Question

All of the following statements about rheumatic fever/heart disease epidemiology in India are true except:

• A. Its prevalence varies between 2 to 11 per 1000 children aged 5-16 years
• B. Mitral regurgitation is the commonest cardiac lesion seen
• C. It occurs equally in females and males
• D. Rheumatic fever occurs in about 2% of streptococcal sore throats

Hint:

Prevalence, equal sex distribution, and the 2 percent post-streptococcal figure are standard facts; the valve lesion claim is the one that does not hold up as stated.

Answer 1

The Correct Option is B

Step 1: Understanding the Question.
This is an except type question, so three statements about rheumatic fever and rheumatic heart disease in India are correct facts and one is wrong, and we need to pick the wrong one.

Step 2: Key Concept or Approach.
Rheumatic fever epidemiology in India is a standard preventive and social medicine topic, covering how common the disease is, who it affects, which valve lesion shows up most, and how often it follows a streptococcal throat infection. Each option needs to be checked against these standard Indian epidemiological figures.

Step 3: Detailed Explanation.
School based surveys in India report a prevalence of rheumatic fever and rheumatic heart disease in the broad range of about 2 to 11 per 1000 children aged 5 to 16 years, depending on the state and the survey method, so option 1 is a true statement. Rheumatic fever itself is known to strike both sexes about equally, though established rheumatic heart disease is picked up somewhat more often in females in some surveys, so calling the acute disease equally distributed between males and females, as in option 3, is an accepted true statement. About 2 to 3 percent of untreated streptococcal sore throats go on to cause rheumatic fever, so option 4, about 2 percent, matches standard teaching and is a true statement. That leaves option 2, mitral regurgitation as the single commonest lesion overall. Mitral regurgitation is indeed the lesion most often found early, during the acute attack in children, because the mitral valve leaflets and chordae are damaged by fresh inflammation before they have time to thicken and scar. But when Indian community based surveys look at the overall burden of established rheumatic heart disease across all ages, mixed mitral valve disease and mitral stenosis, which develop as the valve scars down over repeated attacks and years, make up a large share of the total picture, so mitral regurgitation being labelled the commonest lesion overall is not the safe blanket statement it appears to be, which is why it is marked as the exception here.

Step 4: Final Answer.
The statement that does not hold as an accepted fact is that mitral regurgitation is the commonest cardiac lesion seen, so this is the exception among the four statements.