Red Flags Flashcards
What are the red flags for minor apthous ulcers?
- Non-painful ulcers [TO DENTIST]
- Non-round ulcers for no reason [TO DENTIST]
- Ulcers >1cm in diameter, more than 5-10 at once
- Associated malaise, fever, or other Sx of infection
- Associated eye involvement
- Lasts more than 14 days
What are the red flags for cold sores?
- Duration >14 days (unlikely to be cold sores)
- Cold sores located inside the mouth
- Severe and widespread lesions
- Lesions that spread away from lips and onto face
What are the red flags for deworming patients?
- Presence of blood or pus in stool
- Vomiting daily or frequently
- Fever
- Extremely tired and dehydrated
- Losing weight with no obvious reason
- Diarrhoea or stomach pain for ≥2 weeks.
- Red and itching rash on skin shaped like a worm
What are the red flags for GERD?
Severe pain – possible duodenal ulcer
- Pain described as debilitating or severe
- Persistent pain
- Pain makes patient wake up at night
Pain worse on empty stomach – possible gastric ulcer
Radiating pain (possibility of CVS cause)
Dysphagia – difficulty in swallowing
Odynophagia – pain in swallowing
Bleeding (or signs of bleeding)
- Melaena (indicates upper GIT bleed)
- Vomiting blood (indicates upper GIT bleed)
- Anaemia (sign of internal bleeding)
- Loss of weight (sign of internal bleeding)
What are the red flags for constipation?
Haematemesis
Melaena
Family Hx of colon cancer, IBD
Anaemia
Weight loss
Anorexia
Nausea and vomiting
Severe constipation that is refractory to Tx
New onset constipation in elderly without any apparent cause (sign of colon cancer)
What are the red flags for diarrhea?
Black tarry stools or blood in stools
Mucus in stools
High fever (≥38.5 C)
Symptoms that get worse/do not improve with self-medication (approx. 2-3 days)
Severe dehydration – feeling thirsty, dark yellow urine, urinating less than usual, dizziness, fatigue, dry skin/mouth/lips/tongue
What are the red flags for haemorrhoids?
Children <12yo
Symptoms lasting >3 weeks
Internal haemorrhoids that do not respond to 6-8/52 of Tx
Signs of internal bleeding - Blood mixed in with stool, passing large amt of blood, anemia, melaena
Sharp stabbing pain
Symptoms of N/V, loss of appetite
Moderate-to-severe itching, burning, inflammation, swelling and discomfort
Other pelvic changes that may contribute to Sx
Anorectal seepage or prolapse
A concomitant change in bowel patterns
PMHx of colorectal polyps
Family Hx of IBD or colorectal cancer
What are the red flags for cough?
Red Flags
* Cardiopulmonary chronic diseases (eg asthma, COPD, HF) or GERD
* SOB – inc/dec RR; blue lips/tongue (hypoxia)
* Chest pain – may be pneumonia
* Haemoptysis
- Rust coloured – likely pneumonia
- Pink tinged – may be heart failure
- Dark red – may be carcinoma
* Unintentional weight loss
* Drenching night sweat – may be serious underlying conditions eg TB or lymphoma
* Cough w thick yellow/ green sputum or pus like secretions – bacterial infection (consistency)
* > 7 days
* Suspected drug induced cough
* Inhalation of foreign particles
* Cough worsening during self-Tx or new Sx
* Barking cough (croup) in children – serious infection by para-influenza virus
What are the red flags for a cold?
CV/pulmonary chronic diseases (asthma, COPD, HF)
SOB – esp if hypoxia has set in (turning blue)
Chest pain – possible pneumonia
AIDS or on chronic immunosuppressant therapy
Frail patients of advanced age
Children <2yo
Worsening or additional Sx during self-treatment
Hypersensitivity to OTC, P pharmacologicals
What are some differentials requiring urgent referral to A&E for soft tissue injuries? How should they be ruled out?
- Ligament rupture – inability to bear weight on or use the joint (though not the only possible cause)
- Infection-related causes – fever, associated rash
- Malignancy/metastasis (esp lower back pain) – chronic, no clear cause, rapid weight loss
- Relating to underlying visceral conditions (esp for lower back pain) – referred/radiating pain from elsewhere (think about what other organs are in the area, check for other associated symptoms)
What are the red flags for vaginal candidiasis?
- Vaginal discharge with strong odour – sign of bacterial infection
- Lack of itching
- Sx of systemic infection e.g. fever, abd pain
- Recurrent infection (>3 times a year)
- Pregnant
- Pre-pubescent or post-menopausal
- Immunocompromised
What are the red flags for skin fungal infections?
Involvement of large areas of trunk – PO Tx needed
OTC treatment failure (~4 weeks) – PO Tx needed
Face/scalp involved – need Dr to confirm diagnosis
DM patients
Signs of bacterial infection – e.g. pus, fever
What are the red flags for cerumen impaction?
- Urgent – history of trauma e.g. foreign object stuck into ear
(may have lacerations + if currently stuck need Dr to remove) - Sx of infection – fever, discharge, pain
- Pain associated with ear discharge
- Recent ear surgery in the last 6 weeks
- Bleeding or signs of trauma – urgent
- Ruptured tympanic membrane or tympanostomy tubes
- Incapable of following proper instructions for use of otic drops
- Hypersensitivity to recommended agent
- No improvement after 4 days of self-care
What are the red flags for swimmer’s ear?
- Sx of infection – fever, discharge, pain
- Pain associated with ear discharge
- Recent ear surgery in the last 6 weeks
- Bleeding or signs of trauma – urgent
- Ruptured tympanic membrane or tympanostomy tubes
- Incapable of following proper instructions for use of otic drops
- Hypersensitivity to recommended agent
- No improvement after 4 days of self-care
When should wounds be referred to a doctor?
- Animal bites/punctures
- Item embedded in wound
- Wound doesn’t stop bleeding after pressure is applied for 10mins
- Open wound extends deeper than the skin
- Infected wound – purulent discharge, fever
- Burns to eyes, neck, mouth, throat
- Chemical/Electrical burns
What are the red flags for eyelid disorders?
Non-urgent referral, but as soon as possible
* Chalazion/Stye that becomes bothersome
* Inward or outward turning of lower eyelid (entropion/ectropion)
Urgent
* Middle-aged/elderly patient with painless nodular lesion on or near eyelid – possible carcinoma
Immediate to A&E
* Swollen eyelids w associated feelings of being unwell – possibly orbital cellulitis
What are the red flags for heart failure?
- Dyspnea (SOB)
- Orthopnea (SOB when lying down)
- Lower limb swelling
- Sudden rapid weight gain (>2kg overnight to 2-3/7)
What are the red flags for simple ocular conditions?
- Intense inflammation
- Pain
- Reduced visual acuity or visual changes
- Unilateral (unless there is a clear reason why)
- Progressive disease
What are the red flags for allergic rhinitis?
Unilateral symptoms
Children <12yo (asthma possibility), pregnancy (unless diagnosed by dr and approved for non-Rx Tx)
Symptoms of non-allergic rhinitis – Mucopurulent discharge, unbearable facial pain, anosmia, fever>38C, nosebleed
Post nasal drip (posterior rhinorrhoea, with thick mucus and/or no anterior rhinorrhoea)
Nasal obstruction with no other symptoms
Symptoms of otitis media, sinusitis, bronchitis or other infections
Undiagnosed or uncontrolled asthma, COPD or other lower respiratory diseases
Moderate or severe persistent allergic rhinitis – intermittent still okay to treat
Not responding to Tx or persistent symptoms
Severe or unacceptable side effects of treatment
Medication induced rhinitis
What are the red flags for headaches?
Systemic symptoms including fever
Neoplasm (abnormal growth) in history
Neurologic deficit or dysfunction
Onset of headache is sudden or abrupt
Older age (>50yo)
Pattern change or recent onset of headache
Positional headache (worse standing, better lying down)
Precipitated by sneezing, coughing or exercise
Papilledema
Progressive headache with atypical presentation
Pregnancy or puerperium (6wks after childbirth)
Post-traumatic onset of headache
Pathology of immune system (e.g. HIV/Immunocompromised)
Painkiller overuse or new drug at onset of headache
