Management Stratification Flashcards
Well’s
DVT (/9) and PE (/12.5)
ABCD^2
Chance of Stroke Within 7 Days of TIA (/7)
CHA2DS2VaSc
Chance of Future Stroke when AF is Present (/9)
CURB65
Management of Community-Acquired Pneumonia (/5)
Glasgow
Coma (/15) and Acute Pancreatitis Grading (not diagnosis)
MRC ____ ?
Dyspnoea Scale (/4) or POWER grading for a limb.
List Well’s DVT scoring and the values for each:
(-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
List Well’s PE scoring and the values for each:
(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.
List ABCD^2 and the values for each:
(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
List CHA2DS2VaSc scoring and the values for each:
(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
List CURB65 scoring and the values for each:
(0 to 5)
Confusion = 1
Urea > 7mmol/L = 1
Respiratory Rate >30 = 1
Blood Pressure Sys<90 OR Dia<60 = 1
Age >65 = 1
List Glasgow Coma scoring and the values for each:
(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
List the MRC Dyspnoea scoring and the values for each:
(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)
Management cutoffs for Well’s DVT Score:
(/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.
Management cutoffs for Well’s PE Score:
(/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.
Management cutoffs for CURB65:
(/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.
Management cutoffs for CHA2DS2VaSc:
(/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).
Management cutoffs for Glasgow-Coma Scale:
(/15)
0 = ded
<8 = Conisder Intubation
Rapidly deteriorating = Check airways and consider intubation.
Management cutoffs for ABCD2 Scale:
(/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.
GRACE Score.
6-month risk of a cardiac event (/266 = 90%)
List grace scoring:
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?
What do you give the first-line for hypertension and what affects that decision?
Under 55 / T2DM = ACE-Is/ARBs
Over 55 / Black = CCBs / Thiaz-Like-Di
What do you add second-line for hypertension and what factors affect this?
Under 55 / T2DM = +CCBs OR +Thiaz-Like-Di
Over 55 / Black = +ACE-Is/ARBs or +Thiaz-Like-Di
What do you add third-line for hypertension and what factors affect this?
Diabetes / Any Age / Black = CCBs, ACE-Is/ARBs, and Thiaz-Like-Di
What do you add fourth-line for hypertension and what factors affect this?
Spironolactone if low K+
Alpha/Beta-Blockers if Normal/high K+
What is the target range for clinical and ambulatory blood pressure?
≥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
Duke
Criteria to diagnose Infective Endocarditis. (/5)
OR
Staging of Colon Cancer.
List Duke’s criteria and the values for each:
(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
Management cutoffs for Duke’s criteria:
(/5)
<3 = Rejected - Consider other diagnosis
3-4 = Possible - Consider Trans-Eosophageal-Echo.
5+ = Definite - Start Abx and consider surgery.
Centor
Criteria for bacterial pneumonia (/5)
Diabetes Mellitus: Glucose / HBA1c Cutoffs:
HbA1c: ≥48 mmol/L / ≥6.5%
Fasting Glucose ≥7 mmol/L
Random Glucose ≥11.1 mmol/L + Symptoms
What does FRAX scoring take into account?
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?
List Centor criteria and the values for each:
(FeverPain now preferred)
(/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).
What are the criteria for giving empirical Abx after a urine dipstick?
≥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.
List Duke’s Staging of Colon Cancer
A - Mucosa
B - Through Muscularis (No Lymph)
C - Through Muscularis (With Lymph)
D - Thorugh Muscularis + Distant Metastases
Management cutoffs for Grace scoring?
Low Risk:
-Ticagrelor (P2Y12 ADP-Channel Blocker)
-Aspirin (COX-Inhibitor)
High Risk:
-PCI
-Prasugrel (P2Y12 ADP-Channel Blocker)
-Aspirin
List AKI Stages and the cutoffs for each
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.
List the HbA1C T2DM targets
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——
FRAX Score Management:
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.
QRISK2
Score for Cardiovascular Events
QRISK2 scoring
-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?
PRISMA-7 scoring
Frailty Score: >3 = Frailty needs to be assessed. 1 point each.
- > 85
- Male?
- Is health limiting ADLs?
- Need help on reg basis?
- Health causes staying indoors?
- Relies on someone close to them?
- Uses a stick or aid regularly?
Waterlow
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
- BMI (>25, >30, <20) 0-3.
- Continence (None, U, F, U&F) 0-3.
- Skin (Healthy, dry, wounded++) 0-3.
- Mobility (Complete > WChair) 0-5.
- Sex (M, F) 1, 2.
- Age (14-49, >81) 1, 5.
- Diet (Normal > Anorexia) 0, 3.
- Tissue issues (E.g. Vasc): Upto 22.
- Neuorology (DM, Paraplegia): 5.
- Surg (OrthoBelowWaist / >2h): 5 each
- Meds (Steroids / NSAIDs): 4.
ORBIT
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)
Barthel Index
Frailty Post-Stroke /100 (20x5). 100 = completely independent. Scored by assessing ability to do the following out of 0-2:
- Feeding
- Wheelchair to bed
- Toileting
- Getting on/off toilet
- Bathing
- Walking
- Ascending stairs
- Dressing
- Bowel control
- Bladder control.
SADQ
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
