IE

Question 1

What IE S/S mimics a pneumonia or pleural effusion?

Answer 1

Pulmonary Emboli

Question 2

MC cause of IE

Answer 2

Turbulent blood flow

Question 3

Prognosis and relapse facts

Answer 3

W/in 2 months usually
Risks with Prosthetic valves
Continued IVDU

Question 4

If an IVDU has Left sided organism involvement (S.A.) how do you u TXT?

Answer 4

Surgery (Left sided organisms are bad juju)

Question 5

Acute IE important S/S

Answer 5

HIGH fever + chills (NEG labs & Dx tests)

Question 6

Definite IE requirements per DUKE criteria

Answer 6

MAJ 2
MAJ 1 + 3 min
5 min

Question 7

MIcro-infarct white dots surrounded by hemorrhage found in the eye.

Answer 7

Roth spots

Question 8

Order of IE valve commons

Answer 8

MV > AV > TV > PV

IVDU - (MC) TV

Question 9

How long is IE ABX TXT?

Answer 9

4-6 weeks

Question 10

Subacute - Chronic IE important S/S

Answer 10

LOW fever + non-specific S/S

Question 11

If a TEE misses IE but there is still a high suspicion what can be done?

Answer 11

RPT TEE 3-5 Days after

Question 12

Unstable IE pt - how do you TXT?

Answer 12

Admit & empircally TXT after…

-drawing a min 2 blood cx sets over 30-60m

Question 13

PAINFUL nodules on fingers

Answer 13

Osler Nodes

Immunologic phenomena (Minor Duke Criteria

Question 14

Conditions required for IE to develop

Answer 14

1. Endocardial Injury
2. PLT/Fibrin thrombus formation
3. Bacteria in circulation adhere

Question 15

Community associated IE due to what organism

Answer 15

Streptococcal IE

Question 16

Can a progressing TR cause a pulmonary emboli?

Answer 16

Yes

Question 17

Possible IE requirements per DUKE criteria

Answer 17

MAJ 1 + 1 Min

3 Min

Question 18

When to give IE prophylaxis for dental procedures

Answer 18

C- Cardiac transplant
R- Repaired CHD w/ prosthetic materials
U- Unrepaired cynaotic CHD

Question 19

Emergent indications for surgery

Answer 19

1. Refractory Pulmonary edema (12hr diuretic fail)
2. Severe regurgitation (AR, MR)
3. Cardiogenic shock

Question 20

If pt is acutely ILL how many blood cultures should be obtained over what time span before you can do what?

Answer 20

3 blood cultures collected
Over a 1hr time span
Before beginning Empiric therapy

Question 21

Name of criteria used to DX IE

Answer 21

Duke Criteria

Question 22

Healthcare associated IE due to what organism

Answer 22

Staphylococcal IE

Question 23

If you have three positive blood cultures of an atypical IE organism would you TXT? If so, how?

Answer 23

Yes, Empircally

Question 24

Dx of IE requires HCP to

Answer 24

Detailed HX
PE
BLD Cx
Echo (TTE - initial TOC)
CXR

Question 25

Stable IE pt - How do you TXT?

Answer 25

Admit & wait for blood cx before starting ABX

Question 26

What organisms cause highest mortality?

Answer 26

Fungi and P. Aeruginosa

Question 27

3 types of acute/subacute IE

Answer 27

1. Native valve
2. Prosthetic valve
3. IVDU related

Question 28

If you have refractory bacteria >7D how do you TXT?

Answer 28

Surgery

Question 29

Marantic

Answer 29

non-bacterial thrombotic

Question 30

The majority of procedures can be covered with what ABX prophylaxis?

Answer 30

Amoxicillin 2g

Question 31

PAINLESS flat petechiae seen on palm and soles

Answer 31

Janeway Lesions

Vascular phenomena (Minor Duke criteria

Question 32

Does a increase or change in a pre-existing murmur count towards Major DUKE criteria?

Answer 32

NO - Must be a NEW murmur

Question 33

Besides DUKE criteria what are pathologic criteria to make a DX of Definite IE?

Answer 33

Histology of lesion - Evidence (Vegetation/Abscess)

Microorganism - ID organism on Direct culture or histology

Question 34

What are the differences between echocardiogram methodologies for DX IE

Answer 34

TTE - Initial TOC - Large vegetation’s or valve dysfx

TEE - Small vegetation’s, eval prosthetic (more SENS)

Question 35

Urgent indications for surgery

Answer 35

Any HF

Local infectious complications (fistulas/abscess)