Rheumatic Fever

Question 1

How do they present?

Answer 1

2-3 weeks after throat infection

• fever
• poor appetite
• weight loss
• fever
• painful joints
• heart failure

Question 2

Diagnosis

Answer 2

2 major OR 1 major and 2 minor 
Major 
- carditis 
- polyarthritis 
- syndenham chorea 
- erythema marginatum 
- subcutaneous nodules 

minor

• increased PR interval on ECG
• arthralgia
• increased CRP, ESR, WBC
• fever
• history of previous RF

Question 3

Treatment GAS pharyngitis

AND eradicate remaining streptococci

Answer 3

Benzathine penicillin G - < 30kg - 600 000 IU IMI stat
> 30kg - 1,2 mil IU IMI stat
Penicillin V - 50mg/kg/day - 3 doses before meals po 10 days - compliance (4 doses to eradicate)

Question 4

Secondary prevention - RF prophylaxis

Answer 4

Benzathine penicillin G - < 30kg 600 000 IU IMI
> 30kg 1,2 mil IU IMI
every 3-4 weeks
Penicillin VK 250mg bd PO

Question 5

Medical Rx CCF

Answer 5

Decrease preload = Diuretics - HCTZ, Furosemide, Spironolactone
Increase contractility and function = Inotropes - Digoxin
IV inotropes - Dopamine, Dobutamine
Decrease the after load = Vasodilators - ACE inhibitors
Control compensatory mechanisms = B blockers - CI in children

Question 6

Histology

Answer 6

inflammatory cell infiltration and proliferation of plump macrophages - anitschkow cells resulting in formation of Aschoff bodies