1.The toxic effects of acetaminophen overdose：N-acetyl-p-benzoquinone imine causes oxidative damage, mitochondrial dysfunction, and significant liver injury.
アセトアミノフェン過剰内服。
アセトアミノフェンはグルタチオンと抱合して尿へ。
アセトアミノフェン過剰の時はグルタチオン枯渇→CYP-450を使う代替パスウェイ→highly toxic compound N-acetyl-p-benzoquinone imine産生→oxidative damage・ミトコンドリア機能障害→肝障害
2.Varicocele：mildly painful unilateral testicular swelling caused by venous dilation.
Valsalva maneuverで増悪。
infertilityと関連あり。
精索静脈瘤は片側痛い。
3.腎所見Segmental, transmural fibrinoid necrosis
→PAN
PAN is a systemic necrotizing vasculitis of small- to medium-sized arteries that causes skin, renal, neurologic, and abdominal symptoms but spares the lungs.
Transmural inflammation of the arteries with fibrinoid necrosis is seen on histopathologic examination.
4.
・Trichomoniasis presents with vaginal itching, green frothy discharge, and cervicitis.
T. vaginalis microscopically appears as flagellated trophozoites on wet mount.
トラコマティスはgreen。
・Fuzzy epithelial cells on wet mount describe Gardnerella, which is a normal part of the vaginal flora.
・Gram-negative diplococci found in the vagina are most likely Neisseria gonorrhoeae.
The discharge in gonococcal infections is typically purulent or mucopurulent, not frothy, and can range from yellow to green in color.
ナイセリア
Lactobacillus(gram-positive rod)：major component of the vaginal microflora and typically does not cause pathology in genitourinary tract.
ラクトバシラスはノーマルフローラ。
Spores and pseudohyphae on Giemsa stain of vaginal discharge
→Candida albicans vaginitis。“cottage cheese” discharge.
5.Carbon dioxide is a substrate for carbonic anhydrase, the enzyme in red blood cells that catalyzes the conversion of carbon dioxide to bicarbonate.
In COPD, impaired respiration leads to a build-up of this substrate in the lungs→respiratory acidosis.
carbonic anhydrase炭酸脱水酵素の役割。
6.Methylergonovine：a uterotonic agent used to treat postpartum hemorrhage caused by uterine atony.
・contraindicated for postpartum hemorrhage in patients with preeclampsia or eclampsia or gestational or chronic hypertension due to increased risk of hypertensive crisis.
メチルエルゴノビンは妊婦の出産後の出血に適応。
高血圧緊急症のリスクのため子癇前症がある妊婦には禁忌。
7.IgA vasculitis (previously Henoch-Schönlein purpura) commonly presents in children with purpura, abdominal pain, arthralgias, and nephritic syndrome.
Nephritic syndrome presents with hematuria with or without RBC casts.
IgA腎症。nephritic syndromeは血尿あり、赤血球円柱はあってもなくても。
8.VCM耐性→Alteration in terminal amino acid of microorganism′s cell wall component
9.Hepatic encephalopathy occurs when a buildup of ammonia acts as a toxin to the central nervous system.
肝性脳症。アンモニアがCNSに作用→神経症状来たす。(lethargy, confusion, asterixis, and neuromuscular abnormalities)
治療）Lactulose：acidifying colonic contents and reducing the absorption of ammonia from the bowel.
肝性脳症の治療。ラクツロース
10.Echogenic kidneys reflect fibrosis and scarring
→longstanding CKD.
11.Hepatorenal syndrome
progressive functional renal failure caused by a reduction in the glomerular filtration rate due to declining liver function.
Kidney anatomy：normal in hepatorenal syndrome.
肝腎症候群。腎臓のサイズは変化無し。
12.M3 receptors activate phospholipase C to cleave PIP2 into inositol triphosphate and diacylglycerol.
リン中毒ではM3受容体が関与。
M受容体はqiq。涙はM3。
・cAMP：β-adrenergic receptors and histamine H2 receptors
・cGMP is increased in response to receptor binding by molecules such as peptide hormones (eg, thyroxine) and nitric oxide
・Phosphatidylinositol-3,4,5-trisphosphate is involved in insulin signaling.
13.In a state of hypoglycemia, islet β cells secrete less insulin.
低血糖の時はβ細胞はカリウムチャネルを開いたままにして、脱分極しないようしにしている。
14.SIADH
hyponatremia with elevated urine osmolality yet with a normal total body volume.
原因）tumors or drugs such as SSRI, antipsychotics, and glyburide(SU).
尿浸透圧が高いが、体液量変化なし。
Excessive fluid intake would show low urine osmolality as the kidney excretes excess water
輸液過剰なら尿浸透圧は低い。
脱水、フロセミドでは尿浸透圧は高くならない。
15.
・Hantavirus：a pseudocircular, negative sense RNA structure that is split into three segments, all of which differ from western equine encephalitis.
・Chikungunya virus：severe arthralgias.
・Dengue virus：outside the United States.
ハンタウイルスは3セグメントあり。
チクングニアは関節痛。
デングはアメリカにはいない。日本ではニュースになる。
セグメントがあるRNAウイルスはハンタウイルスとオルソミクソウイルス(インフルエンザウイルス)(8)、アリーナウイルス(2)、レオウイルス(10-12)の4つ。
16.Burkitt lymphoma：aggressive form of non-Hodgkin lymphoma
common symptoms）anorexia, constipation, and abdominal pain.
Biopsy）highly mitotic, basophilic lymphocytes surrounding clear zones of macrophages.
好塩基球！
17.Aminoglycosides
used for）gram-negative rods.
作用）irreversible inhibition of the initiation complex by binding to the 30S ribosomal subunit.
mechanism of resistance) bacterial enzymes altering and inactivating the drug via acetylation, phosphorylation, or adenylation.
アミノグリコシドはグラム陰性桿菌に使用。
耐性の機序はアセチル化、リン酸化、アデニル化で薬効不活化。
18.Poorly controlled type 2 diabetes mellitus
diabetic neuropathyの症状。
特にlight touch・vibratory sensationsの消失
Autonomic neuropathy)
postural hypotension, arrhythmias, abnormalities of sweating, nocturnal diarrhea, gastroparesis, impotence, and bladder dysfunction.
糖尿病罹患歴が長い場合、起立性低血圧に注意。
糖尿病性神経症状確認。
19.Vomiting→loss of stomach hydrochloric acid・volume depletion
→metabolic alkalosis
Tubular responses to contraction alkalosis are increased proximal bicarbonate reabsorption and increased aldosterone-driven collecting duct secretion of hydrogen ions.
嘔吐で代謝性アルカローシス。
腎臓の反応は？近位尿細管でバイカーボを再吸収。
20.Fibrates, especially gemfibrozil, increase the likelihood of rhabdomyolysis when combined with statin therapy.
フィブラートとスタチンで横紋筋融解。
competitive inhibition cytochrome P-450 3A4 metabolism and liver glucuronidation by gemfibrozil→increasing in the blood concentration of the statin.
CYP-450が阻害→スタチンの濃度が上がる。
21.手の神経
abductor pollicis brevis, lumbricals (1 and 2), and opponens pollicis：median nerve
extensor pollicis brevis：radial nerve
ulnar nerve：sensation over the medial 1 1/2 digits and hypothenar eminence and has a deep motor branch that supplies most of the intrinsic muscles of the hand, including the adductor pollicis muscle.
指を閉じるのは尺骨神経
22.Waldenström macroglobulinemia：rare B-lymphocyte lymphoproliferative disorder
・blood hyperviscosity
・secondary to increased levels of IgM (both heavy and light chains), which are secreted by neoplastic plasma cells.
IgM高値。カルシウム高くない。
23.age-related macular degeneration(ARMD) results from the deposition of drusen, which ultimately damages the photoreceptor cells and causes gradual central vision loss.
This patient likely has age-related macular degeneration (ARMD), given her painless loss of vision with reduced visual acuity, increased light requirement, and distortion of straight lines on an Amsler grid, with the straight lines appearing as curves.
加齢黄斑変性Amsler grid
24.肝膿瘍アメーバ。
E histolytica Characteristics：
Microscopic visualization of the stool：trophozoites with phagocytosed RBCs
Multinucleated trophozoites indicate Giardia lamblia
症状）nonbloody, foul-smelling, fatty diarrhea (steatorrhea).
Oocysts with acid-fast staining are indicative of Cryptosporidium
症状）severe watery diarrhea, usually in immunocompromised patients.
25.Turner syndrome
症状）short stature, webbed neck, and infertility.
＋aortic stenosis due to a bicuspid aortic valve±coarctation of the aorta.
ターナーの30%でニ尖弁。
26.Broca aphasia occurs due to damage to Broca area in the frontal lobe, specifically the posterior inferior frontal gyrus.
ブローカー野の場所。
27.Oligodendrocytes give rise to oligodendrogliomas.
These tumors typically appear as large frontal lobe masses.
前頭葉の腫瘍
28.Ependymal cells give rise to ependymomas, which are commonly found in the fourth ventricle and may result in noncommunicating hydrocephalus.
水頭症。
29.Classic galactosemia
症状)infantile cataracts, jaundice, and hepatomegaly.
白内障
Orotic aciduria：megaloblastic anemia, shortness of breath, pale skin, glossitis, and diarrhea.
舌炎
Phenylalanine hydroxylase deficiency presents with cognitive deficiency, seizures, microcephaly, and skin disease.
小頭症
30.
Massive blood transfusions→hypocalcemia caused by the concomitant administration of a large dose of the anticoagulant citrate with the blood.
Possible physical manifestations of hypocalcemia include muscle cramps, tetany, and perioral paresthesias.
A positive Chvostek sign is an indicator of muscle tetany.
大量輸血で低カルシウム血症のリスク。
Chvostek徴候で確認。
31.Injuries that are inconsistent with the explanation provided should raise suspicion for child abuse.
Physicians have a legal and ethical duty to report suspected abuse.
虐待はすぐ連絡。
32.Syringomyelia, an enlargement of the central canal of the spinal cord, commonly occurs at C8-T1. Patients present with loss of pain and temperature sensation but normal position and vibration sensation.
脊髄空洞症
33.First-line therapy for HBV infection：tenofovir, a nucleotide reverse-transcriptase inhibitor.
HBVの1stはテノフォビアー
34.Ursodeoxycholic acid can be used to treat primary biliary cholangitis(PBC).
PBCにウルソ。
35.ACTH is secreted by the anterior pituitary gland and stimulates glucocorticoid steroid hormone secretion from the adrenal cortex. It activates the intracellular cAMP signaling cascade.
BNP is secreted by the ventricles of the heart to decrease systemic vascular resistance and central venous pressure in the setting of heart failure.
It activates the intracellular cGMP signaling cascade.
Cortisol is secreted by the zona fasciculata of the adrenal cortex and helps regulate gene expression.
Erythropoietin is secreted by the interstitial cells of the kidney to increase RBC production. They exert their effect via the JAK-STAT pathway.
エリスロポエチンは腎臓の尿細管間質にあるEPO産生細胞から分泌。
36.thoracic duct and aorta pass through the aortic hiatus, under the median arcuate ligament.
・esophagus and vagus nerves pass through the esophageal hiatus.
37.Methemoglobinemia
increasing in oxidized iron,(a change in iron from the ferrous (Fe2+) to the ferric (Fe3+) state)
メトヘモグロビン血症は酸化イオンが増加する。oxidized hemoglobin(ferric, Fe3+)→酸素が結合できない。
正常のヘモグロビンはferroius, Fe2+。
38.Triptans：5-HT1B/1D (serotonin) receptor agonists
・used as abortive treatment for migraine headaches. They act by inducing cerebral vasoconstriction, inhibiting trigeminal nerve activation, and preventing vasoactive peptide release.
トリプタンは5-HT受容体拮抗薬→脳血管収縮→神経活性化阻害。
39.Euvolemic hyponatremia
→SIADH, chronic kidney disease, or thiazides.
Thiazide diuretics：inhibiting NaCl absorption and limiting the ability of the kidney to dilute the urine.
サイアザイド使用で低ナトリウム。体液量の変化はなし。
40.Lead poisoning
protoporphyrin↑
(1) It blocks δ-aminolevulinic acid dehydratase.
(2) it decreases iron incorporation into protoporphyrin to produce heme.
→protoporphyrin accumulates, and heme decreases.
鉛中毒でプロトポルフィリン上昇。
41.Mononucleosis like illness during pregnancy can result from cytomegalovirus (CMV). CMV infection in the neonate commonly manifests as hearing loss, chorioretinitis, intracranial calcifications around the ventricles, and a blueberry muffin rash.
新生児のCMV感染は難聴、脳室周囲の石灰化、ブルーベリーマフィン。TORCH症候群
Rubella：rash, lymphadenopathy, and joint pain
Infected during pregnancy：Cataracts, deafness, and heart defects (patent ductus arteriosus) are characteristic of congenital rubella.
風疹は白内障、難聴、PDA。TORCH症候群
42.Digoxin(inhibition of Na+/K+-ATPase) toxicity
症状) arrhythmias, nausea, dizziness, and blurry, yellow vision, hyperkalemia.
ジゴキシンはNa+/K+阻害→高Na血症。
43.tPA禁忌項目
・Age <18 or >80 years are contraindications for tPA
・a prothrombin time >15 seconds or a prolonged activated partial thromboplastin time
・a platelet count of <100,000/mm3
・a history of stroke within the last 3 months
44.Plasma osmolarity increases with high loss of water, such as during increased sweating or loss of dilute urine during diabetes insipidus (low ADH or low ADH effect).
発汗などで脱水のときに血漿浸透圧は上昇。
45.Administration of 5% dextrose＝administering pure water
（dextrose is quickly metabolized）
Pure water ingestion→low serum osmolality・decreasing ADH release from the posterior pituitary.
Low ADH：decreasing collecting duct aquaporins＋decreasing water reabsorption+decreasing urea reabsorption from the collecting duct.
5%ブドウ糖はpure water→血漿浸透圧を下げる→ADH分泌下げる。
46.NF-1：autosomal dominant neurocutaneous disorder
・≥6 café-au-lait spots that are >5 mm in diameter at prepubertal ages.
・iris hamartomas(Lisch nodules)
・axillary or inguinal freckling
・neurofibromas
・skeletal abnormalities
・other tumors.
神経線維腫症1型。café-au-lait斑。
47.Achondroplasia：abnormal endochondral ossification
→failure of longitudinal growth of bone
軟骨無形成症は軟骨内骨化の異常。
48.Central diabetes insipidus (DI)：common after brain surgery
→dilute urine and polyuria.
Tx)arginine vasopressin (DDAVP) (providing an ADH-like agent) →concentrates the urine.
DDAVP：releases von Willebrand factor from endothelial cells, helping to aggregate platelets.
下垂体オペ後。中枢性尿崩症の治療でデスモプレシン。
集合管でアクアポリン増やす。夜尿症にも使う(確認・復習その9)
デスモプレシンの作用でvWF分泌増加！！
49.Development of a reentrant circuit
→WPW syndrome, which would be associated with delta waves on ECG.
リエントリー回路→WPW
50.TTP：the formation of many microscopic blood clots
→hemolytic anemia, thrombocytopenia, neurologic findings, impaired kidney function, and fever.
TTPは微小血管閉塞。神経症状、腎機能低下、発熱。
