Infective endocarditis Quiz

6. Based on infective endocarditis (IE) diagnostic criteria, which of the following are the two most important parameters for diagnosis?

5. A 72-year-old man presents to the emergency department with chest pain, fever, fatigue, and arthralgias. His past medical history is significant for rheumatic heart disease and a tooth extraction a few weeks before admission. He is without physical findings of endocarditis on exam, although endocarditis is suspected. Which of the following is the most likely organism?

4. An 82-year-old female recently underwent permanent pacemaker placement for sick sinus syndrome. She presents to the emergency department with shortness of breath, fever, and erythema with purulent drainage around the incision site. Echocardiograph demonstrates a large friable aortic valve vegetation. What is the best definitive management for this patient?

3. A 34-year-old woman presents to the emergency department with a fever. Chest x-ray demonstrates multiple patchy infiltrates in te bilateral lungs. Echocardiography and blood cultures suggest acute bacterial endocarditis involving the tricuspid valve. Which of the following is the most likely etiology?

2. Which of the following is true regarding infective endocarditis (IE) management?

1. What is the most common complication in infective endocarditis (IE)?

A 50 year-old man with mitral valve endocarditis and severe MR undergoes mechanical mitral valve replacement. External pacing is required to come off bypass due to complete heart block which persists through the post-operative ICU stay. Which of the following is true?

A 66-year-old male with a past medical history of hypertension and coronary artery disease is undergoing a pre-operative work-up for coronary artery bypass grafting (CABG). His echocardiogram reveals a small, pedunculated mobile density on the aortic valve measure 1.3 cm. He is otherwise healthy and denies a history of intravenous drug use. Blood cultures are negative. How should the finding be managed?

10. A 23 year old female with a history of intravenous drug abuse (IVDA) presents with fever, chills, and shortness of breath. She used heroin five days ago. Vital signs include temperature 39°C, pulse 110, and blood pressure 109/68. There is a grade II/VI systolic murmur heard best at the lower right sternal border. There are no splinter hemorrhages, peripheral petechiae, or erythematous patches on the palms or soles. No abnormalities are seen on fundoscopic exam. Neurological exam is normal. A chest x-ray shows no evidence of pneumonia. Three sets of blood cultures are drawn, and the patient is started on empiric antibiotic therapy with vancomycin and gentamicin. Which of the following is the most appropriate next step in the management of this patient?

9. Which of the following is true regarding the etiology of endocarditis?

8. Which of the following is the strongest indication for surgical intervention in infective endocarditis (IE)?

7. A patient that had mitral valve replacement (MVR) 25 days prior was admitted to the hospital from the clinic with persistent fever and malaise. Endocarditis is suspected. What the most likely causative organism?