Uworld 4

Question 1

Vasovagal syncope results from what?

Answer 1

Vasovagal syncope typically involves a trigger (eg, prolonged standing), a prodrome (eg, warmth, light headedness) and rapid recovery (eg within 1-2 min).

It results from a transient, autonomic nervous system-mediated cardioinhibitory and vasodepressor response.

Question 2

What is a trait of adenosine deaminase (ADA) inhibition/absence?

Answer 2

It is highly lymphocytotoxic.

Meds that block ADA are used to treat lymphocyte-derived cancers, like hairy cell.

Question 3

Inherited gene mutations in adenosine deaminase leads to?

Answer 3

the autosomal recessive disease of severe combined immunodeficiency

Question 4

What does the anterior cerebral artery supply?

Answer 4

The medial aspects of the frontal and parietal lobes, which contain the upper motor neurons responsible for contralateral lower extremity motor control.

Question 5

Thromoboembolic occulsion of the anterior cerebral artery results in?

Answer 5

Contralateral lower extremity weakness with hyperreflexia

Question 6

What is the pathogenesis of rheumatoid arthritis?

Answer 6

Early activation of CD4+T cells (especially Th1 and Th17) with release of cytokines such as tumor necrosis factor-alpha and IL-1 that cause destruction of cartilage and bone.

Monoclonal antibodies that inhibit tumor necrosis factor-alpha or IL-1 receptors can slow progression of the disease.

Question 7

What can happen if you use lithium during pregnancy?

Answer 7

Lithium is commonly used to treat bipolar disorder.

Its use during pregnancy is associated with Ebstein’s anomaly, which is characterized by apical displacement of the tricuspid valve leaflets, decreased right ventricular volume, and atrialization of the right ventricle.

Question 8

What is S1 radiculopathy in sciatica?

Answer 8

Resulting in pain/sensory loss down the posterior thigh and calf to the lateral aspect of the foot.

Patients may also have weakness on thigh extenson, knee flexion, and foot plantarflexion with an absent Achilles reflex

Question 9

What is seen on histo for aortic root disease with patients who have Marfan?

Answer 9

Marfan syndrome involves a deleterious mutation in fibrillin that mainly affects the structural integrity of the cardiovascular and musculoskeletal systems.

Aortic root disease predisposes to aortic dissection, which can present with sudden-onset chest or back pain, acute aortic regurgitation and heart failure.

Histo: fragmentation and loss of the elastic lamellae with fibrosis and cystic medial degeneration

Question 10

What is stress hyperglycemia?

Answer 10

Transiently elevated blood glucose levels in the context of severe illness (eg, sepsis, burns, major hemorrhage) in patients without preexisting diabetes mellitus.

Cortisol and catecholamines released in response to severe metabolic stress act on the liver to increase glycogenolysis and gluconeogenesis.

Question 11

Pulmonary embolism typically presents with hypoxemia due to?

Answer 11

ventilation/perfusion mismatch and acute resp alkalosis (hypocapnia) due to hyperventilation

Question 12

Chronic alcohol use will act on what receptors?

Answer 12

Downregulates inhibitory GABA receptors and upregulates excitatory NMDA glutamate receptors.

Question 13

Sudden cessation of alcohol leads to what?

Answer 13

decreased GABA activity and increased glutamate activity, resulting in CNS overexcitation (eg, agitation, disorientation, tremulousness, autonomic hyperactivity)

Question 14

What is seen on MRI for vascular dementia?

Answer 14

Multiple small infarcts, microbleeds, and areas of hyperintensity in the white matter that represent demyelination or axon loss

Question 15

What is primary hyperaldosteronism cause by? Clinical findings?

Answer 15

Caused by excessive aldosterone secretion, typically due to an aldosterone-producing adrenal adenoma or bilateral nodular hyperplasia of the zona glomerulosa.

CF: hypertension, low plasma renin, hypokalemia, and metabolic alkalosis.

Question 16

What is severe combined immune deficiency? Labs?

Answer 16

Characterized by combined T and B cell dysfunction.

Bacterial and viral infections, mucocutaneous candidiasis, persistent diarrhea, and failure to thrive.

Labs: absent T cells and hypogammaglobulinemia

The thymic shadow is not present due to severe T cell def

Question 17

Cervical spine trauma can lead to dissection of the vertebral artery, resulting in?

Answer 17

Resulting in infarction of the lateral medulla and causing vertigo/nystagmus, ataxia, loss of pain/temp sensation in the ipsilateral face and contralateral body, bulbar weakness, and ipsilateral Horner syndrome.

Question 18

MOA of aminoglycosides (like gentamicin)

Answer 18

They inhibit genetic code reading and protein synthesis by binding to the prokaryotic 30S ribosomal subunit.

Question 19

How does clonidine cause orthostatic syncope?

Answer 19

Clonidine, an antihypertensive agent. stimulates central alpha 2 adrenergic receptors, causing a decrease in presynaptic release of norepinephrine and a decrease in sympathetic outflow.

This prevents the normal baroceptor-mediated increase in peripheral vascular resistance and heart rate during standing and can cause orthostatic syncope.

Question 20

What are the traits of Actinomyces?

Answer 20

G+ branching, filamentous bacteria that may cause cervicofacial infections when introduced to the submucosa during mechanical trauma (eg tooth extraction).

Manifestations: slowly enlarging, non painful, chronic mandibular mass that evolves into multiple abscesses and sinus tracts draining yellow-orange sulfur granules

Question 21

What is Henoch-Schonlein purpura?

Answer 21

IgA mediated, leukocytoclastic vasculitis that presents with palpable purport, arthralgia/arthritis, abdominal pain, and/or hematuria

Renal involvement is due to mesangial deposition of IgA immune complexes with subsequent mesangial cell proliferation, neutrophilic infiltration, and glomerular damage

Question 22

How is Helicobacter pylori associated with gastric MALT?

Answer 22

Helicobacter pylori is associated with gastric MALT lymphoma due to chronic stimulation of the immune response; the continuous cell dvision predisposes to accumulation of mutations that result in aberrant B-cell proliferation.

Treatment of H pylori can induce remission in the majority of cases of early stage gastric MALT lymphomas

Question 23

Patients with profound and prolonged neutropenia are at especially high risk for fungal infections. What are the common ones?

Answer 23

Aspergillus and Candida

Question 24

What is the treatment of malignant hyperthermia?

Answer 24

Dantrolene, which blocks ryanodine receptors to prevent the release of calcium from the sarcoplasmic reticulum into the cytoplasm of skeletal muscle fibers

Question 25

What is malignant hyperthermia?

Answer 25

Widespread muscle rigidity after administration of inhalation anesthetics and/or succinylcholine to genetically susceptible individuals.

Question 26

What anticoagulant can inactivate thrombin?

Answer 26

Unfractionated heparin is able to bind to both antithrombin and thrombin to allow antithrombin to inactivate thrombin

Question 27

Gustatory (taste) innervation of the anterior 2/3 tongue is provided by?

Answer 27

chorda tympani branch of the facial nerve

Question 28

Why is Pierre Robin characterized as a sequence?

Answer 28

Because the primary defect (hypoplasia of the mandibular prominence) leads to a cascade of further malformations (ie, micrognathia, posteriorly displaced tongue, U shaped cleft palate)

Question 29

Secretin is produced by which cells?

Answer 29

By S cells in the duodenal mucosa in response to stimulation by intraluminal acidity.

Question 30

What is the action of secretin?

Answer 30

Secretin stimulates the release of bicarbonate-rich secretions from the exocrine pancreas, which is the major source of acid-neutralizing bicarbonate entering the duodenum

Question 31

Chronic granulomatous disease is due to?

Answer 31

Chronic granulomatous disease is a primary immunodeficiency due to impaired NADPH oxidase, an enzyme that generates reactive oxygen species in phagolysosomes.

Question 32

Chronic granulomatous disease has recurrent infections with what?

Answer 32

Diminished intracellular killing within neutrophils leads to susceptibility to recurrent infection with catalase producing bacteria (eg Staph aureus, Nocardia, Burkholderia, Serratia) and fungi (eg Aspergillus)

Question 33

Pulmonary arterial hypertension typically affects young women and can be familial. It is characterized by what?

Answer 33

By luminal narrowing of the pulmonary arteries and arterioles, with medial hypertrophy, intimal fibrosis, and the eventual development of plexiform lesions.

Question 34

What is the MOA of Bosentan?

Answer 34

Competitive antagonist of endothelin receptors used for the treatment of pulmonary arterial hypertension

Question 35

What is celiac disease?

Answer 35

An immune-mediated disorder triggered by dietary gluten that causes small-bowel malabsorption. Because the proximal small bowel is primarily affected, iron deficiency leading to microcytic anemia is common.

Question 36

What is seen on histo for celiac disease?

Answer 36

Intraepithelial lymphocytosis, loss of intestinal villi, and mucosal atrophy

Question 37

What is the MOA of protease inhibitors (atazanavir, darunavir, indinavir, ritonavir: -navir)?

Answer 37

HIV antiretroviral meds that inhibit cleavage of the polypeptide precursor into mature viral proteins

Question 38

What is the side effects of protease inhibitors (atazanavir, darunavir, indinavir, ritonavir: -navir)?

Answer 38

Hyperglycemia, lipodystrophy, and drug-drug interactions due to inhibition of cytochrome P450

Question 39

What can Clostridium perfringens cause?

Answer 39

Causes late-onset food poisoning and clostridial myonecrosis (gas gangrene). The food poisoning is toxin-mediated, late onset, and causes transient watery diarrhea.

Question 40

The jaw jerk reflex afferent and efferent pathways are mediated by what nerves?

Answer 40

The jaw jerk reflex is a pathological cranial nerve reflex present in patients with bilateral upper motor neuron lesions, such as amyotrophic lateral sclerosis. Both the afferent and efferent pathways are mediated by the mandibular division of the trigeminal nerve (CN V3)

Question 41

Acid maltase (alpha-glucosidase) deficiency presents how?

Answer 41

Presents in early infancy with cardiomegaly, macroglossia, and profound muscular hypotonia. Abnormal glycogen accumulation within lysosomal vesicles is seen on muscle biopsy.

Question 42

What are the traits for Strep pyogenes?

Answer 42

PYR-positive, beta-hemolytic, G+ coccus that grows in chains

Question 43

Monomicrobial cases of necrotizing fasciitis is due to?

Answer 43

Necrotizing fasciitis is a severe infection of the subcutaneous tissue and deep fascia and is a surgical emergency, Often polymicrobial, but monomicrobial cases due to Strep pyogenes (group A strep)

Question 44

What is nephrogenic diabetes insipidus?

Answer 44

Polyuria, dilute urine (low urine specific gravity), hypernatremia, and high antidiuretic hormone

Question 45

What is the treatment for nephrogenic diabetes insipidus?

Answer 45

Thiazide diuretics and replacement of water losses.

Question 46

Benzodiazepine withdrawal is characterized by?

Answer 46

Anxiety, tremor, insomnia, and sympathetic hyperactivity (eg, diaphoresis, palpitations). Severe withdrawal may also include psychosis, seizures or death.

Question 47

Intestinal type of gastric adenocarcinoma presents how?

Answer 47

Forms a solid mass that projects into the stomach lumen and is composed of gland-forming cuboidal or columnar cells

Question 48

Diffuse type gastric adenocarcinoma presents how?

Answer 48

Infiltrates the stomach wall (linitis plastica) and displays signet ring cells on light microscopy

Question 49

Elderly patients are at increased risk of developing heat-related illness due to several features of normal aging that impair normal thermoregulatory mechanisms, including what?

Answer 49

-tonic contraction of the peripheral vasculature -reduced sweat gland density -reduced effective epidermal area available for heat transfer

Question 50

What genes are mutated in hypertrophic cardiomyopathy?

Answer 50

AD inherited condition resulting from mutations affecting genes that encode for myocardial contractile proteins of the sarcomere; myosin-binding protein C and beta-myosin heavy chain are the most commonly affected proteins. HCM is characterized by asymmetic septal hypertrophy and increased risk of sudden cardiac death

Question 51

Administration of metyrapone will cause what?

Answer 51

A decrease in cortisol synthesis via inhibition of 11-b-hydroxylase. In patients with an intact hypothalamic-pituitary-adrenal axis, this will cause a reactive increase in ACTH, 11-deoxycortisol, and urinary 17-hydroxycorticosteroid levels

Question 52

Sensitization to aeroallergens occurs when inhaled antigens induce what cells?

Answer 52

Induce T-helper (Th) cells to differentiate into Th2 cells. Th2 cells then promote B-cell maturation and isotype class switching to IgE

Question 53

Which carcinomas are the exception to lymphatic spread and instead will spread via hematogenous?

Answer 53

Renal cell carcinoma and hepatocellular carcinoma

Question 54

What changes to the heart occur with age?

Answer 54

Cardiomyocyte hypertrophy (ie, concentric left ventricular hypertrophy) occurs with age to allow for maintenance of left ventricular contractility and ejection fraction despite cardiomyocyte dropout and increased left ventricular after load (due to reduced aortic compliance)

Question 55

How is binge eating differentiated from bulimia nervosa?

Answer 55

By the absence of compensatory behaviors (eg self-induced vomiting, excessive exercise, fasting, misuse of laxatives)

Question 56

Immune glomerular injury results from what?

Answer 56

Results from immune complexes or neutrophil activation. Immune complex formation in the kidney typically produces renal-limited disease (except anti-glomerular basement membrane disease). Preformed circulating immune complex deposition is usually associated with small vessel vasculitis and hypocomplementemia.

Question 57

What is the most common symptomatic presentation of Cryptococcus neoformans infection?

Answer 57

Meningoencephalitis, typically in immunocompromised patients

Question 58

What is the histo for Cryptococcus neoformans?

Answer 58

Budding yeasts with thick polysaccharide capsules, which stain using mucicarmine or India ink

Question 59

Where is the nuclei of the vestibulocochlear nerve (CN VIII) located?

Answer 59

In the pons.

Question 60

Damage to the nuclei of vestibulocochlear nerve (CN VIII) can lead to what?

Answer 60

The vestibular portion of CN VIII conveys information about head position and movement and helps to stabilize the gaze during head movement; damage can lead to nystagmus.

Question 61

What can reverse warfarin? Which is quicker?

Answer 61

Both Vitamin K and fresh frozen plasma are used for reversing warfarin-induced anticoagulation Fresh frozen plasma rapidly reverses warfarin's effects whereas vitamin K requires time for clotting factor re-synthesis.

Question 62

What is the most common childhood nephrotic syndrome?

Answer 62

Minimal change disease

Question 63

What is the pathogenesis of minimal change disease?

Answer 63

Increased glomerular capillary permeability causes massive protein (eg, albumin) loss in the urine. Hypoalbuminemia reduces plasma oncotic pressure, which causes a fluid shift into the interstitial space, resulting in edema. Low oncotic pressure also triggers increased lipoprotein production in the liver (ie, hyperlipidemia).

Question 64

Glucose-6-phosphate dehydrogenase deficiency presents how?

Answer 64

By periods of acute hemolysis after oxidative stress (eg dapsone expsoure). It presents with anemia and hemolysis.

Question 65

Glucose-6-phosphate dehydrogenase deficiency presents how on peripheral smear?

Answer 65

Denaturated hemoglobin inclusions called Heinz bodies

Question 66

How does the Haemophilis influenza type B vaccine work?

Answer 66

The Hib vaccine induces anticapsular antibodies that facilitate complement-mediated phagocytosis of the bacterium. The vaccination series has drastically reduced the incidence of invasive disease caused by Hib, such as meningitis, bacteremia, pneumonia, and epiglottis.

Question 67

Malignant mesothelioma is associated with?

Answer 67

Malignanat mesothelioma is a rare neoplasm typically arising from the pleura. It is strongly associated with asbestos exposure and presents with progressive dyspnea, cough, and chest pain.

Question 68

What is seen on imaging and histo for malignant mesothelioma?

Answer 68

Unilateral pleural thickening or plaque formation is seen on imaging; pleural effusions are also common and may be hemorrhagic. Microscopic examination reveals tumor cells with numerous long, slender microvilli and abundant tonofilaments.

Question 69

Why is intermittent anovulatory cycles common in the first few years after menarche?

Answer 69

It is due to an immature hypothalamic-pituitary-ovarian axis producing low and irregular GnRH pulses. As a result, adolescent girls may have menstrual cycle variability with intermenstrual spotting and heavier menstrual bleeding.

Question 70

What meds cause constipation?

Answer 70

-Non-dihydropyridine calcium channel blockers (eg diltiazem, verapamil) -opiates -5-HT3 antagonists -iron tablets -aluminum containing antacids -meds with anticholinergic properties

Question 71

Lactic acidosis in septic shock results from what?

Answer 71

From tissue hypoxia, which impairs oxidative phosphorylation and causes shunting of pyruvate to lactate following glycolysis. Hepatic hypoperfusion also contributes to the buildup of lactic acid as the liver is the primary site of lactate clearance.

Question 72

Who is at risk for aspiration pneumonia?

Answer 72

Patients with dementia or hemiparesis may have dysphagia, which is a risk factor for aspiration pneumonia. Dependent lung consolidation is commonly seen in aspiration pneumonia.

Question 73

What is the MOA of foscarnet

Answer 73

Pyrophosphate analog that does not require intracellular activation by viral or cellular kinases. It directly inhibits both DNA polymerase in herpesvirus and reverse transcriptase in HIV.

Question 74

Intestinal atresia involving bowel distal to the duodenum occurs due to?

Answer 74

Due to vascular occulsion in utero. Superior mesenteric artery occlusion results in ischemia of the jejunum and ileum, resulting in a blind-ending proximal jejunum and a distal ileum that spirals around the ileocolic vessel that perfuses it (apple peel atresia)

Question 75

Chemotherapy-associated neutropenic fever is most often caused by?

Answer 75

Endogenous commensal bacteria that have translocated across damaged mucosal sites.

Question 76

Infective endocarditis (eg constitutional symptoms, fever, new cardiac murmur) can affect multiple organs, including the kidneys. Which kidney disease?

Answer 76

Glomerulonephritis typically occurs due to injury caused by circulating immune complex-mediated injury (type III HSR), which is characterized by acute kidney injury and hematuria with red blood cell casts.

Question 77

What happens in chronic thiamine (B1) deficiency?

Answer 77

Impairs glucose use, particularly in mammillary bodies, as seen in Wernicke encephalopathy. This occurs due to decreased activity of the enzyme that use thiamine as a cofactor (eg transketolase).

Question 78

What is diagnostic of a chronic thiamine (B1) deficiency?

Answer 78

Low erythrocyte transketolase activity that increases after the addition of thiamine pyrophosphate.

Question 79

What does angiotensin II do?

Answer 79

Angiotensin II preferentially constricts the efferent arteriole, resulting in an increased hydrostatic pressure gradient and an increased net filtration pressure.

Question 80

The net filtration pressure is a result of pressure gradients formed by Starling forces and is calculated by?

Answer 80

Subtracting the oncotic pressure gradient from the hydrostatic pressure gradient

Question 81

What is a major pathogen in burn patients?

Answer 81

Pseudomonas aeruginosa

Question 82

What drugs treat Pseudomonas aeruginosa?

Answer 82

Penicillins (eg ticarcilin, piperacillin) Cephalosporins (ceftazidime, cefepime) Aminoglycosides Fluroquinolones (ciprofloxacin, levofloxacin) Carbapenems (imipenem, meropenem)

Question 83

What is cataracts? What causes it?

Answer 83

Cataracts: progressive opacification of the lens with chronic loss of visual acuity Aging and environmental (eg, UV light) contribute to cataract formation by inducing nuclear sclerosis, photooxidative damage to lens crystallins, and osmotic injury

Question 84

What causes hemolytic disease of the newborn?

Answer 84

Occurs from maternal sensitization to Rh antigens during a prior pregnancy with an Rh(D)+ fetus. In subsequent Rh(D)+ pregnancies, maternal anti-R(D) IgG antibodies cross the placenta and cause a severe autoimmune hemolytic anemia in the fetus and life-threatening hydros fetalis.

Question 85

What is hemoglobin S (HbS)?

Answer 85

It contains valine in place of glutamic acid at the 6th amino acid position of the beta globin chain. This promotes hydrophobic interaction among Hb molecules and results in HbS polymerization and erythrocyte sickling.

Question 86

two functions of Type II pneumocytes

Answer 86

regeneration of the alveolar lining following injury and surfactant production

Question 87

What is the cause of fragile X syndrome?

Answer 87

It is caused by a trinucleotide repeat expansion in the FMR1 gene on the X chromosome, which causes hypermethylation and inactivation.

Question 88

How does fragile X syndrome present?

Answer 88

-Physical findings (eg, long, narrow face; large testes) -intellectual disability -neurobehavorial findings (eg, attention deficit hyperactivity disorder)

Question 89

Where does Aspergillus fumigatus colonize?

Answer 89

Aspergillus fumigatus, a ubiquitous environmental mold, can chronically colonize old pulmonary cavities (eg, prior tuberculosis), forming a fungus ball (aspergilloma) that does not elicit a significant host immune response and is typically discovered incidentally.

Question 90

What is the function of the primary somatosensory cortex (postcentral gyrus)?

Answer 90

the primary somatosensory cortex (postcentral gyrus) is responsible for processing all somatic sensory input from the contralateral side of the body

Question 91

A focal onset seizure originating in the primary somatosensory cortex (postcentral gyrus) results in?

Answer 91

Contralateral sensory disturbance (eg, numbness, paresthesia)

Question 92

What is the timeframe for separation anxiety?

Answer 92

more than 4 weeks in children more than 6 months in adults

Question 93

Reduced aldosterone production in primary adrenal insufficiency leads to what?

Answer 93

Leads to renal sodium wasting with consequent hypovolemia, orthostasis, and potassium retention (hyperkalemia). Low cortisol stimulates increased antidiuretic hormone secretion, which leads to water retention and hyponatremia

Question 94

Why do patients on warfarin develop a transient hypercoagulable state?

Answer 94

Patients on warfarin develop a transient hyper coagulable state due to the short half-life of protein C. This hypercoagulability is further exaggerated by preexisting protein C deficiency and can result in thrombotic occulsion of the microvasculature with skin necrosis.

Question 95

Strep pneumo infection is the leading cause of what diseases in adults?

Answer 95

-community-acquired pneumonia -otitis media -meningitis

Question 96

How does strep pneumo appear on gram stain?

Answer 96

Lancet-shaped G+ cocci in pairs

Question 97

Bacterial meningitis will show what in the cerebrospinal fluid?

Answer 97

Increase in CSF neutrophil count and protein concentrations Decrease in CSF glucose

Question 98

Clostridium tetani produces what kind of neurotoxin?

Answer 98

Produces the neurotoxin tetanospasmin, which blocks inhibitory neurotransmission in the spinal cord and leads to tonic muscular contraction

Question 99

How is tetanus prevented?

Answer 99

By immunization with an inactivated toxoid that triggers the production of antitoxin antibodies (active immunity)

Question 100

How does excessive acetaminophen cause toxicity?

Answer 100

Causes toxicity through its metabolite N-acetyl-p-benzoquinone imine, which disrupts hepatocyte mitochondrial function and induces oxidative injury throughout the liver. The resulting hepatocellular liver injury markedly elevates aminotransferase, with levels sometimes exceeding 1,000 U/L.

Question 101

MOA of dobutamine

Answer 101

b-adrenergic agonist with predominant activity on b1 receptors and weak activity on b2 and a1 receptors. Stimulation of b1 receptors leads to an increased production of cAMP and increasaed cytosolic Ca2+ concentration. This facilitates the interaction between actin and myosin, resulting in increased myocardial contractility.

Question 102

Direct inguinal hernias occur due to?

Answer 102

Occur most commonly in older men due to weakness of the transversalis fascia They protrude medial to the inferior epigastric vessels into the Hesselbach triangle and pass only through the superficial inguinal ring with no direct route to the scrotum

Question 103

What is the cardiorespiratory response to exercise?

Answer 103

Increased heart rate, cardiac output, and respiratory rate in order to balance the increased total tissue oxygen consumption and carbon dioxide production. These coordinated adaptions result in relatively constant arterial blood gas values whereas venous oxygen is decreased and venous carbon dioxide is increased

Question 104

In 90% of individuals, occulusion of the right coronary artery can result in what?

Answer 104

transmural ischemia of the inferior wall of the left ventricle, producing ST elevation in leads II, III, and aVF as well as possible sinus node dysfunction

Question 105

Occlusion of the proximal left anterior descending artery will result in?

Answer 105

anteroseptal transmural ischemia, with ST elevations in leads V1-V4

Question 106

Occulusion of the left circumflex artery will produce?

Answer 106

transmural ischemia of the lateral wall of the left ventricle, with ST elevations mainly in V5 and V6, and possibly also in I and aVL

Question 107

Simvastatin effect on cholesterol

Answer 107

decreases hepatic cholesterol production

Question 108

Cholestyramine effect on cholesterol

Answer 108

Increases hepatic cholesterol and bile acid synthesis