**Question:** All the following are major criteria for diagnosis of rheumatic fever (RF) except

A. Mitral stenosis
B. Sydenham chorea
C. Extra-cardiac manifestations
D. Arthritis

**Correct Answer:** .

**Core Concept:**
Rheumatic fever is a post-infectious complication of group A Streptococcal pharyngitis (strep throat). It is a serious condition that affects the heart, joints, skin, brain, and kidneys. The diagnosis of rheumatic fever is based on the presence of specific major and minor criteria. Major criteria include arthritis, carditis, scleritis, and chorea.

**Why the Correct Answer is Right:**
Option D, "Arthritis," is correctly mentioned as a major criterion for the diagnosis of rheumatic fever. Arthritis is a common manifestation of RF, primarily affecting large joints, often symmetrically. The carditis, scleritis, and chorea are also major criteria.

**Why Each Wrong Option is Incorrect:**
Option A, "Mitral stenosis," is a cardiac manifestation of RF but is not considered as a major criterion for diagnosis. Major criteria include carditis, which refers to inflammation of the heart valves, specifically involving the mitral valve in the case of mitral stenosis.

Option B, "Sydenham chorea," is a neurological manifestation of RF and is considered a major criterion for diagnosis. Sydenham chorea is a sudden onset, involuntary, and hyperkinetic movement disorder, which is typically seen in RF.

Option C, "Extra-cardiac manifestations," refers to various clinical presentations of RF that occur outside the heart, joints, and brain. While these manifestations are important to consider in the clinical evaluation of a patient with suspected RF, they are not specific criteria for diagnosis.

**Clinical Pearl:**
In the clinical evaluation of a patient with suspected RF, it is essential to consider the carditis, chorea, and joint manifestations as major criteria for diagnosis. While extra-cardiac manifestations are important, they are not specific criteria. The presence of these manifestations alone does not confirm the diagnosis of rheumatic fever.

**Correct Answer:** D (Arthritis)