History Taking: Red flags

When taking a history, make sure to remember the “red flags”. It is vital to show the examiner (who is looking at you as a possible future junior doctor) that you are a COMPETENT and SAFE doctor.

Below are a list of red flags based on systems. The list is not exhaustive and is just a guide for some common important questions.

In the (brackets) I have provided possible reasons for the questions.

Cardiology:

1) Progressing chest pain - (ACS)

“Is the chest pain getting worse?” “Is the pain now occurring at rest?”

2) Dizzy spells associated with : shortness of breath (? PE) loss of consciousness (lack of cerebral blood flow) palpitations (cardiac origin)

“Are your dizzy spells associated with loss of consciousness etc?”

Respiratory:

1) chest pain + shortness of breath

“Do you have any chest pain?” (ACS)

2) Leg swelling (1 leg DVT, 2 legs CHF)

“Have you noticed any sudden swelling of your leg/s?”

3) Haemoptysis (PE/Lung cancer)

“Have you noticed any blood in your sputum?” “What colour is your sputum?”

Gastroenterology

1) Weight loss (GI cancer)

“Have you had any unintentional weight loss?” “if so, how much and over what period of time?”

2) Blood in stool (IBD, cancer)

“Have you noticed any blood in your stool?” “What colour are your stools?”

3) Pain on swallowing/food getting stuck (upper GI cancers)

“Have you noticed food getting stuck when you swallow?” “Do you have any discomfort when swallowing food?”

Renal

1) Blood in urine (urological cancer)

“Have you noticed any blood in your urine?” “What colour is your urine?”

Neurological

1) Any new/worsening neurology (Stroke) **This may come in ‘acute station’

“Have you noticed any weakness of your arms/legs/face?”

2) Worsening headaches (SOL)

“Have your headaches got worse over time?” “Is your headache keeping you up at night?”

Musculoskeletal

1) Thoracic back pain (metastases)

“Can you tell me where the pain is exactly?” “Is your back pain disturbing your sleep?”

2) Not being able to weight bear/move joint (fracture/septic joint)

“Are you able to move the ankle?” “Can you put any weight on the foot?”

Psychiatric

1) Suicidal thoughts

“Do you have any thoughts of ending your life" “Do you ever feel that life is not worth living?”

2) Hallucinations

“Do you ever hear voices that others can’t?” “What do these voices say/tell you/do they tell you to hurt yourself or others?”

Endocrine

1) Constitutional symptoms + hyperhidrosis (phaeochromacytoma)

“Where have you noticed the sweating?”

2) Double Vision (Pituitary Adenoma)

“Do you have any double vision?” “When you look at one object, do you see two?”

Dermatological

1) Change in lesion

“Have you noticed any change in colour/size/shape of lesion?” “Does the lesion itch or bleed?”

2) Rash after starting drug (drug allergy)

“Did you notice the rash after starting the antibiotics?” “Did you experience any lip swelling/difficulty in breathing?”

I hope you found this list useful. As I was researching, I realised there are A LOT of questions, but this is not about memorising. It is about having an understanding of WHY you are asking, which will make the remembering easier.

Happy revising :)