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8th > Chapter 155 - The Skin In Infective Endocarditis, Sepsis, Septic Shock, and DIC > Flashcards

Chapter 155 - The Skin In Infective Endocarditis, Sepsis, Septic Shock, and DIC Flashcards

1
Q

Most common cause of right sided infective endorcarditis

A

IV drug use

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2
Q

80% of cases of infective endocarditis

A

Staphylococcal
Streptococcal
Enterococcal

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3
Q

10th leading cause of death in US for all races and sexes at age 45 years and older

A

Sepsis

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4
Q

Most common consequence of sepsis due to systemic activation of coagulation cascade

A

Disseminated intravascular coagulation

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5
Q

Inflammation of endocardial lining of the heart (native or prosthetic, mural endocardium) and implanted material caused by infection from bacteria or fungus

A

Infective endorcarditis

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6
Q

The MC clinical presentation of IE include

A

Fever

Cardiac murmur

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7
Q

IE patients with skin manifestations had higher rates of cerebral emboli with increased mortality.
True or False

A

False, no increase mortality

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8
Q

More frequently associated with extra cerebral emboli

A

Janeway Lesions

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9
Q

1-2 mm red brown or black longitudinal streaks under nail plate result of small capillary vasculitis or from microemboli

A

Splinter hemorrhages

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10
Q

Painless, irregular, nonblanching, erythematous maculopapules that appear on palms and soles and last days to weeks

A

Janeway lesions

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11
Q

Painful red papulonodules with pale center on fingertips lasting days to weeks

A

Osler nodes

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12
Q

Osler nodes are painful due to

A

Glomus body involvement

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13
Q

Most concerning and severe complication of IE

A

Ischemic strokes

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14
Q

The MC cause of IE in high income countries for both naive and prosthetic valves

A

Staphylococcus aureus

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15
Q

Acc to modified Duke Criteria, a clinically definite case is

A

2 major
1 major + 3 minor
5 minor

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16
Q

Acc to modified Duke Criteria, a clinically suspicious case is

A

1 major and 1 minor

3 minor

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17
Q

Major criteria of modified duke criteria microbiologic

A

2 separate blood cultures positive for typical microorganism
OR
Persistently positive blood culture for typical microorganism
OR
Single positive blood culture for Coxiella burnetii or PHASE1 IgG Ab titer to C. Burnetii ratio greater than 1:500

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18
Q

Major criteria of modified duke criteria endocardial involvement

A

New valvular regurgitation
OR
Positive echocardiogram showing oscillating echogenic intracardiac mass at the site of endocardial injury, a periannular abscess, or new dehiscence of prosthetic valve

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19
Q

Minor criteria of modified duke criteria (5)

A

Predisposition to infective endocarditis
Fever
Vascular phenomena (osler nodes, roth spots)
Immune factors (+ RF or glomerulonephritis)
Serologic evidence of active infection not meeting major microbiologic criteria

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20
Q

Prosthetic valve endocarditis is classified as early in first ___ months after valve replacement

A

2

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21
Q

Early prosthetic valve endocarditis is caused by (2)

A

Coagulase negative streptococci

S. Aureus

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22
Q

Vegetations larger than ___ mm are associated with a greater embolic risk

A

10

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23
Q

Poor prognostic indicators (12)

A 
L sided
Vegetation > 10mm
Prosthetic
Old agDM
Immunossuppressed
Heart failure
Renal failure
Septic shock
Brain hemorrhage
MRSA/polymicrobial infections
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24
Q

Person with prosthetic valves have a ___% risk of developing Ie with 1 yr mortality rate of ___%

A

3-4%

50%

25
Q

MC COD

A

Cerebral embolic disease

Congestive heart failure

26
Q

Mx for IE

A

Strep and Staph:
long term parenteral penicillin G for 4-6 weeks
Enterococcal:
Ampicillin/Penicillin + Gentamicin/streptomycin

27
Q

Surgery should be avoided for ___ weeks if IE is complicated by hemorrhagic strokes of if cerebral damage is severe

A

3

28
Q

AHA recommends antibiotic prophylaxis for patients at increased risk of IE.
True or False

A

False, high risk of adverse outcome or procedure with contaminated wound or surgery on oral or nasal mucosa

29
Q

Life threatening organ dysfunction that results from dysregulated host response to infection

A

Sepsis

30
Q

Vasopressor therapy is required to maintain MAP of ___ mmHg or greater and serum lactate level greater than ___mmol/L persisting after fluid resuscitation in septic shock

A

65

2

31
Q

Erythroderma in septic patient suggests

A

TSS

32
Q

Patients with staphylococcal TSS are ___ likely to be erythrodermic and ___ likely to have positive blood culture than patients with streptococcal TSS

A

More

Less

33
Q

Finding of pustules in the skin if septic neonate is suggestive of ____ infection

A

Candidal

34
Q

Purpura in septic patients is suggestive of

A
  1. Oncology patient undergoing BM transplantation
  2. If immunocompromised, opportunistic fungal infection
    (Aspergillus, Fusarium, Candida)
35
Q

In immunosuppressed patients, ___ can cause cellulitis in setting of AIDS

A

Cryptococcus neoformans

36
Q

Patients with liver compromise can develop hemorrhagic bullous cellulitis from ____

A

Vibrio vulnificus

37
Q

Mortality rate exceeds ___% in those with V. Vulnificus sepsis

A

40

38
Q

qSOFA means

A

Quick sequential organ failure assessment

39
Q

qSOFA criteria

A
  1. Partial pressure arterial oxygen/ fraction of inspired oxygen
  2. Mean arterial pressure
  3. Platelet count
  4. Serum bilirubin (> 1.2 mg/dl)
  5. Glasgow coma scale score
  6. Urine output (<500 ml)
  7. Creatinine (> 1.2 mg/dl)
40
Q

SOFA scores greater than ___ are suggestive of a 10% mortality risk

A

2

41
Q

Hypotension in septic shock is most likely produced by (2)

A

COX 2

NO

42
Q

Strong and independent predictor of adverse outcomes in sepsis

A

Decreasing thrombocytopenia (below 150 x 109/L)

43
Q

Sepsis precedes sepric shock in ___% of patients

A

50

44
Q

Acc to Surviving Sepsis Campaign, improving blood volume, cellular hypoxia, and tissue and organ perfusion within the first ___ hours

A

6

45
Q

Defined as acquired reactive syndrome of consumptive hyper coagulation, insufficient anticoagulation, hemorrhage, systemic vascular inflammation, and endothelial dysfunction

A

Disseminated intravascular coagulation

46
Q

Most characteristic cutaneous finding in DIC

A

Diffuse noninflammatory retiform purpura

47
Q

Complications of DIC (3)

A

Amputation
Multiorgan failure
Death

48
Q

In DIC, coagulation is tissue factor dependent.

True or False

A

False, dependent

49
Q

Individuals with high levels of ___ are at hugher risk of mortality than DIC

A

PAI-1

Plasminogen activator inhibitor type I

50
Q

Independent predictor for organ failure and mortality

A

DIc

51
Q

Vaccination for (3) has been shown to decrease sepsis

A

H. Influenzae
S. Pneumoniae
N. Meningitidis

52
Q

Vasopressors should maintain MAP at ___ and serum lactate level at ___

A

65 mmHg

2mmol/L

53
Q

QSoFA scores greater than 2 are indicative of ___% mortality

A

10

54
Q

Necrotic soft tissue infections have higher mortality when associated with (4)

A

Hospital acquired
Older than 75 years old
Severe peripheral vascular disease coexistent sepsis/septic shock

55
Q

Erythematous papule that expands and eventually become a necrotic bulla

A

Ecthyma gangrenosum

56
Q

Treatment for staphylococcal or streptococcal IE

A

4-6 weeks parenteral antibiotics of penicillin derivative

57
Q

Treatment for Enterococcal IE

A

Ampicillin or Penicillin with Gentamicin or Streptomycin

58
Q

Decreases risk of death of Ie

A

Surgical intervention within 48 hours

Vegetations larger than 10mm

59
Q

DIC in neonatal period is suggestive of

A

Protein C /Protein S deficiency

8th (28 decks)

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