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RISK SCORES Flashcards

1
Q

Q-risk:

What is it?

A

Risk of having a heart attack or stroke over the next 10 years

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2
Q

Q-risk:

What personal information do you need?

A
  1. Age
  2. Sex
  3. Ethnicity
  4. BMI - height and weight
  5. Postcode
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3
Q

Q-risk:

What PMHx do you need?

A

C.A.R.D

  • Chronic kidney disease (stage 4/5)
  • Atrial fibrillation
  • Rheumatoid arthritis
  • Diabetic status
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4
Q

Q-risk:

What DHx, FHx and social Hx do you need?

A

DHx: Existing hypertension treatment

FHx: Angina or heart attack in a 1st degree relative <60

Social Hx: Smoking status

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5
Q

Q-risk:

What investigations for direct measures?

A
  • Cholesterol/ HDL ratio

- Systolic blood pressure

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6
Q

Q-risk:

What do the results mean?

A 
<10% = low risk 
10-20% = moderate risk 
>20%= high risk
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7
Q

Q-risk:

Management for risk <10%

A
  • ADVICE that although the risk is low, it can be lower
  • CONSERVATIVE:
  • stop smoking
  • exercise
  • diet change
  • weight loss
  • disease control and adherence to medications
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8
Q

Q-risk:

Management for risk >10%

A
  • ADVICE on relevant lifestyle factors to reduce the risk
  • REVIEW relevant comorbidities that may not be optimally treated.
  • DISCUSS statins (lipid modification therapy)
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9
Q

Negatives of statins

A

Common side effects of statins include nausea, vomiting, and aches and pains in the muscles and joints. You may also have constipation, gas, or diarrhea.

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10
Q

CHA2DS2-VASc:

What is it?

A

Risk of stroke in AF patients, to see whether they should be put on anti-coagulants.

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11
Q

CHA2DS2-VASc:

What personal information do you need?

A
  1. Age (>75, 65-74)

2. Sex- female

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12
Q

CHA2DS2-VASc:

What PMHx do you need?

A

C.H.D.V.S

  1. Congestive heart failure
  2. Hypertension
  3. Diabetes
  4. Vascular disease
  5. Stroke/TIA history
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13
Q

CHA2DS2-VASc:

Score 0 or 1 female

A

Risk : Low
Advice: avoid alcohol, smoking, healthy diet, exercise
Anticoagulant: None

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14
Q

CHA2DS2-VASc:

Score 1 male

A

Risk: Moderate
Advice: avoid alcohol, smoking, healthy diet, exercise
Medication: Oral anticoagulant to be considered e.g. warfarin, NOACs

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15
Q

CHA2DS2-VASc:

Score >2

A

Risk: High
Advice: avoid alcohol, smoking, healthy diet, exercise
Medication: Oral anticoagulant highly recommended e.g. warfarin, NOACs

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16
Q

What do you do for those already on anticoagulants?

A
  1. Manage modifiable risk factors for bleeding (HAS-BLED score, uncontrolled HTN, concurrent use of aspirin or NSAID, harmful alcohol consumption)
  2. For those on warfarin - assess anticoagulation control
  3. For those on apixaban, dabigatran, rivaroxaban - monitor the drug
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17
Q

Negatives of warfarin

Positive of warfarin

A
  1. Daily INR
  2. Teratogenic
  3. Can interfere with other medications
  4. Increased bleeding risk
  5. Diet control
  6. Reversible with vitamin K (++++)
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18
Q

Negatives and positives of NOACs

A
  1. Non-reversible
  2. Increased bleeding risk
  3. Expensive
  4. Contraindicated w/ renal impairment and history of GI bleed
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19
Q

FRAX score

A

Risk assessment tool for estimating 10 -yr risk of osteoporotic fracture in untreated patients

20
Q

FRAX:

What personal information do you need?

A
  1. Age
  2. Sex
  3. Weight (kg)
  4. Height (cm)
  5. Femoral neck BMD (g/cm2)
21
Q

FRAX:

What PMHx do you need?

A

P.S.R

  • Previous fractures
  • Secondary osteoporosis: due to medical condition or treatment
  • Kidney failure, Cushing’s, coeliac, MS, hyperthyroidism, hyperparathyroidism , diabetes.
  • Rheumatoid arthritis
22
Q

FRAX:

DHx

A
  • Glucocorticoids
  • Lithium
  • Barbiturates
23
Q

FRAX:

FHx

A

Parental fractured hip/ any other fractures

24
Q

FRAX:

Social Hx

A
  • Smoker

- Alcohol intake (3 or more units/day)

25
Q

What does the T-score mean?

What is the management for each?

A

A T-score shows how much your bone density is higher or lower than the bone density of a healthy 30-year old adult.
 -1 and above: normal bone density (do not need osteoporosis medicine)
 between -1 and -2.5 – osteopenia (weight bearing exercises, x smoking, should consider medication like Ca+2 and Vit D when they have certain risk factors)
 -2.5 and below – osteoporosis (should consider taking an osteoporosis medicine e.g. bisphosphonates)

26
Q

ABCD2:

A

Risk of stroke after a TIA

27
Q

ABCD2:

What personal information do you need?

A
  1. Age >60
  2. Clinical features of the TIA (unilateral weakness, speech difficulty without weakness)
  3. Duration of the TIA (>60 mins, 10-59)
28
Q

ABCD2:

What PMHx do you need?

A
  • AF present (funny heart beats)
  • Diabetes
  • Any other TIAs in the past? How long apart were they?
29
Q

ABCD2:

What do the scores mean?

A
  • Score 1-3 (low risk) = investigate and referral within one week
  • Score 4 (high risk) or more= investigate and referral within 24 hours.
30
Q

What advice and medication should you give someone who is at a high risk?

A

ADVICE: DO NOT DRIVE for 1 month, diet, exercise, smoking stop, diabetes control, BP control
MEDICATION: antiplatelets, statin

31
Q

WELLS score

A

Probability of developing a DVT/ PE

32
Q

WELLS score

What things should you ask in the HxPC?

A
  • Any paralysis, paresis or recent immobilisations
  • Localised tenderness
  • Entire swollen leg
  • Calf swelling 3cm larger than asymptomatic side
  • Pitting oedema on symptomatic leg
  • Collateral superficial veins
  • Any alternative diagnosis (baker’s cyst, cellulitis) -2 points
33
Q

WELLS score

What PMHx do you want to know?

A
  • Active cancer (treatment ongoing, within 6 months or palliative)
  • Recently bed ridden >3 days
  • Any minor surgery
  • Previous DVT
34
Q

WELLS score

What DHx and social Hx do you want to know?

A
  • Any recent long haul flights?
  • Smoking and alcohol
  • Any HRT or oral contraceptive pill
35
Q

WELLS score: for dvt

Less than or equal to 1

A

DVT unlikely = D-dimer test

36
Q

WELLS score: for dvt

More than or equal to 2

A

DVT likely = D dimer and USS

37
Q

WELLS score: for PE

A 
<4= d-dimer 
2-6= d-dimer and CTPA 
>6= CTPA/ V/Q scan
38
Q

What is a d-dimer test?

A

This test measures the amount of D-dimer, a type of protein the body produces to break down a blood clot. D-dimer is normally undetectable in the blood but it is produced when the body is trying to break down a blood clot.

39
Q

Medication for DVT?

A
  • LMWH (dalteparin)

- Anti-coagulants

40
Q

Lifestyle advice for those with DVT?

A
  • diet
  • exercise
  • smoking cessation
41
Q

Diabetes risk :

What factors to ask in HxPC?

A
  1. polyuria,
  2. polydipsia
  3. unexplained weight loss
  4. visual blurring
  5. genital thrush
  6. lethargy
42
Q

Diabetes risk :

What factors to ask in personal info?

A 
 Age
 Gender
 Ethnicity
 Waist measurement
 BMI (height/weight)
43
Q

Diabetes risk :

What factors to ask in FHx?

A
  • Diabetes

- High BP

44
Q

Diabetes risk :

What factors to ask in PMHx?

A
  • hypertension (any meds for it)
45
Q

Scoring for diabetes risk

A

Low (0-6)
Increased (7-15)
Moderate (16-24)
High (25-47)

46
Q

Lifestyle advice for diabetes

A 
 Regular meals ( keep food and activity diary) 
 Portion size
 Decrease fat
 Limit sugar
 Decrease salt
 Moderate alcohol
 Exercise (150mins/week)
47
Q

5Ts of diabetes

A
  1. Toilet
  2. Thirsty
  3. Tiredness
  4. Thrush
  5. Thinner

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