Risk Scores

Question 1

What does the ABCD2 score assess?

Answer 1

The risk of a stroke after a TIA

Question 2

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

Answer 2

> 6

Question 3

What do the ABCD2 categories stand for?

Answer 3

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)

Question 4

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

Answer 4

Statin and antiplatelt eg clopidogrel

Question 5

What is the acute management for a TIA?

Answer 5

300mg Aspirin

Question 6

When would you use FRAX?

Answer 6

To assess the risk of fracture over the next 10 years

Question 7

How many categories are there in the FRAX assessment?

Answer 7

12

Question 8

What are the FRAX assessment criteria?

Answer 8

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

Question 9

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

Answer 9

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

Question 10

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

Answer 10

Bisphosphonates eg aledronic acid

Calcium tablet eg adcal

Question 11

How would you advise a patient to take alendrotnic acid?

Answer 11

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

Question 12

What is a T-Score?

Answer 12

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

Question 13

What T-score would you diagnose someone with osteoporosis?

Answer 13

T-score of >2.5

Question 14

What T-score would you diagnose someone with osteopenia?

Answer 14

T-Score -1.0 and -2.5

Question 15

What is a Z-Score?

Answer 15

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

Question 16

When would you use the CHAD-VASc risk score?

Answer 16

Stroke risk assessment for patients with AF

Question 17

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

Answer 17

Score of greater than 2

Question 18

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

Answer 18

Anticoagulate

Question 19

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

Answer 19

Think about anti platelet and anticoagulation

Question 20

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

Answer 20

Don’t anticoagulate give lifestyle advice and frequent monitoring

Question 21

What is the maximum score for CHAD-VAsc?

Answer 21

8

Question 22

What is the CHADS-VAsc criteria?

Answer 22

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

Question 23

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

Answer 23

Beta blocker or calcium channel blocker - diltizem or verapamil

Question 24

What does Wells score assess?

Answer 24

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

Question 25

How many criteria are in the Wells Score?

Answer 25

10

Question 26

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

Answer 26

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

Question 27

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

Answer 27

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

Question 28

Give 3 differential diagnoses of DVT?

Answer 28

Cellulitis, trauma/injury, chronic venous insufficiency

Question 29

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

Answer 29

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

Question 30

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

Answer 30

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

Question 31

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

Answer 31

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

Question 32

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

Answer 32

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

Question 33

What is the GOLD standard diagnosis for DVT?

Answer 33

Duplex ultrasound to detect abnormalities in blood flow

Question 34

Name 2 techniques to diagnose a PE?

Answer 34

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

Question 35

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

Answer 35

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

Question 36

What does the Q-Risk score assess?

Answer 36

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

Question 37

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

Answer 37

14

Question 38

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

Answer 38

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

Question 39

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

Answer 39

Heart disease in under 60 year old

Question 40

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

Answer 40

Deprivation, smoking status

Question 41

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

Answer 41

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

Question 42

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

Answer 42

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

Question 43

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

Answer 43

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

Question 44

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

Answer 44

Statin treatment, lifestyle advice, smoking cessation

Question 45

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

Answer 45

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

Question 46

Name 3 modifiable risk factors in the Diabetes risk score?

Answer 46

Hypertension, waist circumference, BMI

Question 47

How many criteria are there in the diabetes risk score?

Answer 47

7

Question 48

Name 4 diagnostic tests for diabetes?

Answer 48

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

Question 49

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

Answer 49

Symptoms: Confusion, drowsiness, coma | Glucose level <3mmol

Question 50

What are the symptoms of DKA?

Answer 50

Nausea, vomitting, polyuria, polydipsia

Question 51

What is hyperosmolar hyperglycaemic state?

Answer 51

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

Question 52

What is the maximum score for the diabetes risk assessment?

Answer 52

47

Question 53

What is considered high risk in diabetes risk assessment?

Answer 53

Score of 25-47

Question 54

What is considered moderate risk in diabetes risk assessment?

Answer 54

Score 16-24

Question 55

What is considered low risk in diabetes risk assessment?

Answer 55

Score 0-15