Rheumatic Fever

Question 1

Multisystem disease d.t. autoimmune reaction to infection w/ GABHS

Answer 1

Rheumatic fever

Question 2

Molecular mimicry

Answer 2

antibodies against M proteins of certain strains of Streptococcus cross react w/ tissue glycoproteins in the heart, joints and other tissues

Question 3

MC clinical presentation of rheumatic fever

Answer 3

polyarthritis

fever

Question 4

pericarditis

Answer 4

audible friction rub, pericardial effusion on echocardiography

Question 5

myocarditis

Answer 5

unexplained HF or cardiomegaly

Question 6

endocarditis/valvulitis

Answer 6

apical holosystolic murmur of mitral regurgitation or basal early diastolic murmur

Question 7

CARDITIS

Answer 7

pancarditis involving pericardium, myocardium and endocardium

Question 8

Hallmark of carditis

Answer 8

valvular damage

Question 9

Characteristic manifestation of carditis

Answer 9

Mitral Regurgitation

Question 10

The single most important prognostic factor in RF

Answer 10

Carditis

Question 11

Most frequent MAJOR manifestation of RF

Answer 11

MIGRATORY POLYARTHRITIS

asymmetric and affects large joints (knees, elbows, ankles, wrists)

highly responsive to salicylates and NSAIDs

Question 12

Involuntary jerking movement affecting the head and upper limbs

Answer 12

SYDENHAM’S CHOREA

females
resolves w/n 6 weeks

Question 13

Bright pink macule or papule that spreads outward in a circular or serpiginous pattern

Answer 13

ERYTHEMA MARGINATUM

trunk, limbs

Question 14

Painless, round, firm, freely movable lesions (0.5-2.0 cm)

Answer 14

SUBCUTANEOUS NODULES

delayed manifestation
associated w/ carditis

Question 15

Minor Clinical Manifestations

Answer 15

arthralgia (joint pains)

fever - 38.4 - 40

Question 16

Minor Laboratory Manifestations

Answer 16

ESR/CRP

prolonged PR interval on ECG

Question 17

Supporting Evidence of a Preceding Streptococcal Infection w/n the last 45 days

Answer 17

elevated or rising anti-streptolysin O or other streptococcal antibody

OR

positive throat culture

OR
rapid antigen test for group A streptococcus

OR

recent scarlet fever

Question 18

Treatment of Streptococcal Tonsillopharyngitis

Answer 18

Penicillin - V - 500 mg BID x 10 days
Amoxicillin PO 50 mg/kg daily x 10 days
Benzathine Pen G IM (1.2. million units as a single dose)

If with penicillin allergy:

Clindamycin PO 300-600 mg TID x 10 days
Azithromycin PO 500 mg OD x 5 days
Clarithromycin 250 mg BID x 10 days

Question 19

Treatment for arthritis or mild carditis

Answer 19

Aspirin 4-8 g/day in 4-5 divided doses up to 2 weeks

Question 20

Treatment for moderated - severe carditis

Answer 20

May add prednisone 1-2 mg/kg/day up to maximum of 3 weeks

dose decreased and tapered by 20-25 % each week

Question 21

Treatment for severe chorea

Answer 21

Carbamazepine or Valproic Acid