threewalkers
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13y F routine exam. Her mom said her daughter had some fever and heart problem 5 years ago. she remember her limbs dancing and had some rash on her arms. She is otherwise normal. PE: apex mild diastolic murmur. the rest of the exam is unremarkable. WHat's the next step?
a. lipid panel
b. CBC
c. penicillin G
d. fast strep.
e. observe
f. EKG
G. echocardiogram
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| drsensitive
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EKG 1st
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| .Mia.
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isn't it G ?
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| threewalkers
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thanks, Mia and drsensitive.
but 
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| .Mia.
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Really ?
You made me think now, is it Penicillin G? It can not be nothing else. ...
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| drsensitive
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CBC than
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| threewalkers
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why not choose Observe? the pt has no complains. The disease is 5 years ago.
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| .Mia.
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I thought the answer would be echo as she might have mitral stenosis, so next I thought its PN G as if she has some mild mitral stenosis, don't you give kids ( she is 13 yo) prophylactically PN G till the adult life ( or what are the rules ) ? She has a murmur, so something is going on with her heart....
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| .Mia.
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You made me think once again .
I google this up :
Preventive and prophylactic therapy is indicated after rheumatic fever and RHD to prevent further damage to valves.
the American Heart Association currently recommends that patients with rheumatic fever without carditis receive prophylactic antibiotics for 5 years or until aged 21 years, whichever is longer.5 Patients with rheumatic fever with carditis but no valve disease should receive prophylactic antibiotics for 10 years or well into adulthood, whichever is longer.
http://emedicine.medscape.com/article/1007946-treatment
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| Ahmed103
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C
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| threewalkers
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yes, Mia and Ahmed, You got it.
The pt has carditis and 5 y ago. The answer is penicillin G im every 4 weeks. Or if pt compliant, oral penicillin V.
How long should the pt be on Pen. depends on echo. , which can tell us if Mitral valve is involved or not. If yes, then pen. for life. If no, pen for another 5 y. so the next step after Rx pen is send her to echo.
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| threewalkers
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Fred, it's from UW.
The pt has carditis and 5 y ago. Dx can be made by her previous presentation.
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| studyin4ck
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i agree with fred, cuz i wud have chosen echo also, but then again the dancing feet---chorea...is prolly from the rheumatic...and she definitley has MS...but then again..its so broad, u cud do echo---then penicillin...
why do they say penicillin first and the echo..how wud that make a dfference, when the pencillin is going to be given lifelong anyways...
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