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 a history of fever and sore th... 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 a history 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? A. Echocardiography B. Musculoskeletal MRI C. Pulse methylprednisolone
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 symptoms include fever, skin rash (erythema marginatum), and joint pain/swelling (polyarthritis). The question asks what the best next step in managing this patient is. Given the clinical suspicion for ARF, the most appropriate next step needs to be identified from the provided options.
Answer
Echocardiography is the best next step to evaluate for carditis, a major manifestation of acute rheumatic fever.
The best next step in management is Echocardiography. The patient's presentation of fever, rash (erythema marginatum), and joint pain/swelling, along with a recent history of fever and sore throat, suggests a high likelihood of acute rheumatic fever (ARF). Echocardiography is crucial for evaluating carditis, a major manifestation of ARF.
Answer for screen readers
The best next step in management is Echocardiography. The patient's presentation of fever, rash (erythema marginatum), and joint pain/swelling, along with a recent history of fever and sore throat, suggests a high likelihood of acute rheumatic fever (ARF). Echocardiography is crucial for evaluating carditis, a major manifestation of ARF.
More Information
Acute Rheumatic Fever (ARF) is a serious inflammatory condition that can develop after a Group A streptococcal infection, such as strep throat or scarlet fever, if it is not properly treated. Echocardiography helps in detecting heart valve damage, a common and potentially severe complication of ARF.
Tips
A common mistake is to focus solely on the joint symptoms and overlook the possibility of ARF, which requires a comprehensive evaluation, including cardiac assessment.
Sources
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