Paediatric Rheumatology MCQs

Handedness: dominance of one hand over the other for performing tasks or activities. It is established in children at around 3 years. key takeaways : Bidextrous grasp -4 months Unidextrous grasp-6 months Palmar grasp-7 months Pincer grasp (immature)-9month Pincer grasp (mature)-12month Handedness-3 years Reference: Nelson textbook of paediatric

If two live vaccines cannot be given together, there should be a gap of at least 1 month (or 4 weeks) to ensure that the antibodies developed from the first vaccine do not interfere with the effectiveness of the second vaccine. Key takeaways:- -There is no need to keep a gap of 1 month between a live vaccine and a killed (inactivated) vaccine. They can be given at the same time or at different intervals -All live vaccines are contraindicated in pregnancy & immunocompromised except During outbreaks &travel (YF,OPV,Cholera) & bite case (rabies) -If two live vaccines are given together, they should be administered at different injection sites. ref :Nelson textbook of paediatric

The most common tumor types are Carcinoid inflammatory myofibroblastic tumor pleuropulmonary blastoma Rare pediatric lung tumors include small cell carcinoma adenocarcinoma pulmonary capillary hemangiomatosis KEY TAKEAWAYS: The most common pulmonary tumor in children is carcinoid tumor. Tags: Topic: SOLID TUMORS Difficulty level: MUST KNOW PYQ: FMGE JULY 2023 Reference: Nelson textbook of paediatrics, 21 st ed, page number: 2316

In KD Patients, large or giant coronary artery aneurysms are responsible for most of the morbidity and mortality. Large or giant aneurysms have been defined by the 2017 American Heart Association (AHA) as having a z score ≥10 or an absolute dimension of ≥8 mm. Japanese Classification of Aneurysms in KD Small: ≤4 mm internal diameter [ID]) Medium (>4 to ≤8 mm ID) Giant (>8 mm ID). Specifically, large or giant aneurysms are associated with the greatest risk of thrombosis or stenosis, angina, and myocardial infarction. Rupture of a giant aneurysm is a rare complication that generally occurs in the 1st months after illness onset and may present as hemopericardium with tamponade. Axillary, popliteal, iliac, or other arteries may also become aneurysmal, but always in the setting of giant coronary aneurysms. Reference: Nelson 21 st Edition, Chapter 191

The likely condition is Kawasaki Disease. Exact cause is unknown. Considered to be a T-cell mediated disease More common in Japanese population Young children more affected, with peak age of 18-24 months Males are more commonly affected than females Anti-Endothelial cell antibodies are positive in many patients, although they are not implicated directly in the disease pathogenesis Genes implicated in Kawasaki disease include ITPKC, CASP-3. Reference : Nelson 21 st Edition, Chapter 191

Most common complication associated with KD is Myocarditis . It might be asymptomatic or present with congestive cardiac failure. Most common cause of death is Thrombosis of Coronary artery aneurysm (CAA). Other complications include: Kawasaki disease shock syndrome Mitral regurgitation Asymptomatic pericardial effusion KEY TAKEAWAYS: Myocarditis, or inflammation of the heart muscle, is a recognized complication of Kawasaki disease. It occurs due to the widespread inflammation in blood vessels and heart tissue that characterizes the disease. Myocarditis in Kawasaki disease can lead to symptoms such as rapid or irregular heartbeat, chest pain, fatigue, and in severe cases, heart failure. Tags: Topic: KAWASAKI DISEASE Difficulty level: MUST KNOW PYQ: INICET MAY 2024 Reference: Nelson textbook of pediatrics, 21 st ed., pg. 1510

Kawasaki Disease (KD) is an acute febrile mucocutaneous lymph node syndrome mainly affecting infants and young children. Cervical Lymph Nodes, NOT axillary LN are involved in Kawasaki Disease Cervical LNs are most commonly unilateral, with at least one node >1.5 cm. Other options are correct. Reference : OP Ghai 10 th Ed, Page 658

Arthralgia is pain in the joints when trying to use them in active or passive movement. This occurs in SLE, JRA and JD, as well as in other, non-rheumatic, conditions. Weakness is mainly associated with dermatomyositis, but not a feature of JIA Malar rashes are seen with SLE and photosensitive dermatitis. Chest pain from pericarditis is seen with SLE and JRA. Reference: Nelson textbook of pediatrics, 1 st SA edition, pg. 1204