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Questions and Answers
Which laboratory findings indicate the presence of infection associated with endocarditis?
What is the significance of valvular vegetations greater than 10 mm?
Which imaging modality is less invasive and often employed first in evaluating endocarditis?
Which histologic finding is commonly associated with cutaneous manifestations of infective endocarditis?
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What laboratory test helps direct appropriate antibiotic therapy in cases of bacteremia?
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Which imaging study would primarily be used to assess for embolic complications in the CNS?
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Which of the following findings might suggest the presence of microemboli in pathology related to infective endocarditis?
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What role does echocardiography play in the context of infective endocarditis?
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Which of the following is a consequence of emboli to the CNS?
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Which laboratory finding is NOT typically associated with infective endocarditis?
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What is the primary use of erythrocyte sedimentation rate in the context of suspected infective endocarditis?
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Which imaging technique is particularly useful for detecting valvular vegetations in cases of infective endocarditis?
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What is a common histologic finding in pathology samples from patients with infective endocarditis?
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What is the role of polymerase chain reaction (PCR) sequencing in cases where bacteria cannot be cultured?
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Which finding would be the most suggestive of an increased embolic risk in infective endocarditis?
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Which laboratory finding is associated with both inflammation and potential renal involvement in infective endocarditis?
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What is the primary reason for performing an EKG in the evaluation of infective endocarditis?
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Which of the following imaging studies is considered more invasive and typically used after transthoracic echocardiography?
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Which feature is commonly seen on MRI scan in patients suffering from complications due to emboli to the CNS?
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In cases of infective endocarditis, what laboratory test may indicate the presence of autoimmune phenomena?
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Study Notes
Diagnosis of Infective Endocarditis
- Bacterial cultures are used to detect bacteremia and guide antibiotic therapy.
- If cultures are not possible, removed valves can be cultured.
- Broad-range polymerase chain reaction sequencing and immunostaining techniques can help identify the organism.
- Erythrocyte sedimentation rate, C-reactive protein, antineutrophilic cytoplasmic antibody (ANCA), and rheumatoid factor elevation, anemia, and red cell casts or pyuria on urinalysis can also indicate IE.
- Histologic findings of the cutaneous manifestations of IE are nonspecific.
- Extravasated red blood cells, fibrinoid degeneration of vasculature, karyorrhexis, and Gram-positive/negative organisms in microemboli on pathology can be suggestive of IE.
- Echocardiography is used to visualize the valves and assess myocardial involvement.
- Transthoracic echocardiography is less invasive and less expensive than transesophageal echocardiography.
- Valvular vegetations can be detected in the majority of cases when these imaging modalities are used in combination.
- High-resolution cardiac CT and 18F-fluorodeoxyglucose positron emission tomography CT are additional imaging options.
- Vegetations larger than 10 mm are associated with a greater embolic risk.
- Emboli to the CNS leads to stroke, brain abscess, and meningitis.
- MRI can identify CNS emboli.
Diagnosis
- Bacterial cultures are important for diagnosing infective endocarditis (IE)
- Cultures from blood, removed heart valves, and broad-ranged polymerase chain reaction sequencing can help identify the bacteria responsible for IE
- Erythrocyte sedimentation rate, C-reactive protein, antineutrophilic cytoplasmic antibody (ANCA), and rheumatoid factor elevation can also be helpful indicators
- Anemia and red cell casts/pyuria on urinalysis are additional indicators of IE
Pathology
- Histologic findings of cutaneous manifestations of IE are often nonspecific
- Evidence of extravasated red blood cells, fibrinoid degeneration of vasculature, karyorrhexis, and Gram-positive/negative organisms in microemboli on pathology are suggestive of IE
Imaging
- An EKG baseline is needed to monitor for changes in conduction that may indicate worsening disease
- Echocardiography allows for visualization of the valves and provides information about myocardial involvement
- Transthoracic echocardiography is less invasive and less expensive than transesophageal echocardiography
- Valvular vegetations can be detected in the majority of cases when these imaging modalities are used together
- High-resolution cardiac CT and 18F-fluorodeoxyglucose positron emission tomography CT are also potential imaging studies
- Vegetations larger than 10 mm are associated with a greater embolic risk
- Emboli to the CNS lead to stroke, brain abscess, and meningitis, which can be identified with MRI
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Description
This quiz covers the diagnosis methods for infective endocarditis (IE), focusing on various diagnostic tools such as bacterial cultures, polymerase chain reaction sequencing, and echocardiography. Participants will explore biochemical markers and histological findings that suggest the presence of IE, enhancing their understanding of this critical condition.
