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Rheumatic Fever& IE MCQ

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1- Which of the following are not major criteria?

A -Carditis

B- Chorea

C -Erythema marginatum

D elevated C-reactive protein

2- what criteria do we need to make the diagnosis of rheumatic fever?

A Monoarthralgia

B Monoarthritis

C Oslers’ nodules
D Erythema marginatum
3-All of the following are major criteria for rheumatic fever except
A) Arthalgia
b) Carditis
c) Subcutaneous nodule
d) Chorea

4- One of the following organisms causes tonsillopharyngitis, which may later complicate by acute rheumatic
fever.

a) Group A, B-hemolytic streptococcus

b) Enterococcus

c) Pseudomonas

5- The commonest age group affected by acute rheumatic fever is

a) 2-4 years

b) 5-15 years

c) Over 50 years
6- Useful test for diagnoses of rheumatic fever is:

a) The Streptozyme test

b) Test for Anti-Streptolysin O antibody

c) Blood Culture

7-Which of the following statements are most accurate about acute rheumatic fever?

A. Occurs as an abnormal immune response to a group A streptococcal infection


B. Occurs as an abnormal immune response to a group B streptococcal infection
C. Most commonly affects the joints, heart, brain, and skin
D. A and C

8- Rheumatic Fever usually follows an infection with:

A.Streptococcus group A
B.Staphylococcus aureus
C.Streptococcus viridans
D.H.influenza

9- One of the tests that is done to confirm diagnosis of Rheumatic Fever:


A. Alpha 1 antitrypsin
B. Rheumatoid factor
C. Anti-streptolysin O
D. Creatine kinase

10-To diagnose a patient with R.F, The patient should have at least:
A. One major, two minor
B. Two major, one minor
C. One major, one minor
D. Two major, two minor

11- Which of the following statements are most accurate about acute rheumatic fever?
a) Occurs as an abnormal immune response to a group A streptococcal infection
b) Occurs as an abnormal immune response to a group B streptococcal infect
c) Usually affects children between the ages of 5 and 15
d) A and C

12- In rheumatic fever, what are arthritis criteria?


A. Monoarthralgia
B. Monoarthritis
C. Polyarthralgia
D. Polyarthritis

13- Treatment of the most common bacterial cause of pharyngitis is important because it will prevent:

A- Glomerulonephritis
B- Bell’s palsy
C- Stevens-Johnson syndrome
D- Acute rheumatic fever
E- Guillain-Barré syndrome

14-In diagnosis of acute rheumatic fever the Jones criteria can be helpful. Which of the following is NOT are
considered a major criteria?
a) Chorea
b) Erythema marginatum
c) Polyarthritis
d) elevated erythrocyte sedimentation rate
15- The minor criteria of rheumatic fever include?
a- Migratory arthralgia
b- Carditis and valvulitis
c- Erythema marginatum
d- Subcutaneous nodules

16- Sydenham chorea is?


a- Unilateral involuntary semipurposeful movements
b- Is a muscular weakness
c- Is an emotional disturbance
d- Is a rhythmic voluntary movements

17- A 7 year old girl presents with a tender and swollen right knee as well as a more recently appearing swollen
left wrist. She also has a fever. This patient fulfills which of the following modified Jones criteria?
a. 1 Major 1 minor
b. 1 Major 2 minors
c. 2 Majors
d. 2 Minors

18- Rheumatic fever is


A- Immunologic disorder affects heart only
B- Characterized by inflammatory reactions involving: heart, joints, CNS
C- A multi system disorder caused by an autoimmune reaction to Group B streptococcal infection

1-Which of the following is a major Modified Duke Infective Endocarditis criterion?


A. Fever > 38ºC
B. Intravenous drug use
C. Osler’s nodes or Roth spots
D. Positive Blood Culture

2. Which of the following is NOT a suitable treatment strategy for bacterial endocarditis?

a. Benzyl penicillin + gentamycin if onset is subacute


b. Empirical therapy once infective endocarditis is suspected
c. Long term oral antibiotics based on culture results (e.g., 4 weeks or longer)
d. Immunosuppressive doses of corticosteroids that are tapered over 4 to 6 weeks

3- A patient is receiving treatment for infective endocarditis. The patient has a history of intravenous drug use and underwent
mitral valve replacement a year ago. The patient is scheduled for a transesophageal echocardiogram tomorrow. On assessment,
you find non-tender erythematous, haem orrhagic spots on the palms or soles. You know that this is a common finding in patients
with infective endocarditis and is known as?

A. Janeway Lesions

B. Roth Spots

c. Osler's Nodes

D. Trousseau’s Sign

4- Patient is admitted with sepsis. The patient has a temperature of 104.2 'F and is experiencing chills. On assessment, you note a
mitral murmur which the patient states they've never had before, and dark, small lines on the patient’s fingernails. The patient has
a history of IV drug use in the past. However, the patient states they are no longer using drugs. The physician suspects possible
infective endocarditis. What diagnostic test do you expect the physician to order in order to confirm the presence of infective
endocarditis?

A. Abdominal ultrasound

B. Heart catheterization

C. Transesophageal echocardiogram

D. White blood cell count


5-What are not typical signs and symptoms of infective endocarditis?

A. Hyperthermia

B chorea

C. Enlarged Spleen

G. Cardiac Murmur

6- A patient with endocarditis has listed in their medical history “Oslers’ nodes

”. You know that this is Minor criteria of infective endocarditis and presents as?

A. Tender nodules in fingers or toes

B. Red and tender lesions found in the eyes

C. Retinal hemorrhages with white centers

D. Purplish spots found on the forearms and groin

7- A 28-year-old male intravenous drug user presents to the emergency department feeling unwell, with intermittent fevers and
weight loss. He is found to have a raised jugular venous pressure, a pansystolic murmur at the left sternal edge that is accentuated
by inspiration, pulsatile liver, painful nodular infarcts in fingers or toes and clubbing of his fingers.

8- What diagnosis best explains this man’s presentation?

A. Infective endocarditis

B. Rheumatic heart disease

C. Tuberculous pericarditis

D. Viral myocarditis

9- The clinical manifestations of IE result from

A. Intracardiac infection
B. Embolization
C. Immunological phenomenon
D. All of the above

10. Which of the following peripheral manifestations causes painful nodules in infective endocarditis patient?

A) Janeway’s lesions
B) Osler’s nodes
C) Petechiae
D) Splinter hemorrhage

11- Which of the following assessments is crucial for the diagnosis of IE?

A) Vital signs
B) Hematology tests
C) Erythrocyte sedimentation rate
D) Blood cultures

12- Based on the recent infective endocarditis diagnostic criteria, the two major parameters for the diagnosis of
this infection are

A)Laboratory abnormalities and positive blood cultures.

B) Positive blood cultures and echocardiographic changes.

C) ECG changes and positive physical findings.

D) Positive physical findings and positive blood cultures.

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