Mehl. endocarditis 03-15 (1)

Question 1

Acute endocarditis. definition?

Answer 1

Bacterial infection of valve in patient with no previous heart valve problem

Question 2

SUBacute endocarditis. definition?

Answer 2

Bacterial infection of valve in patient WITH HISTORY of valve abnormality (ie congenital bicuspid aortic vale, Hx of rheumatic heart disease)

Question 3

Acute endocarditis. M/o?

Answer 3

S. aureus

Question 4

Acute endocarditis. Valves affected?

Answer 4

Left sided heart - mitral and aortic.
These affected because of greater pressure changes (ie from high to low) within left heart, resulting in turbulence that enables seeding.

Question 5

Acute endocarditis. What valves in i/v drug users?

Answer 5

Vegetations on tricuspid

Question 6

SUBacute endocarditis. Mos?

Answer 6

Strep. viridans.

It can be broken down into: S. sanguinis, S. mutans, S mitis.

Question 7

SUBacute endocarditis. Hx of what?

Answer 7

Hx of dental procedure is HY precipitating event, due to inoculation of blood occurs via oral cavity —> previously normal valves get infected.

Question 8

Random points. CP combination of two?

Answer 8

New-onset murmur + fever = endocarditis until proven othervise

Question 9

Random points. What CBC finding?

Answer 9

Reactive thrombocytosis can occur due to infection.

Not specific for endocarditis

Question 10

Random points. Why hematuria can occur?

Answer 10

vegetations launch off –> goes to kidney –> hematuria

Question 11

Random points. Endocarditis + stoke like episode (ie focal neurologic sign) =?

Answer 11

SEPTIC EMBOLUS that launched off to brain

Question 12

Random points. Janeway lesions, osler nodes, splinter hemorrhages = low yield for USMLE

Answer 12

.

Question 13

Random points. HACEK - nonexistent on USMLE

Answer 13

.

Question 14

Mx. FIRST STEP?

Answer 14

BLOOD CULTURE

Question 15

Mx. SECOND STEP?

Answer 15

after culture –> ANTIBIOTICS

Question 16

What confirms diagnosis after blood cultures?

Answer 16

TRANSESOPHAGEAL ECho (TEE)

TTE - NOT DONE FOR ENDOCARDITIS

Question 17

Empiric Tx for 2CK?

Answer 17

Vancomycin + Gentamicin or ampicilin/sulbactam

Question 18

What targets vancomycin?

Answer 18

gram positive (including MRSA)

Question 19

What targets gentamicin?

Answer 19

gram negative

Question 20

what prophylaxis is given prior dental procedure?

Answer 20

Ampicilin
OR
second generation cephalosporin (eg cefoxitin)

Question 21

Indications for prophylaxis? 4

Answer 21

Hx of endocarditis
Prosthetic material in the heart
Any congenital cyanotic heart disease that has not been completely repaired (if repaired with prosthetics = give prophylaxis)
Hx of heart transplant with valvular regurgitation or any kind

Question 22

Highest yield point regarding regurgitation + prophylaxis?

Answer 22

Mitral valve prolapse (MVP) and valve regurgitation or stenoses ARE NOT INDICATION for prophylaxis.

in other words: do not give prophylaxis if the patient had MVP, MR, AS etc

Bicuspid aortic valve is NOT and indication

Question 23

Mehl. Rheumatic heart disease (rheumatic fever) HY points. Mos?

Answer 23

Strep pyogenes (Group A Strep) oropharyngeal infection results in production of antibodies against S. pyogenes’ M-protein that cross-react with the mitral valve (i.e., molecular mimicry; type II hypersensitivity)

Question 24

Mehl. Rheumatic heart disease (rheumatic fever). Valves?

Answer 24

Can occur with the aortic valve in theory, but on USMLE, it is always mitral valve.

Question 25

Mehl. Rheumatic heart disease (rheumatic fever). valve changes?

Answer 25

Results in mitral regurgitation acutely and mitral stenosis late, as discussed earlier.

Question 26

Mehl. Rheumatic heart disease (rheumatic fever). CP?

Answer 26

Presents as JONES (J©NES):Joints (polyarthritis), © Carditis, subcutaneous Nodules, Erythema marginatum (annular, serpent-like rash), Sydenham chorea (autoimmune basal ganglia dysfunction that results in dance-like movements of the limbs)

Question 27

Mehl. Rheumatic heart disease (rheumatic fever). Cutaneous Group A Strep infections?

Answer 27

don’t cause rheumatic fever, but can still cause PSGN.

Question 28

Mehl. Rheumatic heart disease (rheumatic fever). Tx?

Answer 28

penicillin.