Risk Scores

Question 1

Diabetes?

Actions to be taken for each score?

Answer 1

Diabetes risk score.

Age.
Gender.
Ethnicity.
FH of diabetes.
Waist circumference.
BMI.
Hypertension/high BP.

0-6 = low risk.
7-15 = increased risk (lifestyle changes).
16-24 = moderate risk (see GP to discuss risk reduction).
25+ = high risk (urgent GP appointment to discuss risk reduction).

Question 2

Cardiovascular risk (Heart attack or stroke) over the next 10 years?

Answer 2

QRISK2.

Age.
Gender.
Ethnicity.
Smoking Status.
Diabetes.
Angina/heart attack in 1st degree relative.
CKD.
BP treatment.
Rheumatoid arthritis.

Calculates a percentage risk in the next 10 years.

Question 3

Stroke risk in AF?

Bleeding risk on anticoagulation score and associated risk factors?

Answer 3

CHA2DS2VASc for stroke risk in AF.
HAS-BLED for bleeding risk on anticoagulation.

CHA2DS2VASc:
Congestive Heart Failure.
Hypertension.
Age 75 or older (double).
Diabetes Mellitus.
Stroke/TIA/Thromboembolism history (double).
Vascular disease.
Age 65-74.
Sex (female).

If score 2 or more, oral anticoagulation recommended (e.g. apixiban).
If score is 1 in a male, consider anticoagulation.
If score is 0, no anticoagulation needed.

If HASBLED is 3 or more, anticoagulation needs regular review and consideration.

Factors include: Age, renal or hepatic failure, stroke, bleeding, drug or alcohol misuse.

Question 4

10 year risk of a fracture with osteoporosis?

Recommended treatment?

Answer 4

FRAX.

Age.
Sex.
Weight.
Height.
Previous fracture.
Parent had a hip fracture.
Smoking.
Alcohol.
Glucocorticoids.
BMD/T-score.
Rheumatoid arthritis.
Other conditions that can cause osteoporosis (e.g. early menopause).

If risk high enough, treat with biphosphonates and calciferol (Ca + vit. d).

Question 5

Risk of stroke after TIA?
Score classification?

Answer 5

ABCD2.

Age over 60.
Blood pressure high.
Clinical features of the TIA (speech disturbance +1, unilateral facial weakness +2).
Duration of symptoms (10-59 mins = +1, over 1 hour = +2).
Diabetes.

1-3 = low risk.
4-5 = moderate risk.
6+ = high risk.

Not clinically recommended by NICE anymore.

Question 6

Risk of DVT?
Classification of score?

Answer 6

Wells score (DVT VERSION).

All +1:
Active cancer/within the last 6 months.
Paralysis of the lower limb.
Bedridden for 3 days or more, or major surgery.
Tenderness.
Entire leg swollen.
Calf swollen more than 3cm more than the normal leg.
Pitting oedema in symptomatic leg only.
Collateral superficial veins.
Previous DVT.

-2:
Alternative diagnosis is at least as likely as DVT.

If 2 points or more, DVT likely. (venous ultrasound + start anticoagulation - often apixiban).

If 1 or less, DVT unlikely. (D-dimer).