L2: rheumatic fever

Question 1

acute rheumatic fever is often following

Answer 1

group A Beta-hemolytic streptococci infection ( S. pyogenes , due to molecular mimicry )

Question 2

what type of immune response is rheumatic fever ?

Answer 2

delayed immune response to infection

Question 3

what sites are affected by acute rheumatic fever ?

Answer 3

damage occurs to heart valves , joints , subcutaneous tissue , basal ganglia of the Brian

Question 4

describe the arthritis brought on by rheumatic fever :

Answer 4

migratory poly arthritis commonly involving major joints ( wrist , elbows , ankles and knees)

involved joints are tender

does NOT progress into chronic disease

Question 5

what’s the only manifestation of rheumatic fever that leaves permanent damage ?

Answer 5

carditis

acute phase : valvulitis

chronic phase : fibrosis , calcification and stenosis of heart valves (fish mouth valves )(

Question 6

endocarditis :
- valve leaflet damage (usually caused by regurgitant murmur of aortic and mitral valves)

-fibrosis of valve leaflet follows valve leaflet damage leading to stenosis

myocarditis:
-tachycardia out of proportion to fever
-S3 gallop/ frank LVF
-cardiomegaly
-conduction defects

pericarditis :
-fibrous effusion

Question 7

what clinical feature can appear 6/12 after attack of rheumatic fever ?

Answer 7

sydenham cholera

Question 8

erythema margimatum is often associated with ___

Answer 8

chronic carditis

Question 9

subcutaneous nodules often apperear where?

Answer 9

extensor surface of joints , spine ,scapula and scalp

Question 10

subcutaneous nodules are always associated with :

Answer 10

strong sero-positivity and severe carditis

Question 11

Lab findings concerning rheumatic fever :

Answer 11

high ESR and elevated C-reactive protein (more than 3)

throat culture -GABH streptococci

anemia , leukocytosis

ant-DNAse B test

Question 12

diagnosis of rheumatic fever is based on :

Answer 12

modified jones criteria
2 major or 1 major+ 2 minor

exceptions to jones criteria :
if cholera alone is present and no other cause is possible

late onset of carditis with no other reason

patients with documented RHD , one major criterion , arthralgia or high CRP

Question 13

treatment of rheumatic fever :

Answer 13

step 1: eradication of streptococci

– penicillins / erythromycins

step 2: anti inflammatory treatment

-asprin for arthritis
-prednisolone for carditis

step 3 : supportive management

-bed rest
-diuretics amd digitalis for congestive cardiac failure

-diazepam or haloperidol for chorea

step 4: secondary prevention (prevention of recurrent attacks )

• benzathine benzypenicillin

Question 14

treatment for arthritis :

treatment for carditis:

treatment for congestive cardiac failure :

treatment for chorea :

Answer 14

asprin

prednisolone

digitalis / diuretics

diazepam/ haloperidol

benzathine benzylpenicillin