Musculoskeletal

Question 1

What should you ask about the site of the complaint?

Answer 1

Pattern of joint involvement? Small/large joints? One or more? Bilateral? A/symmetrical?

Question 2

What should you ask about the onset of the complaint?

Answer 2

When?
How fast? - Acute ie gout, sub acute ie septic arthritis, RA, chronic ie OA
Has it been constant since the onset? If episodic, describe the frequency/regularity/duration of episodes

Question 3

What should you ask about associated symptoms?

Answer 3

Stiffness, swelling (has anyone else said its swollen?), crepitus (grating of surfaces)
Erythema, increased local temperature 
Systemic temperature (ie gout, sepsis) 
Rashes/skin conditions - psoriasis 
Nodules - rheumatoid or gout tophi 
Fatigue, malaise, depression 
Fever, abdo pain, weight loss (systemic symptoms of vasculitis or connective tissue disease or inflammatory bowel disease) 
Dry mouth and gritty eyes

Question 4

What should you ask about the timing of the complaint?

Answer 4

Is there a relationship with the time of day? ie RA = >60 min morning stiffness, OA=<30 mins

Question 5

What should you ask about exacerbating/relieving factors?

Answer 5

Exercise (degenerative) vs rest (inflammatory)?

NSAIDs

Question 6

What should you ask about the severity of the complaint?

Answer 6

Very severe - acute gout
Slightly less - RA/OA
Any movements that are particularly painful?
Any loss of function?

Question 7

What questions should be about PMH?

Answer 7

Anything similar previously? (+test, diagnoses, treatments - success?)
History of trauma?
Recent infective episode? ie dental or pharyngeal infection?
Diabetes present?
Psoriasis, IBS or coeliac?
TB?
Autoimmune conditions? ie thyroid disease

Question 8

Any questions about family history?

Answer 8

RA? OA? Psoriasis? Gout? UC/Crohn’s? Connective tissue disease? Autoimmune?

Question 9

DH & A?

Answer 9

Any current medication for PC?
Any other current medication?
OTC analgesics - are they effective?
Low dose aspirin, diuretics, immunosuppressants? (gout)

Question 10

What pointers are useful in a social history?

Answer 10

Occupation - either as aetiology or will this condition affect their work? Same with sports/hobbies
Home circumstances? ie type of dwelling, dependents, carers etc
Ability to carry out activities of daily living (option for lots of detail)
Smoking and alcohol?