Chronic Conditions

Question 1

What is meant by Chronic Illness?

Answer 1

Chronic illness is where the diagnosis is already known and the patient has been dealing with their condition for a period of time already.

• The focus for the doctor is helping the patient to manage their illness.
• For this reason, the history of the illness is important and the current activity of the disease.

Question 2

Beyond the cardinal features, what is it important to ascertain for a chronic condition?

Answer 2

Psycho-social context of the patient:

• establish how the disease impacts the patients life
• establish how the lifestyle of the patient impacts on the disease

Question 3

What is asthma?

Answer 3

Asthma is a respiratory disease characterised by inflammation which leads to an increase in airway responsivness to a variety of triggers

Question 4

What are the typical symptoms of asthma?

Answer 4

• dyspnoea
• cough
• wheezing

Question 5

How is severity of asthma identified?

Answer 5

• quantified using peak expiratory flow (basis for asthma treatment)
• spirometry
• frequency of symptoms
  (need for GCS and hospitalisation can also indicate severity)

Question 6

What are some common precipitating factors for asthma?

Answer 6

• viral illnesses, exercise, pollens, smoke, dust and cold air

Question 7

What should you ascertain about the time course of a patient’s asthma?

Answer 7

• onset: childhood? adult?
• occurences: daily? with seasons? infrequent?
• Change over time?
• Episodes?
• Use of medications over time?

Question 8

What are some relieving factors for asthma?

Answer 8

• removal of stimuli

- anti-asthmatic drugs such as bronchodilators and GCS

Question 9

What are some associated features of asthma?

Answer 9

• atopic conditions (eczema, hav fever, hives)

Question 10

What are some considerations for asthma in terms of severity?

Answer 10

• interfere with ADLs?
• comparison with previous attacks
• drugs/hospitalisations? frequency etc?

Question 11

What are important elements of a social history?

Answer 11

• relationships and support systems !!
• -> Who lives at home with you?
• -> Where do you live?
• education and occupation !!
• finances
• ethnicity
• religion and spirituality
• hobbies !!
• pets !!
• travel !!

Question 12

What are important elements of an occupational history?

Answer 12

• may be due to occupational exposure
• ask about current/previous employment
• be sensitive to unemployment and issues surrounding job security
• how does work impact illness/illness impact work
• hobbies
• tasks at home

Question 13

What are the elements of the atopic triad?

Answer 13

• eczema
• hayfever
• asthma

Question 14

How would you recount a patient to a superior in a hospital environment? Summary?

Answer 14

Name, Age, Occupation

• -> who presents with (descriptor + condition/ symptome/…a likely…diagnosis)
• -> on a background of…./…in the context of …
• -> He has the following risk factors/FmHx
• -> His history in more detail is as follows… (time course etc.)