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Medicine Extras > Management Stratification > Flashcards

Management Stratification Flashcards

1
Q

Well’s

A

DVT (/9) and PE (/12.5)

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2
Q

ABCD^2

A

Chance of Stroke Within 7 Days of TIA (/7)

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3
Q

CHA2DS2VaSc

A

Chance of Future Stroke when AF is Present (/9)

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4
Q

CURB65

A

Management of Community-Acquired Pneumonia (/5)

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5
Q

Glasgow

A

Coma (/15) and Acute Pancreatitis Grading (not diagnosis)

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6
Q

MRC ____ ?

A

Dyspnoea Scale (/4) or POWER grading for a limb.

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7
Q

List Well’s DVT scoring and the values for each:

A

(-2 to 9)
Recent Surgery / Bed Bound = 1
Active Cancer = 1
Unilateral Swollen Calf = 1
Swollen Leg = 1
Tender Deep veins = 1
Pitting Oedema = 1
Collateral Leg Veins = 1
Previous DVT = 1
Paralysis/Pariesis = 1
Other DDx = -2

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8
Q

List Well’s PE scoring and the values for each:

A

(0 to 12.5)
Signs/Sx of PE = 3
PE Number-1 Diagnosis = 3
Recent Surgery / Bed Bound = 1.5
HR >100 = 1.5
Previous DVT/PE = 1.5
Haemoptysis = 1
Cancer + Chemo = 1

E M B O L I S M
Emboism Hx ; Malignancy ; Bed-Rest ; Oral blood ; Legs affected ; Increased HR ; Signs of PE ; Most likely Diagnosis PE.

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9
Q

List ABCD^2 and the values for each:

A

(0 to 7)
Age >60 = 1
Blood Pressure >140/90 = 1
Clinical - Speech issue = 1 / Unilateral Weaknes = 2
Duration in mins - <10 = 0 / 10-59 = 1 / >60 = 2
Diabetes = 1

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10
Q

List CHA2DS2VaSc scoring and the values for each:

A

(0 to 9)
Congestive Heart Disease = 1
Hypertension (Clinical bp > 140/90) = 1
Age - <65 = 0 / 65-74 = 1 / ≥75 = 2
Diabetes Melitus = 1
Stroke Hx = 2
Vascular DIsease Hx = 1
Sex Class Female = 1

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11
Q

List CURB65 scoring and the values for each:

A

(0 to 5)
Confusion = 1
Urea > 7mmol/L = 1
Respiratory Rate >30 = 1
Blood Pressure Sys<90 OR Dia<60 = 1
Age >65 = 1

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12
Q

List Glasgow Coma scoring and the values for each:

A

(0-15)
Eyes (/4):
No Opening = 1 / To Pain = 2 / To Command = 3
/ Spontaneous = 4

Verbal (/5)
No Response = 1 / Incomprehensible Sound = 2
/ Confused = 4 / Oriented = 5

Motor (/6)
No Response = 1 / Extends to Pain = 2
/ Flexes to Pain = 3 / Withdraw = 4
/ Moves to Localise Pain = 5 / Obey Command = 6

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13
Q

List the MRC Dyspnoea scoring and the values for each:

A

(0-4) (or 1-5 depending on which version)
Dyspnoea on exertion = 0 (or 1)
Dyspnoea up a hill = 1 (or 2)
Dyspnoea walking with same age = 2 (or 3)
Has to stop after 100m walking = 3 (or 4)
Dyspnoea means cannot leave hosue = 4 (or 5)

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14
Q

Management cutoffs for Well’s DVT Score:

A

(/9)
0-2 = D-Dimer… (+) = USS, then Anti-Coag if (+). if (-)DD, <1% chance.

≥3 = USS, then Anti-Coag if (+)
-DD only used for risk stratification.

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15
Q

Management cutoffs for Well’s PE Score:

A

(/12.5)
0-4 = D-Dimer, then CTAngio, then thrombolysis if all +
≥5 = CTAngio, then consider thrombolysis.
High: Consider thrombolysis without CTangio.

If it is decently suspected to be PE and they are haemodynamically unstable DON”T DELAY ALTEPLASE.

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16
Q

Management cutoffs for CURB65:

A

(/5)
0-1 = Community: PO Amoxicillin

2 = Admit: PO Amoxicillin + PO Clarythromycin

3-5 = Admit: IV Amoxicillin + IV Clarythromycin + Consider ICU Admission

If using C_RB65 then use clinical judgment when they score 1, whether to admit or not.

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17
Q

Management cutoffs for CHA2DS2VaSc:

A

(/9)
0 (M) / 1 (W) = No Antithrombotics
1 (M) = Consider Anththrombotics
≥2 (W) = Offer Antithrombotics
Higher scores have more weight up against the risk of major bleeds (HAS-BLED score).

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18
Q

Management cutoffs for Glasgow-Coma Scale:

A

(/15)
0 = ded
<8 = Conisder Intubation
Rapidly deteriorating = Check airways and consider intubation.

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19
Q

Management cutoffs for ABCD2 Scale:

A

(/7)
(Aspirin 300mg / Clopidog 75mg)
<4 = See within 7 days
4-6 = See by neurology within 24 hours
>6 = See by neurology immediately
Do not drive for at least 1 month following TIA.

20
Q

GRACE Score.

A

6-month risk of a cardiac event (/266 = 90%)

21
Q

List grace scoring:

A

Age
Heart Rate
Systolic BP
Creatinine
Cardiac Arrest on Admission?
ST-Segment Issue on ECG?
Abnormal Cardiac Enzymes?
No CHF / JVD / P-Oedema / Cardiogenic Shock?

22
Q

What do you give the first-line for hypertension and what affects that decision?

A

Under 55 / T2DM = ACE-Is/ARBs
Over 55 / Black = CCBs / Thiaz-Like-Di

23
Q

What do you add second-line for hypertension and what factors affect this?

A

Under 55 / T2DM = +CCBs OR +Thiaz-Like-Di
Over 55 / Black = +ACE-Is/ARBs or +Thiaz-Like-Di

24
Q

What do you add third-line for hypertension and what factors affect this?

A

Diabetes / Any Age / Black = CCBs, ACE-Is/ARBs, and Thiaz-Like-Di

25
Q

What do you add fourth-line for hypertension and what factors affect this?

A

Spironolactone if low K+
Alpha/Beta-Blockers if Normal/high K+

26
Q

What is the target range for clinical and ambulatory blood pressure?

A

≥80 years old = <150/90 clinical BP
≥80 years old = <145/85 ABPM

<80 years old = <140/90 clinical BP
<80 years old = <135/85 ABPM

DM and signs of chronic kidney disease: <130/80

27
Q

Duke

A

Criteria to diagnose Infective Endocarditis. (/5)
OR
Staging of Colon Cancer.

28
Q

List Duke’s criteria and the values for each:

A

(0 to 5)
Vegetation with microbes = 5

2 Positive IE-specific Blood Cultures = 3
Evidence of Endocardial Involvement = 3

Predisposing heart condition or IVDU = 1
Fever = 1
Vascular phenomena (Haemorage etc) = 1
Immunological phenomina (RF+ etc) = 1
1 Positive non-IE-speciffic Blood Culture = 1

29
Q

Management cutoffs for Duke’s criteria:

A

(/5)
<3 = Rejected - Consider other diagnosis
3-4 = Possible - Consider Trans-Eosophageal-Echo.
5+ = Definite - Start Abx and consider surgery.

30
Q

Centor

A

Criteria for bacterial pneumonia (/5)

31
Q

Diabetes Mellitus: Glucose / HBA1c Cutoffs:

A

HbA1c: ≥48 mmol/L / ≥6.5%

Fasting Glucose ≥7 mmol/L
Random Glucose ≥11.1 mmol/L + Symptoms

32
Q

What does FRAX scoring take into account?

A

Current Stats:
-Age
-Gender
-Height
-Weight
-Femoral Neck Bone-Mineral-Density. (g/cm²)

Drugs:
-Corticosteroid Use (Rheumatoid Arthritis?)
-Lithium

PMHx:
-Previous Fracture
-Parent Fractured Hip?
-Secondary Osteoporosis?
——–T1DM, Kidney failure, hyperthyroidism
——–Chronic liver disease, premature menopause.

SocHx:
-Currently Smoking?
-More than 3 units of alcohol a day?

33
Q

List Centor criteria and the values for each:

(FeverPain now preferred)

A

(/5)
Age: >45 = -1 ; 15-44 = 0 ; 3-14 = 1
Tonsillar Exudate/Swelling = 1
Tender cervical lymph nodes = 1
Temp >38ºC = 1
Absence of Cough = 1

(FeverPain similar, but without age cutoffs, without tender lymph nodes, and with the presentation <3 days = 1).

34
Q

What are the criteria for giving empirical Abx after a urine dipstick?

A

≥3 UTI Sx and NO vaginal discharge
= YES

≤2 UTI Sx, Cloudy urine, and Nitrite[+] / Leukocyte[+]
= YES

≤2 UTI Sx, Cloudy urine, and Nitrite[-] / Leukocyte[+]
= 50% - Consider sending culture unless symptoms severe.

≤2 UTI Sx, Cloudy urine, and Nitrite[-] / Leukocyte[-]
= Consider another diagnosis.

35
Q

List Duke’s Staging of Colon Cancer

A

A - Mucosa
B - Through Muscularis (No Lymph)
C - Through Muscularis (With Lymph)
D - Thorugh Muscularis + Distant Metastases

36
Q

Management cutoffs for Grace scoring?

A

Low Risk:
-Ticagrelor (P2Y12 ADP-Channel Blocker)
-Aspirin (COX-Inhibitor)

High Risk:
-PCI
-Prasugrel (P2Y12 ADP-Channel Blocker)
-Aspirin

37
Q

List AKI Stages and the cutoffs for each

A

1:
>26microMol/L in 48h or >50% in a week creatine rise.
Urine output <0.5mL/kg/h for >6h.

2:
>100% creatine rise in a week.
Urine output <0.5mL/kg/h for >12h.

3:
>354microMol/L creatine.
>200% creatine rise in a week.
Urine output <0.3mL/kg/h for >24h.

38
Q

List the HbA1C T2DM targets

A

Patient on one drug without hypoglycaemic effects (lone metformin) / Lifestyle modification:
——48mmol/L——

Patient on drugs with hypoglycaemic effects (Meformin+ Sulfonylureas / SGLT2-I / DPP4):
——53mmol/L——

39
Q

FRAX Score Management:

A

Low Risk (<10%):
-Lifestyle advice + Home adaptations

Intermediate Risk (10-20%):
-DEXA Scan + Bisphosphonates (Alendronate), denosumab, or teriparatide.

High Risk (>20%)
-Calculate T Score, change lifestyle, reassess in 2 years.

40
Q

QRISK2

A

Score for Cardiovascular Events

41
Q

QRISK2 scoring

A

-Age, Sex, Ethnicity
-BMI, Systolic BP, Cholesterol levels.

PMHx:
-CKD, AF
-Rheumatoid Arthritis, Diabetes

DHx:
-Antihypertensives?

FamHx:
-Angina / Heart Attack from 1st degree relative

SocHx:
-Smoking?

42
Q

PRISMA-7 scoring

A

Frailty Score: >3 = Frailty needs to be assessed. 1 point each.

  1. > 85
  2. Male?
  3. Is health limiting ADLs?
  4. Need help on reg basis?
  5. Health causes staying indoors?
  6. Relies on someone close to them?
  7. Uses a stick or aid regularly?
43
Q

Waterlow

A

Pressure Sore Risk Score /64.
Only categories were all mentioned, not every single item on each category.
>10/15/20 = A / High / V-High Risk

  1. BMI (>25, >30, <20) 0-3.
  2. Continence (None, U, F, U&F) 0-3.
  3. Skin (Healthy, dry, wounded++) 0-3.
  4. Mobility (Complete > WChair) 0-5.
  5. Sex (M, F) 1, 2.
  6. Age (14-49, >81) 1, 5.
  7. Diet (Normal > Anorexia) 0, 3.
  8. Tissue issues (E.g. Vasc): Upto 22.
  9. Neuorology (DM, Paraplegia): 5.
  10. Surg (OrthoBelowWaist / >2h): 5 each
  11. Meds (Steroids / NSAIDs): 4.
44
Q

ORBIT

A

Bleeding Risk (Preferred over HASBLED) /7 >3/4 = Med/High Risk.

-Older (>75) (1)
-Reduced Hb (2)
-Bleed Hx (2)
-Insufficient kidneys (1)
-Treatment with antiplatelets (1)

45
Q

Barthel Index

A

Frailty Post-Stroke /100 (20x5). 100 = completely independent. Scored by assessing ability to do the following out of 0-2:

  1. Feeding
  2. Wheelchair to bed
  3. Toileting
  4. Getting on/off toilet
  5. Bathing
  6. Walking
  7. Ascending stairs
  8. Dressing
  9. Bowel control
  10. Bladder control.
46
Q

SADQ

A

Alcohol-Dependence Questionnaire /60 (0-3 per question x20). D/a = day after.
≥16 = Chlordiazepoxide regime /Moderate. ≥31 = Severe.

Sweat d/a. HandShake d/a. BodyShake d/a. DrenchedSweat d/a. DreadWakingUp d/a. FrightenedSocialising d/a. EdgeOfDespair d/a. Frightened d/a. MorningDrink d/a. DownedDrinkASAP d/a. DrankToRidShakes d/a. CravedDrink d/a. >10 unit/d. >20unit/d. >40unit/d. >80unit/d.

2w without then 2d heavy drinking then: (0= none. 3= a lot):
Sweat d/a. Handshake d/a. Bodyshake d/a. CraveDrink d/a

Medicine Extras (24 decks)

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