INFECTIVE ENDOCARDITIS
RHEUMATIC FEVER
VALVULAR DISEASE
100
THIS VALVULAR ABNORMALITY IS THE MOST COMMON PREDISPOSING ABNORMALITY FOR IE IN DEVELOPED COUNTRIES
MITRAL VALVE PROLAPSE
CLASSICALLY, A VEGETATION WILL RESULT IN A STERILE THROMBUS UPON WHICH MICROORGANISMS ADHERE AND COLONIZE
100
COMPLICATION OF WHAT TYPE OF INFECTION
STREPTOCOCCAL PHARYNGITIS
ACUTE RHEUMATIC FEVER WILL DEVELOP 1-5 WEEKS AFTER INITIAL PHARYNGITIS
FEVER GENERALLY PRESENT DURING ACUTE PHASE OF ARF WITH ARTHRITIS, CARDITIS, CHOREA (RARELY), SUBCUTANEOUS NODULES, ERYTHEMA MARGINATUM (TRUNK AND PROXIMAL EXTREMITIES)
100
THE MOST COMMON COMPLICATION OF THIS MURMUR IS AFIB
MITRAL STENOSIS
WHY?
EXERCISE INTOLERANCE AND EXERTIONAL DYSPNEA ARE EARLY SYMPTOMS
PATIENTS WILL EVENTUALLY DEVELOP SIGNS OF HEART FAILURE
A LOUD S1 AND OPENING SNAP IN EARLY DIASTOLE ACCOMPANIED BY A LOW PITCHED RUMBLING DIASTOLIC MURMUR
200
TRUE/FALSE, MANY PATIENTS SEEN EARLY DURING THE BACTEREMIC PHASE OF ILLNESS DO NOT HAVE A CARDIAC MURMUR AND ARE INDISTINGUISHABLE FROM THE LARGE POPULATION OF PATIENTS WHO COME TO THE EMERGENCY DEPARTMENT WITH A FEBRILE VIRAL ILLNESS
TRUE
SYMPTOMS ARE NONSPECIFIC, MOST PATIENTS WILL COMPLAIN OF INTERMITTENT FEVERS AND MALAISE
CLASSIC TRIAD OF FEVER, ANEMIA AND HEART MURMUR IS RARE
200
THIS IS THE MOST COMMON MANIFESTATION OF ACUTE RHEUMATIC FEVER
MIGRATORY POLYARTHTRITIS
CLASSICALLY AFFECTS LARGE JOINTS: KNEES, ANKLES, ELBOW, WRIST
PAIN OUT OF PROPORTION TO EXAM
STERILE INFLAMMATORY SYNOVIAL FLUID IT TAPPED
200
IN THE ACUTE PHASE, THIS VALVULAR ABNORMALITY PRESENTS AS A "TRUE EMERGENCY". IT IS ALSO THE MOST COMMON VALVE ABNORMALITY WORLDWIDE. WHAT IS IT?
MITRAL REGURGITATION
MAY RESULT FROM RUPTURE OF THE CHORDAE TENDINEAE, PAPILLARY MUSCLE DYSFUNCTION DUE TO ISCHEMIA, OR VALVE LEAFLET PERF FROM ENDOCARDITIS OR TRAUMA
IN THE ACUTE PHASE PATIENT'S DEVELOP FULMINANT PULMONARY EDEMA AND CARDIOGENIC SHOCK
NEW HARSH, MIDSYSTOLIC MURMUR
WHAT WILL YOUR ED TREATMENT BE?
WHAT PRESSOR WOULD YOU USE?
IF SUSPECTED EMERGENT ECHO AND CATH IS INDICATED TO ASSESS THE URGENCY FOR SURGERY
300
SOME PATIENTS WILL HAVE COMPLICATIONS OF IE AS PRESENTING COMPLAINTS. THE MOST COMMON AND SEVERE ARE ____ AND ____
CHF AND NEUROLOGIC EVENTS
CONSIDER IE IN SETTING OF CVA SYMPTOMS AND FEVER
CVA MAY RESULT FROM SEPTIC EMBOLI OR RUPTURED MYCOTIC ANEURYSMS
MAY ALSO PRESENT WITH SEPTIC PE OR VERTEBRAL OSTEOMYELITIS
300
THIS IS THE MOST COMMON VALVE AFFECTED BY ACUTE RHEUMATIC FEVER
MITRAL VALVE
MITRAL REGURGITATION WILL DEVELOP
300
THIS VALVULAR ABNORMALITY WILL PROGRESS FROM ANGINA, TO EXERTIONAL SYNCOPE, THEN TO HEART FAILURE
AORTIC STENOSIS
REMEMBER THESE PATIENTS ARE VERY PRELOAD DEPENDENT WITH LITTLE CARDIAC RESERVE
TREATMENT FOR DECOMPENSATED AORTIC STENOSIS RELIES ON FLUID RESUSCITATION, BLOOD TRANSFUSION IF INDICATED, MAINTENANCE OF A SINUS RHYTHM, AVOIDANCE OF VASODILATORS, DIURETICS AND INOTROPIC AGENTS
WHAT PRESSOR WOULD YOU USE IF NEEDED? WHY?
ANGINA RESULTS FROM DECREASED BLOOD SUPPLY FROM REDUCTION IN PERFUSION PRESSURE
SYNCOPE RESULTS FROM FIXED CARDIAC OUTPUT
400
UNEXPLAINED FEVER IN THIS PATIENT POPULATION SHOULD RASE CONCERN FOR IE
IV DRUG USERS
WHICH SIDE OF THE HEART IS MORE COMMONLY INVOLVED IN THESE PEOPLE?
400
ERYTHEMA MARGINATUM
CUTANEOUS FINDINGS OF ARF INCLUDE THIS AND PEA SIZED NONTENDER SUBQ NODULES ON EXTENSOR SURFACES
400
ONE OF OUR FREQUENT FLIERS KNOWN TO PARTAKE IN BOOGER SUGAR, METH AND MARLBORO REDS PRESENTS WITH CHEST AND BACK PAIN HE DESCRIBES AS A TEARING SENSATION. HE IS IN RESPIRATORY DISTRESS AND HYPOXIC WITH RALES ON EXAM. A TECH STICKS AN EKG IN YOUR FACE WHILE YOU ARE TRYING TO PERFORM YOUR PHYSICAL EXAM AND YOU NOTICE DIFFUSE ST DEPRESSIONS. WHAT DO YOU SUSPECT?
AORTIC DISSECTION WITH EXTENSION INTO THE AORTIC ROOT CAUSING DEMAND ISCHEMIA AND CARDIOGENIC SHOCK
WOULD AN IABP HELP? WHY OR WHY NOT?
WHAT DOES THIS PERSON NEED?
500
NAME THESE THINGS.
SPLINTER HEMORRHAGE, ROTH SPOTS, JANEWAY LESIONS, OSLER'S NODE
THESE FINDINGS ARE RARE
30% OF PEOPLE HAVE SPLENOMEGALY
CONJUNCTIVAL AND RETINAL HEMORRHAGES ARE ALSO SEEN
500
NAME 2 MAJOR JONES CRITERIA FOR ARF
PRESENCE OF 2 MAJOR OR 2 MINOR PLUS 1 MAJOR CRITERIA ALONG WITH EVIDENCE OF RECENT STREP INFECTION INDICATE HIGH PROBABILITY OF ARF
500
THIS GENERALLY BENIGN VALVULAR ABNORMALITY IS COMMONLY ASSOCIATED WITH CONNECTIVE TISSUE DISORDERS
MITRAL VALVE PROLAPSE
600
THIS AMOUNT OF BLOOD CULTURES IS RECOMMENDED WITH THE FIRST AND LAST DRAWN ___ APART FROM ONE ANOTHER
2 SEPARATE CULTURES DRAWN AT LEAST AN HOUR APART FROM SEPARATE SITES
HOW MANY CULTURES SHOULD YOU GET IF THE PATIENT HAS A PROSTHETIC VALVE OR PACEMAKER? WHY?
600
TRUE/FALSE, TREATMENT FOR ARF IS SAME AS THAT FOR STREP PHARYNGITIS
TRUE
PENICILLIN FIRST LINE
600
TRUE/FALSE, PROSTHETIC VALVE PATIENTS WITH NO OBVIOUS SOURCE OF FEVER SHOULD BE CONSIDERED FOR ADMISSION, SPECIFICALLY WITHIN 60 DAYS OF SURGERY
TRUE
PROSTHETIC VALVE ENDOCARDITIS SHOULD BE CONSIDERED IN THIS SETTING
700
NAME 2 MAJOR DUKE CRITERIA FOR IE
700
WHAT VALVE ABNORMALITY CAUSES THIS? BONUS NERD POINTS FOR WHAT IT'S CALLED.
AORTIC REGURGITATION
MUSSET'S SIGN
OTHER SIGNS INCLUDE RAPIDLY RISING AND FALLING CAROTI DPULSE, NAIL BED PULSATIONS, A BRUIT OVER THE FEMORAL ARTERY
800
TRUE/FALSE, ED PROCEDURES (SUTURING, INTUBATION, CENTRAL LINES, DELIVERIES, FOLEY CATHETER PLACEMENT (IN ABSENCE OF INFECTION) REQUIRE ANTIBIOTIC PROPHYLAXIS FOR PATIENTS WITH PROSTHETIC VALVES
FALSE
900
ONE EXCEPTION IS MADE IN THE TEXT REGARDING ANTIBIOTIC PROPHYLAXIS FOR ED PROCEDURES IN PATIENTS WITH HIGH RISK CONDITIONS FOR IE. WHAT IS THE PROCEDURE AND WHAT IS THE RECOMMENDATION?
CUTANEOUS ABSCESS DRAINAGE
GIVE VANCOMYCIN 15MG/KG 1 HOUR PRIOR TO PROCEDURE
"HIGH RISK POPULATIONS":
HX OF ENDOCARDITIS, CONGENITAL HEART DEFECT, IV DRUG USE, PROSTHETIC HEART VALVE, PACEMAKER/DEFIBRILLATOR, DIALYSIS, RECENT HOSPITALIZATION WITH CENTRAL LINE OR LONG TERM IV ACCESS