scoring Flashcards

1
Q

ABCD2 score

A

used to assess the risk of stroke following a transient ischeamic attack.
5 parameters
scoring system
Age 0 less than 60 1 if greater than 60
Blood pressure 1 if hypertension (140/90)
Clinical symptoms 1 if speech disturbance 2 if speech and unilateral weakness
Duration 1 if 10-59… 2 if greater than 60
Diabetes… 1 if yes
1-3 low risk
6-7 high risk

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2
Q

Alvarados score

A

This is a scoring system to determine the likelihood of appendicitis
This can be separated into three categories
1. symptoms RIF (2), vomiting, anorexia, abdominal pain that migrates to the RIF
2. signs: rebound tenderness, fever of 37. 3 or more
3. labs: leucocytosis (2) and neutrophillia
less than 5 consider alternatively ddx if greater than 8 it is consistent with appendicitis

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3
Q

CHAD2S-V2AS score

A
This is a scoring system used to determine the risk of thromboembolic stroke in patients with non-rheumatic atrial fibrillation 
C- congestive heart failure 
H hypertension 
Age greater than 75 (2)
D diabetes 
S history of stoke (2)
V vascular disease PVD CAD 
Age between 65-74
Sex female 
IF 2  point anticoagulant with warfarin
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4
Q

Child Pugh score

A

Prothrombin time
albumin greater than 3.5 is (1) less than 2.8 (3)
bilirubin less than 34 is (1) greater than 50 (3)
ascites (1 if none)
encephalopathy (1 if none)
Max they can get for each is three points
however even I would get a score of 5 so 5-6 is a 100% one year survival and a 85% two year survival
10-15 score is a 45% one year survival

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5
Q

Eagle score

A
This is a score that determines the risk of soul flying away after cardiac surgery. 
Age greater than 70
Diabetes 
congestive heart failure 
angina 
previous MI 
if three factors 18% mortality
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6
Q

Framingham risk score

A
this calculates the 10 year risk of cardiovascular disease (PVD, CAD, HF, TIA, and stroke) 
takes into account: 
age and sex 
total cholesterol levels, HDL levels 
smoking status 
systolic blood pressure
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7
Q

True love and Witts score

A

The story of true love… staying there even when someone is having a severe UC episode.
This grades the score based upon severity.
How do you know the severity?
6 topics- the amount of times per day bm, is there any blood, fever, pulse, anemia, or inflammation.

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8
Q

How can you remember the true love and witts score components?

A

The 6 things you have to know about love True love can be a stressful experience- increased bowel motions= less than 4 mild, greater than 6 severe, greater than 8 need to be considering surgery
blood (visible is severe) pumps through the heart faster (greater than 90)
if you are haemorrhaging it may drop the HB (less than 10),
don’t forget inflamed passion (ESR greater than 30)

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9
Q

normal osmolarity of the serum

A

280 to 285 mOsm per kg

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10
Q

Lights criteria

A

this score helps to determine if the effusion is a transudate or exudate if it is in the window protein level between (25-35g per dl)
consider the effusion an exudate if
pleural protein to serum protein: greater than .5
pleural LDH: serum LDH is greater than .6
or if the pleural LDH is greater than 2/3 the upper limit of normal serum value

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11
Q

What is a transudate?

A

pleural protein level is less than 25 g/L

This is the failures heart failure, liver failure, kidney failure, intestinal malabsorption, pulmonary oedema

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12
Q

what is an exudate?

A
protein is greater than 35 grams per litre 
cause are 
cancer- malignancies 
infection- pneumonia, TB 
autoimmune- rheumatoid arthritis, SLE 
vasculitides
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13
Q

What if the PH is less than 7.2

A

it is an empyema reflecting infection.

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14
Q

2010 ACR scoring system

A

This is The American College of Rheumatology Classification criteria for Rheumatoid arthritis
1. joint distribution (5) greater than 10 joints (at least one small) 3: 4-10 small joints,
2. serology (3) neg, low positive *RF and ACPA, high positive
3. symptom duration (1) greater than 6 weeks
4. acute phase reactants (1) abnormal ESR or CRP
greater than 6 RA

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15
Q

How do you assess disease activity in RA?

A

Assessment of Disease Activity (DAS 28)

  1. number of swollen joints out of 28
  2. number of tender joints out of 28
  3. ESR/ CRP result
  4. patients global assessment of health (out of 100)

This is used to assess treatment success

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16
Q

What is the scoring system used in ankle fractures?

A

Weber and Lauge Hansen classification of fractures
A below the level of the syndemotic ligament lateral malleus fracture and medial malleus fracture
inversion
B at the ligament level spiral fracture
eversion oblique fracture of the fibula
C above the ligament level ligament often unstable requiring surgery. upute of both the anterior and posterior syndemotic ligaments this is a result of pronation.

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17
Q

Duke’s criteria for IE

A
Major and minor 
BE home by FIVe PM 
B 2 positive blood cultures 
E endocardium involvement 
F fever greater than 38
Immunological phenomena (oslers nodes, glomerulonepritis) 
Valvular phenomena (septic emboli Janeway lesion 
Echo suggestive but not definite 
Predisposition (IVDU/ heart condition)
Microbiological evidence
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18
Q

NYHA score

A

The New York Heart Association Scoring system to classify the severity of a patient‘s heart failure

  1. Patients with reheat disease but without limitation fo physical activities ordinary activities do not cause fatigue, palpitations, dyspnea or angina
  2. slight limitation of physical activity comfortable at rest but ordinary activity fatigue, palpitations, SOB, angina
  3. Patient with CD with marked limitation fo physical activity. comfoable at rest but less than ordinary activity results in fatigue palpitations, SOb, and angina
  4. symptoms inability doing activities of daily living may have angina at rest.
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19
Q

causes of clubbing

A
respiratory 
carcinoma
bronchial 
mesothelioma  
brachial or mesothelioma

chronic lung suppuration
empyema abscess
brochiectasis, cf

fibrosis
idiopathic pulmonary fibrosis cfa
TB

cardiac
infective endocarditis
congenital cyanosis heart disease
atrial myxoma

GI
cirrhosis 
crohn’s UC
coeliac 
cancer 

other
familial
thyroid acropachy
upper limb AVMs or aneurysm (unilateral clubbing)

20
Q

What is the differential fro a metabolic acidosis

A
shock
DKA
renal or liver failure
drug over dose (TCA) 
renal tubular acidosis 
lactate 

Further differentials can be calculated through the anion gap

21
Q

What is the differential for metabolic alkalosis

A

vomiting
diarrhea
hypokalemia

22
Q

Respiratory acidosis differential

A
severe asthma 
severe pneumonia
severe pulmonary oedema 
myasthenia travis 
drugs like sedatives and opioids 
chest trauma scoliosis 
obesity
23
Q

what is the differential for respiratory alkalosis

A
cranial lesions (stroke) 
anxiety or hyperventilation
24
Q

What is your differential for a high anion gap

A
high anion gap is greater than 16 
lactic acidosis 
irate 
ketones *DKA, alcohol, starvation
drugs/ toxins salicylate, biguinides, ethylene glycol, methanol)
25
Q

What is your differential for a normal anion gap

A
anion gap 6-16 
renal tubular acidosis 
diarrhea 
drugs *actazolamide
addison’s disease 
pancreatic fistula 
ammonium chloride ingestion
26
Q

What are five drug classes of diabetic medications?

A
Biguinides 
sulphonylureas 
thiazolinediones 
DPP4 inhibitors 
SLGT 2 inhibitors
27
Q

How do Biguinides work

A

Example: Metformin
works by increasing insulin sensitivity and decreases the intestinal absorption of glucose and preventing glycogenoslysis in the liver

28
Q

How does Sulfonylureas work?

A

Exert hypoglycemic effects by stimulating insulin secretion: there mechanism of action is to close the ATP sensitive K channels therefore leading to deplorization of the cell.

29
Q

How do Thiazolidendiones work?

A

They avidly bind to peroxisome proliferator activated receptor gamma in adipocytes to promote adipogenesis and fatty acid uptake (in peripheral but not visceral fat)

30
Q

How do DDP 4 inhibitors work?

A

The MOA of inhibitors of dipeptidyl peptidase 4 is to inhibit the degradation of the incretins, glucagon like peptide and insulinotropic peptide.

31
Q

What is the MOA of SGLT2 inhibitors

A

The sodium glucose co transporter 2 inhibitors work by inhibiting the
Na glucose cotransporter on the proximal convulsed tubule. This prevents the reabsorption of glucose and facilitates its excretion in the urine.

32
Q

What is an example of a Sulphonylurea?

A

Gliclazide

33
Q

What is an example of a thiazolidinedoines?

A

Pioglitazone

34
Q

What is an an example of a DPP 4 inhibitor?

A

Sitagliptin

35
Q

What is an example of a SGLT2 inhibitor?

A

dapagliflozin

36
Q

What is the starting dose for Metformin?

A

The starting dose is 500mg OD titration going slowly upwards (each week) until reaching three times a day. the max dose of Metformin is 2g in 24 hours which is broken into a divided dose.

37
Q

What are the contraindications for Metformin?

A

Hepatic or renal impairment

38
Q

What a re the SE of Metformin?

A

GI disturbance metallic taste in the mouth

lactic acidosis

39
Q

What is the dosing for sulphonylureas?

A

Gliclazide

40-80 mg usually a morning dosing

40
Q

What are the SE of Sulphonylureas?

A
N&V 
diarrhea 
constitution 
hyponatraemia 
hypoglycemia 
hepatic dysfunction 
weight gain
41
Q

When are sulfonylureas not indicationed what considerations would you have in prescribing?

A

not a first line agent because it encourages weight gain
hypoglycemia is a risk factor

not to be used in ketoacidosis

42
Q

What are two drugs that are used to treat diabetes in patients with heart failure

A

SGLT 2 inh

GLP 1 RA class (liraglutide do not cause weight gain but can cause hypos

43
Q

Which drug should you avoid in heart failure (antihyperglycemic agent)

A

thiazolidinediones

44
Q

What is after Metformin in a patient with DM

A

Gilclazide

45
Q

Blanchford score

A
urea greater than 6.5 
HB looking for anemia less than 10 very severe 
systolic BP hypotension systolic less than 90 is a poor prognostic indicator 
other markers: tachycardia 
melena 
syncope 
hepatic disease (varicoele) 
cardiac failure