Chronic disease

Question 1

HbA1c
Steps

Answer 1

Tell me what you know
ICE
When and what were the sx?
What type
PMH
Current control - impact
SE of drugs
Complicance
Sx?
What influences change?
Lifestyle advice
Safety net
Monitor glucose regularly?
Injection sites
Results?

Question 2

Peak flow

Answer 2

Check understanding - diurnal dips
How does peak flow come into this
HPC - Eg asthma attacks
Drug HX
Social HX - smoking, PETS, work, allergies
Change - damp house
Lifestyle advice - inhaler technique
Safety net

Question 3

INR

Answer 3

Tell me what you know about INR/warfarin
ICE
Do you understand what warfarin is (thins blood) - requires frequent tests
Current warfarin use
Do you ever miss a dose - what do you do
High or low INR - work out why
Lifestyle advice - medication and monitor, regular amount of vitamin K

Question 4

What are the Sx of high INR ans potential causes?

Answer 4

Too much warfarin, other medication (NSAIDS, St John’s wart, aspirin), Liver failure, decreased vitamin K, alcohol binge, smoking

Bruising, bleeding, headache, blood in urine, bloody dark stools, increased period

Question 5

What are the sx of low INR and potential causes?

Answer 5

Sx: weakness, tingling, visual change, speech disturb, new pain or swelling, new SOB chest pain

Vitamin K (HIGH VIT K), oestrogen (HRT, COCP)

Question 6

ALT readings

Answer 6

What is ALT - liver cell damage
AST:ALT 2:1 is alcohol damage
GGT - liver damage from drugs and alcohol
Bilirubin - gallstones
ALP - bile duct obstruction, bone turnover, Hilary tract disease

Question 7

LFT

Answer 7

ICE/what do you know about the disease
HPC
PMH
SHX - travel, sex, tattoos, alcohol, fat
FHX
Lifestyle advice - CAGE, don’t do drugs, protection, lose weight

Question 8

What is CAGE

Answer 8

USED IN LFT
Have you ever thought about CUTTING down
Do you ever get ANNOYED at others who ask about your drinking
Do you ever feel GUILTY about how much you drink
EYE OPENER - have you ever woken up and needed a drink to start the day

Question 9

What are the causes of raised CRP?

Answer 9

Non specific inflammatory markers
ACUTE MARKER RELEASED BY THE LIVER

• Burns
• trauma
• infection
• tb
  -pneumonia
• MI
  -Lupus
• vasculitis
• RA
• IBD
• certain cancers

Question 10

What are the causes of raised ESR?

Answer 10

Raised in inflammation

Malignancy
Blood cancers, anaemia
SLE, RA, poly myalgia rheumatics, temporal arthritis
TB, acute hepatitis, bacterial

*CHANGES - smoking, compliance, sx, mobility