24 - Clinical Scoring Systems Flashcards
What is the treatment for a DVT and how soon should you start it?
- 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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What are some important medications to remember to put on a prescription for a newly admitted patient?
- Oxygen
- 5000 units dalteparin
- Paracetamol PRN
- Cyclizine PRN
How do you document a ward round?
- Age
- Admitted with
- Background
- Bloods and EWS
- SOAP
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SOAP
Subjective
Objective
Assessment
Plan
How do you calculate a GCS score? (learn image of by heart)
- Eyes 4
- Verbal response 5
- Motor response 6
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How do you interpret a GCS score?
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How do you calculate a CURB 65 score and interpret it?
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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How do you calculate and interpret a Centor score?
Works out the likelihood a pharyngitis is due to Group A strep
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- 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
How do you calculate and interpret a FeverPAIN score?
- 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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How do you calculate and interpret a CHA2DS2-VASc score? (memorise image)
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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What is the BTS classification of asthma severity?
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
What is the MRC dyspnea scale?
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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What are the different stages of CKD?
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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What is the MRC grading of muscle power?
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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How do you calculate a Wells score for DVT and how do you interpret the results? (remember criteria)
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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How do you calculate a Wells score for PE and how do you interpret the results? (remember criteria)
Score of 4 or less then PE unlikely
Score over 4 then PE likely
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How does a NEWS score inform a management plan?
- Decides frequency of observations
- Decides who to escalate to
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What are the different ASA grades? Give some examples of patients that would fit into each grade.
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Helps to work out a patient’s fitness for anaesthesia and the risk of perioperative complications
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What is the HAS-BLED score for and how do you interpret it?
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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What is the Rockall score for and how do you interpret it?
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
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What is the P-POSSUM score for?
Used to predict morbidity and mortality for general surgery (not for trauma patients)
Looks at both patient and operative factors
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What is the NELA score?
Calculate risk of death within 30 days of emergency laparotomy abdominal surgery
What is the Ranson score and how do you interpret the score?
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
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What is the ROME IV score for IBS and how do you interpret it?
Patients with symptoms of IBS, such as chronic and recurrent abdominal pain and/or altered bowel habits for at least 6 months
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What is the ROME IV score for constipation and how do you interpret it?
Diagnoses constipation, looks at stools being constipated 25% of the time
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What is the PHQ-9 score and how do you interpret it? (remember image)
Works out depression severity and helps decide what treatment to do
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What is a GAD-7 score and how do you interpret the score?
Cut off point of 10 or more for diagnosing probable GAD
5,10,15 for mild, moderate, severe anxiety
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What is a FAST score and how do you interpret the score?
Alcohol harm assessment tool used in A+E
Score of 3 or more is FAST positive and prompts and AUDIT questionnaire
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What is a AUDIT score and how do you interpret the score?
● 0 to 7 indicates low risk
● 8 to 15 indicates increasing risk
● 16 to 19 indicates higher risk,
● 20 or more indicates possible dependence
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What is a GPCOG score and how do you interpret the score?
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
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What is the STaRTBack tool and how do you interpret the score?
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
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How do you work out the probability of a PE?
Wells Score:
0-2 LOW
3-6 MODERATE
OVER 6 HIGH
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What patients is CTPA contraindicated in?
- Renal failure
- Allergy to contrast
What are causes of a PE?
- Blood clot from DVT
- Fat embolism from fracture
- Air embolism
- Malignancy
What is the emergency assessment and management of anaphylaxis?
Assessment:
- ABCDE
- BP, Pulse, Sats
- ECG
Management (See image)
- 100% Oxygen
- IM adrenaline 0.5mg
- Chloramphenamine 10mg
- IV fluid challenge
- Serum triptase
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What are some causes of anaphylaxis?
- Drugs e.g NSAIDs, penicillins
- Insect bites or stings
- General anaesthetic
- Foods e.g nuts
- Latex
What are the consequences of anaphylactic shock?
- Shock
- Airway obstruction
- Death
What advice should be given to a patient on discharge after an anaphylactic shock?
- Give two epipens and teach how to use
- Allergen avoidance
- Refer to specialist allergy clinic
What is involved in sepsis 6 snd what are some common causes of sepsis?
- Pneumonia
- UTI
- Pyelonephritis
- Catheter infection
- Line infection
- Bacteraemia
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What is the most sensitive test for diagnosing an ACL tear?
Lachmans (not Anterior Drawer)
What is the ASA grade of this woman?
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ASA 2
Having uncontrolled hypertension and BMI>40 would make her 3
Where are hernias in relation to the pubictubercle
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A 65 year old man is found to have a AAA of 4.6cm, how often is he followed up with US?
3-4.4cm: yearly
4.5-5.4cm: 3 monthly
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How do you classify a farmyard injury with Gustillo Anderson classification?
Automatically type 3
What is the most likely diagnosis?
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Amyloid Nephropathy
- Visible nodules + Congo Red Staining = Apple Green birefrigence
What drugs cause drug-induced lupus?
CHIMP
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What is the most appropriate first line management?
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IM benzylpenicillin and transfer to hospital
What is the most appropriate management for this patient?
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Amitriptylline or NSAIDs
(>3 days do not give aciclovir give above treatment, <3days give aciclovir)