Kim Lee, a 55-year-old married female, presents to a primary care office for evaluation of joint pain. The patient states she has been experiencing joint pain for the past six weeks. The pain started in her lower back and progressed to her knees, hips, wrists, and now fingers and toes. She has taken Motrin, Tylenol, and Aleve with slight relief of these symptoms. She is not sleeping at night. The patient has no past medical history. The patient takes no prescribed medications and has no allergies to medications.
Answer the following questions:

  1. What additional subjective information do you need to obtain from this patient?
  2. Please complete a focused physical exam for this patient providing a rationale for your assessment.
  3. Please provide a list of four differential diagnoses for polyarticular pain with a brief reference rationale.
  4. Please provide a list of four differential diagnoses for myalgia with a brief reference rationale.
  5. What diagnostic tests will you order to evaluate this patient and why? Are there any limitations to the tests that you may consider ordering?

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