Key idea: Back pain that is worse upon waking in morning = Inflammatory back pain = PAIR diagnoses: Psoriatic arthritis, Ankylosing spondylitis, Inflammatory bowel disease, Reiter/ Reactive arthritis (at least on NBME exams)Ģ.Child who presents with inflammatory back pain (worse upon waking in morning) with involvement of sacroiliac joint and decreased flexion at waist (2 features that are highly associated/specific for ankylosing spondylitis) and elevated ESR (further supporting inflammatory back pain) with imaging showing vertebral body squaring and fusion of sacroiliac joint, most consistent with ankylosing spondylitis.Good luck with your exams!ġ: A previously healthy 9-year-old boy is brought to the physician… Lastly, please check out my Youtube channel ( ) and the “Biostatistics Curriculum” option above for free videos and practice questions reviewing all the essential biostatistics topics covered on NBME exams. I also offer reasonably priced tutoring, so please reach out using the Tutoring menu option listed above if you would like personalized support.įurthermore, I offer personal statement and application review services for residency applicants, so please reach out using the “Residency Advising and Application Preparation” menu option above if interested. However, given multiple email requests, I will post my Venmo if you want to send a few dollars to show your support for the website. These answer explanations are and always will be free.
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