Medical Criteria – P

Medical Criteria – P

POSITIVE LAVAGE:

• >10 cc gross blood
• Bile, bacteria, foreign material
• RBC count >100,000 x 10⁶/L
• WBC >500 x 10⁶/L,
• Amylase >175 IU

PULMONARY EMBOLISM (PE):

• Wells’ criteria for PE:

PRE- DIABETES (IMPAIRED GLUCOSE TOLERANCE / IMPAIRED FASTING GLUCOSE):

• Diagnostic Criteria (CDA Guidelines)
  • Impaired fasting glucose (IFG): fasting plasma glucose (FPG) 6.1-6.9 mmol/L
  • Impaired glucose tolerance (IGT): 2h 75 g oral glucose tolerance test (OGTT) 7.8-11.0 mmol/L
  • HbA1c: 6.0-6.4%

PRIMARY HYPERPARATHYROIDISM:

• For asymptomatic patients, surgery is recommended for those who meet ≥1 of the following criteria:
  • Serum calcium concentration more than 0.25 mmol/L (1.0 mg/dL) above the upper limit of normal
  • Creatinine clearance <60 mL/min
  • BMD T-score <-2.5 at hip, spine, or distal radius, and/or previous fragility fracture
  • Age <50 yrs.

PREMENSTRUAL SYNDROME DIAGNOSTIC CRITERIA:

• At least one affective and one somatic symptom during the 5 d before menses in each of the three prior menstrual cycles.
• Affective: Depression, angry outbursts, irritability, anxiety, confusion, social withdrawal
• Somatic: Breast tenderness or swelling, abdominal bloating, headache, swelling of extremities, joint or muscle pain, or weight gain

• Symptoms relieved within 4 d of onset of menses and do not recur until at least day 13 of cycle
• Symptoms present in the absence of any pharmacologic therapy, hormone ingestion, drug or alcohol use
• Symptoms occur reproducibly during 2 cycles of prospective recording
• Patient suffers from identi­fiable dysfunction in social or occupational performance

PREMENSTRUAL DYSPHORIC DISORDER DIAGNOSTIC CRITERIA:

• At least 5 of the following 11 symptoms during most menstrual cycles of the last year (with at least 1 of the fi­rst 4)
  • Depressed mood or hopelessness
  • Anxiety or tension
  • Affective instability
  • Anger or irritability
  • Decreased interest in activities
  • Difficulty concentrating
  • Lethargy
  • Change in appetite
  • Hypersomnia or insomnia
  • Feeling overwhelmed
  • Physical symptoms: breast tenderness/swelling, headaches, joint/muscle pain, bloating, or weight gain
• Symptoms cause signi­ficant distress and/or interfere with social or occupational functioning
• Symptoms must be present during the week prior to menses and resolve within a few days after onset of menses
• May be superimposed on other psychiatric disorders, provided it is not merely an exacerbation of another disorder

POLYCYSTIC OVARIAN SYNDROME:

• Rotterdam diagnostic criteria: 2 of 3 required
  • Oligomenorrhea/irregular menses for 6 mo
  • Hyperandrogenism
    1. Clinical evidence – hirsutism or acne
    2. Biochemical evidence – raised free testosterone
  • Polycystic ovaries on U/S (not appropriate in adolescents)
• Polycystic Ovary Syndrome Diagnostic Criteria Pitfalls and Controversies:
• JOGC 2008; 8:671-679
• At present, there is no clear-cut definition of biochemical hyperandrogenemia, particularly since there is dependence on poor laboratory standards for measuring androgens in women.
• Clinical signs of hyperandrogenism are ill-defined in women with PCOS, and diagnosis of both hirsutism and polycystic ovarian morphology remains subjective. There is also the inappropriate tendency to assign ovulatory status solely on basis of menstrual cycle history or poorly timed endocrine measurements. Therefore, it is important as clinicians to recognize the multi-factorial and complex nature of PCOS and place this in the context of our present diagnostic limitations.

POLYCYTHAEMIA VERA:

• Diagnosis criteria: (WHO 2016) requires meeting either all 3 major criteria, or the first 2 major criteria and the minor criterion

• • Major Criteria
    • Hemoglobin >165 g/L in men, >160 g/L in women, OR Hct >49% in men or >48% in women,

                OR increased red cell mass (>25% above mean normal predicted value)

• • • Bone marrow biopsy showing hypercellularity for age with trilineage growth (Panmyelosis) with prominent erythroid, granulocytic, and megakaryocytic proliferation
  • • presence of JAK2 V617F or JAK2 exon 12 mutation
• Minor Criterion
  • Serum erythropoietin level below reference range for normal (must have at least two major criteria if using erythropoietin level)

PNEUMONIA:

• Criteria for Hospitalization

Table 9. CURB 65 score – Pneumonia Clinical Prediction Tool

* A CRB-65 score may be applied in the community as its criteria depend on clinical assessment alone

PARKINSON’S DISEASE:

• 2015 MDS Clinical Diagnostic Criteria for Parkinson’s Disease “Clinically Established Parkinson’s Disease” requires:
  • Cardinal Parkinsonism Manifestations: Bradykinesia with either rest tremor or rigidity
  • 2 or more supportive criteria (clear and dramatic beneficial response to dopaminergic therapy, levodopa-induced dyskinesia, rest tremor of a limb, olfactory loss/cardiac sympathetic denervation on MIBG scintigraphy)
  • No absolute exclusion criteria and no red flags (see full diagnostic criteria – Mov Disord 2015;30:1591-601)

TOCOLYTICS FOR PRETERM PREMATURE RUPTURE OF MEMBRANES:

• Selection Criteria:

• • Pregnant women with singleton pregnancies and PPROM (23-36 wks. and 6 d GA).

PERSISTENT DEPRESSIVE DISORDER:

• DSM-5 Diagnostic Criteria for Persistent Depressive Disorder

Note: in DSM-IV-TR this was referred to as Dysthymia

• Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for ≥2 yrs.

Note: In children and adolescents, mood can be irritable and duration must be at least 1 yr

• Presence, while depressed, of ≥2 of the following:
  • Poor appetite or overeating
  • Insomnia or hypersomnia
  • Low energy or fatigue
  • Low self-esteem
  • Poor concentration or difficulty making decisions
  • Feelings of hopelessness
• During the 2 yrs. period (1 yr. for children or adolescents) of the disturbance, the person has never been without the symptoms in criteria A and B for more than 2
  months at a time
• Criteria for a major depressive disorder may be continuously present for 2 yrs.
• There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder
• The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specifi­ed or unspecifi­ed schizophrenia
  spectrum and other psychotic disorder.
• The symptoms are not due to the direct physiological eects of a substance or another medical condition
• The symptoms cause clinically signi­cant distress or impairment in social, occupational, or other important areas of functioning

• • speci­fiers:
    • With anxious distress, mixed features, melancholic features, atypical features, mood-congruent psychotic features, mood-incongruent psychotic features, catatonia, peri-partum onset, seasonal pattern
    • Partial remission, full remission
    • Early onset <21 yrs. of age), late onset (>21 yrs. of age)
    • With pure dysthymic syndrome (full criteria for MDE have not been met in at least preceding 2 Yrs.), with persistent MDE (full criteria for MDE have been met throughout preceding 2 yrs.)
    • With intermittent MDEs, with current episode: full criteria for a MDE are currently met, but there have been periods of at least 8 weeks in at least the preceding 2 years with symptoms below the threshold for a full MDE
    • With intermittent MDEs, without current episode: full criteria for a MDE are not currently met, but there has been one or more major depressive episodes in at least the preceding 2 years.
    • Specify current severity: mild, moderate, severe

PANIC DISORDER:

• Dsm-5 Diagnostic Criteria for Panic Disorder

• • Recurrent unexpected panic attacks – a panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time
    four (or more) of the following symptoms occur

• • • • Palpitations, pounding heart, or accelerated heart rate
      • Sweating
      • Trembling or shaking
      • Sensations of shortness of breath or smothering
      • Feelings of choking
      • Chest pain or discomfort
      • Nausea or abdominal distress
      • Feeling dizzy, unsteady, light-headed, or faint
      • Chills or heat sensations
      • Paraesthesia (numbness or tingling sensations)
      • Derealization (feelings of unreality) or depersonalization (being detached from oneself)
      • Fear of losing control or “going crazy”
      • Fear of dying

• • 1 month (or more) of “anxiety about panic attacks” – at least one of the attacks has been followed by one or both of the following:

• • • • Persistent concern or worry about additional panic attacks or their consequences
      • A signifi­cant maladaptive change in behaviour related to the attacks
  • The disturbance is not attributable to the physiological effects of a substance or another medical condition
  • The disturbance is not better explained by another mental disorder

CRITERIA FOR PANIC DISORDER (≥4):

• STUDENTS FEAR the 3 Cs
  • Sweating
  • Trembling
  • Unsteadiness, dizziness
  • Depersonalization, Derealization
  • Excessive heart rate, palpitations
  • Nausea
  • Tingling
  • Shortness of breath
  • Fear of dying, losing control, going crazy
  • 3 Cs: Chest pain, Chills, Choking

PHOBIC DISORDERS:

• Diagnostic Criteria for Phobic Disorders
  • Exposure to stimulus almost invariably provokes an immediate anxiety response; may present as a panic attack
  • Person recognizes fear as excessive or unreasonable
  • Situations are avoided or endured with anxiety/distress
  • Signi­ficant interference with daily routine, occupational/social functioning, and/or marked distress

POST-TRAUMATIC STRESS DISORDER:

• DSM-5 Diagnostic Criteria for Post-Traumatic Stress Disorder

• • Exposure to actual or threatened death, serious injury, or sexual violence in ≥1 of the following ways:

• • • Directly experiencing the traumatic event(s)
    • witnessing, in person, the event(s) as it occurred to others
    • learning that the traumatic event(s) occurred to a close family member or close friend; in cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental
    • Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (i.e., ­first responders collecting human remains, police officers repeatedly exposed to details of child abuse)

• • Presence of ≥1 of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:

• • • Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s)
    • Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s)
    • Dissociative reactions (i.e., ‑flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring
    • Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
    • Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
  • Persistent avoidance of stimuli associated with the traumatic event(s), beginning aer the traumatic event(s) occurred, as evidenced by one or both of the following:
    • Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)
    • Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)

• • Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by ≥2 of
    the following:

• • • Inability to remember an important aspect of the traumatic event(s)
    • Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
    • Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others
    • Persistent negative emotional state (i.e., fear, horror, anger, guilt, or shame)
    • Markedly diminished interest or participation in signifi­cant activities
    • Feelings of detachment or estrangement from others
    • Persistent inability to experience positive emotions
  • Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by ≥2 of
    the following:
    • Irritable behaviour and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects
    • Reckless or self-destructive behaviour
    • Hypervigilance
    • Exaggerated startle response
    • Problems with concentration
    • Sleep disturbance (i.e., Difficulty falling or staying asleep or restless sleep)

• • Duration of the disturbance (criteria B, C, D, and E) is more than 1 month
  • The disturbance causes clinically signi­ficant distress or impairment in social, occupational, or other important areas of functioning
  • The disturbance is not attributable to the physiological effects of a substance or another medical condition
• * Speci­fiers:
  • With dissociative symptoms (not attributable to physiologic effects of a substance or a medical condition)
  • Depersonalization: persistent or recurrent experiences of feeling detached from, or as if one were an outside observer of one’s mental processes or body
  • Derealization: persistent or recurrent experiences of unreality of surroundings
  • With delayed expression: the full diagnostic criteria are not met until 6 months after the event

CRITERIA FOR POST-TRAUMATIC STRESS DISORDER

• TRAUMA
  • Traumatic event
  • Re-experience the event
  • Avoidance of stimuli associated with the trauma
  • Unable to function
  • More than a Month
  • Arousal increased

+ negative alterations in cognition and mood

PULMONARY FUNCTION CRITERIA FOR DIAGNOSIS OF ASTHMA:

PLEURAL EFFUSIONS:

• Distinguish clinically using Light’s Criteria (98% sensitivity and 83% specificity for identifying exudative pleural effusions)

POLYMYOSITIS/DERMATOMYOSITIS:

• Classification Criteria for PM/DMM*

*Definite if 4 present, probable if 3 present NEJM 1975;292:403-407

POLYARTERITIS NODOSA (PAN):

• Classification Criteria for PAN*

*Diagnosed if 3 or more of the above 10 criteria present American College of Rheumatology, 1990

PSORIATIC ARTHRITIS:

• CASPAR Criteria for PsA*

* Note:

• To meet the CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria, a patient must have inflammatory articular disease (joint, spine, or entheseal) with ≥3 points from the above 5 categories
• Arthritis Rheum 2006 Aug;54(8):2665-73. Classification criteria for PsA: development

POLYMYALGIA RHEUMATICA:

• PMR Classification Criteria Scoring Algorithm*

*Required criteria: age ≥50 yr, bilateral shoulder aching, and abnormal ESR/CRP

**A score of 4 or more is categorized as PMR in the algorithm without U/S and a score of 5 or more is categorized as PMR in the algorithm with U/S

**Optional U/S criteria

Ann Rheum Dis 2012; 71:484-492

Also read:

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