The major manifestation of Rheumatic fever include all EXCEPT:

IGNOU PB Bsc Entrance-2023

Medical & Surgical Nursing

Easy

Appeared in: IGNOU PB Bsc Entrance-2023

Explanation

Arthralgia is defined as subjective joint pain without the objective signs of inflammation (swelling, redness, warmth) that characterize arthritis.
According to the Jones criteria, this distinction is critical for diagnosis, placing arthralgia in the minor category.
The question asks for the option that is NOT a major manifestation, making arthralgia the correct answer.
The other three options—Chorea, Erythema marginatum, and Subcutaneous nodules—are all classic major criteria for an initial diagnosis of acute rheumatic fever.

Option A: Chorea (specifically Sydenham's chorea) is a major criterion for rheumatic fever. It involves involuntary, rapid, and uncoordinated jerking movements, especially of the face, hands, and feet.
Option B: Erythema marginatum is a characteristic rash and a major criterion of rheumatic fever. It presents as non-itchy, pink or red macules with clear centers and serpiginous (wavy) borders, typically on the trunk and limbs.
Option C: Subcutaneous nodules are a major criterion of rheumatic fever. These are firm, painless nodules found under the skin, usually over bony prominences like the elbows, knees, and spine. Their presence often correlates with severe carditis.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Jones Criteria for Rheumatic Fever as background academic context rather than a clinical decision trigger.
Nurses must accurately identify and document these signs to help physicians diagnose ARF, as fulfilling the Jones criteria (e.g., 2 major, or 1 major + 2 minor) is essential.
The most critical nursing role is monitoring for carditis (inflammation of the heart), as it is the most serious complication and can lead to permanent rheumatic heart disease (RHD).
Patient education is vital, especially regarding the need for long-term antibiotic prophylaxis (usually penicillin) to prevent recurrent attacks and further heart damage.

How to Approach the Question

First, identify the core concept of the question, which is the clinical manifestations of Rheumatic Fever.
Note the keyword "EXCEPT". This signals that you must find the option that does not fit with the others. Three options will be major manifestations, and one will not be.
Recall the Jones Criteria, which classifies the signs and symptoms of rheumatic fever into 'major' and 'minor' categories.
Systematically categorize each option: Chorea is a major criterion. Erythema marginatum is a major criterion. Subcutaneous nodules are a major criterion.
Identify the outlier: Arthralgia (joint pain without inflammation) is a minor criterion.
Select the outlier, Arthralgia, as it is the correct answer to the "EXCEPT" question.

Concept Tested & Keywords

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