lec 1

Question 1

Rheumatic fever Definition

Answer 1

acute inflammatory disease
immunologically
multisystem

Question 2

Rheumatic fever متى ببلش

Answer 2

few weeks after an episode of group A streptococcal pharyngitis

Question 3

Rheumatic fever نسبة الناس يلي بصير عندهم

Answer 3

3% of infected patients with streptococcal pharyngitis

Question 4

Etiology of Rheumatic fever

Answer 4

Group A β-hemolytic streptococcal infections( pharyngitis or skin)

Question 5

Rheumatic fever occurs mainly among

Answer 5

children (most often) and adolescents but may be seen in adults (20%)

Question 6

Mortality of Rheumatic fever

Answer 6

less than 1%

Question 7

Acute rheumatic fever is

Answer 7

hypersensitivity reaction

Question 8

endothelium is

Answer 8

valvular self antigen

Question 9

myosin

Answer 9

myocardial self antigen

Question 10

M proteins) cross-react with

Answer 10

1. myosin

2. endothelium

Question 11

antibodies and CD4+ T cells directed against

Answer 11

group A streptococcal molecules (M proteins)

Question 12

Pathogenesis of Antibody

Answer 12

activate complement →recruit Fc-receptor bearing cells ( e.g neutrophils and macrophages)

Question 13

Pathogenesis of CD 4 +T cells

Answer 13

Stimulated CD 4 +T cells cytokine
production macrophage activation ( seen
within Aschoff bodies).

Question 14

clinical signs of acute carditis

Answer 14

– pericardial friction rub (by auscultation)
– arrhythmias (ECG)
– myocarditis , if sever cardiac dilation →
functional mitral insufficiency CHF.

Question 15

Laboratory tests

Answer 15

• ↑White blood cell count
•↑ ESR, CRP, Ferritin
• Serum titers of antibodies against one or
more streptococcal antigens (ASO) usually are
elevated.
• cultures for streptococci are ?? negative

Question 16

cultures for streptococci are

Answer 16

negative

Question 17

antibodies against one or more streptococcal antigens

Answer 17

ASO) usually are elevated.

Question 18

Diagnosis of acute rheumatic fever is made based on

Answer 18

serologic elevated ASO titer+ Jones criteria

Question 19

Jones criteria

Answer 19

– Carditis
– Migratory polyarthritis of large joints
– Subcutaneous nodules
– Erythematous annular rash (erythema marginatum) in the skin
– Sydenham chorea, a neurologic disorder characterized by involuntary purposeless, rapid movements

Question 20

minor criteria

Answer 20

– fever
– arthralgia
– elevated blood levels of acute phase reactants.

Question 21

Morphology

Answer 21

discrete inflammatory foci 
 Anitschkow cells
Aschoff bodies
Pancarditis Pancarditis morphological features:
– The pericardium

Question 22

( pathognomonic for rheumatic fever )

Answer 22

Aschoff bodies

Question 23

Anitschkow cells

Answer 23

activated macrophages

Question 24

Anitschkow cells morphology

Answer 24

have abundant
cytoplasm and nuclei with chromatin that is centrally condensed into a slender, wavy ribbon (so-called “caterpillar cells”)

Question 25

Pancarditis morphological features:

– The pericardium

Answer 25

fibrinous exudate, which generally resolves without sequelae مضاعفات

Question 26

Pancarditis morphological features ;

The myocardial

Answer 26

Aschoff bodies within the interstitial connective tissue

Question 27

Pancarditis morphological features:

endocardium

Answer 27

Valve involvement results in fibrinoid necrosis and fibrin deposition
vegetations—verrucae—that cause little disturbance in cardiac
function

Question 28

(Aschoff bodies can be found in

Answer 28

any of the three layers of the heart)

Question 29

chronic rheumatic carditis (RHD) بسبب

Answer 29

Initial attack→ generation of immunologic

memory→ reactivation with any subsequent streptococcal infection

Question 30

chronic rheumatic carditis (RHD) اكتر جزء بنصاب

Answer 30

Valvular disease تحديدا mitral valves

Question 31

in Chronic rheumatic heart disease Valve cusps and leaflets become permanently

Answer 31

thickened and retracted.

Question 32

Chronic rheumatic heart disease is

characterized by

Answer 32

acute inflammation (Aschoff bodies) and 
subsequent (fibrosis) scarring

Question 33

Morphology of CRHD

Answer 33

Neovascularization and diffuse fibrosis

Fibrous bridging

Question 34

Fibrous bridging across the valvular commissures and calcification create

Answer 34

fishmouth” or “buttonhole” stenoses.

Question 35

the mitral valves exhibit

Answer 35

leaflet thickening,
– commissural fusion and shortening,
– thickening and fusion of the chordae tendineae .

Question 36

The most important functional consequence of rheumatic heart disease is

Answer 36

valvular stenosis (mainly) and regurgitation

Question 37

Which valves stenosis

Answer 37

mitral valve alone is involved in 70% .
mitral and aortic 25%
tricuspid valve is less involved
the pulmonic valve almost always escapes injury

Question 38

Clinical Consequences

Answer 38

27+28