Risk assessment Flashcards
12 factors in a FRAX risk assessment.
- Age (40-90)
- Sex
- Weight
- Height
- Previous adulthood fracture?
- Parent with hip fracture?
- Current smoker?
- Glucocorticoid use?
- Rheumatoid arthritis?
- Secondary osteoporosis?
- Alcohol >3u/day?
- Femoral neck BMD?
What does FRAX tell you?
10 year probability of major osteoporotic fracture and hip fracture (%)
What is the advice for a low risk FRAX score?
Lifestyle advice:
- Stop smoking and reduce alcohol
- Weight bearing exercises to increase BMD
- Reduce fall risk (i.e. balance exercises and home modification)
- Calcium and vitD diet
Reassess in five years
What is the advice for an intermediate risk FRAX score?
- DXA scan to measure BMD
2. If T-score < -2.5 = medical treatment
What is the advice for a high risk FRAX score?
DXA scan
- If T >-2.5 = modify risk factors and repeat DXA in 2 years
- If T < -2.5 = medial treatment
What is the medical treatment for an intermediate / high risk FRAX score?
- Bisphosphonates (alendronate 10mg OD)
- If low calcium, 10mcg vitamin D ± calcium
- HRT for menopausal women
What are the factors included in a CHA2DS2-VASc risk assessment?
- Congestive heart failure
- Hypertension
- Age > 75
- Diabetes
- Previous stroke / TIA
- Vascular disease
- Age 65-74
- Sex category (female)
What is the treatment plan for a CHA2DS2-VASc score of 0, 1, and 2+?
0 = no anticoagulation
1 = consider oral aspirin (75mg)
2 = oral anticoagulation (apixaban 5mg BD)
What are the factors included in the Well’s score?
- Active cancer / treatment within last 6 months
- Calf swelling >3cm
- Swollen unilateral superficial veins (non-varicose)
- Unilateral pitting oedema
- Previous DVT
- Swollen leg
- Tenderness
- Recent immobilisation
- Recently bedridden / surgery
- Alternative diagnosis at least as likely - MINUS 2 POINTS
What does a Well’s score of >2 mean, and what should you do?
DVT LIKELY!
Proximal leg vein US within 4 hours
- If not possible, do D-dimer, give 24hr anticoagulation, arrange scan
What does a Well’s score of <2 mean, and what should you do?
DVT UNLIKELY!
D-dimer
- If positive, US within 4hrs
- If negative, consider alternative diagnosis
What is the acute and long term medication for a DVT?
ACUTE = parenteral anticoagulants
- LMWH (SC dalteparin)
- Fondaparinux
LONG TERM = oral anticoagulation
- Warfarin 5mg OD
- Rivaroxaban
What is included in the diabetes risk assessment?
- Gender
- Age
- Ethnicity
- 1st degree relative with DM
- Waist measurement
- BMI
- Hypertension?
What do you do for a low risk score in a diabetes assessment?
- Identify risk factors
- Lifestyle advice + available services
- Encouragement + support
What do you do for a moderate risk score in a diabetes assessment?
- Identify risk factors
- Lifestyle advice + available services
- Would they like to join a structured weight loss programme?
What do you do for a high risk score in a diabetes assessment?
- Identify risk factors
- Lifestyle advice + available services
- Offer referral to intensive lifestyle change programme
What is included in QRISK3?
- Age
- Sex
- Ethnicity
- Postcode
- Smoking habits
- Diabetes T1/2
- CVD in 1st degree relative <60
- Stage 3/4/5 CKD
- AF
- Blood pressure treatment
- Migraines
- Rheumatoid arthritis
- SLE
- Severe mental illness
- Atypical antipsychotic medication use
- Regular steroid tablet use
- Diagnosis / treatment of erectile dysfunction
- Cholesterol / HDL ratio
- Systolic BP
- BMI
What is the management plan for a QRISK3 <10%?
- Lifestyle management
- Manage comorbidities (e.g. HTN, DM, CKD, RA, etc)
- Reassess in 5 years
What is the management plan for a QRISK3 >10%?
- Lifestyle advice
- Manage comorbidities
- Discuss lipid modification
- Atorvastatin 20mg OD?
- HTN medication?
What does the ABCD2 score tell us?
Risk of stroke after TIA in the next 7 days
What is included in an ABCD2 risk assessment?
- Age (1)
- BP (1)
- Clinical features of TIA
- Unilateral weakness ± speech impairment (2)
- Speech impairment only (1) - Duration
- >60 mins (2)
- 10-59 mins (1) - Diabetes (1)
How do you manage someone with a low risk (<4) ABCD2 score?
- Aspirin 300mg OD
- TIA clinic within week
- Risk factor management
- ?MRI?
How do you manage someone with a high risk (>4) ABCD2 score?
- Aspirin 300mg OD
- TIA clinic within 24 hours
- Risk factor management
What advice do you give following a TIA / ABCD2 assessment?
- Lifestyle advice
- Manage co-morbidities
- Driving (must contact DVLA)
- Work (discuss RtW with rehab team)
