osce Flashcards
frax :
- assesses what
ten year probability of fracture %
frax:
- what questions
- age
- sex
- BMI (weight, height)
PMC
PMH
- have you had a fracture spontaneously / from trauma that wouldnt have otherwise fractured
- RA diagnosis
- illnesses associated with secondary osteoperosis : type I (insulin dependent) diabetes, osteogenesis imperfecta in adults, untreated long-standing hyperthyroidism, hypogonadism or premature menopause (<45 years), chronic malnutrition, or malabsorption and chronic liver disease
- BMD - T score…
DH
- currently take glucocorticoids / taken for 3m+ (5mg/day) (prednisolone)
- lithium
FH
- has your mum or dad had a hip fracture
SH
- currently smoking
- daily alcohol units (3+)
frax:
- interpretation of results
% (of probability of fracture within 10 y)
lifestyle (All) :
- weight bearing/ balance exercise, smoking, alcohol, vitamin D, calcium intake, adapt home e.g. trip hazards like rugs, grab bars, good grip shoes
10%+ –> order DEXA. consider bisphosphonate or denosumab
(Close –> consider)
wells:
- assesses what
risk of DVT
wells:
- what questions
PMC
- calf swelling >3cm than other leg
- entire leg swollen
- localized tenderness along deep venous system
- pitting oedema only on bad leg
PMH
- Active cancer / cancer treatment - within 6m
- bed ridden >3d
- major surgery within 12 w
- Paralysis, paresis, or recent plaster immobilization of the lower extremity
- previous DVT documented
DH
FH
SH
- long haul flights
wells:
- interpret results
0 - DVT unlikely –> d dimer testing
1-2 - possible –> high sensitivity d dimer testing (and if pos –> USS)
3+ - DVT likely –> diagnostic USS
DVT–> anticoagulation
qrisk
- assess what
% risk of developing a heart attack or stroke over the next 10 years
in those aged 35–74
qrisk
- what questions
- age
- sex
- ethnicity
(- postcode
- BMI (height, weight)
- cholesterol / HDL ratio
- BP )
PMC
PMH
- DM
- AF
- Chronic kidney disease (stage 3, 4 or 5)?
- migraines
- RA
- SLE
- severe mental illness
- erectile dysfunction diagnosis/ treatment
DH
- HTN medication
- atypical antipsychotic medication
- steroid tablets (regular)
FH
- Angina or heart attack in a 1st degree relative < 60?
SH
- smoking status
qrisk
- interpret results
<10% - low risk –> lifestyle (exercise, diet, weight, smoking, DM control, smoking)
10-20% - moderate risk –> lifestyle, consider statin
20%+ - high risk –> lifestyle + statin
chadvasc
- assesses what
Calculates stroke risk for patients with atrial fibrillation
chadvasc
- what questions
- age
- sex
PMC
PMH
- congestive heart failure
- hypertension
- stroke/ TIA/ thromboembolism
- Vascular disease history (prior MI, peripheral artery disease, or aortic plaque)
- DM
DH
FH
SH
chadvasc
- interpret results
0 –> no anticoagulation
1 –> consider anticoagulation (with vitamin K antagonist like warfarin within therapeutic range (INR 2–3) or a DOAC (rivaroxaban, apixaban), maybe aspirin.)
2 + –> start anticoagulation (with vitamin K antagonist like warfarin within therapeutic range (INR 2–3) or a DOAC (rivaroxaban, apixaban))
consider risk of bleeding (HASBLED score - uncontrolled HTN, anticoag use, liver/kidney disease, alcohol), and balance this
all: lifestyle advice - diet, alcohol, smoking, exercise
abcd
- assesses what
risk of stroke after a suspected transient ischemic attack (TIA)
abcd
- what questions
- age
- BP
PMC – TIA
- unilateral weakness?
- speech disturbance?
- duration of symptoms
PMH
- DM
- other TIAs? how far apart?
DH
FH
SH
abcd
- interpret results
0-3 : low risk - seen by specialist within 7 days
4-5 : moderate risk - seen by specialist within 24h
6-7: high risk
- consult neurology - see specialist immediately
- consider MRI head
all:
- do not drive for at least 1 month
- lifestyle advice - diet, exercise, smoking, medication adherence
