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Juvenile Dermatomyositis — RACP Paediatrics MCQ

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HardRheumatologyJuvenile DermatomyositisRACP Paediatrics

A 10-year-old with juvenile dermatomyositis has improving rash and CK after corticosteroids and methotrexate, but develops nasal speech, coughing with drinks and a weak cough. What is the priority response?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Urgently assess swallowing and respiration while escalating rheumatology treatment

Explanation lettering: B = shown as A · D = shown as B · A = shown as C · E = shown as D · C = shown as E

A is correct because dysphagia, nasal speech and weak cough are organ-threatening muscle manifestations requiring urgent aspiration and respiratory assessment plus specialist disease-control escalation. B incorrectly lets a biomarker override dangerous clinical weakness. C risks adrenal crisis and does not distinguish active myositis from steroid myopathy. D delays prevention until harm occurs. E may help cutaneous disease but does not address bulbar safety or adequate systemic control.

Reference: Australian Rheumatology Association, paediatric corticosteroid information: https://rheumatology.org.au/For-Patients/Paediatric-Medication-Information/N-Z/Steroids; SHARE recommendations for juvenile dermatomyositis: https://pmc.ncbi.nlm.nih.gov/articles/PMC5284351/