PEDIATRIC RHEUMATOLOGY
JEOPARDY
1. A pudgy eleven year old boy develops
severe left hip pain and the next morning cannot walk. The joint exam is abnormal
with decreased rotation of both hips with pain especially noticeable upon exam
in the left hip. The radiographs of the hips are diagnostic. What is ______?
2. A six year boy is noted to gradually
have a patch of hard skin over his right shin. Over one year it extends down to
his foot. The
3. A three year girl is brought to your
clinic with a history of 9 weeks of swelling of the left knee. Her father
carries her down the stairs in the morning. No fever or rash noted. On your
exam the knee is 3+ swollen and she will not fully extend the knee. What is
______?
4. An eleven year old complains of arm
and leg pain after exercise. Your physical exam notes her ability to
hyperextend both elbows and knees, put her thumbs to her forearms, and get her
5th digit parallel to forearm. She entertains her friends at
sleepovers with her ability to place her feet way over her head. She does not
dislocate, bruise easily, or show loose skin. What is ______?
5. A two year old refuses to walk or
sit up. She holds her back straight. The exam of her legs is normal. Her
6. A three old has swollen knees,
ankles, fingers, and wrists for 6 months before she is referred to you. There
has been no rash, fevers, nodules, or eye problems. She has major limitations
in these joints in your joint exam. Her blood work reveals a hemoglobin of 9.2
g%, a platelet count of 550,000 cells/mm3, a sedimentation rate (
7. An eight year limps for one month
and complains of mild knee pain. His right knee is mildly swollen and he is
knock-kneed on that side. His
8. A seven year old develops a very
painful ankle. Three days later her ankle is better but her right knee is now
painful and swollen. One week later her elbow is painful. She runs low grade
fevers. Her
9. A sixteen year teen complains of
morning stiffness in her fingers. Your exam detects swollen PIP finger joints
on both hands. Her
10. A two year old is hospitalized for
fevers for ten days. The fever is up to 39.5 C once to twice a day. The fever
persists in the hospital for three more weeks despite antibiotics and the
infectious disease and oncologic workup is negative. The
11. A seventeen year old is missing
school in her senior year of high school. She complains of pain all over and
feeling tired each morning and during the day. She is sleeping poorly. Your
physical exam reveals tender points >16. The lab screening tests are normal.
What is ______?
12. A thirteen year old referred to you
for swelling in her fingers. You note red ulcers on her palate and red spots on
her palms as well as the swollen PIP joints. Her
13. An eight year old is waking at night
with arm and hip pain. Some mornings she cannot walk. Your physical exam is
normal. Your lab work reveals a hemoglobin of 10 g%, WBC 4500 cells/mm3,
platelets of 205,000 cells/mm3, an
14. A five year old limps on a swollen
ankle and has a low grade fever. He complains of a stomachache. A day later his
mother notices a red, purplish rash on his buttocks and legs. His hands are now
swollen. His mother brings him in to see you and the child is crying with
abdominal pain. What is ______?
15. A six year stops riding his bike. He
can’t keep up with his friends for the first time. His pediatrician notes a
psoriatic-like rash on the boy’s knuckles. On your exam his neck flexors, lower
and upper abdominals, deltoids, and quad muscles are in the fair range of
strength (3/5). His
16. You are called to the emergency room
to see a three year old who has been limping for one day. He has a fresh
17. A seven year boy has had left hip
pain for three weeks and is on crutches. His hip is limited on joint exam. The
18. A two year is admitted for high
fever for six days unresponsive to oral antibiotics. The child’s mother notes
that he had a rash on his abdomen and chest on the second day of the illness.
You note a red tongue and pharynx upon admission. A colleague notes
conjunctival injection on day #2 of hospitalization. The hands are swollen on
hospital day #3. The WBC is 22,000 cells/mm3, the hemoglobin 9.5 g%, platelets
440,000 cells/mm3, and
19. A nine year girl begins to limp
favoring her left knee. Your exam reveals a swollen right knee, a limited left
elbow, a swollen right 4th PIP finger joint, and a swollen second
left toe. The family history is negative except for an aunt with eczema. The
20. A seven year old has trouble writing
in school. Your exam notes very swollen PIP finger joints, knees, and ankles.
You find a papular rash on her thighs. Your eye physician detects iritis. What
is ______?
21. A four year old boy is noticed by
his parents to fall easily and frequently. His teachers believe that he is
becoming more clumsy. No recent viral disease or trauma.Your exam reveals
decreased proximal muscle strength and large calves. There is no rash. His
22. A thirteen year old comes into your
clinic in a wheelchair with a swollen, cool, painful right foot for four weeks.
The teen dates the problem starting just after a minor trauma to the right
ankle. You note exquisite tenderness of the right foot, ankle and lower calf to
light touch as well as coolness and a blue coloration to the foot. The teen is
a dancer and soccer player and is on the honor roll. What is _____?
23. A sixteen year with MCTD develops a
very painful left ankle suddenly one Saturday. She has a mild fever and cries
and cannot walk. In the ER she has a fever of 38.6 C, a very swollen right
ankle that is red, hot, and very painful. She screams if you try to range the
joint. She has a new boy friend but denies sexual activity. What is ______?
24. A twelve year old develops a swollen
knee that persists for 6 weeks. It resolves with ibuprofen. Laboratory testing
revealed an
25. A 14 year old is brought to you for
cold, blue hands. She is tired a lot and has heartburn frequently. You note the
cool handshake but also note a tight oral aperture and tight skin over her
hands and fingers. Her
26. A sixteen year girl complains of
shortness of breath and fatigue. Her hemoglobin is 8 g% and
27. An very large eleven year old
complains of painful feet and ankles for six months. Your exam reveals limited
ankles and subtalar joints. The lab work is normal. An
28. A thirteen year old is referred for
swollen fingers, ankles and a painful gait for four months. Your exam
demonstrates swollen ankles, ankles and knees with limited knees, ankles, and
subtalar joints. His heels are very tender. His
29. A small five year old has complained
of leg and arm pains for two years with joint stiffness. Your physical exam
reveals prominent bony ankles and wrists with mildly decreased wrist, knee, and
ankle range of motion. The PIP’s are enlarged. Labs are normal. Radiographs
show short metacarpals and terminal phalanges as well as flattening of the hip
joints. What is ______ ?
30.
A three year old is referred to you for knee and elbow arthritis for 5
months. He improves on naproxen but his arthritis waxes and wanes. He does OK
until age 8 when he develops shortness of breath with an infiltrate on chest
radiograph and grows H. Influeneza type f from his blood. You order a test.
What is _____?
Please send
your best answers to Linda Wagner-Weiner at lww@uchicago.edu.