Title: Medicine
Tags: Subject::Internal_Medicine Year::4 Subject::Internal_Medicine::Endocrinology Subject::Internal_Medicine::Gastroenterology Subject::Internal_Medicine::Nephrology Type::Comparison Subject::Internal_Medicine::Diabetology Type::Flow Subject::Internal_Medicine::Gastroenterology::G_01 Subject::Internal_Medicine::Nephrology::N_02 Subject::Internal_Medicine::Diabetology::E_11 Subject::Internal_Medicine::Diabetology::E_12 Subject::Internal_Medicine::Gastroenterology::G_02

EnglishQuestion: What three axes are used to organize pituitary disorders?
JapaneseQuestion: 下垂体疾患を整理する3つの軸は何か？
EnglishAnswer: Hormone excess, hormone deficiency, and mass effect.
JapaneseAnswer: ホルモン過剰、ホルモン欠乏、腫瘤効果。

EnglishQuestion: How does hypothalamic dopamine regulate the anterior pituitary?
JapaneseQuestion: 視床下部ドパミンは下垂体前葉をどのように調節するか？
EnglishAnswer: It tonically inhibits prolactin (PRL) secretion.
JapaneseAnswer: プロラクチン（PRL）分泌を持続的に抑制する。

EnglishQuestion: What maximum diameter distinguishes a pituitary microadenoma from a macroadenoma?
JapaneseQuestion: 下垂体微小腺腫と大腺腫を区別する最大径は？
EnglishAnswer: A microadenoma is <10 mm, whereas a macroadenoma is >=10 mm.
JapaneseAnswer: 微小腺腫は10 mm未満、大腺腫は10 mm以上。

EnglishQuestion: Compression of which structure by a pituitary tumor causes bitemporal hemianopia?
JapaneseQuestion: 下垂体腫瘍による両耳側半盲は、どの構造の圧迫で起こるか？
EnglishAnswer: The optic chiasm.
JapaneseAnswer: 視交叉。

EnglishQuestion: How does pituitary stalk compression cause hyperprolactinemia?
JapaneseQuestion: 下垂体茎の圧迫は、どのように高プロラクチン血症を起こすか？
EnglishAnswer: It removes the tonic inhibition of PRL secretion by hypothalamic dopamine.
JapaneseAnswer: 視床下部ドパミンによるPRL分泌の持続的抑制が解除される。

EnglishQuestion: What endocrine emergency should be suspected in a patient with a pituitary lesion, sudden severe headache, visual loss or ophthalmoplegia, altered consciousness, and hypotension?
JapaneseQuestion: 下垂体病変に突然の激しい頭痛、視力低下または眼筋麻痺、意識障害、低血圧を伴う場合、どの内分泌緊急疾患を疑うか？
EnglishAnswer: Pituitary apoplexy.
JapaneseAnswer: 下垂体卒中。

EnglishQuestion: When pituitary apoplexy is suspected, what critical treatment should be given without waiting for test results?
JapaneseQuestion: 下垂体卒中を疑う場合、検査結果を待たずに行うべき重要な治療は？
EnglishAnswer: Administer emergency hydrocortisone and obtain urgent neurosurgical and endocrinology assessment.
JapaneseAnswer: 緊急にヒドロコルチゾンを投与し、脳神経外科・内分泌科の評価を行う。

EnglishQuestion: What additional test is required for a pituitary lesion that contacts the optic chiasm?
JapaneseQuestion: 視交叉に接する下垂体病変で追加すべき検査は？
EnglishAnswer: Formal visual-field testing.
JapaneseAnswer: 正式な視野検査。

EnglishQuestion: In combined pituitary hormone deficiency, which should be started first: hydrocortisone or levothyroxine (LT4)?
JapaneseQuestion: 複数の下垂体ホルモン欠乏では、ヒドロコルチゾンとレボチロキシン（LT4）のどちらを先に開始するか？
EnglishAnswer: Start hydrocortisone first, then begin levothyroxine.
JapaneseAnswer: ヒドロコルチゾンを先に開始し、その後レボチロキシンを開始する。

EnglishQuestion: What can be precipitated by starting levothyroxine (LT4) before treating adrenal insufficiency (AI)?
JapaneseQuestion: 副腎不全（AI）の治療前にレボチロキシン（LT4）を開始すると、何を誘発し得るか？
EnglishAnswer: Adrenal crisis.
JapaneseAnswer: 副腎クリーゼ。

EnglishQuestion: Which laboratory value should guide levothyroxine (LT4) dose adjustment in central hypothyroidism?
JapaneseQuestion: 中枢性甲状腺機能低下症では、レボチロキシン（LT4）の用量調整をどの検査値で行うか？
EnglishAnswer: Free thyroxine (FT4), not thyroid-stimulating hormone (TSH).
JapaneseAnswer: 甲状腺刺激ホルモン（TSH）ではなく遊離T4（FT4）。

EnglishQuestion: Why are hyperkalemia and hyperpigmentation uncommon in central adrenal insufficiency?
JapaneseQuestion: 中枢性副腎不全で高K血症と色素沈着が起こりにくいのはなぜか？
EnglishAnswer: The aldosterone system is usually preserved.
JapaneseAnswer: アルドステロン系が通常保たれるため。

EnglishQuestion: What is the main mechanism by which hyperprolactinemia causes hypogonadism?
JapaneseQuestion: 高プロラクチン血症が性腺機能低下を起こす主な機序は？
EnglishAnswer: Suppression of gonadotropin-releasing hormone (GnRH) secretion.
JapaneseAnswer: 性腺刺激ホルモン放出ホルモン（GnRH）分泌の抑制。

EnglishQuestion: What is the evaluation sequence for persistent unexplained hyperprolactinemia?
JapaneseQuestion: 原因不明の持続性高プロラクチン血症を評価する流れは？
EnglishAnswer: Check for pregnancy, medications, thyroid disease, and renal or hepatic dysfunction -> if needed, test for macroprolactin and repeat PRL measurement -> obtain pituitary MRI.
JapaneseAnswer: 妊娠、薬剤、甲状腺疾患、腎・肝機能障害を確認→必要ならマクロプロラクチン検査とPRL再測定→下垂体MRI。

EnglishQuestion: What should be suspected when a very large pituitary tumor is accompanied by a disproportionately low prolactin (PRL) level, and what measurement should be requested?
JapaneseQuestion: 巨大下垂体腫瘍に不釣り合いに低いプロラクチン（PRL）値を伴う場合、何を疑い、どの測定を依頼するか？
EnglishAnswer: Suspect the hook effect and request measurement after sample dilution.
JapaneseAnswer: フック効果を疑い、検体希釈後の測定を依頼する。

EnglishQuestion: What is the first-line drug treatment for a prolactinoma?
JapaneseQuestion: プロラクチノーマの第一選択薬は？
EnglishAnswer: A dopamine agonist, usually cabergoline.
JapaneseAnswer: ドパミン作動薬、通常はカベルゴリン。

EnglishQuestion: How does the name of growth hormone excess differ before versus after epiphyseal growth-plate closure?
JapaneseQuestion: 成長板閉鎖の前後で成長ホルモン過剰症の名称はどう異なるか？
EnglishAnswer: Before closure it is gigantism; after closure it is acromegaly.
JapaneseAnswer: 閉鎖前は巨人症、閉鎖後は先端巨大症。

EnglishQuestion: What is the diagnostic sequence from biochemical confirmation to localization in acromegaly?
JapaneseQuestion: 先端巨大症で、生化学的確認から局在診断までの流れは？
EnglishAnswer: Reconfirm an elevated age-adjusted insulin-like growth factor 1 (IGF-1) level -> assess growth hormone suppression during an oral glucose load -> after confirmation, obtain pituitary MRI.
JapaneseAnswer: 年齢調整IGF-1高値を再確認→経口ブドウ糖負荷で成長ホルモン抑制を評価→確定後に下垂体MRI。

EnglishQuestion: What is the main treatment for a resectable growth hormone-secreting pituitary adenoma?
JapaneseQuestion: 切除可能な成長ホルモン産生下垂体腺腫の中心的治療は？
EnglishAnswer: Transsphenoidal surgery.
JapaneseAnswer: 経蝶形骨洞手術。

EnglishQuestion: How do arginine vasopressin (AVP) deficiency and AVP resistance differ in their response to desmopressin?
JapaneseQuestion: アルギニンバソプレシン（AVP）欠乏症とAVP抵抗性は、デスモプレシンへの反応がどう異なるか？
EnglishAnswer: Urine concentration improves in AVP deficiency, whereas the response is poor in AVP resistance.
JapaneseAnswer: AVP欠乏症では尿濃縮が改善するが、AVP抵抗性では反応が乏しい。

EnglishQuestion: Which measurements should be obtained together in the initial evaluation of polyuria?
JapaneseQuestion: 多尿の初期評価で同時に測定すべき項目は？
EnglishAnswer: Twenty-four-hour urine volume, blood glucose, serum sodium, serum osmolality, and urine osmolality.
JapaneseAnswer: 24時間尿量、血糖、血清Na、血清浸透圧、尿浸透圧。

EnglishQuestion: Which electrolyte disorder must be particularly avoided during desmopressin therapy?
JapaneseQuestion: デスモプレシン治療中に特に避けるべき電解質異常は？
EnglishAnswer: Hyponatremia.
JapaneseAnswer: 低Na血症。

EnglishQuestion: Which endocrine functions must be shown to be normal before diagnosing syndrome of inappropriate antidiuresis (SIAD)?
JapaneseQuestion: 抗利尿不適合分泌症候群（SIAD）の診断前に、どの内分泌機能が正常であることを確認するか？
EnglishAnswer: Thyroid and adrenal function.
JapaneseAnswer: 甲状腺機能と副腎機能。

EnglishQuestion: What is the initial treatment for SIAD-associated hyponatremia with severe neurologic symptoms such as seizures or coma?
JapaneseQuestion: 痙攣や昏睡など重い神経症状を伴うSIAD性低Na血症の初期治療は？
EnglishAnswer: Give a bolus of 3% hypertonic saline and closely monitor symptoms and serum sodium.
JapaneseAnswer: 3%高張食塩水をボーラス投与し、症状と血清Naを厳密に監視する。

EnglishQuestion: What severe complication can result from overly rapid correction of hyponatremia?
JapaneseQuestion: 低Na血症を急速に補正すると、どの重篤な合併症が起こり得るか？
EnglishAnswer: Osmotic demyelination syndrome.
JapaneseAnswer: 浸透圧性脱髄症候群。

EnglishQuestion: What is the difference between thyrotoxicosis and hyperthyroidism?
JapaneseQuestion: 甲状腺中毒症と甲状腺機能亢進症の違いは？
EnglishAnswer: Thyrotoxicosis is the general state of excessive thyroid hormone action; hyperthyroidism is increased synthesis and secretion by the thyroid gland itself.
JapaneseAnswer: 甲状腺中毒症は甲状腺ホルモン作用過剰の総称で、甲状腺機能亢進症は甲状腺自体による合成・分泌の増加。

EnglishQuestion: What does a low thyroid-stimulating hormone (TSH) level with a high free thyroxine (FT4) level indicate?
JapaneseQuestion: 甲状腺刺激ホルモン（TSH）低値と遊離T4（FT4）高値は何を示すか？
EnglishAnswer: Primary hyperthyroidism.
JapaneseAnswer: 原発性甲状腺機能亢進症。

EnglishQuestion: What does a high thyroid-stimulating hormone (TSH) level with a low free thyroxine (FT4) level indicate?
JapaneseQuestion: 甲状腺刺激ホルモン（TSH）高値と遊離T4（FT4）低値は何を示すか？
EnglishAnswer: Primary hypothyroidism.
JapaneseAnswer: 原発性甲状腺機能低下症。

EnglishQuestion: What should be suspected when free thyroxine (FT4) is low but thyroid-stimulating hormone (TSH) is low to normal?
JapaneseQuestion: 遊離T4（FT4）が低値なのに甲状腺刺激ホルモン（TSH）が低値〜正常の場合、何を疑うか？
EnglishAnswer: Central hypothyroidism or nonthyroidal illness.
JapaneseAnswer: 中枢性甲状腺機能低下症または非甲状腺疾患。

EnglishQuestion: When thyroid-stimulating hormone (TSH) is low but free thyroxine (FT4) is normal, which additional hormone should be measured and why?
JapaneseQuestion: 甲状腺刺激ホルモン（TSH）が低値で遊離T4（FT4）が正常の場合、追加でどのホルモンを測定し、なぜか？
EnglishAnswer: Measure triiodothyronine (T3) because isolated T3 elevation may indicate T3 toxicosis.
JapaneseAnswer: トリヨードサイロニン（T3）を測定する。T3単独上昇のT3中毒症があり得るため。

EnglishQuestion: How does radioactive iodine (RAI) uptake distinguish increased thyroid hormone synthesis from destructive or exogenous causes of thyrotoxicosis?
JapaneseQuestion: 放射性ヨウ素（RAI）摂取率は、甲状腺ホルモン合成亢進と破壊性・外因性の甲状腺中毒症をどう区別するか？
EnglishAnswer: Uptake is increased with increased synthesis and decreased in destructive thyroiditis or exogenous thyroid hormone use.
JapaneseAnswer: 合成亢進では摂取率が上昇し、破壊性甲状腺炎または外因性甲状腺ホルモン使用では低下する。

EnglishQuestion: Which serum protein finding suggests exogenous thyroid hormone use?
JapaneseQuestion: 外因性甲状腺ホルモン使用を示唆する血清蛋白所見は？
EnglishAnswer: A low thyroglobulin (Tg) level.
JapaneseAnswer: サイログロブリン（Tg）低値。

EnglishQuestion: Which antibody causes Graves disease?
JapaneseQuestion: バセドウ病の原因となる抗体は？
EnglishAnswer: Thyroid-stimulating hormone receptor antibody (TRAb).
JapaneseAnswer: 甲状腺刺激ホルモン受容体抗体（TRAb）。

EnglishQuestion: Name two characteristic extrathyroidal manifestations of Graves disease.
JapaneseQuestion: バセドウ病に特徴的な甲状腺外所見を2つ挙げよ。
EnglishAnswer: Thyroid eye disease and pretibial myxedema.
JapaneseAnswer: 甲状腺眼症、前脛骨粘液水腫。

EnglishQuestion: Which antithyroid drug is usually first-line for Graves disease, and in which situations is propylthiouracil (PTU) mainly preferred?
JapaneseQuestion: バセドウ病では通常どの抗甲状腺薬が第一選択で、プロピルチオウラシル（PTU）は主にどの状況で選ぶか？
EnglishAnswer: Methimazole is usually first-line; PTU is preferred mainly during the first trimester of pregnancy and in thyroid storm.
JapaneseAnswer: 通常はメチマゾールが第一選択で、PTUは主に妊娠第1三半期と甲状腺クリーゼで選ぶ。

EnglishQuestion: What should be done if fever and sore throat develop while taking an antithyroid drug?
JapaneseQuestion: 抗甲状腺薬の内服中に発熱と咽頭痛が出た場合、どう対応するか？
EnglishAnswer: Stop the drug immediately and check the white blood cell and neutrophil counts.
JapaneseAnswer: 直ちに薬を中止し、白血球数と好中球数を確認する。

EnglishQuestion: What are the contraindications to radioactive iodine (RAI) therapy for Graves disease?
JapaneseQuestion: バセドウ病に対する放射性ヨウ素（RAI）療法の禁忌は？
EnglishAnswer: Pregnancy and breastfeeding.
JapaneseAnswer: 妊娠と授乳。

EnglishQuestion: Which definitive treatment for Graves disease is favored when there is a large goiter, compressive symptoms, or suspicion of malignancy?
JapaneseQuestion: 大きな甲状腺腫、圧迫症状、悪性疑いがあるバセドウ病で選ばれやすい根治療法は？
EnglishAnswer: Total thyroidectomy.
JapaneseAnswer: 甲状腺全摘術。

EnglishQuestion: Should thyroid storm be diagnosed and treated immediately on the basis of laboratory values or the clinical picture?
JapaneseQuestion: 甲状腺クリーゼは、検査値と臨床像のどちらに基づいて直ちに診断・治療するか？
EnglishAnswer: The clinical picture.
JapaneseAnswer: 臨床像。

EnglishQuestion: In thyroid storm, in what order should a thionamide and iodine be administered?
JapaneseQuestion: 甲状腺クリーゼでは、チオナミドとヨウ素をどの順序で投与するか？
EnglishAnswer: Administer iodine only after a thionamide has blocked new thyroid hormone synthesis.
JapaneseAnswer: チオナミドで甲状腺ホルモンの新規合成を阻害した後に、ヨウ素を投与する。

EnglishQuestion: What is the main treatment sequence for thyroid storm?
JapaneseQuestion: 甲状腺クリーゼの主な治療の流れは？
EnglishAnswer: Intensive care, treatment of the precipitant, and supportive care -> beta-blockade -> thionamide -> iodine -> glucocorticoid.
JapaneseAnswer: 集中治療・誘因治療・支持療法→β遮断→チオナミド→ヨウ素→グルココルチコイド。

EnglishQuestion: What must be evaluated before starting thyroid hormone replacement when central hypothyroidism is suspected?
JapaneseQuestion: 中枢性甲状腺機能低下症を疑う場合、甲状腺ホルモン補充前に何を評価するか？
EnglishAnswer: Adrenal function.
JapaneseAnswer: 副腎機能。

EnglishQuestion: How do the targets for levothyroxine (LT4) dose adjustment differ between primary and central hypothyroidism?
JapaneseQuestion: 原発性甲状腺機能低下症と中枢性甲状腺機能低下症では、レボチロキシン（LT4）の用量調整指標はどう異なるか？
EnglishAnswer: Use thyroid-stimulating hormone (TSH) in primary hypothyroidism and free thyroxine (FT4) in central hypothyroidism.
JapaneseAnswer: 原発性では甲状腺刺激ホルモン（TSH）、中枢性では遊離T4（FT4）を用いる。

EnglishQuestion: Which antibody is most useful in Hashimoto thyroiditis?
JapaneseQuestion: 橋本甲状腺炎で最も有用な抗体は？
EnglishAnswer: Thyroid peroxidase antibody (TPOAb).
JapaneseAnswer: 甲状腺ペルオキシダーゼ抗体（TPOAb）。

EnglishQuestion: Why are antithyroid drugs usually ineffective during the thyrotoxic phase of destructive thyroiditis?
JapaneseQuestion: 破壊性甲状腺炎の中毒期に抗甲状腺薬が通常効かないのはなぜか？
EnglishAnswer: The excess hormone comes from leakage of preformed hormone after follicular destruction, not increased new synthesis.
JapaneseAnswer: 新規合成の亢進ではなく、濾胞破壊によって貯蔵済みホルモンが漏出するため。

EnglishQuestion: How do subacute thyroiditis and painless or postpartum thyroiditis differ in pain and inflammatory markers?
JapaneseQuestion: 亜急性甲状腺炎と無痛性・産後甲状腺炎は、疼痛と炎症反応がどう異なるか？
EnglishAnswer: Subacute thyroiditis causes marked neck pain and tenderness with elevated ESR or CRP; painless and postpartum thyroiditis are usually painless, with mild or normal inflammatory markers.
JapaneseAnswer: 亜急性甲状腺炎では強い頸部痛・圧痛とESRまたはCRP上昇があり、無痛性・産後甲状腺炎は通常無痛で炎症反応は軽度または正常。

EnglishQuestion: What is the laboratory pattern of subclinical hypothyroidism?
JapaneseQuestion: 潜在性甲状腺機能低下症の検査所見は？
EnglishAnswer: Normal free thyroxine (FT4) with elevated thyroid-stimulating hormone (TSH).
JapaneseAnswer: 遊離T4（FT4）正常、甲状腺刺激ホルモン（TSH）高値。

EnglishQuestion: At what persistent thyroid-stimulating hormone (TSH) level should treatment for subclinical hypothyroidism be strongly considered?
JapaneseQuestion: 潜在性甲状腺機能低下症で治療を強く検討する持続性甲状腺刺激ホルモン（TSH）値は？
EnglishAnswer: >=10 mIU/L.
JapaneseAnswer: 10 mIU/L以上。

EnglishQuestion: What are the characteristic systemic findings of myxedema coma?
JapaneseQuestion: 粘液水腫性昏睡の代表的な全身所見は？
EnglishAnswer: Altered consciousness, hypothermia, hypoventilation, bradycardia, hypotension, hyponatremia, and hypoglycemia.
JapaneseAnswer: 意識障害、低体温、低換気、徐脈、低血圧、低Na血症、低血糖。

EnglishQuestion: In myxedema coma, when adrenal insufficiency cannot be excluded, in what order should hydrocortisone and levothyroxine (LT4) be given?
JapaneseQuestion: 粘液水腫性昏睡で副腎不全を除外できない場合、ヒドロコルチゾンとレボチロキシン（LT4）をどの順序で投与するか？
EnglishAnswer: Give hydrocortisone before or together with intravenous LT4.
JapaneseAnswer: ヒドロコルチゾンを先行または併用し、LT4を静注する。

EnglishQuestion: Which tests must always be combined in the initial evaluation of a thyroid nodule?
JapaneseQuestion: 甲状腺結節の初期評価で必ず組み合わせる検査は？
EnglishAnswer: Thyroid-stimulating hormone (TSH) measurement and neck ultrasonography.
JapaneseAnswer: 甲状腺刺激ホルモン（TSH）測定と頸部超音波検査。

EnglishQuestion: Which functional test should be performed next when thyroid-stimulating hormone (TSH) is low in a patient with a thyroid nodule?
JapaneseQuestion: 甲状腺結節で甲状腺刺激ホルモン（TSH）が低値の場合、次に行う機能検査は？
EnglishAnswer: Thyroid scintigraphy.
JapaneseAnswer: 甲状腺シンチグラフィ。

EnglishQuestion: When thyroid-stimulating hormone (TSH) is normal to high in a patient with a thyroid nodule, what determines the indication for fine-needle aspiration (FNA)?
JapaneseQuestion: 甲状腺結節で甲状腺刺激ホルモン（TSH）が正常〜高値の場合、穿刺吸引細胞診（FNA）の適応は何で判断するか？
EnglishAnswer: The ultrasonographic risk pattern and nodule size.
JapaneseAnswer: 超音波リスクパターンと結節径。

EnglishQuestion: Name four historical or clinical features that increase the risk of malignancy in a thyroid nodule.
JapaneseQuestion: 甲状腺結節の悪性リスクを高める病歴・臨床所見を4つ挙げよ。
EnglishAnswer: Childhood head or neck radiation exposure; family history of thyroid cancer or MEN2; rapid growth or hoarseness; and cervical lymphadenopathy.
JapaneseAnswer: 小児期の頭頸部放射線曝露、甲状腺癌またはMEN2の家族歴、急速な増大または嗄声、頸部リンパ節腫大。

EnglishQuestion: Name three high-risk ultrasonographic features of a thyroid nodule.
JapaneseQuestion: 甲状腺結節の高リスク超音波所見を3つ挙げよ。
EnglishAnswer: Any three of: marked hypoechogenicity, taller-than-wide shape, irregular margins or extrathyroidal extension, punctate echogenic foci, and suspicious cervical lymph nodes.
JapaneseAnswer: 著明な低エコー、縦長形状、辺縁不整または甲状腺外進展、点状高エコー、疑わしい頸部リンパ節のうち3つ。

EnglishQuestion: Which condition produces a solitary focus of high uptake with suppression of the surrounding thyroid on scintigraphy?
JapaneseQuestion: シンチグラフィで単発の高摂取域と周囲甲状腺の抑制を示す病態は？
EnglishAnswer: Toxic adenoma.
JapaneseAnswer: 中毒性腺腫。

EnglishQuestion: What does a cold nodule on thyroid scintigraphy mean, and how should it be evaluated next?
JapaneseQuestion: 甲状腺シンチグラフィの冷結節は何を意味し、次にどう評価するか？
EnglishAnswer: It is a nonfunctioning nodule and should be evaluated according to its ultrasonographic risk pattern.
JapaneseAnswer: 非機能性結節を意味し、超音波リスクパターンに従って評価する。

EnglishQuestion: What is the typical management of Bethesda category I cytology?
JapaneseQuestion: ベセスダ分類Iの代表的な対応は？
EnglishAnswer: Repeat ultrasound-guided fine-needle aspiration (FNA).
JapaneseAnswer: 超音波ガイド下で穿刺吸引細胞診（FNA）を再検する。

EnglishQuestion: What is the typical management of Bethesda category II cytology?
JapaneseQuestion: ベセスダ分類IIの代表的な対応は？
EnglishAnswer: Surveillance based on the ultrasonographic risk pattern.
JapaneseAnswer: 超音波リスクパターンに応じた経過観察。

EnglishQuestion: What is the typical management of Bethesda category IV cytology?
JapaneseQuestion: ベセスダ分類IVの代表的な対応は？
EnglishAnswer: Individualize management with diagnostic lobectomy or molecular testing.
JapaneseAnswer: 診断的葉切除または分子検査を含めて個別化する。

EnglishQuestion: Why can fine-needle aspiration (FNA) alone not distinguish follicular adenoma from follicular thyroid carcinoma?
JapaneseQuestion: 穿刺吸引細胞診（FNA）だけで濾胞腺腫と濾胞癌を区別できないのはなぜか？
EnglishAnswer: Histologic evidence of capsular or vascular invasion is required.
JapaneseAnswer: 被膜浸潤または血管浸潤の組織学的確認が必要なため。

EnglishQuestion: How does the fine-needle aspiration (FNA) approach differ between a pure thyroid cyst and a partially solid lesion?
JapaneseQuestion: 純粋な甲状腺嚢胞と部分充実性病変では、穿刺吸引細胞診（FNA）の方針がどう異なるか？
EnglishAnswer: An asymptomatic pure cyst does not require FNA; a partially solid lesion is assessed according to the ultrasonographic features of its solid component.
JapaneseAnswer: 無症候性の純嚢胞にはFNAは不要で、部分充実性病変は充実部の超音波所見に基づいて評価する。

EnglishQuestion: How do the main metastatic routes differ between papillary and follicular thyroid carcinoma?
JapaneseQuestion: 乳頭癌と濾胞癌では、主な転移経路がどう異なるか？
EnglishAnswer: Papillary carcinoma spreads via lymphatics to the cervical lymph nodes; follicular carcinoma spreads hematogenously to bone and lung.
JapaneseAnswer: 乳頭癌はリンパ行性に頸部リンパ節へ、濾胞癌は血行性に骨・肺へ転移する。

EnglishQuestion: What are the characteristic nuclear features of papillary thyroid carcinoma?
JapaneseQuestion: 乳頭癌に特徴的な核所見は？
EnglishAnswer: Orphan Annie eye nuclei, nuclear grooves, and intranuclear cytoplasmic inclusions.
JapaneseAnswer: すりガラス状核、核溝、核内細胞質封入体。

EnglishQuestion: From which cells does medullary thyroid carcinoma arise, and what are its characteristic tumor markers?
JapaneseQuestion: 髄様癌はどの細胞に由来し、代表的な腫瘍マーカーは何か？
EnglishAnswer: It arises from parafollicular C cells; the characteristic markers are calcitonin and CEA.
JapaneseAnswer: 傍濾胞C細胞由来で、代表的マーカーはカルシトニンとCEA。

EnglishQuestion: Why is radioactive iodine (RAI) therapy ineffective for medullary thyroid carcinoma?
JapaneseQuestion: 髄様癌に放射性ヨウ素（RAI）療法が効かないのはなぜか？
EnglishAnswer: It arises from C cells, which do not take up iodine.
JapaneseAnswer: ヨウ素を取り込まないC細胞由来だから。

EnglishQuestion: What is the standard operation for low-risk differentiated thyroid carcinoma <=2 cm that is confined to one lobe, has no extrathyroidal extension, and has no clinically evident lymph-node metastasis?
JapaneseQuestion: 2 cm以下で片葉に限局し、甲状腺外進展と臨床的リンパ節転移がない低リスク分化型甲状腺癌の標準術式は？
EnglishAnswer: Lobectomy.
JapaneseAnswer: 葉切除。

EnglishQuestion: Which features of differentiated thyroid carcinoma generally indicate total thyroidectomy?
JapaneseQuestion: 分化型甲状腺癌で一般に全摘を適応とする進展所見は？
EnglishAnswer: Tumor >4 cm, extrathyroidal extension, clinically evident lymph-node metastasis, or distant metastasis.
JapaneseAnswer: 腫瘍径4 cm超、甲状腺外進展、臨床的リンパ節転移、または遠隔転移。

EnglishQuestion: Are postoperative radioactive iodine (RAI) therapy and thyroid-stimulating hormone (TSH) suppression used uniformly in every patient with differentiated thyroid carcinoma?
JapaneseQuestion: 分化型甲状腺癌の術後に、放射性ヨウ素（RAI）療法と甲状腺刺激ホルモン（TSH）抑制を全例一律に行うか？
EnglishAnswer: No. They are individualized according to recurrence risk and response to treatment.
JapaneseAnswer: 行わない。再発リスクと治療反応に応じて個別化する。

EnglishQuestion: Which tests are used for postoperative surveillance of differentiated thyroid carcinoma?
JapaneseQuestion: 分化型甲状腺癌の術後監視に用いる検査は？
EnglishAnswer: Thyroglobulin (Tg), thyroglobulin antibody (TgAb), and neck ultrasonography.
JapaneseAnswer: サイログロブリン（Tg）、サイログロブリン抗体（TgAb）、頸部超音波検査。

EnglishQuestion: What is the critical sequence from diagnosis of medullary thyroid carcinoma to thyroid surgery?
JapaneseQuestion: 髄様癌の診断から甲状腺手術までの重要な流れは？
EnglishAnswer: RET genetic evaluation -> preoperative assessment for pheochromocytoma -> treat pheochromocytoma first if present -> total thyroidectomy with indicated lymph-node dissection.
JapaneseAnswer: RET遺伝学的評価→褐色細胞腫の術前評価→存在すれば先に治療→甲状腺全摘と必要なリンパ節郭清。

EnglishQuestion: Why must pheochromocytoma be excluded before thyroid surgery in a patient with medullary thyroid carcinoma?
JapaneseQuestion: 髄様癌患者の甲状腺手術前に褐色細胞腫を除外する必要があるのはなぜか？
EnglishAnswer: An undiagnosed pheochromocytoma can cause a fatal catecholamine crisis during surgery.
JapaneseAnswer: 未診断の褐色細胞腫は、手術中に致死的なカテコールアミンクリーゼを起こし得るため。

EnglishQuestion: What must be assessed first in rapidly enlarging anaplastic thyroid carcinoma?
JapaneseQuestion: 急速に増大する未分化甲状腺癌で最初に評価すべきものは？
EnglishAnswer: An impending airway emergency.
JapaneseAnswer: 切迫する気道緊急事態。

EnglishQuestion: Which important molecular alteration should be tested rapidly in anaplastic thyroid carcinoma?
JapaneseQuestion: 未分化甲状腺癌で迅速に検査すべき重要な分子異常は？
EnglishAnswer: BRAF V600E.
JapaneseAnswer: BRAF V600E変異。

EnglishQuestion: Which important drug regimen is used for unresectable BRAF V600E-mutated anaplastic thyroid carcinoma?
JapaneseQuestion: BRAF V600E変異を伴う切除不能未分化甲状腺癌に用いる重要な薬物療法は？
EnglishAnswer: Dabrafenib plus trametinib.
JapaneseAnswer: ダブラフェニブ＋トラメチニブ。

EnglishQuestion: Which calcium measurement is preferred over a corrected total calcium formula in critically ill patients, hypoalbuminemia, or acid-base disorders?
JapaneseQuestion: 重症患者、低アルブミン血症、酸塩基異常では、補正総Ca式よりどの測定を優先するか？
EnglishAnswer: Ionized calcium (iCa).
JapaneseAnswer: イオン化Ca（iCa）。

EnglishQuestion: What are the net effects of parathyroid hormone (PTH) on serum calcium and phosphate?
JapaneseQuestion: 副甲状腺ホルモン（PTH）の血清Caとリンへの正味の作用は？
EnglishAnswer: It increases serum calcium and decreases serum phosphate.
JapaneseAnswer: 血清Caを上昇させ、血清リンを低下させる。

EnglishQuestion: What are the characteristic neuromuscular symptoms of hypocalcemia?
JapaneseQuestion: 低Ca血症の代表的な神経筋症状は？
EnglishAnswer: Perioral and limb paresthesias, muscle spasms, tetany, laryngospasm, and seizures.
JapaneseAnswer: 口周囲・四肢のしびれ、筋攣縮、テタニー、喉頭痙攣、痙攣。

EnglishQuestion: What electrocardiographic change occurs in hypocalcemia?
JapaneseQuestion: 低Ca血症でみられる心電図変化は？
EnglishAnswer: QT prolongation.
JapaneseAnswer: QT延長。

EnglishQuestion: What should be considered when parathyroid hormone (PTH) is low or inappropriately normal in hypocalcemia?
JapaneseQuestion: 低Ca血症で副甲状腺ホルモン（PTH）が低値または不適切に正常の場合、何を考えるか？
EnglishAnswer: Hypoparathyroidism or severe hypomagnesemia.
JapaneseAnswer: 副甲状腺機能低下症または重症低Mg血症。

EnglishQuestion: What should be considered when parathyroid hormone (PTH) is elevated in hypocalcemia?
JapaneseQuestion: 低Ca血症で副甲状腺ホルモン（PTH）が高値の場合、何を考えるか？
EnglishAnswer: Vitamin D deficiency or resistance, chronic kidney disease, or pseudohypoparathyroidism.
JapaneseAnswer: ビタミンD欠乏または抵抗性、慢性腎臓病、偽性副甲状腺機能低下症。

EnglishQuestion: Why is hypocalcemia difficult to correct unless concomitant hypomagnesemia is corrected?
JapaneseQuestion: 合併する低Mg血症を補正しないと低Ca血症が改善しにくいのはなぜか？
EnglishAnswer: Hypomagnesemia impairs both parathyroid hormone (PTH) secretion and PTH action.
JapaneseAnswer: 低Mg血症は副甲状腺ホルモン（PTH）の分泌と作用の両方を障害するため。

EnglishQuestion: What is the initial treatment for hypocalcemia accompanied by seizures, laryngospasm, or arrhythmia?
JapaneseQuestion: 痙攣、喉頭痙攣、不整脈を伴う低Ca血症の初期治療は？
EnglishAnswer: Give intravenous 10% calcium gluconate, monitor the ECG and ionized calcium, and correct magnesium.
JapaneseAnswer: 10%グルコン酸Caを静注し、心電図とイオン化Caを監視し、Mgを補正する。

EnglishQuestion: What is the basic treatment and calcium target in chronic hypoparathyroidism?
JapaneseQuestion: 慢性副甲状腺機能低下症の基本治療とCa目標は？
EnglishAnswer: Use oral calcium plus active vitamin D, target a low-normal serum calcium level, and monitor urinary calcium.
JapaneseAnswer: 経口Caと活性型ビタミンDを用い、血清Caを低正常域に保ち、尿中Caを監視する。

EnglishQuestion: Which hormone should be measured first in the initial differential diagnosis of hypercalcemia?
JapaneseQuestion: 高Ca血症の初期鑑別で最初に測定するホルモンは？
EnglishAnswer: Parathyroid hormone (PTH).
JapaneseAnswer: 副甲状腺ホルモン（PTH）。

EnglishQuestion: What should be considered when parathyroid hormone (PTH) is elevated or inappropriately normal in hypercalcemia?
JapaneseQuestion: 高Ca血症で副甲状腺ホルモン（PTH）が高値または不適切に正常の場合、何を考えるか？
EnglishAnswer: Primary or tertiary hyperparathyroidism and familial hypocalciuric hypercalcemia (FHH).
JapaneseAnswer: 原発性または三次性副甲状腺機能亢進症、家族性低Ca尿性高Ca血症（FHH）。

EnglishQuestion: What are the main causes to investigate when parathyroid hormone (PTH) is suppressed in hypercalcemia?
JapaneseQuestion: 高Ca血症で副甲状腺ホルモン（PTH）が抑制されている場合、主に何を検索するか？
EnglishAnswer: Malignancy, vitamin D-related causes, granulomatous disease, and osteolysis.
JapaneseAnswer: 悪性腫瘍、ビタミンD関連病態、肉芽腫性疾患、骨融解。

EnglishQuestion: What are the typical features of familial hypocalciuric hypercalcemia (FHH), and how does it respond to surgery?
JapaneseQuestion: 家族性低Ca尿性高Ca血症（FHH）の典型的特徴と手術への反応は？
EnglishAnswer: Mild hypercalcemia, relative hypocalciuria, and a family history; conventional parathyroid surgery is usually ineffective.
JapaneseAnswer: 軽度高Ca血症、相対的低Ca尿、家族歴を示し、通常の副甲状腺手術は無効。

EnglishQuestion: What is the treatment sequence for hypercalcemic crisis?
JapaneseQuestion: 高Ca血症クリーゼの治療の流れは？
EnglishAnswer: Isotonic saline -> calcitonin for a rapid reduction -> a bisphosphonate or denosumab for sustained control -> treatment of the cause.
JapaneseAnswer: 等張食塩水→カルシトニンで迅速に低下→ビスホスホネートまたはデノスマブで持続的に抑制→原因治療。

EnglishQuestion: Why is routine forced diuresis with a loop diuretic avoided in hypercalcemia?
JapaneseQuestion: 高Ca血症でループ利尿薬による強制利尿をルーチンに行わないのはなぜか？
EnglishAnswer: It can worsen dehydration.
JapaneseAnswer: 脱水を悪化させ得るため。

EnglishQuestion: How do serum calcium levels differ among primary, secondary, and tertiary hyperparathyroidism?
JapaneseQuestion: 原発性、二次性、三次性副甲状腺機能亢進症では、血清Ca値がどう異なるか？
EnglishAnswer: Calcium is high in primary disease, low to normal in secondary disease, and high in tertiary disease.
JapaneseAnswer: 原発性では高値、二次性では低値〜正常、三次性では高値。

EnglishQuestion: Is localization imaging in primary hyperparathyroidism (PHPT) used for diagnosis or preoperative planning?
JapaneseQuestion: 原発性副甲状腺機能亢進症（PHPT）の局在画像は、診断と術前計画のどちらに用いるか？
EnglishAnswer: It is used for preoperative surgical planning; the diagnosis is biochemical.
JapaneseAnswer: 術前の手術計画に用い、診断は生化学的に行う。

EnglishQuestion: What serum calcium criterion supports surgery in asymptomatic primary hyperparathyroidism (PHPT)?
JapaneseQuestion: 無症候性原発性副甲状腺機能亢進症（PHPT）で手術を支持する血清Ca基準は？
EnglishAnswer: A serum calcium level >1.0 mg/dL above the upper limit of normal.
JapaneseAnswer: 血清Caが基準上限より1.0 mg/dL超高いこと。

EnglishQuestion: Which skeletal, renal, or age criteria support surgery in asymptomatic primary hyperparathyroidism (PHPT)?
JapaneseQuestion: 無症候性原発性副甲状腺機能亢進症（PHPT）で手術を支持する骨、腎、年齢の基準は？
EnglishAnswer: Any of the following: T-score <=-2.5 or vertebral fracture; eGFR or creatinine clearance <60; nephrolithiasis, nephrocalcinosis, or marked hypercalciuria; or age <50 years.
JapaneseAnswer: 次のいずれか：Tスコア-2.5以下または椎体骨折、eGFRまたはクレアチニンクリアランス60未満、腎結石・腎石灰化または著明な高Ca尿、50歳未満。

EnglishQuestion: What is the basic biochemical pattern of hypoparathyroidism?
JapaneseQuestion: 副甲状腺機能低下症の基本的な生化学所見は？
EnglishAnswer: Hypocalcemia, hyperphosphatemia, and low or inappropriately normal parathyroid hormone (PTH).
JapaneseAnswer: 低Ca血症、高リン血症、副甲状腺ホルモン（PTH）低値または不適切に正常。

EnglishQuestion: What T-score on dual-energy X-ray absorptiometry (DXA) is diagnostic of osteoporosis?
JapaneseQuestion: 二重エネルギーX線吸収測定法（DXA）で骨粗鬆症と診断するTスコアは？
EnglishAnswer: <=-2.5.
JapaneseAnswer: -2.5以下。

EnglishQuestion: Which fractures warrant treatment as osteoporosis even when the T-score is greater than -2.5?
JapaneseQuestion: Tスコアが-2.5より高くても骨粗鬆症として治療対象となる骨折は？
EnglishAnswer: A fragility fracture of the hip or vertebra.
JapaneseAnswer: 股関節または椎体の脆弱性骨折。

EnglishQuestion: What treatment is required after an osteoanabolic agent is used in a patient at very high fracture risk?
JapaneseQuestion: 骨折リスクが非常に高い患者に骨形成促進薬を使用した後、どの治療が必要か？
EnglishAnswer: Ongoing antiresorptive therapy.
JapaneseAnswer: 抗吸収療法の継続。

EnglishQuestion: What plan is essential when denosumab is delayed or discontinued?
JapaneseQuestion: デノスマブを延期または中止する際に必須の計画は？
EnglishAnswer: Plan sequential antiresorptive therapy, such as a bisphosphonate, to prevent rebound bone resorption and multiple vertebral fractures.
JapaneseAnswer: 反跳性骨吸収と多発椎体骨折を防ぐため、ビスホスホネートなどの後続抗吸収療法を計画する。

EnglishQuestion: Name four clinical situations that should prompt active suspicion of secondary hypertension.
JapaneseQuestion: 二次性高血圧を積極的に疑う臨床状況を4つ挙げよ。
EnglishAnswer: Any four of: young age at onset; sudden onset or worsening; severe or resistant hypertension; hypokalemia; an adrenal incidentaloma; sleep apnea; and a family history of early-onset hypertension or stroke.
JapaneseAnswer: 若年発症、突然の発症または増悪、重症または治療抵抗性高血圧、低K血症、副腎偶発腫、睡眠時無呼吸、若年性高血圧または脳卒中の家族歴のうち4つ。

EnglishQuestion: How does aldosterone alter sodium, potassium, and hydrogen ion transport in the distal nephron?
JapaneseQuestion: アルドステロンは遠位ネフロンでNa、K、水素イオンの輸送をどう変えるか？
EnglishAnswer: It increases sodium and water reabsorption and increases potassium and hydrogen ion excretion.
JapaneseAnswer: Naと水の再吸収を増やし、Kと水素イオンの排泄を増やす。

EnglishQuestion: What is the basic aldosterone and renin pattern in primary aldosteronism (PA)?
JapaneseQuestion: 原発性アルドステロン症（PA）の基本的なアルドステロン・レニンパターンは？
EnglishAnswer: Autonomous aldosterone secretion with suppressed renin.
JapaneseAnswer: 自律性アルドステロン分泌とレニン抑制。

EnglishQuestion: Which blood-pressure, potassium, and acid-base abnormalities can occur in primary aldosteronism (PA)?
JapaneseQuestion: 原発性アルドステロン症（PA）では、血圧、K、酸塩基にどの異常が起こり得るか？
EnglishAnswer: Hypertension, hypokalemia, and metabolic alkalosis.
JapaneseAnswer: 高血圧、低K血症、代謝性アルカローシス。

EnglishQuestion: Does normokalemia exclude primary aldosteronism (PA)?
JapaneseQuestion: 正常K血症なら原発性アルドステロン症（PA）を除外できるか？
EnglishAnswer: No. Many patients with PA are normokalemic.
JapaneseAnswer: できない。PA患者の多くは正常K血症である。

EnglishQuestion: Which three measurements are obtained in screening for primary aldosteronism, and which ratio is calculated?
JapaneseQuestion: 原発性アルドステロン症のスクリーニングでは、どの3項目を測定し、どの比を算出するか？
EnglishAnswer: Measure aldosterone, plasma renin activity or direct renin concentration, and potassium; calculate the aldosterone-to-renin ratio (ARR).
JapaneseAnswer: アルドステロン、血漿レニン活性または直接レニン濃度、Kを測定し、アルドステロン／レニン比（ARR）を算出する。

EnglishQuestion: Why should hypokalemia be corrected before screening for primary aldosteronism?
JapaneseQuestion: 原発性アルドステロン症のスクリーニング前に低K血症を補正するのはなぜか？
EnglishAnswer: Hypokalemia can falsely lower the aldosterone level.
JapaneseAnswer: 低K血症によってアルドステロン値が偽低値になり得るため。

EnglishQuestion: Besides the ratio itself, what factors must be considered when interpreting the aldosterone-to-renin ratio (ARR)?
JapaneseQuestion: アルドステロン／レニン比（ARR）は、比そのもの以外に何と合わせて解釈するか？
EnglishAnswer: The aldosterone level, degree of renin suppression, assay and units, medications, and blood-sampling conditions.
JapaneseAnswer: アルドステロン値、レニン抑制の程度、測定法と単位、薬剤、採血条件。

EnglishQuestion: What is the basic sequence from a positive screen for primary aldosteronism to treatment?
JapaneseQuestion: 原発性アルドステロン症のスクリーニング陽性から治療までの基本的な流れは？
EnglishAnswer: Suppression testing when needed -> adrenal CT -> generally adrenal venous sampling (AVS) for surgical candidates -> adrenalectomy for unilateral disease or a mineralocorticoid receptor antagonist (MRA) for bilateral disease.
JapaneseAnswer: 必要時に抑制試験→副腎CT→手術候補では原則として副腎静脈サンプリング（AVS）→片側性なら副腎摘除、両側性ならミネラルコルチコイド受容体拮抗薬（MRA）。

EnglishQuestion: When may confirmatory suppression testing for primary aldosteronism be omitted?
JapaneseQuestion: 原発性アルドステロン症で確認抑制試験を省略できるのはどのような場合か？
EnglishAnswer: When renin-independent aldosterone secretion is unequivocal, familial PA is present, or the patient does not want surgery and will proceed directly to medical therapy, among other situations.
JapaneseAnswer: 明白なレニン非依存性アルドステロン分泌、家族性PA、または患者が手術を希望せず直接薬物療法へ進む場合など。

EnglishQuestion: How do the roles of adrenal CT and adrenal venous sampling (AVS) differ in primary aldosteronism?
JapaneseQuestion: 原発性アルドステロン症では、副腎CTと副腎静脈サンプリング（AVS）の役割がどう異なるか？
EnglishAnswer: CT excludes large tumors and defines anatomy; AVS compares aldosterone secretion from each side to determine whether the disease is unilateral.
JapaneseAnswer: CTは大きな腫瘍を除外して解剖を把握し、AVSは左右のアルドステロン分泌を比較して片側性か判定する。

EnglishQuestion: Why should laterality not be determined by CT alone in a surgical candidate with primary aldosteronism?
JapaneseQuestion: 原発性アルドステロン症の手術候補で、CTだけで左右を決めてはいけないのはなぜか？
EnglishAnswer: CT cannot reliably distinguish incidentalomas from small causal lesions, so adrenal venous sampling (AVS) is generally required.
JapaneseAnswer: CTでは偶発腫と小さな原因病変を確実に区別できないため、原則として副腎静脈サンプリング（AVS）が必要。

EnglishQuestion: How does treatment differ between unilateral and bilateral primary aldosteronism?
JapaneseQuestion: 片側性と両側性の原発性アルドステロン症では治療がどう異なるか？
EnglishAnswer: Use unilateral adrenalectomy for surgically eligible unilateral disease and a mineralocorticoid receptor antagonist (MRA) for bilateral disease.
JapaneseAnswer: 手術適格の片側性では片側副腎摘除、両側性ではミネラルコルチコイド受容体拮抗薬（MRA）を用いる。

EnglishQuestion: Which mineralocorticoid receptor antagonists (MRAs) are commonly used for primary aldosteronism?
JapaneseQuestion: 原発性アルドステロン症に用いる代表的なミネラルコルチコイド受容体拮抗薬（MRA）は？
EnglishAnswer: Spironolactone or eplerenone.
JapaneseAnswer: スピロノラクトンまたはエプレレノン。

EnglishQuestion: What sex hormone-related adverse effects can spironolactone cause?
JapaneseQuestion: スピロノラクトンが起こし得る性ホルモン関連副作用は？
EnglishAnswer: Gynecomastia, sexual dysfunction, and menstrual irregularities.
JapaneseAnswer: 女性化乳房、性機能障害、月経異常。

EnglishQuestion: How do the sites of origin differ between pheochromocytoma and paraganglioma?
JapaneseQuestion: 褐色細胞腫とパラガングリオーマでは発生部位がどう異なるか？
EnglishAnswer: Pheochromocytoma arises in the adrenal medulla; paraganglioma arises from extra-adrenal paraganglia.
JapaneseAnswer: 褐色細胞腫は副腎髄質、パラガングリオーマは副腎外傍神経節に由来する。

EnglishQuestion: What is the classic triad of pheochromocytoma and paraganglioma (PPGL)?
JapaneseQuestion: 褐色細胞腫・パラガングリオーマ（PPGL）の古典的三徴は？
EnglishAnswer: Headache, palpitations, and sweating.
JapaneseAnswer: 頭痛、動悸、発汗。

EnglishQuestion: What is the initial biochemical test for pheochromocytoma and paraganglioma (PPGL)?
JapaneseQuestion: 褐色細胞腫・パラガングリオーマ（PPGL）の生化学的初期検査は？
EnglishAnswer: Plasma free metanephrines or 24-hour urinary fractionated metanephrines.
JapaneseAnswer: 血漿遊離メタネフリンまたは24時間尿中分画メタネフリン。

EnglishQuestion: When should imaging generally be performed in the diagnostic evaluation of pheochromocytoma and paraganglioma (PPGL)?
JapaneseQuestion: 褐色細胞腫・パラガングリオーマ（PPGL）の診断では、画像検査を原則いつ行うか？
EnglishAnswer: After biochemical evidence has been obtained with metanephrine testing.
JapaneseAnswer: メタネフリン検査で生化学的根拠を得た後。

EnglishQuestion: What should be reviewed before repeating a mildly elevated metanephrine result in suspected pheochromocytoma and paraganglioma (PPGL)?
JapaneseQuestion: 褐色細胞腫・パラガングリオーマ（PPGL）が疑われ、メタネフリンが軽度上昇している場合、再検前に何を見直すか？
EnglishAnswer: Sampling conditions, medications, obstructive sleep apnea, and acute illness.
JapaneseAnswer: 採取条件、薬剤、閉塞性睡眠時無呼吸、急性疾患。

EnglishQuestion: Why is the old "10% rule" inappropriate for pheochromocytoma and paraganglioma (PPGL)?
JapaneseQuestion: 褐色細胞腫・パラガングリオーマ（PPGL）に古い「10%則」が不適切なのはなぜか？
EnglishAnswer: Hereditary disease occurs in approximately 30-40%, and the proportions of bilateral, multifocal, and extra-adrenal tumors are not fixed at 10%.
JapaneseAnswer: 遺伝性が約30〜40%を占め、両側性、多発性、副腎外腫瘍の割合も10%に固定されないため。

EnglishQuestion: How is malignancy defined in pheochromocytoma and paraganglioma (PPGL)?
JapaneseQuestion: 褐色細胞腫・パラガングリオーマ（PPGL）の悪性は何で定義するか？
EnglishAnswer: Metastasis to nonchromaffin tissue.
JapaneseAnswer: 非クロム親和性組織への転移。

EnglishQuestion: What is the sequence of preoperative management for a catecholamine-secreting pheochromocytoma or paraganglioma (PPGL)?
JapaneseQuestion: カテコールアミン分泌性褐色細胞腫・パラガングリオーマ（PPGL）の術前管理の流れは？
EnglishAnswer: Begin alpha-blockade 7-14 days before surgery -> restore circulating volume with a high-salt diet and adequate fluids -> if needed, add beta-blockade only after adequate alpha-blockade.
JapaneseAnswer: 手術7〜14日前からα遮断→高食塩食と十分な水分で循環血液量を回復→必要なら十分なα遮断後にのみβ遮断を追加。

EnglishQuestion: What can happen if beta-blockade is started before alpha-blockade in pheochromocytoma or paraganglioma (PPGL)?
JapaneseQuestion: 褐色細胞腫・パラガングリオーマ（PPGL）でα遮断より先にβ遮断を開始すると、何が起こり得るか？
EnglishAnswer: Unopposed alpha-adrenergic stimulation can cause severe hypertension and pulmonary edema.
JapaneseAnswer: 無拮抗のαアドレナリン刺激により、重症高血圧と肺水腫を起こし得る。

EnglishQuestion: Which opposing hemodynamic and metabolic changes must be anticipated during and after resection of pheochromocytoma or paraganglioma (PPGL)?
JapaneseQuestion: 褐色細胞腫・パラガングリオーマ（PPGL）の切除中・切除後に備えるべき相反する循環・代謝変化は？
EnglishAnswer: Hypertension during tumor manipulation and hypotension with hypoglycemia after tumor removal.
JapaneseAnswer: 腫瘍操作中の高血圧と、腫瘍摘出後の低血圧・低血糖。

EnglishQuestion: What is the difference between Cushing syndrome and Cushing disease?
JapaneseQuestion: クッシング症候群とクッシング病の違いは？
EnglishAnswer: Cushing syndrome is any state of chronic glucocorticoid excess; Cushing disease is caused by an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma.
JapaneseAnswer: クッシング症候群は慢性グルココルチコイド過剰状態の総称で、クッシング病は副腎皮質刺激ホルモン（ACTH）産生下垂体腺腫によるもの。

EnglishQuestion: What is the most common cause of Cushing syndrome?
JapaneseQuestion: クッシング症候群の最も多い原因は？
EnglishAnswer: Iatrogenic exposure to therapeutic glucocorticoids.
JapaneseAnswer: 治療用グルココルチコイドへの曝露による医原性。

EnglishQuestion: What does a low adrenocorticotropic hormone (ACTH) level indicate in endogenous Cushing syndrome?
JapaneseQuestion: 内因性クッシング症候群で副腎皮質刺激ホルモン（ACTH）低値は何を示すか？
EnglishAnswer: Adrenal ACTH-independent cortisol production.
JapaneseAnswer: 副腎由来のACTH非依存性コルチゾール産生。

EnglishQuestion: Which two conditions must be distinguished when ACTH is elevated or inappropriately normal in Cushing syndrome?
JapaneseQuestion: クッシング症候群でACTHが高値または不適切に正常の場合、鑑別すべき2つの病態は？
EnglishAnswer: Pituitary Cushing disease and ectopic ACTH or corticotropin-releasing hormone (CRH) production.
JapaneseAnswer: 下垂体性クッシング病と、異所性ACTHまたは副腎皮質刺激ホルモン放出ホルモン（CRH）産生。

EnglishQuestion: Which physical findings are relatively specific for Cushing syndrome?
JapaneseQuestion: クッシング症候群に比較的特異的な身体所見は？
EnglishAnswer: Wide reddish-purple striae, proximal muscle weakness, easy bruising, facial plethora, and otherwise unexplained osteoporosis.
JapaneseAnswer: 幅広い赤紫色皮膚線条、近位筋力低下、易出血性、顔面紅潮、他に説明のつかない骨粗鬆症。

EnglishQuestion: What must be checked before testing for endogenous Cushing syndrome?
JapaneseQuestion: 内因性クッシング症候群の検査前に何を確認する必要があるか？
EnglishAnswer: Exogenous glucocorticoid use by every route, including oral, injected, inhaled, topical, and intra-articular administration.
JapaneseAnswer: 経口、注射、吸入、外用、関節内投与を含む、すべての経路での外因性グルココルチコイド使用。

EnglishQuestion: Name three standard initial tests for Cushing syndrome.
JapaneseQuestion: クッシング症候群の代表的な初期検査を3つ挙げよ。
EnglishAnswer: Late-night salivary cortisol, 24-hour urinary free cortisol (UFC), and the 1-mg overnight dexamethasone suppression test (DST).
JapaneseAnswer: 深夜唾液コルチゾール、24時間尿中遊離コルチゾール（UFC）、1 mg一晩デキサメタゾン抑制試験（DST）。

EnglishQuestion: What is the basic diagnostic sequence for Cushing syndrome?
JapaneseQuestion: クッシング症候群の基本的な診断の流れは？
EnglishAnswer: Check for exogenous glucocorticoid use -> confirm cortisol excess with repeated appropriate initial testing -> measure adrenocorticotropic hormone (ACTH) -> localize the source according to the ACTH result.
JapaneseAnswer: 外因性グルココルチコイド使用を確認→適切な初期検査を反復してコルチゾール過剰を確定→副腎皮質刺激ホルモン（ACTH）測定→ACTH結果に応じて局在診断。

EnglishQuestion: Are random cortisol, adrenocorticotropic hormone (ACTH), or imaging used as initial tests to confirm cortisol excess in Cushing syndrome?
JapaneseQuestion: クッシング症候群のコルチゾール過剰確認に、ランダムコルチゾール、ACTH、画像検査を初期検査として用いるか？
EnglishAnswer: No.
JapaneseAnswer: 用いない。

EnglishQuestion: Which test is important in ACTH-dependent Cushing syndrome when pituitary MRI is negative, shows only a small lesion, or conflicts with other findings?
JapaneseQuestion: ACTH依存性クッシング症候群で、下垂体MRIが陰性、小病変のみ、または他の所見と矛盾する場合に重要な検査は？
EnglishAnswer: Inferior petrosal sinus sampling (IPSS).
JapaneseAnswer: 下錐体静脈洞サンプリング（IPSS）。

EnglishQuestion: What is the first-line treatment for Cushing disease?
JapaneseQuestion: クッシング病の第一選択治療は？
EnglishAnswer: Selective transsphenoidal resection of the adenoma.
JapaneseAnswer: 経蝶形骨洞的選択的腺腫摘出術。

EnglishQuestion: Why must exogenous glucocorticoids not be stopped abruptly?
JapaneseQuestion: 外因性グルココルチコイドを急に中止してはいけないのはなぜか？
EnglishAnswer: Adrenal suppression may be present, and abrupt withdrawal can cause adrenal insufficiency (AI).
JapaneseAnswer: 副腎抑制が存在し、急な中止によって副腎不全（AI）を起こし得るため。

EnglishQuestion: What is the relationship between Addison disease and adrenal insufficiency (AI)?
JapaneseQuestion: アジソン病と副腎不全（AI）の関係は？
EnglishAnswer: Addison disease is primary adrenocortical insufficiency caused by autoimmune disease or another primary adrenal process; it is not synonymous with all adrenal insufficiency.
JapaneseAnswer: アジソン病は自己免疫などの原発性副腎病変による原発性副腎皮質機能低下症であり、副腎不全全体の同義語ではない。

EnglishQuestion: How do primary and central adrenal insufficiency differ in ACTH, aldosterone, potassium, and pigmentation?
JapaneseQuestion: 原発性副腎不全と中枢性副腎不全では、ACTH、アルドステロン、K、色素沈着がどう異なるか？
EnglishAnswer: Primary disease may cause high ACTH, low aldosterone, hyperkalemia, and hyperpigmentation. Central disease has low to normal ACTH; aldosterone and potassium are usually preserved, and hyperpigmentation is absent.
JapaneseAnswer: 原発性ではACTH高値、アルドステロン低下、高K血症、色素沈着を来し得る。中枢性ではACTHは低値〜正常で、アルドステロンとKは通常保たれ、色素沈着はない。

EnglishQuestion: What are the basic diagnostic tests for stable adrenal insufficiency (AI)?
JapaneseQuestion: 安定した副腎不全（AI）の基本的な診断検査は？
EnglishAnswer: Simultaneous 8-9 a.m. cortisol and adrenocorticotropic hormone (ACTH) measurement, followed by the standard 250 microgram ACTH stimulation test.
JapaneseAnswer: 午前8〜9時のコルチゾールと副腎皮質刺激ホルモン（ACTH）の同時測定、続いて標準250マイクログラムACTH刺激試験。

EnglishQuestion: What maintenance replacement is used in primary adrenal insufficiency?
JapaneseQuestion: 原発性副腎不全の維持補充療法は？
EnglishAnswer: Divided-dose hydrocortisone plus fludrocortisone for aldosterone deficiency.
JapaneseAnswer: ヒドロコルチゾン分割投与に加え、アルドステロン欠乏にはフルドロコルチゾン。

EnglishQuestion: Why is fludrocortisone usually unnecessary in central adrenal insufficiency?
JapaneseQuestion: 中枢性副腎不全でフルドロコルチゾンが通常不要なのはなぜか？
EnglishAnswer: Aldosterone is usually preserved.
JapaneseAnswer: アルドステロンが通常保たれるため。

EnglishQuestion: What should a patient with adrenal insufficiency (AI) do if vomiting prevents oral medication intake?
JapaneseQuestion: 副腎不全（AI）患者が嘔吐で内服できない場合、どう対応するか？
EnglishAnswer: Use intramuscular hydrocortisone and seek emergency medical care.
JapaneseAnswer: ヒドロコルチゾンを筋注し、救急受診する。

EnglishQuestion: When adrenal crisis is suspected, should treatment wait for blood test results?
JapaneseQuestion: 副腎クリーゼを疑う場合、採血結果を待ってから治療するか？
EnglishAnswer: No. Treat immediately; if possible, draw cortisol and adrenocorticotropic hormone (ACTH) without delaying treatment.
JapaneseAnswer: 待たずに直ちに治療する。可能なら治療を遅らせずにコルチゾールと副腎皮質刺激ホルモン（ACTH）を採血する。

EnglishQuestion: What is the hydrocortisone regimen for adrenal crisis?
JapaneseQuestion: 副腎クリーゼにおけるヒドロコルチゾンの投与法は？
EnglishAnswer: Give 100 mg immediately intravenously or intramuscularly, followed by 200 mg by continuous intravenous infusion over 24 hours or 50 mg every 6 hours.
JapaneseAnswer: 100 mgを直ちに静注または筋注し、その後24時間で200 mgを持続静注、または50 mgを6時間ごとに投与する。

EnglishQuestion: What is the sequence of fluid, metabolic, and etiologic treatment in adrenal crisis?
JapaneseQuestion: 副腎クリーゼにおける補液、代謝、原因治療の流れは？
EnglishAnswer: Restore circulation with isotonic saline -> give glucose if hypoglycemia is present -> treat precipitants such as infection and monitor electrolytes and urine output.
JapaneseAnswer: 等張食塩水で循環を回復→低血糖があればブドウ糖を投与→感染などの誘因を治療し、電解質と尿量を監視。

EnglishQuestion: Why is fludrocortisone usually unnecessary during the acute phase of adrenal crisis?
JapaneseQuestion: 副腎クリーゼ急性期にフルドロコルチゾンが通常不要なのはなぜか？
EnglishAnswer: High-dose hydrocortisone provides sufficient mineralocorticoid activity.
JapaneseAnswer: 高用量ヒドロコルチゾンが十分な鉱質コルチコイド作用をもつため。

EnglishQuestion: How do 21-hydroxylase, 11beta-hydroxylase, and 17alpha-hydroxylase deficiencies differ in blood pressure, potassium, and androgen levels?
JapaneseQuestion: 21-水酸化酵素、11β-水酸化酵素、17α-水酸化酵素欠損症では、血圧、K、アンドロゲン値がどう異なるか？
EnglishAnswer: 21-hydroxylase deficiency causes hypotension, hyperkalemia, and increased androgens; 11beta-hydroxylase deficiency causes hypertension, hypokalemia, and increased androgens; 17alpha-hydroxylase deficiency causes hypertension, hypokalemia, and decreased androgens.
JapaneseAnswer: 21-水酸化酵素欠損は低血圧・高K血症・アンドロゲン増加、11β-水酸化酵素欠損は高血圧・低K血症・アンドロゲン増加、17α-水酸化酵素欠損は高血圧・低K血症・アンドロゲン低下。

EnglishQuestion: What is measured in newborn screening for 21-hydroxylase deficiency?
JapaneseQuestion: 21-水酸化酵素欠損症の新生児スクリーニングで測定するものは？
EnglishAnswer: 17-hydroxyprogesterone (17-OHP).
JapaneseAnswer: 17-ヒドロキシプロゲステロン（17-OHP）。

EnglishQuestion: Which replacements are required for salt-wasting 21-hydroxylase deficiency?
JapaneseQuestion: 塩喪失型21-水酸化酵素欠損症で必要な補充は？
EnglishAnswer: A glucocorticoid, fludrocortisone, and salt supplementation during infancy.
JapaneseAnswer: グルココルチコイド、フルドロコルチゾン、乳児期の食塩補充。

EnglishQuestion: What are the three fundamental axes used to characterize a neuroendocrine neoplasm (NEN)?
JapaneseQuestion: 神経内分泌腫瘍（NEN）を捉える3つの基本軸は何か？
EnglishAnswer: Degree of differentiation and proliferative activity; functional versus nonfunctional status; and primary site and stage.
JapaneseAnswer: 分化度・増殖能、機能性か非機能性か、原発部位・病期。

EnglishQuestion: What is the difference between grade and stage in a neuroendocrine neoplasm (NEN)?
JapaneseQuestion: 神経内分泌腫瘍（NEN）におけるグレードと病期の違いは何か？
EnglishAnswer: Grade indicates proliferative activity and malignant potential, whereas stage indicates the anatomic extent of disease.
JapaneseAnswer: グレードは増殖能・悪性度、病期は解剖学的な広がりを表す。

EnglishQuestion: What are the approximate Ki-67 index cutoffs for G1, G2, and G3 gastroenteropancreatic neuroendocrine tumors (NETs)?
JapaneseQuestion: 消化管・膵NETのKi-67指数によるG1・G2・G3の目安は？
EnglishAnswer: G1: <3%; G2: 3-20%; G3: >20%.
JapaneseAnswer: G1は<3%、G2は3～20%、G3は>20%。

EnglishQuestion: Why can a Ki-67 index >20% alone not distinguish a well-differentiated NET G3 from a poorly differentiated neuroendocrine carcinoma (NEC)?
JapaneseQuestion: Ki-67 >20%だけで高分化NET G3と低分化NECを区別できないのはなぜか？
EnglishAnswer: Both may have a Ki-67 index >20%, so morphologic differentiation must also be assessed.
JapaneseAnswer: 両者ともKi-67 >20%になり得るため、形態学的分化度を併せて判定する必要があるから。

EnglishQuestion: What is a tumor containing both neuroendocrine and non-neuroendocrine components called?
JapaneseQuestion: 神経内分泌成分と非神経内分泌成分が混在する腫瘍を何と呼ぶか？
EnglishAnswer: A mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN).
JapaneseAnswer: 神経内分泌・非神経内分泌混合腫瘍（MiNEN）。

EnglishQuestion: What is the diagnostic sequence from suspected neuroendocrine neoplasm (NEN) to treatment planning?
JapaneseQuestion: 神経内分泌腫瘍（NEN）を疑ってから治療方針決定までの診断の流れは？
EnglishAnswer: Syndrome-directed biochemical tests -> histologic diagnosis with morphology, synaptophysin, chromogranin, and Ki-67 -> contrast-enhanced CT/MRI -> somatostatin receptor PET/CT (SSTR-PET/CT) when indicated -> determination of resectability and systemic treatment.
JapaneseAnswer: 症候に対応した生化学検査→組織診断（形態・シナプトフィジン・クロモグラニン・Ki-67）→造影CT／MRI→適応例でソマトスタチン受容体PET/CT（SSTR-PET/CT）→切除可能性・全身治療の決定。

EnglishQuestion: Why can an elevated chromogranin A level not be used alone to diagnose a neuroendocrine neoplasm?
JapaneseQuestion: クロモグラニンA高値を神経内分泌腫瘍の単独診断に使えない主な理由は？
EnglishAnswer: It may also be elevated by proton pump inhibitors (PPIs), impaired renal function, and atrophic gastritis, and it does not determine whether carcinoid syndrome is present.
JapaneseAnswer: プロトンポンプ阻害薬（PPI）、腎機能低下、萎縮性胃炎でも上昇し、カルチノイド症候群の有無も判別できないから。

EnglishQuestion: What are the classic three manifestations of carcinoid syndrome, and which test confirms it?
JapaneseQuestion: カルチノイド症候群の典型3症状と確認検査は？
EnglishAnswer: Episodic flushing, watery diarrhea, and bronchospasm; measure 24-hour urinary or plasma 5-hydroxyindoleacetic acid (5-HIAA).
JapaneseAnswer: 発作性紅潮、水様性下痢、気管支攣縮；24時間尿または血漿5-ヒドロキシインドール酢酸（5-HIAA）を測定する。

EnglishQuestion: Why does classic carcinoid syndrome from a gastrointestinal NET usually develop only after liver metastasis?
JapaneseQuestion: 消化管NETの典型的カルチノイド症候群が肝転移後に生じやすいのはなぜか？
EnglishAnswer: Before liver metastasis, serotonin entering the portal circulation is inactivated by first-pass hepatic metabolism.
JapaneseAnswer: 肝転移前は門脈に入ったセロトニンが肝初回通過で不活化されるため。

EnglishQuestion: Which valvular lesions are typical of carcinoid heart disease?
JapaneseQuestion: カルチノイド心疾患で典型的に障害される弁と病変は？
EnglishAnswer: Right-sided tricuspid regurgitation and pulmonary valve stenosis.
JapaneseAnswer: 右心系の三尖弁逆流と肺動脈弁狭窄。

EnglishQuestion: What is first-line symptomatic treatment for carcinoid syndrome?
JapaneseQuestion: カルチノイド症候群の症候コントロールの第一選択は？
EnglishAnswer: A long-acting somatostatin analogue (SSA), either octreotide or lanreotide.
JapaneseAnswer: 長時間作用型ソマトスタチンアナログ（SSA；オクトレオチドまたはランレオチド）。

EnglishQuestion: Which situations commonly precipitate a carcinoid crisis?
JapaneseQuestion: カルチノイドクリーゼを誘発し得る代表的状況は？
EnglishAnswer: Surgery, anesthesia, tumor manipulation, and embolization.
JapaneseAnswer: 手術、麻酔、腫瘍操作、塞栓術。

EnglishQuestion: What are the major clinical features of a carcinoid crisis?
JapaneseQuestion: カルチノイドクリーゼの主な臨床像は？
EnglishAnswer: Marked blood-pressure instability, flushing, hyperthermia, bronchospasm, and arrhythmias that may progress to circulatory collapse.
JapaneseAnswer: 著しい血圧変動、紅潮、高体温、気管支攣縮、不整脈から循環虚脱に至る。

EnglishQuestion: What must be treated simultaneously during a carcinoid crisis?
JapaneseQuestion: カルチノイドクリーゼでは何を同時に治療するか？
EnglishAnswer: Give intravenous octreotide while simultaneously providing oxygenation and airway management, fluid resuscitation and vasopressors for cardiopulmonary support, and treatment of the precipitating cause.
JapaneseAnswer: 静注オクトレオチドに加え、酸素化・気道管理、輸液・昇圧薬による呼吸循環支持、誘因治療を同時に行う。

EnglishQuestion: What is the typical presentation of Zollinger-Ellison syndrome caused by a gastrinoma?
JapaneseQuestion: ガストリノーマによるゾリンジャー・エリソン症候群の典型像は？
EnglishAnswer: Refractory or multiple peptic ulcers, gastroesophageal reflux, diarrhea, and steatorrhea.
JapaneseAnswer: 難治性・多発性消化性潰瘍、逆流、下痢、脂肪便。

EnglishQuestion: Which combination of fasting gastrin and gastric pH strongly supports gastrinoma?
JapaneseQuestion: ガストリノーマを強く支持する空腹時ガストリン値と胃内pHの組合せは？
EnglishAnswer: Fasting gastrin >1,000 pg/mL with gastric pH <=2.
JapaneseAnswer: 空腹時ガストリン>1,000 pg/mLかつ胃内pH≤2。

EnglishQuestion: Which major confounders should be checked when hypergastrinemia is found?
JapaneseQuestion: 高ガストリン血症を認めたときに確認すべき主な交絡因子は？
EnglishAnswer: PPI use, atrophic gastritis, and impaired renal function.
JapaneseAnswer: PPI、萎縮性胃炎、腎機能低下。

EnglishQuestion: What is Whipple's triad suggesting an insulinoma?
JapaneseQuestion: インスリノーマを疑うウィップルの三徴は？
EnglishAnswer: Symptoms consistent with hypoglycemia, a low plasma glucose level, and relief after glucose administration.
JapaneseAnswer: 低血糖に一致する症状、血漿ブドウ糖低値、ブドウ糖補給による改善。

EnglishQuestion: What should be demonstrated during symptomatic hypoglycemia to establish the biochemical diagnosis of insulinoma?
JapaneseQuestion: インスリノーマの生化学的診断では症候性低血糖時に何を確認するか？
EnglishAnswer: Inappropriately high insulin, C-peptide, and proinsulin levels despite low glucose, with sulfonylurea and glinide exposure excluded.
JapaneseAnswer: ブドウ糖低値に対するインスリン・Cペプチド（C-peptide）・プロインスリンの不適切高値を確認し、スルホニル尿素薬・グリニド薬を除外する。

EnglishQuestion: When should localization studies for insulinoma be performed?
JapaneseQuestion: インスリノーマの局在診断はいつ行うか？
EnglishAnswer: After biochemical diagnosis has been established, using CT, MRI, endoscopic ultrasonography, or related imaging.
JapaneseAnswer: 生化学的診断を確立した後に、CT・MRI・内視鏡USなどで行う。

EnglishQuestion: What is the curative treatment for a resectable insulinoma, and how is hypoglycemia managed while awaiting surgery or in unresectable disease?
JapaneseQuestion: 切除可能インスリノーマの根治治療と、待機中・切除不能例の低血糖対策は？
EnglishAnswer: Surgery is curative; prevent hypoglycemia with diazoxide, nutritional adjustment, and an SSA in selected cases while awaiting surgery or when the tumor is unresectable.
JapaneseAnswer: 根治治療は手術；待機中・切除不能例ではジアゾキシド、栄養調整、症例に応じたSSAで低血糖を防ぐ。

EnglishQuestion: What is the central lesion in multiple endocrine neoplasia type 1 (MEN1), and which two tumor groups are commonly associated with it?
JapaneseQuestion: 多発性内分泌腫瘍症1型（MEN1）の中心病変と代表的な2つの関連腫瘍は？
EnglishAnswer: Primary hyperparathyroidism is central; pancreatic or duodenal neuroendocrine tumors and pituitary tumors are commonly associated.
JapaneseAnswer: 中心は原発性副甲状腺機能亢進症；膵・十二指腸神経内分泌腫瘍と下垂体腫瘍を伴う。

EnglishQuestion: Which central and associated tumors are shared by MEN2A and MEN2B?
JapaneseQuestion: MEN2AとMEN2Bに共通する中心腫瘍と関連腫瘍は？
EnglishAnswer: Medullary thyroid carcinoma and pheochromocytoma.
JapaneseAnswer: 甲状腺髄様癌と褐色細胞腫。

EnglishQuestion: Which characteristic associated findings distinguish MEN2A from MEN2B?
JapaneseQuestion: MEN2AとMEN2Bを区別する代表的随伴所見は？
EnglishAnswer: MEN2A is associated with primary hyperparathyroidism; MEN2B is associated with mucosal neuromas and a marfanoid habitus.
JapaneseAnswer: MEN2Aは原発性副甲状腺機能亢進症、MEN2Bは粘膜神経腫とマルファン様体型。

EnglishQuestion: What safety-critical treatment sequence is required before thyroid or parathyroid surgery in a patient with MEN2?
JapaneseQuestion: MEN2患者の甲状腺・副甲状腺手術前に必要な安全上の治療順序は？
EnglishAnswer: First exclude pheochromocytoma; if present, provide alpha-blockade and adrenal treatment before thyroid or parathyroid surgery.
JapaneseAnswer: 褐色細胞腫を先に除外し、存在すればα遮断と副腎治療を甲状腺・副甲状腺手術より先に行う。

EnglishQuestion: How is hypogonadism classified when sex steroid levels are low and LH and FSH are elevated?
JapaneseQuestion: 低性ステロイド血症に対してLH・FSH高値なら、性腺機能低下症をどう分類するか？
EnglishAnswer: Primary, or hypergonadotropic, hypogonadism.
JapaneseAnswer: 原発性／高ゴナドトロピン性性腺機能低下症。

EnglishQuestion: How is hypogonadism classified when sex steroid levels are low and LH and FSH are low or inappropriately normal?
JapaneseQuestion: 低性ステロイド血症に対してLH・FSH低値または不適切正常なら、性腺機能低下症をどう分類するか？
EnglishAnswer: Central, or hypogonadotropic, hypogonadism.
JapaneseAnswer: 中枢性／低ゴナドトロピン性性腺機能低下症。

EnglishQuestion: What additional factors should be evaluated in central hypogonadism?
JapaneseQuestion: 中枢性性腺機能低下症で追加評価すべき主な項目は？
EnglishAnswer: Assess other pituitary hormones, prolactin, iron overload, medications, visual-field abnormalities, and headache; perform pituitary MRI when indicated.
JapaneseAnswer: 他の下垂体ホルモン、プロラクチン、鉄過剰、薬剤、視野・頭痛を確認し、必要なら下垂体MRIを行う。

EnglishQuestion: What is the first step when evaluating amenorrhea?
JapaneseQuestion: 無月経を評価するとき最初に行うことは？
EnglishAnswer: Confirm or exclude pregnancy with a pregnancy test.
JapaneseAnswer: 妊娠反応で妊娠を確認・除外する。

EnglishQuestion: Which hormones are routinely measured in amenorrhea after a negative pregnancy test?
JapaneseQuestion: 妊娠反応陰性の無月経で基本的に測定するホルモンは？
EnglishAnswer: TSH, prolactin, FSH, and estradiol.
JapaneseAnswer: TSH、プロラクチン、FSH、エストラジオール。

EnglishQuestion: In amenorrhea, what do elevated FSH and low or inappropriately normal FSH suggest, respectively?
JapaneseQuestion: 無月経でFSH高値なら何を、低値・不適切正常なら何を考えるか？
EnglishAnswer: Elevated FSH suggests primary ovarian insufficiency; low or inappropriately normal FSH suggests hypothalamic or pituitary dysfunction.
JapaneseAnswer: 高値なら原発性卵巣機能不全、低値・不適切正常なら視床下部・下垂体障害を考える。

EnglishQuestion: When should primary amenorrhea be evaluated based on age and pubertal progression?
JapaneseQuestion: 原発性無月経を評価する年齢・経過の目安は？
EnglishAnswer: When menarche has not occurred by age 15 or more than 3 years after breast development began.
JapaneseAnswer: 15歳までに初経がない、または乳房発育開始から3年以上初経がない場合。

EnglishQuestion: Which subtype of idiopathic hypogonadotropic hypogonadism (IHH) is Kallmann syndrome?
JapaneseQuestion: カルマン症候群は特発性低ゴナドトロピン性性腺機能低下症（IHH）のうち何を伴う病型か？
EnglishAnswer: Congenital hypogonadotropic hypogonadism accompanied by hyposmia or anosmia.
JapaneseAnswer: 嗅覚低下または嗅覚脱失を伴う先天性低ゴナドトロピン性性腺機能低下症。

EnglishQuestion: What treatments are used to induce secondary sexual characteristics and to achieve fertility in congenital hypogonadotropic hypogonadism?
JapaneseQuestion: 先天性低ゴナドトロピン性性腺機能低下症で、二次性徴誘導と妊孕性獲得にはそれぞれ何を用いるか？
EnglishAnswer: Use gradually titrated sex steroid replacement to induce secondary sexual characteristics and protect bone; use pulsatile GnRH or gonadotropins to achieve fertility.
JapaneseAnswer: 二次性徴誘導・骨保護には段階的性ステロイド補充；妊孕性獲得には拍動性GnRHまたはgonadotropinを用いる。

EnglishQuestion: Which region loses expression in Prader-Willi syndrome, and what is a characteristic endocrine finding?
JapaneseQuestion: プラダー・ウィリ症候群で発現を失う領域と代表的内分泌所見は？
EnglishAnswer: Loss of expression of the paternally derived 15q11-q13 region, with hypogonadotropic hypogonadism.
JapaneseAnswer: 父由来15q11-q13の発現を失い、低ゴナドトロピン性性腺機能低下を示す。

EnglishQuestion: Which region loses expression in Angelman syndrome?
JapaneseQuestion: アンジェルマン症候群で発現を失う領域は？
EnglishAnswer: The maternally derived UBE3A region.
JapaneseAnswer: 母由来UBE3A領域。

EnglishQuestion: Which age, menstrual, and FSH findings form the diagnostic framework for primary ovarian insufficiency (POI)?
JapaneseQuestion: 原発性卵巣機能不全（POI）の診断軸となる年齢・月経・FSH所見は？
EnglishAnswer: Age <40 years, irregular menses or amenorrhea for at least 4 months, and FSH >25 IU/L.
JapaneseAnswer: 40歳未満で、4か月以上の月経不順または無月経があり、FSH >25 IU/L。

EnglishQuestion: Which etiologic tests should be considered in unexplained primary ovarian insufficiency (POI)?
JapaneseQuestion: 原因不明のPOIで検討する原因検索は？
EnglishAnswer: Karyotyping, testing for an FMR1 premutation, and evaluation for autoimmune disease.
JapaneseAnswer: 核型、FMR1前変異、自己免疫の評価。

EnglishQuestion: Until approximately when should hormone therapy for primary ovarian insufficiency (POI) continue if there is no contraindication?
JapaneseQuestion: POIのホルモン療法は禁忌がなければいつ頃まで続けるか？
EnglishAnswer: Until approximately the natural age of menopause to control symptoms and protect bone and cardiovascular health.
JapaneseAnswer: 症状・骨・心血管保護のため自然閉経年齢頃まで続ける。

EnglishQuestion: How does the presence or absence of a uterus affect hormone therapy for primary ovarian insufficiency (POI)?
JapaneseQuestion: 子宮の有無でPOIのホルモン療法をどう変えるか？
EnglishAnswer: If the uterus is present, combine estrogen with a progestogen; after hysterectomy, estrogen alone is generally used.
JapaneseAnswer: 子宮があればエストロゲンにプロゲストーゲンを併用し、子宮摘出後は通常エストロゲン単独とする。

EnglishQuestion: Which cardiovascular conditions require particular lifelong surveillance in Turner syndrome?
JapaneseQuestion: ターナー症候群で生涯追跡が特に重要な心血管病変は？
EnglishAnswer: Coarctation of the aorta, bicuspid aortic valve, aortic dilation or dissection, and hypertension.
JapaneseAnswer: 大動脈縮窄、二尖大動脈弁、大動脈拡張・解離、高血圧。

EnglishQuestion: What are the Rotterdam criteria for polycystic ovary syndrome (PCOS) in adults?
JapaneseQuestion: 成人の多嚢胞性卵巣症候群（PCOS）のロッテルダム基準は何か？
EnglishAnswer: After excluding other disorders, at least two of the following three: ovulatory dysfunction or menstrual irregularity; clinical or biochemical hyperandrogenism; and polycystic ovarian morphology.
JapaneseAnswer: 他疾患を除外したうえで、①排卵障害・月経不順、②臨床的または生化学的アンドロゲン過剰、③多嚢胞卵巣形態の3項目中2項目。

EnglishQuestion: What is the role of anti-Mullerian hormone (AMH) in diagnosing polycystic ovary syndrome (PCOS) in adults?
JapaneseQuestion: 成人の多嚢胞性卵巣症候群（PCOS）診断における抗Müller管ホルモン（AMH）の位置づけは？
EnglishAnswer: In some settings it may substitute for ultrasonographic polycystic ovarian morphology, but AMH alone must not be used to diagnose PCOS.
JapaneseAnswer: 状況により超音波上の多嚢胞卵巣形態の代替に使えるが、AMH単独では診断しない。

EnglishQuestion: What is the basic treatment for menstrual irregularity and hirsutism in a patient with PCOS who is not seeking pregnancy?
JapaneseQuestion: 多嚢胞性卵巣症候群（PCOS）で妊娠を希望しない月経不順・多毛の基本治療は？
EnglishAnswer: Lifestyle support and a low-dose combined oral contraceptive pill (COCP); consider metformin for metabolic risk.
JapaneseAnswer: 生活支援と低用量複合経口避妊薬（COCP）；代謝リスクにはメトホルミンを検討する。

EnglishQuestion: What is first-line ovulation induction for anovulatory infertility due to PCOS in a patient seeking pregnancy?
JapaneseQuestion: 多嚢胞性卵巣症候群（PCOS）の無排卵性不妊で妊娠を希望する場合の第一選択は？
EnglishAnswer: Letrozole.
JapaneseAnswer: レトロゾールによる排卵誘発。

EnglishQuestion: How is the biochemical diagnosis of male hypogonadism confirmed?
JapaneseQuestion: 男性性腺機能低下症の生化学的診断はどう確認するか？
EnglishAnswer: In addition to compatible symptoms and signs, confirm a low fasting morning total testosterone level on two separate days.
JapaneseAnswer: 症状・徴候に加え、別日の朝の空腹時総テストステロン低値を2回確認する。

EnglishQuestion: Why should exogenous testosterone not be given to a man planning fertility in the near future?
JapaneseQuestion: 妊孕性を近く希望する男性に外因性テストステロンを投与しないのはなぜか？
EnglishAnswer: It suppresses spermatogenesis and may cause testicular atrophy and azoospermia.
JapaneseAnswer: 精子形成を抑制し、精巣萎縮・無精子症を起こし得るから。

EnglishQuestion: What should be done if hematocrit reaches >=54% during testosterone replacement?
JapaneseQuestion: テストステロン補充中にヘマトクリット≥54%となった場合の対応は？
EnglishAnswer: Temporarily stop replacement and evaluate the cause of erythrocytosis.
JapaneseAnswer: 補充を一旦中止し、赤血球増加の原因を評価する。

EnglishQuestion: What are the typical karyotype, gonadal findings, and hormone findings in Klinefelter syndrome?
JapaneseQuestion: クラインフェルター症候群の典型的核型・性腺所見・ホルモン所見は？
EnglishAnswer: Usually 47,XXY, with small firm testes, low testosterone, and elevated LH and FSH.
JapaneseAnswer: 多くは47,XXY、小さく硬い精巣、テストステロン低値、黄体形成ホルモン（LH）・卵胞刺激ホルモン（FSH）高値。

EnglishQuestion: Why can Sertoli cell-only syndrome cause infertility despite a normal testosterone level?
JapaneseQuestion: セルトリ細胞単独症候群でテストステロンが正常でも不妊となる機序は？
EnglishAnswer: The seminiferous tubules lack germ cells, causing nonobstructive azoospermia.
JapaneseAnswer: 精細管に生殖細胞を欠き、非閉塞性無精子症となるため。

EnglishQuestion: Which pathway is abnormal in Noonan syndrome, and how does its usual karyotype differ from Turner syndrome?
JapaneseQuestion: ヌーナン症候群はどの経路の異常で、ターナー症候群と違い核型は通常どうなるか？
EnglishAnswer: It is a RASopathy caused by a pathogenic variant in the RAS/MAPK pathway; the karyotype is usually 46,XX or 46,XY.
JapaneseAnswer: RAS／MAPK経路の病的バリアントによるRASオパチー（RASopathy）で、核型は通常46,XXまたは46,XY。

EnglishQuestion: What causes male infertility in primary ciliary dyskinesia?
JapaneseQuestion: 原発性線毛運動不全症で男性不妊となる機序は？
EnglishAnswer: Impaired sperm motility, through a mechanism distinct from testosterone deficiency.
JapaneseAnswer: 精子運動不良であり、テストステロン低下とは別機序。

EnglishQuestion: What are the typical internal and external genitalia and secondary sexual characteristics in complete androgen insensitivity syndrome?
JapaneseQuestion: 完全型アンドロゲン不応症の内外性器と二次性徴の典型像は？
EnglishAnswer: A 46,XY individual has female external genitalia, a blind-ending vagina, no uterus, breast development, and sparse or absent axillary and pubic hair.
JapaneseAnswer: 46,XYで女性型外性器、盲端腟、子宮欠如、乳房発育を示し、腋毛・陰毛は乏しい。

EnglishQuestion: Why is the uterus absent in complete androgen insensitivity syndrome?
JapaneseQuestion: 完全型アンドロゲン不応症で子宮が欠如するのはなぜか？
EnglishAnswer: Testicular AMH causes regression of the Mullerian ducts.
JapaneseAnswer: 精巣由来AMHがMüller管を退縮させるため。

EnglishQuestion: How is the timing of gonadectomy determined in complete androgen insensitivity syndrome?
JapaneseQuestion: 完全型アンドロゲン不応症の性腺摘出時期はどう決めるか？
EnglishAnswer: A specialist team weighs malignancy risk, spontaneous puberty, and the patient's values; deferring gonadectomy until after puberty is a common option.
JapaneseAnswer: 悪性化リスク、自然な思春期、本人の価値観を踏まえて専門チームで決め、思春期後まで延期する選択が一般的。

EnglishQuestion: What is the pathway from hypoxanthine to uric acid in human purine degradation?
JapaneseQuestion: ヒトのプリン分解でヒポキサンチンから尿酸までの流れは？
EnglishAnswer: Hypoxanthine -> xanthine -> uric acid, with xanthine oxidase involved.
JapaneseAnswer: ヒポキサンチン→キサンチン→尿酸で、キサンチンオキシダーゼが関与する。

EnglishQuestion: What are the causative gene, deficient enzyme, and metabolic abnormalities in Lesch-Nyhan syndrome?
JapaneseQuestion: レッシュ・ナイハン症候群の原因遺伝子・欠損酵素・代謝異常は？
EnglishAnswer: An X-linked pathogenic HPRT1 variant causes deficiency of hypoxanthine-guanine phosphoribosyltransferase (HGPRT), reducing purine salvage and increasing de novo purine synthesis and uric acid production.
JapaneseAnswer: X連鎖性HPRT1病的バリアントによるヒポキサンチン・グアニンホスホリボシルトランスフェラーゼ（HGPRT）欠損で、プリンサルベージ低下、新規プリン合成・尿酸産生増加を来す。

EnglishQuestion: Which characteristic findings other than hyperuricemia suggest Lesch-Nyhan syndrome?
JapaneseQuestion: レッシュ・ナイハン症候群を示唆する高尿酸血症以外の特徴的所見は？
EnglishAnswer: Motor dysfunction, developmental and intellectual disability, and characteristic self-injurious behavior.
JapaneseAnswer: 運動障害、発達・知的障害、特徴的な自傷行動。

EnglishQuestion: What is the difference between hyperuricemia and gout?
JapaneseQuestion: 高尿酸血症と痛風の違いは？
EnglishAnswer: Hyperuricemia is a laboratory finding; gout is an inflammatory disease caused by monosodium urate (MSU) crystals.
JapaneseAnswer: 高尿酸血症は検査所見、痛風は尿酸一ナトリウム（MSU）結晶に対する炎症性疾患。

EnglishQuestion: Does a normal serum urate level during an acute attack exclude gout?
JapaneseQuestion: 急性痛風発作中の血清尿酸が正常なら痛風を除外できるか？
EnglishAnswer: No. Serum urate may be normal during an acute gout attack.
JapaneseAnswer: できない。急性発作中は血清尿酸が正常のこともある。

EnglishQuestion: What inflammatory sequence leads from MSU crystals to an acute gout attack?
JapaneseQuestion: MSU結晶から急性痛風発作に至る炎症の流れは？
EnglishAnswer: MSU crystallization -> macrophage phagocytosis -> NLRP3 inflammasome activation -> IL-1 beta production and neutrophil influx -> acute inflammation.
JapaneseAnswer: MSU結晶化→マクロファージ貪食→NLRP3インフラマソーム活性化→IL-1β産生・好中球流入→急性炎症。

EnglishQuestion: What is podagra?
JapaneseQuestion: ポダグラとは何か？
EnglishAnswer: An acute gout attack involving the first metatarsophalangeal joint.
JapaneseAnswer: 第一中足趾節関節に起こる急性痛風発作。

EnglishQuestion: What are the typical plain-radiograph and ultrasound findings in chronic gout?
JapaneseQuestion: 慢性痛風の単純X線と超音波の典型所見は？
EnglishAnswer: Radiographs show punched-out erosions with overhanging edges; ultrasound shows a double-contour sign or tophi.
JapaneseAnswer: X線は張り出し縁を伴う打ち抜き状骨びらん、超音波は二重輪郭徴候や痛風結節。

EnglishQuestion: What is the standard diagnostic approach when gout is suspected in acute monoarthritis?
JapaneseQuestion: 急性単関節炎で痛風を疑ったときの標準的診断は？
EnglishAnswer: Perform joint aspiration to exclude septic arthritis and use polarized microscopy to identify needle-shaped MSU crystals with strong negative birefringence.
JapaneseAnswer: 関節穿刺で感染性関節炎を除外し、偏光顕微鏡で針状・強い負の複屈折を示すMSU結晶を確認する。

EnglishQuestion: What drugs are used to treat an acute gout attack?
JapaneseQuestion: 急性痛風発作の薬物治療は？
EnglishAnswer: Promptly choose an NSAID, low-dose colchicine, or oral, intramuscular, or intra-articular glucocorticoid according to the patient's comorbidities.
JapaneseAnswer: NSAID、低用量コルヒチン、経口・筋注・関節内グルココルチコイドから併存症に合うものを早期に選ぶ。

EnglishQuestion: What are the major indications for starting urate-lowering therapy in gout?
JapaneseQuestion: 痛風で尿酸降下療法を開始する主な適応は？
EnglishAnswer: Tophi, radiographic damage from gout, or frequent attacks, among others.
JapaneseAnswer: 痛風結節、画像上の痛風障害、頻回発作など。

EnglishQuestion: What is first-line urate-lowering therapy for gout, and how is it initiated?
JapaneseQuestion: 痛風の第一選択尿酸降下薬と導入法は？
EnglishAnswer: Allopurinol is first-line, including in chronic kidney disease; start at a low dose and titrate upward.
JapaneseAnswer: CKDを含めアロプリノールを第一選択とし、低用量で開始して漸増する。

EnglishQuestion: What is the target serum urate level in gout?
JapaneseQuestion: 痛風の血清尿酸目標は？
EnglishAnswer: Usually <6 mg/dL (<360 micromol/L); some guidelines use <5 mg/dL (<300 micromol/L) for severe tophaceous gout.
JapaneseAnswer: 通常<6 mg/dL（<360 μmol/L）；重症結節性痛風では<5 mg/dL（<300 μmol/L）を用いる指針もある。

EnglishQuestion: Which prophylaxis should accompany initiation of urate-lowering therapy, and for how long?
JapaneseQuestion: 尿酸降下療法の導入時に発作予防として何をどれくらい併用するか？
EnglishAnswer: Colchicine, an NSAID, or a low-dose glucocorticoid, usually for 3-6 months.
JapaneseAnswer: コルヒチン、NSAIDまたは低用量グルココルチコイドを通常3～6か月併用する。

EnglishQuestion: What type of drug is febuxostat, and what does it inhibit?
JapaneseQuestion: フェブキソスタットは何を阻害する何系統の薬か？
EnglishAnswer: It is a xanthine oxidase inhibitor, not a uricosuric drug.
JapaneseAnswer: キサンチンオキシダーゼ阻害薬であり、尿酸排泄促進薬ではない。

EnglishQuestion: What is the fundamental mechanism of iron overload in hereditary hemochromatosis?
JapaneseQuestion: 遺伝性ヘモクロマトーシスで鉄過剰が生じる基本機序は？
EnglishAnswer: Hepcidin deficiency or impaired hepcidin action permits continued iron export through ferroportin, increasing intestinal absorption and circulating iron.
JapaneseAnswer: ヘプシジン不足・作用異常によりフェロポルチンからの鉄放出が続き、腸管吸収と血中鉄が増える。

EnglishQuestion: Which organs are primarily damaged by iron overload, and what are representative consequences?
JapaneseQuestion: 鉄過剰が主に障害する臓器と代表的結果は？
EnglishAnswer: Iron deposits in the liver, pancreas, heart, pituitary, joints, and skin, causing conditions such as hepatic fibrosis, diabetes, cardiomyopathy, and hypogonadism.
JapaneseAnswer: 肝・膵・心・下垂体・関節・皮膚に沈着し、肝線維化、糖尿病、心筋症、性腺機能低下などを起こす。

EnglishQuestion: What are the initial tests for hereditary hemochromatosis?
JapaneseQuestion: 遺伝性ヘモクロマトーシスの初期検査は何か？
EnglishAnswer: Transferrin saturation (TSAT) and ferritin.
JapaneseAnswer: トランスフェリン飽和度（TSAT）とフェリチン。

EnglishQuestion: Why can iron overload not be diagnosed from an elevated ferritin level alone?
JapaneseQuestion: フェリチン高値だけで鉄過剰を診断できないのはなぜか？
EnglishAnswer: Ferritin is also elevated in inflammation, liver injury, and metabolic syndrome.
JapaneseAnswer: 炎症、肝障害、メタボリックシンドロームでも上昇するため。

EnglishQuestion: How are MRI and liver biopsy used in hemochromatosis?
JapaneseQuestion: ヘモクロマトーシスでMRIと肝生検はそれぞれどう使うか？
EnglishAnswer: MRI quantifies hepatic iron and assesses fibrosis noninvasively; liver biopsy is reserved for selected cases with an unclear cause or uncertain stage.
JapaneseAnswer: MRIで肝鉄を定量し線維化を非侵襲的評価する；肝生検は原因不明や病期判断困難など選択例に用いる。

EnglishQuestion: What is first-line treatment for hereditary hemochromatosis, and what are the ferritin targets?
JapaneseQuestion: 遺伝性ヘモクロマトーシスの第一選択治療とフェリチン目標は？
EnglishAnswer: Phlebotomy; target approximately 50 microg/L during induction and 50-100 microg/L during maintenance.
JapaneseAnswer: 瀉血；導入期は約50 μg/L、維持期は50～100 μg/Lを目安にする。

EnglishQuestion: What is used for iron overload in patients who cannot undergo phlebotomy because of severe anemia or transfusion dependence?
JapaneseQuestion: 鉄過剰で瀉血不能な重い貧血・輸血依存例には何を用いるか？
EnglishAnswer: Iron chelators such as deferoxamine or deferasirox.
JapaneseAnswer: デフェロキサミンやデフェラシロクスなどの鉄キレート薬。

EnglishQuestion: Why should patients with hemochromatosis avoid raw shellfish?
JapaneseQuestion: ヘモクロマトーシスで生の貝類を避ける理由は？
EnglishAnswer: They are at risk of severe infection with Vibrio vulnificus.
JapaneseAnswer: Vibrio vulnificusによる重症感染リスクがあるため。

EnglishQuestion: What is the causative gene in Wilson disease, and which aspects of copper metabolism are impaired?
JapaneseQuestion: ウィルソン病の原因遺伝子と銅代謝異常は？
EnglishAnswer: Autosomal recessive pathogenic ATP7B variants impair biliary copper excretion and incorporation of copper into ceruloplasmin.
JapaneseAnswer: 常染色体潜性ATP7B病的バリアントにより、銅の胆汁排泄とセルロプラスミンへの組込みが障害される。

EnglishQuestion: Why does a low total serum copper level not exclude Wilson disease?
JapaneseQuestion: ウィルソン病で血清総銅が低値でも病気を否定できないのはなぜか？
EnglishAnswer: Low ceruloplasmin can make total serum copper low despite tissue copper accumulation.
JapaneseAnswer: セルロプラスミン低下により、銅蓄積があっても血清総銅が低くなり得るため。

EnglishQuestion: Which tests are integrated to diagnose Wilson disease?
JapaneseQuestion: ウィルソン病の診断ではどの検査を統合するか？
EnglishAnswer: Integrate ceruloplasmin, 24-hour urinary copper, slit-lamp examination for Kayser-Fleischer rings, hepatic copper quantification, and genetic testing, using the Leipzig score or a similar framework.
JapaneseAnswer: セルロプラスミン、24時間尿中銅、細隙灯でのカイザー・フライシャー輪、肝銅定量、遺伝学的検査をライプツィヒスコアなどで統合する。

EnglishQuestion: How does drug therapy differ between symptomatic Wilson disease and asymptomatic or maintenance-phase disease?
JapaneseQuestion: 症候性ウィルソン病と無症候・維持期では薬物療法をどう使い分けるか？
EnglishAnswer: In symptomatic disease, D-penicillamine or trientine promotes urinary copper excretion; in asymptomatic patients and during maintenance, zinc may be used to reduce intestinal copper absorption.
JapaneseAnswer: 症候性ではD-ペニシラミンまたはトリエンチンで尿中排泄を促進し、無症候例・維持療法などでは亜鉛で腸管吸収を抑える。

EnglishQuestion: Which Wilson disease presentations require urgent referral to a liver transplant center?
JapaneseQuestion: ウィルソン病で肝移植施設へ緊急紹介すべき病態は？
EnglishAnswer: Acute liver failure or decompensated cirrhosis caused by Wilson disease.
JapaneseAnswer: ウィルソン病による急性肝不全または非代償性肝硬変。

EnglishQuestion: What are the three steps in diagnosing diabetes mellitus?
JapaneseQuestion: 糖尿病診断の3段階は？
EnglishAnswer: Confirm hyperglycemia -> confirm the result on another day when required -> determine the diabetes type.
JapaneseAnswer: 高血糖を確認する→必要なら別日に確証する→病型を決める。

EnglishQuestion: What are the central pathophysiologic features of type 1 and type 2 diabetes mellitus?
JapaneseQuestion: 1型糖尿病と2型糖尿病の中心病態はそれぞれ何か？
EnglishAnswer: Type 1 usually involves absolute insulin deficiency caused by autoimmune beta-cell destruction; type 2 involves insulin resistance and progressive beta-cell dysfunction.
JapaneseAnswer: 1型は多くが自己免疫性β細胞破壊による絶対的インスリン欠乏、2型はインスリン抵抗性と進行性β細胞機能不全。

EnglishQuestion: How is latent autoimmune diabetes in adults (LADA) classified?
JapaneseQuestion: 成人発症自己免疫性糖尿病（LADA）はどのように位置づけるか？
EnglishAnswer: It is a phenotype of autoimmune type 1 diabetes that progresses slowly to insulin dependence in adults; "type 1.5 diabetes" is not a separate standard classification.
JapaneseAnswer: 成人で緩徐にインスリン依存へ進む自己免疫性1型糖尿病の表現型であり、「1.5型」を独立した標準分類名とはしない。

EnglishQuestion: What HbA1c level is in the diabetic range for a nonpregnant person?
JapaneseQuestion: 非妊娠者のHbA1cによる糖尿病域は？
EnglishAnswer: HbA1c >=6.5% (>=48 mmol/mol).
JapaneseAnswer: HbA1c 6.5%以上（48 mmol/mol以上）。

EnglishQuestion: What fasting plasma glucose level is in the diabetic range for a nonpregnant person?
JapaneseQuestion: 非妊娠者の空腹時血漿ブドウ糖による糖尿病域は？
EnglishAnswer: >=7.0 mmol/L (>=126 mg/dL).
JapaneseAnswer: 7.0 mmol/L以上（126 mg/dL以上）。

EnglishQuestion: What 2-hour plasma glucose level on a 75-g oral glucose tolerance test (OGTT) is in the diabetic range for a nonpregnant person?
JapaneseQuestion: 非妊娠者の75 g OGTT 2時間値による糖尿病域は？
EnglishAnswer: >=11.1 mmol/L (>=200 mg/dL).
JapaneseAnswer: 11.1 mmol/L以上（200 mg/dL以上）。

EnglishQuestion: Under what condition can diabetes be diagnosed from a random plasma glucose level alone?
JapaneseQuestion: 随時血漿ブドウ糖だけで糖尿病と診断できる条件は？
EnglishAnswer: A random plasma glucose >=11.1 mmol/L (>=200 mg/dL) accompanied by classic symptoms or a hyperglycemic crisis.
JapaneseAnswer: ≥11.1 mmol/L（≥200 mg/dL）に典型症状または高血糖クリーゼを伴う場合。

EnglishQuestion: How is the diagnosis of diabetes confirmed in the absence of unequivocal hyperglycemia?
JapaneseQuestion: 明白な高血糖がない場合、糖尿病診断をどう確証するか？
EnglishAnswer: Confirm two abnormal results, either from the same sample or on separate days.
JapaneseAnswer: 同一検体または別日に2つの異常結果を確認する。

EnglishQuestion: What should be done when two different diagnostic tests for diabetes give discordant results?
JapaneseQuestion: 2種類の糖尿病診断検査の結果が不一致ならどうするか？
EnglishAnswer: Promptly repeat the test whose result exceeded the diagnostic threshold.
JapaneseAnswer: 閾値を超えた検査を速やかに再検する。

EnglishQuestion: Why should a capillary self-monitoring value not be used to confirm diabetes in an asymptomatic person?
JapaneseQuestion: 無症候者の糖尿病確定診断に毛細血管自己測定値を使わない理由は？
EnglishAnswer: Definitive diagnosis requires a standardized venous plasma test, although self-monitoring values may guide emergency decisions.
JapaneseAnswer: 確定診断は標準化された静脈血漿検査で行うため。自己測定値は緊急判断には使える。

EnglishQuestion: Which common situations make HbA1c unsuitable for diagnosing diabetes?
JapaneseQuestion: HbA1cが診断に不向きとなる代表的状況は？
EnglishAnswer: Pregnancy, acute blood loss or transfusion, hemolysis, dialysis, erythropoietin therapy, G6PD deficiency, and certain hemoglobin variants.
JapaneseAnswer: 妊娠、急性出血・輸血、溶血、透析、エリスロポエチン治療、G6PD欠損、特定のヘモグロビン異常など。

EnglishQuestion: Which diagnostic criterion should be prioritized when HbA1c and measured glucose are discordant?
JapaneseQuestion: HbA1cと実血糖が乖離する状況では何を診断基準として優先するか？
EnglishAnswer: Plasma glucose criteria.
JapaneseAnswer: 血漿ブドウ糖基準。

EnglishQuestion: Why is C-peptide a marker of endogenous insulin secretion?
JapaneseQuestion: Cペプチドが内因性インスリン分泌の指標になるのはなぜか？
EnglishAnswer: Proinsulin is cleaved into insulin and C-peptide in equimolar amounts, whereas injected insulin contains no C-peptide.
JapaneseAnswer: プロインスリンがインスリンとCペプチドへ等モルに切断され、注射インスリンにはCペプチドが含まれないから。

EnglishQuestion: Which factors must be considered when interpreting C-peptide?
JapaneseQuestion: Cペプチドを解釈するとき同時に考えるべき要素は？
EnglishAnswer: Glucose level, food intake, renal function, and time since disease onset.
JapaneseAnswer: 血糖値、食事、腎機能、発症からの期間。

EnglishQuestion: Which major islet autoantibodies support autoimmune type 1 diabetes?
JapaneseQuestion: 自己免疫性1型糖尿病を支持する主な膵島自己抗体は？
EnglishAnswer: GAD antibodies, IA-2 antibodies, ZnT8 antibodies, and insulin autoantibodies.
JapaneseAnswer: GAD抗体、IA-2抗体、ZnT8抗体、インスリン自己抗体。

EnglishQuestion: When should insulin autoantibodies ideally be measured?
JapaneseQuestion: インスリン自己抗体はいつ採取するのが望ましいか？
EnglishAnswer: Before insulin treatment begins, because they are difficult to interpret afterward.
JapaneseAnswer: インスリン治療開始前。治療後は解釈しにくい。

EnglishQuestion: Which clues should prompt reevaluation for autoimmune type 1 diabetes in an adult being treated for type 2 diabetes?
JapaneseQuestion: 成人を2型糖尿病として治療中でも自己免疫性1型を再評価すべき手がかりは？
EnglishAnswer: Lean body habitus, autoimmune disease, rapidly declining response to medication, ketosis, or a low C-peptide level.
JapaneseAnswer: 痩せ型、自己免疫疾患、急速な薬効低下、ケトーシス、低Cペプチド。

EnglishQuestion: What is the sequence from insulin resistance to persistent hyperglycemia in type 2 diabetes?
JapaneseQuestion: 2型糖尿病でインスリン抵抗性から持続性高血糖に至る流れは？
EnglishAnswer: Insulin resistance -> compensatory hyperinsulinemia -> glucotoxicity, lipotoxicity, and oxidative stress -> beta-cell dedifferentiation, apoptosis, and reduced secretion -> persistent hyperglycemia.
JapaneseAnswer: インスリン抵抗性→代償性高インスリン血症→糖毒性・脂肪毒性・酸化ストレス→β細胞脱分化・アポトーシス・分泌低下→持続性高血糖。

EnglishQuestion: Which clinical clues suggest maturity-onset diabetes of the young (MODY)?
JapaneseQuestion: 若年発症成人型糖尿病（MODY）を疑う臨床的手がかりは？
EnglishAnswer: Diabetes across successive generations and atypical young-onset diabetes with no obesity or autoantibodies and preserved C-peptide.
JapaneseAnswer: 連続する世代の糖尿病、肥満・自己抗体の欠如、保たれたCペプチドを伴う非典型的若年発症。

EnglishQuestion: What glucose pattern is typical of glucokinase-related MODY (GCK-MODY), and how is it usually treated?
JapaneseQuestion: グルコキナーゼ関連MODY（GCK-MODY）の血糖像と通常の治療は？
EnglishAnswer: Mild, stable fasting hyperglycemia from birth; medication is generally unnecessary except during pregnancy.
JapaneseAnswer: 出生時から軽度で安定した空腹時高血糖を示し、通常は妊娠時を除き薬物不要。

EnglishQuestion: Which feature of HNF1A-MODY and HNF4A-MODY is important for treatment selection?
JapaneseQuestion: HNF1A-MODY／HNF4A-MODYで治療選択に重要な特徴は？
EnglishAnswer: High sensitivity to low-dose sulfonylureas.
JapaneseAnswer: 少量スルホニル尿素薬への感受性が高い。

EnglishQuestion: Which renal and electrolyte findings should be assessed in HNF1B-related diabetes?
JapaneseQuestion: HNF1B関連糖尿病で同時評価すべき腎・電解質所見は？
EnglishAnswer: Renal developmental abnormalities and hypomagnesemia.
JapaneseAnswer: 腎形成異常と低Mg血症。

EnglishQuestion: Why is hypoglycemia often severe in pancreatogenic diabetes?
JapaneseQuestion: 膵性糖尿病で低血糖が重くなりやすいのはなぜか？
EnglishAnswer: Both insulin and glucagon are deficient.
JapaneseAnswer: インスリンだけでなくグルカゴンも不足するため。

EnglishQuestion: At what time of day is glucocorticoid-induced hyperglycemia usually most prominent?
JapaneseQuestion: グルココルチコイド誘発高血糖はどの時間帯に目立ちやすいか？
EnglishAnswer: Postprandially and in the afternoon.
JapaneseAnswer: 食後・午後。

EnglishQuestion: What are the one-step 75-g OGTT diagnostic thresholds for gestational diabetes mellitus?
JapaneseQuestion: 妊娠糖尿病の1段階法75 g OGTTの診断閾値は？
EnglishAnswer: Any one or more of the following: fasting 5.1 mmol/L, 1-hour 10.0 mmol/L, or 2-hour 8.5 mmol/L.
JapaneseAnswer: 空腹時5.1、1時間10.0、2時間8.5 mmol/Lのいずれか1つ以上。

EnglishQuestion: What is standard treatment for gestational diabetes when lifestyle measures and self-monitoring do not achieve target glucose levels?
JapaneseQuestion: 妊娠糖尿病で生活療法・自己測定だけで目標未達なら標準治療は？
EnglishAnswer: Insulin.
JapaneseAnswer: インスリン。

EnglishQuestion: When and how should screening be performed after delivery in a patient with gestational diabetes?
JapaneseQuestion: 妊娠糖尿病の分娩後スクリーニングはいつ・何で行うか？
EnglishAnswer: Perform a 75-g OGTT 4-12 weeks postpartum, then continue diabetes screening every 1-3 years.
JapaneseAnswer: 分娩4～12週後に75 g OGTTを行い、その後も1～3年ごとに糖尿病スクリーニングを続ける。

EnglishQuestion: What do the urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) assess, respectively?
JapaneseQuestion: 尿アルブミン／クレアチニン比とeGFRはそれぞれ何を評価するか？
EnglishAnswer: UACR assesses kidney damage and albuminuria; eGFR assesses kidney function.
JapaneseAnswer: UACRは腎障害・アルブミン尿、eGFRは腎機能を評価する。

EnglishQuestion: How are level 1, level 2, and level 3 hypoglycemia defined?
JapaneseQuestion: 低血糖レベル1・2・3はどう定義するか？
EnglishAnswer: Level 1: glucose <3.9 and >=3.0 mmol/L; level 2: <3.0 mmol/L; level 3: altered mental or physical function requiring assistance from another person, regardless of the glucose value.
JapaneseAnswer: レベル1は血糖<3.9かつ≥3.0 mmol/L、レベル2は<3.0 mmol/L、レベル3は数値を問わず認知・身体機能低下により他者の介助を要する状態。

EnglishQuestion: How do autonomic and neuroglycopenic symptoms of hypoglycemia differ?
JapaneseQuestion: 低血糖の自律神経症状と神経糖欠乏症状をどう区別するか？
EnglishAnswer: Autonomic symptoms include sweating, tremor, palpitations, and hunger; neuroglycopenic symptoms include abnormal behavior, confusion, seizures, and coma.
JapaneseAnswer: 自律神経症状は発汗・振戦・動悸・空腹など、神経糖欠乏症状は異常行動・混乱・痙攣・昏睡など。

EnglishQuestion: What is the initial management of hypoglycemia in a patient who can swallow safely?
JapaneseQuestion: 安全に嚥下できる低血糖患者の初期対応は？
EnglishAnswer: Give 15-20 g of fast-acting carbohydrate, recheck after 15 minutes, and repeat if glucose remains <3.9 mmol/L.
JapaneseAnswer: 速効性糖質15～20 gを摂取させ、15分後に再測定し、<3.9 mmol/Lなら反復する。

EnglishQuestion: What is the initial treatment of severe hypoglycemia or hypoglycemia in a patient who cannot swallow?
JapaneseQuestion: 嚥下不能または重症低血糖の初期治療は？
EnglishAnswer: Give glucagon or intravenous glucose, followed by emergency assessment, repeated glucose measurement, and treatment of the cause.
JapaneseAnswer: グルカゴン投与または静注ブドウ糖を行い、救急評価・反復測定・原因治療へ進む。

EnglishQuestion: Which conditions require prolonged observation because hypoglycemia may be prolonged or recurrent?
JapaneseQuestion: 低血糖が長く再発しやすいため観察が必要な状況は？
EnglishAnswer: Renal failure, liver failure, and sulfonylurea-induced hypoglycemia.
JapaneseAnswer: 腎不全、肝不全、スルホニル尿素薬による低血糖。

EnglishQuestion: Which situations commonly cause euglycemic diabetic ketoacidosis?
JapaneseQuestion: 正常血糖性糖尿病性ケトアシドーシスを起こし得る代表的状況は？
EnglishAnswer: Use of a sodium-glucose cotransporter 2 (SGLT2) inhibitor, pregnancy, and fasting.
JapaneseAnswer: ナトリウム・ブドウ糖共輸送体2阻害薬（SGLT2阻害薬）、妊娠、絶食。

EnglishQuestion: Which three elements constitute the diagnosis of diabetic ketoacidosis (DKA)?
JapaneseQuestion: 糖尿病性ケトアシドーシス（DKA）の診断を構成する3要素は？
EnglishAnswer: Hyperglycemia, ketosis, and metabolic acidosis.
JapaneseAnswer: 高血糖、ケトーシス、代謝性アシドーシス。

EnglishQuestion: What is the diagnostic core of hyperglycemic hyperosmolar state (HHS)?
JapaneseQuestion: 高浸透圧高血糖状態（HHS）の診断の核は？
EnglishAnswer: Severe hyperglycemia, hyperosmolality, and dehydration without marked ketosis or acidosis.
JapaneseAnswer: 高度高血糖、高浸透圧、脱水があり、重いケトーシス・アシドーシスを欠くこと。

EnglishQuestion: What are the ketone and acid-base criteria for diabetic ketoacidosis (DKA)?
JapaneseQuestion: 糖尿病性ケトアシドーシス（DKA）のケトン体・酸塩基基準は？
EnglishAnswer: Beta-hydroxybutyrate >=3.0 mmol/L or urine ketones >=2+, together with pH <7.3 or bicarbonate <18 mmol/L.
JapaneseAnswer: β-ヒドロキシ酪酸≥3.0 mmol/Lまたは尿ケトン≥2+で、pH<7.3またはHCO3−<18 mmol/L。

EnglishQuestion: What are the glucose and osmolality criteria for hyperglycemic hyperosmolar state (HHS)?
JapaneseQuestion: 高浸透圧高血糖状態（HHS）の血糖・浸透圧基準は？
EnglishAnswer: Glucose >=33.3 mmol/L (>=600 mg/dL), with effective serum osmolality >300 mOsm/kg or total osmolality >320 mOsm/kg.
JapaneseAnswer: 血糖≥33.3 mmol/L（≥600 mg/dL）で、有効血清浸透圧>300 mOsm/kgまたは総浸透圧>320 mOsm/kg。

EnglishQuestion: Why is blood beta-hydroxybutyrate preferred to urine ketones in a hyperglycemic crisis?
JapaneseQuestion: 高血糖クリーゼで尿ケトンより血中β-ヒドロキシ酪酸を優先するのはなぜか？
EnglishAnswer: Urine testing mainly measures acetoacetate and may not accurately reflect changes in the predominant ketone body.
JapaneseAnswer: 尿ケトンは主にアセト酢酸を測り、主要なケトン体変化を正確に反映しにくいから。

EnglishQuestion: What is the initial treatment sequence for diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS)?
JapaneseQuestion: 糖尿病性ケトアシドーシス（DKA）・高浸透圧高血糖状態（HHS）治療の初期順序は？
EnglishAnswer: Assess airway, breathing, and circulation and begin monitoring -> restore circulation with isotonic crystalloid -> check serum potassium -> replace potassium and start insulin according to the potassium level -> add glucose but continue insulin until the crisis has resolved.
JapaneseAnswer: 気道・呼吸・循環とモニタリング→等張晶質液で循環回復→血清K確認→Kに応じて補充とインスリン開始→ブドウ糖追加後も病態解消までインスリン継続。

EnglishQuestion: In a hyperglycemic crisis, what should be done before insulin if serum potassium is <3.5 mmol/L?
JapaneseQuestion: 高血糖クリーゼで血清K<3.5 mmol/Lなら、インスリンより先に何をするか？
EnglishAnswer: Replace potassium first and delay insulin.
JapaneseAnswer: Kを先に補充し、インスリン開始を待つ。

EnglishQuestion: In a hyperglycemic crisis, what is usually true of total-body potassium even when the initial serum potassium is normal or elevated?
JapaneseQuestion: 高血糖クリーゼで初期血清Kが正常～高値でも全身Kはどうなっていることが多いか？
EnglishAnswer: Total-body potassium is usually depleted.
JapaneseAnswer: 全身Kは枯渇していることが多い。

EnglishQuestion: How should treatment change once glucose falls to approximately 13.9 mmol/L during treatment of diabetic ketoacidosis (DKA)?
JapaneseQuestion: 糖尿病性ケトアシドーシス（DKA）で血糖が約13.9 mmol/Lまで低下した後の治療は？
EnglishAnswer: Add a glucose-containing fluid and continue insulin until ketosis has resolved.
JapaneseAnswer: ブドウ糖液を追加し、ケトーシスが解消するまでインスリンを継続する。

EnglishQuestion: In hyperglycemic hyperosmolar state (HHS), which variable, in addition to glucose, must not be corrected too rapidly after initial fluid resuscitation?
JapaneseQuestion: 高浸透圧高血糖状態（HHS）で補液を先行し急速補正を避ける対象は何か？
EnglishAnswer: Serum osmolality.
JapaneseAnswer: 血糖値だけでなく血清浸透圧の低下速度。

EnglishQuestion: When should sodium bicarbonate be considered in diabetic ketoacidosis (DKA)?
JapaneseQuestion: 糖尿病性ケトアシドーシス（DKA）で重炭酸Naを検討するのはどのような場合か？
EnglishAnswer: Do not give it routinely; consider it only in extremely severe acidemia, such as pH <7.0.
JapaneseAnswer: 一律投与せず、pH<7.0など極めて重い酸血症でのみ検討する。

EnglishQuestion: Which finding distinguishes proliferative from nonproliferative diabetic retinopathy?
JapaneseQuestion: 糖尿病網膜症の非増殖網膜症と増殖網膜症を分ける所見は？
EnglishAnswer: Proliferative retinopathy features neovascularization, which can cause vitreous hemorrhage and tractional retinal detachment.
JapaneseAnswer: 増殖網膜症では新生血管が出現し、硝子体出血・牽引性網膜剥離などを起こす。

EnglishQuestion: What are the principal treatments for proliferative diabetic retinopathy and vision-threatening diabetic macular edema?
JapaneseQuestion: 増殖糖尿病網膜症と視力に関わる糖尿病黄斑浮腫の中心治療は？
EnglishAnswer: Proliferative retinopathy is treated primarily with panretinal photocoagulation and intravitreal anti-VEGF therapy; macular edema is treated primarily with anti-VEGF therapy.
JapaneseAnswer: 増殖網膜症は汎網膜光凝固・硝子体内抗血管内皮増殖因子薬、黄斑浮腫は抗血管内皮増殖因子薬が中心。

EnglishQuestion: How does the timing of the first dilated eye examination differ between type 1 and type 2 diabetes?
JapaneseQuestion: 1型糖尿病と2型糖尿病で初回散瞳眼底検査の時期はどう違うか？
EnglishAnswer: Within 5 years after onset in type 1 diabetes; at diagnosis in type 2 diabetes.
JapaneseAnswer: 1型は発症後5年以内、2型は診断時。

EnglishQuestion: Which two measures are used to diagnose and monitor diabetes-related kidney disease?
JapaneseQuestion: 糖尿病関連腎臓病はどの2指標で診断・追跡するか？
EnglishAnswer: Urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR).
JapaneseAnswer: 尿アルブミン／クレアチニン比（UACR）と推算糸球体濾過量（eGFR）。

EnglishQuestion: What are the A1, A2, and A3 categories of urine albumin-to-creatinine ratio (UACR)?
JapaneseQuestion: 尿アルブミン／クレアチニン比（UACR）のA1・A2・A3区分は？
EnglishAnswer: A1: <30 mg/g; A2: 30-299 mg/g; A3: >=300 mg/g.
JapaneseAnswer: A1は<30 mg/g、A2は30～299 mg/g、A3は≥300 mg/g。

EnglishQuestion: How is persistent elevation of urine albumin-to-creatinine ratio (UACR) confirmed in diabetes?
JapaneseQuestion: 糖尿病で尿アルブミン／クレアチニン比（UACR）上昇の持続性をどう確認するか？
EnglishAnswer: Account for transient elevation from exercise, infection, fever, menstruation, marked hyperglycemia, or hypertension, and confirm the finding in multiple samples over 3-6 months.
JapaneseAnswer: 運動・感染・発熱・月経・著明な高血糖や高血圧による一過性上昇を考え、3～6か月内の複数検体で確認する。

EnglishQuestion: Which kidney-protective drugs are used in a patient with diabetes, hypertension, and UACR >=30 mg/g?
JapaneseQuestion: 高血圧かつ尿アルブミン／クレアチニン比（UACR）≥30 mg/gの糖尿病患者に用いる腎保護薬は？
EnglishAnswer: Use an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker at the maximum tolerated dose; do not combine them.
JapaneseAnswer: アンジオテンシン変換酵素阻害薬またはアンジオテンシンII受容体拮抗薬を最大忍容量まで用い、両者は併用しない。

EnglishQuestion: At approximately what eGFR should an SGLT2 inhibitor be considered for kidney and cardiovascular protection in type 2 diabetes with chronic kidney disease?
JapaneseQuestion: 2型糖尿病＋慢性腎臓病で腎・心保護目的にSGLT2阻害薬を検討するeGFRの目安は？
EnglishAnswer: eGFR >=20 mL/min/1.73 m2.
JapaneseAnswer: 推算糸球体濾過量（eGFR）≥20 mL/min/1.73 m²。

EnglishQuestion: Which findings suggest nondiabetic kidney disease in a patient with diabetes?
JapaneseQuestion: 糖尿病患者で非糖尿病性腎疾患を疑う所見は？
EnglishAnswer: Rapid eGFR decline without retinopathy, active urinary sediment, or an abrupt increase in proteinuria.
JapaneseAnswer: 網膜症を欠く急速なeGFR低下、活動性尿沈渣、急な蛋白尿増加。

EnglishQuestion: How do typical neuropathic and ischemic foot ulcers differ?
JapaneseQuestion: 神経障害性足潰瘍と虚血性足潰瘍の典型所見を比較すると？
EnglishAnswer: A neuropathic foot is warm with palpable pulses and a painless ulcer at a plantar pressure point; an ischemic foot is cold with reduced pulses and ulcers on the toes or margins.
JapaneseAnswer: 神経障害性は温かく拍動を触れ、足底圧部の無痛性潰瘍；虚血性は冷たく拍動低下し、足趾・辺縁に潰瘍を生じる。

EnglishQuestion: What are the central components of diabetic foot-ulcer treatment?
JapaneseQuestion: 糖尿病足潰瘍治療の中心は何か？
EnglishAnswer: Offloading, appropriate debridement, wound care, glycemic management and smoking cessation, antibiotics only when infection is present, and revascularization for peripheral arterial disease.
JapaneseAnswer: 免荷、適切なデブリードマン、創傷管理、血糖管理・禁煙、感染時のみの抗菌薬、末梢動脈疾患の血行再建。

EnglishQuestion: Should prophylactic antibiotics be given for an uninfected diabetic foot ulcer?
JapaneseQuestion: 感染していない糖尿病足潰瘍に予防的抗菌薬を投与するか？
EnglishAnswer: No.
JapaneseAnswer: 投与しない。

EnglishQuestion: What is the drug-selection principle for type 2 diabetes with atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease?
JapaneseQuestion: 2型糖尿病に動脈硬化性心血管疾患・心不全・慢性腎臓病がある場合の薬剤選択原則は？
EnglishAnswer: Choose an SGLT2 inhibitor or GLP-1 receptor agonist with proven outcome benefits, regardless of HbA1c or metformin use.
JapaneseAnswer: HbA1cやメトホルミン使用の有無にかかわらず、予後改善が示されたSGLT2阻害薬またはGLP-1受容体作動薬を選ぶ。

EnglishQuestion: How is aspirin use distinguished between primary and secondary prevention in diabetes?
JapaneseQuestion: 糖尿病患者へのアスピリンは一次予防と二次予防でどう使い分けるか？
EnglishAnswer: Use it for secondary prevention in established atherosclerotic cardiovascular disease; for primary prevention, weigh bleeding risk and do not prescribe it routinely solely because the patient has diabetes.
JapaneseAnswer: 既存の動脈硬化性心血管疾患には二次予防として用いる；一次予防は出血リスクと比較し、糖尿病だけを理由に一律投与しない。

EnglishQuestion: Which insulin must never be stopped during a sick day in type 1 diabetes?
JapaneseQuestion: 1型糖尿病のシックデイでも中断してはいけないインスリンは？
EnglishAnswer: Basal insulin.
JapaneseAnswer: 基礎インスリン。

EnglishQuestion: What is the general HbA1c target for most nonpregnant adults?
JapaneseQuestion: 多くの非妊娠成人におけるHbA1cの一般的目標は？
EnglishAnswer: Start with <7.0% (<53 mmol/mol) and individualize according to hypoglycemia risk, comorbidities, treatment burden, and patient values.
JapaneseAnswer: <7.0%（<53 mmol/mol）を出発点とし、低血糖リスクや併存症、負担、価値観で個別化する。

EnglishQuestion: What are the general preprandial and postprandial glucose targets for most nonpregnant adults?
JapaneseQuestion: 多くの非妊娠成人における食前・食後の一般的血糖目標は？
EnglishAnswer: Preprandial 4.4-7.2 mmol/L (80-130 mg/dL); peak 1-2 hours postprandially <10.0 mmol/L (<180 mg/dL).
JapaneseAnswer: 食前4.4～7.2 mmol/L（80～130 mg/dL）、食後1～2時間ピーク<10.0 mmol/L（<180 mg/dL）。

EnglishQuestion: What are the general continuous glucose monitoring targets for time in range and time below range?
JapaneseQuestion: 持続血糖測定の目標範囲内時間と目標範囲未満時間の一般的目標は？
EnglishAnswer: Time in range (TIR) >70%; time below range (TBR) <4%, including <1% below 3.0 mmol/L.
JapaneseAnswer: 目標範囲内時間（TIR）>70%、目標範囲未満時間（TBR）<4%、うち<3.0 mmol/Lは<1%。

EnglishQuestion: How much aerobic and resistance exercise is recommended for people with diabetes?
JapaneseQuestion: 糖尿病患者に推奨される有酸素運動とレジスタンス運動の目安は？
EnglishAnswer: At least 150 minutes of moderate-intensity aerobic activity per week, spread over at least 3 days, plus resistance exercise 2-3 times per week.
JapaneseAnswer: 中強度有酸素運動を週150分以上・3日以上に分け、レジスタンス運動を週2～3回加える。

EnglishQuestion: How much weight loss can improve metabolism in people with type 2 diabetes and overweight or obesity?
JapaneseQuestion: 2型糖尿病と過体重・肥満で、体重減少はどの程度から代謝改善を期待できるか？
EnglishAnswer: A loss of at least 5-7% improves glucose and risk factors; a loss of at least 10-15% can provide greater metabolic benefit.
JapaneseAnswer: 5～7%以上で血糖・リスク因子が改善し、10～15%以上でより大きな代謝利益が期待できる。

EnglishQuestion: Which two components constitute physiologic insulin replacement in type 1 diabetes?
JapaneseQuestion: 1型糖尿病の生理的インスリン補充はどの2要素からなるか？
EnglishAnswer: Basal insulin and mealtime bolus insulin.
JapaneseAnswer: 基礎インスリンと食事時追加インスリン。

EnglishQuestion: May insulin be stopped during the honeymoon period of type 1 diabetes?
JapaneseQuestion: 1型糖尿病の寛解期にインスリンを中止してよいか？
EnglishAnswer: No. Endogenous secretion temporarily recovers and lowers the required dose, but insulin is still needed.
JapaneseAnswer: 中止しない。内因性分泌が一時的に回復して必要量が減るだけで、インスリンが不要になったわけではない。

EnglishQuestion: Which comorbidities should be assessed before automatically starting metformin in type 2 diabetes?
JapaneseQuestion: 2型糖尿病の薬剤選択で、メトホルミン一律開始より優先して評価する併存症は？
EnglishAnswer: Atherosclerotic cardiovascular disease, heart failure, chronic kidney disease, obesity, and metabolic dysfunction-associated steatohepatitis.
JapaneseAnswer: 動脈硬化性心血管疾患、心不全、慢性腎臓病、肥満、代謝機能障害関連脂肪肝炎。

EnglishQuestion: Which drug classes are prioritized in type 2 diabetes with atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease?
JapaneseQuestion: 動脈硬化性心血管疾患・心不全・慢性腎臓病がある2型糖尿病で優先する薬剤群は？
EnglishAnswer: A sodium-glucose cotransporter 2 (SGLT2) inhibitor or glucagon-like peptide-1 (GLP-1) receptor agonist with proven benefit.
JapaneseAnswer: 利益が実証されたナトリウム・ブドウ糖共輸送体2阻害薬（SGLT2阻害薬）またはグルカゴン様ペプチド1受容体作動薬（GLP-1受容体作動薬）。

EnglishQuestion: What are the main advantages of metformin, and at what renal function is it contraindicated?
JapaneseQuestion: メトホルミンの主な長所と腎機能上の禁忌は？
EnglishAnswer: It is effective and inexpensive, rarely causes hypoglycemia as monotherapy, and is weight-neutral or causes modest weight loss; it is contraindicated when eGFR <30 mL/min/1.73 m2.
JapaneseAnswer: 有効・安価で単独低血糖が少なく、体重中立～軽度減量；eGFR<30 mL/min/1.73 m²では禁忌。

EnglishQuestion: What are the major organ benefits and important adverse effects of SGLT2 inhibitors?
JapaneseQuestion: ナトリウム・ブドウ糖共輸送体2阻害薬（SGLT2阻害薬）の主な臓器利益と重要な有害事象は？
EnglishAnswer: They reduce heart-failure events and progression of chronic kidney disease and provide some cardiovascular benefit; important adverse effects are genital infection, volume depletion, and euglycemic diabetic ketoacidosis.
JapaneseAnswer: 心不全・慢性腎臓病進展抑制と一部の心血管利益；性器感染、脱水、正常血糖性糖尿病性ケトアシドーシス。

EnglishQuestion: What are the principal strengths and cautions of GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists?
JapaneseQuestion: グルカゴン様ペプチド1受容体作動薬（GLP-1受容体作動薬）／GIP-GLP-1二重作動薬の主な強みと注意点は？
EnglishAnswer: They provide strong glucose lowering and weight loss plus some cardiovascular and kidney benefits; watch for gastrointestinal symptoms and biliary disease, and use cautiously in severe gastroparesis.
JapaneseAnswer: 高い血糖・体重減少効果と一部の心血管・腎利益；消化器症状、胆道疾患に注意し、重い胃不全麻痺では慎重に使う。

EnglishQuestion: Why should a dipeptidyl peptidase-4 (DPP-4) inhibitor not be combined with a GLP-1 receptor agonist?
JapaneseQuestion: ジペプチジルペプチダーゼ4阻害薬（DPP-4阻害薬）をGLP-1受容体作動薬と併用しない理由は？
EnglishAnswer: Both act through the incretin pathway, and their combination provides little additional benefit.
JapaneseAnswer: 同じインクレチン系に作用し、併用による追加利益が乏しいため。

EnglishQuestion: Which class of type 2 diabetes medication should be avoided in heart failure?
JapaneseQuestion: 心不全で避けるべき2型糖尿病薬の系統は？
EnglishAnswer: Thiazolidinediones, because they cause edema.
JapaneseAnswer: 浮腫を起こすチアゾリジン薬。

EnglishQuestion: At what HbA1c level should initial combination therapy be considered in type 2 diabetes?
JapaneseQuestion: 2型糖尿病で初期併用療法を考えるHbA1cの目安は？
EnglishAnswer: When HbA1c is >=1.5 percentage points above the individualized target.
JapaneseAnswer: HbA1cが個別目標より≥1.5%高い場合。

EnglishQuestion: When should insulin be started early in type 2 diabetes?
JapaneseQuestion: 2型糖尿病でインスリンを早期導入する目安は？
EnglishAnswer: In a hyperglycemic crisis, catabolic symptoms, symptomatic hyperglycemia, glucose >=16.7 mmol/L (>=300 mg/dL), or HbA1c >10%.
JapaneseAnswer: 高血糖クリーゼ、異化症状、症候性高血糖、血糖≥16.7 mmol/L（≥300 mg/dL）またはHbA1c>10%。

EnglishQuestion: When an injectable agent is needed in type 2 diabetes without a hyperglycemic crisis, what should usually be considered before insulin?
JapaneseQuestion: クリーゼがなく注射薬を要する2型糖尿病では、多くの場合何をインスリンより先に検討するか？
EnglishAnswer: GLP-1-based therapy.
JapaneseAnswer: グルカゴン様ペプチド1関連療法（GLP-1関連療法）。

EnglishQuestion: At what body mass index (BMI) is anti-obesity medication generally considered?
JapaneseQuestion: 肥満治療薬を一般に検討する体格指数（BMI）の基準は？
EnglishAnswer: BMI >=30, or BMI >=27 with a weight-related complication when lifestyle support alone is insufficient.
JapaneseAnswer: BMI≥30、またはBMI≥27で体重関連合併症があり生活支援だけで不十分な場合。

EnglishQuestion: What are key considerations when treating anti-obesity medication as chronic therapy?
JapaneseQuestion: 抗肥満薬を慢性治療として扱う際の重要な注意点は？
EnglishAnswer: Continually assess efficacy and adverse effects, do not use it during pregnancy, and make a long-term plan anticipating weight regain after discontinuation.
JapaneseAnswer: 効果・副作用を継続評価し、妊娠中は使用せず、中止後の体重再増加を見越して長期計画を立てる。

EnglishQuestion: What are the general body mass index (BMI) criteria for recommending or considering metabolic and bariatric surgery?
JapaneseQuestion: 代謝・肥満外科手術を推奨・検討する一般的な体格指数（BMI）基準は？
EnglishAnswer: Recommend it at BMI >=35 regardless of comorbidities; consider it at BMI 30-34.9 with metabolic disease or an inadequate response to nonsurgical treatment.
JapaneseAnswer: BMI≥35では合併症を問わず推奨し、BMI 30～34.9で代謝疾患または非手術治療不十分なら検討する。

EnglishQuestion: How many of the current five harmonized criteria are required to diagnose metabolic syndrome?
JapaneseQuestion: メタボリックシンドロームの現行統一基準は何項目中いくつで診断するか？
EnglishAnswer: At least three of five: waist circumference, triglycerides, HDL cholesterol, blood pressure, and fasting glucose.
JapaneseAnswer: 腹囲、トリグリセリド、HDLコレステロール、血圧、空腹時血糖の5項目中3項目以上。

EnglishQuestion: What are the triglyceride and HDL cholesterol criteria for metabolic syndrome?
JapaneseQuestion: メタボリックシンドロームのトリグリセリド・HDLコレステロール基準は？
EnglishAnswer: Triglycerides >=1.7 mmol/L (>=150 mg/dL) or treatment; HDL <1.0 mmol/L in men or <1.3 mmol/L in women, or treatment.
JapaneseAnswer: トリグリセリド≥1.7 mmol/L（≥150 mg/dL）または治療中；HDLは男性<1.0、女性<1.3 mmol/Lまたは治療中。

EnglishQuestion: What are the blood pressure and fasting glucose criteria for metabolic syndrome?
JapaneseQuestion: メタボリックシンドロームの血圧・空腹時血糖基準は？
EnglishAnswer: Blood pressure >=130/85 mmHg or antihypertensive treatment; fasting glucose >=5.6 mmol/L (>=100 mg/dL) or diabetes treatment.
JapaneseAnswer: 血圧≥130/85 mmHgまたは降圧治療中；空腹時血糖≥5.6 mmol/L（≥100 mg/dL）または糖尿病治療中。

EnglishQuestion: What do tendon xanthomas and eruptive xanthomas suggest, respectively?
JapaneseQuestion: 腱黄色腫と発疹性黄色腫はそれぞれ何を示唆するか？
EnglishAnswer: Tendon xanthomas suggest familial hypercholesterolemia; eruptive xanthomas suggest severe hypertriglyceridemia.
JapaneseAnswer: 腱黄色腫は家族性高コレステロール血症、発疹性黄色腫は著しい高トリグリセリド血症を示唆する。

EnglishQuestion: At what triglyceride level does the risk of acute pancreatitis increase?
JapaneseQuestion: 高トリグリセリド血症で急性膵炎リスクが上がる閾値は？
EnglishAnswer: Risk rises at >=5.6 mmol/L (>=500 mg/dL) and is especially high at >=11.3 mmol/L (>=1,000 mg/dL).
JapaneseAnswer: ≥5.6 mmol/L（≥500 mg/dL）で上昇し、特に≥11.3 mmol/L（≥1,000 mg/dL）で高い。

EnglishQuestion: Which lipoprotein is elevated in Fredrickson type IIa, and what is the representative disorder?
JapaneseQuestion: フレドリクソン（Fredrickson）IIa型で増加するリポ蛋白と代表疾患は？
EnglishAnswer: Low-density lipoprotein (LDL) is elevated; familial hypercholesterolemia is representative.
JapaneseAnswer: 低密度リポ蛋白（LDL）が増加し、家族性高コレステロール血症が代表。

EnglishQuestion: Which lipoproteins are elevated in Fredrickson type III, and which xanthomas are characteristic?
JapaneseQuestion: フレドリクソン（Fredrickson）III型で増加するリポ蛋白と特徴的黄色腫は？
EnglishAnswer: Remnants, including intermediate-density lipoprotein and chylomicron remnants, are elevated; palmar striated and tuberoeruptive xanthomas are characteristic.
JapaneseAnswer: レムナント（中間密度リポ蛋白・カイロミクロンレムナント）が増加し、手掌線状・結節発疹性黄色腫を示す。

EnglishQuestion: What is first-line therapy for lowering LDL cholesterol in dyslipidemia?
JapaneseQuestion: 脂質異常症で低密度リポ蛋白コレステロール低下の第一選択薬は？
EnglishAnswer: A statin.
JapaneseAnswer: スタチン。

EnglishQuestion: What is the LDL cholesterol target in a patient with diabetes and atherosclerotic cardiovascular disease?
JapaneseQuestion: 糖尿病かつ動脈硬化性心血管疾患がある場合の低密度リポ蛋白コレステロール目標は？
EnglishAnswer: Use a high-intensity statin to achieve a reduction of at least 50% and target <1.4 mmol/L (<55 mg/dL).
JapaneseAnswer: 高強度スタチンで50%以上低下させ、<1.4 mmol/L（<55 mg/dL）を目指す。

EnglishQuestion: How is severe hypertriglyceridemia treated to prevent pancreatitis?
JapaneseQuestion: 重症高トリグリセリド血症で膵炎を予防する治療は？
EnglishAnswer: Correct secondary causes; avoid alcohol and simple carbohydrates; and use a very-low-fat diet, a fibrate, and prescription omega-3 fatty acids.
JapaneseAnswer: 二次性原因を是正し、アルコール・単純糖質を避け、非常に低脂肪の食事、フィブラート、処方オメガ3脂肪酸を用いる。

EnglishQuestion: In esophageal dysphagia, what is suggested by difficulty with solids first versus difficulty with both solids and liquids from the outset?
JapaneseQuestion: 食道性嚥下障害で、固形物から始まる場合と最初から固形物・液体とも困難な場合は何を示唆するか？
EnglishAnswer: Difficulty with solids first suggests a structural lesion; difficulty with both from the outset suggests an esophageal motility disorder.
JapaneseAnswer: 固形物からなら構造病変、最初から両方なら食道運動障害を示唆する。

EnglishQuestion: What is the basic diagnostic sequence for esophageal dysphagia?
JapaneseQuestion: 食道性嚥下障害の基本的な診断順序は？
EnglishAnswer: Perform upper GI endoscopy with biopsies as indicated to exclude structural disease; if unrevealing, use high-resolution esophageal manometry to assess motility disorders.
JapaneseAnswer: 上部消化管内視鏡と必要な生検で構造病変を除外し、異常がなければ高解像度食道内圧検査で運動障害を評価する。

EnglishQuestion: Which alarm features in dysphagia or reflux symptoms warrant early endoscopy?
JapaneseQuestion: 嚥下障害や逆流症状で早期内視鏡を要する警告徴候は？
EnglishAnswer: Progressive dysphagia, weight loss, anemia or bleeding, recurrent vomiting, fever, new symptoms at older age, or a relevant family history.
JapaneseAnswer: 進行性嚥下障害、体重減少、貧血・出血、反復嘔吐、発熱、高齢での新規症状、関連する家族歴。

EnglishQuestion: How do pulsion and traction esophageal diverticula differ in wall structure and mechanism?
JapaneseQuestion: 圧出性食道憩室と牽引性食道憩室は、壁構造と機序がどう異なるか？
EnglishAnswer: A pulsion diverticulum is a false diverticulum in which mucosa and submucosa herniate through muscle because of increased intraluminal pressure; a traction diverticulum is a true diverticulum pulled outward by mediastinal inflammation or fibrosis.
JapaneseAnswer: 圧出性は内圧上昇による仮性憩室、牽引性は縦隔の炎症・線維化に引かれる真性憩室。

EnglishQuestion: What are the typical features of a Zenker diverticulum, and what procedural caution is required?
JapaneseQuestion: ツェンカー憩室の典型像と処置上の注意点は？
EnglishAnswer: It can cause regurgitation of undigested food, halitosis, post-swallow coughing, aspiration, and pneumonia. Evaluate it with a contrast swallow and beware of endoscope misplacement and perforation.
JapaneseAnswer: 未消化食物の逆流、口臭、嚥下後の咳、誤嚥・肺炎を来す。造影嚥下で評価し、内視鏡の誤挿入・穿孔に注意する。

EnglishQuestion: How do sliding and paraesophageal hiatal hernias differ in gastroesophageal junction position and principal risk?
JapaneseQuestion: 滑脱型と傍食道型の食道裂孔ヘルニアは、接合部の位置と主なリスクがどう異なるか？
EnglishAnswer: In a sliding hernia, the gastroesophageal junction moves above the diaphragm and is associated with GERD. In a paraesophageal hernia, the junction remains below the diaphragm while the gastric fundus herniates, creating volvulus and ischemia risk.
JapaneseAnswer: 滑脱型は接合部が横隔膜上へ移動しGERDと関連する。傍食道型は接合部が横隔膜下に残り、捻転・虚血リスクがある。

EnglishQuestion: When should surgery be considered for a hiatal hernia?
JapaneseQuestion: 食道裂孔ヘルニアで手術を検討するのはどのような場合か？
EnglishAnswer: For a large symptomatic paraesophageal hernia, obstruction, bleeding, or risk of volvulus or ischemia.
JapaneseAnswer: 症候性の大きな傍食道型、閉塞、出血、捻転・虚血リスクがある場合。

EnglishQuestion: What are the main pathophysiologic mechanisms of gastroesophageal reflux disease (GERD)?
JapaneseQuestion: GERDの主な病態機序は？
EnglishAnswer: Transient lower esophageal sphincter relaxation, hiatal hernia, increased intra-abdominal pressure, and impaired esophageal clearance permit gastric contents to reflux.
JapaneseAnswer: 一過性LES弛緩、裂孔ヘルニア、腹圧上昇、食道クリアランス低下により胃内容が逆流する。

EnglishQuestion: What initial therapeutic trial is used for typical GERD without alarm features?
JapaneseQuestion: 警告徴候のない典型的GERDで行う初期治療試験は？
EnglishAnswer: A proton pump inhibitor once daily before a meal for 8 weeks.
JapaneseAnswer: 食前1日1回のPPIを8週間試す。

EnglishQuestion: If endoscopy is normal but GERD remains suspected and unproven, what is the next test?
JapaneseQuestion: 内視鏡正常でもGERDが疑われ、診断未確立の場合の次の検査は？
EnglishAnswer: Ambulatory reflux monitoring performed off proton pump inhibitor therapy.
JapaneseAnswer: PPI休薬下の携帯型逆流モニタリング。

EnglishQuestion: What is the role of esophageal manometry in GERD evaluation?
JapaneseQuestion: GERD評価における食道内圧検査の役割は？
EnglishAnswer: It does not diagnose GERD itself; it assesses motility before antireflux surgery or in patients with dysphagia.
JapaneseAnswer: GERDそのものの診断ではなく、手術前または嚥下障害の運動評価に用いる。

EnglishQuestion: What is Barrett esophagus?
JapaneseQuestion: バレット食道とは何か？
EnglishAnswer: A premalignant condition in which distal esophageal stratified squamous epithelium is replaced by columnar epithelium with intestinal metaplasia.
JapaneseAnswer: 下部食道の重層扁平上皮が腸上皮化生を伴う円柱上皮へ置換された前癌病変。

EnglishQuestion: How does Barrett esophagus management differ for no dysplasia, low-grade dysplasia, and high-grade dysplasia or intramucosal cancer?
JapaneseQuestion: バレット食道の管理は異形成の程度でどう変わるか？
EnglishAnswer: No dysplasia: proton pump inhibitor therapy and periodic surveillance. Low-grade dysplasia: expert pathology confirmation and generally endoscopic eradication therapy. High-grade dysplasia or intramucosal cancer: resect visible lesions and ablate the remaining Barrett mucosa.
JapaneseAnswer: 異形成なしはPPIと監視、低異型度は専門病理確認後に原則内視鏡的根絶療法、高異型度／粘膜内癌は可視病変切除と残存粘膜焼灼。

EnglishQuestion: What are the typical symptoms of eosinophilic esophagitis in adults?
JapaneseQuestion: 成人の好酸球性食道炎の典型症状は？
EnglishAnswer: Solid-food dysphagia and food impaction.
JapaneseAnswer: 固形物嚥下障害と食物嵌頓。

EnglishQuestion: What findings establish the diagnosis of eosinophilic esophagitis?
JapaneseQuestion: 好酸球性食道炎の診断要件は？
EnglishAnswer: Symptoms of esophageal dysfunction, at least 15 eosinophils per high-power field on esophageal biopsy, and exclusion of alternative causes.
JapaneseAnswer: 食道機能障害症状、生検で好酸球15個/高倍率視野以上、他原因の除外。

EnglishQuestion: What are the main treatment options for eosinophilic esophagitis?
JapaneseQuestion: 好酸球性食道炎の主な治療選択肢は？
EnglishAnswer: Proton pump inhibitors, swallowed topical corticosteroids, empiric food elimination, and dupilumab in selected patients. Dilate fixed strictures while also treating inflammation.
JapaneseAnswer: PPI、嚥下型局所ステロイド、経験的食物除去、選択例のデュピルマブ。固定狭窄には炎症治療と拡張を併用する。

EnglishQuestion: What is the pathophysiology of achalasia?
JapaneseQuestion: アカラシアの病態は？
EnglishAnswer: Loss of inhibitory neurons in the Auerbach myenteric plexus causes impaired lower esophageal sphincter relaxation and absent esophageal body peristalsis.
JapaneseAnswer: 抑制性神経の消失によりLES弛緩不全と食道体部蠕動消失を来す。

EnglishQuestion: What is the diagnostic sequence for achalasia?
JapaneseQuestion: アカラシアの診断順序は？
EnglishAnswer: Use endoscopy to exclude malignant pseudoachalasia, stricture, and eosinophilic esophagitis; confirm and classify achalasia with high-resolution manometry. A timed barium esophagram provides complementary assessment of emptying.
JapaneseAnswer: 内視鏡で偽アカラシア、狭窄、好酸球性食道炎を除外し、高解像度食道内圧検査で確定・分類する。時間計測バリウム造影で排出を補助評価する。

EnglishQuestion: Which history raises particular concern for malignant pseudoachalasia?
JapaneseQuestion: 癌性偽アカラシアを特に疑う病歴は？
EnglishAnswer: Older age with a short symptom history and rapid weight loss.
JapaneseAnswer: 高齢者で、病歴が短く急速な体重減少を伴う。

EnglishQuestion: Which definitive treatment is especially suitable for type III achalasia?
JapaneseQuestion: アカラシアIII型に特に適する根治的治療は？
EnglishAnswer: Peroral endoscopic myotomy (POEM), because it permits a long myotomy; postoperative GERD is more common.
JapaneseAnswer: 長い筋切開が可能なPOEM。ただし術後GERDが多い。

EnglishQuestion: How are Candida, HSV, and CMV esophagitis distinguished by endoscopic appearance and treatment?
JapaneseQuestion: カンジダ・HSV・CMV食道炎を内視鏡所見と治療でどう見分けるか？
EnglishAnswer: Candida causes white plaques and is treated with fluconazole; HSV causes small punched-out ulcers and is treated with acyclovir-class therapy; CMV causes large linear ulcers and is treated with ganciclovir or valganciclovir.
JapaneseAnswer: カンジダは白苔でフルコナゾール、HSVは打ち抜き状潰瘍でアシクロビル系、CMVは線状潰瘍でガンシクロビル／バルガンシクロビル。

EnglishQuestion: How do a Mallory-Weiss tear and Boerhaave syndrome differ in depth of injury and presentation?
JapaneseQuestion: マロリー・ワイス裂創とブールハーフェ症候群はどう異なるか？
EnglishAnswer: A Mallory-Weiss tear is a mucosal laceration near the gastroesophageal junction causing hematemesis after vomiting; Boerhaave syndrome is a transmural esophageal rupture causing severe chest or upper abdominal pain, dyspnea, and possible mediastinal emphysema after vomiting.
JapaneseAnswer: 前者は胃食道接合部付近の粘膜裂創による嘔吐後の吐血、後者は食道全層破裂による激しい胸・上腹部痛、呼吸困難、縦隔気腫。

EnglishQuestion: What is the initial management of suspected Boerhaave syndrome?
JapaneseQuestion: ブールハーフェ症候群疑いの初期対応は？
EnglishAnswer: Keep the patient nil by mouth, start broad-spectrum antibiotics and IV fluids, assess leakage and contamination with water-soluble contrast CT or esophagography, and urgently consult surgery, therapeutic endoscopy, and drainage teams.
JapaneseAnswer: 絶飲食、広域抗菌薬、輸液を開始し、水溶性造影CT／食道造影で漏出・汚染を評価して緊急専門相談する。

EnglishQuestion: What is the definitional difference between gastritis and gastropathy?
JapaneseQuestion: 胃炎と胃粘膜障害の定義上の違いは？
EnglishAnswer: Gastritis includes histologic inflammation; gastropathy is reactive mucosal injury with little inflammation.
JapaneseAnswer: 胃炎は組織学的炎症を伴い、胃粘膜障害は炎症が乏しい反応性粘膜障害。

EnglishQuestion: Which deficiencies and tumor risks are associated with autoimmune atrophic gastritis?
JapaneseQuestion: 自己免疫性萎縮性胃炎に伴う欠乏と腫瘍リスクは？
EnglishAnswer: Iron and vitamin B12 deficiency, with increased risks of gastric neuroendocrine tumors and gastric cancer.
JapaneseAnswer: 鉄・ビタミンB12欠乏と、胃神経内分泌腫瘍・胃癌リスク上昇。

EnglishQuestion: What are the two major causes of peptic ulcer disease?
JapaneseQuestion: 消化性潰瘍の二大原因は？
EnglishAnswer: Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs).
JapaneseAnswer: H. pylori感染とNSAID。

EnglishQuestion: Which tests can demonstrate active Helicobacter pylori infection?
JapaneseQuestion: H. pyloriの活動性感染を確認できる検査は？
EnglishAnswer: Urea breath testing, stool antigen testing, and endoscopic biopsy with rapid urease testing or histology.
JapaneseAnswer: 尿素呼気試験、便中抗原、内視鏡生検による迅速ウレアーゼ試験または組織検査。

EnglishQuestion: Why should a gastric ulcer be biopsied during endoscopy?
JapaneseQuestion: 胃潰瘍を内視鏡生検する目的は？
EnglishAnswer: To exclude gastric cancer or another malignant lesion.
JapaneseAnswer: 胃癌などの悪性病変を除外するため。

EnglishQuestion: What is a representative empiric first-line Helicobacter pylori regimen when antibiotic susceptibility is unknown?
JapaneseQuestion: 感受性不明時のH. pylori経験的除菌で代表的な第一選択は？
EnglishAnswer: Fourteen days of optimized bismuth quadruple therapy: a proton pump inhibitor, bismuth, tetracycline, and metronidazole.
JapaneseAnswer: 14日間の最適化ビスマス4剤療法：PPI、ビスマス、テトラサイクリン、メトロニダゾール。

EnglishQuestion: When and how should Helicobacter pylori eradication be confirmed?
JapaneseQuestion: H. pylori除菌判定は、いつ・どのように行うか？
EnglishAnswer: At least 4 weeks after antibiotics, with proton pump inhibitors or potassium-competitive acid blockers withheld for at least 2 weeks, using a urea breath test or stool antigen test in every treated patient.
JapaneseAnswer: 抗菌薬終了4週以降、PPI／PCABを2週以上休薬し、尿素呼気試験または便中抗原で全例確認する。

EnglishQuestion: Which findings suggest bleeding, perforation, and gastric outlet obstruction from peptic ulcer disease?
JapaneseQuestion: 消化性潰瘍の出血・穿孔・胃出口閉塞を示唆する所見は？
EnglishAnswer: Bleeding: hematemesis or melena. Perforation: sudden peritoneal signs and free intraperitoneal air. Outlet obstruction: persistent vomiting and a succussion splash.
JapaneseAnswer: 出血は吐血・黒色便、穿孔は急な腹膜刺激徴候と遊離ガス、出口閉塞は持続嘔吐・振水音。

EnglishQuestion: What is gastroparesis, and what is the standard diagnostic test?
JapaneseQuestion: 胃不全麻痺の定義と標準診断検査は？
EnglishAnswer: It is objectively delayed solid-food gastric emptying without mechanical obstruction; diagnose it after excluding obstruction with a 4-hour solid-meal gastric emptying scintigraphy study.
JapaneseAnswer: 機械的閉塞がない固形食胃排出遅延。閉塞除外後の4時間固形食胃排出シンチグラフィで診断する。

EnglishQuestion: What are the fundamentals of gastroparesis treatment?
JapaneseQuestion: 胃不全麻痺治療の基本は？
EnglishAnswer: Use small, frequent meals of small-particle, low-fat food; correct causative drugs and hyperglycemia. Use a prokinetic such as metoclopramide when needed, noting that antiemetics reduce nausea but do not improve emptying.
JapaneseAnswer: 小粒子・低脂肪食を少量頻回とし、原因薬と高血糖を是正する。必要時メトクロプラミドを用い、制吐薬は排出を改善しない。

EnglishQuestion: What is the difference between maldigestion and malabsorption?
JapaneseQuestion: 消化不良と吸収不良の違いは？
EnglishAnswer: Maldigestion is failure to break nutrients into absorbable forms; malabsorption is failure to take up already digested nutrients through the intestinal mucosa.
JapaneseAnswer: 消化不良は栄養素を吸収可能な形へ分解できない状態、吸収不良は分解後の栄養素を腸管から取り込めない状態。

EnglishQuestion: Where are iron, calcium, and folate primarily absorbed, and where are vitamin B12 and bile acids absorbed?
JapaneseQuestion: 鉄・Ca・葉酸と、ビタミンB12・胆汁酸の主な吸収部位は？
EnglishAnswer: Iron, calcium, and folate are primarily absorbed in the duodenum; vitamin B12 and bile acids are absorbed in the terminal ileum.
JapaneseAnswer: 鉄・Ca・葉酸は十二指腸、ビタミンB12・胆汁酸は終末回腸。

EnglishQuestion: What are the three mechanistic categories of malabsorption?
JapaneseQuestion: 吸収不良の3つの機序分類は？
EnglishAnswer: Luminal or premucosal, mucosal, and postmucosal.
JapaneseAnswer: 腔内・粘膜前、粘膜、粘膜後。

EnglishQuestion: How are pancreatic exocrine insufficiency, celiac disease, and intestinal lymphangiectasia classified by the stage of absorption affected?
JapaneseQuestion: 膵外分泌不全、セリアック病、腸リンパ管拡張症はどの障害段階か？
EnglishAnswer: Pancreatic exocrine insufficiency is luminal or premucosal; celiac disease is mucosal; intestinal lymphangiectasia is postmucosal.
JapaneseAnswer: 膵外分泌不全は腔内・粘膜前、セリアック病は粘膜、腸リンパ管拡張症は粘膜後。

EnglishQuestion: Why does extensive ileal resection cause steatorrhea?
JapaneseQuestion: 広範な回腸切除が脂肪便を起こす機序は？
EnglishAnswer: The bile acid pool cannot be maintained, impairing micelle formation.
JapaneseAnswer: 胆汁酸プールを維持できず、ミセル形成が障害されるため。

EnglishQuestion: What does bile acid spillover into the colon cause in limited ileal disease?
JapaneseQuestion: 限局した回腸障害で結腸へ流入した胆汁酸は何を起こすか？
EnglishAnswer: Secretory diarrhea.
JapaneseAnswer: 分泌性下痢。

EnglishQuestion: In malabsorption, foul-smelling steatorrhea suggests dysfunction of what processes?
JapaneseQuestion: 吸収不良で悪臭を伴う脂肪便は何の障害を示唆するか？
EnglishAnswer: Fat digestion or absorption, bile acid availability, or pancreatic enzyme activity.
JapaneseAnswer: 脂質消化・吸収、胆汁酸、または膵酵素の障害。

EnglishQuestion: What is the main mechanism of edema and ascites in malabsorption?
JapaneseQuestion: 吸収不良で浮腫・腹水を来す主な機序は？
EnglishAnswer: Hypoproteinemia or protein-losing enteropathy.
JapaneseAnswer: 低蛋白血症または蛋白漏出性胃腸症。

EnglishQuestion: How does fat malabsorption cause enteric hyperoxaluria and kidney stones?
JapaneseQuestion: 脂肪吸収不良が腸性高シュウ酸尿症と腎結石を起こす機序は？
EnglishAnswer: Unabsorbed fatty acids bind intestinal calcium, leaving more free oxalate available for absorption.
JapaneseAnswer: 脂肪酸が腸管内Caと結合し、遊離シュウ酸の吸収が増えるため。

EnglishQuestion: In malabsorption with macrocytic anemia and elevated methylmalonic acid, which deficiency and anatomic causes should be considered?
JapaneseQuestion: 大球性貧血とメチルマロン酸上昇では、何の欠乏とどの原因を考えるか？
EnglishAnswer: Vitamin B12 deficiency; consider gastrectomy or pernicious anemia, terminal ileal disease, and small intestinal bacterial overgrowth (SIBO).
JapaneseAnswer: ビタミンB12欠乏。胃切除・悪性貧血、終末回腸障害、SIBOを考える。

EnglishQuestion: What does the combination of hypoalbuminemia, lymphopenia, and low immunoglobulins suggest?
JapaneseQuestion: 低アルブミン血症・リンパ球減少・低Igの組合せは何を示唆するか？
EnglishAnswer: Severe malnutrition, intestinal lymphangiectasia, or protein-losing enteropathy.
JapaneseAnswer: 重度栄養不良、腸リンパ管拡張症、蛋白漏出性胃腸症。

EnglishQuestion: What does a low fecal elastase suggest, and in what stool type may it be falsely low?
JapaneseQuestion: 便中エラスターゼ低下は何を示唆し、どの便で偽低値となるか？
EnglishAnswer: It suggests pancreatic exocrine insufficiency and may be falsely low in watery stool.
JapaneseAnswer: 膵外分泌不全を示唆し、水様便では偽低値となり得る。

EnglishQuestion: What conditions are hydrogen and methane breath tests mainly used to support?
JapaneseQuestion: 水素・メタン呼気試験は主に何の補助診断に使うか？
EnglishAnswer: Lactose or fructose malabsorption and small intestinal bacterial overgrowth (SIBO).
JapaneseAnswer: 乳糖・果糖吸収不良とSIBO。

EnglishQuestion: What should be considered when duodenal biopsy shows villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes?
JapaneseQuestion: 十二指腸生検で絨毛萎縮・陰窩過形成・上皮内リンパ球増加を認めたら何を考えるか？
EnglishAnswer: Celiac disease, with tropical sprue in the differential diagnosis.
JapaneseAnswer: セリアック病。熱帯性スプルーも鑑別する。

EnglishQuestion: Which disease produces PAS-positive foamy macrophages in the small-intestinal lamina propria?
JapaneseQuestion: 小腸粘膜にPAS陽性泡沫状マクロファージを認める疾患は？
EnglishAnswer: Whipple disease.
JapaneseAnswer: ウィップル病。

EnglishQuestion: Which small-bowel histologic finding suggests intestinal lymphangiectasia?
JapaneseQuestion: 腸リンパ管拡張症を示唆する小腸組織所見は？
EnglishAnswer: Dilated lymphatic vessels with club-shaped villi.
JapaneseAnswer: 拡張したリンパ管と棍棒状絨毛。

EnglishQuestion: Why does lactose intolerance cause diarrhea, gas, and bloating?
JapaneseQuestion: 乳糖不耐症で下痢・ガス・膨満が起こる機序は？
EnglishAnswer: Undigested lactose causes osmotic diarrhea and is fermented by colonic bacteria, producing gas, abdominal pain, and bloating.
JapaneseAnswer: 未分解乳糖が浸透圧性下痢を起こし、結腸細菌の発酵でガス・腹痛・膨満を生じる。

EnglishQuestion: Why should complete dairy avoidance be avoided in lactose intolerance, and what alternatives can be used?
JapaneseQuestion: 乳糖不耐症で全乳製品除去を避ける理由と代替策は？
EnglishAnswer: To prevent calcium and vitamin D deficiency; determine individual tolerance and use hard cheese, fermented dairy, lactose-free milk, or lactase supplements.
JapaneseAnswer: Ca・ビタミンD不足を防ぐため。耐容量を探り、硬質チーズ、発酵乳、乳糖分解乳、ラクターゼ製剤を使う。

EnglishQuestion: What is intestinal failure?
JapaneseQuestion: 腸管不全の定義は？
EnglishAnswer: Inability to absorb enough nutrients or water and electrolytes to maintain health, requiring intravenous supplementation.
JapaneseAnswer: 健康維持に必要な栄養素または水・電解質を吸収できず、静脈補給を要する状態。

EnglishQuestion: Besides residual small-bowel length, what determines the severity of short bowel syndrome?
JapaneseQuestion: 短腸症候群の重症度を残存小腸長以外に決める要素は？
EnglishAnswer: The presence of the terminal ileum, ileocecal valve, and colon; intestinal adaptation; and the underlying disease.
JapaneseAnswer: 終末回腸・回盲弁・結腸の有無、腸管適応、基礎疾患。

EnglishQuestion: What are the main benefits of retaining the colon in short bowel syndrome?
JapaneseQuestion: 短腸症候群で結腸が残る主な利点は？
EnglishAnswer: Reabsorption of water and sodium, energy recovery through short-chain fatty acids produced from unabsorbed carbohydrate, and slower transit and enhanced adaptation through PYY and GLP-1/2.
JapaneseAnswer: 水・Na再吸収、短鎖脂肪酸によるエネルギー回収、PYY・GLP-1/2による通過抑制と適応。

EnglishQuestion: Which two metabolic complications require attention when the colon is retained in short bowel syndrome?
JapaneseQuestion: 短腸症候群で結腸が残る場合の2つの代謝合併症は？
EnglishAnswer: Calcium oxalate stones from enteric hyperoxaluria and neurologic symptoms from D-lactic acidosis.
JapaneseAnswer: 腸性高シュウ酸尿症によるCaシュウ酸結石と、D-乳酸アシドーシスによる神経症状。

EnglishQuestion: Why can drinking large amounts of water or low-sodium fluid increase output from a high-output jejunostomy?
JapaneseQuestion: 高排出空腸瘻で水や低Na飲料の大量摂取が排液を増やすのはなぜか？
EnglishAnswer: It draws sodium and water into the jejunal lumen.
JapaneseAnswer: 空腸内へNaと水を引き込むため。

EnglishQuestion: What is the basic management sequence for a high-output jejunostomy?
JapaneseQuestion: 高排出空腸瘻の基本的な管理順序は？
EnglishAnswer: Measure intake, output, urine volume, weight, renal function, and electrolytes; resuscitate hypovolemia with isotonic fluid; give high-sodium oral rehydration solution in small frequent amounts; restrict low-sodium drinks; use premeal loperamide, a proton pump inhibitor when indicated, and nutritional and electrolyte replacement.
JapaneseAnswer: 収支・尿量・体重・腎機能・電解質を評価し、等張液で蘇生、高Na経口補水液、低Na飲料制限、食前ロペラミド、必要時PPIと栄養・電解質補充を行う。

EnglishQuestion: What is the central mechanism of refeeding syndrome, and which electrolyte abnormality is most characteristic?
JapaneseQuestion: 再栄養症候群の中心機序と代表的電解質異常は？
EnglishAnswer: A nutrition-induced insulin surge shifts phosphate, potassium, and magnesium into cells, causing especially hypophosphatemia.
JapaneseAnswer: 栄養再開によるインスリン上昇でリン・K・Mgが細胞内へ移動し、特に低リン血症を来す。

EnglishQuestion: How should nutrition be started in a patient at high risk of refeeding syndrome?
JapaneseQuestion: 再栄養症候群高リスク例では栄養をどう開始するか？
EnglishAnswer: Give thiamine before feeding, start with a low energy intake and increase gradually, and closely monitor and replace phosphate, potassium, magnesium, glucose, and fluid balance.
JapaneseAnswer: 開始前からチアミンを投与し、少量から段階的に増量し、リン・K・Mg・血糖・体液量を密に監視・補正する。

EnglishQuestion: What is the immunologic basis of celiac disease?
JapaneseQuestion: セリアック病の免疫学的背景は？
EnglishAnswer: In a patient with HLA-DQ2 or HLA-DQ8, an immune response to gluten-derived gliadin, enhanced by tissue transglutaminase-mediated deamidation, injures the small-intestinal mucosa.
JapaneseAnswer: HLA-DQ2/DQ8を背景に、tTGによる脱アミド化で増強されたグリアジンへの免疫反応が小腸粘膜を傷害する。

EnglishQuestion: What is the basic diagnostic sequence for celiac disease in adults?
JapaneseQuestion: 成人セリアック病の基本的な診断順序は？
EnglishAnswer: While the patient is eating gluten, measure tissue transglutaminase IgA and total IgA; if serology is positive or suspicion remains high, confirm with multiple duodenal biopsies.
JapaneseAnswer: グルテン摂取中にtTG-IgAと総IgAを測定し、陽性または強い疑いなら十二指腸多部位生検で確定する。

EnglishQuestion: Which tests are used for suspected celiac disease in a patient with IgA deficiency?
JapaneseQuestion: IgA欠損例でセリアック病を疑う場合に用いる検査は？
EnglishAnswer: Deamidated gliadin peptide IgG or tissue transglutaminase IgG.
JapaneseAnswer: 脱アミド化グリアジンペプチドIgGまたはtTG-IgG。

EnglishQuestion: How should HLA-DQ2/DQ8 testing be interpreted in celiac disease?
JapaneseQuestion: セリアック病でHLA-DQ2/DQ8検査をどう解釈するか？
EnglishAnswer: A negative result is useful for exclusion; a positive result alone is not diagnostic.
JapaneseAnswer: 陰性なら除外に有用だが、陽性だけでは診断できない。

EnglishQuestion: What should be reassessed when celiac disease does not respond to treatment?
JapaneseQuestion: セリアック病の治療反応不良で再評価するものは？
EnglishAnswer: Hidden gluten exposure, an incorrect diagnosis, refractory celiac disease, and enteropathy-associated T-cell lymphoma.
JapaneseAnswer: グルテン混入、診断違い、難治性セリアック病、腸管関連T細胞リンパ腫。

EnglishQuestion: How do Crohn disease and ulcerative colitis differ in distribution, continuity, and depth of inflammation?
JapaneseQuestion: クローン病と潰瘍性大腸炎は、分布・連続性・炎症深度がどう異なるか？
EnglishAnswer: Crohn disease can affect the GI tract from mouth to anus with discontinuous transmural lesions; ulcerative colitis is confined to the colon, extends continuously proximally from the rectum, and primarily affects the mucosa.
JapaneseAnswer: クローン病は口から肛門までの非連続性・全層性病変、潰瘍性大腸炎は直腸から近位へ連続する大腸限局・粘膜主体病変。

EnglishQuestion: What are the characteristic endoscopic findings in Crohn disease and ulcerative colitis?
JapaneseQuestion: クローン病と潰瘍性大腸炎の特徴的な内視鏡所見は？
EnglishAnswer: Crohn disease: aphthae, longitudinal ulcers, cobblestoning, and strictures. Ulcerative colitis: diffuse erythema, loss of vascular pattern, friability, ulcers, and pseudopolyps.
JapaneseAnswer: クローン病はアフタ、縦走潰瘍、敷石像、狭窄。潰瘍性大腸炎はびまん性発赤、血管透見消失、脆弱性、潰瘍、偽ポリープ。

EnglishQuestion: What are the characteristic histologic findings in Crohn disease and ulcerative colitis?
JapaneseQuestion: クローン病と潰瘍性大腸炎の特徴的な組織所見は？
EnglishAnswer: Crohn disease shows focal chronic inflammation and sometimes noncaseating granulomas; ulcerative colitis shows crypt architectural distortion, basal plasmacytosis, cryptitis, and crypt abscesses.
JapaneseAnswer: クローン病は局所性慢性炎症と時に非乾酪性肉芽腫、潰瘍性大腸炎は陰窩構造異常、基底形質細胞増多、陰窩炎・陰窩膿瘍。

EnglishQuestion: Which local complications result from transmural Crohn disease?
JapaneseQuestion: クローン病の全層性炎症が起こす局所合併症は？
EnglishAnswer: Strictures and obstruction, fistulas, intra-abdominal abscesses, and perianal abscesses or fistulas.
JapaneseAnswer: 狭窄・閉塞、瘻孔、腹腔内膿瘍、肛門周囲膿瘍・痔瘻。

EnglishQuestion: Which substances are commonly malabsorbed in terminal ileal Crohn disease?
JapaneseQuestion: 終末回腸型クローン病で吸収不良となりやすいものは？
EnglishAnswer: Vitamin B12 and bile acids.
JapaneseAnswer: ビタミンB12と胆汁酸。

EnglishQuestion: What do Montreal behavior categories B1, B2, and B3 mean in Crohn disease?
JapaneseQuestion: クローン病のMontreal行動型B1・B2・B3は何を表すか？
EnglishAnswer: B1 is nonstricturing and nonpenetrating; B2 is stricturing; B3 is penetrating.
JapaneseAnswer: B1は非狭窄・非穿通型、B2は狭窄型、B3は穿通型。

EnglishQuestion: What are the typical bowel symptoms of ulcerative colitis?
JapaneseQuestion: 潰瘍性大腸炎の典型的な便症状は？
EnglishAnswer: Bloody diarrhea, mucus, urgency, and tenesmus.
JapaneseAnswer: 血性下痢、粘液便、便意切迫、しぶり腹。

EnglishQuestion: Which findings suggest toxic megacolon, and which drugs should be avoided?
JapaneseQuestion: 中毒性巨大結腸症を疑う所見と避ける薬剤は？
EnglishAnswer: Colonic dilation with worsening abdominal pain, distention, fever, tachycardia, tenderness, and reduced bowel sounds; avoid antidiarrheals, anticholinergics, and opioids.
JapaneseAnswer: 大腸拡張に腹痛増悪、膨満、発熱、頻脈、圧痛、腸雑音低下を伴う。止瀉薬、抗コリン薬、オピオイドを避ける。

EnglishQuestion: Which hepatobiliary disease is strongly associated with inflammatory bowel disease, especially ulcerative colitis?
JapaneseQuestion: IBD、特に潰瘍性大腸炎と強く関連する肝胆道疾患は？
EnglishAnswer: Primary sclerosing cholangitis (PSC).
JapaneseAnswer: 原発性硬化性胆管炎。

EnglishQuestion: What are the main cutaneous and ocular manifestations of inflammatory bowel disease?
JapaneseQuestion: IBDの代表的な皮膚・眼症状は？
EnglishAnswer: Cutaneous: erythema nodosum and pyoderma gangrenosum. Ocular: episcleritis and uveitis.
JapaneseAnswer: 皮膚は結節性紅斑・壊疽性膿皮症、眼は上強膜炎・ぶどう膜炎。

EnglishQuestion: What is the basic diagnostic sequence for inflammatory bowel disease?
JapaneseQuestion: IBDの基本的な診断順序は？
EnglishAnswer: Exclude infection, including Clostridioides difficile; measure blood and stool inflammatory markers; perform ileocolonoscopy with multiple biopsies; and add MR or CT enterography when Crohn disease is suspected.
JapaneseAnswer: C. difficileなど感染を除外し、血液・便中炎症指標を測定、回腸末端を含む大腸内視鏡と多部位生検を行い、クローン病疑いではMR／CT小腸造影を追加する。

EnglishQuestion: What are the main uses of fecal calprotectin in inflammatory bowel disease?
JapaneseQuestion: IBDにおける便中カルプロテクチンの主な用途は？
EnglishAnswer: Detecting intestinal inflammation and assessing treatment response or recurrence.
JapaneseAnswer: 腸管炎症の検出と、治療反応・再燃の評価。

EnglishQuestion: How are ileocolonoscopy and enterography used differently in Crohn disease assessment?
JapaneseQuestion: クローン病評価で回腸大腸内視鏡と小腸造影をどう使い分けるか？
EnglishAnswer: Ileocolonoscopy evaluates ileocolonic mucosa and permits biopsy; MR or CT enterography assesses small-bowel disease and transmural complications such as strictures, fistulas, and abscesses.
JapaneseAnswer: 粘膜と生検は内視鏡、小腸病変や狭窄・瘻孔・膿瘍など全層性合併症はMR／CT小腸造影で評価する。

EnglishQuestion: Beyond symptom relief, what are the treatment goals in inflammatory bowel disease?
JapaneseQuestion: IBD治療の目標は症状改善以外に何か？
EnglishAnswer: Steroid-free remission, improvement of mucosal inflammation, and prevention of hospitalization, surgery, and cancer.
JapaneseAnswer: ステロイドを用いない寛解、粘膜炎症の改善、入院・手術・癌の予防。

EnglishQuestion: Which drug can induce remission in mild, localized ileocecal Crohn disease?
JapaneseQuestion: 軽症の限局性回盲部クローン病の寛解導入薬は？
EnglishAnswer: Budesonide.
JapaneseAnswer: ブデソニド。

EnglishQuestion: What should precede immunosuppression when Crohn disease causes an intra-abdominal abscess?
JapaneseQuestion: クローン病の腹腔内膿瘍で免疫抑制より先に行うことは？
EnglishAnswer: Antibiotics and percutaneous or surgical drainage.
JapaneseAnswer: 抗菌薬と経皮的または外科的ドレナージ。

EnglishQuestion: Why are corticosteroids not used for maintenance therapy in inflammatory bowel disease?
JapaneseQuestion: IBDでステロイドを維持療法に使わないのはなぜか？
EnglishAnswer: They are induction agents and are unsuitable for safe and effective long-term maintenance.
JapaneseAnswer: 寛解導入薬であり、安全で有効な長期維持に適さないため。

EnglishQuestion: Why is azathioprine not used alone to induce remission in Crohn disease?
JapaneseQuestion: アザチオプリンをクローン病の単独寛解導入薬にしない理由は？
EnglishAnswer: It has a slow onset of action.
JapaneseAnswer: 効果発現が遅いため。

EnglishQuestion: What infection-related issues should be checked before starting a biologic or Janus kinase inhibitor?
JapaneseQuestion: 生物学的製剤・JAK阻害薬開始前に確認する感染関連項目は？
EnglishAnswer: Tuberculosis, hepatitis B, and vaccination status.
JapaneseAnswer: 結核、B型肝炎、ワクチン状況。

EnglishQuestion: What is first-line therapy for mild to moderate ulcerative proctitis?
JapaneseQuestion: 軽症～中等症の潰瘍性直腸炎の第一選択は？
EnglishAnswer: Rectal mesalamine.
JapaneseAnswer: 直腸投与メサラジン。

EnglishQuestion: How should 5-aminosalicylic acid be given for mild to moderate left-sided ulcerative colitis?
JapaneseQuestion: 軽症～中等症の左側潰瘍性大腸炎で5-ASAをどう投与するか？
EnglishAnswer: Combine oral 5-aminosalicylic acid with a rectal formulation.
JapaneseAnswer: 経口5-ASAに直腸製剤を併用する。

EnglishQuestion: What is the initial treatment for acute severe ulcerative colitis, and what follows if response is inadequate after about 3 days?
JapaneseQuestion: 急性重症潰瘍性大腸炎の初期治療と約3日で不応時の対応は？
EnglishAnswer: Admit the patient, test for Clostridioides difficile, provide venous thrombosis prophylaxis, and give IV corticosteroids. If response is inadequate, use infliximab or cyclosporine rescue therapy and consult surgery.
JapaneseAnswer: 入院、C. difficile検査、静脈血栓予防、静注ステロイド。不応ならインフリキシマブまたはシクロスポリン救済療法と外科相談。

EnglishQuestion: Which complications of ulcerative colitis warrant consideration of emergency colectomy?
JapaneseQuestion: 潰瘍性大腸炎で緊急大腸切除を検討する病態は？
EnglishAnswer: Perforation, toxic megacolon, uncontrolled massive bleeding, or failure of medical therapy.
JapaneseAnswer: 穿孔、中毒性巨大結腸症、制御不能な大量出血、薬物治療不応。

EnglishQuestion: How does the effect of surgery differ between Crohn disease and ulcerative colitis?
JapaneseQuestion: 手術の効果はクローン病と潰瘍性大腸炎でどう異なるか？
EnglishAnswer: Surgery can treat complications of Crohn disease but does not prevent recurrence; total colectomy can cure the colitis of ulcerative colitis.
JapaneseAnswer: クローン病は合併症を治せても再発し得るが、潰瘍性大腸炎は大腸全摘で大腸炎を根治し得る。

EnglishQuestion: Which infection should be specifically tested for when a patient with inflammatory bowel disease develops new or worsening diarrhea?
JapaneseQuestion: IBD患者の新規・増悪下痢で特に検査すべき感染症は？
EnglishAnswer: Clostridioides difficile infection.
JapaneseAnswer: C. difficile感染。

EnglishQuestion: Why is smoking cessation important in Crohn disease?
JapaneseQuestion: クローン病で禁煙が重要なのはなぜか？
EnglishAnswer: It reduces the risk of relapse and postoperative recurrence.
JapaneseAnswer: 再燃と術後再発リスクを下げるため。

EnglishQuestion: How do reflux hypersensitivity and functional heartburn differ?
JapaneseQuestion: 逆流過敏症と機能性胸やけの違いは？
EnglishAnswer: Acid exposure is normal in both; symptoms correlate temporally with physiologic reflux events in reflux hypersensitivity but not in functional heartburn.
JapaneseAnswer: どちらも酸曝露は正常だが、逆流過敏症では生理的逆流と症状が時間的に関連し、機能性胸やけでは関連しない。

EnglishQuestion: Which disease category must be excluded first before diagnosing functional chest pain?
JapaneseQuestion: 機能性胸痛の診断前に最優先で除外する疾患群は？
EnglishAnswer: Cardiovascular disease.
JapaneseAnswer: 心血管疾患。

EnglishQuestion: What are the two subtypes of functional dyspepsia and their main symptoms?
JapaneseQuestion: 機能性ディスペプシアの2亜型と主症状は？
EnglishAnswer: Postprandial distress syndrome causes postprandial fullness and early satiation; epigastric pain syndrome causes epigastric pain or burning.
JapaneseAnswer: 食後愁訴症候群は食後膨満・早期満腹、心窩部痛症候群は心窩部痛・灼熱感。

EnglishQuestion: Which infection should be tested for and treated during the initial evaluation of functional dyspepsia?
JapaneseQuestion: 機能性ディスペプシアの初期評価で検査・治療する感染症は？
EnglishAnswer: Helicobacter pylori infection.
JapaneseAnswer: H. pylori感染。

EnglishQuestion: Which treatment is useful for supragastric belching?
JapaneseQuestion: 胃上部げっぷに有用な治療は？
EnglishAnswer: Behavioral therapy such as diaphragmatic breathing.
JapaneseAnswer: 横隔膜呼吸などの行動療法。

EnglishQuestion: What is the usual clinical state between attacks of cyclic vomiting syndrome?
JapaneseQuestion: 周期性嘔吐症候群の発作間欠期は通常どうなるか？
EnglishAnswer: The patient is nearly asymptomatic.
JapaneseAnswer: ほぼ無症状となる。

EnglishQuestion: What characterizes rumination syndrome, and what is first-line treatment?
JapaneseQuestion: 反芻症候群の特徴と第一選択治療は？
EnglishAnswer: Food returns to the mouth soon after eating without nausea or forceful vomiting; first-line therapy is behavioral treatment such as diaphragmatic breathing.
JapaneseAnswer: 食後まもなく悪心や努力性嘔吐なしに食物が口へ戻る。第一選択は横隔膜呼吸などの行動療法。

EnglishQuestion: What symptom relationship forms the diagnostic core of irritable bowel syndrome (IBS)?
JapaneseQuestion: IBSの診断の核となる症状関係は？
EnglishAnswer: Recurrent abdominal pain related to defecation and associated with a change in stool frequency or form.
JapaneseAnswer: 反復する腹痛が排便と関連し、便回数または便形状の変化を伴う。

EnglishQuestion: What abdominal pain frequency and duration are used as a guide in the Rome IV criteria for IBS?
JapaneseQuestion: IBSのRome IV基準で用いる腹痛頻度と期間の目安は？
EnglishAnswer: Abdominal pain on average at least 1 day per week during the previous 3 months, with symptom onset at least 6 months before diagnosis.
JapaneseAnswer: 直近3か月に平均週1日以上の腹痛があり、症状開始は診断6か月以上前。

EnglishQuestion: Which Bristol Stool Form Scale types indicate constipation and diarrhea tendencies?
JapaneseQuestion: Bristol便形状スケールで便秘傾向と下痢傾向を示す型は？
EnglishAnswer: Types 1-2 indicate constipation; types 6-7 indicate diarrhea.
JapaneseAnswer: 1～2型が便秘傾向、6～7型が下痢傾向。

EnglishQuestion: Which alarm features in suspected IBS warrant evaluation for organic disease?
JapaneseQuestion: IBSで器質疾患検索を促す警告所見は？
EnglishAnswer: Hematochezia, iron-deficiency anemia, weight loss, nocturnal symptoms, fever, an abdominal mass, new onset at older age, or a family history of colorectal cancer or inflammatory bowel disease.
JapaneseAnswer: 血便、鉄欠乏性貧血、体重減少、夜間症状、発熱、腹部腫瘤、高齢での新規発症、大腸癌・IBD家族歴。

EnglishQuestion: Which two diseases should be selectively excluded in diarrhea-predominant IBS, and with which tests?
JapaneseQuestion: IBS-Dで選択的に除外する2疾患と検査は？
EnglishAnswer: Use serology to exclude celiac disease and C-reactive protein or fecal calprotectin to assess for inflammatory bowel disease.
JapaneseAnswer: セリアック病を血清学で、IBDをCRP・便中カルプロテクチンなどで除外する。

EnglishQuestion: Which dietary fiber is preferred in IBS, and which type can worsen bloating?
JapaneseQuestion: IBSで推奨される食物繊維と、膨満を悪化させ得る繊維は？
EnglishAnswer: Use soluble fiber such as psyllium; insoluble wheat bran can worsen bloating.
JapaneseAnswer: サイリウムなどの可溶性食物繊維を用い、不溶性ふすまは膨満を悪化させ得る。

EnglishQuestion: What are the three stages of a low-FODMAP diet?
JapaneseQuestion: 低FODMAP食の3段階は？
EnglishAnswer: Short-term elimination, reintroduction, and personalization; avoid prolonged excessive restriction.
JapaneseAnswer: 短期の除去、再導入、個別化。長期の過剰制限は避ける。

EnglishQuestion: Which medications can be used for abdominal pain in IBS?
JapaneseQuestion: IBSの腹痛に用いる薬物選択肢は？
EnglishAnswer: Antispasmodics, enteric-coated peppermint oil, and low-dose tricyclic antidepressants.
JapaneseAnswer: 鎮痙薬、腸溶性ペパーミント油、低用量三環系抗うつ薬。

EnglishQuestion: How is dyssynergic defecation confirmed and treated?
JapaneseQuestion: 排便協調障害はどのように確認し、何で治療するか？
EnglishAnswer: Confirm it with multiple objective tests such as anorectal manometry and balloon expulsion testing; first-line treatment is pelvic floor biofeedback.
JapaneseAnswer: 直腸肛門内圧検査、バルーン排出試験など複数の客観検査で確認し、骨盤底バイオフィードバック療法を第一選択とする。

EnglishQuestion: How do true and false diverticula differ in wall structure?
JapaneseQuestion: 真性憩室と仮性憩室の壁構造の違いは？
EnglishAnswer: A true diverticulum contains all layers of the bowel wall; a false diverticulum consists of mucosa and submucosa herniating through a weak point in the muscle layer.
JapaneseAnswer: 真性憩室は腸壁全層、仮性憩室は粘膜・粘膜下層が筋層の脆弱部から突出する。

EnglishQuestion: What is the typical presentation of colonic diverticular bleeding?
JapaneseQuestion: 大腸憩室出血の典型像は？
EnglishAnswer: Sudden painless hematochezia.
JapaneseAnswer: 突然の無痛性血便。

EnglishQuestion: What is the typical presentation of acute colonic diverticulitis, and what is the first imaging study?
JapaneseQuestion: 急性大腸憩室炎の典型像と第一の画像検査は？
EnglishAnswer: Left lower quadrant pain, fever, tenderness, and elevated inflammatory markers; use contrast-enhanced CT for diagnosis and assessment of complications.
JapaneseAnswer: 左下腹部痛、発熱、圧痛、炎症反応上昇を呈し、造影CTで診断と合併症評価を行う。

EnglishQuestion: How should antibiotics be used in mild uncomplicated diverticulitis?
JapaneseQuestion: 軽症単純性憩室炎で抗菌薬をどう使うか？
EnglishAnswer: Do not prescribe them routinely to an immunocompetent patient with mild disease; use them selectively for immunosuppression, frailty, refractory symptoms, or marked inflammation.
JapaneseAnswer: 免疫正常の軽症例には一律投与せず、免疫不全、脆弱性、難治症状、強い炎症で選択的に用いる。

EnglishQuestion: Why is colonoscopy avoided during acute diverticulitis, and when is follow-up colonoscopy performed if needed?
JapaneseQuestion: 憩室炎急性期に大腸内視鏡を避ける理由と実施時期は？
EnglishAnswer: Because of perforation risk; if indicated, perform it after symptoms resolve, usually at least 6-8 weeks later.
JapaneseAnswer: 穿孔リスクがあるため避け、必要なら症状消失後、通常6～8週以降に行う。

EnglishQuestion: How are an abscess and generalized peritonitis from complicated diverticulitis managed?
JapaneseQuestion: 複雑性憩室炎の膿瘍・汎発性腹膜炎をどう管理するか？
EnglishAnswer: Consider percutaneous drainage for an abscess according to size and course; generalized peritonitis or uncontrolled disease requires consideration of emergency surgery.
JapaneseAnswer: 膿瘍は大きさ・経過により経皮ドレナージ、汎発性腹膜炎や制御不能例は緊急手術を検討する。

EnglishQuestion: Which small-bowel stricture is characteristic of NSAID enteropathy?
JapaneseQuestion: NSAID腸症に特徴的な小腸狭窄は？
EnglishAnswer: A concentric diaphragm-like stricture from ulcer scarring, termed diaphragm disease.
JapaneseAnswer: 潰瘍瘢痕による同心円状の隔膜様狭窄。

EnglishQuestion: Which parts of the GI tract are and are not protected from NSAID injury by proton pump inhibitors?
JapaneseQuestion: PPIはNSAID腸症のどの部位を保護し、どこを予防しないか？
EnglishAnswer: They reduce gastric and duodenal injury risk but do not prevent small-bowel or colonic injury.
JapaneseAnswer: 胃・十二指腸障害リスクは下げるが、小腸・大腸障害は予防しない。

EnglishQuestion: What is the typical symptom sequence in ischemic colitis?
JapaneseQuestion: 虚血性大腸炎の典型的な症状経過は？
EnglishAnswer: Sudden cramping abdominal pain and urgency followed within 24 hours by bright-red or maroon stool.
JapaneseAnswer: 突然の疝痛性腹痛と便意に続き、24時間以内に鮮血または暗赤色便が出る。

EnglishQuestion: Why is right-sided ischemic colitis clinically important?
JapaneseQuestion: 右側虚血性大腸炎が重要なのはなぜか？
EnglishAnswer: Bleeding may be limited despite severe pain, and the risk of severe disease is higher.
JapaneseAnswer: 出血が乏しくても強い痛みを呈し、重症化リスクが高いため。

EnglishQuestion: Which findings should prompt urgent CT angiography for suspected acute mesenteric ischemia rather than routine ischemic colitis evaluation?
JapaneseQuestion: 虚血性大腸炎ではなく急性腸間膜虚血を疑い、CT血管造影を急ぐ所見は？
EnglishAnswer: Pain out of proportion to examination, elevated lactate, atrial fibrillation, or suspicion of extensive small-bowel ischemia.
JapaneseAnswer: 診察所見に比して強い痛み、乳酸上昇、心房細動、広範小腸虚血の疑い。

EnglishQuestion: Which findings in ischemic colitis indicate the need for emergency surgery?
JapaneseQuestion: 虚血性大腸炎で緊急手術を要する徴候は？
EnglishAnswer: Peritonitis, gangrene, perforation, uncontrolled bleeding, or clinical deterioration.
JapaneseAnswer: 腹膜炎、壊疽、穿孔、制御不能な出血、臨床悪化。

EnglishQuestion: What takes priority over localizing the lesion in gastrointestinal bleeding?
JapaneseQuestion: 消化管出血で出血源の特定より優先することは？
EnglishAnswer: Assess the airway, breathing, circulation, and mental status, and stabilize the circulation.
JapaneseAnswer: 気道・呼吸・循環と意識を評価し、循環を安定化する。

EnglishQuestion: How do melena and hematochezia suggest the bleeding source, and what important exception applies?
JapaneseQuestion: 黒色便と鮮血便から出血部位をどう推定し、どんな例外に注意するか？
EnglishAnswer: Melena usually suggests an upper source and hematochezia usually a lower source, but rapid massive upper GI bleeding can also cause hematochezia.
JapaneseAnswer: 黒色便は通常上部、鮮血便は多くは下部を示すが、急速な大量上部出血でも鮮血便となる。

EnglishQuestion: Which airway intervention should be considered in gastrointestinal bleeding with massive hematemesis or impaired consciousness?
JapaneseQuestion: 大量吐血や意識障害のある消化管出血で検討する気道処置は？
EnglishAnswer: Endotracheal intubation for airway protection.
JapaneseAnswer: 気道保護のための気管挿管。

EnglishQuestion: What hemoglobin threshold is generally used in a restrictive red-cell transfusion strategy for gastrointestinal bleeding?
JapaneseQuestion: 消化管出血の制限的赤血球輸血で一般的なHb目安は？
EnglishAnswer: About 7 g/dL; individualize a higher target for persistent shock, active myocardial ischemia, or severe cardiovascular disease.
JapaneseAnswer: 約7 g/dL。持続性ショック、活動性心筋虚血、重い心血管疾患では高めに個別化する。

EnglishQuestion: What does a Glasgow-Blatchford bleeding score of 0-1 indicate?
JapaneseQuestion: GBS 0～1は何を意味するか？
EnglishAnswer: Very low risk; admission may be avoided if appropriate outpatient follow-up is assured.
JapaneseAnswer: 超低リスクで、適切な外来フォローを条件に入院を避けられる場合がある。

EnglishQuestion: What does the Rockall score predict?
JapaneseQuestion: Rockallスコアは何を予測するか？
EnglishAnswer: The risk of rebleeding and death using age, shock, comorbidity, and endoscopic findings.
JapaneseAnswer: 年齢、ショック、併存疾患、内視鏡所見から再出血・死亡リスクを評価する。

EnglishQuestion: After resuscitation, when should endoscopy generally be performed for nonvariceal upper GI bleeding?
JapaneseQuestion: 非静脈瘤性上部消化管出血では、蘇生後いつまでに内視鏡を行うか？
EnglishAnswer: Within 24 hours.
JapaneseAnswer: 24時間以内。

EnglishQuestion: What do Forrest classes Ia, Ib, and IIa represent, and what do they require?
JapaneseQuestion: Forrest分類Ia・Ib・IIaは何を表し、どう対応するか？
EnglishAnswer: Ia is spurting bleeding, Ib is oozing bleeding, and IIa is a nonbleeding visible vessel; all require endoscopic hemostasis.
JapaneseAnswer: Iaは噴出性出血、Ibは湧出性出血、IIaは非出血性露出血管で、いずれも内視鏡的止血を行う。

EnglishQuestion: What do Forrest classes IIc and III represent, and do they require endoscopic hemostasis?
JapaneseQuestion: Forrest分類IIc・IIIは何を表し、止血を要するか？
EnglishAnswer: IIc is a flat pigmented spot and III is a clean ulcer base; they generally do not require endoscopic hemostasis.
JapaneseAnswer: IIcは平坦な色素斑、IIIは清浄な潰瘍底で、通常は内視鏡的止血を要しない。

EnglishQuestion: Why should dilute epinephrine injection not be used alone for peptic ulcer bleeding?
JapaneseQuestion: 消化性潰瘍出血で希釈エピネフリン局注を単独使用しない理由は？
EnglishAnswer: It should be combined with another method such as clipping or thermal coagulation to reduce rebleeding.
JapaneseAnswer: 再出血を減らすため、クリップや熱凝固など他の止血法と併用する必要がある。

EnglishQuestion: What acid suppression is used after successful endoscopic hemostasis of a high-risk ulcer?
JapaneseQuestion: 高リスク潰瘍の内視鏡止血成功後に行う酸分泌抑制療法は？
EnglishAnswer: Give high-dose proton pump inhibitor therapy continuously or intermittently for 3 days, then switch to oral therapy.
JapaneseAnswer: 高用量PPIを連続または間欠的に3日間投与し、その後経口療法へ移行する。

EnglishQuestion: What is the treatment sequence for recurrent peptic ulcer bleeding?
JapaneseQuestion: 消化性潰瘍の再出血時の治療順序は？
EnglishAnswer: Repeat endoscopy and hemostasis; if unsuccessful, perform transcatheter arterial embolization; if bleeding remains uncontrolled, consider surgery.
JapaneseAnswer: 再内視鏡止血、失敗なら経カテーテル動脈塞栓術、なお制御不能なら手術。

EnglishQuestion: What should be done about Helicobacter pylori after peptic ulcer bleeding?
JapaneseQuestion: 潰瘍出血後のH. pyloriに対する対応は？
EnglishAnswer: Test for infection, eradicate it if present, and confirm cure.
JapaneseAnswer: 感染を検査し、陽性なら除菌して治癒を確認する。

EnglishQuestion: Which treatments should begin before endoscopy in a patient with cirrhosis and acute upper GI bleeding?
JapaneseQuestion: 肝硬変患者の急性上部消化管出血で内視鏡前から開始する治療は？
EnglishAnswer: A vasoactive drug such as octreotide and a short course of antibiotics such as ceftriaxone.
JapaneseAnswer: オクトレオチドなどの血管作動薬と、セフトリアキソンなどの短期抗菌薬。

EnglishQuestion: After resuscitation, when should endoscopy be targeted in acute variceal bleeding?
JapaneseQuestion: 急性静脈瘤出血では蘇生後いつまでに内視鏡を行うか？
EnglishAnswer: Within 12 hours.
JapaneseAnswer: 12時間以内。

EnglishQuestion: What is first-line endoscopic therapy for bleeding esophageal varices?
JapaneseQuestion: 食道静脈瘤出血の第一選択の内視鏡治療は？
EnglishAnswer: Endoscopic variceal ligation (EVL).
JapaneseAnswer: 内視鏡的静脈瘤結紮術。

EnglishQuestion: Which treatments can be used for fundal gastric varices when endoscopic variceal ligation is unsuitable?
JapaneseQuestion: 胃底部静脈瘤でEVLが不適な場合の治療選択肢は？
EnglishAnswer: Cyanoacrylate injection, EUS-guided coil and glue therapy, balloon-occluded retrograde transvenous obliteration, or transjugular intrahepatic portosystemic shunt, selected by vascular anatomy and local expertise.
JapaneseAnswer: シアノアクリレート注入、EUS下コイル・接着剤、BRTO、TIPSなどを血行解剖と施設経験で選ぶ。

EnglishQuestion: When should early transjugular intrahepatic portosystemic shunt be assessed in high-risk variceal bleeding?
JapaneseQuestion: 高リスク静脈瘤出血で早期TIPSを評価する時期は？
EnglishAnswer: Within 72 hours, ideally within 24 hours.
JapaneseAnswer: 72時間以内、理想的には24時間以内。

EnglishQuestion: What is the role of balloon tamponade or a self-expanding esophageal stent in variceal bleeding?
JapaneseQuestion: 静脈瘤出血におけるバルーンタンポナーデや自己拡張型食道ステントの役割は？
EnglishAnswer: A short-term bridge to definitive therapy such as a transjugular intrahepatic portosystemic shunt.
JapaneseAnswer: TIPSなど確実な治療までの短時間の橋渡し。

EnglishQuestion: What is the standard secondary prevention strategy after esophageal variceal bleeding?
JapaneseQuestion: 食道静脈瘤出血の二次予防の基本は？
EnglishAnswer: Combine a nonselective beta-blocker with repeated endoscopic variceal ligation.
JapaneseAnswer: 非選択的β遮断薬と反復EVLの併用。

EnglishQuestion: Which lower GI source is most strongly suggested by sudden painless massive hematochezia?
JapaneseQuestion: 突然の無痛性大量鮮血便で最も疑う下部消化管出血源は？
EnglishAnswer: Colonic diverticular bleeding.
JapaneseAnswer: 大腸憩室出血。

EnglishQuestion: Which lower GI disease is suggested by hematochezia following sudden abdominal pain?
JapaneseQuestion: 急な腹痛後の血便で疑う下部消化管疾患は？
EnglishAnswer: Ischemic colitis.
JapaneseAnswer: 虚血性大腸炎。

EnglishQuestion: What is the diagnostic and therapeutic sequence for severe ongoing active lower GI bleeding?
JapaneseQuestion: 重症で活動性の下部消化管出血が続く場合の診断・治療順序は？
EnglishAnswer: Use CT angiography to identify extravasation; if positive, proceed to angiography and selective embolization.
JapaneseAnswer: CT血管造影で血管外漏出を検索し、陽性なら血管造影・選択的塞栓術へ進む。

EnglishQuestion: What preparation is required before colonoscopy for stable lower GI bleeding?
JapaneseQuestion: 安定した下部消化管出血で大腸内視鏡前に必要な準備は？
EnglishAnswer: Adequate polyethylene glycol bowel preparation; unprepared colonoscopy is not recommended.
JapaneseAnswer: 十分なPEG前処置。未処置内視鏡は推奨されない。

EnglishQuestion: What is often the first-line test for stable persistent or recurrent bleeding after negative upper endoscopy and colonoscopy?
JapaneseQuestion: 上下部内視鏡陰性の持続・反復出血で、安定例の第一選択となることが多い検査は？
EnglishAnswer: Video capsule endoscopy of the small bowel.
JapaneseAnswer: 小腸被膜内視鏡。

EnglishQuestion: If small-bowel stricture, obstruction, or a mass is suspected, what should precede capsule endoscopy?
JapaneseQuestion: 小腸出血で狭窄・閉塞・腫瘤が疑われる場合、被膜内視鏡より先に行う検査は？
EnglishAnswer: CT enterography.
JapaneseAnswer: CT小腸造影。

EnglishQuestion: How are imaging tests selected for massive active versus intermittent low-flow small-bowel bleeding?
JapaneseQuestion: 小腸の活動性大量出血と間欠性低流量出血で画像検査をどう使い分けるか？
EnglishAnswer: Use CT angiography or catheter angiography for massive active bleeding; consider tagged red-cell scintigraphy for intermittent low-flow bleeding.
JapaneseAnswer: 活動性大量出血はCT血管造影・血管造影、間欠性低流量出血は状況により標識赤血球シンチグラフィ。

EnglishQuestion: What defines acute liver failure (ALF)?
JapaneseQuestion: 急性肝不全の定義は？
EnglishAnswer: In a patient without preexisting cirrhosis, acute liver injury followed within 26 weeks by coagulopathy, usually an INR of at least 1.5, and hepatic encephalopathy.
JapaneseAnswer: 既存肝硬変のない患者で、肝障害発症から26週以内に通常INR 1.5以上の凝固障害と肝性脳症を認める状態。

EnglishQuestion: How does acute liver failure differ from acute-on-chronic liver failure?
JapaneseQuestion: 急性肝不全と慢性肝疾患急性増悪の違いは？
EnglishAnswer: Acute liver failure occurs without underlying cirrhosis; acute-on-chronic liver failure is an acute deterioration of preexisting chronic liver disease.
JapaneseAnswer: 急性肝不全は基礎肝硬変なしに起こり、後者は既存の慢性肝疾患が急性増悪した状態。

EnglishQuestion: What clinical features define hepatic encephalopathy grades I-IV?
JapaneseQuestion: 肝性脳症Grade I～IVの臨床像は？
EnglishAnswer: Grade I: impaired attention, altered sleep-wake cycle, or mild behavioral change. Grade II: lethargy, disorientation, and asterixis. Grade III: marked somnolence to stupor and severe confusion. Grade IV: coma.
JapaneseAnswer: Iは注意低下・睡眠覚醒変化、IIは傾眠・見当識低下・羽ばたき振戦、IIIは強い傾眠～昏迷・著明な混乱、IVは昏睡。

EnglishQuestion: What management is required for grade III-IV hepatic encephalopathy?
JapaneseQuestion: 肝性脳症Grade III～IVで必要な管理は？
EnglishAnswer: Airway protection and mechanical ventilation, with management of raised intracranial pressure.
JapaneseAnswer: 気道保護・人工呼吸管理と頭蓋内圧上昇への対応。

EnglishQuestion: Which drug level should be measured in every patient with acute liver failure?
JapaneseQuestion: 急性肝不全で全患者に測定する薬物濃度は？
EnglishAnswer: An acetaminophen level, regardless of the reported history.
JapaneseAnswer: 申告の有無にかかわらずアセトアミノフェン濃度。

EnglishQuestion: What are two representative causes of extremely high AST and ALT in acute liver failure?
JapaneseQuestion: 急性肝不全でAST・ALTが著明高値となる代表的な2原因は？
EnglishAnswer: Acetaminophen toxicity and ischemic liver injury.
JapaneseAnswer: アセトアミノフェン中毒と虚血性肝障害。

EnglishQuestion: Which hemolytic finding suggests Wilson disease in a young patient with acute liver failure?
JapaneseQuestion: 若年者の急性肝不全でWilson病を示唆する溶血所見は？
EnglishAnswer: Direct antiglobulin test-negative hemolysis.
JapaneseAnswer: 直接抗グロブリン試験陰性の溶血。

EnglishQuestion: What is the initial management sequence for suspected acute liver failure?
JapaneseQuestion: 急性肝不全疑いの初期管理順序は？
EnglishAnswer: Check glucose and stabilize airway, breathing, and circulation; manage in intensive care and contact a transplant center early; investigate causes simultaneously; begin cause-specific therapy and N-acetylcysteine; repeatedly monitor organ function and transplant candidacy.
JapaneseAnswer: 血糖測定とABC安定化、ICU管理と移植施設への早期連絡、原因検索、原因治療とNAC、臓器監視と移植適応評価を並行する。

EnglishQuestion: Which findings suggest progression to severe acute liver failure?
JapaneseQuestion: 急性肝不全の重症化を示唆する所見は？
EnglishAnswer: A shrinking liver, rapidly worsening INR, elevated lactate, hypoglycemia, kidney injury, and progressive encephalopathy.
JapaneseAnswer: 肝萎縮、急速なINR悪化、乳酸上昇、低血糖、腎障害、進行する脳症。

EnglishQuestion: What should abdominal Doppler ultrasonography assess in acute liver failure?
JapaneseQuestion: 急性肝不全で腹部Doppler超音波により評価するものは？
EnglishAnswer: Liver morphology, the portal vein, hepatic veins, hepatic artery, and biliary tree.
JapaneseAnswer: 肝形態、門脈・肝静脈・肝動脈、胆道。

EnglishQuestion: If liver biopsy is needed in acute liver failure, which approach reduces bleeding risk?
JapaneseQuestion: 急性肝不全で肝生検が必要な場合、出血リスクを減らす方法は？
EnglishAnswer: Transjugular liver biopsy.
JapaneseAnswer: 経頸静脈的肝生検。

EnglishQuestion: When should N-acetylcysteine be started for acetaminophen-related acute liver failure?
JapaneseQuestion: アセトアミノフェン関連急性肝不全でNACはいつ開始するか？
EnglishAnswer: Immediately when suspected, even if presentation is delayed or the ingestion time is unknown; do not wait for test results.
JapaneseAnswer: 時間経過後や摂取時刻不明でも、疑えば結果を待たず直ちに開始する。

EnglishQuestion: At what stage of non-acetaminophen acute liver failure is N-acetylcysteine particularly considered?
JapaneseQuestion: 非アセトアミノフェン急性肝不全でNACを特に検討する段階は？
EnglishAnswer: Early disease, especially with mild to moderate hepatic encephalopathy.
JapaneseAnswer: 初期、特に軽度～中等度の肝性脳症。

EnglishQuestion: Which antiviral drugs are started for severe or fulminant acute hepatitis B?
JapaneseQuestion: 重症・劇症の急性B型肝炎で開始する抗ウイルス薬は？
EnglishAnswer: A nucleos(t)ide analog such as entecavir or tenofovir.
JapaneseAnswer: エンテカビルまたはテノホビルなどの核酸アナログ。

EnglishQuestion: How should suspected herpes simplex virus hepatitis be managed in a pregnant or immunocompromised patient?
JapaneseQuestion: 妊婦・免疫不全者でHSV肝炎を疑う場合の対応は？
EnglishAnswer: Start acyclovir without waiting for test results.
JapaneseAnswer: 検査結果を待たずアシクロビルを開始する。

EnglishQuestion: What are the fundamentals of cerebral edema management in acute liver failure?
JapaneseQuestion: 急性肝不全の脳浮腫管理の基本は？
EnglishAnswer: Elevate the head, minimize stimulation, avoid hyponatremia, and protect the airway in grade III-IV encephalopathy; consider mannitol or hypertonic saline for acute neurologic deterioration.
JapaneseAnswer: 頭部挙上、刺激低減、低Na回避、Grade III～IVで気道保護。急な神経悪化ではマンニトールまたは高張食塩水を検討する。

EnglishQuestion: When and why should fresh frozen plasma not be given routinely for coagulopathy in acute liver failure?
JapaneseQuestion: 急性肝不全の凝固障害でFFPをルーチン投与しないのはどんな場合で、なぜか？
EnglishAnswer: Do not give it solely to normalize INR when there is no bleeding or invasive procedure; it obscures INR trends without clear clinical benefit.
JapaneseAnswer: 出血や侵襲的処置がない場合。INR推移を隠し、数値正常化だけでは明確な利益がないため。

EnglishQuestion: Should protein be routinely restricted because of hepatic encephalopathy in acute liver failure?
JapaneseQuestion: 急性肝不全では肝性脳症を理由に蛋白を一律制限するか？
EnglishAnswer: No; prioritize early enteral nutrition.
JapaneseAnswer: 制限しない。早期経腸栄養を優先する。

EnglishQuestion: Why should transfer to a transplant center not wait until prognostic criteria are fulfilled in acute liver failure?
JapaneseQuestion: 急性肝不全で移植施設への転送を予後基準充足まで待たない理由は？
EnglishAnswer: Criteria such as the King's College criteria are not perfectly sensitive, and the disease can deteriorate rapidly.
JapaneseAnswer: King's College基準などは感度が完全でなく、急速に悪化し得るため。

EnglishQuestion: What bilirubin pattern and urine findings occur in prehepatic jaundice?
JapaneseQuestion: 肝前性黄疸のビリルビン分画と尿所見は？
EnglishAnswer: Predominantly unconjugated hyperbilirubinemia, negative urine bilirubin, and increased urine urobilinogen.
JapaneseAnswer: 非抱合型優位、尿ビリルビン陰性、尿ウロビリノーゲン増加。

EnglishQuestion: What laboratory and clinical findings characterize cholestatic jaundice?
JapaneseQuestion: 胆汁うっ滞性黄疸の検査・臨床所見は？
EnglishAnswer: Predominantly conjugated hyperbilirubinemia, disproportionate alkaline phosphatase and gamma-glutamyl transferase elevation, dark urine, pale stool, and pruritus.
JapaneseAnswer: 抱合型優位、ALP・GGT優位、暗色尿、灰白色便、掻痒。

EnglishQuestion: What is the usual management of asymptomatic gallbladder stones?
JapaneseQuestion: 無症候性胆嚢結石の通常の管理は？
EnglishAnswer: Observation.
JapaneseAnswer: 経過観察。

EnglishQuestion: After ultrasonography, how are intermediate-risk and high-risk suspected common bile duct stones evaluated and treated?
JapaneseQuestion: 総胆管結石疑いで中間リスク例と高リスク例をどう評価・治療するか？
EnglishAnswer: Use MRCP or endoscopic ultrasonography to confirm stones at intermediate risk; use ERCP when high-risk disease requires stone extraction or biliary drainage.
JapaneseAnswer: 中間リスクはMRCPまたはEUSで確認し、結石除去・ドレナージを要する高リスク例はERCPを行う。

EnglishQuestion: What are the typical findings of acute cholecystitis, and what is the first imaging test?
JapaneseQuestion: 急性胆嚢炎の典型所見と第一の画像検査は？
EnglishAnswer: Persistent right upper quadrant pain, fever, a Murphy sign, and inflammation; ultrasonography assesses stones, gallbladder enlargement, wall thickening, and pericholecystic fluid.
JapaneseAnswer: 持続する右上腹部痛、発熱、Murphy徴候、炎症を認め、超音波で結石、胆嚢腫大、壁肥厚、周囲液体を評価する。

EnglishQuestion: What is the standard treatment for acute cholecystitis in a surgical candidate?
JapaneseQuestion: 手術可能な急性胆嚢炎の標準治療は？
EnglishAnswer: Early laparoscopic cholecystectomy during the admission.
JapaneseAnswer: 入院早期の腹腔鏡下胆嚢摘出術。

EnglishQuestion: What are the components of Charcot triad and Reynolds pentad in acute cholangitis?
JapaneseQuestion: 急性胆管炎のCharcot三徴とReynolds五徴は？
EnglishAnswer: Charcot triad is fever, right upper quadrant pain, and jaundice; Reynolds pentad adds hypotension and altered mental status.
JapaneseAnswer: 三徴は発熱・右上腹部痛・黄疸、五徴はこれに低血圧・意識障害を加える。

EnglishQuestion: What is the treatment sequence for acute cholangitis?
JapaneseQuestion: 急性胆管炎の治療順序は？
EnglishAnswer: Obtain blood cultures and start fluids and antibiotics; perform urgent biliary drainage for severe disease or poor response and early drainage, generally within 48 hours, even in stable disease. ERCP is the preferred decompression method.
JapaneseAnswer: 血液培養、輸液、抗菌薬を開始し、重症・反応不良では緊急、安定例でも原則48時間以内に胆道ドレナージを行う。第一選択はERCP。

EnglishQuestion: Why are antibiotics alone insufficient for acute cholangitis?
JapaneseQuestion: 急性胆管炎で抗菌薬だけでは不十分なのはなぜか？
EnglishAnswer: The infection occurs behind biliary obstruction, so decompression and relief of obstruction are required.
JapaneseAnswer: 閉塞胆道の感染なので、減圧と閉塞解除が必要なため。

EnglishQuestion: What is the pathophysiologic sequence of acute pancreatitis?
JapaneseQuestion: 急性膵炎の病態生理を流れで答えると？
EnglishAnswer: Duct obstruction or acinar-cell injury causes premature intrapancreatic digestive enzyme activation, leading to autodigestion and cytokine release, then local necrosis, systemic inflammation, and possible organ failure.
JapaneseAnswer: 膵管閉塞・腺房細胞障害で膵内消化酵素が早期活性化し、自己消化とサイトカイン放出から局所壊死、全身炎症、臓器不全へ進む。

EnglishQuestion: What are the two major causes of acute pancreatitis?
JapaneseQuestion: 急性膵炎の二大原因は？
EnglishAnswer: Gallstones and alcohol.
JapaneseAnswer: 胆石とアルコール。

EnglishQuestion: At what triglyceride level is the risk of acute pancreatitis especially high?
JapaneseQuestion: 急性膵炎リスクが特に高いトリグリセリド値の目安は？
EnglishAnswer: At least 1,000 mg/dL.
JapaneseAnswer: 1,000 mg/dL以上。

EnglishQuestion: Which additional causes should be investigated when gallstones and alcohol are unlikely causes of acute pancreatitis?
JapaneseQuestion: 胆石・アルコールが否定的な急性膵炎で追加検索する原因は？
EnglishAnswer: Triglycerides, calcium, medications, autoimmune disease, tumors or anatomic abnormalities, trauma or ischemia, and genetic factors.
JapaneseAnswer: トリグリセリド、Ca、薬剤、自己免疫、腫瘍・解剖異常、外傷・虚血、遺伝要因。

EnglishQuestion: What are the diagnostic criteria for acute pancreatitis?
JapaneseQuestion: 急性膵炎の診断基準は？
EnglishAnswer: At least 2 of 3: typical persistent upper abdominal pain, serum lipase or amylase at least 3 times the upper limit of normal, or characteristic imaging findings.
JapaneseAnswer: 典型的持続性上腹部痛、膵酵素が基準上限3倍以上、特徴的画像所見の3項目中2項目。

EnglishQuestion: Why is lipase generally more useful than amylase in acute pancreatitis?
JapaneseQuestion: 急性膵炎でリパーゼがアミラーゼより有用な点は？
EnglishAnswer: It is more pancreas-specific and remains elevated longer in patients who present late.
JapaneseAnswer: 膵特異性が高く、遅れて受診した患者でも上昇が続きやすい。

EnglishQuestion: Does the magnitude of pancreatic enzyme elevation correlate with acute pancreatitis severity?
JapaneseQuestion: 膵酵素上昇の程度は急性膵炎の重症度と相関するか？
EnglishAnswer: No.
JapaneseAnswer: 相関しない。

EnglishQuestion: Which imaging test should every patient with acute pancreatitis receive for etiologic assessment?
JapaneseQuestion: 急性膵炎で全例に行う原因評価の画像検査は？
EnglishAnswer: Abdominal ultrasonography to assess the biliary tract.
JapaneseAnswer: 胆道系評価のための腹部超音波。

EnglishQuestion: When should contrast-enhanced CT be considered rather than performed routinely at admission for acute pancreatitis?
JapaneseQuestion: 急性膵炎で入院時CTをルーチン施行せず、検討する状況は？
EnglishAnswer: When the diagnosis is uncertain, the patient fails to improve after 48-72 hours, or a local complication is suspected.
JapaneseAnswer: 診断不確実、48～72時間で改善しない、または局所合併症が疑われる場合。

EnglishQuestion: How does the Revised Atlanta Classification define mild, moderately severe, and severe acute pancreatitis?
JapaneseQuestion: Revised Atlanta分類で軽症・中等症・重症をどう定義するか？
EnglishAnswer: Mild: no organ failure and no local or systemic complication. Moderately severe: transient organ failure resolving within 48 hours or a local or systemic complication. Severe: persistent organ failure lasting more than 48 hours.
JapaneseAnswer: 軽症は臓器不全・合併症なし、中等症は48時間以内の一過性臓器不全または局所・全身合併症、重症は48時間超の持続性臓器不全。

EnglishQuestion: Which severity indicators should be reassessed during the first 24-48 hours of acute pancreatitis?
JapaneseQuestion: 急性膵炎の最初の24～48時間に反復評価する重症化指標は？
EnglishAnswer: Vital signs, urine output, blood urea nitrogen, hematocrit, creatinine, oxygenation, and systemic inflammatory response syndrome.
JapaneseAnswer: バイタル、尿量、BUN、ヘマトクリット、Cr、酸素化、SIRS。

EnglishQuestion: What are fluid collections from interstitial edematous pancreatitis called before and after about 4 weeks?
JapaneseQuestion: 間質性浮腫性膵炎の液体貯留は4週未満と約4週以降で何と呼ぶか？
EnglishAnswer: Before 4 weeks: acute peripancreatic fluid collection. At about 4 weeks or later: pancreatic pseudocyst.
JapaneseAnswer: 4週未満は急性膵周囲液体貯留、約4週以降は膵仮性嚢胞。

EnglishQuestion: What are collections from necrotizing pancreatitis called before and after about 4 weeks?
JapaneseQuestion: 壊死性膵炎の貯留は4週未満と約4週以降で何と呼ぶか？
EnglishAnswer: Before 4 weeks: acute necrotic collection. At about 4 weeks or later: walled-off necrosis.
JapaneseAnswer: 4週未満は急性壊死性貯留、約4週以降は被包化壊死。

EnglishQuestion: What fluid strategy is used initially in acute pancreatitis, and how is it adjusted?
JapaneseQuestion: 急性膵炎の初期輸液は何を用い、どう調整するか？
EnglishAnswer: Use moderate, goal-directed hydration with lactated Ringer solution, reassessing vital signs, urine output, blood urea nitrogen, and hematocrit every few hours.
JapaneseAnswer: 乳酸加リンゲル液で中等度の目標指向型輸液を行い、バイタル、尿量、BUN、ヘマトクリットで数時間ごとに調整する。

EnglishQuestion: When and how should oral feeding begin in mild acute pancreatitis?
JapaneseQuestion: 軽症急性膵炎ではいつ・どのような食事を開始するか？
EnglishAnswer: Begin a low-fat solid diet within 24-48 hours if nausea, vomiting, and ileus do not prevent feeding.
JapaneseAnswer: 悪心・嘔吐・イレウスがなければ24～48時間以内に低脂肪固形食を開始する。

EnglishQuestion: For moderately severe or severe acute pancreatitis when oral feeding is not possible, which is preferred: enteral or parenteral nutrition?
JapaneseQuestion: 経口不能な中等症・重症急性膵炎では経腸栄養と静脈栄養のどちらを優先するか？
EnglishAnswer: Enteral nutrition; a nasogastric tube is often as acceptable as a nasojejunal tube.
JapaneseAnswer: 経腸栄養を優先する。経鼻胃管も経鼻空腸管と同等に使えることが多い。

EnglishQuestion: Should prophylactic antibiotics be given for sterile necrosis in acute pancreatitis?
JapaneseQuestion: 無菌性壊死を伴う急性膵炎に予防的抗菌薬を投与するか？
EnglishAnswer: No; treat only suspected infection such as cholangitis, infected necrosis, or pneumonia.
JapaneseAnswer: 投与しない。胆管炎、感染性壊死など感染が疑われる場合に治療する。

EnglishQuestion: When is urgent ERCP indicated in gallstone pancreatitis?
JapaneseQuestion: 胆石性急性膵炎で緊急ERCPを行う適応は？
EnglishAnswer: Perform it within 24 hours when cholangitis is present; do not perform it routinely when neither cholangitis nor persistent biliary obstruction is present.
JapaneseAnswer: 胆管炎を伴う場合は24時間以内。胆管炎も持続性胆道閉塞もなければルーチン施行しない。

EnglishQuestion: When should cholecystectomy be performed for mild gallstone pancreatitis?
JapaneseQuestion: 軽症胆石性急性膵炎の胆嚢摘出はいつ行うか？
EnglishAnswer: During the same admission.
JapaneseAnswer: 同一入院中。

EnglishQuestion: What is the step-up approach for stable infected pancreatic necrosis?
JapaneseQuestion: 安定した感染性膵壊死に対するstep-up approachは？
EnglishAnswer: If possible, use antibiotics to delay intervention until about 4 weeks; then proceed from percutaneous or endoscopic drainage to minimally invasive necrosectomy and, only if necessary, open surgery.
JapaneseAnswer: 可能なら抗菌薬で約4週まで待ち、経皮・内視鏡ドレナージ、低侵襲壊死除去、必要時開腹手術の順で進める。

EnglishQuestion: Is pancreatic pseudocyst intervention determined by size alone?
JapaneseQuestion: 膵仮性嚢胞への介入適応は大きさだけで決めるか？
EnglishAnswer: No; base intervention on infection, pain, bleeding, obstruction, enlargement, or other symptoms and complications.
JapaneseAnswer: 決めない。感染、疼痛、出血、閉塞、増大などの症状・合併症で判断する。

EnglishQuestion: What is the pathophysiology of chronic pancreatitis?
JapaneseQuestion: 慢性膵炎の病態は？
EnglishAnswer: Repeated inflammation replaces pancreatic parenchyma with fibrosis, causing ductal distortion, calcification, and irreversible exocrine and endocrine insufficiency.
JapaneseAnswer: 反復炎症で膵実質が線維化し、膵管変形・石灰化と不可逆的な外分泌・内分泌不全を来す。

EnglishQuestion: Which lifestyle interventions are essential to slow chronic pancreatitis progression?
JapaneseQuestion: 慢性膵炎の進行抑制に必須の生活介入は？
EnglishAnswer: Complete alcohol abstinence and smoking cessation.
JapaneseAnswer: 完全禁酒と禁煙。

EnglishQuestion: Why is hypoglycemia common in pancreatogenic type 3c diabetes mellitus?
JapaneseQuestion: 膵性3c型糖尿病で低血糖を起こしやすい理由は？
EnglishAnswer: Both insulin and glucagon secretion are reduced.
JapaneseAnswer: インスリンだけでなくグルカゴンも低下するため。

EnglishQuestion: What is the first morphologic test for chronic pancreatitis, and what follows if it is nondiagnostic?
JapaneseQuestion: 慢性膵炎の第一の形態評価と、陰性時の次の検査は？
EnglishAnswer: Use contrast-enhanced CT to assess calcification, ductal dilation, and atrophy; if nondiagnostic, use MRI/MRCP and, when needed, endoscopic ultrasonography.
JapaneseAnswer: 造影CTで石灰化・膵管拡張・萎縮を評価し、不明ならMRI／MRCP、必要時EUSを用いる。

EnglishQuestion: Why do normal serum amylase and lipase not exclude chronic pancreatitis?
JapaneseQuestion: 慢性膵炎で血清アミラーゼ・リパーゼ正常を除外根拠にできない理由は？
EnglishAnswer: Advanced disease can destroy enough pancreatic parenchyma that enzyme levels become normal or low.
JapaneseAnswer: 進行例では膵実質が失われ、酵素値が正常または低値となり得るため。

EnglishQuestion: How should pancreatic enzyme replacement therapy be taken for exocrine insufficiency in chronic pancreatitis?
JapaneseQuestion: 慢性膵炎の外分泌不全でPERTをどう服用するか？
EnglishAnswer: Take an adequate dose with every meal and snack; if response is inadequate, increase the dose, verify administration, and consider adding a proton pump inhibitor.
JapaneseAnswer: 十分量を毎回の食事・間食と同時に投与し、不十分なら増量、服薬法確認、PPI併用を検討する。

EnglishQuestion: Why should dietary fat not be uniformly and severely restricted in chronic pancreatitis?
JapaneseQuestion: 慢性膵炎で脂肪を一律に極端制限しない理由は？
EnglishAnswer: Severe restriction worsens malnutrition; with pancreatic enzyme replacement, use small frequent meals containing a usual amount of fat and high protein and energy.
JapaneseAnswer: 栄養不良を悪化させるため。PERT下で通常量の脂肪を含む高蛋白・高エネルギー食を少量頻回とする。

EnglishQuestion: Which decompressive operation is used for chronic pancreatitis with a dilated main pancreatic duct?
JapaneseQuestion: 拡張主膵管を伴う慢性膵炎の減圧手術は？
EnglishAnswer: Lateral pancreaticojejunostomy, also called the Puestow procedure.
JapaneseAnswer: 側々膵空腸吻合術、別名Puestow手術。

EnglishQuestion: Which operations are representative options for an inflammatory pancreatic head mass in chronic pancreatitis?
JapaneseQuestion: 慢性膵炎の膵頭部炎症性腫瘤に対する代表的手術は？
EnglishAnswer: A duodenum-preserving pancreatic head resection or the Frey procedure, which combines local head resection with longitudinal pancreaticojejunostomy.
JapaneseAnswer: 十二指腸温存膵頭切除、または膵頭部限局切除と長軸膵管空腸吻合を組み合わせるFrey手術。

EnglishQuestion: Which clinical changes in chronic pancreatitis should prompt reassessment for pancreatic cancer?
JapaneseQuestion: 慢性膵炎患者で膵癌を再評価すべき変化は？
EnglishAnswer: New pain or a change in pain character, weight loss, jaundice, or sudden worsening of diabetes.
JapaneseAnswer: 新規または性状が変わった疼痛、体重減少、黄疸、糖尿病の急な悪化。

EnglishQuestion: Which urine sediment findings suggest nephritic syndrome?
JapaneseQuestion: 腎炎症候群を示唆する尿沈渣所見は？
EnglishAnswer: Dysmorphic red blood cells, acanthocytes, and red blood cell casts.
JapaneseAnswer: 変形赤血球、アカントサイト、赤血球円柱。

EnglishQuestion: What degree of proteinuria and which key serum finding characterize nephrotic syndrome in adults?
JapaneseQuestion: 成人のネフローゼ症候群を特徴づける蛋白尿量と血清所見は？
EnglishAnswer: Proteinuria of at least 3.5 g/day with hypoalbuminemia.
JapaneseAnswer: 3.5 g/日以上の蛋白尿と低アルブミン血症。

EnglishQuestion: Are nephritic and nephrotic syndromes mutually exclusive?
JapaneseQuestion: 腎炎症候群とネフローゼ症候群は相互排他的か？
EnglishAnswer: No. IgA nephropathy, lupus nephritis, and membranoproliferative patterns can produce both hematuria and nephrotic-range proteinuria.
JapaneseAnswer: いいえ。IgA腎症、ループス腎炎、膜性増殖性パターンでは血尿とネフローゼ域蛋白尿が併存し得る。

EnglishQuestion: Which three methods are used to evaluate a kidney biopsy in suspected glomerular disease?
JapaneseQuestion: 糸球体疾患疑いの腎生検を評価する3つの方法は？
EnglishAnswer: Light microscopy, immunofluorescence, and electron microscopy.
JapaneseAnswer: 光学顕微鏡、免疫蛍光、電子顕微鏡。

EnglishQuestion: What is rapidly progressive glomerulonephritis (RPGN)?
JapaneseQuestion: 急速進行性糸球体腎炎とは何か？
EnglishAnswer: A clinical syndrome in which kidney function declines over days to weeks. Crescents indicate severe glomerular injury but are not a single disease entity.
JapaneseAnswer: 腎機能が数日～数週で低下する臨床症候群。半月体は重度糸球体障害を示すが、単一疾患ではない。

EnglishQuestion: What are the three immunofluorescence categories of RPGN?
JapaneseQuestion: RPGNの免疫蛍光による3分類は？
EnglishAnswer: Anti-GBM disease: linear IgG; immune-complex disease: granular deposits; pauci-immune disease: little or no immune deposition.
JapaneseAnswer: 抗GBM病は線状IgG、免疫複合体型は顆粒状沈着、pauci-immune型は免疫沈着がほぼない。

EnglishQuestion: What is anti-GBM disease with both alveolar hemorrhage and RPGN called?
JapaneseQuestion: 肺胞出血とRPGNを伴う抗GBM病を何と呼ぶか？
EnglishAnswer: Goodpasture syndrome. The absence of hemoptysis does not exclude anti-GBM disease.
JapaneseAnswer: Goodpasture症候群。喀血がなくても抗GBM病は除外できない。

EnglishQuestion: Which treatments are combined when severe anti-GBM disease is strongly suspected?
JapaneseQuestion: 重症抗GBM病を強く疑う場合に併用する治療は？
EnglishAnswer: Corticosteroids, cyclophosphamide, and plasma exchange, started without waiting for the biopsy result when suspicion is high.
JapaneseAnswer: ステロイド、シクロホスファミド、血漿交換。疑いが強ければ生検結果を待たず開始する。

EnglishQuestion: How do the major ANCA-associated vasculitides relate to ANCA specificity?
JapaneseQuestion: 主要なANCA関連血管炎とANCA特異性の関係は？
EnglishAnswer: Granulomatosis with polyangiitis is associated with PR3-ANCA; microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis are associated with MPO-ANCA. Antibody specificity alone does not establish the diagnosis.
JapaneseAnswer: 多発血管炎性肉芽腫症はPR3-ANCA、顕微鏡的多発血管炎と好酸球性多発血管炎性肉芽腫症はMPO-ANCAと関連するが、抗体だけで診断しない。

EnglishQuestion: What is the standard remission-induction regimen for ANCA-associated vasculitis with severe glomerulonephritis?
JapaneseQuestion: 重症糸球体腎炎を伴うANCA関連血管炎の標準寛解導入療法は？
EnglishAnswer: Corticosteroids plus rituximab or cyclophosphamide.
JapaneseAnswer: ステロイド＋リツキシマブまたはシクロホスファミド。

EnglishQuestion: How does the timing of hematuria after infection distinguish IgA nephropathy from poststreptococcal glomerulonephritis?
JapaneseQuestion: 感染後の血尿発症時期でIgA腎症と溶連菌感染後糸球体腎炎をどう区別するか？
EnglishAnswer: IgA nephropathy causes hematuria during or within days of an upper respiratory infection. Poststreptococcal glomerulonephritis occurs about 1–3 weeks after pharyngitis or 3–6 weeks after a skin infection.
JapaneseAnswer: IgA腎症は上気道感染中～数日以内、溶連菌感染後糸球体腎炎は咽頭炎後1～3週または皮膚感染後3～6週。

EnglishQuestion: How is IgA nephropathy confirmed, and what is its characteristic immunofluorescence finding?
JapaneseQuestion: IgA腎症はどう確定し、免疫蛍光で何を示すか？
EnglishAnswer: It is generally confirmed by kidney biopsy showing dominant or codominant mesangial IgA deposition.
JapaneseAnswer: 通常、腎生検でメサンギウム優位または共優位のIgA沈着を確認する。

EnglishQuestion: What is the foundation of supportive treatment for IgA nephropathy with proteinuria?
JapaneseQuestion: 蛋白尿を伴うIgA腎症の支持療法の基本は？
EnglishAnswer: Lifestyle, sodium, and blood pressure management plus a maximally tolerated ACE inhibitor or ARB. Add an SGLT2 inhibitor or other therapy according to progression risk.
JapaneseAnswer: 生活・塩分・血圧管理と最大耐容量のACE阻害薬またはARB。進行リスクに応じSGLT2阻害薬などを追加する。

EnglishQuestion: How should sparsentan be used in relation to ACE inhibitors and ARBs in IgA nephropathy?
JapaneseQuestion: IgA腎症でsparsentanをACE阻害薬・ARBとどう使い分けるか？
EnglishAnswer: Use sparsentan instead of an ACE inhibitor or ARB; do not combine them.
JapaneseAnswer: ACE阻害薬またはARBの代わりに用い、併用しない。

EnglishQuestion: Which complement component falls in poststreptococcal glomerulonephritis, and when should it recover?
JapaneseQuestion: 溶連菌感染後糸球体腎炎で低下する補体と回復時期は？
EnglishAnswer: C3 is usually low and typically normalizes within 6–8 weeks. Persistent hypocomplementemia should prompt reconsideration of the diagnosis.
JapaneseAnswer: C3が低下し、通常6～8週で正常化する。低補体血症が持続すれば診断を再考する。

EnglishQuestion: Which antibody supports a preceding streptococcal infection after pharyngitis versus skin infection?
JapaneseQuestion: 咽頭炎後と皮膚感染後の先行溶連菌感染を支持する抗体は？
EnglishAnswer: Antistreptolysin O after pharyngitis and anti-DNase B after skin infection.
JapaneseAnswer: 咽頭炎後はASO抗体、皮膚感染後は抗DNase B抗体。

EnglishQuestion: Which genes cause Alport syndrome, and what are its representative extrarenal manifestations?
JapaneseQuestion: Alport症候群の原因遺伝子と代表的腎外症状は？
EnglishAnswer: Pathogenic variants in COL4A3, COL4A4, or COL4A5. Sensorineural hearing loss and anterior lenticonus are characteristic extrarenal findings.
JapaneseAnswer: COL4A3、COL4A4、COL4A5の病的変異。感音難聴と前円錐水晶体。

EnglishQuestion: What is the characteristic electron microscopy finding in Alport syndrome?
JapaneseQuestion: Alport症候群の特徴的電子顕微鏡所見は？
EnglishAnswer: Alternating thinning and thickening with lamellation and splitting of the glomerular basement membrane, producing a basket-weave appearance.
JapaneseAnswer: 糸球体基底膜の菲薄化・肥厚、層状化、断裂が混在する籠目状所見。

EnglishQuestion: Which four manifestations characterize IgA vasculitis?
JapaneseQuestion: IgA血管炎を特徴づける4症状は？
EnglishAnswer: Palpable purpura without thrombocytopenia, arthralgia, abdominal pain or gastrointestinal bleeding, and glomerulonephritis.
JapaneseAnswer: 血小板減少を伴わない触知性紫斑、関節痛、腹痛または消化管出血、糸球体腎炎。

EnglishQuestion: Which nephrotic disease carries a particularly high risk of venous thromboembolism?
JapaneseQuestion: 特に静脈血栓塞栓症リスクが高いネフローゼ疾患は？
EnglishAnswer: Membranous nephropathy. Severe hypoalbuminemia, previous thrombosis, immobility, obesity, and malignancy further increase risk.
JapaneseAnswer: 膜性腎症。重度低アルブミン血症、血栓既往、不動、肥満、悪性腫瘍でさらに上昇する。

EnglishQuestion: What are the light microscopy, immunofluorescence, and electron microscopy findings in minimal change disease?
JapaneseQuestion: 微小変化型病の光顕・免疫蛍光・電顕所見は？
EnglishAnswer: Light microscopy: nearly normal glomeruli; immunofluorescence: usually negative; electron microscopy: diffuse podocyte foot process effacement.
JapaneseAnswer: 光顕はほぼ正常、免疫蛍光は通常陰性、電顕はびまん性足突起癒合。

EnglishQuestion: When is immunosuppression appropriate in focal segmental glomerulosclerosis (FSGS), and when is it not routinely used?
JapaneseQuestion: FSGSで免疫抑制が適切な場合と、通常用いない場合は？
EnglishAnswer: Treat primary FSGS with high-dose corticosteroids and use a calcineurin inhibitor if steroid resistant. In genetic or secondary FSGS, treat the cause and provide supportive care rather than routine immunosuppression.
JapaneseAnswer: 原発性FSGSは高用量ステロイド、抵抗例はカルシニューリン阻害薬。遺伝性・二次性は原因治療と支持療法を行い、通常免疫抑制しない。

EnglishQuestion: What are the light microscopy, immunofluorescence, and electron microscopy findings in membranous nephropathy?
JapaneseQuestion: 膜性腎症の光顕・免疫蛍光・電顕所見は？
EnglishAnswer: Light microscopy: diffuse capillary wall thickening with spikes; immunofluorescence: granular IgG and C3 along capillary walls; electron microscopy: subepithelial deposits with a spike-and-dome pattern.
JapaneseAnswer: 光顕は毛細血管壁びまん性肥厚とspike、免疫蛍光は壁沿いの顆粒状IgG・C3、電顕は上皮下沈着とspike-and-dome。

EnglishQuestion: Which autoantibody is most characteristic of primary membranous nephropathy?
JapaneseQuestion: 原発性膜性腎症に最も特徴的な自己抗体は？
EnglishAnswer: Anti-PLA2R antibody; anti-THSD7A and other antibodies may also occur.
JapaneseAnswer: 抗PLA2R抗体。抗THSD7A抗体などもみられる。

EnglishQuestion: What does the term membranoproliferative glomerulonephritis (MPGN) describe?
JapaneseQuestion: 膜性増殖性糸球体腎炎という用語は何を表すか？
EnglishAnswer: A histologic pattern, not a single disease, characterized by mesangial and endothelial proliferation with duplication of the glomerular basement membrane.
JapaneseAnswer: 単一疾患ではなく、メサンギウム・内皮増殖と糸球体基底膜二重化を特徴とする組織パターン。

EnglishQuestion: What is the characteristic light microscopy appearance of MPGN?
JapaneseQuestion: MPGNの特徴的光学顕微鏡像は？
EnglishAnswer: Lobulated glomeruli with tram-track double contours of the glomerular basement membrane.
JapaneseAnswer: 分葉状糸球体と、糸球体基底膜のtram-track状二重輪郭。

EnglishQuestion: Which atypical features in a patient with diabetes should prompt evaluation for another kidney disease or kidney biopsy?
JapaneseQuestion: 糖尿病患者で他の腎疾患評価や腎生検を促す非典型所見は？
EnglishAnswer: Abrupt loss of kidney function, active urine sediment, a short duration of diabetes, or a rapid increase in proteinuria.
JapaneseAnswer: 急激な腎機能低下、活動性尿沈渣、糖尿病罹病期間が短い、蛋白尿の急増。

EnglishQuestion: What is the characteristic Congo red finding in renal amyloidosis?
JapaneseQuestion: 腎アミロイドーシスの特徴的Congo red所見は？
EnglishAnswer: Congo red positivity with apple-green birefringence under polarized light.
JapaneseAnswer: Congo red陽性で、偏光下にapple-green複屈折を示す。

EnglishQuestion: What are the precursor proteins in AL and AA amyloidosis?
JapaneseQuestion: AL・AAアミロイドーシスの前駆蛋白は？
EnglishAnswer: AL amyloid derives from immunoglobulin light chains; AA amyloid derives from serum amyloid A produced during chronic inflammation.
JapaneseAnswer: ALは免疫グロブリン軽鎖、AAは慢性炎症で産生される血清アミロイドA。

EnglishQuestion: How are class III and class IV lupus nephritis distinguished by the proportion of affected glomeruli?
JapaneseQuestion: ループス腎炎class IIIとIVは罹患糸球体割合でどう区別するか？
EnglishAnswer: Class III is focal and affects fewer than 50% of glomeruli; class IV is diffuse and affects 50% or more.
JapaneseAnswer: class IIIは50%未満の巣状病変、class IVは50%以上のびまん性病変。

EnglishQuestion: What is the basic remission-induction regimen for active class III or IV lupus nephritis?
JapaneseQuestion: 活動性class III／IVループス腎炎の基本的寛解導入療法は？
EnglishAnswer: Corticosteroids plus mycophenolate or low-dose intravenous cyclophosphamide. Belimumab or a calcineurin inhibitor may be added according to patient characteristics.
JapaneseAnswer: ステロイド＋ミコフェノール酸または低用量静注シクロホスファミド。患者特性に応じベリムマブやカルシニューリン阻害薬を追加する。

EnglishQuestion: What are the three diagnostic criteria for acute kidney injury (AKI)?
JapaneseQuestion: 急性腎障害の3つの診断基準は？
EnglishAnswer: Any of the following: serum creatinine rises by at least 0.3 mg/dL within 48 hours; rises to at least 1.5 times baseline within 7 days; or urine output remains below 0.5 mL/kg/hour for at least 6 hours.
JapaneseAnswer: 48時間以内にCrが0.3 mg/dL以上上昇、7日以内に基準値の1.5倍以上、または尿量0.5 mL/kg/時未満が6時間以上のいずれか。

EnglishQuestion: What are the three anatomic categories of acute kidney injury?
JapaneseQuestion: 急性腎障害の3つの解剖学的分類は？
EnglishAnswer: Prerenal, intrinsic renal, and postrenal.
JapaneseAnswer: 腎前性、腎性、腎後性。

EnglishQuestion: Which fractional excretion of sodium values typically suggest prerenal AKI versus acute tubular injury?
JapaneseQuestion: FENaは腎前性AKIと急性尿細管障害で通常どう異なるか？
EnglishAnswer: Prerenal AKI typically has FENa below 1%; acute tubular injury typically has FENa above 2%. Diuretics, CKD, sepsis, and other factors can make these values unreliable.
JapaneseAnswer: 腎前性は1%未満、急性尿細管障害は2%超が典型だが、利尿薬、CKD、敗血症などで信頼性が低下する。

EnglishQuestion: How does the urine sediment typically differ between prerenal AKI and acute tubular injury?
JapaneseQuestion: 腎前性AKIと急性尿細管障害の尿沈渣は通常どう異なるか？
EnglishAnswer: Prerenal AKI typically shows hyaline casts; acute tubular injury shows granular or muddy brown casts.
JapaneseAnswer: 腎前性は硝子円柱、急性尿細管障害は顆粒円柱またはmuddy brown cast。

EnglishQuestion: Which clinical situations require urgent kidney replacement therapy in AKI?
JapaneseQuestion: AKIで緊急腎代替療法を要する状況は？
EnglishAnswer: Refractory pulmonary edema or fluid overload, severe hyperkalemia, severe acid–base disturbance, uremic symptoms, or poisoning by a dialyzable toxin. Creatinine alone does not determine the need.
JapaneseAnswer: 難治性肺水腫・体液過剰、重度高K血症、重度酸塩基異常、尿毒症症状、透析可能毒物中毒。Cr値だけでは決めない。

EnglishQuestion: What are the four major forms of acute tubular injury?
JapaneseQuestion: 急性尿細管障害の4つの主要型は？
EnglishAnswer: Ischemic, nephrotoxic, pigment-induced, and crystal-induced injury.
JapaneseAnswer: 虚血性、腎毒性、色素性、結晶性。

EnglishQuestion: What are the main measures for preventing contrast-associated acute kidney injury?
JapaneseQuestion: 造影剤関連AKIの主な予防策は？
EnglishAnswer: Assess risk, use the minimum necessary contrast dose, and provide appropriate intravenous isotonic fluid. Do not use loop diuretics for prophylaxis.
JapaneseAnswer: リスク評価、必要最小限の造影剤量、適切な静注等張液。予防目的にループ利尿薬を使わない。

EnglishQuestion: Which four findings suggest ethylene glycol poisoning, and what is the first-line antidote?
JapaneseQuestion: エチレングリコール中毒を示唆する4所見と第一選択の解毒薬は？
EnglishAnswer: High-anion-gap metabolic acidosis, an osmolar gap, hypocalcemia, and urinary calcium oxalate crystals. Fomepizole is first-line therapy.
JapaneseAnswer: 高AG代謝性アシドーシス、浸透圧ギャップ、低Ca血症、尿中Caシュウ酸結晶。第一選択はホメピゾール。

EnglishQuestion: Which drugs commonly cause acute tubulointerstitial nephritis?
JapaneseQuestion: 急性尿細管間質性腎炎をよく起こす薬剤は？
EnglishAnswer: Antibiotics, nonsteroidal anti-inflammatory drugs, proton pump inhibitors, and antiseizure medications.
JapaneseAnswer: 抗菌薬、NSAID、PPI、抗てんかん薬。

EnglishQuestion: What are the representative urine findings in acute tubulointerstitial nephritis?
JapaneseQuestion: 急性尿細管間質性腎炎の代表的尿所見は？
EnglishAnswer: Sterile pyuria, white blood cell casts, mild-to-moderate proteinuria, and hematuria.
JapaneseAnswer: 無菌性膿尿、白血球円柱、軽度～中等度蛋白尿、血尿。

EnglishQuestion: Is the classic systemic triad required to diagnose acute tubulointerstitial nephritis?
JapaneseQuestion: 急性尿細管間質性腎炎の古典的全身三徴は診断に必須か？
EnglishAnswer: No. Fever, rash, and eosinophilia are often incomplete or absent, so medication history and timing are more important.
JapaneseAnswer: 必須ではない。発熱、発疹、好酸球増多は不完全または欠如し得るため、薬剤歴と時期が重要。

EnglishQuestion: Which tests and treatment should be prioritized in light-chain cast nephropathy from multiple myeloma?
JapaneseQuestion: 多発性骨髄腫のlight-chain cast nephropathyで優先する検査と治療は？
EnglishAnswer: Urgently measure serum free light chains and perform serum and urine immunofixation, then rapidly start anti-myeloma therapy based on high-dose dexamethasone and bortezomib.
JapaneseAnswer: 血清遊離軽鎖、血清・尿免疫固定を緊急測定し、高用量デキサメタゾン＋ボルテゾミブを基盤とする抗骨髄腫治療を迅速に開始する。

EnglishQuestion: Which acid–base disturbance is typical of renal tubular acidosis (RTA)?
JapaneseQuestion: 腎尿細管性アシドーシスに典型的な酸塩基異常は？
EnglishAnswer: Normal-anion-gap metabolic acidosis.
JapaneseAnswer: 正常AG代謝性アシドーシス。

EnglishQuestion: What potassium level, urine pH, and complications characterize type 1 distal RTA?
JapaneseQuestion: 1型遠位RTAのK値、尿pH、合併症は？
EnglishAnswer: Hypokalemia, urine pH above 5.5, nephrocalcinosis, and calcium stones.
JapaneseAnswer: 低K血症、尿pH 5.5超、腎石灰化、Ca結石。

EnglishQuestion: What is impaired in type 2 proximal RTA, and which syndrome may accompany it?
JapaneseQuestion: 2型近位RTAでは何が障害され、どの症候群を伴い得るか？
EnglishAnswer: Proximal tubular bicarbonate reabsorption is impaired, and Fanconi syndrome may coexist.
JapaneseAnswer: 近位尿細管の重炭酸再吸収が障害され、Fanconi症候群を伴い得る。

EnglishQuestion: Which potassium finding and mechanism distinguish type 4 RTA from other forms?
JapaneseQuestion: 4型RTAを他型と区別するK所見と機序は？
EnglishAnswer: Hyperkalemia caused by reduced aldosterone effect or aldosterone resistance.
JapaneseAnswer: アルドステロン作用低下または抵抗性による高K血症。

EnglishQuestion: How are Bartter and Gitelman syndromes distinguished by nephron site, urinary calcium, and magnesium?
JapaneseQuestion: Bartter症候群とGitelman症候群は、障害部位・尿中Ca・Mgでどう異なるか？
EnglishAnswer: Bartter syndrome affects the thick ascending limb and commonly causes hypercalciuria. Gitelman syndrome affects the distal convoluted tubule and causes hypocalciuria and hypomagnesemia. Both cause hypokalemic metabolic alkalosis.
JapaneseAnswer: Bartterは太い上行脚で高Ca尿、Gitelmanは遠位曲尿細管で低Ca尿・低Mg血症。ともに低K性代謝性アルカローシス。

EnglishQuestion: What are the renin and aldosterone findings and treatment in Liddle syndrome?
JapaneseQuestion: Liddle症候群のrenin・aldosterone所見と治療は？
EnglishAnswer: Low renin and low aldosterone with early-onset hypertension. Treat with amiloride or triamterene and sodium restriction; spironolactone is ineffective because aldosterone is already suppressed.
JapaneseAnswer: 低renin・低aldosteroneを伴う若年発症高血圧。amilorideまたはtriamtereneと塩分制限で治療し、spironolactoneは無効。

EnglishQuestion: What is the definition of chronic kidney disease (CKD)?
JapaneseQuestion: 慢性腎臓病の定義は？
EnglishAnswer: An abnormality of kidney structure or function that persists for at least 3 months and has implications for health.
JapaneseAnswer: 健康に影響する腎構造または機能異常が3か月以上持続する状態。

EnglishQuestion: What are the eGFR ranges for CKD categories G3a, G3b, G4, and G5?
JapaneseQuestion: CKD G3a・G3b・G4・G5のeGFR範囲は？
EnglishAnswer: G3a: 45–59; G3b: 30–44; G4: 15–29; G5: below 15 mL/min/1.73 m².
JapaneseAnswer: G3aは45～59、G3bは30～44、G4は15～29、G5は15 mL/min/1.73 m²未満。

EnglishQuestion: What UACR values define albuminuria categories A1, A2, and A3?
JapaneseQuestion: アルブミン尿A1・A2・A3を定義するUACR値は？
EnglishAnswer: A1: below 30 mg/g; A2: 30–300 mg/g; A3: above 300 mg/g.
JapaneseAnswer: A1は30 mg/g未満、A2は30～300 mg/g、A3は300 mg/g超。

EnglishQuestion: What additional evidence is required to diagnose CKD in G1 or G2?
JapaneseQuestion: G1またはG2でCKDと診断するために追加で必要な根拠は？
EnglishAnswer: Another marker of kidney damage, such as albuminuria, abnormal urine sediment, structural abnormality, or histologic abnormality.
JapaneseAnswer: アルブミン尿、尿沈渣異常、構造異常、組織異常など他の腎障害マーカー。

EnglishQuestion: What should be evaluated and corrected before using an erythropoiesis-stimulating agent for anemia of CKD?
JapaneseQuestion: CKD貧血でESA使用前に評価・是正するものは？
EnglishAnswer: Iron deficiency, bleeding, inflammation, and vitamin deficiency; optimize iron status first.
JapaneseAnswer: 鉄欠乏、出血、炎症、ビタミン欠乏。まず鉄状態を最適化する。

EnglishQuestion: Which hemoglobin target should be avoided in adults receiving an erythropoiesis-stimulating agent for CKD?
JapaneseQuestion: CKDでESA投与中の成人に避けるHb目標は？
EnglishAnswer: Do not target a hemoglobin of 13 g/dL or higher. Individualize treatment while generally maintaining hemoglobin below 11.5 g/dL.
JapaneseAnswer: 13 g/dL以上を目標にしない。個別化しつつ通常11.5 g/dL未満に保つ。

EnglishQuestion: How does CKD–mineral and bone disorder lead to secondary hyperparathyroidism?
JapaneseQuestion: CKD-MBDはどのように二次性副甲状腺機能亢進症を起こすか？
EnglishAnswer: Nephron loss → increased FGF23 → reduced active vitamin D → reduced intestinal calcium absorption → hypocalcemia → increased parathyroid hormone.
JapaneseAnswer: ネフロン減少→FGF23上昇→活性型ビタミンD低下→腸管Ca吸収低下→低Ca血症→PTH上昇。

EnglishQuestion: Which genes most commonly cause autosomal dominant and autosomal recessive polycystic kidney disease?
JapaneseQuestion: 常染色体優性・劣性多発性嚢胞腎の主要原因遺伝子は？
EnglishAnswer: ADPKD: PKD1 or PKD2; ARPKD: PKHD1.
JapaneseAnswer: ADPKDはPKD1またはPKD2、ARPKDはPKHD1。

EnglishQuestion: Which patients with ADPKD should be considered for tolvaptan?
JapaneseQuestion: ADPKDでtolvaptanを検討する患者は？
EnglishAnswer: Adults at risk of rapid progression, generally with eGFR at least 25 mL/min/1.73 m². Use Mayo class and eGFR decline to assess risk and monitor liver function.
JapaneseAnswer: 急速進行リスクのある成人で、通常eGFR 25 mL/min/1.73 m²以上。Mayo分類とeGFR低下で評価し、肝機能を監視する。

EnglishQuestion: Which personal or family history strongly supports intracranial aneurysm screening in ADPKD?
JapaneseQuestion: ADPKDで頭蓋内動脈瘤スクリーニングを強く支持する既往歴は？
EnglishAnswer: A personal history of subarachnoid hemorrhage or a family history of aneurysm, subarachnoid hemorrhage, or unexplained sudden death. Noncontrast time-of-flight MRA is first-line.
JapaneseAnswer: 本人のくも膜下出血歴、または家族の動脈瘤、くも膜下出血、原因不明突然死。第一選択は非造影TOF-MRA。

EnglishQuestion: What are the basic management approaches for Bosniak IIF, III, and IV renal cysts?
JapaneseQuestion: Bosniak IIF・III・IV腎嚢胞の基本的管理は？
EnglishAnswer: IIF: periodic contrast imaging; III: individualized urologic management based on malignancy risk; IV: high suspicion for malignancy and evaluation for treatment.
JapaneseAnswer: IIFは定期造影画像、IIIは悪性リスクに応じ泌尿器科で個別管理、IVは悪性を強く疑い治療評価。

EnglishQuestion: What daily urine volume is generally targeted to prevent recurrent urinary stones?
JapaneseQuestion: 尿路結石再発予防で目標とする1日尿量は？
EnglishAnswer: If not contraindicated, increase fluid intake to produce 2–2.5 L of urine per day.
JapaneseAnswer: 禁忌がなければ飲水を増やし、1日2～2.5 Lの尿量を確保する。

EnglishQuestion: What are the treatment principles for uric acid stones and infection stones?
JapaneseQuestion: 尿酸結石と感染結石の治療原則は？
EnglishAnswer: Uric acid stones: alkalinize urine with potassium citrate. Infection or struvite stones: complete stone removal plus control of infection caused by urease-producing organisms.
JapaneseAnswer: 尿酸結石はクエン酸Kで尿をアルカリ化。感染・struvite結石は完全除去とurease産生菌感染の制御。

EnglishQuestion: When should revascularization be considered for atherosclerotic renal artery stenosis?
JapaneseQuestion: 動脈硬化性腎動脈狭窄で血行再建を検討するのはいつか？
EnglishAnswer: When benefit is likely, such as recurrent flash pulmonary edema, rapidly declining kidney function, or hypertension uncontrolled despite optimal medical therapy.
JapaneseAnswer: 反復flash肺水腫、急速な腎機能低下、最適薬物療法でも制御不能な高血圧など、利益が見込める場合。

EnglishQuestion: In what sequence should the diagnostic evaluation of kidney disease be organized?
JapaneseQuestion: 腎疾患の診断評価は、どの順序で整理するか？
EnglishAnswer: Proceed from renal signs to a clinical syndrome, then localize the site of injury, establish the morphologic diagnosis, and finally determine the etiology.
JapaneseAnswer: 腎徴候→臨床症候群→障害部位の局在→形態学的診断→病因の特定、の順に進める。

EnglishQuestion: Which renal compartment is suggested by dysmorphic red blood cells, red blood cell casts, and albumin-predominant proteinuria?
JapaneseQuestion: 変形赤血球、赤血球円柱、アルブミン優位の蛋白尿は、どの腎区画の障害を示唆するか？
EnglishAnswer: Glomerular injury.
JapaneseAnswer: 糸球体障害。

EnglishQuestion: What do muddy brown casts and renal tubular epithelial cells suggest?
JapaneseQuestion: 泥状褐色円柱と腎尿細管上皮細胞は何を示唆するか？
EnglishAnswer: Acute tubular injury.
JapaneseAnswer: 急性尿細管障害。

EnglishQuestion: What diagnosis is suggested by white blood cell casts, sterile pyuria, and drug exposure?
JapaneseQuestion: 白血球円柱、無菌性膿尿、薬剤曝露はどの診断を示唆するか？
EnglishAnswer: Tubulointerstitial nephritis.
JapaneseAnswer: 尿細管間質性腎炎。

EnglishQuestion: What should be considered when sudden severe flank colic radiates to the groin?
JapaneseQuestion: 鼠径部へ放散する突然の激しい側腹部疝痛では、何を考えるか？
EnglishAnswer: Ureteral stone, blood clot, or urinary obstruction caused by papillary necrosis.
JapaneseAnswer: 尿管結石、血塊、または乳頭壊死による尿路閉塞。

EnglishQuestion: What should be considered when persistent flank pain is accompanied by fever?
JapaneseQuestion: 持続する側腹部痛に発熱を伴う場合、何を考えるか？
EnglishAnswer: Acute pyelonephritis, renal abscess, or perinephric abscess.
JapaneseAnswer: 急性腎盂腎炎、腎膿瘍、または腎周囲膿瘍。

EnglishQuestion: How do isomorphic and dysmorphic red blood cells help localize hematuria?
JapaneseQuestion: 均一赤血球と変形赤血球は、血尿の出血部位の推定にどう役立つか？
EnglishAnswer: Isomorphic red blood cells usually suggest urinary tract bleeding, whereas dysmorphic cells, especially acanthocytes, suggest glomerular bleeding.
JapaneseAnswer: 均一赤血球は通常尿路出血を示唆し、変形赤血球、特に有棘赤血球は糸球体出血を示唆する。

EnglishQuestion: What are the main differential diagnoses for white blood cell casts?
JapaneseQuestion: 白血球円柱の主な鑑別診断は？
EnglishAnswer: Pyelonephritis, interstitial nephritis, and glomerulonephritis.
JapaneseAnswer: 腎盂腎炎、間質性腎炎、糸球体腎炎。

EnglishQuestion: What do fatty casts and oval fat bodies suggest?
JapaneseQuestion: 脂肪円柱と卵円形脂肪体は何を示唆するか？
EnglishAnswer: Nephrotic syndrome.
JapaneseAnswer: ネフローゼ症候群。

EnglishQuestion: Which clinically important proteins may be missed by a urine dipstick?
JapaneseQuestion: 尿試験紙で見逃され得る臨床的に重要な蛋白は？
EnglishAnswer: Non-albumin proteins such as immunoglobulin light chains, because the dipstick primarily detects albumin.
JapaneseAnswer: 免疫グロブリン軽鎖などの非アルブミン蛋白。試験紙は主にアルブミンを検出するため。

EnglishQuestion: Which two spot urine ratios are commonly used to quantify proteinuria?
JapaneseQuestion: 蛋白尿の定量に一般的に用いる2つの随時尿比は？
EnglishAnswer: The urine albumin-to-creatinine ratio (UACR) and urine protein-to-creatinine ratio (UPCR).
JapaneseAnswer: 尿アルブミン／クレアチニン比（UACR）と尿蛋白／クレアチニン比（UPCR）。

EnglishQuestion: Is nephrotic-range proteinuria alone sufficient to diagnose nephrotic syndrome?
JapaneseQuestion: ネフローゼ範囲の蛋白尿だけでネフローゼ症候群と診断できるか？
EnglishAnswer: No. Nephrotic syndrome is a clinical syndrome that includes heavy proteinuria, hypoalbuminemia, and edema.
JapaneseAnswer: できない。ネフローゼ症候群は高度蛋白尿、低アルブミン血症、浮腫を含む臨床症候群である。

EnglishQuestion: Which serologic tests should be obtained urgently in rapidly progressive glomerulonephritis (RPGN)?
JapaneseQuestion: 急速進行性糸球体腎炎（RPGN）で緊急に行うべき血清学的検査は？
EnglishAnswer: Antineutrophil cytoplasmic antibodies (ANCA), anti-glomerular basement membrane antibodies, complement levels, antinuclear antibodies, and other tests guided by the presentation.
JapaneseAnswer: 抗好中球細胞質抗体（ANCA）、抗糸球体基底膜抗体、補体値、抗核抗体、および臨床像に応じたその他の検査。

EnglishQuestion: Which representative diseases correspond to linear, granular, and pauci-immune immunofluorescence patterns in RPGN?
JapaneseQuestion: RPGNにおける線状、顆粒状、乏免疫型の蛍光抗体法パターンに対応する代表疾患は？
EnglishAnswer: Linear: anti-GBM disease; granular: lupus nephritis, IgA nephropathy, or infection-related nephritis; pauci-immune: ANCA-associated vasculitis.
JapaneseAnswer: 線状：抗GBM病。顆粒状：ループス腎炎、IgA腎症、感染関連腎炎。乏免疫型：ANCA関連血管炎。

EnglishQuestion: Which serologic combination suggests cryoglobulinemic vasculitis?
JapaneseQuestion: クリオグロブリン血症性血管炎を示唆する血清学的組み合わせは？
EnglishAnswer: Detectable cryoglobulins with a low C4 level.
JapaneseAnswer: クリオグロブリン検出とC4低値。

EnglishQuestion: Which autoantibody is particularly associated with scleroderma renal crisis?
JapaneseQuestion: 強皮症腎クリーゼと特に関連する自己抗体は？
EnglishAnswer: Anti-RNA polymerase III antibody.
JapaneseAnswer: 抗RNAポリメラーゼIII抗体。

EnglishQuestion: Name four major indications for kidney biopsy.
JapaneseQuestion: 腎生検の主な適応を4つ挙げよ。
EnglishAnswer: Unexplained acute kidney injury or rapidly declining kidney function; glomerular hematuria with significant proteinuria; nephrotic syndrome; and renal involvement in a systemic disease when histologic class will change treatment. Allograft dysfunction is another indication.
JapaneseAnswer: 原因不明の急性腎障害または急速な腎機能低下、著明な蛋白尿を伴う糸球体性血尿、ネフローゼ症候群、組織分類が治療を変える全身性疾患の腎病変。移植腎機能障害も適応となる。

EnglishQuestion: Which conditions create major bleeding or procedural risks for kidney biopsy?
JapaneseQuestion: 腎生検で重大な出血・手技リスクとなる病態は？
EnglishAnswer: Uncontrolled hypertension, uncorrected coagulopathy, and inability to cooperate. Active pyelonephritis and infection or tumor at the puncture site should also be avoided.
JapaneseAnswer: コントロール不良の高血圧、未補正の凝固障害、協力不能。活動性腎盂腎炎や穿刺部位の感染・腫瘍も避ける。

EnglishQuestion: Are a solitary kidney and polycystic kidneys absolute contraindications to kidney biopsy?
JapaneseQuestion: 単腎と多発性嚢胞腎は腎生検の絶対禁忌か？
EnglishAnswer: No. The benefit and risk should be individualized, and an alternative technique such as transjugular biopsy may be considered.
JapaneseAnswer: 絶対禁忌ではない。利益とリスクを個別に判断し、経頸静脈生検などの代替手技を検討できる。

EnglishQuestion: How can kidney morphology on ultrasonography help distinguish acute kidney injury from chronic kidney disease?
JapaneseQuestion: 超音波での腎形態は、急性腎障害と慢性腎臓病の鑑別にどう役立つか？
EnglishAnswer: Kidneys are usually normal-sized or enlarged in acute kidney injury. Small kidneys with cortical thinning and increased echogenicity suggest chronic kidney disease, although kidneys may remain enlarged in diabetic kidney disease, amyloidosis, and ADPKD.
JapaneseAnswer: 急性腎障害では通常、腎は正常大または腫大する。皮質菲薄化とエコー輝度上昇を伴う萎縮腎は慢性腎臓病を示唆するが、糖尿病性腎臓病、アミロイドーシス、ADPKDでは腫大が残ることがある。

EnglishQuestion: What are the main options for kidney replacement therapy (KRT)?
JapaneseQuestion: 腎代替療法（KRT）の主な選択肢は？
EnglishAnswer: Kidney transplantation, hemodialysis, peritoneal dialysis, and, for selected patients, comprehensive conservative kidney care.
JapaneseAnswer: 腎移植、血液透析、腹膜透析、および選択された患者に対する包括的保存的腎臓ケア。

EnglishQuestion: When should kidney replacement therapy planning begin in progressive chronic kidney disease?
JapaneseQuestion: 進行性慢性腎臓病では、腎代替療法の計画をいつ開始するか？
EnglishAnswer: Begin shared planning in CKD G4. Early transplant evaluation or dialysis access planning is reasonable when GFR is below 15–20 mL/min/1.73 m² or the two-year KRT risk exceeds 40%.
JapaneseAnswer: CKD G4で共同意思決定による計画を開始する。GFRが15〜20 mL/min/1.73 m²未満、または2年以内のKRTリスクが40%を超える場合、早期の移植評価または透析アクセス計画が妥当。

EnglishQuestion: What should determine initiation of kidney replacement therapy, and what should not determine it alone?
JapaneseQuestion: 腎代替療法の開始は何に基づき、何だけで決めてはいけないか？
EnglishAnswer: Base initiation on uremic symptoms, refractory hyperkalemia or acid–base disturbance, uncontrolled fluid overload or hypertension, and progressive nutritional decline. Do not use a fixed GFR or creatinine value alone.
JapaneseAnswer: 尿毒症症状、難治性高K血症または酸塩基異常、制御不能な体液過剰または高血圧、進行する栄養状態悪化に基づく。固定したGFR値やクレアチニン値だけで開始しない。

EnglishQuestion: Which timing and donor type are associated with particularly favorable kidney transplant outcomes in eligible patients?
JapaneseQuestion: 適格患者で特に良好な腎移植成績に関連する時期とドナー種別は？
EnglishAnswer: Preemptive kidney transplantation before dialysis, especially from a living donor.
JapaneseAnswer: 透析導入前の先行的腎移植、特に生体ドナーからの移植。

EnglishQuestion: Which six major domains are assessed in a kidney transplant candidate?
JapaneseQuestion: 腎移植候補者で評価する6つの主要領域は？
EnglishAnswer: Cardiovascular status, infection, malignancy, immunologic risk, urologic status, and psychosocial factors.
JapaneseAnswer: 心血管状態、感染症、悪性腫瘍、免疫学的リスク、泌尿器科的状態、心理社会的要因。

EnglishQuestion: What is included in the pretransplant immunologic assessment?
JapaneseQuestion: 移植前の免疫学的評価に含まれるものは？
EnglishAnswer: ABO blood group, human leukocyte antigen (HLA) typing, donor-specific antibodies (DSA), and crossmatch testing.
JapaneseAnswer: ABO血液型、ヒト白血球抗原（HLA）タイピング、ドナー特異的抗体（DSA）、クロスマッチ検査。

EnglishQuestion: What does a positive donor–recipient crossmatch indicate?
JapaneseQuestion: ドナー・レシピエント間のクロスマッチ陽性は何を示すか？
EnglishAnswer: It suggests preexisting donor-reactive antibodies and a high risk of hyperacute rejection.
JapaneseAnswer: 既存のドナー反応性抗体と超急性拒絶反応の高リスクを示唆する。

EnglishQuestion: What ethical principles govern consent by a living kidney donor?
JapaneseQuestion: 生体腎ドナーの同意を規定する倫理原則は？
EnglishAnswer: Donation must be voluntary and uncompensated, and the donor may withdraw at any time without giving a reason.
JapaneseAnswer: 提供は自発的かつ無償でなければならず、ドナーは理由を示さずいつでも撤回できる。

EnglishQuestion: What strategies can enable living-donor transplantation across ABO incompatibility?
JapaneseQuestion: ABO不適合を越えて生体腎移植を可能にする戦略は？
EnglishAnswer: Desensitization protocols or kidney paired donation at an experienced center.
JapaneseAnswer: 経験豊富な施設での脱感作プロトコルまたは腎臓交換移植。

EnglishQuestion: Where is a kidney allograft usually placed, and how are its vessels and ureter connected?
JapaneseQuestion: 移植腎は通常どこに置き、血管と尿管をどう接続するか？
EnglishAnswer: It is usually placed extraperitoneally in the iliac fossa. The renal artery and vein are anastomosed to the iliac vessels, and the ureter is implanted into the bladder.
JapaneseAnswer: 通常は腸骨窩の腹膜外に置く。腎動静脈を腸骨血管に吻合し、尿管を膀胱に吻合する。

EnglishQuestion: Which surgical causes should be excluded first in early post-transplant oliguria or allograft dysfunction?
JapaneseQuestion: 移植早期の乏尿または移植腎機能障害で、最初に除外すべき外科的原因は？
EnglishAnswer: Renal artery or vein thrombosis or stenosis, hemorrhage, urinary leak, ureteral obstruction, and compression by a lymphocele, hematoma, or urinoma. Obtain urgent Doppler ultrasonography.
JapaneseAnswer: 腎動静脈の血栓症または狭窄、出血、尿漏、尿管閉塞、リンパ嚢腫・血腫・尿瘤による圧迫。緊急ドプラ超音波検査を行う。

EnglishQuestion: What are the timing, mechanism, and prevention of hyperacute rejection?
JapaneseQuestion: 超急性拒絶反応の発症時期、機序、予防は？
EnglishAnswer: It occurs within minutes to hours because of preexisting antibodies and causes graft thrombosis and immediate nonfunction. Prevent it through antibody assessment and crossmatch testing.
JapaneseAnswer: 既存抗体により数分〜数時間以内に発症し、移植片血栓症と即時無機能を来す。抗体評価とクロスマッチ検査で予防する。

EnglishQuestion: What are the characteristic biopsy findings and basic treatment of T-cell–mediated rejection?
JapaneseQuestion: T細胞性拒絶反応の特徴的な生検所見と基本治療は？
EnglishAnswer: Interstitial inflammation and tubulitis. Confirm with allograft biopsy and treat with corticosteroids or other therapy according to severity.
JapaneseAnswer: 間質炎症と尿細管炎。移植腎生検で確認し、重症度に応じてコルチコステロイドなどで治療する。

EnglishQuestion: Which elements are integrated to diagnose antibody-mediated rejection?
JapaneseQuestion: 抗体関連型拒絶反応の診断では、どの要素を統合するか？
EnglishAnswer: Donor-specific antibodies, histologic evidence of microvascular injury, and evidence such as complement deposition.
JapaneseAnswer: ドナー特異的抗体、微小血管障害の組織学的証拠、補体沈着などの所見。

EnglishQuestion: In what sequence should worsening kidney allograft function be evaluated?
JapaneseQuestion: 移植腎機能悪化はどの順序で評価するか？
EnglishAnswer: Assess hypoperfusion → vascular obstruction → urinary obstruction → calcineurin inhibitor concentration → BK polyomavirus and CMV infection → rejection; perform allograft biopsy when needed.
JapaneseAnswer: 低灌流→血管閉塞→尿路閉塞→カルシニューリン阻害薬濃度→BKポリオーマウイルス・CMV感染→拒絶反応の順に評価し、必要時に移植腎生検を行う。

EnglishQuestion: How is induction immunosuppression commonly selected for standard versus high immunologic risk?
JapaneseQuestion: 標準的免疫学的リスクと高リスクでは、導入免疫抑制療法を通常どう選択するか？
EnglishAnswer: Basiliximab is commonly used for standard risk, whereas a lymphocyte-depleting agent such as antithymocyte globulin is used for higher rejection risk.
JapaneseAnswer: 標準リスクでは通常バシリキシマブを用い、拒絶リスクが高い場合は抗胸腺細胞グロブリンなどのリンパ球枯渇薬を用いる。

EnglishQuestion: What is the usual three-drug maintenance immunosuppression regimen after kidney transplantation?
JapaneseQuestion: 腎移植後の通常の3剤維持免疫抑制療法は？
EnglishAnswer: A calcineurin inhibitor, a mycophenolate preparation, and a corticosteroid.
JapaneseAnswer: カルシニューリン阻害薬、ミコフェノール酸製剤、コルチコステロイド。

EnglishQuestion: What adverse effects are shared by tacrolimus and cyclosporine, and which effects differ?
JapaneseQuestion: タクロリムスとシクロスポリンに共通する副作用と、異なる副作用は？
EnglishAnswer: Both can cause nephrotoxicity, hypertension, and tremor. Tacrolimus more often causes diabetes; cyclosporine may cause hirsutism and gingival hyperplasia.
JapaneseAnswer: 両者とも腎毒性、高血圧、振戦を起こし得る。タクロリムスは糖尿病が多く、シクロスポリンは多毛と歯肉増殖を起こし得る。

EnglishQuestion: What are the major adverse effects and pregnancy concern of mycophenolate preparations?
JapaneseQuestion: ミコフェノール酸製剤の主な副作用と妊娠上の懸念は？
EnglishAnswer: Gastrointestinal symptoms, leukopenia, and teratogenicity; therapy must be changed appropriately before pregnancy.
JapaneseAnswer: 消化器症状、白血球減少、催奇形性。妊娠前に適切に治療薬を変更する必要がある。

EnglishQuestion: Which drugs can cause severe bone marrow suppression when combined with azathioprine?
JapaneseQuestion: アザチオプリンと併用すると重度の骨髄抑制を起こし得る薬は？
EnglishAnswer: The xanthine oxidase inhibitors allopurinol and febuxostat. Avoid the combination unless a specialist makes a major dose reduction with close blood count monitoring.
JapaneseAnswer: キサンチンオキシダーゼ阻害薬のアロプリノールとフェブキソスタット。専門医が大幅減量し血球数を厳密に監視する場合を除き、併用を避ける。

EnglishQuestion: What are the major adverse effects of mTOR inhibitors?
JapaneseQuestion: mTOR阻害薬の主な副作用は？
EnglishAnswer: Dyslipidemia, proteinuria, cytopenias, and impaired wound healing.
JapaneseAnswer: 脂質異常症、蛋白尿、血球減少、創傷治癒障害。

EnglishQuestion: Match hemodialysis, hemofiltration, and hemodiafiltration with their principal solute-removal mechanisms.
JapaneseQuestion: 血液透析、血液濾過、血液透析濾過を、それぞれの主な溶質除去機序と対応させよ。
EnglishAnswer: Hemodialysis uses diffusion; hemofiltration uses convection; hemodiafiltration combines diffusion and convection.
JapaneseAnswer: 血液透析は拡散、血液濾過は対流、血液透析濾過は拡散と対流の両方を用いる。

EnglishQuestion: What mechanism removes water during hemodialysis?
JapaneseQuestion: 血液透析中に水分を除去する機序は？
EnglishAnswer: Ultrafiltration driven by transmembrane pressure.
JapaneseAnswer: 膜間圧差による限外濾過。

EnglishQuestion: What are the main advantages and disadvantages of an AV fistula, AV graft, and central venous catheter?
JapaneseQuestion: 内シャント、人工血管、中心静脈カテーテルの主な長所と短所は？
EnglishAnswer: An arteriovenous fistula has good long-term patency and low infection risk but needs time to mature; a graft can be used sooner but has more infection and thrombosis; a catheter is immediately usable but has high bloodstream infection and central vein stenosis risks.
JapaneseAnswer: 動静脈瘻は長期開存性が良く感染リスクが低いが成熟に時間が必要。人工血管は早期使用できるが感染・血栓が多い。カテーテルは直ちに使用できるが血流感染と中心静脈狭窄のリスクが高い。

EnglishQuestion: Which anticoagulation strategies can be considered for hemodialysis in a patient at high bleeding risk?
JapaneseQuestion: 出血リスクが高い患者の血液透析で検討できる抗凝固戦略は？
EnglishAnswer: Heparin-free dialysis or regional citrate anticoagulation, balancing circuit life against bleeding risk.
JapaneseAnswer: 回路寿命と出血リスクのバランスをとり、無ヘパリン透析または局所クエン酸抗凝固を検討する。

EnglishQuestion: What is the initial management of intradialytic hypotension?
JapaneseQuestion: 透析中低血圧の初期対応は？
EnglishAnswer: Stop or reduce ultrafiltration, place the patient supine, assess the cause, and give an appropriate amount of isotonic fluid if needed.
JapaneseAnswer: 除水を停止または減量し、仰臥位にして原因を評価し、必要なら適量の等張液を投与する。

EnglishQuestion: What is the immediate response to suspected hemolysis during hemodialysis?
JapaneseQuestion: 血液透析中に溶血を疑った場合の直ちに行う対応は？
EnglishAnswer: Stop dialysis, clamp the circuit, do not return the circuit blood, and investigate the cause.
JapaneseAnswer: 透析を中止して回路をクランプし、回路内血液を返血せず、原因を調査する。

EnglishQuestion: What findings suggest bacterial peritonitis in peritoneal dialysis, and what is the initial response?
JapaneseQuestion: 腹膜透析で細菌性腹膜炎を示唆する所見と初期対応は？
EnglishAnswer: Cloudy effluent and abdominal pain. Obtain effluent cell count and culture, then promptly start intraperitoneal antibiotics.
JapaneseAnswer: 排液混濁と腹痛。排液の細胞数測定と培養を行い、速やかに腹腔内抗菌薬を開始する。

EnglishQuestion: What is the standard management principle for fungal peritonitis in peritoneal dialysis?
JapaneseQuestion: 腹膜透析における真菌性腹膜炎の標準的な管理原則は？
EnglishAnswer: Start antifungal therapy and promptly remove the peritoneal dialysis catheter.
JapaneseAnswer: 抗真菌薬を開始し、速やかに腹膜透析カテーテルを抜去する。

EnglishQuestion: For which substances may hemoperfusion be useful?
JapaneseQuestion: 血液吸着が有用となり得る物質は？
EnglishAnswer: Selected toxins that adsorb to charcoal or resin and are poorly removed by conventional hemodialysis, for example because of high protein binding.
JapaneseAnswer: 活性炭や樹脂に吸着し、蛋白結合率が高いなどの理由で通常の血液透析では除去されにくい特定の毒物。

EnglishQuestion: What deficit does hypernatremia represent in relation to total body sodium?
JapaneseQuestion: 高Na血症は体内総Naに対して何が不足した状態か？
EnglishAnswer: A deficit of free water relative to total body sodium. Hypernatremia is defined as a serum sodium concentration above 145 mmol/L.
JapaneseAnswer: 体内総Naに対する自由水不足。高Na血症は血清Na 145 mmol/L超。

EnglishQuestion: How do total body sodium and water change in the three volume-status categories of hypernatremia?
JapaneseQuestion: 高Na血症の低容量・正常容量・高容量型で体内Naと水はどう変化するか？
EnglishAnswer: Hypovolemic: sodium decreases but water decreases even more; euvolemic: sodium is nearly unchanged while water decreases; hypervolemic: sodium increases markedly and water also increases.
JapaneseAnswer: 低容量型はNa減少だが水がより減少、正常容量型はNaほぼ不変で水減少、高容量型はNa著増かつ水も増加。

EnglishQuestion: What should be suspected when hypernatremia is accompanied by polyuria and dilute urine?
JapaneseQuestion: 高Na血症に多尿と希釈尿を伴う場合に疑う病態は？
EnglishAnswer: Diabetes insipidus: arginine vasopressin deficiency in central disease or arginine vasopressin resistance in nephrogenic disease.
JapaneseAnswer: 尿崩症。中枢性はarginine vasopressin欠乏、腎性は同ホルモン抵抗性。

EnglishQuestion: How is the free-water deficit in hypernatremia estimated?
JapaneseQuestion: 高Na血症の自由水欠乏量はどう推定するか？
EnglishAnswer: Total body water × [(measured serum sodium / 140) − 1].
JapaneseAnswer: 体内総水分量×［実測血清Na／140−1］。

EnglishQuestion: In hypernatremia with shock, what must be done before replacing free water?
JapaneseQuestion: ショックを伴う高Na血症では自由水補充前に何を行うか？
EnglishAnswer: Restore circulation with isotonic crystalloid. Once stable, replace free water orally, enterally, or with 5% dextrose or hypotonic saline as appropriate.
JapaneseAnswer: 等張晶質液で循環を回復する。安定後、経口・経腸水または5%ブドウ糖液・低張食塩水で自由水を補充する。

EnglishQuestion: What is the usual upper correction rate for chronic hypernatremia or hypernatremia of unknown duration?
JapaneseQuestion: 慢性または持続時間不明の高Na血症で通常の補正速度上限は？
EnglishAnswer: No more than about 0.5 mmol/L per hour and 10 mmol/L per day.
JapaneseAnswer: 約0.5 mmol/L/時以下、10 mmol/L/日以下。

EnglishQuestion: What should be measured first when evaluating hyponatremia?
JapaneseQuestion: 低Na血症評価で最初に測定するものは？
EnglishAnswer: Serum osmolality, to determine whether true hypotonic hyponatremia is present.
JapaneseAnswer: 血清浸透圧。真の低張性低Na血症かを判定する。

EnglishQuestion: What are representative causes of hyponatremia with high serum osmolality?
JapaneseQuestion: 高浸透圧性低Na血症の代表的原因は？
EnglishAnswer: Hyperglycemia and mannitol, which cause translocational hyponatremia.
JapaneseAnswer: 高血糖とmannitolによる移動性低Na血症。

EnglishQuestion: What does a urine osmolality of 100 mOsm/kg or less indicate in hypotonic hyponatremia?
JapaneseQuestion: 低張性低Na血症で尿浸透圧100 mOsm/kg以下は何を示すか？
EnglishAnswer: Excess water intake or low solute intake. A urine osmolality above 100 mOsm/kg indicates active arginine vasopressin effect.
JapaneseAnswer: 過剰飲水または低溶質摂取。100 mOsm/kg超はarginine vasopressin作用があることを示す。

EnglishQuestion: Which endocrine disorders must not be missed in apparently euvolemic hyponatremia?
JapaneseQuestion: 見かけ上正常容量性の低Na血症で見逃してはいけない内分泌疾患は？
EnglishAnswer: Adrenal insufficiency and hypothyroidism.
JapaneseAnswer: 副腎不全と甲状腺機能低下症。

EnglishQuestion: What are the typical serum osmolality, urine osmolality, and urine sodium findings in syndrome of inappropriate antidiuresis (SIAD)?
JapaneseQuestion: SIADの典型的な血清浸透圧・尿浸透圧・尿中Na所見は？
EnglishAnswer: Effective serum osmolality below 275 mOsm/kg, urine osmolality above 100 mOsm/kg, and usually urine sodium above 30 mmol/L when intake is adequate.
JapaneseAnswer: 有効血清浸透圧275 mOsm/kg未満、尿浸透圧100 mOsm/kg超、摂取十分なら通常尿中Na 30 mmol/L超。

EnglishQuestion: What conditions must be excluded before diagnosing SIAD?
JapaneseQuestion: SIAD診断前に除外する病態は？
EnglishAnswer: Adrenal, thyroid, pituitary, and renal failure, as well as recent diuretic use. SIAD is a diagnosis of exclusion.
JapaneseAnswer: 副腎、甲状腺、下垂体、腎不全と最近の利尿薬使用。SIADは除外診断。

EnglishQuestion: What is the initial treatment for hyponatremia with severe neurologic symptoms?
JapaneseQuestion: 重い神経症状を伴う低Na血症の初期治療は？
EnglishAnswer: Give 150 mL of 3% hypertonic saline over 20 minutes, then reassess serum sodium and symptoms. Repeat the bolus if necessary.
JapaneseAnswer: 3%高張食塩水150 mLを20分で投与し、血清Naと症状を再評価する。必要なら反復する。

EnglishQuestion: What are the initial one-hour target and 24-hour correction limit in symptomatic hyponatremia?
JapaneseQuestion: 症候性低Na血症の最初の1時間の目標と24時間補正上限は？
EnglishAnswer: Initially aim for a sodium increase of about 5 mmol/L or improvement in symptoms. Limit the total increase to 10 mmol/L in the first 24 hours and 8 mmol/L per 24 hours thereafter.
JapaneseAnswer: まずNaを約5 mmol/L上昇または症状改善。最初の24時間は計10 mmol/L以内、以後24時間ごとに8 mmol/L以内。

EnglishQuestion: Which factors increase the risk of osmotic demyelination after correction of hyponatremia?
JapaneseQuestion: 低Na血症補正後の浸透圧性脱髄リスクを高める因子は？
EnglishAnswer: Hypokalemia, alcohol use disorder, malnutrition, liver disease, and an extremely low initial sodium concentration.
JapaneseAnswer: 低K血症、アルコール使用障害、低栄養、肝疾患、初期Naが極端に低いこと。

EnglishQuestion: How may inadvertent overcorrection of hyponatremia be reversed?
JapaneseQuestion: 低Na血症の過剰補正をどう戻すか？
EnglishAnswer: Under specialist supervision, consider 5% dextrose and desmopressin to relower or stabilize the serum sodium.
JapaneseAnswer: 専門管理下で5%ブドウ糖液とdesmopressinを用い、血清Naを再低下または安定化させる。

EnglishQuestion: Does a normal electrocardiogram exclude severe hyperkalemia?
JapaneseQuestion: 正常心電図なら重症高K血症を除外できるか？
EnglishAnswer: No. The electrocardiogram may remain normal even in severe hyperkalemia.
JapaneseAnswer: できない。重症でも心電図が正常なことがある。

EnglishQuestion: List the typical electrocardiographic progression of hyperkalemia.
JapaneseQuestion: 高K血症の典型的心電図進行を答えると？
EnglishAnswer: Peaked T waves → PR prolongation and loss of P waves → QRS widening → sine-wave pattern, bradycardia, or ventricular arrhythmia.
JapaneseAnswer: 尖鋭T波→PR延長・P波消失→QRS幅増大→sine wave、徐脈または心室性不整脈。

EnglishQuestion: What are the three treatment stages for severe hyperkalemia or hyperkalemia with electrocardiographic changes?
JapaneseQuestion: 重症または心電図変化を伴う高K血症の3段階治療は？
EnglishAnswer: 1) Stabilize the cardiac membrane with intravenous calcium; 2) shift potassium into cells with insulin plus glucose and inhaled salbutamol; 3) remove potassium with diuretics, potassium binders, or dialysis.
JapaneseAnswer: 1) 静注Caで心筋膜安定化、2) insulin＋glucoseと吸入salbutamolでKを細胞内移動、3) 利尿薬・K吸着薬・透析で体外除去。

EnglishQuestion: Does intravenous calcium lower the serum potassium concentration in hyperkalemia?
JapaneseQuestion: 高K血症で静注Caは血清Kを下げるか？
EnglishAnswer: No. It temporarily stabilizes the cardiac myocyte membrane.
JapaneseAnswer: 下げない。心筋細胞膜を一時的に安定化する。

EnglishQuestion: Which delayed complication must be monitored after insulin treatment for hyperkalemia?
JapaneseQuestion: 高K血症にinsulinを投与した後に監視する遅発性合併症は？
EnglishAnswer: Hypoglycemia; blood glucose must be monitored for several hours.
JapaneseAnswer: 低血糖。血糖を数時間監視する。

EnglishQuestion: When should sodium bicarbonate be used in hyperkalemia?
JapaneseQuestion: 高K血症でNaHCO3を使うのはいつか？
EnglishAnswer: Not routinely. Consider it when there is another indication, such as severe metabolic acidosis.
JapaneseAnswer: ルーチンには使わない。重度代謝性アシドーシスなど別の適応がある場合に検討する。

EnglishQuestion: Which electrolyte must always be checked and sometimes corrected simultaneously in hypokalemia?
JapaneseQuestion: 低K血症で必ず確認し、同時補正を要することがある電解質は？
EnglishAnswer: Magnesium, because coexisting hypomagnesemia makes potassium repletion ineffective.
JapaneseAnswer: Mg。低Mg血症を伴うとK補充が効きにくい。

EnglishQuestion: Why should dextrose solutions be avoided as the diluent for intravenous potassium replacement?
JapaneseQuestion: 静注K補充の希釈液にブドウ糖液を避ける理由は？
EnglishAnswer: Dextrose stimulates insulin secretion and may worsen hypokalemia by shifting potassium into cells.
JapaneseAnswer: ブドウ糖がinsulin分泌を刺激し、Kを細胞内へ移動させて低K血症を悪化させ得るため。

EnglishQuestion: What neuromuscular and cardiovascular findings occur in hypermagnesemia?
JapaneseQuestion: 高Mg血症でみられる神経筋・心血管所見は？
EnglishAnswer: Reduced deep tendon reflexes, weakness, somnolence, respiratory depression, vasodilation, hypotension, and bradycardia.
JapaneseAnswer: 深部腱反射低下、筋力低下、傾眠、呼吸抑制、血管拡張、低血圧、徐脈。

EnglishQuestion: What are the initial antidotal treatment and definitive removal method for symptomatic hypermagnesemia with severe renal failure?
JapaneseQuestion: 重度腎不全を伴う症候性高Mg血症の初期拮抗治療と除去法は？
EnglishAnswer: Stop magnesium and give intravenous calcium to antagonize its effects. Use hemodialysis for severe toxicity or renal failure.
JapaneseAnswer: Mgを中止し、静注Caで作用を拮抗する。重症中毒または腎不全では血液透析で除去する。

EnglishQuestion: Which electrolyte abnormalities are made refractory by hypomagnesemia?
JapaneseQuestion: 低Mg血症により難治性となる電解質異常は？
EnglishAnswer: Hypokalemia and hypocalcemia.
JapaneseAnswer: 低K血症と低Ca血症。

EnglishQuestion: How should torsades de pointes caused by hypomagnesemia be treated?
JapaneseQuestion: 低Mg血症によるtorsades de pointesをどう治療するか？
EnglishAnswer: Give intravenous magnesium sulfate and adjust the dose and monitoring to kidney function.
JapaneseAnswer: 硫酸Mgを静注し、腎機能に応じて用量と監視を調整する。