Pediatric Rheumatology and Musculoskeletal Disorders MCQs

Pediatrics · 20 free questions with answers & explanations.

1. A 6-year-old girl develops acute onset arthritis of both knees and ankles with fever and a salmon-pink evanescent rash that appears and disappears with temperature spikes. Investigations show elevated ESR, CRP, ferritin >1000 ng/mL, and leukocytosis. ANA and RF are negative. What is the MOST likely diagnosis?
2. A 6-year-old girl presents with arthritis of the knees and ankles for 8 weeks, daily spiking fever to 40°C with characteristic evanescent salmon-colored rash coinciding with fever spikes, hepatosplenomegaly, and lymphadenopathy. Ferritin is 15,000 ng/mL. Which JIA subtype does this presentation MOST closely represent, and what LABORATORY feature has the highest specificity for this diagnosis?
3. A 14-year-old male presents with insidious onset lower back pain and stiffness, worse in the morning and relieved by activity, bilateral sacroiliac joint tenderness on examination, and uveitis. HLAB27 is positive. Diagnosis of enthesitis-related arthritis (ERA) is considered. According to ILAR classification, ERA belongs to which JIA subtype, and what finding on MRI of sacroiliac joints would confirm active sacroiliitis?
4. A 7-year-old girl presents with a 6-week history of arthritis in both knees and her right ankle. She also reports dry eyes and dry mouth. ANA is positive at 1:320 (speckled pattern). Anti-SSA (Ro) and anti-SSB (La) antibodies are positive. Schirmer's test is positive. Which of the following correctly describes the classification of this case under JIA (Juvenile Idiopathic Arthritis)?
5. A 7-year-old girl develops high spiking fever (>39°C) for 3 weeks, evanescent salmon-pink rash coinciding with fever spikes, and arthritis of the knees and wrists. Ferritin is 12,000 ng/mL. RF and ANA are negative. The diagnosis is systemic JIA (sJIA). The drug with a unique mechanism targeting IL-18 and IFN-γ to prevent macrophage activation syndrome (MAS) is:
6. A 14-year-old girl develops painful symmetric swelling of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of both hands for 8 weeks, morning stiffness >1 hour, and anti-CCP antibodies are positive (high titre). The most appropriate initial disease-modifying treatment is:
7. A 6-year-old girl presents with 6 weeks of arthritis involving more than 5 joints, including small joints of both hands and feet, knees, and ankles. She has low-grade fever. RF is negative. ANA is positive at 1:160. Eye examination is normal. Which JIA subtype does she have, and what is her GREATEST long-term ophthalmological risk?
8. A 6-year-old girl has 3 months of arthritis affecting both knees and both ankles (symmetric large joint arthritis) with morning stiffness lasting 90 minutes. She is ANA-positive (1:640), rheumatoid factor is negative, and anti-CCP antibodies are negative. She is at highest risk for which extra-articular complication, and how should it be monitored?
9. A 12-year-old girl presents with 4 weeks of daily fever (>39°C spiking once daily with rapid defervescence), salmon-pink evanescent maculopapular rash appearing with fever, arthritis of multiple joints, hepatosplenomegaly, and lymphadenopathy. Serum ferritin is 18,500 ng/mL, RF negative, ANA negative. Which complication is MOST feared in this condition and requires close monitoring?
10. A 7-year-old girl presents with arthritis in 6 joints (both knees, both wrists, and MCP joints bilaterally) for 8 weeks. Temperature spikes occur twice daily reaching 39.5°C, each episode lasting 2–4 hours, associated with a salmon-colored evanescent rash during the fever. Ferritin is 45,000 ng/mL, and white cell count is 28,000/µL. ANA and RF are negative. What is the MOST likely diagnosis, and what systemic life-threatening complication must be screened for?
11. A 6-year-old boy presents with 6 weeks of daily fever spiking to 40°C (quotidian pattern, normalizing between spikes), salmon-pink evanescent truncal rash appearing with fever, arthritis of both knees and wrists, and hepatosplenomegaly. Ferritin is 12,000 ng/mL. The diagnosis is systemic JIA (sJIA). The pathological cytokine most elevated in sJIA (differentiating it from other JIA subtypes) that serves as a therapeutic target is:
12. A 10-year-old boy is diagnosed with Kawasaki disease (KD) presenting with 6 days of fever and 4 of the 5 classic criteria. Echocardiography on day 7 shows a right coronary artery Z-score of +3.2. The initial treatment combining IVIG and aspirin is given. The PRIMARY reason for giving high-dose aspirin in the acute phase of KD is:
13. A 4-year-old girl has had fever every day for 4 weeks, a salmon-colored evanescent rash appearing during fever spikes, lymphadenopathy, hepatosplenomegaly, and painful swollen knees and wrists. Ferritin is 12,000 ng/mL. RF is negative, ANA is negative. Which JIA subtype does this represent, and what is the significance of the ferritin level?
14. A 6-year-old girl has fever >39°C for 3 weeks, arthritis of multiple joints, salmon-pink evanescent rash that appears with fever and disappears when afebrile, hepatosplenomegaly, lymphadenopathy, and serositis (pericarditis). RF and ANA are negative. Ferritin is 18,000 ng/mL. What is the diagnosis?
15. A 6-year-old girl has been having daily high-spiking fevers for 3 weeks with quotidian (once or twice daily) pattern, evanescent salmon-colored rash appearing with fever, hepatosplenomegaly, and a markedly elevated ferritin (12,000 ng/mL). RF and ANA are negative. The most likely diagnosis and a complication to screen for is:
16. A 9-year-old girl develops persistent arthritis in her right knee and left wrist for more than 6 weeks, with morning stiffness but no systemic features. ANA is positive at 1:320. She is at highest risk for which serious complication?
17. A 10-year-old girl presents with symmetric arthritis of the interphalangeal joints of both hands and wrists for 10 weeks, uveitis (anterior chamber flare), and mild hepatosplenomegaly. ANA is positive at 1:320. RF is negative. Ferritin is 180 ng/mL. What is the most likely diagnosis and the greatest risk associated with uveitis in this condition?
18. A 6-year-old girl presents with 6 weeks of morning stiffness, swelling of 4 small joints (PIP joints bilateral hands), and both ankles. RF is negative. ANA is positive. She has no systemic features. According to ILAR classification, which subtype of Juvenile Idiopathic Arthritis (JIA) does she have, and what is the MOST important ophthalmological complication to screen for?
19. A 5-year-old boy develops daily spiking fevers for 3 weeks with return to normal or subnormal temperatures between spikes. He has a salmon-colored evanescent rash during fever, hepatosplenomegaly, lymphadenopathy, and arthritis of the knees. Ferritin is 18,000 ng/mL. Which cytokine is most responsible for the pathogenesis of this condition?
20. A 5-year-old girl presents with 4 joints affected (knees and ankles, bilateral), morning stiffness, a salmon-colored evanescent rash appearing with fever spikes, and daily fever spikes >39°C for 3 months. Serum ferritin is 18,000 ng/mL and ANA is negative. The MOST likely diagnosis is: