Risk assessment

Question 1

what things are involved in the diabetes risk score?

Answer 1

A - age
B - BMI (height and weight)
C - circumference of waist
D - diabetes in first degree relative
E - ethnicity
G - gender
H - HTN

Question 2

what can the results of the diabetes risk score be?

Answer 2

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)

Question 3

what sort of questions should you ask in the diabetes risk score station regarding presenting complaint?

Answer 3

Toilet (polyuria)
Thirsty (polydipsia)
Tiredness (more than usual)
Thrush (genital itching secondary to infection)
Thinner (unintentional weight loss)

Question 4

what should you ask specifically about in the PMH in the diabetes risk score station?

Answer 4

hypertension
pre diabetes diagnosis
diabetes diagnosis
recent changes to health / infections

Question 5

what other questions should you ask in the diabetes risk score station?

Answer 5

height
weight
BMI
waist circumferacne
ethnicity

Question 6

what should you ask int he family history section of the diabetes risk score station?

Answer 6

any diabetes in your family (looking for first degree relatives)

Question 7

what lifestyle advice may you need to give in the diabetes risk score station?

Answer 7

Regular meals/portion size
decrease fat/sugar/salt
moderate alcohol
Exercise 150mins/week
Weight loss

Question 8

what does the Qrisk score measure?

Answer 8

the risk of developing CVD in the next 10 years

Question 9

what are the variables included in the Qrisk score?

Answer 9

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

Question 10

what do the results of the Qrisk score mean?

Answer 10

<10% = low risk.
10–20% = moderate risk.
>20% = high risk.

Question 11

what advice should you give if the patient is low risk on the Qrisk score?

Answer 11

inform that risk is low but can still reduce riskStop smoking.
Exercise.
Diet change/weight loss.
Disease control/medication adherence.

Question 12

what advice should b given to a patient scoring a moderate risk in the Qrisk score?

Answer 12

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.

Question 13

what is the CHA2DS2VaSc score?

Answer 13

risk of an AF patient having a stroke

Question 14

what are the components of the CHA2DS2VaSc?

Answer 14

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)

Question 15

what would a score of 1 on the CHA2DS2VaSc score mean?

Answer 15

consider anticoagulation with vitamin K antagonist like warfarin within therapeutic range (INR 2–3) or a DOAC (rivaroxaban, apixaban), maybe aspirin.

Question 16

what would a score of 0 in the CHA2DS2VaSc score mean?

Answer 16

no anticoagulation required

Question 17

what would a score of over 2 indicate in the CHA2DS2VaSc score?

Answer 17

anticoagulation required with vitamin K antagonist like warfarin within therapeutic range (INR 2–3) or a DOAC (rivaroxaban, apixaban).

Question 18

what would you do if a patient is already on an anticoagulant score more than 2 on the CHA2DS2VaSc score?

Answer 18

Manage modifiable risk factors for bleeding
(HAS BLED – uncontrolled HTN, renal/liver disease, labile INR, using NSAIDs/antiplatelets, alcohol consumption).

Question 19

what lifestyle advice might you need to give on the CHA2DS2VaSc station?

Answer 19

Avoid alcohol.
Smoking cessation.
Healthy diet.
Exercise.

Question 20

what advice might you need to give on the CHA2DS2VaSc station if the patient is on warfarin?

Answer 20

Needs INR check.
Teratogenic.
Can interfere with other medications.
Increased bleeding risk.
Diet control.
Can be reversed with vitamin K.

Question 21

what advice might you need to give on the CHA2DS2VaSc station if the patient is on a DOAC?

Answer 21

Non-reversible.
Increased bleeding risk.
Expensive.
Contraindicated in renal impairment or Hx of GI bleed.

Question 22

what is the FRAX score?

Answer 22

10 year probability of a fracture in the spine, hip, shoulder or wrist for people aged 40–90 years old.

Question 23

what are the componants of the FRAX score?

Answer 23

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).

Question 24

what is a T score?

Answer 24

A T-score shows how much your bone density is higher/lower than the bone density of a healthy 30-year old adult.

Question 25

what is a Z score?

Answer 25

A Z-score compares the condition of your bones with someone of your age/sex/weight/ethnicity.

Question 26

what do different T scores mean?

Answer 26

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.

Question 27

what should you do if someone is low risk in the FRAX score?(<10%)

Answer 27

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

Question 28

what should you do if someone is intermediate risk in the FRAX score? (10-20%)

Answer 28

DEXA scan to measure BMD + if ≤–2.5, Tx with bisphosphonate like alendronate 10mg OD or denosumab (RANK-L), teriparatide.

Question 29

what should you do if someone is high risk on the FRAX score? (>20%)

Answer 29

T-score >–2.5 modify risk factors and reassess in 2 years.
T score <–2.5 Tx as above.

Question 30

what is the ABCD2 score?

Answer 30

risk of stroke after TIA

Question 31

what are the componants of the ABCD2 score?

Answer 31

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.

Question 32

what other questions could you ask in the ABCD2 score?

Answer 32

AF?
other TIAs in the past

Question 33

wha do the results of the ABCD2 score mean?

Answer 33

Score ≤3 = seen within 7 days
Score 4 ≤ score < 6 = specialist within 24 hours
Score >6 = specialist referral immediately

Question 34

advice might you have to give int he ABCD2 score station?

Answer 34

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

Question 35

what is the wells score?

Answer 35

likelihood of patient having a DVT

Question 36

what are the compnants to the wells score?

Answer 36

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.

Question 37

what do the results of the wells score mean?

Answer 37

Score ≤0 = DVT unlikely, 5% prevalence
Score 1–2 = DVT moderate risk, 17% prevalence
Score ≥3 = DVT likely, 17–53% prevalence

Question 38

what actions might be needed after the wells score?

Answer 38

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.

Question 39

how is a DVT tretaed?

Answer 39

LMWH.
Oral warfarin and maintain INR 2–3 or a DOAC.
Compression stockings.
Treat/seek underlying cause.
Diet, exercise, smoking cessation.