Comprehensive Nursing Pharmacology Q 289

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George, age 8, is admitted with rheumatic fever. Which clinical finding indicates to the nurse that George needs to continue taking the salicylates he had received at home?

  

     A. Chorea

     B. Polyarthritis

     C. Subcutaneous nodules

     D. Erythema marginatum

    

    

Correct Answer: B. Polyarthritis

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Polyarthritis is characterized by swollen, painful, hot joints that respond to salicylates. Polyarthritis refers to a joint disease that involves at least five joints. One or more signs of inflammation, including pain, movement restriction, swelling, warmth, and redness, are seen in the joints involved.

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Option A: Chorea is the restless and sudden aimless and irregular movements of the extremities suddenly seen in persons with rheumatic fever, especially girls. Chorea may be viewed as resulting from increased dopaminergic activity in the projections from the substantia nigra to the striatum, resulting in decreased GABAergic projection from the striatum to the globus pallidus.

Option C: Subcutaneous nodules are non tender swellings over bony prominences sometimes seen in persons with rheumatic fever. Subcutaneous nodules are deep-seated lesions in the skin, located in the deep dermis and subcutis, often with minimal changes appreciated on the surface of the skin. They are often easier to feel than see.

Option D: Erythema marginatum is a skin condition characterized by nonpruritic rash, affecting the trunk and proximal extremities, seen in persons with rheumatic fever. The pathogenesis for the occurrence of these lesions in cases of hereditary angioedema is proposed to be bradykinin mediated. This was evidenced by the presence of dense stromal and endothelial deposits of bradykinin in skin biopsy specimens taken from lesions of erythema marginatum in patients with hereditary angioedema.

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