Rheumatic Fever

Question 1

What is acute rheumatic fever

Answer 1

Non suppurative sequels occuring 2-4 weeks following group A strep pharyngitis

Question 2

Pathophysiology of acute rheumatic fever

Answer 2

Molecular mimicry of antibodies against GAS antigen reacting with host antigens

Question 3

Pathophysiology of carditis in rheumatic fever

Answer 3

Strep M protein and NABG (antigen of GAS ) share epitopes with myosin

Question 4

5 major manifestation of acute rheumatic fever

Answer 4

Migratory arthritis of large joints
Carditis / valvulitis
CNS - Sydenham chorea
Erythema marginatum
Subcutaneous nodules

Question 5

4 minor manifestations of acute rheumatic fever

Answer 5

Arthlagia
Fever
Elevated acute phase reactants ( ESR, CRP)
Prolonged PR interval

Question 6

Conditions leading to high suspicion of rheumatic fever

Answer 6

Group A infection followed by 2 major manifestations or 1major+2minor

Question 7

3 situations where you can suspect rheumatic fever without respecting criteria

Answer 7

Chorea only manifestation

Indolent carditis only manifestation

Recurrent rheumatic fever when history of it

Question 8

Natural history of arthritis in rheumatic fever

Answer 8

Inflammation of several joints in quick succession ( knees, ankles, elbows, wrist) giving sense of migration of pain

Question 9

What is milk maids sign

Answer 9

Muscle weakness where patient squeeze doctors hand with increasing pressure which decreases crapiciously

Question 10

CNS manifestation in rheumatic fever

Answer 10

Hemichorea
Muscle weakness
Diffuse hypotonia
Emotional changes - outburst , crying, restlessness

Question 11

What is erythema marginatum

Answer 11

Pink or faintly red
Non Pruritic rash of trunk and limbs , not face

Question 12

Characteristics of erythema marginatum

Answer 12

Pinky or faintly red
Non Pruritic rash
Trunk and limbs , not face
Extends centrifugal , with return of center to normal
Outer edges sharp
Inner edge diffuse

Question 13

Characteristics of nodules in ARF

Answer 13

Firm
Painless
Few mm to 2cm
Over bony surface or near tendons
Symmetric

Question 14

Investigation for strep A

Answer 14

Throat culture of group A beta hemolytic strep
Rapid strep antigen test
Antistreptolysin O antibody titre

Question 15

Percentage of negative patient for strep A throat culture when manifestations of rheumatic fever appear

Answer 15

75 %

Question 16

Investigation in rheumatic fever

Answer 16

Strep A investigation
ESR , CRP
Cardiac function

Question 17

Goal of treatment

Answer 17

Symptomatic relief
Eradication of group A beta hemolytic strep
Prophylaxis against future GAS infection

Question 18

Management

Answer 18

Antibiotic therapy
Anti inflammatory - aspirin

Question 19

Rheumatic disease definition

Answer 19

Long term damage of cardiac valves after acute rheumatic fever

Question 20

Presentation of rheumatic disease

Answer 20

Progressively worsening signs and symptoms of left and righ heart failure
Signs and symptoms of infective endocarditis

Question 21

Valves affected in order of significance in rheumatic disease

Answer 21

Mitral regurgitation
Mitral stenosis
Aortic regurgitation
Aortic stenosis
Tricuspid valve
Pulmonic valve

Question 22

Investigation of rheumatic cardiac diseas e

Answer 22

FBC
ESR
CRP
Blood urea , electrolytes, creatinine
LFT

Question 23

Management of rheumatic heart disease

Answer 23

Percutaneous balloon mitral valvulotomy to open stenosed mitral valves

Surgical repair or replacement of damaged valve