Chronic Diseases Flashcards
1
Q
What clotting factor is PT?
A
Clotting factor II
2
Q
what does INR stand for?
A
International normalised ratio
3
Q
What drug do you adjust dose for depending on INR?
A
warfarin
4
Q
What does aPTT stand for?
A
activated partial thromboplastin time
5
Q
What drug do you adjust dose for depending on aPTT?
A
Heparin
6
Q
What do INR and aPTT both assess?
A
- How fast blood clots
- Assess pathways of coag cascade
7
Q
What pathway does PT/INR measure?
A
Extrinsic pathway
8
Q
What type of drug is warfarin? how does it work?
A
- anticoagulant
- vit K antagonist
9
Q
what is normal INR range?
A
1
10
Q
what is Normal INR range on warfarin?
A
2-3
11
Q
Patient is on warfarin. What would value of less than 2 mean?
A
increased risk of blood clots
12
Q
Patient is on warfarin. What would value of more than 3 mean?
A
Increased risk of bleeding
13
Q
What is heparin? how does it work?
A
- Anticoagulant
- Indirect thrombin inhibitor
14
Q
What is normal aPTT range?
A
30-40 seconds
15
Q
What is normal aPTT range on heparin?
A
1.5-2.5 x the normal range (60-80)
16
Q
What regular blood checks to patients on NOACs/DOACs need?
A
none! ha
17
Q
What does a higher INR value mean?
A
- Longer it takes for you’re blood to clot
- increased risk of bleeding
18
Q
Questions to ask patient on warfarin?
A
- Why are you taking warfarin?
- how long have you been taking it?
- Any side effects?
- how is it affecting your life?
- Diet (vit K)?
- Alcohol ?
19
Q
What dietary stuff have vitamin K
A
- all those green things! (celery, green grapes, kale, broccoli, cucumber, green beans, green apples)
20
Q
What is idea number (not range) for INR on warfarin?
A
2.5
21
Q
what conditions could cause a raised INR
A
- reduced clotting factors (bleeding disorders)
- liver failure
- too much anticoagulant medicine
22
Q
How should warfarin be taken (timing)?
A
- Same time every day
- Do not double dose to catch up
23
Q
Describe action of warfarin (patient friendly)
A
It is an anticoagulant. This means that it stops the blood from clotting too easily.
24
Q
What is warfarin commonly used to treat?
A
DVT, PE, prevent stroke in AF
25
What high INR symptoms?
- Headache
- Severe stomach ache
- Increased bruising
- Prolonged bleeding after minor cuts/ menstural bleeding/ gum bleeding
- Blood in urine
26
What low INR symptoms?
- sudden weakness/numbess/tingling in limb
- Visual changes
- Inability to speak
- New pain, swelling, redness, heat
- New SOB or chest pain (DVT/PE symptoms)
27
What PMH do you ask about when discussing INR?
- Liver disease
- Bleeding disorders (haemophilia, factor 7 deficiency)
28
How would taking a double dose of warfarin impact INR?
increase INR
29
How does smoking affect INR?
increase INR
30
How to treat low INR?
- LMWH, warfarin
- Compression stockings if immobile
31
How to treat elevated INR
- Vit K
- Decrease warfarin dose and recheck INR
32
What is HbA1c? (patient friendly)
HbA1c shows the average blood glucose level over the previous 2-3 months as the sugar sticks to cells in the blood
33
How often does HbA1c need to be tested
every 3 months
34
what is is most common haemoglobin and what is it made up of?
- HbA1
- 2 alpha + 2 beta chains
35
describe HbA1 compared to HbA1c
- have no protein structural differences
- HbA1c is glycosylated
36
why HbA1c high in diabetic patients
In diabetic patient: not/reduced insulin response => increase blood glucose => longer encounter with RBC => glycosylated Hb => increase HbA1c
37
What Qs should you ask in general history taking for HbA1c?
- T1 or T2 diabetes?
- How long ago were you diagnosed?
- Explain HbA1c and benefits of low HbA1c
38
What is normal HbA1c range? (% and mmol/L)
<6.0% or <42mmol/L
39
What is prediabteic HbA1c range? (% and mmol/L)
6.0 - 6.4% or 42-47 mmol/L
40
What is diabetic HbA1c range? (% and mmol/L)
>6.5% or >48 mmol/L
41
HbA1c SH Qs?
- How is it affecting your life?
- Diet and exercise?
- Smoking?
- Alcohol?
- Medication compliance?
42
What are the benefits of reducing HbA1c?
Reduce risk of:
- Retinopathy
- Neuropathy
- Diabetic nephropathy
- Cataracts
- Heart failure
- Amputation
43
HbA1c PC Qs?
- How are they feeling
- Any recent infection
- Any hospital admissions for DKA/hypos?
- Any symptoms of diabetes?
44
What are the symptoms of diabetes?
- Polyuria
- Polydipsia
- Weight change
- Visions changes
- tingling in feet
- Impotence (ED)
45
What can HbA1c be falsely raised in?
- Kidney failure
- Chronic excessive alcohol intake
- Vitamin B12 deficiency
46
HbA1c DH Qs?
- What diabetes medication do you take?
- How/when are you taking the medication?
- Site rotation?
- Any side effects
47
HbA1c SH Qs?
- Mood/ sleep?
- Home circumstances?
- Affecting ADL?
- Diet (dietary restrictions/ trying to lose weight)
- Exercise
- Smoking + alcohol
48
What advice to lower HbA1c?
- Diet: aware of snacking, cars in food
- Physical activity: regular exercise
- Take extra care when ill: check blood sugar every 4h, keep taking diabetes meds even when don't feel like eating
- Monitor blood sugar level
49
What is spirometry/ what does it measure?
measures functional lung volumes (how much you breath in and out)
50
What does FEV1 depend on? why is this important?
- Age, sex, height, mass, ethnicity
- Used to calculate a predicted FEV1
51
What is FEV1? what is it a measure of?
- Forced expiratory volume in 1sec (greatest vol asap)
- Measure of ability of air to freely flow out of lungs
52
In what type of lung disease in FEV1 reduced?
reduced in obstruction (causing a wheeze)
53
What is FVC? what is is a measure of?
- Forced vital capacity (total col of air a person can exhale after max inhale)
- Measure of total col of air that person can take into lungs
54
In what type of lung disease is FVC reduced?
reduced in restriction
55
Obstruction lung disease: describe FEV1, FVC + FEV1:FVC
FEV1: reduced (< 80% of the predicted normal)
FVC: reduced (but to less extent than FEV1 (FEV1 < FVC))
FEV1:FVC < 0.7
56
Explain physiology of lung function tests in patient with obstruction pathology
- There is an obstruction which slows passage of air out of lung
- Patient can have good total lung vol but air only moves slowly in and out
57
What causes the obstruction in asthma?
bronchoconstriction
58
what causes obstruction in COPD?
chronic airway + lung damage
59
Other than spirometry and peak flow, how else can you distinguish between asthma and COPD?
reversibility of obstruction with bronchodilator indicates asthma
60
What is peak flow?
fastest point of a persons expiratory flow of air (peak expiratory flow rate (PEFR))
61
Describe peak flow technique
- Stand tall, deep breath in, good lip seal, expire hard and fast, repeat 3 times
- Always use same peak flow meter
62
Should you measure peak flow before or after preventer inhaler
before
63
peak flow: what do you do with the 3 attempts?
record the best attempt
64
How is peak flow recorded?
As "percentage of predicted" value
65
Name cause of obstructive lung disease
- Asthma (reversible)
- COPD (irreversible)
- Bronchiectasis
- Inhaled foreign body
- Tumour
66
Describe restrictive lung disease physiology
restriction to the ability of the lungs to expand and take in air.
67
Restrictive lung disease: describe FEV1, FVC + FEV1:FVC
FEV1: reduced (< 80% of the predicted normal)
FVC: reduced (<80% of the predicted normal)
FEV1:FVC: normal (> 70% because FVC proportionally lower)
68
Name some restrictive lung diseases
- pulmonary fibrosis
- sarcoidosis
- scoliosis
69
describe peak flow/ spirometry in patient friendly terms
peak flow: measures how fast you can breathe out so you can see how well your lungs are working
Spirometry: measures lung function, specifically the volume and speed of air that can be inhaled/ exhaled
70
peak flow/ spirometry PC Qs?
- How are you feeling?
- Any recent illnesses/infections?
- Any SOB?
- Particular time you tonic symptoms worsen?
- Symptoms getting worse?
71
peak flow/ spirometry DH Qs?
- Is your condition controlled?
- What medications to you take? how often?
- Chek inhaler technique
72
peak flow/ spirometry SH Qs?
- Any new pets?
- Recent travel anywhere?
- Housing situation (damp)?
- Smoking?
- Alcohol?
- Impact of condition on life?
73
peak flow/ spirometry: what advice would you give?
- stop smoking
- avoid triggers
- vaccination
- exercise
74
Where is CRP produced form?
protein released by the liver
75
What does CRP do?
Travels in blood stream in search of dead or damaged cells => activates complement system
76
What is normal CRP range?
<10 mg/L
77
After how many hours from onset of inflammation does CRP begin to rise?
6 hours
78
After how many hours from onset of inflammation does CRP peak?
24 hours
79
What could cause a rise in CRP?
- Infection
- Autoimmune conditions (crohns, RA)
- Pregnancy
- Burns
- Increasing age
80
What is ESR?
rate at which RBC fall in a test tube over 1 hour
81
What is normal ESR range?
0-10 mm
82
After how many hours from onset of inflammation does ESR rise begin?
after 48 hours
83
What could cause a rise in ESR?
- infection
- polymyalgia rheumatica
- GCA
- autoimmune conditions (SLE, RA)
- pregnancy
- ageing
84
are CRP and ESR sensitive? specific?
- Sensitive
- Non-specific
85
Give examples of how inflammatory markers can assist with monitoring infection
- Post-op infection
- Response to Abx
86
Explain physiology of ESR
inflam => increased fibrinogen => RBC stick together => fall faster
87
ESR/CRP: how should you start consultation?
- Interpret the inflam markers
- Check patients understanding of ESR/CRP
88
Explain ESR/CRP in patient friendly terms
Its a marker of inflammation which tells us that there could be a flare up in you condition or a new infection detected
89
ESR/CRP DH Qs?
- How well is your condition being controlled
- What medication do you take? how often?
- Any side effects
- Any other medications?
90
ESR/CRP SH Qs?
- Recent travel
- Smoking
- Alcohol
- Impact of condition on life
91
ESR/CRP advice?
- Stop smoking
- Advice on disease management and compliance
92
How does smoking affect ESR/CRP?
raises them
93
What are ALT, AST, ALP + GGT? (brief)
enzymes found within the liver and biliary tract
94
What are liver function tests?
Blood tests to monitor hepatic function and damage
95
What can be used to assess livers ability to synthesise enzymes and proteins?
- Albumin
- Prothrombin time (PTT)
96
How would serum albumin levels change in liver disease?
Albumin levels fall with liver disease
97
Other than hepatic causes, what else can cause a decrease in albumin blood levels?
- Decreased protein intake
- Malabsorption
- Losing protein in urine
98
How would prothrombin time change in liver disease? Explain
Prothrombin time would increase
Decline in LF => decreased clotting factors => PTT
99
What can be used to assess livers ability to process bilirubin and secrete bile?
- Bilirubin
- ALP
- GGT
100
Briefly describe liver's role in bilirubin metabolism
- Bilirubin is water insoluble produce of normal ham breakdown and is transported to liver bound to albumin
- Liver converts it to water soluble
- Secreted in bile
101
Other than hepatic causes, increased PTT could indicate what?
- Bleeding disorders
- Vitamin K deficiency
- Anticoagulants (warfarin)
102
What is normal bilirubin range?
3-17 umol/l
103
What is normal alkaline phosphatase (ALP) range?
30-100 umol/l
104
What is normal Gamma-glutanyltransferase (GGT) range?
8-60 u/l
105
What are ALP and GGT ?
enzymes found in tiny bile ducts of liver (+ other tissues)
106
What would raised serum ALP + GGT indicate?
Damage to biliary tract
107
Is ALP or GGT more speck in identifying biliary disease?
GGT
108
What can be used to assess for extent of liver damage?
AST, ALT
(you're f'ed: at fALT so die fAST)
109
Explain how AST and ALT chain in liver damage (physiology)
liver damage => hepatic cell damage => cell content (including enzymes) leak into bloodstream => increased serum AST + ALT levels
110
In which people would you expect the normal range of AST + ALT to be higher?
Men
Obese
111
What is normal aspartate transaminase (AST) range?
3-30 iu/l
112
What is normal alanine transaminase (ALT) range?
3-40 iu/l
113
What is the (one) most specific enzyme to detect liver damage
ALT
114
What causes a rise in AST?
alcohol
115
What causes a rise in serum GGT?
liver damage from drugs and alcohol
116
LFT PMH Qs?
- Gallstones
- Crohn's/UC
- Surgery (bowel removed => malabsorption)
117
LFT DH Qs?
- How well is your condition controlled
- What medication do you take? how often?
- Any side effects?
- Do you take any other medications?
118
LFT SH Qs?
- Recent travel?
- Smoking?
- Alcohol?
- Recreational drugs/toxins?
- Diet
- Impact on ADL?
119
LFT abnormalities advice?
- Stop smoking/alcohol/drugs
- Diet advice
- Advice on disease management if non-compliant
