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Jack's Phase 2B Cards > Assessment Of Chronic Disease Control OSCE Station > Flashcards

Assessment Of Chronic Disease Control OSCE Station Flashcards

1
Q

What is INR?

A

International Normalised Ratio: It is a measure of how long it takes for blood to clot.

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2
Q

What is the normal INR for healthy people and those who take Warfarin?

A

Normal = 1
Warfarin = 2-3 (2.5)

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3
Q

What is the mechanism of action for Warfarin?

A

It is Vitamin K antagonist - Vit K is used by the liver to make clotting factors II, VII, IX, X.

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4
Q

Indications for Warfarin

A

AF, DVT, PE and the presence of artificial heart valves.

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5
Q

What are the symptoms of High INR?

A

Headache, Abdominal Pain, Bruising, Heavy Bleeding, Gingivitis, Haematuria.

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6
Q

What are the symptoms of Low INR?

A

Weakness, Numbness (Stroke Symptoms), Pain, Swelling, Erythema, SOB and pleuritic chest pain.

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7
Q

What Past Medical History is relevant to Warfarin?

A

Liver Failure, Bleeding Disorders

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8
Q

Why is important to not double dose on Warfarin?

A

It can lead to dangerously High INR

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9
Q

What elements of a Social History are important in Warfarin assessment?

A

Vit K Foods - Green leafy vegetables and grapefruit juice.
Alcohol Binge - Increases INR
Smoking - Increases INR

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10
Q

What advice should be given to somebody taking Warfarin?

A

Avoid activities that cause bleeding/bruising.
Brush/Shave gently
Tell the Dentist that they are taking Warfarin

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11
Q

How to treat High INR?

A

Vit K, Blood Components, decrease Warfarin.

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12
Q

How to treat Low INR?

A

LMWH, Increase dose of warfarin, Compression stockings.

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13
Q

What is HbA1c?

A

Glycated Haemoglobin - It is a measure of blood sugar over the last 3 Months.

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14
Q

What are the normal and diabetic values of HbA1c?

A

Normal = 42mmol/L
Prediabetic = 42-47.
Diabetic 48+.

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15
Q

What are the benefits of good HbA1c control?

A

Decreased Risk of:
Retinopathy, Neuropathy, Nephropathy, Cataracts, HF, Amputation

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16
Q

What are the symptoms of poor diabetes control?

A

Polyuria, Polydipsia, Weight Loss, Fatigue, Tingling, Vision Changes

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17
Q

What elements of a past medical history are relevant to an HbA1c discussion?

A

Vascular, Renal (Kidney Failure), Visual Changes.
Alcoholism, B12 Deficiency
(Increase HbA1c)
Blood Loss, Sickle Cell, Thalassemia (Decrease HbA1c)

18
Q

What aspects of a Social History are important for an HbA1c assessment?

A

Dietary Changes, Exercise, ADLs, Alcohol intake and smoking.

19
Q

Advice for lowering HbA1c?

A

Diet (Carbs), Physical Activity, Regular blood pressure monitoring, access to online and medical support.
Taking Extra Care When Ill - “Sick Day rules”

20
Q

What is Peak Flow?

A

The Maximal Expiratory Flow Velocity on forced expiration. It helps patients with Asthma and COPD to better understand their condition.

21
Q

Advice for using a Peak Flow Meter

A

Always use the same meter to take readings - take the reading before taking the reliever inhaler.

22
Q

How to interpret a PEF?

A

Normal PEF values depend on age, height and sex - there is significant variation between morning and evening (Better), in asthmatics - this is known as Diurnal Variation.
Lower PEF means there is airway narrowing.

23
Q

What is Spirometry?

A

Measures functional volumes of lungs.

24
Q

FEV1 Vs FVC

A

FEV1 - Forced expiratory volume in one second.
FVC - Forced Vital Capacity - the maximal volume of air that can be exhaled after maximal inhalation.

25
Q

How to interpret FEV1 and FVC?

A

FEV1/FVC > .7 - Suggests restrictive lung disease such as PF, Guillain-Barre, MG.

26
Q

What aspects of a Social History are important for a Resp Assessment?

A

Pets, Travel, Allergies, Damp, Smoking, Alcohol and ADL’s.

27
Q

What are the two most common inflammatory markers?

A

CRP (C-Reactive Protein)
ESR (Erythrocyte Sedimentation Rate)

28
Q

What is CRP and what is it used for?

A

It is an acute inflammatory protein that is usually below 1mg/dl - levels of CRP are used to monitor disease activity in autoimmune and inflammatory conditions.

29
Q

What is ESR and what is it used for?

A

Inflammation increases fibrinogen which causes RBCs to fall faster. It is raised in malignancy, haematological conditions, connective tissue disorders and infections.

30
Q

What aspects of a Social History are important for Inflammation management?

A

Travel, ADL’s, Smoking, Drinking

31
Q

What are LFTs used for?

A

Investigate liver disease, monitor confirmed liver disease, and monitor hepatotoxic medications.

32
Q

ALT/AST

A

These are enzymes that are found in the liver at high concentrations.
Raised levels indicate hepatocyte damage such as cirrhosis, hepatitis, and malignancy.

33
Q

What does an AST/ALT ratio of 2+ indicate?

A

Alcohol-induced liver damage

34
Q

ALP/GGT

A

ALP is derived from biliary epithelial cells and bones and, therefore, is an indicator of cholestasis or bone disease.
GGT is found in hepatocytes and biliary epithelial cells therefore is highly sensitive for liver damage and cholestasis.

35
Q

How to interpret ALP/GGT?

A

+ ALP, Normal GGT - Bone Disease such as Paget’s, Vit D, Metastates.
+ ALP, + GGT - Cholestasis
Normal ALP, + GGT - Alcoholism

36
Q

Bilirubin

A

A waste product of haemoglobin breakdown, the raised level is jaundice.

37
Q

Albumin

A

Protein synthesised in the liver to transport molecules and to maintain blood pressure.
- Low Levels can be due to malnutrition and hepatorenal disease.
- High Levels are due to infections, dehydration, chronic inflammation, and hepatitis.

38
Q

What Past Medical History is relevant to the LFT station?

A

Gallstones, Inflammatory Bowel Disease, Surgery (Colectomy).

39
Q

What aspects of a Social History are important for LFT management?

A

Travel, Smoking, Alcohol, Recreational drugs, Diet, ADLs.

40
Q

How to approach the MOCD Station?

A

Intro - WIPCER, give the patient the test result and check their understanding of the test and condition. (Explain if necessary).
History - Ask how they are feeling and whether they have had a recent illness.
- Enquire about system-relevant symptoms.
Past Medical History - System relevant enquiry.
Drug History - What do they take and when, side effects, technique, how well is it controlled, any other medications.
Social History - System Specific Enquiry.
- Give the patient advice on managing their condition if asked.

41
Q
A

Jack's Phase 2B Cards (19 decks)

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