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Risk Scores Flashcards

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1
Q

Diabetes risk score: what non-modifiable risk factors? (4)

A
  • Age
  • Gender
  • Ethnicity
  • Relative with diabetes
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2
Q

Diabetes risk score: what modifiable risk factors?

A
  • Waist circumference
  • BMI
  • HTN
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3
Q

Diabetes risk score: describe age points

A

50 - 60 => 5 points
60 - 70 => 9 points
70+ => 13 points

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4
Q

Diabetes risk score: describe gender points

A

Male => 1 point

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5
Q

Diabetes risk score: describe ethnicity points

A

Anything other than white => 6 points

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6
Q

Diabetes risk score: Describe ‘relative with diabetes” points

A

yes => 5 points

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7
Q

Diabetes risk score: describe was it measurement points

A

90 - 100cm => 4 points
100 - 110cm => 6 points
110cm + => 9 points

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8
Q

Diabetes risk score: describe BMI points

A

25 - 30 kg/m2 => 3 points
30 - 35 kg/m2 => 5 points
35 kg/m2 + => 8 points

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9
Q

Diabetes risk score: HTN points

A

yes => 5 points

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10
Q

What is diabetes score total out of?

A

47

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11
Q

Diabetes risk score: what is low risk (points, 1 in x)

A

Low risk: 0 - 6 => 1 in 100 risk

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12
Q

Diabetes risk score: what is increased risk (points, 1 in x)

A

Increased risk: 7 - 15 points => 1 in 35 risk

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13
Q

Diabetes risk score: what is moderate risk (points, 1 in x)

A

Moderate risk: 16 - 24 points => 1 in 10 risk

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14
Q

Diabetes risk score: what is high risk (points, 1 in x)

A

High risk: 25 - 47 points => 1 in 4 points

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15
Q

Darren is 65 year old white man with no family history of diabetes. He is overweight, has a waist circumference of 105cm and has hypertension. What diabetes risk bracket does he fall under?

A

(9 + 1 + 0 + 0) + (6 + 3 + 5) = 24

moderate risk
1 in 10 risk

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16
Q

Leslie is 77 year old black woman with waist circumference of 85cm, BMI or 22kg/m2 and has hypertension. She is concerned about diabetes as her mother had it. What is her diabetes risk score?

A

(13 + 0 + 6 + 5) + (0 + 0 + 5) = 29

High risk
1 in 4 risk

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17
Q

What lifestyle advice to reduce diabetes risk score?

A
  • Regular meals/ portion size
  • Decrease fat/sugar/salt
  • Moderate alcohol
  • Exercise 150mins/week
  • Weight loss
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18
Q

What are the obvious symptoms of diabetes?

A

5Ts
- Toilet (polyuria)
- Thirsty (polydipsia)
- Tiredness (more than usual)
- Thrush (genital itching secondary to infection)
- Thinner (unintentional weight loss)

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19
Q

What is QRisk2 Score calculating risk of?

A

Works out the % risk of having a major coronary event (heart attack or stroke) in next 10 years (in those aged 35-74)

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20
Q

What personal info is required for QRisk3?

A
  • Age
  • Gender
  • Ethnicity
  • BMI
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21
Q

what PMH needed for QRisk3?

A

CARD
- CKD (stage 4 or 5)
- AF
- RA
- Diabetic status

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22
Q

What DH needed for QRisk3?

A
  • Antinhypertensive usage
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23
Q

what FH needed for QRisk3?

A

angina or heart attack in 1st degree relative < 60

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24
Q

what SH QRisk3?

A

smoking status

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25
what direct measurements are needed for QRisk3?
cholesterol/HDL ratio Systolic BP
26
What modifiable risk factors are there for QRisk3?
- BMI - Hypertension - Smoking status - Cholesterol
27
What is interpretation of QRisk3? (%)
<10% => low risk 10 - 20% => moderate risk >20% => high risk
28
QRisk3 low risk management?
Lifestyle changes - Stop smoking - Exercise - Diet change - Weight loss - disease control + medication adherence
29
QRisk3 moderate risk management?
- lifestyle changes - discuss statin pros and cons
30
QRisk3 high risk management?
same as moderate - lifestyle changes - discuss statin pros and cons (higher dose statin)
31
what is CHA2DS2-VAS risk score for?
Risk of stroke in patients with AF
32
what does CHA2DS2-VAS stand for?
- Congestive heart failure - Hypertension - Age > 75 - Diabetes - Stroke/TIA history - Vascular disease - Age: 65 - 74 - Sex (female)
33
In CHA2DS2-VAS, which factors are worth 2 points?
Age: 75 + Stroke/TIA history
34
CHA2DS2-VAS interpretation
0 (male) or 1 (female) => low risk 1 (male) => moderate risk 2 or above => high risk
35
CHA2DS2-VAS low risk advice
- General lifestyle advice
36
CHA2DS2-VAS moderate risk advice
- Lifestyle advice - Consider oral anticoagulation (warfarin, DOAC)
37
CHA2DS2-VAS high risk advice
- Lifestyle advice - Recommend oral anticoagulation (warfarin, DOAC)
38
What does FRAX calculate the risk of?
Osteoporosis risk: probability of fracture in next 10 years (for ppl aged 40 - 90)
39
What personal info does FRAX require?
- Age - Sex (female) - BMI - BMD (bone mineral density)
40
What PMH does FRAX require?
- RA - Prev fracture - Secondary osteoporosis
41
What can cause secondary osteoporosis?
- Kidney failure - hyperthyroidism - Diabetes
42
What DH does FRAX require?
Usage of: - Glucocorticoids - Lithium
43
What FH does FRAX require?
Parental fractured hip
44
What SH does FRAX require?
- Smoker - Alcohol intake >3 units/day
45
What is a T score?
Shows how much higher or lower patients bone density is compared to a healthy 30 year old
46
What is a Z score?
Compares the condition of patients bones to someone of their age/weight/sex/ethnicity
47
Describe the T score ranges
T > -1 => Normal bone density -2.5 < T < -1 => Osteopenia T < -2.5 => Osteoporosis
48
T score: What intervention for: T > -1?
Normal bone density: No intervention
49
T score: What intervention for: -2.5 < T < -1?
Osteopenia: Lifestyle advice, consider medication
50
T score: What intervention for: T < -2.5
Osteoporosis: Lifestyle advice + medication
51
FRAX score interpretation: What are low, intermediate and high risk categories?
- Low risk: < 10% - Intermediate risk: 10 - 20% - High risk: > 20%
52
FRAX score: < 10% management?
Low risk - Lifestyle advice
53
FRAX score: 10 - 20% management?
Intermediate risk - Lifestyle advice - DEXA scan to measure BMD - If T < -2.5: bisphosphonate (alendronic acid or decnosumab (RANK-L)
54
FRAX score: > 20% management?
High risk - GET A SCAN - Lifestyle advice - DEXA scan to measure BMD - If T < -2.5: bisphosphonate (alendronic acid or decnosumab (RANK-L) (same as intermediate)
55
What does Well's score calculate the risk of?
Risk of DVT based on clinical criteria
56
Well's score: HPC factors? (6)
- Paralysis, paresis - Localised tenderness - Entire leg swollen - Calf swelling (3cm larger than asymptomatic leg) - Pitting oedema (confined to just symptomatic leg) - Collateral superficial veins
57
Well's score: PMH factors? (3)
- Active cancer - Recent lower limb immobilisation ( >3 days) or major surgeries - Previous DVT
58
Well's score: DH factors?
- HRT - Oral contraceptive pill
59
Well's score: SH factors?
Long haul flights
60
Well's ranges and risk?
0 => DVT unlikely 1-2 => DVT moderate risk 3+ => DVT likely
61
Wells score: 0, what investigation?
DVT unlikely - No intervention
62
Wells score: 1-2, what investigation?
DVT moderate risk - D-dimer
63
Wells score: 2+, what investigation?
DVT likely - D-dimer - USS (ultrasound scan)
64
Jennifer is 25 year old woman who comes to her GP presenting with a tender, entirely swollen left calf. The symptomatic leg is 2cm larger than the other. Her BMI is 27, has not left the country in years, and has no other PMH. She takes the oral contraceptive pill and is a smoker. What is her Well's score? her risk of DVT? and what investigations/ treatment would you do?
- Tenderness, entirely swollen, OCP (Wells = 3) - Risk: DVT = likely - Investigations: D-dimer, USS - Treatment: Oral warfarin, compression stockings, stop smoking, exercise
65
When is it good to use D-dimer?
When the patient has low risk of DVT
66
D-dimer came back negative. What can you do with this information?
Rule out DVT
67
D-dimer came back positive. What can you do with this information?
DVT possible but this is not diagnostic
68
Describe D-dimer in terms of specificity and sensitivity
High specificity Low sensitivity
69
What is DVT treatment?
- LMWH - Oral warfarin (maintain INR: 2-3) or DOAC - Compression stockings - Treat underlying cause - Diet, exercise, smoking cessation
70
What is gold standard investigation for diagnosing PE?
CTPA (CT pulmonary angiogram)
71
What is ABCD2 a risk score for?
Risk of stroke following TIA: How soon post TIA should patient be seen?
72
ABCD2: what does the A stand for? and how many points?
Age: 60+ => 1 point
73
ABCD2: what does the B stand for? and how many points?
BP: 140/90+ => 1 point
74
ABCD2: what does the C stand for? and how many points?
Clinical features: Max 2 - Unilateral weakness => 2 points - Speech disturbance without weakness => 1 point
75
ABCD2: what does the Ds (both) stand for? and how many points?
Duration: Max 2 - 60min + => 2 points - 10 - 60min => 1 point Diabetes => 1 point
76
ABCD2 interpretation: What are the risk ranges? and what do they mean?
0 - 3: See + investigate within 7 days 4 - 7: See and investigate with 24 hours
77
ABCD2: TIA medication management?
- Antiplatelets (aspirin, clopidogrel) - Statin
78
ABCD2: TIA lifestyle management?
- Diet: lower fats + cholesterol - Exercise - Quit smoking - Medication adherence (diabetes and BP control)

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