Medical Criteria – D

Medical Criteria – D

DIAGNOSIS OF A DRUG REACTION

• Classification by Naranjo et. al has 4 criteria:

1. 1. Temporal relationship between drug exposure and reaction
   2. Recognized response to suspected drug
   3. Improvement after drug withdrawal
   4. Recurrence of reaction on re-challenge with the drug

• • • Definite drug reaction requires all 4 criteria to be met
    • Probable drug reaction requires #1-3 to be met
    • Possible drug reaction requires only #1

DEEP VEIN THROMBOSIS (DVT):

• Wells’ Criteria for DVT

•   Active cancer	+1
•   Paralysis, paresis or recent immobilization of leg	+1
•   Recently bedridden x 3 d or major surgery within 4 wk.	+1
•   Local tenderness	+1
•   Entire leg swollen	+1
•   Calf swelling 3cm > asymptomatic leg	+1
•   Unilateral pitting edema	+1
•   Collateral superficial veins	+1
•   Alternative Dx more likely	-2
*  0: Low probability *   1-2: Moderate probability *  >3: High probability

WELLS’ SCORE FOR DVT CRITERIA (SCORE)

• Paralysis, paresis, or recent orthopaedic casting of lower extremity (1)
• Recently bedridden (>3 d) or major surgery within past 4 wk (1)
• Localized tenderness in deep vein system (1)
• Swelling of entire leg (1)
• Calf swelling >3 cm than other leg (measured 10 cm below the tibial tuberosity) (1)
• Pitting edema greater in the symptomatic leg (1)
• Collateral non-varicose superficial veins (1)
• Active cancer or cancer treated within 6 mo (1)
• Alternative diagnosis more likely than DVT (e.g. Baker’s cyst, cellulitis, muscle damage, superficial venous thrombosis) (-2)
• Total Score Interpretation

• • 3-8: High probability, 1-2: Moderate probability, -2-0: Low probability
• Modified Wells Score

• • Same as above except with 1 additional point for a history of DVT or major surgery within past 12 wks., and the score interpretation is DVT likely for ≥ 2 points and DVT unlikely for ≤1 point. D-dimer is ordered for DVT unlikely patients to fully rule out DVT which can help reduce unnecessary ultrasounds.

DIABETIC KETOACIDOSIS:

• 4 Criteria for DKA Dx
  • Hyperglycemia
  • Metabolic acidosis
  • Hyperketonemia
  • Ketonuria

DIABETES MELLITUS:

• Any one of the following is Diagnostic Criteria.
  • FPG ≥7.0 mmol/L, Fasting = no caloric intake for at least 8 hours

or

• • HbA1C ≥6.5% (in adults). Not for diagnosis of suspected T1DM, children, adolescents, or pregnant women

or

• • 2hPG in a 75g OGTT ≥11.1mmol/L

or

• Random PG ≥11.1 mmol/L. Random = any time of the day, without regard to the interval since last meal
• In the presence of hyperglycemia symptoms (polyuria, polydipsia, polyphagia, weight loss, blurry vision), a confirmatory test is not required
• In the absence of hyperglycemic symptoms, a repeat confirmatory test (FPG, A1C, 2hPG in a 75 g OGTT) done on another day is required for diagnosis of diabetes

DIABETES INSIPIDUS:

• Diagnostic Criteria.
  • Fluid deprivation will differentiate true DI (high urine output persists, urine osmolality < plasma osmolality) from psychogenic DI (psychogenic polydipsia)
  • Response to exogenous ADH (DDAVP) will distinguish central from nephrogenic DI

DEPRESSION

• Criteria for Depression
  • (≥5/9 with at least one of anhedonia or depressed mood for ≥2 wk.)
  • M-SIGECAPS
  • M Depressed Mood
  • S Increased/decreased Sleep
  • I Decreased Interest
  • G Guilt
  • E Decreased Energy
  • C Decreased Concentration
  • A Increased/decreased Appetite and weight
  • P Psychomotor agitation/retardation
  • S Suicidal ideation

DYSPEPSIA:

• Chief criteria of Investigation
  • Gastroscopy if age >60 (and if age <60 or under special circumstances such as risk factors for gastric cancer)

DIABETES MELLITUS

• Diagnostic Criteria for Types 1 and 2 in Children

1. 1. Symptoms (polyuria, polydipsia, weight loss, etc.) and hyperglycaemia (Random glucose ≥11.1 mmol/L)

OR

1. 2. Two of the following on one occasion:

• • • Fasting glucose ≥7.0 mmol/L
    • 2 h plasma glucose during OGTT ≥11.1 mmol/L
    • Random glucose ≥11.1 mmol/L (not appropriate for confirmatory testing)

OR

1. 3. One of the following on two separate occasions*

• • • Fasting glucose ≥7.0 mmol/L
    • 2 h plasma glucose during OGTT ≥11.1 mmol/L
    • Random glucose ≥11.1 mmol/L (not appropriate for confirmatory testing)

*Random glucose is not appropriate for confirmatory (second) testing.

DIFFERENTIAL DIAGNOSIS OF PSYCHOSIS:

• The primary diagnosis needs full criteria to be met
  • Mood: depressive episodes with psychotic features, manic episodes with psychotic features
  • Psychotic: consider symptoms in Criterion A of schizophrenia (see Criteria for Schizophrenia)

DELUSIONAL DISORDER:

• Dsm-5 Diagnostic Criteria for Delusional Disorder

1. 1. The presence of one (or more) delusions with a duration of 1 month or longer
   2. Criterion A for schizophrenia has never been met
      • Note: hallucinations, if present, are not prominent and are related to the delusional theme\
   3. Apart from the impact of the delusion(s) or its ramifi­cations, functioning is not markedly impaired, and behaviour is not obviously bizarre or odd
   4. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods
   5. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder

• Subtypes: Erotomanic, grandiose, jealous, persecutory, somatic, mixed, unspeci­fied
• Further specify: bizarre content, type of episode (i.e., fi­rst episode, multiple episode), severity

DEPRESSION CRITERIA (≥5):

• MSIGECAPS
  • Mood: depressed
  • Sleep: increased/decreased
  • Interest: decreased
  • Guilt
  • Energy: decreased
  • Concentration: decreased
  • Appetite: increased/decreased
  • Psychomotor: agitation/retardation
  • Suicidal ideation

DELIRIUM:

• DSM-5 Diagnostic Criteria for Delirium

1. 1. Attention and awareness: disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment)
   2. Acute and ‑fluctuating: disturbance develops over short period of time (usually hours to days), represents a change from baseline attention and awareness, and tends to ‑fluctuate in severity during the course of a day
   3. Cognitive changes: an additional disturbance in cognition (i.e., memory defi­cit, disorientation, language, visuospatial ability, or perception)
   4. Not better explained: disturbances in criteria a and c are not better explained by another neurocognitive disorder (pre-existing, established, or evolving) and do not occur in the context of a severely reduced level of arousal (i.e., Coma)
   5. Direct physiological cause: evidence that disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e., Due to a drug of abuse or medication), toxin, or is due to multiple etiologies

* Note: Delirium can be described as HYPERactive, HYPOactive, or MIXED presentation. While patients with hyperactive delirium may demonstrate features of restlessness and agitation, as well as experience hallucinations and delusions, those with hypoactive delirium present with lethargy, sedation and respond slowly to questioning

Also read:

1. Criteria in GPNotebook
2. Criteria in NICE
3. Criteria in Statpearls