Scoring Systems

Question 1

APGAR birth prognosis score

Answer 1

Assesses newborn cardiorespiratory function

Performed at 1 and 5 minutes postpartum

A: Activity - active movements (2) arms and legs flexed (1) absent (0)
P: Pulse - >100bpm (2) <3 critically low

Low initial score and no improvement at 5 minutes are associated with adverse outcomes including death

Question 2

CURB-65 score for severity of CAP

Answer 2

C: Confusion
U: Urea >7
R: Respiratory rate >30
B: BP systolic 65

Score 0: Low risk of death, hospitalisation not needed
Rx: Amoxicillin 7 days (+clari if atypical, +fluclox if staph)
Doxycycline / clari if pen allergic

Score 1-2: Increased risk of death, consider admission
Rx: Amoxicillin + clari 7 days
Doxycycline alone if pen allergic

Score 3+: High risk of death, admit and consider ITU input
Rx: BenPen + clari/doxy 7-10 days
If life threatening/comorbidities/nursing home resident - Co-amoxiclav + clari 7-10 days
cefuroxime/cefotaxime + clari if pen allergic

Question 3

Well’s Score - PE

Answer 3

3 points:
Clinical signs/Sx of DVT
PE most likely diagnosis

1.5 points:
HR>100
3 days immobilisation or surgery in past 4 weeks
Previous DVT/PE

1 point:
Haemoptysis
Malignancy

5+ points - PE likely
<5 points - PE unlikely

PE likely - CTPA + LMWH if delay
PE unlikely - d-dimer and CTPA if raised, LMWH if delay

In contrast medium allergy or renal impairment - V/Q scan