Chest Pain and Fever II

Question 1

fever of unknown origin

Answer 1

3 weeks or longer with 1 week of unknown workup

Question 2

fever

Answer 2

PGE2

its release stimulated by IL1, IL6, and TNFalpha

Question 3

causes of FUO

Answer 3

infection, cancer, autoimmune/CT disease

Question 4

duke criteria

Answer 4

for endocaritis

two major
or one major and 3 minor
or 5 minor

major - two positive blood cultures, echo evidence, new regurg murmur

minor - predisposing condition, fever, vascular emboli (janeway/osler/roth), immuno with agglutinating bodies

Question 5

common bug for endocarditis

Answer 5

bartonella hensalae or quintana

Tx - doxycycline and gentamicin

Question 6

acute endocarditis

Answer 6

virulent organisms

valvulr regurg, high fever, early emboli

Question 7

native valve endocarditis

Answer 7

brushing teeth, IV device

staph
or strep viridans
or HACEK

Question 8

IV drug users

Answer 8

staph to tricuspid valve

Question 9

early prostethic valve infection

Answer 9

within 2 months

-coagulase + and - staph

Question 10

late prosthetic valve infection

Answer 10

strep or staph

coag - and +

Question 11

Dx of endocarditis

Answer 11

3 cultures one hour apart

use dukes criteria
-2 positive cultures

Question 12

HACEK

Answer 12

takes a long time to culture

Question 13

negative culture in suspected endocarditis

Answer 13

could be HACEK group

-eikenella, kingella**

Question 14

complications of endocarditis

Answer 14

heart block
CHF
emboli
mycotic aneurysms
myocardial abscess

Question 15

prosthetic aortic valve infection

Answer 15

coxiella burnetii

if owned cat

Question 16

Tx for coxiella infection

Answer 16

doxycycline if acute

doxycycline + rifampin if chronic

Question 17

strep endocarditis Tx

Answer 17

PCN G

Question 18

enterococcal endocarditis Tx

Answer 18

PCN + gentamicin

Question 19

staphaylococcus endocarditis

Answer 19

nafcillin or vanco

Question 20

native valve treatment

Answer 20

vancomycin

Question 21

prosthetic valve

Answer 21

rifampin - kills staph adhered to foreign material**

Question 22

vancomycin

Answer 22

covers staph, strep, enterococcus

Question 23

PCN G

Answer 23

strep

Question 24

ampicillin and gentamicin

Answer 24

enterococcus

Question 25

penicillin sensitive staph

Answer 25

nafcillin

Question 26

nafcillin

Answer 26

for PCN sensitive staph

Question 27

vancomycin

Answer 27

for MRSA or coag negative staph inhibits cell wall synthesis in gram positives

Question 28

gentamicin

Answer 28

30S ribosome

Question 29

rifampin

Answer 29

DNA dependent RNA polymerase

Question 30

poor dentition

Answer 30

strep mutans

Question 31

strep bovis

Answer 31

GI neoplasm

Question 32

enterococci

Answer 32

elderly with urinary problems

Question 33

HACEK

Answer 33

prolonged incubation

Question 34

late prosthetic valve

Answer 34

strep

Question 35

IV drug users

Answer 35

staph

Question 36

alcoholics and street people

Answer 36

bartonella

Question 37

no growth

Answer 37

tropheryma

Question 38

endocarditis prophylaxis

Answer 38

only high risk cardiac populations -previous IE, prostethic valve, cyanotic heart disease perforating procedures of teeth, lungs, skin

Question 39

dental antibiotics

Answer 39

amoxicillin 2 grams 1 hour before procedure

Question 40

syncope, diastolic rumble, weight loss, fever, sed rate elevation

Answer 40

atrial myxoma

Question 41

atrial myxoma

Answer 41

carney complex of pigmented skin cAMP activated protein kinase A