Rheumatology History

Question 1

What are the ddxs for a single, hot, red swollen joint

Answer 1

Septic arthritis, Traumatic, goutpesusodgout and seronegative spondyloarthritis

Question 2

What is a ddx or a sgbnle painful but not inflamed joint

Answer 2

Osteoarthrritis

Question 3

What are the ddx for a single chronic inflamed joint (mono arthritis?)

Answer 3

Chronic infect, seronegative spondyloarthritis, pigmented villonodular synovitis

Question 4

First 4 questions for a presentation of joint pain

Answer 4

1. Which joints are sore?
2. Is it 1 joint of multiple joints?
3. Are the joints swollen or red?
4. Are they getting better or worse?

Question 5

What ar 4 other key questions for a joint pain history

Answer 5

5 .Is the pain worshippers int he morning?

6. Have you injured the joint?
7. Is the back pain worse ti night?
8. Did the back pain start suddenly?

Question 6

What are 3 questions to ask in a sudden onset of joint pain?

Answer 6

1. Is it an injury?
2. Have you recently consumed alcohol? (gout)
3. Is therre any signs of infecitons

Question 7

What are 2 ddx for acute polyarthriis?

Answer 7

Infection (viral/bacterial)

Onset of chronic polyarthritis

Question 8

What are ddx for chronic polyarthritis?

Answer 8

RA, Seronegative spondyloarthritis, OA, Gout, conceive tissue disorder and infection

Question 9

Where infections can cause chronic polyarthritis?

Answer 9

Tb (infectious mono arthritis), Hep C

Question 10

What is the significance of morning stiffness/pai?

Answer 10

Suggests Rheumatoid Arthritis, duration suggests severity

Question 11

what is stiffness after sitting suggestive of?

Answer 11

Osteoarthritis

Question 12

Describe the pattern of OA

Answer 12

Symmetrical and affects many joints

Pain/stiffness that is worse on movement and better with rest

Question 13

Describe the pattern RA

Answer 13

Symmetrical polyarthritis of the PIPs, metacaophalanegeal and wrist joints

Question 14

Describe the pattern of Ankylosing Spondylitis

Answer 14

Sacroiliac joints and spine

Question 15

Describe the pattern of psoriatic arthritis

Answer 15

Asymmetrical oligoarthritis with sausage digits and athritismutilans
Look for other signs of psoriasis (plaques + nail chanes0

Question 16

What is the difference between Heberden’s and Bouchard’s nodes

Answer 16

Heberden’s nodes of those of the DIPs, Bouchard’s are those of the PIPs

Question 17

What are the clinical features of Sjogren’s Sydnreom

Answer 17

Dry eyes, Dry mouth, chest infections, vaginitis

Question 18

Why do you get chest infections with SJS?

Answer 18

Dryness of the much-ciliary tract leads to reduced innate immune response

Question 19

What aspects of the treatment history is key in this history?

Answer 19

Past history of NSAIDs, sulfasalazine, methotrexate, steroids, TNF-inhibitor, biologics
Document side effects of these

Question 20

What aspects of the past history of key in this presentation?

Answer 20

Trauma, surgery

Infection

Question 21

What infections are important to screen for in rheumatoid histroies

Answer 21

Hepatitis, strep pharyngitis, rubella, Tb, gonorrhoea

Question 22

What family conditions should be screened for?

Answer 22

RA, OA, Gout, haemochomratosis, psoriasis and IBD