Scoring systems

Question 1

The modified Glasgow criteria for predicting the severity of pancreatitis.

Answer 1

PaO2 55 years
Neutrophilia >15 x 10^9/L
Calcium 16 mmol/L
Enzymes - LDH >600iu/L; AST>200iu/L
Albumin 10 mmol/L

(3 or more means a severe attack)

Question 2

TIMI score

Answer 2

Age >65
Markers (raised troponin)
ECG (ST segment deviation >=0.5mm)
Risk factors >3
Ischaemia (>= severe angina in last 24 hours)
Coronary stenosis >50%
Aspirin use in the last 7d

NSTEMIs should be treated with early angioplasty if score >3. TIMI assess risk of death and ischaemic events.

Question 3

NYHA classification for heart failure.

Answer 3

I - no limitation of physical activity
II - slight limitation of exercise (fatigue and dyspnoea)
III - marked limitation of activity (comfortable at rest but slight exertion causes symptoms)
IV - symptoms at rest

Question 4

Well’s score for PE

Answer 4

Clinical signs and symptoms of PE - 3
PE is the most likely diagnosis/equally likely - 3
HR >100 - 1.5
Immobilisation for 3 or more days/surgery in the last 4 weeks - 1.5
Previous PE or DVT - 1.5
Haemoptysis - 1
Malignancy treated within the last 6 months/ palliative - 1

Question 5

Well’s score for DVT

Answer 5

Active cancer - 1
Bedridden for more than 3 days/ major surgery in the last 4 weeks - 1
Calf swelling >3cm compared to other leg - 1
Entire leg swollen - 1
Localised tenderness along deep venous system - 1
Pitting oedema in the symptomatic leg - 1
Paralysis, paresis or recent plaster immobilisation - 1
Previously documented DVT - 1
Alternative diagnosis equally if not more likely - -2

Question 6

WHO performance status

Answer 6

0 = normal activity
1 = ambulant, light work possible
2 = ambulant, self caring, up and about >50%
3 = limited self-care, bed/chair bound >50%
4 = bed/chair bound, no self care

Question 7

Light’s criteria

Answer 7

If protein level between 25 and 35 g/L

Pleural fluid protein:serum ratio >0.5
Pleural fluid LDH: serum ratio >0.6
Pleural fluid LDH> 2/3 upper limit of normal for serum

If any of these are true, the effusion is an exudate

Question 8

CURB-65

Answer 8

New onset confusion AMTS < 7 mmol/L
RR >30
BP systolic 90, diastolic 60
Age 65

Question 9

Truelove and Witt’s criteria for assessing UC severity - what are the criteria for severe?

Answer 9

>6 motions a day
Large amount of rectal bleeding
>37.8 degrees temperature at 6am
HR >90
Hb 30

Question 10

Definitions of hypertension

Answer 10

Stage 1 = clinic BP >=140/90mmHg and ambulatory BP >=135/85mmHg

Stage 2 = clinic BP >=160/100mmHg and ambulatory BP >=150/95mmHg

Stage 3 = clinic systolic >= 180mmHg or diastolic >=110mmHg

Question 11

SIRS

Answer 11

> = 2 of the following

Fever >38 or 90
RR >20 or PaCO2 12 or <4

Question 12

ABCD2 score

Answer 12

Age >60 1

BP>140 systolic and/or >90 diastolic 1

Clinical features

• Unilateral weakness 2
• Speech disturbance without weakness 1
• Other 0

Duration of symptoms

• > 60 minutes 2
• 10-59 minutes 1
• <10 minutes 0

Diabetes 1

Question 13

CHA2DS2Vasc score

Answer 13

Congestive heart failure
Hypertension
Age 65-74, or >=75
Diabetes
Stroke/TIA/thromboembolism
Vascular disease

Question 14

Rockall score

Answer 14

Age
BP/HR (shock)
Co-morbidity
Diagnosis
Endoscopic findings

Question 15

Dukes’ classification

Answer 15

A - confined to beneath muscularis mucosae
B - extension through muscularis mucosa
C - lymph node involvement
D - distant metastases