You are discussing with the medical students the role of systemic steroids for the management of rheumatologic diseases. Your discussion should include all the following statements EXCEPT

Correct Answer: D

Rationale: The correct answer is D) they prevent joint destruction. This statement is incorrect because systemic steroids are not primarily used to prevent joint destruction in rheumatologic diseases. Systemic steroids are potent anti-inflammatory medications that are often used for the management of severe systemic illnesses and as bridge therapy while waiting for the therapeutic effects of disease-modifying anti-rheumatic drugs (DMARDs) to take effect. They are also effective for controlling conditions like uveitis, which is inflammation of the eye. In an educational context, it is crucial for medical students to understand the appropriate use of systemic steroids in the treatment of rheumatologic diseases. While steroids can provide quick relief of symptoms and control inflammation in the short term, they are not considered first-line agents for preventing joint destruction in conditions like rheumatoid arthritis. Emphasizing the role of DMARDs in disease modification and long-term management is essential to prevent complications and improve patient outcomes in rheumatologic conditions.

Correct Answer: D

Rationale: In treating juvenile dermatomyositis (JDM), a comprehensive approach combining pharmacological and non-pharmacological therapies is essential. The correct answer, D) bed rest, is the least appropriate non-pharmacological treatment for JDM. Bed rest may lead to muscle weakness and atrophy, exacerbating the symptoms of JDM. A) Physical therapy and B) occupational therapy are crucial components of the non-pharmacological treatment plan for JDM. Physical therapy helps maintain muscle strength and flexibility, while occupational therapy focuses on improving daily functioning. C) Avoidance of sun exposure is also important in managing JDM as sunlight can exacerbate skin rashes and potentially trigger disease flares. Educationally, understanding the rationale behind each non-pharmacological treatment option in JDM is vital for nurses and healthcare professionals caring for pediatric patients. This knowledge helps in providing holistic care and improving patient outcomes.

Correct Answer: A

Rationale: In juvenile idiopathic arthritis (JIA), AA amyloidosis is a serious complication that can arise due to chronic inflammation. The subtype of JIA with the highest prevalence of AA amyloidosis is systemic JIA. This is because systemic JIA is characterized by systemic inflammation involving multiple organs, especially the liver and spleen. The chronic systemic inflammation in systemic JIA can lead to the production of amyloid A protein, which can accumulate in various tissues, causing AA amyloidosis. Oligoarticular JIA is characterized by arthritis affecting fewer than five joints, and it typically has a milder course compared to systemic JIA. Polyarticular JIA involves arthritis affecting five or more joints, but it is less likely to lead to systemic inflammation and AA amyloidosis compared to systemic JIA. Psoriatic arthritis is a form of arthritis associated with psoriasis and is not typically associated with the development of AA amyloidosis. Understanding the different subtypes of JIA and their associated complications is crucial for healthcare providers caring for pediatric patients with arthritis. Recognizing the increased risk of AA amyloidosis in systemic JIA highlights the importance of early detection, monitoring, and appropriate management to prevent this serious complication. This knowledge is essential for nurses, nurse practitioners, and other healthcare professionals working with pediatric patients to provide comprehensive and effective care for children with JIA.

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.

Correct Answer: D

Rationale: In this scenario, the most helpful study to support the suspicion of child abuse in a 3-month-old baby with a severe head injury is a radionuclide bone scan (Option D). This is because a radionuclide bone scan can help identify occult fractures that may not be evident on plain X-rays. Option A, infantogram, is not the most appropriate choice as it provides a general overview of the entire body but may miss subtle fractures. Option B, X-rays of the spine, is not the most helpful study in this context as the primary concern is the head injury. Option C, X-rays of the skull, may show obvious fractures but can miss subtle or occult injuries that a radionuclide bone scan can reveal. Educationally, understanding the importance of selecting the most appropriate diagnostic study in cases of suspected child abuse is crucial for healthcare providers working with pediatric patients. Recognizing the limitations of certain imaging modalities and knowing when to utilize more sensitive tests like a radionuclide bone scan can aid in the accurate diagnosis and appropriate management of cases involving child abuse.