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Phase 2b Sheffield Medicine > Chronic Diseases > Flashcards

Chronic Diseases Flashcards

1
Q

What is INR and what are the aims?

A

International normalised ratio - how long it takes for your blood to clot?

Normal INR is 1
Those on warfarin should aim for 2-3 (2.5 is ideal)

If above this and NOT on warfarin may have a medical condition.

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2
Q

What is Warfarin and what is the advice regarding taking it?

A

Vitamin K antagonist (blocks vitamin K epoxide reductase) leading to a decrease in factors 2, 7, 9 and 10.

Regular blood tests, take at the same time everyday and do not double up the dose to catch up.

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3
Q

What should you do in the introduction for INR and Warfarin chart?

A

Check patients understanding of what warfarin is?
‘Warfarin is an anticoagulant and that means its job is to stop the blood from clotting too easily’

Explain what INR is and risks of it being too high/low are?
‘The higher the INR, the longer it takes the blood to clot and so the increased bleeding risk. The lower the INR, the thicker the blood so increased clotting risk.’

Explain why they are on Warfarin
‘Commonly used to treat blood clots (DVT/PE/prevent stroke in AF)’

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4
Q

What should be explored in presenting complaint for INR and Warfarin chart?

A

Ask how they are feeling.
Any recent infections.
Any diarrhoea/vomiting and explore this.
Any high INR symptoms
Any low INR symptoms

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5
Q

What are high INR symptoms?

A

Headache, severe stomach ache.
Increased bruising.
Prolonged bleeding after minor cuts/menstrual bleeding/gum bleeding.
Blood in urine.

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6
Q

What are low INR symptoms?

A

Sudden weakness/ numbness/ tingling in any limb, visual changes, inability to speak (stroke symptoms).
New pain, swelling, redness, heat in body parts, or new SOB or chest pain (DVT/PE symptoms)

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7
Q

What questions should be asked about past medical history in INR and Warfarin chart?

A

Liver failure (lack of clotting factors)
Bleeding disorders (haemophilia, factor 7 deficiency)

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8
Q

What questions should be asked in drug history for INR and Warfarin chart?

A

‘Do you know how many times you are meant to take the warfarin’
‘How and when do you take the dose, have you missed a dose, did you double a dose’
‘Are you finding this okay or are you struggling to keep up with the dose - why?’
‘Any other medications’

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9
Q

What questions should you ask about social history in INR and Warfarin chart?

A

Enquire about their diet, any changes - increased/decreased vitamin K intake.

Foods containing vitamin K are green fruit and veg
Not necessary to avoid these foods but should keep them consistent if on Warfarin.

Binge drinking alcohol can cause INR to increase.
Smoking can increase INR.

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10
Q

What advice should be given during an INR and Warfarin chart history?

A

Avoids activities that can cause bleeding/bruising.
Brush and shave gently.
Tell a dentist and any other healthcare professional that you take anticoagulants.

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11
Q

What would the treatment be for an elevated INR?

A

Vitamin K.
Blood components may be given during a transfusion to help stop bleeding.
If there is no clear explanation then the warfarin dose can be increased an INR rechecked

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12
Q

What would the treatment be for a low INR?

A

LMWH or Warfarin.
Compression stockings if immobile.

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13
Q

What is a normal value for HbA1c?

A

Normal is 42mmol/L or >6.0%

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14
Q

What is a pre-diabetic HbA1c value?

A

42 < mmol/L ≤ 47 or 6–6.4%

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15
Q

What is the HbA1c value for diabetes?

A

≥48mmol/L or 6.5%

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16
Q

What should you do for the introduction for HbA1c?

A

Check when the patient was diagnosed?
Type 1 or Type 2?

What is their understanding of diabetes and HbA1c? ‘HbA1c shows us the average blood glucose level over the previous 2–3 months as the sugar sticks to cells in our blood’.

‘How well do you think your diabetes is being managed?’

Explain the benefits of lowering HbA1c?

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17
Q

What are the benefits of lowering HbA1c?

A

Reduces the risk of retinopathy (eye problems), neuropathy (losing sensation in your feet/hands) and diabetic nephropathy (kidney issues).

Less likely to suffer from cataracts, heart failure and amputation.

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18
Q

What questions should be asked in the presenting complaint of a diabetes patient?

A

Ask them how they are feeling.

Any recent infections / illnesses - can affect the amount of insulin required.

Any hospital admissions for DKA/hypos?

Any symptoms of diabetes?

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19
Q

What questions should be asked in the past medical history of HbA1c?

A

Any cardiovascular / cerebrovascular / renal / visual complications?

Any co-morbidities?

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20
Q

What can lead to false increases in HbA1c?

A

Kidney failure
Chronic excessive alcohol intake
Vitamin B12 deficiency.

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21
Q

What can lead to a false decrease in HbA1c?

A

Acute / chronic blood loss
Sickle cell disease
Thalassaemia.

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22
Q

What questions should be asked about social history in HbA1c?

A

How is your mood/ sleep?
Are your home circumstances okay?
Do you feel like your disease is affecting your daily life?

Are you adhering to your dietary restrictions.
Have you been on a diet recently?

Exercise?
Smoking?

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23
Q

What would advice for lowering HbA1c be?

A

Dietary modifications.
Physical activity.
Take extra care when ill - sick day rules - check blood every 4 hours, keep taking medication even when you don’t feel like eating.
Monitor blood sugar level.
Advice for support available.

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24
Q

What is CRP?

A

C reactive protein.
Non-specific marker.
Substance produced by the liver and increases in the presence of inflammation.
Acute marker.

25
Q

What is ESR?

A

Erythrocyte sedimentation rate.
Increased fibrinogen means RBCs stick together and so fall faster.
Raised ESR = rate of fall quicker.
ESR rises and falls slowly.

26
Q

What questions should be asked in a CRP/ESR introduction?

A

Check patients understanding of CRP/ESR and their condition –

‘It’s a marker of inflammation which tells us that there could be a flare up in your condition or new infection detected’.

27
Q

What questions should be asked in a presenting complaint of a CRP/ESR history?

A

How are they feeling?
Any recent illnesses/infections?

28
Q

What questions should be asked in a drug history if CRP/ESR?

A

How well do you think your condition is being controlled?
What medications do you take? How often?
Any issues taking your mediation?
Do you take any other medications?

29
Q

What questions should be asked in a social history of CRP/ESR?

A

Recent travel anywhere?
Smoking?
Alcohol?
Impact of condition on life.

30
Q

What advice should be given at the end of a CRP/ESR history?

A

Stop smoking.
Advice on disease management if they’re non-compliant.

31
Q

What diseases is CRP useful for differentiating between?

A

SLE vs RA
Crohn’s disease vs UC

32
Q

What can a low albumin level be a sign of?

A

Can be a sign of malnutrition (Crohn’s/UC, coeliac).
Kidney disease, liver disease (hepatitis, cirrhosis).

33
Q

What can a high albumin be a sign of?

A

Severe infections/dehydration, chronic inflammatory diseases, hepatitis.

34
Q

What can high conjugated bilirubin be a sign of?

A

Liver / bile duct disease.

35
Q

What can low un-conjugated bilirubin be a sign of?

A

Gilbert’s or haemolytic anaemia.

36
Q

In which conditions do liver enzymes increase?

A

Chronic high alcohol excess.
Obesity (especially in men).
Smoking (in women).
Drug reaction.

37
Q

In which conditions would there be increased ALP?

A

Bile duct obstruction stimulates ALP synthesis;

Increase in obstructive liver disease.

Non-hepatic origin like increased osteoblastic activity in Paget’s, osteomalacia, vitamin D deficiency.

38
Q

In which conditions would there be increased GGT?

A

Liver disease markers of drugs/alcohol (increases)

39
Q

In which conditions would there be an increased AST or ALT?

A

Liver disease markers of drugs, toxins, viral (increases).

40
Q

In which conditions would both GGT and ALT be increased?

A

Biliary problems.

41
Q

In which conditions would both AST and ALT be increased?

A

Hepatic problems.

42
Q

What questions should be asked in a LFT introduction?

A

Check patients understanding of LFTs and their condition.
Explain the relevant increased result.

43
Q

What conditions should be asked in the presenting complaint of a LFT history?

A

How are they feeling?
Any recent illnesses/infections?

44
Q

What questions should be last medical history of LFT history?

A

Gallstones in the past.
Crohn’s/UC.
Surgery in past if malabsorption may have had some bowel removed.

45
Q

What questions should be asked about drug history in a LFT history?

A

How well do you think your condition is being controlled?
What medications do you take? How often?
Any issues taking your medication?
Do you take any other medications.

46
Q

What questions should be asked about social history in a LFT history?

A

Recent travel anywhere?
Smoking?
Alcohol?
Recreational drugs/toxins?
Diet.
Impact of condition on life.

47
Q

What advice should be given at the end of a LFT history?

A

Stop smoking/alcohol/drugs.
Diet advice.
Advice on disease management if they’re non-compliant.

48
Q

Should a peak flow be taken before or after a inhaler is used?

A

Take your peak flow before using the preventer inhaler.

49
Q

What does spirometry use?

A

Measures functional lung volumes.

50
Q

List some causes of obstructive lung disease?

A

Reversible (asthma) and irreversible (COPD).
Bronchiectasis.
Inhaled foreign body, tumour.

51
Q

What is obstructive lung disease?

A

Takes a long time to exhale (wheeze) so not much breathed out at 1 second but volumes not bad overall.

FEV1 < FVC
FEV1/FVC < 0.7 with FEV1 < 80% predicted.

52
Q

What is restrictive lung disease?

A

Usually diseases of the interstitium affecting chest wall movement and elasticity.

Due to restriction, lung volumes are small and most of breath is out in the first second.

FEV1/FVC > 80% because of the FVC being proportionally lower.

53
Q

List some causes of restrictive ling disease?

A

Scoliosis, kyphosis, ankylosing spondylitis.
Neuromuscular diseases like Guillain-Barré syndrome, myasthenia gravis.
Pulmonary fibrosis, sarcoidosis, asbestosis.

54
Q

What questions should be asked in the introduction of a spirometry history?

A

Check patients understanding of peak flow/spirometry and their condition:

‘Peak flow test measures how fast you can breathe out so you can see how well your lungs are working’.

‘Spirometry measures lung function, specifically the amount (volume) and the speed (flow) of air that can be inhaled/exhaled’.

55
Q

What questions should be asked in the presenting complaint of a spirometry history?

A

How are they feeling?
Any recent illnesses/infections?
Any SOB?
Is there any particular time you notice your condition worsens (winter etc).
Enquire about red flags.

56
Q

What red flag questions should be asked in a spirometry history?

A

Wheeze is getting worse.
Affecting ADL.
Waking up at night with symptoms (SOB, cough).
Using reliever inhaler more than usual.

57
Q

What questions should be asked in a drug history in a spirometry history?

A

How well do you think your condition is being controlled?
What medications do you take? Which inhalers do you use and how often?
Do you take any other medications (if on steroids then severe).
Any beta-blockers.
Check inhaler technique and check inhaler use has been assessed by the nurse.

58
Q

What questions should be asked about social history in a spirometry history?

A

Any (new) pets?
Recent travel anywhere?
Particularly to places that are polluted.
Housing situation (damp)?
Hayfever.
Smoking? Alcohol? Impact of condition on life.

59
Q

What advice should be given in a spirometry history?

A

Stop smoking.
Avoid precipitants.
Vaccination (flu).
Exercise.
Eating.
Support.

Phase 2b Sheffield Medicine (17 decks)

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