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MJM > L02 - History taking > Flashcards

L02 - History taking Flashcards

1
Q

What are the screening questions?

A
  1. Do you have any pain or stiffness in your muscles, joints or back?
  2. Can you dress yourself completely without any difficulty?
  3. Can you walk up and down stairs without any difficulty?
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2
Q

What is the general approach to history taking?

A
  1. History of presenting complaint
    - Joints
    - Muscle
    - Supporting tissues
    - Bone
  2. Systems review
  3. Past medical history
  4. Family history
  5. Social history
  6. Treatment history
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3
Q

Which topics should you cover when asking about muscoskeletal pain?

A
  1. Site
  2. Distribution
  3. Onset (timing and precipitating factors)
  4. Nature of pain (quality, severity, associated features, relieving factors)
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4
Q

How should you question about the distribution of pain?

A
  • How many joints affected?
  • Monoarticular = 1
  • Oligo-articular = 2-4
  • Polyarticular = >4
  • Symmetrical?
  • Which joints are affected
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5
Q

What does monoarticular/ oligoarticular/ polyarticular mean?

A 
monoarticular = 1 joint affected 
Oligoarticular = 2-4 joints affected 
Polyarticular = more than 4 joints affected
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6
Q

What is referred pain?

A

Pain perceived at a location other than the site of the painful stimulus/ origin

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7
Q

Faster onset –> slower onset (+Examples)

A

Trauma (ACL rupture) –> Infection (septic arthritis) –> Inflammation (rheumatoid) –> Degenerative (osteoarthritis)

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8
Q

Nature of inflammatory pain? Relating to pain/ stiffness (morning)/ swelling/ tenderness/ redness/ warmth?

A 
Pain = At rest (better with moving) 
Stiffness = Long (>45mins)
Swelling = Softer 'boggy' 
Tenderness = V tender 
Redness = Red 
Warmth = Warm
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9
Q

Nature of degenerative pain? Relating to pain/ stiffness (morning)/ swelling/ tenderness/ redness/ warmth?

A 
Pain = Moving (better with rest) 
Stiffness = Short (<20mins)
Swelling = Hard 'bony'
Tenderness = Tender 
Redness = NA
Warmth = NA
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10
Q

Characteristics of bone pain?

A
  • Severe
  • Localised
  • Disturbs sleep
  • Present when moving or not
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11
Q

Characteristics of peri-articular pain

A
  • Around joint
  • Diffuse
  • Not well-localised
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12
Q

What is radiation of pain?

A

Pain that starts in one place and travels to other places of the body

  • Usually along the path of a nerve
  • e.g. Sciatica
  • Neck pain radiating to fingers; hip pain radiating to knee
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13
Q

What are some specific questions for trauma?

A
  1. When and how did the incident occur?
  2. What happened exactly?
  3. How much force?
  4. Has the bone/ joint been damaged before?
  5. History of other trauma/ fractures
  • Peripheral circ intact?
  • Peripheral NS intact?
  • Is the CNS intact?
  • Fit for anaesthetic?
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14
Q

What are the aims of history taking?

A

Identify possible causes of problem

  • Which structures likely to be involved?
  • Time course?
  • Other systems involved?
  • Was there a precipitant?
  • What is the impact of the problem on the patient/ what are their expectations?
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15
Q

How can musculoskeletal problems present?

A
  • Pain
  • Stiffness/ swelling
  • Loss of function
  • Trauma
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16
Q

Which joints are affected in gout?

A

Large joint of big toe

  • Ankles
  • Knees
  • Elbows
  • Wirsts
  • Fingers
17
Q

Which joints are affected in septic arthritis?

A
  • Affects one large joint in body
  • Such as knee or hip
  • Less freq affects multiple joints
18
Q

What is myalgia?

A

Pain in muscle or group of muscle

19
Q

What is extra-articular?

A

Conditions affecting tissues outside the joint

20
Q

What should you be asking for in a past medical history?

A
  1. History of infections/ travel?
  2. Bowel symptoms?
  3. Skin disease?
  4. MSK problems in childhood?
21
Q

What should you be asking for in a social history?

A
  1. Smoking/ alcohol/ other drugs
  2. Occupation
  3. Home situation
    - Who?
    - Dependents?
    - Adaptations?
22
Q

What should you be asking for in a family history?

A
  1. 1st degree relatives with similar conditions
  2. AI diseases
  3. Monogenic: some rare inflammatory syndromes
  4. Polygenic
23
Q

What could be the possible impacts of the problem?

A
  1. Limitation of activities?
  2. Time off work?
  3. Personal hygiene?
  4. Needing to use walking aids/ other devices
  5. Psychological impact
24
Q

What should you look for in a treatment history?

A
  1. What has been tried already?
  2. If prev treatments failed - why?
    - Inefficacy
    - Adverse effects
  3. Could this be related to other drugs
  4. Non-medical treatments
25
Q

What are some non-rheumatological conditions which can affect the MSK system?

A
  1. Sickle cell disease
  2. Cancer metastasis to bone
  3. Vitamin D deficiency

MJM (31 decks)

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