| What type of joints are typically affected by arthritis in rheumatic fever? | Large joints – ankles, knees & wrist | Rheumatic fever (RF) is an acute, nonsuppurative inflammatory disease complicating untreated or partially treated Group A Streptococcus (GAS) pharyngitis Carditis (50%) – Most devastating manifestation • Tachycardia • Dyspnoea • Heart Failure • Murmur on auscultation Arthritis (80%) – Most common manifestation • Multiple joints • Migratory – lasts <1 week in a joint • Large joints – ankles, knees & wrist • Exquisite tenderness with redness & swelling • Prompt response to NSAIDs • Leaves no deformity Chorea (10%) - 2-6 months after streptococcal sore throat • Quasipurposive, involuntary movements with emotional lability • Best seen in hands, arms, tongue and face • Affects fine motor movement like handwriting Erythema marginatum (5%) Transient pink macule with fading centre Mostly located on the trunk and limbs aLow-risk populations ARF incidence ≤2/ per 100 000 school-aged children or all-age RHD prevalence of ≤1/per 1000 population per year bSubclinical carditis is pathological echocardiographic valvulitis cPolyarthralgia should only be considered as a major manifestation in moderate-to high-risk populations after exclusion of other conditions. | 371 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_1_acute_rheumatic_fever.pdf | Rheumatic fever (RF) is an acute, nonsuppurative inflammatory disease complicating untreated or partially treated Group A Streptococcus (GAS) pharyngitis Carditis (50%) – Most devastating manifestation • Tachycardia • Dyspnoea • Heart Failure • Murmur on auscultation Arthritis (80%) – Most common manifestation • Multiple joints • Migratory – lasts <1 week in a joint • Large joints – ankles, knees & wrist • Exquisite tenderness with redness & swelling • Prompt response to NSAIDs • Leaves no deformity Chorea (10%) - 2-6 months after streptococcal sore throat • Quasipurposive, involuntary | 1 | page=1,block=7 | 0.700 | valid |
| What is a risk factor for rheumatic fever related to personal hygiene? | Poor orodental & personal hygiene | Joint manifestations can only be considered in either the major or minor categories but not both in the same patient Erythema marginatum and subcutaneous nodules are 'stand-alone major criteria Subcutaneous nodules – rare Painless, pea-sized, hard nodules On extensor surfaces of limbs, skull and back Repeated group A Streptococcus infections RHD Priming of immune response Repeated or ongoing infections Risk factors: Overcrowding Poor orodental & personal hygiene limited access to healthcare Susceptible host: School going children (5-15 years age) Precipitating event: Group A Streptococcal pharyngitis Molecular mimicry between group A Streptococcus antigens and host tissues Exaggerated T-cell mediated immune response ------------------------ First episode of ARF LABORATORY INVESTIGATIONS Essential Optional 1. Pediatric autoimmune neuropsychiatric disorders (PANDAS)- autoimmune disorder 2. | 433 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_1_acute_rheumatic_fever.pdf | Joint manifestations can only be considered in either the major or minor categories but not both in the same patient Erythema marginatum and subcutaneous nodules are 'stand-alone major criteria Subcutaneous nodules – rare Painless, pea-sized, hard nodules On extensor surfaces of limbs, skull and back Repeated group A Streptococcus infections RHD Priming of immune response Repeated or ongoing infections Risk factors: Overcrowding Poor orodental & personal hygiene limited access to healthcare Susceptible host: School going children (5-15 years age) Precipitating event: Group A Streptococcal |
| What is the age group most susceptible to rheumatic fever? | School going children (5-15 years age) | Joint manifestations can only be considered in either the major or minor categories but not both in the same patient Erythema marginatum and subcutaneous nodules are 'stand-alone major criteria Subcutaneous nodules – rare Painless, pea-sized, hard nodules On extensor surfaces of limbs, skull and back Repeated group A Streptococcus infections RHD Priming of immune response Repeated or ongoing infections Risk factors: Overcrowding Poor orodental & personal hygiene limited access to healthcare Susceptible host: School going children (5-15 years age) Precipitating event: Group A Streptococcal pharyngitis Molecular mimicry between group A Streptococcus antigens and host tissues Exaggerated T-cell mediated immune response ------------------------ First episode of ARF LABORATORY INVESTIGATIONS Essential Optional 1. Pediatric autoimmune neuropsychiatric disorders (PANDAS)- autoimmune disorder 2. | 514 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_1_acute_rheumatic_fever.pdf | Joint manifestations can only be considered in either the major or minor categories but not both in the same patient Erythema marginatum and subcutaneous nodules are 'stand-alone major criteria Subcutaneous nodules – rare Painless, pea-sized, hard nodules On extensor surfaces of limbs, skull and back Repeated group A Streptococcus infections RHD Priming of immune response Repeated or ongoing infections Risk factors: Overcrowding Poor orodental & personal hygiene limited access to healthcare Susceptible host: School going children (5-15 years age) Precipitating event: Group A Streptococcal |
| What is the dose range of amoxicillin for individuals allergic to penicillin? | 25-50mg/kg/day divided into 3 doses | Phenoxymethyl penicillin(Penicillin V) ≤27kg 250mg/dose 10 days <27kg 500mg/dose For individuals allergic to penicillin Amoxicillin 25-50mg/kg/day divided into 3 doses (maximum 1g/day) 10 days Erythromycin 20-40mg/kg/day divided into 2-4 doses (maximum 1g/day) Primary prophylaxis (to Eradicate streptococcus) | 132 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_1_acute_rheumatic_fever.pdf | Phenoxymethyl penicillin(Penicillin V) ≤27kg 250mg/dose 10 days <27kg 500mg/dose For individuals allergic to penicillin Amoxicillin 25-50mg/kg/day divided into 3 doses (maximum 1g/day) 10 days Erythromycin 20-40mg/kg/day divided into 2-4 doses (maximum 1g/day) Primary prophylaxis (to Eradicate streptococcus) | 2 | page=2,block=63 | 0.700 | valid |
| What is the duration of prophylaxis for patients without carditis? | 5 years after the last ARF episode or until 21 years age (whichever is longer) | Category of Patient Duration Patients without carditis 5 years after the last ARF episode or until 21 years age (whichever is longer) Patients with carditis but 10 years after the last acute episode no RHD or until 25 years age (whichever is longer) Patients with RHD who At least until 40 years age have undergone valve (preferably lifelong) surgery (repair or replacement) Anti-inflammatory therapy & supportive care Clinical Manifestation Treatment Schedule Duration Moderate/Severe carditis Prednisolone 2mg/kg/day once daily (Aspirin while tapering Prednisolone) 8-12 WKS Mild carditis Aspirin 75-100mg/day divided into 4 doses 2-4 WKS Polyarthritis Aspirin 75-100mg/day divided into 4 doses or Naproxen 10-20mg/kg/day 2-4 WKS Chorea Carbamazepine 4-10mg/kg/day or Valproic acid 20-30mg/kg/day or Variable depending upon Haloperidol 2-6mg/day the need of the patient Secondary prophylaxis Agent Dose Route Benzathine penicillin ≤27kg 6,00,000U Intramuscular (Penicillin G) >27kg 12,00,000U or Phenoxymethyl 250mg twice daily Oral penicillin(penicillin V) For individuals allergic to penicillin Erythromycin 250mg twice daily Oral | 55 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_1_acute_rheumatic_fever.pdf |
| Where are subcutaneous nodules typically located in rheumatic fever? | On extensor surfaces of limbs, skull and back | Joint manifestations can only be considered in either the major or minor categories but not both in the same patient Erythema marginatum and subcutaneous nodules are 'stand-alone major criteria Subcutaneous nodules – rare Painless, pea-sized, hard nodules On extensor surfaces of limbs, skull and back Repeated group A Streptococcus infections RHD Priming of immune response Repeated or ongoing infections Risk factors: Overcrowding Poor orodental & personal hygiene limited access to healthcare Susceptible host: School going children (5-15 years age) Precipitating event: Group A Streptococcal pharyngitis Molecular mimicry between group A Streptococcus antigens and host tissues Exaggerated T-cell mediated immune response ------------------------ First episode of ARF LABORATORY INVESTIGATIONS Essential Optional 1. Pediatric autoimmune neuropsychiatric disorders (PANDAS)- autoimmune disorder 2. | 256 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_1_acute_rheumatic_fever.pdf | Joint manifestations can only be considered in either the major or minor categories but not both in the same patient Erythema marginatum and subcutaneous nodules are 'stand-alone major criteria Subcutaneous nodules – rare Painless, pea-sized, hard nodules On extensor surfaces of limbs, skull and back Repeated group A Streptococcus infections RHD Priming of immune response Repeated or ongoing infections Risk factors: Overcrowding Poor orodental & personal hygiene limited access to healthcare Susceptible host: School going children (5-15 years age) Precipitating event: Group A Streptococcal |
| What are the characteristics of subcutaneous nodules in rheumatic fever? | Painless, pea-sized, hard nodules | Joint manifestations can only be considered in either the major or minor categories but not both in the same patient Erythema marginatum and subcutaneous nodules are 'stand-alone major criteria Subcutaneous nodules – rare Painless, pea-sized, hard nodules On extensor surfaces of limbs, skull and back Repeated group A Streptococcus infections RHD Priming of immune response Repeated or ongoing infections Risk factors: Overcrowding Poor orodental & personal hygiene limited access to healthcare Susceptible host: School going children (5-15 years age) Precipitating event: Group A Streptococcal pharyngitis Molecular mimicry between group A Streptococcus antigens and host tissues Exaggerated T-cell mediated immune response ------------------------ First episode of ARF LABORATORY INVESTIGATIONS Essential Optional 1. Pediatric autoimmune neuropsychiatric disorders (PANDAS)- autoimmune disorder 2. | 222 | factual | 0.490 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_1_acute_rheumatic_fever.pdf | Joint manifestations can only be considered in either the major or minor categories but not both in the same patient Erythema marginatum and subcutaneous nodules are 'stand-alone major criteria Subcutaneous nodules – rare Painless, pea-sized, hard nodules On extensor surfaces of limbs, skull and back Repeated group A Streptococcus infections RHD Priming of immune response Repeated or ongoing infections Risk factors: Overcrowding Poor orodental & personal hygiene limited access to healthcare Susceptible host: School going children (5-15 years age) Precipitating event: Group A Streptococcal |
| What is a healthcare-related risk factor for rheumatic fever? | limited access to healthcare | Joint manifestations can only be considered in either the major or minor categories but not both in the same patient Erythema marginatum and subcutaneous nodules are 'stand-alone major criteria Subcutaneous nodules – rare Painless, pea-sized, hard nodules On extensor surfaces of limbs, skull and back Repeated group A Streptococcus infections RHD Priming of immune response Repeated or ongoing infections Risk factors: Overcrowding Poor orodental & personal hygiene limited access to healthcare Susceptible host: School going children (5-15 years age) Precipitating event: Group A Streptococcal pharyngitis Molecular mimicry between group A Streptococcus antigens and host tissues Exaggerated T-cell mediated immune response ------------------------ First episode of ARF LABORATORY INVESTIGATIONS Essential Optional 1. Pediatric autoimmune neuropsychiatric disorders (PANDAS)- autoimmune disorder 2. | 467 | factual | 0.490 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_1_acute_rheumatic_fever.pdf | Joint manifestations can only be considered in either the major or minor categories but not both in the same patient Erythema marginatum and subcutaneous nodules are 'stand-alone major criteria Subcutaneous nodules – rare Painless, pea-sized, hard nodules On extensor surfaces of limbs, skull and back Repeated group A Streptococcus infections RHD Priming of immune response Repeated or ongoing infections Risk factors: Overcrowding Poor orodental & personal hygiene limited access to healthcare Susceptible host: School going children (5-15 years age) Precipitating event: Group A Streptococcal |
| What is a risk factor for rheumatic fever related to living conditions? | Overcrowding | Joint manifestations can only be considered in either the major or minor categories but not both in the same patient Erythema marginatum and subcutaneous nodules are 'stand-alone major criteria Subcutaneous nodules – rare Painless, pea-sized, hard nodules On extensor surfaces of limbs, skull and back Repeated group A Streptococcus infections RHD Priming of immune response Repeated or ongoing infections Risk factors: Overcrowding Poor orodental & personal hygiene limited access to healthcare Susceptible host: School going children (5-15 years age) Precipitating event: Group A Streptococcal pharyngitis Molecular mimicry between group A Streptococcus antigens and host tissues Exaggerated T-cell mediated immune response ------------------------ First episode of ARF LABORATORY INVESTIGATIONS Essential Optional 1. Pediatric autoimmune neuropsychiatric disorders (PANDAS)- autoimmune disorder 2. | 420 | factual | 0.490 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_1_acute_rheumatic_fever.pdf | Joint manifestations can only be considered in either the major or minor categories but not both in the same patient Erythema marginatum and subcutaneous nodules are 'stand-alone major criteria Subcutaneous nodules – rare Painless, pea-sized, hard nodules On extensor surfaces of limbs, skull and back Repeated group A Streptococcus infections RHD Priming of immune response Repeated or ongoing infections Risk factors: Overcrowding Poor orodental & personal hygiene limited access to healthcare Susceptible host: School going children (5-15 years age) Precipitating event: Group A Streptococcal |
| What is the dose of benzathine penicillin for individuals weighing 27kg or less? | 6,00,000U | Monitor for activity rebound Monitor for activity rebound Secondary prophylaxis Yes Refer to ARF/RHD expert Subclinical/Mild Salycilates 4-6 weeks Taper doses Agent Dose Duration Benzathine penicillin (Penicillin G) ≤27kg 6,00,000U Once >27kg 12,00,000U or | 222 | factual | 0.370 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726651147_1_acute_rheumatic_fever.pdf | Monitor for activity rebound Monitor for activity rebound Secondary prophylaxis Yes Refer to ARF/RHD expert Subclinical/Mild Salycilates 4-6 weeks Taper doses Agent Dose Duration Benzathine penicillin (Penicillin G) ≤27kg 6,00,000U Once >27kg 12,00,000U or | 2 | page=2,block=23 | 0.700 | valid |