LATEST PEDIATRIC RHEUMATOLOGY
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PEDIATRICS |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 12-year-old girl presents with daily fevers lasting
2 weeks, a salmon-pink rash that appears with
fevers, arthritis in multiple joints, and sore throat.
Laboratory studies show WBC 25,000/µL, ESR 110
mm/hr, CRP 15 mg/dL, and ferritin 2,500 ng/mL.
Which of the following is the most likely diagnosis?
A) Systemic juvenile idiopathic arthritis
B) Acute rheumatic fever
C) Kawasaki disease
D) Systemic lupus erythematosus
Correct answer: A
Rationale: Systemic JIA (Still's disease) is
characterized by quotidian fevers, evanescent
salmon-pink rash, arthritis, and markedly elevated
ferritin levels. Acute rheumatic fever typically follows
streptococcal infection. Kawasaki disease presents
with conjunctivitis and mucocutaneous changes. SLE
typically presents with malar rash and specific
autoantibodies.
,2. A 7-year-old boy with oligoarticular JIA complains
of eye redness and photophobia. Slit-lamp
examination reveals anterior chamber cells. Which of
the following statements about this condition is
TRUE?
A) It is more common in boys with oligoarticular JIA
B) It is typically symptomatic in its early stages
C) ANA positivity is a risk factor for development
D) Topical corticosteroids are contraindicated
Correct answer: C
Rationale: Uveitis in JIA is strongly associated with
ANA positivity, female sex, and young age at disease
onset. It is typically asymptomatic in early stages,
making screening essential. Topical corticosteroids
are first-line treatment.
3. Which of the following medications used in
pediatric rheumatology requires routine monitoring
of complete blood count, liver function tests, and
creatinine due to risk of bone marrow suppression
and hepatotoxicity?
A) Hydroxychloroquine
B) Methotrexate
,C) Naproxen
D) Prednisone
Correct answer: B
Rationale: Methotrexate requires routine monitoring
of CBC, LFTs, and creatinine due to risks of
myelosuppression, hepatotoxicity, and renal
impairment. Hydroxychloroquine requires
ophthalmologic monitoring. Naproxen requires
monitoring for renal and GI side effects.
4. A 5-year-old boy presents with fever for 10 days,
bilateral conjunctival injection without exudate,
cervical lymphadenopathy, polymorphous rash, and
swelling of his hands and feet. Which diagnostic test
would be most helpful in confirming the suspected
diagnosis?
A) Anti-streptolysin O titer
B) Echocardiogram
C) Blood culture
D) Antinuclear antibody test
Correct answer: B
Rationale: The presentation is classic for Kawasaki
disease. Echocardiogram is critical to evaluate for
coronary artery aneurysms, which are the most
, serious complication. ASO is for rheumatic fever.
Blood cultures are typically negative in Kawasaki
disease.
5. A 15-year-old girl with systemic lupus
erythematosus develops new-onset seizures and
psychosis. Laboratory studies show normal CSF
findings and no metabolic abnormalities. Which of the
following is the most appropriate next step in
management?
A) Add aspirin for antiplatelet effect
B) Initiate high-dose intravenous methylprednisolone
C) Start phenytoin alone
D) Increase hydroxychloroquine dose
Correct answer: B
Rationale: Severe neuropsychiatric SLE (seizures or
psychosis) requires high-dose corticosteroids for
disease control. Aspirin or hydroxychloroquine alone
is insufficient. Anticonvulsants may be adjunctive but
do not treat the underlying inflammation.
6. Which of the following autoantibodies is most
specific for the diagnosis of systemic lupus
erythematosus in a child with compatible clinical
features?
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PEDIATRICS |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 12-year-old girl presents with daily fevers lasting
2 weeks, a salmon-pink rash that appears with
fevers, arthritis in multiple joints, and sore throat.
Laboratory studies show WBC 25,000/µL, ESR 110
mm/hr, CRP 15 mg/dL, and ferritin 2,500 ng/mL.
Which of the following is the most likely diagnosis?
A) Systemic juvenile idiopathic arthritis
B) Acute rheumatic fever
C) Kawasaki disease
D) Systemic lupus erythematosus
Correct answer: A
Rationale: Systemic JIA (Still's disease) is
characterized by quotidian fevers, evanescent
salmon-pink rash, arthritis, and markedly elevated
ferritin levels. Acute rheumatic fever typically follows
streptococcal infection. Kawasaki disease presents
with conjunctivitis and mucocutaneous changes. SLE
typically presents with malar rash and specific
autoantibodies.
,2. A 7-year-old boy with oligoarticular JIA complains
of eye redness and photophobia. Slit-lamp
examination reveals anterior chamber cells. Which of
the following statements about this condition is
TRUE?
A) It is more common in boys with oligoarticular JIA
B) It is typically symptomatic in its early stages
C) ANA positivity is a risk factor for development
D) Topical corticosteroids are contraindicated
Correct answer: C
Rationale: Uveitis in JIA is strongly associated with
ANA positivity, female sex, and young age at disease
onset. It is typically asymptomatic in early stages,
making screening essential. Topical corticosteroids
are first-line treatment.
3. Which of the following medications used in
pediatric rheumatology requires routine monitoring
of complete blood count, liver function tests, and
creatinine due to risk of bone marrow suppression
and hepatotoxicity?
A) Hydroxychloroquine
B) Methotrexate
,C) Naproxen
D) Prednisone
Correct answer: B
Rationale: Methotrexate requires routine monitoring
of CBC, LFTs, and creatinine due to risks of
myelosuppression, hepatotoxicity, and renal
impairment. Hydroxychloroquine requires
ophthalmologic monitoring. Naproxen requires
monitoring for renal and GI side effects.
4. A 5-year-old boy presents with fever for 10 days,
bilateral conjunctival injection without exudate,
cervical lymphadenopathy, polymorphous rash, and
swelling of his hands and feet. Which diagnostic test
would be most helpful in confirming the suspected
diagnosis?
A) Anti-streptolysin O titer
B) Echocardiogram
C) Blood culture
D) Antinuclear antibody test
Correct answer: B
Rationale: The presentation is classic for Kawasaki
disease. Echocardiogram is critical to evaluate for
coronary artery aneurysms, which are the most
, serious complication. ASO is for rheumatic fever.
Blood cultures are typically negative in Kawasaki
disease.
5. A 15-year-old girl with systemic lupus
erythematosus develops new-onset seizures and
psychosis. Laboratory studies show normal CSF
findings and no metabolic abnormalities. Which of the
following is the most appropriate next step in
management?
A) Add aspirin for antiplatelet effect
B) Initiate high-dose intravenous methylprednisolone
C) Start phenytoin alone
D) Increase hydroxychloroquine dose
Correct answer: B
Rationale: Severe neuropsychiatric SLE (seizures or
psychosis) requires high-dose corticosteroids for
disease control. Aspirin or hydroxychloroquine alone
is insufficient. Anticonvulsants may be adjunctive but
do not treat the underlying inflammation.
6. Which of the following autoantibodies is most
specific for the diagnosis of systemic lupus
erythematosus in a child with compatible clinical
features?
