PBL Medicine- Purnuske Flashcards
Describe physical exam findings associated with septic emboli
Petechial rash Septic emboli (PE, stroke) Roth’s spots Splinter Hemorrhages under the fingernails
What is the mechanism of action ceftriaxone?
Binds penicillin binding proteins (transpeptidase) and inhibits peptidoglycan synthesis Gram + and - organisms Bactericidal Less susceptible to penicillinases
MOA of penicillin G?
IV/IM form Binds to pbp (transpeptidase) preventing it from cross-linking peptidoglycan Gram + sensitive to B-lactamases
Define penetrance
the percentage of individuals with given genotype who exhibit the phenotype associated
What are symptoms of endocarditis?
FROM JANE Fever Roth Spots Osler’s Nodes Murmur Janeway Lesions Anemia Nailbed hemmorhages Emboli (septic)
Chest Pain Heart failure Abnormal heart rhythms “flu-like” illness
Myocarditis
What bugs causes Myocarditis?
Coxsachievirus B Adenovirus
Chest Pain Tachycardia 3-COMPONENT FRICTION RUB EKG Changes
Pericarditis
What bugs cause pericarditis?
COX A and B Echovirus Influenza
Rank the most common organisms that cause endocarditis?
Staph aureus Strep Viridans Enterococus Species Strep pyogenes
Which pathogen is associated with IV drug use?
Staph
What do pathogenicity islands usually contain?
Methicillin resistance
Where does strep viridans normally reside? Is it normal flora?
Yes, in the oral cavity
What bug is a common cause of endocarditis after GI or OB procedure?
Enterococcus Species
Describe the pathophysiology and relationship between bacterial endocarditis and heart murmurs?
Colonization of mitral valve –> mitral valve regurgitation –> turbulent flow –> murmur
What are the disadvantages of using TEE to visualize heart valves?
Swallowed probe More expensive Higher risk
Describe the relationship between endocarditis and stroke
- Vegetation (clumps of bacteria + mesh of fibrin) can break off the valve and travel to other parts of the body, blocking flow
- Risk of embolization is the highest during the first week of therapy, and in patients with mobile vegetations or >10 mm in diameter occurin on the mitral valve
- Endocarditis can also lead to hemorrhaging in the brain and other parts of the body via septic erosion of arterial walls
- Overalll, stroke risk in patients with endocarditis is 9.1% in the 12 months after diagnosis
What is the mechanism for tPA? Risks? Benefits? Contraindications?
Converts plasminogen to plasmin which degrades fibrin clots
Benefits = increase functional independence without affecting mortality at 3-6 months if given with in 3 hours
Risks= intracranial hemorrhage within the first 7 days after administration
Contraindications = suspected/confirmed endocarditis, intracranial hemmorhage, neuro surgery, head trauma, stroke in past 3 months, uncontrolled hypertension
What is the difference between stable and unstable angina?
Stable angina = chest pain that arises with exertion or emotional stress
Unstable = chest pain that occurs at rest
What is prinzmetal angina?
episodic chest pain unrelated to exerction
Due to coronary artery vasospasm