Skip to main content
SpringerLink
Log in

Alarming Symptoms and Red Flag Findings

  • Chapter
  • First Online:
Book cover Essential Medical Facts Every Clinician Should Know

  • 1388 Accesses

Abstract

Trotter, whose interests extended from neurosurgery to development of the herd instinct theory, the latter based on observing flocks of sheep, packs of wolves, and hives of bees, suggests that we should pay close attention to clinical symptoms and signs – the often-subtle clues to diagnosis. Some of these clues – such as back pain after heavy lifting or the painful blisters of a zoster infection – will be mundane. Others, however, may be both understated – the “casual parenthesis” – and alarming. These are the red flags of medicine, calling for prompt attention. This chapter examines some of these.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Trotter W. Art and science in medicine, Section 6. In: The collected papers of Wilfred Trotter, F.R.S. London: Oxford University Press. 1941.

    Google Scholar 

  2. Freedman DO, Weld LH, Kozarsky PE, et al. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med. 2006;354(2):119–130.

    Article  PubMed  CAS  Google Scholar 

  3. Isturiz RE, Torres J, Besso J. Global distribution of infectious diseases requiring intensive care. Crit Care Clin. 2006;22(3):469–488.

    Article  PubMed  Google Scholar 

  4. Magill AJ. Malaria: diagnosis and treatment of falciparum malaria in travelers during and after travel. Curr Infect Dis Rep. 2006;8(1):35–42.

    Article  PubMed  Google Scholar 

  5. Dorsey G, Gandhi M, Oyugi JH, Rosenthal PJ. Difficulties in the prevention, diagnosis, and treatment of imported malaria. Arch Intern Med. 2000;160(16):2505–2510.

    Article  PubMed  CAS  Google Scholar 

References

  1. Jones R, Charlton J, Latinovic R, Gulliford MC. Alarm symptoms and identification of non-cancer diagnoses in primary care: cohort study. BMJ. 2009;339:b3094.

    Article  PubMed  Google Scholar 

  2. Van den Bruel A, Haj-Hassan T, Thompson M, Buntinx F, Mant D; for the European Network on Recognizing Serious Infection Investigators. Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review. Lancet. 2010;l375(9717):834–845.

    Article  Google Scholar 

References

  1. Lacz NL, Schwatz RA, Kapila R. Rocky Mountain spotted fever. J Eur Acad Dermatol Venereol. 2006;20(4):411–417.

    Article  PubMed  CAS  Google Scholar 

  2. Dantas-Torres F. Rocky Mountain spotted fever. Lancet Infect Dis. 2007;7(11):724–732.

    Article  PubMed  Google Scholar 

  3. Chen LF, Sexton DJ. What’s new in Rocky Mountain spotted fever? Infect Dis Clin North Am. 2008;22(3):415–432.

    Article  PubMed  Google Scholar 

  4. Glaser C, Christie L, Bloch KC. Rickettsial and ehrlichial infections. Handb Clin Neurol. 2010;96C:143–158.

    Article  Google Scholar 

Reference

  1. Thompson MJ, Ninis N, Perera R. Clinical recognition of meningococcal disease in children and adolescents. Lancet. 2006;367(9508):397–403.

    Article  PubMed  Google Scholar 

References

  1. Wormser GP, Dattwyler RJ, Shapiro ED. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43(9):1089–1134.

    Article  PubMed  Google Scholar 

  2. Halperin JJ. Nervous system Lyme disease. Infect Dis Clin North Am. 2008;22(2):261–274.

    Article  PubMed  Google Scholar 

References

  1. Elinav H, Palladas L, Applbaum YH, et al. Plantar ulcers and eyebrow-hair paucity. Clin Infect Dis. 2006;42(5):684–685.

    Article  PubMed  Google Scholar 

  2. World Health Organization Technical Advisory Group. Report on the first WHO Technical Advisory Group on the Elimination of Leprosy. WHO/CDS/CPE/CEE/2000.4, Geneva: World Health Organization. 2000.

    Google Scholar 

  3. Abide JM, Webb RM, Jones HL, Young L. Three indigenous cases of leprosy in the Mississippi delta. South Med J. 2008;101(6):635–638.

    Article  PubMed  Google Scholar 

References

  1. Burns JC, Glode MP. Kawasaki syndrome. Lancet. 2004;364(9433):533–544.

    Article  PubMed  Google Scholar 

  2. Smith LB, Newburger JW, Burns JC. Kawasaki syndrome and the eye. Pediatr Infect Dis J. 1989;8(2):116–118.

    PubMed  CAS  Google Scholar 

  3. Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment and long-term management of Kawasaki disease. A statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004;110(17):2747–2771.

    Article  PubMed  Google Scholar 

References

  1. Awad MM, Bryant AE, Stevens DL, Rood JI. Virulence studies on chromosomal alpha-toxin and theta-toxin mutants constructed by allelic exchange provide genetic evidence for the essential role of alpha-toxin in Clostridium perfringens-mediated gas gangrene. Mol Microbiol. 1995;15(2):191–202.

    Article  PubMed  CAS  Google Scholar 

  2. Christie B. Gangrene bug killed 35 heroin users. West J Med. 2000;173(2):82–83.

    Article  PubMed  CAS  Google Scholar 

References

  1. Gerber A, Karch H, Allerberger F, Verweyen HM, Zimmerhackl LB. Clinical course and the role of shiga toxin-producing Escherichia coli infection in the hemolytic-uremic syndrome in pediatric patients, 1997–2000, in Germany and Austria: a prospective study. J Infect Dis. 2002;186(4):493–500.

    Article  PubMed  Google Scholar 

  2. Slutsker L, Ries AA, Greene KD, Wells JG, Hutwagner L, Griffin PM. Escherichia coli 0157:H7 diarrhea in the United States: clinical and epidemiologic features. Ann Intern Med. 1997;126(7):505–513.

    PubMed  CAS  Google Scholar 

References

  1. Davis RF, Johnston GA, Sladden MJ. Recognition and management of common ectoparasitic diseases. Am J Clin Dermatol. 2009;10(1):1–8.

    Article  PubMed  Google Scholar 

  2. Sutton DL, Thomas DJ. Don’t let the bedbugs bite. Nursing. 2008;38(1):24–26.

    PubMed  Google Scholar 

References

  1. D’Angio GJ. The National Wilms Tumor Study: a 40 year prospective. Lifetime Data Anal. 2007;13(4):463–470.

    Article  PubMed  Google Scholar 

  2. Spreafico F, Bellani FF. Wilms tumor: past, present and (possibly) future. Expert Rev Anticancer Ther. 2006;6(2):249–258.

    Article  PubMed  Google Scholar 

References

  1. McCarthy HJ, Tizard EJ. Clinical practice: diagnosis and management of Henoch-Schönlein purpura. Eur J Pediatr. 2009;169(6):643–50.

    Article  PubMed  Google Scholar 

  2. Rivera F, Anaya S. Henoch-Schönlein nephritis and persistent hypocomplementemia: a case report. J Med Case Reports. 2010;4(1):50–52.

    Google Scholar 

  3. Reamy BV, Williams PM, Lindsay TJ. Henoch-Schönlein purpura. Am Fam Physician. 2009;80(7):697–704.

    PubMed  Google Scholar 

References

  1. Rauch F, Glorieux FH. Osteogenesis imperfecta. Lancet. 2004;363(9418):1377–1385.

    Article  PubMed  CAS  Google Scholar 

  2. Byers PH. Disorders of collagen biosynthesis and structure. In: The metabolic and molecular bases of inherited disease, 8th ed. Scriver C, Beaudet AL, Valle D, Sly W (Eds), New York: McGraw-Hill. 2001;Page 5241.

    Google Scholar 

References

  1. Kamouon-Goldrat A, le Merrer M. Infantile cortical hyperostosis (Caffey disease). J Oral Maxillofac Surg. 2008;66(10):2145–2150.

    Article  Google Scholar 

  2. Bernstein RM, Zaleske DJ. Familial aspects of Caffey’s disease. Am J Orthop. 1995;24(10):777–781.

    PubMed  CAS  Google Scholar 

References

  1. Sinal SH, Stewart CD. Physical abuse of children: a review for orthopedic surgeons. J South Orthop Assoc. 1998;7(4):264–276.

    PubMed  CAS  Google Scholar 

  2. Helfer RE, Slovis TL, Black M. Injuries resulting when small children fall out of bed. Pediatrics. 1977;60(4):533–535.

    PubMed  CAS  Google Scholar 

  3. Nimityongskul P, Anderson LD. The likelihood of injuries when children fall out of bed. J Pediatr Orthop. 1987;7(2):184–186.

    Article  PubMed  CAS  Google Scholar 

  4. Lyons TJ, Oates RK. Falling out of bed: a relatively benign occurrence. Pediatrics. 1993;92(1):125–127.

    PubMed  CAS  Google Scholar 

References

  1. Hutchinson J. Clinical report on herpes zoster frontalis ophthalmicus (shingles affecting the forehead and nose). Ophthalmic Hospital reports and Journal of the Royal London Ophthalmic Hospital, London, 1864;3(72);865–866, 1865;5:191.

    Google Scholar 

  2. Tomkinson A, Roblin DG, Brown MJ. Hutchinson’s sign and its importance in rhinology. Rhinology 1995;33(3):180–182.

    PubMed  CAS  Google Scholar 

  3. Zaal MJ, Völker-Dieben HJ, D’Amaro J. Prognostic value of Hutchinson’s sign in acute herpes zoster ophthalmicus. Graefes Arch Clin Exp Ophthalmol. 2003;241(3):187–191.

    Article  PubMed  Google Scholar 

References

  1. Liebowitz HM. The red eye. N Engl J Med. 2000;343(5):345–351.

    Article  Google Scholar 

  2. Sutherland JE, Mauer RC. Selected disorders of the eye. In: Family medicine: principles and practice, ed. 6. Taylor RB (Ed). New York: Springer, 2003;Page 598.

    Google Scholar 

  3. Pokhrel PK, Loftus SA. Ocular emergencies. Am Fam Phys. 2007;76(6):829–836.

    Google Scholar 

References

  1. Byer NE. Natural history of posterior vitreous detachment with early management as the premier line of defense against retinal detachment. Ophthalmology. 1994;101(9):1503–1513.

    PubMed  CAS  Google Scholar 

  2. Go SL, Hoyng CB, Klaver CC. Genetic risk of rhegmatogenous retinal detachment: a familial aggregation study. Arch Ophthalmol. 2005;123(9):1237–1241.

    Article  PubMed  Google Scholar 

  3. Macguire JI, Benson WE. Retinal injury and detachment in boxers. JAMA. 1986;255(18):2451–2453.

    Article  Google Scholar 

References

  1. Neff KD, Sandoval HP, Fernandez de Castro LE, Nowacki AS, Vroman DT, Solomon KD. Factors associated with intraoperative floppy iris syndrome. Ophthalmology. 2009;116(4):658–663.

    Article  PubMed  Google Scholar 

  2. Bell CM, Hatch WV, Fischer HD, et al. Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery. JAMA. 2009;301(19):1991–1996.

    Article  PubMed  CAS  Google Scholar 

  3. Chang DF, Osher RH, Wang L, Koch DD. Prospective multicenter evaluation of cataract surgery in patients taking tamsulosin (Flomax). Ophthalmology. 2007;114(5):957–964.

    Article  PubMed  Google Scholar 

References

  1. Cherry JD. Clinical practice: croup. N Engl J Med. 2008;358(4):384–391.

    Article  PubMed  CAS  Google Scholar 

  2. Orr ST, Caplan SE. Laryngotracheitis and croup. Am J Dis Child. 1984;138(10):991–992.

    PubMed  CAS  Google Scholar 

Reference

  1. Lamont MS, Alias NA, Win MN. Red flags in patients presenting with headache: clinical indications for neuroimaging. Br J Radiol. 2003;76(908):532–535.

    Article  PubMed  Google Scholar 

References

  1. Leite LR, Macedo PG, Santos SN, Quaglia L, Mesas CE, De Peola A. Life-threatening cardiac manifestations of pheochromocytoma. Case Report Med. 2010;2010:976120. Epub 2010 Feb 10.

    PubMed  Google Scholar 

  2. de Jong WH, Eisenhofer G, Post WJ, et al. Dietary influences on plasma and urinary metanephrines: implications for diagnosis of catecholamine-producing tumors. J Clin Endocrinol Metab. 2009;94(8):2841–2849.

    Article  PubMed  CAS  Google Scholar 

References

  1. Geraldine McMahon C, Yates DW, Hollis S. Unexpected mortality in patients discharged from the emergency department following an episode of nontraumatic chest pain. Eur J Emerg Med. 2008;15(1):3–8.

    Article  PubMed  CAS  Google Scholar 

  2. Wilhelmsen L, Rosengren A, Hagman M, Lappas G. “Nonspecific” chest pain associated with long-term mortality: results from the primary prevention study in Goteborg, Sweden. Clin Cardiol. 1998;21(7):477–482.

    Article  PubMed  CAS  Google Scholar 

  3. Robinson JG, Wallace R, Limacher M, et al. Elderly women diagnosed with non-specific chest pain may be at increased cardiovascular risk. J Women’s Health (Larchmt). 2006;15(10):1151–1160.

    Article  Google Scholar 

Reference

  1. von Kodolitsch Y, Schwartz AG, Nienaber GA. Clinical prediction of acute aortic dissection. Arch Intern Med. 2000;160(19):2977–2982.

    Article  PubMed  CAS  Google Scholar 

Reference

  1. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;344(9):665–671.

    Article  PubMed  CAS  Google Scholar 

References

  1. Stein PD, Terrin ML, Hales CA, et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest. 1991;100(3);598–603.

    Article  PubMed  CAS  Google Scholar 

  2. Stein PD, Beemath A, Matta F, et al. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med. 2007;120(10):871–879.

    Article  PubMed  Google Scholar 

References

  1. Littleton SW, Mokhlesi B. The pickwickian-obesity hypoventilation syndrome. Clin Chest Med. 2009;30(3):467–478.

    Article  PubMed  Google Scholar 

  2. Dickens C. The Posthumous Papers of the Pickwick Club. London: Chapman & Hall. 1837.

    Google Scholar 

  3. Mokhlesi B, Tulaimat A. Recent advances in the obesity hypoventilation syndrome. Chest. 2007;132(4):1322–1336.

    Article  PubMed  Google Scholar 

Reference

  1. Chari ST, Leibson CL, Rabe KG, Ransom J, de Andrade M, Peterson GM. Probability of pancreatic cancer following diabetes: a population-based study. Gastroenterology. 2005;129(2):504–511.

    PubMed  Google Scholar 

References

  1. Sheth SG, LaMont JT. Toxic megacolon. The Lancet. 1998;351:509–513.

    Article  CAS  Google Scholar 

  2. Levine CD. Toxic megacolon. AACN Clin Issues. 1999;10(4):492–499.

    Article  PubMed  CAS  Google Scholar 

References

  1. Kinkade S. Evaluation and treatment of acute low back pain. Am Fam Physician 2007;75:1181–1188, 1190–1192.

    PubMed  Google Scholar 

  2. Ma B, Wu H, Jia LS, Yuan W, Shi GD, Shi JG. Cauda equina syndrome: a review of clinical progress. Chin Med J. 2009;122(10):1214–1222.

    PubMed  Google Scholar 

Reference

  1. Henschke N, Maher CG, Refshauge KM. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum. 2009;60(10):3072–3080.

    Article  PubMed  Google Scholar 

References

  1. Nakajima M, Hirayama K. Midcervical central cord syndrome: numb and clumsy hands due to midline cervical disc protrusion as the C3–4 intervertebral level. Neurol Neurosurg Psychiatry. 1995;58:607–613.

    Article  CAS  Google Scholar 

  2. Yamazaki T, Yanaka K, Fujita K, et al. Traumatic central cord syndrome: analysis of factors affecting the outcome. Surg Neurol. 2005;63(2):95–99.

    Article  PubMed  Google Scholar 

References

  1. Seneviratne U. Guillain-Barré syndrome. Postgrad Med. 2000;76(902):774–782.

    Article  CAS  Google Scholar 

  2. Alshekhlee A, Hussain Z, Sultan B, Katirji B. Guillain-Barré syndrome: incidence and mortality rates in U.S. hospitals. Neurology. 2008;70(18):1608–1613.

    Article  PubMed  Google Scholar 

  3. Hughes RA, Dalakas MC, Cornblath DR, Latov N, Weksler ME, Relkin N. Clinical applications of intravenous immunoglobulins in neurology. Clin Exp Immunol. 2009;158(Suppl 1):34–42.

    Article  PubMed  CAS  Google Scholar 

References

  1. Weitlaulf JC, Finney JW, Ruzek JL, et al. Distress and pain during pelvic examinations: effect of sexual violence. Obstet Gynecol. 2008;112(6):1343–1350.

    Article  Google Scholar 

  2. Luce H, Schrager S, Gilchrist V. Sexual assault of women. Am Fam Phys. 2010;81(4):489–495, 496.

    Google Scholar 

References

  1. Dart RG, Kaplan B, Varaklis K. Predictive value of history and physical examination in patients with suspected ectopic pregnancy. Ann Emerg Med. 1999;33(3):283–290.

    Article  PubMed  CAS  Google Scholar 

  2. Ankum WM, Mol BW, Van der Veen F, Bossuyt PM. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril. 1996;65(6):1093–1099.

    PubMed  CAS  Google Scholar 

  3. Job-Spira N, Fernandez H, Bouyer J, Pouly JL, Germaine E, Coste J. Ruptured tubal ectopic pregnancy: risk factors and reproductive outcome: results of a population-based study in France. Am J Obstet Gynecol. 1999;180(4):938–944.

    Article  PubMed  CAS  Google Scholar 

Reference

  1. Tseng A Jr, Horning SJ, Freiha FS, Resser KJ, Hannigan JF, Torti FM. Gynecomastia in testicular cancer patients. Prognostic and therapeutic implications. Cancer. 1985;56(10):2534–2538.

    Article  PubMed  Google Scholar 

References

  1. Leaute-Labreze C, Lamireau T, Chawki D, Maleville J, Taieb A. Diagnosis, classification, and management of erythema multiforme and Stevens-Johnson syndrome. Arch Dis Child. 2000;83(4):347–352.

    Article  PubMed  CAS  Google Scholar 

  2. Rotunda A, Hirsch RJ, Scheinfeld N, Weinberg JM. Stevens-Johnson syndrome and toxic epidermal necrolysis. Acta Derm Venereol. 2003;83(1):1–9.

    Article  PubMed  Google Scholar 

References

  1. Herrick AL, McColl KEL. Acute intermittent porphyria. Clin Gastroent. 2005;19(2):235–249.

    CAS  Google Scholar 

  2. Grandchamp B. Acute intermittent porphyria. Semin Liver Dis. 1998;18(1):17–24.

    Article  PubMed  CAS  Google Scholar 

  3. Macaline I, Hunter R. The “insanity” of King George 3rd: a classic case of porphyria. BMJ. 1966;1(5479):65–71.

    Article  Google Scholar 

  4. Burgovne K, Swartz R, Ananth J. Porphyria: reexamination of the psychiatric implications. Psychother Psychosom. 1995;64(3):121–130.

    Article  PubMed  CAS  Google Scholar 

References

  1. Bacon BR. Hemochromatosis: diagnosis and management. Gastroenter. 2001;120(4):718–725.

    Article  CAS  Google Scholar 

  2. Niederau C, Strohmeyer G, Stremmel W. Epidemiology, clinical spectrum and prognosis of hemochromatosis. Adv Exp Med Biol. 1994;356(3):293–302.

    Article  PubMed  CAS  Google Scholar 

Reference

  1. Stewart DE, Cecutti A. Physical abuse in pregnancy. Can Med Assoc J. 1993;149(9):1257–1266.

    CAS  Google Scholar 

  2. Hegarty K, Gunn J, Chondros P, Small P. Association between depression and abuse by partners of women attending general practice: descriptive, cross sectional survey. BMJ. 2004;328(7440):621–624.

    Article  PubMed  Google Scholar 

Reference

  1. Taylor RB. Medical wisdom and doctoring: the art of 21st century practice. New York: Springer. 2010, Chapter 4.

    Book  Google Scholar 

Reference

  1. Meador CK. A little book of doctors’ rules II. Philadelphia: Hanley & Belfus. 1999;Page 7.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Family Medicine School of Medicine, Oregon Health & Sciences University, 3181 SW Sam Jackson Park Road, Portland, Oregon, 97239, USA

    Robert B. Taylor

Authors
  1. Robert B. Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert B. Taylor .

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Taylor, R.B. (2011). Alarming Symptoms and Red Flag Findings. In: Essential Medical Facts Every Clinician Should Know. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-7874-5_8

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-7874-5_8

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-7873-8

  • Online ISBN: 978-1-4419-7874-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation