Endocarditis

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Question 1 of 10

1. Question
As availability and use of antibiotics has increased, Infective Endocarditis has replaced older terms and classifications relating to infections of the endocardium.

Which one of the following statements is correct?
- A prior episode of Endocarditis is in itself the most important risk factor for further episodes
- The average age of a patient with endocarditis is younger than 40 years
- Streptococcus is the most implicated organism in endocarditis
- Intravenous drug use increases risk of endocarditis ten-fold
- Nearly 20% of endocarditis are ‘culture negative’
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Question 2 of 10

2. Question
A 67-year-old previously well man presents to the emergency department (ED) with a history of fever for 2 weeks. He saw his GP last week and was advised to rest and use over the counter medication for pyrexia and malaise. His wife has noted that in the last couple of days he has been confused and seems unable to grip his tea cup properly. On examination he has a temperature of 38.8 C, BP 142/74 and pulse rate of 114 and irregular. You can detect a systolic murmur which the wife was not aware of previously.

Which one of the following is correct?
- Involvement of aortic valve leads to rapid onset of cardiac failure
- Fever is the presenting symptom of roughly 50% of patients with IE
- Neurological symptoms are present in up to 40% of patients at presentation
- Nearly two-thirds of patients will have a classical triad of fever, anaemia and heart murmur
- Congestive cardiac failure develops in nearly 25% of patients
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Question 3 of 10

3. Question
You complete a full clinical examination of the gentleman and notice small painful nodules on his fingers suggestive of Oslers nodes. His ECG reveals Atrial Fibrillation but is otherwise normal. Blood tests including full blood count, cultures, renal function and clotting have been sent. You request a chest x ray and echocardiogram.

Which one of the following is correct?
- Signs of arterial embolisation can be found in 50% of patients
- Aortic vegetation is most likely to embolise
- Continued embolic phenomenon after initiation of therapy suggest treatment failure
- Embolic myocardial infarction is a common complication
- Mycotic aneurysms are related to Aspergillus endocarditis
Correct

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Question 4 of 10

4. Question
The transthoracic echocardiogram reveals a calcified mitral valve with 4 mm vegetations.

Urine dipstick is positive for red blood corpuscles. Blood results reveal a CRP of 150, Hb 11.2 g%, and normal kidney and liver function.

You find that he has cerebellar signs and a CT head confirms small cerebellar infarcts.

Which one of the following is correct?
- Trans thoracic echocardiogram is very specific for diagnosis of valvular vegetation
- This patient meets both major Duke criteria for diagnosis of endocarditis
- A negative trans oesophageal echocardiogram rules out infective endocarditis
- Blood cultures are positive in 90% of patients not previously treated with antibiotics
- Cardiac catheterisation is indicated in evaluation of most patients with endocarditis
Correct

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Question 5 of 10

5. Question
The police bring in a 44-year-old female for evaluation. She is complaining of ‘shivers’ and has been sleeping rough. She has been a long term injectable drug user.

Her observations are: Temp 39 C, heart rate 110/min, BP 108/64, RR 24/min, SpO2 94% on air.

On examination you find normal heart sounds, crackles in lungs, mild splenomegaly and petechial haemorrhages.

Which one of the following is correct?
- Recurrence rate of endocarditis in this group is close to 40%
- Injectable drug users have a high incidence of Streptococcal endocarditis
- Concomitant HIV infection predisposes to atypical organism endocarditis
- The pulmonary valve is especially likely to be affected
- Left untreated IE has a fatality rate of about 50%
Correct

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Question 6 of 10

6. Question
Medical treatment of endocarditis involves use of antibiotics.

Which one of the following statements is correct?
- Ceftriaxone as single daily I/V dose will cover HACEK group organisms
- Once the patient has become afebrile, they can be shifted to oral therapy
- A 2-week intensive course of high dose antibiotics is sufficient to eradicate bacteria
- Once antibiotic therapy is commenced, further blood cultures are not required as they are usually sterile
- Prognosis for infected prosthetic valves is similar to that of native valves provided antibiotic therapy is commenced expeditiously
Correct

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Question 7 of 10

7. Question
A 58-year-old male with a mitral valve endocarditis is being treated with IV Vancomycin.

On the sixth day of treatment, he has temperatures and positive blood cultures of Staph, sensitive to Vancomycin.

Which one of the following is correct?
- Reducing ESR is a poor indicator of resolving infection
- Vancomycin leads to quicker resolution of temperatures and negative blood cultures as compared to Penicillin when treating Staphylococcal infection
- Reducing size of valvular vegetation is a good indicator of effective treatment
- Persistent temperature with negative blood cultures suggests treatment failure
- This patient should be evaluated for cardiac and extra cardiac abscesses at this time
Correct

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Question 8 of 10

8. Question
A 38-year-old injectable drug user is being treated for infective endocarditis. On day 4 of treatment she suddenly become short of breath and progresses to acute pulmonary oedema.

Which one of the following is correct?
- Urgent surgery reduces mortality by nearly half in patients with moderate to severe failure due to valvular dysfunction
- Acute myocardial infarction is the most likely cause of this catastrophe
- Peri-valvular abscesses occur in about 30% of prosthetic valves infections
- There is very little role for surgery in fungal infections
- Neurological complications like strokes are an indication for urgent surgery
Correct

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Question 9 of 10

9. Question
It is recognised that pre-existing cardiac abnormality predisposes to infective endocarditis.

Which one of the following is correct regarding antibiotic prophylaxis?
- Antibiotic prophylaxis should be offered to patients undergoing Genito-Urinary (GU) or Gastro-Enteric (GE) procedures at sites of infection
- Antibiotic prophylaxis is routinely offered by dentists to patients with pre-existing heart conditions
- Chlorhexidine mouthwash reduces bacteraemia by 75% prior to dental procedures
- Patients with repaired Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), Patent Ductus Arteriosus (PDA) are at risk of developing IE
- Tattooing and body piercing are not considered risk prone procedures as far as endocarditis is concerned
Correct

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Question 10 of 10

10. Question
Regarding endocarditis, which one of the following statements is correct?
- Loeffler’s (eosinophilic) endocarditis responds well to hydroxyurea treatment
- NBTE (Non Bacterial Thrombotic Endocarditis) is related to Patent Ductus Arteriosus (PDA) and Atrial Septal Defect (ASD)
- Antibiotic treatment reduces embolic phenomenon in infective endocarditis by half after three weeks of treatment
- Trans oesophageal echocardiography has a false negative rate of less than 5%
- Even with appropriate treatment, 5 year mortality for Injected drug users with right sided endocarditis is the highest
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Endocarditis – Post Test

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