Module 3 Exam 2 Flashcards
(117 cards)
1
Q
What is infective endocarditis previously referred to?
A
bacterial endocarditis
2
Q
What may cause bacterial endocarditis?
A
bacteria, but fungi and other microorganisms may also cause the infection therefore that is why its called infective endocarditis
3
Q
What is the current classification of IE based on?
A
- causeative organism
- type of valve infected
- source of infection
4
Q
Wht are the causeative organism classifications of IE?
A
- streptococcal endocarditis
- staphylcoccal endocarditis
- candida endocarditis
5
Q
What are the types of valves infected classifications of IE?
A
- native valve endocarditis (NVE)- original valves
- prosthetic valve endocarditis (PVE)
6
Q
What are the sources of infection in classificate of IE?
A
community
hospital
IVDUs
7
Q
What kind of bacteria accounts for 80-90% of IE cases?
A
streptococci and staphylocci
8
Q
What is Viridians Streptococci?
A
it is an alpha hemolytic streptococci
9
Q
What are constituents of the normal oral flora and GI tract?
A
Viridians streptococci/alpha hemolytic streptococci
10
Q
waht is the most common cause of community aquired NVE?
A
Viridians streptococci/alpha-hemolytic streptococci
11
Q
What is Staphylcocci Aureus?
A
the most common pathogen in IV drug users, nonvalvular infections
12
Q
Is staph aureus a consistuent of oral flora?
A
No
13
Q
Why do we premedicate?
A
if a person gets an IE dental work from several months ago can be blamed
14
Q
Wha tis the most common underlying cause of IE?
A
mitral valve prolapse
15
Q
What are risk factors of IE?
A
- cardiac abnormalities
- IV drug users
- compromised immune system
- infections from poor OH or oral tissue trauma
16
Q
What kind of cardiac abnormalities are risk factors of IE?
A
- heart valve damage via rheumatic fever
- congenital heart defects
- prosthetic heart valves
- ateriosclerosis
17
Q
What kind of risk are IV drug users put at for IE?
A
30% within 2 years of drug use
18
Q
Why is the oral environment a perfect place for bacteria?
A
- its at or near body temperature
- moist
- nutrient rich
- anaerobic
19
Q
What is mitral valve stenosis caused by?
A
Chronic Rheumatic Heart Disease
20
Q
What happens in chronic rheumatic heart disease?
A
- valve fails to open properly
- fibrous thickening of valve leaflets/stiff-rigid
21
Q
What is calcific aortic stenosis?
A
- 3 leaflets
- causes heart to work harder
22
Q
What is a calcific aortic stenosis?
A
valsalva sinus
23
Q
what is valsalva sinus?
A
anatomic dilation of ascending aorta superior to the aortic valve
24
Q
What is mitral valve prolapse?
A
one or both leaflets fail to close properly
25
What happens when the leaflets in mitral valve prolapse fail to close?
- regurgitation into the left ventricle
| - happens during contraction (systole)
26
What can a mitral valve prolapse result in?
a murmer
27
what is a murmer
an audible sound produced as a result of turbulent blood flow
28
What causes valve insufficency?
- familial/nonfamilial
- infection
- calcification
- Tissue degeneration (can be due to age)
29
What are valve problems caused by secondary to the other listed conditions?
- rheumatic heart disease
- coronary artery disease
- congenital conditions
30
What is the cause of rheumatic heart disease?
Rheumatic Fever an Strep pharyngitis
31
What are characteristics of rheumatics fever?
fever, tender joints, chest pain, dyspnea/fatigue, skin rash
32
What are characteristics of Strep Pharyngitis?
- acute sore throat
- pain on swallowing
- fever
- inflamed tonsils/throat
33
What do coronary arteries feed?
superficial part of the heart
34
What are the causes of coronary artery disease?
lack of exercise, smoking, alcohol, heredity, age, diet
35
What is the treatment in valve insufficency?
robotic or transcatheter surgery
36
what kind of valves are used in vavle replacement?
- mechanical valves
| - bioprosthetic valve (pig/cow)
37
What is an embolic lesion?
obstruction of a vessel
38
What are osler nodes associated with?
IE of strep origin
39
What are Osler Nodes?
small tender subcutaneous nodules on pads of fingers and toes
40
What are Janeway Leisons?
small, erythmatous, macular lesions, non tender on soles or palms
41
What are janeway leisons associated with?
Infective Endocarditis (staphylcoccus areus)
42
What are immune complex vasulites?
Roth spots (eye), splinter hemorrhages (fingers), Clubbing of fingers
43
what is clubbing of fingers associated with?
IE and COPD
44
What is the mortality rate in pt's with IE who do not recieve antibiotic TX?
100%
45
What is the mortality rate in pt's with IE who recieve antibiotic TX?
10-70%
46
What is the average hospital stay duration in a person with IE?
4-6 weeks
47
How long does it take symptoms to appear in IE?
within 2 weeks
48
What are symptoms of IE?
fever, malaise, anemia, weekness, athralgia, muscle weekness, heart murmer
49
What to vegetative clusters of micro organisms lead to in IE?
emboli, diminished heart function
50
How do we manange IE in dental?
prevent IE from occuring
51
What can produce a transient bacteremia in dental treatment?
anything that causes injury to the soft tissue or bone resulting in bleeding
52
Have many cases of endocarditis have been associated with dental procedures?
very few
53
what should we do with HIV or immunocompromised patients?
premed
54
why is it so important for those susceptible to IE to keep mouth clean?
because tb and flossing can cause a bacteremia
55
what percent of patients who take penicillin wil have an allergic reaction?
5 to 10%
56
What are antibiotic complications?
resistant bacteria, allergic rxn, failure of antibiotic to protect, improper coverage
57
What is the most recommended antiobiotic?
Amoxicillin
58
REVIEW RECOMMENDATIONS ON PG 76 and DENTAL DRUG BOOKLET of antibiotics
ok
59
What is prescribed as a premed if there is no allergy to penicillin?
amoxicillin
60
what is prescribed as a premed is there is an allergy to penicillin?
Clindamycin
61
What is a general description of rheumatic fever?
childhood disease- most before age 20
62
What is rheumatic fever caused by?
beta-hemolytic group A streptococcus
63
What is the pathophysiology of rheumatic fever?
- beleived to be immune related
| - bacterial by products sensitize connective tissue stimulating antibody production
64
What are clinical findings of Rheumatic fever?
```
carditis
polyarthritis
erythema marginatum
chorea
fever
malaise
```
65
What is carditis in RF?
abnormal murmer resulting from dilation of the valvular ring, destruction of valvular tissue, contraction of chorae tendineae
66
What valve is affected the most in cardidis in RF?
mitral valve
67
What is polyarthritis in RF?
arthritis that occurs in 2 or more joints (usually large joints), develops rapidly, last 2-3 weeks.
68
What is erythema Marginatum in RF?
macule with diffuse redness, center fades, elevated edges
69
What is Chorea in RF?
twitching of voluntary muscles, does not occur at night
70
What is the medical management of RF?
prevention using antibiotics
71
Rheumatic heart disease only occurs from what?
Rheumatic Fever
72
What is Rheumatic Heart disease?
cardiac damage that results from an attack of rheumatic fever
73
What is damaged in rheumatic heart disease?
- mitral or aortic valve
- scarring and calcificaton
- stenosis or regurgitation
74
Rheumatic heart disease is what kind of disease?
a valvular disease
75
What is the most common pathophysiology of Rheumatic heart disease?
mitral stenosis
76
What are damaged valves susceptible to in rheumatic heart disease?
bacterial endocarditis
77
Is the turbulence in a heart murmer physiologic or pathologic?
can be both
78
What does a physiologic-innocent-functional heart murmer involve?
the viscosity of the blood, the velocity of the blood, and the volume of the blood
79
do you need to premed in a physiologic innocent-functional heart murmer
no
80
What is a pathologic heart murmer?
a murmer due to a specific cardiac condition such as previous endocarditis, prothetic heart valve, congenital cyanotic heart disease
81
Does a patient need to premed if they have a pathologic heart murmer?
We need to know more information than just the condition. They may need to premed
82
What does CHD stand for?
congenital heart disease
83
What is a transposition of the great arteries?
anatomic reversal of aorta and pulmonary artery
84
What is require to fix a transposition of the great arteries?
surgery requires shunting via arterial switiching, required in the first few weeks of life
85
The aorta exits the ______________ instead of the ________ and the pulmonary artery exits the __________ instead of the right in transposition of the great arteries
right ventricle, left left ventricle, right
86
What is the most common congential cardiac defect?
Tetrology of Fallot
87
What are characterisics of the tetrology of fallot?
- biventricular origin of teh aorta
- interventricular septum incomplete
- obstructed pulmonary blood flow
- right ventricular hypertrophy
- blue baby syndrome
88
Must you premed in some one who had the a tetrology of fallot?
yes
89
what tx is required in tetrology of fallot?
early diagnosis and surgical repair
90
what is ductus arteriosus?
fetal connection of the pulmonary artery to the aorta
91
What is necessary of the ductus arteriosus for the fetus?
necessary to allow blood to flow through the placenta where it is oxygenated
92
What is the tx for a ductus arteriosus?
surgery
93
Is premed required in a surgically repaired ductus arteriosus?
no
94
is premed required in a non surgically reparied ductus arteriosus?
yes
95
What is a ventricular septal defect?
a hole between ventricles cause by abnormal development of the interventricular septum, is common
96
Is surgical repar necessary for ventricular septal defects?
large ones are repaired, small ones spontaneously close by the age of 10
97
Do you premed in a patient with a ventricular septal defect?
no
98
What is an atrial septal defect?
hole caused by failure of the fetal foramen ovale to close off the two atria from one another
99
should you premed for an atrial septal defect?
no
100
What is coarctation of the aorta?
narrowing of the aortic arch
101
What does coarctation of the aorta result in?
left ventricular hypertrophy, hypertension which can lead to congestive heart failure, stroke, and atherosclerosis
102
Should you premed for a unrepaired coarctation of the aorta? repaired?
Yes, NO
103
What is the most common congenital abnormality?
Bicuspid aortic valve
104
What is a bicuspid aortic valve?
valve only has 2 leaflets instead of the usual 3
105
When were prosthetic valves started to be used?
in the 1960s
106
What are disease cardiac valves replaced by?
- mechanical devices
| - Tissue valves
107
What is PVE
prosthetic valve endocarditis
108
Pts with prosthetic valves are at_________ risk for IE
high
109
Should a patient with a prosthetic valve premed?
yes
110
What is a coronary artery bypass?
grafting procesdures to bypass blocked or narrowed coronary artery
111
Does a patient who had a coronary artery bypass need to premed?
after 6 mo NO premed
112
Do you need to premed for a pacemaker or implanted defibrillator?
first 6 mo- premed
| post 6 mo- consult
113
What is a noncoronary vascular graft?
- synthetic graft
| - replaces segments of major arteries, may have been caused by an aneurysm
114
Do you need to premed for a noncoronary vascular graft?
unclear, do a consult
115
What is Kawasaki Disease?
unknown etiology affecting japanses ethnicity general vasculitis
116
Do you premed in Kawasaki Disease?
-do a consult, proabable premed
117
Do you premed with prosthetic implants?
-advisory statement on whether or not to premed lies with the dentist, shoud premed for high risk pts
