4.12 Rheumatic Fever, Poststreptococcal Disease, Enteric & Hepatic Infections

ABIM Internal Medicine Exam

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1 Chapter 0: The ABIM Exam, Blueprint & Study Strategy

0.1 Exam Format, Question Types & the 2026 Blueprint 0.2 Eligibility, Registration, Fees & Exam-Day Logistics 0.3 Scoring, the Passing Standard & Score Reports 0.4 Building a Blueprint-Weighted Study Plan

2 Chapter 1: Cardiovascular Disease (14% of Exam)

1.1 Ischemic Heart Disease & Acute Coronary Syndromes 1.2 Antithrombotic Therapy, Secondary Prevention & Mechanical Complications of MI 1.3 Atrial Fibrillation, Atrial Flutter & Stroke Prevention 1.4 Supraventricular Tachycardias, Ventricular Arrhythmias & Bradycardias 1.5 Heart Failure: Classification, Staging & Guideline-Directed Medical Therapy 1.6 Device Therapy, HFpEF & the Cardiomyopathies 1.7 Valvular Heart Disease & Endocarditis Prophylaxis 1.8 Pericardial Disease & Acute Aortic Syndromes 1.9 Hypertension: Classification, Diagnosis & Secondary Causes 1.10 Hypertensive Crises & Dyslipidemia 1.11 Adult Congenital Heart Disease & Coarctation of the Aorta 1.12 Syncope: Reflex, Orthostatic & Cardiac Causes 1.13 Cardiac Physical Examination, Murmurs & Antithrombotic Selection

3 Chapter 2: Endocrinology, Diabetes & Metabolism (9% of Exam)

2.1 Diabetes Mellitus: Diagnosis, Glycemic Targets & Pharmacotherapy 2.2 Insulin Therapy, Hyperglycemic Emergencies & Chronic Complications 2.3 Thyroid Function Testing & Hypothyroidism 2.4 Thyrotoxicosis, Thyroid Storm & Thyroid Nodules 2.5 Adrenal & Pituitary Disorders 2.6 Hypercalcemia, Hypocalcemia & Disorders of Mineral Metabolism 2.7 Osteoporosis & Paget Disease of Bone 2.8 Ovarian, Testicular & Reproductive Endocrine Disorders 2.9 Hypoglycemia, Endocrine Tumors, Polyglandular Syndromes & Severe Hypertriglyceridemia

4 Chapter 3: Gastroenterology & Hepatology (9% of Exam)

3.1 Esophageal Disease 3.2 Stomach & Duodenal Disease and Gastrointestinal Hemorrhage 3.3 Inflammatory Bowel Disease 3.4 Celiac Disease & Irritable Bowel Syndrome 3.5 Diverticular Disease & Colorectal Cancer Screening 3.6 Viral Hepatitis, Steatotic & Alcohol-Associated Liver Disease 3.7 Cirrhosis & the Complications of Portal Hypertension 3.8 Acute Pancreatitis 3.9 Chronic Pancreatitis & Biliary Tract Disease 3.10 Inherited, Autoimmune & Drug-Induced Liver Disease 3.11 Small Intestinal Disease, Ischemia & Gastrointestinal Complications of HIV

5 Chapter 4: Infectious Disease (9% of Exam)

4.1 Lower Respiratory Tract Infections & Sepsis Syndromes 4.2 Viral Respiratory Pathogens & Tuberculosis 4.3 Central Nervous System Infections 4.4 Skin, Soft Tissue, Bone & Joint Infections 4.5 Infective Endocarditis & Cardiovascular Infection 4.6 Clostridioides difficile & Catheter-Related Bloodstream Infection 4.7 HIV Diagnosis, Antiretroviral Therapy & Prevention 4.8 Opportunistic Infections & Sexually Transmitted Infections 4.9 Fever of Unknown Origin, Neutropenic Fever & Toxic Shock 4.10 Travel-Related Illness, Vector-Borne Disease & Outbreaks 4.11 Infection Prevention, Nosocomial Infection & Postexposure Prophylaxis 4.12 Rheumatic Fever, Poststreptococcal Disease, Enteric & Hepatic Infections

6 Chapter 5: Pulmonary Disease (9% of Exam)

5.1 COPD: Diagnosis, GOLD Classification & Initial Pharmacotherapy 5.2 Interventions That Reduce COPD Mortality & Exacerbation Management 5.3 Asthma: Diagnosis, Stepwise Therapy & Status Asthmaticus 5.4 Interstitial Lung Disease & Idiopathic Pulmonary Fibrosis 5.5 Sarcoidosis, Hypersensitivity Pneumonitis & Occupational Lung Disease 5.6 Pulmonary Embolism: Diagnosis, Risk Stratification & Anticoagulation 5.7 Pulmonary Hypertension & Sleep-Disordered Breathing 5.8 Acute Respiratory Distress Syndrome & Mechanical Ventilation 5.9 Pleural Disease, Empyema & Pneumothorax 5.10 Bronchiectasis, Cystic Fibrosis & Restrictive Lung Disease 5.11 Evaluation of Cough, Dyspnea, Hemoptysis & the Solitary Pulmonary Nodule

7 Chapter 6: Rheumatology & Orthopedics (9% of Exam)

6.1 Rheumatoid Arthritis: Diagnosis & Systemic Manifestations 6.2 Antirheumatic Pharmacotherapy & the Spondyloarthropathies 6.3 Gout: Pathophysiology & Acute Management 6.4 Urate-Lowering Therapy & Calcium Pyrophosphate Deposition Disease 6.5 Osteoarthritis 6.6 Systemic Lupus Erythematosus 6.7 Systemic Sclerosis, Sjogren Syndrome & Inflammatory Myopathies 6.8 The Vasculitides 6.9 Regional Musculoskeletal Syndromes, Back Pain & Sports Injuries 6.10 Other Primary Rheumatic Disorders & Mixed Connective Tissue Disease 6.11 Osteonecrosis & Metabolic Bone Disease

8 Chapter 7: Hematology (6% of Exam)

7.1 Approach to Anemia & the Microcytic Anemias 7.2 Macrocytic, Normocytic & Hemolytic Anemias 7.3 Hemoglobinopathies, Thalassemias & Paroxysmal Nocturnal Hemoglobinuria 7.4 Platelet Disorders, Thrombocytopenia & the Bleeding Patient 7.5 Coagulation Factor Disorders, Thrombophilia & Anticoagulant Reversal 7.6 Acute Leukemias, Chronic Leukemias & Myeloproliferative Neoplasms 7.7 Lymphomas & Plasma Cell Disorders 7.8 Myelodysplastic Syndrome, Myeloproliferative Neoplasms & Porphyria 7.9 Transfusion Medicine & Late Complications of Transplantation

9 Chapter 8: Medical Oncology (6% of Exam)

8.1 Breast, Lung, Colorectal & Prostate Cancer 8.2 Oncologic Emergencies 8.3 Genitourinary & Gynecologic Malignancies 8.4 Head and Neck, Bone & Soft Tissue Cancer and Cancer of Unknown Primary 8.5 Complications of Cancer & Its Treatment 8.6 Cancer Prevention, Survivorship & Psychosocial Care

10 Chapter 9: Nephrology & Urology (6% of Exam)

9.1 Acute Kidney Injury: Staging, Etiology & Urine Microscopy 9.2 Glomerular Disorders & Nephrotic Syndrome 9.3 Nephritic Syndromes, RPGN & Indications for Renal Replacement Therapy 9.4 Chronic Kidney Disease: Staging & Progression Retardation 9.5 Complications of Chronic Kidney Disease: Anemia, CKD-MBD & Acidosis 9.6 Hyponatremia, Hypernatremia & Water Balance 9.7 Potassium Disorders & Systematic Acid-Base Analysis 9.8 Renal Tubular Acidosis & Nephrolithiasis 9.9 Prostate Disorders, Urinary Incontinence & Other Urologic Conditions 9.10 Cystic Kidney Disease, Obstructive Uropathy, Tubulointerstitial Disease & Hematuria

11 Chapter 10: Neurology (4% of Exam)

10.1 Acute Ischemic Stroke: Syndromes & Reperfusion 10.2 Transient Ischemic Attack, Secondary Prevention & Hemorrhagic Stroke 10.3 Headache & Facial Pain 10.4 Seizures, Epilepsy & Movement Disorders 10.5 Multiple Sclerosis & Neuromuscular Junction Disorders 10.6 Motor Neuron Disease & Acute Peripheral Neuropathy 10.7 Cranial Neuropathies & Neuro-Ophthalmology 10.8 Peripheral Neuropathies, CNS Tumors & Other Neurologic Disorders

12 Chapter 11: Psychiatry & Behavioral Health (4% of Exam)

11.1 Major Depressive Disorder & Medical Mimics 11.2 Antidepressant Pharmacotherapy & Treatment-Resistant Depression 11.3 Bipolar Disorder, Mood Stabilizers & Lithium Toxicity 11.4 Anxiety, Stress-Related & Obsessive-Compulsive Disorders 11.5 Alcohol Use Disorder & Withdrawal 11.6 Pharmacotherapy for Alcohol & Opioid Use Disorder 11.7 Toxidromes, Psychiatric Emergencies & Suicide Risk Assessment 11.8 Psychotic, Somatic Symptom, Factitious & Personality Disorders 11.9 Eating Disorders, Sleep Disorders & Sexual Health

13 Chapter 12: Dermatology (3% of Exam)

12.1 Dermatitis, Papulosquamous & Inflammatory Dermatoses 12.2 Acne, Rosacea & Cutaneous Infections 12.3 Herpes Zoster & Autoimmune Blistering Diseases 12.4 Nodules, Tumors & Cutaneous Oncology 12.5 Dermatologic Emergencies & Severe Cutaneous Adverse Reactions 12.6 Pigment Disorders, Alopecia, Nail Disease & Photosensitivity 12.7 Vascular Dermatoses, Environmental Injury & Cutaneous Signs of Systemic Disease

14 Chapter 13: Obstetrics & Gynecology / Women's Health (3% of Exam)

13.1 Contraception, Preconception Care & Teratogenicity 13.2 Hypertensive Disorders of Pregnancy & Gestational Diabetes 13.3 Thyroid Disease & Venous Thromboembolism in Pregnancy 13.4 Menopause & Menopausal Hormone Therapy 13.5 Abnormal Uterine Bleeding, Endometrial Disease & Gynecologic Cancer Screening 13.6 Breast Disorders & Diseases of the Vulva and Vagina 13.7 Menstrual Disorders, Fibroids, Endometriosis & Early Pregnancy Complications

15 Chapter 14: Geriatric Syndromes (3% of Exam)

14.1 Comprehensive Geriatric Assessment & Frailty 14.2 Falls, Gait Assessment & Polypharmacy 14.3 Urinary Incontinence & Pressure Injuries in Older Adults 14.4 Mild Cognitive Impairment, Dementia & Its Subtypes 14.5 Delirium & the Pharmacotherapy of Cognitive Disorders 14.6 Palliative Care, Hospice & Advance Care Planning 14.7 Chronic Wounds, Nutrition, Swallowing, Constipation & Hip Fracture 14.8 Sensory Impairment, Dizziness, Elder Mistreatment & Care Settings

16 Chapter 15: Allergy & Immunology (2% of Exam)

15.1 Anaphylaxis: Recognition & Emergency Management 15.2 Urticaria & Angioedema 15.3 Drug Allergy, Desensitization & Adult Immunodeficiency 15.4 Food Allergy, Insect Venom Hypersensitivity, Serum Sickness & Contrast Reactions 15.5 Rhinitis, Conjunctivitis, Eosinophilic & Mast Cell Disorders

17 Chapter 16: Preventive Medicine, Immunization & Clinical Epidemiology

16.1 The USPSTF Framework & Evidence-Based Cancer Screening 16.2 Cardiovascular & Metabolic Screening and Primary Prevention 16.3 Adult Immunization & Vaccines in Special Populations 16.4 Clinical Epidemiology, Biostatistics & Study Design

18 Chapter 17: Miscellaneous - Ethics, Patient Safety & Quality Improvement (2% of Exam)

17.1 Principles of Bioethics & Decisional Capacity 17.2 Informed Consent, Treatment Refusal & Special Scenarios 17.3 Surrogate Decision-Making, Advance Directives & Confidentiality 17.4 Patient Safety Science, Medical Error & Diagnostic Reasoning 17.5 Quality Improvement Methods, Health Disparities & Health Equity

19 Chapter 18: Perioperative Medicine & Medical Consultation

18.1 Preoperative Cardiovascular Risk Assessment 18.2 Preoperative Pulmonary Risk & Perioperative Medication Management 18.3 Perioperative Anticoagulation, Bridging & Postoperative Complications

20 Chapter 19: Ophthalmology (1% of Exam)

19.1 The Acute Red Eye & Ophthalmic Emergencies 19.2 Painless Vision Loss & Chronic Ophthalmic Disease 19.3 Uveitis, Scleritis & Orbital Disease

21 Chapter 20: Otolaryngology & Dental Medicine (1% of Exam)

20.1 Dizziness, Vertigo & Epistaxis 20.2 Ear Disorders, Hearing Loss & Upper Respiratory Infections 20.3 Oral Cavity, Salivary Gland, Laryngeal & Taste and Smell Disorders

4.12 Rheumatic Fever, Poststreptococcal Disease, Enteric & Hepatic Infections

Key Takeaways Explain This Topic AI

Rheumatic fever and poststreptococcal glomerulonephritis are individually enumerated blueprint subsections under Infectious Disease.

Acute rheumatic fever follows pharyngeal streptococcal infection, whereas poststreptococcal glomerulonephritis can follow either pharyngeal or skin infection.

Treating streptococcal pharyngitis prevents rheumatic fever but does not prevent poststreptococcal glomerulonephritis.

Enteric infections in the blueprint include bacterial peritonitis and intra-abdominal abscess in addition to gastroenteritis and infectious esophagitis.

Amebic liver abscess is treated medically with metronidazole followed by a luminal agent, whereas most pyogenic liver abscesses require drainage.

Last updated: August 2026

1. Acute Rheumatic Fever

An immune-mediated sequela of group A streptococcal pharyngitis — not of skin infection — appearing two to four weeks after the sore throat, driven by molecular mimicry between streptococcal M protein and host tissue.

Jones criteria require evidence of preceding streptococcal infection plus two major criteria , or one major and two minor .

Major criteria (mnemonic JONES):

• Criterion Detail
• J — Joints Migratory polyarthritis of large joints; the most common major manifestation
• O — Carditis Pancarditis; mitral valve most often affected ; new murmur
• N — Nodules Subcutaneous nodules over extensor surfaces
• E — Erythema marginatum Serpiginous, non-pruritic trunk rash with central clearing
• S — Sydenham chorea Involuntary movements, emotional lability; may appear months later

Minor criteria: fever, arthralgia, elevated erythrocyte sedimentation rate or C-reactive protein, prolonged PR interval.

Evidence of preceding infection — elevated or rising antistreptolysin O or anti-DNase B titer, positive throat culture, or positive rapid antigen test — is required. The throat culture is often negative by the time rheumatic fever appears, so serology carries the diagnosis .

Management:

Anti-inflammatory therapy — high-dose aspirin or NSAIDs for arthritis; corticosteroids for severe carditis.

Penicillin to eradicate residual organisms, even if the culture is negative.

Secondary prophylaxis with long-acting intramuscular penicillin G benzathine — this is the highest-yield management point. Duration depends on whether carditis occurred and whether residual valve disease persists, extending for years and sometimes for life.

The long-term consequence is rheumatic mitral stenosis , appearing decades later.

2. Poststreptococcal Glomerulonephritis

A separate blueprint subsection, and the contrasts with rheumatic fever are exactly what the exam tests.

• Acute rheumatic fever Poststreptococcal glomerulonephritis
• Preceding infection Pharyngitis only Pharyngitis or skin (impetigo)
• Latency 2 to 4 weeks 1 to 3 weeks after pharyngitis; 3 to 6 weeks after skin infection
• Complement Normal Low C3
• Prevented by treating the infection? Yes No
• Recurrence Yes, hence prophylaxis Rare
• Prognosis Chronic valve disease Usually complete recovery in adults and children

Presentation is a nephritic syndrome: hematuria with dysmorphic red cells and red cell casts, sub-nephrotic proteinuria, edema, hypertension and a rise in creatinine.

Low C3 with a normal C4 is the classic serologic signature, and C3 normalizes within 6 to 8 weeks — persistent hypocomplementemia beyond that window should prompt reconsideration of membranoproliferative glomerulonephritis or C3 glomerulopathy. Management is supportive: salt restriction, diuretics and blood pressure control.

The key teaching point — antibiotic treatment of the antecedent streptococcal infection prevents rheumatic fever but does not prevent glomerulonephritis. This is frequently tested as a direct contrast.

3. Enteric Infections

The blueprint lists enteric infections with subtopics: infectious esophagitis, gastroenteritis, pancreatic infection and abscess, bacterial peritonitis , and intra-abdominal abscess other than liver or pancreas .

Spontaneous bacterial peritonitis

Infection of pre-existing ascites without a surgically treatable intra-abdominal source.

Diagnosis: ascitic polymorphonuclear count of 250 cells per microliter or more. Treat on this basis; do not wait for culture, which is negative in a substantial minority.

Usually monomicrobial , typically Escherichia coli , Klebsiella or Streptococcus pneumoniae .

Treatment: third-generation cephalosporin, plus intravenous albumin on days 1 and 3 in those with renal dysfunction or high bilirubin — albumin reduces hepatorenal syndrome and mortality.

Secondary prophylaxis after an episode, and primary prophylaxis in low-ascitic-protein or variceal-bleeding patients.

Secondary bacterial peritonitis

Caused by a perforated viscus and requiring surgery , not antibiotics alone. Distinguish it from spontaneous peritonitis using Runyon criteria on the ascitic fluid: polymicrobial culture, total protein above 1 g/dL, glucose below 50 mg/dL, and lactate dehydrogenase above the serum upper limit. Missing this distinction and managing a perforation medically is a classic exam trap.

Intra-abdominal abscess

Suspect it in persistent fever with leukocytosis after abdominal surgery, diverticulitis, appendicitis or perforation. Source control is the treatment — percutaneous or surgical drainage — with antibiotics as an adjunct. Antibiotics alone rarely sterilize an undrained collection.

4. Hepatic Infections

A named blueprint subsection listing viral hepatitis, liver abscess , cholecystitis and cholangitis.

Pyogenic versus amebic liver abscess

Pyogenic Amebic

Source Biliary tract, portal seeding, hematogenous Entamoeba histolytica , travel to or residence in an endemic area

• Number Often multiple Usually solitary, right lobe
• Demographics Older, biliary disease, diabetes Younger, often male, travel history
• Aspirate Purulent Anchovy paste , usually sterile
• Serology — Positive amebic serology

Treatment Drainage plus antibiotics Metronidazole, then a luminal agent (paromomycin) to eradicate colonization

The management contrast is the exam point: amebic abscess responds to medical therapy alone and does not routinely require drainage, whereas pyogenic abscess almost always requires drainage. Aspiration of an amebic abscess is reserved for large left-lobe lesions at risk of rupture into the pericardium, diagnostic uncertainty, or failure to respond.

Klebsiella pneumoniae invasive syndrome — a hypervirulent strain causing liver abscess with metastatic infection to the eye (endophthalmitis) and central nervous system — is particularly associated with diabetes and East Asian origin, and warrants a careful ophthalmologic examination.

Acute cholangitis

Charcot triad — fever, jaundice, right upper quadrant pain. Adding hypotension and mental status change gives Reynolds pentad , which indicates suppurative cholangitis. Treatment is antibiotics plus urgent biliary decompression by endoscopic retrograde cholangiopancreatography; antibiotics alone are inadequate when the duct is obstructed, because the infected bile is under pressure.