IE, RHD, ARF Flashcards
Vegetation is composed of which of the following?
A. Platelets B. Fibrin C. Microorganisms D. Inflammatory cells E. Two of the options F. All of the options
F. All of the options
What is the most common affected heart valve in infective endocarditis?
A. Aortic valve B. Pulmonic valve C. Bicuspid valve D. Tricuspid valve E. Any of the options
C. Bicuspid valve = Mitral valve
After valve replacement, the risk of PVE is greatest
during which of the following?
A. 2-3 months B. 4-6 months C. 6-12 months D. 12-24 months E. >24 months
C. 6-12 months
All of the following conditions predispose to infective endocarditis EXCEPT:
A. congenital heart disease B. rheumatic heart disease C. degenerative heart valve D. IV drug use E. Two of the options F. None of the options
F. None of the options
Which of the following is the most common cause of acute endocarditis?
A. S. viridans B. S. aureus C. S. gallolyticus D. CoNS E. HACEK group
B. S. aureus
Which of the following is the most common cause of native endocarditis?
A. S. viridans B. S. aureus C. S. gallolyticus D. CoNS E. HACEK group
A. S. viridans (50 to 60% of cases)
Which of the following is a normal component of the oral cavity flora?
A. S. viridans B. S. aureus C. S. gallolyticus D. Actinobacillus E. All of the options
A. S. viridans
Which of the following is the major offender in IE among IV drug abusers?
A. S. viridans B. S. aureus C. S. gallolyticus D. Actinobacillus E. Haemophilus
B. S. aureus
Which of the following laboratory manifestations has the highest frequency on patients with IE?
A. Fever B. Heart murmurs C. Anemia D. Elevated CRP E. Elevated ESR
D. Elevated CRP (>90)
These are small, painless, erythematous lesions on the palms or soles
A. Splinter hemorrhages
B. Osler nodes
C. Janeway lesions
D. Roth spots
C. Janeway lesions
Splinter hemorrhages:
Small areas of red discoloration under the nails
Osler nodes:
Painful red nodules on pads of the fingers and toes
Janeway lesions:
Small, painless, erythematous lesions on the palms or soles
Roth spots:
Red spots with pale centers on fundoscopic exam
All of the following are cardiac findings on patients with IE EXCEPT:
A. Aortic stenosis B. Aortic regurgitation C. Mitral regurgitation D. Tricuspid regurgitation E. Two of the options F. None of the options
A. Aortic stenosis
Which of the following should you opt to use if you’re suspecting Brucella as causative agent of IE?
A. Blood culture B. PCR recovery of microbial DNA C. Cardiac Imaging D. ESR and CRP-level E. CBC
B. PCR recovery of microbial DNA
A 21-yr old physician detects the possible cause of death of her patient who suffered on a 3-day endocarditis. Which of the following accurately describes her findings?
A. Acute endocarditis; 3mm vegetation; S. aureus
B. Acute endocarditis; 7 mm vegetation; S. viridans
C. Acute endocarditis; 11 mm vegetation; S. aureus
D. Subacute endocarditis; 1.5mm vegetation; S. viridans
E. Subacute endocarditis; 15mm vegetation; S. aureus
F. None of the options; needs retest
C. Acute endocarditis; 11 mm vegetation; S. aureus
Which of the following is the best option to view valve vegetations?
A. Chest Xray B. Transthoracic echocardiography C. Transesophageal endocardiography D. CT scan + MRI E. All of the options
C. Transesophageal endocardiography (more sensitive)
All of the following are diagnostic for IE EXCEPT:
A. CBC B. Creatinine C. SGPT/ALT D. Chest XRAY E. ECG F. Two of the options G. All of the options H. None of the options
G. All of the options
A 21 year old physician suspects that her patient has infective endocarditis. She then ordered as series of laboratory tests. Which of the following accurately describes the future results?
A. Elevated ESR and decreased CRP-level B. Elevated ESR and CRP-levels C. Elevated RF and decreased CRP-level D. Elevated Circulating immune complex titers E. Two of the options F. All of the options G. None of the options
E. Two of the options
Which of the following is the first line of treatment for IE?
A. Antimicrobial therapy B. Anticoagulant therapy C. Surgery D. Reassurance with a team of cardiologist + neurologist + anesthesiologist E. Any of the options
A. Antimicrobial therapy
All of the following are TRUE about treatment of IE EXCEPT:
A. All bacteria in the vegetation must be killed
B. Therapy must be bacteriostatic and prolonged
C. Antibiotics must be given orally and parenterally
D. Selective effective therapy requires knowledge of the susceptibility of the causative agent
E. Two of the options
F. None of the options
E. Two of the options
Which of the following is the adverse effect of using aminoglycoside antibiotics?
A. Hepatotoxicity B. Renal toxicity C. GI upset D. Torsades de pointes E. Cardiac arrest
B. Renal toxicity
A 21 year old physician suspects that her patient has infective endocarditis caused by Enterococci species. Which of the following should she give to the patient?
A. Oxacillin + Nafcillin B. Ceftriaxone + Vancomycin C. Vancomycin + Streptomycin D. Penicillin + Ceftriaxone + Gentamicin E. Gentamicin only
C. Vancomycin + Streptomycin
A 21 year old physician suspects that her patient has infective endocarditis. In addition, she identified her patient as high-risk for the disease. Which of the following should she do next?
A. Reassurance with a team of cardiologist + neurologist + anesthesiologist
B. Order transthoracic endocardiography
C. Order transesophageal endocardiography
D. Give cephalosporins
E. Admit the patient and observe for the next 7 days
C. Order transesophageal endocardiography
Which of the following drug is used if the patients have severe or immediate B-lactam allergy?
A. Penicillin G B. Ceftriaxone C. Gentamicin D. Vancomycin E. Ampicillin
D. Vancomycin
Which of the following drugs should be given if the cause is MSSA infecting prosthetic valves?
A. Nafcillin + Gentamicin + Rifampin
B. Vancomycin + Gentamicin + Rifampin
C. Cefazolin + Vancomycin + Ceftriaxone
D. Oxacillin + Cefazolin + Vancomycin
A. Nafcillin + Gentamicin + Rifampin
Vancomycin + Gentamicin + Rifampin (MRSA)
Which of the following should be used to prevent systemic emboli on a patient with IE?
A. Antithrombotic therapy
B. Antimicrobial therapy
C. Cardiac surgery
D. Any of the options
D. Any of the options
Which of the following is the standard oral regimen as prophylactic antibiotic of endocarditis in adults with high-risk cardiac lesions?
A. Amoxicillin B. Ampicillin C. Azithromycin D. Ceftriaxone E. Clindamycin
A. Amoxicillin
All of the following are TRUE about RHD EXCEPT:
A. Resulted from recurrences of rheumatic fever
B. Most common b/w 25 to 40 years old
C. Women > Men
D. May progress to stroke and heart failure
E. Two of the options
F. None of the options
F. None of the options
Which of the following is the most common cause of ARF?
A. Streptococcus pyogenes B. Streptococcus agalactiae C. Staphylococcus haemolitycus D. Staphylococcus aureus E. Adenovirus
A. Streptococcus pyogenes
Which of the following is the most common clinical features of ARF?
A. Monoarthritis B. Polyarthritis C. Endocarditis D. Pancarditis E. Chorea F. Any of the options
B. Polyarthritis (60-75%)
ARF affects all of the following EXCEPT:
A. Knees B. Hips C. Elbows D. MCP joints E. PIP joints F. Two of the options G. None of the options
F. Two of the options
All of the following refer to definite RHD as defined by the World Heart Federation EXCEPT:
A. Pathologic MR and at least 2 features of RHD of the aortic valve
B. MS mean gradient of equal or more than to 4 mmHg
C. Pathologic AR and at least two features of RHD of the mitral valve
D. Two of the options
E. None of the options
D. Two of the options
A 21 year old physician conducts an echocardiography to a patient with RHD. Upon viewing the results, she concluded that there was pathologic MR. Which of the following accurately describes her findings?
A. Jet length 2cm; pansystolic jet B. Jet length >1cm; pandiastolic jet C. Jet length 2mm; pandiastolic jet D. Jet length 1-2mm; pansystolic jet E. None of the options
A. Jet length 2cm; pansystolic jet
All of the following are TRUE about chorea EXCEPT:
A. Also called as Rodenham's chorea B. Found mainly in males C. Affect particularly the lower limbs D. Two of the options E. All of the options
E. All of the options
A 5 year old girl has been diagnosed with ARF based on the appearance of her skin rashes. Which of the following accurately describes her skin?
A. She has erythema spongiosum B. The skin lesions are pink papules, that clear centrally, and spreading edge C. Occurs on the trunk, limbs, and face D. Two of the options E. None of the options
E. None of the options
All of the following are features of ARF EXCEPT:
A. Low grade fever B. Elevated CRP-level C. Skin rashes D. Two of the options E. None of the options
A. Low grade fever
39 is the rule
Which of the following is the most definitive diagnosis for ARF?
A. High grade fever B. Group A strep infection C. Chorea D. Elevated acute-phase reactants E. Pancarditis F. Combination of everything
F. Combination of everything
Which of the following serologic tests are used to diagnose ARF?
A. Antibody test (IgG and IgM) B. Anti-streptrolysin O (ASO) titer C. Anti-DNase B (ADB) titer D. Two of the options E. All of the options
D. Two of the options
Which of the following is the antibiotic drug of choice for treating ARF?
A. Penicillin PO
B. Penicillin IV
C. Amoxicillin PO
D. Amoxicillin IM
A. Penicillin PO
A 12 year old patient has experienced joint pains due to possible ARF. Which of the following should you give?
A. Penicillin G B. Penicillin V C. Warfarin D. Aspirin E. Colchicine
D. Aspirin
The same 12 year old patient went back to your clinic and explained that after taking aspirin, he experienced nausea, vomiting, and tinnitus. What would you say and recommend to him?
A. Decrease the dosage of aspirin
B. Increase the dosage of aspirin
C. Give other NSAIDs
D. Perform another physical exam; consider other diagnosis
E. Explain it’s normal and it will subside later on
C. Give other NSAIDs
As a 21 year old physician, to eliminate the salicylate toxicity, you recommend giving your patient an alternative medication. Which of the following is alternative to aspirin?
A. Celecoxib B. Ibuprofen C. Naproxen D. Indomethacin E. Meloxicam
C. Naproxen
The same 12 year old patient went back to your clinic and explain that the symptoms have subsided, however, he is experiencing symptoms of CHF. Which of the following should you give?
A. Add another NSAID as combined therapy
B. Give glucocorticoids
C. Give beta blockers or calcium channel blockers
D. Explain that he only needs bed rest and the symptoms will subside soon.
B. Give glucocorticoids
A 21 year old physician suspects a possible acute rheumatic fever on her patient. All of the following test are recommended EXCEPT:
A. WBC count B. ESR and CRP-level C. Throat swab after giving antibiotics D. ECG and chest Xray E. Two of the options F. None of the options
C. Throat swab after giving antibiotics
Which of the following drug is considered as the mainstay secondary prevention for ARF?
A. Azithromycin B. Penicillin V C. Benzathine Penicillin G IV D. Benzathine Penicillin G IM D. Benzathine Penicillin G PO
D. Benzathine Penicillin G IM
A 25 year old physician is having a difficulty to diagnose what type of ARF is presented on her 15 year old male patient. She then now opt for a referral. As a 21 year old physician, you diagnosed the disease as a recurrent ARF. Which of the following accurately describes your diagnosis?
A. Clinical carditis + Chorea
B. Polyarthritis + presence of skin rashes w/ pink papules
C. Clinical carditis + Polyarthralgia + Low grade fever
D. Polyarthritis + intramuscular nodules
E. Polyarthralgia + ECG (prolonged PR interval) + Moderate grade fever
E. Polyarthralgia + ECG (prolonged PR interval) + Moderate grade fever
Initial ARF = 2 Major / 1 Major + 1 Minor
Recurrent ARF = 2 Major / 1 Major + 2 Minor / 3 Minor
MAJOR (JONES) Joints (migratory polyarthritis) ❤ (carditis) Nodules (subcutaneous) Erythema marginatum Sydenham chorea
Development of ARF occurs after how many week/s following the infection?
A. 1 B. 2 C. 3 D. 4 E. 5
B. 2
Which of the following is the hallmark of rheumatic carditis?
A. Valvular damage
B. Epitope spreading
C. Tissue scarring
D. Polyarthritis
A. Valvular damage
Which of the following valves is mostly affected in ARF?
A. Aortic valve B. Bicuspid valve C. Tricuspid valve D. Pulmonic valve E. Bicuspid + Aortic valves
B. Bicuspid valve
A 14 year old male patients returns to your clinic for a consultation. He then asked you the possible manifestations of his previous disease (ARF). Which of the following is LEAST likely to occur within the 3-week period of the disease?
A. Erythema marginatum B. Subcutaneous nodule C. Polyarthritis D. Chorea E. Indolent carditis F. Two of the options G. None of the options
F. Two of the options
A 14 year old male patient insists on asking you questions about the possible reasons why he got infected with ARF. Which of the following possible reasons would you opt to explain?
A. You live on a remote area and has high possibility of infection
B. You may have poor hygiene
C. You are malnourished and you are very susceptible to ARF
D. Two of the options
E. All of the options
E. All of the options
All of the following are TRUE about Jones Criteria EXCEPT:
A. Developed by Dr. Robert Jones
B. Initial RF diagnosis as evidenced by 2 Major / 1 Major + 2 Minor / 3 Minor
C. Can be subdivided depending on risk population (low or moderate and high risk)
D. Two of the options
E. All of the options
D. Two of the options
