CARDIOLOGY - RHEUMATIC FEVER

Question 1

Rheumatic Fever is caused by what organism ?

Answer 1

Group A Beta Hemolyticus Streptococcal Bacteria

Question 2

Give an example of group A Beta Hemolyticus Streptococcal Bacteria that is common in ARF

Answer 2

Streptococcus Pyogene

Question 3

Does ARF is hypersensitivity ? If so , which type ?

Answer 3

Type II Hypersensitivity

Question 4

What is the pathophysiology involved ?

Answer 4

Molecular mimicry
- resulting in cross activation

Question 5

Risk factors for Rheumatic fever

Answer 5

i)children 5 to 15 yo
ii)poverty
iii)overcrowding

Question 6

What tissue have the same molecular mimicry ?

Answer 6

i)Skin
ii)Brain
iii)Myocardium
iv)Synovial Joint

Question 7

For the myocardium , what abnormal findings did you aspect ?

Answer 7

i) pericardium - pericardial friction rub (painful)
ii)myocardium - aschoff bodies
iii)endocardium - rheumatic vegetation

Question 8

For the brain , what did you aspect for the findings ?

Answer 8

Syndenham chorea - uncontrolled rapid jerky movement

• affect face , tongue , upper limb

Question 9

For the synovial joints , what abnormal findings did you aspect ?

Answer 9

-polyarthritis
-migratory

Question 10

For the skin , what abnormal findings did you aspect ?

Answer 10

i)erythema marginatum
-occur on extremities
-trunk
ii)subcutaneous nodules
-back of the wrist
-elbow
-knees

Question 11

How to diagnose Acute Rheumatic Fever ?

Answer 11

using Jones Criteria

Question 12

How to diagnose using Jones Criteria

Answer 12

-2 major criteria
-1 major criteria + 2 minor criteria

Question 13

State major criteria in Jones Criteria

Answer 13

-Polyarthritis
-Pancarditis
-Subcutaneous nodules
-Erythema marginatum
-Syndenham Chorea

Question 14

State minor criteria for Jones criteria (CARFEPAL)

Answer 14

CRP increased
Arthralgia
Fever
ESR increased
Prolonged PR interval
Anamnesis
Leukocytosis

Question 15

Besides Jones criteria , what else you need to check in order to diagnose rheumatic fever ?

Answer 15

i)an evidence of post streptococcal
-Rapid Antigen Test
-Culture sensitivity
-Anti Streptolysin O titre

Question 16

What is the complications of ARF ?

Answer 16

-Heart failure
-Infective endocarditis

Question 17

What is the secondary prevention

Answer 17

Secondary prevention of rheumatic heart disease (RHD) is the

-use of antibiotics to prevent recurrent episodes of group A beta-hemolytic streptococcus (GAS)