QuestionSBA
QuestionChoice
The ESR in rheumatic fever is likely to be prolonged, however this is a minor Jones criterion. Evidence of a recent streptococcal infection (e.g. a raised ASOT), in addition to the 2 major criteria present (carditis and arthritis) would confirm the diagnosis.
10028278
c
Erythrocyte sedementation rate (ESR)
QuestionChoice
The most likely diagnosis is rheumatic fever, acquired after a streptococcal throat infection. The patient has risk factors for this being untreated. Polyarthritis is one of the major Jones criteria, as it is evidence of cardiac involvement (the murmur, which is the Carey Coombs murmur of acute rheumatic fever). Evidence of a streptococcal infection (e.g. throat culture or an elevated ASOT) are required in addition to 2 major criteria, or 1 major and 2 minor criteria.
10028276
a
Anti-streptolysin O titre (ASOT)
QuestionChoice
An echocardiogram may show cardiac involvement (which is a major Jones criterion for rheumatic fever), however this has already been evidenced by the findings of a murmur on auscultation. An echocardiogram would not provide more evidence to confirm the diagnosis. Evidence of a recent streptococcal infection (e.g. a raised ASOT), in addition to the 2 major criteria present (carditis and arthritis) would confirm the diagnosis.
10028279
d
Echocardiogram
QuestionChoice
An ECG may show a prolonged PR interval in rheumatic fever due to cardiac involvement, however this is a minor Jones criterion. Evidence of a recent streptococcal infection (e.g. a raised ASOT), in addition to the 2 major criteria present (carditis and arthritis) would confirm the diagnosis.
10028277
b
ECG
QuestionChoice
This would certainly be an important test to carry out. The white cell count in rheumatic fever is likely to be raised, however this is a minor Jones criterion. Evidence of a recent streptococcal infection (e.g. a raised ASOT), in addition to the 2 major criteria present (carditis and arthritis) would confirm the diagnosis.
10028280
e
Full blood count
Concept
Chapter
2693
4330
Rheumatic fever
Topic
194
Infectious Diseases
18053
An anti-streptolysin O (ASOT) titre is a blood test used to detect recent streptococcal throat infection and is often elevated in cases of rheumatic fever, helping to confirm the diagnosis when combined with clinical findings
A 7-year-old boy who has been living in a refugee camp is brought to hospital feeling generally unwell. His mother describes a history of a sore throat a few weeks ago. He has no past medical history and had an otherwise normal development.

On examination, he looks unwell, with multiple swollen joints and a fever. He also has a very short mid-diastolic murmur.

Which test would help confirm the most likely diagnosis?
a