Long case specific questions

Question 1

How will you improve this patient’s compliance?

Answer 1

1. Determine their understanding of their illness and treatment
2. Prescribe least complex schedule
3. Use daily routines as a medication prompt
4. Educate about drugs and side effects
5. Consider calendar
6. Involve families, partners and friends
7. Monitor their response and provide written information

Question 2

How will you manage this patient’s osteoarthritis?

Answer 2

1. Provide education about OA and social support
2. Encourage weight reduction if appropriate
3. PT/OT - muscle strengthening exercise, heat pack, walking aids, ROM exercises
4. Pharmacological therapy - analgesia such as NSAIDs, paracetamol, glucosamine, chondroitin
5. Joint specific treatment - steroid injections
6. Surgery - arthroscopic surgery, joint replacement etc

Question 3

How are you going to stop this patient from smoking?

Answer 3

In 3 steps:

1. Assess dependence
2. Assess willingness to quit
3. Treat using behavioural, psychological and pharmacological interventions
4. Dependence - smoke after waking, daily intake, smoking when sick, smoking in forbidden areas, also CAGE (cut down? angry? guilt? eye opener?)
5. Assess willingness to quit - ready/not ready to quit in 6 months? ready to quit in next 1 month?
6. Behavioral/Pharmacological therapy:
   - Gums
   - Patches - dont prescribe within 4 weeks of AMI, UA or arrythmias. discuss side effects as local skin infection
   - Involve the family
   - Set a quit date

4 R model is useful:

1. Make the advice RELEVANT
2. REPEAT often
3. Stress the RISK
4. Emphasize the REWARD