L04-history taking

Question 1

What are the six areas to take into consideration when taking history for musculoskeletal disorders

Answer 1

1. history of presenting complaint
2. systemic enquiry
3. past medical history
4. family history
5. treatment history

Question 2

What are the seven features to look for in musculoskeletal pain

Answer 2

1. site and circumstances of onset
2. distribution
   
   • joint/ muscle/bone
   • symmetrical or not
3. radiation
   
   • i.e. low back pain wih sciatica
4. quality and severity
5. precipitating factors
6. relieving factors
7. associating features
   
   • i.e. stiffness, tnederness, redness, warmth, swelling, instability, deformity

Question 3

what are the three main classes of musculoskeletal disorder?

Answer 3

1. disorders that affect primarilty the joints, periarticulr tissues and bones i.e. osteoarthritis, gout, tendinitis, frozen shoulder
2. multisystem disorders of uncertain aetiology( thought to be autoimmune) predominantly affect musculoskeletal system often with extra-articular manisfestations i.e. rheumatoid arthritis- which affects multiple joints, Ankylosing spondylitis, systemic lupus erythmatosus
3. disorders that are primarily affecting other systems, but have joint symptoms as side effect,
   
   • haemolological- sickel cell anaemia
   • endocrine- acromegaly
   • metabolic- osteomalacia ( vit D deficiency)
   • malignancies- either metastases to bone or indirect effects of tumours such as inflammatory mediators

Question 4

what are the three major types of pain?

Answer 4

1. somatic pain- most common type of pain, often in the muscles, well localised, treated with standard painkillers
2. visceral pain- diffuse, poorly localised pain, often referred to other parts of he body, or radiates(to parietal peritoneum) producing sharp and well localised pain
3. neuropathic pain- caused by damage to nerves and can be as result of localised trauma or central disease. This is disntinguished by sensory effects, such as numbness and paraethesia and is often described as burning, shooting or aching

Question 5

Associations of pain in a joint (4)

Answer 5

1. from the joints structure itself- i.e. arthritis
2. Periarticular- from the surrounding tissues, diffuse, not well localised- i.e. tendonitis, bursitis
3. bone pain- severe, localised, disturbs sleep
4. referred pain rom somewhere else- i.e. sudden onset of shoulder pain during heart attack

Question 6

what are the six patterns of pain?

Answer 6

1. inflammaory
2. mechanical
3. degenerative
4. bone
5. peri-articular
6. neurological

Question 7

what are the typical features of inflammatory pain in terms of:

1. pain
2. stiffness
3. swelling
4. tenderness
5. Redness+warmth

Answer 7

1. Worse pain at rest
2. Long periods of stiffness
3. swelling of synovium, fluid or bone
4. tenderness present
5. redness and warmth present

Question 8

What are the typical features of non inflammatory- mechanical/degenerative pain in terms of:

1. pain
2. stiffness
3. swelling
4. tenderness
5. redness and warmth

Answer 8

1. worse on moving
2. stiffness for short time period
3. no swelling(fluid) exc trauma, bony swelling in degenerative
4. little tenderness exc trauma
5. no redness or warmth

Question 9

What are the typical features of

1. bone pain
2. peri-articular pain
3. nuerological pain

Answer 9

1. bone- severe, localised, disturbs sleep
2. peri-articular- diffuse, not well localised, around joint
3. neurological- mylgia(muscle pain), muscle tenderness, weakness(note whether there is relationship to pain, site and timin), Paraesthesia- tingling, numbness

Question 10

Systemic enquiry is important in history taking of musculoskeletal disorders. What are the typical extra articular manisfestation relating to infection that has spread to the muscle? (5)

Answer 10

1. General- fatigue, fever, weight loss, enlarged lymph nodes
2. skin rash
3. hair loss
4. mucosal ulcers
5. red and dry eyes

Question 11

Other system manifestations?(4)

Answer 11

1. Cardiovascular
2. respiratory
3. gastrointestinal
4. genitourinary

Question 12

factors to consider when taking patients’ past medical history (3)

Answer 12

1. previous episodes of the same problem (remissions and relapses/flares, or persistent predisposition)
   
   • gout, previous fractures, osteoporosis
2. previous episodes of other musculoskeletal problems
   
   • back problems, various joints (same/different)
3. Previous relavant problems-(to cause/ treatment)
   
   • rash due to psoriasis
   • history of alcoholor IV drug abuse
   • previous surgery or accidents
   • heart attack, lung disease, hpatitis, kidney disease etc

Question 13

What is the purpose of taking family history and give three examples of musculoskeletal problems that can have genertic causes

Answer 13

Family history can give indication to any genetic problems

1. inherited single gene disorders
   
   • Gout- autosomal dominant
2. multigene disorder
   
   • rheumatoid arthritis
3. Ankylosing spondylitis
   
   • strongly associated with immune response gene HLA-B7
   • often a family history
   • affects spine and large joints

Question 14

Questions to ask when taking social history (3)

Answer 14

1. Whether they have enough support at home to cope with their illness
   
   • who does the patient live with?
   • Is anyone dependent on them?
   • what type of home?
   • What help or adaptions needed?
2. Impact of illness on general life, mental health and work
   
   • future expectations
   • their job
3. Impact of lifestyle
   
   • Smoking, alcohol, drug abuse
   • IV drug abise can give rise to infections that could possibly spread to muscles
   • alcohol abuse can give rise to conditions such as peripheral neuropathies

Question 15

Questions to ask when taking treatment history (6)

Answer 15

1. What drugs have been tried for pain
2. Other drugs used to control the conidtion
3. If treatment has been stopped, when was the reason behind it
4. drugs for other conditions
5. other forms of treatment such as physio
6. allergies