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Question 1

Intercostal Neurovascular

Answer 1

• Runs on the inferior portion of the rib, NAV from low to high
• Thoracocentesis should occur on the superior portion of the rib

Question 2

Internal Thoracic

Answer 2

• Supply intercostals and also terminate as superior epigastrics
• In post ductal coarctation these will enlarge, rib notching and anastamoses to increased flow to lower limbs

Question 3

CT of Thorax

Answer 3

• Trachea is central
• Esophagus is smaller and to the patients left followed more laterally by the descending aorta
• Azygous vein and arch of the azygous are midline behind the trachea and partially to R of midline

Question 4

Nodal Supply

Answer 4

SA and AV nodes are supplied by the RCA and infarction will lead to conduction abnormalities

Question 5

Cardiac Auscultation

Answer 5

• Aortic area is in the right second intercostal space
• Pulmonary is the left second intercostal space
• Tricuspid is the Rightlower sternal border
• Mitral is the 5th intercostal space on the left side

Question 6

Truncus Arteriosus

Answer 6

-Becomes the outflow tract

Question 7

Bulbus Cordis

Answer 7

Smooth part of right ventricle

Question 8

Sinus Venosus

Answer 8

Smooth part of right atrium and coronary sinuses

Question 9

Arches

Answer 9

3: Common carotide
4: arch of aorta and proximal brachiocephalic
6: pulmonary artery etc

Question 10

Cardinal Veins

Answer 10

Anterior forms the internal jugular and superior vena cava

-Posterior forms the inferior vena cava and the illiac veins

Question 11

Vittleine

Answer 11

Returns blood from the yolk sac

Question 12

Fat soluble vitamin deficency

Answer 12

Mineral Oil

Question 13

Function of Vitamins

Answer 13

• B1: Decarboxylation reactions (PDH, Transketolase (HMP shnt), alpha ketoglutarate, BCAA)
• B2: FAD: oxidation and reduction
• B3: NAD: Oxidation and reduction
• B5: Pantothenic Acid: CoA (FA synthesis)
• B6: Pyidoxal phosphate, Transamination and decarboxylation. (Heme, ALT/AST, Niacin, Caetacholamines, cystathione
• B7, Biotin: Carboxylation reactions (Pyruvate carboxylase in GNG and Acetyl CoA carboxylase in FA synthesis)
• B9 Folic Acid: THF, leads to 1 carbon transfers
• B12: cobalamin, 1 carbon transfer

Question 14

B1, Thiamine

Answer 14

• Functions in decarboxylation reactions. PDH, Transketolase, AA metabolism via BCAA and ketoglutarate
• Highly metabolic tissues are at most risk (Heart and nerves) because of decreased flux capacity of oxidative phosphorylation
• Dry Beri Beri: Neuropathy and muscle Weakness
• Wet Beri Beri: DCM and high output cardiac failure
• Wernicke Korsakoff: Often precipirated by glucose infusion leads to necrosis of mamillary bodies

Question 15

Vitamin A

Answer 15

• Necessary as transcription factor receptor ligand
• Requried to maintain specialized tissues (Keratomalacia, squamous metaplasia) (also secretory and glandular epithelium is at most risk)
• Also Makes retinal for rods function, Night Blindness commonly seen
• Can be used to treat Measles and APL (ATRA)
• Teratogenic in high doses: Cleft lip and palate and cardiac defects

Question 16

B2 Riboflavin

Answer 16

• FAD, used in oxidation and reductaion reactions (2 ATP generated per molecule)
• Deficency leads to cheliosis which is dry mouth and lips, glossitis, corneal neovascularization
• Can be seen in patietns given phototherapy due to aromatic flavin strucutre

Question 17

B3 Niacin

Answer 17

• NAD, used in oxidation and reduction reactions, 3 ATP per molecule
• Synthesized de novo from tryptphan using B6 as a coenzyme
• Deficency can occur in B6 loss (INH), Hartnup’s disease (Impaired neutral AA resprbtion), carcinoid syndrome
• Pellegra: Dermatitis, Dementia, Diahrrea
• Is used pharmacologically to raise HDL levels, flushin is a side effect, can be reduced with admintration of COX inhibitors

Question 18

B5 Panthothenat

Answer 18

-Compenent of Acetyl CoA deficency is rare

Question 19

B6 Pyridoxine

Answer 19

• Coenzyme in transamination reactions
• Requried for Heme synthesis, Niacin Synthesis, ALT and AST function, Caetacholamine Synthesis and cystiene synthesis
• Symptoms of defecit are peripheral neruopathy and sideroplastic anemia (Decrease ALA-D function)

Question 20

B7 Biotin

Answer 20

• Necessary for carboxylation reactions (anabolic combination reactions)
• Required for GNG and FA synthesis (Pyruvate Carboxylase, etc)
• Deficecny is rare but can occur with antibiotics or conssumption of raw eggs
• Symptoms are diahrrea and dermatitis and also hypoglycemia from impired GNG

Question 21

B9: Folate

Answer 21

• Part of 1 methyl tansfers (actually bind methyl) necessary for pyrimidine synthesis (Thymidine)
• Requries B12 also
• Homocysteine to methionine is methyl donor source
• Labs will show macrocytic anemia without neurologic signs and also elevated methylmalonyl coa and homocystine
• Associated with neural tube defects
• Imparied function and metabolism leading to functional deficency occurs with MTX, Slufonamides, Phenytoin

Question 22

B12 Cyanocobalamine

Answer 22

Necessary Co factor for 1 methyl transfers.
-Homocysteine to methionine and Methylmalonyly CoA to succinyl CoA
-B6 subseqeuntly metabolizes homocystine to cystine and succiinyl coA to Heme
-Trasnfers 1 methyl to SAM from methionine which is necessary for caetacholamine synthesis
-Deficency leads to elevated methylmalonyl CoA, and homocystine, also megaloblastic anemia with subacute combined degeneration (Corticospinal, spinocerebellar, dorsal columns)
-Deficency Caused by:
Destruction of parietal Cells (pernicous anemia or gastric bypass)
-Impaired absorption from crons or sprue
-Diphylatthum Latum tapeworm from fish