Rheumatic Fever Flashcards by m3ali alfarsi | Brainscape

Q

multisystem inflammatory disease resulting from an autoimmune reaction to infection with group A Streptococcus

A

Acute rheumatic fever (ARF)

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Q

Many parts of the body may be affected, The major exception is cardiac valvular damage (rheumatic heart disease [RHD])

A

all of the manifestations resolve completely except cardiac valvular damage which may persist after the other features have disappeared

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Q

usually presents with fever, anorexia, lethargy and joint pain, 2–3 weeks
after an episode of streptococcal pharyngitis

A

Acute rheumatic fever

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Q

usually affects children and young adults between the ages of 5 and 15 years

A

Acute rheumatic fever

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Q

remains endemic in the Indian subcontinent, Africa and South America

A

Acute rheumatic fever

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Q

have antigens that cross-react with cardiac myosin and sarcolemmal membrane proteins

A

Streptococci

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Q

Antibodies produced against the streptococcal antigens cause inflammation in the endocardium, myocardium and as well as the joints, skin and Brain

A

Cause of rheumatic fever

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Q

Rheumatic fever causes a

A

pancarditis

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Q

pancarditis involving

A

endocardium, myocardium and pericardium to varying degrees

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Q

Poverty

A

A risk factors for rheumatic fever

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Q

Overcrowding

A

A risk factors for rheumatic fever

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Q

limited access to medical care

A

A risk factors for rheumatic fever

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Q

Rheumatic fever and resulting endocarditis can cause damage to

A

heart valves

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Q

heart valves damage caused by Rheumatic fever and endocarditis are …….. (4)

A

Mitral or Tricuspid regurgitation
Mitral valve prolapse
Aortic regurgitation
Mitral stenosis

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Q

Rh. fever Signs and Symptoms Result from …….. in ……

A

inflammation

the heart, joints, skin or
central nervous system

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Q

Fever,anorexia or fatigue

A

Rh. Fever symptom

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Q

Arthralgia (joint pain)

A

Rh. fever symptom

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Q

Arthritis[seenin75%patients]

A

Rh. fever symptom

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Q

Carditis

A

Rh. fever symptom

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Q

CNS manifestation

A

Rh. fever symptom

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Q

Skin manifestation

A

Rh. fever symptom

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Q

There may not be any history of sore throat.

A

Rh. fever

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Q

Painful and tender joints

A

Arthritis

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Q

Arthritis Most often in

A

ankles, knees, wrists, elbows, hip or
shoulders [in order of frequency]

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Q

Pain in one joint that migrates to another joint.

A

Migratory poly arthritis

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Q

The process of migration lasts for ………

A

3-6 weeks

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Q

Red, hot or swollen joints but not deforming

A

Arthritis

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Q

Arthritis in Rh. Fever do not progress to

A

chronic arthritis

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Q

involves the endocardium (including valves), myocardium and pericardium to varying degrees.

A

Carditis (pancarditis)

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Q

Breathlessness, Chest pain and Palpitation

A

Symptoms of Carditis (pancarditis)

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Q

Patient may look ill, tired or dyspneic

A

Cardiac signs of acute Rh. Fever

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Q

Tachycardia or irregular pulse

A

Cardiac signs of acute Rh. Fever

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Q

New murmur or Change in old cardiac murmur

A

Cardiac signs of acute Rh. Fever

Q

soft systolic murmur is very common
due to mitral regurgitation

A

Cardiac signs of acute Rh. Fever

Q

Tricusp valve (TV) and Pulmonary valve (PV) are rarely involved in

A

Cardiac signs of acute Rh. Fever

Q

Precordial tenderness

A

Cardiac signs of acute Rh. Fever

Q

Pericardial friction rub

A

Cardiac signs of acute Rh. Fever

Q

Heart failure is ….
Due to ….

A

Cardiac signs of acute Rh. Fever

myocarditis or valves dysfunction.

Q

Raised JVP ,legs edema, 3rd Heart sound and gallop rhythm

A

Symptoms of Heart failure

Q

one-quarter of affected patients will develop

A

chronic rheumatic valvular heart disease

Q

Which side of the heart usually affected

A

left side of the heart (Mitral valve and aortic valve)

Q

left side of the heart is affected (Mitral valve and aortic valve) called as …..

A

Rheumatic Heart Disease

Q

Subcutaneous nodules

A

Skin manifestation of Rh fever

Q

Small (0.5-2cm),painless nodules under the skin

A

Subcutaneous nodules

Q

Seen in 7% of patients

A

Subcutaneous nodules

Q

It’s present on the extensor surface of bone and tendons

A

Subcutaneous nodules

Q

Subcutaneous nodules typically appear ….

A

more than 3 weeks after others signs

Q

Erythema marginatum

A

Skin lesion may appear in Rh fever

Q

Seen in less than 5%

A

Erythema marginatum

Q

Flat or slightly raised, painless rash

A

Erythema marginatum

Q

Seen mainly on the trunk and proximal extremities but not on the face

A

Erythema marginatum

Q

Sydenham chorea (St. Vitus dance)

A

CNS manifestation

Q

purposeless, involuntary , repetitive, jerky and rapid, movements of the hands, feet or face

A

Sydenham chorea(St. Vitus dance)

Q

late neurological manifestation that appears at least 3 months after the episode of acute rheumatic fever, when all the other signs may have disappeared

A

Sydenham chorea(St. Vitus dance)

Q

occurs in up to one-third of cases and is more common in females

A

Sydenham chorea(St. Vitus dance)

Q

Carditis

A

Major manifestation

Q

Poly arthritis

A

Major manifestation

Q

Chorea

A

Major manifestation

Q

Erythema marginatum

A

Major manifestation

Q

Subcutaneous nodules

A

Major manifestation

Q

Fever

A

Minor manifestation

Q

Arthralgia

A

Minor manifestation

Q

Raised erythrocyte sedimentation rate / C-reactive protein

A

Minor manifestation

Q

Previous rheumatic fever

A

Minor manifestation

Q

Leukocytosis

A

Minor manifestation

Q

1st-degree atrioventricular block

A

Minor manifestation

Q

To diagnose rheumatic fever

A

Must be evidence of recent strep infection plus 2 major criteria, or 1 major + 2 minor

Q

Leucocytosis

A

Evidence of a systemic illness

Q

Raised erythrocyte sedimentation rate

A

Evidence of a systemic illness

Q

C-reactive protein

A

Evidence of a systemic illness

Q

Throat swab culture group A beta-hemolytic streptococci

A

Evidence preceding streptococcal infection

Q

Antistreptolysin O antibioties (ASO titres)
Rising titres, or levels of > 200 U for adults or > 300 U for children

A

Evidence preceding streptococcal infection

Q

Chest X-ray
To detect …..

A

Evidence of carditis
Cardiomegaly , pulmonary congestion

Q

ECG
To detect………

A

Evidence of carditis
1st-degree atrioventricular block
2nd-degree atrioventricular block (rarely)
Features of pericarditis
T wave inversion
Reduction inQRS voltage

Q

Echocardiography

A

Evidence of carditis
Cardiac dilatation
Vale abnormalities

Q

aims of management are

A

to limit cardiac damage and relieve symptoms.

Q

Bed rest Bed

A

Management of Rh fever

Q

Treatment of cardiac failure [If any]

A

Q

Antibiotic therapy: Benzathine benzylpenicillin

A

Management of Rh fever

Q

Aspirin

A

Management of Rh fever

relieves the symptoms of arthritis

Q

Steroids [Prednisolone]

A

Management of Rh fever

Rapid symptomatic relief than
aspirin

Q

indicated in cases with carditis or severe arthritis.

A

Steroids [Prednisolone]