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Y4R6 - Pediatrics II 👶 > L6: Acute Rheumatic Fever (Pt 2) > Flashcards

L6: Acute Rheumatic Fever (Pt 2) Flashcards

1
Q
  • In ARF

There are four groups of important clinical and laboratory findings ……..

A
  1. Five major manifestations.
  2. Six minor manifestations.
  3. Evidence of antecedent GABHS infection.
  4. Additional manifestations
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2
Q

In ARF

  • Major Criteria
A
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3
Q

In ARF

  • Minor Criteria
A
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4
Q

In ARF

  • Low-Risk Populations
A
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5
Q

In ARF

  • Moderate to High Risk Populations
A

They include children that are not clearly from a low-risk population

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6
Q

In ARF

  • Major Manifestations
A
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7
Q

Arthritis in ARF

  • Incidence
A

It is the most common manifestation of RF.

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8
Q

Arthritis in ARF

  • Site
A
  • Usually affect large joints (Knees, elbows, ankles, wrists)
  • Never affects: TMJ, cricoarytenoid, sternoclavicular joint, spines, fingers, toes
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9
Q

Arthritis in ARF

  • Characters
A
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10
Q

Carditis in ARF

A
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11
Q

Carditis in ARF

  • Heart murmur of valvulitis
A
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12
Q

Carditis in ARF

  • Cardiomegaly on CXR
A
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13
Q

Carditis in ARF

  • Pericarditis
A
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14
Q

Carditis in ARF

  • Heart Failure
A
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15
Q

SC Nodules in ARF

A
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16
Q

SC Nodules in ARF

  • Site
A
  • Symmetrically, singly or in clusters, on the extensor surfaces of both large & small joints, over scalp, or along spine.
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17
Q

SC Nodules in ARF

  • Characters
A
  1. Hard, painless, nonpruritic, freely mobile & 0.2 - 2.0 cm in diameter
  2. They are not transient, lasting for weeks.
  3. They occur particularly in recurrences.
  4. Indicates severe attack, bad prognosis.
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18
Q

Erythema Marginatum in ARF

A
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19
Q

Erythema Marginatum in ARF

  • Site
A
  • Mainly on the trunk & inner proximal parts of the extremities (never on the face).
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20
Q

Erythema Marginatum in ARF

  • Charcaters
A
  • Nonpruritic, erythematous, serpiginous or annular.
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21
Q

Erythema Marginatum in ARF

  • Course
A
  • Disappear on exposure to cold
  • Reappear after a hot shower or when the patient is covered with a warm blanket
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22
Q

Sydenham’s Chorea in ARF

A
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23
Q

Sydenham’s Chorea in ARF

  • Sex
A

Female > Male

24
Q

Sydenham’s Chorea in ARF

  • Age
A

6 - 12 years

25
Q

Sydenham’s Chorea in ARF

  • Choreiform Movement
26
Q

Choreiform Movement in ARF

  • Characters
A
  • Involuntary
  • Abrupt, erratic
  • Purposeless or quasi-purposive
  • Non repetitive, non-rhythmic movement
27
Q

Choreiform Movement in ARF

  • Increased By
A

Voluntary activity & tension (stress)

28
Q

Choreiform Movement in ARF

  • Decreased By
A

Relaxation and sedation and disappearing in sleep

29
Q

Choreiform Movement in ARF

  • Disappears
A

During sleep

30
Q

Choreiform Movement in ARF

  • Site
31
Q

Uncoordinated voluntary motor activity in Rheumatic Sydenham’s Chorea

32
Q

Uncoordinated voluntary motor activity in Rheumatic Sydenham’s Chorea

  • Gait
A

Disturbed “Legs are flung out or suddenly flex with arms flail about”

33
Q

Uncoordinated voluntary motor activity in Rheumatic Sydenham’s Chorea

  • Speech
A
  • Irregular
  • Indistinct
  • Jerky & staccato.
34
Q

Uncoordinated voluntary motor activity in Rheumatic Sydenham’s Chorea

  • Fine Movement
A
  • Impaired “as feeding, drinking, writing, buttoning & unbuttoning”
35
Q

Rheumatic Sydenham’s Chorea

  • Muscle weakness & hypotonia
36
Q

Rheumatic Sydenham’s Chorea

  • Emotional lability &/or instability
37
Q

Rheumatic Sydenham’s Chorea

  • Difference Between Emotional Lability & Emotional Instability
38
Q

Rheumatic Sydenham’s Chorea

  • Neurological Signs
39
Q

Neurological Signs in Rheumatic Sydenham’s Chorea

  • Milkmaid Sign
A

Waxing & waning of hand grip as if milking the cow

  • Due to irregular repetitive squeezes because of inability to sustain titanic contraction
40
Q

Neurological Signs in Rheumatic Sydenham’s Chorea

  • Spoon “Dishing” Sign
A

Spooning of the extended hands with:
1. Flexion of the wrists
2. Hyperextension of the metacarpo-phalangeal joints”

41
Q

Neurological Signs in Rheumatic Sydenham’s Chorea

  • Pronator Sign
A

Arms & palms turn outward when held above the head

42
Q

Neurological Signs in Rheumatic Sydenham’s Chorea

  • Abnormal Knee Jerk
A

Pendular knee jerk:
- Concomitant rhythmic contraction of quadriceps ms.

Hung-up knee jerk:
- Sustained contraction of quadriceps ms. “with slow return to the pre-stimulus level”.

43
Q

Neurological Signs in Rheumatic Sydenham’s Chorea

  • Darting “Wormian” Tongue
A
  • The tongue darts in & out when protruding with gross fasciculations like bag of worms
44
Q

Effect of prolonged period of latency in chorea

45
Q

Diagnostic significance of chorea in ARF

46
Q

Minor Manifestations in ARF

47
Q

Minor Manifestations in ARF

  • Arthralgia
A
  • It refers to joint pain without the objective changes of arthritis.
  • If arthritis is present —–> it can’t be considered minor manifestation
48
Q

Minor Manifestations in ARF

  • Fever
A
  • The temperature is usually at least 38°C.
  • Present early in the course of untreated rheumatic fever.
49
Q

Minor Manifestations in ARF

  • Increased APR
50
Q

Minor Manifestations in ARF

  • Prolonged PR Interval
A
  • Neither specific for acute RF, nor an indication of active carditis.
  • If carditis is present › it can’t be considered minor manifestation
51
Q

Evidence of Antecedent GABHS Infection in ARF

52
Q

Evidence of Antecedent GABHS Infection in ARF

  • Streptococcal Antibody Tests
53
Q

Additional Manifestations in ARF

54
Q

Additional Manifestations in ARF

  • History of Streptococcal Pharungitis
55
Q

Additional Manifestations in ARF

  • Common Symotoms But not specific
56
Q

Additional Manifestations in ARF

  • +ve family history of rheumatic

Y4R6 - Pediatrics II 👶 (36 decks)

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