Surgical Sieves and Scoring

Question 1

CHADS2(VASC)

Answer 1

Calculates stroke risk for patients with atrial fibrillation:

Congestive Heart Failure
Hypertension
Age >75 years
Diabetes Mellitus
previous Stroke/TIA
VASCular Disease
Female

Question 2

HAS-BLED

Answer 2

Estimates risk of major bleed for patients on anticoagulation to asses risk-benefit in AF care:

Hypertension
Abnormal Renal and Liver Function
Stroke
Bleeding
Labile INR
Elderly (>65)
Drugs/Alcohol (Aspirin, clopidogrel, NSAIDs)

Question 3

CURB-65

Answer 3

Assesses the severity of community-acquired pneumonia (0-5):
Confusion
Urea >7mmol/L
Resp Rate >30
BP <90 systolic or <60 diastolic
65 years or over
(0-1 <5%; 2-3 <10%; 4-5 15-30% mortality)

Question 4

The Blatchford Score

Answer 4

Stratifies patients presenting with haematemesis into low and high risk groups. They are used to guide whether a patient can be managed as an outpatient (0) or if they need urgent intervention (6 or more) - It is important to not that if patient has score in between 0-6, it does not necessarily meant hey have to be admitted. Clinician must use context.

Question 5

Rockall Score (Pre-endoscopy)

Answer 5

Score used to predict the risk of rebleeding and mortality in patients with upper GI haemorrhage. Also used to indicate severity of bleed that help guides the urgency of an endoscopy for patients who have YET to have one.

Question 6

Rockall Score (Post-endoscopy)

Answer 6

Helps stratify which patients need endoscopy and intensive care. IT is less accurate at identifying low-risk patients.

Question 7

Child-Pugh Score

Answer 7

Useful in the prognosis of patients with cirrhosis.

Score of 5-6 (Class A) has 100% one year survival, whilst 10-15 (Class C) has 45%.

The higher the score, the more likely the patient has portal hypertension, varices and ultimately, haematemesis

Question 8

MELD

Answer 8

Model for End-Stage Liver Disease:

1. Used to stratify patients >12 yrs on liver transplant waiting list.
2. Predicts mortality for:
   a. after TIPSS
   b. cirrhotic pt going through non-transplantation surgical procedures
   c. Acute alcoholic hepatits
   d. Acute variceal haemorrhage

Question 9

Glasgow Score (Severity of Pancreatitis)

Answer 9

PaO2 <8kPa
Age >55 
Neutrophilia >15x10^9
Calcium <2.0 mM
Rental Function (UREA) >16 mM
Enzymes (LDH) >600 U/L or AST >200 U/L
Albumin <32 g/L
Sugars >10 mM in non-diabetics 

Score of 3/8 is classed as SEVERE Pancreatitis

Question 10

SIRS (systemic inflammatory response syndrome)

Answer 10

1. Temperature >38 or <36
2. HR >90bpm
3. RR >20/min or pCO2 <4.3 kPa
4. WCC >12 or <4