Criteria

Internal Medicine

Canadian Cardiovascular Society (CCS) grading of angina pectoris

Grade	Description
I	Ordinary physical activity does not cause angina, such as walkingm and climbing stairs. Angina with strenuous or rapid or prolonged exertion at work or recreation.
II	Slight limitation of ordinary activity. Walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, or in cold, or in wind, or under emotional stress, or only during the few hours after awakening. Walking more than two blocks on the level and climbing more than one flight of ordinary stairs at a normal pace and in normal conditions.
III	Marked limitation of ordinary physical activity. Walking one or two blocks on the level and climbing one flight of stairs in normal conditions and at normal pace.
IV	Inability to carry on any physical activity without discomfort, anginal syndrome may be present at rest.

New York Heart Association (NYHA) functional classification

Class	Description
I	No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation or shortness of breath.
II	Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, shortness of breath or chest pain.
III	Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, shortness of breath or chest pain.
IV	Symptoms of heart failure at rest. Any physical activity causes further discomfort.

Modified Medical Research Council (mMRC) dyspnea scale

Grade	Description
0	Not troubled with breathlessness except with strenuous exercise
1	Troubled by shortness of breath when hurrying on the level or walking up a slight hill
2	Walks slower than people of the same age on the level because of breathlessness or has to stop for breath when walking at own pace on the level
3	Stops for breath after walking about 100 yards (91 m) or after a few minutes on the level
4	Too breathless to leave the house or breathless when dressing or undressing

Oxford Community Stroke Project (OCSP) classification

Class	Description
Total anterior circulation infarct (TACI)	Ischemia in both the deep and superficial territories of the MCA
Partial anterior circulation infarct (PACI)	Restricted cortical infarcts due to occlusion of the upper division of the MCA or the lower division
Lacunar infarct (LACI)	Small lacunar infarct in the basal ganglia or the pons
Posterior circulation infarct (POCI)	Associated with the brainstem, cerebellum, or occipital lobes

Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification

1. Large-artery atherosclerosis
2. Cardioembolism
3. Small-vessel occlusion
4. Stroke of other determined etiology
5. Stroke of undetermined etiology

Levine (heart murmur) grading scale

Grade	Description
1	Only audible on listening carefully for some time.
2	Faint but immediately audible on placing the stethoscope on the chest.
3	Loud, readily audible but with no thrill.
4	Loud with a thrill.
5	Loud with a thrill. So loud that it is audible with only the rim of the stethoscope touching the chest.
6	Loud with a palpable thrill. Audible with the stethoscope not touching the chest but lifted just off it.

Pitting edema scale

According to Bates’ Guide to Physical Examination and History Taking, 14e

Grade	Description
1+	Barely detectable impression when finger is pressed into skin
2+	Moderate pitting, indentation subsides rapidly
3+	Deep pitting, indentation remains for a short time
4+	Very deep pitting, indentation lasts a long time

Medical Research Council (MRC) scale for muscle strength

Grade	Description
0	No contraction
1	Flicker or trace of contraction
2	Full range of active movement, with gravity eliminated
3	Active movement against gravity
4	Active movement against gravity and resistance
5	Normal power

Subdivisions of grade 4 are often necessary. Grade 4-, 4, and 4+ may be used to indicate movement against slight, moderate, and strong resistance, respectively.

Eastern Cooperative Oncology Group (ECOG) performance status

Grade	Description
0	Fully active; no performance restrictions.
1	Strenuous physical activity restricted; fully ambulatory and able to carry out light work.
2	Capable of all self-care but unable to carry out any work activities. Up and about >50% of waking hours.
3	Capable of only limited self-care; confined to bed or chair >50% of waking hours.
4	Completely disabled; cannot carry out any self-care; totally confined to bed or chair.

Karnofsky performance status (KPS) scale

Definition	%	Criteria
Able to carry on normal activity and to work. No special care is needed.	100	Normal; no complaints; no evidence of disease
	90	Able to carry on normal activity; minor signs or symptoms of disease.
	80	Normal activity with effort; some signs or symptoms of disease.
Unable to work. Able to live at home, care for most personal needs. A varying amount of assistance is needed.	70	Cares for self. Unable to carry on normal activity or to do active work.
	60	Requires occasional assistance, but is able to care for most of his needs.
	50	Requires considerable assistance and frequent medical care.
Unable to care for self. Requires equivalent of institutional or hospital care. Disease may be progressing rapidly.	40	Disabled; requires special care and assistance.
	30	Severely disabled; hospitalisation is indicated although death not imminent.
	20	Very sick; hospitalisation necessary; active supportive treatment necessary.
	10	Moribund; fatal processes progressing rapidly.
	0	Dead.

Murray and Washington's grading system (sputum)

Group	Epithelial cells per low power (×10) field	White cells per low power (×10) field
1	≥ 25	< 10
2	≥ 25	10-25
3	≥ 25	≥ 25
4	10-25	≥ 25
5	< 10	≥ 25

Los Angeles (LA) grading of esophagitis

Grade	Description
A	One or more mucosal breaks < 5 mm in maximal length
B	One or more mucosal breaks > 5mm, but without continuity across mucosal folds
C	Mucosal breaks continuous between ≥ 2 mucosal folds but involving less than 75% of the esophageal circumference
D	Mucosal breaks involving more than 75% of esophageal circumference

Forrest classification of upper gastrointestinal bleeding (UGIB)

• Acute hemorrhage
  • Forrest Ia (spurting hemorrhage)
  • Forrest Ib (oozing hemorrhage)
• Signs of recent hemorrhage
  • Forrest IIa (non-bleeding visible vessel)
  • Forrest IIb (adherent clot)
  • Forrest IIc (flat pigmented hematin (coffee ground base) on ulcer base)
• Lesions without active bleeding
  • Forrest III (lesions without signs of recent hemorrhage or fibrin-covered clean ulcer base)

Forrest Ia, Ib, and IIa are high-risk lesions, while Forrest IIb is an intermediate- to high-risk lesion.

Revised Atlanta classification of acute pancreatitis

Definition of diagnosis of acute pancreatitis requires two of the following three features:

1. Abdominal pain consistent with acute pancreatitis (acute onset of a persistent, severe, epigastric pain often radiating to the back)
2. Serum lipase activity (or amylase activity) at least 3 times greater than the upper limit of normal
3. Characteristic findings of acute pancreatitis on contrast-enhanced computed tomography (CECT) and less commonly magnetic resonance imaging (MRI) or transabdominal ultrasonography

• If abdominal pain suggests strongly that acute pancreatitis is present, but the serum amylase and/or lipase activity is less than 3 times the upper limit of normal, as may be the case with delayed presentation, imaging will be required to confirm the diagnosis.
• If the diagnosis of acute pancreatitis is established by abdominal pain and by increases in the serum pancreatic enzyme activities, a CECT is not usually required for diagnosis in the emergency room or on admission to the hospital.

BISAP score for pancreatitis mortality

• BUN > 25 mg/dL
• Impaired mental status (any record of disorientation, lethargy somnolence, coma, or stupor)
• SIRS
• Age > 60 years
• Pleural effusion (on chest radiography or CT)

Harris–Benedict equation for basal energy expenditure (BEE/BMR)

• Men BEE (kcal/day) = 66.473 + (13.7516 × weight in kg) + (5.0033 × height in cm) – (6.755 × age in years)
• Women BEE (kcal/day) = 655.0955 + (9.5634 × weight in kg) + (1.8496 × height in cm) – (4.6756 × age in years)

CHA₂DS₂-VA score for stroke risk prediction in atrial fibrillation

Component	Points
Chronic heart failure	1
Hypertension	1
Age 75 years or above	2
Diabetes mellitus	1
Prior stroke, TIA, or arterial thromboembolism	2
Vascular disease	1
Age 65-74 years	1

HAS-BLED score for 1-year risk of major bleeding in patients with atrial fibrillation

Clinical characteristic	Points
Hypertension	1
Abnormal renal and liver function (1 point each)	1 or 2
Stroke	1
Bleeding	1
Labile INRs	1
Elderly	1
Drugs or alcohol (1 point each)	1 or 2

Wells' Criteria for deep-vein thrombosis (DVT)

Glasgow-Blatchford score (GBS) for upper gastrointestinal bleeding (UGIB)

2023 Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) criteria for infective endocarditis (IE)

SOFA (Sepsis-related Organ Failure Assessment) score

SOFA (Sequential Organ Failure Assessment)-2 score

Modified early warning score (MEWS) in medical admissions

Pediatrics

Tanner staging (Sexual Maturity Rating (SMR)) for boys and girls

1. Boys - Genitalia Stages

Stage	Description
1	Pre-adolescent. Testes, scrotum, and penis are of about the same size and proportion as in early childhood.
2	The scrotum and testes have enlarged and there is a change in the texture of the scrotal skin. There is also some reddening of the scrotal skin but this cannot be detected on black and white photographs.
3	Growth of the penis has occurred, at first mainly in length but with some increase in breadth. There has been further growth of testes and scrotum.
4	Penis further enlarged in length and breadth with development of glans. Testes and scrotum further enlarged. There is also further darkening of the scrotal skin, but this is difficult to detect on photographs.
5	Genitalia adult in size and shape. No further enlargement takes place after Stage 5 is reached.

2. Girls - Breast Stages

Stage	Description
1	Pre-adolescent; elevation of papilla only.
2	Breast and bud stage; elevation of breast and papilla as a small mound, enlargement of areola diameter.
3	Further enlargement of breast and areola, with no separation of their contours.
4	Projection of areola and papilla to form a secondary mound above the level of the breast.
5	Mature stage; projection of papilla only, due to recession of the areola to the general contour of the breast.

3. Boys and Girls - Pubic Hair Stages

Stage	Description
1	Pre-adolescent. The vellus over the pubes is no further developed than that over the abdominal wall, i.e. no pubic hair.
2	Sparse growth of long, slightly pigmented, downy hair, straight or only slightly curled, appearing chiefly at the base of the penis. This stage is difficult to see on photographs, particularly of fair-haired subjects.
3	Considerably darker, coarser, and more curled. The hair spreads sparsely over the junction of the pubes. This and subsequent stages were clearly recognizable on the photographs.
4	Hair is now adult in type, but the area covered by it is still considerably smaller than in most adults. There is no spread to the medial surface of the thighs.
5	Adult in quantity and type, distributed as an inverse triangle of the classically feminine pattern. Spread to the medial surface of the thighs but not up the linea alba or elsewhere above the base of the inverse triangle.

Modified Waterlow and Gómez's classification system for malnutrition

	Normal	Mild	Moderate	Severe	Nutritional Status
%W/A	>90%	75–90%	60–75%	<60%	Underweight
%W/H	>90%	80–90%	70–80%	<70%	Wasting
%H/A	>95%	90–95%	85–90%	<85%	Stunting

• %W/A reflects acute/present malnutrition.
• %H/A reflects chronic/past malnutrition.

Centers for Disease Control and Prevention (CDC)'s dehydration scale

Symptom	Minimal or no dehydration (< 3% loss of body weight)	Mild to moderate dehydration (3%–9% loss of body weight)	Severe dehydration (> 9% loss of body weight)
Mental status	Well; alert	Normal, fatigued or restless, irritable	Apathetic, lethargic, unconscious
Thirst	Drinks normally; might refuse liquids	Thirsty, eager to drink	Drinks poorly; unable to drink
Heart rate	Normal	Normal to increased	Tachycardia, with bradycardia in most severe cases
Quality of pulses	Normal	Normal to decreased	Weak, thready, or impalpable
Breathing	Normal	Normal; fast	Deep
Eyes	Normal	Slightly sunken	Deeply sunken
Tears	Present	Decreased	Absent
Mouth and tongue	Moist	Dry	Parched
Skin fold	Instant recoil	Recoil in <2 seconds	Recoil in >2 seconds
Capillary refill	Normal	Prolonged	Prolonged; minimal
Extremities	Warm	Cool	Cold; mottled; cyanotic
Urine output	Normal to decreased	Decreased	Minimal

Downes' clinical croup score

	0	1	2
Inspiratory breath sounds	Normal	Harsh with rhonchi	Delayed
Stridor	None	Inspiratory	Inspiratory and expiratory
Cough	None	Hoarse cry	Bark
Retractions and flaring	None	Flaring and suprasternal retractions	As under 1 plus subcostal, intercostal reactions
Cyanosis	None	In air	In 40% O2

Modified Ross heart failure classification for children

Class	Description
I	Asymptomatic
II	Mild tachypnea or diaphoresis with feeding in infants, dyspnea on exertion in older children
III	Marked tachypnea or diaphoresis with feeding in infants, marked dyspnea on exertion, prolonged feeding times with growth failure
IV	Symptoms such as tachypnea, retractions, grunting, or diaphoresis at rest

Hanifin and Rajka criteria for atopic dermatitis (AD)

3 or more basic features:

• Pruritus
• Typical morphology and distribution:
  • Flexural lichenification or linearity in adults
  • Facial and extensor involvement in infants and children
• Chronic or chronically-repleasing dermatitis
• Personal and family history of atopy (asthma, allergic rhinitis, atopic dermatitis)

Plus 3 or more minor features

Apgar score

Category	Score of 0	Score of 1	Score of 2
Appearance (skin color)	Blue/pale	Blue at extremities, pink body	All pink
Pulse	Absent	< 100 bpm	≥ 100 bpm
Grimace (reflex irritability)	No response to stimulation	Minimal response to stimulation	Prompt response to stimulation
Activity (muscle tone)	Absent	Some extremity flexion	Spontaneously flexed arms and legs that resist extension
Respiratory effort	Absent	Slow and irregular	Breathed and cried lustily

ICD-11 classification

• Severe: 0-3
• Mild and moderate: 4-7
• Normal: > 7

10 warning signs of primary immunodeficiency

Neonatal early-onset sepsis calculator

Phoenix sepsis score

ISSVA classification for vascular anomalies

Wilsons disease scoring system (Leipzig score)

Rochester criteria for febrile infants

Yale observation scale score

OB/GYN

Amsel's criteria for bacterial vaginosis (BV)

Requires at least 3 of the following 4 symptoms or signs:

• Homogeneous, thin discharge (milklike consistency) that smoothly coats the vaginal walls
• Clue cells (e.g., vaginal epithelial cells studded with adherent bacteria) on microscopic examination
• pH of vaginal fluid > 4.5
• A fishy odor of vaginal discharge before or after addition of 10% KOH (i.e., the whiff test)

Modified World Health Organization (mWHO) 2.0 classification of maternal cardiovascular risk

Fracture Risk Assessment Tool (FRAX)

Surgery

American Society of Anesthesiologists (ASA) physical status classification system

Classification	Definition
I	A normal healthy patient
II	A patient with mild systemic disease
III	A patient with severe systemic disease
IV	A patient with severe systemic disease that is a constant threat to life
V	A moribund patient who is not expected to survive without the operation
VI	A declared brain-dead patient whose organs are being removed for donor purposes

Child-Turcotte-Pugh score for cirrhosis mortality

Parameter	Criteria	Points
Bilirubin (Total)	< 2 mg/dL (< 34.2 µmol/L)	+1
	2–3 mg/dL (34.2–51.3 µmol/L)	+2
	> 3 mg/dL (> 51.3 µmol/L)	+3
Albumin	> 3.5 g/dL (> 35 g/L)	+1
	2.8–3.5 g/dL (28–35 g/L)	+2
	< 2.8 g/dL (< 28 g/L)	+3
INR	< 1.7	+1
	1.7–2.3	+2
	> 2.3	+3
Ascites	Absent	+1
	Slight	+2
	Moderate	+3
Encephalopathy	No Encephalopathy	+1
	Grade 1–2	+2
	Grade 3–4	+3

• Class A: 5-6 points (least severe)
• Class B: 7-9 points (moderately severe)
• Class C: 10-15 (most severe)

Milan criteria for liver transplantation

• Single tumor with diameter ≤ 5 cm
• Up to 3 tumors each with diameter ≤ 3 cm
• Extra-hepatic involvement
• Major vessel involvement

Expanded Makuuchi's criteria for liver resection

Barcelona-Clinic Liver Cancer (BCLC) staging classification for hepatocellular carcinoma (HCC)

Alvarado score for acute appendicitis

	Factor	Score
Symptoms	Migration	1
	Anorexia-acetone	1
	Nausea-vomiting	1
Signs	Tenderness in right lower quadrant	2
	Rebound pain	1
	Elevation of temperature	1
Laboratory	Leukocytosis	2
	Shift to the left	1
Total score		10

• Compatible with the diagnosis of acute appendicitis: 5-6
• Probable appendicitis: 7-8
• Very probable appendicitis: 9-10

Appendicitis inflammatory response (AIR) score

Variable	Finding	Score
Vomiting		1
Pain in right inferior fossa		1
Rebound tenderness or muscular defense	Light	1
	Medium	2
	Strong	3
Body temperature	≥38.5°C	1
Polymorphonuclear leukocytes	70–84%	1
	≥85%	2
WBC count	10.0–14.9 × 109/L	1
	≥15.0 × 109/L	2
CRP concentration	10–49 g/L	1
	≥50 g/L	2

• Sum 0–4 = Low probability. Outpatient follow-up if unaltered general condition
• Sum 5–8 = Indeterminate group. In-hospital active observation with rescoring/imaging or diagnostic laparoscopy according to local traditions
• Sum 9–12 = High probability. Surgical exploration is proposed

Pediatric appendicitis score (PAS)

Diagnostic indicant	Score
Cough/percussion tenderness, hopping tenderness	2
Anorexia	1
Pyrexia	1
Nausea/emesis	1
Tenderness in right lower quadrant	2
Leukocytosis (WBC ≥ 10,000 (109/L))	1
Polymorphonuclear neutrophilia	1
Migration of pain	1

• Score ≥ 6 is compatible with the diagnosis of appendicitis
• Score ≥ 7 indicates high probability of appendicitis

Narrow-band imaging International Colorectal Endoscopic (NICE) classification

	Type 1	Type 2	Type 3
Color	Same or lighter than background	Browner relative to background (verify color arises from vessels)	Brown to dark brown relative to background; sometimes patchy whiter areas
Vessels	None, or isolated lacy vessels may be present coursing across the lesion	Brown vessels surrounding white structures	Has area(s) of disrupted or missing vessels
Surface Pattern	Dark or white spots of uniform size, or homogeneous absence of pattern	Oval, tubular or branched white structures surrounded by brown vessels	Amorphous or absent surface pattern
Most likely pathology	Hyperplastic	Adenoma	Deep submucosal invasive cancer
Treatment	Follow up	Polypectomy/EMR/ESD	Surgical operation

Caprini score for venous thromboembolism (VTE)

Rutherford classification for acute limb ischemia

Category	Description/prognosis	Findings		Doppler signals
		Sensory loss	Muscle weakness	Arterial	Venous
I. Viable	Not immediately threatened	None	None	Audible	Audible
II. Threatened
a. Marginally	Salvageable if promptly treated	Minimal (toes) or none	None	Inaudible	Audible
b. Immediately	Salvageable with immediate revascularization	More than toes, associated with rest pain	Mild, moderate	Inaudible	Audible
III. Irreversible	Major tissue loss or permanent nerve damage inevitable	Profound, anesthetic	Profound, paralysis (rigor)	Inaudible	Inaudible

2020 revision of CEAP classification of chronic venous disorders

C class	Description	E class	Description	A class	Description	P class	Description
C0	No visible or palpable signs of venous disease	Ep	Primary	As	Superficial	Pr	Reflux
C1	Telangiectasias or reticular veins	Es	Secondary	Ad	Deep	Po	Obstruction
C2	Varicose veins	Esi	Secondary - intravenous	Ap	Perforator	Pr,o	Reflux and obstruction
C2r	Recurrent varicose veins	Ese	Secondary - extravenous	An	No venous anatomic location identified	Pn	No pathophysiology identified
C3	Edema	Ec	Congenital
C4	Changes in skin and subcutaneous tissue secondary to chronic venous disease	En	No cause identified
C4a	Pigmentation or eczema
C4b	Lipodermatosclerosis or atrophie blanche
C4c	Corona phlebectatica
C5	Healed venous ulcer
C6	Active venous ulcer
C6r	Recurrent active venous ulcer

Each clinical class subcharacterized by a subscript indicating the presence (symptomatic, s) or absence (asymptomatic, a) of symptoms attributable to venous disease

BI-RADS assessment categories and management

Category	Assessment	Management	Likelihood of Cancer
0	Incomplete – Need Additional Imaging Evaluation and/or Prior Mammograms for Comparison	Recall for additional imaging and/or comparison with prior examination(s)	N/A
1	Negative	Routine mammography screening	Essentially 0% likelihood of malignancy
2	Benign	Routine mammography screening	Essentially 0% likelihood of malignancy
3	Probably Benign	Short-interval (6-month) follow-up or continued surveillance mammography	>0% but ≤2% likelihood of malignancy
4	Suspicious	Tissue diagnosis	>2% but <95% likelihood of malignancy
4A	Low suspicion for malignancy		>2% to ≤10% likelihood of malignancy
4B	Moderate suspicion for malignancy		>10% to ≤50% likelihood of malignancy
4C	High suspicion for malignancy		>50% to <95% likelihood of malignancy
5	Highly Suggestive of Malignancy	Tissue diagnosis	≥95% likelihood of malignancy
6	Known Biopsy-Proven Malignancy	Surgical excision when clinically appropriate	N/A

Prostate Imaging Reporting and Data System (PI-RADS)

Category	Description
1	Very low (clinically significant cancer is highly unlikely to be present)
2	Low (clinically significant cancer is unlikely to be present)
3	Intermediate (the presence of clinically significant cancer is equivocal)
4	High (clinically significant cancer is likely to be present)
5	Very high (clinically significant cancer is highly likely to be present)

Lung CT Screening Reporting and Data System (Lung-RADS)

New grading system for Gleason score

Grade group	Gleason score	Description
1	3 + 3 = 6	Only individual discrete well-formed glands
2	3 + 4 = 7	Predominantly well-formed glands with lesser component of poorly formed/fused/cribriform glands
3	4 + 3 = 7	Predominantly poorly formed/fused/cribriform glands with lesser component of well-formed glands
4	8	- Only poorly formed/fused/cribriform glands - Predominantly well-formed glands and lesser component lacking glands - Predominantly lacking glands and lesser component of well-formed glands
5	9–10	Lack of gland formation (or with necrosis) with or without poorly formed/fused/cribriform glands

2023 Bethesda system for reporting thyroid cytopathology

Category	Description
I	Nondiagnostic
II	Benign
III	Atypia of undetermined significance
IV	Follicular neoplasm
V	Suspicious for malignancy
VI	Malignant

Zargar endoscopic classification of caustic injuries

Grade	Description
0	Normal mucosa
I	Edema and erythema of the mucosa
IIA	Hemorrhage, erosions, blisters, superficial ulcers
IIB	Circumferential lesions
IIIA	Focal deep gray or brownish-black ulcers
IIIB	Extensive deep gray or brownish-black ulcers
IV	Perforation

CT classification of esophageal caustic injuries

Bosniak classification of cystic renal masses

International Prostate Symptom Score (IPSS)

The new reconstructive ladder

1. Free flap
2. Tissue expansion
3. Distant flaps
4. Local flaps
5. Dermal matrices
6. Skin graft
7. Negative pressure wound therapy
8. Closure by secondary intention
9. Primary closure

American Association for the Surgery of Trauma (AAST) organ injury scale

• Spleen, liver, kidney
• Renal trauma
• Pancreatic trauma

Modified Bell´s staging criteria for necrotizing enterocolitis (NEC)

Todani classification of bile duct (choledocal) cysts

National Emergency X-Radiography Utilization Study (NEXUS) criteria for cervical spine radiography

• Neurological deficit
• Spinal tenderness (midline)
• Altered mental status
• Intoxication
• Distracting Injury

Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) score

Revised ICG–HNPCC criteria (Amsterdam criteria II)

There should be at least 3 relatives with an HNPCC-associated cancer (colorectal cancer, cancer of the endometrium, small bowel, ureter, or renal pelvis)

• One should be a first-degree relative of the other 2
• At least 2 successive generations should be affected
• At least 1 should be diagnosed before age 50
• Familial adenomatous polyposis should be excluded in the CRC case(s) if any
• Tumors should be verified by pathological examination