Physical Diagnosis
Studies
Microbiology
Miscellaneous
Treatment
100
Image #1
What are splinter hemorrhages?
100
Three most common initial cardiac tests for the work-up of IE.
What are EKG, CXR and echocardiogram (TTE vs TEE)?
100
- on hemodialysis - have an intravascular device - be an IDU - have persistent bacteremia
What are risk factors for staph aureus endocarditis?
100
IDU
What is the most significant risk factor for right-sided endocarditis? However, overall, IDU is associated with more cases of left-sided endocarditis as these predominant. Staph aureus is the most common organism.
100
4:57 pm
What is the start of the Giants' game tonight?
200
Cardiac findings on physical exam warranting consideration of endocarditis.
What are a new regurgitant murmur and new heart failure?
200
A low sensitivity but high specificity cardiac test for endocarditis.
What is a TTE? (sensitivity - 29-63, specificity approaches 100) - If you don't see a vegetation it doesn't mean it doesn't exist! - TTE is the recommended first screening test. Subsequent TEE performed if high clinical suspicion (persistently positive blood cultures and multiple minor criteria) and a technically limited TTE.
200
Propionibacterium spp., cornynebacterium spp., bacillus spp., coagulase-negative staphylococci
What are common contaminants when found in 1/2 positive blood cultures? -However, these can cause IE if the bacteremia is real and persistent. Recheck! -Coag negative staph still accounts for a significant percentage of IE but is simultaneously a common contaminant of blood cultures so think about your clinical suspicion for IE.
200
See Image #5.
Who is Kelly?
200
4-6 weeks
Typical treatment duration for IE. The nature of blood flow and low vascular supply to the endocardium makes drug delivery and phagocytic immune cells more limited to the valves.
300
Petechaie
What is the most common physical finding of endocarditis? Petechaie are often seen on the extremities and mucosal membranes.
300
The most common hematologic finding (on a CBC) in IE. (Bonus 100 points to name the second most common finding.)
What are leukocytosis and (#2) thrombocytopenia? (Patients with subacute endocarditis may have a normal white blood cell count. In general, patients may also have elevated ESR and CRP and a normochromic normocytic anemia but these findings are less specific.)
300
S. Aureus Strep viridans Enterococci
What are the top three most common causes of IE? S. Aureus (31%) Strep viridans (17%) Enterococci (11%)
300
Marantic endocarditis and Libman-Sacks endocarditis
What are two common forms of non-infective endocarditis? Marantic - thrombotic vegetations along the edges of the valves (esp in hypercoaguable patients) Libman-Sacks - immune complex deposition on the valves (esp in Lupus)
300
Coverage for staph, strep and enterococci?
What is empiric coverage of IE? (typically vancomycin) - Important to start empiric coverage AFTER collecting at least three blood cultures but right away in acute cases. - Narrow coverage based on cultures.
400
See Images #2 and 3.
What are Janeway lesions (macular, blanching, nonpainful, erythematous lesions on the palms and soles) and Osler's nodes?
400
Evidence of glomerulonephritis on urinalysis.
What are red cell casts?
400
The minimum number of blood cultures that should be obtained from separate sites over a time period of hours to days depending on severity of disease.
What is three? Acute onset of symptoms especially in an ill patient warrants collecting blood cultures immediately but before, if at all possible, the administration of antibiotics. A subacute presentation can delay the collection of cultures.
400
This risk factor for IE is excepted to cause the number of cases of IE to rise in the coming years based on the growing number of cardiac surgeries performed in older patients in the United States.
What is a prosthetic valve? Prosthetic valves as well as underlying structural heart disease (mitral valave prolapse, bicuspid aortic valves, coarctation of the aorta, VSDs, PDAs, tetralogy of Fallot) are risk factors for IE. The type of prosthesis does not change the risk. 1-4% of valve replacements develop IE in the first year and 1% each year thereafter.
400
Anticoagulation
What is treatment for non-infective endocarditis? - Treat the underlying condition as well!
500
A very specific but the most rare physical finding of IE. (Image #4)
What are Roth spots?
500
Radiographic findings of tricuspid valve endocarditis.
What are multiple focal lung infiltrates with central cavitations, evidence of septic pulmonary emboli?
500
Slow growing gram negative bacteria that are part of the natural human flora.
What are the HACEK organisms? (account for 2% of cases) * Haemophilus aphrophilus and paraphrophilus * Actinobacillus actinomycetemcomitans * Cardiobacterium hominis * Eikenella corrodens * Kingella kingae
500
The requirements to satisfy the Duke Criteria.
What are satisfying two major, one major and three minor, or five minor criteria?
500
Turniansky
What is the good doctor Turner's original family name?
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