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Juvenile idiopathic arthritis — USMLE Step 2 CK MCQ

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ModeratePediatricsJuvenile idiopathic arthritisUSMLE Step 2 CK

A 9-year-old Hispanic girl comes to the pediatric clinic because of new symptoms noticed by a caregiver. History and focused examination are notable for persistent swollen knee, morning stiffness, and limp for more than six weeks. Temperature is 100.6°F (38.1°C), blood pressure is age appropriate, pulse is 128/min, respirations are 32/min, and oxygen saturation is 96% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Growth parameters, hydration status, and focused testing are consistent with the described pediatric presentation. Which of the following is the most appropriate next step in management?

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Correct answer: E — NSAID therapy and rheumatology referral

The vignette describes Juvenile idiopathic arthritis, supported by persistent swollen knee, morning stiffness, and limp for more than six weeks. NSAID therapy and rheumatology referral is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: American College of Rheumatology JIA Guideline