Question

A 24 years old female patient presented with inflammation of elbow and wrist joints, fever, hard swellings over the skin just below (distal to) elbow joint, and some uncontrolled arms and legs movements (flail). On examination, she also has 3/5 grade murmur on the left side of the heart (abnormal heart sounds). Tongue is swelled up with widespread red spots and pale surrounding, like strawberry. Her father had Parkinson’s disease at the age of 55 years and he is concerned if she is developing early Parkinson’s too. She was recently treated for sore throat with amoxacillin 1000 mg and paracetamol 375 mg by mouth (PO), twice a day (BID) for 10 days, and she completely recovered.

What is your preliminary impression?

What labs you recommend (be specific and give reason i.e. what do you expect to see in the report that can lead you to your final impression of the case. For example, blood smear to see malarial parasites).

Treatment OR Prevention

Answer 1

the preliminary assessment shows that diagnosis would be rheumatic fever.

lab investigatons:

1. complete blood count to check if erythrocyte sedimentation rate is increased

2. c reactive protein - increased in acute phase of rheumatic fever

3. ecg to check if any prolongation of pr interval

treatment :

1. antibiotics

2.antiinflammatory agents

3. bed rest

prevention:

1. maintain personal hygiene

2. follow strict handwashing techniques

3. maintain distance from people who are sick

4. do not share clothing or other formites with a person who is sick