Infectious Endocarditis - Dubin Flashcards Preview

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Flashcards in Infectious Endocarditis - Dubin Deck (30):
1

Fever, decreased breath sounds, heart murmur at R sternal border (decrescendo-diastolic), IV drug user, frequent STIs, elevated sed rate, high WBCs, positive PPD. Nodular infiltrates b/l on x-ray.

R-sided infectious endocarditis (via IV drug use)

2

Cause of nodular infiltrates

Septic emboli via tricuspid valve

3

CD4

PCP pneumonia

4

Most likely organism of R-sided infectious endocarditis

Staph. aureus

5

Acute vs. subacute bacterial endocarditis

Subacute = L side, slow onset, systemic symptoms, STREP
Acute = R side, fast onset, lung symptoms, STAPH

6

5 predispositions to infective endocarditis

- Prosthetic valves
- Implantable devices
- Parenteral nutrition tube
- Congenital heart disease
- Previous endocarditis

7

Night sweats are characteristic of ____

TB

8

Clues on physical exam to endocarditis

NEW murmur or CHANGING murmur

9

Lab findings common w/ L-sided endocarditis

Anemia (more likely to be chronic), Hematuria

10

Increased sed rate - meaning

Some immunologic/inflammatory process is occurring

11

Classic manifestations of infective endocarditis (5)

- Osler nodes (painful, pads of fingers and toes)
- Janeway lesions (painless, palms and soles)
- Slit hemorrhages (under nail beds)
- Roth spots (retinal infarcts, center is pale)
- Conjunctival hemorrhages

12

Dental procedure --> ___-sided endocarditis

Organism?

Left

Strep (viridans)

13

Lower bowel or prostate surgery --> endocarditis

Organism?

Enterococcus fecalis

14

Major Jones Criteria for Acute Rheumatic Fever (5)

1. Carditis
2. Polyarthritis
3. Sydenham's Chorea
4. Erythema marginatum
5. Subcutaneous nodules

15

Minor Jones Criteria for Acute Rheumatic Fever (5)

1. Fever
2. Arthralga
3. Previous rheumatic fever or heart disease
4. Acute phase reactants
5. Prolonged P-R interval on EKG

16

Evidences of previous strep. infection (4)

- ASO or other antibodies
- Throat culture for group A
- Group A carb. antigen test
- Recent scarlet fever

17

IV drugs, shortness of breath, heroin, systolic murmur at lower R sternal border, faint crackles in lungs, no other findings. Treated w/ antibiotics. Next step in management?

Echocardiogram (trans-esophageal if possible)

18

Q fever - organism and source

- Coxiella burnetti
- Aerosolized animal fluids
- Obligate intracellular proteobacteria
- Dairy, cattle, sheep, goats

19

Acute Q fever - presentation

Headache, fever, joint pain, GI issues, atypical pneumonia

20

Chronic Q fever - issue?

Endocarditis

21

Diagnosis of Q fever

Serologic PCR

22

When to give prophylactic antibiotics for endocarditis?

- Prosthetic valve, previous endocarditis, Ht transplant, congenital defects)

AND

- Going for dental procedure, tonsillectomy, adenoidectomy, or surgery on infected skin

23

Standard prophylactic medication

If allergic to penicillin?

Amoxicillin

Clindamycin

24

Most common gram negative endocarditis (besides in IV drug users)

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

25

Culture-negative endocarditis

HACEK organisms

26

Treatments for gram positive endocarditis

Strep - Penicillin G
Staph - Nafcillin

27

3 main causes of myocarditis

- Coxsackie viruses
- Trypanosomes (Chaga's disease)
- Borrelia (Lyme disease)

28

Retrosternal chest pain that radiates to neck and L shoulder, cough and difficulty swallowing, night sweats, positive PPD, elevated CBC

Acute pericarditis - secondary to TB

29

Persistent ST elevation in all leads

Pericarditis

30

Most common infectious cause of pericarditis

Coxsackie viruses, many others