Endocarditis

Question 1

Infective Endocarditis is infection of?

Answer 1

cardiac valves and/or the endocardium

Question 2

vegetation ( result of Infective Endocarditis) is formed by

Answer 2

mass of thrombus, necrotic debris and micro-organisms

Question 3

Vegetation of IE is mostly on which side of the heart?

Answer 3

Left(on valve leaflets, mostly aortic and mitral valves.)

Question 4

Right IE is caused by(unusual)

Answer 4

IV drugs ( unsterile material use infects the blood which goes back from circulation to right side of heart)

Question 5

IE types and which one is more dangerous

Answer 5

1-Acute( more severe with 50% death )
2-subacute which can’t be treated but antibiotics

Question 6

Which organism causes IE

Answer 6

*ACUTE( High virulent staphylococcus)
*SUBACUTE(Low virulent hemolytic streptococcus)

Question 7

Which type of IE affects normal valves not just deformed

Answer 7

Acute

Question 8

Hematogenous infection is caused by?

Answer 8

*Intravenous drug abusers
*Previous dental, surgical or interventional procedure .

Question 9

Occult source of bacteremia

Answer 9

Small injuries to skin or mucosal surfaces.

Question 10

Risk Factors of IE

Answer 10

1Cardiac abnormalities
•.Prostheticheartvalves(10%to20%).
(Previous two referee to deformed valve mostly)
3.Intravenousdrugabusers

Question 11

Most common pathogen causing IE

Answer 11

-Hemolytic (viridans) streptococci (50-60%)
*attacks deformed valves(subacute)

Question 12

Major cause of IE in drug abuse

Answer 12

Staphylococcus aureus (10-20%)
attacks healthy or deformed valves(acute)

Question 13

Which organism infects prosthetic valves

Answer 13

Coagulase-negative staphylococci (S.epidermidis)

Question 14

Percent of culture-negative endocarditis

Answer 14

10% No organism is isolated from the blood

Question 15

Gross of vegetation in IE

Answer 15

Friable,bulky,and potentially
destructive
* may lead to embolism

Question 16

What is (ring abscess)

Answer 16

When vegetation erodes into the underlying myocardium to produce an abscess cavity

Question 17

Abscesses development at the sites where emboli lodge leads to

Answer 17

septic infarcts and mycotic aneurysms.

Question 18

most consistent sign of IE

Answer 18

Fever ( cause it’s infection)

Question 19

Clinical sign present in 90% of patients with left- sided lesions

Answer 19

Murmur

Question 20

Diagnosis of IE is done through

Answer 20

Positive blood cultures and echocardiographic findings.

Question 21

Microemboli ( sign of IE)can give rise to:

Answer 21

-Petechia
- Nail bed (splinter) hemorrhages
-Retinalhemorrhages(Rothspots)
- Painless palm or sole erythematous lesions (Janeway lesions)
- Painful fingertip nodules (Osler nodes)

Question 22

Complications of IE

Answer 22

• Glomerulonephritis
• Arrhythmias
• Systemic embolization

Question 23

Deposition in Nonbacterial Thrombotic Endocarditis consists of?

Answer 23

•Deposition of small (1 to 5 mm in diameter) thrombotic masses composed mainly of fibrin and platelets on previously normal cardiac valves.

Question 24

Marantic endocarditis definition

Answer 24

Nonbacterial Thrombotic Endocarditis subtype that Occur in a wide variety of diseases associated with general wasting disease ( like cancer)

Question 25

usual precursor of NBTE

Answer 25

Hypercoagulable states

Question 26

The difference in emboli between IE and NBTE

Answer 26

In IE it’s septic ( more dangerous cause it froms abscess)

Question 27

Thrombotic vegetation location is described as

Answer 27

Nearly complete row of thrombotic vegetations along the line of closure of the mitral valve leaflets.

Question 28

When Systemic lupus erythematoses ( autoimmune diseases) affects heart valve it results in which disease

Answer 28

Libman-Sacks Endocarditis

Question 29

Location of vegetation in LSE

Answer 29

Canoccuranywhereonthevalve surface, on the cords, or even on the atrial or ventricular endocardium

Question 30

Vegetation in rheumatic heart disease morphology:

Answer 30

row of small vegetations along the lines of closure of the valve leaflets.

Question 31

Vegetation morphology in IE

Answer 31

large, irregular masses on the valve cusps that extend onto the cords.

Question 32

Majority of myocarditis cases are caused by

Answer 32

Coxsackieviruses A and B and other enteroviruses.

Question 33

Can myocarditis be caused by influenza virus?

Answer 33

Yes

Question 34

None viral myocarditis is caused by

Answer 34

1-protozoan Trypanosoma cruzi 2-Toxoplasma gondii 3-Trichinosis 4-Borrelia burgdorferi (bacterial spirochete)

Question 35

Borrelia burgdorferi (bacterial spirochete) causes which disease

Answer 35

Lyme

Question 36

the most common helminthic disease with associated cardiac involvement is

Answer 36

Trichinosis

Question 37

protozoan Trypanosoma cruzi is the agent of

Answer 37

Chagas disease.

Question 38

Noninfectious causes of myocarditis:

Answer 38

-Lesions associated with systemic diseases of immune origin: systemic lupus erythematosus and polymyositis. -Drug hypersensitivity reactions(hypersensitivity myocarditis)-eosinophilia is noticed

Question 39

Hypersensitivity myocarditis under microscope looks like

Answer 39

Interstitial and perivascular infiltrates composed of high proportion of eosinophils.

Question 40

- Chagas myocarditis under microscope

Answer 40

Intracellular organisms (Trypanosoma cruzi) inside a myocyte • Accompanied by an inflammatory infiltrate of neutrophils, lymphocytes, macrophages, and occasional eosinophils

Question 41

Morphology of inflammatory involvement in myocarditis

Answer 41

Patchy

Question 42

End result of surviving acute myocarditis

Answer 42

lesions can resolve without significant sequelae or heal by progressive fibrosis.

Question 43

Heart appearance in myocarditis

Answer 43

Normal or dilated

Question 44

Edema, myocyte injury,diffuse lymphocytic infiltrate Are seen in

Answer 44

Active myocarditis

Question 45

In hypersensitivity myocarditis the Interstitial and perivascular infiltrates composed of

Answer 45

high proportion of eosinophils.

Question 46

Which microorganism is seen in chags myocarditis

Answer 46

Intracellular organisms (Trypanosoma cruzi) inside a myocyte *** Accompanied by an inflammatory infiltrate of neutrophils, lymphocytes, macrophages, and occasional eosinophils