Risk scores

Question 1

What is QRISK

Answer 1

Risk of Heart attack in the next 10 years

Question 2

What personal info for QRISK3?

Answer 2

Age
Sex
Ethnicity
BMI- Height (cm) and weight (kg) 
Postcode

Question 3

What past medical history questions would you ask for QRISK3

Answer 3

PMH  (C.A.R.D)
Chronic kidney disease (stage 4 or 5)
Atrial fibrillation
Rheumatoid arthritis
Diabetic status

Question 4

Drug Hx, Family hx and social hx questions for QRISK3

Answer 4

Drug history
Existing hypertension treatment
Family History
Angina or heart attack in a 1st degree relative <60
Social history
Smoking status
Direct measurements
Cholesterol/HDL ratio
Systolic blood pressure (mmHg)

Question 5

How would you interpret these findings for QRISK3

Answer 5

<10% LOW RISK
10-20% MODERATE
> 20% HIGH

Question 6

Management for <10% for QRISK3

Answer 6

Risk <10%
Advise that although the risk is low, further reductions in risk can often still be achieved.
Offer advice on any relevant lifestyle factors that can be improved
stop smoking
exercise
diet change
weight loss
disease control and adherence to medications.
Risk >10%

Question 7

What if the risk is greater than 10% QRISK3?

Answer 7

Risk >10%
Offer advice on any relevant lifestyle factors to reduce the risk
Consider reviewing any relevant comorbidities that may not be optimally treated.
Discuss the benefits and risks of taking a lipid modification therapy.

Question 8

What is CHA2DS2-VAS score

Answer 8

Risk of stroke in Af patients

Question 9

What is in CHA2DS2-VAS score

Answer 9

c: Congestive heart failure
H: Hypertension
A: Age greater than 75 - 2 points
D: Diabetes
S: Stroke/TIA - 2 points
V- Vascular history
A- Age 65-74
S- sex female

Question 10

General lifestyle advice for CHA2DS2-VAS

+ meds you can give for management

Answer 10

General lifestyle advise: avoid alcohol, smoking cessation, healthy diet, exercise.

Warfarin
daily INR, teratogenic, can interfere with other medications, increased bleeding risk, diet control, reversible with vitamin K

NOACs (apixaban, rivaroxaban)
non-reversible, increased bleeding risk, expensive, contraindicated with renal impairement and history of GI bleed

Question 11

Score of 0 male or 1 female for CHA2DS2-VAS management

Answer 11

No anticoagulation just lifestyle

Question 12

Score of 1 male CHA2DS2-VAS management

Answer 12

Oral anticoag with well controlled vitamin K antagonist

Question 13

Score of 2 or higher CHA2DS2-VAS management

Answer 13

Oral anticoag with well controlled vitamin K antagonist

Question 14

What is the FRAX score

Answer 14

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

Question 15

Personal info for FRAX

Answer 15

Personal information 
Age
Sex
Weight (kg)
Height (cm)
Femoral neck BMD (g/cm2)

Question 16

Medical conditions to ask about around FRAX

Answer 16

Past medical history (P.S.R)
Rheumatoid arthritis
Secondary osteoporosis (caused by medical condition or treatment)
Medical conditions resulting in secondary osteoporosis:
Kidney failure
Cushings
Coeliac
MS
Hyperparathyroidism
Hyperthyroidism
Diabetes
Previous fracture

Question 17

Dhx and Fhx for FRAX

Answer 17

Drug history
Glucocorticoids
Lithium
Barbiturates

Family History
Parental fractured hip (have either of your parents had a fractured hip before and ask about normal fracture

Question 18

T and Z score

Answer 18

A T-score shows how much your bone density is higher or lower than the bone density of a healthy 30-year old adult.

Z-score compares the condition of your bones with someone of your age, sex, weight, and ethnic or racial origin

Question 19

What is the ABCD2 score

Answer 19

Estimates the risk of stroke after a suspected transient ischemic attack (TIA).

Question 20

Categories in ABCD2 (two categories for D)

Answer 20

Age ≥ 60 years (+1)
BP ≥ 140/90 mmHg (+1)
Clinical features of the TIA (1 for speech and 1 for unilateral weakness)
Duration of symptoms (1 for 10-59 and 2 for over 1 hour)
Diabetes history (+1)

Question 21

PMH for ABCD2

Answer 21

AF and history of TIAs

Question 22

Management (ABCD2)

Answer 22

Referral:
Immediate: AF present (CHADVAS)
urgent: 0-3
(All patients with suspected TIA should be seen in the next 7 days)
immediate: 4-7
2 TIAs within the same week; antiplatelet treatment
(Patients with a score >4 should be assessed by a specialist within 24hrs)

Question 23

Interpretation of risk ABCD2

Answer 23

*) Low risk - 0-3
Moderate risk: 4-5
High risk >6

Question 24

Medication and life style advice for ABCD2

Answer 24

Medication
antiplatelets ( aspirin, clopidogrel)
statin
Lifestyle
diet (lower fats and cholesterol)
exercise
smoking cessation
adherence to medication
diabetes control
blood pressure control

Question 25

WELLS criteria for DVT

Answer 25

Active cancer
Treatment or palliation within 6 months

Bedridden recently >3 days or major surgery within 12 weeks

Calf swelling >3 cm compared to the other leg
Measured 10 cm below tibial tuberosity

Collateral (nonvaricose) superficial veins present

Entire leg swollen

Localized tenderness along the deep venous system

Pitting edema, confined to symptomatic leg

Paralysis, paresis, or recent plaster immobilization of the lower extremity (bed ridden >3 days from major surgeries or long haul flights)

Previously documented DVT

Alternative diagnosis to DVT as likely or more likely (minus 2)

Question 26

Interpreting a Wells

Answer 26

Scoring:
> or equal to 2 – DVT likely (D dimer and USS)
> or equal to 1 – DVT unlikely (D dimer)

Question 27

Medication for WELLS DVT

Answer 27

LMWH
anticoagulant
Measurement of serum D-dimer is the initial investigation in patients with a low clinical probability score.

Question 28

Diet advice wells

Answer 28

Diet
exercise
smoking cessation

Question 29

Frax components

Answer 29

Age
Sex
Weight and height
Previous fracture
Hip fracture mum or dad
Smoking
glucocorticoids
RA
Alcohol
BMD of femoral neck