Title: Pediatric Cardiology / Acute Rheumatic Fever
Tags: acute-rheumatic-fever arf peds-cardio high-yield jones-criteria carditis chorea prophylaxis duration arthritis diagnosis treatment exam gas high-risk major minor nodules rash timing

Q: What is required to diagnose initial episode of ARF?
A: Evidence of preceding GAS infection + 2 MAJOR criteria OR 1 MAJOR + 2 MINOR criteria

Q: What are the MAJOR Jones criteria?
A: Carditis, Polyarthritis, Chorea, Erythema marginatum, Subcutaneous nodules (mnemonic: JONES)

Q: What are the MINOR Jones criteria?
A: Fever, Arthralgia, Elevated ESR/CRP, Prolonged PR interval

Q: How do Jones criteria differ in high-risk populations (2015 revision)?
A: Monoarthritis OR polyarthralgia counts as MAJOR; lower fever threshold (≥38°C)

Q: What constitutes evidence of preceding GAS infection?
A: Positive throat culture, positive rapid strep test, elevated/rising strep antibodies (ASO, anti-DNase B)

Q: What is the most common cardiac manifestation of ARF?
A: Mitral regurgitation (valvulitis)

Q: What valves are affected in rheumatic carditis?
A: Mitral > Aortic; rarely tricuspid or pulmonary

Q: What echo finding counts as carditis even without murmur (2015 update)?
A: Subclinical carditis - pathological MR or AR on Doppler without auscultatory findings

Q: Does pericarditis without valvulitis count as carditis in ARF?
A: No - valvulitis must be present

Q: What is characteristic of rheumatic fever arthritis?
A: Migratory polyarthritis - large joints, extremely painful, responds dramatically to NSAIDs

Q: How quickly does ARF arthritis respond to aspirin/NSAIDs?
A: Within 24-48 hours (dramatic response is diagnostically helpful)

Q: Can monoarthritis count as major criterion?
A: Only in high-risk populations (moderate-high incidence areas)

Q: What is Sydenham chorea?
A: Involuntary, purposeless movements of face and extremities; emotional lability; hypotonia

Q: When does Sydenham chorea typically appear relative to GAS infection?
A: Delayed - 1-6 months after infection (may be only manifestation)

Q: Can chorea alone diagnose ARF?
A: Yes - if other causes excluded, chorea alone (without other criteria) can diagnose ARF

Q: What is the "milkmaid's grip" sign?
A: Irregular squeeze when patient grips examiner's fingers - sign of chorea

Q: Describe erythema marginatum.
A: Evanescent, pink, non-pruritic rash with pale centers and serpiginous margins on trunk/proximal limbs

Q: Describe subcutaneous nodules in ARF.
A: Firm, painless nodules over bony prominences and extensor tendons; associated with severe carditis

Q: What is the treatment for acute ARF?
A: Antibiotics (penicillin) to eradicate GAS + anti-inflammatory (aspirin or steroids for carditis) + supportive

Q: What is secondary prophylaxis for ARF?
A: Benzathine PCN G 1.2 million units IM every 3-4 weeks (or daily oral PCN)

Q: How long is secondary prophylaxis continued after ARF without carditis?
A: 5 years or until age 21, whichever is longer

Q: How long is secondary prophylaxis continued after ARF with carditis but no residual disease?
A: 10 years or until age 21, whichever is longer

Q: How long is secondary prophylaxis continued with persistent valvular disease?
A: 10 years or until age 40, whichever is longer; LIFELONG if severe or after valve surgery