History taking lecture

Question 1

important questions in HPI

Answer 1

• everything about chronology (relevant for inflam vs non-inflam)
• how long des the pain last
• aggravating and alleviating factors
• occupation
• remember perception of pain may be different from one person to the other*

Question 2

mroning vs evening pain diff

Answer 2

morning = inflammatory
evening = mechanical (also after activity)

Question 3

(imp) mechanical pain symptoms

Answer 3

• history of trauma
• pain at end of the day
• pain with and after activity
• relieved with rest

Question 4

(imp) inflammatory joint symptoms

Answer 4

• worse in the morning
• worse with inactivity (rest, nap), better with mobility
• morning stiffness
• multiple joints

Question 5

very important question not to forget when asking about function in HPI

Answer 5

does the pain affect your sleep?

• waking up in middle of the night (even worse than hard time falling asleep bc of it)
• waking up sleeping on one side (bc of shoulder impingement for example)

Question 6

(imp) red flags in joint pain

Answer 6

• systemic symptoms (fever and weight loss)
• night pain (particularly if daytime pain as well. if benign nocturnal pain of childhood where wake up crying but no pain in day it’s fine)
• refusing to ambulate or to move the limb
• bone pain (suggests infection or malignancy or osteonecrosis)

Question 7

(imp) location not to forget to ask about on history

Answer 7

always ask about joint above and below bc can have referred pain

• shoulder = ask about neck
• knee = hip and ankle
• hip = back, SI joint, knee, pelvis

Question 8

what red flags may indicate infection on physical exam

Answer 8

• fever
• redness
• tenderness