Great Guys, here is the explanation:
The correct answer is B. Acute rheumatic fever is a multisystem inflammatory disease that can follow group A streptococcal pharyngitis. The heart is a primary target of this disease and may be damaged sufficiently to develop permanent sequelae. The most important of these sequelae is chronic rheumatic heart disease with valvular damage. The damage most often involves the mitral and/or aortic valves.
The resulting thickened, blunted cardiac valve leaflets, often with fibrous bridging between valve leaflets and calcification, frequently take on a "fish mouth" or "button hole" stenotic morphology.
- choice A = ballooning of valve leaflets is seen in mitral valve prolapse.
- choice C = irregular, beadlike calcifications on the annulus is seen in calcification of the mitral annulus, seen in elderly individuals.
- choice D =large vegetations and leaflet perforation is seen in acute bacterial endocarditis, which usually involves healthy, rather than previously damaged, valves.
- choice E = Tiny vegetations along line of closure of valve leaflet is seen in marantic (nonbacterial thrombotic) endocarditis, most typically seen at autopsy of patients who die after protracted illness.