infective endocarditis OSPE

Question 1

case

Answer 1

old
2 weeks fever
splinter haemorrhages
non-tender erythematous macules on soles(janeway lesion)
systolic murmur
increase CRP
echocardiography:vegetations on mitral valve

Question 2

modified Duke’s criteria

Answer 2

1) 2 major
2)1 major +3 minor
3) 5 minor

Question 3

major criteria

Answer 3

1.positive blood culture
2. evidence of endocardial involvement

Question 3

AUTOMATED BLOOD CULTURE MEDIA

Answer 3

BACTEC
Bact/ALERT

Question 3

sample

Answer 3

blood culture
1) 2 BC SETS (0-12 HRS)
2) 3 BC SETS OVER 1 HR(0-30-60 MIN)

Question 3

minor criteria

Answer 3

1.fever
2.vascular phenomena:splinter haemorrhage,Janeway lesion
3.immunologic phenomena:oslers node,roth’s spots
4.Lab findings:increased ESR/CRP,Hematuria,Leucocytosis

Question 4

SUB-CULTURING POSITIVE BC

Answer 4

on BloodA and MAC

Question 5

MICROSCOPY

Answer 5

GPC in clusters

Question 6

Culture

Answer 6

nutrient agar:large,opaque,golden yellow
blood agar: beta haemolytic

Question 7

biochem

Answer 7

catalase positive
coagulase positive

Question 8

AST

Answer 8

Kirby Bauer method:Zone of inhibition
Automated (VITEK): MIC

Question 9

ACUTE IE

Answer 9

S.aureus
strep.pneumoniae
Enterobacteriaceae
P.aeruginosa

Question 10

SUBACUTE IE

Answer 10

Viridans strep
Coagulase negative Strep(s.epidermidis

Question 11

CHRONIC IE

Answer 11

coxiella burnetii
brucella spp.

Question 12

ENDOCARDITIS IN IVDU

Answer 12

s.aureus
s.epidermidis
Enterococci
Pseudomonas spp
Candida spp

Question 13

proesthetic valce endocarditis

Answer 13

early: CoNS,s.aureus
late: Viridans streptococci

Question 14

predisposing factors

Answer 14

pre-existing heart disease:rheumatic valvular heart disease,Congenital HD

-Prosthetic valve
-uses of intravascular devices
-IVDU