23 - 155 - THE SKIN IN INFECTIVE ENDOCARDITIS, SEPSIS, SEPTIC SHOCK AND DIC

Question 1

most common cause of right-sided infective endocarditis

Answer 1

intravenous drug use

Question 2

defined as inflammation of the endocardial lining of the heart (naïve or prosthetic heart valves, mural endocardium) and implanted material caused by infection from bacteria or fungus

Answer 2

Infective endocarditis (IE)

Question 3

most common clinical presentations of IE

Answer 3

include fever and a new cardiac murmur

Question 4

painless, irregular, nonblanchable, erythematous maculopapules that appear on the palms and soles and last days to weeks

Answer 4

Janeway lesions

Question 5

clinically definite case of infective endocarditis is defined as fulfilling how any criteria

Answer 5

2 major,
1 major plus 3 minor, or
5 minor criteria

Question 6

A clinically suspicious case of infective endocarditis is defined as fulfilling how many criteria

Answer 6

1 major and 1 minor,
or 3 minor criteria

Question 7

painful red papulonodules with a pale center on the fingertips lasting days to weeks

Answer 7

Osler nodes

Question 8

Histology of janeway lesions

Answer 8

thrombi are found in small vessels in the absence of vasculitis.

Neutrophilic microabscesses can be seen in the dermis with occasional Grampositive organisms

Question 9

Histopath of osler nodes

Answer 9

neutrophilic microabscesses are present in the dermis, and arteriolar microemboli may contain Gram-positive cocci.

Question 10

Most commonly involved area in septic emboli

Answer 10

Toes

followed by fingers, and this condition presents as reticulated purpura or purple digit similar to that seen in cholesterol emboli syndrome

Question 11

Major Criteria in Modified Duke Criteria for Infective Endocarditis

Answer 11

Question 12

Minor Criteria in the Modified Duke Criteria for Infective Endocarditis

Answer 12

Question 13

causative organisms in 80% of IE cases

Answer 13

staphylococci, streptococci (coagulase negative and viridans group) or enterococci

Question 14

most common cause of IE in high-income countries

Answer 14

Staphylococcus aureus for both naïve and prosthetic valves

Question 15

More than half of the cases of IE in injection drug users involve what side of the heart?

Answer 15

Right, involving the tricuspid valve

Question 16

Early prosthetic valve (1st 2 months following valve replacement) endocarditis is most commonly caused by

Answer 16

S. aureus

Question 17

Vegetations larger than ________ are associated with a greater embolic risk

Answer 17

10 mm

Question 18

Poor prognostic indicators of IE

Answer 18

left-sided IE,
vegetation size (>10 mm),
prosthetic valves,
older age,
diabetes,
immunosuppression,
heart failure,
renal failure,
septic shock,
brain hemorrhage,
and infections from methicillin-resistant S. aureus, fungi, or polymicrobial infections.

Question 19

5-year mortality rate of IE

Answer 19

~ 40%

Question 20

major determinant of short-term prognosis of IE

Answer 20

Neurologic failure

Question 21

Most common cause of death in IE

Answer 21

Cerebral embolic disease and congestive heart failure

Question 22

Settings that require surgery in IE

Answer 22

Failure of parenteral antibiotic therapy,
perivulvar abscess,
valvular destruction/dysfunction with heart failure,
persistent fever, and
ischemic neurologic complications

Question 23

defined as life-threatening organ dysfunction that results from a dysregulated host response to infection

Answer 23

Sepsis

Question 24

Septic shock is a subset of sepsis in which vasopressor therapy is required to maintain a mean arterial pressure of _________ and having a serum lactate level greater than __________ persisting after fluid resuscitation

Answer 24

MAP: 65 mm Hg or greater

Lactate: greater than 2 mmol/L

Question 25

Erythroderma in the septic patient suggests

Answer 25

staphylococcal or streptococcal toxic shock syndrome (TSS)

Question 26

finding of pustules on the skin of a septic patient, particularly in the neonate or immunocompromised individual, may be suggestive of

Answer 26

fungal infection, particularly with Candida species

Question 27

most common causes of cellulitis

Answer 27

S. aureus and group A Streptococcus

Question 28

differentiation of sepsis from infection is the presence of

Answer 28

organ dysfunction

Question 29

acquired reactive syndrome of consumptive hypercoagulation, insufficient anticoagulation, hemorrhage, systemic vascular inflammation, and endothelial dysfunction

Answer 29

Disseminated intravascular coagulopathy

Question 30

Settings in Which Disseminated Intravascular Coagulation Can Occur

Answer 30

Question 31

The onset of DIC in the neonatal period is suggestive of

Answer 31

protein C or protein S deficiency.

Question 32

most characteristic cutaneous finding in DIC

Answer 32

diffuse noninflammatory retiform purpura from extensive microvascular occlusion, which is referred to as purpura fulminans

Question 33

independent predictor for organ failure and mortality

Answer 33

DIC