Acute Rheumatic Fever

Question 1

Acute rheumatic fever (ARF) is a multisystem disease resulting from an autoimmune reaction to infection with?
A. group A streptococcus
B. group B streptococcus
C. group C streptococcus
D. group D streptococcus

Answer 1

A. group A streptococcus

Question 2

Genetic association of RHD

Answer 2

Females

Question 3

HLA class II alleles associated with ARF susceptibility
A. HLA-DR5
B. HLA-DR6
C. HLA-DR7
D. HLA-DQ

Answer 3

C. HLA-DR7

HLA-DR7 and HLA-DR4

Question 4

most widely accepted theory of rheumatic fever pathogenesis

Answer 4

molecular mimicry

Question 5

Latent period between the precipitating group A streptococcal infection and the appearance of the clinical features of ARF

Answer 5

~3 weeks (1–5 weeks)

*exceptions are chorea and indolent carditis, up to 6 months

Question 6

Hallmark of rheumatic carditis

Answer 6

Valvular damage

Question 7

Valve almost always affected

Answer 7

Mitral>aortic

Question 8

most common form of joint involvement in ARF

Answer 8

Arthritis

Question 9

Characteristics of arthritis in ARF

Answer 9

Asymmetric polyarthritis is typically migratory over a period of hours affecting large joints, most commonly the knees, ankles, hips, and elbows

Question 10

Classic rash of ARF

Answer 10

erythema margina

Question 11

Which of the following is true of erythema marginatum?
A. It occurs usually on the face
B. Almost almost never on the trunk
C. Occurs usually on the trunk
D. Never on the limbs

Answer 11

It occurs usually on the trunk, sometimes on the limbs, but almost never on the face.

Question 12

The most common serologic tests are:
A. anti-streptolysin O (ASO) 
B. anti-cardiolipin
C. anti-DNase B (ADB) titers
D. A & C

Answer 12

D. A & C

Question 13

Definitive test for RA

Answer 13

None
Diagnosis relies on clinical features together with evidence of the precipitating group A streptococcal infection, and the exclusion of other diagnoses

Question 14

Drug of choice?
A. Penicllin
B. Azithromycin
C. Cephalosporins
D. Fluoroquinolones

Answer 14

A. Penicllin

Question 15

Salicylates and NSAIDs have no value in treatment of
A. arthritis
B. arthralgia
C. Carditis
D. Fever

Answer 15

C. Carditis

Question 16

Not true in low risk minor criteria of Jones Criteria
A. Polyarthralgia
B. Fever ≥38.5°C
C. ESR ≥30 mm in the first hour and/ or CRP ≥3.0 mg/dL
D. Prolonged PR interval

Answer 16

C. ESR ≥30 mm in the first hour and/ or CRP ≥3.0 mg/dL

*should be ≥60 mm in the first hour

Question 17

Recommended Tests for All Cases
A. WBC count
B. CRP
C. Blood cultures if febrile
D. All of he above

Answer 17

D. All of he above

Question 18

Cortiosteroid for chorea

Answer 18

Prednisone or prednisolone may be commenced at 0.5 mg/kg daily, with weaning as early as possible, preferably after 1 week

Question 19

Average duration of untreated ARF

Answer 19

12 weeks

Question 20

When should echocardiogram repeated?

Answer 20

after 1 month

Question 21

mainstay of primary prevention for ARF

Answer 21

Primary prophylaxis

Question 22

mainstay of controlling ARF and RHD

Answer 22

secondary prevention

Question 23

best antibiotic for secondary prophylaxis

Answer 23

Benzathine penicillin G 1.2 million units delivered every 4 weeks

Question 24

Given to penicillin-allergic patients

Answer 24

erythromycin 250 mg twice daily

Question 25

Duration of secondary prophylaxis for Rheumatic fever with carditis but no residual valvular disease
A. For 10 years after the last attack, or 21 years of age
B. For 5 years after the last attack or 21 years of age
C. For 10 years after the last attack, or 40 years of age

Answer 25

A. For 10 years after the last attack, or 21 years of age

B. For 5 years after the last attack or 21 years of age-RF without carditis
C. For 10 years after the last attack, or 40 years of age-RF with persistent valvular disease