Rheumatic fever

Question 1

Multisystem autoimmune inflammatory disease with major cardiac manifestations

Answer 1

Rheumatic fever

Question 2

Rheumatic fever most often affects

Answer 2

children 5-15

Question 3

Rheumatic fever occurs after an infection caused by

Answer 3

group A streptococci
(Not bacterial! - autoimmune disease)

Question 4

AN elevated __ is evidence of a recent streptococcal infection

Answer 4

antistreptolysin O titer

Question 5

T/F: RF is a result of a bacterial infection

Answer 5

FALSE! it is not

Question 6

RF is an example of a __

Answer 6

type II hypersensitivity reaction (to the antibodies produced from group A streptococci)

Question 7

The patients immune response is unable to distinguish between the strep and host tissues resulting in an ___ tissue injury, characterized by nonsuppurative inflammatory lesions of the __

Answer 7

auto-immune mediated tissue injury
joints, heart, subcutaneous tissue, CNS

Question 8

The __ is the classic, myocardial lesion of RF

Answer 8

aschoff body

Question 9

Describe the aschoff body/nodule

Answer 9

large activated macrophages
antischkow cells
multinucleated giant cells - aschoff cells

Question 10

__ occurs in up to 40% OF PATIENTS WITH RF AND CONSISTS OF INFLAMMATION OF THE PERICARDIUM, MYOCARDIUM AND ENDOCARDIUM

Answer 10

Carditis (pancarditis)
Pericarditis
Myocarditis (congestive heart failure - cause of most deaths)
Endocarditis (valvular damage)

Question 11

Rheumatic endocarditis usually occurs in areas subject to greatest hemodynamic stress such as the posits of

Answer 11

valve closure

Question 12

Noncardiac manifestations of RF

Answer 12

Fever and increased ESR
Joint involvement
Skin lesions
CNS involvement

Question 13

Noncardiac manifestations of RF:
Joint involvement

Answer 13

Migratory polyarthritis (occurs in 75% of patients)

Question 14

Noncardiac manifestations of RF:
Skin lesions

Answer 14

subcutaneous nodules (10%)
erythema marginatum (5%)

Question 15

Noncardiac manifestations of RF:
CNS involvement

Answer 15

Sydenham’s chorea (St. Vitus’s dance)

Question 16

Results from single or repeated attacks of RF and consists of the cardiac valve damage (chronic valvulitis) that often occurs many years after the episodes of RF

Answer 16

Chronic rheumatic heart disease

Question 17

Due to fibrotic healing, valves become thickened, fibrotic, rigid and deformed with thickening of chordae tendineae

Answer 17

Chronic rheumatic heart disease

Question 18

The __ is the valve most frequently involved in RHD resulting in a fishmouth or buttonhole deformity

Answer 18

Mitral valve

Question 19

When the tricuspid valve is affected it is always in conjunction with the

Answer 19

mitral valve and aortic valves

Question 20

The __ can be affected by stenosis or insufficiency

Answer 20

aortic valve