Red Book - Chronic Disease Flashcards
From when and how often do we calculate absolute CVD risk?
Every 2 years from 45-74yo (30yo if ATSI)
From when and how often do we measure BP?
Every 2 years from 18yo if low CVD risk
6-12mthly if mod CVD risk
6-12wkly if high CVD risk
6mthly if established CVD
When do we measure lipids?
Every 5 years from 45yo (30yo if ATSI) if low CVD risk
2yly if mod CVD risk
1yly if high CVD risk or established CVD
When do we screen for diabetes?
Every 3 years from 40yo (18yo if ATSI) with AUSDRISK
If high risk (AUSDRISK 12+ or risk factors), test FG or A1c every 3 years
If impaired glucose, test FG or A1c annually
Stroke risk Ax - ABCD2 tool
Ask about Sx of TIA annually, and if positive complete the ABCD2 tool:
Age >60yo (1)
BP >140/90 (1)
Clinical features - unilateral weakness (2), speech impairment (1) or other (0)
Duration - >60 mins (2), 10-59 mins (1), <10 (0)
Diabetes (1)
Scores of 4-7, PHx AF or crescendo Sx require urgent brain + carotid imaging
Who is at high risk of CKD?
Smoking
Obesity
FHx kidney failure
DM
HTN
ATSI >30yo
Established CVD
PHx AKI
How do we screen for CKD if at high risk?
BP, ACR, eGFR every 1-2 years from 18yo
ACR interpretation
Normal: <3.5 in women or <2.5 in men
Microalbuminuria: 3.5-35 in women or 2.5-25 in men
Macroalbuminuria: >35 in women or >25 in men
If ACR positive, repeat samples twice in 3 months
CKD staging
Stage 1: eGFR >90 w microalbuminuria or proteinuria
Stage 2: eGFR 60-89 w microalbuminuria or proteinuria
Stage 3a: eGFR 45-59
Stage 3b: eGFR 30-44
Stage 4: eGFR 15-29
Stage 5: eGFR <15
If screening eGFR <60, repeat within 7 days
Who is at increased risk of oral disease? What are the screening recommendations?
Low SES w/o easy access to dental care, elderly, ATSI, rural / remote, migrants, low saliva (Sjogrens, some drugs eg. psychotropics, head/neck radiation), smokers >50yo, heavy EtOH, high sun exposure
Examine the mouth, teeth and lips at least annually
Who is at increased risk of glaucoma? What are the screening recommendations?
FHx glaucoma (1st° relatives), Caucasian and Asian ≥50yo, African ≥40yo -> refer for ocular exam 5-10y earlier than age of Dx of relative
> 50yo w DM, myopia, long-term steroids, migraine, abnormal BP, eye trauma -> refer for ophthalmoscopy, IOP and VF Ax
Who is at increased risk of urinary incontinence? What are the screening recommendations?
Women who have had children, are overweight, have constipation
People w DM, stroke, resp/cardiac/neuro disorders or recent surgery
Frail, elderly or RACF residents
Case finding by asking about incontinence every 12m
What are the 4 types of urinary incontinence? What are the main causes?
- Stress - pregnancy/childbirth/menopause in women, prostate surgery in men
- Urge - overactive or unstable bladder, neurological conditions, constipation, enlarged prostate, poor bladder habits
- Mixed - more common in older women
- Overflow - caused by outflow obstruction or injury
Osteoporosis - what and when should # risk be assessed?
Risk factors: FHx fragility #, smoking, high EtOH, Vit D def, BMI <20, recurrent falls, low physical activity, immobility
+ PHx endocrine disorders (inc. DM), premature menopause, anorexia nervosa or amenorrhoea for >12m, inflammatory conditions, malabsorption, CKD, liver disease, multiple myeloma, HIV + treatment, drugs (steroids, anti-epileptics, aromatase inhibitors, anti-androgens, excess thyroxine, ?SSRIs)
Assess RFs annually from ≥45yo for women and ≥50yo for men
If RF + >50 for women or >60 for men, recommend DEXA
Who is automatically high risk for type 2 diabetes (regardless of AUSDRISK score)?
Age >40 + overweight
PHx IGT/IFG, GDM, PCOS, CVD
FHx diabetes in first degree relative
High risk ethnic background
ATSI
On anti-psychotic medication
