Endocarditis Flashcards
Miss A, 23Y F, is an intravenous drug user who has presented to ED with a 2 week history of feeling feverish. On examination, her temperature is 38.5 degrees celsius, but she is otherwise stable. She has splinter haemorrhages and janeway lesions. Which of the following is INCORRECT?
Select one:
Appropriate management should include taking three blood cultures, then admitting to hospital. Withhold antibiotic treatment until blood culture results are available.
Echocardiography is more likely to show vegetations on the right side of the heart than the left.
Appropriate management should include starting empiric antibiotic treatment before admitting to hospital.
Transoesophageal echocardiography is more sensitive than transthoracic.
Appropriate management should include starting empiric antibiotic treatment before admitting to hospital.
A 30 year old female presents to the hospital with a two week history of fever, malaise, and loss of appetite. When taking a detailed history she reveals that she had her wisdom teeth removed a month ago. After a series of investigations she is found to have positive blood culture for viridans group streptococci, and a trans thoracic echocardiogram looks suspicious for vegetations of the mitral valve. What antibiotic treatment would you choose for this patient?
Select one:
Gentamicin
Flucloxacillin
Penicillin
She doesn’t need antibiotic treatment
Penicillin
What is the recommended treatment for native valve endocarditis caused by Staphylococcus aureus?
Select one:
augmentin for 3 weeks
penicillin for 2 weeks
tetracycline for 4 weeks
ceftriaxone for 8 weeks
flucloxacillin for 6 weeks
flucloxacillin for 6 weeks
A 53 year old male suspected of having infective endocarditis has blood cultures taken. The cultures come back positive with Enterococcus faecalis. What is the first line antibiotic treatment for this bacteria?
Select one:
Clindamycin
Ceftriaxone
Penicillin + Gentamicin
Co-trimoxazole
Penicillin + Gentamicin
John, a 55-year-old male, presents to ED with a 2 day history of dyspnea, fevers, night sweats and chills, nausea and vomiting and decreased appetite. He also tells you that he’s lost 10kg of weight over the last month and has had a change in bowel habit for about 6 months. When asked about family history, he tells you that his brother, uncle and grandfather have all been diagnosed with bowel cancer. On examination, he is febrile but otherwise stable. You also hear a systolic murmur of which the patient was unaware of. What bacteria do you expect to find on blood culture?
Select one:
Streptococcus gallolyticus
Enterococci
Staphylococcus aureus
Eikenella corrodens
Streptococcus gallolyticus
A 55 year old man presents to you in ED with a fever and chills that have been worsening over the past few weeks. He has no other symptoms of note. You note a heart murmur as well as splinter haemorrhages on his nails. Reviewing his file you discover that this murmur has never been detected before and combined with his other findings, you are concerned that he has endocarditis. Which of the following statements are INCORRECT regarding endocarditis?
Select one:
Viridans Streptococci is a common cause of endocarditis that can be treated with IV Penicillin.
Three blood cultures should be taken, followed by an echocardiogram.
The Jones Criteria can assist in the diagnosis of endocarditis.
Two of the risk factors for endocarditis are IV drug use and prosthetic heart valves.
None of the above.
The Jones Criteria can assist in the diagnosis of endocarditis. (this is for rheumatic fever)
A 28 year old female has presented to ED with 3 days of fluctuating fevers and general malaise. On examination her temperature is 38.4 degrees celsius, HR 108, BP 102/76. She was recently in hospital for internal fixation of her tibia following a car crash. When examining her hands you notice a couple of lesions on her palms and she reports them as being painless. When listening to her heart you hear a murmur. On further questioning she does recall having some heart problem as a child and lots of injections but she hasn’t kept in touch with her doctor about that.
Select one:
Staphlococcus viridians; rest, fluids and pain relief
Enterococci; monitor and assess hourly
Staphlococcus aureus; IV antibiotics
E.coli; rest and fluids
Staphlococcus viridians; IV antibiotics
Staphlococcus aureus; IV antibiotics
Mr McKay, a 67 year old male, has had a three week history of fevers above 38 degrees celcius, and an elevated heart rate. On examination of his hands, you see that many of his nail beds have splinter haemorrhages, and that there are several painful red raised lesions on his palms. He says he had a prosthetic valve put into his heart 5 years ago.Endocarditis is on your differential. Which of the following statements is false?
Select one:
A possible causative organism of this is Streptococcus Viridans
If blood culture indicates that non-methicillin-resistant Staphylococcus aureus is causing the endocarditis, treatment with Flucloxacillin is recommended
Recommended initial investigations include FBC, CRP/ESR and blood culture
The lesions on his palms are known as Janeway lesions and may be present in cases of endocarditis
The lesions on his palms are known as Janeway lesions and may be present in cases of endocarditis
Mr G is 56yrs old and comes into the doctors complaining of fever, night sweats and malaise for the last 3 days. Mr G has a history of congenital heart valve problems and has recently undergone dental surgery. The doctor decides to do an echocardiogram on Mr G and a small vegetation is indentified on a heart valve. What bacteria typically causes endocarditis after dental surgery?
Select one:
Staph. aureus
S. bovis
Enterococci
Strep. mitis
Strep pyogenes
Strep. mitis
A 62 year old man named Percy Jackson presents to your practice, saying that he has been unwell and tired for the past 2 weeks. Upon further questioning, he was also feverish and has been having night sweats. While his symptoms are quite vague and non-specific, Percy is known to have had a history of Chronic Rheumatic Heart Disease, for which he got a prosthetic valve. You decide to conduct an echocardiogram, which showed vegetations along the prosthetic valve. Gram stain of a positive blood culture showed alpha haemolytic colonies on blood agar and microscopy revealed gram-positive cocci in chains. Which is the primary antibiotic you use as treatment for Percy’s infection?
Select one:
PO Amoxicillin
IM Flucloxacillin
IV Penicillin
IV Ceftriaxone
IM Gentamicin
IV penicillin
What is the first line antibiotic treatment for native valve endocarditis caused by Staphylococcus aureus?
Select one:
Penicillin 4 weeks
Flucloxacillin 6 weeks
Flucloxacillin 4 weeks
Pencillin 6 week
Ceftriaxone 4 weeks
Flucloxacillin 6 weeks
RD, a 23 year old female presents to ED with shortness of breath that has been worsening over the past few weeks. She has also been feverish, and has a temperature of 38.5. All other vitals are stable, aside from a raised respiratory rate. She has no urinary, abdominal or neurological signs/symptoms and reports no previous trauma. Upon questioning, however, you discover that RD suffered from many sore throats and other illnesses as a child. She has recently had a dental extraction and dental abscess. . On examination, she has splinter haemorrhages on her nails and a systolic heart murmur that hasn’t been previously heard. Following results of an echo and blood culture, the doctors are suspicious of infective endocarditis, secondary to a history of rheumatic heart disease. What microscopic appearance of her blood culture ismost likely?
Select one:
Gram negative cocci in chains
Gram positive cocci in clumps
Gram negative bacilli
Gram positive cocci in chains
Gram positive cocci in chains (Strep viridans)
Which of the following is LEAST likely to be a risk factor for endocarditis?
Select one:
Intracardiac devices eg implantable cardioverter-defibrillators
Diabetes
Artificial heart valves
History of infective endocarditis
Chronic rheumatic heart disease
Diabetes
A 32-year-old male with a history of IV drug use presented to ED with flu-like symptoms, shortness of breath and inspiratory chest pain. On examination, he was found to have a significant murmur and after a transoesophageal echocardiogram was performed, he was dignosed with bacterial endocarditis. Which of the following findings would be LEAST likely in this patient?
Select one:
Septic pulmonary emboli.
Tricuspid valve involvement.
A holosystolic murmur increasing with inspiration.
Mitral valve involvement.
Staphylococcus aureus isolation from blood.
Mitral valve involvement
