NBME 10 99, 165 + NBME 11 127 endocarditis Flashcards
NBME 10 99Q. 17-y/o + intellectual disorder + temp. 37.8°C, pulse 110/min, RR 22/min, BP 120/70 mm Hg. Examination shows splinter hemorrhages under the nails. A grade 2/6 systolic murmur is heard best at the upper left sternal border. There is a systolic ejection click. S1 and S2 are normal. Abdominal examination shows splenomegaly. Hb 9,1; leu 30k; plt 928; ESR 110; Urine blood 2+; protein 1+. NEXT STEP? —> 2nd step?
BLOOD CULTURE —-> GIVE ANTIBTIOTICS
NBME 10 99Q. Bacterial endocarditis is rare in children indicates what pathology?
Underlying congenital heart disease, rheumatic heart disease, or central venous catheter use.
NBME 10 99Q.
Bacterial endocarditis.
Patients may also develop reactive thrombocytosis and congestive splenomegaly.
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NBME 10 99Q. Bacterial endocarditis. Common complication?
Septic emboli
NBME 10 99Q.
Bacterial endocarditis.
In children with underlying heart disease - mos?
Gram-positive organisms are most common and include Staphylococcus aureus and Viridans group Streptococci.
NBME 10 99Q.
Bacterial endocarditis. what need to do to evaluate underlying disease?
Echocardiography should be performed to evaluate for underlying heart disease and the possible need for valvular surgery to eliminate the underlying source of infection.
TTE!!!!!
TEE netinka
NBME 11 127Q.
67y/o + dental procedure + had aortic valve replacement; He had an episode of hives several years ago after treatment with penicillin. Examination shows a grade 2/6, systolic ejection murmur; no gallops are heard. Most appropriate antibiotic for prophylaxis?
Macrolides (eg, clarithromycin) can be used in patients that are allergic to penicillins.
NBME 11 127Q. prophylaxis if no allergy to penicillins?
Amoxicillin is the most commonly prescribed antibiotic for bacterial endocarditis prophylaxis.
NBME 11 127Q. prophylaxis if cannot take oral amoxicillin?
ampicillin
NBME 11 127Q. prophylaxis - why not vancomycin?
Vanco is for Tx, no prohyplaxis
NBME 11 127Q. also mehlman rase kad second-generation cephalo can be used for prophylaxis (eg cefoxitin)
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NBME 11 127Q.
Cardiac features include: prosthetic heart valves (as in this patient), prosthetic valve repair material, prior infective endocarditis, unrepaired congenital cyanotic heart disease, or repaired cyanotic heart disease with residual shunts or valvular regurgitation near prosthetic material, repaired congenital defects with a catheter-based intervention (for the first 6 months after the procedure), and valvular regurgitation in a heart transplant recipient.
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NBME 10 165Q.
A 37-year-old woman comes to the physician for endocarditis prophylaxis prior to undergoing tooth extraction. The patient reports mouth pain but otherwise feels well. Two years ago, echocardiography showed mitral valve prolapse and trace mitral regurgitation. She has no other history of serious illness and takes no medications. Vital signs are within normal limits. Cardiac examination shows a normal S and S ;
there is no S or S , and no murmurs are heard. Which of the following is the most appropriate oral antibiotic 34
prophylaxis prior to this patient’s dental procedure?
No antibiotic prophylaxis is indicated
No antibiotic prophylaxis is indicated in this patient with mitral valve prolapse and no prior history of bacterial endocarditis who is about to undergo a dental procedure.
NBME 10 165Q.
Antibiotic prophylaxis with amoxicillin given as a single dose of 2 g thirty minutes prior to a dental procedure is only indicated for patients at the highest risk for severe complications from infective endocarditis.
NBME 10 165Q.
For patients unable to take amoxicillin because of an allergy, other alternatives include?4
vancomycin, azithromycin, clindamycin, or a cephalosporin.
NBME 10 165Q.
Patients who should receive prophylaxis include those with a prior history of endocarditis, patients with any type of prosthetic valve, and those with unrepaired congenital cyanotic heart disease. While rare, patients with valvular disease in a transplanted heart should also be given prophylaxis
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