Diagnostic Criteria Flashcards
Probability of sinusitis in adult (5 criteria)
- Maxillary Toothache
- Purulent secretion on phys exam
- Hx of colored nasal discharge
- Decongestants ineffective
- Abnormal transillumination
Positive: 1= 21% 2=40% 3=63% 4=81% 5=92% of adults have sinusitis
Bacterial sinusitis diagnosis adults (4)
- Purulent rhinorrhea (worse on one side)
- Bilateral purulent rhinorrhea
- Pus in nasal cavity (on exam)
- Maxillary sinus pain (worse on one side)
Positive: 1= 4% 2=50% 3=85% 4=85% of patients have bacterial sinusitis
Centor Criteria for Strep. Pharyngitis
- Fever - Temp > 38
- Absence of cough (cough more likely viral)
- Swollen anterior cervical lymphadenopathy
- Tonsillar swelling or exudates
- Age
3-14 yrs = +1
15-44 = 0
>45 = -1
4-5 = 53% have strep
0-1 no abx, symptomatic tx
2 and above get rapid strep and/or culture except all children get culture
4: tx with empiric antibiotics
Modified duke criteria
Positive if 2 major 5 minor 1 major + 3 minor 1 histo finding
MAJOR
1. typical microorgansim for IE from TWO separate blood cx
(ex Viridians, streptococci, Staphylococcus aureus, Streptococcus bovis, HACEK group (Haemophilus spp. Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella spp., and Kingella kingae),
- single positive bcx for Coxiella
- Evidence of endocardial involvement: Positive echocardiogram for IE, abscess, new valvular regurgitation (not a worsening or changing of preexisting murmur)
minor:
1. Predisposing heart condition or IVDA
2. Fever
3. Vascular phenomena (emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjuctival hemorrhages, Janeway lesions
4. Immunologic phenomena:
- Glomerulonephritis
- Osler’s nodes
- Roth’s spots
- Rheumatoid factor
- Microbiological evidence
- BCX that does not meet major criterion (organisms inconsistent with IE or single positive) or serologic evidence of organism consistent with IE
Pathologic: (if any positive definitely have)
1. Vegetation or intracardiac abscess present confirmed by histology
- Bacteria demonstrated by culture or histology in a vegetation or in a vegetation that embolized or in an intracardiac abscess.
the Ottawa ankle rules/foot rules
Within 10 days of injury
- There is any pain in the malleolar zone; AND
- Any one of the following:
-Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus,
OR
-Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus,
OR
An inability to bear weight both immediately and in the emergency department for four steps.
- There is any pain in the midfoot zone; and
- Any one of the following:
-Bone tenderness at the base of the fifth metatarsal (for foot injuries),
OR
-Bone tenderness at the navicular bone (for foot injuries),
OR
-An inability to bear weight both immediately and in the emergency department for four steps.
GET THE XRAY
Indications of renal biopsy for CKD
After:
- renal imaging (ultrasound)
- microscopic eval of urine sample
If
- Unknown etiology after hx or lab eval
- suspect parenchymal disease
- or if prognosis or tx will be based on biopsy
CI if bil small kidneys on imaging (low likelihood of improving outcome) bc small = irreversible
Rheumatic fever diagnostic criteria
- throat cultures growing GABS OR
- elevated anti-streptolysin o
+
2 major OR
1 major and 2 minor
Major criteria
1. Arthritis (migratory polyarthritis)
2. Carditis (clinical and/or subclinical)
3. subcutaneous nodules
4. Erythema marginatum
5. Chorea
Minor criteria:
1. Polyarthralgia (joint pain no inflammation)
2. Fever (≥38.5° F),
3. sedimentation rate ≥60 mm and/or C-reactive protein (CRP) ≥3.0 mg/dl
4. Prolonged PR interval if carditis not established
5. Leukocytosis
ACR diagnostic criteria of RA
Any patient with 6 or more points after the criteria have been applied is considered to have RA.
Before the criteria can be applied, patients need to have at least 1 joint with synovitis
Joint distribution:
1 large joint - 0 points
2-10 large joints - 1 point
1-3 small joints (large joints excluded) - 2 points
4-10 small joints (large joints excluded) - 3 points
> 10 joints (at least 1 small joint) - 5 points.
Serology
Negative RF and negative anticyclic citrullinated peptide (anti-CCP) antibodies - 0 points
Low positive RF or anti-CCP antibodies (≤3 x upper normal limit) - 2 points
High positive RF or anti-CCP antibodies (>3 x upper normal limit) - 3 points.
Symptom duration:
<6 weeks - 0 points
≥6 weeks - 1 point.
Acute-phase reactants:
Normal CRP and ESR - 0 points
Abnormal CRP or ESR - 1 point.
CURB-65
Predicting mortality from CAP
- Confusion
Yes+1 - BUN > 19 mg/dL (> 7 mmol/L)
Yes+1 - Respiratory Rate ≥ 30
Yes+1 - Systolic BP < 90 mmHg or Diastolic BP ≤ 60 mmHg
Yes+1 - Age ≥ 65
Yes+1
The CURB-65 is used as a means of deciding the action that is needed to be taken for that patient.
0-1: Treat as an outpatient
2: Consider a short stay in hospital or watch very closely as an outpatient
3-5: Requires hospitalization with consideration as to whether they need to be in the intensive care unit
Diagnostic criteria for metabolic syndrome (5)
- Waist circumference (central obesity) inches (89 centimeters) for women and 40 inches (102 centimeters) for men.
- TAGs > 150 mg/dl or being treated for elevated TAGs
- Low HDL cholesterol <50
- HTN >130/85
- Fasting glucose >100 mg/dl
3/5 = metabolic syndrome
Confers greater risk for CVD or diabetes
Irritable bowel syndrome ROME III diagnostic criteria
Onset of symptoms at least 6 months prior
With the past 3 months…
At least 3 days per month experiencing abdominal pain associated with at least 2 of the following…
- Improvement with defecation
- Change in stool frequency
- Change in stool appearance
HASBLED
HAS-BLED is a scoring system developed to assess 1-year risk of major bleeding in patients taking anticoagulants with atrial fibrillation.
H Hypertension: (uncontrolled, >160 mmHg systolic)
A Abnormal renal function: Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L
Abnormal liver function: Cirrhosis or Bilirubin >2x Normal or AST/ALT/AP >3x Normal
S Stroke: Prior history of stroke
B Bleeding: Prior Major Bleeding or Predisposition to Bleeding
L Labile INR: (Unstable/high INR), Time in Therapeutic Range 65 years
D Prior Alcohol or Drug Usage History (≥ 8 drinks/week)
Medication Usage Predisposing to Bleeding: (Antiplatelet agents, NSAIDs)
whereby a score of ≥3 indicates “high risk” and some caution and regular review of the patient is needed.[4] The
Well’s score
0-4 PE unlikely
4+ PE likely
- Evidence/signs of DVT +3
- Diagnosis other than PE unlikely +3
- Tachycardia >100 +1.5
- Immobilization or surgery in past 4 weeks +1.5
- previous DVT +1.5
- hemoptysis +1
- malignancy +1
Low probability > d-dimer > CTAngio if pos
High probability >CTAngio > Ventilation/perfusion scan if inconclusive
Gout diagnosis
Points are scored as follows:
- acute onset with maximum symptoms within 1 day +0.5
- joint erythema +1.0
- cardiovascular disease or hypertension +1.5
- male sex +2.0
- previous attack of joint pain or arthritis +2.0
- first metatarsophalangeal joint involved +2.5
- serum uric acid >5.88 mg/dL +3.5
The maximum score is 13.0 points. A score ≥8.0 would mean a clinical diagnosis of gout. Nongout diagnoses should be considered if the score is ≤4 points. An intermediate point total of 4.5–7.5 calls for either joint aspiration for polarized light microscopy or referral to a rheumatologist.
Rotterdam criteria for PCOS
Two of the following three.
- Hyperandrogenism - hirsutism OR elevated serum androgen levels
- Oligomenorrhea with cycle length greater or equal to 35 days
- Twelve or greater small follicles in an ovary on pelvic ultrasound
> weight loss, use of combined contraceptive, and metformin to prevent insulin resistance
