Chronic Disease Stations

Question 1

What is bilirubin?

Answer 1

Breakdown product of RBC

Question 2

Name 5 factors that can cause a rise in bilirubin

Answer 2

Gilbert’s syndrome
Stress
Fasting
Drugs
Haemolytic disease

Question 3

What is Gilbert’s syndrome?

Answer 3

Inherited disease where liver can’t process bilirubin properly = raised bilirubin levels on testing + episodes of jaundice

Question 4

Name 3 drugs that can increase bilirubin levels

Answer 4

Rifampicin
Sulfonamide Abx
Carbimazole (thyroid meds)

Question 5

What is ALT?

Answer 5

Alanine transaminase - marker of liver cell damage

Question 6

What is a high ALT?

Answer 6

> 120 IU/L

Question 7

Name 4 hepatic causes of raised ALT

Answer 7

Alcohol
Viral hepatitis
Drugs
Wilson’s disease

Question 8

Name 4 drugs that can increase ALT levels

Answer 8

NSAIDs
Abx
Statins
Anti-epileptics

Question 9

Name 4 non-hepatic causes of raised ALT

Answer 9

Coeliac disease
Strenuous exercise
Muscle disease
Hypo/hyperthyroidism

Question 10

What is AST?

Answer 10

Aspartate aminotransferase

Question 11

What does an AST:ALT >2.1 indicate?

Answer 11

Alcohol related liver disease

Question 12

What does an AST:ALT <2.1 indicate?

Answer 12

Hepatic steatosis/chronic viral hepatitis

Question 13

What is ALP?

Answer 13

Alkaline phosphatase

Question 14

Name 2 physiological causes of raised ALP

Answer 14

3rd trimester pregnancy
Bone growth in adolescents

Question 15

Name 4 pathological causes of raised ALP

Answer 15

Heart failure
Bone diseases
Steroids
Bile duct obstruction/pathology

Question 16

What is gammaGT used for?

Answer 16

Sensitive but non-specific marker for hepatobiliary disease

Question 17

Name 7 causes of raised gamma GT

Answer 17

Hepatobiliary disease
Pancreatic disease
Alcoholism
COPD
Diabetes
MI
DRugs e.g. OCP, carbamazepine (anti-epileptic)

Question 18

Name 5 causes of low albumin

Answer 18

Liver disease
Malnutrition/absorption
Pregnancy
Injury/infection
Chronic illness-increased catabolism

Question 19

Name 4 conditions that can increase HbA1c levels

Answer 19

Iron deficiency
Alcoholism
Chronic renal failure
Splenectomy

Question 20

Name 3 conditions that can decrease HbA1c levels

Answer 20

Chronic liver disease
Haemoglobinopathies
RA

Question 21

Name 3 drugs/vitamins that can decrease HbA1c levels

Answer 21

Vit C
Vit E
Aspirin
Ribavirin (anti-viral for hepatitis)

Question 22

What advice would you give to someone with raised HbA1c levels?

Answer 22

High fibre, low sugar diet
Less saturated fats
Exercise + physical activity
Reduce alcohol + smoking
Attend yearly check ups e.g. urinalysis, eye tests, diabetic foot screenings

Question 23

What is INR?

Answer 23

International Normalised Ratio - measure of how thick/thin blood is - how well it clots

Question 24

What symptoms should you ask about for raised INR?

Answer 24

Bruising
Bleeding-gums, heavy periods, nosebleeds etc
Blood in stool/urine
Sudden severe back pain-spontaneous retroperitoneal bleeding

Question 25

What symptoms should you ask about for decreased INR?

Answer 25

Stroke symptoms Visual changes DVT/PE symptoms-pain, red, swollen, chest pain, SOB

Question 26

Name 4 contraindications for warfarin

Answer 26

Pregnancy Hemorrhagic stroke Within 72hrs major surgery Severe hepatic impairment (processed by liver)

Question 27

Name 3 factors that can exaggerate the effects of warfarin

Answer 27

Weight loss Acute illness Smoking cessation

Question 28

Name 3 factors that can reduce the effect of warfarin

Answer 28

Weight gain Diarrhoea Vomiting

Question 29

What questions should you ask about taking medications?

Answer 29

Same time every day? Ever forget doses? Do you ever double dose?

Question 30

Name 4 key drug interactions that enhance the effect of warfarin

Answer 30

Alcohol Abx-clarithromycin, co-trimox Aspirin, clopidogrel Amiodarone NSAIDs Cranberry juice

Question 31

Name 4 key drug interactions that decrease the effect of warfarin

Answer 31

St John's wort Rifampicin Vit K Carbamazepine (anti-epileptic)

Question 32

What key questions should you ask about diet in an INR station?

Answer 32

Changes in vit K intake e.g. broccoli, kale, spinach Have they been avoiding grapefruit + cranberries?

Question 33

How does warfarin work?

Answer 33

Inhibits vit K dependant clotting factors

Question 34

What are the vit K dependant clotting factors?

Answer 34

II, VII, IX, X (1972)

Question 35

What is the target INR for people on warfarin?

Answer 35

2-3 (2.5)

Question 36

What should INR be in people not on warfarin?

Answer 36

1-2

Question 37

What 3 questions should you ask in an asthma review?

Answer 37

-Have you had trouble sleeping due to asthma symptoms? -Have you had your usual asthma symptoms during the day? -Has your asthma interfered with your everyday activities?

Question 38

What are the side effects of ACE inhibitors to be aware of for an asthma review?

Answer 38

Cough

Question 39

What effect do BB have on asthma?

Answer 39

Exacerbate

Question 40

What areas of social history are important in asthma reviews?

Answer 40

New pets Job Mould/home conditions Air temp changes Liver with/near smokers? Job stress Recent move?

Question 41

Advice for asthma review

Answer 41

Ask family/friend smokers to go outside Flu vaccine Avoid cold air/pollen triggers Regular exercise Inhaler technique + reviews Peak flow dairy for next month

Question 42

What is a moderate PEFR?

Answer 42

>50-75%

Question 43

What is a severe PEFR?

Answer 43

33-50%

Question 44

What is a life threatening PEFR?

Answer 44

<33%

Question 45

How do you manage an acute exacerbation of asthma?

Answer 45

Salbutamol Prednisolone O2

Question 46

What score is used for measuring breathlessness?

Answer 46

MRC dyspnoea score (0-4)

Question 47

What symptoms should you ask about for raised inflammatory markers?

Answer 47

Fever, vomiting, diarrhoea, night sweats, weight loss How are they feeling today? Impact on daily life

Question 48

What PMHx should you ask about for raised inflammatory markers?

Answer 48

Autoimmune disorders Bone conditions Active cancers Lung diseases

Question 49

How should you start a chronic disease station?

Answer 49

Intro Ask about their understanding Explain test results + problems that can occur due to specific results

Question 50

What should you ask about the patient's current condition?

Answer 50

How are they feeling today? Recent illness/infection Symptoms troubling them? Specific symptoms for condition Specific complications of condition e.g. diabetic foot

Question 51

What are the 4T's for diabetic symptoms?

Answer 51

Toilet Thirsty Tired Thinner

Question 52

What should you ask about management of their condition?

Answer 52

Taking meds? Med compliance Technique/taking them correctly-time of day etc Side effects of meds?

Question 53

Explain purpose of peak flow to a patient

Answer 53

Measures how fast you can breath out to see how well your lungs are working

Question 54

Name 7 triggers for asthma

Answer 54

Smoking Damp Pets Exercise Allergies Infections Work

Question 55

Name 4 red flags for asthma

Answer 55

Worsening wheeze Affecting ADLs Waking up at night Fast heart rate

Question 56

Give 3 pieces of advice for asthma management

Answer 56

Stop smoking Flu vaccine Exercise

Question 57

What should you ask about patient understanding for INR station

Answer 57

Do they know what INR is? Do they know why they are on warfarin + how it works?

Question 58

Name 2 practical reasons for a high INR

Answer 58

Double dosing warfarin Change in warfarin regimen

Question 59

Why would you ask about liver failure for an INR station?

Answer 59

Lack of clotting factors

Question 60

What bleeding disorders would you ask about for an INR station?

Answer 60

Haemophilia Factor 7 deficiency

Question 61

What can binge drinking do to INR?

Answer 61

Increases

Question 62

What does smoking do to INR?

Answer 62

Increases

Question 63

What can crp/esr tell you?

Answer 63

Condition flare up/ new infection

Question 64

What can low albumin show?

Answer 64

Malnutrition-Crohns/UC, kidney or liver disease

Question 65

What can high albumin show?

Answer 65

Severe infection/dehydration, chronic inflammatory diseases, hepatitis

Question 66

What key part of social Hx should you ask for LFT's?

Answer 66

Travel Hx - hepatitis risks, alcohol, unprotected sex etc