Rheumatology – Prometric Style Questions, Set 2

What this deck covers

Rheumatology – Prometric Style Questions, Set 2 in 50 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for board, MRCPCH and Prometric examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 50 cases, in order

1. Four months of collarbone pain
2. Are other bones involved?
3. Only one bone involved
4. A vertebra losing height
5. Blisters on palms and soles
6. Five days after a sore throat
7. A knee and a sore heel
8. Sore hands after his rash
9. A third course of antibiotics
10. Eight weeks, still swollen
11. Four swellings in two years
12. Puffy hands in the cold
13. Which test supports it?
14. Two specialists, no label
15. One side firm for months
16. Fevers despite two drugs
17. A coin-sized red patch
18. It worked, then stopped
19. Numb leg, blurred eye
20. An operation on her foot
21. Back pain and lost height
22. Density scan on its own
23. Protecting her bones
24. What to record each visit
25. Weaker while the rash fades
26. A bedsheet is too much
27. Everything has been normal
28. Splint, crutches, and worse
29. Four months of opioids
30. Two months out of school
31. Swollen, or not swollen?
32. Buttock pain, normal films
33. A wrist that will not bend
34. A scan in a well child
35. Her mouth opens less
36. A new drug, and a boyfriend
37. Hoping for a baby next year
38. When is it safest?
39. Asking for the pill
40. Two flares, few prescriptions
41. Exhausted, but the tests are fine
42. Taken out of all sport
43. Letters about attendance
44. No friends, no hobbies
45. A cure they read about
46. Better sitting forward
47. Breathless, and anaemic
48. Small lungs on the film
49. Quiet disease, and smoking
50. Pain with no surgical cause

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: Sterile inflammation of the bone, A longer course of the same anti-inflammatory drug, Arthritis reacting to the gut infection, As slow recovery from the virus, An antibody against double stranded DNA, A drug blocking an interleukin, Stop the drug and investigate urgently, Imaging of the spine from the side, A disease flare, Physiotherapy with desensitisation, A plain radiograph, Continue as she is, Review when she conceives, See her without her mother present.

Clinical pearls from this deck

• Negative cultures and failed antibiotics are not a treatment failure. They are the diagnosis telling you what it is.
• Do not ask him where it hurts. Most of the lesions that would confirm this are ones he cannot feel.
• Many lesions are reassuring. One lesion is not, and that is the reverse of how it feels.
• Walking normally is not reassurance here. The vertebra collapses long before anything neurological happens.
• Look at the palms and soles before you call this idiopathic. The skin often explains the bones.
• Time it from the sore throat. Under ten days, additive, and unmoved by anti-inflammatories is a different disease from the one you are thinking of.

Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.

More from this system: all Rheumatology case decks · pediatric reference values.