Red Flags Flashcards
1
Q
Vaginal disch
A
-flag symps- Recent change partner Blood stained disch Post coital bleed Lower abdo pain and fever Hx of intermenstrual bleeding Foul smelling - causes- Bacterial vaginosis Candidiasis DM TSS Chlamydia, gonorrhoea, trichomoniasis Cerival pathology PID Rectovaginal fistula
2
Q
Fever in kids
A
-flags under 5yo- Decr fluid intake and urine output Grunting Floppy, irritable Persis temp over 5d depsite antipyretic regularly. Incr RR, subcostal or intercostal recess Non blanching petechial rash Cool peripheries Incr smelly urine Bulging fontanelle Reduc interest in ext stim New onset seiz Complex birth -flags over 5- New onset headache or seiz New rash esp if non blanching New vomit Bloody diarr New abdo pain New jnt pain or swelling New back pain New limp New sore throat, otalgia, ear disch Photophobia, maybe with neck stiff New vaginal disch New testic swelling, maybe with erythema New dyuria, freq or haematuria Unexpl persis wl Persis neck, goin or axillary lumps Recent travel Persis night sweats over 6 wk New cough, SOB, expectorate, CP Persis fever over 1wk no clear cause -causes- Illness eg chickenpox, croup, URTI, otitis media or externa, tonsillitis. Less comm rash eg measles, slapped cheek, kawasaki. Acute resp eg bronchitis, whooping cough, pneum. Chronic resp eg TB. ENT eg quinsy, glandular fever, mastoiditis Dental infec Mesenteric adenitis Meningitis GI infec Pyloric stenosis Intussusception Malaria, dengue, lymes Appendicitis Testic or ovarian torsion UTI Haem malig Cellulitis -use centor criteria- Tonsillar exudate Cervical LN Fever No cough Score 3/4 of these means likely AB req
3
Q
Abdo pain
A
-flags- Possible preg Acute systemic unwell Dehyd Post trauma Guarding or rebound tenderness Distension Unexpl wl -causes- Constipat or obstruc Diverticulitis Appendicitis IBS Gallbladder Pancreatitis Malig UTI, Renal colic Ectopic preg, miscarriage, ovarian cyst, PID, endometriosis. AAA! DKA Coeliac Spleen rupture
4
Q
Wl or appettite loss
A
-flags- V rapid wl New dyspepsia over 55yo Dysphagia, vomit Persis low mood Alc dep Cog impair- MMSE Night sweats Resp symps, persis cough over 3wk, haemoptysis Bone pain PolyU and polyD, haematuria Change bowel habit over 6wk, rectal bleed Unexpl persis fever Recent travel Post menop, intermenstrual or post coital bleed -causes- Infec Metabolic eg hypothyr Malig GI eg gastritis, oesophagitis, IBD Psych eg dep, anx, alc or drug dep, ED Cog impair, dementia Malabs Malnutrit TB, HIV Haem malig DM Thyrotoxicosis Addisons AI Drug s/e eg GLP1 analogues
5
Q
SOB
A
-flags-
CP and other cardiac symps
Sudden onset and persis
Cyanosis, cant compl sentence, confus, agitat, leg swell
Stridor, wheeze, persis cough
Hx of long immobil, trauma, prev resp complics
Onset or worsening orthopnea
-causes-
Exacerbation LTC eg COPD, asthma, CF, HF
Airway trauma eg FB asp, excess sec, anaph, TE, pneumothorax, MI
Complic of ILD, asbestosis, CA, mets
Infec eg pneum, epiglottitis, meningitis
Anaem, liver or renal fail, DM
Psychogenic
Rare eg guillain barre, MG, MS, toxicity (CO, NSAID).
6
Q
Bone pain
A
-flags- Hx of malig Wl Night sweats Low appet Night pain Proggresive or persis Recent trauma Symmetrical jnt swell Thoracic pain -causes- Fracture Primary bone CA eg osteosarcoma, mets Vit D defic osteomalacia Mutip myeloma Pagets OP, OA, RA HyperCa Bone TB Psychosomatic Iatrogenic eg isphosphonates
7
Q
Neck pain
A
-flags- Trauma or surg Systemic ill eg wl, night sweat, fever Sev pain Nocturnal pain SC comp signs???? Sig Verteb body tenderness Hx TB, HIV, CA, RA -causes- Whiplash Cervical spondylosis/degen Verteb disc prolapse RA or seroneg arthropathies Malig TB, meningitis Cervical rib Neck A distension or aneur Verteb frac
8
Q
Back pain
A
-flags- Thoracic pain V yng or old Loss bowel or bladder control Weak or numb limbs Foot drop or gait disturb High fever Saddle anaeshesia Hx carcinoma Struc deformity -causes- SC comp! Cauda equina synd Tumour Infec Lumbar disc herniation Periph neuropathy Prim or met carcinoma Fracture Mechanical Rheumatoid, vascular, visceral
9
Q
Fever in adult
A
Persis fever over 3 wk no clear cause Travel Persis cough, SOB, expectorate, haemoptysis New headache Photophobia, neck stiff New rash esp non blanch petechial New facial swelling or pain Persis neck swell/LN swell over 6wk. Night sweat over 6wk Uninten wl New abdo pain Bloody diarr New dysuria, haematuria New vag disch with lower abdo pain New testic swell New sig lower back pain New jnt swell HIV expos Skin breakdown eg ulcer Indwelling device IV drug use Chemo recent Preg in last wk, and birth compics. -causes- Infec eg tonsillitis, gland fever, bronchitis, whooping, penum. TB ENT infec eg sinusitis, parotitis, otitis Dental infec Cerebral abcess, meningitis Malaria, lymes GI infec UTI PID Orchitis Infective endocarditis Malig Malig hyperthermia Diverticulitis Empyema
10
Q
Diarrhoea
A
-flags- Over 4wk in adult, 2 wk in kids Wl Nocturnal or continuous Blood or mucous Pale offensive Dehyd Travel In kids, if assoc fail to thrive or malnutr then consider CF, coeliac, chronic infec eg UTI. -causes- IBS IBD Malig C diff Diverticular dis Malabs Chronic infec DM Post surg Drug s/e eg NSAID Alc or laxative abuse Food intol Imm defic Mesenteric isch Radiation enteritis Autonomic neurop
11
Q
TATT
A
-flags- Dysphagia Mood Bleeding Sig unexpl wl Alt bowel habit Lymphadenop with malig feats Breast or other lump Post menop bleed Localising neuro signs Suicidal ideation -causes- Iron defic anaem, comm due to menstruation Malig Psych Socila/lifestyle stressors Sys illness
12
Q
Weight gain
A
-flags- Rapid onset Recurr hypoglycaemia Headache Uncontrollable hunger SOB Abdo pain Hair and skin change Constipation or cold intol Menstrual disturb Mood disturb -causes- Lifestyle- diet, exercise, alc Cushings Insulinoma Hypothyr PCOS Preg Genetic eg prader willi Drug s/e Organ fail MH eg dep
13
Q
Night sweats
A
-flags- Sig uninten wl HIV RFs Travel Enlarged LN TB RFs Recurr bact infec Hx of alc or drug excess Meningism- neck stiff, photophobia, headache Haemoptysis -causes- Infec Malig Complex infec eg TB, HIV Dryg s/e Anx Menop
14
Q
Pelvic pain acute
A
-flags- Pelvic mass Preg Vaginal bleed and pain if post menop Testic mass/torsion Shoulder radiation -causes- Miscarriage Ectopic preg Rupture corpus luteal cyst If preg then premat labour, placental abruption, uterine rupt. Ovulation Dysmenorrhoea PID Rupt or torsion of ovarian cyst Degen fibroid changes Pelvic tum or pevlic V thrombosis Diverticulitis Appendicitis Prostatitis Orchitis Bowel obstruc Adhesions Strangulated hernia Urolithiasis MSK Neurogenic- herpes, syphillis, N impinge eg tum MS Pelvic floor musc dysfunc
15
Q
Groin swelling
A
-flags- V pain Systemic ill Irreducible and tender Hx of CA Prev surg Pulsatile Groin node with new trunk/limb/pelvic symps. -causes- Ing hernia Femoral hernia- high rsik strang Lymphadenop Vasc pathol eg femoral A aneur Undesc testis Psoas abcess
16
Q
Cervical lymphadenopathy
A
-flags- Persis over 6 wk Firm hard Over 2cm Rapid increasing Sig uninten wl, night sweats, appet loss HIV or hep expos Travel and fever since Breast lumps or bronchogenic CA symps Gen lymphadenop -causes- URTI Infectious mononucleosis HIV, hep, syphillis, dengue, TB Mets Lymphoma, acute leuk SLE
17
Q
Parasthesia
A
-flags- Post trauma, surg, or sys infec Multip areas or progressive symps Behav or mem changes Fever and systemic upset Alt ANS func or musc weakness Age, chronic conds, lifestyle -causes- Mechanical press temporary Chronic N comp eg CTS Progressing arthritis, fibromyalgia, vert collapse, disc herniat, cervical rib. Electrolyte disturb eg hyperventil, dehyd, alt Ca Drug s/e eg BDZ, SSRI withdraw Chemo Metal pois MS, MND Brain or SC comp eg abcess, trauma, tum, mets Sensory epil or psychosomatic DM polyneuropathy Hypothyr Frostbite AI Malnutr and vit defic Infec eg herpes simplex, HIV, VZ, lymes, guillain barre, bells. Limb isch, thrombosis, periph vasc dis TIA or migraine.
18
Q
Facial pain
A
-flags- Systemic illn Progressive pain, disabil, distress Focal neuro deficit Wl Facial swell or rash Vis disturb Hear loss, tinnitus, vertigo Unilat nasal obstruc or disch -causes- Sinus dis Dental caries, abcess, cyst Salivary gl eg stones, mumps, parotitis Tempromandib disorder Neoplasia eg nasoP or brainstem Trigeminal neuralgia, or glossoP neuralgia Giant cell arteritis Migraine Cluster headache Carotid artery dissection
19
Q
Chest pain
A
-flags- Exertional Sudd onset Dyspnoea Haemoptysis Sig uninten wl New dyspepsia if over 55 Leg swell, flights, immobil -causes- ACS HVD PE Pneum Lung CA Pneumothorax Dissecting thoracic AA Costochondritis Anx
20
Q
Diplopia
A
-flags- Persis headache Pupil size change Ptosis Ocular fatigue Loss vis Neuro symps eg weakness, dysphasia Alc hx Eyeball protrusion Facial trauma -causes- Refrac error MG Horners (apical lung tum, dissecting carotid A) IC tum, abcess, haemorr Orbital floor frac Thyrotox CN 3,4,6 palsy Opiates Alc intox Temporal arteritis MS
21
Q
Arrhythmia
A
-flags- Palpitat with CP or SOB or on exertion Pre syncope Syncope Uninten wl Fam hx sudd death Drug use Alc abuse -causes- Caffeine Anx Alc withdraw TCA, domperidone Amphetamine abuse AF, VF, SVT, HB Cardiomyopathy Long QT synd WPW Electrolyte disturb Phaeochromo
22
Q
Vomiting
A
-flags-
Sev abdo pain eg obstruc, pancreatitis, cholecyctitis
Guarding sugg peritonitis
Absent or scanty bowel sounds
Rectal bleed- GI inflamm and malig
Haematemesis- peptic ulcer, mallory weiss tear, oes varices, malig
Acute or focal neuro symps- CNS infec, tum, stroke. Esp if headache.
CP- isch gastroparesis
Anorexia or wl- CA, psych causes
Shock, vol deplet, life threat illness- adrenal insuff if low Na too.
-causes-
Gastroeneteritis, us viral
ADR
Motion sickness
Preg
Vestibular disorder
ACS
Endoc eg DKA, hypoglycaemia, hyperCa, thyr prob.
GI eg biliary colic, cholecystitis, pancreatitis, hep, gastritis, peptic ulcer, food pois, obstruc.
Malig eg ovarian, renal, stomach, smallc ell lung, liver mets.
Neuro eg migraine, CNS infec, tum, stroke, vestib N lesion, parkinsons.
Psych- ED, drug OD
Renal- nephrolithiasis, renal fail, pyelonephritis
Other- alc, cannabis, chemo, radiotherapy.
23
Q
Amenorrhoea
A
-flags- Over 14 and no signs of puberty Vis field defect or lack sense smell Virilisation Excess wl Galactorrhoea Abdo mass -cause- Preg Menop Medicat Life- exercise, stress Turners, kallman, sheehan synds Pvarian or adrenal malig Imperforate hymen Cushings PCOS Hypothyr
24
Q
Delerium
A
-flags- Alt conciousness Over 65 Head trauma Neuro signs Sev headache Delerium tremens Vom -causes- HIDEMAP- Hypoxia, infec, drugs, endoc eg DM, metab eg Ca, alc, psychosis. Infec Drug s/e, or toxic from non prescribed drugs Vasc dis Metab Epil post ictal Vit B defic Endoc Neopasia Urin reten Constip
25
Q
Dysphagia
A
-flags- Steady prog in eld with solids first indics CA Solid and liq sugg motil or neuro Liquid fine but solid bad sugg stricture Wl Pain on swallow likely malig Hx reflux or dyspepsia Lymphadenop Choking, drooling Musc wasting, CN symps CREST synd signs- calcinosis, raynauds, oes dysfunc, sclerodactyly, telangiectasia. -causes- Oesophagitis maybe with stricture Oes, gastric, pharyng CA FB Stroke Achalasia Syringomyelia MG, MND, MS, myopathy, parkinsons Pahryngeal pouch Ext comp CREST, scleroderma.
26
Q
Blurred vis
A
-flags- Sudd change Eye pain Vis field defect HIV, imm comprom Pre exist systemic disorder -causes- Refrac error Age macular degen Cataracts DM retinopathy Glaucoma Optic neutitis Systemic dis eg HTN, DM, myeloma, HIV
27
Q
Headache
A
-flags- Onset over 50 Thunderclap subarach Neurological S+S Meningism Imm supp, malig Red eye and haloes around lights- acute angle closure glaucoma Worsening symps Temporal arteritis symps -causes- IC malig Haemorr Idiopathic IC HTN Infec eg encephalitis, meningitis Giant cell arteritis Analgesia overuse CO pois
28
Q
LOC
A
-flags- CP, palpit, SOB Syncope on exertion Fam hx gardiac probs Preceding headache Limb jerk, tongue bite, urin incontin Using hyoplgycaemics -causes- Epil Orthostatic hypot Hypog Vasovagal syncope Arrhyth HVD Cardiomyop Dehyd Hyperventil synd Pseudoseiz Iatrogenic
29
Q
Jaundice
A
-flags- Abdo pain Palpab gall bladder Wl Fever Encephalop GI bleed Coagulaopathy -causes- Malig eg panc head carcinoma, cholangiocarcinoma. Prim sclerosing cholangitis Prim biliary cirrhosis Biliary stricture Haemolytic anaemia Haemochromotosis, gilberts ALD Drug indeuced hyperbilirubinaemia
30
Q
Dizziness
A
-flags- Faint Hear loss Headache Vertigo CP Behav change -causes- Post hypot BPPV Menieres Labyrinthitis, vestibular neuronitis Ototox Mid ear dis, labyrinth fail MI or arrhyth Epil Head inj Brain tum or mets.
31
Q
Rectal bleed
A
-flags- Wl Alt blood PR Change bowel habit Abdo pain Mucous passed PR Anorexia -causes- Haemorrhoids Anal fissure Gastroenteritis Trauma Anticoag, NSAID Colorectal malig IBD Diverticular dis
32
Q
Breast lump
A
-flags- Hard, irregular Fixed to skin or chest wall. Maybe skin tethering. Fixed axillary lymphadenopathy Bloody nipple disch -causes- Malig Fibrocystic change Fibroadenoma Infec Galactocoele Fat necrosis due to trauma Lipoma
33
Q
Resp infec
A
-flags- Cough over 3 wk Persis cough in smoker Persis hoarseness over 3wk Persis sore throat Persis palpab neck lumps Persis unilat enlarged tonsil Diffic compl sentences Diffic swallow SOB Pleuritic CP Headache, photophob, neck stiff Non blanch rash -causes- Bronchogenic carcinoma Pneum Peritonsillar abcess Bronchitis Traceitis Bronchiolitis PE Meningoencephalitis Tonsillar malig
34
Q
Moles
A
-flags- New or changing appearance Chanes in size, esp if irregular Change in colour esp irreg pigment, and regression to lighter areas. Changes in moles over 6mm Mole that looks diff to others. -causes- Benign naevi Dysplastic naevi Seborrhoeic keratosis and warts Malig melanoma Haemangioma Lentigo maligna Pigmented BCC
35
Q
Pregnancy
A
-flags- Sev back pain Vis changes Headache New swelling Shoulder tip pain Acute SOB Leg swell and pain Intractable vom Unilat pelvic or lower abdo pain Vaginal bleed Epigastric pain Rigid or tender uterus High fever HTN Sev itch Reduced foetal movem Proteinuria Sepsis signs -causes- Premature Miscarriage Ectopic preg Placental abruption Pre eclampsia Obstetric cholestasis Pyelonephritis DVT, PE Hyperemesis gravidarum Placenta preavia Antepartum haemorrhage
