Rheumatology Flashcards
(180 cards)
1
Q
What is the minimum duration of arthritis required to diagnose JIA?
A) 2 weeks | B) 4 weeks | C) 6 weeks | D) 8 weeks
A
C) 6 weeks
JIA is defined as arthritis lasting at least 6 weeks in a child under 16 years of age.
2
Q
Which subtype of JIA is most commonly associated with chronic uveitis?
A) Oligoarticular JIA | B) Systemic JIA | C) Psoriatic arthritis | D) Enthesitis-related arthritis
A
A) Oligoarticular JIA
Oligoarticular JIA, especially in ANA-positive young girls, is most associated with chronic uveitis.
3
Q
Which laboratory marker is most commonly positive in oligoarticular JIA?
A) RF | B) Anti-CCP | C) ANA | D) HLA-B27
A
C) ANA
ANA is commonly positive in oligoarticular JIA and is used to monitor uveitis risk.
4
Q
Which JIA subtype is characterized by quotidian fever and evanescent rash?
A) Polyarticular JIA | B) Psoriatic arthritis | C) Systemic JIA | D) Oligoarticular JIA
A
B) Systemic JIA
Systemic JIA is characterized by systemic inflammation including spiking fevers and transient rash.
5
Q
What is the first-line disease-modifying treatment for JIA?
A) NSAIDs | B) Hydroxychloroquine | C) Methotrexate | D) Azathioprine
A
C) Methotrexate
Methotrexate is the first-line DMARD for most types of JIA that are unresponsive to NSAIDs.
6
Q
A 7-year-old girl presents with arthritis in 3 joints and positive ANA. What is the most likely diagnosis?
A) Oligoarticular JIA | B) Systemic JIA | C) Psoriatic arthritis | D) ERA
A
A) Oligoarticular JIA
Oligoarticular JIA affects 1–4 joints, often in girls under 6, and frequently shows ANA positivity.
7
Q
Which cytokine is most associated with systemic JIA pathogenesis?
A) TNF-alpha | B) IL-2 | C) IL-6 | D) IL-10
A
C) IL-6
IL-6 is a key cytokine in systemic JIA, and IL-6 inhibitors like tocilizumab are effective.
8
Q
Which HLA type is commonly associated with Enthesitis-related arthritis (ERA)?
A) HLA-DR4 | B) HLA-B27 | C) HLA-A2 | D) HLA-DQ2
A
B) HLA-B27
HLA-B27 is commonly associated with ERA, a subtype that may involve sacroiliac joints.
9
Q
Which JIA subtype typically mimics adult rheumatoid arthritis?
A) Systemic JIA | B) ERA | C) Psoriatic arthritis | D) Polyarticular RF-positive JIA
A
D) Polyarticular RF-positive JIA
Polyarticular RF-positive JIA resembles adult RA, with symmetrical small joint involvement.
10
Q
Which test is essential to monitor for complications in ANA-positive oligoarticular JIA?
A) ANA titer | B) Slit-lamp eye examination | C) Fundus examination | D) Visual acuity test
A
B) Slit-lamp eye examination
Slit-lamp exams are crucial in ANA-positive oligo JIA to detect asymptomatic anterior uveitis.
11
Q
What is the most appropriate treatment for macrophage activation syndrome (MAS)?
A) High-dose corticosteroids | B) NSAIDs | C) Methotrexate | D) Antibiotics
A
A) High-dose corticosteroids
MAS is treated with high-dose steroids and IL-1/IL-6 inhibitors due to its inflammatory nature.
12
Q
Which JIA subtype has the highest risk of progression to sacroiliitis?
A) Psoriatic arthritis | B) Polyarticular JIA | C) Enthesitis-related arthritis | D) Systemic JIA
A
C) Enthesitis-related arthritis
ERA commonly progresses to axial involvement, including sacroiliitis, especially in adolescents.
13
Q
Which JIA subtype is least likely to present with fever and rash?
A) Oligoarticular JIA | B) Systemic JIA | C) ERA | D) Psoriatic arthritis
A
A) Oligoarticular JIA
Oligoarticular JIA typically has no systemic features and is limited to a few joints.
14
Q
What is the most likely diagnosis in a child with arthritis, psoriasis, and dactylitis?
A) ERA | B) Psoriatic arthritis | C) Polyarticular JIA | D) Systemic JIA
A
B) Psoriatic arthritis
Psoriatic arthritis is diagnosed when arthritis occurs with psoriasis or features like dactylitis.
15
Q
Which lab abnormality is typical in systemic JIA?
A) Low ESR | B) Thrombocytopenia | C) Low CRP | D) Elevated ferritin
A
D) Elevated ferritin
Systemic JIA shows elevated acute-phase reactants; very high ferritin suggests MAS.
16
Q
Which imaging modality is most sensitive for early detection of joint inflammation in JIA?
A) X-ray | B) MRI | C) Ultrasound | D) Bone scan
A
B) MRI
MRI is the most sensitive imaging for early joint changes including synovitis and bone marrow edema.
17
Q
What is the most common extra-articular manifestation of JIA?
A) Hepatitis | B) Uveitis | C) Thyroiditis | D) Iritis
A
A) Uveitis
Uveitis, especially anterior chronic uveitis, is the most common extra-articular complication, particularly in ANA-positive cases.
18
Q
Which drug is a biologic agent used in refractory JIA cases?
A) Hydroxychloroquine | B) Sulfasalazine | C) Mycophenolate | D) Etanercept
A
D) Etanercept
Etanercept is a TNF inhibitor used in patients with moderate to severe or methotrexate-resistant JIA.
19
Q
Which subtype of JIA often presents with dactylitis and nail pitting?
A) Polyarticular JIA | B) ERA | C) Psoriatic arthritis | D) Systemic JIA
A
C) Psoriatic arthritis
Psoriatic arthritis can present with arthritis, psoriasis, dactylitis, and nail changes like pitting or onycholysis.
20
Q
Which feature differentiates systemic JIA from other autoimmune diseases?
A) Positive ANA | B) Positive RF | C) Positive anti-dsDNA | D) Negative ANA and RF
A
D) Negative ANA and RF
Systemic JIA typically presents with systemic features but lacks autoantibodies (ANA and RF negative).
21
Q
Which is the most common initial symptom of systemic lupus erythematosus (SLE) in children?
A) Rash | B) Fever | C) Arthralgia | D) Fatigue
A
C) Arthralgia
Arthralgia is a common early presenting symptom in pediatric SLE, often preceding other features.
22
Q
What autoantibody is most specific for SLE diagnosis?
A) ANA | B) Anti-dsDNA | C) Anti-Sm | D) Anti-RNP
A
C) Anti-Sm
Anti-Sm is the most specific antibody for SLE, though less sensitive than ANA or anti-dsDNA.
23
Q
Which of the following is part of the ACR criteria for SLE diagnosis?
A) Elevated CRP | B) Raynaud’s phenomenon | C) Malar rash | D) ANA titer <1:40
A
C) Malar rash
Malar rash is one of the 11 ACR classification criteria for SLE.
24
Q
What is the most common renal lesion in pediatric SLE?
A) Focal segmental glomerulosclerosis | B) Minimal change disease | C) Diffuse proliferative GN | D) Membranous GN
A
C) Diffuse proliferative GN
Diffuse proliferative glomerulonephritis (Class IV) is the most common and severe renal lesion in pediatric SLE.
25
Which lab marker correlates best with SLE disease activity?
A) ESR | B) CRP | C) Anti-Sm | D) Anti-dsDNA
D) Anti-dsDNA
Anti-dsDNA levels correlate with disease activity and renal involvement.
26
Which type of anemia is commonly seen in active SLE?
A) Iron deficiency anemia | B) Microangiopathic anemia | C) Hemolytic anemia | D) Aplastic anemia
C) Hemolytic anemia
Autoimmune hemolytic anemia is common in active SLE due to antibody-mediated RBC destruction.
27
What is the first-line treatment for mild non-renal SLE symptoms in children?
A) Corticosteroids | B) Methotrexate | C) Hydroxychloroquine | D) Cyclophosphamide
C) Hydroxychloroquine
Hydroxychloroquine is the first-line therapy for mild skin/joint symptoms and improves long-term outcomes.
28
What is the most serious complication of lupus nephritis?
A) Nephrolithiasis | B) Rapidly progressive glomerulonephritis | C) Nephrotic syndrome | D) Renal artery stenosis
B) Rapidly progressive glomerulonephritis
Lupus nephritis may progress rapidly and is a major cause of morbidity; early treatment is critical.
29
Which neuropsychiatric manifestation is commonly seen in pediatric SLE?
A) Seizures | B) Myopathy | C) Peripheral neuropathy | D) Guillain-Barre syndrome
A) Seizures
Seizures and psychosis are common neuropsychiatric manifestations of pediatric SLE.
30
Which complement components are typically low in active SLE?
A) C1 and C4 | B) C2 and C3 | C) C3 and C4 | D) C1 and C2
C) C3 and C4
C3 and C4 are typically low in active lupus due to complement consumption.
31
Which antibody is associated with neonatal lupus and congenital heart block?
A) Anti-dsDNA | B) Anti-RNP | C) Anti-Ro/SSA | D) Anti-Sm
C) Anti-Ro/SSA
Anti-Ro/SSA antibodies are linked to neonatal lupus and congenital heart block.
32
Which is a major side effect of long-term corticosteroid therapy in SLE patients?
A) Hyperkalemia | B) Hyperpigmentation | C) Avascular necrosis | D) Hypercalcemia
C) Avascular necrosis
Avascular necrosis is a serious complication of chronic steroid use, especially with high doses.
33
Which biologic agent is approved for use in refractory pediatric SLE?
A) Tocilizumab | B) Etanercept | C) Belimumab | D) Infliximab
C) Belimumab
Belimumab is a biologic approved for refractory SLE targeting B-cell activation.
34
Which of the following is a common cutaneous finding in pediatric SLE?
A) Discoid rash | B) Gottron’s papules | C) Erythema nodosum | D) Acneiform eruption
A) Discoid rash
Discoid lesions are chronic cutaneous manifestations of SLE, often scarring.
35
Which of the following best describes the arthritis of SLE?
A) Erosive and symmetrical | B) Non-erosive and asymmetrical | C) Erosive and migratory | D) Non-erosive and symmetrical
D) Non-erosive and symmetrical
SLE arthritis is typically non-erosive, symmetrical, and affects small joints.
36
What is the hallmark feature of Kawasaki disease?
A) Daily wheezing | B) Prolonged fever | C) Recurrent seizures | D) Hematuria
B) Prolonged fever
Fever for ≥5 days is the hallmark of Kawasaki disease, required for diagnosis.
37
What is the most serious complication of Kawasaki disease?
A) Renal failure | B) Coronary artery aneurysms | C) Hepatic fibrosis | D) Uveitis
B) Coronary artery aneurysms
Coronary artery aneurysms are the most serious and potentially fatal complication.
38
Which age group is most commonly affected by Kawasaki disease?
A) <6 months | B) 6 months to 5 years | C) 5 to 10 years | D) Adolescents
B) 6 months to 5 years
Kawasaki disease most commonly affects children between 6 months and 5 years.
39
Which of the following is NOT a diagnostic criterion of classic Kawasaki disease?
A) Bilateral conjunctivitis | B) Lymphadenopathy | C) Urticarial rash | D) Oral mucosal changes
C) Urticarial rash
Urticarial rash is not part of the classic diagnostic features; the rash is polymorphous.
40
How many days of fever are required for the diagnosis of Kawasaki disease?
A) ≥3 days | B) ≥5 days | C) ≥7 days | D) ≥10 days
B) ≥5 days
At least 5 days of fever is required for a diagnosis of classic Kawasaki disease.
41
Which laboratory finding is typically elevated in Kawasaki disease?
A) Eosinophils | B) Platelets | C) ESR | D) Anti-dsDNA
C) ESR
ESR is typically elevated due to systemic inflammation in Kawasaki disease.
42
Which of the following is part of the classic mucocutaneous findings in Kawasaki disease?
A) Vesicular rash | B) Strawberry tongue | C) Psoriatic plaques | D) Scaly palms
B) Strawberry tongue
Strawberry tongue is a characteristic oral mucosal finding in Kawasaki disease.
43
What is the first-line treatment for Kawasaki disease?
A) Corticosteroids | B) IVIG | C) Azithromycin | D) Antihistamines
B) IVIG
IVIG is the first-line therapy and reduces risk of coronary aneurysm when given early.
44
When is IVIG ideally administered in Kawasaki disease?
A) Within 24 hours | B) Day 3–5 of illness | C) After 10 days | D) After fever resolves
B) Day 3–5 of illness
Optimal IVIG timing is between day 3 and 5 of illness before aneurysm formation peaks.
45
Which is the most appropriate imaging to evaluate coronary arteries in Kawasaki disease?
A) CT angiography | B) Echocardiography | C) MRI heart | D) Cardiac catheterization
B) Echocardiography
Echocardiography is the preferred imaging for coronary artery assessment in KD.
46
What is the mechanism of coronary aneurysm formation in Kawasaki disease?
A) Immune complex deposition | B) Neutrophilic vasculitis | C) Lymphocytic vasculitis | D) Direct viral invasion
B) Neutrophilic vasculitis
The pathogenesis involves neutrophilic infiltration of medium-sized vessels.
47
Which of the following is an indication of incomplete Kawasaki disease?
A) Fever ≥5 days with <4 principal features and coronary abnormalities | B) Uveitis and fever | C) Only rash and conjunctivitis | D) Fever for 2 days and lymphadenopathy
A) Fever ≥5 days with <4 principal features and coronary abnormalities
Incomplete KD is suspected if the patient has fever ≥5 days with fewer features but evidence of coronary involvement.
48
What is the typical platelet count finding in the subacute phase of Kawasaki disease?
A) Thrombocytopenia | B) Normal platelets | C) Thrombocytosis | D) Pancytopenia
C) Thrombocytosis
Thrombocytosis occurs in the subacute phase, often >7 days after onset.
49
What should be given along with IVIG in the acute management of Kawasaki disease?
A) Aspirin | B) Heparin | C) Steroids | D) Beta-blockers
A) Aspirin
Aspirin is used for its anti-inflammatory and anti-platelet effects along with IVIG.
50
What is the recommended follow-up for a child with giant coronary aneurysms post-Kawasaki disease?
A) Annual ECG only | B) No follow-up needed if asymptomatic | C) Lifelong cardiology follow-up with imaging | D) Discharge at 2 months
C) Lifelong cardiology follow-up with imaging
Children with giant aneurysms require long-term cardiac follow-up due to ongoing risk.
51
What is the most common presenting symptom of Henoch-Schönlein purpura (HSP)?
A) Hematuria | B) Abdominal pain | C) Purpura | D) Joint pain
C) Purpura
Palpable purpura is the most common and characteristic presenting symptom in HSP.
52
Which immunoglobulin is primarily involved in HSP pathogenesis?
A) IgG | B) IgA | C) IgE | D) IgM
B) IgA
HSP is a small-vessel vasculitis with immune complex deposition primarily involving IgA.
53
Which of the following is a hallmark skin finding in HSP?
A) Petechiae | B) Urticaria | C) Palpable purpura | D) Vesicles
C) Palpable purpura
HSP rash is described as palpable purpura, often on lower extremities and buttocks.
54
Which of the following systems is least likely to be involved in HSP?
A) Skin | B) Joints | C) Kidneys | D) Lungs
D) Lungs
The lungs are not typically involved in HSP, unlike systemic vasculitides like GPA.
55
What is the most common gastrointestinal complication of HSP?
A) Intussusception | B) Appendicitis | C) Gastroenteritis | D) Constipation
A) Intussusception
Intussusception is a known GI complication due to bowel wall edema and hemorrhage.
56
Which laboratory test is most useful to support the diagnosis of HSP nephritis?
A) CBC | B) ANA | C) Urinalysis | D) CRP
C) Urinalysis
Urinalysis helps detect hematuria and proteinuria, key indicators of renal involvement.
57
What is the typical platelet count in HSP?
A) Low | B) Normal | C) Elevated | D) Variable
B) Normal
Platelet count is usually normal or elevated; thrombocytopenia suggests another cause.
58
Which of the following is an indication for corticosteroid therapy in HSP?
A) Mild arthralgia | B) Skin rash only | C) Severe abdominal pain | D) Subclinical hematuria
C) Severe abdominal pain
Corticosteroids are indicated in severe abdominal pain, nephritis, or scrotal involvement.
59
What is the most common age range affected by HSP?
A) <1 year | B) 2–11 years | C) 12–18 years | D) >18 years
B) 2–11 years
Most cases occur in children aged 2–11 years, with peak incidence between 4–6 years.
60
What is the typical renal finding in HSP-related nephritis?
A) Crescentic GN | B) Membranous GN | C) IgA nephropathy | D) Post-infectious GN
C) IgA nephropathy
HSP nephritis often resembles IgA nephropathy, with mesangial IgA deposits.
61
What triggers HSP in many cases?
A) Viral or bacterial infection | B) Autoimmune diseases | C) Malignancy | D) Vaccines only
A) Viral or bacterial infection
Most HSP episodes are preceded by viral or streptococcal infections.
62
Which is a common joint manifestation in HSP?
A) Joint deformity | B) Non-migratory arthritis | C) Migratory arthralgia | D) Ankylosis
C) Migratory arthralgia
Joint symptoms are common and often migratory, involving knees and ankles.
63
What distinguishes HSP purpura from other types of rash?
A) It blanches with pressure | B) It is raised and palpable | C) It is vesicular | D) It is non-purpuric
B) It is raised and palpable
HSP purpura is non-blanching, raised, and palpable due to small-vessel vasculitis.
64
What is the most important prognostic factor in HSP?
A) Extent of skin rash | B) Degree of joint pain | C) Renal involvement | D) Presence of abdominal pain
C) Renal involvement
Renal involvement is the main determinant of long-term prognosis in HSP.
65
Which test confirms IgA deposition in HSP?
A) Skin biopsy with immunofluorescence | B) Renal ultrasound | C) Blood culture | D) ESR
A) Skin biopsy with immunofluorescence
Skin biopsy with IgA deposition in vessel walls confirms the diagnosis.
66
What is the most characteristic cutaneous feature of Juvenile Dermatomyositis?
A) Butterfly rash | B) Malar rash | C) Heliotrope rash | D) Discoid rash
C) Heliotrope rash
Heliotrope rash is a violet-colored rash around the eyes, characteristic of JDM.
67
Which muscle enzyme is most commonly elevated in active JDM?
A) ALT | B) AST | C) CK | D) LDH
C) CK
Creatine kinase (CK) is the most commonly elevated enzyme in active muscle inflammation.
68
Which rash is typically found over the knuckles in JDM?
A) Erythema nodosum | B) Gottron’s papules | C) Livedo reticularis | D) Urticaria
B) Gottron’s papules
Gottron’s papules are scaly erythematous lesions over knuckles, pathognomonic for JDM.
69
What is the pathophysiology of JDM?
A) Antibody-mediated vasculitis of capillaries | B) IgE-mediated reaction | C) Neutrophilic panniculitis | D) Lymphocytic infiltration of synovium
A) Antibody-mediated vasculitis of capillaries
JDM involves immune-mediated small vessel vasculitis affecting skin and muscle capillaries.
70
Which test is most specific for confirming the diagnosis of JDM?
A) Serum CK | B) Muscle biopsy | C) EMG | D) ANA
B) Muscle biopsy
Muscle biopsy confirms inflammation and is the gold standard for diagnosis.
71
Which of the following is the hallmark muscle symptom of JDM?
A) Proximal muscle weakness | B) Muscle hypertrophy | C) Muscle cramps | D) Muscle atrophy only
A) Proximal muscle weakness
JDM classically presents with proximal muscle weakness (e.g., difficulty climbing stairs).
72
What is a common gastrointestinal complication in severe JDM?
A) Intussusception | B) Pancreatitis | C) GI perforation | D) Appendicitis
C) GI perforation
Severe vasculitis in JDM can lead to GI ulceration and perforation, a serious complication.
73
Which autoantibody is associated with calcinosis in JDM?
A) Anti-TIF1γ | B) Anti-Mi-2 | C) Anti-NXP2 | D) Anti-Jo1
C) Anti-NXP2
Anti-NXP2 antibodies are linked with increased risk of calcinosis in JDM.
74
What is the first-line treatment for moderate to severe JDM?
A) IVIG alone | B) Hydroxychloroquine | C) High-dose corticosteroids | D) NSAIDs
C) High-dose corticosteroids
Systemic corticosteroids are essential in controlling active JDM inflammation.
75
What is the typical EMG finding in JDM?
A) Normal pattern | B) Myopathic pattern with fibrillation | C) Neuropathic pattern | D) Demyelination
B) Myopathic pattern with fibrillation
EMG shows myopathic changes including short-duration, low-amplitude motor unit potentials.
76
Which imaging modality is preferred to assess muscle inflammation in JDM?
A) MRI | B) CT scan | C) X-ray | D) Ultrasound
A) MRI
MRI can detect muscle edema and inflammation non-invasively, aiding diagnosis and monitoring.
77
What is heliotrope rash?
A) Rash on chest | B) Red rash around eyes | C) Scaling on scalp | D) Nailbed changes
B) Red rash around eyes
Heliotrope rash is a purplish periorbital rash, often with eyelid edema.
78
What is the long-term complication of untreated JDM?
A) Renal failure | B) Blindness | C) Cardiomyopathy | D) Calcinosis
D) Calcinosis
Calcinosis cutis is a chronic complication of untreated or poorly managed JDM.
79
What is the role of corticosteroids in JDM management?
A) For maintenance only | B) Limited use | C) Essential for disease control | D) Only used in adults
C) Essential for disease control
Corticosteroids remain the cornerstone of initial and maintenance therapy in JDM.
80
Which of the following lab findings supports a diagnosis of JDM?
A) Low ESR | B) Positive RF | C) Elevated muscle enzymes | D) Thrombocytopenia
C) Elevated muscle enzymes
Muscle enzyme elevation (CK, AST, LDH, aldolase) is supportive of inflammatory myopathy.
81
What is the most common risk factor for developmental dysplasia of the hip (DDH)?
A) Breech presentation | B) Male sex | C) Prematurity | D) High birth weight
A) Breech presentation
Breech presentation is the most significant risk factor for DDH.
82
Which clinical test detects hip dislocation by reducing the femoral head into the acetabulum?
A) Barlow test | B) Ortolani test | C) Galeazzi test | D) Trendelenburg test
B) Ortolani test
The Ortolani test reduces a dislocated hip and produces a 'clunk'.
83
What is the most appropriate initial imaging modality for suspected DDH in a 6-week-old infant?
A) MRI pelvis | B) Hip X-ray | C) Ultrasound | D) CT scan
C) Ultrasound
Ultrasound is preferred in infants <6 months as the femoral head is not yet ossified.
84
What is the first-line treatment for DDH diagnosed at 4 weeks of age?
A) Hip spica | B) Pavlik harness | C) Closed reduction | D) Open reduction
B) Pavlik harness
Pavlik harness is the first-line non-invasive treatment for DDH in neonates.
85
Which physical finding suggests DDH in a newborn?
A) Genu valgum | B) Limb hypertonia | C) Asymmetric thigh/gluteal folds | D) Clubfoot
C) Asymmetric thigh/gluteal folds
Asymmetric skin folds and leg shortening are classic early signs of DDH.
86
In which position does the Pavlik harness hold the hip?
A) Extension and adduction | B) Extension and external rotation | C) Flexion and abduction | D) Flexion and internal rotation
C) Flexion and abduction
The Pavlik harness holds the hips in flexion and abduction to promote stable positioning.
87
What is the key aim of DDH screening?
A) Prevent functional deformities | B) Screen for scoliosis | C) Prevent early osteoarthritis | D) Detect and treat dislocation early
D) Detect and treat dislocation early
The purpose of DDH screening is to detect hip instability early and prevent long-term complications.
88
What is the classic age for performing hip ultrasound in infants at risk for DDH?
A) At birth | B) 2 weeks | C) 4–6 weeks | D) 6 months
C) 4–6 weeks
Ultrasound is typically performed at 4–6 weeks in infants at risk for DDH.
89
Which of the following is a late sign of undiagnosed DDH?
A) Leg lengthening | B) High-pitched cry | C) Limp and waddling gait | D) Clubfoot
C) Limp and waddling gait
A limp or waddling gait in walking children may suggest missed or late-diagnosed DDH.
90
Which maneuver dislocates an unstable hip when performed?
A) Galeazzi | B) Ortolani | C) Trendelenburg | D) Barlow
D) Barlow
The Barlow maneuver tests for instability by attempting to dislocate the hip.
91
What is the typical age range for SUFE presentation in boys?
A) 4–6 years | B) 6–9 years | C) 10–16 years | D) 17–19 years
C) 10–16 years
SUFE most commonly presents during the adolescent growth spurt, around 10–16 years in boys.
92
Which of the following is the most significant risk factor for SUFE?
A) Obesity | B) Hypertension | C) Early walking | D) Tall stature
A) Obesity
Obesity increases shear stress on the growth plate, predisposing to SUFE.
93
What is the classic physical examination finding in SUFE?
A) Painful external rotation | B) Loss of hip flexion | C) Limited internal rotation of hip | D) High-pitched cry
C) Limited internal rotation of hip
Loss of internal rotation is an early and reliable finding in SUFE.
94
Which direction does the femoral head slip in SUFE?
A) Anterior and medial | B) Posterior and inferior | C) Lateral and superior | D) Anterior and superior
B) Posterior and inferior
The femoral head slips posteriorly and inferiorly relative to the neck.
95
Which imaging view is best for early diagnosis of SUFE?
A) AP pelvis | B) CT scan | C) MRI | D) Frog-leg lateral view
D) Frog-leg lateral view
Frog-leg lateral radiograph is most sensitive for early detection of SUFE.
96
What is the initial management of confirmed SUFE?
A) Bed rest and NSAIDs | B) Closed reduction and hip spica | C) Immediate surgical fixation | D) Observation
C) Immediate surgical fixation
Surgical pinning is the standard of care to prevent progression and complications.
97
Which of the following complications is most feared in SUFE?
A) Chondrolysis | B) Femoral head necrosis (AVN) | C) Osteomyelitis | D) Septic arthritis
B) Femoral head necrosis (AVN)
AVN (avascular necrosis) of the femoral head is the most serious complication.
98
How is SUFE classified radiologically?
A) Based on degree of slip | B) Based on hip rotation | C) Based on duration of pain only | D) Based on acetabular depth
A) Based on degree of slip
SUFE is graded as mild, moderate, or severe based on percentage of slippage.
99
What is the typical gait pattern observed in SUFE?
A) Trendelenburg gait | B) Antalgic gait | C) Waddling gait | D) Hemiplegic gait
B) Antalgic gait
Antalgic gait is common due to pain and instability at the hip.
100
Which endocrine disorder is associated with SUFE?
A) Diabetes mellitus | B) Congenital adrenal hyperplasia | C) Hypothyroidism | D) Hyperthyroidism
C) Hypothyroidism
Endocrine disorders like hypothyroidism and growth hormone deficiency are linked to SUFE.
101
What is Perthes disease?
A) Septic arthritis of the hip | B) Avascular necrosis of the femoral head | C) Dislocation of the femoral head | D) Epiphyseal separation
B) Avascular necrosis of the femoral head
Perthes disease is idiopathic avascular necrosis of the femoral head in children.
102
What is the typical age range for Perthes disease onset?
A) 1–3 years | B) 3–8 years | C) 8–12 years | D) >13 years
B) 3–8 years
It typically presents between ages 3 and 8, especially in boys.
103
Which gender is more commonly affected by Perthes disease?
A) Females | B) Males | C) Equal in both sexes | D) More common in preterm infants
B) Males
Boys are more frequently affected than girls by a ratio of ~4:1.
104
What is the underlying pathology in Perthes disease?
A) Inflammatory destruction of cartilage | B) Vascular compromise leading to necrosis | C) Autoimmune joint inflammation | D) Trauma-induced joint effusion
B) Vascular compromise leading to necrosis
Impaired blood supply to the femoral head leads to osteonecrosis and collapse.
105
Which of the following is a classic symptom of Perthes disease?
A) Hip swelling | B) High-grade fever | C) Painless limp | D) Referred pain to the arm
C) Painless limp
Children often present with a limp that may or may not be painful.
106
What is the most common early sign on X-ray in Perthes disease?
A) Increased joint space | B) Femoral head fragmentation | C) Sclerotic femoral epiphysis | D) Osteopenia of the pelvis
C) Sclerotic femoral epiphysis
Early radiographs may show sclerosis and flattening of the femoral epiphysis.
107
Which imaging modality is most sensitive in early Perthes disease?
A) CT scan | B) Bone scan | C) MRI | D) Ultrasound
C) MRI
MRI is the most sensitive modality for early detection of ischemia in the femoral head.
108
Which of the following is a poor prognostic factor in Perthes disease?
A) Age <5 years at onset | B) Bilateral involvement | C) Pain improves with rest | D) Male gender
B) Bilateral involvement
Bilateral disease is less common but associated with worse prognosis.
109
Which physical examination finding is typical in Perthes disease?
A) Fixed flexion deformity | B) Limited abduction and internal rotation | C) Hypermobile hip | D) Trendelenburg sign absent
B) Limited abduction and internal rotation
Loss of abduction and internal rotation is typical due to joint stiffness and irritation.
110
What is the primary aim of treatment in Perthes disease?
A) Prevent joint infection | B) Promote early walking | C) Maintain femoral head in acetabulum | D) Immediate surgical correction
C) Maintain femoral head in acetabulum
Treatment aims to maintain femoral head containment within the acetabulum to promote healing.
111
Which joint is most commonly involved in oligoarticular JIA?
A) Elbow | B) Knee | C) Ankle | D) Shoulder
B) Knee
The knee is the most commonly involved joint in oligoarticular JIA.
112
What is a typical orthopedic complication of JIA affecting growth?
A) Epiphyseal overgrowth | B) Scoliosis | C) Clubfoot | D) Talipes equinovarus
A) Epiphyseal overgrowth
Chronic joint inflammation in JIA can stimulate overgrowth of the growth plate (epiphysis).
113
Which type of JIA is most associated with temporomandibular joint (TMJ) involvement?
A) Oligoarticular | B) Enthesitis-related arthritis | C) Systemic JIA | D) Polyarticular JIA
D) Polyarticular JIA
TMJ arthritis is most common in polyarticular JIA and can lead to facial asymmetry.
114
What is the first-line imaging modality for detecting early joint inflammation in JIA?
A) MRI | B) X-ray | C) CT scan | D) Bone scan
A) MRI
MRI detects early joint synovitis and erosions before X-ray changes are visible.
115
Which orthopedic feature results from chronic inflammation in JIA?
A) Osteomalacia | B) Joint hypermobility | C) Bony ankylosis | D) Bone fracture
C) Bony ankylosis
Chronic synovitis may result in fibrosis and bony ankylosis in severe cases.
116
What deformity is commonly seen in the hands of patients with long-standing polyarticular JIA?
A) Swan-neck deformity | B) Flexion at DIP | C) Boutonnière deformity | D) Ulnar deviation
A) Swan-neck deformity
Swan-neck deformity is a common finger deformity in longstanding JIA.
117
Which of the following best describes the arthritis in JIA?
A) Erosive, migratory, and symmetrical | B) Non-erosive and intermittent | C) Non-erosive, symmetrical, or asymmetrical | D) Erosive and asymmetrical
C) erosive and asymmetrical
118
Which contracture is commonly seen in the knee in JIA?
A) Flexion contracture | B) Extension contracture | C) Valgus deformity | D) Genu recurvatum
A) Flexion contracture
Chronic inflammation and muscle imbalance can lead to knee flexion contractures.
119
What is the orthopedic aim of physical therapy in JIA management?
A) Immobilization of joints | B) Pain reduction only | C) Maintain range of motion and function | D) Promote bone fusion
C) Maintain range of motion and function
Physical therapy helps maintain joint mobility and prevent fixed deformities.
120
What is the long-term orthopedic concern in systemic JIA with delayed treatment?
A) Craniosynostosis | B) Growth plate tumor | C) Joint destruction and deformity | D) Osteogenesis imperfecta
C) Joint destruction and deformity
Delayed treatment in systemic JIA can result in irreversible joint damage and deformity.
121
What is transient synovitis of the hip?
A) Chronic joint inflammation | B) Benign self-limiting hip inflammation | C) Hip dislocation | D) Early-onset arthritis
B) Benign self-limiting hip inflammation
Transient synovitis is a temporary, non-infectious inflammation of the hip joint.
122
What is the most common age range for transient synovitis?
A) <1 year | B) 1–3 years | C) 3–8 years | D) >12 years
C) 3–8 years
Most common in children aged 3–8 years.
123
Which symptom is typically seen in transient synovitis?
A) High fever and vomiting | B) Painful limp without systemic illness | C) Joint stiffness | D) Referred pain to upper limb
B) Painful limp without systemic illness
Children present with a limp and hip pain, usually without systemic symptoms.
124
What is a common trigger preceding transient synovitis?
A) Recent trauma | B) Viral upper respiratory infection | C) Vaccination | D) Antibiotic use
B) Viral upper respiratory infection
It often follows a recent viral illness, especially upper respiratory infections.
125
How does transient synovitis differ from septic arthritis?
A) Fever and high WBC in both | B) Septic arthritis is painless | C) Septic arthritis has systemic features, TS does not | D) TS causes more swelling
C) Septic arthritis has systemic features, TS does not
Unlike septic arthritis, TS lacks fever, toxic appearance, and marked lab derangements.
126
What is the usual duration of symptoms in transient synovitis?
A) <12 hours | B) 1–3 days | C) 1–2 weeks | D) >3 weeks
C) 1–2 weeks
Symptoms typically resolve within 7–10 days.
127
Which position does the affected leg typically assume?
A) Flexion, external rotation, and abduction | B) Extension and adduction | C) Neutral rotation | D) Internal rotation with adduction
A) Flexion, external rotation, and abduction
Affected children often hold the hip in flexion, abduction, and external rotation to reduce joint pressure.
128
What is the preferred initial imaging for transient synovitis?
A) CT scan | B) MRI | C) Ultrasound of the hip | D) Plain radiograph
C) Ultrasound of the hip
Ultrasound may show joint effusion and is helpful to exclude other diagnoses.
129
Which of the following laboratory findings is typical in transient synovitis?
A) High CRP and ESR | B) Normal or mildly elevated inflammatory markers | C) Positive blood culture | D) Anemia and leukocytosis
B) Normal or mildly elevated inflammatory markers
ESR/CRP may be normal or slightly raised in TS, in contrast to septic arthritis.
130
What is the mainstay of treatment for transient synovitis?
A) Surgery | B) Antibiotics | C) NSAIDs and rest | D) Corticosteroids
C) NSAIDs and rest
Treatment is supportive with rest, NSAIDs, and monitoring.
131
What is the most common causative organism of septic arthritis in children?
A) Streptococcus pneumoniae | B) Haemophilus influenzae | C) Staphylococcus aureus | D) Escherichia coli
C) Staphylococcus aureus
Staph aureus is the most common pathogen in children with septic arthritis.
132
Which joint is most commonly involved in pediatric septic arthritis?
A) Shoulder | B) Knee | C) Ankle | D) Hip
D) Hip
The hip is the most frequently affected joint in young children.
133
What is the classic presentation of septic arthritis in a child?
A) Low-grade fever and intermittent joint pain | B) Sudden onset fever, joint swelling, and refusal to move the limb | C) Rash and joint hypermobility | D) Recurrent morning stiffness
B) Sudden onset fever, joint swelling, and refusal to move the limb
Septic arthritis presents with fever, joint pain, warmth, swelling, and pseudoparalysis.
134
Which laboratory findings are typically elevated in septic arthritis?
A) Low WBC, low ESR/CRP | B) High WBC, ESR, and CRP | C) Anemia and thrombocytopenia | D) Normal labs
B) High WBC, ESR, and CRP
Inflammatory markers (WBC, ESR, CRP) are usually elevated in septic arthritis.
135
Which imaging modality is most useful for early detection of joint effusion?
A) X-ray | B) CT scan | C) MRI | D) Ultrasound
D) Ultrasound
Ultrasound is sensitive for detecting joint effusion, especially in deep joints like the hip.
136
What is the gold standard for diagnosis of septic arthritis?
A) Blood culture | B) Synovial fluid aspiration and analysis | C) X-ray | D) Clinical examination
B) Synovial fluid aspiration and analysis
Definitive diagnosis is made by aspirating joint fluid for Gram stain, culture, and analysis.
137
What is the initial step in management of suspected septic arthritis?
A) Immediate joint immobilization | B) Empiric IV antibiotics and joint aspiration | C) Oral antibiotics | D) NSAIDs only
B) Empiric IV antibiotics and joint aspiration
Prompt initiation of IV antibiotics and aspiration is critical to prevent joint damage.
138
Which of the following increases the risk of septic arthritis in children?
A) Cystic fibrosis | B) Sickle cell disease | C) Juvenile idiopathic arthritis | D) All of the above
D) All of the above
Conditions like sickle cell disease and JIA predispose children to joint infections.
139
How should antibiotics be administered in initial septic arthritis treatment?
A) Oral antibiotics | B) Intramuscular antibiotics | C) Intravenous antibiotics | D) Subcutaneous antibiotics
C) Intravenous antibiotics
IV antibiotics are the standard initial route to ensure adequate joint tissue levels.
140
Which complication can occur if septic arthritis is not treated promptly?
A) Bone overgrowth | B) Chondrolysis and joint destruction | C) Joint laxity | D) Muscle hypertrophy
B) Chondrolysis and joint destruction
Delayed treatment may lead to permanent cartilage damage and joint deformity.
141
What is the most common causative organism of acute hematogenous osteomyelitis in children?
A) Streptococcus pyogenes | B) Staphylococcus aureus | C) Escherichia coli | D) Pseudomonas aeruginosa
B) Staphylococcus aureus
Staphylococcus aureus is the most frequent cause of osteomyelitis in children.
142
Which bone is most commonly affected in pediatric osteomyelitis?
A) Femur | B) Radius | C) Ulna | D) Skull
A) Femur
Long bones, especially the femur and tibia, are most often involved.
143
What is the typical route of infection in acute osteomyelitis in children?
A) Direct inoculation | B) Lymphatic spread | C) Hematogenous spread | D) Local extension
C) Hematogenous spread
In children, osteomyelitis commonly results from hematogenous seeding of the bone.
144
Which clinical feature is most characteristic of acute osteomyelitis?
A) Gradual onset of scoliosis | B) Acute pain and fever with localized tenderness | C) High-pitched cry | D) Limp without pain
B) Acute pain and fever with localized tenderness
Fever, pain, swelling, and tenderness over a bone are key signs of acute osteomyelitis.
145
Which laboratory markers are elevated in osteomyelitis?
A) ESR and CRP | B) Hemoglobin and platelet | C) AST and ALT | D) Calcium and phosphate
A) ESR and CRP
ESR and CRP are typically elevated and help in diagnosis and monitoring response.
146
Which imaging modality is most sensitive in early detection of osteomyelitis?
A) X-ray | B) Ultrasound | C) CT scan | D) MRI
D) MRI
MRI detects bone marrow edema and early inflammation before X-ray changes appear.
147
What is the gold standard for diagnosis of osteomyelitis?
A) Blood culture only | B) Bone biopsy and culture | C) Bone scan | D) ESR >100
B) Bone biopsy and culture
Bone biopsy and culture provide definitive diagnosis and guide antibiotic selection.
148
Which blood investigation can guide targeted antibiotic therapy?
A) ESR | B) CRP | C) WBC count | D) Blood culture
D) Blood culture
Blood cultures may identify the causative organism in up to 50% of cases.
149
What is the typical duration of intravenous antibiotic therapy in uncomplicated osteomyelitis?
A) 2–3 days | B) 5–7 days | C) 1–2 weeks | D) 3–4 weeks
D) 3–4 weeks
Treatment typically includes IV antibiotics for 3–4 weeks depending on response.
150
Which of the following is a complication of untreated or poorly managed osteomyelitis?
A) Muscle atrophy | B) Growth arrest and chronic infection | C) Skin blistering | D) Tendon rupture
B) Growth arrest and chronic infection
Delayed or untreated osteomyelitis can result in chronic infection or growth disturbances.
151
What is the most common type of clubfoot?
A) Positional | B) Neuromuscular | C) Syndromic | D) Idiopathic
D) Idiopathic
Idiopathic clubfoot is the most common and occurs without underlying syndromes.
152
Which of the following is a component of the clubfoot deformity?
A) Valgus heel | B) Forefoot adduction | C) Knee hyperextension | D) Foot eversion
B) Forefoot adduction
Forefoot adduction is a core component of the CTEV deformity.
153
What is the most common cause of idiopathic clubfoot?
A) Genetic mutation | B) Abnormal intrauterine position | C) Unknown multifactorial etiology | D) Neurological injury
C) Unknown multifactorial etiology
Idiopathic clubfoot likely results from multifactorial genetic and environmental causes.
154
What is the first-line treatment for idiopathic clubfoot?
A) Surgery at birth | B) Bracing | C) Serial casting using Ponseti method | D) Observation only
C) Serial casting using Ponseti method
The Ponseti method, involving serial manipulation and casting, is the standard of care.
155
What is the goal of the Ponseti method?
A) Pain control | B) Achieve painless plantigrade foot | C) Prevent relapse only | D) Delay surgery
B) Achieve painless plantigrade foot
The aim is a functional, plantigrade, and pain-free foot with minimal surgery.
156
Which tendon is commonly released or lengthened during clubfoot correction?
A) Tibialis anterior | B) Achilles tendon | C) Peroneus brevis | D) Flexor digitorum longus
B) Achilles tendon
Achilles tendon tenotomy is frequently required to correct the equinus deformity.
157
What is the best time to initiate treatment for clubfoot?
A) After 1 year | B) Within first month of life | C) At 6 months | D) After walking begins
B) Within first month of life
Early treatment within the first month yields best results and prevents stiffness.
158
Which of the following is NOT a component of the CAVE acronym used in Ponseti technique?
A) Cavus | B) Adduction | C) Valgus | D) Equinus
C) Valgus
Valgus is not a component; the deformity includes Cavus, Adduction, Varus, and Equinus.
159
What is the typical sequence of correction in the Ponseti method?
A) Correct equinus first | B) Correct cavus last | C) Correct deformities in a set order | D) Surgery followed by casting
C) Correct deformities in a set order
Ponseti method corrects deformities in a specific sequence: cavus → adduction → varus → equinus.
160
What is the role of the Denis-Browne bar after Ponseti casting?
A) To maintain foot in corrected position | B) To allow walking | C) To reduce pain | D) To assist foot growth
A) To maintain foot in corrected position
The Denis-Browne bar maintains correction and prevents recurrence, especially in early years.
161
What is the most common type of scoliosis in children?
A) Congenital | B) Neuromuscular | C) Idiopathic | D) Post-traumatic
C) Idiopathic
Idiopathic scoliosis, especially adolescent-onset, is the most common type.
162
Which tool is used to measure the degree of scoliosis on an X-ray?
A) Cobb angle | B) Risser sign | C) Nash-Moe grading | D) Apgar score
A) Cobb angle
Cobb angle is the standard method for measuring scoliosis severity.
163
What is the threshold Cobb angle for diagnosing scoliosis?
A) 5° | B) 7° | C) 10° | D) 15°
C) 10°
A Cobb angle ≥10° defines scoliosis radiologically.
164
What is the most common curve pattern in adolescent idiopathic scoliosis?
A) Left thoracic | B) Right thoracic | C) Left lumbar | D) Double curve
B) Right thoracic
The right thoracic curve is the most typical pattern in idiopathic scoliosis.
165
Which of the following is a red flag for non-idiopathic scoliosis?
A) Right thoracic curve | B) Pain with curve | C) Shoulder asymmetry | D) Uneven waist
B) Pain with curve
Pain, neurological symptoms, or early onset may indicate non-idiopathic causes.
166
What is the mainstay of treatment for idiopathic scoliosis with Cobb angle between 25–40°?
A) Observation | B) Physical therapy only | C) Bracing | D) Surgery
C) Bracing
Bracing is recommended for curves between 25–40° in growing children.
167
What physical sign is typically seen on forward bend test in scoliosis?
A) Winged scapula | B) Thoracic hump | C) Absent deep tendon reflex | D) Straight spine
B) Thoracic hump
The rib or thoracic hump on bending forward indicates spinal rotation.
168
At what Cobb angle is surgical correction typically considered?
A) >20° | B) >30° | C) >40° | D) >60°
C) >40°
Surgery is usually recommended for progressive curves >40° in growing children.
169
What is the most appropriate initial imaging for scoliosis evaluation?
A) MRI | B) CT | C) Standing spinal X-ray | D) Bone scan
C) Standing spinal X-ray
Standing AP/lateral spinal X-ray is the standard initial assessment tool.
170
Which gender has a higher risk of progression in adolescent idiopathic scoliosis?
A) Boys | B) Girls | C) Equal risk | D) Risk unrelated to gender
B) Girls
Girls are more likely to have progressive idiopathic scoliosis requiring treatment.
171
What is the most common malignant bone tumor in children?
A) Osteosarcoma | B) Ewing sarcoma | C) Chondrosarcoma | D) Fibrosarcoma
A) Osteosarcoma
Osteosarcoma is the most common primary malignant bone tumor in children and adolescents.
172
Which benign bone tumor presents with pain relieved by NSAIDs?
A) Osteoblastoma | B) Osteoid osteoma | C) Non-ossifying fibroma | D) Osteochondroma
B) Osteoid osteoma
Osteoid osteoma causes localized pain that dramatically improves with NSAIDs.
173
What is the typical age of onset for Ewing sarcoma?
A) <5 years | B) 5–10 years | C) 10–20 years | D) >20 years
C) 10–20 years
Ewing sarcoma typically presents during adolescence, often around age 10–20.
174
Which tumor has a characteristic sunburst pattern on X-ray?
A) Ewing sarcoma | B) Chondrosarcoma | C) Osteosarcoma | D) Osteoid osteoma
C) Osteosarcoma
Osteosarcoma shows a sunburst periosteal reaction due to rapid bone formation.
175
Which bone tumor is associated with t(11;22) translocation?
A) Osteosarcoma | B) Chondrosarcoma | C) Ewing sarcoma | D) Fibrous dysplasia
C) Ewing sarcoma
Ewing sarcoma is associated with the EWS-FLI1 fusion due to t(11;22) translocation.
176
What is a common site for osteosarcoma?
A) Skull | B) Spine | C) Pelvis | D) Metaphysis of long bones
D) Metaphysis of long bones
Osteosarcoma commonly affects metaphyseal regions of femur, tibia, and humerus.
177
What is Codman’s triangle in bone tumors?
A) Inflammatory node | B) Subperiosteal abscess | C) Raised periosteum with tumor spread | D) Benign osteoma
C) Raised periosteum with tumor spread
Codman's triangle is a periosteal elevation seen in aggressive bone lesions like osteosarcoma.
178
Which tumor shows onion-skin periosteal reaction on imaging?
A) Osteosarcoma | B) Osteoblastoma | C) Ewing sarcoma | D) Giant cell tumor
C) Ewing sarcoma
Ewing sarcoma shows onion-skin or layered periosteal reaction due to rapid growth.
179
Which is the most common benign bone tumor in children?
A) Osteochondroma | B) Aneurysmal bone cyst | C) Fibrous dysplasia | D) Osteoblastoma
A) Osteochondroma
Osteochondroma is the most common benign bone tumor in children, usually asymptomatic.
180
What is the mainstay of treatment for localized osteosarcoma?
A) Chemotherapy alone | B) Radiation therapy | C) Surgery with chemotherapy | D) Observation only
C) Surgery with chemotherapy
Osteosarcoma treatment involves limb-sparing surgery combined with multi-agent chemotherapy.
