Rheumatic fever: pharmacotherapy and prophylaxis MCQs With Answer

Rheumatic fever: pharmacotherapy and prophylaxis MCQs With Answer

Introduction: This quiz set is designed for M.Pharm students studying Pharmacotherapeutics II to deepen understanding of pharmacologic management and prevention strategies for rheumatic fever. It covers mechanisms, drug selections, dosing regimens, special situations (penicillin allergy, pregnancy), anti-inflammatory and immunosuppressive therapy, and secondary prophylaxis guidelines. Questions emphasize rationale for drug choice, comparative pharmacology (e.g., benzathine penicillin versus oral penicillin), and evidence-based durations of prophylaxis tied to clinical presentation. Use these MCQs to test clinical decision-making, memorize key dosing principles, and reinforce mechanistic links between therapies and rheumatic heart disease prevention.

Q1. Which antibiotic regimen is considered first-line to eradicate group A Streptococcus in a patient presenting with acute rheumatic fever?

• Single intramuscular injection of benzathine penicillin G
• Oral azithromycin for 3 days
• Oral doxycycline for 7 days
• Intravenous vancomycin for 5 days

Correct Answer: Single intramuscular injection of benzathine penicillin G

Q2. For secondary prophylaxis against recurrent rheumatic fever in an adult, what is the recommended benzathine penicillin G dose and interval?

• 600,000 units intramuscular every 2 weeks
• 1.2 million units intramuscular every 4 weeks
• 2.4 million units intramuscular every 12 weeks
• 500 mg oral penicillin V twice daily

Correct Answer: 1.2 million units intramuscular every 4 weeks

Q3. In a patient with documented rheumatic carditis and persistent valvular disease, what is the generally recommended minimum duration of secondary antibiotic prophylaxis?

• 5 years or until age 21, whichever is later
• 6 months only
• At least 10 years or until age 40 (or longer depending on severity)
• No prophylaxis is required

Correct Answer: At least 10 years or until age 40 (or longer depending on severity)

Q4. Which antibiotic is the preferred alternative for eradication of group A Streptococcus in a truly penicillin-allergic patient?

• Erythromycin
• Tetracycline
• Metronidazole
• Ciprofloxacin

Correct Answer: Erythromycin

Q5. What is the first-line anti-inflammatory therapy for symptomatic control of arthritis in acute rheumatic fever?

• High-dose aspirin
• Low-dose aspirin only (antiplatelet dose)
• Oral colchicine
• Topical NSAIDs

Correct Answer: High-dose aspirin

Q6. Corticosteroids are indicated in acute rheumatic fever primarily for which clinical scenario?

• Severe carditis with heart failure or significant myocardial involvement
• Mild migratory arthritis without cardiac involvement
• To eradicate group A Streptococcus from the throat
• As routine therapy for all cases to prevent recurrence

Correct Answer: Severe carditis with heart failure or significant myocardial involvement

Q7. The immunopathologic mechanism most responsible for rheumatic fever is best described as:

• Autoimmune molecular mimicry between streptococcal M protein and cardiac tissue
• Direct bacterial invasion of heart valves by group A Streptococcus
• Type I hypersensitivity reaction mediated by IgE
• Deposition of immune complexes in the glomerulus only

Correct Answer: Autoimmune molecular mimicry between streptococcal M protein and cardiac tissue

Q8. What is the usual duration of oral penicillin V therapy to eradicate group A Streptococcus in acute rheumatic fever when oral therapy is chosen?

• 3 days
• 5 days
• 10 days
• 6 weeks

Correct Answer: 10 days

Q9. Which statement best describes the effect of corticosteroid therapy on long-term valvular outcomes in rheumatic carditis?

• Corticosteroids reduce acute inflammation but have not consistently been shown to prevent long-term valve deformity
• Corticosteroids completely prevent chronic valvular lesions when given early
• Corticosteroids are contraindicated because they worsen valve damage
• Corticosteroids eradicate group A Streptococcus and prevent recurrence

Correct Answer: Corticosteroids reduce acute inflammation but have not consistently been shown to prevent long-term valve deformity

Q10. In a pregnant patient with acute rheumatic fever who is allergic to penicillin, which antibiotic is generally recommended for eradication of streptococcal infection?

• Erythromycin (macrolide)
• Tetracycline
• Trimethoprim-sulfamethoxazole
• Fluoroquinolone (ciprofloxacin)

Correct Answer: Erythromycin (macrolide)

Q11. What is the recommended pediatric anti-inflammatory dosing range for aspirin in acute rheumatic fever?

• 60–100 mg/kg/day divided into 4 doses
• 1–2 mg/kg/day once daily
• 5 mg/kg every 12 hours
• 500 mg once weekly

Correct Answer: 60–100 mg/kg/day divided into 4 doses

Q12. Which medication is considered effective for symptomatic management of Sydenham’s chorea associated with rheumatic fever?

• Sodium valproate (valproic acid)
• High-dose amoxicillin
• Low-dose aspirin
• Metoprolol

Correct Answer: Sodium valproate (valproic acid)

Q13. Prompt antibiotic treatment of streptococcal pharyngitis prevents rheumatic fever most effectively if initiated within what time frame after symptom onset?

• Within 9 days of sore throat onset
• Only after 21 days
• After symptoms have resolved
• Antibiotics do not prevent rheumatic fever

Correct Answer: Within 9 days of sore throat onset

Q14. Compared to oral penicillin V, the pharmacologic advantage of benzathine penicillin G for secondary prophylaxis is:

• Prolonged low serum levels allowing monthly dosing
• Superior penetration into intracellular bacteria
• Lower risk of allergic reactions
• Oral bioavailability is higher

Correct Answer: Prolonged low serum levels allowing monthly dosing

Q15. Which of the following is a common adverse effect specifically associated with long-term intramuscular benzathine penicillin prophylaxis?

• Pain and induration at injection sites
• Renal tubular necrosis
• Marked QT prolongation
• Ototoxicity with hearing loss

Correct Answer: Pain and induration at injection sites

Q16. Which of the following clinical features are considered major Jones criteria for the diagnosis of rheumatic fever? (Select the option that lists only major criteria.)

• Migratory polyarthritis, carditis, erythema marginatum, subcutaneous nodules, Sydenham’s chorea
• Fever, elevated ESR, prolonged PR interval
• Sore throat, cough, rhinorrhea
• Proteinuria, hematuria, hypertension

Correct Answer: Migratory polyarthritis, carditis, erythema marginatum, subcutaneous nodules, Sydenham’s chorea

Q17. For secondary prophylaxis in a patient who is noncompliant with daily oral regimens, which strategy best improves adherence and reduces recurrence risk?

• Monthly benzathine penicillin G intramuscular injections
• Switching to once-weekly oral penicillin V
• Yearly intramuscular penicillin only during high-risk seasons
• No prophylaxis required if symptomatic-free

Correct Answer: Monthly benzathine penicillin G intramuscular injections

Q18. Which statement about macrolide use (e.g., azithromycin, erythromycin) for streptococcal eradication or prophylaxis is correct?

• Macrolides are effective alternatives for penicillin-allergic patients but macrolide resistance among Streptococcus pyogenes may limit efficacy
• Macrolides are preferred over penicillin in all patients due to fewer side effects
• Macrolides are contraindicated in children under all circumstances
• Macrolides permanently eliminate risk of recurrence after a single dose

Correct Answer: Macrolides are effective alternatives for penicillin-allergic patients but macrolide resistance among Streptococcus pyogenes may limit efficacy

Q19. Which pharmacologic principle explains aspirin’s anti-inflammatory action in rheumatic fever?

• Irreversible inhibition of cyclooxygenase enzymes, reducing prostaglandin synthesis
• Blockade of TNF-alpha receptors directly
• Enhancement of leukotriene production
• Competitive antagonism at beta-adrenergic receptors

Correct Answer: Irreversible inhibition of cyclooxygenase enzymes, reducing prostaglandin synthesis

Q20. For a patient with a history of rheumatic fever but no evidence of prior carditis, what is the recommended duration of secondary prophylaxis?

• 5 years or until age 21, whichever is longer
• Indefinite lifelong prophylaxis for all patients
• No prophylaxis is ever required
• Only during the winter months for 2 years

Correct Answer: 5 years or until age 21, whichever is longer

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