cardiovasc+ pneumo

Question 1

if considering early change to oral antibiotic therapy for tx of stable IE, what should be done ?

Answer 1

baseline TEE before switching to Oral and repeat TEE 1-3 days before completing antibiotic regimen should be performed

Question 2

major microbio criteria ( >1 ) for IE

Answer 2

• ≥2 BCx with typical organisms:
• S. aureus/lugdunensis, Streptococci (except GAS or pneumo), E. faecalis, HACEK, Granulicatella, Abiotrophia, Gemella in Native Valve
• ≥3 BCx with occasional/rare organisms
• Blood PCR for Coxiella, Bartonella, T. whipplei
• Coxiella burnetii in 1 BCx or IgG > 1:800
• Bartonella henselae or quintana IgG > 1:800

Question 3

majhor imaging criteria for IE

Answer 3

Echo or Cardiac CT: vegetation, valve/leaflet perforation or aneurysm, abscess, pseudoaneurysm, fistula, prosthetic valve dehiscence or New significant valvular regurgitation
- PET: Abnormal activity of valve, aortic graft, or intracardiac leads

Question 4

major surgical criteria for IE

Answer 4

C) Surgical Criteria
- Evidence of IE by direct inspection during surgery

Question 5

minor predispo for IE

Answer 5

Predisposition: Prior IE, Prosthetic Valve, Prior Valve Repair, Congenital heart disease, Regurgitation/Stenosis, Pacemaker/ICD, HOCM, PWID

Question 6

minor vasc phenomena

Answer 6

Arterial emboli, septic pulmonary infarcts, cerebral or splenic abscess, mycotic aneurysm, ICH, conjunctival hemorrhage, Janeway lesion, purulent purpura

Question 7

immunological phenomena IE

Answer 7

Rheumatoid Factor, Osler Nodes, Roth Spots, immune-complex GN

Question 8

micro evidence but minor IE

Answer 8

Cx for organism consistent with IE not meeting major criteria, BCx/PCR with organism consistent with IE from sterile body site, PCR for skin bacteria on valve/wire

Question 9

imaging criteria minor IE

Answer 9

Abnormal activity on PET within 3m of implant of prosthetic valve, aortic graft, intracardiac leads, prosthetic material

Question 10

IE MSSA tx :
native vs prosthetic

Answer 10

clox/cefazoln
prost : clox/cefazolin + rifampin + genta

Question 11

IE MRSA ( or CNST) tx :
native vs prosthetic

Answer 11

vanco
prost : vanco +gent + rifampn

Question 12

IE viridans, strep galloliticus/bovis tx :
native vs prosthetic

Answer 12

pen G / CTX ( both)

Question 13

IE e faecalim tx :
native vs prosthetic

Answer 13

amp+genta
amp + ctx

Question 14

IF e facieux tx
native vs prosthetic

Answer 14

vanco + genta

Question 15

IE HACEK tx :
native vs prosthetic

Answer 15

ceftriaxone

Question 16

class 1 surgical indicatiobn ( early indications)

Answer 16

Valve dysfunction with signs or symptoms of heart failure (persistent despite OMM)

Left-sided IE caused by S. aureus, fungi or highly resistant organisms

Heart block, annular/aortic root abscess, destructive penetrating lesions

Persistent bacteremia or fever > 5d after starting appropriate antibiotics

Complete removal of implantable electronic cardiac device (PPM/CRT/ICD) systems in patients with definite endocarditis

Question 17

how long should you delay IE surgery after a major ishcemic or hmrg stroke ?

Answer 17

4 weeks

Question 18

procedures requiring IE prophylaxis >?

Answer 18

1. dental
2. resp
3. skin

Question 19

patient populationb requiring ppx IE

Answer 19

previous IE
prosthetic valvce
cong heart disease
cardiac transplant

Question 20

post influenza pneumonia, which organism is the culprit ?

Answer 20

staph aureus/mrsa

Question 21

if no comorbidities, which antibiotics ?

Answer 21

amoxicillin 1g TID&raquo_space; doxycycline&raquo_space; azithro

Question 22

which antibiotics in healthy ouptaitnet is not appropriat efor majority of canada ?

Answer 22

Azithro

Question 23

outpatient comorbidities CAP options

Answer 23

amoxclav + macrolide>/doxy
or FQ

Question 24

legionella has ++ resistance to which antibiotics when doing a inpatient treatment without risk factors for mrsa/PSA

Answer 24

doxycyline > macrolide or fq

Question 25

aspiration pneumonia, what do you avoid adding

Answer 25

anaerobic coverage unless think has abscess or empyema

Question 26

pathogens part of your HAP/VAP ?

Answer 26

core pathogens like s pneumoniae, mssa, h influenza, GNB ( pseudomonas, stenotrephomonas)

Question 27

which tx could be used in pseudomonas and MSSA but is unreliable ?

Answer 27

levofloxacin

Question 28

HAP/VAP duration ?

Answer 28

7 days

Question 29

therapes in covid in mild illness is helpful in which sense ?

Answer 29

reduce risk of hospitalisation

Question 30

if severe covid, and on IMV/ECMO- what would you add ?

Answer 30

immunomodulator
- tocilizumab
- baricitinib
- sarilkumab