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Flashcards in Musculoskeletal Deck (10):

What should you ask about the site of the complaint?

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


What should you ask about the onset of the complaint?

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


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


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


What should you ask about exacerbating/relieving factors?

Exercise (degenerative) vs rest (inflammatory)?


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?


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?
Autoimmune conditions? ie thyroid disease


Any questions about family history?

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


DH & A?

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


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?