Differential Diagnosis Reference Guide

Comprehensive differential diagnoses with distinguishing features and red flag

questions
FALLS
Diagnosis Key Distinguishing Red Flag Questions
Features
Mechanical fall No dizziness/LOC, tripping, Did you feel dizzy before? Any
normal witnesses account, LOC? Any chest pain? New
environmental hazards medications?
Syncope Prodrome (lightheaded, vision Any warning? Palpitations?
changes), witnesses saw Chest pain? Prior cardiac
pallor/fall, rapid recovery history? Family history sudden
death?
Postural hypotension Fall on standing, medications Do you get dizzy standing? New
(antihypertensives, diuretics), medications? Volume depletion
Parkinson's symptoms?
Arrhythmia Sudden collapse, palpitations, Palpitations? Chest pain? Prior
no warning, cardiac history, arrhythmias? Family history
abnormal ECG sudden cardiac death?
Seizure Tonic-clonic movements, tongue Any jerking? Tongue biting?
biting, incontinence, prolonged Lost control of bladder? How
confusion post-fall long confused after?
Stroke/TIA Focal weakness, speech Any weakness one side?
changes, falls to one side, risk Speech difficulty? Vision
factors changes? Facial droop?
Hypoglycemia Diabetic, missed meals, Are you diabetic? Missed
confusion, sweating, tremor meals? Sweating? Confusion?
What medications?
Infection (sepsis) Fever, confusion, reduced Fever? Cough? Urinary
mobility, tachycardia, symptoms? Confusion? Feeling
hypotension generally unwell?
CONFUSION / ACUTE CONFUSIONAL STATE
Diagnosis Key Distinguishing Red Flag Questions
Features
Delirium (infection) Acute onset, fluctuating, fever, How quickly did confusion start?
inflammatory markers, Fever? Cough? Urinary
identifiable source symptoms? Previous cognition?
Delirium (metabolic) Acute onset, medications, Recent medication changes?
dehydration, abnormal Fluid intake? Vomiting/diarrhea?
U&Es/glucose/calcium Known kidney/liver disease?
Delirium (drugs/withdrawal) Recent medications, alcohol New medications? Alcohol use?
history, benzodiazepines, Stopped any medications
opioids, anticholinergics suddenly? Recreational drugs?
Dementia Gradual onset over months- How long has memory been
years, progressive, ADL decline, poor? Getting worse? Manage
memory problems at home? Wandering? Getting
lost?
Hypoglycemia Diabetic, tremor, sweating, rapid Diabetic? Insulin? Missed
improvement with glucose meals? Sweating? Tremor?
Stroke Sudden onset, focal neurology, Sudden onset? Weakness?
vascular risk factors, abnormal Speech problems? Prior
imaging TIA/stroke?
Encephalitis Headache, fever, seizures, Headache? Fever? Seizures?
behavioral changes, reduced Recent viral illness? Travel?
GCS Immunocompromised?
Hypoxia/Hypercarbia Respiratory disease, low O2 Breathless? Known COPD?
sats, high CO2, lung pathology Blue lips? Drowsy
progressively?
MOVEMENT DISORDERS
Diagnosis Key Distinguishing Red Flag Questions
Features
Parkinson's disease Resting tremor, bradykinesia, Tremor at rest? Stiffness?
rigidity, postural instability, Slowness? Handwriting
asymmetric onset smaller? Smell loss?
Essential tremor Action/postural tremor, bilateral, Tremor with movement?
improves with alcohol, family Improves with alcohol? Family
history history? Affects writing?
Drug-induced parkinsonism Antipsychotics, metoclopramide, Taking any medications?
prochlorperazine, bilateral, Antipsychotics? Anti-sickness
reversible tablets? Recent changes?
Huntington's disease Chorea, psychiatric symptoms, Jerky movements? Family
dementia, family history, age history? Personality changes?
30-50 Memory problems?
Wilson's disease Young <40, tremor, psychiatric, Age? Liver problems?
Kayser-Fleischer rings, liver Psychiatric symptoms? Family
disease history?
Dystonia Sustained muscle contractions, Involuntary movements?
twisting, abnormal postures, Twisting? Worse with certain
task-specific activities? Medications?
Tardive dyskinesia Long-term antipsychotic use, Long-term antipsychotic use?
oro-facial dyskinesia, Mouth/tongue movements? Lip
choreoathetoid movements smacking?
Cerebellar disease Ataxia, intention tremor, Unsteady walking? Slurred
dysmetria, nystagmus, speech? Alcohol history? Family
dysarthria history?
ACUTE LIMB WEAKNESS
Diagnosis Key Distinguishing Red Flag Questions
Features
Stroke Sudden onset, UMN signs, Sudden onset? Face drop?
facial droop, dysphasia, risk Speech problems? Arm/leg
factors weakness? Time of onset?
Guillain-Barré syndrome Ascending weakness, areflexia, Progressing upwards? Tingling?
sensory symptoms, recent Recent infection/diarrhea?
infection Breathing difficulty?
Myasthenia gravis Fatigable weakness, ptosis, Worse as day goes on? Double
diplopia, bulbar symptoms, vision? Droopy eyelids?
worse evening Difficulty swallowing?
Spinal cord compression Back pain, bilateral leg Back pain? Bladder/bowel
weakness, sensory level, problems? Sensory level?
bladder/bowel dysfunction Cancer history? Trauma?
Peripheral nerve injury Trauma, localized weakness, Recent injury? Localized to one
follows nerve distribution, nerve? Sensory changes?
sensory loss Numbness?
Transverse myelitis Acute onset, bilateral Both legs? Bladder problems?
symptoms, sensory level, Back pain? Sensory level?
sphincter dysfunction Recent infection?
Conversion disorder Non-anatomical pattern, Stressful life events? Previous
inconsistent exam, similar episodes? Secondary
psychological stressors, give- gain? Hoover's sign?
way weakness
Hypokalaemia Generalized weakness, Medications?
medications (diuretics), Vomiting/diarrhea? Palpitations?
vomiting/diarrhea, ECG Muscle cramps?
changes
TRANSIENT ISCHEMIC ATTACK (TIA) / STROKE-LIKE SYMPTOMS
Diagnosis Key Distinguishing Red Flag Questions
Features
TIA/stroke Sudden focal neurology, What time did symptoms start?
vascular risk factors, resolves Resolved completely? Previous
<24h (TIA) TIA? Risk factors?
Migraine with aura Gradual onset, visual Gradual or sudden? Zig-zag
symptoms, march of symptoms, lines? Spreading? Headache?
headache follows, young Previous migraines?
Hypoglycemia Confusion, sweating, tremor, Diabetic? Missed meals?
diabetic, improves with glucose Sweating? Rapid improvement
with food?
Seizure (focal) Positive symptoms (jerking), Any jerking? Confused after?
post-ictal confusion, Todd's Tongue biting? Previous
paresis, tongue biting seizures?
Syncope Loss of consciousness, no focal Lost consciousness?
neurology, rapid recovery, Palpitations? Chest pain? Fell
cardiac symptoms down?
Peripheral vestibular Vertigo, nausea, hearing loss, Room spinning? Hearing loss?
tinnitus, no focal weakness Ringing? Nausea? Worse with
head movement?
Functional neurological Non-anatomical, inconsistent, Stress? Previous similar?
psychological stressors, normal Dragging leg? Inconsistent
investigations signs?
Subdural hematoma Trauma history, fluctuating Recent head injury?
symptoms, headache, Anticoagulants? Headaches?
elderly/anticoagulated Falls? Progressive symptoms?
DEPRESSION & SUICIDE RISK
Diagnosis Key Distinguishing Red Flag Questions
Features
Major depressive disorder Low mood >2 weeks, Low mood how long? Lost
anhedonia, sleep/appetite interest in things?
change, guilt, concentration loss Sleep/appetite? Thoughts of
harm?
Bipolar depression Previous mania/hypomania Ever felt opposite - really high
episodes, family history, young mood? Racing thoughts? Risky
onset behavior? Family history?
Adjustment disorder Recent identifiable stressor, Recent stressful event? When
symptoms <6 months, less did symptoms start? Coping
severe than MDD with loss/change?
Persistent depressive disorder Low mood ≥2 years, chronic but How many years low mood?
less severe than MDD Constantly or episodic? Ever felt
normal?
Substance-induced Alcohol, drugs, medications Alcohol/drug use? Medications?
(beta-blockers, steroids), Depression started when?
temporal relationship Substance use pattern?
Medical cause Hypothyroidism, anemia, Tired? Weight change? Other
vitamin deficiencies, chronic medical conditions? Cold
disease intolerance?
Bereavement Recent loss, grief symptoms, Recent loss? Grieving normally?
maintains sense of self-worth, Thoughts you should have died
improves with time too?
Psychotic depression Delusions/hallucinations, severe Hearing voices? Strange
depression, high suicide risk beliefs? Severe depression?
Psychomotor retardation?
STRESS & ADJUSTMENT DISORDERS
Diagnosis Key Distinguishing Red Flag Questions
Features
Adjustment disorder Identifiable stressor, symptoms Recent stressful event? Started
within 3 months, when? Affecting
distress/impairment work/relationships?
Generalized anxiety disorder Excessive worry ≥6 months, Worrying constantly? Can't
multiple concerns, restlessness, control it? About many things?
fatigue How long?
Acute stress reaction Severe stressor, symptoms <1 Recent trauma? When did
month, immediate onset symptoms start? Nightmares?
Avoiding reminders?
PTSD Trauma exposure, re- Traumatic event? Flashbacks?
experiencing, avoidance, Nightmares? Avoiding
hyperarousal, >1 month reminders? Easily startled?
Depression Low mood, anhedonia, Low mood? Lost interest?
biological symptoms, may be Sleep/appetite? Energy?
precipitated by stress Concentration?
Panic disorder Recurrent panic attacks, fear of Sudden panic attacks?
attacks, avoidance behavior Palpitations? Fear of dying?
Avoiding places?
Burnout Work-related chronic stress, Work stress? Exhausted? Lost
exhaustion, cynicism, reduced motivation? Cynical about work?
efficacy
Medical cause Hyperthyroidism, cardiac Palpitations? Weight loss?
disease, respiratory disease, Tremor? Chest pain?
anemia Breathlessness?
POST-TRAUMATIC STRESS DISORDER (PTSD)
Diagnosis Key Distinguishing Red Flag Questions
Features
PTSD Trauma exposure, re- Traumatic event? Flashbacks?
experiencing, avoidance, Nightmares? Avoiding
negative thoughts, reminders? Always on edge?
hyperarousal, >1 month
Acute stress disorder Similar to PTSD but <1 month Recent trauma (within month)?
duration, dissociation more Feel detached? Like watching
prominent yourself? Numb?
Adjustment disorder Stressor but symptoms less Stressful event? Distressed but
severe, no full PTSD criteria managing? Intrusive thoughts
sometimes?
Depression May follow trauma, biological Low mood? Energy?
symptoms, low mood Appetite/sleep? Interest in
predominates activities? Trauma history?
Panic disorder Panic attacks not triggered by Panic attacks out of the blue?
trauma reminders, no avoidance Or trauma-related? Avoiding
trauma reminders?
Obsessive-compulsive disorder Obsessions/compulsions not Intrusive thoughts about trauma
related to trauma, different or other things? Rituals?
pattern Compulsions?
Psychosis Hallucinations/delusions not Voices? Strange beliefs?
consistent with trauma, thought Disorganized speech? Trauma
disorder or other content?
Substance misuse May be self-medicating, Alcohol/drugs? Started after
temporal relationship, trauma? How much? Trying to
withdrawal symptoms cope?
PSYCHOSIS
Diagnosis Key Distinguishing Red Flag Questions
Features
Schizophrenia Delusions, hallucinations, How long symptoms? Voices?
disorganized speech/behavior, What do they say? Strange
negative symptoms >6 months beliefs? Motivation/self-care?
Brief psychotic disorder Sudden onset, <1 month, full How long symptoms? Recent
recovery, often after stressor stress? Ever happened before?
Sudden onset?
Schizoaffective disorder Mood episode + psychosis, Mood very high or low?
psychosis persists without mood Psychosis only when mood
symptoms abnormal or all the time?
Bipolar disorder Elevated mood, decreased need Mood very high? Racing
(manic/psychosis) sleep, grandiosity, psychosis thoughts? Don't need sleep?
during mania Spending money? Previous
episodes?
Depression with psychotic Severe depression, mood- Severely depressed? Delusions
features congruent delusions (guilt, about being
nihilism) punished/worthless? Suicidal?
Substance-induced Drugs (cannabis, Drugs? Which? When? Started
amphetamines, cocaine), before or after drug use? Drug
temporal relationship screen?
Delirium Acute onset, fluctuating, How quickly started?
inattention, disorganized Fluctuates? Confused? Medical
thinking, medical cause illness? Elderly?
Organic cause Brain tumor, encephalitis, Headaches? Seizures? Fever?
autoimmune, temporal lobe Memory problems? Neurological
epilepsy, dementia signs?
DETERIORATING MEMORY / DEMENTIA
Diagnosis Key Distinguishing Red Flag Questions
Features
Alzheimer's disease Gradual onset, episodic memory Memory problems how long?
loss, hippocampal atrophy, Recent events forgotten?
biomarkers Getting lost? Living
independently?
Vascular dementia Stepwise decline, vascular risk Sudden worsening? Previous
factors, strokes, white matter strokes? Risk factors? Focal
changes neurology?
Lewy body dementia Visual hallucinations, Seeing things not there?
parkinsonism, fluctuating Stiffness/tremor? Varies day-to-
cognition, REM sleep behavior day? Acting out dreams?
Frontotemporal dementia Behavioral/personality changes, Personality change?
language problems, young Inappropriate behavior?
onset <65 Language problems? Age?
Disinhibition?
Normal pressure hydrocephalus Triad: gait apraxia, urinary Shuffling gait? Urinary
incontinence, dementia, incontinence? Cognitive
enlarged ventricles decline? Previous
meningitis/bleed?
Depression (pseudodementia) 'I don't know' answers, insight, Depressed? Giving up easily on
biological symptoms, reversible tests? Recent stress? 'Don't
know' vs wrong answers?
Vitamin B12/thiamine deficiency Reversible, peripheral Diet? Alcohol use? Tingling?
neuropathy, macrocytic anemia, Blood tests? Vegetarian/vegan?
poor diet/alcohol
Hypothyroidism Cognitive slowing, fatigue, cold Tired? Cold? Weight gain?
intolerance, weight gain, Constipation? Slow thinking?
bradycardia
VISUAL HALLUCINATIONS IN THE ELDERLY
Diagnosis Key Distinguishing Red Flag Questions
Features
Lewy body dementia Formed visual hallucinations, Detailed visions?
parkinsonism, cognitive People/animals?
fluctuation, REM behavior Stiffness/tremor? Fluctuating?
Acting out dreams?
Delirium Acute onset, fluctuating, Sudden onset? Confused?
inattention, medical Worse evening? Infection?
cause/infection Medical illness?
Charles Bonnet syndrome Visual impairment, retained Eyesight poor? Know visions
insight, complex visual not real? Otherwise well?
hallucinations, no cognitive Cognitive function normal?
decline
Parkinson's disease dementia Established PD, cognitive Parkinson's disease? How
decline, visual hallucinations, long? Medications? Cognitive
worsened by medications decline?
Medication-induced Anticholinergics, dopamine New medications? Parkinson's
agonists, opioids, medications? Pain medications?
benzodiazepines Sleeping tablets?
Posterior cortical atrophy Visual processing problems, Visual problems?
preserved memory initially, Reading/judging distances
Alzheimer's variant difficult? Memory initially OK?
Stroke (occipital) Sudden onset, visual field Sudden onset? Lost part of
defect, consistent with vascular vision? Vascular risk factors?
territory
Psychosis (late-onset) Paranoid delusions, auditory > Paranoid thoughts? Hearing
visual hallucinations, social voices? Withdrawn? How long?
withdrawal
SEIZURE
Diagnosis Key Distinguishing Red Flag Questions
Features
Generalized tonic-clonic LOC, tonic then clonic phase, Lost consciousness? Jerking?
tongue biting, incontinence, Tongue biting? Wet self?
post-ictal confusion Confused after? Witnesses?
Focal seizure Awareness may be preserved, Aware during? Started one body
localized symptoms, may part? Warning beforehand?
generalize, aura Spread? Remember?
Absence seizure Brief LOC (seconds), staring, no Brief staring? Lasted seconds?
falling, child/adolescent, Fell? Happened before? Age?
immediate recovery Provoked by lights?
Syncope Precipitant, pale, rapid recovery, Warning? Pale? Hot
no prolonged confusion, brief environment? Prolonged
jerking possible standing? Rapid recovery?
Non-epileptic attack Eyes closed, prolonged, resists Eyes closed during? Very long?
eye opening, asynchronous Previous trauma/stress? Many
movements, psychological investigations?
Hypoglycemia Diabetic, confusion, sweating, Diabetic? Missed meal?
tremor, rapid response to Sweating? Blood sugar
glucose checked? Improved with food?
Cardiac arrhythmia Sudden collapse, palpitations, Palpitations? Cardiac history?
cardiac history, abnormal ECG Family history sudden death?
ECG abnormal?
Stroke/TIA Focal weakness persists, no Weakness after? Jerking or
jerking, consciousness may be limp? Speech problems? Facial
preserved droop?
MULTIPLE SCLEROSIS & DEMYELINATING DISEASE
Diagnosis Key Distinguishing Red Flag Questions
Features
Multiple sclerosis Dissemination in time and Multiple episodes? Different
space, relapses/remissions, body parts? Vision loss?
MRI lesions, oligoclonal bands Sensory symptoms? Uhthoff's?
Neuromyelitis optica Optic neuritis, transverse Optic neuritis? Paralysis? Both?
myelitis, AQP4 antibodies, Severe? Asian/Afro-Caribbean?
severe attacks
ADEM Monophasic, post-infection, Recent infection? Child? Single
children, encephalopathy, episode? Confused/drowsy?
multifocal demyelination Vaccinations?
CNS vasculitis Headaches, seizures, stroke- Headaches? Fever? Joint pain?
like, systemic features, Rash? Stroke symptoms?
angiography abnormal Systemic illness?
Sarcoidosis Systemic features, lung Cough? Breathless? Skin
involvement, granulomas, changes? Lymph nodes?
CSF/ACE elevated Systemic symptoms?
CNS lymphoma Immunocompromised, Immunocompromised? HIV?
progressive, mass lesions, Progressive symptoms?
elevated CSF protein Headaches? Single mass?
Functional neurological Non-anatomical, inconsistent, Symptoms fit anatomy? Vary?
psychological factors, normal Stress? Distracted do symptoms
MRI stop? MRI normal?
Vitamin B12 deficiency Subacute combined Diet? Vegan? Tingling? Position
degeneration, peripheral sense loss? Macrocytic
neuropathy, dorsal columns anemia?
GRADUAL VISION LOSS
Diagnosis Key Distinguishing Red Flag Questions
Features
Cataracts Gradual, glare, cloudy lens, How gradual? Glare? Misty
bilateral, painless, age-related vision? Both eyes? Any pain?
Age?
Glaucoma (open angle) Peripheral vision loss, painless, Side vision affected? Any pain?
elevated IOP, optic disc cupping Family history? Halos around
lights?
Age-related macular Central vision loss, Central vision affected? Straight
degeneration metamorphopsia, lines wavy? Reading difficult?
drusen/neovascularization, Age >60?
elderly
Diabetic retinopathy Diabetic, floaters, blurred vision, Diabetic? How long? Control?
maculopathy/proliferative Floaters? Blurred vision?
changes
Refractive error Gradual, improves with pinhole, Improves looking through
correctable with glasses pinhole? Wearing glasses?
When last tested?
Optic nerve disease Vision loss, color vision Color vision affected? Painful
affected, RAPD, disc changes, eye movements? Previous optic
unilateral/bilateral neuritis?
Retinal detachment Flashes, floaters, curtain coming Flashes of light? Floaters?
down, risk factors (myopia, Curtain/shadow? Short-sighted?
trauma) Trauma?
Chronic retinal vein occlusion Vascular risk factors, Risk factors? Sudden or
hemorrhages, cotton-wool gradual? Hemorrhages on
spots, gradual vision loss fundoscopy?
RED EYE
Diagnosis Key Distinguishing Red Flag Questions
Features
Conjunctivitis (bacterial) Purulent discharge, bilateral, Discharge? Sticky? Both eyes?
injected conjunctiva, no vision Vision OK? Contact lens
loss wearer?
Conjunctivitis (viral) Watery discharge, bilateral, Watery discharge? Both eyes?
preauricular lymph nodes, URTI Recent cold? Lymph nodes?
Conjunctivitis (allergic) Itchy, bilateral, seasonal, clear Itchy? Both eyes? Seasonal?
discharge, chemosis Hay fever? Itchy elsewhere?
Subconjunctival hemorrhage Painless, bright red patch, no Painful? Vision affected?
vision loss, Trauma? Coughing fit?
trauma/cough/Valsalva Straining? Anticoagulants?
Anterior uveitis Painful, photophobia, small Painful? Light hurts? Blurred
pupil, blurred vision, cells in AC vision? Previous episodes?
Autoimmune disease?
Acute angle closure glaucoma Severe pain, vomiting, haloes, Severe pain? Vomiting?
hazy cornea, fixed mid-dilated Haloes? Vision very blurred?
pupil, EMERGENCY Hard eye? URGENT
Scleritis Deep boring pain, worse eye Deep pain? Worse moving eye?
movement, autoimmune, blue Autoimmune disease? Taking
tinge NSAIDs?
Episcleritis Painless/mild discomfort, Painful? Just red patch?
localized redness, benign, self- Otherwise well? Previous
limiting episodes?
DOUBLE VISION (DIPLOPIA)
Diagnosis Key Distinguishing Red Flag Questions
Features
3rd nerve palsy Ptosis, dilated pupil (if surgical), Droopy eyelid? Pupil large? Eye
eye down and out, position? Severe headache?
diabetes/aneurysm Diabetes?
6th nerve palsy Horizontal diplopia, worse on Double vision looking sideways?
gaze to affected side, Which direction worse?
converging Diabetes? Raised ICP?
4th nerve palsy Vertical diplopia, worse on down Double vision looking down?
gaze, head tilt, trauma Tilting head? Trauma? Difficulty
stairs/reading?
Myasthenia gravis Fatigable, ptosis, variable, Worse as day goes on? Droopy
worse evening, no pupil eyelids? Difficulty swallowing?
involvement Previous thymus?
Thyroid eye disease Exophthalmos, lid lag, restricted Bulging eyes? Thyroid problem?
movements, thyroid dysfunction Gritty eyes? Can't look up?
Stroke (brainstem) Other brainstem signs, sudden Sudden onset? Dizzy? Weak?
onset, vertigo, ataxia Numb? Slurred speech? Ataxia?
Multiple sclerosis INO, young, previous episodes, Previous episodes? Optic
other neuro symptoms neuritis? Sensory symptoms?
Young adult?
Orbital fracture Trauma, enophthalmos, Recent trauma? Numbness
restricted movements, cheek? Eye sunken in? Can't
infraorbital numbness look up?
CHILDHOOD FRACTURES
Diagnosis Key Distinguishing Red Flag Questions
Features
Supracondylar fracture Fall on outstretched hand, Fall on hand? Elbow swollen?
elbow swelling/deformity, Fingers pink/warm? Sensation
brachial artery/nerve risk OK? Check ABI pulse
Greenstick fracture Incomplete fracture, bent bone, How injured? Bone bent not
forearm common, young broken completely?
children Pain/swelling? Age?
Buckle/torus fracture Compression injury, wrist Fall on hand? Wrist pain?
common, minimally displaced, Minimal swelling? Stable? Can
stable move?
Clavicle fracture Birth trauma or fall, visible Birth injury? Fall? Visible lump?
deformity, reluctant to move arm Not using arm? Birth history?
NAI (Non-accidental injury) Multiple fractures, different Story fit? Multiple injuries?
ages, inconsistent history, Bruises different ages? Rib
metaphyseal/rib fractures, delay fractures? Metaphyseal? Delay?
presentation
Salter-Harris fracture Growth plate injury, may be Through growth plate? How
subtle, limb deformity risk if injured? Age? Joint swelling?
missed Leg length?
Toddler's fracture Spiral tibia fracture, low-energy Twisted ankle? Young child?
twist, young child, refusing to Won't walk? No obvious injury?
walk Spiral on X-ray?
Pulled elbow Sudden pull on extended arm, Pulled by arm? Age 1-4?
child holds arm pronated, won't Holding arm still? Pronated?
use, age 1-4 Won't supinate?
BACK PAIN
Diagnosis Key Distinguishing Red Flag Questions
Features
Mechanical back pain Gradual onset, worse Sudden or gradual? Worse
movement, better rest, no red bending? Better lying?
flags Radiation? Bladder/bowel OK?
Cauda equina syndrome Bilateral sciatica, saddle Both legs? Numbness between
anesthesia, bladder/bowel legs? Bladder control? Bowels?
dysfunction, reduced anal tone, Anal sensation? URGENT
EMERGENCY
Spinal cord compression Bilateral leg weakness, sensory Bilateral leg weakness?
level, bladder/bowel, back pain, Sensory level? Bladder/bowel?
cancer history Cancer? Trauma?
Prolapsed disc Sciatica, positive SLR, Leg pain worse than back?
dermatomal pattern, worse Tingling? Which area? Worse
coughing/straining coughing? SLR?
Spinal fracture Trauma, osteoporosis, steroids, Fall? Osteoporosis? Steroids?
tenderness, elderly Point tenderness? Elderly?
Trauma?
Ankylosing spondylitis Young male, morning stiffness Morning stiffness? How long?
>30min, improves with exercise, Better with exercise? Young?
HLA-B27, sacroiliitis Iritis? Inflammatory markers?
Spinal infection Fever, night sweats, Fever? Night sweats? Weight
immunocompromised, IV drug loss? Immunocompromised?
use, progressive IVDU? Progressing?
AAA rupture Sudden severe pain, collapse, Sudden severe? Tearing?
pulsatile mass, vascular Collapse? Pulsatile mass?
disease, >60, EMERGENCY Vascular disease? Age?
URGENT
SHOULDER PAIN
Diagnosis Key Distinguishing Red Flag Questions
Features
Rotator cuff tear Trauma or degenerative, Fall/trauma? Weakness lifting
weakness abduction, painful arm? Painful 60-120°? Can't
arc, drop arm test hold arm up? Age?
Subacromial impingement Painful arc 60-120°, Painful lifting arm? Mid-range
Neer/Hawkins tests positive, 60-120°? Worse overhead?
overhead activities Night pain? Hawkins test?
Frozen shoulder Gradual onset, global restriction, Started gradually? Can't move
severe pain, diabetic any direction? Severe pain?
Night pain? Diabetic?
AC joint arthritis Pain top of shoulder, tender AC Pain top of shoulder? Tender
joint, cross-body adduction pain there? Worse reaching across?
Previous injury?
Calcific tendonitis Severe pain, acute onset, Sudden severe pain? Can't
restricted movement, move? Previous episodes?
calcification on X-ray Calcification on X-ray?
Referred pain (cervical) Neck pain, dermatomal Neck pain? Radiates? Worse
radiation, worse neck turning head? Tingling?
movement, neurological signs Weakness?
Cardiac pain Chest/shoulder pain, breathless, Chest pain? Breathless?
sweating, risk factors, radiation Sweating? Risk factors?
to arms Brought on by exertion?
Polymyalgia rheumatica Bilateral shoulders/hips, Both shoulders? Morning
stiffness >30min, >50 years, stiffness? Over 50? Hips too?
raised ESR Weight loss? ESR?
WIDESPREAD PAIN & FATIGUE
Diagnosis Key Distinguishing Red Flag Questions
Features
Fibromyalgia Widespread pain >3 months, Where pain? How long? Tired?
fatigue, sleep disturbance, Sleep? Stress? Tender points?
tender points Otherwise well?
Chronic fatigue syndrome Fatigue >6 months, post- How long tired? Worse after
exertional malaise, unrefreshed activity? Sleep unrefreshing?
sleep, cognitive problems Concentration? Sore throat?
Polymyalgia rheumatica Shoulder/hip girdle, stiffness Shoulders/hips? Stiffness?
>30min, >50 years, raised Morning? Over 50? Weight
ESR/CRP loss? ESR raised?
Hypothyroidism Fatigue, cold intolerance, weight Cold? Weight gain? Dry skin?
gain, dry skin, bradycardia Hair loss? Constipation? TSH?
Depression Low mood, anhedonia, Low mood? Lost interest?
biological symptoms, Sleep/appetite? Energy?
pain/fatigue secondary Concentration?
Vitamin D deficiency Bone/muscle pain, fatigue, risk Sun exposure? Dark skin?
factors (limited sun, dark skin) Covered up? Bone pain?
Vitamin D level?
Inflammatory arthritis Joint swelling, morning stiffness, Joints swollen? Stiff morning?
raised inflammatory markers How long stiffness? ESR/CRP?
Autoantibodies?
Hypercalcemia Fatigue, constipation, bone Thirsty? Urinating more?
pain, polyuria, Constipated? Bone pain?
'stones/bones/groans/moans' Calcium level?
SWOLLEN HAND JOINTS
Diagnosis Key Distinguishing Red Flag Questions
Features
Rheumatoid arthritis Symmetrical small joints, Which joints? Morning stiffness?
morning stiffness >30min, Symmetrical? DIP joints?
RF/anti-CCP, DIP spared Fatigue? RF/CCP?
Osteoarthritis DIP/PIP joints, Which joints? Bony swelling?
Heberden's/Bouchard's nodes, Worse with use? DIP joints?
bony swelling, asymmetric Age?
Psoriatic arthritis Psoriasis, DIP joints, Psoriasis? Which joints? DIP
asymmetric, dactylitis, nail involved? Sausage digit? Nail
changes pitting?
Gout MCP joints possible, tophi, Sudden attacks? Tophi?
acute attacks, raised uric acid Previous gout? Kidneys? Uric
acid?
SLE Young female, symmetrical, Age? Sex? Rash? Mouth
systemic features, ANA positive ulcers? Raynaud's? Fatigue?
ANA?
Reactive arthritis Recent infection (STI, GI), Recent infection? Diarrhea?
asymmetric, STI? Eyes? Urethritis?
urethritis/conjunctivitis Asymmetric?
Polymyositis/dermatomyositis Proximal muscle weakness, Weak? Difficulty stairs? Rash
gottron's papules, heliotrope knuckles? Eyelids? Muscle
rash enzymes?
Sarcoidosis Systemic features, lung Breathless? Cough? Skin
involvement, granulomas, changes? Eyes? Lymph nodes?
dactylitis ACE/Ca raised?
BILATERAL KNEE PAIN
Diagnosis Key Distinguishing Red Flag Questions
Features
Osteoarthritis Age >45, gradual onset, worse Age? Gradual onset? Worse
with activity, bony swelling, walking/stairs? Bony swelling?
crepitus Morning stiffness <30min?
Rheumatoid arthritis Symmetrical, morning stiffness Morning stiffness?
>30min, RF/anti-CCP, systemic Symmetrical? Hands affected?
Fatigue? RF/CCP?
Chondromalacia patellae Young, anterior knee pain, Age? Front of knee? Worse
worse stairs/kneeling, stairs/kneeling? Grinding?
retropatellar Giving way?
Pes anserine bursitis Medial knee pain, tender pes Medial knee? Tender inside?
anserine insertion, obese/OA Obese? OA elsewhere?
Fibromyalgia Widespread pain, fatigue, Just knees or widespread?
tender points, normal Fatigue? Sleep? Tender
investigations everywhere? Tests normal?
Bursitis Kneeling occupation, localized Kneel a lot? Swelling front?
(prepatellar/infrapatellar) swelling, tender bursa Localized? Hot? Red?
Hypermobility syndrome Joint laxity, pain multiple joints, Very flexible? Multiple joints?
young, Beighton score Dislocations? Beighton score?
Young?
Gout (polyarticular) Acute attacks, tophi, raised uric Sudden attacks? Tophi?
acid, chronic tophaceous gout Previous gout? Other joints?
Uric acid?
HOT PAINFUL SWOLLEN JOINT
Diagnosis Key Distinguishing Red Flag Questions
Features
Septic arthritis Fever, systemically unwell, Fever? Unwell? Single joint?
single joint, red/hot/swollen, Red/hot? Recent infection?
WCC raised, EMERGENCY Cannot move joint? URGENT
Gout Acute onset, 1st MTP common, Sudden severe? 1st MTP?
severe pain, raised uric acid, Previous attacks? Alcohol?
crystals in aspirate Diet? Uric acid?
Pseudogout Elderly, knee common, acute Elderly? Knee? Previous? X-ray
onset, chondrocalcinosis on X- shows calcification? Calcium
ray, calcium crystals crystals aspirate?
Reactive arthritis Recent infection (GI/GU), Recent infection? Diarrhea?
asymmetric, enthesitis, STI? Eye symptoms? Urethritis?
conjunctivitis
Rheumatoid flare Known RA, multiple joints, Known RA? Multiple joints?
morning stiffness, raised Morning stiffness? Worse than
inflammatory markers usual?
Haemarthrosis Trauma, anticoagulation, Trauma? Anticoagulants?
haemophilia, sudden swelling Bleeds easily? Previous?
post-injury Haemophilia?
Cellulitis Spreading erythema, systemic Spreading redness? Skin
symptoms, skin break, not joint break? Entry point? Joint moves
involved OK? Beyond joint?
Psoriatic arthritis flare Psoriasis, DIP joints, dactylitis, Psoriasis? Which joints?
asymmetric Sausage digit? Nail changes?
HIP PAIN IN A CHILD
Diagnosis Key Distinguishing Red Flag Questions
Features
Transient synovitis Age 3-10, recent viral illness, Age? Recent cold? Limping?
limp, self-limiting, CRP/WCC Fever? Well otherwise? Blood
normal tests normal?
Septic arthritis Fever, refusal weight-bear, Fever? Won't weight-bear?
systemically unwell, Kocher Unwell? How unwell?
criteria, EMERGENCY WCC/CRP raised? URGENT
Perthes disease Age 4-8, limp, groin/thigh pain, Age 4-8? Gradual onset? Pain
avascular necrosis femoral head where? X-ray changes?
Avascular necrosis?
SUFE Age 10-15, obese, groin/knee Age 10-15? Obese? Knee/groin
pain, externally rotated leg, pain? Leg turns out? Can
urgent if acute weight-bear? Acute or gradual?
Developmental dysplasia hip Infant, clunks, asymmetric skin Age? Clunk? Clicks?
folds, limited abduction Asymmetric creases? Abduction
limited? Hip check done?
Juvenile idiopathic arthritis Chronic >6 weeks, morning How long? Morning stiffness?
stiffness, systemic features Other joints? Fever? Rash?
possible Eyes?
Referred pain Knee/abdomen pain with hip Pain where? Examined hip?
pathology, examine hip if child Abdomen? Back?
knee pain
Soft tissue injury Trauma, localized tenderness, Injury? Localized? X-ray
normal X-ray, improving normal? Improving? Normal
movements?
JOINT PAIN & RASH
Diagnosis Key Distinguishing Red Flag Questions
Features
Reactive arthritis GI/GU infection, asymmetric, Recent infection? Diarrhea?
urethritis, conjunctivitis, STI? Eyes red? Rash soles?
keratoderma Urethritis?
Viral arthritis Recent viral illness, Recent viral illness? Which
symmetrical, self-limiting, rash virus? Rash type? Self-limiting?
characteristic of virus Symmetrical?
Rheumatic fever Post-strep, migratory Recent sore throat? Migratory?
polyarthritis, erythema Heart murmur? Ring-shaped
marginatum, carditis, chorea rash? Jerky movements?
SLE Malar rash, photosensitive, Butterfly rash? Sun-sensitive?
mouth ulcers, young female, Mouth ulcers? Raynaud's?
ANA positive Age/sex? ANA?
Psoriatic arthritis Psoriatic plaques, DIP joints, Psoriasis where? DIP joints?
dactylitis, nail pitting Sausage digits? Nails pitted?
Vasculitis Palpable purpura, systemic Purpura? Non-blanching?
features, ANCA, cryoglobulins Kidneys? Lungs? ANCA?
Systemic illness?
Lyme disease Erythema migrans, tick bite, Tick bite? Bull's eye rash?
migratory arthritis, large joints When? Large joints? Migratory?
Serology?
Gonococcal arthritis STI contact, tenosynovitis, Sexual history? Pustules?
papules/pustules, disseminated Tenosynovitis? Genital
infection symptoms? Swabs?
JOINT PAIN & ASTHMA
Diagnosis Key Distinguishing Red Flag Questions
Features
Churg-Strauss (EGPA) Asthma, eosinophilia, p-ANCA, Asthma when started?
vasculitis, peripheral neuropathy Eosinophils? Rash?
Numbness? p-ANCA? Sinusitis?
SLE Asthma not classic, but can Rash? Photosensitive? Mouth
occur; young female, ANA, ulcers? Kidneys? ANA?
multi-system Raynaud's?
Reactive arthritis (asthma Recent infection, asymmetric, Recent infection? Diarrhea/STI?
coincidental) urethritis, conjunctivitis Eyes? Urethritis? Asthma
longstanding?
Rheumatoid arthritis Asthma separate; RA Morning stiffness?
symptoms: symmetrical, Symmetrical? Small joints?
morning stiffness, RF/CCP RF/CCP? Asthma separate?
Drug-induced (aspirin/NSAIDs) Aspirin-exacerbated respiratory Asthma worse with
disease, nasal polyps, asthma aspirin/NSAIDs? Nasal polyps?
worsens NSAIDs Using NSAIDs for joint pain?
Sarcoidosis Lung involvement common, Cough? Breathless? Löfgren's
arthritis (Löfgren's), erythema (EN + hilar nodes + arthritis)?
nodosum ACE raised?
Osteoarthritis + asthma Two common conditions OA features? Age >45? Worse
coexisting, no relationship with use? Asthma
separate/longstanding?
Hypersensitivity reaction Drug-induced, both asthma and New medications? Both started
joint symptoms develop, recent recently? Drug history?
medication Eosinophils?
OVERDOSE / POISONING
Diagnosis Key Distinguishing Red Flag Questions
Features
Paracetamol Nausea/vomiting, RUQ pain What time taken? How much?
delayed, hepatotoxicity, treat Staggered? Nausea? RUQ
with NAC even if late pain? Paracetamol level?
URGENT
Salicylate Hyperventilation, tinnitus, Tinnitus? Breathing fast?
confusion, metabolic acidosis, Confused? Salicylate level?
alkalinize urine Time taken? Acid-base?
Opioid Reduced GCS, pinpoint pupils, Drowsy? Pinpoint pupils?
respiratory depression, Breathing slow? Which opioid?
naloxone antidote Naloxone response?
Benzodiazepine Reduced GCS, respiratory Drowsy? Which
depression, flumazenil (caution - benzodiazepine? Breathing?
seizures) Seizure history? Flumazenil
caution
Tricyclic antidepressant Arrhythmias, seizures, Which TCA? Drowsy? Fit? Wide
anticholinergic (dry, dilated QRS? Dry/flushed/dilated
pupils, urinary retention) pupils? Urinary retention?
SSRI Serotonin syndrome, seizures, Which SSRI? Agitated?
QT prolongation, generally safer Tremor? Sweating? Rigid?
than TCA Seizures? QT prolonged?
Beta-blocker Bradycardia, hypotension, Which beta-blocker? HR? BP?
bronchospasm, reduced GCS, Wheezy? Diabetic? ECG?
glucagon/atropine Glucagon available?
Calcium channel blocker Severe hypotension, Which CCB? BP? HR? Blood
bradycardia, hyperglycemia, sugar? Calcium/insulin given?
calcium/insulin therapy Severe?
CHILD CAN'T SIT STILL
Diagnosis Key Distinguishing Red Flag Questions
Features
ADHD Inattention, hyperactivity, Can't focus? Easily distracted?
impulsivity, multiple settings, Fidgety? Impulsive? At school
onset <12, impairment and home? Age onset?
Autism spectrum disorder Social communication Social interaction problems?
difficulties, repetitive behaviors, Repetitive behaviors? Sensory
sensory issues sensitive? Eye contact?
Anxiety disorder Worries, restless, physical Worrying a lot? About what?
symptoms, specific triggers Restless when anxious? Avoids
things? Physical symptoms?
Oppositional defiant disorder Defiant, argumentative, angry, Defiant? Argues? Loses
vindictive, not hyperactive per temper? Vindictive? Blames
se others? Hyperactive or defiant?
Tic disorder Motor/vocal tics, may have Tics? Movements? Sounds?
ADHD comorbidity, worse with Can suppress briefly? Worse
stress when stressed? ADHD
symptoms?
Hyperthyroidism Rare in children, weight loss, Weight loss? Sweating? Heat
tremor, heat intolerance, intolerance? Palpitations?
tachycardia Tremor? TFTs?
Sleep disorder Poor sleep, tired, inattentive, Sleep quality? Snoring?
hyperactivity paradoxically Apneas? Tired? Behavior worse
when tired?
Learning disability Frustration, boredom, acts out, Struggling academically?
may mimic ADHD, cognitive Frustrated? Bored? Acts out at
assessment school? Cognitive assessment?
LEARNING DISABILITY
Diagnosis Key Distinguishing Red Flag Questions
Features
Intellectual disability IQ <70, adaptive function Developmental delay? IQ
impaired, onset developmental tested? Adaptive functioning?
period Support needs?
Specific learning disorder Reading difficulty, normal IQ, Reading problems? Spelling?
(dyslexia) discrepancy with ability Normal IQ? Discrepancy
academic and ability?
Specific learning disorder Math difficulty, normal IQ, Math problems? Difficulty with
(dyscalculia) number sense impaired numbers? Normal in other
areas?
Autism spectrum disorder Social/communication Social interaction?
difficulties, may have learning Communication? Repetitive
difficulties behaviors? Learning problems?
ADHD Inattention affects learning, Can't focus? Distracted?
normal intelligence, treatable Hyperactive? Intelligence
normal? ADHD criteria?
Hearing impairment Affects language/learning, Hearing tested? Speech delay?
normal intelligence, correctable Normal intelligence? Responds
to sounds?
Visual impairment Affects reading/learning, normal Vision tested? Glasses?
intelligence, correctable Squints? Normal intelligence?
Environmental/social Neglect, lack of stimulation, Home environment? Neglect?
reversible with intervention Schooling? Parental
engagement? Reversible?
FOUR LIMB WEAKNESS
Diagnosis Key Distinguishing Red Flag Questions
Features
Guillain-Barré syndrome Ascending weakness, areflexia, Progressing upwards? Tingling?
post-infection, autonomic Recent infection? Reflexes?
dysfunction Breathing OK?
Myasthenia gravis Fatigable, ptosis, diplopia, Worse as day goes on? Double
bulbar, worse evening, normal vision? Droopy eyelids?
reflexes Swallowing? Reflexes?
Cervical cord compression UMN signs, sensory level, Neck pain? Sensory level?
bladder/bowel, neck pain, MRI Bladder/bowel? Brisk reflexes?
abnormal Upgoing plantars?
Motor neuron disease UMN + LMN signs, no sensory, Fasciculations? Wasting? Brisk
fasciculations, progressive, reflexes? Bulbar symptoms?
bulbar Sensory OK?
Inflammatory myopathy Proximal weakness, raised CK, Difficulty stairs/from chair? CK
muscle biopsy, rash if raised? Rash? Muscle pain?
dermatomyositis
Hypokalaemia Generalized weakness, U- Medications?
waves ECG, diuretics, Vomiting/diarrhea? K+ level?
vomiting/diarrhea ECG changes? Muscle cramps?
Critical illness ICU patient, prolonged ICU admission? Ventilated?
myopathy/neuropathy ventilation, neuromuscular Weak all over? CK normal?
blockers, steroids EMG?
Periodic paralysis Episodic weakness, triggered Episodes? Triggers? K+ level
(exercise, carbohydrates), K+ during? Family history?
abnormal during attack Between episodes normal?
FOCAL WEAKNESS
Diagnosis Key Distinguishing Red Flag Questions
Features
Stroke Sudden onset, UMN pattern, Sudden onset? Face/arm/leg?
facial droop, dysphasia, Speech? Time started?
vascular risk factors Vascular risk factors?
Transient ischemic attack As stroke but resolves <24h, Resolved? How long lasted?
high risk early stroke Previous episodes? Risk
factors?
Todd's paresis Weakness after focal seizure, Recent seizure? Jerking?
resolves within 48h, witnessed Resolving? Duration? Previous
seizure seizures?
Peripheral nerve lesion Follows nerve territory, sensory Which nerve territory? Trauma?
and motor, trauma/compression Compression? Sensory loss?
Foot/wrist drop?
Mononeuropathy Single nerve, diabetes, Single nerve? Diabetic?
vasculitis, may be painless Vasculitis? Painful? Sudden or
gradual?
Brachial neuritis Severe shoulder pain then Severe shoulder pain? Then
weakness, viral prodrome, self- weak? Recent viral illness?
limiting Improving?
Hemiplegic migraine Focal weakness, preceded by Preceded by aura? Headache?
aura, headache, family history, Family history? Age? Previous
young episodes?
Functional neurological disorder Non-anatomical, give-way Sudden? Give-way weakness?
weakness, Hoover's sign, Inconsistent? Stress? Hoover's
psychological positive? MRI normal?
TRAUMA
Diagnosis Key Distinguishing Red Flag Questions
Features
Major trauma Multiple injuries, unstable, Mechanism? Airway?
ABCDE approach, trauma team Breathing? Circulation?
activation Disability? Exposure? Activate
trauma team
Head injury LOC, GCS, amnesia, vomiting, LOC? How long? GCS?
seizure, focal neurology, Vomiting? Seizure? Focal
imaging criteria signs? Anticoagulated? CT
head criteria?
Spinal injury Midline tenderness, neurology, Midline pain? Neurology? High-
immobilize, Canadian risk mechanism? Canadian C-
C-spine/NEXUS rules spine criteria? Immobilized?
Chest trauma Breathless, hemothorax, Breathless? Chest pain?
pneumothorax, flail chest, Decreased breath sounds?
cardiac tamponade Trachea? Penetrating? Sats?
Abdominal trauma Pain, peritonism, free fluid, Abdominal pain? Peritonism?
FAST scan, observation vs CT Penetrating? Blunt? BP? FAST?
vs surgery CT?
Pelvic fracture High-energy, unstable, massive High-energy mechanism? Pelvic
hemorrhage, binder, blood pain? BP? Binder? Transfusion?
products Unstable fracture?
Long bone fracture Deformity, fat embolism risk Which bone? Open?
(femur), compartment Neurovascular intact?
syndrome, neurovascular Compartment syndrome risk?
Analgesia?
Burns TBSA%, depth, inhalation injury, TBSA%? Depth? Inhalation?
fluid resuscitation, refer if criteria Face/hands/genitals? Fluid
met resuscitation? Refer criteria?
OTORRHOEA (EAR DISCHARGE)
Diagnosis Key Distinguishing Red Flag Questions
Features
Acute otitis externa Painful, itchy, discharge, canal Painful? Itchy? Pull on ear?
swelling, tender tragus Swimming? Diabetic? Discharge
smell?
Acute otitis media with Preceding ear pain, discharge Was ear painful? Then
perforation after perforation, relief of pain discharge and relief? Recent
URTI? Child?
Chronic suppurative otitis media Persistent discharge >6 weeks, How long discharging? Hearing
hearing loss, perforation, loss? Smelly? Attic perforation?
cholesteatoma risk Cholesteatoma?
Cholesteatoma Foul discharge, hearing loss, Smelly discharge? Hearing
attic perforation, erosion of bone loss? Attic area? Erosion on
CT? Previous ear disease?
Mastoiditis Post-auricular Fever? Behind ear swollen?
swelling/tenderness, fever, Recent ear infection?
systemically unwell, recent AOM Systemically unwell? Protruding
ear?
CSF otorrhea Clear discharge, beta-2 Clear watery? Head injury?
transferrin positive, head injury, Skull fracture? Worsens
skull base fracture bending forward? Beta-2
transferrin?
Foreign body Child, unilateral discharge, may Child? Put something in ear?
be foul, visible on otoscopy Unilateral? Foul? Visible?
Eczematous otitis externa Itchy, dry, flaky, bilateral, atopy, Itchy? Both ears? Eczema
less pain than infective elsewhere? Atopy? Flaky? Less
painful?
NECK LUMP
Diagnosis Key Distinguishing Red Flag Questions
Features
Reactive lymph node Recent URTI, mobile, tender, Recent infection? Tender?
<2cm, improves with infection Mobile? <2cm? Improving?
Systemically well?
Thyroid nodule Moves with swallowing, Moves swallowing? Midline?
midline/lateral, solitary or Size? Other nodules?
multinodular goiter Symptoms? TFTs? Hoarse?
Thyroglossal cyst Midline, moves with swallowing Midline? Moves swallowing?
AND tongue protrusion, young Tongue protrusion? Age? Since
childhood?
Branchial cyst Lateral neck (anterior to SCM), Lateral? Smooth? Age 20-30?
smooth, young adult, may be Anterior to SCM? Infected?
infected Transilluminates?
Cystic hygroma Posterior triangle, Posterior triangle?
transilluminates, infant/child, Transilluminates? Age? Since
soft compressible birth? Soft?
Lymphoma Painless, rubbery, non-tender, B Painless? Rubbery?
symptoms, multiple nodes, Fever/sweats/weight loss?
young adult/elderly Multiple sites? Age?
Malignant lymph node Hard, fixed, irregular, >2cm, Hard? Fixed? >2cm?
elderly, smoking/alcohol, Smoking/alcohol? Hoarse?
primary site? Dysphagia? Find primary? Age?
Salivary gland swelling Pre-auricular (parotid) or Which gland? Worse eating?
submandibular, worse with Tender? Dry mouth? Facial
eating, tender if infected weakness? Stone?
NASAL BLOCKAGE
Diagnosis Key Distinguishing Red Flag Questions
Features
Viral URTI Bilateral, acute, clear discharge, Both sides? How long? Clear
sneezing, self-limiting <10 days runny? Sneezing? Fever?
Improving?
Allergic rhinitis Bilateral, seasonal/perennial, Both sides? Seasonal? Itchy?
itchy, sneezing, clear discharge, Sneezing? Triggers? Hay fever?
triggers Atopy?
Acute sinusitis Facial pain, purulent discharge, Facial pain? Green discharge?
>10 days, fever, double- How long? Fever? Getting
sickening worse after improving?
Chronic rhinosinusitis Symptoms >12 weeks, nasal How long? >12 weeks? Polyps?
polyps possible, post-nasal drip, Smell reduced? Post-nasal
reduced smell drip? Asthma?
Nasal polyps Bilateral, reduced smell, Reduced smell? Asthma?
asthma, aspirin sensitivity, Aspirin makes breathing worse?
greyish masses Polyps seen?
Deviated nasal septum Unilateral or bilateral, trauma One side worse? Trauma
history, C-shaped or S-shaped history? Always been? Which
side? C or S shape?
Turbinate hypertrophy Bilateral, chronic, may be Both sides? Chronic? Allergies?
allergic/vasomotor, turbinates Turbinates enlarged? Responds
large to decongestants?
Foreign body Child, unilateral, foul discharge, Child? One side? Put something
visible on anterior rhinoscopy up nose? Foul smell?
Discharge?
EPISTAXIS (NOSEBLEED)
Diagnosis Key Distinguishing Red Flag Questions
Features
Anterior epistaxis (Little's area) Visible bleeding point, younger, Can see where bleeding? Front
trauma/picking, responds to of nose? Picking? Compressed?
compression Age?
Posterior epistaxis Profuse, elderly, hard to control, Profuse? Down throat? Elderly?
may need posterior Hypertension? Can't see
packing/surgery source? Not stopping?
Trauma Direct trauma, septal Trauma? Nose broken? Septal
fracture/hematoma, clear hematoma? Clear injury?
mechanism Deformity?
Hypertension May be causative or BP? Hypertensive?
consequence, check BP, rare as Medications? Headache?
sole cause Epistaxis or secondary rise?
Anticoagulation Warfarin, DOACs, antiplatelet, Anticoagulants? Which? INR?
check INR/bleeding risk Bleeding elsewhere? Can
reverse?
Hereditary hemorrhagic Family history, telangiectasias, Family history? Telangiectasias
telangiectasia recurrent epistaxis, young onset (face, lips)? Recurrent? Young
onset? GI bleeds?
Bleeding disorder Coagulopathy, platelet disorder, Bleeding elsewhere? Bruising?
bleeding elsewhere, bruising Previous bleeds? FBC/clotting?
Family history?
Tumor Unilateral, persistent, nasal One side? Persistent? Blocked
obstruction, blood-stained nostril? Blood-stained
discharge, elderly discharge? Mass seen? Age?