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OSCE > Risk assessment > Flashcards

Risk assessment Flashcards

1
Q

What are the seven components of the diabetes risk score?

A

Age, sex, ethnicity, relatives with diabetes, waist measurement, BMI, high blood pressure

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2
Q

What is the diabetes risk score out of and what do the scores mean?

A

out of 47
- tells you if your risk is low (<6), increased (7-15), moderate (16-24) or high (25-47)

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3
Q

What investigations would you do for the diabetes risk score?

A

HbA1c, fasting plasma glucose, random plasma glucose, 2-hour post 75mg oral glucose, fasting lipid profile

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4
Q

How can you manage patients at high risk of diabetes?

A

lifestyle changes, exercise, weight loss, metformin, BP management, lipid management

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5
Q

What is the QRisk score for?

A

Likelihood of developing cardiovascular disease. percentage risk of having a heart attack/stroke in the next 10 years (in patients aged 35-74)

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6
Q

What are the 17 components of the QRisk score?

A

age and sex, ethnicity, smoking status, FH in first degree relative, CKD, AF, hypertension, migraines, RA, SLE, severe mental illness, steroids, erectile dysfunction, high cholesterol, blood pressure, BMI

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7
Q

How often do you do a QRisk score?

A

Every 5 years

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8
Q

What investigations should be done for a QRisk score?

A

ECG, troponin, FBC, U&E, glucose, lipids, clotting, CXR

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9
Q

At what QRisk percentage should you offer treatment other than lifestyle advice?

A

> 10%

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10
Q

What management can you offer for a high QRisk score?

A

lifestyle advice, atorvostatin 20mg, control hypertension, diabetes, AF, RA etc

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11
Q

What is the CHA2DS2VAS score for?

A

The risk of a stroke in the next year in patients with AF, to assess for the need for anticoagulation

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12
Q

What are the 8 components of the CHA2DS2VASc score?

A

Congestive heart failure, hypertension, age > 75, diabetes, stroke/TIA/thromboembolism, vascular disease, age (65-75), sex

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13
Q

What CHADSVASc score is indicative for the need for anticoagulation?

A

2 +

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14
Q

What anticoagulants are used for patients with AF?

A

warfarin, apixaban, rivaroxiban

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15
Q

How do you manage patients with a high CHADSVASc score?

A

anticoagulants, smoking cessation, physical activity, check BP regularly, decrease stress, control comorbidities

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16
Q

What does the FRAX score do?

A

used to estimate the risk of a fracture in the next 10 years (patients aged 40-90)

17
Q

What are the 12 components of the FRAX score?

A

Age, sex, weight, previous fracture, parent with fractured hip, current smoker, glucocorticoids, RA, secondary osteoporosis, alcohol (£+ units per day), femoral neck BMD

18
Q

What investigations would you do for a FRAX score?

A

bone profile, FBC, U&E, DEXA scan

19
Q

What do the DEXA scan scores mean?

A

< 1 = normal
1-2.5 = osteopenia
2.5+ = osteoporosis

20
Q

How can you reduce fracture risk?

A
  • smoking cessation, reduce alcohol intake, weight bearing exercises, calcium and vitamin D rich diet/supplements, bisphosphonates
21
Q

What are the side effects of bisphosphonates?

A

GI upset, take plenty of water on an empty stomach, do not eat or lie down afterwards, MSK pain

22
Q

What is the ABCD2 score for?

A

The risk of having a stroke after TIA

23
Q

What are the 5 components of the ABCD2 score?

A
  1. Age
  2. BP > 140/90
  3. composition: unilateral weakness = 2. speech disturbance without weakness = 1.
  4. Duration > 1 hour = 2 points
  5. Diabetes
24
Q

What do the scores mean on the ABCD2 score?

A

If score > 4 refer to TIA clinic within 24 hours, refer to TIA clinic within 1 week if score < 4.
a score > 6 = patient has an 8% risk of having a stroke within 2 days and 35% within 1 week

25
Q

What investigations do you do for ABCD2 score?

A

diffusion weighted MRI, CXR, ECG, Echo, carotid doppler

26
Q

How do you manage patients with the high ABCD2 score?

A
  • refer to TIA clinic (24hrs/1week)
  • antiplatelets, anticoagulants
  • warfarin if cardioembolic
  • control BP, lipids, DM
  • lifestyle
  • Carotid endarterectomy if stenosis > 70%
27
Q

What are the 9 components of the Well’s score?

A

one point for each
active cancer, paralysis/immobilisation of legs, bedridden > 3days. localised tenderness near veins, entire leg swelling, calf swelling > 3cm than other leg, pitting oedema, collateral superficial veins, previous DVT
(-2 point if there is another likely diagnosis)

28
Q

How do you interpret the Well’s score?

A

< 4 = d-dimer
4 + = d-dimer + CTPA + leg ultrasound

29
Q

What is the management of high wells score?

A
  • anticoagulation (rivaroxiban/apixiban)
  • investigate for cancer/thrombophilia if unprovoked
  • regular exercise
  • stockings, elevate leg
30
Q

What is a T score?

A

How much your bone mineral density if higher or lower than the bone density of a healthy 30 year old

31
Q

What PMH do you ask about in QRisk3?

A

CARDSMS
chronic kidney disease
AF
RA
Diabetes
SLE
Migraines
Severe mental illness

OSCE (4 decks)

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