Classification Flashcards
Classification - dyspoea in COPD
mMRC
0: dyspnoeic after strenous exercise
1: dyspnoeic when hurrying on level ground/ walking uphill
2: more dyspnoeic than same age/ takes breaks at own pace
3: 100 yards or a few mins
4: cannot leave the house, dyspnoeic when getting dressed
COPD Classification
GOLD Grading
A: mMRC (sx) < 2 + exacerbation (risk) < 2
B: mMRC (sx) > 2 + exacerbation (risk) < 2
C: mMRC (sx) < 2 + exacerbation (risk) > 2 or 1 admin
D: mMRC (sx) < 2 + exacerbation (risk) > 2 or 1 admin
Pneumonia Severity Score
CURB-65 Confusion, Urea > 7mmol/L, RR>30, BP < 90/60 Mild - 1: Manage in Community Moderate - 2: Admit Severe > 3: Admit + Consider ICU
Staging Criteria for Sarcoisodis?
Scadding Criteria
0: Normal CXR
1: Hilar or Mediastinal Enlargement only
2: Nodal Enlargement + Parenchymal Disease
3: Parenchymal Disease only
4: End-stage Lung Disease (Pulmonary Fibrosis)
Pleural Effussion Criteria?
Light’s Criteria
Transudate:
Protein (pleural/serum) < 0.5
LDH (pleural/serum) <0.6
Exudate:
Protein (pleural/serum) > 0.5
LDH (pleural/serum) > 0.6
Well’s Score PE
Signs + Sx: 3 Most likely dx: 3 TC >100bpm: 1.5 Immobilization >3d, recent surgery < 4 wks: 1.5 Hx. VTE: 1.5 Haemoptysis: 1 Malignancy (tx < 6months): 1
PE
Likely > 4
Unlikely < 4
Well’s Score DVT
Paralysis, Paresis, PLaster immobilization: 1 Immobilization, Surgery < 12weeks: 1 Malignancy: 1 U/L pitting oedema: 1 Localized Tenderness - distribution of deep venous system: 1 Entire leg swollen: 1 Collateral Superficial veins: 1 Hx. DVT: 1 Swelling > 3cm larger than C/L side: 1 Other Dx more likely: - 2
DVT
Likely >2
Unlikely < 2
AKI Classification?
RIFLE
Severity:
Risk:
^ SCreat x1.5, GFR red 25%, UO < 0.5ml/kg/hr x 6hrs
Injury:
^ SCreat x2, GFR red 50%, UO < 0.5ml/kg/hr x 12hrs
Failure:
^ SCreat x3, GFR red 75%, UO < 0.3ml/kg/hr x 24hrs (oliguria) or anuria x 12hrs
Outcome:
Loss: Persistent ARF >4weeks
ESKD: >3months
AKI Staging?
KDIGO 2012 Classification
Stage 1: ^ SCreat x1.5, UO < 0.5ml/kg/hr x >6hrs
Stage 2: ^SCreat x2, UO < 0.5ml/kg/hr x >12hrs
Stage 3. ^SCreat x3, UO < 0.3ml/kg/hr >24hrs (oliguria) or anuria >12hrs
Thyroid FNA Cytology Classification?
British Thy System
Thy1: Non-diagnostic
Thy2: Non-neoplastic
Thy3a: Atypical fetaures present
Thy3f: Follicular neoplasm suspected
Thy4: Suspicious of malignancy
Thy5: Diagnostic of malignancy
Cirrhosis Classification?
Child-Pugh Score
Total Bilirubin (umol/L): 1 point <34, 2 points 34-50, 3 points >50
Serum Albumin (g/L): 1 point >35, 2 points 28-35, 3 points <28
PT INR:
1 point <1.7, 2 points 1.7 - 2.3, 3 points > 2.3
Ascites:
1 point None, 2 points Mild, 3 points Mod - Severe
Hepatic Encephalopathy:
1 point None, 2 points GI-GII, meds, 3 points GIII-GIV, Refractory
Class A: 5-6 100% 1-year survival
Class B: 7-9 80% 1-year survival
Class C: 10-15 45% 1-year survival
Scoring System for Wilson’s Disease
Liepzig Criteria
KF Rings
Neurological Sx
Serum Caeruloplasmin
Coombe’s -ive haemolytic anaemia
Liver Cu
Urinary Cu
Mutation Analysis (ATP7B)
Hepatic Encephalopathy
Grade 1: Changes in behaviour, mild confusion, slurred speech, disordered sleep
Grade 2: Lethargy, moderate confusion
Grade3: Marked confusion (stupor), incoherent speech, sleeping but arousable
Grade 4: Coma, Unresponsive to pain
Glascow Coma Score
E1: Unresponsive
E2: Pain
E3: Speech
E4: Spontaneously
V1: Unresponsive V2: Incomprehensible sounds V3: Inappropriate words V4: Confused V5: Orientated -time, person, place
M1: No Response M2: Abnormal Extension (decerebrate) M3: Abnormal Flexion (decorticate) M4: Flexion withdrawl from pain M5: Moves to localized pain M6: Obeys commands
3: Totally Unresponsive
<8: Comatose - protect airway?
Operative Morbidity + Mortality
P-POSSUM
Physiological + Operative Severity Score for enUmeration of Morbidity + Mortality
Parameters Age Cardiac Signs Respiratory History Systolic BP (mmHg) Pulse GCS Hb WCC Urea Sodium Potassium Echo
Operative Severity: Multiple surgeries Total Blood Loss Peritoneal Soiling Malignancy Mode of Surgery
Classification of Hepato Renal Syndrome
Type 1: Cirrhois with rapidly progressive acute renal failure
Type 2: Cirrhosis with sub acute renal failure
Type 3: T1 or T2 HRS superimposed on CKD/AKI
Type 4: Fulminant liver failure with HRS
Prognosis in Liver Failure/ Predict Survival following TIPS placement
MELD: Model for End Stage Liver Disease
3.78 x loge serum bilirubin (mg/dL) + 11.2 x loge INR + 9.57 x log e serum creatinine (mg/dL) + 6.43 (constant for liver disease aetiology)
King’s College Hospital Criteria for Acute Liver Failure
Paracetamol
pH <7.3 or Arterial Lactate>3.5 (@4hrs) or >3 (@12hrs) or PT > 100s (INR >6.5)
Serum Creatinine > 300
Grade 3 or 4 Encephalopathy
King’s College Hospital Criteria for Acute Liver Failure
Non-Paracetamol
PT >100s (INR > 6.5), irrespective of encephalopathy
or
Any 3 of;
1. Age < 11 > 40
2. Aetiology of non-A/B hepatitis, halothane hepatitis, idiosyncratic drug use
3. Jaundice > 7d before onset of encephalopathy
4. PT > 50s (INR > 3.5)
5. Serum Bilirubin > 17mg/dL
Aortic Stenosis Classification
Mild - Moderate - Severe
Moderate:
Jet Velocity 3-4 m/s
Transvalvular Gradient 20-40 mmHg
Valve Area 1 - 1.5 cm2
Functional Classification of Heart Failure?
NYHA - New York Heart Ass.
1: No Limitation. Normal exercise - doesn’t cause fatigue or dyspnoea
2: Mild Limitation. Comfortable @ rest. Normal exercise - fatigue + dyspnoea
3: Marked Limitation. Comfortable @ rest. Less than normal exercise - fatigue + dyspnoea
4: Debilitated. Sx of HF @ rest
Staging Classification for Heart Failure?
ACC - American College of Cardiology
A: At risk but no structural disease or symptoms
B: Structural Heart Disease. No Sx
C: Structural Heart Disease + Current/ Previous Sx
D: Refractory HF - req. specialist intervention
Framingham Criteria
Dx of HF
2 major or 1major + 2 minor
Major: S3 - Gallop Rhythm Pulmonary Oedema Weight Loss > 4.5kgs - 5days when tx Abdominojugular Reflux Distended Neck Veins Increased Cardiac Shadow - CXR
Minor: Hepatomegaly B/L Effusions - CXR B/L Peripheral Oedema TC > 120bpm Dyspnoea - ordinary exertion Nocturnal Cough
Dx. Infective Endocarditis?
Modified Duke Criteria
2 major + 1 minor
1 major + 3 minor
5 minor
Major Criteria
Blood Cultures
2 +ive seperate Cultures - typical organisms
3 +ive cultures, persistently +ive >12 apart
1 +ive culture - coxiella burnetti
Endocardium Involvement
Echo - vegetation, abscess, pseudoaneurysm, dehiscence, prosthetic valve
PET CT - ^ Activity aroud prosthetic valve
Cardiac CT - Paravalvular Lesions
Minor Criteria Predisposition (IVDU, Cardiac Lesion) Fever > 38degrees Vascular Phenomenon Immunological Phenomenon \+ive blood culture that does not meet major criteria
Risk Stratification - ACS
Killip Classification
30 day mortality
Class I: No clinical signs - HF (6%)
Class II: Crackles, S3, JVP (13%)
Class III: Acute Pulmonary Oedema - Flash (38%)
Class IV: Cardiogenic Shock (81%)
Functional Dyspepsia
Rome Criteria
Continuous Dyspepsia 3/12 Dx of Exclusion >/= 1 of Postprandial Fullness Early Satiety Epigastric Pain Burning No evidence structural disease
Classification of SAH?
Hunt + Hess Scale
Grade 1: Asymptomatic or mild headache
Grade 2: Mod-Severe Headache, Occulomotor Palsy
Grade 3: Confusion, Drowsy or mild focal signs
Grade 4: Stupor (localizes to pain)
Grade 5: Coma (posturing or no motor response to pain)
Stages of Clubbing
1: Normal appearace + angle but increased loss of fluctuancy of the nail bed
2: Loss of angle between nail + nailbed
3: Increase curvature of nail
4: Expansion of terminal phalynx - drumstick appearrance
ARDS Definition?
Berlin Criteria Acute Onset: within 1 week of insult/worsening resp sx Hypoxia: Mild: P:F <300, PEEP/CPAP >/= 5 Mod: P:F <200, PEEP/CPAP >/= 5 Severe: P:F < 100, PEEP/CPAP >/= 5
Lung Water (inflammatory/pulmonary oedema): not fully explained by cardiac failure or fluid overload
Abnormal CXR: B/L opacities (not explained by effusion, collaspe, malignancy or nodules)
Inflammatort Spinal Pain?
ASAS definition
spinal pain > 3 months +
>/=4 of
onset < 40yrs insidious onset improves with exercise no improvement with rest pain at night (improves on getting up)
Criteria for Psoriatic Arthritis
CASPAR criteria
inflammatory articular disease, w/t >/= 3 of
Evidence of psoriasis: personal, past, FHx
Psoriatic Nail Dystrophy
-ive test for Rh Factor
Dactylitis: current or Hx
Radiological evidence of juxta articular new bone formation
CKD Criteria
Either of the following > 3months
1+ Albuminuria - ACR > 30mg/g Urine Sediment Abnormalities Electrolyte or Other abnormalities Histological Abnormalities Structural Abnormalities detected by imaging Hx Kidney Transplant
GFR < 60mL/min/1.73m2
Stages of CKD
KDIGO
G1: eGFR > 90 - normal
G2: eGFR < 90 - mildly decreased
G3a: eGFR < 60 - mild to mod decreased
G3b: eGFR < 45 - Moderately-severe decreased
G4: eGFR < 30 - severely decreased - nephrology F/U
G5: eGFR <15 - ESKD - dialysis
Diabetic Nephropathy Characteristics
Clinical Syndrome
- Persistent Albuminuria > 300mg/day 2 occcasions 3-6/12 apart
- Progressive decline in eGFR
- Elevated arterial BP
Stratifying Risk of Stroke following TIA
ABCD2 Age > 60yrs (1) BP > 140/90 (1) Clinical Features: - U/L waekness (2) - Slurred Speech without weakness (1) Duration of Sx - Sx > 1hr (2) - Sx 10- 60mins (1) Diabetes (1)
Score > 4 high risk - assessed within 24hrs
Mortality in SAH
I: None II: Neck Stiffness + CN Palsy - 11% III: Drowsiness - 37% IV: Drowsy with hemiplegia - 71% V: Prolonged Coma - 100%
Traumatic Brain Injury Classification
I: No visible intracranial injury
II: Cisterns present, Midline shift < 5mm, small, high or mixed density lesion < 25cc
III: Cisterns compressed or absent
IV: midline shift > 5mm
