IE, Dubin

Question 1

5 causes of NBTE

Answer 1

1. RHD (10-35yo)
2. Bicuspid valve (50-60)
3. Calcific aortic stenosis (60-70)
4. MV-Prolapse
5. Marfan Syndrome

Question 2

PPD greater than 10mm, think what?

Answer 2

Acute pericarditis, incarceration, coxsackie A or B

Question 3

Dairy cattle, goats, etc. Think what disease and what organism?

Answer 3

Q-Fever, Coxiella burnetti (obligate intracellular proteobacteria).

Question 4

HA, fever, joint pain, GI, atympocal pneumonia ot ARDS, think what?

Answer 4

Acute Q-fever

Question 5

Chronic Q-fever can lead to what?

Answer 5

endocarditis.

Question 6

Major causes of myocarditis: viral, bacterial, parasitic.

Answer 6

Viral - coxsackie
Bacteria - Borellia burdorferi
Parasitic - Trypanosome, babeosis

Question 7

5 Predisposing factors to IE. Why?

Answer 7

All promote bacterial growth.
1.  PRosthetic valve.
2. implant devices
3.  Parenteral nutrition
4.  Congenital heart defect
5/  Previous endocarditis

Question 8

What Hx tips you off to IE?

Answer 8

Fever, chills, COUGH (right-side), orthopnea, night sweats, fatigue, weight loss

Question 9

PE in IE (3)

Answer 9

MURMUR (changed or new)

Signs of HF, CVA signs

Question 10

Lab findings in IE

Answer 10

ANEMIA (left side), increased WBC,

INCREASED SED RATE or CRP, hematuria, thrombocytopenia

Question 11

ESR of 70+, think what?

Answer 11

cancer

Question 12

Best imaging for IE

Answer 12

trans throacic (or esophageal) ECHOCARDIOGRAM

Question 13

Painful, purple, (palpable) erythematous subcutaneous nodules on pads of fingers and toes.

Answer 13

Osler nodes.

Question 14

Painless, hemorrhagic plaques on soles and palms.

Answer 14

Janeway Lesions

Question 15

Thin, linear hemorrhage under nailbeds of fingers/toes.

Answer 15

Splinter hemorrhage

Question 16

Retinal infarct with central pallor and surrounding hemorrhage.

Answer 16

Roth spot

Question 17

Gran negative bugs that can cause IE.

Why dont they always show up on culture?

Answer 17

Haemophilum
Actinobacilus
Cardiobacterium
Eikenella
Kingella

SLOW growing

Question 18

Tx for IE caused by Gram positive bugs.

Answer 18

Staph - naficillin

Strep - Penicillin G

Question 19

Tx for IE caused by Gram negative bugs.

Answer 19

Ampicillin and cephriaxone

Question 20

What situations warrent prophylaxis?

Answer 20

Person has: prosthetic valve, previous endocarditis, heart transplant, CHD (repaired CHD in past 6mo or residual defects or unrepaired cyanotic CHD)
Person HAVING: dental, tonsillectomy, adenoidectomy, surgery on infarcted skin

Question 21

Major Jones criteria

Answer 21

J=joints=polyarteritis
O=heart=carditis
N=nodules=subcutanous
E=erythematous marginatum
S=Syndham Chorea

Question 22

Minor Jones criteria

Answer 22

Fever, arthralgia, previous RF, APR (ESR), Prolonged PR interval on ECG.

Question 23

What evidence of preceding strep infection can be found to meet Jones criteria?

Answer 23

ASO, Grp A Strep, Recent Scarlet Fever

Question 24

What are the number of major/minor requirements for Jones Criteria?
What is this used to diagnose?

Answer 24

Acute RF
2 major
1 major, 2 minor
Evidence of preceding strep infection

Question 25

What is this?
Persistent ST elevation in all leads, Retrosternal chest pain, night sweats, PPD10+mm.
Viral - Coxsackie

Answer 25

Pericarditis