L6: Acute Rheumatic Fever (Pt 3)

Question 1

Diagnostic Criteria for ARF

Answer 1

Question 2

Diagnostic Criteria for ARF

• 1ry Episode of ARF

Answer 2

2 major criteria OR 1 major + 2 minor criteria (++ evidence of GABHS infection)

Question 3

Diagnostic Criteria for ARF

• Recurrent Attack of ARF Without RHD

Answer 3

2 major criteria OR 1 major + 2 minor criteria (++ evidence of GABHS infection)

Question 4

Diagnostic Criteria for ARF

• Recurrent Attack of ARF With RHD

Answer 4

2 major criteria OR 1 major + 2 minor criteria OR 3 minor criteria

(++ evidence of GABHS infection)

Question 5

Diagnostic Criteria for ARF

• Rheumatic Choria, Insidious onset rheumatic carditis

Answer 5

• No need for other manifestations

OR

• Evidence of GABHS infection

Question 6

Diagnostic Criteria for ARF

• Chronic valve lesions of RHD (Patients presenting for the 1st time é pure MS or double mitral lesion &/or aortic valve dis)

Answer 6

• No need for other manifestations

OR

• Evidence of GABHS infection

Question 7

Diagnostic Criteria for ARF

• Probable diagnosis of ARF “initial or recurrent”

Answer 7

• 1 major
  OR
• 1 minor
  OR
• Absence of streptococcal serology results

Question 8

The following precautions help in applying the 2002-2003 WHO Criteria in ARF

Answer 8

Question 9

Clinical Course of ARF

Answer 9

Question 10

Clinical Course of ARF

• Carditis

Answer 10

• Only which can cause permanent cardiac damage.
• Mild carditis disappears rapidly in weeks.
• Severe carditis may last for 2 to 6 months.

Question 11

Clinical Course of ARF

• Arthritis

Answer 11

• Subsides within a few days to several weeks, even without treatment, and does not cause permanent damage.

Question 12

Clinical Course of ARF

• Chorea

Answer 12

• Gradually subsides in 3 to 6 months or longer and usually does not cause permanent neurologic sequelae.

Question 13

DDx of ARF

Answer 13

Question 14

DDx of ARF

• Causes of Arthritis

Answer 14

Question 15

DDx of ARF

• DDx of Carditis

Answer 15

Question 16

DDx of ARF

• DDx of Chorea

Answer 16

Question 17

Indications of Rheumatic Activity

Answer 17

Question 18

Sympyoms of Rheumatic Activity

Answer 18

Persistent arthralgia & arthritis

Question 19

Signs of Rheumatic Activity

Answer 19

Question 20

Echo Indicating Rheumatic Activity

Answer 20

Question 21

Labs Indicating Rheumatic Activity

Answer 21

Question 22

…… Aren’t Evidence of Rheumatic Activity

Answer 22

Prolonged PR, Increased ASO, Chorea, Erythema marginatum

Question 23

Why chorea is not a marker of active rheumatic fever although it is a major manifestation in the diagnosis of rheumatic fever?

Answer 23

Question 24

Lab Dx of ARF

Answer 24

Question 25

Lab Dx of ARF

• Documentation of recent streptococcal infection

Answer 25

Question 26

Documentation of recent streptococcal infection

• Methods

Answer 26

Question 27

Documentation of recent streptococcal infection

• Significance

Answer 27

It is essential in the initial attack “except for chorea & low grade carditis”.

Question 28

Lab Dx of ARF

• Documentation of positive inflammatory response

Answer 28

Question 29

Documentation of positive inflammatory response

• Methods

Answer 29

Question 30

Documentation of positive inflammatory response

• Significance

Answer 30

• It is an essential minor manifestation “except for chorea”.
• It is a marker of disease activity & a guide for anti-inflammatory therapy.

Question 31

Lab Dx of ARF

• Documentation of Associated Carditis

Answer 31

Question 32

Documentation of Associated Carditis

• Methods

Answer 32

Question 33

Documentation of Associated Carditis

• ECHO Findings

Answer 33

Question 34

Documentation of Associated Carditis

• Significance

§§

Answer 34

Inclusion of echo abnormalities may enhance correct diagnosis of acute RF