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Y3M - Rheumatology > History Taking > Flashcards

History Taking Flashcards

1
Q

Main symptoms of Rheumatic disease.

A

Pain

Swelling

Stiffness

Fatigue

Weakness

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2
Q

What should you ask about regarding pain?

A

What type of pain?

Why is it happening?

When does it happen?

How bad is it?

Where is the pain?

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3
Q

How do patients tell you that they have neuralgic pain?

A

Burning or pins and needles

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4
Q

Acute pain in rheutmatic disease.

A

Gout

PMR

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5
Q

Insidious pain in rheumatic disease.

A

RA

SLE

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6
Q

What to ask about when the pain comes about?

A

Acute or insidious onset?

Nocturnal pain? (indicates inflammatory or destructive process)

Pain aggravated by rest (inflammatory arthritis) or by activity (OA)?

Pain better with NSAIDs or steroids?

Pain worse on particular movements? (periarticular pathology)

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7
Q

Why is it important to ask the patient how bad the pain is?

A

To set a baseline against which to measure improvement with treatment.

Impacted daily living?

Support from family and friends?

Aids or adaptations made due to pain?

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8
Q

Where is pain from acromioclavicular joint usually felt?

A

In the joint itself.

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9
Q

Where is pain from the GHJ and rotator cuff usually felt?

A

In the upper arm

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10
Q

Where is pain from the hip usually felt?

A

Groin

Buttock

Thigh

Knee

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11
Q

Where can pain from AAA be felt?

A

As back pain

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12
Q

Explain pain due to tenosynovitis or tendinitis.

A

Usually triggered only by certain movements.

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13
Q

Where is tennis elbow pain felt?

A

Outside of the elbow joint and worse on resisted elbow extension.

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14
Q

Where is achilles tendinitis pain felt?

A

Above the heel and is worse on active plantar flexion.

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15
Q

Where is De Quervain’s tenosynovitis pain felt?

A

In the snuffbox area of the wrist and is worse when pinching or using thumb to operate a smart phone.

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16
Q

Common muscular pain in rheumatic disease.

A

Fibromyalgia

Inflammatory muscle disease

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17
Q

Pain in proximal joints.

A

PMR

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18
Q

Pain in distal joints only.

A

OA

Gout

Psoriatic Arthritis

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19
Q

Small joint pain only.

A

Early stages of RA

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20
Q

Large joints only?

A

OA

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21
Q

Large and small joint pain.

A

Late stages of RA

22
Q

How many joints in monoarticular?

A

1 joint

23
Q

What is it called when 2-4 joints are affected?

A

Oligoarticular or pauciarticular

24
Q

What is it called when over 4 joints are affected?

A

Polyarticular

25
Q

Symmetrical joint involvement.

A

RA

26
Q

Asymmetrical joint involvment.

A

PsA or gout

27
Q

Causes of acute monoarthritis.

A

Septic arthritis unless otherwise proven.

Infections - S. aureus and streptococcal most common.

Crystal induced like gout or pseudogout

Trauma -> haemoarthrosis

28
Q

Causes of chronic monoarthritis.

A

Infections - TB

Inflammatory - PsA, reactive arthritis, foreign body

Non-inflammatory - OA, meniscal tear, osteonecrosis, neuropathic like Charcot’s

Tumour

29
Q

Causes of acute polyarthritis

A

Inflammatory - RA, PsA, reactive arthritis

Autoimmune - SLE and vasculitis e.g.

Viral infection - HIV, Chikungunya, parvovirus

Crystal arthritis - Uncontrolled gout

30
Q

Causes of chronic polyarthritis.

A

Inflammatory - RA, PsA, reactive arthritis

Autoimmune - SLE and vasculitis e.g.

Crystal - uncontrolled gout

31
Q

Causes of arthritis in DIPJs.

A

PsA accompanied with nail dystrophy on affected digit.

OA with heberden’s nodes.

32
Q

Explain history of stiffness.

A

How long it takes the patient to loosen up and get going in the mornings or after resting.

Duration of early morning stiffness?

Stiffness generalised or in a certain place?

Localised stiffness?

33
Q

Stiffness lasting longer than 30 minutes in the morning.

A

RA

PsA

34
Q

Generalised stiffness.

A

Suggestive of inflammatory disease.

35
Q

Spinal stiffness in the morning.

A

Suggestive of ankylosing spondylitis.

36
Q

Stiffness localised to a joint or brief inactivity gelling.

A

OA

37
Q

What to ask about joint swelling?

A

How rapid did it come about? (gout is rapid)

Preceding injury to swelling and pain?

How long does it last? (if less than 24h then likely not significant)

Swelling parallel to the join line?

Bony swelling?

Soft and tender swelling?

Swelling extrude chalky material?

Swelling extrude hard yellowish lumps?

38
Q

Bony swelling?

A

OA

39
Q

Soft and tender swelling?

A

Clinical synovitis indicating inflammatory disease

40
Q

Swelling extrude chalky material?

A

Tophi in gout

41
Q

Swelling extrude hard yellowish lumps?

A

Calcinosis in systemic sclerosis

42
Q

Why is it important to ask about fatigue?

A

FIbromyalgia feel tired from moment they wake up and is called “unrefreshed sleep”.

Patients with inflammatory arthritis usually become fatigued several hours into their day’s activities.

It is important to distinguish fatigue from depression and muscle weakness.

43
Q
A
44
Q

What drugs can can cause cutaneous hypersensitivity vasculitis?

A

Penicillin

45
Q

What drugs can cause lupus skin rashes?

A

E.g. minocycline and sulfasalazine

46
Q

What drugs can worsen Raynaud’s symptoms?

A

Beta blockers

47
Q

What drugs can reduce uric acid excretion and lead to gout?

A

Diuretics

48
Q

What is seronegative spondyloarthropathy associated with?

A

Anterior uveitis

Psoriasis

IBD

49
Q

Why is a sexual history important?

A

Sexually acquired infection or diarrhoea may indicate reactive arthritis or gonococcal arthritis.

50
Q

Why is family history important?

A

Because its presence often influence a patient’s expectations through their knowledge of their family member’s experiences of disease and its treatment.

51
Q

Why is social history important in rheumatic disease?

A

Smoking can cause more severe RA and also Raynaud’s

Alcohol -> gout

Methotrexate + alcohol -> cirrhosis

Back pain common in manual workers.

Knee OA in coal miners, hip OA in farmers may be eligible for industrial compensation.

52
Q

Constitutional symptoms in rheumatic disease.

A

Fever

Night sweats

Weight loss

Loss of appetite

Suggestive of inflammatory, infection or neoplasia.

Y3M - Rheumatology (20 decks)

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