How should you assess the onset of a symptom?

Screen for unnoticed symptoms (e.g., "Any recent fatigue, weight changes, or dizziness?").

1. Headache

Red Flags:

• Thunderclap onset (seconds/minutes).

• Fever + neck stiffness.

• New neurological deficits (vision loss, weakness).

• Worst headache of life.

• Worsening with coughing/Valsalva.
  Questions:

• "Did it start suddenly, like a ‘clap of thunder’?"

• "Any fever, neck stiffness, or rash?"

• "Any vision changes, weakness, or confusion?"

Chest Pain

Red Flags:

• Radiates to jaw/arm.

• Associated with sweating, SOB, nausea.

• History of cardiac disease.
  Questions:

• "Does the pain spread anywhere?"

• "Are you sweating, short of breath, or nauseated?"

• "Any history of heart disease?"

• Sudden hearing loss.

• Focal neurological signs.

• Persistent imbalance.
  Questions:

• "Any hearing loss or ringing in the ears?"

• "Do you have weakness, slurred speech, or numbness?"

Hallucinations

Red flags

• New-onset without psychiatric history.

• Confusion or altered consciousness.

• Drug/alcohol use.
  Questions:

• "Are you using any drugs/alcohol?"

• "Any confusion, fever, or head injury?"

Fever 

red flags

• Prolonged (>1 week).

• Night sweats/weight loss/neck stiffness/photophobia

• Recent travel to endemic areas.
  Questions:

• "Any weight loss or night sweats?"

• "Have you traveled recently?"

•  

Loss of Consciousness

Red Flags:

• No warning (syncope vs. cardiac cause).

• Chest pain/palpitations prior.

• Head injury.
  Questions:

• "Did you have palpitations or chest pain beforehand?"

• "Did you hit your head?"

• First-time seizure.

• Postictal confusion >30 mins.

• Trauma during episode.
  Questions:

• "Is this your first seizure?"

• "How long did confusion last afterward?"

Weakness

Red Flags

• Sudden onset/asymmetrical.

• Facial droop, slurred speech.
  Questions:

• "Is one side weaker? Any facial drooping?"

• "Can you lift both arms equally?"

•  

Abdomen

Red Flags

• Rigid abdomen (peritonitis).

• Blood in stool/vomit.

• Sudden, severe pain.
  Questions:

• "Is your abdomen hard/tender?"

• "Any blood in vomit or stool?"

• Projectile vomiting (ICP).

• Blood (coffee-ground or fresh).

• Weight loss.
  Questions:

• "Is the vomiting forceful/projectile?"

• "Any blood in vomit?"

•  

Constipation

Red flags

• No stool/flatus + vomiting (obstruction).

• Blood in stool.
  Questions:

• "Are you passing gas or stool?"

• "Any blood in stool?"

Hearing loss

Red flags

• Sudden onset.

• Unilateral + tinnitus.
  Questions:

• "Did it start suddenly?"

• "Is it one-sided? Any ringing?"

•  

Vision loss

Red flag

• Sudden onset.

• Painful eye (acute glaucoma).
  Questions:

• "Did vision loss happen suddenly?"

• "Any eye pain or headache?"

Diarrhea

Red Flags

• Blood/mucus.

• Dehydration (dizziness, reduced urine).
  Questions:

• "Any blood/mucus in stool?"

• "Are you dizzy or urinating less?"

Urinary incontinence

Red flags

• Sudden onset + leg weakness (cauda equina).

• Associated back pain.
  Questions:

• "Any leg weakness or numbness?"

• "Any recent back injury/pain?"

Urinary retention

Red flags

• Inability to void + lower abdominal pain.

• History of prostate issues/spinal injury.
  Questions:

• "When did you last urinate?"

• "Any prostate issues or back pain?"

•  

• New-onset + saddle anesthesia.
  Questions:

• "Any numbness around the buttocks/genitals?"

• Excessive thirst + weight loss (diabetes).
  Questions:

• "Are you unusually thirsty?"

• "Any recent weight loss?"

Jaundice

Red flags

• Dark urine + pale stools (obstructive cause).

• RUQ pain (gallstones).
  Questions:

• "Is your urine dark or stools pale?"

• "Any abdominal pain?"

• Rapid onset + weight loss (malignancy).

• Ascites (liver disease).
  Questions:

• "Any weight loss or alcohol use?"

• "Is the swelling painful?"

Vaginal bleeding

Red flags

• Postmenopausal bleeding.

• Heavy bleeding + dizziness (hypovolemia).
  Questions:

• "Are you postmenopausal?"

• "Are you pregnant or could you be?"

•  

Vaginal discharge

Red Flags

• Foul odor + fever (PID).

• Associated pelvic pain.
  Questions:

• "Is there a strong odor?"

• "Any pelvic pain or fever?"

• Hemoptysis (TB, cancer).

• Persistent >3 weeks + weight loss.
  Questions:

• "Are you coughing up blood?"

• "Any weight loss or night sweats?"