أسئلة المحاضرة السابعة باثولوجي CVS (قبل التعديل)

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Questions and Answers

Which type of endocarditis primarily affects the endocardium lining the valves?

Mural Endocarditis

Myocarditis

Acute Valvular Endocarditis (correct)

Chronic Valvular Endocarditis

What characteristic appearance may valves exhibit in cases of mitral stenosis?

Fish-mouth appearance (correct)

Smooth texture

Mottled surface

Rough edges

What is a common complication of acute valvular endocarditis?

Chronic venous congestion of the lung (correct)

Pulmonary fibrosis

Aortic regurgitation

Residual cardiac myopathy

Which of the following describes Aschoff's nodules?

Small adherent valvular thrombi Signup and view all the answers

What is the primary outcome of rheumatic vegetations in endocarditis?

Healing by fibrous tissue Signup and view all the answers

Which condition is NOT classified under cardiac manifestations of rheumatic fever?

Pulmonary hypertension Signup and view all the answers

In which type of endocarditis are the valve cusps swollen, red, and lost transparency?

Acute Valvular Endocarditis Signup and view all the answers

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

30-40% Signup and view all the answers

What age group is most affected by rheumatic fever?

Ages 5-15 Signup and view all the answers

Which condition precedes the development of acute rheumatic fever?

Group A streptococcal pharyngitis Signup and view all the answers

What mechanism explains the autoimmune reactions seen in rheumatic fever?

Type II hypersensitivity Signup and view all the answers

Which of the following factors is NOT linked to the susceptibility to acute rheumatic fever?

Age of the individual Signup and view all the answers

In terms of global prevalence, where is rheumatic fever most common?

Developing countries in Asia, Africa, and South America Signup and view all the answers

What does molecular mimicry in the context of rheumatic fever refer to?

Cross-reactivity between host peptides and streptococcal antigens Signup and view all the answers

Which of the following statements about Group A Streptococcus is incorrect?

All strains of Group A produce rheumatic fever. Signup and view all the answers

What role do HLA alleles play in acute rheumatic fever?

They help in presenting antigens and autoantigens to T-cells. Signup and view all the answers

What is implicated in the formation of autoantibodies in rheumatic fever?

Streptococcal antigens cross-reacting with heart tissue Signup and view all the answers

Which type of hypersensitivity reaction is involved in the damage of endocardial and myocardial cells in rheumatic fever?

Type II cytotoxic reaction Signup and view all the answers

Which laboratory result is indicative of a recent streptococcal infection?

Increased anti-streptolysin O (ASO) levels Signup and view all the answers

What is the characteristic lesion associated with rheumatic heart disease?

Aschoff's bodies Signup and view all the answers

What occurs in the germinal centers after the activation of helper T cells?

Differentiation of B cells into plasma cells Signup and view all the answers

Which of the following describes the primary function of autoantibodies generated during rheumatic fever?

Mediating inflammation in joint and heart tissues Signup and view all the answers

What pathological change is mainly observed in Aschoff's bodies?

Fibrinoid necrosis Signup and view all the answers

What role do antigen presenting cells play during streptococcal infection?

Presenting streptococcal antigens to T cells Signup and view all the answers

What is the most important consequence of rheumatic fever?

Chronic valvular endocarditis Signup and view all the answers

Which valve is almost always involved in the inflammatory deformity caused by rheumatic fever?

Mitral valve Signup and view all the answers

What structural change occurs to the valve cusps as a result of rheumatic fever?

Become fibrosed and thickened Signup and view all the answers

What type of valve deformity can result from healing of acute lesions by fibrosis?

Stenosis Signup and view all the answers

Which area is primarily affected in mural endocarditis?

Mac-callum’s area in left atrium Signup and view all the answers

What are Aschoff's bodies associated with in rheumatic fever?

Characteristic rheumatic reaction Signup and view all the answers

What is the typical appearance of the myocardium in rheumatic myocarditis?

Swollen and flabby Signup and view all the answers

Which of the following is a complication of rheumatic myocarditis?

Left ventricular failure Signup and view all the answers

What is the common cause of sero-fibrinous pericarditis?

Rheumatic fever Signup and view all the answers

Which appearance is characteristic of adhesions between the visceral and parietal pericardium in rheumatic pericarditis?

Bread and butter appearance Signup and view all the answers

What is a potential complication of rheumatic carditis?

Cardiac arrhythmias Signup and view all the answers

Fleeting polyarthritis more commonly occurs in which group?

Adults Signup and view all the answers

What is the composition of subcutaneous nodules associated with rheumatic fever?

Central necrosis surrounded by chronic inflammatory cells Signup and view all the answers

Which characteristic describes erythema marginatum in rheumatic fever?

Annular and more common in children Signup and view all the answers

Which joint is most likely affected by the migratory polyarthritis of rheumatic fever?

Wrist Signup and view all the answers

What type of fluid is typically found in the joint cavity affected by migratory polyarthritis in rheumatic fever?

Sero-sanguinous fluid Signup and view all the answers

Which of the following correctly describes the immunological mechanism underlying rheumatic fever?

It involves autoimmune reactions that are type II hypersensitivity. Signup and view all the answers

What environmental factor increases the risk of developing acute rheumatic fever?

Overcrowding and malnutrition. Signup and view all the answers

In which population is rheumatic fever most prevalent?

Children in developing countries. Signup and view all the answers

Which strain of Group A Streptococcus is considered to be rheumatogenic?

Group A. Signup and view all the answers

What is one of the genetic aspects influencing susceptibility to acute rheumatic fever?

HLA and tumor necrosis factor polymorphisms. Signup and view all the answers

How long after a Streptococcal infection does acute rheumatic fever typically develop?

1-4 weeks post-infection. Signup and view all the answers

Which of the following correctly identifies a clinical manifestation of rheumatic fever?

Fleeting polyarthritis. Signup and view all the answers

What is the process described by molecular mimicry in the context of rheumatic fever?

Cross-reactivity between streptococcal antigens and host tissues. Signup and view all the answers

What mechanism primarily leads to the inflammation observed in rheumatic fever?

Cross-reactivity of antibodies against streptococcal antigens with cardiac tissue Signup and view all the answers

Which cells are primarily activated by streptococcal antigens during the immune response?

Naïve CD4+ T cells Signup and view all the answers

What is the central feature of an Aschoff body in rheumatic heart disease?

Granulomatous formation with central fibrinoid necrosis Signup and view all the answers

What clinical evidence suggests a recent streptococcal infection in patients?

Detection of high levels of anti-streptolysin O (ASO) antibodies Signup and view all the answers

Which type of hypersensitivity reaction is involved in the damage to cardiac cells during rheumatic fever?

Type II cytotoxic reaction Signup and view all the answers

Which process is observed as a complication due to the deposition of antibody-antigen complexes?

Migratory polyarthritis Signup and view all the answers

Which of the following complications results from the autoimmune response in rheumatic fever?

Heart valve regurgitation Signup and view all the answers

What is the primary long-term pathological consequence observed in the heart due to rheumatic fever?

Chronic fibrosis of cardiac tissue Signup and view all the answers

What pathological change occurs in valve cusps due to rheumatic fever?

Fibrosis and thickening of cusps Signup and view all the answers

What is the most frequent result of multiple episodes of rheumatic fever?

Rheumatic valvular heart disease Signup and view all the answers

Which of the following complications can arise from untreated rheumatic valvular heart disease?

Left ventricular dysfunction Signup and view all the answers

What is a common type of deformity resulting from healing of acute lesions in rheumatic fever?

Stenosis or incompetence of valves Signup and view all the answers

Which area is primarily affected in mural endocarditis?

Mac-callum's area in the left atrium Signup and view all the answers

What type of lesions are typically associated with rheumatic myocarditis?

Focal areas of cloudy swelling and necrosis Signup and view all the answers

What occurs to the chordae tendinae due to rheumatic heart disease?

They undergo shortening, thickening, and fusion Signup and view all the answers

What is the typical appearance of the myocardium in cases of rheumatic myocarditis?

Swollen and flabby muscle with dilated chambers Signup and view all the answers

What is the characteristic appearance of fibrin deposits in rheumatic pericarditis?

Milk patches on the surface of the heart Signup and view all the answers

Which of the following is least likely to be a complication of rheumatic carditis?

Pulmonary embolism Signup and view all the answers

Erythema marginatum in rheumatic fever typically occurs in which areas of the body?

Trunk and upper limbs Signup and view all the answers

What is the composition of subcutaneous nodules formed in rheumatic fever?

Fibrinoid necrosis surrounded by chronic inflammation Signup and view all the answers

In cases of migratory polyarthritis due to rheumatic fever, which fluid is typically found in affected joint cavities?

Sero-sanguinous fluid Signup and view all the answers

Which description best fits the adhesion between the visceral and parietal pericardium in rheumatic pericarditis?

Bread and butter appearance Signup and view all the answers

Which characteristic of fleeting polyarthritis is true?

It occurs intermittently and affects large joints sequentially. Signup and view all the answers

What is the primary pathological change seen in Aschoff's bodies during rheumatic fever?

Chronic inflammatory cell infiltration Signup and view all the answers

What symptom is most likely the first feature observed in Chorea minor?

Emotional changes Signup and view all the answers

Which of the following accurately describes Libman-Sacks endocarditis?

Small or medium-sized vegetations on either side of the valve leaflets Signup and view all the answers

In the context of rheumatic fever, what is the main distinction between subacute endocarditis and acute endocarditis?

Acute endocarditis has marked vegetations along the closure lines Signup and view all the answers

Which of the following is NOT a major criterion for diagnosing rheumatic fever?

Fever Signup and view all the answers

Which type of vegetations is typically associated with Nonbacterial thrombotic endocarditis (NBTE)?

Small bland vegetations usually attached at the line of closure Signup and view all the answers

What characterizes the vegetations seen in rheumatic fever compared to infective endocarditis?

They are small and warty Signup and view all the answers

Which of the following minor criteria is associated with elevated levels in rheumatic fever?

Increased ESR or CRP Signup and view all the answers

What gender is predominantly affected by Chorea minor?

Females Signup and view all the answers

Study Notes

Rheumatic Fever

Acute, immune-mediated, multi-system inflammatory disease affecting the heart, joints, subcutaneous tissue, and central nervous system.
It is considered a type II hypersensitivity reaction.
It primarily affects children between 5-15 years old without gender preference.
It is the most frequent cause of acquired heart disease in children and adolescents.
Common in developing countries, remaining endemic in parts of Asia, Africa, and South America.
Occurs 1-4 weeks after Group A (β-hemolytic) streptococcal pharyngitis (GAS) infection.
Less than 3% of patients develop rheumatic fever after experiencing GAS pharyngitis.
Susceptibility to rheumatic heart disease (RHD) is determined by antigenic mimicry, genetic predisposition, and environmental factors.

Preceding GAS Infection

A preceding GAS infection is necessary for the development of ARF.
Pharyngitis inducing strains of GAS A, B, and C are the more 'rheumatogenic' patterns. However, any strain of GAS can cause ARF.

Host Susceptibility

Host susceptibility to ARF is polygenic, influenced by more than two genes.
Monozygotic twins show approximately 40% concordance risk for ARF.
HLA and tumor necrosis factor polymorphisms, and an allele on the immunoglobulin heavy chain, play a role in genetic susceptibility to ARF.
HLA alleles influence immune response to infections and autoimmune response by presenting antigens and autoantigens to T-cell receptors.

Environmental Predisposition

Cold climates, low socio-economic standards, overcrowding, & malnutrition contribute to ARF.
Repeated exposures to GAS and recurrent infections like tonsillitis increase susceptibility.

Molecular Mimicry

Molecular mimicry occurs when similarities exist between Streptococcus pyogenes antigens and host peptides. This triggers a cross-reactive immune response against both self and foreign peptides.
The M protein and N-acetyl-β-D-glucosamine (NABG) of GAS species exhibit structural similarities to cardiac myosin.
This leads to the production of autoantibodies against type I collagen.

Immune Response and Damage

Antibodies produced against streptococcal antigens cross-react with antigens in heart tissue or joints, activating neutrophils and macrophages and inducing inflammation.
Antibody-antigen complexes can also deposit in joints, causing the characteristic migratory polyarthritis
During GAS infection:
- Antigen-presenting cells like dendritic cells and B cells present streptococcal antigens to naïve CD4+ T cells, leading to their activation into helper T cells.
- Activated helper T cells activate B cells.
- Activated B cells in the germinal centers differentiate into plasma cells which produce antibodies as part of a normal humoral response against S.pyogenes bacteria.
Type II cytotoxic reaction causes damage to endocardial and myocardial cells, releasing autoantigens.
Autoantigens stimulate the production of autoantibodies.
Type III and Type IV autoimmune reactions begin with the formation of allergic granulomas.

Evidence of Abnormal Immune Reaction

Fever occurs 2-4 weeks after infection.
Elevated anti-streptolysin O (ASO) titers indicate a recent streptococcal infection and are used in diagnosis.
The microorganisms are absent.
Penicillin prevents recurrence.

Aschoff’s Body

The characteristic lesion in rheumatic fever.
Granulomatous formations found on the surface of cardiac valves in patients with RHD.
Small pale foci seen in the heart, joints, subcutaneous tissue, and sometimes the CNS.
Often perivascular.
Central area of fibrinoid necrosis.
Collection of chronic inflammatory cells, Anitschkow cells with occasional Aschoff giant cells and a sprinkle of lymphocytes.
Fate: fibrosis.

Cardiac Manifestations: Pancarditis

Carditis is the most serious presentation of rheumatic fever (40% of patients with ARF).
RHD accounts for about 15 to 20% of heart failure cases in endemic countries.
Includes pericarditis, myocarditis, and endocarditis.

Endocardium

Rheumatic endocarditis affects the endocardium lining the heart valves and cusps.
Subdivided into valvular endocarditis and mural endocarditis.

Valvular Endocarditis

Inflammation of the cardiac cusps.
Affects the mitral valve, mitral and aortic valves together, or the aortic valve alone.
Rarely affects the tricuspid and pulmonary valves.
Two types: acute valvular endocarditis and chronic valvular endocarditis.
Complications include aortic stenosis, aortic incompetence, mitral stenosis, and pulmonary hypertension, leading to right-sided heart failure.
Mitral stenosis causes chronic venous congestion in the lungs.

Acute Valvular Endocarditis

Aschoff’s nodules with edema result in swelling of the valve leaflets.
The valve cusps become swollen, red, and lose their transparency.
Friction between their free borders leads to endothelial injury and thrombosis (vegetations).
Rheumatic vegetations:
- Small (1-2 mm) adherent valvular thrombi (no emboli).
- Found on the atrial surface, appearing small, beaded, and pale.
- Located on the free border of the valve, primarily the mitral and aortic valves.
- Fate: healing by fibrous tissue.
Valve cusps are edematous and vascular.
Infiltrated diffusely by inflammatory cells.
Occasional Aschoff's bodies.
Vegetations consist of platelets and fibrin.

Chronic Valvular Endocarditis

The most important consequence of rheumatic fever.
After multiple episodes of RF, progressive fibrosis of heart valves can occur, leading to rheumatic valvular heart disease.
Untreated valvular heart disease can lead to heart failure or death.
Inflammatory deformity of valves:
- Almost always involves the mitral valve.
- Can also involve the aortic or other valves.
Fibrosed, thickened cusps.
Deformities: healing of acute lesions by fibrosis results in:
- Stenosis: fusion of cusps, preventing proper valve opening.
- Incompetence: contraction of the cusps, preventing proper valve closure.
- Combined stenosis and incompetence.
- Shortening, thickening, and fusion of chordae tendinae.
Calcification can occur in any form.
Valve cusps are fibrosed.
Contain thick-walled vessels and some lymphocytes.
Patches of calcification may be seen.
Vegetations are fibrosed.

Mural Endocarditis

Affects the Mac-Callum’s area in the posterior wall of the left atrium above the mitral valve.
Characteristic rheumatic reaction is seen with Aschoff's bodies.
Heals by fibrosis.
The resulting rough surface often leads to thrombosis.

Rheumatic Myocarditis

Myocardium of the left side is affected, especially the left atrium.
The muscle becomes swollen and flabby, and the chambers dilate.
Aschoff's bodies may be seen as scattered pale foci, usually on the endocardial side of the interstitial tissue.
Interstitial edema and inflammation are present.
Cloudy swelling or necrosis of the myocardium may occur.
Lesions heal by fibrosis.
The condition is generally mild but rarely can produce left ventricle failure.

Rheumatic Pericarditis

The most common cause of sero-fibrinous pericarditis, mainly at the heart base.
The pericardial sac fills with serous fluid, and fibrin deposits on both visceral and parietal pericardium.
N/E: white patches of fibrosis on the heart surface (milk patches), adhesions between visceral and parietal pericardium (bread and butter appearance), adhesions between parietal pericardium and adjacent mediastinal structures (adherent mediastino-pericarditis) - interferes with cardiac contractions.
M/E: Aschoff's bodies may be present similar to any sero-fibrinous inflammation.

Complications of Rheumatic Carditis

Cardiac arrhythmias, particularly atrial fibrillation.
Valvular lesions.
Sub-acute bacterial endocarditis.

Extracardiac Manifestations

Migratory Polyarthritis

Fleeting polyarthritis, more common in adults.
Affects large joints like the knee, ankle, and wrist, one after another.
M/E:
- Synovial membrane and periarticular tissue show the characteristic rheumatic reaction.
- The joint cavity contains sero-sanguinous fluid.
- Complete resolution with no after-effects.

Subcutaneous Nodules

Oval or spherical nodules attached to deeper structures.
Formed of central fibrinoid necrosis surrounded by chronic inflammatory cells and fibrous tissue.
More common in children.

Erythema Marginatum

Annular erythema, more common in children.
Located on the trunk and upper arms and legs.
Never found on the face, palms, or soles.
GAS shares epitopes with keratin, and cross-reactivity may lead to erythema marginatum.
Can persist intermittently for weeks to months, even after successful ARF treatment.

Rheumatic Fever

Rheumatic fever is an acute immunologically mediated, multi-system inflammatory disease, typically affecting children between 5-15 years old.
It is a type II hypersensitivity autoimmune reaction with no gender predilection.
The most common cause of acquired heart disease in children and adolescents, prevalent in developing countries.
Occurs 1-4 weeks following a Group A (β-hemolytic) streptococcal pharyngitis (GAS) infection.
Less than 3% of patients develop rheumatic fever after a GAS infection.

Pathogenesis

Molecular mimicry: Similarities between GAS antigens and host peptides cause an immune response cross-reacting with both self and foreign peptides.
Genetic predisposition: Host susceptibility to rheumatic fever is polygenic (influenced by multiple genes).
- Monozygotic twins have a 40% concordance risk for rheumatic fever.
- HLA and tumor necrosis factor polymorphisms, and an allele on the immunoglobulin heavy chain, play a role in genetic susceptibility.
Environmental factors: Cold climate, low socioeconomic standards, overcrowding, and malnutrition contribute to susceptibility.
- Repeated exposures to GAS and recurrent infections like tonsillitis are risk factors.

Immune Responses

The M protein and N-acetyl-β-D-glucosamine (NABG) of GAS species share structural similarity to cardiac myosin, triggering an immune response.
Autoantibodies against type I collagen are also generated.
Antibodies produced against GAS antigens cross-react with heart and joint antigens, leading to inflammation.
Antibody-antigen complexes deposit in joints, causing migratory polyarthritis.
Type II cytotoxic reaction causes damage to endocardial and myocardial cells, releasing autoantigens, stimulating autoantibody production.

Characteristic Lesions

Aschoff bodies: Granulomatous formations found on cardiac valves in patients with RHD.
- Small pale foci seen in heart, joints, subcutaneous tissue, and sometimes the CNS.
- Often perivascular.
- Contain a central area of fibrinoid necrosis, chronic inflammatory cells, Anitschkow cells, occasional Aschoff giant cells, and lymphocytes.
Aschoff bodies heal by fibrosis.

Chronic Valvular Endocarditis

The most important complication of rheumatic fever.
Following multiple episodes of rheumatic fever, progressive fibrosis of heart valves can lead to rheumatic valvular heart disease.
If untreated, valvular heart disease can lead to heart failure or death.
Microscopic appearance:
- Valve cusps are fibrosed.
- Thick-walled vessels and some lymphocytes are present.
- Patches of calcification may be seen.
- Vegetations are fibrosed.

Mural Endocarditis

Affects the MacCallum's area in the posterior wall of the left atrium above the mitral valve.
Exhibits the characteristic rheumatic reaction with Aschoff bodies.
Heals by fibrosis, resulting in a rough surface prone to thrombosis.

Rheumatic Myocarditis

Primarily affects the myocardium of the left side, especially the left atrium.
Microscopic appearance:
- Muscle is swollen and flabby, with dilated chambers.
- Aschoff bodies may be seen as scattered pale foci.
- Aschoff bodies are found in interstitial tissue, commonly on the endocardial side.
- Interstitial edema and inflammation are present.
- Cloudy swelling or necrosis of the myocardium may occur.
Lesions heal by fibrosis.
Usually mild, but rare cases can lead to left ventricular failure.

Rheumatic Pericarditis

The most common cause of serofibrinous pericarditis, predominantly at the heart base.
Microscopic appearance:
- Pericardial sac filled with serous fluid and fibrin deposited on both visceral and parietal pericardium.
- Macroscopic appearance:
  - White patches of fibrosis on the heart surface (milk patches).
  - Adhesions between visceral and parietal pericardium (bread and butter appearance).
  - Adhesions between the parietal pericardium and adjacent mediastinal structures (adherent mediastino-pericarditis), interfering with cardiac contractions.

Other Manifestations

Migratory polyarthritis: More common in adults, affecting large joints like knees, ankles, and wrists.
- The synovial membrane and periarticular tissue show characteristic rheumatic reactions.
- The joint cavity contains sero-sanguinous fluid.
- Complete resolution occurs with no after effects.
Subcutaneous nodules: Oval or spherical nodules attached to deeper structures.
- Contain a central fibrinoid necrosis surrounded by chronic inflammatory cells and fibrous tissue.
- More common in children.
Erythema marginatum: Annular erythema, more common in children.
- Usually appears on the trunk, upper arms and legs.
- Never found on the face, palms, or soles.
- May persist intermittently for weeks to months, even after successful ARF treatment.
Sydenham Chorea: A mild meningoencephalitis of the basal ganglia.
- A late neurological manifestation, appearing 3 months after an ARF episode.
- More common in females.
- Characterized by purposeless involuntary movements of the hands, feet, and face.

Diagnostic Criteria

Major criteria:
- Carditis.
- Polyarthritis.
- Chorea.
- Dermatologic affection (erythema marginatum, subcutaneous nodules).
Minor criteria:
- Fever.
- Arthralgia.
- Elevated ESR or CRP.
- Raised ASO titre.
- ECG changes.
- Leucocytosis.

Comparison of Vegetative Endocarditis

Rheumatic endocarditis: Small, warty vegetations along the lines of closure of valve leaflets.
Infective endocarditis: Large, irregular masses on valve cusps that can extend onto chordae.
Nonbacterial thrombotic endocarditis: Small, bland vegetations usually attached at the line of closure.
Libman-Sacks endocarditis: Small or medium-sized vegetations on either or both sides of the valve leaflets.

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أسئلة المحاضرة السابعة باثولوجي CVS (قبل التعديل)

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Questions and Answers

Which type of endocarditis primarily affects the endocardium lining the valves?

What characteristic appearance may valves exhibit in cases of mitral stenosis?

What is a common complication of acute valvular endocarditis?

Which of the following describes Aschoff's nodules?

What is the primary outcome of rheumatic vegetations in endocarditis?

Which condition is NOT classified under cardiac manifestations of rheumatic fever?

In which type of endocarditis are the valve cusps swollen, red, and lost transparency?

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

What age group is most affected by rheumatic fever?

Which condition precedes the development of acute rheumatic fever?

What mechanism explains the autoimmune reactions seen in rheumatic fever?

Which of the following factors is NOT linked to the susceptibility to acute rheumatic fever?

In terms of global prevalence, where is rheumatic fever most common?

What does molecular mimicry in the context of rheumatic fever refer to?

Which of the following statements about Group A Streptococcus is incorrect?

What role do HLA alleles play in acute rheumatic fever?

What is implicated in the formation of autoantibodies in rheumatic fever?

Which type of hypersensitivity reaction is involved in the damage of endocardial and myocardial cells in rheumatic fever?

Which laboratory result is indicative of a recent streptococcal infection?

What is the characteristic lesion associated with rheumatic heart disease?

What occurs in the germinal centers after the activation of helper T cells?

Which of the following describes the primary function of autoantibodies generated during rheumatic fever?

What pathological change is mainly observed in Aschoff's bodies?

What role do antigen presenting cells play during streptococcal infection?

What is the most important consequence of rheumatic fever?

Which valve is almost always involved in the inflammatory deformity caused by rheumatic fever?

What structural change occurs to the valve cusps as a result of rheumatic fever?

What type of valve deformity can result from healing of acute lesions by fibrosis?

Which area is primarily affected in mural endocarditis?

What are Aschoff's bodies associated with in rheumatic fever?

What is the typical appearance of the myocardium in rheumatic myocarditis?

Which of the following is a complication of rheumatic myocarditis?

What is the common cause of sero-fibrinous pericarditis?

Which appearance is characteristic of adhesions between the visceral and parietal pericardium in rheumatic pericarditis?

What is a potential complication of rheumatic carditis?

Fleeting polyarthritis more commonly occurs in which group?

What is the composition of subcutaneous nodules associated with rheumatic fever?

Which characteristic describes erythema marginatum in rheumatic fever?

Which joint is most likely affected by the migratory polyarthritis of rheumatic fever?

What type of fluid is typically found in the joint cavity affected by migratory polyarthritis in rheumatic fever?

Which of the following correctly describes the immunological mechanism underlying rheumatic fever?

What environmental factor increases the risk of developing acute rheumatic fever?

In which population is rheumatic fever most prevalent?

Which strain of Group A Streptococcus is considered to be rheumatogenic?

What is one of the genetic aspects influencing susceptibility to acute rheumatic fever?

How long after a Streptococcal infection does acute rheumatic fever typically develop?

Which of the following correctly identifies a clinical manifestation of rheumatic fever?

What is the process described by molecular mimicry in the context of rheumatic fever?

What mechanism primarily leads to the inflammation observed in rheumatic fever?

Which cells are primarily activated by streptococcal antigens during the immune response?

What is the central feature of an Aschoff body in rheumatic heart disease?

What clinical evidence suggests a recent streptococcal infection in patients?

Which type of hypersensitivity reaction is involved in the damage to cardiac cells during rheumatic fever?

Which process is observed as a complication due to the deposition of antibody-antigen complexes?

Which of the following complications results from the autoimmune response in rheumatic fever?

What is the primary long-term pathological consequence observed in the heart due to rheumatic fever?

What pathological change occurs in valve cusps due to rheumatic fever?

What is the most frequent result of multiple episodes of rheumatic fever?

Which of the following complications can arise from untreated rheumatic valvular heart disease?

What is a common type of deformity resulting from healing of acute lesions in rheumatic fever?

Which area is primarily affected in mural endocarditis?

What type of lesions are typically associated with rheumatic myocarditis?

What occurs to the chordae tendinae due to rheumatic heart disease?

What is the typical appearance of the myocardium in cases of rheumatic myocarditis?

What is the characteristic appearance of fibrin deposits in rheumatic pericarditis?

Which of the following is least likely to be a complication of rheumatic carditis?

Erythema marginatum in rheumatic fever typically occurs in which areas of the body?

What is the composition of subcutaneous nodules formed in rheumatic fever?

In cases of migratory polyarthritis due to rheumatic fever, which fluid is typically found in affected joint cavities?

Which description best fits the adhesion between the visceral and parietal pericardium in rheumatic pericarditis?

Which characteristic of fleeting polyarthritis is true?

What is the primary pathological change seen in Aschoff's bodies during rheumatic fever?

What symptom is most likely the first feature observed in Chorea minor?

Which of the following accurately describes Libman-Sacks endocarditis?

In the context of rheumatic fever, what is the main distinction between subacute endocarditis and acute endocarditis?

Which of the following is NOT a major criterion for diagnosing rheumatic fever?