[Guest]

A 12-year-old girl is admitted to the hospital because of marked shortness of breath, an erythematous rash, and painful, swollen hip and knee joints. She is agitated. X-ray film of the chest shows an enlarged heart and changes consistent with pulmonary edema. Intractable congestive heart failure develops, and she dies on the second hospital day. The child most likely had a recent history of which of the following?
(A) Cyanosis with chest pain
(B) Jaundice
(C) Meningitis
(D) Pharyngitis
(E) Skin infection

 

[Guest]

I don't think this is a step 1 question

 

[add1]

The answer would be pharyngitis. How come no one attempted to answer?

 

[noothan]

dali do u mind explaining why pharyngitis

 

[apx85]

E) Skin infection

Sounds like Rheumatic fever to me: arthralgias, rash, myocarditis

MCC: Group A Strep

 

[apx85]

E) Skin infection

Sounds like Rheumatic fever to me: arthralgias, rash, myocarditis

MCC: Group A Strep

Ahhh sorry! the answer is pharyngitis caused by Group A strep leading to Rheumatic fever

Rheumatic fever is NOT caused by skin infection. Skin infection or pharyngitis with Group A strep can cause Post-strep glomerulonephritis but only pharyngitis can cause rheumatic fever! --> The reason why this is true is not known, but observational studies have shown that there tends to be a greater immune response to pharyngitis than impetigo (skin infection).

 

[add1]

The above post just explained it. This is pure rheumatic fever.

 

[Dr_Kal_El]

yup pharyngitis = RF etc

most of the answers just jump out at me, and i kinda am taken aback by that....I think i'm clearly underestimating my prep, haha

 

[patelMD]

Doesn't this question seem tooo simple for step 1? )

 

[usluipek]

I am not convinced it is rheumatic fever, because it seldom cause death like this. What is the source of this question?

 

[carisma_200x]

this is rheumatic fever 'cause 3 major criteria present here: carditis , arthritis and skin rash ( although its not described at all )
Pharyngitis is the most likely correct answer.
Severe carditis and CNS involvement (sydenham chorea) are the main causes of death in RF which is usually benign condition!

Good Question

 

[usluipek]

I am still not convinced. Although rhematic fever cause carditis, but it rarely cause cardiac failure and death. I want to know what is the source for this question and what is the correct answer given by the source.

basicq, pls give the source and the right answer, so we have a closure.

 

[Mondoshawan]

I am still not convinced. Although rhematic fever cause carditis, but it rarely cause cardiac failure and death. I want to know what is the source for this question and what is the correct answer given by the source.
basicq, pls give the source and the right answer, so we have a closure.

The question is from an older 'free 150', and the answer was D. Pharyngitis, so the source was as legit as they come...

 

[usluipek]

OK, thanks. I will just use this for USMLE sake. But in reality, death due to rheumatic fever while rash is present is very rare, especially when antibiotic is so widely available

 

[dr_rachitmangal]

hi there

well RF can only be prevented by antibiotics....but if the antibody's have once shown cross reaction...then no amount of antibiotics whatever class can help....well steroids alone could have helped in this patient.....also this stem is asking us after the cross reaction phase...that was pretty obvious...although RF is less common due to good antibiotics....but i guess once it sets in...then no use of antibiotics.....

plz correct me if i'm wrong

thanks