L6: Acute Rheumatic Fever (Pt 2) Flashcards
(56 cards)
1
Q
- In ARF
There are four groups of important clinical and laboratory findings ……..
A
- Five major manifestations.
- Six minor manifestations.
- Evidence of antecedent GABHS infection.
- Additional manifestations
2
Q
In ARF
- Major Criteria
A
3
Q
In ARF
- Minor Criteria
A
4
Q
In ARF
- Low-Risk Populations
A
5
Q
In ARF
- Moderate to High Risk Populations
A
They include children that are not clearly from a low-risk population
6
Q
In ARF
- Major Manifestations
A
7
Q
Arthritis in ARF
- Incidence
A
It is the most common manifestation of RF.
8
Q
Arthritis in ARF
- Site
A
- Usually affect large joints (Knees, elbows, ankles, wrists)
- Never affects: TMJ, cricoarytenoid, sternoclavicular joint, spines, fingers, toes
9
Q
Arthritis in ARF
- Characters
A
10
Q
Carditis in ARF
A
11
Q
Carditis in ARF
- Heart murmur of valvulitis
A
12
Q
Carditis in ARF
- Cardiomegaly on CXR
A
13
Q
Carditis in ARF
- Pericarditis
A
14
Q
Carditis in ARF
- Heart Failure
A
15
Q
SC Nodules in ARF
A
16
Q
SC Nodules in ARF
- Site
A
- Symmetrically, singly or in clusters, on the extensor surfaces of both large & small joints, over scalp, or along spine.
17
Q
SC Nodules in ARF
- Characters
A
- Hard, painless, nonpruritic, freely mobile & 0.2 - 2.0 cm in diameter
- They are not transient, lasting for weeks.
- They occur particularly in recurrences.
- Indicates severe attack, bad prognosis.
18
Q
Erythema Marginatum in ARF
A
19
Q
Erythema Marginatum in ARF
- Site
A
- Mainly on the trunk & inner proximal parts of the extremities (never on the face).
20
Q
Erythema Marginatum in ARF
- Charcaters
A
- Nonpruritic, erythematous, serpiginous or annular.
21
Q
Erythema Marginatum in ARF
- Course
A
- Disappear on exposure to cold
- Reappear after a hot shower or when the patient is covered with a warm blanket
22
Q
Sydenham’s Chorea in ARF
A
23
Q
Sydenham’s Chorea in ARF
- Sex
A
Female > Male
24
Q
Sydenham’s Chorea in ARF
- Age
A
6 - 12 years
25
Sydenham's Chorea in **ARF**
- Choreiform Movement
26
Choreiform Movement in **ARF**
- Characters
- Involuntary
- Abrupt, erratic
- Purposeless or quasi-purposive
- Non repetitive, non-rhythmic movement
27
Choreiform Movement in **ARF**
- Increased By
Voluntary activity & tension (stress)
28
Choreiform Movement in **ARF**
- Decreased By
Relaxation and sedation and disappearing in sleep
29
Choreiform Movement in **ARF**
- Disappears
During sleep
30
Choreiform Movement in **ARF**
- Site
31
Uncoordinated voluntary motor activity in **Rheumatic Sydenham's Chorea**
32
Uncoordinated voluntary motor activity in **Rheumatic Sydenham's Chorea**
- Gait
Disturbed "Legs are flung out or suddenly flex with arms flail about"
33
Uncoordinated voluntary motor activity in **Rheumatic Sydenham's Chorea**
- Speech
* Irregular
* Indistinct
* Jerky & staccato.
34
Uncoordinated voluntary motor activity in **Rheumatic Sydenham's Chorea**
- Fine Movement
* Impaired "as feeding, drinking, writing, buttoning & unbuttoning"
35
**Rheumatic Sydenham's Chorea**
- Muscle weakness & hypotonia
36
**Rheumatic Sydenham's Chorea**
- Emotional lability &/or instability
37
**Rheumatic Sydenham's Chorea**
- Difference Between Emotional Lability & Emotional Instability
38
**Rheumatic Sydenham's Chorea**
- Neurological Signs
39
Neurological Signs in **Rheumatic Sydenham's Chorea**
- Milkmaid Sign
Waxing & waning of hand grip as if milking the cow
- Due to irregular repetitive squeezes because of inability to sustain titanic contraction
40
Neurological Signs in **Rheumatic Sydenham's Chorea**
- Spoon "Dishing" Sign
Spooning of the extended hands with:
1. Flexion of the wrists
2. Hyperextension of the metacarpo-phalangeal joints"
41
Neurological Signs in **Rheumatic Sydenham's Chorea**
- Pronator Sign
Arms & palms turn outward when held above the head
42
Neurological Signs in **Rheumatic Sydenham's Chorea**
- Abnormal Knee Jerk
**Pendular knee jerk:**
- Concomitant rhythmic contraction of quadriceps ms.
**Hung-up knee jerk:**
- Sustained contraction of quadriceps ms. "with slow return to the pre-stimulus level".
43
Neurological Signs in **Rheumatic Sydenham's Chorea**
- Darting "Wormian" Tongue
- The tongue darts in & out when protruding with gross fasciculations like bag of worms
44
Effect of prolonged period of latency in chorea
45
Diagnostic significance of chorea in ARF
46
Minor Manifestations in **ARF**
47
Minor Manifestations in **ARF**
- Arthralgia
- It refers to joint pain without the objective changes of arthritis.
- If arthritis is present -----> it can't be considered minor manifestation
48
Minor Manifestations in **ARF**
- Fever
- The temperature is usually at least 38°C.
- Present early in the course of untreated rheumatic fever.
49
Minor Manifestations in **ARF**
- Increased APR
50
Minor Manifestations in **ARF**
- Prolonged PR Interval
- Neither specific for acute RF, nor an indication of active carditis.
- If carditis is present › it can't be considered minor manifestation
51
Evidence of Antecedent GABHS Infection in **ARF**
52
Evidence of Antecedent GABHS Infection in **ARF**
- Streptococcal Antibody Tests
53
Additional Manifestations in **ARF**
54
Additional Manifestations in **ARF**
- History of Streptococcal Pharungitis
55
Additional Manifestations in **ARF**
- Common Symotoms But not specific
56
Additional Manifestations in **ARF**
- +ve family history of rheumatic
