Risk scores for OSCE

Question 1

What factors need to be asked about in the Diabetes Risk Score Station history?

Answer 1

Age
Gender (M>F)
BMI (High increases risk)
Ethnicity (Kala, Caribbean, South Asian at higher risk)
Pregnancy (increases risk)
Lifestyle factors: poor diet, sedentary, smoking, alcohol, disturbed sleep
PMH: Hypertension, Polycystic Ovary Syndrome, Depression +(anti-psychotics increase risk)
FHx- close relative with DM

Question 2

What are the results for the diabetes risk score and how are they stratified?

Answer 2

0-6= Low Risk
7-15= Increased
16-24= moderate
25-47= High

Question 3

What factors need to be asked about in the Qrisk2 (risk of CVD in 10 years) score history?

Answer 3

Age
Gender
BMI
Ethnicity
Lifestyle: Diet, Exercise, Smoking, Alcohol
PMH: AF, diabetes, RA, CKD
FHx: angina or heart attack in 1st degree relatives under 60

Question 4

What are the risk stratifications for Qrisk and what actions should be taken?

Answer 4

<10%- Low Risk
10-20%-Moderate Risk
>20%= High Risk

Above 10% offer lifestyle changes
Above 20% offer a statin

Question 5

What are the factors to ask about in CHA2DS2Vascs score and how many points are allocated?

Answer 5

Congestive Heart Failure (+1)
HTN (+1)
Age >65(+1) or >75 (+2)
Diabetes (+1)
Previous Stroke/TIA/ or Thromboembolism (+2)
Vascular Disease (+1)
Female Sex (+1)

Question 6

How are the results of CHA2DS2VascS stratified and how do they guide treatment?

Answer 6

• 0 = low
• 1 = low-moderate (antiplatelet or anticoagulation)
• > 2 = moderate-high (anticoagulation)

Question 7

What are the factors to ask about for the ABCD2 Risk score station?

Answer 7

Age- >60=+1
Blood Pressure- >140/90=+1
Clinical Features of TIA-
Unilateral Weakness = +2
Speech disturbances without unilateral weakness= +1
Duration of Symptoms-
<10 minutes=0
10-59 minutes=+1
>60 minutes=+2
Diabetes=+1

Question 8

How is the risk score for ABCD2 Stratified and what are the implications of each score?

Answer 8

0-3= low risk
4-5= Moderate risk
6-7= High Risk

If high risk patient should undergo MRI, Carotid Ultrasound, and Neurology should be consulted

Question 9

What are the questions for the Well’s Score for DVT?

Answer 9

• Age, gender, BMI
• DVT Px:
  o Calf swelling >3cm (+1)
  o Entire leg swollen (+1)
  o Pitting oedema (+1)
  o Localised leg tenderness along the deep venous system (+1)
  o Superficial veins (+1)
• Bedridden for >3 days OR major surgery within 12wks (+1) [immobilisation]
• Plaster cast (+1)
• Recent travel (+1)
• Previous DVT/PE (+1)
• Contraception, hormone therapy (+1)
• Pregnancy (+1)
• Lifestyle: diabetes, smoking, obesity, immobile
• PMH: cancer, clotting OR bleeding disorders
• FHx

Question 10

How is the risk stratified for the Well’s Score and what are the treatment implications?

Answer 10

0= low risk
1-2= Moderate risk and a high sensitivity D Dimer should be done
3+= High risk and a diagnostic Ultrasound Scan of the calf is required

Question 11

What are the questions for the FRAX Score Station?

Answer 11

Age
Gender(F>M)
BMI (low BMI increases risk)
Previous Fracture
Parent Fractured Hip
Bone Mineral Density (DEXA Scan)
Lifestyle: Smoking, Alcohol, Diet, Exercise
PMH: Rheumatoid Arthritis
-secondary osteoporosis e.g. T1DM, malnutrition malabsorption, chronic liver disease
DH: Glucocorticoid Use

Question 12

How are the results presented for FRAX?

Answer 12

% osteoporosis risk in 10 years
% hip fracture in 10 years

Question 13

What does the Wells Score Assess?

Answer 13

Risk of DVT

Question 14

What does FRAX assess?

Answer 14

Risk of Fracture within 10 years

Question 15

What does ABCD2 score assess?

Answer 15

Risk of further stroke following TIA

Question 16

What does CHA2DS2Vascs assess?

Answer 16

Risk of stroke with Atrial Fibrillation and whether to anti-coagulate the patient