Endocarditis 1

Question 1

What is infective endocarditis?

Answer 1

Microbial infection of the endocardium of the heart

Question 2

What can infective endocarditis infect in the heart? (3)

Answer 2

Inner lining of the heart (endocardium)
Chordae Tendinae
Valves

Question 3

What Staph strains cause endocarditis? (2)

Answer 3

Staph aureus

Coagulase neg Staph

Question 4

What Streptococcus strains cause endocarditis? (3)

Answer 4

Mutans
Sanguis
Bovis

Question 5

Mnemonic for remembering infectious organisms for Bacterial endocarditis? (5)

Answer 5

"HACEK" 
Haemophillus
Actinobacillus
Cardiobacterium Hominis 
Eikenella
Kingella kingae

Question 6

Painful, swollen subcutaneous nodules on the pulp of fingers and toes are called whaT?

Answer 6

Osler node

Question 7

Non-tender nodules on the palms or soles called what?

Answer 7

Janeway lesion

Question 8

How big are Osler nodes?

Answer 8

1mm to greater than 1cm

Question 9

Hoe big are Janeway Lesions?

Answer 9

Variable size

Question 10

What type of endocarditis does Osler nodes signify?

Answer 10

Subacute

Question 11

What type of endocarditis does Janeway lesions signify?

Answer 11

Acute

Question 12

Histologic findings of Janeway lesion?

Answer 12

Septic microemboli

Question 13

Histologic findings of Osler node?

Answer 13

Vasculitis

Question 14

What clinical finding way we see on the nails for infective endocarditis?

Answer 14

Splinter hemorrhages

Question 15

Perivalvular abscesses run the risk of causing what? (3)

Answer 15

Valve disfunction
Heart block
Stroke

Question 16

Major criteria for bacterial endocarditis? (3)

Answer 16

1) Laboratory Evidence of IE (blood cultures)
2) Endocardial involvement seen on transthoracic or transesophageal echocardiogram
3) New Valvular regurgitation

Question 17

Minor criteria for bacterial endocarditis? (4)

Answer 17

1) Predisposing heart condition
2) Fever
3) Vascular Phenomenon
4) Immunologic Phenomenon

Question 18

How do you treat gram positive IE?

Answer 18

Penicillin or Ampicillin if sensitive

If not sensitive then Vancomycin and Amino-glycoside for 2-6weeks

Question 19

Anticoagulation therapy good idea?

Answer 19

No, doesn’t prevent embolism and may increase risk of bleeding

Question 20

Endocarditis main presenting symptoms?

Answer 20

Fever and murmur

Question 21

Best first test for endocarditis?

Answer 21

Blood cultures

Question 22

Most likely eye finding in bacterial endocarditis?

Answer 22

Roth Spots

Question 23

Symptom of endocarditis involving the finger nail?

Answer 23

Splinter hemorrhage

Question 24

Which skin symptom is also associated with endocarditis?

Answer 24

Osler nodes and Janeway lesions

Question 25

Cardiac exam reveals which murmur?

Answer 25

Mitral regurgitation

Question 26

Inspiration increases murmurs on which side of the heart

Answer 26

Right sided

Question 27

Expiration increases murmurs on which side of the hearT?

Answer 27

Left sided

Question 28

Pansystolic murmur that decreases with inspiration best heard where on chest?

Answer 28

Left sternal border

Question 29

After blood cultures are performed what is the next best step?

Answer 29

Start antibiotics

Question 30

best empiric choice for antibiotics?

Answer 30

Vancomycin and gentamycin

Question 31

A patient with redness and flushing at the neck line in response vancomycin and gentamicin should be treated how?

Answer 31

Decrease RATE of infusion

Question 32

In endocarditis what is likely found on lab testing?

Answer 32

Low compliment levels

Question 33

Strep bovid should trigger you to what exam?

Answer 33

Colonoscopy to check for malignancy

Question 34

Equation for sensitivity?

Answer 34

Sensitivity = TP/(TP+ FN)

Question 35

Equation for positive predictive value?

Answer 35

TP/All positive

Question 36

When do you use transesophageal echocardiogram over transthoracic echocardiogram?

Answer 36

When the patient has had a valve replacement

Question 37

Endocarditis caused by Bartonella is associated with who?

Answer 37

Alcoholics on the street and flea bites

Question 38

Indication for prophylaxis?

Answer 38

``` Prosthetic valve Heart transplant recipient Previous endocarditis Uncorrected cyanotic heart disease PLUS Dental work with bleeding Tonsillectomy/adenoidectomy ```

Question 39

If there is a prosthetic valve involved then what antibiotic can you add?

Answer 39

Rifampin