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Cardiology Internal Med. > Rheumatic Fever > Flashcards

Rheumatic Fever Flashcards

1
Q

Explain rheumatic heart fever?

A

Acute
Inflammatory
Non communicable

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2
Q

What pathology is secondary only to streptococcal throat infection?

A

Rheumatic heart fever

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3
Q

Name a condition which is secondary to both streptococcal skin and throat infection?

A

Post-streptococal glomerulonephritis

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4
Q

Carriers of rheumatic heart fever are at low risk of 3%only.True or False

A

True

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5
Q

Name the criteria used for diagnosis of rheumatic heart fever?

A

Jones criteria

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6
Q

What is the most common age group to develop rheumatic heart fever

A

5-15 years

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7
Q

Jones Diagnostic criteria

A

2 major/ 1 major+2 minor

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8
Q

Name conditions that fall in major jones criteria

A 
Polyarthritis 
Pan carditis 
Erythema marginatum
Subcutaneous nodules 
Sydenhams chorea
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9
Q

What clinical features come under minor jones criteria

A

Polyarthralgia

Fever

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10
Q

What lab results are stated under minor criteria

A

Increased ESR
Increased CRP
Increased ASO titres

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11
Q

What ecg finding is stated under minor jones criteria?

A

Increased PR interval

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12
Q

What is the essential criteria for diagnosis of rheumatic heart fever?

A

Positive throat culture
Recent streptococcal infection
Recent scarlet fever
Positive ASO titres

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13
Q

What drug category is used in polyarthritis?

A

Salicylates

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14
Q

What joints are most commonly affected in polyarthritis?

A 
Large joints WAKE
Wrist
Ankle
Knee
Elbow
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15
Q

Name the most common major symptoms of rheumatic heart fever

A

Polyarthritis

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16
Q

Name the most common major condition that causes death in rheumatic heart fever?

A

Pan carditis

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17
Q

What is the other name for pericarditis?

A

Bread and butter carditis

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18
Q

What are pathognomonic sign of myocarditis in pan carditis?

A

Aschoff bodies

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19
Q

What are the two types of endocarditis seen in pan carditis?

A

Valvular (shows aschoff bodies)

Mural (shows MC calum bodies and Aschoff bodies)

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20
Q

What are the 4 components of Aschoff bodies?

A

Primary T lymphocytes
Anthiscow cells (modified macrophages)
Giant cells
Plasma cells

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21
Q

Which major symptom of rheumatic heart fever never occurs isolated?

A

Subcutaneous nodules (occurs mostly. With carditis)

22
Q

What are the size of subcutaneous nodules?

A

0.5 - 2cm

23
Q

Subcutaneous nodules in rheumatic heart fever are painless.

True or false

A

True

24
Q

Subcutaneous nodules occurs near bony prominences of ?

A 
(VWOKE)
Vertebrae 
Wrist 
Occiput
Knee
Elbow
25
Q

Which is last manifestation to occur in rheumatic heart fever?

A

Sydenhams chorea

26
Q

Sydenham’s chorea of pregnancy?

A

Chorea gravidarum

27
Q

Precipitation factors of chorea?

A

Pregnancy
OCPs
Recurring streptococcus infection

28
Q

How much time does patient generally take to recover from Sydenham’s chorea

A

6 months

29
Q

Typical symptoms of chorea?

A

Milkmaids grip
Darting of protruded tongue
Pronator sign
Spooning of extended hand

30
Q

Name 2 clinical condition in rheumatic heart fever that occur with carditis?

A

Subcutaneous nodules

Erythema marginatum

31
Q

Erythema marginatum is on the face and is pruritic. True or false

A

False

32
Q

What is modified jones diagnostics criteria?

A
  1. 2 major/1 major&2minor with increased ASO titres
  2. Recurrent rheumatic heart fever without established RHD
  3. Recurrent rheumatic heart fever with established RHD
  4. Rheumatic chorea
  5. valvular lesions (MS/MR/AR)
33
Q

Most common affected valve in rheumatic heart fever?

A

Mitral valve(MAT P)

Aortic>tricuspid >pulmonary

34
Q

Earliest valvular lesion in acute rheumatic fever?

A

Mitral regurgitation

35
Q

Earliest valvular lesion in chronic rheumatic fever?

A

Mitral stenosis

36
Q

Drug of choice in patients with polyarthritis,arthralagia,fever?

A

Aspirin, penicillin

37
Q

What is drug dosage of aspirin in children

A

50-60 mg/kg/day to 80-100mg/kg/day

38
Q

What is dosage of aspirin in adults?

A

4-8g/day

39
Q

What is the possible toxicity of aspirin ?

A

Tinnitus

Nausea, vomiting

40
Q

What drug is used if aspirin is not tolerated by the patient?

A

NSAID (naproxen)

41
Q

What is dosage of napraxone used if aspirin is not tolerated?

A

10-20mg/kg/day

42
Q

If patient is refractory to aspirin and nsaids then what can you give?

A

Corticosteroids (prednisone and prednisolones)

43
Q

Route of administration for benzathine penicillin

A

IM

44
Q

Dosage of benzathine penicillin?

A

1.2mn units

If patient <27 kgs then 6 lakh units

45
Q

Oral preparation of penoxymethyl penicillin?

A

500mg/kg/day

250mg/kg/day (if <27kg of weight)

46
Q

Patients who are allergic to penicillin are given which antibiotic drug?

A

Sulfadiazene, sulfisoxazole OR Erythromycin

47
Q

If a patient with carditis lands up in congestive heart failure which drug will you give?

A

Glucocorticoids (prednisone)

48
Q

In case of moderate to severe rheumatic chorea what drug will you prescribe?

A

Valproic acid or carbamazepine

Rest in very mild cases

49
Q

Secondary prophylaxis regime in Rheumatic heart fever without carditis?

A

For 5 years or upto age of 21 years

Whichever is longer

50
Q

Secondary prophylaxis regimen in rheumatic heart fever with carditis but no valvular lesion?

A

For 10 years or upto age of 21 years

Which ever is longer

51
Q

Secondary prophylaxis regimen for rheumatic heart fever with carditis and residual valvular lesion?

A

For 10 years or upto age of 40 years

Which ever is longer

Cardiology Internal Med. (10 decks)

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