Ishi Kokka Shiken flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Resting membrane potential

The electrical potential difference across the cell membrane at rest, typically about -70 mV in neurons, maintained by the Na+/K+ ATPase pump and selective ion permeability.

Cardiac output formula

Cardiac output equals heart rate multiplied by stroke volume; normal resting value is approximately 5 L/min; Fick principle can also calculate it.

Competitive inhibitor effect

A competitive inhibitor binds reversibly to the active site, increasing the apparent Km while Vmax remains unchanged; effect can be overcome by increasing substrate concentration.

Inflammation cardinal signs

Redness, heat, swelling, pain, and loss of function; caused by vasodilation, increased vascular permeability, and mediators such as histamine, prostaglandins, and bradykinin.

IgG antibody

The most abundant immunoglobulin in serum, the only class that crosses the placenta, and a key mediator of secondary immune responses and opsonization.

First-pass metabolism

Orally administered drugs absorbed from the gut pass through the liver before reaching systemic circulation, reducing bioavailability; drugs with high first-pass effect require higher oral doses.

Troponin in myocardial infarction

Cardiac troponin rises 3-6 hours after myocardial injury, peaks at 12-24 hours, and remains elevated for 7-10 days; highly specific for myocardial damage.

KDIGO acute kidney injury criteria

Increase in serum creatinine by ≥0.3 mg/dL within 48 hours or ≥1.5 times baseline within 7 days, or urine output <0.5 mL/kg/h for 6 hours.

Diabetes diagnostic criteria

HbA1c ≥6.5%, fasting plasma glucose ≥126 mg/dL, 2-hour OGTT ≥200 mg/dL, or random glucose ≥200 mg/dL with symptoms; repeat testing required unless unequivocal.

SAAG in ascites

Serum-ascites albumin gradient; value ≥1.1 g/dL indicates portal hypertension (e.g., cirrhosis), while <1.1 g/dL suggests nonportal causes such as malignancy or tuberculosis.

Alvarado score

Clinical scoring system for acute appendicitis; components include migration of pain, anorexia, nausea/vomiting, tenderness, rebound tenderness, elevated temperature, leukocytosis, and left shift; score ≥7 supports appendectomy.

Hemorrhagic shock classes

Class I: <15% blood loss; Class II: 15-30%; Class III: 30-40% with hypotension; Class IV: >40% with marked hypotension and altered mental status.

Indirect inguinal hernia

Hernia that passes through the deep inguinal ring, lateral to the inferior epigastric vessels, and is the most common type of inguinal hernia, especially in younger patients.

Sentinel lymph node biopsy

Procedure to identify and remove the first draining lymph node(s) from a tumor; used for staging clinically node-negative breast cancer and melanoma to avoid unnecessary lymphadenectomy.

APGAR score components

Appearance, Pulse, Grimace, Activity, and Respiration; each scored 0-2, total 0-10; 7-10 normal, 4-6 moderately depressed, 0-3 severely depressed.

Kawasaki disease criteria

Fever ≥5 days plus at least 4 of 5: bilateral conjunctivitis, oral mucous membrane changes, polymorphous rash, extremity changes, cervical lymphadenopathy; treat with IVIG and aspirin.

Preeclampsia severe features

Blood pressure ≥160/110 mmHg, platelets <100,000/μL, elevated liver enzymes, progressive renal insufficiency, pulmonary edema, or new visual/cerebral symptoms in a pregnant patient after 20 weeks.

Postpartum hemorrhage management

Uterine massage and oxytocin first; then carboprost, misoprostol, or methylergonovine; tranexamic acid; escalate to balloon tamponade, uterine artery embolization, or surgery if needed.

Ischemic stroke thrombolysis window

Intravenous alteplase is indicated within 4.5 hours of symptom onset in eligible patients with acute ischemic stroke after excluding hemorrhage on noncontrast CT.

Status epilepticus first-line treatment

Benzodiazepines such as intravenous lorazepam are first-line for convulsive status epilepticus, followed by second-line agents like fosphenytoin, levetiracetam, or valproate.

Serotonin syndrome triad

Altered mental status, autonomic hyperactivity, and neuromuscular abnormalities (clonus, hyperreflexia, tremor); caused by serotonergic drugs; treat with cyproheptadine in severe cases.

Delirium features

Acute onset, fluctuating course, inattention, and disorganized thinking; common in hospitalized older adults; identify and treat the underlying cause rather than sedating.

Anaphylaxis treatment

Intramuscular epinephrine 0.3-0.5 mg (1:1000) into the anterolateral thigh is first-line; adjuncts include antihistamines, corticosteroids, and intravenous fluids; observe for biphasic reaction.

ARDS Berlin criteria

Acute onset within 1 week, bilateral opacities on chest imaging, respiratory failure not fully explained by cardiac failure, and PaO2/FiO2 ≤300 mmHg with PEEP ≥5 cmH2O.

Malignant hyperthermia treatment

Dantrolene 2.5 mg/kg IV is the specific antidote; triggered by volatile anesthetics and succinylcholine; supportive care includes cooling, hyperventilation, and treating hyperkalemia.

Sepsis initial resuscitation

For sepsis with hypotension or lactate ≥4 mmol/L, give 30 mL/kg crystalloid within the first 3 hours, obtain blood cultures, and start broad-spectrum antibiotics promptly.

Sensitivity and specificity

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives); both are intrinsic test properties independent of prevalence.

Informed consent elements

Capacity, disclosure of diagnosis, nature of procedure, material risks, benefits, alternatives, and consequences of refusal; patient must understand and voluntarily agree.

Brain death criteria

Irreversible loss of all brain function including brainstem; confirmed by coma, absent brainstem reflexes, and apnea test, after excluding confounders such as hypothermia or drugs.

OLDCARTS mnemonic

Onset, Location, Duration, Character, Aggravating/Associated factors, Relieving factors, Timing, and Severity; structured approach to characterize a patient's symptoms during the medical interview.

SPIKES protocol

Six-step framework for breaking bad news: Setting, Perception, Invitation, Knowledge, Emotions, and Strategy/Summary; emphasizes empathy and patient-centered communication.

Anion gap calculation

Anion gap = Na+ - (Cl- + HCO3-); normal 8-12 mEq/L; elevated in metabolic acidosis from unmeasured anions such as lactate, ketones, or toxins.