Risk Scores

Question 1

ABCD2 what is each?

Answer 1

/7 - calculates risk of stroke after TIA

Age > 60 =1

Blood pressure > 140/90 (HTN) =1

Clinical features (max 2)

• unilateral weakness =2
• speech difficulty, no weakness =1

Duration (max 2)

• > 60mins =2
• 10-59mins =1

Diabetes =1

Question 2

ABCD2 output meanings

Answer 2

>6 = high risk of TIA becoming stroke. Specialist referral immediately. 
4-5 = moderate risk- seen within 24hrs
0-3 = low risk - seen within 7 days (still an urgent referral) 

Note referral is immediate regardless if they have AF

Question 3

ABCD2 - stroke management

Answer 3

Anti platelets (300mg aspirin daily or 75mg clopidogrel) 
Warfarin if the patient has AF long term

The rest is just risk factor control. Diet, exercise, smoking cessation, diabetes control, HTN control, cholesterol control.

Question 4

CHA2DS2 VASC what is each?

Answer 4

Used to calculate the risk of stroke in AF

C - congestive HF =1
H - HTN =1
A -age>75 =2
D - DM =1
S - stroke, TIA, TE =2

V - vascular disease =1
A - 65-74 = 1
S - sex (female) = 1

Question 5

CHA2DS2 VASC output meaning

Answer 5

0 = no therapy
1+ in males = anticoagulation (apixaban)
2+ in females = anticoagulation (apixaban)

Question 6

Leicester diabetes score what is each?

Answer 6

The score calculates those at risk of diabetes

Need to ask:
Age
Gender
Ethnicity
Relative with diabetes 
Waist measurement 
BMI (weight and height measurement)
HTN

Question 7

Diabetes score - output meanings

Answer 7

0-6 - low risk. Nothing, 1% of diabetes
7-15 - increased risk. Make lifestyle changes (1/35 chance of getting diabetes)
16-24 - moderate risk. See your GP about how to reduce risk (1/10 chance of getting diabetes)
25-47 - high risk. See GP for blood test ASAP (1/4 chance of getting diabetes

Question 8

Leicester diabetes score - management advice

Answer 8

Lifestyle advice - diet (regular meals, smaller portion size, decrease fat, sugar, salt, alcohol), exercise 150mins/week (8 week challenge), weight loss.
Recognising signs of diabetes - toilet (polyuria), thirsty, tiredness, thrush, thinner.

Question 9

FRAX score, what is each?

Answer 9

Stands for fracture assessment tool. Calculates 10yr probability in a person with untreated osteoporosis.
Information needed is:
- age, sex, weight, height
- femoral neck BMD (found on DEXA scan)
- past medical history (remembered as PSR)
1. Previous fracture
2. Secondary osteoporosis (hyper(para)thyroid, renal/liver disease, cushing’s, coeliac, MS, DM)
3. Rheumatoid arthritis
- Drug history. Ask about steroids, lithium (mood booster), barbiturates (depressants)
- Family history of fractured hip
- Social history: smoker, alcohol intake,

Question 10

FRAX output management

Answer 10

You will get either a treat, or lifestyle advise:

• Lifestyle advise = calcium and vitamin D supplements, lots of sun, exercising regularly, quitting smoking, and alcohol.
• Treatment = bisphosphonates or alternatives. Ad cal considered too.

If indicated to not treat, review in 5yrs.

Question 11

Qrisk3 what to ask and what is it?

Answer 11

Qrisk3 calculates risk of a stroke/MI within the next 10yrs

Age, sex, ethnicity, BMI, postcode

PMHx - remember CARD
CKD stage 4 or 5
AF
RA
DM
Also, migraines, SLE, severe mental illness

DHx - HTN treatment, antipsychotics, steroid tablets

FHx - angina or MI in 1st degree relative <60

SHx - smoking status

Direct measurements

• cholesterol / HDL ratio
• systolic BP

Question 12

Qrisk3 output meanings

Answer 12

<10% = low risk. Advice on further lifestyle changes despite risk being low.
10-20% = moderate risk. Advised same as >10%
>20% = high risk. Advised same as >10%

If risk is >10%, offer advice on lifestyle factors, consider reviewing comorbidities that could be better controlled (HTN, DM etc.), discuss benefits/risks of lipid lowering therapy (statins).

Question 13

Qrisk3 management

Answer 13

Lifestyle:
Stop smoking 
Exercise
Diet change
Weight loss
Disease control and adherence to medications

Question 14

Well’s DVT score what is each?

Answer 14

Active cancer/within 6 months
Bedridden for >3days or major surgery within 12 weeks.
Previous DVT

Paralysis or immobilisation of lower extremities
Tenderness along deep venous system
Entire leg swollen
Calf swelling >3cm
Unilateral pitting oedema
Collateral superficial veins
An alternative diagnosis is as/more likely as DVT

Also ask about OCP/HRT/smoking/ long haul flights.

Question 15

Well’s DVT score output meaning

Answer 15

> /3 DVT likely. D-dimer and USS regardless.
1-2 - moderate risk. D-dimer, if positive then US.
0 - DVT unlikely. D-dimer, if positive then US.

Question 16

Well’s DVT management

Answer 16

If DVT then LMWH (5 days), then oral anticoagulants (Rivaroxaban).
Long term anticoagulants, physical activity.
Treat underlying cause.
Prevention - diet, exercise, smoking cessation.

Question 17

Well’s PE what is each?

Answer 17

Clinical signs of DVT
Alternative diagnosis less likely.
HR >100bpm
Haemoptysis

Previous PE or DVT
Surgery (last 4 weeks) or immobilisation for >3days.
Active cancer

Question 18

Well’s PE score output meaning

Answer 18

If wells < then PE unlikely. D-dimer and if unavailable within 4hrs offer anticoagulation.

If Well’s >4 then PE likely. Immediate CTPA, anticoagulate based on the results.

Question 19

Well’s PE score management

Answer 19

PE suspected - oxygen, fluid resus.
PE confirmed:
- If haemo stable - DOAC (Rivaroxaban)
- if haemo unstable then thrombolysis (alteplase).

Consider O2 if <90%, fluids and analgesia.

Prevention - diet, exercise, smoking cessation and hydration. Also mobilise.