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115 Cards in this Set
- Front
- Back
Headache, eye pain, blurry or haloed vision, nausea, vomiting
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Acute closed-angle glaucoma
Total loss of vision Urgent care referral or semi-urgent PCP Symptoms closely resemble classic migraine |
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Sudden cataclysmic headache in middle-aged hypertensive patient
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Nontraumatic subarachnoid hemorrhage (NTSAH)
Paralysis, death If stable, PCP. Unstable, 911 "Worst headache of my life" |
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Atraumatic, progressive, intermittent hip pain on movement and decreased hip ROM
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Avascular necrosis of hip, also Prrthese disease, "Legg-Calve-Perthes" or aseptic necrosis of hip
Disabling osteoarthritis of hip Semiurgent PCP Generally diagnosis between 4-10 years of age |
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Hip, knee, groin pain with limp in obese adolescent with or without trauma, decreased ROM
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Slipped capital femoral epiphysis
Severe hip arthritis and loss of function PCP or orthopedist |
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Knee trauma with pain and immediate and severe swelling of the knee
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Internal derangement of knee (ACL, PCL, menisci)
Permanent pain and disability PCP or orthopedist Tests - Lachman, anterior and posterior drawer, Mcmurray |
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Mid-abdominal pain followed by vomiting, then pain moving to lower right abdomen
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Acute appendicitis
Infection of abdominal cavity, sepsis and death ER McBurney's point |
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Posterior calf pain reliably occurring after walking specific distance
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Intermittent claudication from peripheral artery disease
Loss of limb, increased risk of stroke and MI Timely PCP or urgent care if no PCP |
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Late teen to early adult with focal persistent shin pain after increasing running distance
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Stress fracture of tibia
Complete tibial fracture Timely PCP Shin splints tend to be bilateral, stress fractures tend to be unilateral |
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Neck pain with tingling, numbness, or pain radiating down one arm
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Cervical nerve root radiculopathy
Permanent neuromuscular deficit in arm or hand Timely PCP or orthopedic surgeon Four grades from minimal sensory fiber compression to major compression of motor and sensory fibers with severe pain and numbness with weakness and muscle atrophy |
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Neck pain and progressive sensory changes and weakness in both arms and legs (slower onset)
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Spinal cord injury
Paralysis and loss of function Timely PCP if stable, avoid risk of fall or trauma |
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Shoulder pain and progressive inability to abduct the arm due to shoulder stiffness
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Adhesive capsulitis of shoulder (frozen shoulder)
Longterm disability and pain Timely PCP for further referral |
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Severe sore throat, high fever, drooling, difficulty swallowing in an adult
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Peritonsillar abscess
Possible sepsis and death PCP or ENT |
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Pain on urination (dysuria) with high fever, chills, frequent urination, malaise, pain in back
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Kidney infection(acute pyelonephritis)
Kidney scarring, failure, abscess, sepsis, death PCP, urgent care or ER if high fever, shaking chills, appears septic |
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Chronic tenderness in anatomical snuff box, pain of wrist after fall on outstretched hand
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Occult fracture of scaphoid bone
Malunion, nonunion, avascular necrosis Timely PCP or urgent care |
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Bunion deformity (hallux valgus) of great toe displacing adjacent toes
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Hallux valgus deformity with subluxation of adjacent joints
Chronic pain, disability PCP |
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Abdominal pain and rigidity of abdominal muscles (general red flag)
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Irritation of inner lining of abdominal peritoneum from blood and or pus
ER |
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Persistently inflamed joint (general red flag)
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Possible dz includes inflammatory arthritist, lupus, rheumatoid arthritis, gout, pseudogout
Permanent joint and soft tissue damage, damage to vital organs, deformity and disability |
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Acute joint pain and or inflammation after surgery
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Possible sepsis and death within 24 hrs
ER |
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Joint inflammation with no recent surgery or trauma (general red flag)
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Many serious conditions possible
Prompt referral |
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Persistent and chronic joint inflammation with acute flare (general red flag)
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Possible permanent destruction of bone, cartilage, or tendon
Rheumatology consult |
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Pain that worsens progressively over weeks to months (general red flag)
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Ongoing tissue damage
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Pain that steadily increases over weeks to months (general red flag)
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Treat of irreversible tissue damage from cancer, nerve damage, post-surgical pain syndromes, ischemia, etc
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Progressively worsening pain after surgery (general red flag)
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Never normal
Refer back to surgeon |
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Increasingly painful area that turns numb (general red flag)
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Possible conditions include carpal tunnel syndrome, spinal radiculopathy
Total sensory nerve destruction |
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Worsening of any stable chronically recurring pain (general red flag)
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New tissue necrosis or injury
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Progressive and unremitting bone pain (general red flag)
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Bone cancer
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Unexplained fracture caused by minimal or unidentified trauma (general red flag)
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Pathological deterioration of bone, possibly due to cancer, osteoporosis, Paget's disease, etc
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Pain or loss of function after trauma with severe immediate pain at the time of trauma, numbness, weakness and or loss of function (general red flag) (pain may diminish significantly after trauma in these cases)
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Fracture or disruption of vital structure
Note - any trauma severe enough to produce exquisiste pain at timeof injury can seriously damage tissues. |
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Severe pain and swelling in joint immediately after trauma (general red flag)
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Ruptured arteriral or arteriolar vessels
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Intense pain and skin changes persisting many weeks after trauma (general red flag)
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Complex regional pain syndrome (reflex sympathetic dystrophy)
Notes - after initial decrease in healing process, pain begins to increase. Three stages post-injury. Symptoms of stage 1(right after injury to 3 mo) may include severe burning pain, muscle spasm, joint stiffness, fast hair growth, scalding or wire brush sensation on skin from light touch such as clothes. Stage 2 (3 months post injury) changes in the nails, localized osteoporosis, skin may become cold, pale, taut, smooth or glassy, weak muscle tone. Stage 3 irreversible changes in skin, joints, bones, unrelenting pain, dry scaly mottled skin, thick and ridged nails, tremors, involuntary contractions |
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Upper abdominal pain and vomiting blood
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Upper GI hemorrhage from inner lining of stomach and or esophagus
Possible death Semiurgent transport by other if stable, 911 if vomiting blood and unstable cardiopulmonary |
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Daily heartburn for many years
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Chronic esophagitis
Barrett's esophagus or esophageal cancer PCP, gastroenterologist Test for H. pylori, possible endoscopy |
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Severe abdominal pain better with leaning forward, nausea and vomiting
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Acute pancreatitis
Severe pain, possible fatality ER |
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Sudden lessening of appendicitis symptoms, followed by later worsening of pain, fever
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Honeymoon period in abdominal pain due to rupture of appendix, followed by peritonitis
Sepsis, shock, death ER by family or friend, otherwise 911 if no other transport available |
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Mid to lower abdominal colicky pain, vomiting, constipation, abdominal distention
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Bowel obstruction
Death ER with advance call to triage nurse or doc or 911 |
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Low back pain with progressive leg numbness, tingling, weakness
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Compression neuropathy from pressure on lumbar nerve roots (radiculopathy), (possible disk involvement)
Permanent numbness, weakness, loss of function Tests for patellar or Achilles tendon reflex, decreased strength in dorsiflexion, straight leg raise test (compression radiculopathy) Grade 1- mild pain, no sensory impairment. Treat and monitor. Grade 2- moderate pain, constant parasthesia, sensory loss objectively verified. Aggressive treatment and refer for eval. Grade 3- very painful, parasthesia, constant numbness, weakness or loss of reflex, no atrophy evident. Aggressive treatment, semiurgent referral to PCP or specialist Grade 4- severe pain, numbness, parasthesia, inability to move some muscles, atrophy. Semiurgent referral. |
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Back pain with insidious onset and progressive, unintentional weight loss
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Cancer of the spine
Disability and death Semiurgent PCP |
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Back pain, progressive bilateral leg weakness and erectile dysfunction in a man over 40
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Cauda equina syndrome (lower soinal canal narrowing - spinal stenosis)
Permanent weakness in lower extremities, anal incontinence, impotence PCP |
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Severe localized midline back pain with spinal process tenderness to percussion
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vertebral compression fracture with possible underlying osteoporosis or tumor
Extreme pain, disability, prolonged bedrest PCP or ER if overwhelming pain |
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Chest pain coming on reliably with physical exertion
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Angina pectoris - ischemic myocardial pain secondary to coronary artery disease
MI Urgency proportionate to severity of symptoms |
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Sarp chest pain, SOB, unilateral or bilateral assymetric ankle swelling
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Pulmonary embolus
Sudden death 911 |
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Sudden spontaneous sharp unilateral chest pain, SOB
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Pneumothorax
Death If minor symptoms, semiurgent referral. If severe and unstable symptoms, 911. Smokers less likely to self-resolve. Note - tension pneumothorax likely from major trauma |
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Earache, ear drainage, fever, severe tenderness of mastoid process
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Acute mastoiditis
Oteomyelitis of mastoid bone, infection of nearby tissues causing thrombosis, abscess, meningitis, facial nerve damage, labyrinth destruction Semiurgent PCP, urgent care, or ENT. Deep local needling contraindicated. More common in very young |
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Persistent elbow pain and stiffness after fall on outstretched hand
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Fracture of radial head of elbow
Permanent stiffness, deformity, arthritis, nerve damage PCP semiurgent |
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Elbow swelling and pain with diminished radial pulse and or hand numbness after fall
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Supracondylar fracture of humerus
Ischemic necrosis, permanent neurological impairment ER, call to triage to notify of diminished radial, pulse |
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Facial pain over sinuses, fever, purulent drainage from nose continuously for more than 3 months or recurrently fore more than six months
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Chronic bacterial sinusitis
Abscess formation possibly leading to meningitis, damaged vision, encephalitis, osteomyelitis PCP if no urgent symptoms |
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Severe sudden anxiety, smothering sensation, chest pain with complete recovery
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Panic disorder
If Treatment is not effective, consult with PCP |
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Non-drug induced auditory hallucinations, delusions, tangential thinking
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Schizophrenia
Psychiatric consult, psychiatric emergency services or 911 if needed |
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Patient who feels pessimistic, hopeless, helpless
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Major depression
Emergency psychological services if suicide risk, PCP or psychological/psychiatric consult otherwise |
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Depression followed by episode of hyper-excitation and euphoria
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Bipolar disorder
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Personality change, social withdrawal, unstable relationships, evasiveness, decreased academic performance
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Drug abuse or addiction
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Palpitations that occur reliably with exercise and go away with rest (general red flag)
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Some type of heart disease
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Chest pain that occurs reliably with exercise and goes away with rest (general red flag)
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Coronary artery disease
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Resting heart rate over 100 beats per minute, hyper vigilance, warm skin
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Hyperthyroidism (thyrotoxicosis)
Thyroid storm leading to heart failure and death PCP; throid storm requires ER |
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Irregularly irregular pulse with rate over 100 bpm
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Atrial fibrillation with uncontrolled ventricular response
Disability, stroke, heart failure, sudden death Transport to ER by other; 911 if severe symptoms |
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Persistent and progressive tingling numbness or weakness in any part of the body (general red flag)
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General red flag for progressive neuronal destruction
Total permanent numbness, weakness or paralysis |
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Acute paralysis or loss of strength, balance or coordination (general red flag)
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General red flag for acute neuronal damage
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Fifteen minute episode of unilateral tingling/numbness that resolves completely
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Transient ischemic attack - temporary neurological dysfunction from ischemia due to vascular occlusion
Stroke risk If in midst of neurological symptoms, urgent transport to ER with triage call. Resolved TIA same day PCP referral or ER. May present with transient aphasia |
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Slow onset of patchy numbness and weakness in more than one area of the body
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Multiple sclerosis
PCP Tests for numbness with cotton ball, strengthof major muscles, limb reflexes, romberg's sign (ataxia), gait and coordination, vision test, vibration and position sense of toes, Babinski |
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Growth or change in dark skin lesion
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Malignant melanoma
Semiurgent PCP Melanomas are usually dark and a suspicious if A - assymetry B- borders are irregular or blurred C- color is dark or mixed shades D- diameter greater than 6 mm E- evolving skin lesion different from others in sizenor shape |
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Unilateral painless lymph node swelling in neck, groin or arm
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Lymphoma
Refer to PCP with solitary lymph node |
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Painless and hard area within testicle, especially of young adult male
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Testicular cancer
Potentially rapidly fatal Semi urgent PCP |
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Oe-sided ankle/distal calf swelling or asymmetrical bilateral swelling with more than 3 cm difference
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Blood clot in deep vein of calf (deep vein thrombosis)
Pulmonary embolism and death Same day ER; if symptoms of pulmonary embolus 911 |
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Bilateral, pitting ankle swelling with SOB
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Congestive heart failure
Disability and death Mild symptoms, PCP. Mderate symptoms, ER with other driving. Severe symptoms 911. |
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Swelling of one arm with shoulder and or armpit pain
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Subclavian artery deep vein thrombosis
Severe pain and dysfunction Semi urgent PCP |
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Swelling and itching of lips following insect sting or ingestion of drug, food, herb or supplement
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Impending anaphylactic shock reaction
Sudden death Urgent care or 911 depending on presence of acute respiratory distress |
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Sudden, painless loss of vision in one eye
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Detached retina
Permanent blindness Semi urgent PCP or opthalmalogist |
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Transient, painless "curtain" coming down over vision of one eye then lifting
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Amaurosis Fugax (AF) - brief and fleeting attacks of monocular partial or total blindness lasting seconds to minutes
Warning for stroke or MI due to atherosclerosis PCP Carotid doppler to determine extent of disease in internal carotid arteries |
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Double vision following blunt trauma to one eye. Eye subsequently appears lower than the other eye.
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"Blowout fracture" of eye orbit with entrapment of inferior rectus muscle in fracture
Permanent loss of vision and removal of the eyeball Urgent PCP or opthalmologist |
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Blurry vision, frequent urination, increased hunger and fatigue in adult
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Adult onset diabetes mellitus (type 1)
Type 1- usually diagnosis in childhood Type 2- more common in adulthood Gestational Disability, blindness, neuropathy, loss of lower limbs, renal failure, heart dz, death If diabetic emergency ER Note - known insulin-taking patients who present with anxiety, tremor, sweating and racing pulse should be assumed to be having a hypoglycemic reaction. Give glucose. Hyperglycemic coma requires insulin - 911 |
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Mild weight gain with lethargy, dry hair and cold extremities
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Hypothyroidism
PCP |
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Weight loss andor failure to maintain adequate body weight due to body image concerns
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Anorexia nervosa
PCP |
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Progressively decreasing mental function at any age (general red flag)
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Degeneration and deathof brain neurons
Dementia and related sequelae |
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Chronic or repeated dizziness occurring other than when standing up. (general red flag)
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Cerebral neuronal hypofunction from a variety of causes which can result in disability and death
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Chronic or repeated dizziness occurring other than when standing up with possible abnormal pulses, bradycardia or tachycardia, low blood pressure, weak pulse, or bilateral pedal edema
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decreased perfusion of blood to the brain from arrhythmia or heart weakness
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Chronic or repeated dizziness occurring other than when standing up with more chronic and less episodic dizziness and SOB
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Normal perfusion of blood to brain but decreased oxygen in the brain from pulmonary or decreased hemoglobin or RBCS
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Chronic or repeated dizziness occurring other than when standing up with dizziness, jittery, symptoms of low blood sugar 1-3 hours after eating
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Decreased blood glucose
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Chronic or repeated dizziness occurring other than when standing up with simple seizures
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Seizures
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Chronic or repeated dizziness occurring other than when standing up with neurological symptoms
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Intracranial mass
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Increasing confusion in an elderly person days, weeks or months after minor head trauma
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Chronic subdural hematoma
Mental deterioration, coma, death If stable with neurological presentation, ER by other. |
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Severe dizziness immediately after standing up
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Severe orthostatic hypotension
Possible syncope and falling PCP |
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Dizziness and slow heart beat<60bpm that does not increase with activity in an elderly person
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Sick sinus syndrome
Debility, falling, death PCP by other |
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Sudden unconsciousness followed by severe drowsiness in otherwise healthy adult
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Seizure
Disability, death PCP |
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Sudden leg weakness and possible unconsciousness in elderly person when turning head
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"Drop attack" from vertebrobasilar artery insufficiency (VBI)
Falling episodes, increased risk of stroke Avoid extreme neck rotation, PCP or cardiologist |
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Loud snoring, gasping during sleep, excessive daytime sleepiness
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Sleep apnea
- obstructive: respiratory effort normal, physical block to airflow - central sleep apnea : breathing interrupted by lack of respiratory effort because brain centers are not functioning properly - complex: features of both Timely PCP Diagnosis by polysomnography. |
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Cat bite of finger with subsequent swelling and pain
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Serious infection of tendon and or bone (osteomyelitis)
PCP |
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Bleeding from orifice (general red flag)
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Potentially serious tissue destruction
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Bright red rectal bleeding in those over 45
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Possible rectal or colon cancer
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Melena (black rectal blood)
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Upper Gi hemorrhage
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Vomiting blood
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Brisk upper GI from ulcer, cancer or ruptured blood vessels
Urgent |
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Hemoptysis - coughing blood of 1/4 tsp or more
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Possible lung cancer, serious lung infection
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Cough with bloody sputum in patient without obvious respiratory infection
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Lung cancer
PCP |
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Painless, bloody urination in man over 50 (gross hematuria)
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Urinary tract cancer (usually bladder)
PCP timely |
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Vaginal bleeding years after last menses
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Uterine cancer
PCP |
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New retraction of nipple or fixed lump in breast of male or female
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Breast cancer
Semi urgent PCP |
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Sudden SOB in the middle of the night, cough, bilateral ankle swelling
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Paroxysmal nocturnal dyspnea from congestive heart failure
Disability and or death Semi urgent to 911 depending on severity |
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Cough with severe episodic shortness of breath and expiratory wheezing
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Moderate to severe chronic asthma
Disability and death Grade 1- mild wheezing, no significant SOB, no hx of ER or hospitalization. Semi urgent within 2 days. Grade 2 - mild to moderate wheezing, mild SOB, hx of ER or hospital visits - same day PCP or pulmonary specialist. Grade 3- moderate wheezing and SOB and hx of ER or hospital visits - to PCP if office nebulizer or to ER. Grade 4- severe wheezing, SOB, bluish lips and chest tightness - 911 |
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Unexplained or poorly explained trauma or failure to thrive in toddler or young child
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Child abuse or neglect
Psychological, sexual and or physical trauma or death Same day CPS |
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Noncentering of reflected light in one pupil, crossed eye
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Strabismus
Permanent loss of vision in one eye Timely PCP |
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Child with severe sore throat, high fever over 102, inspiratory stridor, drooling
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Acute epiglottitis
Respiratory arrest and death ER urgent |
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Crying child holding one arm flexed against body with hand pronated
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Nursemaid's elbow - elbow dislocation
Refer to family practitioner, pediatrician or orthopedic surgeon |
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New onset constipation and weight loss in person over 40
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Carcinoma of colon and rectum
PCP Earlier symptoms may include persistent change in bowel habits, constipation preceded by diarrhea, persistent feeling of incomplete defecation, bright red blood in stool or melena, persistently narrower or thinner stools |
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Persistent unexplained diarrhea (>3-5 stools daily) over months or years (general red flag)
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Parasitic enteritis or significant malabsorption syndrome
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Acute bloody diarrhea with 6-8 stools per day and fever over 101.5
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Either acute inflammatory enteritis from bacteria, virus or parasite OR inflammatory autoimmune bowel disease such as Crohn's or UC
Disability and risk of death from severe dehydration or electrolyte balance PCP same or next day |
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Chronic fatigue with SOB and or chest pain (General red flag)
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General red flag for significant cardiopulmonary disease resulting in decreased blood flow to the brain
Semi urgent to urgent referrral depending on severity of symptoms |
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Chronic fatigue with enlarged lymph node and or abdominal mass (General red flag)
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Possibility of widespread cancer
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Chronic fatigue in patient with jaundice or enlarged liver (General red flag)
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Serious liver disease, liver cancer or cancer metastasized to liver
Semi urgent PCP |
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Chronic debilitating fatigue, muscle pain and sleep disturbance
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Chronic fatigue syndrome
Symptoms may also include impairment of short term memory or concentration, recurrent sore throat, tender lymph nodes and headache |
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Fever over 105
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Risk of Brain damage
Urgent care |
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Persistent fever over 101.5 for more than two weeks, "fever of unknown origin"
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Red flag for occult infection, metabolic or autoimmune disease
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Fever over 103.5 plus severe sore throat
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Streptococcal throat infection
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Progressive unilateral loss of hearing, loss of balance
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Acoustic neuroma - benign tumor of vestibulocclear nerve (CNVIII)
Permanent deafness, loss of balance, disability Slow growing tumors, timely PCP |
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Indigestion, RUQ pain, feeling of fullness following a meal
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Acute gall bladder inflammation (acute cholecystitis)
Possible ileus (bowel obstruction), empyema (gallbladder infection), sepsis, death Asymptomatic patient - timely PCP ER if persistent symptoms |
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Hx of no menstruation, late menarche with skipped menses and extremely light flow
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General red flag for hypoestrogenemia, low estrogen
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Amenorrhea, anorexia, athleticism in young women
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Female athletic triad
Osteoporosis Timely PCP |