Rhumatic fever

Question 1

is rheumatic fever infectious disease ?

Answer 1

no, its a complication of scalet fever or strut throat infection that caused by not any bacteria but because the strepto bacteria

Question 2

is strepto bacteria responsible for the complication of the valvular disease ?

Answer 2

no, but the immunological response to the bacteria

because the bacterial antigen cross react with the target organ and AB cross react with the heart and the brain

Question 3

whats the initial attacks of the disease ?

and the latent period ?

Answer 3

attack the pt from 6 yrs to 20 but rarely oattack at age above 30yrs

and the latent period until the appearance of the syptmoas is 18 days that means from 1 week to 5 week

and acute attack cure after 3months (12weeks)

Question 4

If pt have rheumatic fever (at the time of presentation )

dose the bacterial culture is beneficial ?

Answer 4

only 25% pf the pt who are diseased the bacterial culture for them is pstitive .

Question 5

whats the most common feature of rheumatoid fever ?

Answer 5

is a migratory arthritis in 80% pf pt usually with fever and rarely causes deformity

Question 6

which type of joint dose the rheumatoid fever attack ?

Answer 6

rheumatoid fever attack the large joint 
1-shoulder 
2- elbow 
3-knee
4-ankle
but rheumatoid arthritis attack the small joint

Question 7

How the rheumatic fever affect the heart ?

Answer 7

it's cause pan carditis means involve all the layers of the heart 
pericarditis 
new or changing murmur 
cardiomegaly 
heart failure

Question 8

pt who have carditis which type of problem will experience ?

Answer 8

60%will having moral valve then40% develop combined mitral and aortic .

Question 9

whats the sedenham chorea ?

Answer 9

dancing movement of the hands and the feet at the initial time of presentation .

Question 10

erythema marginatum لازم نحفظ الصوره

Answer 10

its rare happened in 10%

Question 11

what the carditis considered in the rheumatoid fever?

Answer 11

its the most lethal signs

Question 12

شنو هو الفحص المختبري الي يني انو سبب المراض الي بالقلب هو حمى الروماتيديه؟

Answer 12

by Antistreptolysin O (ASO) titer is a blood test to measure antibodies against streptolysin O and anti DNAase or antihyurindase النتيجه هي ٩٠٪

Question 13

is throat culture beneficial ?

Answer 13

no it only used in the recent infection only

Question 14

ARE C-reactive and ESR important in diagnosis ?

Answer 14

not important in diagnosis but more use as follow up

Question 15

COULD U USE THE ECG FOR DIGNOSIS THE CARDITIS ?

Answer 15

YES, ECG IS HELPFUL FOR CARDITIS IF PR ARE PROLONG (normally the PR interval less than one small square is larger its prolong )بس هذا ما يعتبر علامه خطره انو راح يصير بي مرض بالقلب

Question 16

شلون اشخص انو هذا المرض الي بالقلب سببه الحمى الروماتيديه ؟بدون فحص بالاب ؟

Answer 16

according two criteria

TWO MAJOR OR TWO MINOR + evidence of strept inf

Question 17

what’re the majo criteria r in the rheumatoid disease ?

Answer 17

major = MSC
1- migratory arthritis 
2-sunceoutanous nodule 
3-sydenham chorea 
4-carditis

Question 18

what’re the minor criteria ?

Answer 18

fever and arthralgia

elveted reactant and prolong PR

Question 19

how to treatment ?

Answer 19

1- treat the acute attack
2- treat the current infection
3- treat the further attack

Question 20

which drug is used ?

Answer 20

pencillin is used as treatment of acute attack while the parenteral benzathine penicillin (1.2 m unit for 4 week )because its have long term action used to prevent further attack واذا البيت مال المريض مزدحم اطي كل ٣ اسابيع

and aspirin as analgesia and we use high doses to work as Anti-inflmtory effect

NSID for treat the sever carditis

NSID should be tapered … reduced 25% each week after 2-3 weeks

steroid as prednisolone should dose reduced taper over 2weeks and instead use high dose of aspirin

methylpredsolone in sever cases

haloperidol is an antipsychotic medicine treat chorea

Question 21

if pt allergic pt penicillin?

Answer 21

used oral cephalosporin rather than erythromycin .

Question 22

شكد نظل نطي المريض بروفيلاكسس؟

Answer 22

for 1O yrs as AHA recommended بس الدكتور كال مدى الحياة