infectious endocarditis

Question 1

inferior leads

Answer 1

II, III, aVF

Question 2

endocarditis is associated with what kind of murmurs

Answer 2

regurgitative

Question 3

number 1 reason to operate on valve

Answer 3

valve rupture

Question 4

murmur increases on inpsiration

Answer 4

right sided lesion

-tricuspid

Question 5

murmur that increases on expiration

Answer 5

left sided lesion

-mitral

Question 6

pansystolic (holosystolic) murmur that decreases with inspiration

Answer 6

best heard on left side

-mitral stenosis

Question 7

IV drug users often infect with valve?

Answer 7

tricuspid valve

-infect there lungs

Question 8

more common lesions in endocarditis

Answer 8

left sided lesions

Question 9

what should be given after blood culture

Answer 9

antibiotics

Question 10

best antibiotics

Answer 10

vancomycin and gentamicin

-don’t know if have staph A resistant

Question 11

what other lab panels will likely be abnormal with endocarditis

Answer 11

• anemia of chronic disease

- low compliment levels

Question 12

when to suspect endocarditis

Answer 12

fever

new murmur

Question 13

eye examination with endocarditis

Answer 13

roth spots

Question 14

physical examination findings with endocarditis

Answer 14

olser’s nodes, splinter hemorrhages (on nails)

-or Janesway lesions (not painful)

Question 15

streptococcus bovis endocarditis is associated with lesions in

Answer 15

in the colon
-do colonoscopy
Strep. Bovis: think buttocks

Question 16

would rather have a more sensitive or specific test?

Answer 16

more sensitive

-think airport metal detector-> want them to be 100% sensitive, but not so specific

Question 17

when is the exception for when get a TEE

Answer 17

prosthetic valves

• abscesses
• vegetation
• dishessence

Question 18

resist ordering for endocarditis first

Answer 18

TEE and TTE

Question 19

if have MRSA endocarditis

Answer 19

want to use beta-lactam

• nafcillin
• so if on vancomycin, switch to a beta-lactam

Question 20

homeless, alcoholic, flea bitten, fever and murmur

Answer 20

Bartonella

trench fever

Question 21

prophylaxis for under going colonoscopy with endocarditis

Answer 21

NO prophylaxis needed

-no GI procedures need prophylaxis

Question 22

which procedures DONT receive prophylaxis

Answer 22

• GI
• GU
• dental fillings

Question 23

need prophylaxis

Answer 23

• bleeding extractions

- tonsolectomy

Question 24

indications for prophylaxis

Answer 24

-prosthetic valve
-heart transplant recipient
-previous case of endocaritis
-uncorrected cyanotic heart disease
PLUS (doing one of these things)
-dental work with bleeding
-tonsillectomy/adenoidectomy

Question 25

prophylaxis for those who need it

Answer 25

oral amoxicillin

-if penicillin allergic-> clindamycin

Question 26

risks for endocarditis

Answer 26

• prosthetic valve

- positive blood cultures

Question 27

first thing to do

Answer 27

order blood cultures

Question 28

more sensitive TTE or TEE

Answer 28

TEE

Question 29

if have a prosthetic valve

Answer 29

straight to TEE

Question 30

with prosthetic valve infected, sensitive staph

Answer 30

add rifampin

-increases tissue penetration

Question 31

what do to after + blood culture

Answer 31

echo

-if TTE negative, try TEE