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MBChB IV Paediatrics > Rheumatic Fever > Flashcards

Rheumatic Fever Flashcards

1
Q

How do these children present?

A 
Signs and symptoms appears 2-3 weeks post pharyngeal infection in age 5-15 children 
Fever 
Tiredness 
Heart failure 
Painful joints 
Poor appetite/weight loss
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2
Q

Jones Criteria

A 
Major 
Carditis 
Polyarthritis 
Syndenham chorea 
Erythema marginatum 
Subcutaneous nodules 
Minor 
Prolonged PR interval on ECG 
Arthralgia 
Previous Hx or evidence of RF fever 
Acute phase reactants : increase CRP, ESR, WBC
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3
Q

How do you treat GAS pharyngitis?

A

Benzathine penicillin G

  • <30kg 600 000 IU stat IMI
  • > 30kg 1.2mil IU stat IMI

Penicillin V
- 50mg/kg/day in 3 doses before meals po for 10 days (compliance)

Penicillin allergy
- erythromycin
 <30kg 125mg qid po x 10 days
 >30kg 250mg qid po x 10 days
- cephalexin
 25-100mg/kg/day in 3 doses po
- cephaloridine
 30-50 mg/kg/day in 3 doses IMI
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4
Q

What is the secondary prevention against rheumatic fever?

A

RF prophylaxis

Benzathine penicillin G IMI
Penicillin VK - 250mg bd po
Erythromycin 250mg bd po

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5
Q

What is rheumatic fever?

A

An overreaction of body’s immune system to it’s own tissue after GAS throat infection

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6
Q

Which antibodies are produced in rheumatic fever and against which tissues?

A

M protein - heart, joint (glycoproteins)
Cell wall polysaccharide - cardiac valves
Hyaluronate capsule - joints (human hyaluronate)
Membrane antigens - smooth + cardiac mm, dermal fibroblasts, neurons of caudate nucleus

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7
Q

Which children get rheumatic fever?

A

5-15yo
Poverty
Genetic predisposition

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8
Q

What is a differential for rheumatic fever?

A 
Arthritis
Infection (TB, HIV, IE)
Autoimmune
Cancer (leukemia)
Drug reaction
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9
Q

What is the primordial prevention against rheumatic fever?

A

Socioeconomic upliftment (housing, healthcare)

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10
Q

What is the primary prevention against rheumatic fever?

A

Diagnose GAS throat infections and treat

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11
Q

What is the tertiary prevention against rheumatic fever?

A

Manage chronic RHD
F/U
Ensure compliance and screen for complications

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12
Q

How do patients with GAS pharyngitis present?

A 
Fever
Sore throat
Halitosis
Tonsillar hypertrophy
Red pharynx
Follicle
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13
Q

Discuss treatment of acute rheumatic fever

A
  1. Antibiotic
    - Benzathine penicillin G
    <30kg 600 000 IU stat IMI
    >30kg 1.2mil IU stat IMI
    - Pen V
    50-100mg/kg/day in 4 doses x 10 days
  2. Bedrest
  3. Anti-inflammatories
    - aspirin 80-120mg/kg/day in 4doses po
    - prednisone 1-2mg/kg/day in 2-4 doses po
  4. Monitor disease activity
  5. Manage chorea
  6. Manage CCF
  7. Surgery if needed
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14
Q

When can a child start walking again during ARF treatment?

A

Joints normal
No cardiomegaly
Normal resting pulse

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15
Q

Name side effects of aspirin

A 
Tinnitus
Dizziness
Vomiting
Gastric bleeding
Pulmonary oedema
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16
Q

Name side effects of prednisone

A 
Cushingoid appearance
Hypertension
Hyperglycemia
Immunosuppression
Insomnia
Emotional lability
17
Q

What bloods should you do to monitor rheumatic fever?

A 
FBC
U+E
ESR 
CRP
ASOT
Blood culture
18
Q

How do you treat chorea?

A

Haloperidol 0.025 - 0.05 mg/kg/day po

Risperidone 0.01-0.5 mg/kg/dose bd po

19
Q

How do you manage CCF

A
  1. Decr preload
    - lasix 1-4mg/kg/day in 2-4 doses IV
    - aldactone 2-3mg/kg/day in 2-3 doses po
  2. Incr contractility
    - digoxin 0.01mg/kg/day bd po
    - dopamine/dobutamine in ICU
  3. Decr afterload
    - Captopril 0.5-6mg/kg/day in 3-4 doses po
20
Q

What do you need to add if you give lasix?

A

Potassium supplement

21
Q

Which is preferable: a valve replacement or a valve repair?

A

Valve repair - no warfarin needed!

Replacement - warfarin lifelong and repeated every 15-20y

22
Q

How does rheumatic fever appear on histology?

A

Inflammatory cell infiltration
Proliferation of plump macrophages ( Anitschkow cells)
Results in formation of Aschoff nodules

23
Q

What do you need to diagnose RF?

A
  1. Evidence of GAS infection

2. 2 major/1 major + 1 minor criterion

24
Q

Why are beta blockers contraindicated in children?

A

Drop BP

Blocks compensatory tachycardia

25
Q

What is the duration of secondary prophylaxis?

A

RF, no carditis, no valvular - 5y or until 21yo
RF w/ carditis, no valvular - 10y to adulthood
RF w/ carditis + valvular - 10y to age 40
CRHD - lifelong

MBChB IV Paediatrics (81 decks)

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