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Y3 Medicine > 24 - Clinical Scoring Systems > Flashcards

24 - Clinical Scoring Systems Flashcards

1
Q

What is the treatment for a DVT and how soon should you start it?

A

- Rivaroxaban/Apixaban or LMWH

  • Needs to be started within 4 hours, if cannot do US or D-dimer in this time start interim. If confirmed need at least 3 months treatment
  • Take clotting screen, FBC, LFTs, U+Es before anticoagulation but do not wait for results
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2
Q

What are some important medications to remember to put on a prescription for a newly admitted patient?

A
  • Oxygen
  • 5000 units dalteparin
  • Paracetamol PRN
  • Cyclizine PRN
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3
Q

How do you document a ward round?

A
  • Age
  • Admitted with
  • Background
  • Bloods and EWS
  • SOAP
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4
Q

How do you calculate a GCS score? (learn image of by heart)

A
  • Eyes 4
  • Verbal response 5
  • Motor response 6
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5
Q

How do you interpret a GCS score?

A
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6
Q

How do you calculate a CURB 65 score and interpret it?

A

C - Confusion

U- Urea >7

R- RR>30

B - Sys <90 or Dias <60

65 years old

1 = outpatient treatment

2 = consider inpatient or outpatient treatment with close follow up

>3 = inpatient treatment with possible ICU referral

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7
Q

How do you calculate and interpret a Centor score?

A

Works out the likelihood a pharyngitis is due to Group A strep

  • Age
  • Exudate
  • Swollen lymph nodes
  • Fever
  • Cough

Score of 1 or less no test or treatment

Score of 2 then rapid antigen test but not treat

Score of 3 or more then rapid antigen test and treat empirically

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8
Q

How do you calculate and interpret a FeverPAIN score?

A
  • Fever in last 24 hours
  • Purulence
  • Attend rapidly <3 days
  • Inflammed tonsils
  • No cough or coryza

Score of 1 then no antibiotics

Score of 2-3 consider delayed antibiotics

Score of 4-5 then antibiotics needed

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9
Q

How do you calculate and interpret a CHA2DS2-VASc score? (memorise image)

A

Calculates the stroke risk of a patient with AF

  • Score of 0 (male) or 1 (female) then no anticoagulation
  • Score of 1 (male) then anticoagulation recommended
  • Score of 2 or more then anticoagulant
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10
Q

What is the BTS classification of asthma severity?

A

Moderate acute - PEF >50-75% best or predicted, no features of acute severe

Acute Severe - PEF >33-50%, RR>25, cannot speak in full sentences, HR>110

Life threatening - Silent chest, Normal pCO2, PEF<33% or cannot do, sats <92%, altered consciousness, pO2 <8, exhaustion, arrhythmias, hypotension

Near fatal - Raised pCO2

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11
Q

What is the MRC dyspnea scale?

A

1 - Breathless on strenuous exertion

2 - Breathless when hurrying on the level or walking up a slight hill

3 - Breathless compared to same age on level ground or has to stop for breath when walking at own pace

4 - Stops for breath after walking 100m

5 - Too breathless to leave house or dress self

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12
Q

What are the different stages of CKD?

A

Stage 1 - Normal eGFR>90 with proteinuria so kidney damage

Stage 2 - eGFR 60-90 with proteinuria

Stage 3 - eGFR 30-60

Stage 4 - eGFR 15-30

Stage 5/ESRD - eGFR<15

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13
Q

What is the MRC grading of muscle power?

A

0 - no contraction

1 - flicker or trace of contraction

2 - movement with gravity eliminated

3 - movement against gravity

4 - movement against gravity and resistance

5 - normal power

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14
Q

How do you calculate a Wells score for DVT and how do you interpret the results? (remember criteria)

A

Score of 1 or less DVT is unlikely, do a D-Dimer

Score of 2 or more DVT is likely, do a doppler US

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15
Q

How do you calculate a Wells score for PE and how do you interpret the results? (remember criteria)

A

Score of 4 or less then PE unlikely

Score over 4 then PE likely

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16
Q

How does a NEWS score inform a management plan?

A
  • Decides frequency of observations
  • Decides who to escalate to
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17
Q

What are the different ASA grades? Give some examples of patients that would fit into each grade.

A

Helps to work out a patient’s fitness for anaesthesia and the risk of perioperative complications

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18
Q

What is the HAS-BLED score for and how do you interpret it?

A

Assess 1-year risk of major bleeding in people taking anticoagulants for atrial fibrillation

  • Low risk for major bleed = 1 or less
  • Moderate risk for major bleed = 2
  • High risk for major bleed = 3-5
  • Very high risk for major bleed = 6 or more
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19
Q

What is the Rockall score for and how do you interpret it?

A

Identify patients at risk of rebleeding or death following acute upper GI bleed

Looks at clinical bleeding AND endoscopy results

- <3 low risk of rebleeding

- 6 or more then surgery indication

- 8 or more high risk of mortality

20
Q

What is the P-POSSUM score for?

A

Used to predict morbidity and mortality for general surgery (not for trauma patients)

Looks at both patient and operative factors

21
Q

What is the NELA score?

A

Calculate risk of death within 30 days of emergency laparotomy abdominal surgery

22
Q

What is the Ranson score and how do you interpret the score?

A

Used to predict the severity and mortality of acute pancreatitis

Looks at age, WBC, glucose, LDH and AST on admission then 48 hours later looks at more parameters

23
Q

What is the ROME IV score for IBS and how do you interpret it?

A

Patients with symptoms of IBS, such as chronic and recurrent abdominal pain and/or altered bowel habits for at least 6 months

24
Q

What is the ROME IV score for constipation and how do you interpret it?

A

Diagnoses constipation, looks at stools being constipated 25% of the time

25
Q

What is the PHQ-9 score and how do you interpret it? (remember image)

A

Works out depression severity and helps decide what treatment to do

26
Q

What is a GAD-7 score and how do you interpret the score?

A

Cut off point of 10 or more for diagnosing probable GAD

5,10,15 for mild, moderate, severe anxiety

27
Q

What is a FAST score and how do you interpret the score?

A

Alcohol harm assessment tool used in A+E

Score of 3 or more is FAST positive and prompts and AUDIT questionnaire

28
Q

What is a AUDIT score and how do you interpret the score?

A

● 0 to 7 indicates low risk

● 8 to 15 indicates increasing risk

● 16 to 19 indicates higher risk,

● 20 or more indicates possible dependence

29
Q

What is a GPCOG score and how do you interpret the score?

A

GP screening tool for cognitive impairment/dementia

- 9 = no significant cognitive impairment and further testing not necessary.

- 5-8 = more information required. Proceed with Step 2, informant section.

- 0-4 = cognitive impairment is indicated. Conduct standard investigations

30
Q

What is the STaRTBack tool and how do you interpret the score?

A

Tool to screen primary care patiets with lower back pain for prognostic indicators

Helps modify patient risk factors and match them up with a treatment plan

31
Q

How do you work out the probability of a PE?

A

Wells Score:

0-2 LOW

3-6 MODERATE

OVER 6 HIGH

32
Q

What patients is CTPA contraindicated in?

A
  • Renal failure
  • Allergy to contrast
33
Q

What are causes of a PE?

A
  • Blood clot from DVT
  • Fat embolism from fracture
  • Air embolism
  • Malignancy
34
Q

What is the emergency assessment and management of anaphylaxis?

A

Assessment:

  • ABCDE
  • BP, Pulse, Sats
  • ECG

Management (See image)

  • 100% Oxygen
  • IM adrenaline 0.5mg
  • Chloramphenamine 10mg
  • IV fluid challenge
  • Serum triptase
35
Q

What are some causes of anaphylaxis?

A
  • Drugs e.g NSAIDs, penicillins
  • Insect bites or stings
  • General anaesthetic
  • Foods e.g nuts
  • Latex
36
Q

What are the consequences of anaphylactic shock?

A
  • Shock
  • Airway obstruction
  • Death
37
Q

What advice should be given to a patient on discharge after an anaphylactic shock?

A
  • Give two epipens and teach how to use
  • Allergen avoidance
  • Refer to specialist allergy clinic
38
Q

What is involved in sepsis 6 snd what are some common causes of sepsis?

A
  • Pneumonia
  • UTI
  • Pyelonephritis
  • Catheter infection
  • Line infection
  • Bacteraemia
39
Q

What is the most sensitive test for diagnosing an ACL tear?

A

Lachmans (not Anterior Drawer)

40
Q

What is the ASA grade of this woman?

A

ASA 2

Having uncontrolled hypertension and BMI>40 would make her 3

41
Q

Where are hernias in relation to the pubictubercle

A
42
Q

A 65 year old man is found to have a AAA of 4.6cm, how often is he followed up with US?

A

3-4.4cm: yearly

4.5-5.4cm: 3 monthly

43
Q

How do you classify a farmyard injury with Gustillo Anderson classification?

A

Automatically type 3

44
Q

What is the most likely diagnosis?

A

Amyloid Nephropathy

  • Visible nodules + Congo Red Staining = Apple Green birefrigence
45
Q

What drugs cause drug-induced lupus?

A

CHIMP

46
Q

What is the most appropriate first line management?

A

IM benzylpenicillin and transfer to hospital

47
Q

What is the most appropriate management for this patient?

A

Amitriptylline or NSAIDs

(>3 days do not give aciclovir give above treatment, <3days give aciclovir)

Y3 Medicine (24 decks)

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