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Scoring systems Flashcards

1
Q

What is the scoring system used to assess the liklihood of a septic joint (eg septic arthritis vs transient synovitis)?

A
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2
Q

What is the scoring system used to assess stroke risk in patients with AF?

A

CHA2DS2-VASc

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3
Q

What is the scoring system to evaluate risk of haemorrhage on anticoagulation for AF?

A

HASBLED Score

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4
Q

List the elements of the PERC Score.

Who should it be used in?

A

Effectively rules out PE (<2% probability) in patients with a pre-test probability of <15%.

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5
Q

What are the elements of the Well’s Score?

What do the scores equate to?

A

<2 points: low risk = (1.3% incidence PE) -> PERC or D-dimer

Score 2-6 points: moderate risk (16.2% incidence of PE): D-dimer testing or CTA.

Score >6 points: high risk (37.5% incidence of PE): consider CTA. D-dimer testing is not recommended.

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6
Q

What is the HEART Score?

What does it predict?

A

Predicts the risk of Major Adverse Coronary Events (MACE) in the next 6/52 for patients with undifferentiated chest pain.

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7
Q

What is the TIMI Score for NSTEMI/UA?

What does it predict?

Give an estimate of the risk for various scores.

A
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8
Q

What is the GRACE Score?

What is it used for and what are its elements?

A
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9
Q

What are the inclusion criteria for stroke lysis?

A
  • Clinical diagnosis of ischemic stroke causing measurable neurologic deficit
  • Onset of symptoms <4.5 hours before beginning treatment;
  • Age ≥18 years
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10
Q

What is the dose of tPA for stroke lysis?

A

0.9mg/kg alteplase IV (maximum 90mg) over 60 minutes (10% given as a bolus)

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11
Q

What is the NNT to obtain functional independence for thrombolysis in ischaemic stroke?

A

10 - 13 depending on measure of “functional independence 0-1 vs 0-2.

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12
Q

What is the modified Rankin Score?

A
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13
Q

What is the number needed to harm (NNTH) for patients treated with thrombolysis in ischaemic stroke?

A

sICH - 42

Death - 122

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14
Q

What are the indications for GTN infusion in STEMI?

A
  • Ischaemic pain not responsive to opiates
  • Severe hypertension
  • Cardiogenic APO with HTN
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15
Q

What are the indications for thrombolysis in STEMI?

A

Indications:

  • PCI not available within 90mins of first medical contact AND
  • All patients (without contraindications) who present within 12 hours of symptom onset of STEMI.
  • Patients who present more than 12 hours after symptom onset may be considered however in selected cases when:
    • There are ongoing symptoms
    • There is ongoing electrical and /or hemodynamic (cardiogenic shock) instability.

NB: The ideal treatment for all STEMIs is acute PCI or in some cases emergency CABGs

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16
Q

What are the absolute and relative contrindications to thrombolysis (PE and STEMI)?

A
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17
Q

List ten causes of non-MI tropinaemia (cardiac and non-cardiac).

A

Cardiac:

  • CHF
  • Cardiac contusion or electrical injury (defib/electrocution)
  • Tachy/bradyarrhythmias
  • Kawasaki’s disease
  • Takotsubo’s disease (stress cardiomyopathy)

Non-cardiac:

  • PE
  • Aortic dissection
  • Sepsis
  • >30% BSA burns
  • Hypoxia
  • ICH/SAH
  • Renal failure
  • Extreme exertion
18
Q

List the STEMI criteria.

A
  • >20mins of typical ischaemic chest pain
  • Persistent (>20mins) ECG changes in >= 2 contiguous leads of:
    • >2.5mm STE in V2-V3 (males < 40y)
    • >2.0mm STE in V2-V3 (males > 40y
    • >1.5mm STE in V2-V3 (females)
    • >1mm in all other leads
  • LBBB new or which meets Sgarbossa Criteria
19
Q

What are the recommended timeframes for patients with confirmed ACS (STEMI or NSTEACS)?

  1. STEMI
  2. Very high-risk NSTEACS
  3. High risk NSTEACS
  4. Intermediate risk NSTEACS
A
  1. Emergent -> activate cath lab
  2. PCI <2h
  3. PCI < 24h
  4. PCI <72h
20
Q

What are the features of Very High Risk NSTEACS?

A
  • Haemodynamic instability:
    • Heart failure/ cardiogenic shock
    • Mechanical complications of myocardial infarction
  • Life-threatening arrhythmias or cardiac arrest
  • Recurrent or ongoing ischaemia (e.g. chest pain refractory to medical treatment) or
  • recurrent dynamic ST segment and/or T wave changes, particularly with:
    • de Winter T wave changes
    • Wellens syndrome (or LMCA syndrome)
    • posterior MI
21
Q

What targets should be aimed for when utilising an MTP?

A
  • Temp >35
  • Calcium >1.1
  • pH > 7.2
  • Lactate < 4
  • Platelets >50
  • INR < 1.5
  • APTT/PT <1.5 normal
  • Fibrinogen > 1
  • BE < -6
22
Q

What are PESI and Simplified PESI?

What do they predict?

What are the features that suggest poorer outcomes in patients w/ PE?

A

PE Severity Index (11 clinical criteria)

Simplified PE Severity Index (6 clinical criteria)

They predict the risk of death at 30days. In sPESI, any one criteria increases the risk from 1.1% to 8.9%.

sPESI:

  • Age > 80
  • History of cancer
  • History of cardiopulmonary disease
  • HR > 110
  • SBP < 100
  • SaO2 < 90%

PESI is a weighted system and also includes:

  • Gender
  • RR > 30
  • T < 36
  • ALOC
23
Q

What electrolyte imbalances are most common in re-feeding syndrome?

Give three effects of each of these imbalances.

A
24
Q

List ten clinical indications (hx, exam or lab) for medical admission in patients with Eating Disorders.

A
  • BMI < 12
  • Weight loss 1kg/wk over multiple weeks
  • Grossly inadequate nutritional intake <1000cal/day
  • High risk of re-feeding syndrome, eg:
    • SBP < 80mmHg
    • Postural SBP drop > 10mmHg
    • HR < 40 or > 120
    • Postural HR inc > 20bpm
    • T < 35degs
    • Any arrhythmia (QTc prolongation, non-specific ST or T-wave changes)
    • BSL < 2.5
    • Na < 125
    • K < 3.0
    • Mg < 0.7
    • PO4 < 0.8
    • eGFR < 60
    • Alb < 30
    • Neutrophils < 1.0
    • Markedly elevated ALT/AST > 500
      *
25
Q

List three options for BP reduction in the pre-eclamptic patient and what medication should be avoided (and why)?

What BP endpoints should be aimed for?

A
  • labetalol IV 5-10mg injected slowly
  • hydrallazine IV 10-20mg slowly
  • nifedipine PO 10-20mg or IV 100-200mg over 2 min
  • GTN IV 0.1-0.8mcg/kg/min

Avoid sodium nitroprusside due risk of cyanide toxicity to fetus

Aim to aggressively reduce BP <140/90 (10-20mmHg/20mins)

26
Q

What is the dose of steroid to be given if premature labour is at risk?

A

Betamethasone 11.4mg IMI x2 q12h

27
Q

Give eight risk factors for pre-eclampsia.

A
  • PET during another pregnancy
  • advanced maternal age
  • multiple pregnancy
  • high BMI
  • conception before age 20
  • connective tissue disorders
  • protein C and S deficiencies
  • factor V leiden mutation
  • hyperhomocysteinemia
28
Q

List the priorities in managing the eclamptic patient.

A
  1. Call for help - O+G, ICU and paeds/neonatolgy
  2. Resuscitate
    1. A B C D E
    2. Remember cautious fluid boluses due risk of APO
  3. Control seizures
    1. 4g IV MgSO4 over 20mins
    2. 1g/hr IV MgSO4 infusion ongoing
    3. 0.1-0.2mg/kg IV/IM midazolam if seizures continue and/or while getting MgSO4
  4. Control BP
    1. Hydralazine 10-20mg IV slowly over 2min
    2. Labetalol 5-10mg IV slowly over 2min
    3. Nifedipine 100-200mg IV slowly over 2min
    4. GTN infusion 0.1-0.8mcg/kg/min
  5. Prepare for delivery if pre-partum
    1. Continuous CTG monitoring or POCUS
    2. Liaise with O+G, Paeds and OR
  6. Remember
    1. Betamethasone 11.4mg IM if pre-term
    2. Anti-D if blood group mandates
    3. Left lateral decubitus position
29
Q

What is the method for determining the nature of a pleural exudate?

A

Light’s Criteria:

  • Pleural protein : Serum protein = > 0.5
  • Pleural LDH : Serum LDH = > 0.6
  • Pleural LDH > 0.66 (2/3) x upper limit of normal for serum LDH
  • Serum albumin - pleural albumin < 1.2g/dL

One criteria being met has high sensitivity for exudative pleural effusion.

30
Q

What are the characteristics of pleural fluid that suggests a chylothorax?

A
  • Cloudy or turbid fluid
  • Triglycerides > 110 (raised)
31
Q

What does a putrid smelling pleural fluid sample suggest?

A

Possible anaerobic infection

32
Q

What are the important levels of haematocrit in pleural fluid analysis?

A

<1% – non-significant

1-20% – Cancer, PTE, trauma, pneumonia

>50% – Haemothorax

33
Q

What is suggested by a raised amylase level in pleural fluid analysis?

A

Pancreatitis as cause for pleural effusion

34
Q

What are the common causes of a lymphocytosis in pleural aspirate?

A

>85% leucocyte count suggests:

  • Malignancy -> lymphoma
  • TB pneumonia
  • Sarcoid
  • Rheumatoid
35
Q

What risk factors suggest high liklihood of stroke after TIA?

A

ABCD2 score:

Age > 60y - 1pt

BP >140mmHg 1pt

Clinical features: Speech w/out weakness 1pt; unilateral weakness 2pts

Duration of symptoms: 10-59mins - 1pt; >=60mins 2pt

DM 1pt

Predicts risk of stroke at 2days, 7days and 90days post TIA

0-3pts - Low risk

4-5pts - Moderate risk

6-7pts - High risk

36
Q

What are the toxic doses of salicylate toxicity and the associated expected symptoms?

A
  • >150mg/kg - minimal symptoms
  • 150-300mg/kg - mild/mod toxicity -> tachypnoea (respiratory alkalosis), tinitus, vomiting, mild condusion/delirium
  • 300-500mg/kg - severe toxicity -> Metabolic acidosis (HAGMA), altered LOC, seizures
  • >500mg/kg - life threatening seizures, cerebral oedema, death
37
Q

List three methods of gastric decontamination.

A
  1. Gastric lavage - not for ALOC patients unless I+V
  2. Single dose AC - 1g/kg (50g max) - not for uncooperative, alcohols, metals or corrosives
  3. Whole bowel irrigation - 2L/h polyethylene glycol electrolyte solution - precede with AC and give via NGT
38
Q

List three methods of enhanced elimination and the agents that the method may benefit in.

A
  1. Multiple dose activated charcoal
    • Carbamazepine
    • Theophylline
    • Phenobarbitone
    • Quinine
  2. Urinary alkalinisation
    • Salicylates
    • Phenobarbitone
  3. Haemodialysis
    • Toxic alcohols
    • Theophyline
    • Salicylates
    • Lithium
    • Valproate
    • K+ overdose
    • Carbamazepine
    • Metformin lactic acidosis
    • Phenobarbitone
39
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Scoring systems (1 decks)

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