This page is dedicated to organizing various examples of standardized exam questions whose answer is acute rheumatic fever. While this may seem a odd practice, it is useful to see multiple examples of how acute rheumatic fever will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each condition has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for acute rheumatic fever.
- Recent sore throat: suggesting recent strep throat infection
Question # 1
A 7 year old girl is brought to the clinic because she has a rash and joint pains that are bother her. Her past medical history is unremarkable other then a sore throat that resolved on its own about 2 weeks ago. Last week the patient noticed pain in her knees. This pain resolved after a few days, however now she complains of pain in her wrists and ankles. The patient has also developed a non-pruiritc pink rash on her back. Her temperate is 101.2°F, pulse is 87/min, and respirations are 18/min. A physical exam reveals both pain and stiffness in the wrists and ankles. A fait, erythematous rash with sharp borders is present on her trunk and proximal lines. Th rest of her exam is non-contributory. Lab results are collected and are as follows:
- Leukocytes: 7,500/µL
- Hemoglobin: 12.9 g/dL
- platelets: 220,000/µL
- CRP: 38 mg/dL **
- ESR: 40 m/hr **
What diagnosis could explain this presentation?
History of sore throat + polyarthritis + erythema marginatum (rash) + fever + elevated CRP + elevated ESR = acute rheumatic fever
TESTABLE FACTS ABOUT THIS CONDITION (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying condition. Often there are specific testable facts regarding some aspect of the disease’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
- What type of hypersensitivity reaction: Type II hypersensitivity reaction
- Bacterial virulence factor responsible: M protein
- Major complications: myocardiits
Page Updated: 11.25.2016