Conrad Fischer 3 Flashcards
(79 cards)
What is the first step in management in an IV drug user with suspected acute endocarditis?
Blood cultures and IV antibiotics. Antibiotics BEFORE waiting for results of culture or getting echo
Which antibiotics should be used in suspected acute endocarditis?
Empiric therapy should be vancomycin and gentamicin due to synergistic effect
What is “red man syndrome?”
Possible histamine mediated response to rapid infusion of vancomycin
What is the best next step if a patient on vancomycin develops “red man syndrome?”
Decrease rate of infusion. Total dose need not be decreased. Antihistamines and corticosteroids are not necessary.
Which type of anemia can be present in infectious endocarditis?
Anemia of chronic disease
What happens to complement levels in endocarditis?
Low complement levels are associated with endocarditis. There are circulating immune complexes and activation of the immune system
What is the next step when a patient’s blood culture is positive for Streptococcus bovis?
Colonoscopy. Strep bovis is HIGHLY associated with colonic pathology (cancer, polyps, and diverticulosis)
What should be added to therapy of endocarditis in individuals with prosthetic valves?
Rifampin. Helps with tissue penetration
What is the best next study in suspected endocarditis if a transthoracic echo is negative?
Transesophageal echo
Under what conditions would a transesophageal echo be indicated first (instead of transthoracic)?
In patients with prosthetic valves
What organism is associated with endocarditis in homeless, flea bitten, patients?
Bartonella
Which organism is associated with drinking unpasteurized milk?
Brucella
What type of prophylaxis is necessary prior to colonoscopy?
None
What are the indications for endocarditis prophylaxis?
Patients with prosthetic valves, uncorrected cyanotic heart disease, previous endocarditis, or heart transplantation who are going to undergo dental procedures with bleeding or oral surgery
What type of endocarditis prophylaxis is necessary in a patient with aortic stenosis undergoing dental work?
None. ONLY if they have one of the criteria (prosthetic valves, uncorrected cyanotic heart disease, previous endocarditis, or heart transplant)
What antibiotic(s) should be used when prophylaxis for endocarditis is indicated?
Oral amoxicillin. If allergic, use clindamycin
What is the typical presentation of giardiasis?
Flatus/bloating in patient with history of camping/hiking
Which skin lesions are associated with IBD?
Erythema nodosum and pyoderma gangrenosum
What skin condition is associated with celiac disease?
10% of patients will have dermatitis herpetiformis
What is erythema nodosum?
Idiopathic inflammation of the subcutaneous tissue resulting in tender, reddish brown lesions of the legs
What is erysipelas?
Acute streptococcal infection of the deep epidermis with lymphatic . Usually Group A Strep
Which skin lesion in IBD corresponds to the level of disease activity?
Erythema nodosum. Pyoderma gangrenosum does NOT correspond to disease activity
What is pterygium?
Outgrowing from the conjunctiva due to irritation. Can be replaced with amniotic transplant
Which ophthalmological findings are seen in IBD?
Iritis and uveitis. Debris from inflammation of the iris floats up and gets stuck on the back of the cornea
