Clinical Soring Systems

Question 1

MRC dyspnoea scale

Answer 1

0 = breathlessness on intense exercise
1 = breathlessness on slight hill or hurrying
2 = breathlessness causes you to have to take breaks or walk slower than people your age
3 = breathlessness causing you to stop after 100 yards or a few minutes
4 = breathlessness on ADLs like getting dressed

Question 2

CURB 65

Answer 2

Confusion (new onset)
Urea over 7mmol/L
Resp rate of 30 or over
BP under 90/60
65 years or older

0-1 = mild pneumonia - if worried with score of 1 then admit to hospital
2 = moderate pneumonia - admit to hospital
3-5 = severe pneumonia - admit to intensive care unit

Question 3

FeverPAIN

Answer 3

Fever (within 24 hours)
Purulence
Attended within 3 days of onset
Inflamed tonsils
No coryzal symptoms

0-1 = 13-18% streptococci - no antibiotics
2-3 = 34-40% streptococci - consider 3 day delay before antibiotic prescribed
4-5 = 62-65% streptococci - immediate antibiotic use if severe, or 2 day delay if not

For tonsillitis. Antibiotic is Phenoxymethylpenicillin (Penicillin V)

Question 4

CHA2DS2-VASc

Answer 4

C = history of congestive heart failure
H = history of hypertension
A = Age of 75+ (2 points)
D = history of diabetes
S = history of stroke or TIA or other thromboembolic event (yes to any = 2 points)
V = history of vascular disease (prior MI, peripheral arterial disease, aortic plaque)
A = Age of 65-74
S = sex - female

Question 5

BTS classification of asthma severity

Answer 5

Worst Sx determines grading

Moderate asthma attack
PEF 51-75%

Severe asthma attack
PER 33-50%
RR of 25 or over
HR of 110 or over
Inability to complete sentences

Life threatening
PEF less than 33%
O2 sats less than 92
paO2 less than 8kPa
Altered conscious level

Near fatal
Silent chest
Raised paCO2
Requiring mechanical ventilation with raised inflation pressures

Question 6

CKD classification

Answer 6

eGFR grades: Albumin:creatinine ratio (ACR) grades:
G1 >90 A1 = <3
G2 60-89 A2 = 3-30
G3a 45-59 A3 = >30
G3b 30-44
G4 15-29
G5 <15

Question 7

MRC grading of muscle power

Answer 7

0 = no contraction
1 = flicker or trace of contraction
2 = active movement, with gravity eliminated
3 = active movement against gravity
4 = active movement against gravity and resistance
5 = normal power

Question 8

Glasgow Coma Score

Answer 8

Scoring out of 15 assessing best eye (1-4), verbal (1-5) and motor response (1-6).
3 is lowest score (coma/dead), 15 is highest score where they are totally alert.

Best eye response:
1 - no eye opening
2 - eye opening to pain
3 - eye opening to sound
4 - eye open spontaneously

Best verbal response:
1 - no verbal response
2 - incomprehensible sounds
3 - inappropriate words
4 - confused
5 - oriented

Best motor response:
1 - no motor response
2 - abnormal extension to pain
3 - abnormal flexion to pain
4 - withdrawal from pain
5 - localising pain
6 - obeys commands