Which of the following statements about Rheumatic fever is false?

AIIMS Raipur NO - 2019 (Shift-2)

Medical & Surgical Nursing

Easy

Appeared in: AIIMS Raipur NO - 2019 (Shift-2)

Explanation

The statement that rheumatic fever involves myocarditis but not endocarditis is false.
Rheumatic carditis is characteristically a pancarditis, meaning it involves inflammation of all three layers of the heart: the endocardium, myocardium, and pericardium.
Endocarditis, particularly affecting the heart valves (especially the mitral valve), is a hallmark of rheumatic fever and is responsible for the long-term complication of rheumatic heart disease.
The inflammation of the endocardium leads to valvulitis, causing regurgitation and, over time, stenosis, which results in permanent valve damage.

Option A: This statement is true. Rheumatic fever is a post-infectious syndrome with a characteristic latent period of about 2 to 4 weeks following a Group A streptococcal pharyngitis (sore throat).
Option B: This statement is true. Aschoff bodies are pathognomonic microscopic lesions (granulomas) found in the heart tissue, particularly the myocardium, of patients with acute rheumatic fever. Their presence confirms a diagnosis of rheumatic carditis.
Option C: This statement is true. Rheumatic fever is an autoimmune reaction triggered by an untreated or inadequately treated pharyngeal infection with Group A β-hemolytic streptococcus.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pathophysiology and clinical manifestations of Rheumatic Fever as background academic context rather than a clinical decision trigger.
Understanding that rheumatic fever causes pancarditis is critical for nurses, as monitoring must encompass all aspects of cardiac function. This includes listening for new murmurs (endocarditis), assessing for signs of heart failure (myocarditis), and listening for friction rubs (pericarditis).
The primary long-term danger of rheumatic fever is chronic rheumatic heart disease (RHD) resulting from valvular damage caused by endocarditis. Nursing care focuses on secondary prevention with long-term penicillin prophylaxis to prevent recurrent attacks and further valve damage.
What if? If a patient with a history of rheumatic fever presents with a new fever and joint pain, the nurse must have a high index of suspicion for a recurrence. The priority is to assess for signs of carditis and ensure the patient is evaluated for restarting or adjusting antibiotic prophylaxis.

How to Approach the Question

First, identify the keyword 'false' in the question stem. This means you are looking for the incorrect statement among the options.
Next, read each option and evaluate its accuracy based on your knowledge of Rheumatic Fever.
Recall the key features of Rheumatic Fever: its cause (Group A Strep), its latency period (2-4 weeks post-infection), and its major manifestations (e.g., carditis, arthritis).
Specifically, remember that cardiac involvement is a 'pancarditis,' affecting all layers of the heart.
Evaluate the option 'Myocarditis but no endocarditis'. This statement contradicts the principle of pancarditis, as endocarditis is a key and often the most damaging component.
Confirm that the other three options are factually correct statements about the disease, solidifying your choice of the false statement.

Concept Tested & Keywords

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) pp. 458-460, 460-462