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Finals Revision > Risk scores (OSCE) > Flashcards

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
Q

What is used to assess severity of just depression symptoms?

A

PHQ-9

Patient health questionnaire

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26
Q

What’s included in PHQ-9?

A 
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
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27
Q

What’s used to assess for generalised anxiety disorder?

A

GAD-7

generalised anxiety disorder-7

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28
Q

What’s included in GAD-7?

A

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

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29
Q

What is used to assess post natal depression?

A

Edinburgh post natal depression scale

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30
Q

What score is used if a PE is suspected?

A

A 2 level PE Wells score

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31
Q

What is included in a 2 level PE Wells score?

A

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

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32
Q

What does the score from the 2 level PE Wells score mean?

A

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
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33
Q

What score is used if a DVT is suspected?

A

A 2 level DVT Wells score

34
Q

what’s included in a 2 level DVT wells score?

A

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
Q

What does the score mean from the 2 level DVT wells score?

A

2 or more = DVT likely

1 or less = DVT unlikely

36
Q

what is the management for suspected DVT based on score from 2 level DVT wells score?

A 
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
Q

What questionnaire is used to detect eating disorders and aid treatment?

A

SCOFF

38
Q

Questions in the SCOFF questionnaire

A

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
Q

What do the scores mean in the SCOFF questionnaire?

A

2 or more = anorexia nervosa or bulimia

40
Q

What tools are used to screen for alcohol use?

A

AUDIT
CAGE
FAST

41
Q

Questions in CAGE questionnaire

A

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
Q

What scoring system is used to risk stratify patients with community acquired pneumonia?

A

CURB-65 or CRB-65 in GP as they can’t get a urea

43
Q

What is included in CURB-65 / CRB-65?

A 
C = confusion 
U = urea >7 mmol/L
R = resp rate >30
B = blood pressure <90/60
65 = over 65
44
Q

What does the score mean that’s calculated from the CURB-65 tool?

A

Score of 0 = treat CAP at home with oral amoxicillin

Score of 1+ = hospital assessment

Score of 4 = 30% mortality at 30 days

45
Q

How is daytime sleepiness assessed?

A

Epworth Sleepiness Scale

46
Q

What is asked on the Epworth sleepiness scale?

A

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
Q

What scoring system is used to classify the severity of lower urinary tract symptoms in men?

A

IPSS

International prostate symptoms score

48
Q

What is included in the IPSS?

A

Incomplete emptying

Frequency (urinate again after <2hrs)

Intermittency

Urgency

Weak stream

Straining to start

Nocturia

49
Q

What does the score from the IPSS mean?

A

Score 20–35: severely symptomatic

Score 8–19: moderately symptomatic

Score 0–7: mildly symptomatic

50
Q

What score is used to indicate prognosis in prostate cancer?

A

Gleason score

51
Q

What is included in the Gleason score?

A

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
Q

What score is used to assess the health of a newborn immediately after birth?

A

APGAR score

53
Q

what is included in the APGAR score?

A

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
Q

What does the score generated by APGAR mean?

A

0-3 very low score
4-6 moderate low score
7-10 baby in good state

55
Q

What scoring system is used to assess whether the induction of labour will be required?

A

The Bishop score

56
Q

What is included in the bishop score?

A 
Cervical position 
Cervical consistency
Cervical effacement 
Cervical dilation 
Fetal station
57
Q

How do you interpret the bishop score?

A

<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
Q

What scoring system is used to screen for patients at risk of developing pressure areas?

A

Waterlow score

59
Q

what’s included in the Waterlow score?

A

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
Q

How do you interpret the Waterlow score?

A

10+ - risk
15+ - high risk
20+ - very high risk

61
Q

what scoring system is used to estimate the 10 year risk of fragility fracture?

A

FRAX score

used in assessment of osteoporosis

62
Q

what’s included in the FRAX score?

A 
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
Q

What does the FRAX score mean?

A

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
Q

Who is the FRAX score valid for?

A

40-90 year olds

QFracture is a new score to predict 10 year risk of fragility fracture, for 30-99 year olds

65
Q

What scoring systems are used to assess the which cases of severe pancreatitis may require ICU management?

A

Ranson score
Glasgow score
APACHE II

66
Q

What is included in the ranson score/glasgow score/APACHE II?

A 
age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST
67
Q

what tool is used to screen for malnutrition?

A

MUST score (malnutrition universal screening tool)

68
Q

What’s included in a MUST score?

A

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
Q

How do you interpret a MUST score?

A

0 = low risk

1 = medium risk (observe)

2 = high risk (treat)

70
Q

What scoring system is used to decide if a patient needs antibiotics if they have an acutely sore throat, acute pharyngitis or acute tonsillitis?

A

Centor criteria

71
Q

What’s included in the centor criteria?

A

presence of tonsillar exudate

tender anterior cervical lymphadenopathy or lymphadenitis

history of fever

absence of cough

72
Q

when should antibiotics be prescribed according to the centor criteria?

A

when you score 3 or more

73
Q

What scoring system is used to stratify risk before an endoscopy in patient with an upper GI haemorrhage?

A

Glasgow-Blatchford score

74
Q

what’s included in a Glasgow-blatchford score?

A 
Hb
BUN 
Systolic BP
Sex
Heart rate >100
Melena present
Recent syncope
Hepatic disease hx
Cardiac failure present
75
Q

How do you interpret the Glasgow-Blatchford score?

A

Low risk = score 0

Any score higher than 0 = need an intervention e.g. transfusion, endoscopy or surgery

76
Q

What tool is used to calculate a patients chance of having an MI or stroke over the next 10 years?

A

QRISK

77
Q

what’s included in the QRISK score?

A 
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
Q

How is the score from QRISK used?

A

If there’s a 10 year cardiovascular risk of 10% or more OR T1DM OR eGFR <60 = 20mg atorvastatin once daily

79
Q

What scoring system is used to predict the risk that someone has previously undiagnosed T2DM?

A

Cambridge diabetes risk score

80
Q

What’s included in the Cambridge diabetes risk score?

A 
Gender
Prescribed anti-HTNs
Prescribed steroids
Age
BMI
Family hx of DM
Smoker
81
Q

How do you calculate someones GCS?

A

Motor response

  1. Obeys commands
  2. Localises to pain
  3. Withdraws from pain
  4. Abnormal flexion to pain
  5. Extending to pain
  6. None

Verbal response

  1. Orientated
  2. Confused
  3. Words
  4. Sounds
  5. None

Eye opening

  1. Spontaneous
  2. To speech
  3. To pain
  4. None

Finals Revision (18 decks)

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