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Cardiology Internal Med. > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

What is infective endo carditis?

A

Presence of vegetations on the valves due to microbial colonisations, these vegetations are friable and can cause emboli.

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2
Q

List the tendancy of vegetations in endocarditis from highest to lowest?

A

Infective endocarditis
NOn bacterial thrombotic endocarditis
Rheumatic heart fever
Libmann sachs endocarditis

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3
Q

Which condition has the highest tendency for vegetations?

A

Infective endocarditis

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4
Q

Which condition has the lowest tendency to develop vegetations?

A

Libmann sachs endocarditis (SLE)

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5
Q

Small vegetations are seen in which condition?

A

Rheumatic fever and NBTE

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6
Q

Small to medium vegetations are seen in which condition?

A

Libmann sachs endocarditis

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7
Q

Large vegetations are seen in which condition?

A

Infective endocarditis

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8
Q

In which condition vegetations can be seen near angle of closure of valves?

A

Rheumatic fever and NBTE

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9
Q

What is the location of vegetations in libmann sachs endocarditis?

A

Both upper and lower sides of valves

But mostly lower

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10
Q

What is location of vegetations in infective endocarditis?

A

Both upper and lower sides of the valves

But mostly upper

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11
Q

Verocous and warty texture is seen which conditions?

A 
Rheumatic fever 
Libmann sachs (DORLANDs Vegetations)
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12
Q

Irregular texture is seen in which condition?

A

Infective endocarditis

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13
Q

In which all conditions do you see NBTE

A

Cancer
Pro-myelolytic leukaemia
High estrogenic states

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14
Q

Firm vegetations are seen in which condition?

A

Rheumatic heart fever

Libmann sachs endocarditis

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15
Q

Destruction of valves occurs in which conditions?

A

Libmann sachs endocarditis

Infective endocarditis

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16
Q

Most friable vegetations are seen in which condition?

A

Infective endocarditis

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17
Q

Which all conditions have sterile vegetations?

A

Rheumatic heart fever
NBTE
Libmann sachs

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18
Q

Emboli due to vegetations occurs in which conditions?

A

NBTE

Infective endocarditis

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19
Q

Most common valves affected in libmann sachs endocarditis are?

A

Tricuspid and mitral valves

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20
Q

Most common affected valves in NBTE?

A

Mitral valve

Aortic and tricuspid are less often

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21
Q

Most common affected valves in rheumatic heart fever?

A

Mitral and aortic valves

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22
Q

Most common organism to cause infective endocarditis?

A

Staph aureus

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23
Q

Least common organism to cause infective endocarditis?

A

Salmonella typhi

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24
Q

List all organisms that cause infective endocarditis?

A 
Staph aureus 
Strep. Viridans
Strep. Epidermidis
Pseudomonas
Enterococci
Salmonella typhi
HACEK GROUP
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25
Q

Name organism in HACEK GROUP

A 
Hemophillus
Agragatibacter
Cardiobacterium
Ekinella
Kingella
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26
Q

Name a condition that is caused by staph aureus, is highly virulent and occurs in native valve?

A

Acute infective endocarditis

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27
Q

Name a condition that occurs due to streptococci, low virulent and occurs mostly in previously affected valves?

A

Subacute infective endocarditis

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28
Q

Give etiology of infective endocarditis of IV drug abusers?

A

Candida and staph aureus

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29
Q

A patient is diagnosed with infective endocarditis and history tells you that he got prosthetic valves 8 months prior to consult. What is the organism.

A

Strep. Epidermidis(<12 months of prosthetic valve replacement)

30
Q

A patient is diagnosed with infective endocarditis and history tells you that he got prosthetic valves 2 years prior to consult. What is the organism.

A

Strep Viridans(>12 months of prosthetic valve replacement)

31
Q

Absence of murmurs occurs in which type of infective endocarditis?

A

Infective endocarditis of IV drug abuse

32
Q

Most common etiology of Hospital acquired I.E?

A

Staph aureus

33
Q

Most common etiology of community acquired I.E?

A

Streptococci

34
Q

Most common etiology in I.E with abcess formation

A

Staph. Aureus

35
Q

Most common etiology of prosthetic valve endocarditis?

A

Strep. Epidermidis

36
Q

Which organism causes Austrian syndrome

A

Strep pneumoniae

37
Q

What is triad of Austrian syndrome?

A

Oslers triad

  • meningitis
  • I.E
  • pneumonia
38
Q

Name all the high risk lesions for I.E

A 
MR
AS
AR
Coarctation of aorta 
Tetralogy of fallot
PDA
VSD
39
Q

Name the low risk lesion for I.E

A

ASD

Mitral valve prolapse without MR

40
Q

Name the moderate risk lesion for I.E?

A

PS
MS
TS
Mitral valve prolapse with MR

41
Q

List the symptoms of I.E?

A
  1. chills, malaise, anorexia, weight loss, back pain,
  2. High grade fever , splenomegaly, digital infarction, emobism
  3. Janeway lesions(painless)
  4. Roth spots
  5. Oslers nodes(painful)
  6. Murmurs
42
Q

What are the lab test results for I.E?

A 
Anemia 
Leukocytosis
Rheumatoid factors +
2/3 cultures positive (all done 1 hour apart)
ESR &amp; CRP elevated
43
Q

Which diagnostic criteria is used for I.E?

A

Dukes criteria

44
Q

List major criterias of Duke’s criteria?

A

2/3 cultures positive

Involvement of valvular lesions

45
Q

List minor criteria of Duke’s

A

Fever

Predisposing cardiac lesions

Positive blood culture (but not meeting major criteria)

VASCULAR phenomenon (janeway lesion, pulmonary infarct,mycotic aneurysm, intracranial haemorrhage)

IMMUNOLOGICAL henomenon( oslers nodes,roth spots,glomerulonephritis)

46
Q

Confirmed diagnosis of I.E if

A

2 major
1 major + 3 minor
5 minor

47
Q

What are valvular complications of I.E

A

Valvular insufficiency
Valvular stenosis
Valvular perforations

48
Q

What are the mural complications of IE

A

Abcess formation

Pericarditis(due to abcess spread)

49
Q

What is complications associated with aorta in IE?

A

Perforations of aorta

50
Q

In case of IE in patient with prosthetic valves. Which procedure is necessary?

A

Tracheoesophageal cardiography

51
Q

Pencillin susceptible streptococci treatment?

A
  1. Penicillin G/ ceftriaxone / vancomycin-for 4 weeks

2. Gentamicin for 2 weeks

52
Q

Relatively Penicillin resistant streptococci treatment?

A
  1. Penicillin G/ ceftriaxone for 4 weeks.
  2. Gentamicin for 2 weeks.
  3. vancomycin for 4 weeks.
53
Q

Organism Moderate resistant to penicillin treatment ?

A
  1. Penicillin G/ceftriaxone for 6 weeks
  2. Gentamicin for 6 weeks
  3. Vancomycin for 4 weeks
54
Q

Treatment for enterococci

A

Penicillin/ampicillin/vancomycin
Gentamicin
(BOTH FOR 4 TO 6 WEEKS)

55
Q

Treatment for MSSA(methicillin susceptible staph aureus)

A
  1. Nafcillin/oxacillin/flucoxacillin

2. Cefazolin/vancomycin

56
Q

Treatment for MRSA infecting native valves

A

Vancomycin

57
Q

Treatment for MRSA infecting prosthetic valves

A

Vancomycin
Gentamicin
Rifampicin

58
Q

Treatment for MSSA infecting Prosthetic valves?

A

Nifacilin/oxacillin/flucoxacillin(6-8 weeks)

Gentamycin(2 weeks)

59
Q

HACEK group treatment?

A

Ceftriaxone 2g/day IV
Or give ampicillin or sublactam

All for 4 weeks

60
Q

Doxycycline can be given for which organism

A

Coxella burmetti and bartonella species.

61
Q

For batonella species what treatment is given

A

Doxycycline/ampicillin/ceftriaxone

Gentamicin

62
Q

For coxiella burmetti what is the treatment?

A

Doxycycline

63
Q

Indication for surgical treatment in IE?

A 
Aortic valve endocarditis 
Prosthetic valve endocarditis 
Fungal endocarditis 
Presence of valve ring abscess
Failiure of medical treatment 
Very large vegetations that can cause emboli
64
Q

What is the etiology of fungal endocarditis

A

Candida and aspergillosis

65
Q

Medical and surgical treatment for fungal endocarditis?

A

Medical- Amphotericin B & Flucytosine

Surgical - Radical surgical debridement

66
Q

Most commonly affect population with fungal endocarditis

A

People with prosthetic valves or immune compromised

67
Q

A Patient with prosthetic valve and infective endocarditis is undergoing another surgery. What prophylaxis drug will you suggest.

A

Amoxicillin
Clindamycin/cefalexin/clarithromycin (if allergic to amoxicillin)
Gentamycin(if gram -ve organism)

68
Q

Cardiac high ridk lesions where amoxicillin prophylaxis is requir

A 
Prosthetic valves endocarditis 
Prior bacterial endocarditis 
Cyanotic congenital heart disease 
PDA
Coarctation of aorta
69
Q

Cardiac moderate risk lesions where amoxicillin prophylaxis is required?

A 
Hypertrophic cardiomyopathy 
MR
AR
Bicuspid aortic valve
VSD
Mitral valve prolapse
70
Q

Low risk cardiac lesions where amoxicillin prophylaxis is required

A

Presence of cardiac pacemaker, fibrillators
CABG
ASD
Physiological and functional murmurs

Cardiology Internal Med. (10 decks)

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