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Department of Clinical Epidemiology University of Santo Tomas Faculty of Medicine and Surgery

Department of Clinical Epidemiology University of Santo Tomas Faculty of Medicine and Surgery Case 1: Acute Rheumatic Fever Cueto, Mary Anne to Diaz, Cristina Group 1 – 3B. Clinical Decision on a DIAGNOSTIC TEST. Case Scenario.

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Department of Clinical Epidemiology University of Santo Tomas Faculty of Medicine and Surgery

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  1. Department of Clinical Epidemiology University of Santo Tomas Faculty of Medicine and Surgery Case 1: Acute Rheumatic Fever Cueto, Mary Anne to Diaz, Cristina Group 1 – 3B

  2. Clinical Decision on a DIAGNOSTIC TEST

  3. Case Scenario E.C., a 28 year old housewife was admitted because of dyspnea. Three days ago, she had dental extraction then the next day she began coughing productive of yellowish sputum. She also had chest pain radiating to the back lasting for 30 mins and occurring even at rest. She is febrile (38 C) with joint pain and myalgia. The Past Medical History - frequent streptococcal throat infection in childhood; at age 16 years diagnosed to have valvular heart disease and given monthly Benzathine Penicillin.

  4. Salient Features 28 year old housewife Dyspnea History of dental extraction 3 days ago Productive cough Yellowish sputum Unstable angina Febrile Joint pain Myalgia Past medical history of frequent streptococcal throat infection as a child Valvular heart disease

  5. Acute Rheumatic Fever and Rheumatic Heart Disease on the Navajo Reservation, 1962-77. JOHN COULEHAN, MD, SHELLIE GRANT, MD, KEITH REISINGER, MD, PAUL KILLIAN, MD, KENNETH D. ROGERS, MD, CHARLES KALTENBACH, DrPH

  6. Modified Jones Criteria • Presence of two major or one major and two minor, plus evidence of antecedent group A streptococcus infection.

  7. Plus evidence of recent streptococcal infection

  8. Differential Diagnosis

  9. Clinical Question How useful is echocardiography in the evaluation of a 28 year old female presenting with signs and symptoms of acute rheumatic fever?

  10. Search terms: Echocardiography, acute rheumatic fever, adult Population: Population: 452 patients with acute rheumatic fever diagnosed by Jones criteria, 230 males and 222 females, age range from 1 yr 11mos to 51 years old Intervention: Echocardiographic diagnostic procedure outcome: incremental role of echocardiography

  11. Journal Title: The Role of Echocardiography in Diagnosing Carditis in the Setting of Acute Rheumatic Fever Ishwarappa B. Vijayalakshmi, JayapalMithravinda, Arale N. PrabhuDevaSpectrum of Disease

  12. Spectrum of Disease: Ectopic Pregnancy 65% 75% 25%

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