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History Taking > Musculoskeletal > Flashcards

Flashcards in Musculoskeletal Deck (10):
1

What should you ask about the site of the complaint?

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

2

What should you ask about the onset of the complaint?

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

3

What should you ask about associated symptoms?

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

4

What should you ask about the timing of the complaint?

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

5

What should you ask about exacerbating/relieving factors?

Exercise (degenerative) vs rest (inflammatory)?
NSAIDs

6

What should you ask about the severity of the complaint?

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

7

What questions should be about PMH?

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

8

Any questions about family history?

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

9

DH & A?

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

10

What pointers are useful in a social history?

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?