Medicine Marrow Pg No 1045-1054 (Infectious Diseases)
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Questions and Answers

Which genotype of Hepatitis C is most commonly found worldwide?

  • Genotype 3
  • Genotype 4
  • Genotype 1 (correct)
  • Genotype 2

    • Hepatitis C virus can integrate its genome into the host chromosome.

    False

    What type of virus is Hepatitis C classified as?

    +ve sense RNA virus

    Hepatitis C is associated with __________ and hepatocellular carcinoma (HCC).

    <p>cirrhosis</p> Signup and view all the answers

    Match the following Hepatitis C transmission modes with their associated rates:

    <p>Percutaneous = 0.6-6% Transfusion = 1/18000000 Perinatal = Negligible Sexual = Negligible</p> Signup and view all the answers

    What is the most common condition associated with left-sided infective endocarditis?

    <p>Mitral valve prolapse combined with mitral regurgitation</p> Signup and view all the answers

    Mitral stenosis is a risk factor for infective endocarditis.

    <p>False</p> Signup and view all the answers

    What percentage of infective endocarditis cases are left-sided?

    <p>75%</p> Signup and view all the answers

    Infective endocarditis due to IV drug abuse is mostly associated with __________ involvement.

    <p>right-sided</p> Signup and view all the answers

    Match the conditions with their risk factors for infective endocarditis:

    <p>Mitral valve prolapse = Combined with mitral regurgitation Ventricular septal defect = Congenital condition Calcific degenerative aortic stenosis = Degenerative condition IV drug abuse = Right-sided infective endocarditis</p> Signup and view all the answers

    Which of the following is NOT a positive echocardiography finding for infective endocarditis?

    <p>Pulmonary hypertension</p> Signup and view all the answers

    Transesophageal echocardiography typically has lower sensitivity compared to transthoracic echocardiography.

    <p>False</p> Signup and view all the answers

    Name one indication for choosing transesophageal echocardiography over transthoracic echocardiography.

    <p>Vegetations &lt; 2mm</p> Signup and view all the answers

    In the case of a positive TTE result for suspected endocarditis, the next step is to prescribe __________ for endocarditis.

    <p>Rx</p> Signup and view all the answers

    Match the echocardiography methods with their sensitivity range:

    <p>TTE (Transthoracic) = 60 - 65% TEE (Transesophageal) = 85 - 95%</p> Signup and view all the answers

    Which of the following is a cardiac complication associated with MPGN?

    <p>Heart failure</p> Signup and view all the answers

    Empyema is classified as a cardiac complication of MPGN.

    <p>False</p> Signup and view all the answers

    What are the two major criteria required to meet the Modified Duke Criteria for diagnosis?

    <p>Blood culture results</p> Signup and view all the answers

    The __________ is required to determine blood culture positivity in Modified Duke Criteria.

    <p>HACEK group</p> Signup and view all the answers

    Match the following major criteria with their specific requirements for blood culture:

    <p>3 sets from 3 sites = Blood culture requirement 20 ml each sample = Volume requirement per set 10 ml aerobic culture = Sample type requirement Coxiella burnetti = Typical organism</p> Signup and view all the answers

    What is the typical incubation period for Salmonellosis?

    <p>5-20 days</p> Signup and view all the answers

    Rose spots are a common feature observed in the first week of Salmonellosis.

    <p>False</p> Signup and view all the answers

    Name one complication that can occur due to Salmonellosis.

    <p>Encephalopathy or GI perforation.</p> Signup and view all the answers

    The infective dose for Salmonellosis is approximately ________ organisms/mL.

    <p>105</p> Signup and view all the answers

    Match the following weeks with their corresponding features in Salmonellosis:

    <p>Week 1 = Step ladder fever ± chills, relative bradycardia Week 2 = Vague abdominal pain, GI disturbances Week 3 = Complications: Encephalopathy and GI perforation</p> Signup and view all the answers

    What is the most common organism associated with native valve infective endocarditis?

    <p>S. aureus</p> Signup and view all the answers

    Prosthetic valve infective endocarditis is most commonly caused by Streptococcus viridans within the first 12 months after valve replacement.

    <p>False</p> Signup and view all the answers

    List one predisposing condition for infective endocarditis in individuals aged 15-60 years.

    <p>Rheumatic heart disease</p> Signup and view all the answers

    In infective endocarditis associated with IV drug users, the predominant organism is __________.

    <p>MRSA</p> Signup and view all the answers

    Match the age range with the associated predisposing conditions for infective endocarditis:

    <p>15-60 = Rheumatic heart disease 10-30 = Congenital heart disease 15-35 = Mitral valve prolapse 25-45 = None</p> Signup and view all the answers

    What is the accompanying symptom of high-grade fever in Dengue?

    <p>Retro-orbital pain</p> Signup and view all the answers

    Doxycycline is started on the fourth day of fever.

    <p>False</p> Signup and view all the answers

    What is the first step in the investigation for a patient with suspected dengue fever?

    <p>NS-1 antigen test</p> Signup and view all the answers

    In cases of malaria, fever is typically accompanied by ______ and rigors.

    <p>chills</p> Signup and view all the answers

    Match the type of fever with its related infection feature:

    <p>Salmonella = Step ladder/Rising pattern Malaria = Chills and rigors with fatigue Leptospirosis = Myalgia and conjunctival suffusion Dengue = High-grade fever with retro-orbital pain</p> Signup and view all the answers

    What is the chance of chronic Hepatitis C developing over 40 years?

    <p>85%</p> Signup and view all the answers

    Anicteric Hepatitis is usually diagnosed easily.

    <p>False</p> Signup and view all the answers

    What is the incubation period for Hepatitis C?

    <p>50 days</p> Signup and view all the answers

    The sustained viral response rate for chronic HCV is approximately __________.

    <p>99.5-99.7%</p> Signup and view all the answers

    Match the following extra hepatic manifestations with their descriptions:

    <p>Sjogren's syndrome = Autoimmune disorder affecting moisture-producing glands Extranodal B cell marginal zone lymphoma = Type of cancer involving B cells in the salivary glands Essential mixed cryoglobulinemia = Condition involving abnormal proteins in the blood Lichen planus = Inflammatory condition affecting skin and mucous membranes</p> Signup and view all the answers

    Which of the following is a common laboratory feature associated with subacute infective endocarditis?

    <p>Normocytic anemia</p> Signup and view all the answers

    Osler nodes are characteristically tender.

    <p>True</p> Signup and view all the answers

    What are Janeway lesions typically associated with in terms of endocarditis type?

    <p>Acute infective endocarditis</p> Signup and view all the answers

    The presence of __________ represents a type of macroembolic event that can occur in patients with subacute infective endocarditis.

    <p>stroke</p> Signup and view all the answers

    Match the following clinical findings with their respective descriptions:

    <p>Janeway Lesion = Macules of variable size and irregular shape. Osler Node = Nodules of 1 mm to ≥1 cm. Roth Spots = Pale center with surrounding erythema. Splinter Hemorrhage = Linear streaks under the nails.</p> Signup and view all the answers

    What is the primary treatment for Streptococcus viridans if resistant to penicillin?

    <p>Ceftriaxone 2g IV once daily for 4 weeks</p> Signup and view all the answers

    Gentamicin is given alone in the treatment of Enterococci infections.

    <p>False</p> Signup and view all the answers

    What antibiotic is used for prophylaxis in patients with a prosthetic valve before dental procedures?

    <p>Amoxicillin 2g orally</p> Signup and view all the answers

    For patients unable to take oral medication, __________ is administered IV for prophylaxis.

    <p>Ampicillin 2g</p> Signup and view all the answers

    Match each bacterium with its respective treatment:

    <p>Streptococcus viridans = Penicillin G 2-3 million units IV every 4 hours Enterococci = Ceftriaxone 2g IV for 4 weeks if resistant Staphylococcus (MRSA) = Vancomycin 15 mg/kg IV twice daily Prophylaxis = Amoxicillin 2g orally before procedures</p> Signup and view all the answers

    Which of the following conditions indicates the need for surgical intervention in native valve endocarditis?

    <p>Acute valvular regurgitation</p> Signup and view all the answers

    Gentamicin is needed only for Enterococci infections.

    <p>False</p> Signup and view all the answers

    List one medical condition that requires prophylaxis for infective endocarditis.

    <p>Previous episode of IE</p> Signup and view all the answers

    Study Notes

    Echocardiography

    • Transthoracic echocardiography (TTE) sensitivity: 60-65%
    • Transesophageal echocardiography (TEE) Sensitivity: 85-95%
    • TTE is used for suspected infective endocarditis (IE) in native valves
    • TEE is used for suspected IE in prosthetic valves or when TTE is equivocal or negative
    • TEE is used for suspected IE with complications like vegetations < 2mm, myocardial abscess, valve perforation, etc.

    Infective Endocarditis

    • Risk factors: Congenital heart conditions like MVP, septal defects, IV drug abuse, rheumatic heart disease, degenerative aortic stenosis.
    • Types: Left-sided (75%), combined (15%), right-sided (10%).
    • Left-sided IE: Common in patients with MVP and mitral regurgitation.
    • Right-sided IE: Common in IV drug abusers and patients with IV central lines.
    • Complications: Cardiac complications like stroke, heart failure, perivalvular abscess, non-cardiac complications like embolic occlusion, immunological reactions, mycotic aneurysm.

    Hepatitis C Virus (HCV)

    • Positive-sense RNA virus from the Flaviviridae family.
    • 7 genotypes, genotype 1 is most common worldwide, and genotype 3 is most common in India.
    • Associated with cirrhosis, hepatocellular carcinoma (HCC).
    • Transmission: Percutaneous (IV drug users, CKD patients), transfusion, perinatal, breastfeeding, and sexual modes are negligible.

    Membranoproliferative Glomerulonephritis (MPGN)

    • Caused by 1C3, 1C4, and HCV.
    • Can cause cardiac complications like stroke, ACS, heart failure, and conduction block due to perivalvular abscess.

    Salmonellosis

    • Incubation period: 5-20 days.
    • Infective dose: 105 organisms/mL.
    • Complication: Gallstones in chronic carrier state (6%).
    • Clinical presentation: Step ladder fever, abdominal pain, GI disturbances, hepatomegaly, splenomegaly, rose spots.
    • Investigations: Widal test (low positivity in the 1st and 2nd week, 80-100% positivity in the 3rd week), blood culture (90% positivity in the 1st week).

    Modified Duke Criteria for IE Diagnosis

    • Major Criteria:
      • Positive blood culture (typical organism, persistently positive culture, HACEK group, single positive culture or antibodies detected)
      • Echocardiographic evidence (oscillating intracardiac mass, abscess, new partial dehiscence, new aortic/mitral regurgitation)
    • Minor Criteria: Predisposition to IE, fever, vascular phenomenon (emboli).
    • Diagnosis: 2 major criteria, 1 major + 3 minor, or 5 minor criteria.

    Pathogenesis of IE

    • Valvular endothelial injury leads to platelet fibrin clot formation.
    • Bacterial seeding onto the clot.
    • Bacterial adherence and proliferation on the clot, forming a vegetation.

    Classification of IE

    • Native Valve:
      • Most common: Mitral valve (left-sided)
      • Associated valvular heart disease: Mitral regurgitation, congenital heart disease
      • CKD associated IE: Tricuspid
    • Prosthetic Valve:
      • < 12 months: CONS > MRSA > Gram-negative bacilli

      • 12 months: Streptococcus viridans > S.aureus > Enterococci

      • IV drug users associated IE: MRSA

    Various Endocarditis and Associated Organisms

    • Native Valve: S.aureus > Streptococcus viridans > Enterococci
    • Prosthetic Valve:
      • < 12 months: CONS > MRSA > Gram-negative bacilli

      • 12 months: Streptococcus viridans > S.aureus > Enterococci

    • IV drug users: MRSA

    Clinical Presentation of IE

    • Acute IE: High mortality (100%), associated with abscess, osteomyelitis, leading to severe sepsis and septic shock.
    • Subacute IE: Longer duration (2-8 months), characterized by fever, anorexia, weight loss, fatigue, myalgia, and signs like new onset or worsening cardiac murmur, embolic events, splenomegaly, clubbing, vasculitis.

    Subacute IE Features

    • Laboratory: Anemia, elevated WBC, ESR, CRP, rheumatoid factor positive, proteinuria and microscopic hematuria.
    • Signs: Cardiac murmur changes, macroembolic events (stroke, ACS), microembolic events (petechiae, splinter hemorrhage).
    • Vasculitis Manifestations: Osler nodes, Janeway lesions, Roth spots, MPGN.

    Treatment of IE

    • Streptococcus viridans: Penicillin G IV for 4 weeks.
    • Enterococci: Penicillin G IV for 4-6 weeks, plus Gentamicin IV.
    • Staphylococcus (MRSA): Vancomycin IV for 4-6 weeks, plus Gentamicin IV for prosthetic valve IE.
    • Culture negative: Consider rare conditions, antibiotic treatment based on clinical suspicion.

    Surgical Intervention for IE

    • Native Valve: Acute valvular regurgitation, fungal endocarditis, perivalvular aortic abscess.

    Prophylaxis of IE

    • Indications: Prosthetic valve, previous IE episode, post-cardiac transplant, unrepaired CHD, repaired CHD within 6 months.
    • Medication: Amoxicillin 2g orally before procedures, alternatives for penicillin allergy, IV options if oral route not possible.
    • Pre-procedural prophylaxis: Dental, respiratory tract, or incision/drainage procedures.

    HCV Hepatology

    • Incubation period: 50 days.
    • Chronic hepatitis: 85% over 40 years.
    • Anicteric hepatitis: Often undiagnosed.
    • Enzyme levels: Variable.
    • Fulminant failure: 0.1-1%.
    • Anti-HCV testing (EIA): Positive indicates acute/chronic infection, negative indicates no HCV contact.
    • Treatment: New DAAs (Direct-Acting Antivirals) are effective for patients > 12 years old with high SVR rates.
    • Extrahepatic manifestations: Sjogren's syndrome, lymphoma, cryoglobulinemia, porphyria, lichen planus, MPGN, autoimmune thyroid disease.
    • Acute phase: Fever, fatigue, malaise, possible asymptomatic or extrahepatic manifestations.

    Tropical Infections

    • Fever on Day 1: Paracetamol + decongestants, screen for foci of infection.
    • Fever on Day 3:
      • Salmonella: Step-ladder fever pattern.
      • Malaria: Chills and rigors with fatigue.
      • Leptospirosis, scrub typhus: Myalgia, conjunctival suffusion.
      • Dengue: High-grade fever, retro-orbital pain, occipital pain, vomiting.
      • Investigations: CBC, dengue NS-1 antigen, quantitative buffy coat for malaria.
    • Fever on Day 4: Doxycycline + Cotrimoxazole DS.
    • Fever on Day 5: Blood culture for aerobic, anaerobic, and fungal cultures.
    • Typhoid:
      • Isolated from South India, high sensitivity.

    Remember that this is just a summary of the text. You should always consult a healthcare professional for any health concerns.

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    Description

    Explore the vital concepts of echocardiography techniques and the intricacies of infective endocarditis. This quiz covers sensitivity comparisons between transthoracic and transesophageal echocardiography, risk factors, types, and complications associated with infective endocarditis. Test your knowledge on how these elements are crucial for diagnosing heart conditions.

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