Risk assessment Flashcards
what things are involved in the diabetes risk score?
A - age
B - BMI (height and weight)
C - circumference of waist
D - diabetes in first degree relative
E - ethnicity
G - gender
H - HTN
what can the results of the diabetes risk score be?
low risk - 0-6 points (1 in 100 chance)
increased risk - 7-15 points (1 in 35 chance)
moderate risk - 16-24 points (1 in 10 chance)
high risk - 25-47 points (1in 4 chance)
what sort of questions should you ask in the diabetes risk score station regarding presenting complaint?
Toilet (polyuria)
Thirsty (polydipsia)
Tiredness (more than usual)
Thrush (genital itching secondary to infection)
Thinner (unintentional weight loss)
what should you ask specifically about in the PMH in the diabetes risk score station?
hypertension
pre diabetes diagnosis
diabetes diagnosis
recent changes to health / infections
what other questions should you ask in the diabetes risk score station?
height
weight
BMI
waist circumferacne
ethnicity
what should you ask int he family history section of the diabetes risk score station?
any diabetes in your family (looking for first degree relatives)
what lifestyle advice may you need to give in the diabetes risk score station?
Regular meals/portion size
decrease fat/sugar/salt
moderate alcohol
Exercise 150mins/week
Weight loss
what does the Qrisk score measure?
the risk of developing CVD in the next 10 years
what are the variables included in the Qrisk score?
age
sex
ethnicity
BMI
PMH - C (CKD stage 4 or 5), A (AF), R (RA), D (diabetes)
antihypertensive treatment
angina or a heart attack in the first degree relative
smoking status
cholesterol / HDL ratio
systolic blood pressure
what do the results of the Qrisk score mean?
<10% = low risk.
10–20% = moderate risk.
>20% = high risk.
what advice should you give if the patient is low risk on the Qrisk score?
inform that risk is low but can still reduce riskStop smoking.
Exercise.
Diet change/weight loss.
Disease control/medication adherence.
what advice should b given to a patient scoring a moderate risk in the Qrisk score?
Offer advice on any relevant lifestyle factors to reduce risk.
Consider reviewing any relevant comorbidities that may not be optimally controlled.
Discuss the benefits and risks of taking a lipid modification therapy.
what is the CHA2DS2VaSc score?
risk of an AF patient having a stroke
what are the components of the CHA2DS2VaSc?
congestive heart failure
hypertension
age (1 point for 65-75, 2 points for over 75)
diabetes
stoke / tia history (2 points)
vascular disease
sex (1 point for female)
what would a score of 1 on the CHA2DS2VaSc score mean?
consider anticoagulation with vitamin K antagonist like warfarin within therapeutic range (INR 2–3) or a DOAC (rivaroxaban, apixaban), maybe aspirin.
what would a score of 0 in the CHA2DS2VaSc score mean?
no anticoagulation required
what would a score of over 2 indicate in the CHA2DS2VaSc score?
anticoagulation required with vitamin K antagonist like warfarin within therapeutic range (INR 2–3) or a DOAC (rivaroxaban, apixaban).
what would you do if a patient is already on an anticoagulant score more than 2 on the CHA2DS2VaSc score?
Manage modifiable risk factors for bleeding
(HAS BLED – uncontrolled HTN, renal/liver disease, labile INR, using NSAIDs/antiplatelets, alcohol consumption).
what lifestyle advice might you need to give on the CHA2DS2VaSc station?
Avoid alcohol.
Smoking cessation.
Healthy diet.
Exercise.
what advice might you need to give on the CHA2DS2VaSc station if the patient is on warfarin?
Needs INR check.
Teratogenic.
Can interfere with other medications.
Increased bleeding risk.
Diet control.
Can be reversed with vitamin K.
what advice might you need to give on the CHA2DS2VaSc station if the patient is on a DOAC?
Non-reversible.
Increased bleeding risk.
Expensive.
Contraindicated in renal impairment or Hx of GI bleed.
what is the FRAX score?
10 year probability of a fracture in the spine, hip, shoulder or wrist for people aged 40–90 years old.
what are the componants of the FRAX score?
Personal information –
Age.
Sex.
Weight (kg).
Height (cm).
Past medical history –
Rheumatoid arthritis.
Previous fracture.
Secondary osteoporosis;
Kidney failure, hyperthyroidism, coeliac disease, kidney failure, T1DM, chronic liver disease, premature menopause.
Femoral neck BMD from previous DEXA-T scan (g/cm2).
Drug history –
Glucocorticoids.
Lithium.
Family history –
Parental fractured hip.
Social history –
Smoking.
Alcohol intake (≥3 alcoholic drinks a day).
what is a T score?
A T-score shows how much your bone density is higher/lower than the bone density of a healthy 30-year old adult.
what is a Z score?
A Z-score compares the condition of your bones with someone of your age/sex/weight/ethnicity.
what do different T scores mean?
T–score ≥ –1 = normal bone density, no intervention.
–2.5 < T–score ≤ –1 = osteopenia, consider medication, lifestyle advice
T–score ≤ –2.5 = osteoporosis, medication, lifestyle advice.
what should you do if someone is low risk in the FRAX score?(<10%)
Lifestyle advice;
More weight-bearing exercise, quitting smoking and limiting alcohol.
Calcium + vitamin D rich diet, balance exercises.
Home adaptations;
Getting rid of throw rugs, installing grab bars.
Wearing shoes with good grip.
reasses in 5 years
what should you do if someone is intermediate risk in the FRAX score? (10-20%)
DEXA scan to measure BMD + if ≤–2.5, Tx with bisphosphonate like alendronate 10mg OD or denosumab (RANK-L), teriparatide.
what should you do if someone is high risk on the FRAX score? (>20%)
T-score >–2.5 modify risk factors and reassess in 2 years.
T score <–2.5 Tx as above.
what is the ABCD2 score?
risk of stroke after TIA
what are the componants of the ABCD2 score?
Age ≥60 = 1 point.
BP ≥140/90mmHg = 1 point.
Clinical features;
Unilateral weakness = 2 points.
Speech disturbance without weakness = 1 point.
Duration –
≥60 minutes = 2 points.
10 ≤ minutes < 60 = 1 point.
Diabetes = 1 point.
what other questions could you ask in the ABCD2 score?
AF?
other TIAs in the past
wha do the results of the ABCD2 score mean?
Score ≤3 = seen within 7 days
Score 4 ≤ score < 6 = specialist within 24 hours
Score >6 = specialist referral immediately
advice might you have to give int he ABCD2 score station?
Lifestyle advice;
Diet (lower fats and cholesterol).
Exercise more.
Smoking cessation.
Antithrombotic treatment;
300mg aspirin immediately then continued long term 75mg OD.
Clopidogrel 75mg.
Secondary prevention (adherence to medication);
Control HTN.
Statin for patients with high cholesterol.
Carotid endarterectomy if ICA stenosis >70%
don’t drive for at least 1 month
what is the wells score?
likelihood of patient having a DVT
what are the compnants to the wells score?
History of presenting complaint –
Paralysis, paresis or recent immobilisation of leg = 1 point.
Localised tenderness along the deep venous system = 1 point.
Entire leg swollen = 1 point.
Calf swelling >3cm compared to other leg (measured 10cm below the tibial tuberosity) = 1 point.
Pitting oedema, confined to symptomatic leg = 1 point.
Collateral superficial veins present = 1 point.
Past medical history –
Bedridden recently >3 days or major surgery within 12 weeks = 1 point.
Active cancer (treatment or palliation within 6 months) = 1 point.
Previous DVT = 1 point.
Alternative Dx to DVT as or more likely = –2 points.
Social history can ask about long-haul flights, smoking and HRT/OCP if appropriate.
what do the results of the wells score mean?
Score ≤0 = DVT unlikely, 5% prevalence
Score 1–2 = DVT moderate risk, 17% prevalence
Score ≥3 = DVT likely, 17–53% prevalence
what actions might be needed after the wells score?
D-dimer is good for a negative exclusion, high specificity, low sensitivity –
If negative then it can be ruled out.
If positive it isn’t diagnostic.
Good if they have a low clinical probability score.
USS doppler veins if high risk.
CTPA is gold standard for diagnosing PE.
how is a DVT tretaed?
LMWH.
Oral warfarin and maintain INR 2–3 or a DOAC.
Compression stockings.
Treat/seek underlying cause.
Diet, exercise, smoking cessation.
