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Phase 2b > Risk assessment > Flashcards

Risk assessment Flashcards

1
Q

DIABETES RISK

What risk factors would you ask for in personal information?

A
  • Age (≥50 scores)
  • Gender (male scores).
  • Ethnicity (other than white European).
  • Waist measurement.
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2
Q

DIABETES RISK

What risk factors would you ask for in past medical history?

A
  • Height/weight for BMI.

- HTN.

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3
Q

DIABETES RISK

What risk factors would you ask for in family history?

A
  • Relatives with diabetes.
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4
Q

DIABETES RISK

What score constitutes a low risk?

A

0–6 (1 in 100 risk)

- Maintain healthy lifestyle.

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5
Q

DIABETES RISK

What score constitutes an increased risk?

A

7–15 (1 in 35 risk)

- ?Lifestyle changes.

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6
Q

DIABETES RISK

What score constitutes a moderate risk?

A

16–24 (1 in 10 risk)

- Lifestyle changes + ?bloods

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7
Q

DIABETES RISK

What score constitutes a high risk?

A

≥25 (1 in 4 risk)

- Lifestyle changes + HbA1c/FGT

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8
Q

DIABETES RISK

What lifestyle advice would you give for someone with increased diabetes risk?

A
  • Regular meals/portion size.
  • Decrease fat/sugar/salt.
  • Moderate alcohol.
  • Exercise 150mins/week.
  • Weight loss.
  • ?medication
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9
Q

QRISK2 CVS RISK

What does the QRISK2 score generate?

A
  • Gives risk of a person developing CVD over the next 10 years in those aged 35–74.
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10
Q

QRISK2 CVS RISK

What risk factors would you ask for in personal information?

A
  • Age.
  • Sex.
  • Ethnicity.
  • BMI.
  • Postcode.
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11
Q

QRISK2 CVS RISK

What risk factors would you ask for in past medical history?

A

C.A.R.D

  • CKD (stage 4/5).
  • AF.
  • RA.
  • Diabetic status.
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12
Q

QRISK2 CVS RISK

What risk factor would you ask for in drug history?

A
  • Antihypertensives?
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13
Q

QRISK2 CVS RISK

What risk factor would you ask for in family history?

A
  • Angina/MI in first degree relative <60y/o.
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14
Q

QRISK2 CVS RISK

What risk factor would you ask for in social history?

A
  • Smoking status.
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15
Q

QRISK2 CVS RISK

What risk factors would you ask for in direct measurements?

A
  • Cholesterol/HDL ratio (ask if known to have high cholesterol).
  • Systolic BP (might know).
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16
Q

QRISK2 CVS RISK

What constitutes a low risk?

A

<10%

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17
Q

QRISK2 CVS RISK

What constitutes a moderate risk?

A

10–20%

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18
Q

QRISK2 CVS RISK

What constitutes a high risk?

A

> 20%

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19
Q

QRISK2 CVS RISK

What is the management for a risk of <10%

A
  • Advise that risk is low but further reductions in risk can still often be achieved.
  • Lifestyle advice (stop smoking, exercise more, diet change/weight loss, control any diseases, medication adherence).
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20
Q

QRISK2 CVS RISK

What is the management for a risk of >10%

A
  • Lifestyle advice (stop smoking, exercise more, diet change/weight loss, control any diseases, medication adherence).
  • Consider reviewing any poorly controlled comorbidities.
  • Discuss benefits/risks of taking lipid modification therapy.
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21
Q

CHA2DS2VaSc SCORE

What does the CHA2DS2VaSc score generate?

A
  • Stroke risk in patients with AF.
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22
Q

CHA2DS2VaSc SCORE

What does the CHA2DS2VaSc score stand for?

A 
Congestive heart failure (1)
HTN (1)
Age (65–74 = 1, ≥75 = 2)
Diabetes (1)
Stroke/TIA (2) 
Vascular disease (1)
Sex Category female (1)
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23
Q

CHA2DS2VaSc SCORE

What score means that no anticoagulation is required?

A

0

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24
Q

CHA2DS2VaSc SCORE

What score means that anticoagulation should be considered?

A

1
Vitamin K antagonist like warfarin monitored for therapeutic range (INR 2-3)
DOAC like rivaroxaban/apixaban.

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25
Q

CHA2DS2VaSc SCORE

What score means that anticoagulation is required?

A

2
Vitamin K antagonist like warfarin monitored for therapeutic range (INR 2-3)
DOAC like rivaroxaban/apixaban.

26
Q

CHA2DS2VaSc SCORE

If the patient is already on anticoagulation, what should be done?

A
  • Manage modifiable risk factors for bleeding (HAS-BLED)
  • Uncontrolled HTN.
  • Renal/liver disease.
  • Labile INR.
  • Alcohol consumption.
27
Q

CHA2DS2VaSc SCORE

What lifestyle advice can be given to a patient at risk of stroke?

A
  • Avoid alcohol.
  • Smoking cessation.
  • Healthy diet.
  • Exercise more.
28
Q

CHA2DS2VaSc SCORE

What warfarin advice should be given to the patient?

A
  • Needs monthly INR check.
  • Teratogenic + can interfere with other medications.
  • Diet needs to be controlled.
  • Increased bleeding risk but can be reversed with vitamin K.
29
Q

CHA2DS2VaSc SCORE

What DOAC advice should be given to the patient?

A
  • No checks required.
  • Increased bleeding risk and non-reversible.
  • Contraindicated in renal impairment or Hx of GI bleed.
30
Q

FRAX SCORE

What does the FRAX score generate?

A

10 year probability of a fracture in the spine/hip/shoulder/wrist for people aged 40–90y/o.
- Osteoporosis risk.

31
Q

FRAX SCORE

What risk factors would you ask for in personal information?

A
  • Age.
  • Sex.
  • Weight.
  • Height.
32
Q

FRAX SCORE

What risk factors would you ask for in past medical history?

A
  • RA.
  • Secondary osteoporosis (kidney failure, hyperthyroidism, coeliac disease, renal failure, T1DM, chronic liver disease, premature menopause).
  • Previous fracture.
  • Femoral neck BMD from previous DEXA-T scan.
33
Q

FRAX SCORE

What risk factors would you ask for in drug history?

A
  • Glucocorticoids.

- Lithium.

34
Q

FRAX SCORE

What risk factor would you ask for in family history?

A
  • Parental fractured hip.
35
Q

FRAX SCORE

What risk factors would you ask for in social history?

A
  • Smoking.

- Alcohol intake (≥3 alcoholic drinks/day).

36
Q

FRAX SCORE

What is a T-score? What is a Z-score?

A
  • A T-score shows you how much your bone density is higher/lower than the bone density of a healthy 30-year old adult.
  • A Z-score compares the condition of your bones with someone of your age/sex/weight/ethnicity.
37
Q

FRAX SCORE

What T-score would indicate normal bone density?

A

≥ –1

38
Q

FRAX SCORE

What T-score would indicate osteopenia?

A

–2.5 < T-score ≤ –1

39
Q

FRAX SCORE

What T-score would indicate osteoporosis?

A

≤ –2.5

40
Q

FRAX SCORE

What score would constitute a low risk and what advice would you give?

A

≤10%

  • Reassess in 5y.
  • Lifestyle (more weight-bearing exercise, stop smoking, limit alcohol, Ca2+/vitamin D rich diet, balance exercises).
  • Home adaptations (remove throw rugs, installing grab bars, shoes with good grips).
41
Q

FRAX SCORE

What score would constitute an intermediate risk and what advice would you give?

A

10 < % < 20

  • DEXA scan to measure BMD and start Tx if >–2.5 modify risk factors and reassess in 2 years, if osteoporosis alendronate 10mg OD (first line) or denosumab (RANK-L) or teriparatide.
  • Lifestyle (more weight-bearing exercise, stop smoking, limit alcohol, Ca2+/vitamin D rich diet, balance exercises).
  • Home adaptations (remove throw rugs, installing grab bars, shoes with good grips).
42
Q

FRAX SCORE

What score would constitute a high risk and what advice would you give?

A

≥20%

  • DEXA scan to measure BMD and start Tx if >–2.5 modify risk factors and reassess in 2 years, if osteoporosis alendronate 10mg OD (first line) or denosumab (RANK-L) or teriparatide.
  • Lifestyle (more weight-bearing exercise, stop smoking, limit alcohol, Ca2+/vitamin D rich diet, balance exercises).
  • Home adaptations (remove throw rugs, installing grab bars, shoes with good grips).
43
Q

ABCD2 SCORE

What does the ABCD2 score generate?

A
  • Risk of stroke after a TIA.
44
Q

ABCD2 SCORE

What does ABCD2 stand for?

A 
Age (≥60) (1)
BP (≥140/90mmHg) (1)
Clinical features;
- Unilateral weakness (2)
- Speech disturbance w/o weakness (1)
Duration;
- ≥60m (2), 10–59m (1)
Diabetes (1)
45
Q

ABCD2 SCORE

What would you ask for in past medical history?

A
  • AF.

- Previous TIAs, how far apart they were?

46
Q

ABCD2 SCORE

What score would constitute a specialist referral within 7 days?

A

≤3

47
Q

ABCD2 SCORE

What score would constitute a specialist referral within 24h?

A

4–5

48
Q

ABCD2 SCORE

What score would constitute a specialist referral immediately?

A

≥6

49
Q

ABCD2 SCORE

What lifestyle advice can be given for TIAs?

A
  • Diet (lower fats/cholesterol).
  • Exercise more.
  • Smoking cessation.
50
Q

ABCD2 SCORE

What anti-thrombotic treatment can be given in TIAs?

A
  • 300mg aspirin immediately then continued long term 75mg OD.
  • Clopidogrel 75mg OD.
51
Q

ABCD2 SCORE

What secondary prevention can be given in TIAs?

A

Medication adherence

  • Control HTN.
  • Statins for patients with high cholesterol.
52
Q

ABCD2 SCORE

What treatment may be indicates in TIA and what crucial advice should be given to patients?

A
  • Carotid endarterectomy if ICA stenosis >70%

- Do not drive for at least 1 month following a TIA.

53
Q

WELLS’ SCORE

What does Wells’ score generate?

A
  • DVT risk.
54
Q

WELLS’ SCORE

What risk factors would you ask for in Hx of PC?

A
  • Paralysis, paresis or recent immobilisation of leg?
  • Localised tenderness along the deep venous system?
  • Entire leg swollen?
  • Calf swelling >3cm compared to the other leg (10cm below tibilar tuberosity).
  • Pitting oedema, confined to symptomatic leg?
  • Collateral superficial veins present?
55
Q

WELLS’ SCORE

What risk factors would you ask for in past medical history?

A
  • Bedridden recently >3 days or major surgery within 12 weeks.
  • Active cancer (Tx/palliation within 6m).
  • Previous DVT.
56
Q

WELLS’ SCORE

What risk factors could you ask for in drug history?

A
  • HRT/OCP.
57
Q

WELLS’ SCORE

What risk factors could you ask about in social history?

A
  • Long-haul flights.

- Smoking.

58
Q

WELLS’ SCORE

What score indicates a DVT is unlikely?

A

≤0 5% prevalence

59
Q

WELLS’ SCORE

What score indicates a DVT is a moderate risk?

A

1–2 17% prevalence

60
Q

WELLS’ SCORE

What score indicates a DVT is likely?

A

≥3 17–53% prevalence.

61
Q 
WELLS' SCORE
What investigations would you do if someone had a...
i) low risk?
ii) higher risk?
iii) PE risk?
A

i) D-dimer for negative exclusion due to its high specificity.
ii) USS doppler veins.
iii) CTPA.

62
Q

WELLS’ SCORE

What is the treatment for DVT?

A
  • LMWH.
  • Warfarin with INR 2–3 or DOAC.
  • Compression stockings.
  • Diet/exercise/smoking cessation.
  • Treat underlying cause.

Phase 2b (10 decks)

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