きついですね。
体力的に。
寝たいです。
1.Antihistamine intoxication：consistent with anticholinergic toxicity.
elevated heart rate, blood pressure, respiratory rate, mydriasis, decreased bowel sounds, dry skin, and dry mouth.
ヒスタミン中毒は抗コリン中毒と似ている。
2.Methamphetamine：a sympathomimetic and acute intoxication that presents with elevated vital signs, hyperthermia, diaphoresis, agitation, psychosis, and hyperkalemic metabolic acidosis.
アンフェタミンはバイタル↑
3.Cannabis intoxication presents with altered mental status, increased appetite, and conjunctival injection
カンナビノイド中毒は食欲旺盛！
4.Indirect inguinal hernias：especially in infants in the first year of life.
These hernias are the result of a congenital defect of the processus vaginalis when it fails to close.
子供はindirect。
5.Glycolysis is the biochemical process that converts glucose into pyruvate, and is regulated by several key rate-limiting steps.
Citrate inhibits phosphofructokinase-1, the enzyme that catalyzes the rate-limiting step of glycolysis.
グルコースからピルビン酸生成過程の律動にクエン酸
6.低リン血症→腎不全orビタミンD不足
血中カルシウム低下、尿中リン増加→ビタミンD不足。
7.S saprophyticus is a secondary cause of cystitis, especially in sexually active women.
サプロフィティカス
8.プロスタグランジン
・Prostaglandin D2：sleep/wake cycles and allergic responses.
・Prostaglandin F2a：degradation of the corpus luteum and stimulates oxytocin secretion.
・Prostaglandin I2 inhibits platelet aggregation, relaxes smooth muscle, reduces systemic and pulmonary vascular resistance by direct vasodilation, and promotes natriuresis in the kidneys.
D2は睡眠、アレルギー
F2aはオキシトシン
I2は血小板凝集阻害、筋肉弛緩、血管抵抗低下。
9.Aromatase inhibitors prevent peripheral conversion of testosterone to estradiol and of androstenedione to estrone.
→used to lower estrogen levels and to treat hormone-responsive breast cancer in postmenopausal women.
10.bicornuate uterus：incomplete fusion of the paramesonephric ducts.
11.horseshoe kidneyはinferior mesenteric artery下腸間膜動脈によって上行が妨げられる。
12.Aedes aegypti mosquito transmits dengue fever, yellow fever, Zika fever, and chikungunya.
・Ixodes tick transmits babesiosis, anaplasmosis, and Lyme disease.
・Phlebotomus sandfly transmits leishmaniasis.
・tsetse fly transmits African trypanosomiasis (caused by Trypanosoma brucei.)
13.Phenytoin：used for status epilepticus.
Its adverse effects include gum hypertrophy, hair growth, nausea, and poor coordination.
毛増える。
14.A tibial nerve is injured.
→loss of sensation on the sole of the foot and cannot curl their toes.
Proximal lesions to the tibial nerve result in loss of inversion and plantar flexion and an everted foot at rest.
脛骨神経麻痺で足底の感覚障害・鶏歩。
15.Sildenafil・vardenafil(PDE-5 inhibitors) prevent metabolism of cGMP
→smooth muscle relexation：vasodilation & erection
16.The medial meniscus is tested by a McMurray test.
pressure to a flexed knee results in a click or pain with external rotation.
半月板診察。マクマリーテスト。
17.Hyaluronidase breaks down connective tissue as part of the virulence of S. pyogenes, S aureus, and Pseudomonas.
ヒアルロニダーゼ
18.Zero-order drug elimination follows a linear pattern, whereas first-order elimination is proportional to drug concentration; drugs with zero-order drug elimination include phenytoin, ethanol, and high-dose aspirin(mnemonic: PEA).
ゼロオーダーはPEA。
19.tracheoesophageal fistula would result in polyhydramnios (excess amniotic fluid).
羊水多い→消化管
羊水少ない→腎臓
20.Potentiation of GABAA receptors leads to sedation, muscle relaxation, respiratory depression, hypotension, nausea, blurred vision, and coma.
・Inhibition of muscarinic receptors causes mydriasis, dry skin, dry mouth, and constipation.
・Blockade of norepinephrine reuptake causes mydriasis, tactile hallucinations, and agitation.
21.Metronidazole is a first-line therapy for treating giardiasis.
It has been associated with disulfiram-like reactions.
Patients should be advised against drinking alcohol while undergoing treatment.
旅行者下痢症。内服開始後飲酒→嘔吐→disulfiram-like reactions.
22.Germ tube–negative fungi, such as histoplasmosis, blastomycosis, and coccidioidomycosis, rarely present as scrapable plaques in the mouth and throat.
C albicans is a germ tube–positive fungus.
Germ tube–negative fungiは呼吸器症状と関連することが多い。
23.BK virus usually causes nephropathy in renal allograft patients and may clinically manifest as ureteral stenosis or tubulointerstitial nephritis.
24.Hemolytic anemia presents with decreased hemoglobin and hematocrit, scleral icterus, and dark urine.
G6PD deficiency can lead to hemolytic anemia when patients are exposed to oxidizing agents (eg, primaquine).
G6PD reduces NADP+ to NADPH, which in turn reduces glutathione and confers protection to erythrocytes against oxidative injury.
25.infliximab, used for patients with Crohn disease for whom corticosteroid therapy has failed.
Infliximab：monoclonal chimeric antibody that binds to and neutralizes TNF-α.
a tuberculin skin test (purified protein derivative) for tuberculosis screening is recommended for all patients.
Common adverse effects：upper respiratory tract infections, headache, and gastrointestinal distress.
Crohn病にはTNF-αに作用するモノクローナル抗体であるインフリキシマブ。
結核確認。副作用は上気道症状、頭痛、消化器症状。
26.Legionnaires pneumophila：a gram-negative, nonencapsulated bacterium that stains with silver stain.
L pneumophila grows best on buffered charcoal yeast extract agar with iron and cysteine.
レジオネラはシルバーステイン。培地はBCYE。
27.婦人科系は日本語が出てこない...
・Abruptio placentae presents with uterine contractions, pain, and signs of fetal distress.
早期胎盤剥離は痛い。
・Placenta accreta results in severe postpartum hemorrhage.
癒着胎盤
・Vasa previa is a very rare cause of antepartum hemorrhage.
前置血管
・Placenta previa occurs when the placenta overlies the internal cervical.
Placenta previa typically presents with painless bleeding in the third trimester, which distinguishes it from abruptio placentae, characterized by painful third-trimester bleeding.
前置胎盤は3期に痛くない出血。
第1期（0～12週）、第2期（13～24週）、第3期（25週から分娩まで）
28.Nonhomologous end joining involves bringing together two DNA fragments to repair double-stranded breaks, which may result in some loss of genetic material and is responsible for ataxia-telangiectasia.
Mismatch repair replaces segments of DNA that include mismatched bases and is involved in Lynch syndrome.
Homologous recombination requires two homologous DNA duplexes to repair damaged DNA and is implicated in BRCA1-positive cancers.
Base excision repair corrects DNA damage involving deamination, depurination, and alkylation caused by reactive oxygen species, ionizing radiation, and alkylating agents.
29.ACTH stimulates glucocorticoid steroid hormone secretion from the adrenal cortex
It activates the intracellular cAMP signaling cascade.
BNP：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.
Erythropoietin：secreted by the interstitial cells of the kidney to increase RBC production.：JAK-STAT pathway.
30.A hapten：a small molecule that cannot elicit an immune response on its own. It must form a complex with a large carrier, such as a protein, to be immunogenic.
ハプテン：抗体と結合するが、分子量が小さいために単独では抗体産生を惹起する活性を示さない物質のことである。 不完全抗原とも呼ばれる。 適当な高分子タンパク質と結合することにより免疫原性を持つ完全抗原となる
31.Decreased osteoblast function may be seen in vitamin D deficiency or hypoparathyroidism and can lead to osteomalacia or hypocalcemia.
ビタミンD欠乏で骨芽細胞の機能低下。
32.Lesions in the subthalamic nucleus can cause contralateral hemiballismus, a movement disorder that results in wild, flailing movements of the limbs.
33.Gentamicin can cause acute tubular necrosis(ATN), which presents with granular, muddy brown casts in the urine.
34.Acute (allergic) interstitial nephritis(AIN)：rash, fever, and/or eosinophilia.
Urinalysis reveals urine WBCs (sometimes with eosinophils) and WBC casts.
AIN重要ですね。
ATNとAINの区別が...muddy brown casts...
Common causes of acute interstitial nephritis include nonsteroidal inflammatory drugs and antibiotics such as penicillins, cephalosporins, and sulfonamides.
35.Prevents hyperextension of the knee=posterior drawer test.
後十字靱帯の障害
車事故でダッシュボードに膝ぶつけるケース。
36.Topiramate is used to prevent seizures and migraines. Its adverse effects include psychomotor slowing, sedation, and renal stones.
トピラメートの副作用に結石
37.The only drug for sickle cell disease
→hydroxyurea, which increases fetal hemoglobin production, thereby lowering the risks of RBC sickling and sickling-related complications.
ハイドロキシウレアは胎児ヘモグロビン産生
38.Classic galactosemia is associated with infantile cataracts, jaundice, and hepatomegaly.
Orotic aciduria is associated with megaloblastic anemia, shortness of breath, pale skin, glossitis, and diarrhea.
Phenylalanine hydroxylase deficiency presents with cognitive deficiency, seizures, microcephaly, and skin disease.
39.G6PD deficiency presents with hemolytic anemia as a result of oxidative challenge, for example, taking sulfa drugs.
In patients with G6PD deficiency, NADPH levels are too low to maintain glutathione in a reduced state during oxidative stress.
40.The West Nile virus is a flavivirus that is transmitted via the Culex mosquito. Symptoms include headache, body aches, joint pain, vomiting, diarrhea, or rash and central nervous system infection, such as encephalitis or meningitis.
41.Decreased afterload occurs with arterial vasodilators such as hydralazine and ACE-I。
42.Pheochromocytomas arise from the chromaffin cells of the adrenal medulla, which are derived from neural crest cells.
43.Peptostreptococcus and other anaerobic organisms are a common cause of aspiration pneumonia.
44.Flumazenil is an antidote to benzodiazepine that is a competitive antagonist.
Competitive antagonists shift the dose response curve to the right, with an apparent decrease in potency.
フルマゼニルは競合。反応曲線は右に移動。
45.Osteochondroma, which usually occurs in men younger than 25 years, originates from the metaphysis of long tubular bones
46.Sublimation is a type of mature defense mechanism in which socially unacceptable impulses or actions are replaced with those deemed acceptable.
47.In a unimodal, positively skewed distribution curve, the mean is higher than the median, which is higher than the mode: mean > median > mode.
48.The t(14;18) translocation causes upregulation of the antiapoptotic factor Bcl-2.
→blocking apoptosis and promoting growth of the malignant cells.
49.Exenatide：a glucagon-like peptide 1(GLP1) analog used for type 2 DM.
Side effects include nausea, vomiting, and pancreatitis.
Canagliflozin：a sodium-glucose cotransporter 2 inhibitor that blocks reabsorption of glucose in the early proximal tubule.
Adverse effects：recurrent urinary tract infections and yeast infections
副作用にyeast infections
50.
Severe indirect hyperbilirubinemia in an infant
→Crigler-Najjar syndrome: early in life / often fatal without a liver transplant.
Severeなのはタイプ1。移植必要。
