Step 2 IM endocarditis 2-2-2015

ruhland1's version from 2016-02-02 11:32

Section 1

Question Answer
MC endocleftsided
right sided ECIVDU and infection
acute ECF and rapid degrade of heart tissue
acute ECS. Aureus infects MVP and rheumatic dz valves damages
MVPMC factor in infective endocarditis
Subacute bact ECEnterococci by GI/GU srx, S. Viridians
Oral ECS. Viridians
colitis/colorecatl cxStrep. Bovis
Marantic ECa paraneoplastic synd, sterile vegetations on valves as 2ndary to up coag due to up mucin production
Libman SacksSLE, up mitral regurg
vegatiations mitral valvelibman sacks
EC complicchordai tendenae rupture, emboli
EC complicglomerulonephritis, suppurative pericarditis

Section 2

Question Answer
EC sx"high F for weeks" fever of unknown origin, cough, SOB, wkness
EC auscregurg mumur
OslerOUCH, small tender nodes fingers and toes
janewaydark, non tender macules on palms and soles
roth spotsretinal hemmorhages
subungual petechiaesplinter hemm
organS meg
FROM JANEaF, Roth, Osler, Murmur, Janeway, Aneria, Nail, Emobli
EC dxDuke criteria
Duke crit3 blood cultures separated in time and lovcation, Echocardious graph for veg, and CXR may reveal septic emboli in right sideded endocarditis
EC echocardiographnegative does not r/o endocard
EC cxrseptic emobli in right sided endocard
EC txempiric prolonged abx, and surgical valve replace

Section 3

Question Answer
Acute EC IVDUtricuspid and S Aureus
Acute EC bugsStep Pneu, Step Pyogenes, N. Gonn
Subacute bact ECEnterococcus think UTI, S Viridians think URI, S. Epid think skin
S. VirSacute bact EC URI
S. EpidSacute bact EC skin
EnterococciSubacute bact UTI
Murantic ECmeta cx seeding valves, poor prog
LibmanSLE, asx but murmur can be heard
EC riskRight HDz, Valve H dz, IVDU, immunosupp, prosthetic heart valve
EC spreadneuro, joint, lung and causes F of unknown origin
Duke crit3 blood cultures separted in time and location, multiple positive culture of same organism is highly suspect, Echo find veg, CXR septoc emboli in right sided endocard
EC ddxosteomyelitis
EC ddxabscess
EC ddxpneumonia
EC ddxother causes of fever unkn origin

Section 4

Question Answer
EC tx4-6 weeks, tailor based on org
S viridiansceftriaxone, vanco, amoxicillin, clindamycin
Entero FaecailisAmpicillin
Entero UTInitofurantoin
Vanco resistant enterococcilinezolind, daptomycin
Staph EpidVanco, Dicloxicillin, TMP-SMX
murmurmitral regurg
EC vavle replacement indicCHF from valve regurg, ABX do not work, valvular annular abscess,
EC vavle replacement indicveg>1.0cn
EC vavle replacement indicperiphreal embolism of veg,
EC bugS Viridian, S Aureeus, Entero
EC and S Bovis thinkcolon cancer
EC A Regurgearly diastolic decrescendo, murmur does not move and is at left lower sternal border

Section 5

Question Answer
EC and infcn but (-) blood cultureHACEK
EC findingnew murumur in signs of infxn
EC findingsplenomeg
EC findingOslernode Janeway lesion
EC findinRoth spot, retinal hemm
EC StepPenicillin + Gentamycin 4 weeks, altern is IV Ceftiaxone with Genta
EC StpahNaficillin with Gentamicin
EC MRSAVanco with Gentamicin
EC HACEKCeftriaxone for 4 weeks