1.Desmopressin is a second-line treatment for nocturnal enuresis. It acts on vasopressin V2 receptors in the renal collecting ducts to increase aquaporins and water reabsorption.
夜尿症の第2選択薬にデスモプレシン。集合管でアクアポリンを増やす。
2.MG can present as generalized weakness diplopia, ptosis, and difficulty chewing.
MG is a cytotoxic (type II) hypersensitivity reaction caused by antibodies against postsynaptic acetylcholine receptors at the neuromuscular junction.
MGは2型HSR。
3.Acute opioid intoxication can present with cardiorespiratory depression and pinpoint pupils.
Opioids are agonists at μ, κ, and δ opioid receptors. Activation of the μ opioid receptor is linked to respiratory depression.
呼吸抑制と縮瞳→オピオイド中毒。
オピオイドにはμ、κ、δの受容体があるが、呼吸抑制を起こすのはμ。
4.Activation of κ opioid receptors causes dysphoria, hallucinations, miosis, analgesia, and sedation.
不穏、幻覚、散瞳、無痛覚、鎮静
5.Inhibition of γ-aminobutyric acid type A (GABAA) receptors leads to hypoventilation, convulsions, blurred vision, tinnitus, diaphoresis, and chills.
GABA阻害→下がる。耳鳴り。
6.Sublimation is a mature defense mechanism that involves the expression of uncomfortable emotions (eg, anger at social injustice) in a socially useful way, such as becoming an advocate for social justice.
社会的に実現不可能な（反社会的な）目標や葛藤、満たすことができない欲求から、別のより高度で社会に認められる目標に目を向け、その実現によって自己実現を図ろうとすること。例えば、満たされない性的欲求や攻撃欲求を芸術やスポーツ、学問という形で表現することは、昇華と言える
https://ja.wikipedia.org/wiki/
Projection is an immature defense mechanism in which a person attributes their unwanted emotions, thoughts, or motives to another person. For example, a person may be annoyed at their spouse but then accuse their spouse of being angry with them.
心理学における投影とは、自己のとある衝動や資質を認めたくないとき（否認）、自分自身を守るため（防衛機制）それを認める代わりに、他の人間にその悪い面を押し付けてしまう（帰属させる）ような心の働きをいう。たとえば「私は彼を憎んでいる」は「彼は私を憎んでいる」に置き換わる。そのひとつに責任転嫁（Blame shifting）があり
https://ja.wikipedia.org/wiki/
このあたりの理解があいまい。
7.tranylcypromineはMAO-I
SSRIからの切り替えに14日間をあけずに開始→セロトニン症候群。
8.Exogenous steroid use causes suppression of endogenous testosterone formation and leads to testicular atrophy, acne vulgaris, aggressive behavior, gynecomastia, and infertility.
ステロイド使用で内因性テストステロン抑制→精巣萎縮、攻撃的な行動、女性化乳房、不妊。
9.In Cushing disease, there will be a decrease in the elevated serum cortisol and in ACTH following a high-dose dexamethasone suppression test.
クッシング病の診断には高用量デキサメタゾン抑制試験。
高用量で抑制されればクッシング病、抑制されなければACTH産生の2次性のクッシング症候群の診断。
あるいはCRH刺激試験でACTH、コルチゾールが上昇すればクッシング病、上昇しなければ2次性のクッシング症候群。
10.Spina bifida is related to defective closure of the posterior neuropore, which typically occurs in the fourth week of development and sixth week of gestation.
後部神経孔閉じるのは4週。二分脊椎症は閉じない状態。
11.片側の腎動脈狭窄でレニン上昇、対側の腎臓でのレニンは減少。
12.MMで腎障害が起こる理由は？
The renal failure of multiple myeloma is mostly due to tubular precipitation of large casts composed of immunoglobulin light chains.
13.This patient with altered mental status and elevated plasma osmolality (320 mOsm/kg ) most likely has ingested a nonethanol alcohol like methanol, propylene glycol, or ethylene glycol (ie, has elevated exogenous osmoles in the blood).
Hyperosmolarity is most often caused by increases in serum sodium, glucose, or urea (blood urea nitrogen; all normal here). If these are normal, an exogenous (ingested) osmole is present, most often ethanol (not present here).
意識変容＋浸透圧上昇→浸透圧上昇を来たすのは高Na、高尿酸、エタノールがcommon。
メタノール、プロピレングリコール、エチレングリコールが鑑別に上がる。（いずれもアニオンギャップ）
メタノール→blindness、腎不全
エチレングリコール→急性腎障害
serum osmolality：(2 × [Na+, mmol/L]) + [glucose (mg/dL)/18] + [urea (mg/dL)/3]
14.Hairy cell leukemia is a leukemia derived from memory B cells, which stain positive for tartrate-resistant acid phosphatases.
TRAP陽性→HCL；高齢者に多い。緩徐進行。
15.10代のリンパ腫でmediastinal mass→acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL)
TdT陽性→ALL。
pre B cell→急性白血病。
pre T cell→若年男性に多い。胸腺腫あり。
16.In G6PD-deficient individuals, the peroxides and free radicals accumulate, which results in Heinz bodies and hemolytic anemia.
G6PD欠損→ペルオキシダーゼ、フリーラジカル蓄積。
17.Gentamicin can cause acute tubular necrosis.
ゲンタマイシンは急性尿細管壊死を起こす。brown casts確認。
18.Acute (allergic) interstitial nephritis presents with rash, fever, and/or eosinophilia. Urinalysis reveals urine WBCs (sometimes with eosinophils) and WBC casts.
Common causes of acute interstitial nephritis include nonsteroidal inflammatory drugs and antibiotics such as penicillins, cephalosporins, and sulfonamides.
19.Fever can be caused endogenous pyrogens, including IL-1, IL-6, interferon, and TNF, which act on the anterior hypothalamus to increase production of prostaglandins, which increase the hypothalamic set-point temperature.
発熱を来たす因子→IL-1,6,INF,TNF。プロスタグランジン産生→視床下部のセットポイント上げる。
20.inability to recognize faces, a condition known as prosopagnosia。
A stroke that occludes the right posterior cerebral artery (PCA) is most commonly the vascular cause of prosopagnosia.
相貌失認が起こるのは右後大脳動脈の梗塞。
21.Coarse facies are associated with hyper IgE syndrome.
特異的顔貌とグロブリン。
22.
ataxia telangiectasia (AT), is a syndrome caused by defective DNA repair mechanisms characterized by cerebellar degeneration, spider angiomas (telangiectasias), and immunodeficiency (IgA deficiency, recurrent sinopulmonary infections).
IgAが低いのは毛細血管拡張性運動失調症
23.Conical teeth are associated with nuclear factor-kB essential modulatordeficiency syndrome, which is associated with elevated IgM or IgA levels.
24.A heart murmur may be seen in DiGeorge syndrome, which also would present with a unique facial morphology, cleft palate, hypoparathyroidism, and T-cell deficiency.
DoGeorgeでは心雑音あり。
25.正常値
bleeding time;2-7min
PPT;25-40sec
PT;11-15sec
26.Prostaglandin E2 is the primary mediator of pain related to uterine stimulation; NSAIDs constitute the first-line treatment for primary dysmenorrhea.
月経困難症の疼痛を来たす因子はプロスタグランジンE2。
子宮を刺激。
27.Brain natriuretic peptide is a hormone secreted from ventricular myocytes in response to ventricular volume overload, as seen in congestive heart failure.
Brain natriuretic peptide acts on the renal collecting duct to decrease sodium reabsorption and increases glomerular filtration rate, leading to urinary sodium loss.
BNPは心室の心筋から分泌。腎集合管に作用し、ナトリウム再吸収阻害。GFR上昇。
28.Breast milk contains very little iron.
母乳には鉄が少ないので、完全母乳で育てていると赤ちゃんが鉄欠乏性貧血になる。
29.Cyanide strongly binds to the iron within complex IV of the electron transport chain(ETC), thus inhibiting electron transport and cellular respiration.
チアノーゼでは鉄と結合することで電気的輸送が障害され、細胞呼吸ができなくなる。
30.
・Conversion of androstenedione to testosterone is facilitated by the enzyme 17β-hydroxysteroid dehydrogenase.
アンドロステンジオンからテストステロンは17。
・Conversion of testosterone to dihydrotestosterone is facilitated by the enzyme 5α-reductase.
テストステロンからジヒドロテストロンは5。
31.Intussusception occurs when a segment of small intestine telescopes into an immediately distal segment of bowel. Symptoms include vomiting, bloody diarrhea, and hyperactive bowel sounds.
腸重積は血便、腸蠕動音亢進
32.Lithium is contraindicated during pregnancy because it has been associated with Ebstein anomaly in the fetus.
リチウム→胎児のエプスタイン奇形。
33.インターロイキン “Hot T-bone stEAK”:
IL-1:fever(hot).
IL-2:stimulates Tcells.
IL-3:stimulates bone marrow. GM-CSF様作用。
IL-4:stimulates IgE & IgG production.
IL-5:stimulates IgA production.好酸球の分化にも作用。
IL-6:stimulates aKute-phase protein production
IL-8:neutrophils
IL-12:Tcell → Th1 cell。Activates NK cells
TNFα:activates endothelium. WBC recruitment, vascular leak.
前にもまとめたな。#41 IL系。復習。骨付き肉！
34.Penicillin acts as a hapten and binds to the RBC membrane, which is recognized by IgG or IgM antibodies that mediate the destruction of RBCs.
薬剤誘発性溶血性貧血ではペニシリン等がハプテンとして作用しRBCの膜に結合し破壊。
35.Achondroplasia occurs when a cell-signaling defect in the fibroblast growth factor receptor 3 (FGFR3) causes a defect of cartilage-derived bone.
軟骨無形成症の遺伝子はFGFR3でAD。
36.新生児の髄膜炎の起因菌→リステリア、GBS、E.coli
Listeria monocytogenes are gram-positive, catalase-positive bacillus rods.
37.Bupivacaine is a long-acting amide-based anesthetic that may produce cardiotoxic effects such as cardiac arrhythmias and hypotension.
ブピバカインは2度房室ブロックの副作用あり。
38.
Cortical neurons and erythrocytes use GLUT1.
Hepatocytes and pancreatic β-cells use GLUT2.
Only two tissues in the body express GLUT4: adipose tissue and skeletal muscle.
GLUT4はinsulin dependent。
39.心不全で内服開始→gout。治療薬は？
frosemide
40.epinephrine is a non selective adrenergic receptor.
α1・β1作用で血圧上昇。
フェントラミンなどのα1ブロッカー内服中にエピネフリン使用ではβ2作用が増強され血管拡張→拡張期血圧が低下する。
“epinephrine reversal.”
41.Cowden syndrome is caused by an autosomal dominant mutation in the PTEN gene found on chromosome 10.
It is one of the hamartoma-tumor syndromes with the principal components being skin signs and intestinal polyps defined as hamartomas. Associated with these findings is an increased risk for breast cancer, thyroid disease, endometrial cancer, renal cell cancer, and colorectal cancer.
カウデン症候群は皮膚・粘膜、消化管、乳腺、甲状腺、中枢神経、泌尿生殖器などに良性の過誤腫性病変が多発する常染色体優性遺伝性疾患である。
染色体10番の異常。
小児慢性特定疾患情報センターhttps://www.shouman.jp/disease/html/detail/12_04_012.html
42.A patient with pharyngitis, cervical lymphadenopathy, and low-grade fever with a pseudomembrane on the pharynx is likely infected with C diphtheriae.
C diphtheriae is best cultured on a Löffler medium in combination with tellurite agar.
ジフテリアの特徴は咽頭扁桃のgrayish white pseudomembrane。
・ジフテリアは先進国では少ない。
・ジフテリアはLoffler mediumで培養。
43.AfではJV tracingでa wave消失→心房の収縮がないことを示唆。
・The c wave in JV tracing corresponds to right ventricular contraction.
c波→右心室収縮
・The x descent corresponds to downward displacement of the tricuspid valve into the right ventricle during rapid ejection.
x波→三尖弁の右心室への偏位
・The v wave in JV tracing corresponds to increased right atrial pressure secondary to rapid atrial filling against a closed tricuspid valve.
v波→三尖弁閉鎖後の流入による右心房圧
・The y descent in JV tracing corresponds to the right atrium emptying into the right ventricle when the tricuspid valve opens.
y波→三尖弁開放時の右房から右室への流入による右房内
44.胞状奇胎
・69,XXX is the karyotype of a partial mole, which would show fetal parts on ultrasonography.
部分胞状奇胎は1つの卵子に2つの精子が受精した状態→3倍体になる。胎児成分と嚢胞状の2成分からなる。
・A complete mole occurs when a haploid sperm replicates with an empty egg; it has a karyotype of 46,XX or 46,XY.
全胞状奇胎は卵子の核が消失。23Xの精子が2倍体となる。
10％程度で絨毛癌や侵入奇胎など悪性腫瘍に移行。
45.HPV
HPV 1はsoles of the feet (plantar warts).
HPV 2はfingers
HPV 11はanogenital warts and low-grade cervical changes.
HPV 16はcervical, anogenital, and oropharyngeal cancers.
46.Osteochondroma, which usually occurs in men younger than 25 years, originates from the metaphysis of long tubular bones and presents with numbness, tingling, a painless bump near the joints, and pain with activities.
骨軟骨腫は25歳以下の男性。関節周囲の無痛性腫瘤。動作で疼痛誘発。
・Chondrosarcoma usually occurs in the fifth or sixth decade of life and affects the axial skeleton.
軟骨肉腫は60歳以上。
47.DiGeorge syndrome
functional T cellsがないためリンパ節も未熟。特にparacortex。
the region in a lymph node that houses T cells—the paracortex—will be poorly developed.
・Cortical follicles are in the outer cortex.
B-cell proliferationする場所。
この部位の障害→SCID、X-linked agammaglobulinemia (absent B-cell development).
48.In sarcoidosis, there is a cell-mediated immune response to an unknown antigen, in which macrophages form granulomas to attempt to wall off the antigen.
The granulomas that form in sarcoidosis are masses of inflammatory cells formed.
サルコイドーシスは抗原に対する細胞介在性の免疫反応→肉芽形成。
49.Infiltration with eosinophils is seen in caseating granulomas associated with fungal infections such as histoplasmosis and aspergillosis
好酸球が含まれる乾酪性肉芽→ヒストプラスマやアスペルギルスなど真菌感染。
その他乾酪性肉芽は結核。
50.Overgrowth of granulation tissue with tissue repair due to excess collagen presents as a keloid on gross examination.
肉芽増殖→ケロイド。
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。
