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joint disease 1


joint disease 1


حالة سريرية

الوصف الكامل Background

An 18-year-old man is evaluated because of a 2-day history of fever, chills, and migratory arthralgias involving the ankles, knees, elbows, and shoulders. On physical examination there are subcutaneous nodules on the volar surface of both forearms, and a grade 2/6 systolic murmur and an S3 heard at the left ventricular apex. There is no objective evidence of joint disease.

Which of the following additional findings establishes a definite diagnosis of acute rheumatic fever in this patient?

( A ) Arthritis
( B ) Erythema marginatum
( C ) Choreoathetosis
( D ) An elevated erythrocyte sedimentation rate
( E ) A throat culture positive for group A streptococci

المرجع

.

by
بعد التخرج

The Dx requires 2 major (or one major and 2 minor) AND evidence of preceding Group A strep infection.

Majors: carditis?, poly arthritis, chorea, erythema marginatum, subcutaneous nodules
Minors: previous rheumatic fever, Arthralgias, Fever, Acute phase reactants(HIGH ESR, or WBC), prolonged P-R interval.

2(or 1) majors + 2 minors +

Quote:
( E ) A throat culture positive for group A streptococci
DAM's picture
DAM

it's e
exactly as Dam said....
Fouad's picture
Fouad
بعد التخرج

Quote:
grade 2/6 systolic murmur and an S3 heard at the left ventricular apex

r they considered carditis?

DAM's picture
DAM

Critique (Correct Answer = E)

The patient has two major criteria, carditis and subcutaneous nodules, for the diagnosis of acute rheumatic fever. Although the addition of other major criteria, such as choreoathetosis, erythema marginatum, or arthritis, strengthens the likelihood of the diagnosis, a definite diagnosis cannot be made without a positive throat culture for streptococci or a rise and fall in antistreptolysin-O titer. The presence of two or more of the Jones criteria can also be observed in other systemic diseases not due to streptococcal infection. A high erythrocyte sedimentation rate and first-degree atrioventricular block are findings that are not specific for acute rheumatic fever

زهرة الجبل
بعد التخرج


many thanx

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DAM
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