Pediatric Rheumatology Multiple Choice Questions (MCQs)

Pediatric Rheumatology Multiple Choice Questions (MCQs)

Read the following statement and answer Q 1‐2

A 12 year old boy presented with multiple firm, painless swellings on the back and lower extremities. He has joints contractures. You have noticed these findings. Inflammatory markers are normal.

1. This boy is prone to have:

A. Atherosclerosis

B. Ankylosis of the large joints of the axial and appendicular skeleton

C. Spondylitis

D. Hypertension

E. Nephropathy

2. The most likely diagnosis is:

A. Juvenile osteopetrosis

B. Osteogenesis Imperfecta

C. Mixed connective tissue disease

D. Congenital Myositis Ossificans

E. Juvenile Dermatomyositis

Read the following statement and answer Q 3‐4

You have been asked to evaluate this newborn baby boy because of this finding. He is a product of fullterm
gestation, C‐section due to fetal distress. His mother is 27‐year‐old who’s known to have
xerophthalmia, xerstomia and enlarged parotid glands. She had history of 2 abortions. She is on long term
treatment of corticosteroids and Methotrexate.

3. The most important organ needs to be examined:

A. Eyes

B. Joints

C. Heart

D. Primitive reflexes

E. Reticuloendothelial system

4. The most appropriate blood test is:

A. Anti‐Histone antibody

B. Erythrocyte sedimentation rate

C. Anti‐Ro/ SSA antibody

D. Anti‐double stranded DNA antibody

E. Lipid profile

Read the following statement and answer Q 5‐6

A 12‐year‐old girl known case of systemic lupus erythematosus was referred to your hospital with this finding.

5. The most relevant laboratory test result is:

A. Leukopenia

B. Prolonged partial thromboplastin time

C. Thrombocytosis

D. Hypoalbuminemia

E. Coomb’s positive hemolytic anemia

6. Accordingly, the most appropriate laboratory test:

A. Antinuclear antibody

B. Anti‐histone antibody

C. Anti‐β 2 glycoprotein I antibody

D. Anti‐double stranded DNA antibody

E. Bleeding time

7. A 10‐year‐old girl presented with this finding. She stated that, it is exacerbated by cold and

associated with tingling and numbness. The correct statement is:

A. Idiopathic Raynaud’s disease is the diagnosis

B. Similar changes can involve the tongue and toes

C. Morphea is the most likely underlying cause

D. High dose of Corticosteroids is the best effective treatment

E. Nifedipine would aggravate her symptoms

8. A 13‐ year old girl presented with shortness of breath and coughing blood. Of the following, the least likely diagnosis is:

A. Wegner’s granulomatosis

B. Microscopic polyangiitis

C. Sarcoidosis

D. Acute serum sickness

E. Idiopathic hemaosidrosis

9. The most commonly affected organ in addition to her lungs is:

A. Heart

B. Joints

C. Kidney

D. Skin

E. Gut

10. This hand‐Xray most probably belongs to a child with:

A. Juvenile idiopathic arthritis

B. Scleroderma

C. Wegner’s granulomatosis

D. Acute Leukemia

E. Ewing sarcoma

11. This X‐ray belongs to a boy who’s most likely have:

A. Abnormal peripheral pulses

B. Hypertension

C. Chronic headache

D. Erosive peripheral arthritis

E. Ataxia

12. Your expectation for this boy is:

A. He is at high risk for chronic arthritis

B. He would have scleroderma‐like skin

C. He would have morning stiffness

D. He would have pulmonary valve stenosis

E. He would complain of intermittent lower limb pain

13. A 5‐year‐old boy presented with history of arthritis and these findings. The most important laboratory test for the diagnosis is:

A. Antinuclear antibody

B. Rheumatoid factor

C. Erythrocyte sedimentation rate

D. Antistreptolysin O antibody

E. Direct coomb’s test

Read the following statement and answer Q 14‐ 15

A 10 year old boy presented with myalgia and hypertension. Skin biopsy from the lesion was consistent with erythema nodosum.

14. Your expectation for this boy is:

A. Presence of fever, night sweats and weight loss are less likely

B. Fixed lung necrotizing pneumonitis is highly expected

C. High polymorph‐nuclear leukocytes counts

D. Thrombocytopenia is a common finding

E. His disease has a self‐limited course

15. The most likely diagnosis is:

A. Henoch‐Schonlein purpura

B. Cogan’s syndrome

C. Sarcoidosis

D. Polyarteritis nodosa

E. Wegener’s granulomatosis

16. A 10 year old girl referred to your hospital with chronic and exacerbations of burning pain in the feet and hands. These episodes are precipitated by heat and dependency. The most likely diagnosis is:

A. Idiopathic Raynaud’s

B. Erythromelalgia

C. Arterial occlusive disease

D. Hand‐foot‐mouth syndrome

E. Systemic sclerosis

17. A 13‐ year old girl referred to your hospital because of hematuria. Three months ago, she had history of nasal blockage associated with mild swelling and pain and she ended with this finding. The incorrect statement is:

A. Churg‐Struss syndrome is one of the differential diagnosis

B. She is at risk to develop lung involvement

C. Abnormal sinus x‐ray

D. ANA is more important than ANCA

E. Renal biopsy is one of the important investigations

18. A 12‐year‐old boy presented with history of chronic arthritis. You would expect to find:

A. Frontal alopecia

B. Sacroiliac joint involvement

C. Bruit over subclavian artery

D. Hypermobile joints

E. Coxa vara

Read the following statement and answer Q 19‐ 20

A 9‐year‐old girl was referred with history of fatigability, arthritis and intermittent fever. Your examination revealed these findings.

19. The correct statement is:

A. Swimming in a sunny day is highly recommended to improve her arthritis

B. Genital ulceration is important finding to confirm the diagnosis

C. Most likely she would develop destructive arthritis

D. She is a candidate for Pneumococcal vaccine

E. The most common cause of morbidity in her case is the migraine headache

20. You would expect her laboratory test result:

A. Low total white cell counts and low lymphocyte counts

B. High white cell counts and high polymorph‐nuclear cell counts

C. Normal ESR and C‐reactive protein

D. High platelet counts

E. High complement levels

Read the following statement and answer Q 21‐ 22

A 10 year old boy referred to your hospital with 3 months history of recurrent painful lesions. Two months ago he developed these lesions on his lower extremity. He gave a history of sagital sinus thrombosis 6 months ago.

21. The most likely diagnosis is:

A. Reiter’s syndrome

B. Systemic lupus erythematosus

C. Steven Johnson syndrome

D. Behcet’s disease

E. Histocytosis X

22. The most important organ needs to be examined:

A. Eyes

B. Joints

C. Gut

D. Liver

E. Heart

Read the following statement and answer Q 23‐ 24

A 7 year old girl presented with history of high spiking. The temperature rises to 39C and higher on daily or twice‐daily basis, with rapid return to baseline or below the baseline. Mother noticed that fever is almost always accompanied by this rash.

23. This rash is known as:

A. Erythema marginatum

B. Livedo reticularis

C. Salmon pink rash

D. Erythema nodosum

E. Psoriasis

24. Most likely she will have the following:

A. Prolonged PR interval

B. High white cell counts with high polymorph‐nuclear cell counts

C. Low C‐reactive protein

D. High IgM level for B. burgdorferi

E. Urine RBC casts

Read the following statement and answer Q 25‐ 27

A 6 year old boy presented with 2 months history of fatigability, recurrent severe abdominal pain and this finding.

25. The most likely diagnosis is:

A. Psoriasis

B. Behcet disease

C. Systemic lupus erythematosus

D. Juvenile dermatomyositis

E. Steven Johnson syndrome

26. The most appropriate imaging study for this boy is:

A. Skeletal survey

B. Bone scan

C. Abdominal ultrasound

D. MRI of the pelvic girdle

E. Brain CT scan

27. One of the potential complications is:

A. Cardiomyopathy

B. Encephalopathy

C. Interstitial nephritis

D. Subcutaneous swellings

E. Deafness

28. The examination of the periungual skin showed this finding. The correct statement is:

A. It is normal finding

B. It is a sing of bleeding tendency

C. Most probably the patient has muscle weakness

D. You need to consult dermatologist for possible skin biopsy

E. Lower GI‐endoscopy is badly needed

Read the following statement and answer Q 29‐ 30

A 9 year old boy, who was completely healthy, presented with 4 months history of back pain. The pain is progressive and severe. Currently, he is unable to walk

29. You would like to clarify the following:

A. History of fever.

B. History of gastrointestinal bleeding.

C. History of abnormal movements.

D. History of muscle weakness.

E. History of skin rash.

30. The most likely working diagnosis is:

A. Ewing sarcoma.

B. Osteomeyelitis.

C. Fracture

D. Eosinophilic granuloma

E. Lymphoma

Read the following statement and answer Q 31‐ 33

You have been asked to evaluate this young boy, who’s presented with 8 days history of high grade fever and maculopapular skin rash. He was treated with oral antibiotic with poor response.

31. The important laboratory test is:

A. Antinuclear antibody

B. Antistreptolysin O antibody

C. Complement level

D. Serum albumin

E. Urine culture

32 Your treatment choice is:

A. Broad spectrum antibiotic intravenously to complete 10 days

B. Stop antibiotic and wait till he complete 10 days of his disease course

C. High dose of IVIG

D. High dose of IVIG and Corticosteroids.

E. High doses of IVIG and acetylsalicylic acid

33. This patient is at risk of developing:

A. Transient Uveitis

B. Septic meningitis

C. Autoimmune hepatitis

D. Proliferative glomerulonephritis

E. Endocarditis

34. An 11‐year‐old girl who’s healthy apart from intermittent lower limb pain. Your expectation is:

A. She would have elevated muscle enzymes

B. She would have abnormal bone scan

C. She is at high risk for leg length discrepancy

D. Hard insoles would relief her symptoms

E. She would have poor outcome

Read the following statement and answer Q 35‐ 36

This patient presented with this finding and history of right knee pain and swelling, 3 weeks later developed left ankle pain.

35. These findings are consistent with:

A. Henoch‐Schonlein purpura

B. Psoriatic arthritis

C. Psoriasis

D. Juvenile dermatomyositis

E. Fungal infection

36. This patient is at risk of:

A. Interstitial nephritis

B. Uveitis

C. Interstitial pneumonitis

D. Calcinosis

E. Thrombosis

37. A young boy presented with recurrent headache and high blood pressure. Work up showed this finding. You would expect that he has the following:

A. Normal renal function

B. Low ESR

C. Abnormal peripheral pulses

D. Symmetrical arthritis

E. Scleroderma‐like skin

Read the following statement and answer Q 38‐ 39

38. You have been asked to evaluate this patient who’s known to have poly‐articular juvenile idiopathic arthritis. He is on treatment. You would expect that this complication is due to:

A. The primary disease

B. High dose of corticosteroids

C. Methotrexate

D. Naproxen

E. Poor nutrition

39. This patient is expected to receive:

A. Colchicine

B. Folic acid

C. Kenalog in Orabase

D. Topical antibiotic

E. Xylocaine gel

40. The following is true about acute rheumatic fever:

A. It is the classical example of reactive arthritis

B. The second common cause of acquired heart disease in the developing countries

C. It is almost always associated with erosive arthritis

D. Scarlet fever is not enough evidence for streptococcal infection

E. The American heart association recommendation is to give long acting penicillin injection

every 3 months instead of 4 months