risk scores

Question 1

what risk score is used to assess probability of DVT

Answer 1

wells score

Question 2

list the key things you need to ask about in a wells score history

Answer 2

CUTE BAPS

Question 3

explain a DVT in patient friendly language

Answer 3

.

Question 4

how would manage the different Wells score outcomes?

Answer 4

high - USS
moderate - USS
low - D-dimer

Question 5

how would you manage a patient with a DVT

Answer 5

• LMWH
• anticoag
• compression stockings
• treat underlying cause
• diet / exercise / smoking cessation

Question 6

what is FRAX used to assess?

Answer 6

% risk of fracture in 10 years

Question 7

what key things do you need to know to calculate FRAX?

Answer 7

GRAB PASSS

Question 8

what medical conditions can result in secondary osteoporosis?

Answer 8

• kidney failure
• cushings
• coeliac
• ms
• hyperparathyroidism
• hyperthyroidism
• diabetes

Question 9

what is a T score?

Answer 9

comparison of a persons bone density to a healthy 30 year old

Question 10

how would you manage a low FRAX score?

Answer 10

• FRAX is <10%
• reassess in 5 years
• lifestyle –> quit smoking & limit alcohol
• calcium and vit D rich diet

Question 11

name some osteoporosis medications?

Answer 11

• bisphosphonates (alendronate)

- denosumab (RANK-L)

Question 12

what FRAX score is considered high risk?

Answer 12

> 20%

Question 13

you need to assess the risk of a patient having a stoke or MI in the next 10 years - what risk score do you use?

Answer 13

QRISK-2

Question 14

what do you need to ask about for a QRISK-2 assessment

Answer 14

(check notes)

Question 15

what are the % QRISK 2 boundaries?

Answer 15

<10% = low risk
10-20% = moderate risk
>20% = high risk

Question 16

what advice would you give someone to reduced their risk (based on QRISK2)?

Answer 16

LIFESTYLE

• stop smoking
• diet change / weight loss
• exercise
• disease control + medication adherence

Question 17

you have be asked to calculate the stroke risk of a patient with AF - what risk score would you use?

Answer 17

CHA2DS2-VASc

Question 18

what do you need to ask about in a CHA2DS2-VASc assessment?

Answer 18

see notes

Question 19

what would a CHA2DS2-VASc score of > 2 mean?

Answer 19

patient is high risk

Question 20

how would you advise a low risk CHA2DS2-VASc patient?

Answer 20

• consider anticoagulants

- lifestyle advice!!

Question 21

how would you manage a high risk CHA2DS2-VASc patient?

Answer 21

anticoagulant/antiplatelet therapy

- lifestyle advice

Question 22

don’t need to know BUT what are potential modifiable risk factors for bleeding?

Answer 22

HAS BLED

Question 23

explain why you would use anticoagulants vs anti platelets

Answer 23

• clotting in arterial system mainly platelet driven (activated by contact with damaged endothelium/atheroma) –> antiplatelets
• clotting in venous system/AF due to blood stasis & is mostly clotting factor driven

Question 24

what key things does a patient need to know about starting warfarin?

Answer 24

• needs INR checks
• teratogenic
• increased bleeding risk
• diet control
• can interfere with other medications
• reversible with vitamin K

Question 25

what key things do you need to know about DOACs?

Answer 25

- non reversible - increased bleeding risk - contraindicated in those with renal impairment and/0r history of a GI bleed - (expensive)

Question 26

what is ABCD2 used to calculate?

Answer 26

risk of stroke after TIA (scored out of 7)

Question 27

what things do you need to ask about in an ABCD2 assessment?

Answer 27

see notes

Question 28

outline the risk boundaries for ABCD2 scores and how you would manage them

Answer 28

``` >6 = high risk --> specialist within 24 hours 4-6 = moderate risk <3 = low risk ```

Question 29

management for abcd2 risk assessment?

Answer 29

- lifestyle advice | - antithrombotic treatment?

Question 30

what would you ask about when assessing someone's diabetes risk?

Answer 30

see notes

Question 31

what are some key signs of diabetes?

Answer 31

- polyuria - polydipsia - tiredness - thrush - blurred vision - thinner

Question 32

what advice would you give someone to help lower their diabetes risk?

Answer 32

- diet advice - exercise 150mins/week - weight loss