Term
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Definition
| inflammation involving the tissue around the nailbed |
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Term
| what is the definition of purpura? |
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Definition
| a purplish/brownish red discoloration of the skin that is >.5 com in diameter |
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|
Term
| what is vegetation as it applies to IE? |
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Definition
| a pathologic growth of the tissue/blood clot composed of fused platelets, fibrin, and bacteria that is adherent to the diseased endocardium |
|
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Term
| what is fungating vegetation? |
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Definition
| a spongy vegetation that has the appearance of fungus |
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Term
| what is the major bacteria responsible for IE in the US? what part of the heart does it usually affect? |
|
Definition
| staph aureus, which generally affects the R side of the heart (though some can affect the L side) |
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Term
| is staph aureus coagulase negative or positive? what is the morphology of its colonies? |
|
Definition
| positive, it is found as cocci in clusters |
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Term
| what after staph aureus is the second most responsible bacteria for IE? |
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Definition
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Term
| where is strep viridans usually found? what level hemolytic is it? gram +/-? is there another type of strep that is also responsible for a significant case number of IE? |
|
Definition
| strep viridans is usually found as a part of oral flora and is gram + and alpha hemolytic (partial/greenish hemolysis). strep pneumonia is also responsible for a high number of IE cases (also alpha hemolytic). |
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Term
| what after strep viridans is the second most responsible bacteria for IE? |
|
Definition
| CNS or coagulase negative staph such as staph epidermis |
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Term
| after CNS, what is the next most common bacterial cause of IE? what is an important consideration for pts infected with strep bovis? |
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Definition
| strep bovis - which has a classic association with colon CA, so pts with this infection need to have their colon screened |
|
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Term
| where do enterococcus feacalis infections usually come from? |
|
Definition
| the genitio-urinary system |
|
|
Term
| what role does gram negative bacteria play in IE? |
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Definition
| a small role - the most common cause of gram negative IE is antibx use |
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Term
| what is still the leading cause of acquired heart disease worldwide? is there a difference between prevalence of this in developed/nondeveloped countries? |
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Definition
| rheumatic heart disease - mainly in developing countries, where in developed countries - kawasaki is becoming the leading cause |
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Term
| what are the best tools in developing countries fo dxing diseases like rheumatic heart disease? |
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Definition
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Term
| why has rheumatic heart disease diminished in developed countries, even before the advent of antibx? |
|
Definition
| less overcrowding and improved sanitation |
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|
Term
| is acute RF still a clinical challenge? |
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Definition
|
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Term
| *what strain of strep causes strep throat in children that can include RF as possible sequelae? |
|
Definition
| *strep pyogenes (group A, beta-hemolytic- complete hemolysis) |
|
|
Term
| how does strep throat lead to rheumatic heart disease? |
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Definition
| the M-protein (virulence factor of group A streptococcus) can cause an immunological insult |
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|
Term
| how does the a heart affected by rheumatic carditis appear? |
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Definition
|
|
Term
| how does a pt with rheumatic carditis appear? |
|
Definition
| non-specific; cough, dyspnea, L knee and abd pain. as it progresses: biventricular heart failure, hepatomegaly and cardiogenic shock may occur |
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|
Term
| rheumatic heart disease is a disease of _________? |
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Definition
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Term
| what are ways to incur bacteremia that may lead to IE? |
|
Definition
| brushing teeth, chewing food, aspiration, body piercing, using a toothpick, IV drug abuse (any irritation or insert on mucous membrane can give you bacteremia) |
|
|
Term
| how does staph aureus bind? |
|
Definition
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Term
| what is the difference between symptoms and signs? |
|
Definition
| symptoms are what the pt will tell you, while signs are what you find out upon examination |
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|
Term
| what is a problem with the clinical features of rheumatic heart disease? |
|
Definition
| they are non-specific, symptoms: fever, rigors, dyspnea, malaize, anorexia, weight loss, back pain. signs: fever, heart murmur, changing/new murmur, embolic phenomena, splinter hemorrages, splenomegaly, and hematuria |
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|
Term
| since not all bacteremia causes IE, what is an important part of dx? |
|
Definition
| continuous bacteremia (at least 3 cx) needs to be established |
|
|
Term
| can gangrene be caused by IE? |
|
Definition
| yes, the vegetations in IE can thrown septic clots |
|
|
Term
| what are peripheral manifestations of IE? |
|
Definition
| roth's spots, splinter hemorrage, osler's nodes (tender), janeway lesions (non tender), and conjunctival petechiae |
|
|
Term
| can IE cause digital clubbing? |
|
Definition
| yes, but there is not a definitive link. congenital cyanotic heart disease or lung CA can also be involved |
|
|
Term
| what is schamroth's sign? |
|
Definition
| opposing thumbs are placed nail-nail, knuckle-knuckle and a diamond shaped hole should form |
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|
Term
|
Definition
| the concave counterpart to schamroth's sign - associated with iron-deficiencys anemia, DM, lupus and reynaud's |
|
|
Term
| what is the best test to order in dx of IE? |
|
Definition
|
|
Term
| can clostridium perfinges cause IE? |
|
Definition
| this is rare but possible, it would be seen in cases where too many antibx have been administered to a pt (c diff has surpassed S aureus as the number 1 hospital acquired organism) |
|
|
Term
| **can IE cause sudden visual loss? |
|
Definition
| yes via macular hemorrhage. the pt in this cased presented w/IE 3 months after dental work and then had weight loss, fever and digital clubbing (as well as vision loss) |
|
|
Term
| can IE cause a splenic infarct? |
|
Definition
| yes as well as brain infarcts due to emboli thrown to cerebral arteries |
|
|
Term
| what should be considered if pts suspected of IE have a h/o goat/sheep contact? |
|
Definition
| *brucella, which can give you culture-negative endocarditis because will not show up on gram-stain and have to do *serology |
|
|
Term
| what is an important bacteria that can cause IE after GI or genito-urinary sx? how does it stain? |
|
Definition
| enterococci, which is gram positive and does not cause hemolysis (group D) |
|
|
Term
| can serratia marcescens (gram negative) cause IE? |
|
Definition
| yes, uncommon, but possible |
|
|
Term
| what is the prognosis for pts with aspergillus IE? |
|
Definition
|
|
Term
| what is the leading organism responsible for fungal IE? |
|
Definition
| candida albicans, followed by aspergillus |
|
|
Term
| what are the HACEK organisms? |
|
Definition
| haemophilus aphrophilus, actinobacillus actinomycetemcomitans, cardiobacterium hominis, eikenella corrodens, and kingella kingae |
|
|
Term
| what should we think of when we hear eikenella corrodens? |
|
Definition
| human bite (clenched fist injury) - for cat or dog bites, pasteuerella multocida is the classic organism |
|
|
Term
| when is IE prophylaxis recommended? |
|
Definition
| in the case of a prosthetic cardiace valve, previous IE, or CHD. also in association with dental procedures involving gingival manipulation/perforation of the oral mucosa, repiratory tract procedures involving incision/bx, and sx procedures involving infected skin/tissue |
|
|
Term
| what is an important cause of R sided IE in IVDU? |
|
Definition
|
|
Term
| what is a clue to investigate colonic CA? |
|
Definition
|
|
Term
| what is the leading cause of acquired heart disease in developing countries? |
|
Definition
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