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

An except question wants the one false claim hiding among three true ones about rheumatic fever in India, so each statement needs to be tested on its own.

1. Prevalence 2 to 11 per 1000 children aged 5-16: Indian school survey data does report this wide range depending on the region studied, so this figure is accepted as true.
2. Mitral regurgitation is the commonest cardiac lesion seen: Mitral regurgitation is common in the fresh, acute phase in children, but across the whole population of established rheumatic heart disease, mitral stenosis and mixed mitral disease, which form as the valve scars with repeated attacks, account for a large part of the overall lesion pattern. So flatly calling mitral regurgitation the commonest lesion is not a safe, universal statement.
3. It occurs equally in females and males: Acute rheumatic fever is generally taught to affect boys and girls at roughly equal rates, so this statement stands as true.
4. Rheumatic fever occurs in about 2% of streptococcal sore throats: This matches the standard figure that only a small fraction, around 2 to 3 percent, of untreated streptococcal throat infections progress to rheumatic fever, so this is true.

Three of the four statements line up with accepted epidemiological teaching. The lesion pattern claim is the weak one, since it only holds for the acute phase and not for the disease as a whole, so it is picked as the exception.

Let's summarize:

• Prevalence range, equal sex split, and the 2 percent post-strep figure are standard accepted facts.
• The commonest lesion claim shifts with disease stage, acute versus established disease, so it is not a blanket truth.

So the exception, the statement that is not simply true, is that mitral regurgitation is the commonest cardiac lesion seen.