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Question 1

What is Chadvasc a measure of?

Answer 1

Stroke risk in AF

Question 2

What are the factors in Chadvasc?

Answer 2

CHF
HTN
Age: 65-75, 75+ (2)
Diabetes
Stroke/TIA (2)
Vasc disease
Female

Question 3

What are the actions taken from a Chadvasc score?

Answer 3

0: no anticoagulant
1: consider anticoagulant; warfarin (2-3INR), DOAC, aspirin
2: do anticoagulant

Question 4

What are the key points with warfarin?

Answer 4

Needs INR CHECK
Teratogenic
Can interfere with other meds
Increased bleeding risk
Diet control
Can be reversed with vitamin K

Question 5

What is FRAX a measure of?

Answer 5

10 year Risk of fracture in spine, shoulder, hip or wrist for ppl from 40-90yo

Question 6

What are the factors to consider in FRAX?

Answer 6

Age
Sex
Weight
Height
RA
Precious fracture
Secondary osteoporosis
Femoral neck BMD ( from DEXA)
Glucocorticoids or lithium
Paternal hip fracture
Smoking
Greater than or equal to 3 drinks per day

Question 7

How should you interpret the scores of FRAX?

Answer 7

Less than 10% - reassess in 5yr
10-20: DEXA scan with bisphisphonetes
High 20+

Question 8

What are the factors in diabetes risk score?

Answer 8

Age
Gender
Ethnicity
Family history
Waist circumference
BMI
Has hypertension or on medication for it

Question 9

How should you interpret the diabetes risk score?

Answer 9

0-6: low
7-15: increased
16-24: moderate
25+: high

Question 10

What is QRISK2 the measure of?

Answer 10

10year risk of heart attack or stroke

Question 11

What factors are looked at in QRISK2?

Answer 11

Age, sex, ethnicity, BMI
CKD (4/5), AF, RA, diabetic
Anti hypertensives
Angina/heart attack in 1• relative
Smoke
Cholesterol/LDL ratio
Systolic Bp

Question 12

How do you interpret the risk on QRISK2?

Answer 12

<10% low risk - offer advice
10-20: moderate
20+: high
*for latter two offer advice, LDL modification and review control of comorbidities

Question 13

What is ABCD2 a measure of?

Answer 13

Stroke after TIA

Question 14

What are the points in ABCDD?

Answer 14

Age over 60 (1)
High BP (1)
Clinical features: unilat weak (2), just speak disturbance (1)
Duration: over 60 (2), between 10 and 60 (1)
Diabetes (1)

Question 15

What is the interpretation of ABCDD score?

Answer 15

3 or less: within 7 days
4-6: within 24hr
6+: IMMEDIATELY

Question 16

What is the management for a TIA?

Answer 16

Lifestyle
Antitheomvotic: 300mg aspirin, the long term 75, clopidogrel 75
2• prev: control HTN and cholesterol
Carotid endarterectomy

DO NOT DRIVE FOR 1 MONTH

Question 17

What is the Wells score?

Answer 17

Chance of a DVT

Question 18

How is the wells score calculated?

Answer 18

• Cancer (or within past 6 month)
  -Paralysis or recent immobilisation of low
  -Recently bedridden 3 days OR within 12 weeks of surgery (with gen an)
• localised tenderness along distribution of the venous system
  -entire leg swollen
  -calf more than 3cm greater than other leg
  -pitting odema was confined to symptomatic leg
  -collateral superficial veins
  -previously documented DVT

Alternative DX more likely (-2)

Question 19

How should you interpret score of wells?

Answer 19

0: unlikely 5%
1-2: moderate risk, 17%
3+: likely, 17-53

Question 20

Investigations for DVT?

Answer 20

D diner; specific but not sensitive
USS Doppler veins
CTPA: GOLD for PE

Question 21

What is the DVT treatment?

Answer 21

LMWH
Oral warfarin
Compression stockings
Treat underlying cause
Diet, exercise, smoking