Scoring Systems

Question 1

What is the Modified Glasgow Criteria?

Answer 1

Used to assess Acute Pancreatitis.

• PaO₂ <59.3 mmHg (7.9 kPa)
• Age >55 years
• WBC >15 x 10³/µL (10⁹/L)
• Calcium <8 mg/dL (2 mmol/L)
• Urea >44.8 mg/dL (serum urea >16 mmol/L)
• LDH >600 IU/L
• Albumin <3.2 g/dL (32 g/L)
• Glucose >180 mg/dL (10 mmol/L)

≥3 is Severe Pancreatitis​

Question 2

What is CHA2DS2-VAS?

Answer 2

Used to determine the need to anticoagulate a patient in atrial fibrillation

• Congenital Heart Failure: 1
• Hypertension: 1
• Age >75: 2
• Diabetes Mellitus: 1
• Stroke/TIA: 2
• Vascular Disease: 1
• Age >65: 1
• Sex female: 1

Question 3

What is DAS28?

Answer 3

Measure of disease activity in rheumatoid arthritis

Question 4

What is the Child-Pugh classification?

Answer 4

A scoring system used to assess the severity of liver cirrhosis

• Bilirubin (Total)
• Albumin
• INR
• Ascites
• Encephalopathy

Question 5

What is the Wells Score?

Answer 5

Used to assess risk of PE

• Clinical signs and symptoms of DVT: +3
• PE is #1 diagnosis OR equally likely: +3
• Heart rate > 100: +1.5
• Immobilization at least 3 days OR surgery in the previous 4 weeks: +1.5
• Previous, objectively diagnosed PE or DVT: +1.5
• Hemoptysis: +1
• Malignancy w/ treatment within 6 months or palliative: +1

Question 6

What is the MMSE? (mini-mental state exam)

Answer 6

Used to assess cognitive impairment

• Orientation
• Registration
• Attention and Calculation
• Recall
• Language

Question 7

What are in hospital mental condition scores?

Answer 7

• HAD: Hospital Anxiety and Depression (HAD) scale to assess severity of anxiety and depression symptoms
• PHQ-9 Patient Health Questionnaire to assess severity of depression symptoms

Question 8

What is CURB-65?

Answer 8

Used to assess the prognosis of a patient with pneumonia

• Confusion: 1
• Urea > 19 mg/dL (> 7 mmol/L): 1
• Respiratory Rate ≥ 30: 1
• Systolic BP < 90 mmHg or Diastolic BP ≤ 60 mmHg: 1
• Age ≥ 65: 1

Question 9

What is the Epworth Sleepiness Scale?

Answer 9

Used in the assessment of suspected obstructive sleep apnoea

Question 10

What are scoring system for Prostate Cancer?

Answer 10

• IPSS
  
  • International prostate symptom score
• Gleason score
  
  • Indicates prognosis in prostate cancer

Question 11

What is the FRAX score?

Answer 11

Risk assessment tool developed by WHO which calculates a patients 10-year risk of developing an osteoporosis related fracture

Question 12

What is the nutritional assessment critieria?

Answer 12

MUST

Malnutrition

Question 13

What is the HAS-BLED score?

Answer 13

Used to assess the risk of bleeding from anticoagulation

• Hypertension: 1
  
  • Uncontrolled, >160 mmHg systolic
• Renal disease: 1
  
  • Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L
• Liver disease: 1
  
  • Cirrhosis or bilirubin >2x normal with AST/ALT/AP >3x normal
• Stroke history: 1
• Prior major bleeding or predisposition to bleeding: 1
• Labile INR: 1
  
  • Unstable/high INRs, time in therapeutic range <60%: 1
• Age >65: 1
• Medication usage predisposing to bleeding: 1
  
  • Aspirin, clopidogrel, NSAIDs
• Alcohol use: 1
  
  • ≥8 drinks/week

Question 14

What is the BLATCHFORD-Score?

Answer 14

Used to stratify which patients are low risk for GI bleed before endoscopy

• Hemoglobin
• Urea
• Initial systolic BP
• Sex
• Heart rate ≥100
• Melena present
• Recent syncope
• Hepatic disease history
• Cardiac failure present

Question 15

What is the Rockall Score?

Answer 15

• Age
  
  • <60 years: 0
    
    • 60-79 years: +1
      
      • ≥80 years: +2
• Shock
  
  • No shock (SBP ≥100 AND HR <100): 0
    
    • Tachycardia (SBP ≥100 AND HR ≥100): +1
      
      • Hypotension (SBP <100): +2
• Comorbidities
  
  • No major comorbidity: 0
    
    • Any comorbidity EXCEPT renal failure, liver failure, and/or disseminated malignancy: +2
      
      • Renal failure, liver failure, and/or disseminated malignancy: +3
• Diagnosis
  
  • Mallory-Weiss tear: 0
    
    • No lesion identified and no stigmata of recent hemorrhage: 0
      
      • All other diagnoses: +1
        
        • Malignancy of upper GI tract: +2
• Major stigmata of recent hemorrhage
  
  • None: 0
    
    • Dark spot only: 0
      
      • Blood in upper GI tract: +2
        
        • Adherent clot: +2
          
          • Visible or spurting vessel: +2

Question 16

What is the FeverPAIN criteria?

Answer 16

• Fever (during previous 24 hours)
• Purulence (pus on tonsils)
• Attend rapidly <3 days after onset of symptoms
• Inflamed tonsils severely
• No cough or coryza (inflammation of mucus membranes in the nose)

0-1 no abx, 2-3=delayed abx, 4-5=abx

Question 17

What is GRACE ACS score?

Answer 17

Estimates admission-6 month mortality for patients with acute coronary syndrome.

• Age
• Heart rate/pulse
• Systolic BP
• Creatinine
• Cardiac arrest at admission
• ST segment deviation on EKG?
• Abnormal cardiac enzymes
• Killip class (signs/symptoms)
  
  • No CHF, Rales and/or JVD, Pulmonary edema, Cardiogenic shock

Question 18

Describe the MRC Dyspneoa Scale

Answer 18

Stage 1: Breathless only with strenuous exercise

Stage 2: Short of breath when hurrying on the level or up a slight hill.

Stage 3: Slower than most people of the same age on a level surface or Have to stop when walking at my own pace on the level.

Stage 4: Stop for breath walking 100 meters or After a walking few minutes at my own pace on the level

Stage 5: Too breathless to leave the house.

Question 19

How is Anxiety assessed?

Answer 19

GAD-7: Used as a screening tool and severity measure for generalised anxiety disorder

Question 20

How is Back pain scored in Primary Care?

Answer 20

STarTback

Designed to screen primary care patients with low back pain for prognostic indicators that are relevant to initial decision making

Question 21

How are Alcoholic Assessed?

Answer 21

CAGE

• Have you ever felt you needed to Cut down on your drinking?
• Have people Annoyed you by criticizing your drinking?
• Have you ever felt Guilty about drinking?
• Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

AUDIT-C for alcohol use can be used as well

Question 22

Describe classifcation for Cellulitis management

Answer 22

Eron Classification (admit at >1)

• Class I: No signs of systemic toxicity and no co-morbidities
• Class II: May or may not have systemic illness but has a co-morbidity such as peripheral vascular disease, obesity or venous insufficiency
• Class III: Significant systemic toxicity (eg confusion, tachycardia, tachypnoea, hypotension) plus unstable co-morbidities
• Class IV: Sepsis or Necrotising fasciitis