rheumatic

Question 1

grp A beta hemolytic strep (strep pyogenes)

Answer 1

rheumatic fever

Question 2

peak incidence between 5-15 yo
F>M
occurs 10 -20 years after original attack
affects mitral (MR then MS) > aortic > tricupid

Answer 2

rheumatic fever

Question 3

molecular mimicry between streptococcal helical surface antigens and similar shaped human proteins in the valvular leaflets and in the myocardium (actin - myosin)

Answer 3

rheumatic fever

Question 4

endocarditis/ valvulitis MV > AV > TV and PV, requires auscultation of a new valvular murmur or abnormal ecg finding

Answer 4

carditis - major

Question 5

persistent tachycardia put of proportion to fever

Answer 5

myocarditis - carditis - major

Question 6

pericardial fiction rub or effusion

Answer 6

pericarditis - carditis - major

Question 7

primary cause of morbidity

Answer 7

heart failure - carditis - major

Question 8

inflammation of joints; no residual deformity

Answer 8

polyarthritis - major

Question 9

molecular mimicry
delayed onset autoimmune reaction
Hx/PE: restlessness, purposeless jerking movements of face, arms and legs; involuntary choreoathetoid movements that disappear with sleep; high risk for chronic valvular dz

Answer 9

Sydenham chorea - major

Question 10

painless, pink rash in trunk or extremities

rash wax and wane or persistent weeks to months

Answer 10

erythema marginatum - major

Question 11

rarely noticed
firm small non tender attached to fascia or tendon sheaths over tiny prominences
persistent and recurrent

Answer 11

subcutaneous modules - major

Question 12

joint pain without redness, swelling or tenderness

Answer 12

polyarthalgia - minor

Question 13

occurs in acute phase

Answer 13

fever - minor

Question 14

prolonged PR interval over .2 sec

Answer 14

minor jones

Question 15

elevated CRP > 3 and ESR > 30

Answer 15

minor jones

Question 16

diagnosis of rheumatic fever

Answer 16

throat culture growing GABHS or increase anti streptolysin O titer
+
2 major or 1 major + 2 minor