What are red flag questions for vascular causes?
- History of DVT or clotting disorders
- Cold hands or feet
- Swelling in limbs
- Claudication
- Virchow’s Triad present
- Throbbing pain
- Discoloration of skin
These questions help identify potential vascular issues.
What are red flag questions for infections/inflammatory causes?
- Recent infections anywhere in the body
- Fever present
- Night sweats
- Generalized malaise
- Red, swollen, warm joint
- Stiff neck or severe headache
- Recent travel or tick bites
- History of tuberculosis or HIV
These questions help identify potential infections or inflammatory conditions.
What are red flag questions for neoplastic causes?
- Family history of cancer
- Night pain that is unrelenting
- Unexplained weight loss
- Fever without obvious cause
- Night sweats
- Palpable lump or mass
- Muscle weakness that’s progressive
- Smoking history
These questions help identify potential neoplastic conditions.
What are red flag questions for degeneration/deficiency/drugs causes?
- Family history of arthritis or osteoporosis
- Pain pattern (worse with activity or rest)
- Muscle weakness present
- Taking medications (steroids, PPIs, SSRIs, statins)
- Dietary vitamin D intake
- Weight-bearing pain
- Giving way or buckling of joints
- Locking or catching sensations
These questions help identify potential degenerative or deficiency-related issues.
What are red flag questions for iatrogenic/idiopathic/intoxication causes?
- Recent surgery or procedures
- Any injections recently
- New medications started
- Alcohol consumption
- Onset of symptoms after medical intervention
- Bruising or unusual bleeding
- Swelling after procedure
These questions help identify potential iatrogenic or intoxication-related issues.
What are red flag questions for congenital causes?
- Family history of similar conditions
- Symptoms present since childhood
- Birth complications or developmental delays
- Joint hypermobility or frequent dislocations
- Scoliosis or spinal abnormalities noted in childhood
- Flat feet or foot deformities since birth
- Down syndrome or other genetic conditions
These questions help identify potential congenital issues.
What are red flag questions for autoimmune/allergic causes?
- Family history of autoimmune diseases
- Multiple joints affected
- Psoriasis or skin rashes present
- Bowel changes
- Eye inflammation or redness
- Nail changes
- Morning stiffness >1 hour
- Back pain with inflammatory pattern
These questions help identify potential autoimmune or allergic conditions.
What are red flag questions for trauma/RSI causes?
- Specific mechanism of injury or onset
- Recent fall, impact, or accident
- Repetitive activities or overuse
- Swelling immediately after injury
- Able to bear weight or use the affected area
- Hearing or feeling a pop, snap, or tear
- Gait changes or limping
- Restricted range of motion
- Deformity visible
These questions help identify potential trauma or repetitive strain injuries.
What are red flag questions for endocrine/metabolic causes?
- History of diabetes
- Tingling, burning, or numbness
- Diet high in red meat, alcohol, seafood
- Thyroid problems or medication
- Osteoporosis or previous fractures
- Bone pain that’s deep and constant
- Referred pain patterns
- Heat or cold intolerance
These questions help identify potential endocrine or metabolic issues.
What are the most critical ‘can’t miss’ red flags across all categories?
- FEVER + Joint pain/back pain = Infection
- NIGHT PAIN (unrelenting) = Cancer/tumor
- SADDLE ANESTHESIA + Bowel/bladder dysfunction = Cauda equina
- THUNDERCLAP HEADACHE = Subarachnoid hemorrhage
- WEIGHT LOSS + Night sweats = Cancer or TB
- AGE >50 + New onset pain + Jaw claudication = Polymyalgia rheumatica
- NEURO DEFICITS = Spinal cord compression
These combinations indicate serious pathology that requires immediate attention.
What questions indicate serious pathology in the cervical spine?
- Severe headache with stiff neck
- Double vision, dizziness, or vertigo
- Difficulty swallowing or speaking
- Drop attacks or sudden falls
- Numbness in all four limbs
- Loss of fine motor skills
- Gait or balance problems
- Bowel or bladder changes
- Trauma to neck or recent manipulation
These questions help identify potential serious cervical spine issues.
What questions indicate serious pathology in the thoracic/lumbar spine?
- Saddle anesthesia
- Loss of bowel or bladder control
- Bilateral leg weakness or numbness
- Fever with back pain
- Unrelenting night pain
- Weight loss
- History of cancer
- Age >50 with new onset severe back pain
- Recent significant trauma
- Osteoporosis or steroid use
These questions help identify potential serious thoracic or lumbar spine issues.
What questions indicate serious pathology in the shoulder?
- Night pain that wakes you from sleep
- Rest pain (constant)
- Weight loss or feeling unwell
- Smoking history
- Recent infection or fever
- Both shoulders affected
- Weakness that’s progressive
- Dislocation with nerve symptoms
- Severe pain after minimal trauma
These questions help identify potential serious shoulder issues.
What questions indicate serious pathology in the hip/pelvis?
- Groin pain with fever
- Unable to bear weight
- Shortened, externally rotated leg
- Bilateral hip/shoulder pain in person >50
- Night pain unrelieved by rest
- Recent steroid use
- Alcohol abuse
- Pelvic pain with bowel/bladder changes
- Vaginal discharge or pelvic symptoms
These questions help identify potential serious hip or pelvic issues.
What questions indicate serious pathology in the knee?
- Hot, red, swollen knee with fever
- Unable to bear weight or locked knee
- Significant effusion that appeared rapidly
- Recent tick bite or rash
- Night pain with constitutional symptoms
- Knee giving way or buckling frequently
- Bilateral knee swelling
- Age <20 with bone pain
These questions help identify potential serious knee issues.
What questions indicate serious pathology in the foot/ankle?
- Red, hot, swollen foot with fever
- Diabetes with foot ulcer or infection
- Cold, blue foot with severe pain
- Impaired sensation or foot drop
- Recent puncture wound
- Unable to bear weight after injury
- Deformity or obvious fracture
- Swelling in one leg only
These questions help identify potential serious foot or ankle issues.
When should you urgently refer or image?
- IMMEDIATE (ER): Fever + septic joint, cauda equina syndrome
- URGENT (24-48h): Suspected cancer, spinal cord compression
- SEMI-URGENT (1-2 weeks): Age >50 new onset, night pain
These timeframes help prioritize urgent medical attention.
What are the key inflammatory arthritis red flags?
- Morning stiffness >1 hour
- Multiple small joints affected symmetrically
- Improvement with activity, worse with rest
- Family history of RA, psoriasis
- Gradual onset over weeks to months
- Age 30-50 (typical RA onset)
- Psoriasis, nail pitting, or dactylitis
- Back pain worse at night, improves with movement
These questions help identify potential inflammatory arthritis.
What physical exam findings are considered red flags?
- Fever >38°C
- Visible deformity or gross swelling
- Neurovascular compromise
- Saddle anesthesia on perineal exam
- Positive straight leg raise with crossed signs
- Hoffmann sign or hyperreflexia
- Scapular winging
- Wrist drop
- Claw hand
- Atrophy with fasciculations
These findings indicate potential serious pathology.
What historical factors increase the risk of serious pathology?
- Age >50 or <20 years
- History of cancer
- Immunosuppression
- Intravenous drug use
- Recent infection or bacteremia
- Trauma
- Osteoporosis or chronic steroid use
- Prolonged steroid use
- Family history of inflammatory arthritis or cancer
These factors help assess risk for serious conditions.
