4.1 P) Cardiovascular Endocarditis

Front 1

IN regards to Endocarditis, which is incorrect:
1. Most patients with endocarditis have an identifiable cardiac

abnormality OR risk factor for the disease
2. Clinical presentation is non specific and variable
3. Female > Male 3:2
4. mitral valve > aortic>tricuspid>pulmonary
5. mitral valve prolapse {MVP} is a common predisposing cardiac lesion.

Back 1

3. Male > Female >= 2:1

Front 2

Risk factors for Endocarditis

Back 2

1. Structural Cardiac Abnormality
a. Congenital (bicuspid aortic valve )
b. Acquired (Rheumatic Ht. Disease)
c. Prosthetic valve
2. Risk Factors

a. Injecting drug user

b. Indwelling catheters

c. Poor dental hygiene

d. HIV

Hint 2

a. Congenital - bicuspid aortic valve
b. Acquired - Rheumatic Heart Disease
Risk FActors:
1. injecting drug use
2. Indwelling catheters
3. Poor dental hygiene
4. HIV

Front 3

Which is incorrect in regards to endocarditis:
1. Cocaine use is associated with endocarditis
2. SLE associated endocarditis = Libman-Sacks endocarditis
3. Coagulase Positive Staphylococcus aureus is the most common

aetiological bacterium.
4. Staphylococcus > Enterococcus > Streptococcus Viridans
5. Blood cultures are negative in 5% of patients with endocarditis

{with no prior antibiotic treatment }

Back 3

Staph > Strep Viridans > Enterococcus

Front 4

HACEK group of organisms

Back 4

Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella

Front 5

In regards to endocarditis, fever may be absent in which patients? { 5 types}

Back 5

1. Elderly
2. Hx antibiotic OR antipyretic use
3. Severe CCF
4. Renal Failure
5. Immunosuppression

Front 6

In regards to Cardiac manifestations of

endocarditis, which is incorrect?
1. murmurs are often regurgitant in nature
2. murmurs may be present in up to 85% of cases of IE
3. Acute / progressive CCF occurs in 25%
4. Arrhythmias and Heart blocks can both occur
5. Pericarditis can occur

Back 6

3. Acute progressive CCF in 70%

Front 7

IN regards to arterial embolisation in

endocarditis, which is incorrect?
1. The most common CNS complication is Middle Cerebral Artery {MCA} embolic stroke
2. SAH can occur with rupture of mycotic aneurysm
3. Retinal artery embolism causes acute monocular blindness
4. Coronary artery emboli usually arise from mitral valve
5. Arterial emboli can occur with Pulmonary / Splenic/Renal and

Mesenteric arteries.

Back 7

4. Aortic valve

Front 8

The Three Cornerstone components of the

current diagnostic criteria for Infective

Endocarditis are?

Back 8

1. Blood Cultures
2. Echocardiography
3. Clinical observation**

Front 9

The Duke Criteria for diagnosing Infective

Endocarditis has a 90% sensitivity, and consists broadly of which criteria :

Back 9

1. Major Criteria
2. Minor Criteria

Front 10

The Duke Criteria for Definite Endocarditis

consists of what 3 combinations of major and minor criteria ?

Back 10

1. 2 major criteria
2. 1 major and any 3 minor criteria
3. 5 minor criteria

Front 11

Major Duke Criteria for Endocarditis?

Back 11

1. + Blood cultures from 2 separate cultures
2. Evidence for endocardial involvement by echocardiography:
a. Endocardial vegetation
b. Paravalvular abscess
c. New partial dehiscence of prosthetic valve
d. New valvular regurgitation

Front 12

Minor Criteria for Infective Endocarditis ?

Back 12

1. Predisposition
a. predisposing heart condition
b. IV drug use
2. Fever > 38 degrees celcius
3. Vascular phenomena
a. arterial emboli
b. septic pulmonary infarcts
c. mycotic aneurysm
d. conjunctival haemorrhages
e. Janeway lesions
4. Immunologic phenomena
a. Osler's nodes
b. Roth's Spots
c. Rheumatoid factor
5. Microbiological evidence
- single blood culture
6. Echocardiograph findings {c/w endocarditis -but not meeting major criteria}

Front 13

Which blood tests are strongly associated with endocarditis ?
1. anaemia {70-90% cases}
2. elevated ESR {>90% cases}
3. elevated procalcitonin
4. None of the above
5. All of the above

Back 13

5.

Front 14

Which ECG changes are associated with

Endocarditis?
1. Prolonged PR interval
2. New LBBB and RBBB
3. Junctional tachycardia
4. Wenkebach Mobitz Type 1 Second degree heart block
5. Complete Heart Block

Back 14

All.

Front 15

In regards to Echocardiography of

endocarditis, which is incorrect?
1. TTE is the first choice for suspected native valve endocarditis
2. Sensitivity of TTE is highest in injecting drug users.
3. TOE is recommended in suspected endocarditis with prosthetic valves
4. Sensitivity of TTE varies according to the population , and is lower with COPD and obesity.
5. The sensitivity of TTE in injecting drug users of 88-94% is related to their larger, left-sided vegetations.

Back 15

5. Injecting drug users have larger Right -sided lesions