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Acute Rheumatic Fever — RACP Adult Medicine MCQ

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ModerateCardiologyAcute Rheumatic FeverRACP Adult Medicine

A 10-year-old Indigenous Australian boy from remote NT presents with fever, migratory polyarthritis (knees, ankles, wrists), and a new pansystolic murmur at the apex. ECG shows a prolonged PR interval. ASO titre is markedly elevated. Throat swab grows group A Streptococcus. What modified Jones criterion category does the migratory polyarthritis represent?

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Correct answer: B — Major criterion

In Australian guidelines (using the 2015 AHA modified Jones criteria for high-risk populations including Aboriginal and Torres Strait Islander Australians), migratory polyarthritis is a MAJOR criterion. In low-risk populations, only polyarthritis is major while monoarthritis is minor. The updated criteria lower the diagnostic threshold for high-risk populations. Carditis (new murmur, echocardiographic valvulitis) is also a major criterion.

Reference: RHDAustralia – 2024 – ARF Guidelines; 2015 AHA Jones Criteria