A 7-year-old girl presents to the clinic with fever and skin rash for 1 day. She also has pain and swelling in both knees and wrists. The family gave story of fever and sore throat... A 7-year-old girl presents to the clinic with fever and skin rash for 1 day. She also has pain and swelling in both knees and wrists. The family gave story of fever and sore throat two weeks ago which has been recovered completely. On examination she has pain, swelling, and limited movement in both knees and wrists. She has erythema marginatum rash. The remaining exam is unremarkable. She is started on antibiotic and anti-inflammatory medications. Which of the following is the best next step in management?
Understand the Problem
The question describes a 7-year-old girl presenting with symptoms suggestive of acute rheumatic fever (ARF) following a recent streptococcal infection. The key findings are fever, skin rash (erythema marginatum), and migratory polyarthritis (pain and swelling in knees and wrists). The question asks for the best next step in management, given the clinical presentation and initial treatment with antibiotics and anti-inflammatory medications. Echocardiography is crucial to evaluate for carditis, a major manifestation of ARF.
Answer
Perform an ECG and echocardiogram to evaluate for carditis.
The best next step in management is to perform an ECG and echocardiogram to evaluate for carditis, a complication of acute rheumatic fever.
Answer for screen readers
The best next step in management is to perform an ECG and echocardiogram to evaluate for carditis, a complication of acute rheumatic fever.
More Information
The patient's presentation is highly suggestive of Acute Rheumatic Fever (ARF) following a recent streptococcal infection. The Jones criteria are used to diagnose ARF, and this patient meets the criteria with evidence of a prior streptococcal infection (fever and sore throat two weeks ago) plus multiple major criteria including migratory polyarthritis (pain and swelling in knees and wrists) and erythema marginatum. Carditis is a major complication of ARF that can lead to long-term heart damage, so evaluation with ECG and echocardiogram is essential.
Tips
A common mistake is to focus solely on the presenting symptoms (fever, rash, joint pain) without connecting them to the preceding illness and considering the possibility of a post-infectious complication like ARF.
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