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Stage 3: EJR - Infectious diseases > Endocarditis, PUO > Flashcards

Endocarditis, PUO Flashcards

1
Q

Describe the 4 steps in formation of vegetations in endocarditis

A
  1. Alteration of valvular surface
  2. Deposition of platelets & fibrin
  3. Colonisation by bacteria
  4. Development of vegetation
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2
Q

Classic triad presentation of endocarditis

A
  1. Persistent pyrexia of unknown origin
  2. New/changing murmur
  3. Embolic phenomena
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3
Q

Non-specific symptoms of heart failure

A
  • Temperature >38C, Night sweats
  • Fatigue, muscle & joint pain
  • Unexplained weight loss
  • Dyspnoea
  • Vomiting, headache, coma, delirium
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4
Q

According to Duke’s criteria, what is a definite diagnosis of endocarditis (how many major/minor)

A
  • 2 major criteria OR
  • 1 major + 2 minor OR
  • 5 minor
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5
Q

Which bacteria, if found in a single blood culture, is sufficient for diagnosing endocarditis

A

Coxiella burnetii

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6
Q

What are the major Duke’s criteria (2 criteria)

A
  1. blood cultures positive for endocarditis

2. evidence of endocardial involvement (on ECHO)

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7
Q

What are the minor Duke’s criteria (6 criteria)

A
  1. predisposing heart condition
  2. IVDU
  3. fever
  4. vascular phenomena
  5. immunological phenomena
  6. other microbiological evidence (that doesn’t meet major criteria)
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8
Q

What are embolic phenomena in endocarditis

A 
o	Arterial emboli (major)
o	Septic pulmonary infarcts
o	Mycotic aneurysm
o	Intracranial bleed
o	Conjunctival bleed
o	Janeway’s lesions
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9
Q

What are vascular phenomena in endocarditis

A

o Glomerulonephritis
o Osler’s nodes
o Roth’s spots
o Rheumatoid factor

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10
Q

What are lifestyle-related risk factors for infective endocarditis

A
  • IVDU
  • Body piercings
  • Tattoos
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11
Q

What medical history are risk factors for infective endocarditis

A
  • poor oral hygiene
  • invasive dental work
  • hx of endocarditis
  • immunocompromised
  • rheumatic heart disease
  • congenital heart conditions
  • haemodialysis
  • anything causing bacteriamia eg colon cancer, serious UTI
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12
Q

What valve problems are risk factors for infective endocarditis

A
  • stenosis or regurgitation in any of the 4 valves
  • artificial heart valves
  • age related degenerative valvular lesions
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13
Q

Complications of infective endocarditis

A
  • heart failure
  • valve abscess (may lead to heart block)
  • embolisms
  • pericarditis
  • glomerulonephritis (autoimmune side effect)
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14
Q

Which sided endocarditis occurs more in IVDU

A

R sided

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15
Q

Which sided endocarditis occurs more in cocaine users

A

L sided

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16
Q

Which sided endocarditis is more severe

A

L sided often has worse outcomes

L sided is also more common

17
Q

Janeways lesions vs Oslers nodes - which is painful

A

Janeways lesions are painless

Oslers nodes are painful

18
Q

What causes Roth spots

A

Mixture of fibre and platelet deposition

19
Q

Most common bacterial causes of infective endocarditis

A
  • Staph aureus

- Strep viridians

20
Q

Most common valve involved in infective endocarditis

A

Mitral

21
Q

Where + timing to get blood cultures from in a chronic/subacute presentation

A

3 different sites

6h apart

22
Q

Where + timing to get blood cultures from in an acute presentation

A

2 different sites

within 1h

Stage 3: EJR - Infectious diseases (16 decks)

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