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Phase 2b OSCE > RISK SCORES > Flashcards

RISK SCORES Flashcards

1
Q

What Risk scoring systems do we need to know for the OSCE

A
  • Diabetes risk (diabetes risk score)
  • Cardiovascular risk (QRisk)
  • Stroke risk in atrial fibrillation (CHADs2VASc)
  • Osteoporosis risk (FRAX)
  • Risk of stroke after TIA (ABCD2)
  • DVT (Wells’ score)
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2
Q

What’s included in the Diabetes Risk score?

A

Age
Sex
Ethnic Background
First Degree relative with diabetes

BMI
Waist Size
On medication for high blood pressure/have been told you have high blood pressure

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3
Q

What is the value score highest in each diabetes risk score parameter, for the 4 non modifiable risk scores?

A

Age = 70 or older = 13 points
Male - 1 point
Non white european ethnic group = 6 points
Having a first degree relative with diabetes - 5 points

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4
Q

What is the value score highest in each diabetes risk score parameter, for the 3 modifiable risk scores?

A

43 inch or above waist = 9 points
BMI 35 or above = 8 points
Being on Hypertension medication - 5 points

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5
Q

What is the scoring system cardiovascular risk? What does it specifically quantify?

A

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

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6
Q

What are the categories of risk factors seen in the Q risk score?

A

Personnal Info
PMH
Drug History
Direct measurements
Family History
Social history

PP DD FS

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7
Q

What are the risk factors related to Personal information in the Q risk score?

A

Age
Sex
Ethnicity
BMI (weight and height)
Postcode

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8
Q

What are the risk factors related to Past medical history in the Q risk score?

A

Chronic kidney disease (stage 4 or 5)
Atrial fibrillation
Rheumatoid arthritis
Diabetic status

CARD

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9
Q

What are the risk factors related to Drug history in the Q risk score?

A

Anti hypertension medication
Antipsychotic medication
Erectile dysfunction treatment

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10
Q

What are the risk factors related to Direct physiological measurements in the Q risk score?

A

Cholesterol/HDL ratio
Systolic Blood pressure

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11
Q

What are the risk factors related to Family and social history in the Q risk score?

A

Family
Angina/Heart attack in first degree relative <60 years old

Social
Smoking status
Could argue that postcode area is part of social history

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12
Q

What percentage Q risk scores are deemed as low, moderate and high risk?

A

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

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13
Q

How should you manage a patient whos Q risk score is more than 10%

A

look into the likelihood of a familial lipid disorder

Exclude possible secondary causes of dyslipidemia (such as excess alcohol, uncontrolled diabetes, hypothyroidism, liver disease, and nephrotic syndrome).

Offer atorvastatin 20 mg daily if the person decides to take this and there are no contraindications

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14
Q

How should you manage a patient whos Q risk score is less than 10%

A

Advise that although the risk is low, further reductions in risk can often still be achieved.

  • Offer lifestyle advice
  • Control co-morbidities
  • Advise that a further risk assessment should be considered in 5 years.
  • Be supportive and encouraging

Do not rule out treatment with atorvastatin 20 mg for the primary prevention of CVD just because the person’s 10-year QRISK3 score is less than 10% if they have an informed preference for taking a statin or there is concern that risk may be underestimated.

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15
Q

What does the CHA2DS2 VAS score gauge?

A

Risk of stroke in AF patients

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16
Q

What are the risk factors in the CHA2DS2 VAS score?

A

Congestive Heart failure
Hypertension
Age >75
Diabetes
Stroke/TIA history

Vascular Disease
Age >65
Sex - Female

17
Q

What risk factors in the CHADS VAS score are worth 2 points

A

Age >75
Previous History of stroke/TIA
Both worth 2 points, the others are worth 1 point

18
Q

What CHADS VAS scores indicate low risk, and what should be done for them?

A

Score of 0 if male, or 1 of female - no anticoagulant therapy needed

19
Q

What CHADS VAS scores indicate moderate risk, and what should be done for them?

A

1 if male. Oral anticoagulants should be considered

20
Q

What CHADS VAS scores indicate high risk, and what should be done for them?

A

2 or greater for male or female - Oral anticoagulant is recommended

21
Q

Give examples of medications given as oral anticoagulants due to CHADS VAS score >2

A

direct-acting oral anticoagulant (DOACs) or a vitamin K antagonist such as warfarin

DOACs are the first-line option, eg apixaban or

22
Q

Medications used in CHADS VAS - how do DOACs and Warfarin work?

A

Apixaban, rivaroxaban and edoxaban inhibit factor Xa within the clotting cascade and thereby prevent thrombus formation.

Warfarin is a vitamin K antagonist. Clotting factors 10, 9, 7 and 2 are vitamin K dependent =

Therefore, if the action of vitamin K is antagonised these factors will not be activated and hence thrombus formation is inhibited.

23
Q

What is the FRAX score specifically used for?

A

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

24
Q

What does the FRAX score take into account?

A

Age
Sex
BMI

Previous fractures
Parental hip fracture

Smoking status
Alcohol consumption
Glucocorticoid use (>3 months a year)

Rheumatoid arthritis
Secondary osteoporosis

25
Q

Name some diseases that can cause secondary osteoporosis

A

Kidney failure
Cushings
Coeliac
MS
Hyperparathyroidism
Hyperthyroidism
Diabetes

26
Q

What is the gold standard investigation you would do for suspected osteoporosis? What does it give?

A

DEXA Scan (dual-energy xray absorptiometry)

Measures bone mineral density by measuring how much radiation is absorbed by the bones

Scanning Hip is best

Gives T score and Z score

27
Q

Define T score and Z score

A

T score (main one) - number of standard deviations below the mean for a healthy young adult their bone density is.

and Z score - represent the number of standard deviations the patients bone density falls below the mean for their age.

28
Q

What are some lifestyle management/light treatment for mild osteoporosis/osteopenia?

A

Activty and exercise
Weight control
Reduce alcohol/stop smoking
NICE recommend calcium supplementation with vitamin D - eg Calcihew-D3

vitamin D supplementation.

29
Q

What T scoring on a DEXA scan would be indicative of

Better than reference
No evidence of oesteoporosis
Osteopenia (offer lifestyle advice)
Osteoporosis

A

T-score
>0 BMD = is better than the reference.
0 to -1 = BMD is in the top 84%: no evidence of osteoporosis.
-1 to -2.5 = Osteopenia. Risk of later osteoporotic fracture. Offer lifestyle advice.
-2.5 or worse = Osteoporosis. Offer lifestyle advice and treatment Repeat DEXA in 2yrs.

30
Q

What is the treatment for someone at high risk of a fracture? (specific drug name)

A

Bisphosphonates- they interfere with osteoclast activity reducing their activity.

Alendronate 70mg once weekly

31
Q

What does the ABCD2 score guage?

A

Its a helpful tool to stratify which patients are at a higher risk of having a stroke following a suspected TIA

Risk of stroke after TIA

32
Q

What are the categories seen in the ABCD2 score

A

Age >60 years old
BP >140/90
Clinical Features - either Unilateral weakness, or speach disturbance but no weakness
Duration of Symptoms - 10-59 mins or >60 mins
Diabetes

33
Q

What are the scoring for the factors in the ABCD2 score

A

A – Age – > 60 (1 point)
B – Blood pressure (at presentation), 140/90 or more (1 point)

C – Clinical features: Unilateral weakness (2 points), Speech disturbance without weakness (1 point)

D – Duration, 60 minutes or longer (2 points), 10-59 minutes (1 point)
D – Presence of diabetes (1 point)

34
Q

What number on the ABCD2 score would indicate that a patient is at high risk of a stroke, and what should be done?

A

Score 1-3 should be seen an investigated in one week
Score 4 or more should be seen and investigated within 24 hours

ABCD2 score
Risk of stroke at 2 days
0-3 = 1%
4-5 = 4%
6-7 = 8%

35
Q

What does the Wells score do?

A

tests the clincal probability of a DVT

36
Q

What kind of things are included in a Wells score?

A

ARB TWOC CHA

Active Cancer in last 6 months
Recent immobilsaction (Plaster cast) or paralysis
Bed ridden or major surgery in last 12 weeks

Tenderness along vein
Whole leg is swollen
Oedma (pitting) that is greater in the symptomatic leg
Calf swelling of 3cm or more compared to normal leg

Collateral Superficial veins
History of Previous DVT
Alternative diagnosis at least as likely as a DVT

taken from OHCM 9th edition

37
Q

What mamagement would you carry out if the Wells score was greater or equal 2? (DVT likely)

A

Duplex ultrasound of leg within 4 hours: this is diagnostic (offer a D-dimer if the scan is negative); if an ultrasound is not possible to arrange within 4 hours:
○ Perform a D-dimer AND
○ Offer interim anticoagulation for 24 hours (ideally in a form that can be easily continued) AND
○ Arrange the ultrasound for the following day

taken from OHCM 9th edition

38
Q

What management would you carry out if the Wells score was lower or equal to 1? (DVT unlikely)

A

D-Dimer with a result available within 4 hours: if D-Dimer results cannot be obtained within 4 hours, offer interim anticoagulation until the result is available
○ If D-Dimer is raised: perform a duplex ultrasound within 4 hours
○ If D-Dimer is normal: a DVT is unlikely and alternative diagnoses should be considered

39
Q

What preventive and non-medicinal treatment can you give for DVT?

A
  • Compression stockings
  • Frequent calf exercises during long periods of immobilisation
    Prophylactic anticoagulation with LMWH e.g. in patients who have had surgery and will be immobilised for a long period of time

Phase 2b OSCE (2 decks)

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