Pericarditis/Endocarditis

Question 1

What is the treatment for pericarditis

Answer 1

1. NSAIDs
2. Colchicine

If contraindicated for patient, glucocorticoids

Question 3

What is the most common cause of death in patients with endocarditis

Answer 3

Heart failure

Question 4

What position relieves the pain in pericarditis

Answer 4

Sitting up and leaning forward

Question 5

Diagnosis for endocarditis is based on what three things

Answer 5

1. Clinical manifestations
2. Blood cultures
3. Echo

Question 7

What are the non-cardiac risk factors for endocarditis

Answer 7

1. IV durg use
2. Indwelling intravenous catheter
3. Immunosuppression
4. Sental or surgical procedure
5. Being old

Question 8

What unique feature of endocarditis is the reason why a patient’s presenting complaint may not be centered around the heart, but rather on a body system affected by IE

Answer 8

Spectic emboli (vegetations) shower throughout the body

Question 10

Treatment for endocarditis

Answer 10

No acute symptoms = wait 3 days for blood culutre

Acute symptoms = vancomycin

Question 12

In the patient population that does not include healthcare workers and IV drug users, what are the most common pathogens associated with infectious endocarditis

Answer 12

Staphy aureus
Viridans Streptococci

Euqal proportions

Question 13

What is the most common indication for cardiac surgery in patient with infective endocarditis

Answer 13

Heart failure

Question 15

Which is more difficult to treat, endocarditis of native valve or prosthetic valve

Answer 15

Prosthetic valve - may require surgical replacement

Question 16

Dental procedures that require prophylaxis with abx only include these things:

Answer 16

Prosthetic heart valve
Prior infectious endocarditis
Congenital heart disease
Procedures on infected skin or MSK tissue

Question 17

What is Beck’s triad

Answer 17

Hypotension
Muffled heart sounds
JVD

Question 19

What is the definitive treatment for constrictive pericarditis

Answer 19

Pericardiectomy

Question 20

Which echo has a higher sensitivity for endocarditis

Answer 20

Transesophageal echo

Question 21

What are the cardiac risk factors associated with endocarditis

Answer 21

1. Prior infectious endocarditis
2. Prosthetic valve
3. Cardiac device
4. Valvular/congenital heart disease

Question 28

What is the MOST COMMON symptoms of infectious endocarditis

Answer 28

FEVER!

Especially if it is longer than a week

FEVER OF UNKNOWN ORIGIN

Question 30

Petechiae and splinter hemorrhages are cutaneous manifestations of:

Answer 30

Endocarditis

Question 31

How many patients with pericarditis have recurrent pericarditis

Answer 31

1/3

Question 32

What is a normal amount of ultrafiltrae of plasma in the pericardial sac

Answer 32

15-50mL

Question 35

You think your patient has pericarditis but you don’t hear that classic pericardial friction rub, a scratchy squeaky noise over the left sternal border. Can you rule it out?

Answer 35

Nope, the pericardial friction rub can vary in intesity and can come and go

Question 36

Which pathogen is responsible for the majority of cases of healthcare- associated infectous endocarditis AND IE in IV drug users

Answer 36

Staph aureus

Question 37

What are osler nodes

Answer 37

Tender subcutaemous violaceous nodules pads of fingers and toes

Endocarditis

Question 39

What is the name of the triad assocaited with cardiac tamponade

Answer 39

Beck’s triad

Question 40

What are Janeway lesions?

What are they associated with

Answer 40

Non-tender erythematous macules, palms and soles

Endocarditis

Question 41

Why are glucocorticoids not a first line treatment for pericarditits

Answer 41

Because they can cause recurrent pericarditis

Question 42

What are Roth spots What are they associated with

Answer 42

Exudative, edematous hemorrhagic lesions of the retina with pale centers Endocarditis

Question 43

How do you take blood cultures for infective endocarditis

Answer 43

At least three sets Separate venipuncture sites Spaced over 30-60 minutes

Question 45

Where does the pain radiate in pericarditis

Answer 45

Tricccccck it doesn’t!

Question 48

Janeway lesions are more common in acute or subacute endocarditis

Answer 48

Acute

Question 49

Osler nodes are more common in acute or subacute endocarditis

Answer 49

Subacute

Question 51

What labs can you order for pericarditis that are sensitive and specific?

Answer 51

None! You can order troponin, ESR, CRP, and CBCN but none of them are sensitive nor specific

Question 53

What physical exam findings occur is most cases of infectious endocarditis (85%)

Answer 53

Cardiac murmurs

Question 54

What is the traetment for cardiac tamponade

Answer 54

Cardiac tamponade DEMANDS PERICARDIOCENTESIS or SURGERY

Question 55

The majority (60%) of patient with pericarditis will have an associated :

Answer 55

Pericardial effusion

Question 56

What does pleuritic mean

Answer 56

Worse when you take a deep breath

Question 62

If the etiology of pericarditis needs to be delineated (because its lasting a long time) what tests can you order to help you determine the cause

Answer 62

1. TB test 2. ANA (rheum stuff) 3. HIV serology 4. Chest CT (effusion) 5. MRI

Question 63

What type of chest pain is associated with pericarditis

Answer 63

SHARP, PLEURITIC

Question 66

How do you describe a pericardial friction rub

Answer 66

Scratchy or squeaking heart sound

Question 70

In western countries, what is the most common etiology of pericarditis

Answer 70

Viral

Question 72

Which viruses are most common for causing pericarditis

Answer 72

Coxsackievirus and influenza