CVS

Question 1

Subacute Endocarditis (HACEK)

Answer 1

ROS: insidious onset, previously abnml valves, fatigue, low-grade fever, splinter hemorrhages
Pathogenesis: nml flora of mouth, organisms w/ low virulence introduced to blood and grow on damaged valves
Diagnosis: blood culture w/ G-ve rods

Question 2

S. bovis

Answer 2

PYR -ve, hydrolyzes bile, assoc. w/ colon ca

Question 3

Baylisascaris procyonis

Answer 3

Causes myocarditis
Pathogenesis: develops in gut & penetrates bloodstream as fatal NLM
Source: raccoon feces
Diagnosis: Anti-NLM Ab

Question 4

Subacute endocarditis

Answer 4

Damaged/diseased valves, slower onset than acute with less virulent organisms

Question 5

Acute endocarditis

Answer 5

Healthy valves (rapid onset) with highly virulent organism

Question 6

Subacute Endocarditis (Candida)

Answer 6

Risk: pt w/ indwelling vascular catheter
ROS: insidious onset, previously abnml valves, fatigue, low-grade fever, splinter hemorrhages
Pathogenesis: organism w/ low virulence introduced into blood and grow on damaged valves
Diagnosis: G+ve yeast

Question 7

Janeway lesions

Answer 7

Non-tender, erythematous lesions on palms/soles

Question 8

Acute Endocarditis (S. pyogenes)

Answer 8

Risk: previously nml valve, tricuspid in IV drug users
ROS: rapid onset
Pathogenesis: highly virulent organism, PMN infiltration, abscess formation then vegetations formed on valves
Diagnosis: G+ve, catalase -ve, β-hemolytic, bacitracin sensitive

Question 9

Paragonimus westermani

Answer 9

Lung fluke that causes myocarditis
Infectious stage: metacercaria
Source: freshwater crustaceans, snails, clams
Prevalence: Asia

Question 10

Acute Endocarditis (Staph aureus)

Answer 10

Risk: previously nml valve, tricuspid in IV drug users
ROS: rapid onset
Pathogenesis: highly virulent organism, PMN infiltration, abscess formation then vegetations formed on valves
Diagnosis: G+ve, catalase +ve, coagulase +ve

Question 11

Myocarditis

Answer 11

Etiology: Coxsackie B, and Adenovirus
ROS: stabbing CP, acute HF, diffuse pn, CHF, arrhythmia, fever
Diagnosis: elevated Troponin I, lymphocytosis or neutropenia to suggest viral infection

Question 12

Subacute endocarditis (Staph epidermidis)

Answer 12

Risk: IV drugs
ROS: insidious onset, previously abnml valves, fatigue, low-grade fever, splinter hemorrhages
Pathogenesis: organism w/ lov virulence introduced into blood and grow on damaged valves
Diagnosis: G+ve, catalase +ve, coagulase -ve, novobiocin sensitive

Question 13

Osler nodes

Answer 13

Tender nodules

Question 14

Enterococcus fecalis

Answer 14

PYR +ve, grows @ 6.5% NaCl, normal flora of colon, hydrolyzes bile

Question 15

Infective endocarditis (IVDU)

Answer 15

S. aureus and P. aeruginosa

Question 16

Aggregibacter actinomycetemcomitans (HACEK)

Answer 16

Urease +ve, non-motile, Vancomycin resistant
Virulence: Leukotoxin A kills PMNs and all cells expressing CD18; inhibits PMN functions
Diagnosis: star-like or “crossed cigars” on agar after 5-6d

Question 17

Toxocara spp.

Answer 17

Causes myocarditis
Prevalence: children, migrants <20yo
Source: dog and cat feces
Diagnosis: Anti-VLM or Anti-OLM Ab

Question 18

Subacute Endocarditis (Enterococcus)

Answer 18

Risk: elderly male w/ prostate probs; pt w/ colon ca
ROS: insidious onset, previously abnml valves, fatigue, low-grade fever, splinter hemorrhages
Pathogenesis: organisms w/ low virulence introduced into blood and grow on damaged valves
Diagnosis: G+ve, catalase -ve, γ-hemolytic, bile resistant, grows in 6.5% NaCl, PYR+

Question 19

Subacute Endocarditis (Strep viridans)

Answer 19

Risk: s/p dental surgery
ROS: insidious onset, previously abnml valves, fatigue, low-grade fever, splinter hemorrhages
Pathogenesis: nml flora, oropharynx
Diagnosis: G+ve, catalase -ve, alpha hemolytic, bile resistant, optochin resistant

Question 20

Cardiobacterium hominis

Answer 20

Oxidase +ve, Erythromycin resistance
ROS: fever, splenomegaly, emboli, patechiae, clubbing
Diagnosis: slow growing (1wk on chocolate agar)