OSCE - Endocarditis

Question 1

Patient with fever, tachycardia, raised CRP, WCC and trop has a seizure, what Ix would you do?

Answer 1

CT head
MRI head and spine - vasculitis
LP - men/encephalopathy

TTE - ischaemia ECG

Auto-antibodies for vasculitis
ESR

Question 2

What type of echo is best for endocarditis

Answer 2

TOE

Sensitivity 90% (TTE 50%)

Question 3

Problems with TOE

Answer 3

Invasive - needs sedation or anaesthesia

Risk of aspiration

Risk of oesophageal repute 1:3000

Gastric injury

ET tube displace

Question 4

Scoring system for IE and criteria

Answer 4

Dukes or modified Dukes

There are major and minor criteria

Diagnosis is:

2 major

1 major plus 3 minor

5 minor

Question 5

Major criteria

Answer 5

Positive Blood Culture
Two separate BCs with a typical IE organism (Viridians/aureus)

Echo indicating IE
Mass on valve
Intra cardiac abscess
Prosthetic valve dysruption

Question 6

Minor Criteria

Answer 6

Fever > 38C

IVDU or pre-existin cardiac lesion

BC and echo, could be IE, but not precise major

Immuno signs - Janeways, Oilers, Splinters

Vasculitic signs