Rationale to Quiz

1.    Which symptom presented is NOT a sign of rheumatic fever?

C. changes in vision

The other symptoms listed, truncal rash, joint tenderness, and nausea are all associated symptoms of rheumatic fever. Changes in vision are not commonly associated with this disease process. Other symptoms can include inflamed oral mucosa, heart murmur, and fatigue. 

 

2.    Rheumatic fever is caused by which of the following bacteria?

C. Streptococcus

Rheumatic fever occurs following the unsuccessful treatment of group-A, beta-hemolytic streptococcus bacteria. The other choices listed do not cause this disease process. 

 

3.   Which of the following factors in the patient’s history and physical is LEAST relevant to the diagnosis of Rheumatic fever?

C.  the mother’s history of type-2 diabetes

The patient’s mother’s history of diabetes is not relevant to this diagnosis. A history of a sore throat 3 weeks prior is an indicator that the patient came in contact with streptococcus bacteria, and that the initial treatment with Augmentin was ineffective. The fact that the family lives in Flint, MI is relevant in this case. Poor water quality is a significant environmental factor that can lead to the spread of disease among a population. While the patient’s father’s medical history is unknown in this case, what is unknown could be significant. There is a genetic factor involved that could predispose the patient to this disease that could have been passed from the father.  

 

4. The provider orders blood work on a patient he suspects is experiencing Rheumatic fever. Which of the following test results would indicate inflammation and cardiac symptoms? Select all that apply.

A, C

Both an increase in C-reactive protein and WBC count are positive indicators of Rheumatic fever. Choice B is incorrect because we would expect an increase in erythrocyte sedimentation rate. Hemoglobin and hematocrit are not relevant lab values in this situation. 

 

5. According to the Jones Criteria, which of the following sets of symptoms would indicate a positive diagnosis for Rheumatic fever? Select all that apply.

B, C

According to the Jones Criteria, a patient must exhibit essential criteria, and 2 major criteria to come to a positive result. A patient may also exhibit essential criteria, 1 major criteria, and 2 minor criteria. Choices B and C are the only sets of symptoms that follow this.