Medicine, Pharmacology, and Testing/Treatment

The human body is organized in the hierarchy cell → tissue → organ → system. A gathering of cells with the same function is a tissue, and a combination of tissues is an organ. The direction in which organs form cells, or tissue is broken-down organ, is reversed and wrong. A system is a unit of cooperating organs, like the circulatory system, not the internal structure of a cell.

Insulin is secreted from the islets of Langerhans in the pancreas and works to lower blood glucose; deficiency of its secretion or action is the essence of diabetes. The liver stores and metabolizes glucose but does not secrete insulin. The thyroid secretes thyroid hormone, and the adrenal glands secrete cortical and medullary hormones.

Myocardial infarction is a disease in which a coronary artery supplying the heart muscle becomes blocked and the muscle beyond it dies. Angina pectoris involves narrowed coronary arteries causing transient ischemia without necrosis, which distinguishes it from infarction. Arrhythmias are treated with pacemakers and ablation, while mammography is a breast X-ray examination. Hypertension is a state of high blood pressure.

The main cause of COPD is years of smoking, so the claim that bacterial infection is the main cause is wrong. Long-term inhalation of harmful substances such as tobacco smoke damages the airways and lungs, making it hard to exhale. That gas exchange occurs in the alveoli, that asthma involves repeated airway-narrowing attacks, and that the respiratory system consists of trachea, bronchi, and alveoli are all correct.

Helicobacter pylori is a bacterium living in the stomach, known to be associated with gastric and duodenal ulcers and gastric cancer, and eradication therapy is performed. It is not a virus, and its site is neither the alveoli nor the large intestine. Oxygen is carried by red blood cells. Ulcerative colitis is an inflammatory bowel disease of unknown cause, not established as caused by H. pylori.

Type 2 diabetes is closely related to lifestyle factors such as overeating and inactivity, and to constitution, and accounts for the great majority of diabetes patients in Japan. Type 1 is the type in which the insulin-secreting cells are destroyed and secretion is largely lost; it is not caused by lifestyle alone, and its patient numbers are far smaller than type 2. Diabetes is a disease of chronically high blood glucose.

The role of platelets is hemostasis, so the statement that they carry oxygen is wrong. Oxygen transport is the work of red blood cells, which contain hemoglobin. White blood cells and lymphocytes take part in defending the body against pathogens. The liquid component of blood is plasma, and plasma with the clotting components removed is serum.

The autonomic nerves, together with the somatic nerves, belong to the peripheral nervous system, so classifying them as central is wrong. The central nervous system consists of the cerebrum (frontal, temporal, parietal lobes, and so on), brainstem, cerebellum, and spinal cord. Cerebrovascular disease and brain tumors are representative diseases of the brain and nervous system, examined with CT, MRA, and the like.

Iatrogenic disease is harm arising from medical acts such as tests and treatment, and as a factor from outside the body it is classified as an external cause — so calling it internal is wrong. Internal causes are factors on the body's side, such as individual and congenital predisposition. External causes include nutritional, chemical, and physical causes, pathogenic organisms, and iatrogenic disease.

Malignant tumors grow autonomously, infiltrate surrounding tissue, and can metastasize to distant organs via blood and lymph vessels — these are their hallmarks. Benign tumors grow expansively and usually do not metastasize. The claim that malignant tumors disappear naturally is wrong. In lesion classification, tumors (neoplasms) are a category separate from inflammation.

ADME stands for Absorption, Distribution, Metabolism, and Excretion, describing the process by which a drug enters the body, is carried through it, is transformed mainly in the liver, and leaves the body mainly through the kidneys. None of the other options is the correct composition of ADME.

Drug metabolism is carried out mainly by the drug-metabolizing enzymes of the liver, so the statement naming the kidneys is wrong. What the kidneys mainly handle is excretion into the urine. That the blood-brain barrier restricts drug entry into the brain, and that the unbound (free) form exerts the effect, are both correct.

OTC drugs are classified, in descending order of risk, into categories 1, 2, and 3; category 1, with particularly high risk, may be sold only by a pharmacist. The highest risk is category 1, not 3. OTC drugs can be bought without a prescription — the difference from prescription drugs. Categories 2 and 3 may be sold by a pharmacist or a registered salesperson.

Generic drugs are manufactured and sold with the same active ingredient and the same indications after the original drug's patent term has expired. The active ingredient is identical to the original, and free manufacture during the patent term is not possible. They can be used in insured care, and their use is promoted to contain healthcare costs.

Unless otherwise noted, the period of use of a prescription is within 4 days including the date of issue (per the notes on the prescription form). It is the window for the patient to bring it to a pharmacy, and dispensing cannot be received on an expired prescription. 2, 14, and 30 days are all wrong.

Under the Narcotics and Psychotropics Control Act (麻薬及び向精神薬取締法), only narcotics practitioners licensed by the prefectural governor may administer or prescribe narcotics for the treatment of disease. A physician's license alone is not enough — a separate license is required. Narcotics are not OTC drugs and are handled under strict control. No system allows prescribing on a consent form alone.

NANDA is the classification system for nursing diagnoses. NIC classifies nursing interventions and NOC classifies nursing outcomes, and the 3 are used as a set to standardize the nursing process. ICD-10 is the international statistical classification of diseases and related health problems, not a nursing diagnosis classification.

The nursing care intensity measure (severity and medical/nursing care need) evaluates how much nursing effort and medical intervention each inpatient requires, and is used to evaluate facility standards for inpatient charges such as the basic hospitalization fee. It does not measure ward size, individual nurses' performance, or outpatient waiting times.

Biochemistry tests analyze specimens such as blood and are specimen tests. Electrocardiography, electroencephalography, and spirometry directly measure the patient's body and are classified as physiological function tests. Distinguishing specimen tests from physiological tests is basic to understanding the laboratory department and its system interfaces.

HbA1c is the proportion of hemoglobin in red blood cells bound to glucose; reflecting the red cell lifespan, it represents the average blood glucose state over roughly the past 1 to 2 months. The glucose level at the time of sampling is shown by the blood glucose test. Liver inflammation is assessed with AST and ALT, and renal filtration with creatinine and eGFR.

Creatinine is a waste product from muscle excreted by the kidneys, making it an indicator of kidney function, so the pairing with liver function is wrong. When kidney function declines, blood creatinine rises and eGFR falls. AST and ALT for liver function, CRP for inflammation, and HbA1c for glucose metabolism are all correct pairings.

CRP is a protein whose production in the liver increases with inflammation; it is the representative inflammation marker, rising in infections and inflammatory diseases. Average blood glucose is reflected by HbA1c, blood typing uses ABO and RhD tests, and the prostate tumor marker is PSA — all wrong as descriptions of CRP.

The reference range is set so that about the central 95% of healthy people's measured values fall within it. Therefore about 5% of healthy people fall outside it, and deviation from the range does not immediately mean disease. Reference ranges can also differ by measurement method and population, so the claim of a single worldwide value is wrong.

The crossmatch test reacts the donor's and recipient's blood in vitro before transfusion to confirm compatibility — that no harmful transfusion reaction will occur. Together with ABO and RhD typing and irregular antibody screening, it secures transfusion safety. Assessing glucose, screening tumors, and measuring lung function are the roles of other tests.

In the electrocardiogram, the QRS complex represents excitation (depolarization) of the ventricles. The P wave represents atrial excitation and the T wave recovery from ventricular excitation, so the swapped statements are wrong. The ECG is a physiological test recording the heart's electrical activity from the body surface, differing in principle from ultrasound examinations, which image reflected sound.

Spirometry is a physiological function test that measures the volume and speed of exhaled and inhaled air, yielding vital capacity, forced expiratory volume in 1 second (FEV1), and FEV1% (FEV1/FVC); a reduced FEV1% suggests an obstructive ventilatory disorder such as COPD. Recording the heart's electrical activity is electrocardiography, microscopic examination of tissue is a pathology test, and a test using a radiopharmaceutical is a nuclear medicine test.

Pathology tests examine cells and tissue collected from the patient under a microscope; they are not classified as physiological function tests, which directly measure the body as in electrocardiography, so this statement is incorrect. Using stains such as the Papanicolaou method in cytology, diagnosing by microscopic examination of specimens in histopathology, and performing an autopsy after death to clarify the pathological condition are all correct.

The positive predictive value is "the proportion of people who actually have the disease among those who tested positive." The number of positive people is 45+15=60, of whom 45 have the disease, so 45÷60=75%. 90% corresponds to this test's sensitivity (45/50) and specificity (135/150), which are different from the predictive value. 30% and 25% result from mixing up the calculation.

MRI uses a strong magnetic field and electromagnetic waves, so it does not involve radiation exposure. X-ray CT and plain X-ray radiography irradiate X-rays, and nuclear medicine tests administer a radiopharmaceutical, so all of them involve exposure. Whether or not exposure occurs is basic knowledge relevant to choosing and explaining tests.

MRI obtains images using a strong magnetic field and electromagnetic waves, so it may be contraindicated or require caution for people with implanted metal devices such as pacemakers. X-rays are used in CT and plain radiography, and a radiopharmaceutical is used in nuclear medicine tests. MRI produces loud noise during imaging and requires the patient to remain inside a narrow bore for a long time, so it actually requires caution for patients with claustrophobia.

A nuclear medicine test administers a radiopharmaceutical containing a radioisotope (RI) and images its distribution in the body with a scintillation camera or similar device to evaluate organ function and metabolism; it includes bone scintigraphy, PET, and SPECT. Using ultrasound reflection is ultrasonography, using a magnetic field is MRI, and direct observation with a camera is endoscopy.

Ultrasonography images the reflection of ultrasound applied from the body surface; it involves no radiation exposure, allows real-time observation of moving organs, and is easy to repeat. Because ultrasound is reflected and attenuated by bone and air, it is unsuited to observing the inside of bone. A strong magnetic field is needed for MRI, not ultrasonography.

Treatment that aims for cure by removing the cause of the disease is curative treatment; palliative treatment refers to treatment aimed at relieving symptoms and slowing progression rather than cure, so this statement is incorrect. It is correct that non-invasive treatment places a relatively small burden on the body, that surgical treatment includes surgery, and that medical treatment includes drug therapy.

TDM measures a drug's blood concentration and uses it to design the dose and dosing interval so that the level stays within the therapeutic range without exceeding the toxic range; it is performed for drugs whose therapeutic and toxic ranges are close. The preoperative confirmation procedure is the time-out, and an anticancer drug's treatment plan is called a regimen. Checking prescription content is dispensing work, not TDM.

Brachytherapy (including intracavitary irradiation) is a method that places a radioactive source near the lesion for irradiation. External beam radiotherapy irradiates from outside the body, so the description with the explanation reversed is incorrect. The content of irradiation is recorded in an irradiation record. Particle therapy using proton beams and heavy-ion beams is actually performed.