scoring Flashcards
ABCD2 score
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
Alvarados score
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
CHAD2S-V2AS score
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
Child Pugh score
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
Eagle score
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
Framingham risk score
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
True love and Witts score
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.
How can you remember the true love and witts score components?
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)
normal osmolarity of the serum
280 to 285 mOsm per kg
Lights criteria
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
What is a transudate?
pleural protein level is less than 25 g/L
This is the failures heart failure, liver failure, kidney failure, intestinal malabsorption, pulmonary oedema
what is an exudate?
protein is greater than 35 grams per litre cause are cancer- malignancies infection- pneumonia, TB autoimmune- rheumatoid arthritis, SLE vasculitides
What if the PH is less than 7.2
it is an empyema reflecting infection.
2010 ACR scoring system
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
How do you assess disease activity in RA?
Assessment of Disease Activity (DAS 28)
- number of swollen joints out of 28
- number of tender joints out of 28
- ESR/ CRP result
- patients global assessment of health (out of 100)
This is used to assess treatment success
What is the scoring system used in ankle fractures?
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.
Duke’s criteria for IE
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
NYHA score
The New York Heart Association Scoring system to classify the severity of a patient‘s heart failure
- Patients with reheat disease but without limitation fo physical activities ordinary activities do not cause fatigue, palpitations, dyspnea or angina
- slight limitation of physical activity comfortable at rest but ordinary activity fatigue, palpitations, SOB, angina
- Patient with CD with marked limitation fo physical activity. comfoable at rest but less than ordinary activity results in fatigue palpitations, SOb, and angina
- symptoms inability doing activities of daily living may have angina at rest.
causes of clubbing
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)
What is the differential fro a metabolic acidosis
shock DKA renal or liver failure drug over dose (TCA) renal tubular acidosis lactate
Further differentials can be calculated through the anion gap
What is the differential for metabolic alkalosis
vomiting
diarrhea
hypokalemia
Respiratory acidosis differential
severe asthma severe pneumonia severe pulmonary oedema myasthenia travis drugs like sedatives and opioids chest trauma scoliosis obesity
what is the differential for respiratory alkalosis
cranial lesions (stroke) anxiety or hyperventilation
What is your differential for a high anion gap
high anion gap is greater than 16 lactic acidosis irate ketones *DKA, alcohol, starvation drugs/ toxins salicylate, biguinides, ethylene glycol, methanol)
What is your differential for a normal anion gap
anion gap 6-16 renal tubular acidosis diarrhea drugs *actazolamide addison’s disease pancreatic fistula ammonium chloride ingestion
What are five drug classes of diabetic medications?
Biguinides sulphonylureas thiazolinediones DPP4 inhibitors SLGT 2 inhibitors
How do Biguinides work
Example: Metformin
works by increasing insulin sensitivity and decreases the intestinal absorption of glucose and preventing glycogenoslysis in the liver
How does Sulfonylureas work?
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.
How do Thiazolidendiones work?
They avidly bind to peroxisome proliferator activated receptor gamma in adipocytes to promote adipogenesis and fatty acid uptake (in peripheral but not visceral fat)
How do DDP 4 inhibitors work?
The MOA of inhibitors of dipeptidyl peptidase 4 is to inhibit the degradation of the incretins, glucagon like peptide and insulinotropic peptide.
What is the MOA of SGLT2 inhibitors
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.
What is an example of a Sulphonylurea?
Gliclazide
What is an example of a thiazolidinedoines?
Pioglitazone
What is an an example of a DPP 4 inhibitor?
Sitagliptin
What is an example of a SGLT2 inhibitor?
dapagliflozin
What is the starting dose for Metformin?
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.
What are the contraindications for Metformin?
Hepatic or renal impairment
What a re the SE of Metformin?
GI disturbance metallic taste in the mouth
lactic acidosis
What is the dosing for sulphonylureas?
Gliclazide
40-80 mg usually a morning dosing
What are the SE of Sulphonylureas?
N&V diarrhea constitution hyponatraemia hypoglycemia hepatic dysfunction weight gain
When are sulfonylureas not indicationed what considerations would you have in prescribing?
not a first line agent because it encourages weight gain
hypoglycemia is a risk factor
not to be used in ketoacidosis
What are two drugs that are used to treat diabetes in patients with heart failure
SGLT 2 inh
GLP 1 RA class (liraglutide do not cause weight gain but can cause hypos
Which drug should you avoid in heart failure (antihyperglycemic agent)
thiazolidinediones
What is after Metformin in a patient with DM
Gilclazide
Blanchford score
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
