RED FLAGS

154 slides
Chest Pain
Larg Ant.M.I:hypotention,pulmonary edema,or oliguria.
Pulmonary Embolism:Tachycardia,tachypnea,hypoxia
M.I:ST segment elevation or new LBBB
Ruptured papillary muscle:New systolic mitral murmur.
Aortic dissection:Mediastinal widening CXR
Cocaine abuse:Arrhythmia&or chest pain in younger pt.

154 slides
DVT
Dyspnea, tachypnea
Chest pain
Syncope
Hypotension, pulmonary edema, cyanosis
Fever

154 slides
DM hyperglycemic crisis
DKA:*Rapid onset<24h |mild deh.
*N/V |rapid/deep beath
*Abdominal pain |fruity swelling breath
*Malaise
*type 1
*HHS :*Gradual onset |more severe deh.
*mental status changes=coma
*type 2

154 slides
Thyroid Nodule
strong
Clinical Hx:*Family Hx of medullary thyroid CA or MEN.
*Rapid growth of nodule.
*Physical exam:*Firm or hard nodule
*Nodule fixed
*Paralysis of vocal cords
*LAP

154 slides
Thyroid Nodule
moderate
Clinical Hx:*Male sex
*pt age less than 20/older than 65 *Previous radiation to the head or nech
Physical Exam:*Nodule greater than 4cmor partialy cystic
*Symptoms suggesting compression(dysphagia/hoarseness/dyspnea)

154 slides
High Risk of Serious Nutritional Problems
Weight loss of >5% in 1 month/ 7.5% in 3 month/ 10% in 6 month
Weight loss or gain associated with other systemic symptoms
History of upper gastrointestinal surgery or disease.

154 slides
Sore Throat
Peritonsillar abscess:Hot-potato voice/toxic appearance/altered mental status.
EMN with increased risk of splenic rupture:Splenic enlargement
Respiratory compromise:increased resp.rate/enlarged tonsils/cervical LAP.

154 slides
Abdominal or Pelvic pain
Hx abrupt onset of pain:--perforation or rupture(ulcer,appendix,gallbladder,colon,ectopic pregnancy,spleen,abdonimal aortic aneurysm)
--Acute vascular event(mesenteric infarction,Aor.D,MI,PE)
--Volvulus,strangulated hernia,ovarian torsion,pancreatitis.
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

154 slides
Abdominal and pelvic pain devami
Examination
*shock :perforation or rupture with intraabdominal hemorrhage or peritonitis severe pancreatitis
*Distention:Bowel obst.,ileus,volvulus,toxic megacolon,bowel ischemia,abdom.aortic aneurysm,ascites
*Focal peritoneal signs:Appendicitis,diverticulitis,cholecystitis,cholangitis,abscess,PID,pancreatitis

154 slides
Elevated LFT
Abdominal pain
Elevation of other markers of liver function
Hematemesis
Rectal bleeding
Signs of advanced liver failure:
*spider angiomas
*lower extremity edema
*CHF
*HJR

154 slides
Dyspepsia
Cancer:unexplained weight loss/anorexia/dysphagia/melena/anemia/heme+ stool/long standing reflux symptoms.
Bleeding ulser:Hematemesis/melena/hematochezia/heme+ stool/orthostatic hypotention/shock/anemia
Obstruction:Dysphagia/odynophagia/early satiety/recurrent vomiting/weight loss.
Perforated ulcer:Sudden onset of severe abdm. Pain rigit/peritoneal signs/shock

154 slides
Dyspepsia
Waight loss
Persistent vomiting
Dysphagia
Anemia
Bleeding(hematemesis,hematochezia,melana)
Nighttime awakening
Fever

154 slides
Risk Factores for Severe Acute Lower GI Bleeding
*HR>/= 100 beats/minute
*Systolic BP 115
*Syncope
*nontender abdominal examination
*bleeding per rectum during first 4h of evaluation
*Aspirine use
*More than 2 active comorbid conditions(HF,IHD,Renal F,LF,cancer)

154 slides
ALGIB Interpretation
*>/= 3 risk factors:high(approximately 80%)risk of severe bleeding
*1-3 risk factors:moderate (approximately 45%)risk of severe bleeding
*0 risk factors:low (approximately<10%)risk of severe bleeding

154 slides
Breast Cancer
Pain:Unilateral/noncyclic.
Nipple discharge:Unilateral
watery,serous,serosanguineous,bloody.
single duct
*Breast Mass:Unilateral/hard,immobile/noncystic
*History:Postmenapausal
Personal Hx of breast Ca
Family Hx of breast Ca

154 slides
Complicated UTI
Male gender
Prepubertal or geriatric age
Symptoms for more than 7 days
An immunosuppressing condition
An episode of acute pyelonephritis within the past year
Known anatomic abnormality
D.M
Fever
Flank pain or tenderness

154 slides
Pelvic Pain or Abnormal uterine Bleeding
*Uterine cancer:any vaginal bleeding in postmenopausal W or intermenstral bleeding in a perimenopausal W,>5mm of thickness of endometrium on transvaginal U/S,palpable pelvic mass,or endometrial cells on Pap smear
*Ectopic pregnancy: amenore+unilateral pelvic pain+vaginal bleeding,may have adnexal fullness palpated on pelvic exam.

154 slides
Pelvic pain devami
*Missed or threatened abortion:amenore+severe pelvic cramping/pain &vaginal bleeding
*PID:Fever+purulent vag. Discharge+abd.vag. Pain+trnderness+malaise+septic appearance
*Tubo-ovarian abscess:same of above without discharge

154 slides
Criteria for hospitalization pt.with PID
*Nonresponse to oral therapy
*Pt. is pregnant
*Severe illness such as N/V/^fever
*Surgical emergencies cannot be excluded
*Tubo-ovarian abscess present
*Unable to follow or tolerate outpatient oral regimen

154 slides
Low Back Pain
General:Failure to improve after 4-6w
Night pain/pain at rest Progressive motor sensory deficit
*Cancer:Age>50
Hx of CA
Unexplained weight loss
*Infection:IV drug use
Recent UTI or skin inf.
Immunosuppression
Fever or chills
*Fracture:Age >50
Hx of osteoporosis
Chronic oral steroid use
Substance abuse
Trauma

154 slides
Back Pain
Bowel or bladder incontinence
Anesthesia(saddle)
Constitutional symptoms/malignancy
Chronic disease
Paresthesias Numbness
Age> 50
Iv drug use
Neuromotor deficits
Not relive pain with rest or drug or at night
Osteoprosis femal or CS drug use