Juvenile idiopathic arthritis has many subtypes. Arthritis must be present to make a diagnosis of any subtype; involved joints oftenly have the following signs EXCEPT

Correct Answer: C

Rationale: In the context of juvenile idiopathic arthritis (JIA), the correct answer is C) erythema. Erythema, or redness of the skin overlying the affected joints, is not a common sign associated with JIA. The presence of swelling, warmth, and limitation of movement are typical manifestations of arthritis in JIA. Swelling is a key indicator of inflammation in the joint, warmth is a sign of increased blood flow and inflammation, and limitation of movement is a result of joint inflammation and pain. These signs are commonly seen in various subtypes of JIA and are important clinical markers for diagnosis and monitoring of the condition. Educationally, understanding the typical signs and symptoms of JIA is crucial for healthcare providers working with pediatric patients. Recognizing these signs can lead to early detection, proper management, and improved outcomes for children with JIA. By knowing the distinguishing features of JIA, healthcare professionals can provide timely and effective care for pediatric patients with this condition.

Correct Answer: D

Rationale: In a 4-year-old boy suspected of having transient synovitis, the best therapeutic approach is option D, antibiotics. Transient synovitis is a self-limiting condition characterized by hip pain and limping in young children. It is typically caused by a viral infection and does not require invasive treatment. Antibiotics are not indicated because transient synovitis is not bacterial in nature. Option A, methotrexate, is a medication used in conditions like juvenile idiopathic arthritis but is not appropriate for transient synovitis. Option B, aspiration of joint fluid, is invasive and unnecessary for a self-limiting condition like transient synovitis. Option C, observation, is the most appropriate approach for this condition as it resolves on its own without specific treatment. From an educational perspective, understanding the appropriate management of common pediatric conditions like transient synovitis is crucial for healthcare providers working with children. It helps in avoiding unnecessary procedures, reducing healthcare costs, and ensuring optimal care for pediatric patients. Educating healthcare professionals on evidence-based practices for pediatric conditions improves patient outcomes and enhances the quality of care provided.

Correct Answer: D

Rationale: In the treatment of juvenile dermatomyositis (JDM), a comprehensive approach involving both pharmacological and non-pharmacological therapies is essential. The correct answer, D) bed rest, is the least appropriate non-pharmacological treatment program for JDM because maintaining mobility and activity is crucial in managing the condition. Physical therapy (option A) is an essential component of the non-pharmacological treatment program for JDM as it helps improve muscle strength, flexibility, and function. Occupational therapy (option B) is also important in helping children with JDM participate in daily activities and maintain independence. Avoidance of sun exposure (option C) is crucial in managing JDM as sunlight can exacerbate skin rashes and muscle weakness in these patients. On the other hand, bed rest can lead to muscle weakness, joint stiffness, and a decline in overall physical function, which are counterproductive in the management of JDM. Educationally, understanding the rationale behind each treatment option is crucial for healthcare providers caring for children with JDM. By knowing the appropriate non-pharmacological interventions, providers can offer comprehensive care that addresses both the physical and functional aspects of the condition, ultimately improving the quality of life for these patients.

Correct Answer: A

Rationale: In the context of pediatric rheumatology, understanding the subtypes of juvenile idiopathic arthritis (JIA) and their associated complications is crucial. The correct answer is A) systemic JIA. AA amyloidosis is a serious complication that can occur in systemic JIA due to chronic inflammation. Systemic JIA is characterized by systemic symptoms such as fever, rash, and arthritis, and it has the highest risk for developing AA amyloidosis. Option B) oligoarticular JIA typically involves fewer than five joints and is less likely to lead to systemic complications like AA amyloidosis. Option C) polyarticular JIA affects five or more joints but is less commonly associated with AA amyloidosis compared to systemic JIA. Option D) psoriatic arthritis is a distinct subtype of JIA associated with psoriasis and usually does not have a high prevalence of AA amyloidosis. Educationally, knowing the association between systemic JIA and AA amyloidosis reinforces the importance of early recognition and aggressive treatment of this subtype to prevent serious long-term complications. Understanding the distinctions between JIA subtypes and their potential complications is essential for healthcare providers caring for pediatric patients with rheumatologic conditions.

Correct Answer: D

Rationale: The rationale is that tuberculin skin tests (TST) may give false-negative results immediately after arrival due to factors like recent travel stress or malnutrition. Therefore, repeating the test after 3-6 months ensures more accurate results. The other tests are generally required to be repeated for ongoing monitoring.