Chronic Disease Stations Flashcards
What is bilirubin?
Breakdown product of RBC
Name 5 factors that can cause a rise in bilirubin
Gilbert’s syndrome
Stress
Fasting
Drugs
Haemolytic disease
What is Gilbert’s syndrome?
Inherited disease where liver can’t process bilirubin properly = raised bilirubin levels on testing + episodes of jaundice
Name 3 drugs that can increase bilirubin levels
Rifampicin
Sulfonamide Abx
Carbimazole (thyroid meds)
What is ALT?
Alanine transaminase - marker of liver cell damage
What is a high ALT?
> 120 IU/L
Name 4 hepatic causes of raised ALT
Alcohol
Viral hepatitis
Drugs
Wilson’s disease
Name 4 drugs that can increase ALT levels
NSAIDs
Abx
Statins
Anti-epileptics
Name 4 non-hepatic causes of raised ALT
Coeliac disease
Strenuous exercise
Muscle disease
Hypo/hyperthyroidism
What is AST?
Aspartate aminotransferase
What does an AST:ALT >2.1 indicate?
Alcohol related liver disease
What does an AST:ALT <2.1 indicate?
Hepatic steatosis/chronic viral hepatitis
What is ALP?
Alkaline phosphatase
Name 2 physiological causes of raised ALP
3rd trimester pregnancy
Bone growth in adolescents
Name 4 pathological causes of raised ALP
Heart failure
Bone diseases
Steroids
Bile duct obstruction/pathology
What is gammaGT used for?
Sensitive but non-specific marker for hepatobiliary disease
Name 7 causes of raised gamma GT
Hepatobiliary disease
Pancreatic disease
Alcoholism
COPD
Diabetes
MI
DRugs e.g. OCP, carbamazepine (anti-epileptic)
Name 5 causes of low albumin
Liver disease
Malnutrition/absorption
Pregnancy
Injury/infection
Chronic illness-increased catabolism
Name 4 conditions that can increase HbA1c levels
Iron deficiency
Alcoholism
Chronic renal failure
Splenectomy
Name 3 conditions that can decrease HbA1c levels
Chronic liver disease
Haemoglobinopathies
RA
Name 3 drugs/vitamins that can decrease HbA1c levels
Vit C
Vit E
Aspirin
Ribavirin (anti-viral for hepatitis)
What advice would you give to someone with raised HbA1c levels?
High fibre, low sugar diet
Less saturated fats
Exercise + physical activity
Reduce alcohol + smoking
Attend yearly check ups e.g. urinalysis, eye tests, diabetic foot screenings
What is INR?
International Normalised Ratio - measure of how thick/thin blood is - how well it clots
What symptoms should you ask about for raised INR?
Bruising
Bleeding-gums, heavy periods, nosebleeds etc
Blood in stool/urine
Sudden severe back pain-spontaneous retroperitoneal bleeding
What symptoms should you ask about for decreased INR?
Stroke symptoms
Visual changes
DVT/PE symptoms-pain, red, swollen, chest pain, SOB
Name 4 contraindications for warfarin
Pregnancy
Hemorrhagic stroke
Within 72hrs major surgery
Severe hepatic impairment (processed by liver)
Name 3 factors that can exaggerate the effects of warfarin
Weight loss
Acute illness
Smoking cessation
Name 3 factors that can reduce the effect of warfarin
Weight gain
Diarrhoea
Vomiting
What questions should you ask about taking medications?
Same time every day?
Ever forget doses?
Do you ever double dose?
Name 4 key drug interactions that enhance the effect of warfarin
Alcohol
Abx-clarithromycin, co-trimox
Aspirin, clopidogrel
Amiodarone
NSAIDs
Cranberry juice
Name 4 key drug interactions that decrease the effect of warfarin
St John’s wort
Rifampicin
Vit K
Carbamazepine (anti-epileptic)
What key questions should you ask about diet in an INR station?
Changes in vit K intake e.g. broccoli, kale, spinach
Have they been avoiding grapefruit + cranberries?
How does warfarin work?
Inhibits vit K dependant clotting factors
What are the vit K dependant clotting factors?
II, VII, IX, X (1972)
What is the target INR for people on warfarin?
2-3 (2.5)
What should INR be in people not on warfarin?
1-2
What 3 questions should you ask in an asthma review?
-Have you had trouble sleeping due to asthma symptoms?
-Have you had your usual asthma symptoms during the day?
-Has your asthma interfered with your everyday activities?
What are the side effects of ACE inhibitors to be aware of for an asthma review?
Cough
What effect do BB have on asthma?
Exacerbate
What areas of social history are important in asthma reviews?
New pets
Job
Mould/home conditions
Air temp changes
Liver with/near smokers?
Job stress
Recent move?
Advice for asthma review
Ask family/friend smokers to go outside
Flu vaccine
Avoid cold air/pollen triggers
Regular exercise
Inhaler technique + reviews
Peak flow dairy for next month
What is a moderate PEFR?
> 50-75%
What is a severe PEFR?
33-50%
What is a life threatening PEFR?
<33%
How do you manage an acute exacerbation of asthma?
Salbutamol
Prednisolone
O2
What score is used for measuring breathlessness?
MRC dyspnoea score (0-4)
What symptoms should you ask about for raised inflammatory markers?
Fever, vomiting, diarrhoea, night sweats, weight loss
How are they feeling today?
Impact on daily life
What PMHx should you ask about for raised inflammatory markers?
Autoimmune disorders
Bone conditions
Active cancers
Lung diseases
How should you start a chronic disease station?
Intro
Ask about their understanding
Explain test results + problems that can occur due to specific results
What should you ask about the patient’s current condition?
How are they feeling today?
Recent illness/infection
Symptoms troubling them?
Specific symptoms for condition
Specific complications of condition e.g. diabetic foot
What are the 4T’s for diabetic symptoms?
Toilet
Thirsty
Tired
Thinner
What should you ask about management of their condition?
Taking meds?
Med compliance
Technique/taking them correctly-time of day etc
Side effects of meds?
Explain purpose of peak flow to a patient
Measures how fast you can breath out to see how well your lungs are working
Name 7 triggers for asthma
Smoking
Damp
Pets
Exercise
Allergies
Infections
Work
Name 4 red flags for asthma
Worsening wheeze
Affecting ADLs
Waking up at night
Fast heart rate
Give 3 pieces of advice for asthma management
Stop smoking
Flu vaccine
Exercise
What should you ask about patient understanding for INR station
Do they know what INR is?
Do they know why they are on warfarin + how it works?
Name 2 practical reasons for a high INR
Double dosing warfarin
Change in warfarin regimen
Why would you ask about liver failure for an INR station?
Lack of clotting factors
What bleeding disorders would you ask about for an INR station?
Haemophilia
Factor 7 deficiency
What can binge drinking do to INR?
Increases
What does smoking do to INR?
Increases
What can crp/esr tell you?
Condition flare up/ new infection
What can low albumin show?
Malnutrition-Crohns/UC, kidney or liver disease
What can high albumin show?
Severe infection/dehydration, chronic inflammatory diseases, hepatitis
What key part of social Hx should you ask for LFT’s?
Travel Hx - hepatitis risks, alcohol, unprotected sex etc
