What does Peak Expiratory Flow measure?
How hard and fast the patient can exhale. In diseases with increased airway resistance e.g. asthma, the peak flow will be reduced.
What does spirometry measure?
The forced vital capacity (how much you can breathe out), the forced expiratory volume in 1 second and the FEV1/FVC can be calculated from this.
What is the equation to work out the percentage in PEFR?
Obtained value/Expected value x100
Give examples of and describe an obstructive disease
Obstructive diseases are due to narrowing of the bronchi/bronchioles. This could be due to inflammation. Examples include asthma, copd, emphysema, bronchiectasis
Describe and give examples of a restrictive disease
Restrictive disease is characterised by restricted lung expansion. Examples include pulmonary fibrosis.
What would the spirometry show for an obstructive disease.
Decreased FEV1, normal/decreased FVC.
FEV1/FVC will not be normal even if the FVC has decreased because it will not do so proportionally
What would the spirometry for a restrictive disease look like.
Both the FEV1 and FVC would be reduced. However the FEV1/FVC ratio will be normal.
Di-George syndrome
Repeated infections Muiltiple viral and bacterial infections Recurrent candidiasis Facial features suggestive Decreased T cell count Hypocalcaemia Cardiovascular system is abnormal
Pancoast tumour
Can invade the brachial plexus and cause muscle wasting in the hand and interrupts sympathetic innervation to the head
Graft-versus host disease
Recurrent skin rashes and infections
Skin abnormal across whole body
Underlying diagnosis form of SCID
Eaton Lambert syndrome
Paraneoplastic change
Hyporeflexia
Proximal limb weakness
Reduced autonomic activity
Geographic tongue
Characterised by red streaks on the tongue. No known cause. Harmless
Black hairy tongue
Caused by proliferation of chromogenic microorganisms causing brown staining of elongated fusiform papillae.
Cause is unknown by heavy smoking and antiseptic mouth washes are said to be associated.
Gingivae swelling
Swelling of the gums due to inflammation of fibrosis hyperplasia.
Associated with drugs, pregnancy, wegners granulomatos.
Chronic gingivitis
Accumalation of bacterial plaque. Resolves when plaque is removed. Common cause of bleeding gums.
Acute ulcerative gingivitis
Associated with poor oral hygiene. Proliferation of spirocheate and fusiform bacteria.
Treatment of acute ulcerative gingivitis
Oral metronidazole 200mg 3 times daily
Glassins
Red, smooth sore tongue.
Associated with B12, folate and iron deficiency
Also seen in Candida infections
What is the Henderson Hasselbach equation used for?
Calculating the pH of buffers.
What is the Henderson Hasselbach equation?
pH= pKa + log ([A-]/[HA]
How do you work out pH?
-log [H+]
How do you work out pKa
-log [Ka]
What is Ka
HA—–> H+ + A-
Ka (acid dissociated constant)= [H+][A-]/[HA]
What is an amphipathic molecule?
Both hydrophillic and hydrophobic
What sort of substances dissolve in water?
Polar substances
What do amphipathic molecules form in water?
Micelles where the hydrophobic end is in the middle surrounded by the hydrophillic ends.
Which amino acid is the expection to the configuration?
Cystiene
What is a stereoisomer?
Non-superimposable mirror images.
What are proteins made up of?
20 different L amino acids.
Recurrent apthous ulcers
Could be major or minor
Minor recurrent apthous ulcers
Less than 10mm in diameter. Usually clear up within 14 days. Have a grey/white centre with a thin erythematous halo.
Major recurrent apthous ulcers
Greater than 10mm in diameter. Often persist for weeks to months and heal by scarring
What diseases can cause ulcers?
IBD and coeliacs can cause ulceration. Also HIV and lupus.
Cause of recurrent apthous ulcers?
Unknown- deficiencies of iron, folic acid or vitamin B12 are sometimes present but not usually linked.
Treatment of recurrent apthous ulcers?
No treatment- avoid acidic foods and drinks
Possible topical corticosteroid or tetracycline mouth wash.
Neoplasia (squamous cell carcinoma)
Malignant tumour of the mouth. Can be caused by tobacco or heavy alcohol consumption.
Treatment of neoplasia
Surgical resection. Often requires dissection of the neck to access the lymph nodes involved.
Oral pigmentation lesions
Black areas on the gingivae. Can result from dental amalgum sequestering into tissues.
Oral white patches
Transient white patches either due to Candida infection or are very occasionally seen in systemic lupus erythematosus.
Oral candidiasis is seen in the use of inhaled corticosteroids or antibiotics.