A 10-year-old boy, the star pitcher for the Salt Lake City Little League Baseball team, had a sore throat about 2 weeks ago but did not tell anyone because he was afraid that he would miss the playoffs. Because several children have been diagnosed with rheumatic fever in the area, his mother is worried that he may be at risk as well. You tell her that several criteria must be met to make the diagnosis but that the most common finding is which of the following?

a.Carditis

b.Arthralgia

c.Erythema marginatum

d.Chorea

e.Subcutaneous nodules
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Answer / Explanation:


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The answer is b, Arthralgia.

It is often difficult to establish a diagnosis of rheumatic fever because no single clinical manifestation or laboratory test is confirmatory. However, it is important to make an accurate diagnosis because of the need to treat the acute problems promptly and effectively and to institute long-term antibiotic prophylaxis to prevent recurrences.

To assist in diagnosis, the American Heart Association identified a set of major and minor standards relating to the manifestations of the disease, called the Jones criteria (modified), and recommends that these criteria be applied in the diagnosis of every patient with possible rheumatic fever. The major criteria are carditis, arthritis, erythema marginatum, chorea, and subcutaneous nodules.

The minor criteria are arthralgia (joint pain with no objective findings), fever or history of rheumatic fever, increased erythrocyte sedimentation rate (ESR), positive C-reactive protein, increased WBC and anemia, and prolonged PR and QT intervals on ECG. To make the diagnosis of rheumatic fever, the following criteria should be met: 2 major manifestations; 1 major and 2 minor manifestations plus strong evidence of a preceding group A beta-hemolytic streptococcal infection (culture, rapid antigen-antibody rise or elevation); or scarlet fever.
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