Infectious Endocarditis - Dubin

Question 1

Fever, decreased breath sounds, heart murmur at R sternal border (decrescendo-diastolic), IV drug user, frequent STIs, elevated sed rate, high WBCs, positive PPD. Nodular infiltrates b/l on x-ray.

Answer 1

R-sided infectious endocarditis (via IV drug use)

Question 2

Cause of nodular infiltrates

Answer 2

Septic emboli via tricuspid valve

Question 3

CD4

Answer 3

PCP pneumonia

Question 4

Most likely organism of R-sided infectious endocarditis

Answer 4

Staph. aureus

Question 5

Acute vs. subacute bacterial endocarditis

Answer 5

Subacute = L side, slow onset, systemic symptoms, STREP
Acute = R side, fast onset, lung symptoms, STAPH

Question 6

5 predispositions to infective endocarditis

Answer 6

• Prosthetic valves
• Implantable devices
• Parenteral nutrition tube
• Congenital heart disease
• Previous endocarditis

Question 7

Night sweats are characteristic of ____

Answer 7

TB

Question 8

Clues on physical exam to endocarditis

Answer 8

NEW murmur or CHANGING murmur

Question 9

Lab findings common w/ L-sided endocarditis

Answer 9

Anemia (more likely to be chronic), Hematuria

Question 10

Increased sed rate - meaning

Answer 10

Some immunologic/inflammatory process is occurring

Question 11

Classic manifestations of infective endocarditis (5)

Answer 11

• Osler nodes (painful, pads of fingers and toes)
• Janeway lesions (painless, palms and soles)
• Slit hemorrhages (under nail beds)
• Roth spots (retinal infarcts, center is pale)
• Conjunctival hemorrhages

Question 12

Dental procedure –> ___-sided endocarditis

Organism?

Answer 12

Left

Strep (viridans)

Question 13

Lower bowel or prostate surgery –> endocarditis

Organism?

Answer 13

Enterococcus fecalis

Question 14

Major Jones Criteria for Acute Rheumatic Fever (5)

Answer 14

1. Carditis
2. Polyarthritis
3. Sydenham’s Chorea
4. Erythema marginatum
5. Subcutaneous nodules

Question 15

Minor Jones Criteria for Acute Rheumatic Fever (5)

Answer 15

1. Fever
2. Arthralga
3. Previous rheumatic fever or heart disease
4. Acute phase reactants
5. Prolonged P-R interval on EKG

Question 16

Evidences of previous strep. infection (4)

Answer 16

• ASO or other antibodies
• Throat culture for group A
• Group A carb. antigen test
• Recent scarlet fever

Question 17

IV drugs, shortness of breath, heroin, systolic murmur at lower R sternal border, faint crackles in lungs, no other findings. Treated w/ antibiotics. Next step in management?

Answer 17

Echocardiogram (trans-esophageal if possible)

Question 18

Q fever - organism and source

Answer 18

• Coxiella burnetti
• Aerosolized animal fluids
• Obligate intracellular proteobacteria
• Dairy, cattle, sheep, goats

Question 19

Acute Q fever - presentation

Answer 19

Headache, fever, joint pain, GI issues, atypical pneumonia

Question 20

Chronic Q fever - issue?

Answer 20

Endocarditis

Question 21

Diagnosis of Q fever

Answer 21

Serologic PCR

Question 22

When to give prophylactic antibiotics for endocarditis?

Answer 22

• Prosthetic valve, previous endocarditis, Ht transplant, congenital defects)

AND

• Going for dental procedure, tonsillectomy, adenoidectomy, or surgery on infected skin

Question 23

Standard prophylactic medication

If allergic to penicillin?

Answer 23

Amoxicillin

Clindamycin

Question 24

Most common gram negative endocarditis (besides in IV drug users)

Answer 24

HACEK organisms (Haemophilus, actinobacillus, cardiobacterium, eikenella, kingella)

Question 25

Culture-negative endocarditis

Answer 25

HACEK organisms

Question 26

Treatments for gram positive endocarditis

Answer 26

Strep - Penicillin G

Staph - Nafcillin

Question 27

3 main causes of myocarditis

Answer 27

• Coxsackie viruses
• Trypanosomes (Chaga’s disease)
• Borrelia (Lyme disease)

Question 28

Retrosternal chest pain that radiates to neck and L shoulder, cough and difficulty swallowing, night sweats, positive PPD, elevated CBC

Answer 28

Acute pericarditis - secondary to TB

Question 29

Persistent ST elevation in all leads

Answer 29

Pericarditis

Question 30

Most common infectious cause of pericarditis

Answer 30

Coxsackie viruses, many others