Red Flags

Question 1

What are some red flags for back pain?

Answer 1

HOW SNAP?
Hx malignancy (breast/bronchus/thyroid/kidney/prostate) or TB (Pott's vertebrae) 
Onset sudden in elderly 
Weight loss 
Supine - worse 
Nocturnal pain 
Age - <20/>50
Progressive or constant 

+ systemically unwell, (bilateral) leg signs, bladder/bowel/sexual deficits

Question 2

What are some red flags for cough?

Answer 2

Persistent >3wks
Pleuritic chest pain (PE)
Haemoptysis (lung Ca, TB)
Monophonic wheeze (lung Ca) (polyphonic = asthma)
Paroxysmal nocturnal cough/dyspnoea or orthopnoea (CCF)
Unintentional weight loss (lung Ca, CCF)
Productive >3/12 (COPD)

Question 3

What are some red flags for dyspnoea?

Answer 3

Sudden onset (PE, pneumothorax)
Chest pain (MI, CCF, infection, PE)
Drowsiness/agitation/confusion (infection)
Fever (infection)

Question 4

What are some upper GI red flags? (ie for haematemesis)

Answer 4

ALARMS
Anaemia (iron def - ask about symptoms) 
Loss of weight 
Anorexia 
Recent onset/progressive 
Melaena/haematemesis 
Swallowing changes

Question 5

What are some chest pain red flags?

Answer 5

SHONE 15
SOB (ACS, PE/pneumothroax)
Hx - leg swelling/long haul flights/cancer/immobility/cardiac problems/recent untreated infection (PE, CCF, valve disease)
Onset sudden/unprovoked (ACS/PE/pneumothorax)
Nausea/vomiting/sweating (ACS)
Exertion exacerbates (angina)
15 mins or more (ACS, PE/pneumothorax)

Question 6

What are some headache red flags?

Answer 6

SNOOP
Systemic - fever/vomiting/neck stiffness/photophobia
Neurological signs - focal signs/seizure/altered mental state/papilloedema
Onset sudden (esp under 40)
Other symptoms - trauma related, nocturnal pain, rash
Previous headaches different - frequency/character

Question 7

What are some jaundice red flags?

Answer 7

Palpable gall bladder (+painless jaundice = Courvoisier's law = not stones, possible gall bladder or pancreas head malignancy) 
Weight loss 
Fever 
Encephalopathy 
Coagulopathy - bleeding/bruising