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Nursing QUESTION #9270
Question 1
A 10-year-old child is admitted with acute rheumatic fever. The Jones Criteria are used for diagnosis. Which combination represents MAJOR criteria only?
  • Fever, elevated ESR, prolonged PR interval, arthralgia
  • Carditis, polyarthritis, Sydenham's chorea, erythema marginatum, subcutaneous nodules✔️
  • Arthralgia, elevated CRP, leukocytosis, preceding streptococcal infection
  • Mitral regurgitation murmur, elevated ASO titer, fever, leukocytosis
Correct Answer Explanation

Jones Criteria for Acute Rheumatic Fever (ARF) — 2015 AHA Revision:

Diagnosis requires: evidence of preceding Group A Streptococcal (GAS) infection PLUS:

  • 2 Major criteria, OR
  • 1 Major + 2 Minor criteria
Major CriteriaMinor Criteria
Carditis (clinical or subclinical/echocardiographic)Fever (\(\geq 38.5°C\))
Polyarthritis (migratory)Elevated ESR or CRP
Sydenham's ChoreaProlonged PR interval on ECG
Erythema MarginatumArthralgia (only if arthritis not counted as major)
Subcutaneous NodulesElevated WBC

Mnemonic for Major criteria: JONES — Joints (polyarthritis), Oh (carditis), Nodules, Erythema marginatum, Sydenham's chorea

Treatment:

  • Penicillin V × 10 days (eradicate GAS)
  • Aspirin for arthritis/carditis
  • Corticosteroids for severe carditis
  • Secondary prophylaxis: Benzathine Penicillin \(1.2\,\text{MU}\) IM every 3–4 weeks for years (duration depends on carditis severity)