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Red Flags Flashcards

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USMLE® Step 1 flashcards
1
Q

Cancer red flags:

A 
Persistent pain at night
Constant pain anywhere in the body
Unexplained weight loss
Loss of appetite
Unusual bumps or growths
Unwarranted fatigue
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2
Q

Cardiovascular Red Flags

A

Shortness of breath
Dizziness
Pain or a feeling of heaviness in the chest
Pulsating pain anywhere in the body
Constant and severe pain in lower leg (calf) or arm
Discolored or painful feet
Swelling (no history of injury)

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3
Q

Gastrointestinal/genitourinary

A 
Frequent or severe abdominal pain
Frequent heartburn or indigestion
Frequent nausea or vomiting
Change in or problems with bladder function
Unusual menstrual irregularities
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4
Q

Miscellaneous

A

Fever or night sweats
Recent severe emotion disturbances
Swelling or redness of any joint without history of injury
Pregnancy

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5
Q

Neurological

A

Changes in hearing
Frequent or severe headaches without history of injury
Problem with swallowing or changes in speech
Changes in vision (blurriness or loss of sight)
Problem with balance, coordination, or falling
Fainting spells (drop attacks)
Sudden weakness

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6
Q

Back-related tumor

A

Age over 50 years
History of cancer
Unexplained weight loss
Failure of conservative therapy

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7
Q

Back-related infection (spinal osteomyelitis)

A

Recent infection (urinary tract or skin infection)
Intravenous drug user/abuser
Concurrent immunosuppressive disorder

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8
Q

Back-related infection findings:

A

Deep constant pain, increases with weight bearing
Fever, malaise, and swelling
Spine rigidity, accessory mobility may be limited

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9
Q

Back related tumor findings:

A

Constant pain not affected by position or activity

Worse at night

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10
Q

Cauda equina syndrome

A

History of spinal stenosis or degenerative disk disease
Urine retention or incontinence
Fecal incontinence
Saddle anesthesia
Global or progressive weakness in the lower extremities
Sensory deficits in the feet (L4, L5, S1 areas
Ankle dorsiflexion, toe extension, and ankle plantarflexion weakness

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11
Q

Spinal Fracture

A

History of trauma (including minor falls or heavy lifts for individuals with osteoporosis or elderly individuals)
Prolonged use of steroids
Age over 70 years

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12
Q

Physical exam spinal fracture findings:

A

Exquisitely tender with palpation over fracture site
Increased pain with weight bearing
Edema in local area

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13
Q

Abdominal Aneurysm

A

Back, abdominal or groin pain
Presence of peripheral vascular disease or coronary artery disease and associated risk factors (age >50, smoker, HTN, DM
Symptoms not related to movement stresses associated with somatic LBP

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14
Q

Abdominal Aneurysm physical exam findings:

A

Abnormal width of aortic or iliac arterial pulses

Presence of a bruit in the central epigastric region upon auscultation

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15
Q

Colon Cancer

A

Age of 50 years
Bowel disturbances (rectal bleeding or black stools)
Unexplained weight loss
History of colon cancer in the immediate family
Pain unchanged by positions or movement

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16
Q

Physical Exam findings for colon cancer

A

Possible tenderness to palpation of abdomen in area of cancer
May have ascites
May have hypoactive or hyperactive bowel sounds in the later stages

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17
Q

Pathological fractures of the femoral neck

A 
Older women (>70 years) with hip, groin, or thigh pain
History of a fall from a standing position
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18
Q

Physical Exam findings for pathological fractures of femoral neck

A

Severe, constant pain that is worse with movement

A shortened and externally rotated lower extremity

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19
Q

Osteonecrosis of the femoral head (avascular necrosis)

A

History of long-term corticosteroid use (patients with rheumatoid arthritis, systemic lupus erythematosus, or asthma)
History of avascular necrosis of the contralateral hip
Trauma

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20
Q

Physical Exam findings for Osteonecrosis of the femoral head (avascular necrosis)

A

Gradual onset of pain; may refer to groin, thigh, or medial knee that is worse with weightbearing
Stiff hip joint; restrictions primarily in IR and flexion

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21
Q

Legg-Calve-Perthes disease

A

Boys age 5 to 8 with groin or hip pain
Antalgic gait
Pain complaints aggravated with hip movement, especially hip flexion and internal rotation

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22
Q

Slipped capital femoral epiphysis

A

Overweight adolescents
History of a recent growth spurt or trauma
Groin aching exacerbated with weight bearing
Involved leg held in external rotation
Range of motion limitations of hip internal rotation

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23
Q

Peripheral arterial occlusive disease

A 
Age > 60 yrs
History of type 2 diabetes
History of ischemic heart disease
Smoking history
Sedentary lifestyle
Concurrent intermittent claudication
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24
Q

Physical Exam findings for Peripheral arterial occlusive disease

A

Unilaterally cool extremity (bilateral if aorta is involved)
Prolonged capillary refill time (>2 sec)
Decreased pulses in arteries below level of the occlusion
Prolonged vascular filling time

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25
Q

Deep vein thrombosis

A

Recent surgery, malignancy, pregnancy, trauma or leg immobilization
Calf pain, edema, tenderness, warmth
Calf pain that is intensified with standing or walking and relieved by rest and elevation
Possible pallor and loss of dorsalis pedis pulse

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26
Q

Compartment syndrome

A

History of blunt trauma, crush injury, or unaccustomed exercise
Severe, persistent leg pain that is intensified with stretch applied to involved muscles
Swelling, exquisite tenderness and palpable tension/hardness of involved compartment
Paresthesia, paresis, pallor, pulselessness

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27
Q

Septic Arthritis

A

History of recent infection, surgery, or injection
Coexisting immunosuppressive disorder
Constant aching or throbbing pain, joint swelling, tenderness, warmth
May have elevated body temperature

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28
Q

Cellulitis

A

History of recent skin ulceration or abrasion, venous insufficiency, congestive heart failure, or cirrhosis
Pain; skin swelling; warmth; advancing, irregular margin of erythema/reddish streaks
Fever, chills, malaise, and weakness

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29
Q

Myocardial infarction

A

Presence of risk factors: previous history of coronary artery disease, HTN, smoking, DM, elevated cholesterol
Men over age 40 years; women over age 50 years

30
Q

Physical Exam findings for MI:

A

Chest pain
Pallor, sweating, dyspnea, nausea, palpatations
Symptoms lasting > 30 mins and not relieved with sublingual nitroglycerin

31
Q

Unstable angina pectoris

A

History of coronary artery disease
Physical exam findings
Chest pain that occurs outside of a predictable pattern
Not responsive to nitrogylcerin

32
Q

Stable angina pectoris

A

Common in people > 65 years
More common in men
History of coronary artery disease
Chest pain/pressure that occurs with predictable levels of exertion
Symptoms predictably alleviated with rest of nitroglycerin

33
Q

Pericarditis

A

Often associated with autoimmune diseases (systemic lupus erythematosus, RA)
History of MI
History of renal failure, open heart surgery, or radiation therapy

34
Q

Exam findings for Pericarditis

A

Sharp/stabbing chest pain that may be referred to the lateral neck or either shoulder
Increased pain with left sidelying
Relieved with forward leaning while sitting (supporting arms on knees or a table.

35
Q

Pulmonary embolus

A

History of, or risk factors for developing, deep vein thrombosis
Immobility
Trauma
Cancer

36
Q

Physical Exam findings for PE

A

Chest, shoulder, or upper abdominal pain
Dyspnea
Tachypnea
Tachycardia

37
Q

Pleurisy

A

History of a recent or concurrent respiratory disorder (infection, pneumonia, tumor, TB)
Physical exam findings
Severe, sharp, knifelike pain with inspiration
Dyspnea, decreased chest wall expansion

38
Q

Pneumothorax

A

Recent bout of coughing or strenuous exercise or trauma
Chest pain, intensified with inspiration
Difficulty ventilating or expanding rib cage
Hyperresonance on percussion
Decreased breath sounds

39
Q

Pneumonia

A

History of bactierial, viral, fungal, or mycoplasmal infection
Often follows influenza
History of inhalation of toxic or caustic chemicals, smoke, dusts, or gases (smoking)

40
Q

Exam findings for Pneumonia:

A

Pleuritic pain, may be referred to the shoulder
Fever, chills, headaches, malaise, nausea
Productive cough

41
Q

Cholecystitis

A

Most common in middle age (particularly in women)

WBC count may be elevated (12,000-15,000/mL)

42
Q

Exam findings for cholecystitis

A

Colicky pain in right upper quadrant with accompaning right scapular pain
Symptoms may worsen with ingestion of fatty foods
Symptoms not increased by activity or relieved by rest

43
Q

Peptic ulcer

A

Dull or gnawing pain or burning sensation in the epigastrium, mid-back, or supraclavicular regions
Symptoms relieved with food
History of infection (H. pylori)
History of multiple stressors, poor coping skills, persistent anxiety, and depression

44
Q

Exam findings for peptic ulcer

A

Localized tenderness at right epigastrim

Constipation, bleeding, vomiting, tarry-colored stools, coffee-ground emesis

45
Q

Pyelonephritis (kidney infection)

A

More common in women
Recent or coexisting UTI
Kidney stone or past episode of kidney stone

46
Q

Physical Exam findings for Pyelonephritis (kidney infection)

A

Fever, chills, malaise, headache, flank pain
Enlarged prostate
Tenderness over the costovertebral angle (Murphy’s sign)

47
Q

Nephrolithiasis (kidney stones)

A 
Reside in hot and humid environment
Past episodes of kidney stones
Sudden, severe back or flank pain
Chills, fever, nausea, or vomiting
Renal colic
Symptoms of UTI
48
Q

Spinal Fracture

A 
History of fall or motor vehicle crash
History of osteoporosis
Prolonged use of steroids
Age over 70 years
Loss of function of mobility
49
Q

Physical exam findings for spinal fracture:

A 
Midline tenderness at level of fracture
Most common levels are T11-L1
Bruising
Lower extremity neurologic deficits
Evidence of increased thoracic kyphosis
50
Q

Cervical ligamentous instabilities

A

Major trauma such as MVA or fall from a height
History of RA or ankylosing spondylitis
Oral contraceptive use
Long tract neurologic signs especially present in more than one extremity; dizziness; nystagmus; vertigo with head/neck movements/positions; clonus; positive Babinski’s sign

51
Q

Cervical central cord lesion

A

Older age or post trauma
Incontinence
Gait disturbances due to hyperreflexic lower extremities
Upper extremity (especially hand) atrophy and paresis

52
Q

Cervical and shoulder girdle peripheral entrapment neuropathies

A

Paresthesias
Pain present at rest and possibly with a retrograde distribution
Muscles innervated can be tender to palpate
Muscles and sensory distribution follow specific nerve pattern

53
Q

Spinal accessory nerve injury

A

History of a penetrating injury, such as stab or GSW
Direct blow or stretching of the nerve during a fall or MVA
Surgical history of radical neck dissection for tumor or cervical lymph node biopsy

54
Q

Spinal accessory nerve injury exam findings:

A

Assymmetry of the neck line and drooping of the shoulder
Inability to shrug
Lack of scapular stabilization
Weakness of shoulder abduction

55
Q

Axillary nerve injury

A

Patients > 40 with shoulder dislocation
History of traction force or blunt trauma to the shoulder
History of brachial neuritis or quadrilateral space syndrome
Weakness of shoulder abduction and flexion
Lack of sensation of lateral aspect of the upper arms

56
Q

Long thoracic nerve injury

A

Identified in players of many sports, including tennis, volleyball, archery, golf, fymnastics, bowling, weight lifting, soccer, hockey, and rifle shooting
Recent chest surgery or trauma to the thoracic cage
Serratus anterior weakness with scapular winging
Loss of scapulohumeral rhythm

57
Q

Suprascapular nerve injury

A

Deep, poorly localized pain
History of fracture of the scapula with involvement of the notch and blade of the scapula
Traction injury mechanism

58
Q

Suprascapular nerve injury physical exam findings:

A

Similar presentation to rotator cuff tear because of wasting of the supraspinatus and/or infraspinatus muscles
Loss of strength in abduction and external rotation of the shoulder

59
Q

Pancoast Tumor

A

Men over age 50 years with history of cigarette smoking
Nagging-type pain in the shoulder and along the vertebral border of the scapula
Pain that progressed from nagging to burning in nature, often extending down the arm and into the ulnar nerve distribution

60
Q

Vertebrobasilar artery insufficiency

A 
Dizziness
Vertigo that lasts for minutes
Headaches
Visual disturbances
Nausea
Loss of consciousness
Apprehension with end range neck movements
61
Q

Meningitis

A 
History of recent bacterial or viral infection (influenza)
History of skull fracture
Positive slump sign
Headache
Fever
GI signs of vomiting and symptoms of nausea
Photophobia
Confusion
Seizures
Sleepiness
62
Q

Primary brain tumor

A 
age 20-64
Ataxia
Speech deficits
Sensory abnormalities
Headache
GI signs of vomiting and symptoms of nausea
Visual changes
Altered mental status 
Seizures
63
Q

Subarachnoid hemorrage

A

History of smoking, HTN, and alcohol abuse
Headache of sudden onset (worse HA of life)
Brief loss of consiousness
Brain tumor signs (neurologic dysfunction, nausea and vomiting)
Meningeal irritation (nuchal rigidity, fever, photophobia, nausea and vomiting)

64
Q

Fractures

A

Recent fall or trauma
History of osteoporosis
Extended use of steroids (e.g. respiratory problems)
Pathologies with improper bone remodeling
Pain, tenderness, swelling, ecchymosis

65
Q

Radial head fracture

A

Fall onto an outstretched arm that is supinate (FOOSH injury)
Anterolateral pain and tenderness at the elbow
Inability to supinate and pronate the forearm
Elbow held against the side with 70 degrees of flexion and slightly supinated

66
Q

Distal radius (Colles’) fracture

A 
Fall onto an outstretched arm with forceful wrist extension
Age > 40 
Women affected more than men
History of osteoporosis
Wrist held in neutral resting position
Wrist swelling
Movements into extension are painful
67
Q

Scaphoid fracture

A

Wrist swelling
Wrist held in neutral position
Pain in the “anatomic snuff box”
FOOSH

68
Q

Triangular fibrocartilaginous complex tear

A

Traumatic fall on outstretched hand with forearm pronated
Commonly associated with Colles’ fractures
Ulnar-sided wrist pain
Tenderness and clicking with passive ulnar deviation
Weakness with grip strength
Dorsal ulnar head subluxation

69
Q

Space Infection of the Hand

A

Recent puncture of skin
Recent insect bite
Presence of an abscess
Purulent tenosynovitis of tendons that go through that space

70
Q

Physical Exam findings Space Infection of the Hand:

A

Typical signs of inflammation: swelling in palm, dorsum of hand, or fingertips
Pain, tenderness, warmth, erythema
Signs of long-standing infection: high fever, chills, weakness, malaise

71
Q

Raynaud’s phenomenon/disease

A

Paist medical history of RA, occlusive vascular disease, smoking, or use of beta blockers
Hands or feet that blanch, go cyanotic and then red with exposed to cold or emotional stress
Pain and tingling in hands or feet when they turn red

72
Q

Complex regional pain syndrome (CRPS) – formerly RSD – reflex sympathetic dystrophy)

A

Trauma including fracture, dislocation, or surgery
Pain does not respond to typical analgesics
Severe aching, stinging, cutting, or boring pain that is not typical of injury; hypersensitivity
Area swollen (pitting edema), warm, and erythematous

Medical Lectures (11 decks)

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