Scoring Systems

Question 1

What is the TIMI Score for NSTE-ACS for?

Answer 1

Prognostication of NSTE-ACS patients for recurrent cardiac events and identifying those who will benefit from an early invasive strategy

Question 2

What are the components of the NSTE-ACS TIMI score?

Answer 2

1 point each

Age 65 or up
3 or more CAD risk factors (family history, HPN, hypercholesterolemia, DM, and smoker)
Known CAD of 50% stenosis or more
Aspirin use in last 7 days
Severe angina in last 24 hours
Elevated cardiac markers
ST deviation of 0.5 mm or more

Question 3

What is a high risk NSTE-ACS TIMI score and what is the associated mortality rate?

Answer 3

3 or more (13% mortality)

Question 4

What is the Kilip Scoring?

Answer 4

Prognostication of STEMI

Question 5

How many classes are there in the Kilip scoring?

Answer 5

Four

Question 6

Description and risk of mortality of Kilip I

Answer 6

No rales or signs of pulmonary or venous congestion
Normal BP
0 - 5%

Question 7

Description and risk of mortality of Kilip II

Answer 7

Moderate heart failure
With bibasal rales
Normal BP
S3 gallop
Tachypnea or signs of right-sided CHF (venous & hepatic congestion)
10 - 20%

Question 8

Description and risk of mortality of Kilip III

Answer 8

Severe heart failure
With mid-basal rales and pulmonary edema
Presence of S3 and S4
Normal BP
35 - 45%

Question 9

Description and risk of mortality of Kilip IV

Answer 9

Shock with SBP < 90 mmHg and peripheral vasoconstriction
Peripheral cyanosis
Mental confusion and oliguria
85 - 95%

Question 10

What is the TIMI score for STEMI for?

Answer 10

30-day mortality

Question 11

What are the components of the TIMI Score for STEMI?

Answer 11

Age 65 - 74 (2 points)
Age 75 or greater (3 points)
DM, HPN, angina (1 point)

SBP < 100 mmHg (3 points)
HR > 100 bpm (2 points)
Kilip II - IV (2 points)
Weight < 67 kg (1 point)

Anterior ST elevation or LBBB on ECG (1 point)
Time to treatment > 4 hours (1 point)

Question 12

What is a high risk STEMI TIMI score?

Answer 12

5 or more points (12% mortality)

Question 13

What is the Well’s Scoring?

Answer 13

Determines the likelihood of a venous thromboembolism

Question 14

What are the components of the PE Well’s Score?

Answer 14

Signs and symptoms of DVT (3)
Alternative diagnosis to PE unlikely (3)
Immobilized > 3 days or surgery within 4 weeks (1.5)
Prior PE or DVT (1.5)
HR > 100 (1.5)
Hemoptysis (1)
Cancer (1)

Question 15

What is the cut-off for the PE Well’s Score?

Answer 15

5 or more

Question 16

What is Forrest classification?

Answer 16

UGIB classification of rebleed risk, mortality and need for endoscopic intervention

Question 17

Enumerate the Forrest classification

Answer 17

IA - spurting - 100% rebleed
IB - oozing - 55% rebleed
IIA - Visible vessel - 43% rebleed
IIB - adherent clot - 22%
IIC - pigmented flat spot - 10%
III - clean-based ulcer - 5%