Diagnostic Criteria Flashcards
JONES Criteria
RHEUMATIC FEVER
2 major or 1 major + 2 minor
J - migratory polyarthritis O - heart (pericarditis, CHF, valve disease) N - subQ nodules E - erythema marginatum S - S. chorea
- fever
- elev ESR
- polyarthralgia
- prior rheumatic fever
- prolonged PR
- evid preceding strep infection
Duke Criteria
INFECTIOUS ENDOCARDITIS
2 major or 1 major 3 minor or 5 minor
- Sustained bacteremia of known endocarditis organism
- New regurg or abnormality seen on valve imaging
- fever
- predisposing condition - abnormal valve
- vascular signs (PE, janeway lesions, ICH)
- immune signs (Osler nodes, glomerularnephritis, RF, roth spots)
- Pos blood cx - not known organism
- Pos echo - not major criteria
Definition of Hypertensive Urgency / Emergency
Sys > 220
OR diastolic > 120
EMER = signs end organ damage (altered, papilledema, renal failure, hematuria, USA, MI, CHF, pulmonary edema)
SIRS
2+ of following
- Temp >38 or < 36
- Hyperventilation >20 or PaCO2 < 32
- Tachy > 90
- WBC > 12 or <4 or >10% bands
Sepsis
Septic Shock
Sepsis - SIRS + source of infection
Shock - sepsis + hypotension despite adequate fluids
Indications for Home O2 Requirement
SaO2 < 88%
PaO2 < 55
PaO2 55-59 but evidence for pulmonate or polycythemia
Light’s Criteria
EXUDATIVE IF …
- Pleural protein / serum protein > .5
- Pleural LDH / serum LDH > .6
- Pleural LDH > 2/3 ULN for serum LDH
ARDS
BERLIN CRITERIA
Bilat infiltrates on CXR (white out)
Pulmonary edema not explained by CHF or fluid overload (wedge pressure < 18)
PaO2/FiO2 = 100 - 300 (100 being more severe)
***AKA hypoxemia refractory to oxygen therapy
Pulmonary HTN
Mean pulmonary artery pressure > 25 mmHg
Well’s Criteria
Sx or signs DVT - 3 pt
Alt diagnosis less likely - 3 pt
HR > 100 - 1.5 pt
Immobilization for 3 days or surgical in 4 wks - 1.5 pt
Previous DVT or PE - 1.5 pt
Hemoptysis - 1 pt
Malignancy (pall or therapy in last 6 mo) - 1 pt
Score > 4 means PE likely
SAAG
Serum Ascites Albumin Gradient
Serum albumin - ascites albumin
If > 1.1 then portal HTN likely
Indications for Paracentesis of Ascites
- New onset ascites
- Worsening ascites
- Suspected SBP
SBP Dx
WBC > 500 or PMN > 250 in ascites fluid
Cx - can be negative
Child’s Score
Ascites - none/moderate/severe
Bili - <2/2-3/>3
Encephalopathy - none/moderate/severe
INR - <1.7 / 1.7-2.3 / > 2.3
Albumin - > 3.5 / 2.8 - 3.5 / < 2.8
A - 5 to 6 pts
B - 7 to 9 pts
C - 10 to 15 pts
PBC v. PSC v. AIH
Primary Biliary Cirrhosis - AI, women, AMA
Primary Sclerosing Cholangitis - UC
Autoimmune Heptatitis - anti smooth muscle and anti liver kidney
Ranson Criteria
Pancreatitis Prognosis
ADMISSION (“ga law”)
- Glucose > 200
- Age > 55
- LHD > 350
- AST > 250
- WBC > 16,000
48 HOURS ("c hobbs")
Ca < 8
HCT dec >10%
PaO2 < 60
BUN inc > 8
Base Deficit > 4
Fluid sequestration > 6 L
Mortality approaches 100% if 7+ criteria
DM Dx
2 fasting > 125
Single random glucose > 200 + sx
2 hr post-prandial > 200 (give 75 g load)
HgbA1c > 6.5%
Criteria for Brain Death
Irreversible absence of brain or brainstem function (apnea, no pupil, doll’s eyes, etc)
No drug or metabolic intoxication present
Body temp > 32
Clinical evidence or imaging to provide cause of brain death
Repeat exam or repeat EEG (isoelectric)
Criteria for Brain Death
Irreversible absence of brain or brainstem function (apnea, no pupil, doll’s eyes, etc)
No drug or metabolic intoxication present
Body temp > 32
Clinical evidence or imaging to provide cause of brain death
Repeat exam or repeat EEG (isoelectric)
MS Dx
2 episodes of sx + evidence 2 white matter lesions
2 episodes of sx + 1 white matter lesion + oligoclonal bands in CSF
SLE Dx
4/11 Sx
Rash (4) - malar, discoid, ulcers, photosensitive
Arthritis
Pericarditis, pleuritic
Heme - anemia, leukopenia, thrombocytopenia, etc
Renal - > .5 g/day protein
CNS - sz or psychosis
Anti DS DNA, false pos syphilis, anti-smith
Pos ANA
What test is used for scleroderma dx?
Schirmer - filter paper to test lacrimal secretion
RA Dx
- inflammation of 3+ joints
- sx for 6+ wks
- Elev CRP and ESR
- Pos RF or anti-CPP
- Xrays showing erosion and peri-articular de-calcifications
Polymyositis
- Symm proximal muscle weakness
- Elev CPK
- EMG myopathy findings
- Muscle biopsy showing myositis
***If rash then diagnosis is dermatomyositis
Fibromyalgia
Widespread axial pain for 3+ mo
11/18 possible tender points
R/o RA, hypothyroid, Lyme, depression, ankylosing spondylitis, etc
Various Vasculitis Dx
Giant Cell Temporal - temporal artery biopsy
Takayasu - arteriogram
Churg-Strauss - pANCA and eosinophilia
GPA - c-ANCA + lung biopsy, hematuria
PAN - pANCA, NO LUNG IINVOLVEMENT, biopsy of tissue or mesenteric angiography
AKI
Increase in serum creatinine by ≥0.3 mg/dL within 48 hours
Increase in serum creatinine to ≥1.5 times baseline, which is known or presumed to have occurred within the prior seven days
Urine volume <0.5 mL/kg/hour for six hours
MGUS v Mult Myeloma
MGUS
- IgG spike < 3 g
- < 10% plasma cells in bone marrow
- Bence jones proteinuria < 1 g / 24 hrs
- no end organ damage
MM - > 10% abnormal plasma cells in bone marrow + 1 of following ... 1- M protein in serum 2- M protein in urine 3- lytic bone lesions on imaging
CML v. True Leukomoid Reaction
Leukomoid
- no splenomegaly
- inc leukocyte alkaline phos
- hx infection
CML
- splenomegaly
- dec leukocyte alkaline phos
- no infection recently
Polycythemia Vera
3 MAJOR or 2 MAJOR + 2 MINOR
Maj
- RBC mass > 32 women, > 36 men
- O2 sat > 92%
- splenomegaly
Min
- Platelets > 400
- WBC > 12
- Leuk alk phos > 100 w/o infection or fever
- Vit B12 > 900
Essential Thrombocytopenia
Platelets > 600,000
Pos PPD by Population
Pos > 15 mm in normal patient
Pos > 10 mm if high-risk prison/immigrants/DM
Pos > 5 mm if HIV, steroid user, organ transplant, contact w/ someone w/ active Tb
