Rhematic Fever Flashcards
Def rhematic fever
Auto immune inflammatory dx involoving 5
Heart
Large joints
Chore
Skin
Skin
Mention organism causing rehmatic fever all names
Group A B-hemolytic streptoccoci
Streptococcus pyrogens
What is meant by b hemolytic
Complete hemolysis on the blood agar
Mention story of incidence
5-15 y in developing countries
Equal both البنات دماغهم طاقه
In developing countries
Cause of rehmativ fever
Following upper respirate tract infection or scarlet fever or impetigo after 2 to 4 weeks group a better hemolytic streptoccoci
In presence of genetic susceptibility
What is the antigen of the tissues that is containing molecular mimicry
Myosin
Describe pathogensis of rhemuatic feverr…
Once carditid always……..
Carditis
Mentio the two types of lesion done in rehmatic fever
Which is more specific in evidence of strepto coccus (scarlet fever or pharyngitid)
Scarlet fever bec it is done only by streptococcus pyobens onlyyyyyuhuyyyyyy
How to spot imptigo
Honeycomb scles
How to spot scarlet fever
S sreptococcus
S sand paper rash
S strawberry rash
What is modification of johns criteria
Subclincal carditits
Poly arthralgia
Chorea 1st inv
Ecg
How to diagnose rheumatic fever according to criteria
What is significnace of sc nodules in rh fever
Poor prognosis it indicates fibrosis
What is modified criteria for diagnosis of rheumatic fever?
What is a minor criteria for the diagnosis of rheumatic fever?
How to differentiate between digital toxicity and ECG changes, traumatic fever
By ECG at DC digital ST segment depression curved
What are the evidence of the strept
يا اما هيا او اللي طلع ضدها او أونبص في الزور او سكارليت
Diagnosis based on two major criteria is……… based on one major and two minor
Stronger
Own rhematic fever, manifestations, are reversible except
Carditis
Define arthralgia
Joint pain only
Define arthritis
Joint pain, red, hot, tender, swollen with limited mobility
Evidence for recent streptoccocs infection is required for all cases except
Chorea
Diagnosis of recurrent fever dependence on
Three minor criteria
Two major criteria
One major +2 minor criteria
Plus evidence of infection
Probable rehmatic fever
One major or one minor or absence of a streptococcal serology
Cp of rhematic fever
Arthritis 70
Pan carditis 50
Chorea 15
Erythema marginatum 5
Sc nodules 2-10
Mention characters of arthritis of rhematic fever
70 %
Signs of inflm
Polyarthritis
Big joints
Fleeting
Fate no no
Salicylates dramatic
Asymmetrical
When arthritis is mono at
Early stage
Describe erythema margintum
Red macules with clear pale center
Sharp prog margins
Recurrent
Trunk limbs
No itchy
No face
Sc nodules describtion`
Small
Painless swellimhs
Prominences bones
Not inflammed
Why sc nodules may ne missed
Skin is notw inflammed
Rheumatic chorea maybe the only manifestation of automatic fever
Because it occurs late after the manifestations after four months, and the echo is essential to exclude subclinical carditis
Progmosis of chroea
Self limite
Decribe manifestions of chorea
Most serious manifestation of rheumatic fever
Pen carditis
GR; what at carey comb murmr appears at mid diastole and pre systole
Due to atrial contraction against stenosis
How to differentiate between the number of joint affected
More than five is poly
2 to 4 is oligo
1 mono
What is the function of pericardium?
Limit the diastole of the heart
Describe becks triad
Pericardial effusion
Tender liver
Congested neck veins
Distant heart sound
What makes distant heart sound
Pericardial effusion
How the pain and the rub disappears during pericarditis
Boy treatment
By effusion
All affection of endocardium is regurge except
3 stensis
Fibrosis
Carey comb
Austin flint
Which part of the endocardium is more affected?
Left side mitral valve
Describe Austin flint murur
Aortic regurge
Functional mitral stenosis
Atrial contractions at diastole
Transient s4
Functional mitral stenosis
Austin flint
What makes double Apex and describe it
One Apex at diastole which is abnormal atrial contraction
Bikes at all, which is normal ventricle contraction
Soft systolic murmur propagating to axilla muffled S1
Mitral regurge
Soft systolic murmur propagating to Azela with S1
Double mitral lesion
Why weak S1
Loss of muscular component due to myocarditis
Decribe endocarditis
Or austin flint
Describe myocarditis , pericarditis of rheumatic fever
How to differentiate between the pericardial rub and a precordial pain from pelusristy
If the pain is not related to respiration, so it’s cardiac
Mention all galloping of heart during rhematic
Most common s3 indication for chf
Transient se for carey comb
According to robotic heart, disease lesions are usually seen in
Adolescence
What are the early complications of rheumatic heart?
Congestive heart failure dilated with S3
Dysrrthmia
Differentiate between other causes of arthritis
Why rhematic arthritis doesn’t damage the joint while rhemotiod damage the joint
Because it damages a articular cartilage while at Eelmatic, it damages, synovial membrane, and synovial fluid
How to differentiate between rheumatic. Chorea and the other causes of chorea
Wilson liver damage CNS affection(tremors, rigidity, gait affection)
Increase liver copper content decrease the serum ceruplasmin
Differentiate the innocent murmur from rheumatic murmur
Mention inv done incase case of rhematic fever
Throat swab is usually negative
As organism usually dissaperead from pharynx
Esr may be normal in case of chorea
Due to late affection
Echo use incase of rhematic fever
Valvular insufficient
Ventricular dilation
Flask shaped heart
Pericardial effusion
Ecg findings incase of rhematic fever
Prolonged pr
Can rhematic occur after tonsillectomy
Yes by scarlest fever
Pharingitis
Is asot positive is enough
No must rising titre
250-400
Max dose of cortisol
60 mg
Primary prevention is hard
Bec 30% of cases are subclinical
Decribe the preventive ttt of rhematic fever
Benzathine penicillin
Dose
Route
Duration
Se
Mention specific ttt of rhematic fevevr
Asprini dose for arthritis
100mg/ kg / day for 2-3 weeks
75mg/ kg / 3 times w-3 weeks
Carditis ttt doses
Predensione
2mg/kg/day for 2 weeks then taper over 4 weeks
And start 75mg/ kv for 6 weeks
Mention primary prevention doses of penecilin
