Rheumatic Fever

Question 1

Criteria for Rheumatic Fever?

Answer 1

Revised Jones Criteria

Question 2

Mx for Rheumatic Fever

Answer 2

Penicillin i.e amox for any residual bugs
Bed rest
Manage heart failure
Chorea (may treat using haloperidol - usually self-limiting

Question 3

Causative agent?

Answer 3

Group A B-haemolytic Strep

Question 4

Classification of Strep?

Answer 4

Lancefield grouping

Question 5

What might I see on ECG for rheumatic fever?

Answer 5

Prolonged PR interval

Question 6

What antigen responsible for Rheumatic Fever?

Answer 6

M antigen

Question 7

SSx?

Answer 7

CASES:

1) Carditis
2) Arthritis
3) Subcutaneous nodules
4) Erythema marginatum
5) Syndenham’s chorea

FRAPP:

1) Fever
2) Raised ESR or CRP
3) Arthralgia (but not if arthritis is one of the major criterion)
4) Prolonged PR interval –> heart block (but not if carditis is the major criterion)
5) Previous rheumatic fever

Question 8

What Ix and findings?

Answer 8

 Positive throat culture
 Rapid streptococcal antigen test +ve
 Elevated or rising streptococcal antibody titre (e.g. antistreptolysin O (ASO) or DNase B titre)

Question 9

Most common valvular disorder caused by Rheumatic Fever?

Answer 9

Mitral stenosis