Rheumatic fever

A 14 years-old boy is brought to physician because of fever and malaise. He reports having sore throat 3 weeks ago. His temperature is 38.7 C, pulse 100/ min and blood pressure is 100/70 mmHg. Blood culture has been sent to laboratory. Which of following is the most likely diagnosis of rheumatic fever?

• Streptococcus

• Pseudomonas

• Staphylococcus

• Shigella

Which of the following factors in the patient’s history and physical is relevant to the diagnosis of Rheumatic fever?

• Sore throat from 3 weeks previous

• Living in the current condition of MI

• The mother's history of type 2 diabetes

• A possible genetic factor from father who's history is unknown

Following Jones criteria which is correct for diagnosis rheumatic fever?

• Three major criteria

• One major plus one minor criteria

• Two minor criteria

• One major plus two minor criteria

A 15 years-old boy is brought to physician because of fever, malaise, and severe right knee joints pain and swelling for 3 days. Five days ago, he had swelling and pain in left ankle joint which has seen resolved. He reports having sore throat 3 weeks ago. There are painless 3 to 4 mm over the elbow.   His temperature is 38.5 C, pulse 110/ min and blood pressure 90/60 mm Hg. Cardiopulmonary examination is normal. His erythrocyte sedimentation rate is elevated 55 mm/h. Arthrocentesis of the right knee joints yield clear; no organisms are identified on Gram stain. Which of following is the most likely diagnosis?

• Acute rheumatic fever

• Septic arthritis

• Infective endocarditis

• Juvenile idiopathic arthritis

A 51 years-old man comes to the physician for 2 months of intermittent low-grade fever, malaise and joint pain. He has recurrent dental abscesses requiring drainage but has otherwise been healthy. His temperature 38.3 C and pulse 112/ min. There are reddish-brown lesions underneath the nail beds and tender violaceous nodules on the bilateral thenar eminence. Two set blood culture grow Streptococcus. A transthoracic echocardiogram shows moderate regurgitation of the mitral valve . Which of the following mechanisms is most likely directly involved in the pathogenesis of rheumatic fever affect heart valve?

• Antibody cross-reaction

• Fibrin clots formation

• Calcification due to aging

Which of following immune response most likely seen in rheumatic fever?

• M protein

• IgA protease

• N-acetyl-β-d-galactosamine

• CAMPs factor

Which symptom is NOT related to Jones criteria?

• Nausea

• Truncal rash

• Fever

• Prolong PR