A 16-year-old boy presents with a temperature of 38.4 C (101

Discussion in 'USMLE STEP 2 CS' started by Drgames., Aug 23, 2008.

  1. Drgames.

    Drgames. Guest

    A 16-year-old boy presents with a temperature of 38.4 C (101 F) and low back, wrist, and knee pain. He had a sore throat 1 month earlier. His arthritis is diffuse. Pea-sized swellings are noted over the skin on his knees. He has a serpiginous erythematous area on his anterior trunk. His blood and throat cultures are negative, and his CBC is unremarkable. His antistreptolysin-O (ASO) titer is high. Which of the following is the most appropriate therapy?

    A. Acetaminophen
    B. Aspirin
    C. Penicillin
    D. Penicillin and aspirin
    E. Supportive care
  2. Guest

    Guest Guest

    Explanation:

    The answer is D. This patient has acute rheumatic fever from group A streptococci. He has migratory polyarthritis, erythema marginatum, and subcutaneous nodules. Other features absent in this patient are chorea and carditis. His ASO titer indicates recent infection with Streptococcus. It is advisable to administer penicillin for the infection. The arthritis can be managed with salicylates.

    Acetaminophen (choice A) may be needed to keep his temperature down and prevent a febrile seizure. However, this is not a treatment. Also, a nonsteroidal anti-inflammatory drug is needed for the arthritis.

    Aspirin (choice B) will combat the arthritis, but the infection will remain untreated. Such a course will expose the patient to potential rheumatic heart disease, including severe mitral stenosis, in the future.

    The penicillin alone (choice C) will cover the infection and eliminate the risk of rheumatic heart disease. However, the patient also has a painful arthritis that needs to be addressed.

    Supportive care (choice E) is not an option for this patient. Even if he is allergic to penicillin, an alternative coverage for gram-positive bacteria is mandatory. Prophylactic therapy for an associated movement disorder is not needed.

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