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Phase 2b OSCE > Chronic disease management > Flashcards

Chronic disease management Flashcards

1
Q

What does INR stand for, and what information does it provide?

A

International Normalised Ratio (of prothrombin time). It provides information about a person’s blood’s tendency to clot

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2
Q

What should normal INR be, an what is the INR target range for a patient taking warfarin?

A

Normal: 1

Taking warfarin: 2 - 3

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3
Q

Name 5 foods that are high in Vitamin K

A

Broccoli, kale, green apples, cucumber, celery, pears, avocado (plus other green fruit and veg)

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4
Q

Explain (simply) the mechanism of action for warfarin

A

It is an anticoagulant - this decreases the bodies ability to form blood clots. It blocks an enzyme that stops the production of some clotting factors (specifically II, VII, IX and X)

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5
Q

Give 5 symptoms of a high INR (ie. symptoms of the complications of a prolonged clotting time)

A

Unusual/severe headache, increased bruising, prolonged bleeding after minor cuts, prolonged menstrual bleeding, bleeding from gums, haematemesis/haematuria/blood in stools

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6
Q

Give 5 factors (other than medication) that increase the risk of an elevated INR

A 
DISEASE, DOSE, DRUGS, DIET
Liver failure (bc lack of clotting factors), alcohol, bleeding disorders, decrease in vitamin K intake, smoking
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7
Q

How can changing warfarin adherence increase the risk of elevated INR?

A

DISEASE, DOSE, DRUGS, DIET
Taking too much warfarin (e.g double dosing), using warfarin and heparin together (which is fine, but INR needs to be checked more regularly)

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8
Q

Give 3 examples of medications that, in combination with warfarin, increase the risk of an elevated INR

A

Aspirin, NSAIDs, St Johns wart (herbal medication), Omeprazole, Metronidazole

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9
Q

Give 3 examples of lifestyle changes that can be made to decrease a person’s risk of bleeding

A

Avoid activities that may cause bleeding or bruising
Brush and shave gently
Tell your dentist and other healthcare professionals if you take anticoagulation

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10
Q

Give 5 symptoms of a low INR (ie. symptoms of a reduced clotting time)

A

Stroke symptoms: weakness in a limb, speech changes, visual changes, numbness/tingling

DVT/PE symptoms: new pain/swelling/redness/heat in a body part, new SOB or chest pain

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11
Q

Give 3 factors (other than warfarin adherence) that increase the risk of a low INR

A

Supplements containing vitamin K, high intake of foods containing vitamin K, oestrogen containing medication (e.g. OCP and HRT)

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12
Q

How is an elevated INR treated?

A

Vitamin K
Blood components
If there isn’t a clear explanation, warfarin dose may be decreased and INR re-checked in 4-7 days

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13
Q

How is a low INR treated?

A

LMWH, Warfarin

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14
Q

Name 4 conditions in which warfarin may be prescribed

A

Stroke, MI, DVT/PE, Atrial Fibrillation, Thrombophilia

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15
Q

What are the rules regarding taking warfarin and going on holiday?

A

Arrange for your INR to be checked before you go away. If you’re away for longer than a month, you may need your INR checking while you’re away. Make sure you have enough medication to last the duration of your trip

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16
Q

What is HbA1c and what information does it provide

A

HbA1c measure the amount of glycated haemoglobin in a person’s blood.

It gives an average blood glucose level over 2-3 months, and therefore gives an indication of a patient’s long(er) term management of their diabetes

17
Q

What are the HbA1c values for normal, pre-diabetes and diabetes

A

Normal: 42mmol/L or < 6.0%

Pre-diabetes: 42-47 mmol/L or 6.0 - 6.4%

Diabetes: 48 mmol/L or >6.5%

18
Q

What specific symptoms should be explored to assess the severity of a patient’s diabetes?

A

Polyuria, polydipsia, nocturia, polyphagia, visual changes, neuropathy symptoms, nephropathy symptoms, hospital admissions for DKA

19
Q

Give an example of a medication that can increase HbA1c levels

A

Corticosteroids

20
Q

Give 3 conditions which may falsely RAISE HbA1c

A

Kidney failure, chronic excessive alcohol intake, vitamin B12 deficiency

21
Q

Give 3 conditions which may falsely DECREASE HbA1c

A

Acute/chronic blood loss, sickle cell anaemia, thalassaemia

22
Q

Give 5 pieces of (brief) advice for keeping HbA1c levels under control

A 
Be careful what you eat
Stick to your treatment plan
Be as active as possible
Take extra care when you're ill (sick day rules)
Regularly your blood sugar level
23
Q

What questions could be asked to assess a patient’s compliance to diabetes medication?

A

How and when are they taking the medication?
How are they finding taking the medication? Any side effects?
Are they injecting it correctly?
Are they monitoring your glucose levels regularly?

24
Q

What should be asked in social history (for all chronic disease management stations)

A 
How is the disease affecting your ADLs?
Diet: Have you been on a diet recently or tried to lose any weight? (specifically for diabetes) are you adhering to the correct dietary restrictions?
Exercise
Smoking
Alcohol
25
Q

What is peak flow (in simple terms)?

A

A measurement of how quickly you can blow out air out of your lungs, to see how well your lungs are working

26
Q

What is spirometry (in simple terms)?

A

Measures lung function: specifically the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled

27
Q

What are the red flags for worsening asthma control?

A

Wheeze is getting worse
Affecting daily activities
Waking up at night with symptoms
Using reliever inhaler more than usual

28
Q

Give 2 examples of good peak flow habits

A

Take your peak flow BEFORE using your preventer inhaler

Always use the same peak flow meter

29
Q

What questions can be asked to find the cause of an asthma exacerbation?

A

Is there a particular time you notice that you asthma is worse (e.g. is it worse during the winter months)?
Any pets/new pets?
Recent travel? (e.g. to places that are particularly polluted)
Housing - damp?
Hayfever

30
Q

What questions can be asked in the drug history to assess asthma/COPD control?

A 
Are you currently taking any medication?
Which inhalers do you use?
How often are you using your inhaler?
What is your inhaler technique?
Do you take any other medication to help (e.g. oral steroids to help asthma)
Beta-blockers? (can worsen asthma)
31
Q

Give 6 pieces of lifestyle advice to help control a patient’s asthma/COPD

A 
Avoid/quit smoking
Avoid precipitants
Vaccination
Exercise
(?) eating
Support (GP/nurse reviews, asthma.org.uk)
32
Q

Give 7 causes of a raised CRP

A 
Burns
Trauma
Infections
Heart attack
Chronic inflammatory diseases
IBD
Certain cancers

Phase 2b OSCE (2 decks)

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