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  1. What are the bile acid resins?
    Cholestyramine, Colestipol, Colesevelam
  2. What are the bile acid resins and how do they work?
    • Cholestipol, Cholestyramine, Colesevelam
    • They work by binding to bile acid in the GI, preventing its circulation.
  3. How do the values of these change in the use of Bile acid resins? LDL, HDL, TRIGLYCERIDES
    • LDL:⇓⇓
    • HDL: Slightly⇑
    • TRIGLYCERIDES: Slightly ⇑
  4. Which lipid lowering agens should be used in caution in patients with preexisting galbladder disease?
    • Bile acid resins: Cholestyramine, Colestipol, Colesevelam
    • Fibrates: Gemfibrozil, Clofibrate, Bezafibrate, Fenofibrate
  5. What causes Primary hemochromatosis?
    Caused by C28Y or H63D mutation on HFE gene.
  6. This disease is caused by a C28Y mutation on HFE gene.
    Primary hemochromatosis
  7. This disease is caused by a H63D mutation on the HFE gene.
    Primary hemochromatosis
  8. What is the function of the HFE protein?
    The HFE protein normally interacts with the transferrin receptor to increase endocytosis of the iron-transferrin complex.
  9. Micronodular cirrhosis are characteristic of?
  10. Describe the findings of hemochromatosis.
    • 1. Micronodular cirrhosis
    • 2. Diabetes mellitus
    • 3. Skin pigmentation (bronze diabetes)
  11. What are patients with hemochromatosis at risk for?
    • Heart failure
    • TESTICULAR atrophy
  12. Abnormal migration of the ventral pancreatic duct results in?
    Annular pancreas
  13. What causes an annular pancreas?
    Abnormal migration of the VENTRAL pancreatic bud around the 2nd part of the duodenum
  14. Incomplete fusion of the ventral and dorsal pancreatic buds leads to the formation?
    Pancreas divisum
  15. What is the most common cause of Intraparenchymal hemorrage?
  16. This intracranial hemorrage is caused by systemic hypertension.
    Intraparenchymal hemorrage
  17. What are Charcot-Bouchard pseudoaneurysms? Where are they commonly found?
    • Expansion of small arteries that perfuse the BASAL GANGLIA and INTERNAL CAPSULE.
    • Associated with Intraparenchymal hemorrage.
  18. What is the pathology seen below?
    Image Upload 1
    • Intraparenchymal (hypertensive) hemorrage
    • Charcot-bouchard aneurysm
  19. What is the pathology seen below?
    Image Upload 2
    • Intraparenchymal (hypertensive) hemorrage
    • Charcot-bouchard aneurysm
  20. What is the pathology seen below?
    Image Upload 3
    • T wave inversion- Indicates recent MI
    • T wave represents ventricular repolarization
  21. What does the T wave represent?
    Ventricular repolarization
  22. What represents ventricular repolarization on the ECG?
    T wave
  23. What does a T wave inversion indicate?
    Recent MI
  24. What is the normal duration of the QRS complex?
    Less than 120 msec
  25. What causes a widened ORS complex?
    • 1. Right bundle branch block
    • 2. Fasicular block
    • 3. Pacemakers
  26. What is the most common cause of aortic stenosis ?
    Early onset calcification of aortic valve leaflets/ bicuspid valve leaflets.
  27. Early onset of calification of bicuspid aortic valve leaflets is associated with which pathology?
    Aortic steonosis
  28. Describe the presentation of Aortic stenosis
    • Syncope- lightheadedness
    • Angina
    • Dyspnea
  29. Describe the heart murmur of an aortic stenosis
    Systolic ejection murmur that radiates to the carotids
  30. Myxomatous degeneration of the mitral valve leaflets can cause?
    Mitral valve prolapse
  31. What is a major side effect of Linezolid?
    Linezolid is a weak monoamine-oxidase inhibitor and thus can precipitate serotonin syndrome.
  32. Which antibiotic can cause serotonin syndrome?
  33. What toxicity is Clindamycin associated with?
    Infection with Clostridium difficile
  34. What are the toxicities associated with the use of Doxycycline?
    • GI distress
    • Discoloration of teeth
    • Enamel hypoplasia
    • Inhibition of bone growth
    • Photosensitivity
  35. What is the function of Tropomyosin?
    Prevents cross linking between actin and myosin
  36. This structure prevents cross linking between actin and myosin.
  37. What removes the tropomyosin out of the myosin-binding groove on actin filaments?
  38. What is the DOC for the treatment of trigeminal neuralgia?
  39. What is the MOA and use of Baclofen?
    • GABA agonist; muscle relaxant
    • Used in the treatment of Spasticity in Multiple Sclerosis
  40. What are the effects of Glucocorticoids on the liver?
    Promote an increase in liver protein synthesis involved in GLUCONEOGENESIS
  41. What are the effects of glucocorticoids on gluconegenesis?
    Increases gluconeogenesis
  42. What are the effects of glucocorticoids on the skin?
    • Inhibit fibroblast proliferation and collagen formation in the skin.
    • As a result, there is skin thinning, susceptible to trauma. Purple striae, impaired wound healing
  43. What are the effects of glucocorticoids on: T lymphocyte, Eosinophils, Neutrophils
    • T lymphocytes: ⇩
    • Eosinophils: ⇩
    • Neutrophils: ⇧
  44. What are the effects of neutrophils on glucocorticoid administration?
    Neutrophils counts actually increase as a result of remargination from the walls of blood vessels.
  45. What are the effects of glucocorticoids on bone mass?
    • Decrease bone mass by direct inhibition of osteoblast- bone forming cells⇩ GI Ca2+ absorption, ⇧ Renal Ca2+ excretion
    • Can cause OSTEOPOROSIS
  46. What are the effects of glucocorticoids on insulin?
    Insulin antagonist
  47. What are the effects of glucocorticoids on skeletal muscle?
    Skeletal muscle weakness
  48. What is responsible for Gram negative septic shock?
    Lipid A of lipopolysaccaride
  49. E.coli strains that cause neonatal meningitis synthesize?
    K-1 capsular antigen
  50. K1 capsular antigen is a virulence factor for which diseases?
    E.coli - pneumonianeonatal meningitis
  51. The O anigen is characteristic of?
    Gram-negative bacteria
  52. What is the main regulator of Thyroid stimulating hormone (TSH) secretion? How does it work?
    • 1. T4 produces T3 
    • 2. T3 inhibits TRH (Thyrotropin releasing hormone) secreting neurons of the hypothalamus 
    • 3. T3 also inhibits TSH secreting neurons of the anterior pituitary
    • 4. T3 also decreases responsiveness of TSH to TRH.
  53. How is T3 made?
    Conversion of T4 to T3 by type II deiodinase present within the cells of the hypothalamus and pituitary gland.
  54. The thyroid hormone exists in three forms. What are they?
    • T4- produced in the greatest quantity by the thyroid gland
    • T3- the most acitve form
    • Reverse T3- an inactive form
  55. What are the effects of Exogenous T3 supplementation?
    Reduce circulating level of TSH and thus decrease secretion of T4 from the thyroid gland (which would also lead to decreased rT3)
  56. What causes Appendicitis?
    • 1. Lumen obstruction by fecolith (in adults)
    • 2. Lymphoid hyperplasia (in children)
    • 3. Foreign bodies, tumors
  57. Describe the pain associated with Appendicitis.
    Pain starts periumbilical (around bellybutton) and then moves to the right lower abdominal quadrant
  58. What is McBurney's point?
    • 1/3 the distance from the right anterior superior iliac spine to the umbilicus
    • Image Upload 4
  59. What are some differentials to Appendicitis?
    • Diverticulitis (elderly)
    • Ectopic pregnancy (use β-hCG to rule out)
  60. What is the pathology seen below?
    Image Upload 5
    Pulmonary fibrosis
  61. What is the pathology seen below?
    Image Upload 6
    Pulmonary fibrosis
  62. What is the pathology below?
    Image Upload 7
    • Pulmonary fibrosis - 
    • Progressive fibrosis can lead to cystically-dilated bronchioles that later coalesce to form the honeycomb appearance found in advanced disease
  63. Describe the changes of these in idiopathic pulmonary fibrosis.
    FEV1, FVC, FEV1/FVC ratio, TLC Diffusion capacity,
    • FEV1: ⇩
    • FVC: ⇩
    • FEV1/FVC ratio: ⇧ (greater than 80%)
    • Diffusion capacity: ⇩
  64. In this pathology, chest x ray shows a diffuse pattern of small, irregular reticulonodular opaciates that are most pronounced in the lower lobes.
    Pulmonary fibrosis
  65. Describe the chest x-ray findings of pulmonary fibrosis.
    Reticulonodular, net like opacities that are most pronounced in the lower lobes.
  66. Which drugs cause pulmonary fibrosis?
    • Lung fibrosis from
    • Bleomycin
    • Amiodarone
    • Busulfan
    • Methotrexate
  67. What is the pathology seen below?
    Image Upload 8
    • Pulmonary hypertension
    • Enlarged pulmonary arteries and right ventricle
    • Image Upload 9
  68. t(14; 18) is characteristic of?
    • Follicular lymphoma 
    • 14- heavy chain Ig
    • 18- Bcl-2 (anti-apoptotic gene)
  69. Why is Bcl-2 considered a protooncogene?
    It has anti-apoptotic effects
  70. t(8;14) is characteristic of?
    • Burkitt lymphoma
    • 8- c-myc
    • 14- heavy chain Ig
  71. This disease has a mutation in p53.
    Li-Fraumeni syndrome
  72. What is hydrocephalus ex vacuo and what causes it?
    In hydrocephalus ex vacuo, ventricular enlargement occurs due to brain atrophy and is not accompanied by increase in CSF pressure.
  73. Hydrocephalus ex vacuo/ Ex vacuo ventriculomegaly can occur in which diseases?
    • Decreased brain tissue
    • Alzheimer's disease
    • Pick disease
    • HIV infection***
  74. What is the pathology?
    Image Upload 10
    • Hydrocephalus ex vacuo
    • Brain atrophy, no ⇧ in CSF, Normal intracranial pressure
  75. What is the pathology?
    Image Upload 11
    • Communicating hydrocephalus
    • All ventricles are dilated
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