Acute Rheumatic Fever Quiz

A 9-year-old boy is brought to the paediatric outpatient department with complaints of fever and pain that started in his right knee and has now moved to his left ankle. His mother reports he had a sore throat about three weeks ago, which resolved without specific treatment. On examination, his temperature is 38.8°C, his left ankle is swollen, warm, and exquisitely tender to palpation. His heart rate is 120/min. Auscultation reveals a soft, blowing, high-pitched diastolic murmur best heard at the left third intercostal space with the diaphragm of the stethoscope, with the patient sitting up and leaning forward. Which of the following is the most likely valvular lesion?

• Mitral stenosis

• Mitral regurgitation

• Aortic stenosis

• Aortic regurgitation

A 10-year-old girl is diagnosed with her first episode of acute rheumatic fever with carditis but without evidence of heart failure. According to the 2020 American Heart Association guidelines, what is the recommended duration for secondary prophylaxis with benzathine penicillin G?

• 5 years after the last attack or until 21 years of age, whichever is longer.

• 10 years after the last attack or until 21 years of age, whichever is longer.

• 10 years after the last attack or until 40 years of age, whichever is longer.

• Lifelong prophylaxis.

A 12-year-old male presents with purposeless, involuntary, and abrupt movements of his limbs and facial grimacing for the past week. His mother notes that his handwriting has become clumsy and he is more emotionally labile. He has no fever or joint pains. ASO titre is elevated. An echocardiogram is normal. Which of the following statements regarding his condition is most accurate?

• The latent period between the streptococcal infection and the onset of these symptoms is typically less than one week.

• This manifestation is considered a minor criterion in the Jones criteria.

• Anti-neuronal antibodies cross-reacting with the basal ganglia are the likely pathogenic mechanism.

• Treatment with salicylates is the first-line therapy to shorten the duration of the movements.

Which of the following is considered the single most definitive evidence of a preceding Group A streptococcal (GAS) infection in a patient suspected of having Acute Rheumatic Fever?

• A history of sore throat 2-3 weeks prior to symptom onset.

• An elevated Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP).

• A positive throat swab culture for Streptococcus pyogenes.

• A markedly elevated or rising anti-streptolysin O (ASO) or anti-DNase B titre.

A 14-year-old girl is being managed for acute rheumatic carditis with moderate mitral regurgitation and early signs of congestive heart failure. Which therapeutic agent is considered the cornerstone of management for controlling the inflammatory process in the myocardium and pericardium in this specific clinical scenario?

• High-dose Aspirin

• Prednisolone

• Digoxin

• Intravenous Immunoglobulin (IVIG)

A young patient diagnosed with acute rheumatic fever presents with several non-pruritic, serpiginous macules with pale centers and erythematous, raised margins over the trunk and proximal limbs. The rash appears to be transient, disappearing and reappearing. What is this clinical sign called, and what is its primary clinical significance?

• Erythema nodosum; a minor manifestation.

• Subcutaneous nodules; a major manifestation.

• Erythema marginatum; a major manifestation.

• Annular erythema of infancy; not related to rheumatic fever.

In the 2015 revision of the Jones criteria, the distinction between low-risk and moderate/high-risk populations was introduced. For a patient from a high-risk population (e.g., in many parts of South India), which of the following would be considered a major criterion for diagnosing Acute Rheumatic Fever?

• Polyarthralgia

• Fever ≥ 38.5°C

• ESR ≥ 60 mm in the first hour

• Monoarthritis

A 15-year-old on secondary prophylaxis for a previous episode of rheumatic carditis develops fever, myalgia, and a sore throat. A rapid streptococcal antigen test is positive. What is the most appropriate immediate management step?

• Increase the dose of benzathine penicillin for the next injection.

• Administer a full 10-day course of oral amoxicillin.

• Assume it is a viral infection as he is already on prophylaxis.

• Administer a single dose of intramuscular ceftriaxone.

Which of the following pathological lesions is considered pathognomonic for rheumatic carditis when identified on myocardial biopsy or post-mortem examination?

• Fibrinous pericarditis

• MacCallum's patch on the left atrial endocardium

• Anitschkow cells within a granulomatous lesion

• Verrucous vegetations on the line of valve closure

A child is successfully treated for an initial episode of acute rheumatic fever that involved polyarthritis and mild carditis (a transient apical systolic murmur that resolved completely on follow-up echocardiography). The patient's family is counselled about secondary prophylaxis. Which statement provides the most accurate rationale for this long-term treatment?

• "The prophylaxis will reverse the minimal valve damage that has already occurred."

• "Each subsequent streptococcal infection has a significantly higher risk of causing a more severe carditis recurrence."

• "This treatment is required to prevent the development of Sydenham's chorea later in life."

• "The penicillin prevents the patient from being a carrier of streptococcus and spreading it to others."