Risk scores Flashcards
What does a FRAX score calculate?
% risk of fracture in the next 10 years
What must you ask in a FRAX score?
Intro - age, sex
PMH
- RA
- previous fracture
- 2ndry osteoporosis (Cushing’s, kidney, coeliac, MS, hyperthyroidism, hyperparathyroidism, diabetes)
Meds - glucocorticoid use
Family HX - parental fracture
Social - smoking, alcohol (3+ units per day)
O/E - height, weight, DEXA scan
Causes of secondary osteoporosis?
Cushing's disease MS Kidney failure Coeliac Hyperthyroidism Hyperparathyroidism Diabetes
What is the purpose of the Well’s criteria?
Calculate risk at presentation for DVT diagnosis
What must you ask in in a Well’s score?
PMH
- bed ridden >3/7 OR surgery in last 12/52
- active cancer
- previous DVT
- immobilisation (eg paralysis, plaster cast)
O/E
- swelling of calf >3cm
- pitting oedema (symptomatic leg)
- tenderness of deep veins
- entire leg swollen
- collateral veins present
Management after Well’s score calculated?
0 = unlikely
- D-dimer w/in 4 hrs
- start DOAC, stop if negative
1-2 = moderate risk
- high sensitivity D-dimer (US doppler if +ve)
- start DOAC
2+ = likely
- doppler ultrasound w/in 4 hours
- if not possible high sensitivity D-dimer
- start DOAC
What to check before starting DOAC? (plus counselling)
Examples - apixaban, rivaroxaban
Check renal function and if previous GI bleeds
- if have - CI’d and give warfarin
Warn not reversible, may experience bruising
What does a QRisk3 score calculate?
% risk of MI or stroke in the next 10 years
What do you need to ask to calculate QRisk3?
Intro - age, sex, postcode, ethnicity
PMH
- diabetes
- AF
- RA
- SLE
- CKD stage 3-5
- severe mental illness
- erectile dysfunction
Meds
- corticosteroids
- antihypertensive
- atypical antipsychotics
Family hx - angina or MI in 1st degree relative under age 60
Social - smoking status
O/E
- BMI
- last 2 systolic BP
- HDL level
Management after calculating QRisk3?
Low risk
- lifestyle, risk factor modification
- reassess in 5 years
High risk
- start statin
- lifestyle, risk factor modification
What does a CHA2DS2-Vasc score calculate?
% risk pf stroke in patients with AF
What must you ask in a CHA2DS2-Vasc score?
Intro
- age (65-74 = 1, >75 = 2)
- sex (F)
PMH
- congestive heart failure
- hypertension
- diabetes
- stroke / TIA (2)
- vasc - MI, PVD
Management after calculating CHA2DS2-Vasc?
Score = 0
- lifestyle
Score = 1
- lifestyle
- consider DOAC
Score = 2+
- DOAC
What must you ask to calculate a diabetes risk score?
Intro
- sex (M)
- age (>70 = 3, 60-70 = 2, 50-60 = 1)
HOPC - common symptoms
- polyuria, polydipsia, weight loss, visual blurring
PMH - hypertension
Family Hx - diabetes in first degree relative
O/E - waist circumference
>100 = 3
100-109 = 2
90-99 = 1
