Rheumatology

???) In septic arthritis of the hip joint in infants, one of the following is not true:

Rapid destruction of the hip is the most striking feature

Staphylococcus aureus is now the predominant invader

A femoral venipuncture is a point of enter of the infecting microorganism

As a rule the baby is very ill with signs of general toxemia and high fever

Local examination may fail to reveal the true nature of the disease in its early stages especially if antibiotics had been given

Answer: 4* As a rule the baby is very ill with signs of general toxemia and high fever

***) A 3 years old presents to you with a two months history of spiky fever and refusal to walk. Physical examination revealed a sick looking child, painful movements of the extremities and splenomegaly. The most likely diagnosis is one of the following:

Rheumatic fever

Scurvy

Juvenile ankylosing spondilitis

Dermatomyositis

Juvenile rheumatoid arthritis

Answer: 5* Juvenile rheumatoid arthritis

1.    Henoch-Schonlein Purpura.

***) Regarding Henoch-Schonlein purpura, all are true except:

Is a vasculitis of small blood vessels

Is the most common cause of non-thrombocytopenic purpura

Typically follow upper respiratory tract infection.

Most cases occur between 2-8 years of age

Platelets function is abnormal

Answer: 5* Platelets function is normal, but counts less than normal.

2.    Kawasaki Disease.

???) Concerning Kawasaki disease, all the following are true except:

Patients are more than 7 years old

Fever is present in all cases for over 5 days and does not respond to antibiotics

Coronary artery aneurysms develop during the second week of illness

Rash: truncal, polymorphous, non-vesicular

Bilateral conjunctival injection, injected pharynx, strawberry tongue

Answer:  1* Patients are more than 7 years old

???) Regarding Kawasaki, all statements are true except:

Age of onset is less than 5 years

High grade fever more than 5 days is essential criteria

Is the commonest cause of acquired cardiac disease in developing countries

20% of untreated patients develop coronary artery abnormalities

Has differential diagnosis with scarlet fever

Answer: 3* Is the commonest cause of acquired cardiac disease in developing countries

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***) Gamma-globulin may be used in the management of children with all of the following conditions, except:

Premature baby with sepsis

Child with X-linked agammaglobulinemia

Child with recurrent infection due to IgA deficiency

Measles prophylaxis in a susceptible child

Hepatitis A prophylaxis in a susceptible child

Answer: 3* Child with recurrent infection due to IgA deficiency