Risk Flashcards
Q-Risk 2 assess…
The risk of CVD within ten years
Which demographics are used to calculate a Q-Risk score?
Age, Sex, BMI, Ethnicity, Post Code
When assessing Q-Risk, what in particular needs to be elicited from the past medical history?
C - Chronic kidney failure
A - Atrial fibrillation
R - Rheumatoid arthritis
D - Diabetic status
Which type of medication should be investigated while taking a drug history to elicit a Q-Risk score?
Hypertensive treatment
Which direct measurements should be recorded for a Q-Risk assessment?
Blood pressure and Cholesterol / HDL ratio
Which aspect of the social history should be investigated to establish a Q-Risk score?
Smoking status
What should be explored withing the family history to calculate a Q-Risk score?
Angina or heart attack in a first degree relative aged under 60 years
What should be explored withing the family history to calculate a Q-Risk score?
Angina or heart attack in a first degree relative of less than 60 years of ahe
Which factors make up the CHADSVAS Score?
Congestive heart failure Hypertension Age >75 Diabetes Stroke or TIA Vascular disease Age 65-74 Sex - Female
Which factors of the CHADVAS Score are worth two points
Stroke or TIA
Age >75
With a CHADVAS Score of 0, what management would be advised?
No treatment
With a CHADVAS Score of 1, what management would be advised?
Consider anticoagulation and start in those who are clinically at risk
With a CHADVAS Score of 2, what management would be advised?
Start anticoagulation
What is a CHADVAS Score a measure of?
The risk of stroke in patients with atrial fibrillation
What does FRAX assess the risk of?
Fracture
What personal information is used to calculate a FRAX score?
Age, Sex, Weight, Height, Femoral neck bone mineral density if known
What needs to be elicited from the patients past medical history to calculate a FRAX Score?
Previous Fracture, Rheumatoid arthritis and Causes of secondary osteoporosis - Kidney failure, Coeliac disease, Hyperthyroidism,,,
It is important to ask about which type of medication when calculating a FRAX Score?
Glucocorticoids
Which aspects of the social history are apart of the FRAX Score?
Smoking, 3+ Units of alcohol a day
What needs to be checked regards a patient’s family history to calculate a FRAX Score?
Parental hip fracture
In relation to the FRAX, what is a T-score?
Compares bone density to that of a healthy 30 year old adult
A T-Score of -1 standard deviation and above is indicative of what?
Healthy bone tissue
A T-Score of between -1 and -2.5 standard deviations is indicative of what?
Osteopenia - Consider starting bisphosphonates in light of certain risk factors
A T-Score of -2.5 standard deviations and below is indicative of what?
Osteoporosis - Start bisphosphonates
ABCD2 is a risk assessment tool used for what?
Calculating the risk of stroke following a TIA
What contributing factors make up the ABCD2 score?
Age, Blood pressure (140/90), Clinical features (Unilateral weakness and Speech difficulty w/o weakness), Duration, Diabetes
Which factors of ABCD2 score two pints?
Unilateral weakness, Duration of sixty minutes or more
Which factor of ABCD2 scores zero points?
Duration of less than ten minutes
What aspects of a patient’s past medical history should be investigated when working with the ABCD2 score?
Current AF and Previous TIAs and when they occurred
What is the risk of stroke within two days in a patient scoring 0-3, 4-5 and 6+ respectively when using ABCD2?
1%, 4% and 8%
When using ABCD2 how would a patient currently in AF be managed?
Immediate referral to a specialist
When using ABCD2 how would a patient scoring 0-3 be managed?
Urgent referral - All patients with suspected TIA should be seen within one week by a specialist
When Using ABCD2 how would a patient scoring 4-7 be managed?
Immediate referral - Should be seen be a specialist within 24 hours
What lifestyle advice can be given to reduce the risk of stroke in those scoring on ABCD2?
Diet, Exercise, Smoking Cessation, Adherence to medication (diabetic and anti-hypertensive meds)
Which types of medications can be used to reduce the risk of stroke in those scoring on ABCD2?
Anticoagulants (clopidogrel, aspirin) and Statins
Wells Score is used to calculate the risk of what?
Probability if developing a DVT
What information should be elicited from the patient’s presenting complaint to calculate their Wells Score?
Localised tenderness, Entire leg swelling, Calf swelling >3cm, Paralysis/Paresis/Immobility, Pitting oedema, Collateral superficial veins
What aspects of the patient’s past medical history contribute to the Wells Score?
Previous DVT, Recent major surgery, Bedridden for more than 3 days, Active cancer treatment
Which medications or therapies need to be asked about when working with Wells Score?
HRT and Oral contraceptives
What needs to be asked when discussing a patient’s social history in regards Wells Score?
Smoking status and Recent long haul flights
How would a Wells Score of 1 or less be managed?
DVT unlikely
D-dimer - if negative rule out DVT, if positive request USS
How would a Wells score of 2 or greater be managed?
DVT likely
D-dimer and USS - if both negative rule out DVT, if USS positive treat as DVT, if D-dimer positive and USS negative repeat USS in a week
What lifestyle advice would be given to someone scoring on Wells Criteria?
Diet, Exercise, Smoking cessation
Which medications can be prescribed for those scoring on Wells Criteria?
LMWH and Anticoagulants
Which risk factors are associated with diabetes?
Age, Sex, Ethnicity, Waist measurement, BMI, Hypertension, Family history
When assessing diabetes risk which signs of hyperglycemia should be investigated?
Polyuria, Polydipsia, Weight loss, Fatigue, Genital thrush, Blurred Vision
What levels of risk are associated with a diabetes risk score?
Low - 0-6%
Increased - 7-15%
Moderate - 15-24%
High - 24-47%
What diet advice can be given to reduce the risk of diabetes?
Eat regular meals, Watch portion size, Reduce fat and salt, Limit sugar, Moderate alcohol
What exercise advice can be given to reduce the risk of diabetes?
150 minutes of moderate intensity exercise which raises both heart rate and respiration rate per week
Those at risk of diabetes should be helped to recognise the five T’s. What are the five T’s?
Thirst (polydipsia), Tiredness, Thrush, Toilet (polyuria), Thinning (weight loss)
