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Phase 2b > chronic management history questions > Flashcards

chronic management history questions Flashcards

1
Q

what does INR stand for

A

international normalised ratio

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2
Q

what is the normal INR

A

1

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3
Q

what should INR be on warfarin

A

2-3 (2.5 = ideal)

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4
Q

what factors does vitamin K effect

A

10, 9, 7, 2

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5
Q

what is warfarin

A

a Vitamin K antagonist - blocks vit K epoxide reductase

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6
Q

What specifications for taking warfarin are there

A

take at the same time daily
don’t double dose to catch up

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7
Q

what overall questions should you ask in HxPC for INR station

A

any recent infections/illness
any diarrhoea/vomiting and if so is it bloody/dark

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8
Q

what are some symptoms to ask about with high INR

A

headache
severe stomach ache
increased bruising
prolonged bleeding after minor cuts/mentruation/gum bleeding
blood in urine

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9
Q

what are some common symptoms in low INR that should be specifically asked about

A

sudden weakness/numb/tingling in limb
visual changes
inability/slurred speech
new pain/swelling/redness/heat in body parts
new SOB or chest pain

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10
Q

PMHx specifically for INR Hx

A

liver failure
bleeding disorder

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11
Q

DHx specific questions in INR station

A

what medication do you take
how and when many time are you taking it
do you know how often you should be
have you missed a day - and did you double dose to compensate?
do you manage okay - if not, why?
any other meds - aspirin, NSAIDs, herbal, OCP/HRT

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12
Q

SHx for INR Hx

A

any diet change - green fruit/veg
alcohol - binge can increase INR
smoking - can increase INR

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13
Q

advice for INR

A

decrease chances of bleeding - avoid activities that could cause it
tell dentist and other HCPs you are on an anticoagulant

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14
Q

how to treat high INR

A

vit K
blood components via transfusion
decrease warfarin and recheck

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15
Q

treatment for low INR

A

LMWH
warfarin
compression stockings if immobile

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16
Q

what is HbA1C

A

the glycated Hb over 3 months

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17
Q

what is the normal HbA1C

A

normal = <42 mmol/L / <6%

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18
Q

what is pre-diabetes HbA1C

A

42-47 / 6-6.4%

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19
Q

what is diabetes HbA1C

A

> 48mmol/L / 6.5%

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20
Q

general questions to ask with diabetes chronic management

A

when was the patient diagnosed
Type 1/type 2
do you understand diabetes/HbA1C
how well do you think it is managed

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21
Q

what are the benefits of lowering you HbA1C

A

reduce risk of retinopathy, neuropathy, nephropathym HF, cataracts, amputation

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21
Q

questions to ask in HxPC in diabetes chronic management

A

how are you feeling
any recent illness/infection
any diarrhoea/vomiting
any recent hospital admissions - for hypos/DKA
any polyuria/polydipsia
vision changes
change in sensations - leg tingling/no feeling
weight change/loss
impotence/ED

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22
Q

specific past medical history questions in diabetes chronic management

A

any CVD/cerebrovascular/renal/visual complications
any co-morbidities

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22
Q

what may HbA1C be falsely raised in

A

kidney failure
chronic excess alcohol intake
bit B12 deficiency

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23
Q

what may HbA1C be falsely low in

A

acute/chronic blood loss
sickle cell disease
thalassaemia

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24
Q

drug history specific questions for diabetes chronic management

A

what medication do you take for your diabetes
how/when are you taking it
any side effects
do you find taking it okay - if not why?
do you struggle to keep up with dose + why?
are you altering injection site?
do you monitor your glucose levels
any other meds/changes

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25
Q

social history specific questions for diabetes chronic management

A

how is your mood/sleep
are home circumstances okay
do you feel like the disease is affecting your life?
adhere to diabetic diet/tried to lose weight
exercise?
smoking?
alcohol - if increase/decrease why?

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26
Q

advice to lower HbA1C

A

diet modification - aware of snacking and sugary foods + affect carbs have on HbA1C
physical activity - reg. exercise can help stop HbA1C increase - but check with doctor as some meds may induce hypos with exercise
sick day rules - check BM more regularly (4hr), keep taking meds even if you don’t feel like eating, contact diabetes team, check ketones
monito BM
ask for support - GP, diabetic nurse, online resource, training course

27
Q

what are some rules for doing peak flow

A

take PF before using preventer inhaler

28
Q

what does spirometry measure

A

functional lung volumes

29
Q

causes of obstructive lung disease

A

reversible - asthma
irreversible - COPD
bronchiectasis
inhaled foreing body/tumour

30
Q

describe FEV1 and FVC in obstructive lung diseases

A

takes a long time to breath out (wheeze) so not much is exhaled in 1 second but volume overall not bad
FEV1 < FVC
FEV1/FVC < 0.7 with FEV1 < 80% predicted

31
Q

what are restrictive lung diseases caused by

A

disease of the interstitium, affecting chest wall movemtn and elasticity - like scoliosis, kyphosis, ankylosing spondlyitis, neuromuscular - GBS, MG
pulmonary fibrosis, sarcoidosis and asbestosis

32
Q

describe FEV1 and FVC in restrictive lung diseases

A

due to restriction, lung volume small and most breath out in 1st second, therefore, FEV1/FVC >80% as FVC proportionally lower

33
Q

introduction questions for an lung chronic management station

A

do you understand what is meant by PF and spirometry (PF = how fast your breath out to see how well lungs are working and S = measures lung function, specifcally amount and speed of air that can be inhaled and exhaled

34
Q

HxPC in lung chronic management history

A

how are you feeling
any recent illness/infections
any SOB
anytime you notice condition is worse

35
Q

redflags to ask about in a lung chronic management station

A

is your wheeze getting worse/not resolving
affecting ADL
wake up at night with Sx (SOB/cough)
using relief inhaler more than normal

36
Q

Dhx in lung chronic management history - questions

A

how well do you think your condition is controlled
what meds do you take
which inhalers do you use and how often
any other meds
any beta-blockers
have you had technique and use of inhaler checked by a specialist

37
Q

social history questions for lung chronic management

A

any pets - new?
recent travel (polluted?)
housing situation (damp)
hayfever
smoking
alcohol
how does your condition impact your life

38
Q

advice for lung chronic disease management stations

A

stop smoking
avoid precipitants
vaccination (flu)
exercise
eating
support

39
Q

what is CRP

A

a non-specific acute marker produced by the liver that increases during inflammation

40
Q

what is CRP measured for

A

routinely measured to assess activity of autoimmune/inflammatory diseases

41
Q

what are some examples of chronic conditions CRP can be used to monitor

A

RA
JIA
seronegative arthritis
crohns
vasculitis
pancreatitis

42
Q

what can CRP be used to assist making a diagnosis of and monitoring infection

A

infective endocarditis
abscess post-op infection
response to ABx

43
Q

what can CRP be used to differentiate between

A

inflammatory conditons
SLE vs RA
crohns vs UC

44
Q

other causes for raised CRP

A

burns, trauma
infections - pneumonia, TB
chronic inflammatory diseases - SLE, RA, vascultitis
MI, IBD, cancers

45
Q

causes for raised ESR

A

malignancy - lymphomas, carcinomas of colon/breast
haematological - multiple myeloma, anaemia of acute/chronic disease combined with Fe deficient
connective tissue disorders - SLE, RA, polymyalgia rheumatica and temporal arteritis
infections - TB, acute hepatitis, bacterial

46
Q

HxPC questions for infection marker chronic management

A

do you know what ESR/CRP is … could be new infection or flare up of your condition
how are you feeling
any recent illness/infection

47
Q

DHx questions for infection marker chronic management stations

A

how well do you think your condition is managed
what meds do you take and how often
any issues with taking them
any other meds/allergies

48
Q

SHx questions for inflammatory markers

A

recent travel anywhere
smoking
alcohol
impact of condition on life

49
Q

advice for raised inflammatory markers chronic management

A

stop smoking
disease management if non-compliant

50
Q

what are some causes for low albumin

A

malnutrition (crohns/Uc/coeliacs)
kidney disease
liver disease (hepatitis, cirrhosis)

51
Q

what are some causes for high albumin

A

severe infections
dehydration
chronic inflammatory disease
hepatitis

52
Q

what is meant by globulins

A

total proteins

53
Q

what does a high conjugated bilirubin indicate

A

liver/bile duct diseaseha

54
Q

what does a high unconjugated bilirubin mean

A

Gilbert’s syndrome
haemolytic anaemia

55
Q

what are liver enzymes raised in

A

chronic high alcohol excess
obesity (esp men)
smoking (esp women)
srug reaction

56
Q

what does ALP indicate

A

bile duct obstruction stimulates ALP synthesis
increases in increased obstructive liver disease
non-hepatic origin like osteoblastic activity in Paget’s, osteomalacia, vit D deficient

57
Q

what does GGT indicate

A

liver disease markers of drugs/alcohol (increase)

58
Q

what does AST/ALT indicate

A

liver disease markers of drugs, toxins and viral (increase)

59
Q

what does GGT + ALP indicate

A

biliary problems

60
Q

what does AST + ALT indicate

A

hepatic problems

61
Q

what does GGT + ALP risen > AST + ALT indicate

A

obstructive jaundice

62
Q

question in intro of liver enzymes chronic management

A

do you know what LFTs are

63
Q

HxPC questions for liver enzymes chronic management

A

how are you feeling
any recent illness/infection

64
Q

PMHx for liver enzymes chronic management station

A

past gallstones
Crohn’s/UC
surgery in past if malabsorption may have had some bowel removed

65
Q

DHx for liver enzymes chronic management stations

A

how well do you think your condition is controlled
what meds do you take and how often
any issues with your medication
do you take any other meds

66
Q

social history for liver enzymes chronic management stations

A

recent travel
smoking
alcohol
recreational drug/toxins
diet
how does this impact your life

67
Q

advice for liver enzymes chronic management station

A

stop smoking/acohol/drugs
diet advice
asdvice in disease management if non-compliant

Phase 2b (16 decks)

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