Medsurg

Red Flags

Assessment of these areas should raise concern whether the problem has a systemic or viscerogenic origin.

Past Medical Hx

• Personal/family Hx of cancer

• Recent infection when followed by neurological Sx, joint or back pain

• Recent Hx of trauma

• Hx of immunosuppression

• Hx of drug use: injection

Risk Factors of Possible Systemic Disease

• Substance abuse including alcohol, drug, or tobacco

• Age

• Gender

• BMI

• Exposure to radiation

• Race/ethnicity

• Sedentary lifestyle

• Domestic violence

• Hysterectomy

• Occupation

Clinical Presentation

• Insidious onset/unknown etiology

• Sx not improved or relieved by physical therapy

• Significant weight loss or gain without attempting to lose or gain

• Gradual, progressive, or cyclical presentation of Sx

• Sx that are unrelieved by rest or change of position

• Sx persisting beyond expected time of condition

• Sx do not fit typical neuromuscular or musculoskeletal pattern

• A growing mass or a hematoma that is not decreasing in size

• Postmenopausal bleeding

• Bilateral Sx such as edema, numbness, tingling, clubbing, nail bed changes, skin rash, or pigment changes

• Change in muscle tone or ROM in those with neurological conditions

Pain Pattern

• Pain w/full painless ROM

• Pain not consistent with psychological overlay

• Throbbing or deep, aching pain

• Poorly localized pain

• Pain that comes and goes like spasms

• Pain associated with S&S relating to certain viscera or system, e.g., GI, GU, cardiac, pulmonary

• Change of pain with food intake

Associated S&S

• Unusual menstrual cycle or Sx

• Presence of unusual/abnormal vital signs, including HR, temp, etc

• Proximal muscle weakness and/or DTRs

• Change in mental status including confusion

• Joint pain with skin rashes

Cancer Assessment

Early Warning Cancer Signs (American Cancer Society)

• Changes in bowel/bladder habits

• Sore that does not heal in 6 wk

• Unusual bleeding or discharge

• Thickening or lump in breast or elsewhere

• Indigestion or difficulty in swallowing

• Obvious change in wart/mole

• Nagging cough or hoarseness

• Proximal muscle weakness

• Change in deep tendon reflexes

Other Screening Clues

• Previous personal Hx of any cancer

• Recent wt loss of 10 lb or more within 1 mo

• Constant pain, unrelieved by rest or change in position

• Night pain

• Development of new neurological deficits

• Changes in size, shape, tenderness, & consistency of lymph nodes, painless & present in >1 location

• Women: chest, breast, axillary, or shoulder pain of unknown cause

• Bloody sputum

Adapted from Goodman C. and Snyder T. Differential Diagnosis for Physical Therapists, ed. 4. Philadelphia: Elsevier, 2006. p. 7.