Cardiology: rheumatic fever prophylaxis: practice question

A Pediatrics 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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Pediatrics · Cardiology: rheumatic fever prophylaxis

Sample item

A child with rheumatic fever and carditis without residual valve disease needs secondary prophylaxis. Which regimen is preferred and for how long?

ABenzathine penicillin 1.2 million units IM every 3 to 4 weeks, for 10 years or until age 21, whichever is longerBOral penicillin for 1 week onlyCBenzathine penicillin onceDAspirin lifelong

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

The answer and the reasoning

A. Benzathine penicillin 1.2 million units IM every 3 to 4 weeks, for 10 years or until age 21, whichever is longer

Secondary prophylaxis with benzathine penicillin every 3 weeks in high-risk areas (every 4 weeks elsewhere) prevents recurrence. Duration is 10 years or until age 21 after carditis without residual disease, and 10 years or until age 40 with valvular disease. Erythromycin or sulfadiazine is used in penicillin allergy.

Option by option

A. Benzathine penicillin 1.2 million units IM every 3 to 4 weeks, for 10 years or until age 21, whichever is longer (correct)
Correct. Long-term benzathine penicillin is standard.
B. Oral penicillin for 1 week only
A one-week course does not give lasting protection.
C. Benzathine penicillin once
A single dose does not prevent recurrences.
D. Aspirin lifelong
Aspirin does not prevent streptococcal infection.

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.

Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is A, Benzathine penicillin 1.2 million units IM every 3 to 4 weeks, for 10 years or until age 21, whichever is longer. Secondary prophylaxis with benzathine penicillin every 3 weeks in high-risk areas (every 4 weeks elsewhere) prevents recurrence.

Why is "Oral penicillin for 1 week only" not the answer?

A one-week course does not give lasting protection.

Why is "Benzathine penicillin once" not the answer?

A single dose does not prevent recurrences.

Why is "Aspirin lifelong" not the answer?

Aspirin does not prevent streptococcal infection.

What concept does this question test?

It tests Cardiology: rheumatic fever prophylaxis in Pediatrics. Duration is 10 years or until age 21 after carditis without residual disease, and 10 years or until age 40 with valvular disease. Erythromycin or sulfadiazine is used in penicillin allergy.

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 prophylaxis?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics 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.