1. The peak incidence of Rheumatic Fever occurs in the following age group:

5 years

5 -15 years

15 -25 years

25 -35 years

2. Child is said to be suffering from 'Juvenile' mitral stenosis if the age of child is:

5 years

5 -15 years

15 -25 years

25 -35 years

3. Following statements are true except:

Organism implicated for initiation in Rheumatic Fever is Group A beta-hemolytic streptococcus

The long held opinion that only streptococcal pharyngitis and not streptococcal skin infections may be followed by Acute Rheumatic Fever has been challenged

0.3 percent of patients suffering from Group A beta-hemolytic streptococcus throat infections develop Acute Rheumatic Fever

In Indian patients with acute rheumatic fever, genetic linkage to Human Leucocyte Antigen -DL7 has been demonstrated

4. Following statements are true except:

Group A streptococcus produces somatic and extracellular antigens

Group specific polysaccharide of GAS wall is antigenically akin to glycoprotein found in human and bovine cardiac valves

M protein of GAS cross reacts with human heart tissues particularly sacrolemmal membrane proteins and cardiac myosin

In chorea, antibodies directed against GAS cell membrane cross react with tissues in the frontal lobe of the brain

5. Following statements are true except:

Acute Rheumatic Fever is considered a multisystem autoimmune disease

Exact role of hot cross reacting antibodies in the pathogenesis of ARF is not clear

C3 C4 complements are reduced in ARF

CD4 CDs cell ratio is raised in ARF

6. A 23 years old lady has presented for the first time in your OPD. She has been diagnosed as stable severe mitral stenosis and mild mitral regurgitation. As per 2002 -2003, WHO criteria for diagnosis of Rheumatic Heart Disease, she should fulfil following manifestations of Revised Jones Criteria

One major manifestation and two minor manifestations

Two minor manifestations

One minor manifestation with supporting evidence of antecedent group A streptococcal infection

Does not require any other criteria

7. Following statements about carditis in Acute Rheumatic Fever are true except:

Around 40 percent cases of ARF develop carditis

About 66 percent of ARF patients with carditis develop Rheumatic Heart Disease on follow up

Tricuspid Regurgitation is the commonest valvular lesion during ARF

Pericarditis, Pericardial effusion and arrhythmias may also occur in rheumatic carditis

8. Following statements about Pathogenesis of Acute Rheumatic Fever are true except:

Pathologic hall mark of rheumatic carditis is Aschoff body

Aschoff body comprises of perivascular infiltrates of large cells arranged in a rosette form around a vascular area of fibrinoid necrosis

Aschoff bodies are usually seen in Acute Stage of Rheumatic carditis

On gross examination, on opening of left atrium, one sees a thickened patch of tissue just above the base of posterior mitral leaflet termed as 'Mac Callum's patch'

9. Following statements in the setting of Acute Rheumatic Fever are true except:

Polyarthritis is the most common manifestation

Subcutaneous nodules are present in 3-6 percent of cases

Erythema marginatum is a macular, evanescent and pruritic rash mostly on trunk and arms but never on face

Chorea may be the only manifestation of ARF

10. Following statements about diagnosis of Acute Rheumatic Fever are true except:

One must look for supportive evidence for antecedent Group A streptococci infection

In about 80 percent of ARF patients, Anti-streptolysin 0 titres are raised

AS 0 titres are at peak usually 3 months after streptococcal infection

Anti-deoxyribonuclease 13 titre remains elevated longer than Anti-streptolysin 0 titres

11. Following statements about course and prognosis of Acute Rheumatic Fever are true except:

The course and ultimate prognosis of Acute Rheumatic Fever is usually directly related to the severity of polyarthritis

The course and prognosis also depends upon recurrence of rheumatic fever

There is always a tendency to develop rheumatic fever with repeated group A streptococci infection

There is a greater chance for recurrence in young children and in the first 3 years after the first attack

12. One of the following drug in following dosage is recommended for secondary prophylaxis for Acute Rheumatic Fever except:

Benzathine Penicillin 1.2 million units every 3 weeks (weight 30 mg)

Penicillin V 500 mgm b.l.d daily

Erythromycin stearate 250 mgm b.l.d. daily

Sulfadiazine 1 gmjkg (0.5 grnjkg in children)

13. Following statements about Infective Endocarditis are true except

IE is a microbial infection of the endothelial surface of the heart

Infection may occur at the site of septal defect chordae tendinae, mural endocardium, heart valve leaflets

Mural Endocardium is more commonly involved

Prosthetic valve may prOVide a nidus for infection, as well as barrier to eradication

14. Following statements about Infective Endocarditis are true except:

Infective endocarditis usually occurs more frequently in men

The age specific incidence of endocarditis increases progressively after 30 years of age

Predisposing conditions cannot be identified in 25 to 45 percent of patients

Among neonates, infective endocarditis typically involves the mitral valve of structurally normal hearts.

15. Commonest organism incriminated in native valve endocarditis in the age group of 2 months to 15 years is

Streptococci

S. Aureus

Enterococci

Gram negative bacteria

16. Following statements about Prosthetic Valve Endocarditis are true except:

The risk of PVE is greatest during the initial 6 months after valve surgery

During the initial months after valve implantation, bio prosthetic valves are at greater risk of infection than mechanical valve

PVE represents 7 to 25 percent of all infective endocarditis cases

PVE can be broadly divided into two groups based on the time of onset of infection after valve surgery -early and late

17. In the setting of Prosthetic valve endocarditis, within two months of surgery, commonest organism incriminated is

Staphylococcus aureus

Coagulase -negative staphylococci

Gram negative baccilli -P. Aeruginosa

Fungi -candida species

18. Of the following, commonest clinicial sign of infective endocarditis is

Fever

Changing or new murmur

Embolic Event

Clubbing

19. Following clinical features in infective endocarditis are due to Immune mediated injury:

Glomerulonephritis

Osler's nodes

Janeway lesions

Roth's spots

20. Following statements about the cardiac manifestations of Infective Endocarditis are true except:

Murmur is present in about 80 -85 percent of cases

Congestive Heart failure develops in 30 -40 percent of patients

Heart failure due to mitral valve dysfunction progresses more rapidly than does that due to aortic valve dysfunction

Embolic to a coronary artery occur in of patients and may result in myocardial infarction

21. As per modified Duke Criteria of Infective Endocarditis, patient is said to suffering from 'Definite' Infective Endocarditis if he/she meets the following combinations of clinical criteria except:

Two major criteria

One major and two minor criteria

One major and three minor criteria

Five minor criteria

22. Following statements about Infective Endocarditis are true except:

Systemic Emboli are among the most common clinical sequelae of IE

Embolic often antedate diagnosis of IE

Incidence of embolic events decreases promptly during administration of effective antibiotic therapy

Embolic stroke syndromes, predominantly involving the anterior cerebral artery territory, occurs in 15 to 20 percent of patients with IE

23. Following statements about Fungal Infective Endocarditis are true except:

Is associated with high mortality (Survival Rate

Is associated with large bulky vegetations

Candida and Aspergillus species are the most common causes

Blood cultures are usually positive incase of Aspergillus whereas they are rarely positive with Candida.

24. In the setting of IE, following features suggest need of emergent (same day) surgery

Acute aortic regurgitation plus preclosure of mitral valve

Sinus of Valsalva abscess ruptured into right heart

Rupture into pericardial sac

Fungal Endocarditis

25. As per modified Duke criteria of Infective Endocarditis, following clinical criteria are considered as minor criteria except:

Predisposing heart condition or intravenous drug use

Fever 38°C

Major Arterial Emboli

Typical micro-organism for infective endocarditis grown from two separate blood cultures

26. Following statements are true except:

Minimum Inhibitory Concentration of the antibiotic is the lowest concentration that inhibits growth of the causative organism

Minimum Bactericidal Concentration of the antibiotic is the lowest concentration that decreases a standard inoculum of organisms 99.9 percent during 48 hours

For the vast majority of streptococci and staphylococci, the MIC and MBC of penicillins, cephalosporins or vancomycin are the same or differ only by a factor of two to four

organisms for which MBC of these antibiotics is 10 fold or greater than MIC are occasionally encountered

27. In the setting of Infective Endocarditis, following statements about mycotic aneurysms are true except

They result from septic embolization of vegetations to the arterial vasa vasorum or to the 'intraluminal space.

Arterial branching points favour the impaction of emboli

They occur more frequently in visceral arteries followed by intracranial arteries

Intra-abdominal mycotic aneurysms are often asymptomatic until leakage or rupture occurs.

28. Following statements about mitral valve Annulus are true except:

Annulus is a saddle shaped structure

Posteriorly it merges with aortic annulus while anteriorly there is a C shaped discrete fibrous annulus

Normal diameter is about 2.5 -3.5 cms

Normal motion and contraction contribute to the normal mitral valve function

29. Following statements about Mitral Stenosis are true except:

The predominant cause of MS is rheumatic fever

25% of all patients with Rheumatic Heart Disease have isolated MS

40% of all patients with RHD have combined MS and MR

Multivalve involvement is seen in 38% of MS patients with the aortic valve affected in about 35% and the tricuspid valve in about 30%.

30. Following statements about the Pathophysiology of Mitral valve obstruction are true except:

The transvalvular pressure gradient for any given valve area is a function of the square of the transvalvular flow rate

Doubling of flow rate doubles the pressures gradient

Increase in left atrial pressure would cause increase in the pulmonary artery wedge pressure

Increases in pulmonary artery wedge pressure would cause interstitial congestion and this presents as symptoms of dyspnea

31. Following statements about physical signs of mitral stenosis are true except:

Pulse is normal or low volume

With severe pulmonary artery hypertension, right ventricle may form the apex

First heart sound is loud except in calcific and nonpliable valve

Severity of mitral stenosis is directly proportional to A2 -OS distance

32. Following statements about echocardiographic score in mitral stenosis, used to predict outcome of Mitral Balloon Valvuloplasty are true except:

Echocardiographic score is based on valve thickness, calcification, mobility and subvalvular :thickening

Patients witlt an echocardiographic score of 8 or less have more favourable result from BMV than those with score higher than 8

Patient is said to have Grade 3 Subvalvular Thickening, if thickening of the chordal structures extends upto one third of the chordal length.

Patient is said to have grade 3 mobility, if the valve continues to move forward in diastole mainly from the base.

33. Following statements about Atrial Fibrillation in the setting of Mitral Stenosis are true except:

With increase in left atrial size, there are more chances of patient developing AF

Initially, AF may be paroxysmal, but later it becomes persistent and then chronic

Loss of Atrial contraction also contributes to decrease in mean left atrial pressure

Incidence of thromboembolic complications in AF due to rheumatic mitral stenosis is 17 times more than that seen in lone AF

34. Following statements are true except:

Congenital Mitral Regurgitation may be due to cleft mitral leaflet

Rheumatic involvement is the most important cause of mitral regurgitation in our country

Myxomatous mitral valve is characterized by deposition of mucopolysaccharides in the spongiosa layer

In idiopathic degeneration of chordae, usually anterior leaflets are involved and their rupture leads to mitral regurgitation

35. In compensated chronic mitral regurgitation, following statements are true except:

Left atrium is enlarged

Left ventricle is enlarged

Increased preload of left ventricle

Increased after load of left ventricle

36. In compensated chronic severe mitral regurgitation, 2nd heart sound is

Widely split

Normal split

Narrow split

Reverse split

37. Following statements about Aortic Stenosis are true except:

Congenital bicuspid aortic valve is one of the common congenital abnormality -about 8 percent

Congenital abnormalities of aortic valve may lead to unicuspid Aortic valve

Degenerative aortic valve disease that is seen increasingly in elderly shares common pathogenesis with atherosclerosis

Patient is often, the orifice size decreases from normal 3-4 cm^2 to 1.5cm^2

38. Following statements about physicaJ signs in aortic stenosis are true except:

A grade I murmur in the abscence of decompensation suggests mild lesion

A grade IV murmur almost always suggests severe aortic stenosis

In children and elderly, seleCtive conduction of high frequency sounds to apical area may give to murmw at apex

An early peaking loud grade ry murmur is specific to severe aortic stenosis

39. Patient is said to be suffering from severe mitral regurgitation if he/she meets the following criteria except

Regurgitant volume more tpan 60 ml per beat

Regurgitant fraction more than 40 percent

Effective orifice IIlore than 0.4 cm^2

Pulmonary vein systolic flow reversal

40. As per ACCjAHA guidelines for management of patients with severe aortic regurgitation, following are class I indications for Aortic Regurgitation except:

Symptomatic patients

Asymptomatic patients with EF 0.50 at rest

Asymptomatic patients undergoing CABG or surgery on Aorta or heart valves

Asymptomatic patients, Normal LV functions, EDD 75 mm, ESD 55 mm

41. Following statements about Pericardium are true except:

Pericardium consists of two layers

Parietal pericardium thickness may be upto 2.5 to 3.0 mm

The phrenic nerves lie over the parietal pericardium and supply most of it

The normal intrapericardial pressure can vary from 5 to 10 mm of Hg

42. Following statements about electrocardiogram in acute pericarditis are true except:

Four stages of evolution of ECG changes may occur

In stage there is ST segment elevation with concavity upwards

In stage II, there is T wave invertion

In stage IV, T wave normalizes

43. Following statements about size of the Pericardia:l Effusion(PE) are true except:

Small PE Mostly seen in anterior part of the heart

Moderate PE (100-500 ml) Seen all around the heart, width 1.0 cm

Large PE 500 ml) More than 1 cm in width all around

Tamponade -swinging motion of the heart, diastolic collapse of right ventricle and respiratory flow variation across the atrioventricular valves

44. Following statements about Pathophysiology of constrictive pericarditis are true except:

There is restriction of ventricular dilatation and diastolic filling of the ventricles

There is dissociation of intracardiac and intrathoracic pressures

Difference in diastolic pressure between the ventricles is more than 5 mm of Hg

There is systemic and pulmonary venous congestion

45. Following are the features of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) except:

It is marked by myocardial cell loss with partial or total replacement of RV muscle by adipose and fibrous tissue

Clinical manifestations are seen in adolescence or early adulthood predominantly in males

ECG shows inverted T waves in right precordial leads

They develop reentrant ventricular tachyarrhythmias of RBBB configuration usually precipitated by exercise.

46. In constrictive pericarditis, following hemodynamic changes occur except:

Left ventricular pressure tracing shows square root sign

Equalization of diastolic pressure in all 4 chambers

Ventricular filling occurs only in early diastole

Jugular venous pressure is decreased

47. Which of the following hemodynamic aspects of constrictive pericarditis is incorrect?

There is dissociation of intracardiac and intrathoracic pressures

There is elevation of intracardiac diastolic pressures

Affects early filling phase of ventricles

Causes equalization of diastolic pressures in all 4 chambers

48. The following are related to severity of mitral stenosis except:

Atrial fibrillation

Length of diastolic murmur

A2-0S interval

Pulmonary hypertension

49. Cardiac catheterization in rhem1atic mitral regurgitation:

Routine cardiac catheterizi1hon is mandatory before mitral valve replacement in all patients

Pre-operative coronary angiogram is mandatory before valve replacement in those with risk factors

LV angiogram helps to assess LV function and regional wall motion abnormalities

Quantification of mitral regurgitation by catheterization is the gold standard which of the above is correct









50. For assessing severity of aortic stenosis clinically, which of the following is less reliable?

Length of systolic murmur

Intensity of systolic murmur

Late peaking of murmur

S1-ejection click interval

51. The following echocardiographic features are suggestive of severe mitral regurgitation except:

Pulmonary vein systolic flow reversal

Effective regurgitant orifice area more than 0.3 sq. cms

Regurgitant faction more than 55%

Regurgitation jet reaches posterior wall of left atrium

52. Which of the following statements about infective endocarditis is incorrect?

More common in men

More common in older persons

Rheumatic valvular disease is a common predisposing lesion

Among congenital heart disease, it is more common in ASD

53. vVhich of the following regarding subcutaneous nodules in rheumatic fever is correct

Painful and tender

Freely movable

Occur on extensor surface of elbows, knees and spine

Occur in 10 of case Which of the above is correct









54. Pathogenesis of Acute Rheumatic Fever -which of the following is wrong?

Abnormal immune response of heart

Toxic effect of extracellular toxin of Group A Streptococci

Streptococcal m Protein cross reacts with human cardiac myosin

Streptococcal antibodies cross react with caudate nucleus

55. In Rheumatic Fever, which of the following statements is not correct?

Severity of carditis determines prognosis

Recurrence of rheumatic fever is common in children

If Carditis occurs in first attack chance of carditis recurrence is high

Children with no carditis in first attack will never have cardiac murmur in long term follow up

56. Prevention of Rheumatic Fever:

Prompt treatment of pharyngitis with penicillin

Injectable penicillin is inferior to oral penicillin

Those with carditis should have prophylaxis up to 40 years of age

Vaccines are routinely recommended for prophylaxis Which of the above is correct









57. Which of the following statements regarding clinical features of acute rheumatic fever is wrong?

Subcutaneous nodules are always associated with carditis

Diagnosis requires two major or one major and two minor criteria

Supportive evidence of streptococcal infection is always required in all types of presentation

Valvulitis produces carey coombs murmur

58. Which of the following regarding ASO titer is not correct?

Two-fold rise in sample taken 2-4 weeks interval is significant

Not useful for diagnosis for chorea

Return to normal levels before antideoxyribonuclease B Levels

More than 250 Todd units significant in children

59. Which of the following regarding clinical features of Mitral stenosis is incorrect?

Chest pain is due to low stroke volume

Pulmonary infarct can cause pleuritic pain

Onset of atrial fibrillation may precipitate pulmonary edema

Syncope is unusual

60. In Echo Doppler assessment of Mitral Stenosis, which of the following statements is wrong?

In atrial fibrillation, average of valve gradient in 5 cycles to be taken

Valve area calculated by pressure half time is fallacious in coexistant atrial septal defect

Associated mitral regurgitation does not affect continuity equation

Transvalvular gradient will be falsely low in bradycardia

61. Renal dysfunction in infective endocarditis is caused by the following:

Immune complex glomerulonephritis

Aminoglycoside induced injury

LV dysfunction

All of the above

62. Which of the folloWing regarding neonatal infective endocarditis is incorrect?

Involves tricuspid valve

There is often structural abnormality of heart

Carries high mortality

Consequence of infected vascular access catheters

63. Chemoprophylaxis against infective endocarditis is indicated in the following conditions except:

Dental scaling

Tonsillectomy

Vaginal hysterectomy

Cystoscopy

64. As per Duke's criteria, infective endocarditis is said to be possible when:

Two major criteria

One major one minor criteria

Five minor criteria

None of the above

65. Which of the following is incorrect regarding Mitral Valve?

Mitral annulus posteriorly merges with aortic annulus

Posterior leaflet occupies 2/3rd of annulus

Posterior leaflets has three scallops

Primary chordae are twelve in number

66. Echo in infective endocarditis:

TEE has higher sensitivity and specificity for detecting vegetation

TEE has better in PVE

Vegetations show independent mobility

TEE is more useful to diagnose myocardial abscess Which of the above is correct?









67. Following regimens can be tried in culture negative endocarditis except:

Ampicillin Gentamycin

Ceftrioxone Gentamycin

Vancomycin to be added if prosthetic valve is present

Rifampicin Gentamycin

68. Regarding mitral stenosis, which of the following statements, is wrong?

QRS axis of less than 60 suggest severe mitral stenosis

Right axis deviation indicates Pulmonary hypertension

R/S ratio of more than 1 and V1 indicates pulmonary hypertension

P Mitrale is the most common ECG finding

69. The following are immunological phenomenon of infective endocarditis except:

Janeway lesion

Osler's nodes

Roth's spots

Rheumatoid factor

70. Which of the following statements about clinical features of infective endocarditis is incorrect

Fever and new murmur or changes in pre-existing murmur is common

Worsening cardiac failure due to valve destruction

Roth Spots are macular non tender lesions in hand

Worsening of renal function is due to the disease as well as drugs

71. Treatment of Rheumatic fever is:

Penicillin need not be given if throat culture does not grow streptococci

Carditis with cardiac enlargement does not require bed rest

Recommended dose of Aspirin is 100 mg/kg/day

While tapering steroids salicylate is to be added Which of the above are correct









72. A 35 years old female presents with repeated episodes of ventricular tachycardia. Gives history of flu like illness one week ago. ECG shows left burtdle branch block with diffuse. ST-T changes. Echocardiogram shows mild LV dilatation with severe LV dysfunction. The likely diagnosis is:

Restrictive cardiomyopathy

Myocarditis

Dilated cardiomyopathy

All of the above

73. Which of the following regarding clinical aspect of rheumatic fever is correct?

Rheumatic fever produces only pericarditis

Mitral stenosis can occur in acute stage

Aschoff bodies are characteristic of acute carditis

Mac Callum's patch occurs in left atrium

74. A 40 years male presented with slowly progressive exertional breathlessness and ankle edema of 2 months duration. Neck veins are distended. Echocardiogram showed normal sized LV with EF of 60% with dilated of both atria. Mild mitral and tricuspid regurgitation. The likely diagnosis is

Dilated cardiomyopathy

Restrictive cardiomyopathy

Hypertrophic cardiomyopathy

Mycarditis

75. Which of the following is incorrect regarding systolic murmur of HOCM

Increase by valsalva manoeuver

Increase by amyl nitrate inhalation

Decrease on standing

Decrease on elevation of legs

76. A 50 years old female has easy fatiguability, significant weight loss and exertional dyspnoea of 4 months. On examination, she has small lump in her left breast, jugular venous pressure of 10 cm above sterna angle and no cardiac murmurs. Chest X-ray shows cardiomegaly with normal pulmonary parenchyma. Echocardiogram showed moderate pericardial effusion. The likely diagnosis is

Mesothelioma

Carcinoma of breast with metastasis

Carcinoma uterus with metastasis

Viral pericarditis

77. Which of the following regarding treatment of I10CM is wrong?

DDD pacing is indicated when there is severe bradycardia due to beta-blockers

In septal ablation, alcohol is percutaneously injected into first septal branch of LAD

Pacemaker implantation is routinely done after septal ablation

Septal myectomy is done by trans aortic approach

78. Which of the following is incorrect regarding rheumatic valvular heart disease?

Involvement of pulmonary valve is unusual

Commissural fusion and subvalvular apparatus involvement is common

Valvular regurgitation is uncommon in acute phase

Stenotic complications occur in 10 years in Indians

79. Which of the following statements about inves.tigations in acute rheumatic fever is incorrect?

Both ESR and CRP are elevated

ESR is more useful in follow up

ASO is elevated in chorea

PR prolongation is a feature of carditis

80. The following are poor prognostic indications of HOCM except:

Family history of sudden death

LV outflow gradient of 30 mm at rest

BP fall with exercise

Supraventricular tachycardia on Holter

81. Rheumatic arthritis:

Is typically fleeting in character

Dose not involve cervical spine

Usually does not extend beyond 6 weeks

Affects small joints of hands vVhich of the above statements are correct?









82. Which of the following regarding pathophysiology of infective endocarditis is incorrect?

Vegetations occurs at the site of jet impact on the endometrium

Embolic complications are unusual

Immunological complications are common

Treatment with antibiotics reduces the incidences of embolism

83. Which of the following is incorrect regarding Sydenham/s chorea?

Occurs many weeks after streptococcal sorethroat

Manifest as quasipurposive involuntary movements

Involves face and extremities

Elevated serum ASO titer is diagnostic

84. Which of the following regarding Rheumatic Carditis is incorrect?

Is always pancarditis

Established valvular heart disease develop in 2/3 of case

Aortic regurgitation is more common than mitral reb'11rgitation

Apical mid diastolic murmur can occur in acute phase MCC-004 15 P.T.O.

85. Which of the following about Pericardial rub is not correct?

Is a phasic scratching sound

Increase on inspiration

Always has three components

Best audible in lower left parasternal region

86. The following indicate functional MR except:

Mitral regurgitation jet is eccentric

Global or regional LV dysfunction is present

Apical displacement of AML with tenting

Mitral leaflets are not thickened

87. Which of the following about cardiac temponade is incorrect?

Will result if 200 ml of pericardial fluid accumulates rapidly

Increased JVP with prominent "Y" descent

Pulses paradoxsus is characteristic

Echocardiography shows early diastolic RV collapse

88. Which of the following statements regarding Echo features of cardiac temponade is incorrect?

Less than 50% inspiratory collapse of dilated inferior vena cava

Increase by more than 25% of mitral E velocity during inspiration

Increase by more than 25% of tricuspid E velocity during inspiration

Right ventricular diastolic collapse

89. Nhich of the following facts about pericardium is wrong?

Receives arterial supply from internal mammary artery

Phrenic nerve supplies visceral pericardium

Visceral pericardium drains to trachea bronchial

Prevents acute cavitary dilatation

90. Which of the following is not true regarding Rheumatic Fever?

Immunological mediated connective tissue disorder following infection of throat by Group A Streptococci

It licks the heart and bites the joint in younger individuals

Maximum incidences is in the age group of 5-15 years

There is resurgence of rheumatic fever due to increased virulence of streptococci.