Red flags Flashcards
Haemoptysis red flags
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
Cough red flags
dyspnea
weight loss
hemoptysis
risk factors for TB or HIV
Wheezing red flags
accessory muscle use, clinical signs of tiring, decreased levels of consciousness
fixed inspiratory & expiratory wheezing
swelling of the face & tongue (angiooedema)
Chest pain red flags
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)
Dyspnea red flags
dyspnea at rest during exam.
decreased level of consciousness, agitation or confusion
accessory muscle use & poor air excursion
chest pain
crackles
weight loss
palpitations
Palpitation red flags
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
Syncope red flags
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
Oedema red flags
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
Lymphadenopathy red flags
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
Limb pain red flags
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
Lymphadenopathy Red Flags
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
Musculoskeletal Red Flags
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
Joint Pain Red Flags
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
Globus Sensation Red Flags
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
Dyspepsia Red Flags
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)
Acute Abdominal Pain Red Flags
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
Chronic Abdominal Pain Red Flags
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
Diarrhoea Red Flags
The following suggest serious pathology in combination with diarrhoea:
Blood or pus Fever Signs of dehydration Chronic diarrhoea Weight loss
Constipation Red Flags
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
Red flags in HA Presentation
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
Red flags for HA - additional features
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)
Red Flags - Nausea/ Vomiting
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
Jaundice Red Flags
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
Dysuria – Red Flags
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