Scoring Systems

Question 1

Glasgow Coma Scale - Eye Opening

Answer 1

4- spontaneously
3- to speech
2- to pain
1- none

Question 2

Glasgow Coma Scale - Verbal Response

Answer 2

5- orientated
4- confused
3- inappropriate
2- incomprehensible
1- none

Question 3

Glasgow Coma Scale - Motor Response

Answer 3

6- obeys commands
5- localises to pain
4- withdraws from pain
3- flexion to pain
2- extension to pain
1- none

Question 4

You are assessing the motor component of a patient’s Glasgow Coma Scale. They are unable to obey commands but bend their elbow when their finger nail bed is stimulated. What do you do next?

Answer 4

3- flexion to pain

Question 5

If you were told by a colleague that their assessment of a patient’s Glasgow Coma Scale was E2, V3, M5, how would you interpret this?

Answer 5

The patient’s eyes open to pressure, they can utter some words but do not form sentences, and they are able to localise to trapezius pinch.

Question 6

If you were told by a colleague that their assessment of a patient’s Glasgow Coma Scale was E4, V3, M2, how would you interpret this?

Answer 6

Eyes open spontaneously
Say inappropriate words. e.g. ask you for a drink when you ask them where they are
Extension to pain

Question 7

CURB-65

Answer 7

Confusion
Urea >7
Resp rate >30
Blood pressure <90S or <60D
Over 65?
1 point for each

Question 8

CURB65 - 1 point

Answer 8

Low risk, consider outpatient treatment

Question 9

CURB65 - 2 points

Answer 9

Moderate risk, consider inpatient or outpatient with close followup

Question 10

CURB65 - 3 points

Answer 10

Severe risk group, consider in patient treatment with possible intensive care admission

Question 11

CURB65 - 4 points

Answer 11

Severe risk group, consider in patient treatment with possible intensive care admission

Question 12

CURB65 - 5 points

Answer 12

Severe risk group, consider in patient treatment with possible intensive care admission

Question 13

71M, wandering streets [new confusion].
O/E RR32; BP 95/50
What’s his CURB-65 score?

Answer 13

4 points
inpatient recommended

Question 14

67-year-old male with CAP, blood pressure of 120/85mmHg, and confusion
CURB65?

Answer 14

2 points
short inpatient or outpatient with close followup

Question 15

68-year old male with CAP, blood pressure of 130/80mmHg, and respiratory rate of 18/min
CURB65?

Answer 15

1 point
Outpatient tx

Question 16

69-year old female with CAP, blood pressure of 125/82mmHg, and creatinine of 2.1mg/dL (Baseline is 0.8mg/dL)
CURB65?

Answer 16

2 points
short inpatient or outpatient with close follow up

Question 17

58-year old female with CAP, blood pressure of 100/50mmHg, and confusion
CURB65?

Answer 17

2 points
inpatient is recommended - use clinical judgement alongside CURB65

Question 18

32-year-old female with CAP, blood pressure of 90/50mmHg, altered mental status, and respiratory rate 34/min
CURB65?

Answer 18

3 points
inpatient tx recommended

Question 19

FeverPAIN score

Answer 19

Fever
Purulent tonsils
Attend rapidly [<3 days]
Inflamed tonsils
No cough
1 point for each

Question 20

FeverPAIN - 0 point

Answer 20

Unlikely streptococcal infection; no antibiotic recommended

Question 21

FeverPAIN - 1 point

Answer 21

Unlikely streptococcal infection; no antibiotic recommended

Question 22

FeverPAIN - 2 points

Answer 22

Consider delayed antibiotics [prescribe, only take if not better after a few days]

Question 23

FeverPAIN - 3 points

Answer 23

Consider delayed antibiotics

Question 24

FeverPAIN - 4 points

Answer 24

Consider antibiotics

Question 25

FeverPAIN - 5 points

Answer 25

Consider antibiotics

Question 26

Centor criteria

Answer 26

Age [3-14y] Exudate or swollen tonsils Tender/swollen anterior or cervical lymph nodes Fever No cough 1 point for each

Question 27

CHA2DS2-VASc score

Answer 27

Congestive Heart Failure - 1point Hypertension - 1point Age >75 - 2points Diabetes - 1point Stroke, TIA, TE - 2point Vascular disease - 1point Age 65-74 - 1point Sex category [female] - 1point

Question 28

CHA2DS2-VASc - 0 point

Answer 28

no anticoagulation

Question 29

CHA2DS2-VASc - 1 point

Answer 29

consider anticoagulation [unless scoring solely due to Sc]

Question 30

CHA2DS2-VASc - 2 points

Answer 30

strongly consider anticoagulation

Question 31

S/S of moderate acute asthma

Answer 31

increasing symptoms PEF >50-75% best or predicted no features of acute severe asthma

Question 32

S/S of acute severe asthma

Answer 32

Any of the following: PEF 33-50% best or predicted respiratory rate >=25/min heart rate >=110/min inability to complete sentences in one breath

Question 33

S/S of life-threatening asthma

Answer 33

Pt with severe asthma, any one of the following: PEF <33% best or predicted SpO2 <92% PaO2 <8kPa 'normal' PaCO2 [4.6-6] altered conscious level exhaustion arrhythmia hypotension cyanosis silent chest poor respiratory effort

Question 34

S/S near fatal asthma

Answer 34

Raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures

Question 35

MRC Dyspnoea Scale 1

Answer 35

no breathlessness except with strenuous exercise

Question 36

MRC Dyspnoea Scale 2

Answer 36

Shortness of breath when hurrying on the level or walking up a slight hill

Question 37

MRC Dyspnoea Scale 3

Answer 37

Walks slower than people of the same age on the level because of breathlessness or has to stop for breath when walking at own pace on the level

Question 38

MRC Dyspnoea Scale 4

Answer 38

Stops for breath after walking about 100m or after a few minutes on the level

Question 39

MRC Dyspnoea Scale 5

Answer 39

Too breathless to leave the house or breathless when dressing or undressing

Question 40

CKD Classification - groups

Answer 40

G1 G2 G3a G3b G4 G5

Question 41

CKD - G1 [GRF and term to describe]

Answer 41

>=90 ml/min/1.73m2 normal or high

Question 42

CKD - G2 [GRF and term to describe]

Answer 42

60-89 mildly decreased

Question 43

CKD - G3a [GRF and term to describe]

Answer 43

45-59 mildly-moderately decreased

Question 44

CKD - G3b [GRF and term to describe]

Answer 44

30-44 mildly-moderately decreased

Question 45

CKD - G4 [GRF and term to describe]

Answer 45

15-29 severely decreased

Question 46

CKD - G5 [GRF and term to describe]

Answer 46

<15 kidney failure

Question 47

MRC Muscle Power Scale

Answer 47

0 no contraction 1 flicker or trace of contraction 2 active movement, with gravity eliminated 3 active movement against gravity 4 active movement against gravity and resistance 5 normal power