ICM -- Infective Endocarditis

Question 1

Risk factors for Infective Endocarditis?

Answer 1

IVDA
Poor Dental Hygiene
Dialysis/Indwelling Catheter
Diabetes
Prosthetic Valves

Question 2

What is infective endocarditis?

Answer 2

A microbial infection of the endocardium of the heart

Inner lining, chordae tendinae, valves

Question 3

What organisms cause IE?

Answer 3

Staph aureus (G+, slow clearing)
Coag negative staph (saph. epi) (Early prosthetic valve IE)
Streptococci (mutans, sanguis, bovis)

Question 4

Someone gets strep bovis – what do you do

Answer 4

Colonoscopy

Question 5

Uncommon infections leading to IE

Answer 5

Haemophillus
Actinobacillus
Cardiobacterium hominis
Eikenella
Kingella kingae
(enterococci, fungi, coxiella)

Question 6

Signs and symptoms of IE?

Answer 6

FEVER + MURMUR
Weight Loss, Fatigue
Heart Failure
Night Sweats
Skin Petechiae or Conunctival hemorrhages
Splinter hemorrhages
Osler Nodes
janeway lesions

Question 7

What are osler nodes?

Answer 7

Painful, swollen subcutaneous nodules on the pulp of the fingers and toes

Question 8

What are Janeway lesions?

Answer 8

Nontender nodules on the palms of the soles

Question 9

Janeway vs. Osler. Location?

Answer 9

J – Soles/Palms/Plantar Surfaces

O – Finger and toe tips, thenar/hypothenar eminences

Question 10

Janeway vs. Osler. Size and Shape

Answer 10

J – Macules of variable size/shape

O – 1mm or greaer

Question 11

Janeway vs. Osler. Tender?

Answer 11

Just Osler

Question 12

Janeway vs. Osler. Course?

Answer 12

J – Days to weeks

O – Hours to days

Question 13

Janeway vs. Osler. Type of Endocarditis?

Answer 13

J – Acute

O – Subacute

Question 14

Janeway vs. Osler. Culture?

Answer 14

J – Positive

O – Negative

Question 15

Janeway vs. Osler. Histology?

Answer 15

J – Septic microemboli

O – Vasculitis

Question 16

Perivalvular abscess can cause…

Answer 16

Valve dysfunction
Heart Block
Stroke

Question 17

What do you use to diagnose IE?

Answer 17

The Modified Dukes Criteria

2 major, 1 major+3 minor, 5 minor

Question 18

Major criteria for IE diagnosis

Answer 18

1. Lab evidence (2+ blood cultures, 1 for cox)
2. Endocardial involvement (Echocardiogram)
3. New valvular regurgitation

Question 19

Minor criteria for IE diagnosis

Answer 19

Predisposing Heart Condition
Fever
Vascular phenomenon
Immunologic Phenomenon
Positive Blood Culture (not from one of the major causes)

Question 20

Examples of vascular phenomenon associated with IE?

Answer 20

Emboli (Janeway), Mycotic Aneurysm, Hemorrhageshi

Question 21

Examples of immunologic phenomenon associated with IE?

Answer 21

Glomerulonephritis, Osler Nodes, Rh factor

Question 22

How do you treat IE before you know about sensitivity?

Answer 22

Vancomycin plus Aminoglycoside

Question 23

How do you treat IE after you know about sensitivity?

Answer 23

PCN sens – PCN or Ampicillin + Aminoglycoside
PCN insens – Vancomycin + Aminoglycoside
2-6 Weeks IV antibiotics

Question 24

Do you use anticoagulation treatments for endocarditis?

Answer 24

Nope

Question 25

Defining symptom of pericarditis

Answer 25

Chest Pain

Question 26

Defining characteristic of carcinoid syndrome patients

Answer 26

Flushed

Question 27

The best first test for a potential endocarditis patient

Answer 27

Blood cultures

Question 28

Which endocarditis patient should get a transesophageal echo?

Answer 28

Ones with a prosthetic valve

Question 29

Name for the retinal hemorrhages associated with endocarditis?

Answer 29

Roth Spots

Question 30

Which murmurs increase with inspiration?

Answer 30

Right side of heart

Question 31

Septic emboli in the lung + IE is associated with

Answer 31

IV drug use

Question 32

Best step to take for an IE patient following blood cultures?

Answer 32

Start antibiotics

Question 33

What is Red Man Syndrome? What do you do about it?

Answer 33

Reddness and flushing at the neck line occuring after treatment with vancomycin caused by histamine release from mast cells. Treat by decreasing the rate of infusion.

Question 34

Equation for sensitivity

Answer 34

(True Positives) / (TP + False Negatives)

Question 35

Equation for specificity?

Answer 35

True Positives / (TP+False Positives)

Question 36

Alcoholic homeless flea bitten people are associated with what infection?

Answer 36

Bartonella

Question 37

Indications for IE prophylaxis?

Answer 37

``` Prosthetic Valve Heart Transplant Recipient Previous endocarditis Cyanotic Heart Disease PLUS: Dental Work (w/bleeding) or tonsillectomy. ```

Question 38

How do you modify treatment if the infection is in a prosthetic valve?

Answer 38

Add rifampin