Chronic diseases

Question 1

Why might a patient be on warfarin?

Answer 1

Previous PE or DVT
AF
After surgery
(basically at higher risk for blood clot)

Question 2

What should a normal INR be? And for those taking warfarin?

Answer 2

Normal = 1

On warfarin= 2-3

Question 3

What questions should be checked from a patient taking warfarin?

Answer 3

How/when do they take it? (need to take it same time every day)
Do they take it every day? (if not, why?)
Do they get any side effects? What other medications they are on ?
Any recent illness?

Question 4

What factors can affect warfarins effectiveness?

Answer 4

Alcohol
Diet- Vit K in leafy greens
Drugs (NSAIDs, Abx, Amiodarone, new medications)

Question 5

What are the side effects of high INR?

Answer 5

Headache
Increased bleeding and bruising
Blood in urine and stools

Question 6

What can increase INR?

Answer 6

Too much warfarin
Other medications (Aspirin, NSAIDS, St Johns wort, ABx, omeprazole)
Bleeding disorders
Liver failure
Decreased Vit K intake
Alcohol, smoking

Question 7

Symptoms of low INR?

Answer 7

Sudden weakness in limb
Numbness, tingling
Visual changes,
Speech distrubance
New pain, swelling, SOB or Chest pain

Question 8

What can decrease your INR?

Answer 8

Vit K supplements/ increased intake

Oestrogen

Question 9

What is a HbA1C?

Answer 9

Average blood glucose level over previous 2-3 moths (glycated haemoglobin)

Question 10

What is a normal HbA1c?

Answer 10

<42 mmol/L

Question 11

What HbA1c level indicated pre-diabetes?

Answer 11

42-47mmol/L

Question 12

What HbA1c level indicated diabetes?

Answer 12

48mmol/L

Question 13

What is a normal BM reading?

Answer 13

4-7mmol/L

less than 4, on the floor, more than 7 going to heaven

Question 14

What history questions would you ask for a diabetes station?

Answer 14

Current symptoms (polyuria, polydypsia, weight loss, visual changes, tingling/ numbness, impotence)
PMH
Management of diabetes (compliance, medications, rotating sites? monitoring regularly? Side effects?)
Lifestyle: Mood/ sleep, how it affects life, diet, exercise, smoking, alcohol

Question 15

Why do we worry about high HbA1C?

Answer 15

The higher the score, the greater the risk of developing diabetes complications:
Eye problems (retinopathy)
Foot problems 
Heart attack/ stroke (affects blood vessels)
Kidney problems (nephropathy)
Nerve damage (neuropathy)
Gum disease
Sexual problems

Question 16

What does a peak flow measure?

Answer 16

How quickly you can blow air out of your lungs

Question 17

What does a normal peak flow score depend on?

Answer 17

Age, height genfer

Question 18

What does a significant difference between scores indicate?

Answer 18

Asthma, poor control of condition

Diurnal variation

Question 19

What does a low peak flow score indicate?

Answer 19

Airways are narrowed

Question 20

What is a normal peak flow reading?

Answer 20

400-700 litres per minute

Question 21

What does spirometry show?

Answer 21

Measures how much breath out in one forced breath, and maximum air that can be blown out

Question 22

What are the spirometry results in an obstructive picture?

Answer 22

FEV1/FVC <70%

]

Question 23

What are the spirometry results in a restrictive picture?

Answer 23

FEC1/FVC ration normal

Both decreased

Question 24

What questions should a patient be asked in a peak flow/ spirometry patient?

Answer 24

Smoking 
Adherence to meds
How its afffecting life
Current symptoms
Triggers
Exercise
Eating
Time of day
Pets
Travel
Housing
Work
Hay fever
Smoking
Previous hospital admissions

Question 25

What is CRP and what does it indicate when its raised?

Answer 25

Produced in the liver and raised in inflammation

Question 26

Main causes of raised CRP?

Answer 26

``` Burns Trauma INfections (pneumonia, TB) MI/ VTE Chronic inflammatory diseases (RA_ IBD Certain cancers ```

Question 27

Is CRP more sensitive in acute or chronic inflammation?

Answer 27

Acute- rises in 4-6 hours

Question 28

What is ESR?

Answer 28

An inflammatory arker

Question 29

What can a raised ESR indicate?

Answer 29

Malignancy: lymphoma, carcinoma, multiple myeloma, anaemia Connective tissue disease (SLE, RA, Polymyalgia, temporal arteritis) Infections (TB, hepatitis, bacterial)

Question 30

Is ESR more sensitive in acute or chronic inflammation?

Answer 30

Chronic- peaks at 7-10 days

Question 31

What questions should you asked the patient if they have raised ESR/ CRP?

Answer 31

Smoking Compliance to meds/ treatments Symptoms Mobility

Question 32

What are the different LFTS and what do they all indicate if raised?

Answer 32

``` Albumin ALT (liver cell damage) AST (liver damage-Alcohol) AST: ALT ratio 2:1 (alcoholic damage) GGT: Liver damage (biliary tree) Bilirubin (gallstone) ALP: Bile duct obstruction/ biliary tract disease ```

Question 33

What social Hx questions would you ask with raised LFTS?

Answer 33

``` Recent travel Medictions Alcohol (CAGE questionaire) Tattooes Unprotected sex IVD use Diet ```

Question 34

What questions are used in the CAGE questionaire for alcoholics?

Answer 34

1. Have you ever felt you need to cut down on your drinking? 2. Have people annoyed you by criticising your drinking? 3. Have you ever felt guilty about drinking? 4. Have you ever felt you needed a drink first thing int the morning?

Question 35

Questions to ask patients with raised tumour markers?

Answer 35

``` Symptoms Weight loss Current meds and compliance Impact on life Concerns Support ```