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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


C. Penicillin?










I'd go woth C...only Penicillin

I would try to avoid both aspirin and acetaminophen here as

1. The fever's not very high...anyway it helps kill the bugs

2. What about the effect on kidneys???...I am sure there IS some renal involvement here

Edited by Doc2378 on Nov 25, 2005 - 2:59 PM


D. Penicillin and aspirin


grin another controversial question. Which is the answer?




Given answer is D, rheumatoid arthritis, I still not check the textbook, if anyone has more infos, plz post it


did u mean rheumatoid arthritis or rheumatic fever?


Yeah, i just want to edit it now nod

Rheumatic fever


Asprine n penicilline both .Asprine to tackle inflammation n peni for RHD t/t


Thanks a lot for this nice question and the useful discussion!

This is treatment of rheumatic fever during the attack:

1. Anti-infective therapy— Eradication of the streptococcal infection is essential.Penicillin benzathine LA is the drug of choice.Erythromycin, 250 mg orally four times a day, may be substituted if the patient is allergic to penicillin.

2. Anti-inflammatory agents

a.Aspirin. Currently, 30–60 mg/kg/d is given in four divided doses. This dosage is often more than sufficient to effect dramatic relief of the arthritis and fever.

b.Corticosteroids. Corticosteroids are rarely indicated in current therapy. However, in the unusual patient with severe carditis and manifestations of congestive heart failure, therapy may be not only effective but also lifesaving.

3. Therapy of congestive heart failure

4. Bed rest and ambulation— Bed rest is not required for patients with arthritis and mild carditis without congestive heart failure.


ya its d

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