Rheumatology

Question 1

A 7 year old boy has a limp for several weeks. Findings on physical examination are normal except for limitation of internal rotation and abduction of his hip. The most likely diagnosis is

1. Congenital hip dysplasia
2. Perthes’ disease
3. Septic arthritis
4. Slipped capital femoral epiphysis
5. Transient synovitis of the hip

Answer 1

2. Perthes’ disease

Question 2

An 8 year old boy presents with a 2 month history of pain and swelling of his right knee. All of the following should be considered in your differential diagnosis except ?

1. Oligo-articular juvenile idiopathic arthritis
2. Lyme arthritis
3. Tuberculous arthritis
4. Rheumatic fever arthritis
5. Enthesitis related arthritis

Answer 2

4. Rheumatic fever arthritis

Question 3

3year old girl is being referred with 3 months hx of abnormal gait, “refuses to walk”. Swelling of knee noticed after a fall. Persistence of symptoms despite temporary immobilisation. The following is the most likely diagnosis:

1. Juvenile Arthritis involving the knee
2. Systemic Lupus Erythematodes
3. Type III growth plate fracture of the distal femur
4. Pain amplification syndrome

Answer 3

1. Juvenile Arthritis involving the knee

Question 4

A 5 year old boy presents with a 6 weeks history of arthritis, fever and a macular rash on his trunk. The most likely diagnosis is:

1. Rheumatic Fever
2. Systemic Lupus erythematodes
3. Septic Arthritis
4. Systemic Juvenile Idiopathic arthritis
5. Kawasaki Disease

Answer 4

4. Systemic Juvenile Idiopathic arthritis

Question 5

The following statement is true:

1. Uveitis is a complication of Psoriatic Arthritis
2. The majority of polyarticular JIA cases are RF positive
3. ANA are typically positive in systemic JIA
4. Uveitis in JIA usually presents with a non-exsudative conjunctivitis

Answer 5

1. Uveitis is a complication of Psoriatic Arthritis

Question 6

The following lab result is not characteristic for Macrophage Activation Syndrome as part of sJIA:

1. Elevated Ferritin
2. Elevated Liver Enzymes
3. Elevated CRP
4. Elevated ESR
5. Elevated Triglycerides

Answer 6

4. Elevated ESR

Question 7

A 10 year old girl is referred because the school teacher noted a sudden onset of deterioration of her hand writing. On exam involuntary movements of the extremities are noted. No other symptoms of note. The following is the most likely diagnosis:

1. Juvenile Arthritis involving the wrist
2. Systemic Lupus Erythematodes
3. Rheumatic Fever presenting with Chorea
4. Pain amplification syndrome

Answer 7

3. Rheumatic Fever presenting with Chorea

Question 8

What is the most sensitive test for lupus?

1. anti double stranded DNA antibodies
2. C-reactive protein
3. antinuclear antibodies
4. antiphospholipid antibodies

Answer 8

3. antinuclear antibodies

Question 9

What is the most common vital organ involvement is SLE?

1. Kidney – glomerulonephritis
2. CNS – psychosis or seizure disorder
3. Liver – lupus hepatitis
4. Lungs – serositis and interstitial lung disease

Answer 9

1. Kidney – glomerulonephritis

Question 10

Which statement is not correct… In systemic lupus erythematodes the following autoantibodies can be found typically

1. anti-Ro antibodies
2. anti SSc-antibodies
3. anti-La antibodies
4. anti-ds-DNS antibodies
5. Anti-Phospholipid antibodies

Answer 10

2. anti SSc-antibodies