Endocarditis Tutoring By Alaina Darby

A defect in which valve would put a patient at the most risk for endocarditis? Aortic Tricuspid Pulmonic Mitral d

GR is a 21 yo WF who had a mitral defect at birth that couldn’t be totally repaired. Which of the following would put her at least risk for endocarditis? Wisdom tooth extraction Gum tissue graft Tooth brushing Upper airway procedure c

If a patient presents with fever, a new murmur, and pulmonary infarct, what pathogen should you most likely suspect? Strep mutans Strep bovis Staph aureus Pseudomonas c

BG is a 34 yo WF who is suspected to have endocarditis BG is a 34 yo WF who is suspected to have endocarditis. She injects heroin sometimes when with friends. Which valve is most likely infected? Aortic Tricuspid Pulmonic Mitral b

BG is a 34 yo WF who is suspected to have endocarditis BG is a 34 yo WF who is suspected to have endocarditis. She injects heroin sometimes when with friends. Which sign/symptom would most likely not be seen? New murmur Chills Splenomegaly Weight loss c

BG is a 34 yo WF who is suspected to have endocarditis BG is a 34 yo WF who is suspected to have endocarditis. She injects heroin sometimes when with friends. Which vascular complication would be more likely in this patient? Pulmonary infarct Janeway lesions Conjunctival hemorrhage Arterial emboli a

DM is a 45 yo WM who comes in complaining of pain in his leg and seems somewhat confused. What would you not want to do immediately? ECHO Get blood cultures Take history Bolus fluids Vitals: RR 26 Temp 38.3 HR 64 BP 115/76 d

DM is a 45 yo WM who comes in complaining of pain in his leg and seems somewhat confused. When taking cultures, how many tubes of blood should you get? At least 2 At least 3 At least 4 At least 5 Vitals: RR 26 Temp 38.3 HR 64 BP 115/76 c

ER has a positive ECHO with cultures positive for E. coli ER has a positive ECHO with cultures positive for E. coli. He also has a preexisting murmur. How would you diagnose him? Definite IE Possible IE Rejected Vitals: RR 26 Temp 37.8 HR 64 BP 115/76 b

JD has a positive ECHO with cultures positive for Coxiella JD has a positive ECHO with cultures positive for Coxiella. He also has a preexisting murmur. How would you diagnose him? Definite IE Possible IE Rejected Vitals: RR 26 Temp 37.8 HR 64 BP 115/76 b

Remember your bugs! Strep (viridans, bovis) Staph (aureus) HACEK (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella) Enterococci Coxiella b

JD has a positive ECHO with cultures positive for Coxiella JD has a positive ECHO with cultures positive for Coxiella. When would you want to get another culture if there is no primary focus found? 1 hour 12 hours 24 hours Not necessary Vitals: RR 26 Temp 37.8 HR 64 BP 115/76 d

FR has a positive ECHO with 2 cultures (one positive and one negative) for S. aureus. The cultures were taken 3 hours apart How would you diagnose? Definite IE, no more cultures needed Possible IE, another culture 1 hour from last Possible IE, at least 2 more cultures 1 hour apart Reject IE, look for another cause of symptoms Vitals: RR 26 Temp 37.8 HR 64 BP 115/76 c

Time your cultures appropriately! 1 culture… Coxiella ONLY! 2 cultures… 12 hours apart 3 cultures… all positive, 1 hour apart 4 cultures… most positive, 1 hour apart b

Which bug(s) should you also consider in an IVDU with left-sided IE but not in other populations? S. aureus HACEK Pseudomonas No special considerations d

JR presents with a new murmur and positive ECHO but his cultures are negative. He has a bite wound on his hand. How should you treat him? Penicillin Ceftriaxone Vancomycin Rifampin b

JR presents with a new murmur and positive ECHO but his cultures are negative. He has a bite wound on his hand. What is the most likely pathogen? Haemophilus Aggregatibacter Cardiobacterium Eikenella d

PB has a prosthetic valve that was placed 9 months ago PB has a prosthetic valve that was placed 9 months ago. He presents with symptoms diagnostic of IE. How should you treat him empirically? Vanc + cefepime + gent + rifampin Vanc + augmentin Vanc + ceftriaxone Vanc + cefepime a

PB has a prosthetic valve that was placed 9 months ago PB has a prosthetic valve that was placed 9 months ago. He presents with symptoms diagnostic of IE. What are your major concerns with this regimen? Hepatic failure Kidney failure Hemolysis Hearing loss b

PB (70kg) has a prosthetic valve that was placed 9 months ago PB (70kg) has a prosthetic valve that was placed 9 months ago. He presents with symptoms diagnostic of IE. Cultures come back with penicillin susceptible S. viridans. How should you treat? Ceftriaxone 2g Q24 x 6 weeks Ceftriaxone 2g Q24 + gentamicin 200mg x 2 weeks Ceftriaxone 2g Q24 + gentamicin 200mg x 4 weeks Ceftriaxone 2g Q24 + gentamicin 200mg x 6 weeks a

PB (70kg) has a prosthetic valve that was placed 9 months ago PB (70kg) has a prosthetic valve that was placed 9 months ago. He presents with symptoms diagnostic of IE. Cultures come back with penicillin susceptible S. viridans. You decide to use ceftriaxone 2g Q24 x 6 weeks. If you add gentamicin, how should you dose it? 100mg Q12 x 2 weeks 200mg Q24 x 2 weeks 100mg Q12 x 6 weeks 200mg Q24 x 6 weeks b

To which patient would you not consider adding gentamicin? Native valve strep Native valve staph Prosthetic valve strep Prosthetic valve staph b

Which of the following should be added for an IVDU, most likely? Vancomycin Ampicillin Gentamicin Zosyn d

Prosthetic (> 6 weeks) Dosing is important!! Strep Staph Native (2-4 weeks) Prosthetic (6 weeks) Native (6 weeks) Prosthetic (> 6 weeks) *PCN 12-18 million U/day Nafcillin 12 g/day *Nafcillin 12 g/day *Ceftriaxone 2 g/day Cefazolin 6 g/day *Rifampin 900 g/day Vanc 30 mg/kg/day *Vanc 30 mg/kg/day This is total daily dose… some are divided into multiple doses These are just the basics… be able to differentiate treatment in MRSA vs MSSA *May add gent for 2 weeks

PB (70kg) has a native valve that was placed 9 months ago PB (70kg) has a native valve that was placed 9 months ago. He presents with symptoms diagnostic of IE. Cultures come back with enterococcus. Which should be used? Ceftriaxone 2 g IV q12 hours Ceftriaxone 2 g IV q24 hours Ampicillin 2 g IV q4 hours PCN-G 8 million units IV 6x per day c

JF has IE and a prosthetic valve that was placed 9 months ago JF has IE and a prosthetic valve that was placed 9 months ago. Cultures come back with enterococcus. He has been treated with ampicillin for 7 days now and his cultures came back clear 5 days ago. How long should therapy continue? 21 days 23 days 37 days 42 days c

Which drug should not be used for MRSA? Vancomycin Daptomycin Vanco + Nafcillin Linezolid D

Who should receive prophylaxis? Prosthetic cardiac valve undergoing dental surgery Repaired CHD undergoing dental surgery Prosthetic cardiac valve undergoing GI surgery Repaired CHD undergoing GI surgery a

Your patient is allergic to PCN and needs prophylaxis for a dental procedure. What is preferred? Amoxicillin 2 g PO Ceftriaxone 1 g IM Clindamycin 600 mg PO Azithromycin 500 mg PO c