Infective Endocarditis

Question 1

microbial infection of heart valve, lining of a cardiac chamber or blood vessel, or a congenital anomaly (e.g. septal defect).

Answer 1

Infective endocarditis

Question 2

Infective endocarditis may affect

Answer 2

Both Prosthetic and native valve

Question 3

What cause Infective endocarditis

Answer 3

usually a bacterium

Question 4

Other causes of Infective endocarditis

Answer 4

rickettsia, chlamydia or fungus

Question 5

What are the bacteria which may cause Infective endocarditis

Answer 5

streptococci or staphylococci

Question 6

avascular valve tissue and presence of fibrin and platelet aggregates , help to

Answer 6

protect proliferating organisms from host defense mechanisms.

Question 7

Extracardiac manifestations such as ……. (2)
Due to ………….

Answer 7

vasculitis and skin lesions

emboli or immune complex deposition

Question 8

Morbidity and mortality in Infective endocarditis are

Answer 8

higher

Question 9

What is the division of Infective endocarditis based on onset and duration of symptoms before diagnosis
(3)

Answer 9

Acute bacterial endocarditis (ABE)

Subacute bacterial endocarditis(SBE)

Question 10

Refers to an abrupt onset of symptoms (infective endocarditis)

Answer 10

Acute bacterial endocarditis (ABE)

Question 11

Insidious, evolves over several weeks or months (infective endocarditis)

Question 12

Embolic events are common

Answer 12

Acute bacterial endocarditis (ABE)

Question 13

cardiac or renal failure may develop rapidly

Answer 13

Acute bacterial endocarditis (ABE)

Question 14

should be suspected when a patient with congenital or valvular heart disease develops:

Persistent fever, Night sweats, Complains of unusual tiredness, Weight loss, and Develops new signs of valve dysfunction or heart failure.

Answer 14

Subacute bacterial endocarditis(SBE)

Question 15

Congenital heart defects

Answer 15

Risk factor for infective endocarditis

Question 16

Artificial heart valves

Answer 16

Risk factor for infective endocarditis

Question 17

History of endocarditis

Answer 17

Risk factor for infective endocarditis

Question 18

Damaged heart valves

Answer 18

Risk factor for infective endocarditis

Question 19

History of intravenous (IV) drug abuse

Answer 19

Risk factor for infective endocarditis

Question 20

Subacute bacterial endocarditis(SBE) should be suspected when a patient with congenital or valvular heart disease develops …………. (5)

Answer 20

Persistent fever
Night sweats
Complains of unusual tiredness
Weight loss
Develops new signs of valve dysfunction or heart failure

Question 21

malaise
confusion
weakness
Fever
weight loss

Answer 21

Non specific symptoms and signs

Question 22

Affects normal valves over days to weeks

Answer 22

Acute bacterial endocarditis (ABE)

Question 23

more likely due to Staphylococcus aureus which has much greater virulence

Answer 23

Acute bacterial endocarditis (ABE)

Question 24

presents as a severe febrile illness with prominent and changing heart murmurs and petechiae

Answer 24

Acute bacterial endocarditis (ABE)

Question 25

Clinical stigmata of chronic endocardia are usually absent

Answer 25

Acute bacterial endocarditis (ABE)

Question 26

Most of the patients of SBE have

Answer 26

murmur

Question 27

Purpura and petechial hemorrhages on the skin and mucous membrane

Answer 27

Sign of Infective Endocarditis

Question 28

Splinter hemorrhages under the fingernails or toe nails

Answer 28

Sign of Infective Endocarditis

Question 29

Osler's nodes are painful tender swellings at the fingertips

Answer 29

Sign of Infective Endocarditis due to vasculitis; they are rare.

Question 30

Janeway Lesions

Answer 30

Sign of Infective Endocarditis

Question 31

non tender small erythematous or hemorrhagic macule or nodular skin lseions on the palms or soles, only few millimeter in diameter

Answer 31

Janeway Lesions

Question 32

Digital clubbing

Answer 32

Sign of Infective Endocarditis late sign

Question 33

Roth spots

Answer 33

Sign of Infective Endocarditis

Question 34

Retinal hemorrhages with small, clear centers; immunological event, rare

Answer 34

Roth spots

Question 35

spleen is frequently palpable

Answer 35

Sign of Infective Endocarditis

Question 36

liver may be enlarged

Answer 36

Sign of Infective Endocarditis

Question 37

Microscopic hematuria

Answer 37

Sign of Infective Endocarditis common

Question 38

Embolic stroke or peripheral arterial embolism

Answer 38

Sign of Infective Endocarditis

Question 39

murmur

Answer 39

Sign of Infective Endocarditis

Question 40

Skin rashes typically consisting of multiple petechiae, often on the legs and conjunctivae , are due to

Answer 40

vasculitis

Question 41

Dark-red to brown or black , linear lesions on the nail

Answer 41

Subungual (splinter) haemorrhages Non specific

Question 42

Tender subcutaneous red spots under the skin of the fingers usually found on the distal pads of the digits

Answer 42

Osler nodes Rare Specific

Question 43

Nontender maculae on the palms and soles(vascular embolic event)

Answer 43

Janeway lesions Specific

Question 44

Flame-shaped retinal hemorrhages with a 'cotton-wool' centre result from septic emboli Similar appearances may occur in patients with anemia or leukemia

Answer 44

Roth’s spots Seen by fundiscopical examination

Question 45

(+) blood culture

Answer 45

Major criteria

Question 46

Endocardial involvement

Answer 46

Major criteria

Question 47

Typical organism from 2 cultures

Answer 47

Positive blood culture

Question 48

Persistent positive blood cultures taken > 12 hrs apart

Answer 48

Positive blood culture

Question 49

3 or more Positive cultures taken over > 1 hr

Answer 49

Positive blood culture

Question 50

Positive echocardiographic findings of vegetations

Answer 50

Endocardial involvement

Question 51

New valvular regurgitation

Answer 51

Endocardial involvement

Question 52

Predisposing valvular or cardiac abnormality

Answer 52

Minor criteria

Question 53

IV drug misuse

Answer 53

Minor criteria

Question 54

Pyrexia 38C or more

Answer 54

Minor criteria

Question 55

Embolic phenomenon

Answer 55

Minor criteria

Question 56

Vasculitic phenomenon

Answer 56

Minor criteria

Question 57

Blood cultures suggestive: organism grown but not achieving major criteria

Answer 57

Minor criteria

Question 58

Suggestive echocardiographic findings

Answer 58

Minor criteria

Question 59

2 major or 1 major + 3 minor or 5 minor

Answer 59

Definite endocarditis

Question 60

1 major + 3 minor or 3 minor

Answer 60

Possible endocarditis

Question 61

Surgical intervention

Answer 61

Management of endocarditis if there is valvular obstruction,fungal IE, myocardial abscess, unstable infected prosthetic valve

Question 62

Antibiotics: Penicillin/ gentamicin /vancomycin/amoxicillin

Answer 62

Management of endocarditis Choice of antibiotics depends on the organism/severity and sensitivity