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From: Kambiz
Date: 15 Apr 2004
Time: 23:23:36 -0400
Remote Name: 67.71.63.22
Hey ! Arman ! how're yo doin buddy ?! What is your idea about this Q ? I picked Blood culture but the right answer is ASO ! 18-year-old male complains of fever and transient pain in both knees and elbows. The right knee was red and swollen for 1 day the week prior to presentation. On physical exam, the patient has a low-grade fever but appears generally well. There is an aortic diastolic murmur heard at the base of the heart. A nodule is palpated over the extensor tendon of the hand. There are pink erythematous lesions over the abdomen, some with central clearing. The following laboratory values are obtained: Hct: 42 WBC: 12,000/L 20% polymorphonuclear leukocytes 80% lymphocytes ESR: 60 mm/h Which of the following tests is most critical to diagnosis? A. Blood cultures B. Antistreptolysin O antibody C. Echocardiogram D. Antinuclear antibodies E. Creatinine phosphokinase Explanation This 18-year-old presents with classic features of rheumatic fever. His clinical manifestations include arthritis, fever, and murmur. A subcutaneous nodule is noted, and a rash of erythema marginatum is described. These subcutaneous nodules are pea-sized and usually seen over extensor tendons. The rash is usually pink with clear centers and serpiginous margins. Laboratory data shows an elevated erythrocyte sedimentation rate as usually occurs in rheumatic fever. The ECG shows evidence of first-degree AV block. An antistreptolysin O antibody is necessary to diagnose the disease by documenting prior streptococcal infection. Most experts recommend the use of glucocorticoids when carditis is part of the picture of rheumatic fever. Therefore, in this patient with first-degree AV block, corticosteroids would be indicated. Penicillin should also be given to eradicate group A -hemolytic streptococci.