MCQ – 89235

A 9-year-old girl develops breathlessness for 3 weeks, which was only on exertion, to begin with, but now she experiences it on rest as well. she was treated for acute pharyngotonsillitis a few weeks before the onset of this illness. Along with these complaints, she also gives a history of left knee swelling last week which subsided, but now she has pain and difficulty bearing weight on the right ankle joint.O/E there is a loud pansystolic murmur of grade 4-5 in the mitral area. What are the most likely diagnosis and the next best step in management:

Correct Answer � B Explanation

Ans. B.  Aspirin + benzathine penicillin

Explanation:Diagnosis of acute rheumatic fever can be made by JONES criteria. Major criteria include polyarthritis (polyarthritis or monoarthritis or polyarthralgia in moderate to high-risk populations), carditis, erythema marginatum, Sydenham’s chorea, and subcutaneous nodules.Minor criteria include polyarthralgia (monoarthralgia in high risk ), fever >38.5C,ESR > 60 ,CRP > 3mg/dl ,prolonged PR interval. Diagnosis can be made by 2 major criteria or 1 major and 2 minor

In this patient there is the history of typical arthritis and evidence of mitral valvulitis causing mitral regurgitation and a loud pansystolic murmur ( both major criteria ); which also needs to be confirmed by an ECHO 

NSAIDs are the major stay of treatment in ARF, traditionally aspirin has been used commonly

Eradication of GAS ( group A Streptococcus) is done by benzathine penicillin 

Heart failure is managed with diuretics and in severe cases, steroids are used