A 53-year-old female presents with worsening shortness of breath with activity. Physical exam reveals a diastolic murmur with an opening snap. The patient’s medical history is significant for a left hip replacement 10 years ago, and she vaguely recalls an extended period of illness as a child described as several severe episodes of sore throat followed by rash, fever, and joint pains. Administration of which of the following treatments at that time would have been most effective in reducing her risk of developing cardiac disease?
ACiprofloxacin
BVancomycin
CPenicillin
DAcyclovir
EAspirin
A 6-year-old boy presents to his pediatrician accompanied by his mother for evaluation of a rash. The rash appeared a little over a week ago, and since that time the boy has felt tired. He is less interested in playing outside, preferring to remain indoors because his knees and stomach hurt. His past medical history is significant for an upper respiratory infection that resolved uneventfully without treatment 2 weeks ago. Temperature is 99.5°F (37.5°C), blood pressure is 115/70 mmHg, pulse is 90/min, and respirations are 18/min. Physical exam shows scattered maroon macules and papules on the lower extremities. The abdomen is diffusely tender to palpation. There is no cervical lymphadenopathy or conjunctival injection. Which of the following will most likely be found in this patient?
ACoronary artery aneurysms
BLeukocytoclastic vasculitis
CThrombocytopenia
DMitral regurgitation
EOccult malignancy
A 7-year-old boy is brought to the physician because of a 5-day history of fever, malaise, and joint pain. He had a sore throat 4 weeks ago that resolved without treatment. His temperature is 38.6°C (101.5°F) and blood pressure is 84/62 mm Hg. Physical examination shows several firm, painless nodules under the skin near his elbows and the dorsal aspect of both wrists. Cardiopulmonary examination shows bilateral basilar crackles and a blowing, holosystolic murmur heard best at the cardiac apex. Both knee joints are warm. Laboratory studies show an erythrocyte sedimentation rate of 129 mm/h. The immune response seen in this patient is most likely due to the presence of which of the following?
AM protein
BCAMP factor
CTSST-1
DIgA protease
EHyaluronic acid capsule
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