Which of the following is not included in essential jones criteria?
**Core Concept**
The Jones criteria are a set of guidelines used to diagnose acute rheumatic fever (ARF), a complication of untreated or undertreated group A beta-hemolytic streptococcal (GABHS) pharyngitis. The essential criteria are a combination of clinical and laboratory findings that support the diagnosis of ARF.
**Why the Correct Answer is Right**
The essential Jones criteria include major and minor criteria. The major criteria are carditis, polyarthritis, chorea, erythema marginatum, and subcutaneous nodules. The minor criteria are clinical (fever, arthralgia, and previous GABHS infection) and laboratory findings (elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), and prolonged PR interval on electrocardiogram (ECG)). The correct answer is not included in the essential criteria, which would be a finding not associated with ARF.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is not typically included in the essential Jones criteria, as it is not a recognized symptom or finding associated with ARF.
**Option B:** This option is a major criterion for ARF and is included in the essential Jones criteria.
**Option C:** This option is a minor criterion for ARF and is included in the essential Jones criteria.
**Option D:** This option is a major criterion for ARF and is included in the essential Jones criteria.
**Clinical Pearl / High-Yield Fact**
To diagnose ARF, clinicians must carefully evaluate the patient's history, physical examination, and laboratory findings to determine the presence of major and minor criteria. A diagnosis of ARF requires the presence of at least two major criteria, or one major and two minor criteria.
**Correct Answer: A.**