Infective Endocarditis Flashcards¶
Q: What are the two major criteria in the modified Duke criteria for IE? A: 1) Positive blood cultures (typical organism from 2 separate cultures OR persistently positive OR Coxiella) 2) Evidence of endocardial involvement (vegetation/abscess on echo OR new valvular regurgitation) Tags: infective-endocarditis, diagnosis, high-yield
Q: How many Duke criteria are needed for "definite" infective endocarditis? A: 2 major OR 1 major + 3 minor OR 5 minor criteria Tags: infective-endocarditis, diagnosis, high-yield
Q: What is the most common organism causing pediatric native valve endocarditis? A: Viridans group streptococci (35-40%) Tags: infective-endocarditis, microbiology, high-yield
Q: What organism causes acute, aggressive endocarditis with rapid progression? A: Staphylococcus aureus - presents with high fever, toxic appearance, and may cause sepsis, stroke, or heart failure Tags: infective-endocarditis, microbiology, high-yield
Q: What are Osler nodes? A: Painful, tender nodules on fingertips/toes - an immunologic phenomenon in subacute IE Tags: infective-endocarditis, clinical, high-yield
Q: What are Janeway lesions? A: Painless erythematous lesions on palms/soles - represent septic emboli in IE Tags: infective-endocarditis, clinical
Q: How many blood culture sets should be drawn when IE is suspected? A: 3 sets from separate venipuncture sites, before antibiotics if possible Tags: infective-endocarditis, diagnosis, high-yield
Q: What vegetation size significantly increases embolic risk in IE? A: >10 mm - very high risk if >15 mm, should discuss surgery Tags: infective-endocarditis, prognosis, high-yield
Q: What is the empiric antibiotic regimen for native valve IE? A: Vancomycin + Gentamicin (covers MRSA and streptococci pending cultures) Tags: infective-endocarditis, treatment, high-yield
Q: What is added to empiric therapy for prosthetic valve IE? A: Rifampin - regimen is Vancomycin + Gentamicin + Rifampin Tags: infective-endocarditis, treatment, high-yield
Q: How long is antibiotic treatment for native valve viridans streptococcal IE? A: 4 weeks (can consider 2 weeks with gentamicin synergy if low-risk) Tags: infective-endocarditis, treatment
Q: What is the minimum duration of antibiotics for prosthetic valve IE? A: 6 weeks regardless of organism Tags: infective-endocarditis, treatment
Q: What are the HACEK organisms? A: Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella - fastidious gram-negatives, initially culture-negative Tags: infective-endocarditis, microbiology
Q: How long should blood cultures be held when HACEK organisms are suspected? A: 21 days (slow-growing, fastidious organisms) Tags: infective-endocarditis, diagnosis
Q: What are indications for urgent surgery in IE? A: Heart failure from valve dysfunction, fungal endocarditis, annular/aortic abscess, new heart block, persistent sepsis >5-7 days Tags: infective-endocarditis, treatment, high-yield
Q: What new ECG finding in IE suggests abscess formation? A: New heart block (AV block) - abscess near conduction system requires urgent surgery Tags: infective-endocarditis, diagnosis, high-yield
Q: What is the CNS complication risk in IE and how does it affect surgical timing? A: Stroke in 20-40%. After hemorrhagic stroke, delay surgery 4 weeks; after ischemic stroke alone, may operate within 2 weeks if needed Tags: infective-endocarditis, complications
Q: What valve is typically affected in IE with a VSD? A: Tricuspid valve - jet lesion from VSD flow Tags: infective-endocarditis, chd
Q: Is right-sided IE generally managed more conservatively than left-sided? A: Yes - right-sided IE can often be treated medically; surgery reserved for persistent sepsis, large vegetations with recurrent PE, or valve destruction Tags: infective-endocarditis, treatment
Q: What serology tests should be considered in culture-negative IE? A: Bartonella, Coxiella burnetii (Q fever), Brucella Tags: infective-endocarditis, diagnosis
Q: What are Roth spots? A: White-centered retinal hemorrhages - an immunologic phenomenon in IE Tags: infective-endocarditis, clinical
Q: What is the in-hospital mortality for pediatric IE? A: 5-15% (higher with prosthetic valves and S. aureus) Tags: infective-endocarditis, prognosis
Q: When should echocardiography be repeated during IE treatment? A: 1-2 weeks into therapy (or sooner if clinical change) and at end of therapy Tags: infective-endocarditis, monitoring
Q: What conditions require lifelong IE prophylaxis after an episode of IE? A: All patients with previous IE - they are at high risk for recurrence Tags: infective-endocarditis, prevention, high-yield