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Cardiology Exam IV > Micro: Rheumatic Fever > Flashcards

Micro: Rheumatic Fever Flashcards

1
Q

Hx related to S.pyogenes infection (not yet RF)

A

Sore throat
Head Ache
Abdominal pain, N/V

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2
Q

Physical findings associated with S.pyogenes infection (not yet RF)

A

Pharyngeal erythema and exudate*
Enlarged/Tender Cervical lymph nodes
Palatal Petechiae
Running fever (102 or so)

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3
Q

The differential between viral and bacterial sore throats is …

A

presence of purulence with bacterial

Both viral and bacterial will present with redness

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4
Q

How is S.pyogenes infection Dx ?

A

Rapid Strep Test (antigen based)

If this is negative, does not mean there is no strep (80-90% sensitive. Bacterial antigen titers may not be high enough to detect early on)

If Neg: Throat culture !

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5
Q

Streptoccoci Characteristics

A 
General:
Gram +
Catalase -
Coagulase -
Faculative Anaerobes
Capnophilic (Like CO2)

Lab:
Beta hemolytic
Bacitracin sensitive
PYR positive(L-pyrrolidonylarylamidase enzyme)
What else is PYR+? Enterococcus (vert similar to streptococcus)

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6
Q

ASO titer

A

anti-streptolysin O

ASO destroys RBC’s. This test can be useful in determining strep throat after the infection has been cleared. Good for determining cause of rheumatic fever

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7
Q

Anti-Dnase B test

A

Good for Strep skin infections (can be used for throat as well)

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8
Q

what are two physical finding associated with Scarlett Fever ?

A

Sandpaper Rash

Strawberry tongue

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9
Q

What is the S.pyogenes virulence factor associated with Strawberry tongue and Sandpaper rash ?

A

Pyrogenic Exotoxin

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10
Q

What is the most dangerous disease state associated with pyrogenic exotoxin ?

A

Necrotizing fasciitis

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11
Q

Describe the chronology of Rheumatic Fever

A

Patient developes strep. throat
2-3 weeks later patient presents with symptoms associated with disease
Most likely will be + for ASO

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12
Q

What is the virulence factor associated with Rheumatic fever ?

A

M-Protein

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13
Q

How does M-protein lead to developement of RF ?

A

Binds fibrinogen
Binds IgG–> Strong response –> bind auto-antigens !!!**
Binds complement factor H
discourages binding of C3b to surface

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14
Q

Which strains of Strep are NOT associated with causing Acute RF ?

A

Those which are pyodermal in nature (cause purulent rash )

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15
Q

What happens to virulence of Strep which have been passed between many people ?

A

Virulence increases !

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16
Q

Where will you find auto-antigens that are similar to M-protein ?

A

Cardiac myosin–>myocarditis etc.
Sarcolemmal membrane protein
Synovium (joints)
Articular cartilage (joints)

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17
Q

What percentage of people with asymptomatic pharyngitis will go on to develop Acute RF (ARF) ?

A

33% (1/3 as the ppt states)

18
Q

Age group associated with ARF ?

A

School children 5-15

19
Q

Which HLA type predisposes African americans to ARF ? Caucasians ?

A

HLA DR-2

HLA-DR4

20
Q

What syndromes associated with ARF are females more prone to ?

A

Syndeham Chorea

Mitral Valve Stenosis

21
Q

What valve is most commonly affected with ARF associated endocarditis ?

A

Mitral (as always)

22
Q

Aschoff bodies are associated with ARF that affects what heart layer?

A

Myocardium

23
Q

Describe ARF associated pericarditis

A

Inflammatory lesions of epicardial connective tissue
Fibrinous or serofibrinous exudate
Usually resolves without lesions

24
Q

Jones Criteria for ARF

A
  1. Evidence of GABHS + Two major indicators

2. 1 Major indicator + 2 Minor indicators

25
Q

Jones Criteria: Major manifestations

A 
Carditis
Polyarthritis
Chorea
Erythema marginatum
Subcutaneous nodules
26
Q

Jones Criteria: Minor Manifestations

A 
Arthralgia
Fever
Elevated acute phase reactants
   Erythrocyte sedimentation rate (ESR)
   C-reactive protein (CRP)
Prolonged PR interval
Supporting evidence of GABHS infection
27
Q

Clinical Manifestations that peak within the first month of ARF

A

Polyartheritis
Carditis
Erythema marginatum

28
Q

Clinical Manifestations that peak after the first month of onset with ARF

A

Chorea

Subcutaneous nodules

29
Q

Murmurs associated with ARF

A

High-pitched blowing holosystolic apical murmur of mitral regurgitation

Low-pitched apical mid-diastolic flow murmur

High-pitched decrescendo diastolic murmur of aortic regurgitation

30
Q

Is mitral and aortic stenosis associated with Chronic or Acute RF associated valvular disease ?

A

CHRONIC (Only)

31
Q

Chronic scarring of Mitral valve is described as

A

“fish mouth”

32
Q

What happens to the chordae tendinae in Chronic rheumatoid valvulitis

A

shortened and thickened (these connect the papillary muscles to the Tri/Bicuspid valves)

33
Q

percent of patients with polyarthritis on first attack of ARF ?

A

75%

Increases with age

34
Q

Polyartheritis is associated with which joints in the body

A

Knees, ankles, elbows, wrists

35
Q

What is the prognosis for polyarthritis ?

A

May migrate to other joints but will typically resolve in 4 weeks with no residual damage

36
Q

Syndeham Chorea

A

St. Vitus dance
15% of cases exhibit
Rapid, purposeless movements of face, upper extremities

Seen in women more than men

37
Q

What is often seen when patients with Syndeham Chorea sleep ?

A

The chorea subsides

38
Q

Describe the hypothesis on how Syndeham chorea occurs in the setting of ARF ?

A

antistreptococcal antibodies cross react with proteins in basal ganglia of brain triggering an inflammatory response (PANDAS is sub-type of Syndeham that may cause OCD, Tourettes etc)

39
Q

Describe erythema marginatum

A

serpiginous
Rash appears intermittently for weeks to months
Nonpruritic, nonpainful, erythematous

Due to vasomotor response ?

40
Q

Subcutaneous nodules (Aschoff bodies in heart) are formed from edmeatous fragmented collagen fibers. Where do you often see these nodules ?

A

extensor surfaces of wrists, elbows, knees

Allegedly can be seen in the myocardium of the heart (known as Aschoff bodies there)

41
Q

Subcutaneous nodules are associated with …

A

Severe Carditis !

42
Q

How could ARF lead to hemoptysis ?

A

Valves incompetent –> backflow into lungs –> bloody coughing

Cardiology Exam IV (9 decks)

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