Red flags Flashcards

Question

Red flag symptoms for widespread joint pain

Answer 1

* Night sweats * Appetite loss * Unintentional weight loss * Joint swelling/redness and heat * Early morning stiffness * Persistent fever of more than 3 weeks * Night pain * New onset headaches * Jaw claudication * Scalp tenderness * Significant lethargy * Hx of IBD * Hx of uveitis

Answer 2

* Significant unintentional weight loss * New-onset dyspepsia, age >55 * Dysphagia * Symptoms raising suspicion of malignancy * Persistent low mood * Features suggesting alcohol dependence * Mini–Mental State Examination (MMSE) score, or equivalent, suggesting cognitive impairment * Genitourinary, gastrointestinal or respiratory symptoms * Loss of taste or smell contributing to the loss of appetite

Answer 3

* Preceding chest pain * Preceding dyspnoea * Preceding headaches * Preceding palpitations * Preceding abdominal pain * Associated weakness of arm, face or leg * Associated with exercise or posture * Blood loss * Evidence of GI bleeding * Associated tongue biting, urinary incontinence or prolonged limb jerking * New medication * Preceding lightheadedness * Known diabetic on an oral hypoglycaemic or insulin

Answer 4

* Persistent weakness (> 4 weeks) * Muscle wasting * Loss of power * Recurrent falls * Unusual paraesthesiae * Visual symptoms * Significant, unintentional weight loss * Night sweats * Loss of appetite

Answer 5

* > 4 weeks duration * History of significant trauma * Early morning symptoms * Persistent fevers/systemic upset * Abnormal rashes * Associated weakness * Muscle wasting * Significant unintentional weight loss * Joint pains * Swelling or redness * Significant fatigue * New numbness or power loss in a limb * Loss of bowel or bladder control

Answer 6

* Significant preceding trauma or neck surgery * Systemic upset (unintentional weight loss, night sweats, fevers) * Severe pain * Nocturnal pain * Relatively young (<20 years) or old (>55 years) * Signs of spinal cord compression * Significant vertebral body tenderness * History of TB, HIV, cancer or inflammatory arthritis * Severe headache +/– fever +/– non-blanching rash

Answer 7

* Significant unintentional weight loss * Any symptoms warranting a two-week wait referral (see cancer risk assessment tools) * A history of foreign travel * Risk factors for HIV * Palpable lymph glands * Risk factors for TB * Recurrent bacterial infections requiring antibiotics * History of alcohol excess or recreational drug use * Signs of meningeal irritation (meningism), such as neck stiffness, photophobia, headache * Haemoptysis * Symptoms suggestive of COVID-19, such as cough, anosmia, dysgeusia * Persistent nose bleeds, bleeding gums or petechiae

Answer 8

* Sudden or rapid onset * Confusion or loss of consciousness * Slurred speech * Change in vision * Saddle anaesthesia * Loss of bladder or bowel control * Difficulty walking * Numbness after a head, neck or back injury

Answer 9

* Periorbital oedema in a child * Change in medication * Accompanying breathlessness * Pain, hyperpigmentation, absent leg pulse * Signs of sepsis * High blood pressure

Answer 10

* Chest pain * Acute dizziness or syncope * Shortness of breath * Hypotension * Focal neurological symptoms

Answer 11

* Persistent cough for more than three weeks * Pleuritic chest pain * Dyspnoea * Haemoptysis * Persistent nocturnal cough * Wheeze * Recurrent chest infections * Coughing up phlegm every morning for more than three months of the year * Unintentional weight loss * History of night sweats

Answer 12

* Persistent sore throat for >6 weeks * Persistent cough, fever, loss of taste and loss of smell * Excessive drooling * Trismus * Unilateral facial swelling * Dysphagia * Dyspnoea * Immunosuppressant medication, such as carbimazole and monoclonal antibodies (MABs) * Persistent unilateral tonsillar enlargement * Neck stiffness * Photophobia * Non-blanching rash

Answer 13

* Weight loss * Change in bowel habit, especially diarrhoea and/or increased frequency * Iron-deficiency anaemia * Abdominal mass * Rectal/anal mass * Faecal occult blood

Answer 14

* Cough >3 weeks * Persistent cough in a smoker * Haemoptysis * Persistent hoarseness >3 weeks * Persistent sore throat * Persistent palpable neck lumps * Persistent unilateral enlarged tonsil * Difficulty completing sentences * Difficulty swallowing (particularly own saliva) * Shortness of breath * Pleuritic chest pain * Headache, photophobia and neck stiffness * Non-blanching rash * Nasal flaring/grunting in babies * Recession of intercostal muscles in young children

Answer 15

* Rash covering more than 90% of a person’s body surface area * Punched-out lesions in a person with eczema * Fever * An unwell patient (adult or child) * Diarrhoea * Nausea and vomiting * Headache * Photophobia * Non-blanching rash * Arthralgia and muscle pains * Pharyngitis * Blisters and bullae * Scalded skin appearance * Skin lesions

Answer 16

* Recent immobility or surgery * 3cm discrepancy compared to the other calf * Unilateral swelling * Calf pain/tightness/redness

Answer 17

* Onset after trauma, surgery or systemic infection * Multiple areas involved or progressive symptoms * Additional behavioural or memory changes, or dizziness/headaches * Fever or other systemic upset * Disturbances of autonomous nervous system or objective muscular weakness * Patient is at high risk because of age, existing chronic conditions or lifestyle factors

Answer 18

* Sudden and pulsatile tinnitus * Significant neurological signs/symptoms * Severe vertigo * Sudden unexplained hearing loss * Developing after head injury * Severe functional or psychological distress

Answer 19

* Significant unexplained weight loss * Lymphadenopathy with features of malignancy or infection such as HIV * Other features of malignancy - haemoptysis, dysphagia, rectal bleeding, altered bowel habit, breast lump, postmenopausal bleeding (also see NICE guidance on suspected cancer2) * Muscle or joint pain suggestive of inflammatory joint or connective tissue disease * Localising or focal neurological signs * Suicidal ideation

Answer 20

* Sudden onset * Progressive * Stepwise (suggestive of stroke or MS) * Neurological deficits * Age under 50 years in the absence of family history of essential tremor

Answer 21

* Pain * Painless acute retention * Haematuria or clots * History of prolonged bladder outflow obstruction

Answer 22

* Severe abdominal pain – consider GI obstruction, acute pancreatitis or cholecystitis. If guarding, peritonism and absent or scanty bowel sounds are found, think acute abdomen. * Rectal bleeding – consider GI inflammation or malignancy * Haematemesis – peptic ulcer, Mallory-Weiss tear, oesophageal varices, malignancy * Acute or focal neurological symptoms – CNS infection, tumour, stroke. Beware the patient with vomiting and unexplained headache * Chest pain or other features of acute coronary syndrome. Ischaemic gastroparesis should be considered in older patients with known atherosclerotic disease * Anorexia or weight loss may indicate cancer. Also consider psychiatric causes * Shock, volume depletion or life-threatening illness – consider adrenal insufficiency, which is a medical emergency, with nausea, vomiting, volume depletion and low sodium

Answer 23

* Rapid onset * Recurrent hypoglycaemia * Headache * Uncontrollable hunger * Shortness of breath * Abdominal pain * Hair or skin change * Constipation or cold intolerance * Menstrual disturbance * Mood disturbance