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CRRAB I Week 1 > PBL Case 1 > Flashcards

PBL Case 1 Flashcards

1
Q

MOA Ceftriaxone:

A
  • Inhibits cell wall synthesis

- Binds to penicillin binding proteins, inhibiting peptidoglycan synthesis

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2
Q

MOA Vancomycin:

A
  • Inhibits cell wall synthesis
  • Forms H bonds w/ D-alanyl-D-alanine moiety of the NAM/NAG peptide, which normally forms the backbone of the bacterial cell wall
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3
Q

MOA Penicillin G:

A
  • Inhibits cell wall synthesis

- Beta-lactam ring binds to DD-transpeptidase inhibiting cross-linking & remodeling of peptidoglycan

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4
Q

MOA tPA:

A
  • Can cause hemorrhagic conversion

- Converts plasminogen to plasmin which breaks up clots

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5
Q

What are the most common organisms that cause acute endocarditis?

A
  1. Staph. aureus

2. Strep. pyogenese

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6
Q

What are the most common organisms that cause subacute endocarditis?

A
  1. Streptococcal species (viridians)

2. Enterococci

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7
Q

What is the most common endocarditis cause in IV drug users?

A

Staph. aureus

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8
Q

Describe the normal flow of blood through the cardiac chambers and normal function of the four cardiac valves:

A
  1. Blood enters the right atrium from superior and inferior vena cavae.
  2. Blood in right atrium flows through right AV valve (tricuspid) into right ventricle.
  3. Contraction of right ventricle forces pulmonary valve open.
  4. Blood flows through pulmonary valve into pulmonary trunk
  5. Blood is distributed by right and left pulmonary arteries to the lungs, where it unloads CO2 and loads O2.
  6. Blood returns from lungs via pulmonary veins to left atrium.
  7. Blood in left atrium flows through left AV valve (mitral/bicuspid) into left ventricle.
  8. Contraction of left ventricle (simultaneous with step 3) forces aortic valve open
  9. Blood flows through aortic valve into ascending aorta.
  10. Blood in aorta is distributed to every organ in the body, where it unloads O2 and loads CO2.
  11. Blood returns to the heart via venae cave.
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9
Q

What are the virulence factors of Staph Aureus?

A
  • Biofilm formation
  • Protein A (binds Fc portion of IgG)
  • Coagulase - activates fibrinogen
  • Capsule
  • Adhesins
  • Pathogenicity Islands (Methicillin Resistance)
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10
Q

What are the virulence factors for Strep. viridians?

A

(strep. mutans)
- Needs some kind of damage for colonization event
- Makes Dextran for Glycolcalyx formation and surface adhesion proteins for colonization.

-M protein keeps bacteria from being phagocytosed and the complement-activation cascade

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11
Q

How does bacterial endocarditis cause a murmur?

A
  1. Colonization on the heart valve
  2. Mitral valve regurgitation
  3. Turbulent flow
  4. Murmur
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12
Q

ECHO (transthoracic echocardiogram)

A

Superior for imaging structures that are thin and highly mobile owing to its greater temporal resolution and the absence of partial volume effects

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13
Q

TEE (transesophageal echocardiography)

A
  1. Used when there is an inability to get clear imagine through standard ECHO
  2. TEE provides more detailed information on the size, shape and movement of heart muscle, the condition of aorta, how the heart valves are working and the quality of blood flow through the heart and arteries
  3. Done with a swallowed probe; more expensive, higher risk
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14
Q

Cardiovascular magnetic resonance (CMR):

A
  1. Has potential to visualize all parts of the valve (leaflets, chord tendineae, and papillary muscles) throughout the entire cardiac cycle. Congenitally abnormal valve leaflets (bicuspid), aberrant papillary muscles, etc. have all been reported by CMR.
  2. 2D echocardiography remains the primary approach for visualization of valve anatomy. But CMR is a reasonable alternative if ultrasound windows are poor.
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15
Q

What are the properties of S. mutans?

A 
Alpha hemolytic
Bacitracin resistant
Catalase - 
Cocci
Gram +
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16
Q

What are the properties of S. pyogenes?

A 
Beta hemolytic
Bacitracin sensitive
Catalase - 
Cocci
Gram +
17
Q

What is gamma hemolysis?

A

Doesn’t damage RBC at all, no color change

18
Q

What is alpha hemolysis?

A

Strep. Viridans

Partial degradation of RBCs, leads to color change/oxidation and turns surrounding area green

19
Q

What is beta hemolysis?

A

Group A strep (streptococcus pyogenese)

-Completely destroys RBCs

20
Q

Describe the relationship between endocarditis and stroke:

A

Vegetation (bacteria + fibrin mesh) break off from the valve and travel to other parts of the body, blocking blood flow.

  • Risk of embolization is highest during first week of therapy and in patients with mobile vegetations or vegetations >10 mm in diameter occurring on the mitral valve.
  • Endocarditis can also lead to hemorrhaging in the brain and other pats of the body via septic erosion of arterial walls!
21
Q

What is the overall stroke risk in patients with endocarditis?

A

9.1% in 12 months after diagnosis

22
Q

What is the MOA for tPA and Streptokinase?

A

tPA - converts plasminogen to plasmin which degrades fibrin clots
Streptokinase - biosynthetic form of tPA

23
Q

What are the benefits and risks of tPA and streptokinase?

A

Risks: intracranial hemorrhage within first 7 days after admin.
Benefits: inc. functional independence without affecting mortality at 3-6 months if given within 3 hours

24
Q

What are contraindications of tPA and streptokinase?

A

Suspected/confirmed endocarditis, intracranial hemorrhage on CT, clinical presentation suggests subarachnoid hemorrhage, neurological surgery, head trauma or stroke in past 3 months, uncontrolled hypertension, hx of intracranial hemorrhage, seizure at stroke onset, known arteriovenous malformation, neoplasm, aneurysm, abnormal blood glucose

25
Q

What evidence supports the genetic risk for development of rheumatic fever?

A

Monozygotic and dizygotic twin studies

26
Q

What differentiates PTSD from a generalized anxiety and/or cardiac symptoms?

A

Prior trauma

27
Q

How to differentiate between PTSD and generalized anxiety?

A

PTSD - traumatic situations outside the usual human experience
(gunshot wound, loss of children in traumatic way, refugee status)
-In our case, the length of symptoms being experienced rules out adjustment disorder

28
Q

What are the 6 traits of which you need 3 for generalized anxiety?

A

For GAD: General worry, and inability to control the worry. Need three/six for diagnosis:

  1. restlessness or feeling keyed up or on edge
  2. being easily fatigued
  3. difficulty concentrating or mind going blank
  4. irritability
  5. muscle tension
  6. sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
29
Q

Define generalized anxiety disorder:

A
  • Lasts more than 6 months unrelated to a specific person, situation or event
  • Associated with sleep disturbance, fatigue, GI disturbance, difficulty concentrating
30
Q

What is adjustment disorder?

A

Emotional symptoms (anxiety, depression) causing impairment following identifiable psychosocial stressor (e.g., divorce, illness) and lasting 6 months in presence of chronic stressor)

31
Q

What tests can be used to rule out heart problems when someone has anxiety?

A
  • EKG , bloodwork, echo, and stress test & holter monitor is enough to rule out significant heart problems
  • Ask patient if there is a triggering event, situation, emotional state
32
Q

What do you HAVE to do before giving prophylactic antibiotics?

A

Draw for blood cultures!!

33
Q

What is the tPA mechanism?

A
  • Plasminogen –> Plasmin
  • Plasmin degrades clot into FDPs (fibrin degradation products)
  • Ischemic stroke due to breaking off and lodging of vegetation. tPA likely most effective when vegetation has large number of platelets
  • tPA (alteplase) use is not agreed upon by professional societies and use is highly dependent on clinical situation, although some guidelines exist
  • generally not recommended bc so many patients hemorrhage

CRRAB I Week 1 (13 decks)

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