Acute Rheumatic Fever Flashcards¶
Jones Criteria Basics¶
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 Tags: arf, jones-criteria, high-yield
Q: What are the MAJOR Jones criteria? A: Carditis, Polyarthritis, Chorea, Erythema marginatum, Subcutaneous nodules (mnemonic: JONES) Tags: arf, jones-criteria, major, high-yield
Q: What are the MINOR Jones criteria? A: Fever, Arthralgia, Elevated ESR/CRP, Prolonged PR interval Tags: arf, jones-criteria, minor
Q: How do Jones criteria differ in high-risk populations (2015 revision)? A: Monoarthritis OR polyarthralgia counts as MAJOR; lower fever threshold (≥38°C) Tags: arf, jones-criteria, high-risk, high-yield
Q: What constitutes evidence of preceding GAS infection? A: Positive throat culture, positive rapid strep test, elevated/rising strep antibodies (ASO, anti-DNase B) Tags: arf, gas, diagnosis
Carditis¶
Q: What is the most common cardiac manifestation of ARF? A: Mitral regurgitation (valvulitis) Tags: arf, carditis, high-yield
Q: What valves are affected in rheumatic carditis? A: Mitral > Aortic; rarely tricuspid or pulmonary Tags: arf, carditis
Q: What echo finding counts as carditis even without murmur (2015 update)? A: Subclinical carditis - pathological MR or AR on Doppler without auscultatory findings Tags: arf, carditis, high-yield
Q: Does pericarditis without valvulitis count as carditis in ARF? A: No - valvulitis must be present Tags: arf, carditis
Arthritis¶
Q: What is characteristic of rheumatic fever arthritis? A: Migratory polyarthritis - large joints, extremely painful, responds dramatically to NSAIDs Tags: arf, arthritis, high-yield
Q: How quickly does ARF arthritis respond to aspirin/NSAIDs? A: Within 24-48 hours (dramatic response is diagnostically helpful) Tags: arf, arthritis, treatment
Q: Can monoarthritis count as major criterion? A: Only in high-risk populations (moderate-high incidence areas) Tags: arf, jones-criteria
Chorea¶
Q: What is Sydenham chorea? A: Involuntary, purposeless movements of face and extremities; emotional lability; hypotonia Tags: arf, chorea, high-yield
Q: When does Sydenham chorea typically appear relative to GAS infection? A: Delayed - 1-6 months after infection (may be only manifestation) Tags: arf, chorea, timing
Q: Can chorea alone diagnose ARF? A: Yes - if other causes excluded, chorea alone (without other criteria) can diagnose ARF Tags: arf, chorea, diagnosis, high-yield
Q: What is the "milkmaid's grip" sign? A: Irregular squeeze when patient grips examiner's fingers - sign of chorea Tags: arf, chorea, exam
Skin Manifestations¶
Q: Describe erythema marginatum. A: Evanescent, pink, non-pruritic rash with pale centers and serpiginous margins on trunk/proximal limbs Tags: arf, rash
Q: Describe subcutaneous nodules in ARF. A: Firm, painless nodules over bony prominences and extensor tendons; associated with severe carditis Tags: arf, nodules
Treatment & Prophylaxis¶
Q: What is the treatment for acute ARF? A: Antibiotics (penicillin) to eradicate GAS + anti-inflammatory (aspirin or steroids for carditis) + supportive Tags: arf, treatment
Q: What is secondary prophylaxis for ARF? A: Benzathine PCN G 1.2 million units IM every 3-4 weeks (or daily oral PCN) Tags: arf, prophylaxis, high-yield
Q: How long is secondary prophylaxis continued after ARF without carditis? A: 5 years or until age 21, whichever is longer Tags: arf, prophylaxis, duration
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 Tags: arf, prophylaxis, duration
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 Tags: arf, prophylaxis, duration, high-yield