Acute Rheumatic Fever

Question 1

ARF autoimmune infection mostly secondary to

Answer 1

Group A Streptococci (upper respiratory tract)

Question 2

Hallmark of ARF

Answer 2

Cardiac Valvular Damage

MC: Mitral Valve +/- Aortic valve

Question 3

HLA classes associated with ARF

Answer 3

DR7

DR4

Question 4

Most widely accepted theory of ARF pathogenesis

Answer 4

Molecular Mimicry

Question 5

MC clinical presentation of ARF

Answer 5

Polyarthritis

Fever

Question 6

Typical arthritis in ARF

Answer 6

Migratory, asymmetric, polyarthritis

Question 7

Classic rash of ARF

Answer 7

Erythema marginatum

serpiginous, evanescent, NEVER on face

Question 8

Skin manifestation commonly associated with carditis

Answer 8

Subcutaneous nodules

Question 9

Jones Criteria for primary episode of RF

Answer 9

2 major

or

1 major and 2 minor

(presence of group a strep infection)

** criteria the same as with recurrent RF without RHD

*** if with RHD, 2 minor will suffice

Question 10

Major manifestations of RF

Answer 10

Carditis
polyArthritis
Sydenham Chorea
Erythema marginatum
Subcutaneous nodules

(CASES)

Question 11

ECG finding in RF

Answer 11

Prolonged PR interval

Question 12

Treatment for RF

Answer 12

Pen V 500 mg BID x 10 days
or
Amoxicillin 5mkd x 10 days
or
Pen G 1.2 MU as SD

Question 13

Treatment principles in RF

Answer 13

Long Term bed rest NOT recommended

No AEDs unless with severe chorea may give carbamezepine or valproic or IVIg if refractory

GCs are controversial

Salicylates and NSAIDS only once Dx is confirmed

Question 14

Diagnostic monitoring principles for possible ARF

Answer 14

ECG if with prolonged PR repeat after 2 weeks and 2 months

Echo if negative yet highly suspicious repeat after 1 month

Anti strep serology repeat after 10-14 days if 1st test is not confirmatory

Question 15

Mainstay of secondary prevention

Answer 15

Pen G (benzathine) 1.2 MU q 4 weeks
(if high risk q 3 or 2)