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History Taking of AIR

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Title: Physical examination and history taking Author: Small fish Last modified by: dx2300xd Created Date: 1/25/2004 4:18:58 PM Document presentation format – PowerPoint PPT presentation

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Title: History Taking of AIR


1
History Taking of AIR
  • ??????? ???????
  • ????? ????? ?????

2
History Taking
  • A.??
  • B.???????? (present illness)
  • C. Positive findings and negative findings

3
History Taking
  • D. Personal profile
  • E. Past History
  • F. Allergic History
  • G. Family History
  • H. Travel history
  • I. Review of System

4
Arthritis VS Non-arthriticular
Synovitis Non-articular
Swelling ?????????????? ?????????
Tender ????????? ??????Vague
Stiffness gt 30 minutes lt 30 minutes
ROM Passive active Passive gt active
ESR Increased Normal
5
Diagnostic spectrum
  • Mono..(1) Oligo..(2-4) Poly..(gt5)
  • OA OA OA
  • Septic Psoriatic Psoriatic
  • Gout Reactive RA
  • Pseudo gout Enteropathic Crystal
  • AS CTDs
  • Septic Sarcoid
  • Sarcoid

6
Arthritis/arthralgia Description of articular
symptoms
  • Onset Time Abrupt Acute
    minutes to hours
  • Insidious Subacute hours to days
  • Gradual Chronic 2 weeks
  • Duration
  • Character 1. Intermittent 2. Migratory
    ?????? or Rheumatic fever
  • 3. Addictive

7
Pain-free interval
  • ???
  • ???
  • ???

????
??
8
  • ???
  • ???
  • ???

????
??
9
????????????????????
????????????????????
  • ???
  • ???
  • ???

????
??
??pain-free interval
10
Arthritis/arthralgia Description of articular
symptoms
  • Type of joint 1. Large/ small
  • 2. Axial / peripheral, 3. Upper / lower, 4.
    Symmetry /asymmetry
  • Type of symptoms
  • Pain, Stiffness, Erythema
    Swelling Warm Loss of motion
  • External factors affecting symptoms

11
??????
  • ??
  • ????
  • ??
  • ????
  • ????
  • ?????

12
?? I
  • ??? localized the location of pain
  • Arthritis / soft tissue ?
  • Patterns
  • Exacerbating factors / releaving factors
  • ???? ? -- morning stiffness -- night pain

13
Stiffness
  • Morning stiffness gt one hour
  • Improved after exercise

14
Weakness
  • Weakness vs muscular weakness
  • D/D muscular weakness
  • Proximal muscle / distal muscle
  • Symmetric / asymmetric Diurnal change
  • D/D neurologic problems

15
Constitutional symptoms (????)
  • Fever
  • infection ? Autoimmune disease ( SLE,
    vasculitis. Adult onset stills disease )
  • Malignancy
  • Fatigue
  • Body weight loss

16
Raynauds phenomenon ( ???? )
  • 3-phase or 2-phase color change
  • Pale ? purple ? Red Pale ? purple
    numbness, pain, tingling, heat
  • MCTD, PSS, SLE, Sjogrens syndrome, CREST
    syndrome

17
Arthritis / arthralgia
  • ?????????
  • Prodromal presentation
  • Fever/ chills
  • Hair loss / oral ulcers / malar rashes
  • Raynauds phenomenon
  • Morning stiffness
  • Muscular weakness/ proximal /distal
  • Dry eyes, dry mouth
  • Heel pain / lower back pain
  • Genital ulcer / urethritis
  • Skin rashes / skin ulcers

18
Sicca complex
  • Dry eyes a. ?????? b. ?????? c. ??????
  • Dry mouth
  • a. ??????,???????????? b. ???????? ( ????????
    ) c. ??????? d. ??????????

19
History taking
  • A.??
  • B.???????? (present illness)
  • C. Positive findings and negative findings

20
Personal history
  • Smoking
  • Alcoholism
  • Betnut chewing
  • Social history ( ?? )
  • Economic status ( ????)
  • Family and marriage
  • Psychiatric status

21
Personal history
  • Sexual history
  • a. Reiters syndrome
  • b. Gonadococcal arthritis
  • c. AIDS d. others

22
Past history
  • Blood transfusion
  • Viral Hepatitis history
  • Hepatic dysfunction
  • TB ( pul. / Extra-pul )
  • Thyroid disease
  • Gestational history ( abortion ?! )
  • Malignancy

23
Medication history
  • Past use and present use ( ???????????????)
  • Drug-induced lupus
  • Sulfa --- SLE
  • Drug-induced nephropathy
  • Drug allergy

24
Allergic history and travel history
  • Drug allergic history -- What drug
  • -- What symptoms/signs
  • -- How to management
  • Travel history

25
Past history
  • Pregnancy -- GnPmSA? -- Spontaneous abortion
  • Major surgery
  • Oral contraceptive pills
  • Psychiatric history

26
Family history
  • Sibling or parents with autoimmune diseases
  • AS, SLE, RA, Gouty arthritis, seronegative
    spondyloarthropathy,
  • Nodular OA ( hands ), Marfans syndrome

27
Evaluation and drug compliance
  • Medication ( duration, effects, side effects and
    dosage )
  • Compliance !!
  • Rehabilitation ( esp. myofascial pain )

28
Operation / biopsy history
  • Operative history ( esp. articular)
  • Kidney biopsy
  • Synovial membrane biopsy
  • Skin biopsy

29
(No Transcript)
30
Selected symptoms reviews
General
Fever / fever type
Fatigue
Shaking chills
Body weight loss
Intercurrent illness



31
Selective Review of System-Skin
Alopecia Levido reticularis
Malar rash Skin dystrophic change
Photosensitivity Telangiectasis
Discoid rash Psoriasis
Other skin rash Mechanics hand
Raynauds phenomenon Periungal telangiectasia
Skin ulcers, digital Periungal erythema
Skin ulcers, non-digital Hypo/hyperpigmentation
Petechia Purpura
Pitting nails Onycholysis / onychodystrophy
32
Selected symptoms reviews
ENT Chest
Conjunctivitis Chest pain, pleuritic
Uveitis Chest pain, others
Dry eyes Dyspnea
Dry mouth Orthopnea
Mucosal ulcers ( pain ?) Chest tightness
Nasal lesions Hemoptysis
Salivary gland enlarge. Wheezing
Headache Lymphadenopathy
33
Selected symptoms reviews
GI GU
Dysphagia Genital ulcers
Abdominal pain Hematuria by history
Diarrhea Proteinuria by history
Melana/ hematemesis Renal stone
Nausea/ vomiting Urethral discharge
Peptic ulcer syndromes
Menstrual abnormality

34
Selective review of System
Musculo-skeletal Musculo-skeletal
Arthralgia Heel pain
Arthritis Sausage fingers/toes
Jaccoud deformity Muscle weakness
Morning stiffness Proximal/distal
Buttock pain c/ diurnal change
Lumbasacral pain Muscle atrophy
Cough pain
35
Selected symptoms reviews
Hematologic Neuromuscular
Anemia by history Seizure
Neutropenia by history Thrombocytopenia by Hx Muscle pain Claudication
Muscle weakness ( proximal/distal )
Neurologic sign
Psychiatric disorders
36
HCV and Cryoglobulinemia
  • Blood transfusion
  • Viral hepatitis history
  • Tattoo ( ??,??,??)
  • Drug addiction ( drug abuse )
  • ??????

37
Systemic lupus erythematosus
  • SLE -- Initial presentation
  • -- Criteria -- SLEDAI -- Lupus nephritis
    data charts
  • -- Antiphospholipid antibody syndromes

38
Rheumatoid arthritis
  • Active synovitis identify the active
    synovitis by figures pre-MTP pulse and
    post-MTP pulse
  • Extra-articular symptoms

39
Scleroderma ( PSS )
  • History of exposure to ????, ??
  • Raynauds phenomenon
  • Puffy hands / swollen fingers
  • Sclerodactyly
  • Dysphageal
  • Chest tightness and SOB
  • Periungal telangiecatsis
  • Skin description hyper/hypopigmentation

40
Polymyositis / dermatomyositis
  • Muscle weakness proximal /distal
  • EOM ?
  • Neurosensory deficits ?
  • Skin sign Gottrons signs helitropes eyes
    malar rashes Arthritis
  • Dysphageal SOB, chest tightness

41
Adult Onset Stills Disease
  • Fever patterns -- spiking ( noctural fever )
  • Prodromal symptoms -- Sore throat
  • Associated symptoms -- rashes / Arthritis /
    arthralgia

42
Sjogrens syndrome
  • Subject dry eyes
  • Subject dry mouth
  • Other symptoms

43
Ankylosing spondylitis
  • Onset ages
  • Pain patterns -- alternative buttock pain
    with/without radiation -- peripheral
    arthritis/arthralgia
  • Eye involvement uveitis
  • Enthesopathy ( heel pain )

44
Seronegative spondyloarthropathy
  • Skin symptoms
  • Uretheral/genital symptoms
  • Ocular symptoms
  • Articular distributions -- Axial / peripheral
    -- Large / small
  • Nails
  • Enthesopathy

45
  • Special charts
  • Description of clinical findings ????
  • ????

46
Thanks for your attention
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