Red flags

Question 1

Haemoptysis red flags

Answer 1

Massive haemoptysis (more than 600ml in 24hr)
Back pain
malaise, weight loss, fatigue
extensive smoking history
dyspnea at rest during exam. or absent or decreased breath sounds

Question 2

Cough red flags

Answer 2

dyspnea
weight loss
hemoptysis
risk factors for TB or HIV

Question 3

Wheezing red flags

Answer 3

accessory muscle use, clinical signs of tiring, decreased levels of consciousness
fixed inspiratory & expiratory wheezing
swelling of the face & tongue (angiooedema)

Question 4

Chest pain red flags

Answer 4

abnormal vital signs - tachycardia, bradycardia, tachypnea, hypotension
signs of hypoperfusion - confusion, ashen colour, diaphoresis (perspiring a lot!)
shortness of breath
asymmetric breath sounds or pulses
new heart murmurs
pulsus paradoxus (abnormally large drop in BP)

Question 5

Dyspnea red flags

Answer 5

dyspnea at rest during exam.
decreased level of consciousness, agitation or confusion
accessory muscle use & poor air excursion
chest pain
crackles
weight loss
palpitations

Question 6

Palpitation red flags

Answer 6

light-headedness or syncope
chest pain
dyspnea
new onset of irregularly irregular heart rhythm
heart rate greater than 120bpm or lower than 45bpm at rest
significant underlying heart disease
family history of sudden death

Question 7

Syncope red flags

Answer 7

syncope during exertion
multiple reoccurances within a short time
heart murmur or other findings suggesting structural heart disease; eg: chest pain
older age
significant injury during syncope
family history of sudden unexpected death

Question 8

Oedema red flags

Answer 8

sudden onset
significant pain
shortness of breath
history of a heart disorder or an abnormal cardiac examination
hemoptysis, dyspnea or pleural friction rub
hepatomegaly, jaundice, ascites, splenomegaly, hematemesis
unilateral leg swelling with tenderness

Question 9

Lymphadenopathy red flags

Answer 9

Node > 2 cm
Node that is hard or fixed to underlying tissue
Supraclavicular node
Risk factors for HIV or TB 
Fever and/or weight loss
Splenomegaly

Question 10

Limb pain red flags

Answer 10

Sudden, severe pain
Signs of acute limb ischemia (e.g., coolness, pallor, pulse deficits, delayed capillary refill)
Dyspnea, chest pain, and/or sweating
Signs of systemic toxicity (e.g., delirium, tachycardia, shock, pallor) – blood poisoning, cellulitis
Crepitation, tenseness, foul discharge, bullae, necrosis
Risk factors for deep vein thrombosis
Neurologic deficits

Question 11

Lymphadenopathy Red Flags

Answer 11

Node > 2 cm
Node that is hard or fixed to underlying tissue
Supraclavicular node
Risk factors for HIV or TB 
Fever and/or weight loss
Splenomegaly

Question 12

Musculoskeletal Red Flags

Answer 12

Age of onset 55yr
Violent trauma
Constant progressive, non mechanical pain (no relief with bed rest)
Past medical history of malignant tumour
Prolonged use of corticosteroids
Drug abuse, immunosuppression, HIV
Systematically unwell
Unexplained weight loss
Widespread neurology (including cauda equina syndrome)
Structural deformity
Fever

Question 13

Joint Pain Red Flags

Answer 13

Erythema, warmth, effusion, and decreased range of motion
Fever with acute joint pain
Acute joint pain in a sexually active young adult
Skin breaks with signs of cellulitis adjacent to the affected joint
Underlying bleeding disorder or use of anticoagulants
Systemic or extra-articular symptoms

Question 14

Globus Sensation Red Flags

Answer 14

Neck or throat pain
Weight loss
Abrupt onset after age 50
Pain, choking, or difficulty with swallowing
Regurgitation of food
Muscle weakness
Palpable or visible mass
Progressive worsening of symptoms

Question 15

Dyspepsia Red Flags

Answer 15

The following suggest serious pathology in combination with a dyspepsia:

Acute episode with dyspnoea, diaphoresis*, or tachycardia
Anorexia
Nausea or vomiting
Weight loss
Blood in the stool
Dysphagia or odynophagia
Failure to respond to therapy with H2 blockers or proton pump inhibitors (PPIs)

Question 16

Acute Abdominal Pain Red Flags

Answer 16

The following suggest serious pathology in combination with acute abdominal pain:

Severe pain
Signs of shock (eg, tachycardia, hypotension, diaphoresis, confusion)
Signs of peritonitis
Abdominal distention

Question 17

Chronic Abdominal Pain Red Flags

Answer 17

The following suggest serious pathology in combination with chronic abdominal pain:

Fever
Anorexia, weight loss
Pain that awakens patient
Blood in stool or urine
Jaundice
Oedema
Abdominal mass or organomegaly

Question 18

Diarrhoea Red Flags

Answer 18

The following suggest serious pathology in combination with diarrhoea:

Blood or pus
Fever
Signs of dehydration
Chronic diarrhoea
Weight loss

Question 19

Constipation Red Flags

Answer 19

The following suggest serious pathology in combination with constipation:

Distended, tympanitic abdomen
Vomiting
Blood in stool
Weight loss
Severe constipation of recent onset/worsening in elderly patients

Question 20

Red flags in HA Presentation

Answer 20

Age
Over 50 years at onset of new headache
Under 10 years at onset or recurrent in children

Characteristics
First, worst or different from usual headache
Progressive headache (over weeks)
Persistent headache precipitated by Valsalva manoeuvre (cough, sneeze, bending or exertion) or other associated with raised ICP
Wakes Pt at night
Thunderclap headache (explosive onset) or sudden onset no previous history
Localised pain in definite area e.g. eye, ear

Question 21

Red flags for HA - additional features

Answer 21

Additional features
New onset headache in a patient with a history of cancer
Concurrent systemic illness
Neurological signs-confusion/impaired consciousness dizziness + vertigo/personality change
Seizures/convulsions
Symptoms/signs of Giant Cell Arteritis (e.g. intense temporal palpatory pain)

Question 22

Red Flags - Nausea/ Vomiting

Answer 22

The following suggest serious pathology in combination with nausea and vomiting:

Signs of hypovolemia
Headache, stiff neck, or mental status change
Peritoneal signs (e.g., guarding, rigidity, rebound tenderness)
Distended, tympanitic abdomen

Question 23

Jaundice Red Flags

Answer 23

Red flags that suggest a serious pathology in conjunction with jaundice include:

Marked abdominal pain and tenderness
Altered mental status
GI bleeding (occult or gross)
Ecchymoses, petechiae, or purpura

Question 24

Dysuria – Red Flags

Answer 24

The following suggest significant pathology when associated with dysuria:

    Fever
    Flank pain or tenderness
    Immunocompromised patient
    Recurrent episodes (including frequent childhood infections)
    Known urinary tract abnormality
    Male gender

Question 25

Haematuria – Red Flags

Answer 25

The following suggest significant pathology when associated with haematuria:

Gross haematuria (i.e. significant amounts of blood)
Persistent microscopic haematuria, especially in older patients
Age > 50
Hypertension and oedema
Systemic symptoms (e.g., fever, night sweats, weight loss)

Question 26

Red Flags - Numbness

Answer 26

The following suggest significant pathology when associated with numbness:

Sudden onset (e.g., within minutes or hours) of numbness
Sudden or rapid onset (e.g., within hours or days) of weakness
Dyspnea
Signs of cauda equina or conus medullaris syndrome (e.g., saddle anaesthesia, incontinence, loss of anal wink reflex)
Neurologic deficits below a spinal segment
Loss of sensation on both the face and body (on the same side or opposite sides)