Heart Failure & Valvular Diseases Q 38 - Gyan Darpan : Learning Portal
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Thursday, 28 April 2022

Heart Failure & Valvular Diseases Q 38

An 18-year-old client who recently had an URI is admitted with suspected rheumatic fever. Which assessment findings confirm this diagnosis?
     A. Erythema marginatum, subcutaneous nodules, and fever
     B. Tachycardia, finger clubbing, and a load S3
     C. Dyspnea, cough, and palpitations
     D. Dyspnea, fatigue, and syncope

Correct Answer: A. Erythema marginatum, subcutaneous nodules, and fever

Diagnosis of rheumatic fever requires that the client have either two major Jones criteria or one minor criterion plus evidence of a previous streptococcal infection. Major criteria include carditis, polyarthritis, Sydenham’s chorea, subcutaneous nodules, and erythema marginatum (transient, non pruritic macules on the trunk or inner aspects of the upper arms or thighs). Minor criteria include fever, arthralgia, elevated levels of acute phase reactants, and a prolonged PR-interval on ECG.

Option B: A number of other clinical features are often observed in patients with ARF but are not included as manifestations in the Jones Criteria, including lethargy, abdominal pain, and epistaxis, as well as rapid sleeping pulse rate and tachycardia out of proportion to fever.
Option C: The chorea of ARF, also referred to as Sydenham’s chorea or St. Vitus’s dance, occurs in up to 30% of patients with ARF. It is characterized by involuntary, non-rhythmic, and purposeless movements of the trunk and limbs, which are often more pronounced on one side of the body
Option D: There are four other clinical features that are considered minor manifestations of ARF: fever, arthralgia, elevated acute phase reactants, and prolonged PR interval on an electrocardiogram. Arthralgia usually involves several joints in a pattern similar to that of polyarthritis.

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