Risk assessment Flashcards
What are the seven components of the diabetes risk score?
Age, sex, ethnicity, relatives with diabetes, waist measurement, BMI, high blood pressure
What is the diabetes risk score out of and what do the scores mean?
out of 47
- tells you if your risk is low (<6), increased (7-15), moderate (16-24) or high (25-47)
What investigations would you do for the diabetes risk score?
HbA1c, fasting plasma glucose, random plasma glucose, 2-hour post 75mg oral glucose, fasting lipid profile
How can you manage patients at high risk of diabetes?
lifestyle changes, exercise, weight loss, metformin, BP management, lipid management
What is the QRisk score for?
Likelihood of developing cardiovascular disease. percentage risk of having a heart attack/stroke in the next 10 years (in patients aged 35-74)
What are the 17 components of the QRisk score?
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
How often do you do a QRisk score?
Every 5 years
What investigations should be done for a QRisk score?
ECG, troponin, FBC, U&E, glucose, lipids, clotting, CXR
At what QRisk percentage should you offer treatment other than lifestyle advice?
> 10%
What management can you offer for a high QRisk score?
lifestyle advice, atorvostatin 20mg, control hypertension, diabetes, AF, RA etc
What is the CHA2DS2VAS score for?
The risk of a stroke in the next year in patients with AF, to assess for the need for anticoagulation
What are the 8 components of the CHA2DS2VASc score?
Congestive heart failure, hypertension, age > 75, diabetes, stroke/TIA/thromboembolism, vascular disease, age (65-75), sex
What CHADSVASc score is indicative for the need for anticoagulation?
2 +
What anticoagulants are used for patients with AF?
warfarin, apixaban, rivaroxiban
How do you manage patients with a high CHADSVASc score?
anticoagulants, smoking cessation, physical activity, check BP regularly, decrease stress, control comorbidities
What does the FRAX score do?
used to estimate the risk of a fracture in the next 10 years (patients aged 40-90)
What are the 12 components of the FRAX score?
Age, sex, weight, previous fracture, parent with fractured hip, current smoker, glucocorticoids, RA, secondary osteoporosis, alcohol (£+ units per day), femoral neck BMD
What investigations would you do for a FRAX score?
bone profile, FBC, U&E, DEXA scan
What do the DEXA scan scores mean?
< 1 = normal
1-2.5 = osteopenia
2.5+ = osteoporosis
How can you reduce fracture risk?
- smoking cessation, reduce alcohol intake, weight bearing exercises, calcium and vitamin D rich diet/supplements, bisphosphonates
What are the side effects of bisphosphonates?
GI upset, take plenty of water on an empty stomach, do not eat or lie down afterwards, MSK pain
What is the ABCD2 score for?
The risk of having a stroke after TIA
What are the 5 components of the ABCD2 score?
- Age
- BP > 140/90
- composition: unilateral weakness = 2. speech disturbance without weakness = 1.
- Duration > 1 hour = 2 points
- Diabetes
What do the scores mean on the ABCD2 score?
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
What investigations do you do for ABCD2 score?
diffusion weighted MRI, CXR, ECG, Echo, carotid doppler
How do you manage patients with the high ABCD2 score?
- refer to TIA clinic (24hrs/1week)
- antiplatelets, anticoagulants
- warfarin if cardioembolic
- control BP, lipids, DM
- lifestyle
- Carotid endarterectomy if stenosis > 70%
What are the 9 components of the Well’s score?
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)
How do you interpret the Well’s score?
< 4 = d-dimer
4 + = d-dimer + CTPA + leg ultrasound
What is the management of high wells score?
- anticoagulation (rivaroxiban/apixiban)
- investigate for cancer/thrombophilia if unprovoked
- regular exercise
- stockings, elevate leg
What is a T score?
How much your bone mineral density if higher or lower than the bone density of a healthy 30 year old
What PMH do you ask about in QRisk3?
CARDSMS
chronic kidney disease
AF
RA
Diabetes
SLE
Migraines
Severe mental illness
