RISK SCORES Flashcards
What does the QRISK2 calculate?
The % risk of MI or stroke in 10 years
What are the key risk factors included in a QRISK2 score?
Age, sex, ethnicity, BMI
PMH: CKD, Atrial fibrillation, rheumatoid arthritis, Diabetes
DH: On antihypertensives
Family history: Angina/ heart attack in first degree relative <60
SH: Smoking
Investigations: Cholesterol/ HDL ratio, BP
What percentages indicate low, moderate and high risk on a QRISK2 score?
<10%= low risk 10-20%= moderate risk >20%= high risk
What is the management for people on a low risk QRISK2 score?
Lifestyle factors; Stop smoking exercise Diet change/ weight loss Disease control/ medication adherence
What is the management for people with moderate-high QRISK2 score?
Advice on lifestyle factors
Review co-morbities for optimum control
Discuss benefits and risks of taking lipid modification therapy
What does the CHA2DS2VASc score calculate?
The risk of stroke with atrial fibrillation
What does each part of CHA2DS2VaSc stand for?
Congestive heart failure HTN Age Diabetes Stroke/ TIA previous Vascular disease (peripheral) Sex
What should be offered if there is a CHA2DS2VaSc score of 2 or more
Anticoagulation such as warfarin or DOAC (apixaban, rivaroaxban)
What should be flagged to the patient if they are on/ starting warfarin?
Be careful of eating leafy greens Will need daily INR Teratogenic Can interfere with other medications Increased bleeding risk
What is given for clotting in the arterial system vs the venous system?
Arterial: Anti-platelets (e.g. clopidogrel)
Venous: Anticoagulants (e.g. warfarin, apixaban)
What is the ABCD2 score used to assess?
Risk of stroke after TIA?
What risk factors does the ABCD2 score consider?
Age Blood pressure Clinical features of TIA: -Unilateral weakness -speech disturbance Duration of symptoms (>60 mins) Diabetes
(Also ask if they’ve had any TIAs in the past)
What ABCD2 scores indicate low, moderate and high risks?
<3 = low 3-5 = Moderate >6 = high
What is the advice is the patient has a high ABCD2 score?
Lifestyle: diet, exercise, smoking, adherence to medication
Medication: Antiplatelets, statin
DO NOT DRIVE FOR AT LEAST 1 MONTH
What is the Well’s score used to calculate?
Risk of DVT
What factors does the Well’s score take into account?
Immobility (bedridden) Long haul flight On oral contraceptive pill Previous surgery Active cancer History of DVT Smoking
What things would you expect to find on examination of DVT (and so should ask about)?
Redness Swelling (is it unilateral?) Pitting oedema Tenderness Collateral veins Neurological signs
What Well’s score would indicate a DVT was likely?
> 3
How would you investigate a suspected DVT?
D-dimer to exclude
USS doppler
CTPA
How would you manage a suspected DVT?
LMWH Oral warfarin Compression stockings Treat underlying cause Lifestyle modification
What does the FRAX score calculate?
The % risk of fracture in 10 years
What questions are included in a FRAX assessment? (10)
Age Gender Weight/ height Previous fracture Parent fractures hip Smoking Alcohol intake (>3 drinks a day) Glucocorticoid use (Steroids) RA Secondary osteoporosis (DEXA scan)
What medical conditions result in secondary osteoporosis?
Kidney failure Cushings Coeliac MS Hyperparathyroidism Hyperthyroidism Diabetes
What score is used to show how much a persons bone density is higher or lower than that of a healthy 30 year old?
T score
