INFECTIVE ENDOCARDITIS | from PART 1 (AB)

Question 1

What is infective endocarditis (IE) often a complication of?

Answer 1

Congenital or acquired heart diseases

Question 2

In the absence of congenital heart disease (CHD)

Answer 2

what is a common risk factor for IE?

Question 3

What percentage of pediatric IE cases occur without structural heart disease?

Answer 3

8% to 10%

Question 4

What factors are commonly associated with IE in adults and adolescents?

Answer 4

IV drug use and degenerative heart disease

Question 5

What are common etiologic agents for native valve endocarditis after dental procedures?

Answer 5

Viridans group Streptococci

Question 6

Which pathogen can be diagnostic of IE if found in even one culture?

Answer 6

Coxiella burnetii

Question 7

Which bacteria are associated with prosthetic valve endocarditis?

Answer 7

Staphylococcus epidermidis

Question 8

What initial process usually triggers infective endocarditis?

Answer 8

Turbulent blood flow

Question 9

What cardiac conditions can lead to endothelial trauma predisposing to IE?

Answer 9

PDA

Question 10

What forms on damaged endothelium that serves as a nidus for bacterial growth?

Answer 10

Non-bacterial thrombotic endocarditis (NBTE) and biofilm

Question 11

Why is good oral hygiene important for cardiac patients?

Answer 11

Reduces risk of transient bacteremia

Question 12

At what age should oral hygiene begin?

Answer 12

6 months

Question 13

What is the minimum recommended toothbrushing frequency for adults?

Answer 13

Twice a day

Question 14

What cardiac history is relevant in a patient with suspected IE?

Answer 14

CHD

Question 15

What are common preceding procedures linked to IE?

Answer 15

Dental

Question 16

What are the classic constitutional symptoms of IE?

Answer 16

Fever

Question 17

What are some embolic phenomena seen in IE?

Answer 17

Roth spots

Question 18

Where are Osler nodes located?

Answer 18

Palmar or plantar aspects of extremities

Question 19

How do Janeway lesions present?

Answer 19

Erythematous papular rash

Question 20

What new physical exam finding may suggest IE?

Answer 20

New or changing heart murmur

Question 21

What is a common sign of IE affecting the spleen?

Answer 21

Splenomegaly

Question 22

What types of metastatic infections may complicate IE?

Answer 22

Meningitis

Question 23

What are common laboratory findings in IE?

Answer 23

Positive blood cultures

Question 24

What are classic immune-related lab findings in IE?

Answer 24

Rheumatoid factor

Question 25

What are classic findings on echocardiogram in IE?

Answer 25

Vegetations

Question 26

What are the major Duke criteria for diagnosing IE?

Answer 26

Positive blood cultures and evidence of endocardial involvement

Question 27

How many major and minor criteria are needed for a definitive IE diagnosis?

Answer 27

2 major OR 1 major + 3 minor OR 5 minor

Question 28

What findings are required for a pathologic diagnosis of IE?

Answer 28

Microorganisms in vegetation

Question 29

How is "possible" infective endocarditis defined?

Answer 29

1 major + 1 minor OR 3 minor criteria

Question 30

What are reasons to reject an IE diagnosis?

Answer 30

Alternative diagnosis

Question 31

What bacteria must be found in 2 separate cultures to meet a major Duke criterion?

Answer 31

Viridans streptococci

Question 32

What is the minimum time interval for blood cultures in persistent bacteremia for IE?

Answer 32

≥12 hours apart OR ≥1 hour apart for 3 out of 4 cultures

Question 33

What echocardiographic findings meet major Duke criteria?

Answer 33

Oscillating mass

Question 34

What minor Duke criteria relate to the patient's background?

Answer 34

Predisposing heart condition or IV drug use

Question 35

What minor Duke criteria relate to clinical findings?

Answer 35

Fever >38°C

Question 36

What lab finding meets a minor Duke criterion?

Answer 36

Positive blood culture not meeting major criteria

Question 37

What is the mortality rate for infective endocarditis?

Answer 37

20% to 25%

Question 38

What are common complications of IE?

Answer 38

Heart failure

Question 39

What is the first-line antibiotic treatment for native valve endocarditis?

Answer 39

Penicillin G Sodium or Ceftriaxone PLUS Gentamicin

Question 40

What antibiotic can be used if Pen G or Ceftriaxone is not tolerated in native valve endocarditis?

Answer 40

Vancomycin

Question 41

What is the first-line treatment for staphylococcal IE without prosthetic valve?

Answer 41

Nafcillin or Oxacillin PLUS Gentamicin

Question 42

What if the patient is allergic to penicillin for staphylococcal IE?

Answer 42

Vancomycin

Question 43

What echocardiographic findings in IE require surgery?

Answer 43

Persistent vegetation

Question 44

What valvular dysfunction requires surgery in IE?

Answer 44

Acute aortic or mitral insufficiency with heart failure

Question 45

What perivalvular complications indicate need for surgery in IE?

Answer 45

Abscess

Question 46

Which cardiac conditions have highest risk for adverse IE outcomes?

Answer 46

Prosthetic valves

Question 47

In what situation is dental prophylaxis for IE no longer needed after 6 months?

Answer 47

Completely repaired CHD with no residual defect