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Phase 2B > Risk Assessment Tools B > Flashcards

Risk Assessment Tools B Flashcards

1
Q

Describe the risk assessment osteoporotic fracture

A

FRAX assessment tool

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2
Q

Describe the FRAX assessment tool

A

Risk of osteoporotic fracture

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3
Q

What are the 3 sections of scoring of the FRAX assessment tool

A

High risk - >10% (red zone)

Intermediate risk - but below 10% (orange zone)

Low risk - below 10% (green)

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4
Q

Name the frax score mnemonic

A

FRAX SCORE

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5
Q

Name the risk factors of FRAX score

A

Fracture
Rheumatoid arthiritis
Age + ethnicity
X -sex

Smoking (current)
Corticosteroids
Osteoporosis - secondary
Relative - parental hip fracture
Ethanol > 3 units per day

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6
Q

What are the secondary causes of osteoporosis

A

Nutritional deficiencies
IBS/Coeliac disease
Type 1 diabetes
Uncontrolled hyperthyroidism
Hypogonadism
Early menopause < 45 years
CKD, chronic liver disease
Osteogenesis imperfecta in adults

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7
Q

What’s a key piece of information you want to know about in FRAX score

A

Have you had a DEXA scan

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8
Q

If someone has a FRAX risk score > 10% what do you give

A

Bisphosphonates (alendronic acid) + calcium and vitamin D

Risk appropriate exercise and falls prevention

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9
Q

If someone is at low FRAX score risk (<10%)

A

Calcium, vitamin D + risk appropriate exercise

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10
Q

How much calcium should be recommended for people with increased risk of fragility fracture

A

1000 mg/day

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11
Q

What does a DXA scan measure

A

Bone density in neck of the femur

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12
Q

What is T-score

A

Standard deviation of units above or below the average bone density neck of femur of a young and healthy person

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13
Q

What does a T-score of +1 to -1 mean

A

Your bone density is in normal range for a young and healthy person

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14
Q

What does a T-score of -1 to -2.5 mean

A

Bone density is slightly below the normal range for a young and healthy person

= osteopenia

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15
Q

What does a T-score of < -2.5 mean

A

Osteoporosis

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16
Q

What does Z-score mean

A

Compares your bone density to people of the same age

Having a low Z score may indicate that another condition or medicine is affecting your bone density levels

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17
Q

What is the risk factor for suspected of a DVT

A

Wells score

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18
Q

What does the wells score measure

A

Risk of a DVT

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19
Q

What is the mnemonic for Wells score

A

EMBOLISM

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20
Q

Describe the mnemonic for Wells

A

Embolism history
Malignancy
Bedridden (> 3days), surgery (last 12 weeks requiring general or regional)
Own blood - haemoptysis
Leg DVT symptoms
Increase HR > 100
Sign DVT
Most likely diagnosis

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21
Q

Name 3 signs of a leg DVT

A

Swollen calf
Pitting oedema in calf
Local tenderness in calf

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22
Q

Describe the investigation if DVT is likely after Wells score

A

Offer proximal leg ultrasound scan with results available after 4 hours

If cannot be carried out = D-dimer

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23
Q

Describe the treatment if a DVT is unlikely after wells score

A

Offer D-dimer test

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24
Q

What is the first line treatment for DVT (Wells score)

A

DOAC

2nd line = warfarin

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25
Q

What is key information about warfarin

A

Aim for international normalised ration (INR) target 2.5 (keep within a range of 2-3)

26
Q

What is the risk score factor for the 10 year risk of having a heart attack or stroke

A

QRisk score

27
Q

What does the QRisk score measure

A

10 year risk of having a heart attack or stroke

28
Q

What is the mneumonic for remembering QRisk

A

FLASH BODIES

29
Q

Describe the mnemonic for QRisk

A

Family history
Lipids (statins)
Age/AF
Sex + ethnicity
Health
Blood pressure + treatment
Obesity (height and weight)
Diabetes
Increased thrombosis
Erectile dysfunction - treatment
Smoking

30
Q

What is important family history when taking the QRisk score

A

Angina or heart attack in a 1st degree relative

31
Q

What does heath include in flash bodies for QRisk score

A

Migraines
RA
SLE
Mental illness (antipsychotics)
CKD

32
Q

What are the levels of Qrisk score

A

Low risk <10%
Moderate risk 10-20%
High risk > 20%

33
Q

Describe what low risk Qrisk stands for

A

<10%

One in ten chance of having a stroke or heart attack in the next 100 years

34
Q

Describe what having a moderate Q risk stands for

A

10-20% risk

1 to 2 in 10 chance of having a stroke or heart attack in the next 10 years

35
Q

Describe what having a high Q risk score means

A

> 20%

Have at least 2 in 10 chance of having stroke or heart attack in the next 10 years

36
Q

If a Q risk score is > 10% what should be done

A

Statins

37
Q

What information should be given when prescribing statins

A

Reduce cholesterol which in some cases can lower your risk of hart attack and stroke by up to 25%

Designed to be taken every night

38
Q

What lifestyle changes should be given for Q Risk score

A

Stop smoking
Eat a balanced/healthy diet
Reduce alcohol intake
Keep an eye on your weight aim for 20-25
Exercise regularly
Take medication to reduce BP as needed

39
Q

What happens after a Qrisk is given and support given

A

Can re test cholesterol in 6-12 months, measure weight and BP to recalculate risk

40
Q

What is the risk score for stroke risk in atrial fibrillation

A

CHADS2-VASC

41
Q

What does CHADS2-VASC measure

A

Stroke risk in atrial fibrillation

42
Q

What should be done along side when doing the CHADVASC

A

HAS-BLED for major bleeding for patients on anticoagulation (.e.g. apixaban - DOAC)

43
Q

What are the risk scoring for CHADVASC

A

Low risk - score 0 in men or 1 in women

Intermediate risk - score 2

High risk - score 3 or more

44
Q

What should be done with a risk score of 0 in men or 1 in women

CHADVASC

A

Low risk - no antithrombotic therapy needed

45
Q

What should be done with a risk score of 2 (CHADVASC)

A

Consider anticoagulation

46
Q

What should be considered with a risk factor 3 (CHADVASC)

A

High risk - 3 or more = anticoagulation needed

47
Q

Describe CHADVASC

A

CHF history
Hypertension history
Age 65-74
Diabetes history
Stroke/TOA/thromboembolism history
Vascular disease history (prior MI, peripheral artery disease or aortic plaque)
A > or equal to 75
Sex - 1 point for being female

48
Q

What is mnemonic to remember diabetes control

A

GLUCOSE BAD

49
Q

Describe the mnemonic for diabetes control

A

Glycaemic control
Lipids
Urine microalbuminuria
Cigarettes
Ophthalmology
Sexual, psychosocial and diabetes distress
Extremities
Aspirin
Dental examination

50
Q

What is the aim on HBA1c

A

48 mmol/L

51
Q

What is pre-diabetes

A

42-27 mmol/mol

52
Q

What are important areas to ask in diabetes

A

Male or female
Older
Ethnic groups
Close relatives with type 2 diabetes
Waist measurement
Weight and height
HTN

53
Q

Are males or females at higher risk of diabetes

A

Males

54
Q

In CHADVASC what scores you two points

A

Age > (or equal to) 75

History of vascular disease

55
Q

What are the alcohol recommendations

A

14 units per week, should be evenly spread over 3-4 days (also decreases risk of cancer)

56
Q

What is the daily recommended salt limit

A

6g of salt (one teaspoon)

57
Q

What is INR based on

A

Prothrombin time - measures how long for a blood clot to form based on prothrombin

58
Q

What is INR aim for ‘normal’ people

A

1

59
Q

What is the INR aim for people on warfarin

A

2-3

60
Q
A

Phase 2B (15 decks)

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