Scoring Systems

Question 1

What is the Glasgow Coma Scale (GCS) score?

Answer 1

Scoring system used to objectively describe the extent of impaired consciousness in all types of acute medical and trauma patients.

Question 2

Three domains of calculating GCS.

Answer 2

• eye opening
• verbal response
• motor response

Question 3

GCS scoring (eye opening):

Answer 3

4 (spontaneous)
3 (to sound)
2 (to pressure)
1 (none)

Question 4

GCS scoring (verbal response):

Answer 4

5 (orientated)
4 (confused)
3 (words)
2 (sounds)
1 (none)

Question 5

GCS scoring (motor response):

Answer 5

6 (obeys commands)
5 (localising)
4 (normal flexion)
3 (abnormal flexion)
2 (extension)
1 (none)

Question 6

What is CURB-65 scoring?

Answer 6

Estimates mortality of community acquired pneumonia to help determine inpatient vs outpatient treatment.

Question 7

CURB-65 score calculation:

Answer 7

Confusion (+1)
Urea >7mmol/L (+1)
Respiratory rate ≥ 30 (+1)
Blood pressure <90/60 (+1)
Age ≥ 65 (+1)

Score 0/1 = outpatient
Score 2 = inpatient
Score 3 = ITU

Question 8

What is FeverPAIN scoring?

Answer 8

Predicts the likelihood of strep throat (and therefore need for antibiotics).

Question 9

FeverPAIN score calculation:

Answer 9

Fever (+1)

Purulent tonsils (+1)
Absence of cough (+1)
Inflammation (+1)
New onset <3 days (+1)

If FeverPAIN ≥ 4 = antibiotics

Question 10

What is CHA2DS2-VASc scoring?

Answer 10

Estimates stroke risk in patients with atrial fibrillation.

Question 11

CHA2DS2-VASc score calculation:

Answer 11

Coronary heart failure (+1)
Hypertension (+1)
Age > 75 (+2)
Diabetes mellitus (+1)
Stroke / TIA (+2)
Vascular disease (+1)
Age > 65 (+1)
Sex (F) (+1)

If CHA2DS2-VASc ≥ 1 (M) consider anticoagulation.

If CHA2DS2-VASc ≥ 2 (F) consider anticoagulation.

Question 12

Give the BTS guidelines for moderate acute asthma.

Answer 12

• PEFR 50-75% best or predicted
• no features of acute severe asthma
• increasing symptoms

Question 13

Give the BTS guidelines for acute severe asthma.

Answer 13

• PEFR 33-49% best or predicted
• respiratory rate ≥ 25/min
• heart rate ≥ 110bpm
• inability to complete sentences in one breath

Question 14

Give the BTS guidelines for life-threatening asthma.

Answer 14

• PEF <33%
• SpO2 < 92%
• PaO2 < 8kPa
• normal PaCO2

Clinical signs may include altered conscious level, exhaustion, arrhythmia, hypotension, cyanosis, silent chest or poor respiratory effort.

Question 15

Give the BTS guidelines for near fatal asthma.

Answer 15

• raised PaCO2

Question 16

What is MRC dyspnoea score?

Answer 16

Stratifies severity of dyspnoea in respiratory diseases, particularly COPD.

Question 17

MRC dyspnoea score calculation:

Answer 17

0 - dyspnoea with strenuous exercise

1 - dyspnoea when walking up a slight hill

2 - dyspnoea meaning patient has to walk slower or stop for breath

3 - dyspnoea meaning patient has to stop for breath after walking for a few minutes

4 - too dyspnoeaic to leave house or breathless when dressing

Question 18

Classification of CKD has two domains:

Answer 18

• ACR
• GFR

Question 19

Give GFR categories description and ranges when scoring CKD.

Answer 19

G1 = ≥90 (normal / high)
G2 = 60-89 (mild reduction)
G3a = 45-59 (mild-moderate reduction)
G3b = 30-44 (moderate-severe reduction)
G4 = 15-29 (severe reduction)
G5 = <15 (kidney failure)

Note if in G1/A1 or G2/A1 there is no CKD.

Question 20

Give ACR categories description and ranges when scoring CKD.

Answer 20

A1 = <3 (normal)
A2 = 3-30 (moderately increased)
A3 = >30 (severely increased)

Note if G1/A1 or G2/A1 there is no CKD.

Question 21

MRC muscle power scale calculation:

Answer 21

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

Question 22

What is ASA scoring system used for?

Answer 22

Classifies health of patients prior to surgery.

Question 23

What is ORBIT (HAS-BLED) scoring system used for?

Answer 23

Estimates major bleeding risk for patients on anticoagulation, to assess risk-benefit in atrial fibrillation care.

Question 24

What is Rockall scoring system used for?

Answer 24

Determines severity of GI bleeding, can only be determined within endoscopy.

Question 25

What is POSSUM scoring system used for?

Answer 25

Estimates morbidity and mortality for general surgery patients.

Question 26

What is NELA scoring system used for?

Answer 26

Risk calculation for estimate of death within 30 days of emergency abdominal surgery.

Question 27

What is Ranson scoring system used for?

Answer 27

Estimates mortality of patients with pancreatitis, based on initial and 48-hour lab values.

Question 28

What is ROME scoring system used for?

Answer 28

Estimates likelihood of irritable bowel syndrome as a diagnosis.

Question 29

What is PHQ-9 scoring system used for?

Answer 29

Objectifies degree of depression severity.

Question 30

What is GAD-7 scoring system used for?

Answer 30

Objectifies degree of anxiety severity.

Question 31

What is FAST scoring system used for?

Answer 31

Predicts presence of pericardial or intra-abdominal injury after penetrating or blunt trauma.

Question 32

What is GPCOG scoring system used for?

Answer 32

General Practitioner Assessment of Cognition score is designed as a GP screening tool for dementia.

Question 33

What is STaRTBack scoring system used for?

Answer 33

Estimates risk of chronicity of back pain.

Question 34

What is Epworth scoring system used for?

Answer 34

Estimates whether there is excessive daytime sleepiness that requires medical attention (e.g. sleep apnoea).

Question 35

What is Berlin scoring system used for?

Answer 35

Provides diagnostic criteria for ARDS.

Question 36

What is MUST scoring system used for?

Answer 36

Identifies patients who are malnourished or at risk of malnutrition.

Question 37

What is QRISK scoring system used for?

Answer 37

Estimates 10-year probability of having a fatal coronary event (e.g. MI, stroke).