ARF and RHD cont Flashcards

1
Q

risk groups for primary prevention of ARF

A
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2
Q

recommended antibiotic treatment for strep A sore throat/tonsillitis

A
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3
Q

recommended antibiotic treatment for strep A skin sores

A
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4
Q

strep A skin sores aare introduced through

A

a break in the skin eg. insect bite, scabies, headlice, tinea, minor trauma

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5
Q

what do strep A skin sores look like

A

round or linear,
have pus or thick crust evident

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6
Q

efficacy of cotrimoxazole for skin sores

A

A three-day course of
twice-daily or a five-day course of once-daily
cotrimoxazole were found to be non-inferior to
BPG for treatment of skin sores.15 Cotrimoxazole
had significantly fewer side effects, was well
tolerated, and provides a pain-free alternative for
treatment of skin sores for children

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7
Q

features of ARF arthritis

A

usually extremely painful on movement, out of proportion to the clincial signs
very responsive to NSAIDs including aspirin

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8
Q

how to rule out septic arthritis

A

Patients presenting with monoarthritis should be thoroughly investigated for septic arthritis, as well as rheumatic fever and any other
relevant differential diagnoses. Once initial investigations have been sent, including joint aspirate for microscopy and culture (collected appropriately to avoid clotting of the sample), it may be appropriate to treat presumptively with empirical antibiotics appropriate to cover septic arthritis pathogens until an alternative diagnosis, such as rheumatic fever, is confirmed.

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9
Q

clinical presentation of sydenhaam’s chorea

A

predominantly affects females, particulalry in adolescence
jerky, uncoordinated movements, especially affecting the hands and feet, tongue and face
dissappear during sleep, may affect one side only

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10
Q

milkmaid’s grip

A

rhythmic squeezing when the patient grasps the examiners fingers

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11
Q

spooning

A

flexion of the wrists and extension of the fingers

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12
Q

pronator sign

A

turning outward of the arms and palms when held above the head

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13
Q

subcutaneous nodules

A

very rare but highly specific
Nodules are usually 0.5–2 cm in
diameter, round, firm, freely mobile and painless nodules that occur in crops of up to 12 over the elbows, wrists, knees, ankles, Achilles tendon, occiput and posterior spinal processes of the vertebrae. They tend to appear one to two weeks after the onset of other symptoms, last only one to two weeks (rarely more than a month) and are strongly associated with carditis.

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14
Q

clinical appearance of erythema marginatum

A

It occurs as bright pink macules or papules that blanch under pressure and spread outwards
in a circular or serpiginous pattern. It is rapidly evanescent (that is, waxes and wanes during
the course of a day). The lesions are not itchy or painful, and occur on the trunk and proximal
extremities, but almost never on the face. The rash can be difficult to detect in dark-skinned
people, so close inspection is required.

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15
Q

is antinflammatory medication effective for erythema marginatum

A

no

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16
Q

carditis

A

Usually presents clinically as an apical holosystolic (pansystolic) murmur (MR),
and/or an early diastolic murmur at the base of the heart or left sternal edge
(AR)
May only be detected using echocardiography (subclinical carditis)

17
Q

are NSAIDs effective for arthritis in ARF

A

yes

18
Q

strep rapid antigen test

A

not as accurate as culture, it is recommended that a negative test be followed up with a culture

19
Q

ddx for polyarthritis with fever

A

septic arthritis
connective tissue and other autoimmune disease
viral arthropathy
reactive arthropathy
lyme disease
sickle cell anaemia
infective endocarditis
leukaemia or lymphoma
gout and pseudo gout

20
Q

ddx for carditis

A

innocent murmur
mitral valve prolapse
congenital heart disease
infective endocarditiis
hypertrophic cardiomyopathy
myocarditis: viral or idiopathic
pericarditis: viral or idiopathic

21
Q

ddx for sydenham chorea

A

SLE
drug intoxication
wilson’s disease
tic disorder
cerebral palsy
encephalitis
familial chorea
huntingtons
intracranial humour
lyme disease

22
Q

how to tell the difference between ARF and post strep reactive arthritis

A

reactive arthritis will affect joints such as the small joints of the hands not so commonly affected by ARF
reactive arthritis is less responsive to NSAIDs
diagnosis of reactive arthritis should rarely be made it at risk populations

23
Q

priorities in managing ARF in the acute setting

A
  • culturally safe care
  • IM ben pen G
  • Influenza vaccine as a strategy to prevent reye’s syndrome for chldren recieving aspirin
  • arthritis and fever: paracetamol until diagnosis confrimed, then naproxen, ibuprofen or aspirin once diagnsois is confirmed
    carbamazepine or sodium valproate for chorea if severe
    bed rest for carditis, anti-failure medication as required
    corticosteroids for severe carditis
24
Q

paediatric anti-failure medication

A

furosemide
spironolactone
enalapril (choice of ACE inhibitor will depend on the clinical situation

25
Q

secondary prophylaxis is

A

the consistant and regular administration of antibiotics to people who has had ARF or rheumatic heart disease to prevent future group A strep infections and the recurrence of ARF

26
Q

what do you use for secondary prophylaxis

A

long-acting benzathine benzylpenecillin G
not to be confused with benzyl penecillin

27
Q

regimen of secondary prophylaxis

A

benzathine benzylpenecillin G
deep IM injection
every 28 days or every 21 days in some populations

28
Q

duration of secondary prophylaxis

A

depends on ARF episode/identified abnormality on echo

29
Q

how long is secondary prophylaxis for probable ARF with normal echo

A

minimum 5 years or until age 21, whichever is longer
will also nee follow up echos

30
Q
A