Risk assessment Flashcards
DIABETES RISK
What risk factors would you ask for in personal information?
- Age (≥50 scores)
- Gender (male scores).
- Ethnicity (other than white European).
- Waist measurement.
DIABETES RISK
What risk factors would you ask for in past medical history?
- Height/weight for BMI.
- HTN.
DIABETES RISK
What risk factors would you ask for in family history?
- Relatives with diabetes.
DIABETES RISK
What score constitutes a low risk?
0–6 (1 in 100 risk)
- Maintain healthy lifestyle.
DIABETES RISK
What score constitutes an increased risk?
7–15 (1 in 35 risk)
- ?Lifestyle changes.
DIABETES RISK
What score constitutes a moderate risk?
16–24 (1 in 10 risk)
- Lifestyle changes + ?bloods
DIABETES RISK
What score constitutes a high risk?
≥25 (1 in 4 risk)
- Lifestyle changes + HbA1c/FGT
DIABETES RISK
What lifestyle advice would you give for someone with increased diabetes risk?
- Regular meals/portion size.
- Decrease fat/sugar/salt.
- Moderate alcohol.
- Exercise 150mins/week.
- Weight loss.
- ?medication
QRISK2 CVS RISK
What does the QRISK2 score generate?
- Gives risk of a person developing CVD over the next 10 years in those aged 35–74.
QRISK2 CVS RISK
What risk factors would you ask for in personal information?
- Age.
- Sex.
- Ethnicity.
- BMI.
- Postcode.
QRISK2 CVS RISK
What risk factors would you ask for in past medical history?
C.A.R.D
- CKD (stage 4/5).
- AF.
- RA.
- Diabetic status.
QRISK2 CVS RISK
What risk factor would you ask for in drug history?
- Antihypertensives?
QRISK2 CVS RISK
What risk factor would you ask for in family history?
- Angina/MI in first degree relative <60y/o.
QRISK2 CVS RISK
What risk factor would you ask for in social history?
- Smoking status.
QRISK2 CVS RISK
What risk factors would you ask for in direct measurements?
- Cholesterol/HDL ratio (ask if known to have high cholesterol).
- Systolic BP (might know).
QRISK2 CVS RISK
What constitutes a low risk?
<10%
QRISK2 CVS RISK
What constitutes a moderate risk?
10–20%
QRISK2 CVS RISK
What constitutes a high risk?
> 20%
QRISK2 CVS RISK
What is the management for a risk of <10%
- 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).
QRISK2 CVS RISK
What is the management for a risk of >10%
- 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.
CHA2DS2VaSc SCORE
What does the CHA2DS2VaSc score generate?
- Stroke risk in patients with AF.
CHA2DS2VaSc SCORE
What does the CHA2DS2VaSc score stand for?
Congestive heart failure (1) HTN (1) Age (65–74 = 1, ≥75 = 2) Diabetes (1) Stroke/TIA (2) Vascular disease (1) Sex Category female (1)
CHA2DS2VaSc SCORE
What score means that no anticoagulation is required?
0
CHA2DS2VaSc SCORE
What score means that anticoagulation should be considered?
1
Vitamin K antagonist like warfarin monitored for therapeutic range (INR 2-3)
DOAC like rivaroxaban/apixaban.
CHA2DS2VaSc SCORE
What score means that anticoagulation is required?
2
Vitamin K antagonist like warfarin monitored for therapeutic range (INR 2-3)
DOAC like rivaroxaban/apixaban.
CHA2DS2VaSc SCORE
If the patient is already on anticoagulation, what should be done?
- Manage modifiable risk factors for bleeding (HAS-BLED)
- Uncontrolled HTN.
- Renal/liver disease.
- Labile INR.
- Alcohol consumption.
CHA2DS2VaSc SCORE
What lifestyle advice can be given to a patient at risk of stroke?
- Avoid alcohol.
- Smoking cessation.
- Healthy diet.
- Exercise more.
CHA2DS2VaSc SCORE
What warfarin advice should be given to the patient?
- 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.
CHA2DS2VaSc SCORE
What DOAC advice should be given to the patient?
- No checks required.
- Increased bleeding risk and non-reversible.
- Contraindicated in renal impairment or Hx of GI bleed.
FRAX SCORE
What does the FRAX score generate?
10 year probability of a fracture in the spine/hip/shoulder/wrist for people aged 40–90y/o.
- Osteoporosis risk.
FRAX SCORE
What risk factors would you ask for in personal information?
- Age.
- Sex.
- Weight.
- Height.
FRAX SCORE
What risk factors would you ask for in past medical history?
- 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.
FRAX SCORE
What risk factors would you ask for in drug history?
- Glucocorticoids.
- Lithium.
FRAX SCORE
What risk factor would you ask for in family history?
- Parental fractured hip.
FRAX SCORE
What risk factors would you ask for in social history?
- Smoking.
- Alcohol intake (≥3 alcoholic drinks/day).
FRAX SCORE
What is a T-score? What is a Z-score?
- 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.
FRAX SCORE
What T-score would indicate normal bone density?
≥ –1
FRAX SCORE
What T-score would indicate osteopenia?
–2.5 < T-score ≤ –1
FRAX SCORE
What T-score would indicate osteoporosis?
≤ –2.5
FRAX SCORE
What score would constitute a low risk and what advice would you give?
≤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).
FRAX SCORE
What score would constitute an intermediate risk and what advice would you give?
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).
FRAX SCORE
What score would constitute a high risk and what advice would you give?
≥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).
ABCD2 SCORE
What does the ABCD2 score generate?
- Risk of stroke after a TIA.
ABCD2 SCORE
What does ABCD2 stand for?
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)
ABCD2 SCORE
What would you ask for in past medical history?
- AF.
- Previous TIAs, how far apart they were?
ABCD2 SCORE
What score would constitute a specialist referral within 7 days?
≤3
ABCD2 SCORE
What score would constitute a specialist referral within 24h?
4–5
ABCD2 SCORE
What score would constitute a specialist referral immediately?
≥6
ABCD2 SCORE
What lifestyle advice can be given for TIAs?
- Diet (lower fats/cholesterol).
- Exercise more.
- Smoking cessation.
ABCD2 SCORE
What anti-thrombotic treatment can be given in TIAs?
- 300mg aspirin immediately then continued long term 75mg OD.
- Clopidogrel 75mg OD.
ABCD2 SCORE
What secondary prevention can be given in TIAs?
Medication adherence
- Control HTN.
- Statins for patients with high cholesterol.
ABCD2 SCORE
What treatment may be indicates in TIA and what crucial advice should be given to patients?
- Carotid endarterectomy if ICA stenosis >70%
- Do not drive for at least 1 month following a TIA.
WELLS’ SCORE
What does Wells’ score generate?
- DVT risk.
WELLS’ SCORE
What risk factors would you ask for in Hx of PC?
- 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?
WELLS’ SCORE
What risk factors would you ask for in past medical history?
- Bedridden recently >3 days or major surgery within 12 weeks.
- Active cancer (Tx/palliation within 6m).
- Previous DVT.
WELLS’ SCORE
What risk factors could you ask for in drug history?
- HRT/OCP.
WELLS’ SCORE
What risk factors could you ask about in social history?
- Long-haul flights.
- Smoking.
WELLS’ SCORE
What score indicates a DVT is unlikely?
≤0 5% prevalence
WELLS’ SCORE
What score indicates a DVT is a moderate risk?
1–2 17% prevalence
WELLS’ SCORE
What score indicates a DVT is likely?
≥3 17–53% prevalence.
WELLS' SCORE What investigations would you do if someone had a... i) low risk? ii) higher risk? iii) PE risk?
i) D-dimer for negative exclusion due to its high specificity.
ii) USS doppler veins.
iii) CTPA.
WELLS’ SCORE
What is the treatment for DVT?
- LMWH.
- Warfarin with INR 2–3 or DOAC.
- Compression stockings.
- Diet/exercise/smoking cessation.
- Treat underlying cause.