Acute And Chronic Rheumatic Fever

Question 1

What is rheumatic fever?

Answer 1

An autoimmune inflammatory disease that occurs as a sequela of Group A streptococcal infection.

Question 2

Which organs can be affected by rheumatic fever?

Answer 2

Joints, heart, skin, and brain.

Question 3

What is the most significant complication of rheumatic fever?

Answer 3

Rheumatic heart disease (RHD).

Question 4

Which countries have the highest incidence of rheumatic fever?

Answer 4

Developing countries like Nigeria, India, Australia, and parts of Africa.

Question 5

What is the estimated number of new acute rheumatic fever cases per year?

Answer 5

470,000 new cases per year.

Question 6

Which valve is most commonly affected by rheumatic heart disease?

Answer 6

The mitral valve (90.9% of cases).

Question 7

What is the primary cause of acute rheumatic fever?

Answer 7

Group A streptococcal throat infections.

Question 8

What is the role of molecular mimicry in rheumatic fever pathogenesis?

Answer 8

Streptococcal antigens mimic human tissues, leading to an autoimmune response.

Question 9

What is an Aschoff body?

Answer 9

A granulomatous lesion seen in the myocardium in rheumatic fever.

Question 10

What are the major Jones criteria for diagnosing rheumatic fever?

Answer 10

Carditis, polyarthritis, Sydenham’s chorea, subcutaneous nodules, and erythema marginatum.

Question 11

What are the minor Jones criteria?

Answer 11

Fever, arthralgia, prolonged PR interval, elevated ESR/CRP, previous rheumatic fever history.

Question 12

What is Sydenham’s chorea?

Answer 12

A late neurological manifestation of rheumatic fever with involuntary, purposeless movements.

Question 13

What is erythema marginatum?

Answer 13

A pink, non-pruritic rash with serpiginous margins, mainly on the trunk.

Question 14

Which antibody test is most useful in diagnosing rheumatic fever?

Answer 14

Antistreptolysin O (ASO) titer.

Question 15

What ECG finding is associated with rheumatic fever?

Answer 15

Prolonged PR interval (first-degree AV block).

Question 16

What are the key cardiac manifestations of rheumatic fever?

Answer 16

Carditis, valvulitis, pericarditis, and congestive heart failure.

Question 17

What is the most common valvular lesion in rheumatic heart disease?

Answer 17

Mitral stenosis.

Question 18

What is Carey Coombs’ murmur?

Answer 18

A mid-diastolic murmur associated with rheumatic mitral valvulitis.

Question 19

What is the recommended antibiotic for eradicating streptococcal infection in rheumatic fever?

Answer 19

Benzathine penicillin G.

Question 20

What is the alternative antibiotic for penicillin-allergic patients?

Answer 20

Erythromycin.

Question 21

How long should secondary prophylaxis be given for rheumatic fever?

Answer 21

At least 5-10 years or until 21 years of age, whichever is longer.

Question 22

What is the first-line anti-inflammatory treatment for rheumatic fever?

Answer 22

Aspirin or NSAIDs.

Question 23

When are corticosteroids used in rheumatic fever?

Answer 23

For severe carditis with heart failure.

Question 24

What are the common complications of rheumatic fever?

Answer 24

Heart failure, valvular disease, arrhythmias, stroke.

Question 25

How does rheumatic fever affect the pericardium?

Answer 25

It causes fibrinous pericarditis without tamponade.

Question 26

What is Jaccoud's arthropathy?

Answer 26

A chronic, non-erosive arthritis seen in recurrent rheumatic fever.

Question 27

What is the primary prevention strategy for rheumatic fever?

Answer 27

Prompt treatment of streptococcal throat infections with antibiotics.

Question 28

How does chronic rheumatic heart disease develop?

Answer 28

Progressive fibrosis, thickening, and calcification of valves over decades.

Question 29

Which two valves are commonly affected in chronic rheumatic heart disease?

Answer 29

Mitral and aortic valves.

Question 30

What is the leading cause of acquired heart disease in young adults in developing countries?

Answer 30

Rheumatic heart disease.

Question 31

What is the most common cause of mitral stenosis?

Answer 31

Chronic rheumatic heart disease.

Question 32

What is the most common valvular abnormality in chronic rheumatic heart disease?

Answer 32

Mitral stenosis with commissural fusion and chordal shortening.

Question 33

What is the classic murmur in mitral stenosis?

Answer 33

Low-pitched diastolic rumble with an opening snap at the apex.

Question 34

What is the best initial diagnostic test for rheumatic heart disease?

Answer 34

Echocardiography.

Question 35

What is the role of balloon valvuloplasty in rheumatic heart disease?

Answer 35

Used for mitral stenosis in selected patients.

Question 36

What is the role of surgery in rheumatic heart disease?

Answer 36

Valve repair or replacement in severe cases.

Question 37

What is the best imaging modality for assessing valvular damage?

Answer 37

Echocardiography with Doppler.

Question 38

How does rheumatic fever affect the joints?

Answer 38

Migratory polyarthritis affecting large joints like the knees and ankles.

Question 39

What is the typical duration of arthritis in rheumatic fever?

Answer 39

2-4 weeks with no residual joint damage.

Question 40

What is the characteristic lesion of rheumatic fever in the myocardium?

Answer 40

Aschoff bodies.

Question 41

What host factors increase susceptibility to rheumatic fever?

Answer 41

Genetic factors, including specific immune system polymorphisms.

Question 42

What is the prognosis of rheumatic fever without carditis?

Answer 42

Good; most cases resolve within 6-12 weeks.

Question 43

What is the prognosis of rheumatic fever with carditis?

Answer 43

Higher risk of developing chronic rheumatic heart disease.

Question 44

What is the most effective way to prevent recurrence of rheumatic fever?

Answer 44

Long-term penicillin prophylaxis.

Question 45

What is the recommended treatment for severe mitral stenosis in chronic RHD?

Answer 45

Percutaneous balloon mitral valvotomy (PBMV) or valve replacement.

Question 46

What are the long-term complications of chronic rheumatic heart disease?

Answer 46

Heart failure, atrial fibrillation, stroke, infective endocarditis.

Question 47

What are the risk factors for developing rheumatic fever?

Answer 47

Overcrowding, poor hygiene, genetic susceptibility, previous Group A strep infections.

Question 48

What clinical sign suggests heart failure in rheumatic fever?

Answer 48

Cardiomegaly on chest X-ray.

Question 49

What cardiac arrhythmia is most commonly associated with rheumatic heart disease?

Answer 49

Atrial fibrillation.

Question 50

What are the effects of aortic involvement in rheumatic heart disease?

Answer 50

Aortic regurgitation leading to left ventricular dilation.

Question 51

What is the characteristic rash of rheumatic fever?

Answer 51

Erythema marginatum.

Question 52

What is the role of corticosteroids in rheumatic fever?

Answer 52

Used in severe carditis to reduce inflammation.

Question 53

What percentage of rheumatic fever patients develop chronic rheumatic heart disease?

Answer 53

Up to 60-70% in developing countries.

Question 54

What is the most common cause of death in chronic rheumatic heart disease?

Answer 54

Heart failure due to severe valvular dysfunction.