RF

Question 1

Diabetes

Answer 1

Risk (%) of developing type 2 diabetes within the next 10 years

Introduction:
• Age: Increasing
• Sex: Male
• Ethnicity: non British Caucasian

PMH:
• Hypertension

Medications:
• Antihypertensive
• Statins

FHx:
• FHx t2 diabetes

SHx:
• Smoking
• Alcohol (+3 units/day)
• BMI (weight and height) >25
• Waist Circumference

Question 2

Diabetes management

Answer 2

• 7-15% Low risk: Lifestyle modifications
• 16-24% Moderate risk; 25-47% High risk: Refer to GP for fasting glucose and HBA1C testing

Diagnosis
Symptomatic patients:
Presence of diabetic symptoms + one abnormal plasma glucose
1. Random plasma [glucose] / glucose after OGTT ≧ 11mmol/l
2. Fasting plasma [glucose] ≧ 7mmol/l

Question 3

Wells score

Answer 3

Risk of DVT at presentation

Focussed Hx:

Introduction:
• Age: ≧60

PC: VTOSS
• Visible veins (collateral/ varicose)
• Tender veins
• Oedema (pitting)
• Swelling of calf (>3cm)
• Swelling of whole leg

HPC:
• Risk factors: combined pill, long haul flights
• Alternative diagnosis as likely

Question 4

Wells score management

Answer 4

Management
• Score > 3: DVT is likely
- Leg vein USS scan
- Take blood for d-dimer testing
- Give interim 24 hour dose of anticoag

• Score of less than <3

• D-dimer testing
• If positive, then refer for vein USS

Question 5

ABCD2

Answer 5

This is used to determine the risk for stroke following a TIA in the next 2, 7 and 90 days
Focussed Hx:

Introduction:
• Age: ≧60

HPC:
• Clinical features:
- +2 if unilateral weakness
- +1 if speech deficit (no weakness)
• Duration:
- +2 if >60 mins
- +1 if 10-59 mins
• Other Sx:
• Numbness and tingling

PMH:
• Previous stroke/TIA
• Diabetes
• Hypertension (>140/90)
• Others: Arrhythmias, high cholesterol, angina, MI

Question 6

ABCD2 Management

Answer 6

Management
• X drive for a month after TIA

0-3: low risk - 1% risk of stroke in 2 days

• Manage as outpatient
• See specialist within 2 weeks
• Give a statin i.e. Simvastatin
• Give antiplatelet: Clopidogrel or Aspirin

4-5: moderate risk - 4% risk of stroke in 2 days
6-7: high risk - 8% risk of stroke in 2 days

• See specialist within a 24hrs
• Consider Ix i.e. MRI/ carotid USS
• Give a statin i.e. Simvastatin
• Give antiplatelet: Clopidogrel or Aspirin

Question 7

CHADS2VASC

Answer 7

This is used to estimate the risk a patient has of getting a stroke in the next year given that they have AF
Focussed Hx:

Introduction:
• Age:
- +1 if >65 - 74
- +2 if >75
• Sex: +1 if female

PMH: HVASCD
• Hypertension (more than 140/90) or treated hypertension
• Vascular Disease (peripheral)
• Stroke/ TIA
• Congestive heart failure/left ventricle systolic dysfunction
• Diabetes

Medications:
• Anti-hypertensives
• Statins

Question 8

CHADS2VASC Management

Answer 8

• A low score of 0 in males and 0-1 in females no anticoagulation therapy is required
• Males with a score of 1: anticoagulation may be considered, taking into account the patient’s preference
• Score of 2 and above give either warfarin or a NOAC (oral anticoagulation)

Question 9

FRAX

Answer 9

Estimates 10-year probability (%) of osteoporotic bone fracture
Focussed Hx:

Introduction:
• Age: increasing /
• Sex: Female /

PMH: PORS
• Previous fracture /
• (Secondary) Osteoporosis  T1D, CKD, osteogenesis inperfecta, untreated hyperthyroid, premature menopause <40, malnutrition, chronic liver disease /
• RA /
• Scan - BMD of neck of femur /

Medications:
• Glucocorticoids (+3 months)

Question 10

FRAX management

Answer 10

Management
• High risk: ≧10% - Arrange a DEXA scan
• Lifestyle advice: cut down smoking, maintain healthy BMI if underweight, household modifications
• Treatment: ADCAL - vitamin D (sunlight; supplements), calcium i.e. drink milk; dairy products, alendronic acid (tablet)

Question 11

QRISK

Answer 11

% score is risk of having a MI or stroke within the next 10 years; everyone aged 40 – 74 gets an NHS health check where Q RISK is taken

Focussed Hx:

Introduction:
• Age: increasing
• Sex: male
• Ethnicity: South Asian

PMH: High CARD
• High cholesterol
• Hypertension (140/90)
• CKD (stage 4 or 5)
• AF
• RA
• Diabetes (T2)

Medications:
• Anti-hypertensives
• Statins

FHx:
• Angina or heart attack in a first degree relative under < 60 y/o

SHx:
• Smoking/alcohol
• BMI (weight and height)
• Stress

Question 12

QRISK management

Answer 12

Results & management

< 10%: low risk
• Lifestyle modifications: Healthy diet/exercise/stop smoking
• Review any comorbidities that may not be treated (Htn, diabetes or high cholesterol)

> 10%: high risk
• Lifestyle modifications: Healthy diet/exercise/stop smoking
• Review any comorbidities that may not be treated (Htn, diabetes, high cholesterol, RA, CKD, AF)
• Discuss benefits and risks of statins i.e. atorvastatin