Handwritten medical student notes on lined paper with a blue pen, slightly messy but readable handwriting style. The notes are titled "RHEUMATIC FEVER" underlined at the top. Content organized with headings and bullet points: RHEUMATIC FEVER ━━━━━━━━━━━━━━━━━━━ • Def: Systemic inflammatory disease following Group A β-hemolytic Streptococcal pharyngitis (2-4 wks later) • Age: 4-9 years most common • Only pharyngitis (NOT impetigo) causes RF CLINICAL FEATURES (Jones Criteria) MAJOR (CASES): → C - Carditis (most serious) - mitral valve most affected → A - Arthritis (migratory polyarthritis, large joints) - most common → S - Sydenham's Chorea (CNS involvement) → E - Erythema Marginatum (trunk → limbs, ring-shaped rash) → S - Subcutaneous Nodules MINOR: → Fever, Arthralgia → ↑ ESR, ↑ CRP → Prolonged PR interval on ECG Dx = 2 Major OR 1 Major + 2 Minor + evidence of preceding GAS infection INVESTIGATIONS: • ASO titer (most useful) - often positive even when throat culture negative • Throat culture / rapid strep antigen test • ESR, CRP ↑ • ECG - prolonged PR interval • Echo - valvular lesions • Blood culture CLINICAL EXAMINATION: • Auscultation - new murmur (Carey Coombs murmur - mitral) • Joints - hot, swollen, tender, migratory • Skin - erythema marginatum • Neurological - involuntary movements (chorea) TREATMENT: • Penicillin - eradicate strep • Aspirin/NSAIDs - arthritis • Corticosteroids - severe carditis • Prophylaxis: Benzathine Penicillin monthly (10 yrs or till age 21) COMPLICATIONS: Rheumatic Heart Disease (10-20 yrs later)

Handwritten medical student notes on lined paper with a blue pen, slightly messy but readable handwriting style. The notes are titled "RHEUMATOID ARTHRITIS (RA)" underlined at the top. Content organized with headings and bullet points: RHEUMATOID ARTHRITIS (RA) ━━━━━━━━━━━━━━━━━━━━━━━━ • Chronic systemic inflammatory autoimmune disease • Targets: Synovium → pannus formation → joint destruction • F:M = 3:1, peak age 20-50 yrs, prevalence 1-2% • HLA-DR4 association PATHOGENESIS: → Synovial lining proliferates → pannus → Leukocyte invasion → protease + cytokine cascade → RF = autoantibody to IgG Fc fragment CLINICAL FEATURES: • Hallmark: Symmetric synovitis + Morning stiffness >1 hr • Small joints of hands/wrists/feet (PIP, MCP joints) • Constitutional: fever, fatigue, weight loss DEFORMITIES: → Boutonniere deformity → Swan neck deformity → Z-deformity of thumb → Ulnar deviation at MCP joints EXTRA-ARTICULAR: • Rheumatoid nodules (subcutaneous) • Vasculitis, Pericarditis, Pleuritis • Keratoconjunctivitis sicca (Sjogren's) • Felty's syndrome (RA + splenomegaly + neutropenia) ACR CRITERIA (4 of 7 for ≥6 wks): 1. Morning stiffness >1 hr 2. Arthritis in ≥3 joint areas 3. Arthritis of hand joints 4. Symmetric arthritis 5. Rheumatoid nodules 6. Serum RF positive 7. Radiographic changes (erosions) INVESTIGATIONS: • RF (Rheumatoid Factor) - positive in 70-80% • Anti-CCP antibodies (more specific) • ESR, CRP ↑ • CBC: normocytic normochromic anemia • X-ray: periarticular osteoporosis → erosions → joint space narrowing TREATMENT: • NSAIDs - symptomatic • DMARDs: Methotrexate (1st line), Hydroxychloroquine, Sulfasalazine • Biologics: Anti-TNF (Infliximab, Etanercept) • Steroids: short-term flares