Rheumatic fever

Question 1

Cardiac manifestations of rheumatic fever x5

Answer 1

1. Pericardial effusion
2. Cardiac enlargement or cardiac failure
3. ST segment elevation in pericarditis
4. Flat or inverted T waves in myocarditis
5. New or changed heart murmurs

Question 2

Pathological characteristics of rheumatic fever x3

Answer 2

1. Aschoff nodules
2. Serofibrinous effusion
3. Vegetations on endocardium ie heart valves

Question 3

How does rheumatic fever develop from GAS

Answer 3

Autoimmune reaction triggered by molecular mimicry of cell wall M proteins in the GAS and the cardiac myosin and laminin
It is a Type II hypersensitivity reaction, delayed immune response to infection

Question 4

Investigations for rheumatic fever x5

Answer 4

1. Throat swabs
2. Serology- antistreptokinase and antistreptolysin O titre
3. Cardiac echo and ECG
4. Inflammatory markers- ESR, C reactive proteins

Question 5

Pathophysiology of RF x5

Answer 5

1. Vegetation
2. Inflammation and fibrosis
3. Short thick chordae tendinea
4. Endocarditis
5. Myocarditis and fibrinous pericarditis

Question 6

GAS stains that produce RF x6

Answer 6

M types 1 3 5, 6 18 24

Question 7

Consequences of pharyngitis secondary to GABH x3

Answer 7

1. Acute rheumatic fever
2. Rheumatic HD
3. Post strep glomerulonephritis

Question 8

Acute and chronic valvular changes in carditis x5

Answer 8

1. Acute- valvulitis
2. Chronic- fibrosis, calcifications and stenosis
   Results in valvular insufficiency

Question 9

Clinical manifestations of Sydenham’s chorea x4

Answer 9

1. Clumsiness
2. Deteriorations of handwriting
3. Emotional lability
4. Grimacing face

Question 10

Pathogenesis of Sydenham’s chorea

Answer 10

Antibodies reacting with brain ganglioside in the basal ganglia

Question 11

Describe the erythema marginatum in RF x4

Answer 11

Pale center
1-2 inches in size
Red irregular margin
More on trunk and limbs

Question 12

RF features on an echocardiogram x5

Answer 12

1. Valve edema
2. LA and LV dilatation
3. Mitral regurgitation
4. Pericardial effusion
5. Decreased contractility

Question 13

Differential diagnosis for RF

Answer 13

1. Infective endocarditis
   2.

Question 14

Treatment of RF x5

Answer 14

1. Bed rest for patients with fever, carditis, arthrits
2. Antibiotics- penicillin or erythromycin x10/7
3. Acetaminophen if there’s only arthralgia and atypical arthritis
4. High dose salicylates eg aspirin in polyarthritis with carditis
5. Corticosteroids in polyarthritis with carditis, cardiomeg, CHF

Question 15

Supportive therapy for carditis in RF x4

Answer 15

Digoxin
Diuretics
Oxygen therapy
Fluid and salt restriction

Question 16

Who receives secondary prophylaxis in RF

Answer 16

1. Documented history of RF
2. Isolated chorea
3. W/o evidence of RHD

Question 17

Secondary prophylaxis in patients who are allergic to penicillin x4

Answer 17

Cephalexin
Azithromycin
Clarithromycin
Clindamycin

Question 18

Secondary prophylaxis options in RF x4

Answer 18

Penicillin G
Penicillin V
Sulfadiaxine
Macrolide