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A 14 years old young man that was healthy before due to fever, migratory pain and swelling of large joints plus chest pain which became better in sithing and bending forward position was brought to ED, apparently patient 4 weeks ago was affected with pharyngitis and consumed ampicillin for a while. in laboratory exams pharynx culture became negative, ESR=100 mm in first hour and ASO titer was more than 633 Todd, in heart physical exam which of the findings below is more probable?
A. S3
B. pansystolic 3/6 murmur at mitral locus
C. lng diastolic rumble at apex
D. pericardial friction rub


I'll go with D. pericardial friction rub, which is consistent with an inflammatory condition such as Rheumatic Fever and his symptoms of bending forward.

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