Red flags (and diagnostic triads)
Pediatric Fevers
| Condition | Description |
|---|---|
| Age < 3 months (<6 months amber) | Always consider UTI |
| Unwell | Appears unwell (e.g. to nurse) Pale, mottled, ashen, or cyanosed Not responding to social cues Drowsy, doesn’t wake or stay awake Weak cry Grunting, RR>60, chest in-drawing Reduced skin turgor, tachycardia, CRT >3 sec, dry mucous membranes, reduced urine output Poor feeding in infants Non-blanching rash, bulging fontanelle, neck stiffness Status epilepticus, focal seizures, focal neurological signs |
| UTI | Vomiting, poor feeding, lethargy, irritability, abdominal pain or tenderness, urinary symptoms |
| Meningitis | Pallor + drowsiness + fever + neck stiffness +/- bulging fontanelle +/- status epilepticus |
| Meningococcal infection | Drowsiness + fever + purpuric rash +/- neck stiffness +/- delayed capillary refill |
| Herpes simplex encephalitis | Focal neurological signs, seizures, reduced level of consciousness |
| Rheumatic fever | Malaise + fever + transient polyarthritis +/- rash +/- chorea |
| Septic arthritis OR osteomyelitis | Limb or joint swelling, non-use of leg |
| Scarlet fever | Fever + sandpaper rash + exudative pharyngitis + strawberry tongue |
| Kawasaki disease | Fever > 5days + conjunctivitis (sparing limbus) + cracked red lips + strawberry tongue + pharyngitis without exudate + large lymphadenopathy + maculopapular rash + swollen/desquamating/erythematous palm, soles, perineum (late) |
| Wilms tumour | Chronic fever + abdominal mass +/- haematuria |
| Neuroblastoma | Chronic fever + extreme malaise +/- anaemia |
Paediatric Respiratory
| Condition | Description |
|---|---|
| General Symptoms | Grunting, RR>60, chest in-drawing |
| Epiglottitis | Fever + drooling + stridor + extreme lethargy |
| Bronchiolitis | <12 months + drowsiness + cough + wheezing |
| Croup | URTI + brassy cough + stridor |
| Pneumonia | Drowsiness + tachypnoea + chest wall recession |
| Asthma OR aspirated FB | Coughing + wheezing + chest wall recession |
Paediatric Gastro/Abdominal
| Condition | Description |
|---|---|
| Acute appendicitis | Abdominal pain + pallor + a/n/v |
| Mesenteric adenitis | Abdominal pain + malar flush + fever +/- URTI |
| Pyloric stenosis | <3 months, usually male + weakness + weight loss + vomiting |
| Intussusception | Pallor + severe, intermittent abdominal pain + inactivity |
| Oesophageal or duodenal atresia | Neonate + vomiting + drooling + abdominal distension |
| Lead poisoning | Chronic + lethargy/malaise + vague abdominal pains + irritability/abnormal behaviour |
| Haemolytic uraemic syndrome | Gastroenteritis epidemic + extreme malaise + diarrhoea + severe abdominal pain |
Paediatric Haematology
| Condition | Description |
|---|---|
| Iron deficiency anaemia OR thalassaemia major | <2 years + lethargy + pallor + irritability |
| Acute lymphocytic leukaemia | Malaise + pallor + bone pain |
| Acute myeloid leukaemia | Malaise + pallor + gingival hypertrophy/bleeding/ulceration |
Developmental Delay (Syndromes)
| Condition | Description |
|---|---|
| Fragile X syndrome | Large ears + long, narrow face + large genitals |
| Prader-Willi syndrome | Small hands, feet & genitals + narrow forehead + eating disorder |
| Williams syndrome | ‘Elfin’ face + low set ears + cardiac murmur |
| Turner syndrome | Female + short stature + webbed neck + pigmented naevi +/- cardiac murmur |
| Noonan syndrome | Short stature + webbed neck + broad forehead + ptosis + low-set ears +/- cardiac disorder +/- deafness |
Other Paediatric
| Condition | Description |
|---|---|
| Henoch-Schonlein purpura | Arthralgia (lower limbs) + palpable purpuric rash (buttocks, legs) +/- abdominal pain |
| Reye syndrome | Respiratory symptoms + vomiting + mental changes + seizure/coma |
| Tourette’s syndrome | Male child – Snorting, blinking + grunts/oral noises +/- expletives |
| Medulloblastoma | Headache + a/n/v + ataxia |
Adolescents
| Condition | Description |
|---|---|
| Substance abuse | Irritability + appetite changes + vague abdominal pain |
| Scheuermann’s disease | Back pain/discomfort + kyphosis + inability to touch toes |
| Slipped femoral capital epiphysis | Limp + knee pain + hip pain |
| Osgood-Schlatter disorder | Knee pain after activity + tender knee + lump + pain on kneeling |
Respiratory/ENT
| Condition | Description |
|---|---|
| Life-threatening asthma | Silent chest |
| TB or sarcoidosis | Malaise + fever + cough (+/- erythema nodusum) |
| Lung ca | Malaise + cough + weight loss |
| EBV | Fever + sore throat + cervical lymphadenopathy |
Cardiac
| Condition | Description |
|---|---|
| Ventricular arrhythmias (FHx) | Long QT |
| Aortic stenosis | Triad of dyspnoea, (pre)syncope, chest pain |
| Cardiac arrhythmia | Fatigue + dizziness + syncope |
| Cardiomyopathy | Fatigue + dyspnoea on exertion + dizziness (+/- FHx) |
| Infective endocarditis | Fever + murmur + embolic phenomena |
Abdominal Pain
| Condition | Description |
|---|---|
| Ectopic pregnancy | Amenorrhoea/abnormal PV bleeding |
| Ovarian cancer | >40yo, family Hx, bloating, pain, early satiety (CT) |
| Porphyria | Young, hyponatremia, HTN |
| Crohn disease | Diarrhoea + fever |
Other Gastroenterology
| Condition | Description |
|---|---|
| Coeliac disease | Fatigue + weight loss + diarrhoea |
| Faecal impaction | Anorexia/nausea + faecal leaking + abdominal bloating |
| Giardiasis | Abdominal cramps + flatulence + profuse diarrhoea |
Fever/Infections
| Condition | Description |
|---|---|
| Septicaemia | Fever + rigors + hypotension (also consider tachycardia, tachypnoea, reduced urine output, confusion) |
Endocrine/Metabolic
| Condition | Description |
|---|---|
| DM | Polyuria + polydipsia + skin/orifice infections |
| Hypothyroidism | Lethargy + physical/mental slowing + constipation |
| Hypokalaemia | Fatigue + weakness + cramps |
Haematology
| Condition | Description |
|---|---|
| Non-Hodgkin lymphoma | Malaise + night sweats + painless lymphadenopathy |
| Haemochromatosis | Lethargy + tiredness + arthralgia |
Rheumatology
| Condition | Description |
|---|---|
| Systemic sclerosis | Arthralgia + Raynaud phenomenon + GORD (+/- skin changes) |
| SLE | Fatigue + polyarthritis + fever or skin lesions |
Urology/Renal
| Condition | Description |
|---|---|
| Malignancy | Haematuria |
| Renal ca | Haematuria + loin pain + palpable loin mass |
| CRF | Fatigue plus anorexia/n/v + sallow skin |
Gynaecology
| Condition | Description |
|---|---|
| PCOS | Menstrual dysfunction + obesity + hirsutism |
Geriatric
| Condition | Description |
|---|---|
| Falls | Delirium |
| Hypoactive delirium | “Difficult historian” |
| Delirium | Picking at bedclothes |
Palliative
| Condition | Description |
|---|---|
| Cry for help | Euthanasia request (fears, concerns, pain) |
Medications
| Condition | Description |
|---|---|
| Renal failure | Diuretic, ACEI/AR2B, NSAID, metformin, omeprazole (interstitial nephritis) |
Back Pain
| Condition | Description |
|---|---|
| Multiple myeloma | Weakness + weight loss |
| Red flags | Major trauma Minor trauma in elderly or osteoporotic, Age >50 or <20 years History of cancer Constitutional symptoms (fever, chills, weight loss) Recent bacterial infection IV drug use Immunosuppression Pain worsening at night or when supine Severe or progressive sensory alteration or weakness Bladder or bowel dysfunction Evidence of neurological deficit (in legs or perineum in the case of low back pain) |
| Yellow flags | The belief that pain is harmful or severely disabling Fear-avoidance behaviour (avoiding activity because of fear of pain) Low mood and social withdrawal Expectation that passive treatment rather than active participation will help |
Other MSK
| Condition | Description |
|---|---|
| Paget disease | Aching bones + waddling gait + deafness |
Headache
| Condition | Description |
|---|---|
| SAH | Vomiting + sudden onset + neck stiffness +/- altered consciousness +/- crescendo +/- FHx SAH/aneurysm/sudden unexplained death |
| Meningitis | Fever + vomiting (+/- rash) |
| Idiopathic intracranial HTN | Young obese female + visual obcurations + papilloedema |
| Temporal arteritis | Jaw claudication, temporal pain |
| Migraine | Recurrent, unilateral + nausea +/- vomiting + visual aura + acute onset |
| Cluster headache | Recurrent + severe + retro-orbital + rhinoorhoea + lacrimation |
Other Neurology
| Condition | Description |
|---|---|
| Increased ICP | Drowsiness + vomiting + severe headache |
| Cerebral tumour | Increased IOP +/- focal signs +/- epilepsy |
| TIA (carotid) | Acute and transient uniocular visual loss OR dysphasia OR hemiplegia |
| Cauda equina syndrome | Severe low back pain Saddle anesthesia (loss of sensation in the areas that would sit on a saddle, including the inner thighs, back of the legs, and area around the rectum) Bowel and bladder dysfunction (such as urinary retention or incontinence) Sexual dysfunction Lower extremity weakness and loss of sensations (may affect one or both legs) Loss of reflexes in the lower limbs |
| Charcot foot in neuropathy (esp diabetic) | |
| Meniere syndrome | (Episodic vertigo) + vomiting + tinnitus + hearing loss + acute onset |
| Acoustic neuroma | Dizziness + hearing loss + dizziness |
| BPPV | Vertigo provoked by movement + positive Hallpike test |
| Complex partial seizure | Blank spell + lip smacking/automation + olfactory/gustatory hallucination |
| Simple partial seizure | Gradual spread of focal jerking |
| Cerebellar disease (e.g. MS) | Dysarthria + intention tremor + nystagmus |
| MS | Visual disturbance (blurred/transient loss) + Limb weakness + Limb paraesthesia |
| Parkinson disease | Rigidity + bradykinesia + resting tremor |
| Essential tremor | Tremor (postural or action) + head tremor + absence of Parkinsonian features |
| Myasthenia gravis | Fatiguable/weakness eyelids, eye movements + limbs (proximal) + bulbar muscles (speech, swallowing) |
| Guillain-Barre syndrome | Weakness of limbs + face + areflexia + acute onset |
| Miller-Fisher variant of GBS | Ataxia + ophthalmoplegia + areflexia + acute onset |
| Horner syndrome | Enopthalmas + meiosis + ptosis +/- anhydrosis |
| Motor neurone disease | UMN + LMN signs + fasciculations |
| Pseudobulbar palsy | Dysphagia + dysphonia/dysarthria + spastic tongue |
| Myotonic dystrophy | Temporalis atrophy + frontal balding + muscle weakness +/- myotonia + cataracts |
| Creutzfeldt Jakob disease | Dementia + myoclonus + ataxia |
Burns
| Condition | Description |
|---|---|
| Inhalation | Singeing, carbonaceous material/soot |
| Circumferential | Chest, limbs |
| Face, hands, feet, genitals | — |
| Full thickness | Loss of sensation |
| Blast injury | — |
| Fluid replacement | — |
| Tetanus |