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Phase 2b OSCE > Risk assessment > Flashcards

Risk assessment Flashcards

1
Q

12 factors in a FRAX risk assessment.

A
  1. Age (40-90)
  2. Sex
  3. Weight
  4. Height
  5. Previous adulthood fracture?
  6. Parent with hip fracture?
  7. Current smoker?
  8. Glucocorticoid use?
  9. Rheumatoid arthritis?
  10. Secondary osteoporosis?
  11. Alcohol >3u/day?
  12. Femoral neck BMD?
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2
Q

What does FRAX tell you?

A

10 year probability of major osteoporotic fracture and hip fracture (%)

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3
Q

What is the advice for a low risk FRAX score?

A

Lifestyle advice:

  1. Stop smoking and reduce alcohol
  2. Weight bearing exercises to increase BMD
  3. Reduce fall risk (i.e. balance exercises and home modification)
  4. Calcium and vitD diet

Reassess in five years

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4
Q

What is the advice for an intermediate risk FRAX score?

A
  1. DXA scan to measure BMD

2. If T-score < -2.5 = medical treatment

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5
Q

What is the advice for a high risk FRAX score?

A

DXA scan

  • If T >-2.5 = modify risk factors and repeat DXA in 2 years
  • If T < -2.5 = medial treatment
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6
Q

What is the medical treatment for an intermediate / high risk FRAX score?

A
  1. Bisphosphonates (alendronate 10mg OD)
  2. If low calcium, 10mcg vitamin D ± calcium
  3. HRT for menopausal women
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7
Q

What are the factors included in a CHA2DS2-VASc risk assessment?

A
  1. Congestive heart failure
  2. Hypertension
  3. Age > 75
  4. Diabetes
  5. Previous stroke / TIA
  6. Vascular disease
  7. Age 65-74
  8. Sex category (female)
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8
Q

What is the treatment plan for a CHA2DS2-VASc score of 0, 1, and 2+?

A

0 = no anticoagulation

1 = consider oral aspirin (75mg)

2 = oral anticoagulation (apixaban 5mg BD)

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9
Q

What are the factors included in the Well’s score?

A
  1. Active cancer / treatment within last 6 months
  2. Calf swelling >3cm
  3. Swollen unilateral superficial veins (non-varicose)
  4. Unilateral pitting oedema
  5. Previous DVT
  6. Swollen leg
  7. Tenderness
  8. Recent immobilisation
  9. Recently bedridden / surgery
  10. Alternative diagnosis at least as likely - MINUS 2 POINTS
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10
Q

What does a Well’s score of >2 mean, and what should you do?

A

DVT LIKELY!

Proximal leg vein US within 4 hours

  • If not possible, do D-dimer, give 24hr anticoagulation, arrange scan
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11
Q

What does a Well’s score of <2 mean, and what should you do?

A

DVT UNLIKELY!

D-dimer

  • If positive, US within 4hrs
  • If negative, consider alternative diagnosis
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12
Q

What is the acute and long term medication for a DVT?

A

ACUTE = parenteral anticoagulants

  • LMWH (SC dalteparin)
  • Fondaparinux

LONG TERM = oral anticoagulation

  • Warfarin 5mg OD
  • Rivaroxaban
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13
Q

What is included in the diabetes risk assessment?

A
  1. Gender
  2. Age
  3. Ethnicity
  4. 1st degree relative with DM
  5. Waist measurement
  6. BMI
  7. Hypertension?
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14
Q

What do you do for a low risk score in a diabetes assessment?

A
  1. Identify risk factors
  2. Lifestyle advice + available services
  3. Encouragement + support
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15
Q

What do you do for a moderate risk score in a diabetes assessment?

A
  1. Identify risk factors
  2. Lifestyle advice + available services
  3. Would they like to join a structured weight loss programme?
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16
Q

What do you do for a high risk score in a diabetes assessment?

A
  1. Identify risk factors
  2. Lifestyle advice + available services
  3. Offer referral to intensive lifestyle change programme
17
Q

What is included in QRISK3?

A
  1. Age
  2. Sex
  3. Ethnicity
  4. Postcode
  5. Smoking habits
  6. Diabetes T1/2
  7. CVD in 1st degree relative <60
  8. Stage 3/4/5 CKD
  9. AF
  10. Blood pressure treatment
  11. Migraines
  12. Rheumatoid arthritis
  13. SLE
  14. Severe mental illness
  15. Atypical antipsychotic medication use
  16. Regular steroid tablet use
  17. Diagnosis / treatment of erectile dysfunction
  18. Cholesterol / HDL ratio
  19. Systolic BP
  20. BMI
18
Q

What is the management plan for a QRISK3 <10%?

A
  1. Lifestyle management
  2. Manage comorbidities (e.g. HTN, DM, CKD, RA, etc)
  3. Reassess in 5 years
19
Q

What is the management plan for a QRISK3 >10%?

A
  1. Lifestyle advice
  2. Manage comorbidities
  3. Discuss lipid modification
    - Atorvastatin 20mg OD?
    - HTN medication?
20
Q

What does the ABCD2 score tell us?

A

Risk of stroke after TIA in the next 7 days

21
Q

What is included in an ABCD2 risk assessment?

A
  1. Age (1)
  2. BP (1)
  3. Clinical features of TIA
    - Unilateral weakness ± speech impairment (2)
    - Speech impairment only (1)
  4. Duration
    - >60 mins (2)
    - 10-59 mins (1)
  5. Diabetes (1)
22
Q

How do you manage someone with a low risk (<4) ABCD2 score?

A
  1. Aspirin 300mg OD
  2. TIA clinic within week
  3. Risk factor management
  4. ?MRI?
23
Q

How do you manage someone with a high risk (>4) ABCD2 score?

A
  1. Aspirin 300mg OD
  2. TIA clinic within 24 hours
  3. Risk factor management
24
Q

What advice do you give following a TIA / ABCD2 assessment?

A
  1. Lifestyle advice
  2. Manage co-morbidities
  3. Driving (must contact DVLA)
  4. Work (discuss RtW with rehab team)

Phase 2b OSCE (3 decks)

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