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OSCE > Risk Scores > Flashcards

Risk Scores Flashcards

1
Q

What does the ABCD2 score assess?

A

The risk of a stroke after a TIA

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2
Q

What score is considered high risk of stroke according to ABCD2?

A

> 6

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3
Q

What do the ABCD2 categories stand for?

A

Age (>60), BP (>140 or >90), Clinical Features (Unilateral weakness =2, speech disturbance =1) diabetes =1, duration of symptoms (>60 mins or 10-59 mins =1)

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4
Q

What long term treatment would you give to reduce the risk of stroke?

A

Statin and antiplatelt eg clopidogrel

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5
Q

What is the acute management for a TIA?

A

300mg Aspirin

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6
Q

When would you use FRAX?

A

To assess the risk of fracture over the next 10 years

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7
Q

How many categories are there in the FRAX assessment?

A

12

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8
Q

What are the FRAX assessment criteria?

A

Previous fracture, alcohol intake, 1st degree relative hip fracture, age, height, weight, T-score, RA , steroid use, smoking status, secondary osteoporosis (diabetes, COPD, thyroid)

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9
Q

Give 3 lifestyle management factors you would advise for someone with a FRAX rise of 70%.

A

Quit smoking, increase calcium intake in diet (include dairy, leafy green veg, fish and nuts) exercise eg brisk walking, limit alcohol

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10
Q

What medical management factors you would advise for someone with a FRAX rise of 70%.

A

Bisphosphonates eg aledronic acid

Calcium tablet eg adcal

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11
Q

How would you advise a patient to take alendrotnic acid?

A

Take with a glass of water sitting upright for at least 30 mins to reduce oesphagitis

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12
Q

What is a T-Score?

A

Bone density can be compared to that of a healthy young adult. The difference is calculated as a standard deviation (SD

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13
Q

What T-score would you diagnose someone with osteoporosis?

A

T-score of >2.5

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14
Q

What T-score would you diagnose someone with osteopenia?

A

T-Score -1.0 and -2.5

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15
Q

What is a Z-Score?

A

Compares your bone density to what is normal in someone your age and body size.

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16
Q

When would you use the CHAD-VASc risk score?

A

Stroke risk assessment for patients with AF

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17
Q

What is considered a high risk score for CHADSVASC assessment of stroke?

A

Score of greater than 2

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18
Q

If a patient has a CHADSVasc risk of >2 what management would you advise?

A

Anticoagulate

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19
Q

If a patient has a CHADSVasc risk of 1 what management would you advise?

A

Think about anti platelet and anticoagulation

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20
Q

If a patient has a CHADSVasc risk of 0 what management would you advise?

A

Don’t anticoagulate give lifestyle advice and frequent monitoring

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21
Q

What is the maximum score for CHAD-VAsc?

A

8

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22
Q

What is the CHADS-VAsc criteria?

A

Congestive heart failure (1) , hypertension (1), age (65-74=1, >75-2), diabetes (1), sex (female =1), previous stroke/thromelbolsim =1 vascular disease (1)

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23
Q

Name 2 medications you could use to control rate in AF?

A

Beta blocker or calcium channel blocker - diltizem or verapamil

24
Q

What does Wells score assess?

A

The Wells’ Criteria for DVT Objectifies risk of deep vein thrombosis (DVT) based on clinical findings.

25
Q

How many criteria are in the Wells Score?

A

10

26
Q

What are the risk factors for DVT (Wells score)?

A

Bedridden (3+ days), paralysis/immobilisation, active cancer, previous DVT, recent travel, oral contraceptive or HHT, smoking, alcohol, recent surgery

27
Q

What clinical findings of DVT are included in the Wells score?

A

Unilateral calf swelling, whole leg swelling, localised tenderness, collateral superficial veins, unilateral pitting oedema

28
Q

Give 3 differential diagnoses of DVT?

A

Cellulitis, trauma/injury, chronic venous insufficiency

29
Q

What does a Well’s score of ≥3 suggest? How would you manage them?

A

A score of 3 or higher suggests DVT is likely. Pretest probability 17-53%.

30
Q

What does a Well’s score of 1-2 suggest? How would you manage them?

A

A score of 1-2 is considered moderate risk with a pretest probability of 17%.*

31
Q

What does a Well’s score of 0 suggest? How would you manage them?

A

A score of 0 or lower is associated with DVT unlikely with a prevalence of DVT of 5%

32
Q

What are the limitations to using D-Dimer to assess DVT risk?

A

D-dimer increases in pregnancy, after operation, infection - very sensitive but not specific

33
Q

What is the GOLD standard diagnosis for DVT?

A

Duplex ultrasound to detect abnormalities in blood flow

34
Q

Name 2 techniques to diagnose a PE?

A

Computerised tomography pulmonary angiography or V/Q scan (ventilation/perfusion)

35
Q

What 3 questions would you ask to rule out PE for a patient with a DVT?

A

Have you had any shortness of breath?
Have you coughed up any blood?
Have you got any chest pain?

36
Q

What does the Q-Risk score assess?

A

Cardiovascular risk assessment - risk of developing cardiovascular disease (heart attack, stroke, TIA) within the next 10 years

37
Q

How many criteria are there in the Q-risk score?

A

14

38
Q

What specific PMH would you ask about to assess Q-risk score? (4)

A

Diabetes, chronic kidney disease (Stage 4 or 5), rheumatoid arthritis, atrial fibrillation

39
Q

What question would you ask about family history in Q-risk score?

A

Heart disease in under 60 year old

40
Q

What questions would you ask in social history to assess Q-risk score?

A

Deprivation, smoking status

41
Q

Name 3 modifiable risk factors that are assessed in the Q-risk score?

A

BMI, cholesterol/HDL ratio and BP (BP medication), Smoking status

42
Q

Name 3 non-modifiable risk factors in the Q-risk score?

A

Age, sex, ethnicity, deprivation, rheumatoid arthritis, family history of heat disease, AF

43
Q

What would you advise for a patient with a Q-Risk score of <10%?

A

Lifestyle advice, review co-morbidities, don’t start statin

44
Q

What would you advise for a patient with a Q-Risk score of >10%?

A

Statin treatment, lifestyle advice, smoking cessation

45
Q

Name 4 non-modifiable risk factors in the Diabetes risk score?

A

First degree diabetic relative, sex (male higher risk), ethnicity, age

46
Q

Name 3 modifiable risk factors in the Diabetes risk score?

A

Hypertension, waist circumference, BMI

47
Q

How many criteria are there in the diabetes risk score?

A

7

48
Q

Name 4 diagnostic tests for diabetes?

A
  1. Random plasma glucose >11mmol/L
  2. Fasting plasma glucose >7mmol/L
  3. Oral glucose tolerance test >11mmol/L
  4. Hba1c >48mmol/L
49
Q

What are the symptoms for hypoglycaemia and what would their blood sugar be?

A

Symptoms: Confusion, drowsiness, coma

Glucose level <3mmol

50
Q

What are the symptoms of DKA?

A

Nausea, vomitting, polyuria, polydipsia

51
Q

What is hyperosmolar hyperglycaemic state?

A

Very high blood glucose without DKA. Symptoms severe dehydration and nausea. Risk factors = heatwaves, elderly, nursing home

52
Q

What is the maximum score for the diabetes risk assessment?

A

47

53
Q

What is considered high risk in diabetes risk assessment?

A

Score of 25-47

54
Q

What is considered moderate risk in diabetes risk assessment?

A

Score 16-24

55
Q

What is considered low risk in diabetes risk assessment?

A

Score 0-15

OSCE (9 decks)

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