MSK Histories

Question 1

What should you ask in a systems review in a patient with back pain?

Answer 1

Trauma
Neuro Sx: leg weakness, sensations, incontinence
Stiffness in morning?
Constitutional

Question 2

What red flags should you ask about when taking history from someone with back pain? (11)

Answer 2

New onset incontinence
Saddle anaesthesia
Muscle weakness in legs
Weight loss
History of cancer
Non-mechanical
Night time pain
Violent trauma
Age <20 or >50
Thoracic back pain
IVDU

Question 3

What yellow flag symptoms should you ask about when taking history from someone with back pain? (5)

Answer 3

Negative attitude that their back pain is severely disabling
Belief: activity is harmful to recovery
Belief: passive treatment will be beneficial
Depression/social withdrawal
Financial difficulties

Question 4

What are yellow flag symptoms used for?

Answer 4

Prognostic of long-term disability

Question 5

What are the common differential diagnoses you should consider in someone with back pain? (2)

Answer 5

Mechanical non-specific lower back pain

Radiculopathy - sciatica

Question 6

What are the serious differential diagnoses you should consider in someone with back pain? (9)

Answer 6

Cauda equina
Malignancy
Osteoporotic crush factor
Infection - discitis or TB
Inflammatory back pain e.g. ank spond
Non spinal cause 
- dissecting aortic aneurysm
- ruptured AAA
- Fibromylagia
- Pancreatitis, endometriosis, renal calculi

Question 7

What should you ask in a systems review in a patient with joint pain? (6)

Answer 7

Morning stiffness
Swelling 
Infections - STIs, gastroenteritis
Uveitis/iritis
Spondyloarthropathy
Rashes, mouth ulcers, dry eyes/mouth, raynauds

Question 8

What differential diagnoses you should consider in someone with joint pain? (inflammatory) (3)

Answer 8

Rheumatoid arthritis
Sero -ve spondyloarthritis
SLE

Question 9

What differential diagnoses you should consider in someone with joint pain? (non-inflammatory) (4)

Answer 9

Osteoarthritis
Gout
Septic arthritis
Fibromyalgia