Scales & Classifications Flashcards
Scale used to measure degree of disability due to breathlessness
MRC dyspnoea scale
- Not troubled by breathlessness except on strenuous exercise
- Short of breath when hurrying or walking up a slight hill
- Walks slower than contemporaries on the level because of breathlessness, or has to stop for breath when walking at own pace
- Stops for breath after about 100 m or after a few minutes on the level
- Too breathless to leave the house, or breathless when dressing or undressing
Scale for predicting mortality in community acquired pneumonia
CURB65
Confusion of new onset (defined as an AMTS of 8 or less) Blood
Urea nitrogen greater than 7 mmol/l (19 mg/dL)
Respiratory rate of 30 breaths per minute or greater
Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg or less
Age 65 or older
Scale for classifying heart failure
New York Heart Association (NYHA) classification is used to grade the severity of functional limitations in a patient with heart failure:
class I no limitation of physical activity ordinary physical activity does not cause fatigue, breathlessness or palpitation (includes asymptomatic left ventricular dysfunction)
class II slight limitation of physical activity patients are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, breathlessness or angina pectoris (symptomatically ‘mild’ heart failure)
class III marked limitation of physical activity although patients are comfortable at rest, less than ordinary activity will lead to symptoms (symptomatically ‘moderate’ heart failure)
class IV inability to carry out any physical activity without discomfort symptoms of congestive cardiac failure are present even at rest. Increased discomfort with any physical activity (symptomatically ‘severe’ heart failure)
Grading system for muscle power
MRC scale for muscle power
0 No muscle contraction is visible.
1 Muscle contraction is visible but there is no movement of the joint.
2 Active joint movement is possible with gravity eliminated.
3 Movement can overcome gravity but not resistance from the examiner.
4 The muscle group can overcome gravity and move against some resistance from the examiner.
5 Full and normal power against resistance. Deep tendon reflexes
Measurement of consciousness state
Glasgow Coma Scale Grades of
Best Motor Response 6 Carrying out request (‘obeying command’) -patient does simple things you ask. 5 Localising response to pain. 4 Withdrawal to pain - pulls limb away from painful stimulus. 3 Flexor response to pain - pressure on nail bed causes abnormal flexion of limbs - decorticate posture. 2 Extensor posturing to pain - stimulus causes limb extension - decerebrate posture. 1 No response to pain.
Grades of Best Verbal Response 5 Oriented - patient knows who and where they are, and why, and the year, season and month. 4 Confused conversation - patient responds in conversational manner, with some disorientation and confusion. 3 Inappropriate speech - random or exclamatory speech, with no conversational exchange. 2 Incomprehensible speech - no words uttered, only moaning. 1 No verbal response.
Eye Opening 4 Spontaneous eye opening. 3 Eye opening in response to speech - that is, any speech or shout. 2 Eye opening in response to pain. 1 No eye opening. return to history
Sleep apnoea screening scale
Epworth daytime sleepiness scale
Sitting and reading Watching TV
Sitting still in a public place (e.g. a theatre, a cinema or a meeting)
As a passenger in a car for an hour without a break Lying down to rest in the afternoon when the circumstances allow
Sitting and talking to someone
Sitting quietly after lunch without having drunk alcohol In a car or bus while stopped for a few minutes in traffic
Scale assessing whether or not to anticoagulate in AF
CHADSVASC
Congestive heart failure
Hypertension
Age ≥ 75 (2) Age 65-74 (1)
Diabetes mellitus
Stroke/TIA/thrombo-embolism(2)
Vascular disease
Sex Female
Risk of bleeding with anticoagulants
HASBLED
Hypertension
Abnormal renal and liver function
Stroke
Bleeding
Labile INRs
Elderly
Drugs or alcohol
Hypertension: (uncontrolled, >160 mmHg systolic) 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 Stroke: Prior history of stroke Bleeding: Prior Major Bleeding or Predisposition to Bleeding Labile INR: (Unstable/high INRs), Time in Therapeutic Range 65 years Prior Alcohol or Drug Usage History (≥ 8 drinks/week) Medication Usage Predisposing to Bleeding: (Antiplatelet agents, NSAIDs)
Scale risk of adverse outcome following upper GI bleed
Rockall
Mortality risk following hip fracture
Nottingham hip fracture scale - predicts 30day mortality following surgery
Age
Sex
Admission Hb
MMTS
Living in an institution
Number of comorbidities
Malignancy
Whether to prescribe antibiotics in tonsillitis
Centor
History of fever
Tonsillar exudates
Tender anterior cervical adenopathy
Absence of cough
The modified Centor criteria add the patient’s age to the criteria: Age under 15 add 1 point Age over 44 subtract 1 point
-1, 0 or 1 point(s) – No antibiotic or throat culture necessary (risk of strep. infection <10%)
2 or 3 points - Should receive a throat culture and treat with an antibiotic if culture is positive (risk of strep. infection 32% if 3 criteria, 15% if 2)
4 or 5 points - Consider rapid strep testing and or culture. (Risk of strep. infection 56%) - IDSA and ASIM no longer recommend empiric treatment for strep based on symptomatology alone.
Ankle fracture classifications
Weber
Salter Harris classification
Fracture
Open fracture classification
Gustillo-Anderson
Type I wound < 1 cm
Type II 1-10cm
Type III A > 10 cm, high energy adequate tissue for coverage includes segmental / comminuted fractures even if wound <10cm farm injuries are automatically Gustillo III
Type IIIB extensive periosteal stripping and requires free soft tissue transfer
Type IIIC vascular injury requiring vascular repair
Rheumatoid classification
DAS28
Asthma severity
Mild: No features of severe asthma PEFR >75%
Moderate: No features of severe asthma PEFR 50-75%
Severe (if any one of the following): PEFR 33 – 50% of best or predicted, Cannot complete sentences in 1 breath, Respiratory Rate > 25/min Heart Rate >110/min
Life threatening (if any one of the following): PEFR < 33% of best or predicted Sats <92% or ABG pO2 < 8kPa Cyanosis, poor respiratory effort, near or fully silentchest Exhaustion, confusion, hypotension or arrhythmias Normal pCO2
Near Fatal: Raised pCO2
Lung cancer survival
NSCLC 5 Year Survival All NSCLC – 10-13%
Stage 1 following surgical resection – 60-70%
Stage II following surgical resection – 30-55%
Stage III – 7%
Stage IV – 1%
Scale in suspected/ query PE
Wells score
Clinical signs and symptoms of DVT (minimum of leg swelling and pain with palpation of the deep veins) 3
An alternative diagnosis is less likely than PE 3
Heart rate > 100 beats per minute 1.5
Immobilisation for more than 3 days or surgery in the previous 4 weeks 1.5
Previous DVT/PE 1.5
Haemoptysis 1
Malignancy (on treatment, treated in the last 6 months, or palliative) 1
PE likely - more than 4 points
PE unlikely - 4 points or less
Classification acute kidney injury
RIFLE
Risk: increased Cr x 1.5, decreased GFR>25% Urine output <0.5ml/kg/h x 6h
Injury: Crx 2, GFR >50%, UO <0.5ml/kg/hr x 12hr
Failure: Cr x 3, GFR > 75%, UO <0.5ml/kg/hr x24 or anuria
Loss: persistent ARF - complete LOF > 1 month
ESKD: complete LOF >3month
Scale to predict mortality in hospital exacerbations of COPD
DECAF Dyspnoea Eosinophilia Consolidation Acidaemia atrial Fibrillation
EGFR variables
CAGE - Creatinine, Age, Gender, Ethnicity
Test for suspected acromegaly
Oral glucose tolerance test (OGTT) -
GH normally becomes undetectable following glucose challenge
WHO performance status
0 - normal, fully active without restriction
1 - Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work
2 - Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours
3 - Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours
4 - Completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair
5 - Dead
Dukes colon cancer staging
Dukes A - invasion but not through bowel wall
Dukes B - invasion through bowel wall penetrating muscular layer but not lymph nodes
Dukes C - involvement of lymph nodes
Dukes D - widespread metastases
ASA grades
- Normal and healthy
- Mild systemic disease
- Severe systemic disease
- Systemic disease which is a constant threat to life
- Moribund - not expected to survive 24h even with operation
Scale to classify macroscopic appearance of gastric cancers
Bormann’s classification
Type I lesions—Pedunculated and exophytic.
Type II lesions—Ulcer craters confined to mucosa and submucosa.
Type III lesions extend into the muscularis.
Type IV lesions extend beyond the stomach.
Acute pancreatitis - assess severity and predict mortality
Modified Glasgow Criteria valid for EtOH and gallstones
P = pO2
A = age
N = neutrophils (=WCC)
C = calcium
R = renal function (=urea)
E = enzymes (ALT/LDH)
A = albumin
S = sugar (=glucose)
UC severity
Truelove and Witts criteria
Classification of colonic perforation due to diverticular disease
The Hinchey classification - The classification is I-IV:
Hinchey I - localised abscess (para-colonic)
Hinchey II - pelvic abscess
Hinchey III - purulent peritonitis (the presence of pus in the abdominal cavity)
Hinchey IV - feculent peritonitis.
Classification of rectal prolapse
full thickness (complete), where all the layers of the rectal wall prolapse, or involve the mucosal layer only (partial)
external if they protrude from the anus and are visible externally, or internal if they do not circumferential, where the whole circumference of the rectal wall prolapse,
or segmental if only parts of the circumference of the rectal wall prolapse present at rest, or occurring during straining.
Classification peripheral artery disease - Fontaine
Fontaine Classification
Stage I – Asymptomatic. Of note: Fontaine stage I does in fact describe patients who are for the most part asymptomatic. Careful history may actually reveal subtle and non-specific symptoms such as paresthesias. Physical examination may reveal cold extremities and other signs of “subclinical” peripheral artery disease. More examples include bruits over blood vessels and lack of normal pulses.
Stage II – Intermittent claudication. This stage takes into account the fact that patients usually have a very constant distance at which they have pain: Stage IIa – Intermittent claudication after more than 200 meters of pain free walking. Stage IIb – Intermittent claudication after less than 200 meters of walking
Stage III – Rest pain. Rest pain is especially troubling for patients during the night. The reason for this is twofold: First, the legs are usually raised up on to a bed at night, thus diminishing the positive effect gravity may have had during the day when the legs were dependent. Second, during the night the lack of sensory stimuli allow patients to focus on their legs.
Stave IV – Ischemic ulcers or gangrene (which may be dry or humid).
Classification peripheral artery disease - Rutherford
The Rutherford classification has seven stages:
Stage 0 – Asymptomatic
Stage 1 – Mild claudication
Stage 2 – Moderate claudication – The distance that delineates mild, moderate and severe claudication is not specified in the Rutherford classification, but is mentioned in the Fontaine classification as 200 meters.
Stage 3 – Severe claudication
Stage 4 – Rest pain
Stage 5 – Ischemic ulceration not exceeding ulcer of the digits of the foot
Stage 6 – Severe ischemic ulcers or frank gangrene
Aortic Dissection Classification
Stanford classification The Stanford classification is divided into two groups, A and B, depending on whether the ascending aorta is involved.
Type A – proximal (70%); involves the ascending aorta and/or aortic arch, and possibly the descending aorta. The tear can originate in the ascending aorta, the aortic arch, or more rarely, in the descending aorta. It includes DeBakey types I and II.
Type B – distal (30%); involves the descending aorta or the arch (distal to the left subclavian artery), without the involvement of the ascending aorta. It includes DeBakey type III.
Gangrene classification
Wet: tissue death + infection Dry: tissue death only - coagulative necrosis
Pregangrene: tissue on the brink of gangrene Gas gangrene: Clostridium perfringes myositis
Fournier gangrene is a type of necrotizing fasciitis or gangrene affecting the perineum
Meleney’s gangrene, or Meleney’s ulcer is a cutaneous condition that is a postoperative, progressive bacterial gangrene
CEAP classification
Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) classification for chronic venous disorders
Hepatorenal syndrome classification
Type 1 HRS: rapidly progressive deterioration. Survival <2wks.
Type 2 HRS: steady deterioration. Survival around 6 months.
Kings College Hospital Criteria in Acute Liver Failure - paracetamol induced
The King’s College Criteria identify two groups of patients that have a poor prognosis with acetaminophen induced liver failure:
Arterial pH < 7.3
or all of: PT>100s Cr>300uM Grade 3/4 encephalopathy
Kings College Hospital Criteria in Acute Liver Failure - non-paracetamol
In patients with non-acetaminophen acute liver failure, the following criteria were identified as being associated with a poor prognosis:
INR greater than 6.5;
or, 3 out of 5 of:
Drug induced Age <1- or >40
Serum bilirubin > 300uM
1 week from jaundice to encephalopathy
PT>50s
Child-Pugh Grading of Cirrhosis
Predicts risk of bleeding, mortality and need for treatment. Graded A-C using 5 factors:
Albumin Bilirubin Clotting Distension: ascites Encephalopathy Score >8 = significant risk of variceal bleeding
Encephalopathy grading
- Confused
- Drowsy
- Stupor
- Coma
Maddrey score
Predicts mortality in alcoholic hepatitis
Mild 0-5% 30d mortality
Severe 50% 30d mortality
1 year after admission
Garden classification
stage I : incomplete fracture of the neck (so-called abducted or impacted)
stage II : complete without displacement
stage III: complete with partial displacement: fragments are still connected by posterior retinacular attachment; there is malalignment of the femoral trabeculae
stage IV : this is a complete femoral neck fracture with full displacement: the proximal fragment is free and lies correctly in the acetabulum so that the trabeculae appear normally aligned
Seddon classification
Three types of neurological injury
1) Neuropraxia - temporary interruption without loss of axonal continuity
2) Axonotmesis - disruption of axon –> Wallerian degeneration
3) Neurotmesis - disruption of entire nerve fibre
Classification extension supracondylar fractures of humerus
Gartland:
Type 1: non displaced
Type 2: angulated with intact posterior cortex
Type 3: displaced with no cortical contact
Classification of brachial plexus injuries
Leffert classification of brachial plexus injury: It is based on etiology and level of injury and is as follows
I Open (usually from stabbing)
II Closed (usually from motorcycle accident)
IIa Supraclavicular
III Radiation induced
IV Obstetric
IVa Erb’s (upper root) - waiter’s tip hand;
IVb Klumpke (lower root)
Dukes Criteria for infective endocarditis
Major Criteria:
A. Positive blood culture for Infective Endocarditis: Typical organism in 2 separate cultures. OR Persistently positive cultures (3 sets, at different times, from different places, at peak temperature).
B. Evidence of Endocardial involvement: Positive echocardiogram (Vegetation, abscess, prosthetic valve damage). OR New valvular regurgitation.
Minor Criteria:
- Predisposition
- Fever >38°C
- Vascular / Immunological signs
- Positive blood culture (But does not meet Major criteria)
- Positive echocardiogram (But does not meet Major criteria) Definite Infective Endocarditis: 2 Major OR 1 Major, 3 Minor OR 5 Minor
IQ scores for mild, moderate, severe ID
Mild 50-69
Moderate 35-49
Severe 20-34
Profound <20
Tool to screen for delirium
Abbreviated mental test MMSE
Confusion Assessment Method
Clock drawing
Assessment tool to assess suicide risk
SADPERSONS scale The score is calculated from ten yes/no questions, with one point for each affirmative answer:
S: Male sex
A: Age (<19 or >45 years)
D: Depression
P: Previous attempt
E: Excess alcohol or substance use
R: Rational thinking loss
S: Social supports lacking
O: Organized plan
N: No spouse
S: Sickness
This score is then mapped onto a risk assessment scale as follows: 0–4: Low 5–6: Medium 7–10: High
Scoring system applied within 24 hours of admission of a patient to an intensive care unit
APACHE
Classification of stroke
The Bamford/ Oxford classification system, is a simple bedside method of classifying acute ischaemic strokes. It uses the patients’ symptoms to classify which region of the brain has been affected, and once classified it allows for prediction of a patient’s prognosis.
- Total Anterior Circulation Stroke (TACS) Higher Cerebral Dysfunction & Homonymous Visual Field Defect & Ipsilateral Motor +/- Sensory Deficit Mortality: 39% at 1 month, 60% at 1 year, Recurrence: Low Risk
- Partial Anterior circulation stroke (PACS) 2 out of 3 of TACS Symptoms OR Higher Cerebral Dysfunction Alone OR Monoparesis Mortality: 4% at 1 month, 16% at 1 year, Recurrence: Very High Risk
- Lacunar stroke (LACS) Motor Stroke OR Sensory Stroke OR Sensori-motor Stroke OR Ataxic Hemiparesis Mortality: 2% at 1 month, 11% at 1 year, Reccurrence: Low Risk
- Posterior circulation stroke (POCS) Ipsilateral Cranial Nerve Palsy with Contralateral Motor Deficit OR Bilateral Deficit OR Disorder of Conjugate Eye Movement OR Cerebellar Dysfunction OR Isolated Homonymous Hemianopia Mortality: 7% at 1 month, 19% at 1 year, Recurrence: High Risk
Assessing extent of burns
Wallace’s Rule of Nines: head + neck = 9%, each arm = 9%, each anterior part of leg = 9%, each posterior part of leg = 9%, anterior chest = 9%, posterior chest = 9%, anterior abdomen = 9%, posterior abdomen = 9%
Lund and Browder chart: the most accurate method the palmar surface is roughly equivalent to 1% of total body surface area (TBSA). Not accurate for burns > 15% TBSA
Tool to screen for problem drinking
AUDIT questionnaire
Screening tool for post-natal depression
The Edinburgh Postnatal Depression Scale may be used to screen for depression: 10-item questionnaire, with a maximum score of 30 indicates how the mother has felt over the previous week
score > 13 indicates a ‘depressive illness of varying severity’ sensitivity and specificity > 90% includes a question about self-harm
Specific investigation in suspected Addison’s disease
ACTH stimulation test (short Synacthen test). Plasma cortisol is measured before and 30 minutes after giving Synacthen 250ug IM.
Adrenal autoantibodies such as anti-21-hydroxylase may also be demonstrated.
Specific investigation in suspected Acromegaly
Oral glucose tolerance test is used to confirm a raised IGF-1: GH is normally inhibited by glucose. If the glucose load fails to suppress the GH level below 1.0 mcg/L this confirms the diagnosis of acromegaly.
Tools recommended by NICE to assess risk of fragility fractures
FRAX or QFRACTURE tools
DKA criteria
Glucose >11mmol/L
pH <7.3 or HCO3<15
Capillary ketones > 3mmol/L or ++ urinary ketones
Definition of shock
Shock is a medical emergency in which the organs and tissues of the body are not receiving an adequate flow of blood. This deprives the organs and tissues of oxygen (carried in the blood) and allows the buildup of waste products. Shock can result in serious damage or even death.
Sepsis definition and symptoms
Sepsis is the body’s overwhelming and life-threatening response to infection which can lead to tissue damage, organ failure, and death
Symptoms - SEPSIS
Shivering, fever, or very cold
Extreme pain or general discomfort
Pale or discoloured skin
Sleepy, difficult to rouse, confused
I feel like i might die
Short of breath
Assessing severity of UC
Truelove and Witt’s severity index
Number of bowel movements per day
Blood in stool
Pyrexia (greater than 37.8oc)
Pulse >90bpm
Anaemia
Erythrocyte sedimentation
