Hx Taking

Question 1

What are the three screening questions for MSK disease?

Answer 1

• Are you free of any pain or stiffness in joints, muscles or back?
• Can you dress yourself without difficulty?
• Can you manage walking up and down stairs?

*If yes to all 3 = MSK disease unlikely

Question 2

What acronym will you use to explore rheumatological sx?

Answer 2

• Pain
• Rashes, skin lesions, nail changes
• Immune
• Stiffness
• Malignancy
• Swelling, sweats

Question 3

How would you further explore pain?

Answer 3

• Use SOCRATES

Site

• monoarthritis/oligoarthritis/polyarthritis
• asymmetrical/symmetrical
• extensor/flexor region

Onset

• sudden/gradual

Character

• dull ache, burning, sharping
• constant/come and go

Radiation

Associated Sx

• joint stiffness
• skin rashes
• fever

Time

• duration
• occurance in a particular day

Exacerbating & Releiving factors

Severity

Question 4

How would you further explore Rashes, skin lesions and nail changes?

Answer 4

• Rashes - SLE
• Raynaud’s - SLE, SS, polymyositis, dermatomyositis
• Nodules - Gout
• Koilonychia - SLE
• Onycholysis - PA, sarcoidosis
• Pitting - PA
• Telengactasia - SS

Question 5

What are the 3 diseases you can explore relating to immune in PRISMS?

Answer 5

• SS
• SLE
• Sjogren’s syndrome

Question 6

What acronym will you use for exploring Systemic Sclerosis?

Answer 6

• Calcinosis
• Raynaud’s phenomenon
• Esophageal dysmotility
• Sclerodactylyl
• Telangiectasia

Question 7

What sx would you explore for SLE?

Answer 7

• Constitutional symptoms: fatigue, fever and weight loss.
• Musculoskeletal symptoms: arthralgia and myalgia.
• Dermatological symptoms: malar rash, photosensitivity and discoid lupus(coin shaped lesion)
• Renal symptoms: haematuria and oedema (acute nephritic disease).
• Neuropsychiatric symptoms: seizures and psychosis.
• Respiratory symptoms: shortness of breath, cough and chest pain (e.g. pneumonitis and interstitial lung disease).
• Gastrointestinal symptoms: nausea, dyspepsia and abdominal pain.
• Cardiac symptoms: chest pain and shortness of breath (e.g. pericarditis, myocarditis).
• Haematological symptoms: fatigue, shortness of breath, fevers and bruising (e.g. leukopenia, anaemia, thrombocytopenia).

Question 8

What are the key features of Sjogren’s syndrome?

Answer 8

• Dry eyes
• Dry mouth
• Chronic cough

Question 9

Which Rheumatoid diseases causes joint stiffness?

Answer 9

• RA
• AP
• SLE
• Reactive Arthritis

Question 10

How would you explore malignancy?

Answer 10

• Weight loss
• Fatigue
• Night sweats
• Change in diet

Question 11

What are the examples of paraneoplastic syndromes that can have arheumatological presentation?

Answer 11

• Carcinomatous Polyarthritis
• Paraneoplastic vasculitis
• Lambert Eaton Syndrome
• Hypertrophic Osteoarthropathy

Question 12

List examples of extra-articular manifestation of rheumatological disease

Answer 12

• Dry eyes - Sjogren’s syndrome
• Red eyes - AS
• Urethritis - Reactive Arthritis
• Mouth/genital ulcers - SLE
• ILD - SLE
• Back pain - AS

Question 13

What PMH is a typical indicator of rheumatological disease?

Answer 13

• UC/Chrons - AS
• Perceding infections
• Psoriasis

Question 14

What drugs are rheumatoid patients typically on?

Answer 14

• Analgesics
  
  • paracetamol, NSAIDs, opiates
• Corticosteroid
  
  • prednisolone
• Anti-TNF
  
  • infliximab
• Biologics
  
  • rituximab

Question 15

What would you like to clarify in SHx?

Answer 15

• Living conditions
• Smoking
• Alcohol
• Recreational/elicit drug use
• Sexual Hx
• Occupation

Question 16

What arthritides causes monoarthritis?

Answer 16

• septic arthritis
• OA
• Gout
• haemarthrosis

Question 17

What arthritides causes oligoarthritis? (5 or less joints)

Answer 17

• Gout
• PA
• Reactive arthritis
• AS
• OA

Question 18

What arthritides causes polyarthritis? (5 or more joints)

Answer 18

• RA
• PA
• RA
• SLE
• OA

Question 19

What FHx is typical of rheumatological patients?

Answer 19

• RA
• Gout
• misscarriages