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These 10 free Pediatric Rheumatology questions are organized by exam domain, so you can see how each part of the Certification in Pediatric Rheumatology blueprint is tested. Reveal the answer and explanation under each question.
An 18-year-old with childhood-onset systemic lupus erythematosus is seven weeks pregnant. Her disease has been clinically quiet for 18 months on hydroxychloroquine 200 mg daily. She weighs 54 kg, tolerates treatment, and has no retinal toxicity. She asks whether stopping the drug would better protect the fetus. How should her hydroxychloroquine regimen be handled?
Correct answer: D - Continue the current daily dose throughout pregnancy.
A 9-year-old with ANA-positive oligoarticular juvenile idiopathic arthritis has no active synovitis on methotrexate. Her chronic anterior uveitis has required prednisolone acetate 1% twice daily for five months; attempts to reduce the drops cause recurrent anterior chamber cells. Methotrexate has been optimized, adherence is reliable, and she has never received a biologic. Which agent is preferred as the first biologic for her ocular disease?
Correct answer: C - Adalimumab
At a surveillance visit, a 15-year-old with systemic lupus erythematosus feels well and has a blood pressure of 108/66 mm Hg. Serum creatinine remains 0.55 mg/dL. Two first-morning urine specimens, obtained two weeks apart and outside menstruation, have protein-to-creatinine ratios of 0.9 and 1.1 g/g. Urine cultures are negative. C3, C4, and anti-dsDNA levels are unchanged from her previous visit. What is the appropriate next diagnostic step?
Correct answer: A - Arrange a kidney biopsy despite the preserved kidney function.
A 13-year-old is reviewed eight weeks after Kawasaki disease. The largest coronary aneurysm has an internal diameter of 8.4 mm and a body-size-adjusted z score of 9.2. There is no intraluminal thrombus, active bleeding, or other contraindication to antithrombotic treatment. Which classification and thromboprophylaxis plan fit these measurements?
Correct answer: B - Large/giant aneurysm; combine low-dose aspirin with anticoagulation.
The muscle findings seem surprisingly mild in a 14-year-old with newly diagnosed juvenile dermatomyositis: strength is nearly normal and creatine kinase is 86 U/L (reference 30-170). In contrast, she has ulcerated Gottron papules, inflammatory arthritis, and a new dry cough. Chest CT demonstrates interstitial lung disease. This combination most strongly suggests which myositis-specific antibody?
Correct answer: D - Anti-MDA5
Over three months, a band of indurated skin on an 8-year-old's thigh has extended across the knee. Its advancing edge is violaceous, knee extension is becoming restricted, and MRI shows inflammation extending into the fascia. ESR and CRP are normal. The lesion is diagnosed as active linear localized scleroderma. What treatment best addresses the risk of permanent functional loss?
Correct answer: B - Weekly methotrexate with a systemic glucocorticoid induction course.
For two years, a 7-year-old has had abrupt febrile attacks every few weeks. Each lasts 24-48 hours and brings severe abdominal pain, sometimes with a swollen ankle. CRP rises during attacks and returns to normal between them; growth and interval examinations are normal. There is no associated pharyngitis, aphthous ulceration, periorbital edema, or prolonged migratory myalgia. Which diagnosis-treatment pairing best accounts for this pattern?
Correct answer: A - Familial Mediterranean fever; daily colchicine.
Eight weeks after a minor ankle sprain, a 13-year-old still uses crutches and cannot tolerate a sock touching the affected foot. The foot intermittently becomes cool and mottled. Examination shows diffuse allodynia without joint swelling, focal weakness, or a vascular deficit; inflammatory markers are normal and MRI shows no ongoing structural injury. Her family worries that walking will cause damage. Which initial strategy offers the best chance of restoring function?
Correct answer: B - Begin graded rehabilitation, desensitization, and psychological pain-management skills.
A previously healthy 12-year-old from a Lyme-endemic region has had intermittent, atraumatic knee swelling for four months. Conventional two-tier serum testing shows a positive screening immunoassay, a positive IgM immunoblot, and a negative IgG immunoblot. He has not received antibiotics or immunosuppressive therapy. How should these results affect the evaluation of his arthritis?
Correct answer: A - The isolated IgM result does not support late Lyme arthritis; investigate other causes.
A lateral spine radiograph obtained for new back pain in a 12-year-old receiving prolonged glucocorticoids for juvenile dermatomyositis confirms a vertebral compression fracture. There has been no trauma, and imaging shows no focal infection or tumor. DXA using pediatric reference values gives a lumbar-spine BMD z score of -1.4. How should the apparently reassuring DXA result be reconciled with the fracture?
Correct answer: C - Diagnose osteoporosis on the basis of the atraumatic vertebral fracture.
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