Cardiology: rheumatic fever: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Cardiology: rheumatic fever

Sample item

A 10-year-old girl has purposeless, jerky movements of her hands and facial grimacing that have worsened over 3 weeks, with emotional lability. She had a sore throat 3 months ago. She is afebrile, there is no joint pain, and the ESR, C-reactive protein and ASO titre are normal. What is the correct interpretation?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Sydenham chorea, which can establish acute rheumatic fever without other criteria

Sydenham chorea is a delayed neurological manifestation of group A streptococcal infection, appearing 1 to 6 months after the throat infection. Because of this latency, ESR, CRP and ASO may already have normalised. Under the Jones criteria, chorea alone is sufficient to diagnose rheumatic fever once other causes are excluded, and it calls for secondary prophylaxis with benzathine penicillin.

Option by option

  • A. Sydenham chorea, which can establish acute rheumatic fever without other criteria (correct)

    Chorea is a major criterion that alone suffices, even with normal inflammatory markers and no evidence of recent infection.

  • B. Huntington disease presenting in childhood

    Huntington disease is autosomal dominant, usually presents in adulthood and has no preceding streptococcal infection.

  • C. Not rheumatic fever, because acute-phase reactants are normal

    Normal ESR, CRP and ASO are expected in late chorea and do not exclude rheumatic fever.

  • D. Wilson disease, which needs a slit-lamp examination to exclude

    Wilson disease should be considered in a differential of childhood movement disorder, but the post-pharyngitis timing and emotional lability fit Sydenham chorea.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Sydenham chorea, which can establish acute rheumatic fever without other criteria. Sydenham chorea is a delayed neurological manifestation of group A streptococcal infection, appearing 1 to 6 months after the throat infection.

Why is "Huntington disease presenting in childhood" not the answer?

Huntington disease is autosomal dominant, usually presents in adulthood and has no preceding streptococcal infection.

Why is "Not rheumatic fever, because acute-phase reactants are normal" not the answer?

Normal ESR, CRP and ASO are expected in late chorea and do not exclude rheumatic fever.

Why is "Wilson disease, which needs a slit-lamp examination to exclude" not the answer?

Wilson disease should be considered in a differential of childhood movement disorder, but the post-pharyngitis timing and emotional lability fit Sydenham chorea.

What concept does this question test?

It tests Cardiology: rheumatic fever in General Medicine. Because of this latency, ESR, CRP and ASO may already have normalised. Under the Jones criteria, chorea alone is sufficient to diagnose rheumatic fever once other causes are excluded, and it calls for secondary prophylaxis with benzathine penicillin.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiology: rheumatic fever?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.