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Risk scores (OSCE) Flashcards

1
Q

What risk score is used to evaluate if someone with AF needs anticoagulation?

A

CHA2DS2-VASc

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2
Q

What does CHA2DS2-VASc stand for?

A 
Congestive HF
Hypertension 
A2 - Age >75 (2 points)
Diabetes
S2 - previous stroke/TIA (2 points)
V- vascular disease
Age - 65-74
Sex - female
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3
Q

What do the scores of CHA2DS2-VASc mean for management?

A

0 = no anticoagulation (do echo to exclude valvular heart disease - valvular heart disease + AF = must be anti coagulated)

1 = consider anticoagulation in males, no treatment for women as they score 1 with their gender

> 1 = offer anticoagulation

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4
Q

What is the risk score used to assess a patient’s risk of major bleed whilst on anticoagulation?

A

ORBIT (was HAS-BLED)

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5
Q

What is included in the ORBIT score?

A 
Low Hb / haemltocrit 
Age 75+
Previous bleeding - GI or intracranial 
eGFR <60
Anti-platelet medication use
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6
Q

When is ORBIT used

A

Before starting someone on an anticoagulant to decide if the risk of stroke overweighs the risk of bleeding

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7
Q

What is included in HAS-BLED?

A 
Hypertension 
Abnormal renal or liver function 
Stroke
Bleeding 
Labile INRs while on warfarin 
Elderly
Drugs or alcohol
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8
Q

What does the ORBIT score mean for management?

A

0-2 - low risk of bleed

3 - medium risk of bleed

4-7 - high risk of bleed

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9
Q

What score is used to risk stratify patients who have had a TIA?

A

ABCD2

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10
Q

What is included in ABCD2?

A

Age >60
BP >140/90
Clinical feature: unilateral weakness (2 points) or speech impairment without weakness (1 point)
Duration of symptoms: >60 mins (2 points), 10-59 mins (1 point)
Diabetes (on medication/insulin)

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11
Q

What does the score of ABCD2 mean?

A

0-3 : low score 1% risk of stroke in week

4-5: moderate score 6% risk of stroke in week

6-7 : high score 11% risk of stroke in week

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12
Q

How is chronic heart failure classified?

A

The NYHA classification (New York Heart Association)

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13
Q

What are the classes with the NYHA classification?

A

NYHA Class I
no symptoms
no limitation: ordinary physical exercise does not cause undue fatigue, dyspnoea or palpitations

NYHA Class II
mild symptoms
slight limitation of physical activity: comfortable at rest but ordinary activity results in fatigue, palpitations or dyspnoea

NYHA Class III
moderate symptoms
marked limitation of physical activity: comfortable at rest but less than ordinary activity results in symptoms

NYHA Class IV
severe symptoms
unable to carry out any physical activity without discomfort: symptoms of heart failure are present even at rest with increased discomfort with any physical activity

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14
Q

What scoring system is used to measure disease activity in rheumatoid arthritis?

A

DAS28

Disease activity score 28

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15
Q

What is included in DAS28?

A 
ESR
CRP
Number of swollen joints
Number of tender joints
Patient rates global activity of arthritis during the past week on a scale of 0 to 100
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16
Q

What does the score from DAS28 show?

A 
<3.2 = low disease activity
3.2-5.1 = moderate disease activity 
>5.1 = high disease activity

Change in the value by 1.2 is considered significant

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17
Q

What scoring system is used to assess the severity of liver cirrhosis?

A

Child-Pugh classification

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18
Q

What is included in the Child-Pugh classification?

A 
Total bilirubin 
serum albumin 
INR
Ascites
Hepatic encephalopathy
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19
Q

What does the score from the child-pugh classification show?

A

Class A = 5-6 points = least severe liver disease

Class B = 7-9 points = moderately severe liver disease

Class C = 10-15 points = most severe liver disease

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20
Q

What has replaced the Child-Pugh classification in deciding the severity of liver cirrhosis?

A

MELD score - model for end stage liver disease

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21
Q

What is included in the MELD score?

A

Bilirubin
Creatinine
INR

Used to predict 3 month mortality

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22
Q

What is a scoring system used to assess cognitive impairment?

A

MMSE

Mini mental state exam

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23
Q

What is included in an MMSE?

A

What’s the year, season, date, day of the week and month?

Where are we: state, country, town, hospital, floor

3 unrelated objects

Count backwards from 100 in 7s

Recall 3 things

Ask patient to name 2 objects

No ifs ands or buts

Paper in right hand, fold it and drop on floor

‘Close your eyes’

Write a seance

Copy picture of cube

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24
Q

What score is used to assess severity of anxiety and depression symptoms?

A

HAD scale

Hospital anxiety and depression scale

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25
What is used to assess severity of just depression symptoms?
PHQ-9 | Patient health questionnaire
26
What's included in PHQ-9?
``` Little interest/pleasure in doing things Feeling down/depressed/hopeless Trouble falling asleep/staying asleep or sleeping too much Feeling tired/little energy Poor appetite/overeating Feeling bad about yourself Trouble concentrating Moving / speaking slowly Thoughts of suicide/self harm ```
27
What's used to assess for generalised anxiety disorder?
GAD-7 | generalised anxiety disorder-7
28
What's included in GAD-7?
Felling nervous/anxious/on edge Not being able to stop/control worrying Worrying too much about different things Trouble relaxing Being so restless that its hard to sit still Becoming easily annoyed or irritable Feeling afraid that something bad will happen
29
What is used to assess post natal depression?
Edinburgh post natal depression scale
30
What score is used if a PE is suspected?
A 2 level PE Wells score
31
What is included in a 2 level PE Wells score?
Clinical signs & symptoms of a DVT = 3 points Alternative diagnosis is less likely than PE = 3 points HR >100 = 1.5 points Immobilisation for >3 days or surgery in last 4 week = 1.5 points Previous DVT/PE = 1.5 points Haemoptysis = 1 point Malignancy (on treatment, treated in last 6 months or palliative) = 1 point
32
What does the score from the 2 level PE Wells score mean?
PE likely - more than 4 points - Do a CTPA (+ve = treat, -ve = US leg for DVT) - If there's delay in CTPA = interim therapeutic coagulation with LMWH PE unlikely - 4 points or less - D-dimer - If d-dimer is positive then do CTPA
33
What score is used if a DVT is suspected?
A 2 level DVT Wells score
34
what's included in a 2 level DVT wells score?
Active cancer - 1 point Paralysis, paresis or recent plaster immobilisation of lower limbs - 1 point Recently bedridden for >3 days / major surgery in last 12 weeks = 1 point Localised tenderness along the distribution of the deep venous system = 1 point Entire leg swollen = 1 point Calf swelling at least 3cm larger than asymptomatic side = 1 point Pitting oedema only in symptomatic leg = 1 point Collateral superficial veins (non-varicose) = 1 point Previous DVT = 1 point Another diagnosis at least as likely as DVT = -2 points
35
What does the score mean from the 2 level DVT wells score?
2 or more = DVT likely 1 or less = DVT unlikely
36
what is the management for suspected DVT based on score from 2 level DVT wells score?
``` DVT likely (2 or more points) = - Proximal leg US within 4 hours or d-dimer + anticoagulation + scan within 24 hours ``` DVT unlikely (1 or less points) = - D-dimer with result within 4 hours or anticoagulate while awaiting d-dimer - If d-dimer positive, do proximal leg US If at any point US scan is negative, it needs to be repeated within 1 week
37
What questionnaire is used to detect eating disorders and aid treatment?
SCOFF
38
Questions in the SCOFF questionnaire
Do you make yourself Sick because you feel uncomfortably full? Do you worry that you have lost Control over how much you eat? Have you recently lost more than One stone in a 3 month period? Do you believe yourself to be Fat when others say you're too thin? Would you say that Food dominates your life?
39
What do the scores mean in the SCOFF questionnaire?
2 or more = anorexia nervosa or bulimia
40
What tools are used to screen for alcohol use?
AUDIT CAGE FAST
41
Questions in CAGE questionnaire
Have you ever felt you should Cut down on your drinking? Have people Annoyed you by criticising your drinking? Have you ever felt Guilty about your drinking? Have you ever had an Eye opener to steady nerves?
42
What scoring system is used to risk stratify patients with community acquired pneumonia?
CURB-65 or CRB-65 in GP as they can't get a urea
43
What is included in CURB-65 / CRB-65?
``` C = confusion U = urea >7 mmol/L R = resp rate >30 B = blood pressure <90/60 65 = over 65 ```
44
What does the score mean that's calculated from the CURB-65 tool?
Score of 0 = treat CAP at home with oral amoxicillin Score of 1+ = hospital assessment Score of 4 = 30% mortality at 30 days
45
How is daytime sleepiness assessed?
Epworth Sleepiness Scale
46
What is asked on the Epworth sleepiness scale?
How likely are you to fall asleep in the following situations: - Sitting & reading - Watching TV - Sitting inactive in a public space - Lying down to rest in the afternoon - Sitting and talking to someone - Sitting after lunch without alcohol - As a passenger in a car for 1 hour - In a car while stopped in traffic
47
What scoring system is used to classify the severity of lower urinary tract symptoms in men?
IPSS | International prostate symptoms score
48
What is included in the IPSS?
Incomplete emptying Frequency (urinate again after <2hrs) Intermittency Urgency Weak stream Straining to start Nocturia
49
What does the score from the IPSS mean?
Score 20–35: severely symptomatic Score 8–19: moderately symptomatic Score 0–7: mildly symptomatic
50
What score is used to indicate prognosis in prostate cancer?
Gleason score
51
What is included in the Gleason score?
Is based on how differentiated cells are 1. Small uniform glands 2. More storm between glands 3. Distinctly infiltrative margins 4. Irregular masses of neoplastic glands 5. Only occasional gland formation
52
What score is used to assess the health of a newborn immediately after birth?
APGAR score
53
what is included in the APGAR score?
Pulse - >100 = 2 points - <100 = 1 point - Absent = 0 points Respiratory effect - Strong, crying = 2 points - Weak, irregular = 1 point - Nil = 0 points Colour - Pink = 2 points - Blue extremities = 1 point - Blue all over = 0 points Muscle tone - Active movement = 2 points - Limb flexion = 1 point - Flaccid = 0 points Reflex irritability - Cried on stimulation/sneezes/coughs = 2 points - Grimace = 1 point - Nil = 0 points
54
What does the score generated by APGAR mean?
0-3 very low score 4-6 moderate low score 7-10 baby in good state
55
What scoring system is used to assess whether the induction of labour will be required?
The Bishop score
56
What is included in the bishop score?
``` Cervical position Cervical consistency Cervical effacement Cervical dilation Fetal station ```
57
How do you interpret the bishop score?
<5 = labour unlikely to start without induction (membrane sweep, vaginal prostaglandin, maternal oxytocin infusion, amniotomy or cervical ripening balloon) 8 or more = cervix is ripe and favourable, high chance of spontaneous labour
58
What scoring system is used to screen for patients at risk of developing pressure areas?
Waterlow score
59
what's included in the Waterlow score?
Weight Continence Skin type and visual aspect of risk areas Mobility Sex Age Appetite Tissue malnutrition - cachexia, cardiac insufficiency, PAD, anaemia, smoker Neurological defects - DM, paraplegic, CVA Surgery - orthopaedic surgery below waist, over 2 hrs in surgery Medications - steroids, cytotoxic, NSAIDs
60
How do you interpret the Waterlow score?
10+ - risk 15+ - high risk 20+ - very high risk
61
what scoring system is used to estimate the 10 year risk of fragility fracture?
FRAX score | used in assessment of osteoporosis
62
what's included in the FRAX score?
``` Age Sex Weight Height Previous fracture Parent fractured hip Current smoking Glucocorticoids RA Secondary osteoporosis Alcohol 3 or more units per day Femoral neck bone mineral density (do DEXA scan) ```
63
What does the FRAX score mean?
FRAX without BMD: - Low risk = reassure + lifestyle advice - Intermediate risk = BMD test - High risk = bone protection FRAX with BMD: get results categorised into one of the following: - Reassure - Consider treatment - Strongly recommend treatment
64
Who is the FRAX score valid for?
40-90 year olds | QFracture is a new score to predict 10 year risk of fragility fracture, for 30-99 year olds
65
What scoring systems are used to assess the which cases of severe pancreatitis may require ICU management?
Ranson score Glasgow score APACHE II
66
What is included in the ranson score/glasgow score/APACHE II?
``` age > 55 years hypocalcaemia hyperglycaemia hypoxia neutrophilia elevated LDH and AST ```
67
what tool is used to screen for malnutrition?
MUST score (malnutrition universal screening tool)
68
What's included in a MUST score?
BMI Unplanned weight loss in past 3-6 months by % Acutely ill and there has been/is likely to be a period of no nutritional intake for >5 days
69
How do you interpret a MUST score?
0 = low risk 1 = medium risk (observe) 2 = high risk (treat)
70
What scoring system is used to decide if a patient needs antibiotics if they have an acutely sore throat, acute pharyngitis or acute tonsillitis?
Centor criteria
71
What's included in the centor criteria?
presence of tonsillar exudate tender anterior cervical lymphadenopathy or lymphadenitis history of fever absence of cough
72
when should antibiotics be prescribed according to the centor criteria?
when you score 3 or more
73
What scoring system is used to stratify risk before an endoscopy in patient with an upper GI haemorrhage?
Glasgow-Blatchford score
74
what's included in a Glasgow-blatchford score?
``` Hb BUN Systolic BP Sex Heart rate >100 Melena present Recent syncope Hepatic disease hx Cardiac failure present ```
75
How do you interpret the Glasgow-Blatchford score?
Low risk = score 0 | Any score higher than 0 = need an intervention e.g. transfusion, endoscopy or surgery
76
What tool is used to calculate a patients chance of having an MI or stroke over the next 10 years?
QRISK
77
what's included in the QRISK score?
``` age Sex Postcode Ethnicity Smoking status DM Angina / MI in 1st degree relative CKD - 3, 4 or 5 AF? On blood pressure treatment Migraines? RA? SLE? Mental illness Atypical antipsychotic Regular steroids? Erectile dysfunction? Cholesterol/HDL ratio Systolic BP BMI ```
78
How is the score from QRISK used?
If there's a 10 year cardiovascular risk of 10% or more OR T1DM OR eGFR <60 = 20mg atorvastatin once daily
79
What scoring system is used to predict the risk that someone has previously undiagnosed T2DM?
Cambridge diabetes risk score
80
What's included in the Cambridge diabetes risk score?
``` Gender Prescribed anti-HTNs Prescribed steroids Age BMI Family hx of DM Smoker ```
81
How do you calculate someones GCS?
Motor response 6. Obeys commands 5. Localises to pain 4. Withdraws from pain 3. Abnormal flexion to pain 2. Extending to pain 1. None Verbal response 5. Orientated 4. Confused 3. Words 2. Sounds 1. None Eye opening 4. Spontaneous 3. To speech 2. To pain 1. None

Finals Revision (18 decks)

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