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2b > Communication skills > Flashcards

Communication skills Flashcards

1
Q

Foods containing vitamin K

A

Green fruit and veg

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2
Q

How does warfarin thin blood

A

It stops vitamin K activating clotting factors

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3
Q

High INR symptoms

A

Headache, stomache
Bleeding, bruising
Blood from everywhere

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4
Q

Drugs that increase INR

A

Overdosing
Aspirin, NSAIDs
Omeprazole, prednisolone, rifampicin

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5
Q

Conditions that increase INR

A

Liver failure, bleeding disorders

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6
Q

Social history things that increase INR

A

Decrease in vit K intake
Binge drinking
Smoking

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7
Q

How is an elevated INR treated

A

Vitamin K

Blood transfusion

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8
Q

How to keep INR stable

A 
Have INR measured
Take meds as directed
Keep vitamin K stable
Limit alcohol
Dont smoke
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9
Q

How to decrease risk of bleeding

A

Avoid activities
Shave gently
Tell dentist etc youre on warfarin

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10
Q

When should you contact your doctor about your warfarin

A

Increased brusing
Bleeding increased
Darker stool
Blood in urine

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11
Q

Warfarin HPC which increases INR

A 
Recent illness
Fever
N/V/D
Pain or stress
SE of warfarin
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12
Q

Warfarin DHx which increases INR

A

What is current dose?
Any missed dose?
Same time everyday?
Double dosing?

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13
Q

Other drugs which cause INR to go up

A 
New medicines
Stopped some?
NSAIDs
Aspirin
Antibiotics
Amiodarone
Steroids
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14
Q

Warfarin SHx which increases INR

A

Major changes to diet?
Liver consumption?
Sudden change in vitamin K foods?
Cranberry juice?

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15
Q

Low INR symptoms

A 
Sudden weakness
Numbness or tingling
Visual changes
Slurred speech
Pain, swelling, redness or heat in body parts
SOB or chest pain
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16
Q

Causes of low INR

A

Supplements with vitamin K
High dietary intake
Oestrogens

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17
Q

Treatment of low INR

A

LMWH

Warfarin

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18
Q

What is warfarin

A

Anticoagulant, blocks enzyme which activates vitamin K. So means clotting factors arent produced

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19
Q

When should you take normal dose and when should you double dose when you forget

A

if you remember before midnight then you can take it

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20
Q

Warfarin interactions

A 
Aspirin
Ibuprofen
Herbal medicines
Alcohol
Some food and drink
Dietary changes
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21
Q

Can I go abroad on warfarin

A

If youre going to be away more than a month then you need it checked abroad

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22
Q

What should you do at the start of the warfarin history

A
  • you are on warfarin, your INR is
  • do you know what INR and warfarin is
  • risks of high and low
  • explain why they need to be on it
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23
Q

Warfarin PC questions

A

How are you feeling?
Infections or illnesses?
D and V?
Increased bleeding or bruising?

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24
Q

Warfarin DHx questions

A

Do you know how many times you are meant to be taking it?
How and when do you take?
Are you finding it ok?
Are you taking it everyday?

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25
Q

Warfarin DHx, other medications and side effects to ask about

A

Aspirin, NSAIDs, antibiotics, herbal.

Bleeding, bruising, blood from anywhere, headaches

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26
Q

Warfarin SHx questions

A

Diet
-leafy greens, kale, brocoli, green apples, pears. This can interact and reverse
Smoking
Alcohol

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27
Q

What is HbA1c

A

Glycated haemoglobin, gives the average blood glucose level over the previous two to three months

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28
Q

Normal HbA1c

A

less than 42mmol/mol or <6%

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29
Q

Prediabetes HbA1c

A

42-47mmol/mol or 6-6.4%

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30
Q

Diabetes HbA1c

A

48mmol/mol or >6.5%

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31
Q

Benefits of lowering HbA1c

A 
Reduces risk of 
-retinopathy
-neuropathy
-diabetic nephropathy
Less likely to 
-cataracts
-heart failure
-amputation
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32
Q

Management plan for lowering HbA1c

A

Dietary modifications
Physical activity
medications

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33
Q

Conditions which raise HbA1c

A

Kidney failure
Alcoholism
B12 deficiency

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34
Q

Conditions which reduce HbA1c

A

Blood loss
Sickle cell disease
Thalassaemia

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35
Q

Medications which increase HbA1c

A

Corticosteroids

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36
Q

Advice for someone on HbA1c monitoring

A

Be careful what you eat- aware of snacking
Stick to treatment plan- take meds as recommended
Be as active as possible
Sick day rules
Monitor BM

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37
Q

What should you say at the start of a HbA1c history

A 
I understand you are.. I can see your HbA1c is
When were you diagnosed
What type
Do you know what HbA1c is
How well do you think its being manage
Benefits of it being high or low
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38
Q

Diabetes PC questions

A 
Howre you feeling
Recent infections or illness
(D or V)
Hospital admissions for DKA
Polyuria, polydipsia, weight loss, vision change, neuropathy, ED
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39
Q

Diabetes PMH

A

Cardiovascular, cerebrovascular, renal, visual complications or comorbiditis

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40
Q

Diabetes DHx

A

How do you think its being controlled, do you think its going well
- recent changes

41
Q

Diabetes compliance questions

A

How and when are you taking it?
How are you finding it? SE?
Injecting different sites?
Monitoring glucose?

42
Q

Diabetes SHx

A 
ADLs
Diet
Exercise
Smoking
Alcohol
43
Q

How should you finish a diabtes history

A

Explain advantages of keeping it down. Mention support

  • GP
  • Diabetes nurses
  • Online resources
  • Training courses
44
Q

Good BM for diabetes people

A

4-7mmol/mol

45
Q

Peak flow is affected by

A 
Age
Sex
Height
Weight
Inhalers
46
Q

What is blue inhaler for

A

Reliever. Ventolin (salbutamol). Rescue from acute symptoms. SABA- stops bronchospasm

47
Q

What is brown inhaler for

A

If youre having to use blue 3 times a week. Used everyday to prevent symptoms

48
Q

Peak flow advice

A

Take your peak flow before preventer inhaler.

Always use same meter.

49
Q

Peak flow red flags

A

Wheeze is getting worse
ADLs affected
Waking up at night with symptoms
Reliever inhaler more than usual

50
Q

What does spirometry do

A

Measures functional lung volumes

51
Q

Obstructive lung disease examples

A 
Asthma
COPD
Bronchiectasis
Inhaled foreign body
Tumour
52
Q

Describe obstructive spirometry

A

Takes a long time to breath out. FEV1/FVC <0.7

FEV1<80%

53
Q

Restrictive lung disease examples

A

Kyphosis and scoliosis. AnkSpond. Neuromuscular
Fibrosis
Sarcoidosis
Asbestosis

54
Q

Restrictive spriometry

A

Lower lung volumes.

FEV1/FVC >80%

55
Q

What do you say at the start of a peak flow/spirometry

A

I understudand you are.. Your peak flow/ spirometry is..
Do you know what that is
How well do you think your conditions is managed

56
Q

How do you explain peak flow

A

The peak flow test measures how fast you can breath out, so you can see how well your lungs are working

57
Q

How do you explain spirometry

A

It measures lung function, specifically the amount and speed of air that can be breathed in and out

58
Q

Peak flow/spirometry HPC

A 
Ask howre they feeling
Illnesses or infections
SOB
PND
Cough
Wheeze
59
Q

Peak flow/ spirometry DHx- control

A

How well is it being controlled?

  • taking meds
  • which inhalers
  • other meds
  • Beta blockers
  • inhaler technique been checked by nurse?
60
Q

Peak flow/spirometry DHx- exacerbations

A 
Time when worse?
Pets?
Travel?
Housing?
Havfever?
61
Q

Peak flow/spirometry SHx

A

Smoking
Alcohol
Impact of condition on life

62
Q

Peak flow/ spirometry lifestyle advice

A 
Smoking
Avoid precipitants
Vaccination
Exercise
Eating
Support
63
Q

What is CRP

A

Non specific marker

Produced by liver in the presence of inflammation

64
Q

3 categories where CRP is measured

A

Autoimmune/ autoinflammatory conditions
Infection monitoring
Differentiation between inflammatory conditions

65
Q

Causes of elevated CRP

A 
Burns
Trauma
Infections
Heart attack
Chronic inflammatory conditions
-lupus
-vasculitis
-RA
IBD
Ca
66
Q

What is ESR

A

Distance erythrocytes settle in anticoagulated blood under gravity in an hour

67
Q

Causes of high ESR categories

A

Malignancy
Haematologic
Connective tissue disorders
Infections

68
Q

Cancers which raise ESR

A

Malignant lymphoma

Carcinomas of colon and breast

69
Q

Haematologic causes of raised ESR

A

Multiple myeloma

Anaemia of chronic disease

70
Q

Connective tissue disorders which cause raised ESR

A

SLE
RA
PMR
Temporal arteritis

71
Q

Infections which cause raised ESR

A

TB
Acute hepatitis
Bacterial

72
Q

What is low albumin

A

A sign of malnutrition and may occur when your body does not get or absorb enough nutrients.

73
Q

Conditions which cause low albumin

A

Crohns, coeliac, kidney and liver disease

74
Q

Conditions which cause high albumin

A

Severe infections, dehydration, chronic inflammatory diseases, hepatitis

75
Q

What is the LFT- Globulins

A

Total proteins without albumin

76
Q

What is ALP

A

Bile duct obstruction stimulates ALP synthesis

77
Q

In what conditions is ALP raised

A

Obstructive liver disease, increased osteoblast activity (pagets, osteomalacia, vitamin D deficiency)

78
Q

What is GGT

A

Liver disease marker, raised in drugs and alcohol

79
Q

What are AST and ALT

A

Raised in any liver injury. Drugs, toxins, viral

80
Q

What is high conjugated bilirubin suggestive of

A

Liver or bile duct disease

81
Q

What is high unconjugated bilirubin suggestive of

A

Gilberts or haemolytic anaemia

82
Q

When are liver enzymes increased

A

Chronic alcohol excess
Obesity
Smoking
Drug reaction

83
Q

What are tumour markers

A

Substances found at higher than normal levels in the body fluid of some people with cancer

84
Q

What are tumour markers used for

A 
Guide treatment
Monitor treatment
Predict recovery
Watch for recurrance
Detect cancer in high risk
85
Q

What are problems with tumour markers

A

Other conditions can increase levels
May be high in people without cancer
May vary with time

86
Q

Normal CEA

A

<2.5 in non smoker <5 in smoker

87
Q

Benign conditions that increase CEA

A 
Smoking
Infection
IBD
Pancreatitis
Liver cirrhosis
88
Q

When is CEA used

A

Mainly as a colorectal cancer marker. Raised CEA indicates progression or recurrence of cancer

89
Q

Which conditions is CEA used in

A

Lung cancer
Breast cancer
Liver cancer
Colorectal cancer

90
Q

Who is allowed a PSA

A

Anyone over 50 who has spoken about the advantages and disadvantages with a GP or nurse

91
Q

What is PSA

A

Protein made by the prostate gland

92
Q

When are PSA levels high

A

Men with prostate cancer
Prostatitis
BPH

93
Q

Advantages of psa

A

Can help pick up prostate cancer before you have any symptoms
May detect a fast growing cancer at an early stage

94
Q

Disadvantages of PSA

A

May not have cancer
Can miss out cancer
If raised you need a biopsy which has SE of pain, infection, blood in urine

95
Q

How to start a PSA history

A

Check patient understanding of BPH and PSA

96
Q

PSA HPC

A 
Howre you feeling
Urgency
Incontinence
Incomplete emptying
Dysuria
Haematuria
Hesitancy
Stream 
Terminal dribbling
97
Q

PSA PMH

A 
Enlarged prostate?
UTI
Surgery
Catheterisation
Trauma
Inflammation
DRE
98
Q

PSA DHx

A 
Compliance?
Alfuzosin
Doxazosin
Tamsulosin
-Finasteride
99
Q

PSA SHx

A 
ADL
Smoking
Alcohol
Diet
Exercise
Sexual history (ejaculation increases it)

2b (28 decks)

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