Risk Assessments Flashcards
What factors influence a DMT2 risk score ?
Gender, age, ethnicity, FHx, Waist size, BMI, PMHx (HTN)
What are the categories calculated in a DMT2 RS ? e.g. low-high ?
Low = 0 - 6
Increased = 7-15
Moderate = 16 - 24
High = 25 - 47
How does age impact a DMT2 score ?
49 or younger = 0
50-59 = 5
60-69 = 9
70+ = 13
How does gender impact a DMT2 score ?
Male = 1
Female = 0
How does ethnicity impact a DMT2 score ?
White European = 0
Other = 1
How does waist measurement impact a DMT2 score ?
Less than 90cm = 0
90-99.9 = 4
100-109.9 = 6
110 or above = 9
How does BMI impact DMT2 score ?
Less than 25 = 0
25-29.9 = 3
30-34 = 5
35 or above = 8
How does BP impact a DMT2 score ?
HTN = 5
What is the pathology of T2DM ?
Insulin resistance due to B-cell dysfunction
Hyperglycaemia results due to reduced insulin secretion
How does FHx impact the score ?
Yes = 5
What are normal HbA1c tests
<42 mmol/L
What are pre-diabetic HbA1c tests ?
42-47 mmol/L
What are diabetic HbA1c tests ?
> 47
What is first line treatment for T2DM ?
If the condition can be managed with lifestyle changes instead of medications, then it should be
What is second line treatment for T2DM ?
Metformin
What medications could be given in addition to metformin ?
Metformin +
Sulphonylurea
DDP4 inhibitor
Pioglitazone 2
SGLT-2i
What does a QRISK2 calculate ?
Risk of having an MI or stroke within the next 10 years
List the variables of a QRISK2 score ?
Age, sex ethnicity, Post-code, Smoko, DM, Angina or MI in first degree relative <60, CKD (stage 4 or 5), AF, HTN treatment, RA, Cholesterol/HDL ratio, Systolic BP, BMI
Which variables are modifiable in a QRISK2 ?
Smoko, Cholesterol, BMI
Which variables are non-modifiable in a QRISK2 ?
Age, sex, ethnicity, DM, FHx, RA, HTN
What should an ideal QRISK2 score be ?
<10%
What does a CHAD2VASc calculate ?
Risk of stroke for patient in AF
What does CHADS2VASc stand for ?
Congestive HF = 1
HTN = 1
Age = > 75 = 2
DM = 1
Stroke/TIA/Systemic embolism = 2
Vascular disease = 1
Age = 1
Sex = 1
What are the different scores in a CHADS2VASc
0 male or 1 female
Low risk
No anticoagulation
1 male
Moderate risk
Oral anticoagulant should be considered
2 or greater
High risk
Oral anticoagulant is recommended
Which factors are non-modifiable in a CHADS2VASc ?
Congestive HF
Age
DM
Sex
Stroke/TIA/Systemic embolism
CHADS2VASc -What factors impact stroke risk ?
Risk of stroke is 5 times higher in person with AF than normal sinus rhythm
Severity of stroke is greater when associated with AF
Anticoagulation treatment reduced the risk of stroke by about 2/3rds
What treatment could be provided for clot risk ?
Warfarin
DOAC e.g. rivaroxaban or apixaban
Both carry a risk of bleeding
What does a FRAX calculate ?
Used to calculate the risk of fracture in the next 10 years
What are the variables ?
Age, sex, weight, height, previous #, FHx of #,. smoko , GCs, RA, Secondary osteoporosis (T1DM, Hyperthyroidism, chronic liver disease), alcohol and bone mineral density (DEXA)
How are the results of a FRAX calculated ?
Results come out as a %
A score of 5% or more for a hip facture at age 70+ suggests one should consider treatment alongside lifestyle changes
What is a DEXA scan ?
A scan which looks at the mineral density of your bones and compares it to scans from people of a similar age
What are the different scores from a FRAX ?
T score and Z score
What are the different T scores ?
Greater than -1 = normal
-1 - -2.5 = Osteopenia
<-2.5 = Osteoporosis
What does a Z score suggest ?
> -2 suggest that something other than ageing may be responsible for your bone mineral density
What is osteopenia ?
When your bone density scan shows lower bone density than the average for your age
What is osteoporosis ?
Significant loss of bone mineral density resulting in fragile bones which are a risk of breaking
What does ABCD2 stand for ?
Age > 60
Blood pressure > 140/90
Clinical features e.g. unilateral weakness (2) speech disturbances without weakness (1)
Duration of symptoms e.g. 60 mins + = 2, 10-59 mins =1
DM = 1
What are the results for an ABCD2 score ?
0-3 = low risk ~3% chance of stroke of stroke in the next 90 days
4-5 = moderate risk ~10% chance of stroke in the next 90 days
6-7 = high risk ~18% chance of a stroke in the next 90 days
What treatment could you give for a TIA ?
Antiplatelets e.g. aspirin (instant), dipyridamole (2 weeks), clopidogrel
Anticoagulants e.g. heparin or warfarin, long term statins e.g. simvastatin
Control risk factors e.g. HTN
What treatment could you give for a stroke ?
Thrombolysis e.g. alteplase
What is a Well’s DVT score
Tool to calculate the risk of developing a deep vein thrombosis (and PE)
What are the variables in a Wells score ?
Active cancer, bedridden > 3 days, major surgery within 12 weeks, Calf swelling > 3 days (unilateral), collateral superficial veins, entire leg swollen, localised tenderness confined to symptomatic leg, pitting edema, paralysis, paresis or plaster immobilisation, previous DVT, alternative diagnosis likely (-1)
What are the results of a Wells score ?
Moderate risk = 1-2
High risk = 3+
Signs and symptoms of DVT
Pulse is present
Pain-aching cramping
Skin pigmentation in galter area (medial and lateral malleolus)
Thickened and tough may be reddish blue
What are the risks of a DVT ?
Develop into an ulcer
Stroke
MI
What treatment could be given for a DVT ?
D-dimer could exclude
Heparin or warfarin
