency results in the clinical manifestation of cataracts forming early in life.
ガラクトキナーゼの障害で白内障。
26.Central DIの病変は？
→ADH is made in the paraventricular and supraoptic nuclei of the hypothalamus.
・Lateral nucleus of the hypothalamus→“hunger center”
・Ventromedial nucleus of the hypothalamus→satiety, and damage leads to overeating, obesity, and aggressive behavior.
27.Legionnaires' disease is caused by L pneumophila.
L pneumophila can be visualized with silver stain, as Gram stain will show neutrophils and poorly staining organisms.
市中肺炎の原因菌にレジオネラ。
28.A deficiency of an intestinal brush border enzyme describes lactase deficiency. It presents with abdominal pain, diarrhea, bloating, and flatulence following ingestion of lactose.
29.Lipid-soluble substances are absorbed by the lymphatic system and pass through the thoracic duct, thus avoiding first-pass metabolism.
脂溶性物質はリンパ系から胸管を経由→肝臓の初期代謝
30.Drusen deposition is seen in dry age-related macular degeneration. This presents gradually with central vision loss in elderly patients, and fundoscopy would show small yellow drusen.
31.DM眼症；黄斑浮腫
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.
The underlying mechanism behind the visual disturbances in NPDR is macular edema as a result of microaneurysm formation and hemorrhage from fragile vessels.
32.Glycerol-3-phosphate (G3P) is formed after triglycerides are broken down into free fatty acids and glycerol, which can then be phosphorylated in the liver by glycerol kinase.
33.HMG-CoA lyase for ketone production.
HMG-CoA reductase for cholesterol synthesis.
34.Acetyl-CoA carboxylase catalyzes the rate-limiting step of fatty acid synthesis, the carboxylation of acetyl-CoA to malonyl-CoA, a substrate for fatty acid synthase.
the carboxylation of acetyl-CoA to form malonyl-coenzyme A.
脂肪酸合成の律動。
35.IgG antibodies are typically involved in warm autoimmune hemolytic anemia (AIHA).
Medications, systemic lupus erythematosus, and chronic lymphocytic leukemia can precipitate an IgG response that causes extravascular hemolysis.
In both cold agglutinin disease and warm autoimmune hemolytic anemia (AIHA), cross-reactive IgM antibodies.
温→IgG
冷→IgM
36.Mineralocorticoids like aldosterone act in the kidney in the cortical collecting duct. They increase Na+ reabsorption, increase K+ excretion, and increase H+ ion secretion, which aids in excreting the acids that normally accumulate as a result of metabolism.
アルドステロンは集合管に作用。Kイオン、Hイオン排出。
37.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.
ステロイド関連の顔の皮疹→しゅさ様皮膚炎
口の周りの1−2mmの皮疹が特徴的。
38.Hepatitis A virus, a picornavirus, is a single-stranded RNA virus
A肝炎はピコルナウイルス。
39.Yellow fever is characterized by high fever, jaundice, elevated aminotransferase levels with accompanying hepatomegaly, acute kidney injury, hemorrhage, and low WBC count.
Yellow fever virus, a flavivirus, is an enveloped single-stranded RNA virus that is transmitted via a mosquito vector.
黄熱はフラビウイルス科フラビウイルス属。日本脳炎と同じ。
C肝ウイルスはフラビウイルス科ヘパシウイルス属
Yellow feverがなかなか思い浮かばないです。
40.高血圧にも骨粗鬆症にも効果がある薬は？
→thiaziede：カルシウム再吸収するため。
41.Adenosine diphosphate ribosylation of adenyl cyclase→Vibrio cholerae toxin, which acts through adenosine diphosphate ribosylation to permanently activate adenyl cyclase, thereby increasing concentrations of cAMP.
42.Diphtheria presents with pharyngitis, cervical adenopathy, low-grade fever, and a characteristic gray-white pseudomembrane. Cardiac involvement can be seen 1 to 2 weeks after the onset of symptoms and can result in potentially life-threatening myocarditis and cardiomyopathy.
ジフテリアの診断。
Symptoms of diphtheria are due to a bacteriophage-encoded exotoxin called “diphtheria toxin.” The phage-encoded exotoxin inhibits cellular protein synthesis by adenosine diphosphate ribosylation of elongation factor 2 (EF-2), preventing the EF-2 from translocating tRNA from A site to P site.
43.Vulvovaginal candidiasis is generally associated with a normal vaginal pH range (3.8 to 4.5).
・Bacterial vaginosis is generally associated with a vaginal pH range of 5.0 to 6.0 and would present with gray or white thin and malodorous discharge.
・Trichomonas vaginalis infection is typically associated with a vaginal pH between 5.0 and 7.0 and would present with frothy, green vaginal discharge.
・A vaginal pH of 8.0 is suggestive of the presence of either cervical mucus or semen.
膣のpHで鑑別！？
44.Patients with GPA typically have positive autoantibodies against the proteinase-3 enzyme in neutrophils (PR3). They are sometimes termed cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA) based on the distribution of the immunofluorescence on staining (see figure). These antibodies are specific for GPA.
GPAはcANCA/PR3(proteinase 3)陽性
45.Plasma is a blood product containing fibrinogen and clotting factors and may be used to treat coagulation disorders.
Plasma is used to treat coagulation disorders and warfarin overdose because it contains clotting factors. It is separated from RBCs through the use of anticoagulants and a centrifuge, causing the fibrinogen and clotting factors present in blood to remain in plasma. The RBCs then become packed RBCs. Although serum is similar to plasma, it is separated from RBCs only after clotting has been allowed to happen. Therefore, serum does not contain fibrinogen because the fibrinogen was used in the RBC clot. Serum is typically used for blood typing in a laboratory, and plasma is typically given to patients.
46.Nephrogenic DI is usually due to ADH resistance caused by pathology in the principal cells of the cortical collecting duct.
腎性尿崩症の障害部位は集合管のprincipal cell！！
47.Sperm motility is facilitated by interaction with dynein, a molecular motor protein that slides along the microtubules within the axoneme.軸糸？
Sperm acquire motility in the epididymis.
The epididymis is lined with a layer of pseudostratified columnar epithelium with stereocilia.
・The epididymis is lined with a layer of pseudostratified columnar epithelium with stereocilia.
・Pseudostratified columnar epithelium without cilia lines the vas deferens, through which the sperm travel after maturing.
・Simple cuboidal cell epithelium with luminal flagella lines the rete testes. The rete testes are located in the testicular hilum and transport sperm from the seminiferous tubules to the ductuli efferentes and epididymis.
・Tall simple columnar epithelium composes the Sertoli cells. They are located in the convoluted seminiferous tubules and secrete Müllerian inhibitory factor.
・Mucin-secreting columnar epithelium describes goblet cells that secrete mucin, which are scattered in the respiratory and gastrointestinal epithelium and in the eyelid.
48.. A helpful mnemonic for remembering the journey of sperm is SEVE(N) UP: Seminiferous tubules, Epididymis, Vas deferens, Ejaculatory duct, [Nothing,] Urethra, Penis.
49.Factor V mutation can result in factor V that is resistant to cleavage by activated protein C.
第Ⅴ因子はプロテインCによる代謝に耐性あり。
50.APL is associated with translocation t(15;17) and peripheral smear showing myeloblasts with Auer rods.
DIC合併しやすい。
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。
