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2b OSCE > Risk Scores > Flashcards

Risk Scores Flashcards

1
Q

What is the difference between abcd2, chadsvasc + qrisk3?

A

Abcd2 - stroke risk after TIA
Chadsvasc - stroke risk with a fib
Qrisk3 - CVD risk within 10yrs

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2
Q

What score assesses stroke risk with atrial fibrillation?

A

CHADSVASc

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3
Q

What score assesses risk of cardiovascular disease within 10yrs?

A

QRISK

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4
Q

What score assesses risk of osteoporotic fracture?

A

FRAX

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5
Q

What score assesses risk of DVT?

A

Well’s score

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6
Q

What score assesses stroke risk after TIA?

A

Abcd2

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7
Q

What does CHA2DS2 stand for?

A

C-congestive heart failure
H-hypertension
A-age 75+
D-diabetes mellitus
S-stroke/TIA/thrombo-embolism Hx

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8
Q

What does VASc stand for?

A

V-vascular Hx
A-age 65-74
Sc-sex female

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9
Q

What CHADSVASc areas score 2 points?

A

Age 75+
Previous stroke/TIA/thrombo-embolism

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10
Q

What CHADSVASc score would require action?

A

1+ in men
2+ in women

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11
Q

What action would you take for a raised CHADSVASc score?

A

Prescribe anticoagulation
DOAC e.g. apixaban

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12
Q

What is a high QRISK score?

A

20%+

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13
Q

Name the 10 areas explored in the QRISK score

A

Age
Sex
Diabetes
Smoking
Angina/MI in 1st degree relative
AF
BP Tx
Rheumatoid arthritis
BMI
Chronic kidney disease

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14
Q

At what risk % are statins offered with QRISK?

A

10%+

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15
Q

What action would you take for a raised QRISK score?

A

Prescribe statins e.g. atorvastatin

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16
Q

Name the 10 areas explored with the FRAX score

A

Age
Sex
Weight + height
Fracture Hx
Parental hip fracture
Smoking
Steroid use
Rheumatoid arthritis
Osteoporosis
Alcohol

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17
Q

What ages can the FRAX score be used for?

A

40-90yrs

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18
Q

What action would you take for someone with a low FRAX risk?

A

Lifestyle advice, reassess in 5yrs

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19
Q

What action would you take for someone with a medium FRAX risk?

A

Measure bone mineral density

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20
Q

What action would you take for someone with a high FRAX risk?

A

Offer oral bisphosphonates e.g. alendronic acid

21
Q

What would you ask about to assess diabetes risk (9)?

A

Age
Sex
Ethnicity
1st degree relative w/ diabetes
Waist circumference
BMI-height + weight
Hypertension
Physical activity
Alcohol

22
Q

What action would you take for someone with a raised diabetes risk score?

A

Lifestyle advice-healthy eating = physical activity
Consider medications e.g. metformin-biguanide

23
Q

What areas would you explore for Well’s score? (9)

A

Active cancer
Major surgery <12wks
Bedridden >3 days
Previous DVT
Leg swollen
Large veins which aren’t varicose
Pitting oedema
Calf-one >3cm bigger than other
Tenderness

24
Q

What Well’s score indicates a DVT/PE is likely?

A

2+ for DVT
4+ for PE

25
Q

What action would you take for a patient with a Well’s score of 4+?

A

Order CTPA - computed tomography pulmonary angiogram

26
Q

What action would you take for a patient with a Well’s score of 2+?

A

D-dimer
Prescribe DOAC e.g. apixaban

27
Q

What does ABCD2 stand for?

A

A-age 60+
B-BP > 140/90
C-clinical features-unilateral weakness (2), speech impairment
D-duration 10-59min =1
60+ =2
Diabetes

28
Q

What would you do if someone had an ABCD2 of 4+?

A

Admit
Dual antiplatelet therapy (aspirin + clopidogrel)

29
Q

What does orbit assess?

A

Bleeding risk in patients on anti-coags for a fib

30
Q

What should you ask about for orbit (6)?

A

Age >74
Sex
Hb <13
Bleeding Hx e.g. GI bleeds, haemorrhagic stroke
GFR < 60ml/min/1.73m2
Tx with antiplatelets

31
Q

What is a high ABCD2 score?

A

4+

32
Q

What questions about drug Hx should you ask for diabetes risk score?

A

On antihypertensives?
Ever been on steroids?

33
Q

What questions about social Hx should you ask for diabetes risk score?

A

Smoking
BMI
Waist circumference

34
Q

What is a moderate diabetes risk score?

A

22/47

35
Q

What is a high diabetes risk score?

A

33/47

36
Q

What should you do for someone with a moderate/high diabetes risk score?

A

Send to GP with letter + instructions to discuss T2DM risk
Go through factors that contributed to person’s score

37
Q

What q’s should you ask about PMHx for QRISK3?

A

Diabetes
CKD
A fib
Rheumatoid arthritis
SLE
Migraines

38
Q

What q’s should you ask about drug Hx for QRISK3?

A

Antihypertensives
Steroids
Atypical antipsychotics e.g. clozapine/risperidone

38
Q

What q’s should you ask about PMHx for FRAX?

A

Fracture in adult life?
Rheumatoid arthritis
Secondary osteoporosis
Kidney failure
Hyperthyroidism
Coeliac disease
T1DM
Chronic malnutrition/malabsorption

39
Q

What is a T score?

A

Bone density compared to a healthy 30yr old

40
Q

What is a Z score?

A

Compares condition of bone to someone of same age/sex/ethnicity

41
Q

What q’s should you ask about drug Hx for FRAX?

A

Glucocorticoids e.g. prednisolone, dexamethasone
Lithium

42
Q

What advice would you give to manage a FRAX score <10%?

A

Sufficient calcium-need more if female 50+, male 70+
Vit D
Less caffeine
Stop smoking
30 mins weight bearing exercise
Adequate protein
Decrease risk of fall e.g. move rugs, good lighting

43
Q

What type of medication is clopidogrel?

A

P2Y12 inhibitor

44
Q

Name an anticoagulant

A

Warfarin

45
Q

Name an antiplatelet

A

Aspirin

46
Q

What q’s should you ask about the leg for Well’s?

A

Localised tenderness?
Entire leg swollen?
Calf swelling >3cm?
Pitting oedema?
Collateral superficial veins?
Red?

47
Q

What q’s should you ask about PMHx for Well’s?

A

Bedridden recently?
Recent major surgery?
Active cancer?
Previous DVT?

48
Q

What should you do for patients with a Well’s score >3?

A

D-dimer test
US of legs
Anticoag treatment-apixaban

2b OSCE (2 decks)

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