Risk Assessment Tools B Flashcards by Amber Dabill

Describe the risk assessment osteoporotic fracture

FRAX assessment tool

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Describe the FRAX assessment tool

Risk of osteoporotic fracture

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

High risk - >10% (red zone)

Intermediate risk - but below 10% (orange zone)

Low risk - below 10% (green)

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Name the frax score mnemonic

FRAX SCORE

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Name the risk factors of FRAX score

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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What are the secondary causes of osteoporosis

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

Have you had a DEXA scan

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

Bisphosphonates (alendronic acid) + calcium and vitamin D

Risk appropriate exercise and falls prevention

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

Calcium, vitamin D + risk appropriate exercise

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

1000 mg/day

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What does a DXA scan measure

Bone density in neck of the femur

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What is T-score

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

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

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

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

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

= osteopenia

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What does a T-score of < -2.5 mean

Osteoporosis

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What does Z-score mean

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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What is the risk factor for suspected of a DVT

Wells score

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What does the wells score measure

Risk of a DVT

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What is the mnemonic for Wells score

EMBOLISM

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Describe the mnemonic for Wells

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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Name 3 signs of a leg DVT

Swollen calf
Pitting oedema in calf
Local tenderness in calf

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Describe the investigation if DVT is likely after Wells score

Offer proximal leg ultrasound scan with results available after 4 hours

If cannot be carried out = D-dimer

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Describe the treatment if a DVT is unlikely after wells score

Offer D-dimer test

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

DOAC

2nd line = warfarin

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What is key information about warfarin

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

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

QRisk score

What does the QRisk score measure

10 year risk of having a heart attack or stroke

What is the mneumonic for remembering QRisk

FLASH BODIES

Describe the mnemonic for QRisk

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

What is important family history when taking the QRisk score

Angina or heart attack in a 1st degree relative

What does heath include in flash bodies for QRisk score

Migraines RA SLE Mental illness (antipsychotics) CKD

What are the levels of Qrisk score

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

Describe what low risk Qrisk stands for

<10% One in ten chance of having a stroke or heart attack in the next 100 years

Describe what having a moderate Q risk stands for

10-20% risk 1 to 2 in 10 chance of having a stroke or heart attack in the next 10 years

Describe what having a high Q risk score means

> 20% Have at least 2 in 10 chance of having stroke or heart attack in the next 10 years

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

Statins

What information should be given when prescribing statins

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

What lifestyle changes should be given for Q Risk score

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

What happens after a Qrisk is given and support given

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

What is the risk score for stroke risk in atrial fibrillation

CHADS2-VASC

What does CHADS2-VASC measure

Stroke risk in atrial fibrillation

What should be done along side when doing the CHADVASC

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

What are the risk scoring for CHADVASC

Low risk - score 0 in men or 1 in women Intermediate risk - score 2 High risk - score 3 or more

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

Low risk - no antithrombotic therapy needed

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

Consider anticoagulation

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

High risk - 3 or more = anticoagulation needed

Describe CHADVASC

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

What is mnemonic to remember diabetes control

GLUCOSE BAD

Describe the mnemonic for diabetes control

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

What is the aim on HBA1c

48 mmol/L

What is pre-diabetes

42-27 mmol/mol

What are important areas to ask in diabetes

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

Are males or females at higher risk of diabetes

Males

In CHADVASC what scores you two points

Age > (or equal to) 75 History of vascular disease

What are the alcohol recommendations

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

What is the daily recommended salt limit

6g of salt (one teaspoon)

What is INR based on

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

What is INR aim for 'normal' people

What is the INR aim for people on warfarin

2-3