This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Medicine
All of the following can occur in rheumatic fever except: September 2007, 2010 
Select and explain. 
A. Mitral regurgitation, B. Mitral stenosis, C. Pericarditis, D. Loud first hea sound
D: Loud first hea sound
Answer: D: Loud first hea sound 
Explanation: Ans. D: Loud first hea sound The mitral valve is almost always affected, sometimes together with the aoic valve; isolated aoic valve involvement is rare. Early valvular damage leads to regurgitation. Over ensuing years, usually as a result of recurrent episodes,leaflet thickening, scarring, calcification, and valvular stenosis may develop. Pericarditis may develop and commonly causes a friction rub. Myocardial inflammation leads to softening of first hea sound.