Which among the following is NOT a major manifestation of rheumatic fever?

DSSSB - 28 August 2019 (Shift-1)

Medical & Surgical Nursing

Easy

Appeared in: DSSSB - 28 August 2019 (Shift-1)

Explanation

Arthralgia, which is defined as joint pain without objective signs of inflammation (like swelling or redness), is classified as a minor criterion under the revised Jones criteria for diagnosing rheumatic fever.
The question specifically asks to identify the option that is NOT a major manifestation, making Arthralgia the correct choice.
It is critical to distinguish arthralgia (minor criterion) from polyarthritis (a major criterion), which involves inflammation of multiple large joints.
The other options—Carditis, Subcutaneous nodules, and Chorea—are all well-established major manifestations of rheumatic fever.

Option A: This is incorrect because carditis, an inflammation of the heart (endocardium, myocardium, and/or pericardium), is one of the most definitive and serious major manifestations of acute rheumatic fever.
Option B: This is incorrect because subcutaneous nodules, which are firm, painless nodules over bony prominences, are a classic major manifestation of rheumatic fever, strongly associated with severe carditis.
Option C: This is incorrect because Sydenham's chorea, a neurological disorder with involuntary movements, is a specific and well-known major manifestation of rheumatic fever.

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.
Accurate identification of major vs. minor criteria is essential for diagnosing acute rheumatic fever (ARF) and initiating timely treatment. This prevents recurrent attacks and the progression to chronic rheumatic heart disease (RHD), a leading cause of acquired heart disease in children and young adults worldwide.
Nurses play a vital role in assessing patients for these signs. Differentiating between arthralgia (subjective pain) and arthritis (objective swelling, redness, warmth) during a physical examination can be the deciding factor in whether a patient meets the diagnostic criteria.
What if? If the patient presented with painful, swollen, and warm knees and ankles, this would be classified as polyarthritis, a major criterion. This would significantly increase the likelihood of an ARF diagnosis compared to a finding of arthralgia alone.

How to Approach the Question

First, recognize that the question uses a negative keyword, 'NOT'. This means you are looking for the option that does not fit the category of 'major manifestation'.
Next, recall the Jones criteria used for diagnosing rheumatic fever. Mentally list the five major manifestations: Carditis, Polyarthritis, Chorea, Erythema marginatum, and Subcutaneous nodules.
Evaluate each option against this list.
Carditis is on the list of major manifestations, so it is an incorrect answer.
Subcutaneous nodules are on the list, so this is also incorrect.
Chorea is on the list, making it incorrect.

Concept Tested & Keywords

Concept Tested: Jones Criteria for Rheumatic Fever
Stem keywords: rheumatic fever, major manifestation
Lead-in keywords: NOT
Negative lead-in flag: Question asks for the exception (NOT a major manifestation).

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