Rheumatic Fever for Nursing Faculty

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Questions and Answers

What is the primary characteristic of rheumatic fever?

It exclusively affects the skeletal muscles.

It is a nonsuppurative complication of a streptococcal infection. (correct)

It leads to immediate tissue necrosis.

It primarily affects the lungs.

Which age group is most commonly affected by rheumatic fever?

Adults over 30 years

Children aged 5-15 years (correct)

Children aged 1-4 years

Infants under 1 year

According to Jones criteria, which combination of symptoms indicates a highly probable diagnosis of rheumatic fever?

Two major criteria and no history of infection

One major criterion and one minor criterion

One major and two minor criteria with evidence of a preceding infection (correct)

Two minor criteria only

What percentage of patients with acute rheumatic fever are affected by rheumatic carditis?

50 to 70% Signup and view all the answers

Which of the following is a serious consequence of rheumatic carditis?

Chronic valvular damage Signup and view all the answers

How does tachycardia associated with rheumatic fever usually present?

Disproportionate to level of fever Signup and view all the answers

What is the tendency for rheumatic fever to recur in a child who has previously had an attack?

50% chance of recurrence Signup and view all the answers

Which demographic is at a higher risk of developing rheumatic fever?

Overcrowded poor societies Signup and view all the answers

What is a characteristic feature of arthritis as described?

Joint is red, hot, swollen, and tender Signup and view all the answers

Which of the following joints are typically affected by arthritis?

Wrist and ankle Signup and view all the answers

What happens to arthritis symptoms with the start of salicylate therapy?

Symptoms disappear within one day Signup and view all the answers

What is true regarding the chronic effects of arthritis?

It leaves the joint intact Signup and view all the answers

Which percentage of patients is affected by rheumatic chorea according to the findings?

10% Signup and view all the answers

What is a noted investigation useful in suspected cases of rheumatic fever?

Echocardiography Signup and view all the answers

Which of the following is a complication of rheumatic fever?

Chronic valvular disease Signup and view all the answers

What is the recommended primary prophylaxis for preventing rheumatic fever?

Benzathine penicillin Signup and view all the answers

Study Notes

Definition

Rheumatic fever (RF) is an inflammatory disease affecting connective tissues, particularly joints and the heart.
Can also involve the CNS, skin, and subcutaneous tissues.

Etiology

RF is a complication of group A beta-hemolytic streptococcal infections, particularly after upper respiratory tract infections.

Epidemiology

Affects males and females equally, typically between ages 5-15.
Occurs in 3% of untreated or inadequately treated streptococcal infections.
Recurrence rate in children with previous attacks is about 50%.
Family history increases occurrence chance by 10%.
More prevalent in overcrowded and impoverished communities.

Clinical Picture and Diagnosis

No singular clinical or laboratory test confirms RF; diagnosis is probable with Jones criteria.
Jones criteria:
- Two major criteria + evidence of prior streptococcal infection.
- One major and two minor criteria + evidence of prior streptococcal infection.

Major Clinical Manifestations

Carditis

Affects 50-70% of patients within the first three weeks of acute RF.
Involves all heart layers: myocardium, endocardium, and pericardium.
Can lead to chronic valvular damage; mild cases may go undetected.
Symptoms include cardiomegaly, tachycardia, rapid sleeping pulse, arrhythmias, and congestive heart failure.

Arthritis

Characterized by red, hot, swollen, tender joints with limited movement, typically affecting large joints.
Symptoms often resolve within a week without treatment or within a day with salicylate therapy.
Does not lead to chronic joint disease.

Rheumatic Chorea

Occurs in about 10% of cases, typically 2-6 months post-infection.
May be the sole manifestation or accompany carditis.

Subcutaneous Nodules

Found in about 1% of cases, mainly in those with severe carditis.
Appear as pea-sized, firm, painless nodules over bony prominences.

Other Investigations

Echocardiography is crucial for suspected RF; detects valvular regurge, cardiac dilatation, decreased function, and pericardial effusion.

Differential Diagnosis

Exclude carditis from viral myocarditis, arthritis from rheumatoid arthritis, chorea from degenerative diseases, and pericarditis from various causes including tuberculosis and viral infections.

Complications

Chronic valvular disease, heart failure, infective endocarditis, arrhythmias, thromboembolism leading to stroke, and potentially death from severe carditis.

Primary Prophylaxis

Early treatment of streptococcal infections is vital to prevent RF.
Prophylactic options include:
- Benzathine penicillin 1,200,000 units IM once.
- Procaine penicillin 400,000 units/day for 10 days.
- Oral penicillin V 125-250mg/dose three times daily for 10 days.
- Erythromycin 40mg/kg/day orally in three divided doses.

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Description

This quiz covers the key concepts of rheumatic fever (RF), including its definition, etiology, and involvement of various body systems. It is designed for nursing students and faculty at Sohag University, providing essential knowledge about this inflammatory disease. Test your understanding of RF and its complications.