Question 1 25 year old patient comes to the internal medicine clinic complaining

Question 1
25 year old patient comes to the internal medicine clinic complaining of 2 weeks of fatigue and cough. The patient admits that he is a heroin addict. On examination, pulse: 110 beat/minute and regular, BP: 110/80, T: 38.8 RR: 25 /minute. A holosystolic murmur is heard at the left lower sternal border. scattered crackles are heard in lung examination. Mild splenomegaly in abdomen examination. There is swelling and tenderness in the right and left ankle joint with some palpable purpuric eruptions on both legs. A normal neurological examination. What is the most likely diagnosis
Select one:
a.
Acute rheumatic fever
b.
Systemic lupus erythomatosus
c.
Serum thickness
d.
Rheumatoid artheritis
e.
Infectious mononeuclosis
Question 2
Which of the following is an essential part of the diagnosis of acute rheumatic fever in this patient?
Select one:
a.
Positive streptococcal culture from joint aspiration
b.
High titer of rheumatoid factor
c.
Positive blood culture
d.
Evidence of streptococcal infection
e.
CNS affection
Question 3
The holosystolic murmur in that patient signifies affection of which of the following?
Select one:
a.
Pericardial effusion
b.
Conduction system
c.
Swelling of MV leaflets
d.
Destruction of MV leaflets
e.
Myocarditis
Question 4
What is the neurological affection in acute rheumatic fever?
Select one:
a.
Hemisensory loss
b.
Chorea
c.
Tremors
d.
Hemiplegia
e.
Ataxia
Question 5
What is the skin affection in acute rheumatic fever?
Select one:
a.
Erythema multiforme
b.
Necrolytic migratory erythema
c.
Erythema nodosum
d.
Erythema toxicum
e.
Erythema marginatum
Question 6
17 year old patient comes to the internal medicine clinic complaining of knee and ankle pain associated with dyspnea and orthopnea. The patient mentions that he had a sore throat 2 weeks ago that went away with the aid of some herbal remedies. On examination, pulse: 110 beat/minute and regular BP: 110/80, T: 37.8 cd RR: 25 /minute. There is swelling and tenderness in the right and left ankle joint. Apex is hyperkinetic with 3rd heart sound and holosystolic murmur heard at the apex and radiate to the axilla. Bibasal crackles are heard in lung examination. The abdomen is soft without tenderness. A normal neurological examination. A throat swab is positive for streptococcus pyogenes. What could prevent this non-suppurative streptococcal sequel?
Select one:
a.
Prompt administration of penicillin in streptococcal sore throat
b.
Tonsillectomy
c.
No effective way for primary prevention.
d.
Prompt administration of salicylic acid in streptococcal sore throat
e.
Continues warm water throat washing.
Question 7
What is the treatment of this patient current condition?
Select one:
a.
Aspirin, steroid, penicillin and diuretic
b.
Aspin
c.
Acetaminophen
d.
Aspirin, steroid, and penicillin
e.
Aspirin and steroid
Question 8
What is the expected sequel of arthritis in acute rheumatic fever?
Select one:
a.
Total resolution
b.
Persistent effusion
c.
Joint destruction
d.
Pannus formation
e.
Joint contracture
Question 9
What is the expected sequel of repeated carditis in acute rheumatic fever?
Select one:
a.
Ventricular septal defect
b.
Restrictive pericarditis
c.
Hypertrophic cardiomyopathy
d.
Chronic rheumatic heart disease
e.
Total resolution
Question 10
What is the best secondary prevention for this patient?
Select one:
a.
Rifampicin for 6 months
b.
No effective secondary prevention
c.
Ceftriaxone 1 gram every 15 days
d.
Benzathine penicillin G every 15-30 day deep intramuscular
e.
Secondary prevention is not cost-effective as recurrence is unlikely.