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Old 07-03-2011
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Question Asymmetrical Polyarthritis + Prolonged PR!

An 16 y old M presents with arthritis i,e asymmetrical and involves more than 3 joints..on examination patient has several subcutaneous nodule and cardiac exam reveals s3 gallop. ECG shows prolong PR? most likely diagnosis and why?

a. lymes
b. endocardities
c. rheumatoid arthrities
d. gout
e. rheumatic fever
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Old 07-03-2011
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e.rheumatic fever

asymmetric : excludes RA

Sub cutaneos nodules :excludes gout,lymes

IE and RF are left and the syndrome most likely points to RF ,,i guess


whats the right answer?
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Old 07-03-2011
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arthritis carditis subcutaneous nodules prolong pr -e.rheumatic fever

b hemolytic streptococcyus group A is the cause..

other criteria are choria

fever history of rheumatic fever arthralgy elevated crp- leucocytes
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Old 07-03-2011
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Quote:
Originally Posted by confident View Post
an 16 y old M presents with arthritis i,e asymmetrical and involves more than 3 jts..on examination patient has several subcutaneous nodule and cardiac exam reveals s3 gallop. ecg shows prolong pr?most likely diagnosis and why?
a.lymes
b.endocardities
c.rheumatoid arthrities
d.gout
e.rheumatic fever
yes answer is e rheumatic fever:group a streptococci
migratory polyarthrities,sore throat 2 wks prior to presentation,here sub nodule and jt involvement,pr prolong indicates 2 jones major and 1 minor criteria confirm diagnosis.

in lymes disease erythema migrans,mono or oligoarticular involvement is seen.

in endocardities--petechiae,oslers node,jt and muscle ache,new or changed murmur is seen

in ra--small jts first involved,morning stiffness seen,rheumatoid nodule seen which are mostly near to jts and attached to tendon and fasciae,sometimes involve lung so lung features are seen like sob,lung nodule

in gout--nighttime swelling,tenderness,pain in mostly big toe found.

syphilis --(not given here as a option but for complition sake i am typing)nodules mostly painless sometime painfull,change in size and configuration and ulcerate.
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Default Subcutaneous node in rheumatic fever!

Asymmetrical Polyarthritis + Prolonged PR!-rheumatic_fever.jpg
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