ID of CV

Question 1

In a patient with subacute infective endocarditis, what lab and imaging should include in the work up?

Answer 1

Blood cultures x4 and TTE

Question 2

Staphylococcus epidermidis is implicated for subacute endocarditis. what tests would confirm staphylococus epidermidis?

Answer 2

• blood culture revealing G+ cocci in clusters
• catalase positive
• coagulase negative

Question 3

ABX prophylaxis is indicated for a patient who has had infective endocarditis or are at risk of endocarditis. what abx are used for patients who are allergic to penicillin?

Answer 3

Oral cephalexin hr before procedure

Question 4

What is the best empiric treatment for a patient with acute infective endocarditis?

Answer 4

Vancomysin and ceftriaxone

Question 5

In a patient with endocarditis, would their estimated sedimentation rate be elevated or decreased?

Answer 5

elevated

Question 6

what microorganism is associated dental procedure related endocarditis?

Answer 6

Streptococcus viridans

Question 7

Fever, decreased breath sounds, heart murmur at right sternal border (decrescendo-distolic), IV drug user, frequent STI, elelvated sedimentation rate, high WBCs, positive PPD, nodular infiltrates bilaterally on xray, all indicate _

Answer 7

R-sided infectious endocarditis (via IV drug use)

Question 8

The nodular infiltrates thats seen in lung fields in an pt with endocarditis is usually due to _

Answer 8

septic emboli via tricuspid valve

Question 9

The most likely organism of R-sided infectious endocarditis is _

Answer 9

Staph aureus

Question 10

Differentiate between acute and subacute endocarditis

Answer 10

1. Subacute = L side, slow onset, systemic symptoms, S. viridans, HACEK, enterococus are common causative agents.
2. Acute = R sided thus affects Tri > Bi > aorta > pulm. fast onset, HIGH fever,SOB, pleuritic chest pain symptoms. S. aureus common cause

Question 11

What are predispositions to infective endocarditis?

Answer 11

1. Prosthetic valves
2. implantable devices
3. Parenteral nutrition tube
4. Congenital heart disease(BAV, VSD, PDA, C of A)
5. Previous endocarditis
6. Structural heart disease
7. Valvular heart disease rheumatic, MVP, aortic valve)
8. Hemodialysis
9. HIV

Question 12

New murmur or changing murmur almost always indicates _

Answer 12

endocarditis

Question 13

Dental procedures –> _sided endocarditis and the likely organism involved is _

Answer 13

Left.

Strep viridans

Question 14

What are the major jone’s criteria for acute rheumatic fever?

Answer 14

1. Carditis
2. polyarthritis
3. sydenham’s chorea
4. Erythema marginatum
5. Subcutaneous nodules

Question 15

What the minor jones criteria for acute rheumatic fever?

Answer 15

1. Fever
2. arthralgia
3. previous rheumatic fever or heart disease
4. acute phase reactants
5. prolonged P-R interval on EKG

Question 16

When is prophylactic antibiotics for endocarditis indicated?

Answer 16

• prosthetic valve, previous endocarditis, Heart transplant, congenital defects
• going for dental procedure, tonsillectomy, adenoidectomy, or surgery on infected skin

Question 17

What is the standard prophylactic medication? what if pt is allergic to penicillin?

Answer 17

Amoxicillin (oral), ampicillin, cefazolin, or ceftriaxone (if unable to take oral)

If allergic to penicillin or ampicilin then clindamycin, cephalexin, azithromycin or clarithromycin

If allergic to penicillin/ampicillin and unable to take oral med then caphalexin, ceftrixone or clindamycin

Question 18

what are the most common gram negative endocarditis (besides in IV drug users)

Answer 18

HACEK organisms (Haemophilus, actinobacillus, cardiobaterium, eikenella, kingella)

Question 19

What are the common treatments for gram positive endocarditis?

Answer 19

Strep = penicillin G
Staph = Nafcillin

Question 20

what are the 3 main causes of myocarditis?

Answer 20

• Coxsackie B viruses
• Trypanosomas (Chagas disease)
• Borrelia (lyme disease)

Question 21

Pt presents with retrosternal chest pain that radiates to neck and L shoulder, cough and difficulty swallowing, night sweats, positive PPD, elevated CBC. what is the likely diagnosis?

Answer 21

• acute pericarditis secondary to TB

Question 22

The most common infectious cause of pericarditis?

Answer 22

• Coxsakie viruses (Also Echovirus and flu)

Question 23

In a patient with subacute endocarditis, what lab findings would support the diagnosis?

Answer 23

1. Hematuria
2. Proteinuria
3. Blood culture + for coxiella, and others
4. Increased ESR
5. retinal hemorrhages

Question 24

What’s needed to have met to diagnose IE according to Duke criteria?

Answer 24

One of the following

1. 2 major criteria
2. 1 major with 3 minor criteria
3. 5 minor criteria

Question 25

What's considered a major criteria according to the Duke's criteria for diagnosis of infective endocarditis?

Answer 25

1. Positive blood culture with an infecting microorganism | 2. Evidence of endocardial involvement via ECHO or signs or new valvular regurg

Question 26

What's considered a minor criteria according to the Duke's criteria for diagnosis of infective endocarditis?

Answer 26

1. Predisposition to IE such IV drug user, prosthetic valve etc 2. Fever 3. Vascular phenomena: emboli, infarcts, aneurysm, hemorrhage, janeway lesion 4. Immunologic phenomenon: glomerulonephritis, osler nodes, roth spots rhematoid factor 5. Microbiologic evidence: positive blood culture or serology titer that do not meet major criteria

Question 27

a 28 year old male with recent URI presents with substernal chest pain that radiates to B/L shoulders. the pain is central in nature with associated diaphoresis and ever. Cardiac auscultation reveals a friction rub. what is the most likely diagnosis? and what is the classification of the causative agent?

Answer 27

Acute Pericarditis due to a viral infection, most likely coxsakie B virus, a member of picornavirus which is classified as +ssRNA naked icosahedral virus

Question 28

Pleuritic chest pain can be relieved in what position?

Answer 28

Sitting upright and leaning forward

Question 29

What is the treatment for acute pericarditis?

Answer 29

high dose ASA (steroids) and colchicine

Question 30

What lab values can be monitored to ensure treatment effectiveness in a patient with acute pericarditis?

Answer 30

CRP (C-reactive protein)

Question 31

Aside from viral, what are some other causes of pericarditis?

Answer 31

- Chronic kidney failure with uremia - Neoplastic processes (hodgkin, mets, lymphomas) - Dressler - most MI - SLE - Drug induced (PCN, clozpine, minoxidil) - Radiation - S/P invasive cardiac procedure

Question 32

Inflammatory pericardial syndrome is diagnosed with at least 2 of which 4 criteria?

Answer 32

1. Pericarditic chest pain 2. Pericardial rubs 3. New widespread ST elevation or PR depression 4. pericardial effusion Others: CRP, ESR, WBC, CT, CMR