case 29 || Solution || Part 2

@medic_altimesMT

The answer to the given question is “Acute Rheumatic Fever”

⏩Diagnosis of RHD:

REVISED (1992) JONES CRITERIA:

It says a patient should have:

Essential Criteria

+

2 Major Criteria / 1 Major & 2 Minor Criteria


⏩Essential Criteria:

✅Elevated or rising ASO titers
✅Elevated Anti DNase B
✅Positive throat culture
✅Rapid antigen test for GAS

⏩Major Criteria:

⏹Migratory Polyarthritis:
⏹Subcutaneous Nodules
⏹Erythema marginatum
⏹Carditis
⏹Sydenham’s chorea

⏩Minor Criteria:

✅Fever (> 38.5)
✅Polyarthralgia
✅Increased ESR or CRP
✅Prolonged PR interval

⏩On Myocardial Autopsy:

⏹Aschoff’s body consisting of:

✅Swollen Myofiber
✅Lymphocytes
✅Plasma Cells
✅Histiocytes

(As shown in the Picture)

For more updates & full explanation

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case 29 || Solution || Part 3

@medic_altimesMT

The answer to the given question is “Acute Rheumatic Fever”

⏩Morphology in Acute Phase:

✅Microscopically, the characteristic feature is ‘Aschoff’s body’

✅Aschoff’s body are foci of ‘Swollen Eosinophilic Collagen’ surrounded by:

•T-lymphocytes
•Few plasma cells
•Plump activated macrophages called ‘Anitschkow cells’

(As shown in the picture)

✅Inflammatory Valvulitis:

Beady Fibrinous Vegetations called “Verrucae” present along the ‘Lines of Closure of Valve’

(As shown in the picture)


⏩Anitschkow cells / Caterpillar cells

(As shown in the picture)


For more updates & full explanation

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case 29 || Solution || Part 4

@medic_altimesMT

The answer to the given question is “Acute Rheumatic Fever”

⏩Morphology in Chronic Phase:

✅‘Fish-mouth’ / ‘Button-hole’ Stenosis On Cut Section

Fibrosis & Dystrophic Calcification (White) of Mitral Valve

(As shown in the picture)


✅MacCallum Plaques

Seen in the ‘Posterior wall of Left Atrium’

(As shown in the picture)


⏩Additional Info:

‘Bread and Butter’ Pericarditis:

•Fibrinous/ Serofibrinous exudate

(As shown in the picture)

For more updates & full explanation

https://www.tg-me.com/medic_altimesMT

@usmle_in_arabic 2021
KAPLAN USMLE STEP 2 CK LECTURE NOTES: internal medicine