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joint pain

Practice targeted AMC-style multiple-choice questions on joint pain.

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A 45-year-old man presents to the clinic with a 2-week history of a painful, swollen left knee. He denies any trauma or fever. On examination, the knee is warm, swollen, and tender with a limited range of motion. Aspiration of the knee joint reveals cloudy fluid with a white blood cell count of 50,000/mm³ and needle-shaped crystals that are negatively birefringent under polarized light microscopy. What is the most appropriate initial treatment for this condition?

A. Allopurinol
B. Corticosteroid injection
C. Antibiotics
D. Colchicine
E. Nonsteroidal anti-inflammatory drugs (NSAIDs)
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A 10-year-old boy presents to the pediatric clinic with a history of fever, a rash characterized by erythema marginatum, and migratory arthralgia. His mother reports that he had a sore throat about three weeks ago, which resolved without treatment. On examination, he has a temperature of 38.5°C, a heart rate of 110 bpm, and a faint erythematous rash on his trunk. His joints are tender but not swollen. Given the suspicion of acute rheumatic fever, which of the following is the most appropriate next step in management?

A. Perform an anti-streptolysin O (ASO) titer test
B. Echocardiogram
C. Start aspirin therapy
D. Throat swab culture
E. Initiate corticosteroid treatment
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A 32-year-old woman presents to her general practitioner with a 2-week history of fatigue, joint pain, and a facial rash that worsens with sun exposure. She also reports hair loss and oral ulcers. On examination, she has a malar rash and mild swelling of the small joints in her hands. Laboratory tests reveal a positive antinuclear antibody (ANA) and anti-double-stranded DNA antibodies. What is the most likely diagnosis?

A. Psoriatic arthritis
B. Dermatomyositis
C. Systemic lupus erythematosus (SLE)
D. Rheumatoid arthritis
E. Sjogren's syndrome
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A 32-year-old woman presents to the emergency department with a 2-day history of fever, malaise, and a painful, swollen left knee. She denies any recent trauma or travel history. She has no significant past medical history and is not on any medications. On examination, her temperature is 38.7°C, heart rate is 110 bpm, and blood pressure is 120/80 mmHg. The left knee is erythematous, warm, and tender with a moderate effusion, and she has limited range of motion due to pain. Laboratory tests reveal leukocytosis with a left shift. Blood cultures are pending. What is the most appropriate next step in the management of this patient?

A. Start empirical intravenous antibiotics
B. Arthrocentesis of the left knee
C. Administer oral NSAIDs
D. Refer to rheumatology for further evaluation
E. Order an MRI of the knee
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A 32-year-old woman presents to her GP with a 3-month history of fatigue, joint pain, and a facial rash that worsens with sun exposure. She also reports hair loss and oral ulcers. On examination, she has a malar rash and mild swelling of the small joints of her hands. Laboratory tests reveal a positive ANA and anti-dsDNA antibodies. What is the most likely diagnosis?

A. Dermatomyositis
B. Systemic lupus erythematosus (SLE)
C. Psoriatic arthritis
D. Sjogren's syndrome
E. Rheumatoid arthritis
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A 31-year-old man presents with gradual onset lateral knee pain that worsens with running and has no history of trauma. The pain is localized above the joint line, and there is no swelling. What is the likely diagnosis?

A. Patellofemoral pain syndrome
B. Quadriceps tendon tear
C. Lateral collateral ligament sprain
D. Iliotibial band syndrome
E. Lateral meniscus tear
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A 25-year-old man presents to the clinic with a 2-week history of a painful, swollen right knee. He denies any trauma or recent travel. He has a history of psoriasis. On examination, the right knee is warm, swollen, and tender with a reduced range of motion. There are no other joint abnormalities. What is the most likely diagnosis?

A. Gout
B. Septic arthritis
C. Psoriatic arthritis
D. Reactive arthritis
E. Rheumatoid arthritis
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A 31-year-old man presents with gradual onset lateral knee pain that worsens with running. There is no history of trauma. The pain is localized above the joint line, and there is no swelling. What is the likely diagnosis?

A. Lateral meniscus tear
B. Iliotibial band syndrome
C. Patellofemoral pain syndrome
D. LCL sprain
E. Quadriceps tendon tear
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A 32-year-old woman presents to her general practitioner with a 2-week history of fatigue, joint pain, and a facial rash that worsens with sun exposure. She also reports hair loss and oral ulcers. Laboratory tests reveal anemia, leukopenia, and positive antinuclear antibodies (ANA). What is the most likely diagnosis?

A. Systemic lupus erythematosus (SLE)
B. Sjogren's syndrome
C. Psoriatic arthritis
D. Rheumatoid arthritis
E. Dermatomyositis
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A 60-year-old woman presents to her GP with a 3-month history of increasing fatigue and joint pain, particularly in her hands and knees. She also reports morning stiffness lasting over an hour. On examination, there is swelling and tenderness in the metacarpophalangeal and proximal interphalangeal joints. Blood tests reveal a positive rheumatoid factor and elevated C-reactive protein. What is the most appropriate initial treatment for her condition?

A. Hydroxychloroquine
B. Prednisone
C. Sulfasalazine
D. Methotrexate
E. Ibuprofen
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A 32-year-old woman presents to her general practitioner with a 3-month history of fatigue, joint pain, and a facial rash that worsens with sun exposure. She also reports hair loss and oral ulcers. On examination, she has a malar rash, mild synovitis in her hands, and no signs of organomegaly. Laboratory tests reveal anemia, leukopenia, and positive antinuclear antibodies (ANA) with a high titer. Which of the following is the most appropriate initial management for this patient?

A. Hydroxychloroquine
B. Azathioprine
C. Methotrexate
D. Cyclophosphamide
E. Prednisone
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A 32-year-old woman presents to the clinic with a 3-week history of joint pain, morning stiffness lasting over an hour, and swelling in her hands and wrists. She has no significant past medical history and is not on any medications. On examination, there is synovitis in the metacarpophalangeal and proximal interphalangeal joints bilaterally. What is the most likely diagnosis?

A. Rheumatoid arthritis
B. Psoriatic arthritis
C. Osteoarthritis
D. Systemic lupus erythematosus
E. Gout
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A 28-year-old woman presents to her general practitioner with a 2-week history of fatigue, joint pain, and a facial rash that worsens with sun exposure. She also reports hair loss and oral ulcers. On examination, she has a malar rash and mild swelling in her hands. Laboratory tests reveal a positive antinuclear antibody (ANA) test and elevated anti-double-stranded DNA antibodies. What is the most likely diagnosis?

A. Systemic lupus erythematosus (SLE)
B. Dermatomyositis
C. Rheumatoid arthritis
D. Psoriatic arthritis
E. Sjögren's syndrome
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