Chronic Disease Management Flashcards
Normal INR? Those on warfarin aim for what? People with an INR higher than the normal range who aren’t taking warfarin may have what? Warfarin is what? Taken how? Higher INR means what?
1
2-3–> 2.5= an ideal
A medical condition
Vit K antagonist–> decrease in factors 2,7,9 and 10
Regular blood tests, take at same time every day, do not double dose to catch up
The longer it takes the blood to clot and so the increase bleeding risk, lower= thicker the blood, so increased clotting risk
High INR symptoms? Low INR?
Headache, severe stomach ache, increased bruising, prolonged bleeding after minor cuts/ menstrual bleeding/ gum bleeding, blood in urine
Sudden weakness/ numbness/ tingling in any limb, visual changes, inability to speak (stroke symptoms), new pain, swelling, redness, heat in body parts/ new SOB/ chest pain (DVT/PE) symptoms
What can cause INR to increase? Advice for decreasing the risk of bleeding?
Binge drinking alcohol, smoking
Avoiding activities that can cause bleeding/ bruising, brush/ shave gently, tell dentist and any other HCP that you take anticoagulants
Treating elevated INR? Low INR?
Vitamin K, blood components may be given during a transfusion to help stop bleeding, no clear explanation then the warfarin dose can be decreased and INR rechecked
LMWH, warfarin, compression stockings if immobile
Normal, pre-diabetic and diabetic values for HbA1c?
42mmol/L/ <6.0%, between 42 and 47 mmol/L, diabetes= >48 mmol/L
PC for HbA1c?
How are they feeling, recent infections/ illnesses, D+V/ illness can affect amount of insulin required, hospital admissions for DKA/ hypos, symptoms of diabetes?
PMHx for HBA1c? Falsely raised when? Falsely decreased in what?
CV/ cerebrovascular/ renal/ visual comps, co-morbidities
In kidney failure, chronic excessive alcohol intake, vitamin B12 deficiency
Acute/ chronic blood loss, sickle cell disease, thalassaemia
Drug history for HBa1c?
Diabetic medication, how/ when are you taking medication, any SEs? Dose ok? Injecting correctly, monitoring glucose levels? Other medications/ changes?
Social hx?
ADLs- mood/ sleep, home circumstances, affecting ADLs?
Adhering to dietary restrictions? Recent diet/ lose weight? Exercise, alcohol
Advice for lowering HbA1c?
Dietary modifications; awareness of snacking and sugary foods/ carbs affecting blood sugar level
Physical activity; regular, check with doctor first
Extra care when ill- taking when not feeling like eating, contact diabetes team, check ketones
Monitor blood sugar level- spot increase early and take steps to prevent it
Support= GP, diabetes, online resources, training courses
Take peak flow when? Spirometry measures what? Values for obstructive lung disease? Restrictive disease?
Before using preventer inhaler
Always use same peak flow meter
Functional lung volumes
FEV1 80% because of FVC being proportionally lower
PC for peak flow/ spirometry? Red flags?
Feeling, recent illnesses/ infections/ SOB, time worsens?
Wheeze= getting worse, affecting ADL, waking up at night with symptoms, using reliever inhaler more than usual
Drug hx?
How well is condition being controlled? What medications take? Inhalers and how often? Any other medications? Beta- blockers?
Check inhaler technique and inhaler use assessed by nurse
Social hx? Advice?
New pets, recent travel- polluted, housing- damp, hayfever, smoking, alcohol, impact of condition on life
Stop smoking, avoid precipitants, vaccination, exercise, eating, support
CRP produced by what and is what? Measured for what?
Non-specific marker produced by the liver in the presence of inflammation, acute marker
Rheumatological, Crohn’s, vasculitis, polyarteritis nodosa, pancreatitis
CRP assists with Ix and monitoring what? Differentiation between what?
IE, abscess post-op infection, response to ABx
SLE vs RA
Crohn’s vs UC
Causes for raised CRP?
Burns, trauma, pneumonia, TB, SLE, vasculitis, RA, MI, IBD, cancers
ESR means what?
Increased fibrinogen means RBCs stick together and so fall faster, raised ESR= rate of fall= quicker
ESR= rises and falls slowly
Causes for raised ESR?
Malignancy; malignant lymphoma, carcinomas of colon/ breast
Haematological- multiple myeloma, anaemia of acute/ chronic disease combined with iron def anaemia
CNDs- SLE, RA, polymyalgia rheumatica and temporal arteritis
Infections; TB, acute hepatitis, bacterial
Low albumin when? High when? Globulins measures what?
Malnutrition- Crohn’s/ UC, coeliac, kidney/ liver disease (hepatitis, cirrhosis)
Severe infections/ dehydration, chronic inflammatory diseases, hepatitis
Total proteins
High conjugated bilirubin?
Liver/ bile duct disease
High unconjugated= Gilbert’s or haemolytic anaemia
Liver enzymes increase when?
Chronic high alcohol excess, obesity in men, smoking in women, drug reaction
What stimulates ALP synthesis?
Bile duct obstruction; increase in obstructive liver disease, non- hepatic origin like increased osteoblastic activity in Paget’s, osteomalacia, vitamin D deficiency
Liver disease marker of drugs/ alcohol? AST/ALT markers of what? GGT+ ALP? AST+ALT? GGT+ALP risen> AST+ ALT?
GGT Drugs, toxins, viral Biliary issues Hepatic problems Obstructive jaundice
Non-modifiable RFs for diabetes and points?
Age between 50 and 60= 5 points, between 60 and 70= 9 points, >70=13 points
Male= 1 point
Other than white European= 6 points
Relative with diabetes= 5 points
Modifiable RFs for diabetes and points?
Waist between 90 and 100cm= 4 points Between 100 and 110cm= 6 points >110cm= 9 points BMI between 25 and 30= 3 points Between 30 and 35= 5 points Above 35= 8 points HTN= 5 points
Points for low, increased, moderate and high risk in diabetes risk?
0-6
7-15
16-24
25-47 points
Lifestyle advice for diabetes?
Regular meals/ portion size, decrease fat/ sugar/ salt, moderate alcohol
Exercise= 150mins/ week
Wt loss
What is QRISK2 score? Personal info?
Risk of person developing CVD over next 10 years in those aged 35-74
Age, sex, ethnicity, BMI
PMHx? Drug hx? FHx? Social hx? Direct measurements?
CKD- stage 4/5, atrial fibrillation, RA, diabetic status
Antihypertensives
Angina/ MI in first degree relative< 60 y/o
Smoking status
Cholesterol/ HDL ratio, systolic BP
% for low risk? Moderate risk? High risk?
<10%, 10-20%, >20%
Management for <10%?
Risk is low- further reductions in risk can often be still achieved
Advice on relevant lifestyle factors can improved- stop smoking, exercise, diet change/wt loss, disease control/ medication adherence
Management above 10% risk?
Adivce on relevant lifestyle factors to reduce risk
Reviewing relevant comorbidities that may not be optimally controlled
Discuss benefits and risk of lipid modification therapy
CHADVASc stands for what and points?
Congestive HF= 1 point
HTN= 1 point
Age, between 65 and 75 y/o=1 point, >2 points= 75, diabetes= 1 point, stroke= 2 points, vascular disease= 1 point, sex category female= 1 point
Score 0 CHADVASc do what? Score 1? Score 2 or more?
No anticoagulation required
Consider anticoagulation with vit K antagonist like warfarin within INR 2-3/ DOAC, maybe aspirin
Anticoagulation with vitamin K antagonist like warfarin within INR 2-3/ DOAC
Already on anticoagulant CHADVASc? General lifestyle advice?
Manage modifiable RFs for bleeding
Avoid alcohol, smoking cessation, healthy diet, exercise
Warfarin advice?
Needs INR check, teratogenic, can interfere with other meds, increased bleeding risk, diet control, can be reversed with vitamin K
DOACs advice?
Non-reversible, increased bleeding risk, expensive, C/I in renal impairment/ Hx of GI bleed
FRAX score is risk score for what? Personal info?
10 year probability of a fracture in the spine, hip, shoulder or wrist for people aged 40-90 years old
Age, sex, weight, height
PMhx?
RA, previous fracture, secondary OP; kidney failure, hyperthyroidism, coeliac disease, kidney failure, T1DM, chronic liver disease, premature menopause, femoral neck BMD from previous DEXA-T scan
Drug hx? FHx? Social hx?
Glucocorticoids, lithium
Parental fractured hip
Smoking, alcohol intake=>3 drinks a day
T- score shows what? Z score?
How much your bone density is higher/ lower than the bone density of a healthy 30-year old adult
Your condition of your bones with someone of your age/ sex/ weight/ ethnicity
T-score values for normal, osteopenia and osteoporosis?
> -1= normal
-2.5 to -1= osteopenia
Tx for low risk FRAX score?
Lifestyle advice- more weight-bearing exercises, quitting smoking and limiting alcohol, calcium and vit D rich diet, balance exercises
Home adaptations= rid of throw rugs, installing grab bars, good grip shoes
Intermediate FRAX score tx?
DEXA scan to measure BMD if
High risk FRAX score tx?
> -2.5= modify RFs and reassess in 2 years
ABCD2 factors and points?
Age>60 y/o= 1 point, BP>140/90= 1 point, Clinical features- unilateral weakness=2 points/ speech disturbance without weakness= 1 point
Duration: >60 mins= 2 points, between 10 and 60 mins= 1 point
Diabetes= 1 point
Enquire about AF, any other TIAs, how long apart were they
Score<3 tx with ABCD? Between 4 and 6? >6?
Seen within 7 days
Specialist within 24 hours
Specialist referral
Lifestyle advice for TIA? Antithrombotic tx? 2ndary prevention?
Diet- lower fats and cholesterol, exercise more, smoking cessation
300mg aspirin immediately then continued long term 75mg OD, clopidogrel 75mg
Control HTN, statin for high cholesterol
Carotid endarterectomy if ICA stenosis> what %? Not drive for how long following TIA?
70%
1 month
HPC for Well’s score and points?
Paralysis/ paresis or recent immobilisation of leg= 1 point
Localised tenderness along deep venous system=1 point
Entire leg swollen= 1 point
Calf swelling> 3cm compared to to other leg= 1 point
Pitting oedema on symptomatic leg= 1 point
Collateral superficial veins present =1 point
PMHx and points for Well score? Social hx?
Bedridden recently>3 days/ major surgery within 12 weeks= 1 point
Active cancer= 1 point
Previous DVT= 1 point
Alternative dx to DVT as/ more likely= 2 points
Long-haul flights, smoking and HRT/ OCP if appropriate
Score<0 Well’s score, 1-2, >3?
DVT unlikely
Moderate risk
DVT likely
If high risk Wells’ score, do what? DVT tx?
USS Doppler veins
LMWH, oral warfarin and INR 2-3/ DOAC
Compression stockings
Treat/ seek underlying cause
Diet, exercise, smoking cessation
