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IV drug users are particularly susceptible for what kind of heart infection? What is the most likely causative organism for this infection?

Infectious endocarditis, Staph aureus

1

Somebody presents to your office with a low grade fever, general malaise and night sweats, weakness, anorexia, and back pain. Physical exam findings show a murmur, conjunctival petechiae, splinter hemorrhages, Roth's spots, and Janeway lesions. What is the most likely causative organism?

Streptococcus viridans

2

What are Roth's Spots?

Immunologic spots found in retinas

3

What are Janeway Lesions?

Septic microemboli found on the palms or soles

4

What are Osler's nodes?

Lesion on the pads of fingers or toes with immunologic histology

5

What are the five minor Duke criteria?

1. Predisposition (IV drug user, artificial valve/RHD)
2. Fever above 100.3F (38C)
3. Vascular phenomena (Arterial emboli, Janeway lesions)
4. Immunologic phenomena (Osler's nodes, Roth's spots, Rh factor)
5. Microbiological evidence not meeting major criterium

6

What are the two major Duke criteria?

1. Two positive cultures spaced apart
2. Evidence of endocardial involvement

7

What Duke criteria are needed for a endocarditis diagnosis?

2 Major criteria
1 Major, 3 minor
5 minor

8

What is the most common treatment for infectious endocarditis?

Peptidoglycan syth inhibitors
Penicillin G, Vancomycin, Ceftriaxone, Gentamicin, Ampicillin, Nafcillin,

9

A patient presents to your office with a low-grade fever and general flu-like symptoms. She complains of some chest pain and feels like she may be having a heart attack. What is the most likely diagnosis?

Myocarditis

10

What are the most likely causative agents of myocarditis?

Viruses
Coxsackie B and Adenovirus

11

A patient presents to your office with a high fever and chest pain that is significantly worse when swallowing and lying down. The patient has a very high HR and when auscultating the chest cavity you hear a rub with each heartbeat. What are the most likely causitive organisms?

Fever? Bacterial.
Staph aureus
Strep pneumo
H. flu
Neisseria meningitidis

12

What are the most common viral causes of pericarditis?

Coxsackie (A and B)
Echovirus
Influenza

13

What is the first thing you should do for a pericarditis?

Pericardiocentesis

14

A patient comes in complaining of a sickness that began with a fever, vomiting and abdominal pain. Soon afterward they got a rash developing distally and spreading to the trunk. What is the most likely causative organism and what is the best treatment option?

Ricketsia ricketsii
Doxycycline

15

What does Ricketsia rickettsii infect in the body?

endothelial cells