Risk Assessments Flashcards
What is ABCD2 score used for?
Used for calculating the risk of a stroke after a TIA.
What are the parameters used for ABCD2?
A - Age
B - Blood pressure
C - Clinical Features
D - Duration
D - Diabetes
How would you score age in a ABCD2 score?
If the patient’s age is above (and including) 60 years old = 1 point.
Below 60 years old = 0 points.
How would you score blood pressure in a ABCD2 score?
If the patient has a blood pressure of above (and including) 140/90 = 1 point.
Anything below this = 0 points.
How would you score clinical features in a ABCD2 score?
Unilateral weakness following TIA = 2 points.
Speech disturbances without weakness = 1 point.
None of the above = 0 points.
How would you score duration in an ABCD2 score?
TIA is longer than (and including) 60 minutes = 2 points.
TIA was between (and including) 10 minutes to below 60 minutes = 1 point.
How would you score diabetes in an ABCD2 score?
If the patient has diabetes = 1 point. `
In total, how many points is an ABCD2 score out of?
7 points.
What else could be enquired about when performing an ABCD2 risk assessment?
Atrial fibrillation
Previous history of TIA exploration - how far apart they were.
What would an ABCD2 score of less than (and including) 3 indicate for referral?
See the patient within 7 days.
What would an ABCD2 score of 4 or 5 indicate for referral?
See a specialist within 24 hours.
What would an ABCD2 score of 6 or 7 indicate for referral?
Specialist referral needed immediately.
What is some lifestyle advice that can be given following a TIA?
Diet lower in fats and cholesterol.
Exercise more.
Smoking cessation.
What would the antithrombotic treatment be following a TIA?
STAT - 300mg Aspirin.
FIRST LINE - Continued clopidogrel 75mg OD.
Second line - Modified-release dipyridamole 200mg DB.
Third line - Aspirin 75mg OD.
What is secondary prevention advice for patients for TIA?
Control of hypertension .
Statin for patients with high cholesterol.
What should a patient not do following a TIA and how long for?
Do not drive for at least one month following TIA.
What surgical procedure can be given to a patient if internal carotid artery occlusion is above 70%?
Carotid endarterectomy.
What is QRISK2 score used for?
Gives risk of a person developing CVD over the next 10 years in those aged 35–74.
What personal information is used for QRISK2 scoring?
Age
Sex
Ethnicity
BMI - Therefore height and weight.
What past medical history is used for QRISK2 scoring?
Chronic Kidney Disease (stage 4/5) present?
Atrial fibrillation
Rheumatoid arthritis
Diabetic status
What drug history is used for QRISK2 scoring?
Antihypertensives
What family history is used for QRISK2 scoring?
Angina or heart attack in a first degree relative <60 years old.
What social history is used for QRISK2 scoring?
Smoking status
What direct measurements are used in QRISK2 scoring?
Cholesterol / HDL ratio
Systolic blood pressure (mmHg)
What can the results of a QRISK2 score be and what would they mean?
<10% = low risk.
10–20% = moderate risk.
>20% = high risk.
What is the management of an individual with a QRISK score of <10% (low risk)?
Advise that risk is low but further reductions in risk can often still be achieved.
Offer advice on relevant lifestyle factors that can be improved:
- Stop smoking if relevant
- Exercise
- Diet change / weight loss
- Disease control / medication adherence
What is the management of an individual with a QRISK score of >10% (medium-high risk)
Offer advice on any relevant lifestyle factors to reduce risk.
Consider reviewing any relevant comorbidities that may not be optimally controlled.
Discuss the benefits and risks of taking a lipid modification therapy.
What is the CHA2DS2VaSc scoring system used for?
Calculates the risk of stroke in Atrial Fibrillation.
What are the parameters used for a CHA2DS2VaSc score?
C - Congestive heart failure.
H - Hypertension
A - Age
D - Diabetes
S - Stroke / TIA
Va - Vascular disease
Sc - Sex Category
How would you score congestive heart failure in a CHA2DS2VaSc score?
If the patient has congestive heart failure = 1 point.
How would you score hypertension in a CHA2DS2VaSc score?
If the patient has hypertension = 1 point.
How would you score age in a CHA2DS2VaSc score?
Patient is above (and including) 75 years old = 2 points.
Patient is between the ages of (and including) 65 and 75 = 1 point.
How would you score diabetes in a CHA2DS2VaSc score?
If the patient has diabetes = 1 point.
How would you score stroke / TIA in a CHA2DS2VaSc score?
If the patient has a history of stroke or TIA = 2 points.
How would you score vascular disease in a CHA2DS2VaSc score?
If the patient has vascular disease = 1 point.
How would you score sex category in a CHA2DS2VaSc score?
If the patient is female = 1 point.
Male = 0 points.
What is a CHA2DS2VaSc score out of?
9 possible points.
What would a CHA2DS2VaSc score of 0 indicate for treatment?
No anticoagulation required.
What would a CHA2DS2VaSc score of 1 indicate for treatment?
Consider anticoagulation with vitamin K antagonist like warfarin within therapeutic range (INR 2–3) or a DOAC (rivaroxaban, apixaban), maybe aspirin.
What would a CHA2DS2VaSc score of 2 or more indicate for treatment?
Anticoagulation required with vitamin K antagonist like warfarin within therapeutic range (INR 2–3) or a DOAC (rivaroxaban, apixaban).
What would the treatment be for a patient that has a CHA2DS2VaSc of above 1 but is already on an anticoagulant?
Manage modifiable risk factors for bleeding (HAS BLED – uncontrolled HTN, renal/liver disease, labile INR, using NSAIDs/antiplatelets, alcohol consumption).
What is general life advice for a high CHA2DS2VaSc score?
Avoid alcohol
Smoking cessation
Healthy diet
Exercise
What is Warfarin advice after prescription?
Needs INR check.
Teratogenic.
Can interfere with other medications.
Increased bleeding risk.
Diet control.
Can be reversed with vitamin K.
What is DOAC advice after prescription?
Non-reversible.
Increased bleeding risk.
Expensive.
C/I in renal impairment/Hx of GI bleed.
What is FRAX score used for?
Gives 10 year probability of a fracture in the spine, hip, shoulder or wrist for people aged 40–90 years old.
What personal information is used in the FRAX score calculation?
Age
Sex
Weight (Kg)
Height (cm)
What past medical history is used in the FRAX score calculation?
Rheumatoid arthritis.
Previous fracture.
Secondary osteoporosis.
- Kidney failure
- Hyperthyroidism
- Coeliac disease
- Diabetes mellitus type 1
- Chronic liver disease
- Premature menopause
Femoral neck BMD from previous DEXA-T scan (g/cm2)
What drug history is used in the FRAX score calculation?
Glucocorticoids
Lithium
What family history is used in the FRAX score calculation?
Parental hip fracture.
What social history is used in the FRAX score calculation?
Smoking.
Alcohol intake (≥3 alcoholic drinks a day)
What does a T score indicate from a FRAX score?
A T-score shows how much your bone density is higher/lower than the bone density of a healthy 30-year old adult.
What does a Z score indicate from a FRAX score?
A Z-score compares the condition of your bones with someone of your age/sex/weight/ethnicity.
What does a T score of ≥ –1 indicate?
Normal bone density, no intervention.
What does a T score of between -2.5 and -1 indicate?
Osteopenia, consider medication, lifestyle advice
What does a T score of less than -2.5 indicate?
Osteoporosis, medication, lifestyle advice.
What would the treatment be for an individual who has a low risk (≤10%) FRAX score?
Lifestyle - weight bearing exercise, quitting smoking, limiting alcohol
Diet - calcium, vitamin D
Home adaptations - wearing shoes with good grip, getting rid of rugs
Reassessment in 5 years
What would the treatment be for an individual who has a intermediate (10 < % < 20) risk FRAX score?
DEXA scan to measure BMD
If T below -2.5 then Biphosphonates (alendronate 10mg OD)
or RANK-L (Denosumab)
or Teriparatide
What would the treatment be for an individual who has a high risk (≥20%) FRAX score?
If T above -2.5 then modify risk factors.
Reassess in 2 years.
If T below -2.5 then Biphosphonates (alendronate 10mg OD)
or RANK-L (Denosumab)
or Teriparatide
What is a QRISK2 score used for?
Gives risk of a person developing CVD over the next 10 years in those aged 35–74
What personal information is used in a QRISK2 score calculation?
Age
Sex
Ethnicity
BMI and therefore Height and Weight
What past medical history is used in a QRISK2 score calculation?
Chronic Kidney Disease stage 4/5.
Atrial Fibrillation
Rheumatoid arthritis
Diabetic status
What drug history is used in a QRISK2 score calculation?
Antihypertensives.
What family history is used in a QRISK2 score calculation?
Angina / Heart attack in first degree relative <60 years old.
What social history is used in a QRISK2 score calculation?
Smoking status
What direct measurements are used in a QRISK2 score calculation?
Cholesterol / HDL ratio
Systolic blood pressure (mmHg)
What are the three outcomes for a QRISK2 score calculation?
<10% = low risk.
10–20% = moderate risk.
>20% = high risk.
What is the management for a QRISK2 score of <10%?
Advise that risk is low but further reductions in risk can often still be achieved.
Stop smoking
Exercise
Diet change and weight loss
Disease control / medication adherence
What is the management for a QRISK2 score of >10%?
Offer advice on any relevant lifestyle factors to reduce risk.
Consider reviewing co-morbidities that may not be optimally controlled.
Discuss the benefits and risks of taking lipid modification therapy.
What is the diabetes risk score out of?
47
What non-modifiable risk factors affect diabetes risk score?
Age
Gender
Ethnicity
Relative with diabetes
What modifiable risk factors affect diabetes risk score?
Waist measurement
Height and weight
Hypertension
What points are given for age in diabetes risk score?
50 ≤ age < 60 = 5 points.
60 ≤ age < 70 = 9 points.
≥70 = 13 points.
What points are given for gender in diabetes risk score?
male = 1 point.
female = 0 points.
What points are given for ethnicity in diabetes risk score?
Any other ethnicity other than white European = 6 points.
What points are given for relative with diabetes in diabetes risk score?
Yes = 5 points.
No = 0 points.
What points are given for waist measurement in a diabetes risk score?
90 ≤ cm < 100 = 4 points.
100 ≤ cm < 110 = 6 points.
≥110cm = 9 points.
What points are given for BMI (weight and height) in a diabetes risk score?
25 ≤ kg/m2 < 30 = 3 points.
30 ≤ kg/m2 < 35 = 5 points.
≥35kg/m2 = 8 points.
What points are given for hypertension in a diabetes risk score?
Yes = 5 points.
No = 0 points.
What are the total score boundaries for diabetes risk score?
Low risk = 0 – 6 points
Increased risk = 7 - 15 points
Moderate risk = 16 - 24 points
High risk = 25 - 47 points.
What do the relative risk boundaries indicate for chances of developing diabetes?
Low risk = 1 in 100
Increased risk = 1 in 35 risk
Moderate risk = 1 in 10 risk
High risk = 1 in 4 risk
What are the 5 Ts for recognising diabetes?
Toilet (polyuria)
Thirsty (polydipsia)
Tiredness (more than usual)
Thrush (genital itching)
Thinner (unintentional)
What is Well’s score used for?
The Wells’ Criteria for DVT Objectifies risk of deep vein thrombosis (DVT) based on clinical findings.
What points are given for history of presenting complaint in a Well’s score?
Paralysis, paresis, or recent immobilisation = 1 point.
Localised tenderness along the deep venous system = 1 point.
Entire leg swollen = 1 point.
Calf swelling >3cm compared to other leg = 1 point.
Pitting oedema, confined to symptomatic leg = 1 point.
Collateral superficial veins present = 1 point.
What points are given for past medical history in a Well’s score?
Bedridden recently >3 days or major surgery within 12 weeks = 1 point.
Active cancer (treatment within 6 months) = 1point.
Previous DVT = 1 point.
What would you give negative points for in Well’s scoring?
-2 points for an alternative diagnosis being more likely.
What additional questions can be asked about in Well’s scoring?
Long-haul flights.
Smoking
HRT/OCP if appropriate.
What does a Well’s score of ≤0 indicate?
DVT unlikely, 5% prevalence.
What does a Well’s score of 1-2 indicate?
DVT moderate risk, 17% prevalence
What does a Well’s score of ≥3 indicate?
DVT likely, 17–53% prevalence
What investigations would you use on someone with a suspected DVT?
D-Dimer - good for negative exclusion, high specificity, low sensitivity.
USS doppler veins if high risk
CTPA is gold standard for diagnosing PE.
What are some options for DVT treatment?
LMWH
Oral Warfarin and maintain INR 2-3 or a DOAC
Compression stockings
Treat / seek underlying cause
Diet, exercise, smoking cessation.
