IE, Rheumatic fever, myocardial/pericardial disease, dissection

Question 1

IE risk factors

Answer 1

Prosthetic valves
Valve disease (VSD, PDA, CoA)
Rheumatic fever
Dental caries, IVDU

Question 2

Causative agents of IE

Answer 2

Strep. viridans, S. bovi
Staph aureus, epidermis
HACEK

Question 3

Main clinical features in IE

Answer 3

Fever, rigors, splenomegaly, clubbing
New/changing murmur
Haematuria, roth spots

Question 4

Hand features of IE

Answer 4

Janeway lesions, Osler’s node, splinter haemorrhages

Question 5

Duke major

Answer 5

\+ve blood culture 
Endocardium involved (echo/valve regurg)

Question 6

Duke minor - 5

Answer 6

Predisposition 
Fever>38
Emboli (septic infarcts)
Immune phenomenon - GN, oslers node, roth spots 
\+ve blood culture

Question 7

Diagnose IE if

Answer 7

2 major or
1 major + 3 minor or
5 minor

Question 8

ECG change in IE

Answer 8

AV block

Question 9

Treat empiric IE acute and subacute

Answer 9

Acute - fluclox + gent

Subacute - benpen + gen

Question 10

IE due to strep and enterococci treat

Answer 10

Strep - Benpen + gent

Enterococci - Amox + gent

Question 11

IE due to staph treat

Answer 11

Fluclo + rifampicin

Question 12

Cause of rheumatic fever

Answer 12

Group A beta-haemolytic strep

Question 13

Diagnose rheumatic fever

Answer 13

Evidence of GAS infection (scarlet fever, +ve throat culture, ASOT +ve, rapid strep antigen)
2 major or
1 major + 2 minor

Question 14

Major Jones criteria

Answer 14

STREP 
S - Sydenham's chorea 
T - Transient arthritis 
R - Subcutaneous nodules 
E - Erythema marginatum 
P - Pancarditis (pericarditis, myocarditis, endocarditis)

Question 15

Minor Jones criteria

Answer 15

Prolonged PR 
Raised ESR/CRP 
Temp rise 
Previous rheumatic fever
Arthralgia

Question 16

Patient with pancarditis (AV block/chest pain) + joint pain cause

Answer 16

Rheumatic fever

Question 17

Treat rheumatic fever

Answer 17

IM benpen
Analgesia
Chorea - Haloperidol

Question 18

Drug causes of pericarditis

Answer 18

Penicillin
Isoniazid
Procainamide
Hydralazine

Question 19

ECG changes in pericarditis

Answer 19

Saddle shaped ST elevation

PR depression

Question 20

Blood changes in pericardtis and myocarditis

Answer 20

Troponin can be raised

Question 21

Infective causes of pericarditis

Answer 21

Coxsackie, flu, EBV, HIV, pneumonia

Question 22

Clinical feature in constrictive pericarditis

Answer 22

Kussmaul’s sign (raised JVO in inspiration)
S3
Quiet heart sounds

Question 23

Treat pericarditis

Answer 23

Analgesia (ibruprofen)
Treat cause
Consider steroids

Question 24

ECG change in pericardial effusion

ECHO results

Answer 24

Low voltage QRS
Electrical alternans
Echo free zone around heart

Question 25

Treat pericardial effusion

Answer 25

Pericardiocentesis + treat cause

Question 26

Tamponade signs

Answer 26

Beck's triad - reduced BP, raised JVP, quiet HS Pulsus paradox - pulse fades on inspiration Kussmaul sign

Question 27

Treat tamponade

Answer 27

Treat cause + pericardiocentesis

Question 28

Drug causes of myocarditis

Answer 28

Cyclophosphamide Herceptic CBZ, phenytoin

Question 29

Autoimmune cause of myocarditis

Answer 29

SLE

Question 30

Treat myocarditis

Answer 30

supportive and treat cause

Question 31

Treat HOCM

Answer 31

-ve inotropes (B blocker, Ca blocker) Amiodarone Anticoagulate if AF

Question 32

Features of cardiac myxoma

Answer 32

Clubbing, fever, raised ESR | Signs as in MS

Question 33

Treat dilated cardiomyopathy

Answer 33

Heart failure medication | Biventricular pacing, ICD

Question 34

Drug causes of dilated cardiomyopathy

Answer 34

Alcohol | Doxorubicin, cyclophosphamide

Question 35

Causes of dilated cardiomyopathy

Answer 35

Dystophy - muscular, myotonic, glycogen storage disease SLE thyrotoxicosis

Question 36

Features Ehlers Danlos

Answer 36

Hyperelastic skin + hypermobile joints cardiac - MVP, AR, MR, aneurysm Fragile blood vessels

Question 37

Marfan's syndrome inheritance

Answer 37

Autosomal dominant

Question 38

Marfan cardiac, ocular features

Answer 38

Cardiac - aortic aneurysm/dissection, MVP/regurg | Ocular - superotemporal lens dislocation

Question 39

Marfan MSK features

Answer 39

High-arched palate, pectus excavatum, scoliosis, pes planus, joint hypermobility

Question 40

Mx marfans

Answer 40

Refer to ortho, cardio, ophthal | B blockers, reduce cardiointensive sports

Question 41

Stanford A and B aortic dissection

Answer 41

A - ascending aorta involved | B - Ascending aorta not involved

Question 42

Risk factors for dissection

Answer 42

HTN, CoA Trauma Vasculitis, marfans, ehlers danlos

Question 43

Diagnose dissection

Answer 43

Spiral CT

Question 44

Mx dissection

Answer 44

HDU, BP control, analgesia, surgery