Risk Assessment Tools B Flashcards
Describe the risk assessment osteoporotic fracture
FRAX assessment tool
Describe the FRAX assessment tool
Risk of osteoporotic fracture
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)
Name the frax score mnemonic
FRAX SCORE
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
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
What’s a key piece of information you want to know about in FRAX score
Have you had a DEXA scan
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
If someone is at low FRAX score risk (<10%)
Calcium, vitamin D + risk appropriate exercise
How much calcium should be recommended for people with increased risk of fragility fracture
1000 mg/day
What does a DXA scan measure
Bone density in neck of the femur
What is T-score
Standard deviation of units above or below the average bone density neck of femur of a young and healthy person
What does a T-score of +1 to -1 mean
Your bone density is in normal range for a young and healthy person
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
What does a T-score of < -2.5 mean
Osteoporosis
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
What is the risk factor for suspected of a DVT
Wells score
What does the wells score measure
Risk of a DVT
What is the mnemonic for Wells score
EMBOLISM
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
Name 3 signs of a leg DVT
Swollen calf
Pitting oedema in calf
Local tenderness in calf
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
Describe the treatment if a DVT is unlikely after wells score
Offer D-dimer test
What is the first line treatment for DVT (Wells score)
DOAC
2nd line = warfarin
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
1
What is the INR aim for people on warfarin
2-3
