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Phase 2b OSCE > Risk scores > Flashcards

Risk scores Flashcards

1
Q

What is QRisk2?

A

Tool to measure the risk (given as a probability) of a having a heart attack or stroke within the next 10 years

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2
Q

Give 5 components of QRisk2 in ‘personal information’

A

Age, Sex, Ethnicity, BMI, Postcode

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3
Q

5 components of QRisk2 in the PMH (Hint: CARD)

A

CKD, Atrial Fibrillation, Rheumatoid Arthritis, Diabetes

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4
Q

1 component of QRisk2 in Drug History

A

Existing hypertension treatment

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5
Q

2 components of QRisk2 in FH/Social History

A

Angina/Heart Attack in a 1st degree relative <60, Smoking status

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6
Q

2 components of QRisk2 in obs

A

Cholesterol/HDL ratio, Systolic BP

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7
Q

What does a <10% risk mean, and give 4 examples of management advice

A

Low risk. Advice: Smoking cessation, Weight loss, Disease control and adherence to medications, Exercise, diet change

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8
Q

Give 3 examples of management advice to someone with a QRisk2 of >10%

A

1) . Offer advice on any relevant lifestyle factors to reduce risk.
2) . Consider reviewing any relevant co-morbidities that may not be optimally treated
3) . Discuss the benefits and risks of taking a lipid modification therapy

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9
Q

What are the components of QRisk2? (There’s 14!)

A 
Age
Sex
Ethnicity
BMI
Postcode
CKD
Atrial Fibrillation
Rheumatoid Arthritis
Diabetes
Existing hypertension treatment
Angina/heart attack in a 1st degree relative <60
Smoking status
Systolic BP
Cholesterol/HDL ratio
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10
Q

What is CHADS-VASc used for?

A

Tool to assess the annual stroke risk (given as a percentage) in patients with atrial fibrillation

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11
Q

What are the components of CHADS-VASc (with their respective points)

A 
Congestive heart failure (+1)
Hypertension (+1)
Age >= 75 (+2)
Diabetes (+1)
Stroke/TIA history (+2)
Vascular history (+1)
Age 65-74 (+1)
Sex (Female) (+1)
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12
Q

What is the anticoag recommendation for a score of 0 (male) / 1 (female) ?

A

No anticoagulation therapy

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13
Q

Anticoag recommendation for a score of 1 (male) ?

A

Oral anticoagulation should be considered

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14
Q

Anticoag recommendation for a score of 2 or more?

A

Oral anticoagulation is recommended

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15
Q

What is the FRAX score used for?

A

Tool to estimate the 10 year risk of osteoporosis in untreated patients

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16
Q

5 components of FRAX in personal information?

A

Age, Sex, Weight + Height (BMI), Femoral neck BMD

17
Q

3 components of FRAX in PMH? (Hint: PSR)

A

Previous fracture, Secondary osteoporosis, Rheumatoid arthritis

18
Q

Give 5 causes of secondary osteoporosis

A

Kidney failure, Cushings, Coeliac, MS, Hyperparathyroidism, Hyperthyroidism, Diabetes, Corticosteroids, Lithium

19
Q

Give 3 drugs than can cause osteoporosis

A

Glucocorticoids, Lithium, Barbiturates

20
Q

1 component of FRAX in family history

A

Parental fractured hip (“have either of yours parents had a fractured hip before - also ask about any other fractures)

21
Q

2 components to ask about in social history

A

Smoking status, Alcohol intake

22
Q

What does a T score represent? (FRAX)

A

How a persons bone density compares with bone density of a healthy 30-year old of the same sex

23
Q

Interpret the following T scores:

1) . -1 and above
2) . -1 to -2.5
3) . -2.5 and below

A

1) . Normal bone density
2) . Osteopenia. Consider medication when they have certain risk factors
3) . Osteoporosis. Consider taking an osteoporosis medication (e.g. bisphosphonates, calcium and vitamin d supplements, denosumab, terapratide)

24
Q

What is a Z score? (FRAX)

A

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

25
Q

What is the ABCD2 score used for?

A

Used to estimate the 2 day stroke risk (given as a percentage) in TIA patients

26
Q

What are the components of ABCD2 (with their respective points)

A 
Age >60 (+1)
Blood pressure > 140/90 (+1)
Clinical features:
     Unilateral weakness (+2)
     Speech disturbance without weakness (+1)
Duration:
     >60 mins (+2)
     10-59 mins (+1)
     <10 mins (+0)
Diabetes (+1)
27
Q

What else should be asked in the PMH and DH with regards to ABCD2?

A

1) . Ask about AF. If present, IMMEDIATE referral
2) . Ask about previous TIAs and how far apart they were
3) . Ask about whether they take any antiplatelet treatment

28
Q

How would a score of 0-3 be managed?

A

Urgent referral. All patients with a suspected TIA should be seen within the next 7 days

29
Q

How would a score of 4-7 be managed? What other factors would trigger an urgent referral?

A

Immediate referral - should be assessed by a specialist within 24hrs

Other factors: 2 TIAS within the same week, taking antiplatelet medication

30
Q

What is the Wells score used for?

A

Used to assess the likelihood of a patients presentation being due to a DVT

31
Q

Give 6 components of the Wells score that could be asked in the HPC?

A

Paralysis, paresis (weakness), or recent immobilisation of the lower limb
Localised tenderness
Entire swollen leg
Calf swelling 3cm larger than the asymptomatic leg
Pitting oedema confined to the symptomatic leg
Visible collateral superficial veins

32
Q

3 components of Wells in the PMH?

A

Active malignancy (ie. ongoing treatment, within 6 months or palliative)
Recently bedridden >3 days or major surgeries
Previous DVT

33
Q

2 components of Wells in drug history / social history?

A

Recent long haul flights

Oral contraceptive pill / HRT

34
Q

Name some other risk factors for DVT that are not included in Wells

A 
Pregnancy
FH of clots
Heart failure
Stroke
Thrombophilias
35
Q

What is the initial investigation in patients with a low Wells clinical probability score?

A

serum D-dimer

36
Q

Interpret the following Wells score and suggest the appropriate investigations:

1) . <= 1
2) . >= 2

A

1) . DVT is unlikely (perform a serum D-dimer)

2) . DVT is likely (perform a serum D-dimer and an ultrasound of the suspected leg)

37
Q

What are the components of the Diabetes risk score?

A 
Age
Gender
Ethnicity
Waist measurement
BMI
High blood pressure/taking meds for it
Family history of diabetes
38
Q

What else should be asked (other than the risk score components) to assess severity/risk of Diabetes?

A

Ask about symptoms of hyperglycaemia:

Polyuria, polydipsia, polyphagia, unexplained weight loss, visual blurring, genital thrush, lethargy

39
Q

Give 5 examples of counselling advice for diabetes risk reduction / control

A

Exercise more (aim for 150 mins a week, do as much as you can to regulerly increase HR and RR)

Diet: limit sugar, decrease fat, have regular meals and only healthy snacks

Research about diabetes: www.diabetes.co.uk

Recognise the signs of diabetes (the 5 Ts: toilet, thirsty, tired, thinner, thrush)

Phase 2b OSCE (2 decks)

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