Joint pain: Clinical (To be retired)
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Joint pain: Clinical (To be retired)
Medicine and surgery
Allergy and immunology
Antihistamines for allergies
Glucocorticoids
Cardiology, cardiac surgery and vascular surgery
Coronary artery disease: Clinical (To be retired)
Heart failure: Clinical (To be retired)
Syncope: Clinical (To be retired)
Hypertension: Clinical (To be retired)
Hypercholesterolemia: Clinical (To be retired)
Peripheral vascular disease: Clinical (To be retired)
Leg ulcers: Clinical (To be retired)
Adrenergic antagonists: Alpha blockers
Adrenergic antagonists: Beta blockers
ACE inhibitors, ARBs and direct renin inhibitors
Thiazide and thiazide-like diuretics
Calcium channel blockers
Lipid-lowering medications: Statins
Lipid-lowering medications: Fibrates
Miscellaneous lipid-lowering medications
Antiplatelet medications
Dermatology and plastic surgery
Hypersensitivity skin reactions: Clinical (To be retired)
Eczematous rashes: Clinical (To be retired)
Papulosquamous skin disorders: Clinical (To be retired)
Alopecia: Clinical (To be retired)
Hypopigmentation skin disorders: Clinical (To be retired)
Benign hyperpigmented skin lesions: Clinical (To be retired)
Skin cancer: Clinical (To be retired)
Endocrinology and ENT (Otolaryngology)
Diabetes mellitus: Clinical (To be retired)
Hyperthyroidism: Clinical (To be retired)
Hypothyroidism and thyroiditis: Clinical (To be retired)
Dizziness and vertigo: Clinical (To be retired)
Hyperthyroidism medications
Hypothyroidism medications
Insulins
Hypoglycemics: Insulin secretagogues
Miscellaneous hypoglycemics
Gastroenterology and general surgery
Gastroesophageal reflux disease (GERD): Clinical (To be retired)
Peptic ulcers and stomach cancer: Clinical (To be retired)
Diarrhea: Clinical (To be retired)
Malabsorption: Clinical (To be retired)
Colorectal cancer: Clinical (To be retired)
Diverticular disease: Clinical (To be retired)
Anal conditions: Clinical (To be retired)
Cirrhosis: Clinical (To be retired)
Breast cancer: Clinical (To be retired)
Laxatives and cathartics
Antidiarrheals
Acid reducing medications
Hematology and oncology
Anemia: Clinical (To be retired)
Anticoagulants: Warfarin
Anticoagulants: Direct factor inhibitors
Antiplatelet medications
Infectious diseases
Pneumonia: Clinical (To be retired)
Urinary tract infections: Clinical (To be retired)
Skin and soft tissue infections: Clinical (To be retired)
Protein synthesis inhibitors: Aminoglycosides
Antimetabolites: Sulfonamides and trimethoprim
Miscellaneous cell wall synthesis inhibitors
Protein synthesis inhibitors: Tetracyclines
Cell wall synthesis inhibitors: Penicillins
Miscellaneous protein synthesis inhibitors
Cell wall synthesis inhibitors: Cephalosporins
DNA synthesis inhibitors: Metronidazole
DNA synthesis inhibitors: Fluoroquinolones
Herpesvirus medications
Azoles
Echinocandins
Miscellaneous antifungal medications
Anti-mite and louse medications
Nephrology and urology
Chronic kidney disease: Clinical (To be retired)
Kidney stones: Clinical (To be retired)
Urinary incontinence: Pathology review
ACE inhibitors, ARBs and direct renin inhibitors
PDE5 inhibitors
Adrenergic antagonists: Alpha blockers
Neurology and neurosurgery
Stroke: Clinical (To be retired)
Lower back pain: Clinical (To be retired)
Headaches: Clinical (To be retired)
Migraine medications
Pulmonology and thoracic surgery
Asthma: Clinical (To be retired)
Chronic obstructive pulmonary disease (COPD): Clinical (To be retired)
Lung cancer: Clinical (To be retired)
Antihistamines for allergies
Bronchodilators: Beta 2-agonists and muscarinic antagonists
Bronchodilators: Leukotriene antagonists and methylxanthines
Pulmonary corticosteroids and mast cell inhibitors
Rheumatology and orthopedic surgery
Joint pain: Clinical (To be retired)
Rheumatoid arthritis: Clinical (To be retired)
Lower back pain: Clinical (To be retired)
Anatomy clinical correlates: Clavicle and shoulder
Anatomy clinical correlates: Arm, elbow and forearm
Anatomy clinical correlates: Wrist and hand
Anatomy clinical correlates: Median, ulnar and radial nerves
Anatomy clinical correlates: Bones, joints and muscles of the back
Anatomy clinical correlates: Hip, gluteal region and thigh
Anatomy clinical correlates: Knee
Anatomy clinical correlates: Leg and ankle
Anatomy clinical correlates: Foot
Acetaminophen (Paracetamol)
Non-steroidal anti-inflammatory drugs
Glucocorticoids
Opioid agonists, mixed agonist-antagonists and partial agonists
Antigout medications
Osteoporosis medications
Assessments
Joint pain: Clinical (To be retired)
USMLE® Step 2 questions
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Transcript
Content Reviewers
Rishi Desai, MD, MPHContributors
Antonella Melani, MDJoint pain is associated with a variety of disorders, so identifying the underlying cause can be hard.
First off, there’s the pain itself and there’s the underlying condition.
The underlying condition causing the joint pain which can either be acute or chronic.
In acute conditions, like a trauma, the joint pain develops right away, whereas in an infection or a bone or soft tissue malignancy the joint pain develop over days to weeks.
Alternatively, in chronic conditions like osteoarthritis, the joint pain happens over weeks to months, and in inflammatory conditions, that typically cause intermittent flares of joint pain, which are acute attacks, but the cause is still chronic.
The first step is to see how many joints are involved.
Generally speaking, joint pain can be monoarticular, meaning only one joint is involved, or polyarticular, meaning two or more joints are involved.
The major causes of monoarticular joint pain are trauma, infection, malignancy, and osteoarthritis.
The major causes of polyarticular joint pain are inflammatory autoimmune diseases, like lupus, as well as other systemic diseases like sarcoidosis.
Now, in the early stages and during flares, some inflammatory diseases can cause monoarticular pain.
So the next step is to figure out if the joint pain is inflammatory or non-inflammatory.
In non-inflammatory disease, the joint pain tends to be acute, worsen with movement and is relieved by rest.
On the other hand, in inflammatory diseases, symptoms tend to be more chronic, and worsen with immobility, leading to morning stiffness.
In addition, with inflammatory conditions, there’s usually swelling, loss of function, redness, and warmth.
Additionally, inflammatory conditions may cause an effusion or synovitis.
In contrast, in non-inflammatory conditions, there might be swelling and loss of function, but there’s usually no redness or warmth.
Finally, inflammatory diseases can cause a wide variety of extra-articular symptoms like fever, fatigue, skin rash, adenopathy, alopecia, oral and nasal ulcers, pleuritic chest pain, Raynaud phenomenon, or dry eyes and mouth.
If an inflammatory condition is suspected, then lab work can help confirm the diagnosis.
A complete blood count might show an increased white blood cell count, an elevated ESR and CRP, and specific antibodies might be elevated, for example, an ANA anti- double stranded DNA antibodies for lupus, rheumatoid factor and anti-citrullinated peptide antibodies for rheumatoid arthritis, anti- Ro and La antibodies for Sjogren’s syndrome, anti-centromere antibodies for scleroderma, and anti-topoisomerase antibodies for systemic sclerosis.
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