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OSCE Stations > Risk Assessments > Flashcards

Risk Assessments Flashcards

1
Q

What factors influence a DMT2 risk score ?

A

Gender, age, ethnicity, FHx, Waist size, BMI, PMHx (HTN)

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2
Q

What are the categories calculated in a DMT2 RS ? e.g. low-high ?

A

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

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3
Q

How does age impact a DMT2 score ?

A

49 or younger = 0
50-59 = 5
60-69 = 9
70+ = 13

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4
Q

How does gender impact a DMT2 score ?

A

Male = 1
Female = 0

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5
Q

How does ethnicity impact a DMT2 score ?

A

White European = 0
Other = 1

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6
Q

How does waist measurement impact a DMT2 score ?

A

Less than 90cm = 0
90-99.9 = 4
100-109.9 = 6
110 or above = 9

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7
Q

How does BMI impact DMT2 score ?

A

Less than 25 = 0
25-29.9 = 3
30-34 = 5
35 or above = 8

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8
Q

How does BP impact a DMT2 score ?

A

HTN = 5

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9
Q

What is the pathology of T2DM ?

A

Insulin resistance due to B-cell dysfunction
Hyperglycaemia results due to reduced insulin secretion

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10
Q

How does FHx impact the score ?

A

Yes = 5

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11
Q

What are normal HbA1c tests

A

<42 mmol/L

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12
Q

What are pre-diabetic HbA1c tests ?

A

42-47 mmol/L

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13
Q

What are diabetic HbA1c tests ?

A

> 47

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14
Q

What is first line treatment for T2DM ?

A

If the condition can be managed with lifestyle changes instead of medications, then it should be

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15
Q

What is second line treatment for T2DM ?

A

Metformin

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16
Q

What medications could be given in addition to metformin ?

A

Metformin +
Sulphonylurea
DDP4 inhibitor
Pioglitazone 2
SGLT-2i

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17
Q

What does a QRISK2 calculate ?

A

Risk of having an MI or stroke within the next 10 years

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18
Q

List the variables of a QRISK2 score ?

A

Age, sex ethnicity, Post-code, Smoko, DM, Angina or MI in first degree relative <60, CKD (stage 4 or 5), AF, HTN treatment, RA, Cholesterol/HDL ratio, Systolic BP, BMI

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19
Q

Which variables are modifiable in a QRISK2 ?

A

Smoko, Cholesterol, BMI

20
Q

Which variables are non-modifiable in a QRISK2 ?

A

Age, sex, ethnicity, DM, FHx, RA, HTN

21
Q

What should an ideal QRISK2 score be ?

A

<10%

22
Q

What does a CHAD2VASc calculate ?

A

Risk of stroke for patient in AF

23
Q

What does CHADS2VASc stand for ?

A

Congestive HF = 1
HTN = 1
Age = > 75 = 2
DM = 1
Stroke/TIA/Systemic embolism = 2
Vascular disease = 1
Age = 1
Sex = 1

24
Q

What are the different scores in a CHADS2VASc

A

0 male or 1 female
Low risk
No anticoagulation
1 male
Moderate risk
Oral anticoagulant should be considered

2 or greater
High risk
Oral anticoagulant is recommended

25
Q

Which factors are non-modifiable in a CHADS2VASc ?

A

Congestive HF
Age
DM
Sex
Stroke/TIA/Systemic embolism

26
Q

CHADS2VASc -What factors impact stroke risk ?

A

Risk of stroke is 5 times higher in person with AF than normal sinus rhythm
Severity of stroke is greater when associated with AF
Anticoagulation treatment reduced the risk of stroke by about 2/3rds

27
Q

What treatment could be provided for clot risk ?

A

Warfarin
DOAC e.g. rivaroxaban or apixaban
Both carry a risk of bleeding

28
Q

What does a FRAX calculate ?

A

Used to calculate the risk of fracture in the next 10 years

29
Q

What are the variables ?

A

Age, sex, weight, height, previous #, FHx of #,. smoko , GCs, RA, Secondary osteoporosis (T1DM, Hyperthyroidism, chronic liver disease), alcohol and bone mineral density (DEXA)

30
Q

How are the results of a FRAX calculated ?

A

Results come out as a %
A score of 5% or more for a hip facture at age 70+ suggests one should consider treatment alongside lifestyle changes

31
Q

What is a DEXA scan ?

A

A scan which looks at the mineral density of your bones and compares it to scans from people of a similar age

32
Q

What are the different scores from a FRAX ?

A

T score and Z score

33
Q

What are the different T scores ?

A

Greater than -1 = normal
-1 - -2.5 = Osteopenia
<-2.5 = Osteoporosis

34
Q

What does a Z score suggest ?

A

> -2 suggest that something other than ageing may be responsible for your bone mineral density

35
Q

What is osteopenia ?

A

When your bone density scan shows lower bone density than the average for your age

36
Q

What is osteoporosis ?

A

Significant loss of bone mineral density resulting in fragile bones which are a risk of breaking

37
Q

What does ABCD2 stand for ?

A

Age > 60
Blood pressure > 140/90
Clinical features e.g. unilateral weakness (2) speech disturbances without weakness (1)
Duration of symptoms e.g. 60 mins + = 2, 10-59 mins =1
DM = 1

38
Q

What are the results for an ABCD2 score ?

A

0-3 = low risk ~3% chance of stroke of stroke in the next 90 days
4-5 = moderate risk ~10% chance of stroke in the next 90 days
6-7 = high risk ~18% chance of a stroke in the next 90 days

39
Q

What treatment could you give for a TIA ?

A

Antiplatelets e.g. aspirin (instant), dipyridamole (2 weeks), clopidogrel
Anticoagulants e.g. heparin or warfarin, long term statins e.g. simvastatin
Control risk factors e.g. HTN

40
Q

What treatment could you give for a stroke ?

A

Thrombolysis e.g. alteplase

41
Q

What is a Well’s DVT score

A

Tool to calculate the risk of developing a deep vein thrombosis (and PE)

42
Q

What are the variables in a Wells score ?

A

Active cancer, bedridden > 3 days, major surgery within 12 weeks, Calf swelling > 3 days (unilateral), collateral superficial veins, entire leg swollen, localised tenderness confined to symptomatic leg, pitting edema, paralysis, paresis or plaster immobilisation, previous DVT, alternative diagnosis likely (-1)

43
Q

What are the results of a Wells score ?

A

Moderate risk = 1-2
High risk = 3+

44
Q

Signs and symptoms of DVT

A

Pulse is present
Pain-aching cramping
Skin pigmentation in galter area (medial and lateral malleolus)
Thickened and tough may be reddish blue

45
Q

What are the risks of a DVT ?

A

Develop into an ulcer
Stroke
MI

46
Q

What treatment could be given for a DVT ?

A

D-dimer could exclude
Heparin or warfarin

OSCE Stations (3 decks)

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