Assessment Of Chronic Disease Control OSCE Station

Question 1

What is INR?

Answer 1

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

Question 2

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

Answer 2

Normal = 1
Warfarin = 2-3 (2.5)

Question 3

What is the mechanism of action for Warfarin?

Answer 3

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

Question 4

Indications for Warfarin

Answer 4

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

Question 5

What are the symptoms of High INR?

Answer 5

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

Question 6

What are the symptoms of Low INR?

Answer 6

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

Question 7

What Past Medical History is relevant to Warfarin?

Answer 7

Liver Failure, Bleeding Disorders

Question 8

Why is important to not double dose on Warfarin?

Answer 8

It can lead to dangerously High INR

Question 9

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

Answer 9

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

Question 10

What advice should be given to somebody taking Warfarin?

Answer 10

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

Question 11

How to treat High INR?

Answer 11

Vit K, Blood Components, decrease Warfarin.

Question 12

How to treat Low INR?

Answer 12

LMWH, Increase dose of warfarin, Compression stockings.

Question 13

What is HbA1c?

Answer 13

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

Question 14

What are the normal and diabetic values of HbA1c?

Answer 14

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

Question 15

What are the benefits of good HbA1c control?

Answer 15

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

Question 16

What are the symptoms of poor diabetes control?

Answer 16

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

Question 17

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

Answer 17

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

Question 18

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

Answer 18

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

Question 19

Advice for lowering HbA1c?

Answer 19

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

Question 20

What is Peak Flow?

Answer 20

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

Question 21

Advice for using a Peak Flow Meter

Answer 21

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

Question 22

How to interpret a PEF?

Answer 22

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.

Question 23

What is Spirometry?

Answer 23

Measures functional volumes of lungs.

Question 24

FEV1 Vs FVC

Answer 24

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

Question 25

How to interpret FEV1 and FVC?

Answer 25

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

Question 26

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

Answer 26

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

Question 27

What are the two most common inflammatory markers?

Answer 27

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

Question 28

What is CRP and what is it used for?

Answer 28

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.

Question 29

What is ESR and what is it used for?

Answer 29

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

Question 30

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

Answer 30

Travel, ADL's, Smoking, Drinking

Question 31

What are LFTs used for?

Answer 31

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

Question 32

ALT/AST

Answer 32

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

Question 33

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

Answer 33

Alcohol-induced liver damage

Question 34

ALP/GGT

Answer 34

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.

Question 35

How to interpret ALP/GGT?

Answer 35

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

Question 36

Bilirubin

Answer 36

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

Question 37

Albumin

Answer 37

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.

Question 38

What Past Medical History is relevant to the LFT station?

Answer 38

Gallstones, Inflammatory Bowel Disease, Surgery (Colectomy).

Question 39

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

Answer 39

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

Question 40

How to approach the MOCD Station?

Answer 40

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.