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What is the most common microorganism associated with early prosthetic valve endocarditis?

  • Streptococci
  • Staphylococcus aureus (correct)
  • Bartonella
  • Coxiella

    • Which of the following statements is true regarding right-sided infective endocarditis in intravenous drug users (IVDU)?

  • It is associated with a low embolic risk.
  • It primarily affects the mitral valve.
  • It most commonly involves the tricuspid valve. (correct)
  • Only bacterial pathogens are involved.

    • Which of the following is not considered a risk factor for prosthetic valve endocarditis?

  • Indwelling catheters
  • Immunodeficiency
  • Regular exercise (correct)
  • Previous endocarditis

    • In the context of possible infective endocarditis, how many minor criteria must be met for a diagnosis?

    <p>3 minor criteria</p> Signup and view all the answers

    Which of the following conditions is a potential minor criterion for infective endocarditis?

    <p>Unrepaired cyanotic congenital heart disease</p> Signup and view all the answers

    What is the most common pathogen associated with Native Valve Endocarditis (NVE)?

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

    Which treatment regimen is typically used for Subacute Bacterial Endocarditis (SBE) caused by viridans streptococci?

    <p>Penicillin G or ceftriaxone + gentamicin</p> Signup and view all the answers

    What is a significant characteristic of the infection caused by S.aureus in the context of endocarditis?

    <p>Acute clinical course often associated with IVDU</p> Signup and view all the answers

    Which of the following is NOT associated with Hemodialysis patients in terms of infective endocarditis causative agents?

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

    What clinical features are required for a diagnosis of Definite Infective Endocarditis (IE)?

    <p>2 major criteria</p> Signup and view all the answers

    Which treatment option is preferred for Prosthetic Valve Endocarditis (PVE)?

    <p>Vancomycin + rifampin + gentamicin</p> Signup and view all the answers

    What association does S.bovis have in clinical practice?

    <p>Commonly linked to colorectal cancer or IBD</p> Signup and view all the answers

    Which group of organisms are primarily considered gram-negative and are associated with infective endocarditis?

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

    What is the most common cause of large bowel obstruction in adults?

    <p>Colon Cancer</p> Signup and view all the answers

    At what age is screening for colorectal cancer recommended to begin?

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

    Which dietary factor is associated with an increased risk of colorectal cancer?

    <p>High red or processed meat consumption</p> Signup and view all the answers

    What type of pattern is identified on a barium enema for colorectal cancer?

    <p>Apple core lesion</p> Signup and view all the answers

    Which is a protective factor against colorectal cancer?

    <p>Regular use of NSAIDs</p> Signup and view all the answers

    What is the peak age for colorectal cancer diagnosis?

    <p>65 years</p> Signup and view all the answers

    What type of anemia is associated with advanced colorectal cancer?

    <p>Iron deficiency anemia</p> Signup and view all the answers

    Which of the following is a common chemotherapy regimen for colorectal cancer?

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

    What genetic syndrome involves a mutation of the APC gene?

    <p>Familial Adenomatous Polyposis</p> Signup and view all the answers

    Which chemotherapy agent is classified as a VEGF inhibitor?

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

    What is the most common cause of chronic pancreatitis?

    <p>ETOH (alcohol) abuse</p> Signup and view all the answers

    Which diagnostic test is most sensitive and specific for assessing pancreatic function?

    <p>Fecal elastase testing</p> Signup and view all the answers

    In acute hepatitis A, which serological marker indicates recent infection?

    <p>IgM anti-HAV</p> Signup and view all the answers

    Which of the following symptoms is typically seen in acute hepatitis B?

    <p>Dark urine</p> Signup and view all the answers

    Which laboratory finding is expected in chronic hepatitis B?

    <p>AST/ALT in the hundreds</p> Signup and view all the answers

    What is a common management strategy for chronic pancreatitis?

    <p>Oral pancreatic enzyme replacement</p> Signup and view all the answers

    Which therapy is often used for chronic hepatitis B with severe symptoms?

    <p>Antiviral therapy</p> Signup and view all the answers

    What is a characteristic finding in abdominal imaging for chronic pancreatitis?

    <p>Calcification of the pancreas</p> Signup and view all the answers

    What is the incubation period for hepatitis A?

    <p>15-45 days</p> Signup and view all the answers

    Which of the following is a sign of chronic pancreatitis?

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

    What is the main route of transmission for hepatitis C?

    <p>Blood, especially through intravenous drug use</p> Signup and view all the answers

    For which patient group is post-exposure prophylaxis for hepatitis A most recommended?

    <p>Healthy individuals aged 1-40 years</p> Signup and view all the answers

    What is the main clinical manifest of acute hepatitis A typically seen prior to jaundice?

    <p>Anorexia and nausea</p> Signup and view all the answers

    What is a key clinical manifestation of Pancoast syndrome?

    <p>Shooting arm pain</p> Signup and view all the answers

    Which group is recommended for annual low-dose CT screening?

    <p>Individuals aged 55-80 who have quit smoking within 15 years</p> Signup and view all the answers

    What is a common site for carcinoid tumors?

    <p>GI tract</p> Signup and view all the answers

    What symptom is associated with carinoid syndrome?

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

    Which bacteria is most commonly associated with community-acquired pneumonia?

    <p>Streptococcus pneumoniae</p> Signup and view all the answers

    What should be suspected in a patient showing new lung infiltrate after endotracheal intubation?

    <p>Hospital-acquired pneumonia</p> Signup and view all the answers

    Which diagnostic tests are typically used for community-acquired pneumonia (CAP)?

    <p>CBC, CMP, CRP, procalcitonin</p> Signup and view all the answers

    What is the preferred outpatient treatment for community-acquired pneumonia in adults?

    <p>Amoxicillin plus macrolide</p> Signup and view all the answers

    Which clinical feature is NOT included in the CURB-65 assessment?

    <p>Elevated liver enzymes</p> Signup and view all the answers

    What alternative treatment option is available for outpatient management of pneumonia?

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

    In cases of suspected MRSA pneumonia, which antibiotic is typically indicated?

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

    What is characterized by a gradual onset of symptoms including a low-grade fever and cough?

    <p>Mycoplasma pneumonia</p> Signup and view all the answers

    Which of the following is a risk factor for developing community-acquired pneumonia?

    <p>Excessive alcohol use</p> Signup and view all the answers

    What is a typical feature of nosocomial pneumonia?

    <p>Acquired more than 48 hours after admission</p> Signup and view all the answers

    Study Notes

    Endocarditis

    • Subacute Bacterial Endocarditis (SBE): Less virulent organisms like viridans streptococci infect abnormal valves, causing a slow progression over weeks to months.
    • Native Valve Endocarditis (NVE): The most common causes are Staphylococcus aureus, viridans streptococci, and enterococci.
      • S. aureus leads to acute endocarditis, often in IVDU (intravenous drug users).
      • Viridans streptococci cause subacute endocarditis.
      • Enterococci are associated with UTIs and GI/GU procedures.
    • Prosthetic Valve Endocarditis (PVE): Infection of artificial heart valves.
      • Early PVE (≤12 months): Streptococci, S. aureus, and CoNS (Coagulase Negative Staphylococcus).
      • Late PVE (≥12 months): Streptococci, especially viridans streptococci and S. bovis.
    • Modified Duke Criteria: Used to diagnose endocarditis.
      • Definite IE: Two major criteria, one major + three minor, or five minor criteria.
      • Possible IE: Three minor criteria, unrepaired cyanotic congenital heart disease, or a previous history of endocarditis.
    • Pathologic Criteria: One criterion is a confirmed microorganism from the culture/histology of a vegetation, or features of active endocarditis on the histology.
    • Treatment:
      • NVE: Vancomycin.
      • PVE: Vancomycin, rifampin, and gentamicin.
      • Viridans streptococci: Penicillin G or ceftriaxone + gentamicin.
      • Enterococci: Ampicillin or penicillin G + gentamicin.
      • HACEK: Ceftriaxone.
    • IVDU: Right-sided endocarditis, often affecting the tricuspid and pulmonic values.
      • Common causative organisms: S. aureus.
    • Surgery: Recommended for PVE, heart failure, uncontrolled IE, perivalvular extension or complications, fungal IE, and high embolic risk.

    Colon Cancer

    • Colorectal cancer (CRC): Most common cause of large bowel obstruction in adults.
    • Risk factors:
      • Age >50 years.
      • African American ethnicity.
      • Family history of CRC.
      • Inflammatory bowel disease (UC > Crohn).
      • Diet (low fiber, high in red/processed meat and animal fat).
      • Obesity.
      • Smoking.
      • Excessive alcohol consumption.
    • Protective factors:
      • Physical activity.
      • Regular use of aspirin and NSAIDs.
    • Genetics:
      • Familial adenomatous polyposis (FAP): APC gene mutation leading to the development of adenomas in childhood; nearly all patients develop colon cancer by age 45. Prophylactic colectomy is recommended for survival.
      • Turcot syndrome: FAP-like syndrome with CNS tumors (e.g., medulloblastoma, glial tumors).
      • Lynch syndrome: Increased risk of colon cancer and other cancers. Recommend colonoscopy every 1-2 years beginning at 20-25 years old.
    • Clinical manifestations:
      • Right-sided (proximal): Chronic occult bleeding often leading to iron deficiency anemia.
      • Left-sided (distal): Bowel obstruction.
    • Screening:
      • Fecal occult blood testing (FOBT): Annually starting at age 50.
      • Colonoscopy: Every 10 years for ages 50-75; every 5 years with FOBT every 3 years.
      • Flexible sigmoidoscopy: Every 5 years + FOBT every 3 years.
    • Treatment:
      • Surgery: Removal of the tumor and surrounding tissue.
      • Chemotherapy:
        • FOLFOX: Folinic acid, fluorouracil, and oxaliplatin.
        • FOLFIRI: Folinic acid, fluorouracil, and irinotecan.
      • VEGF inhibitors: Bevacizumab.
      • Metastatic disease: Palliative chemotherapy.

    Chronic Pancreatitis

    • Definition: Progressive inflammatory changes to the pancreas leading to loss of endocrine and exocrine function.
    • Etiologies:
      • Alcohol abuse (most common).
      • Idiopathic causes.
      • Hypocalcemia, hyperlipidemia, islet cell tumors, familial causes.
      • Trauma and iatrogenic causes.
    • Clinical manifestations:
      • Calcification of the pancreas: Seen in about one-third of patients.
      • Steatorrhea.
      • Diabetes.
      • Weight loss.
      • Epigastric or back pain.
    • Diagnostics:
      • CT scan: Calcification of the pancreas.
      • Abdominal X-ray: Calcified pancreas.
      • Endoscopic ultrasound or ERCP.
      • Pancreatic function testing: Fecal elastase is the most sensitive and specific test.
    • Management:
      • Abstinence from alcohol.
      • Pain control.
      • Low-fat diet.
      • Vitamin supplementation.
      • Oral pancreatic enzyme replacement.
      • Pancreatectomy: Only if pain is intractable despite medical therapy.

    Pneumonia

    • Community-Acquired Pneumonia (CAP): Acute onset of fever, cough with or without sputum, and dyspnea.
    • CAP Risk factors:
      • Older age.
      • Tobacco use.
      • Excessive alcohol consumption.
    • CAP Clinical manifestations:
      • Tachycardia, tachypnea.
      • Crackles (rales) and rhonchi.
      • Tactile fremitus, egophony, and dullness to percussion.
    • CAP Common causative organisms: Mycoplasma (most common in ambulatory settings).
    • CAP Diagnostics:
      • Lab tests: CBC, CMP, CRP, procalcitonin.
      • Imaging: Chest X-ray.
        • Viral pneumonia: Bilateral, multifocal, patchy, or ground-glass opacities.
        • Bacterial pneumonia: Dense lobar or alveolar consolidations.
    • CAP Management:
      • Outpatient treatment: Amoxicillin + macrolide (preferred) or doxycycline. FQ monotherapy is an alternative.
      • Inpatient, non-ICU treatment: Antipneumococcal beta-lactam + macrolide or FQ monotherapy.
      • Inpatient, ICU treatment: Antipneumococcal beta-lactam + Azithromycin (preferred) or FQ.
    • Nosocomial Pneumonia: Pneumonia acquired in a hospital setting.
      • Hospital-Acquired Pneumonia (HAP): New lung infiltrate and ≥2 clinical features of infection (e.g., new-onset fever, leukocytosis or leukopenia, purulent sputum).
      • Ventilator-Associated Pneumonia (VAP): New lung infiltrate and ≥2 clinical features of infection within 48 hours of endotracheal intubation.
      • Nosocomial pneumonia risk factors: Age >50 years, previous IV antibiotics within 90 days, structural lung disease.
      • Common causative organisms: Pseudomonas aeruginosa (cystic fibrosis).
      • Management:
        • Suspect MRSA: Vancomycin or linezolid.
        • Suspect Pseudomonas: Beta-lactam + FQ.
    • CURB-65 Assessment:
      • Confusion: Confusion (1 point).
      • Urea: Blood urea nitrogen (BUN) >19 mg/dL (1 point).
      • Respiratory rate: Respiratory rate ≥ 30 (1 point).
      • Blood pressure: Systolic blood pressure (SBP) ≤90 mmHg (1 point).
      • Age: Age ≥65 years (1 point).

    Hepatitis

    • Hepatitis A (HAV): Transmitted via fecal-oral route.
      • Clinical manifestations:
        • Prodromal symptoms: Anorexia, nausea/vomiting, fatigue, malaise, arthralgias, myalgias, headache, photophobia, pharyngitis, cough, and coryza.
        • Jaundice: Appears 1-2 weeks after prodromal symptoms.
        • Other symptoms: Right upper quadrant pain.
      • Diagnostics:
        • Acute infection: IgM anti-HAV.
        • Past exposure: IgG anti-HAV.
      • Management: Supportive treatment. Infection is self-limiting.
        • Post-exposure prophylaxis:
          • Healthy individuals, ages 1-40 years: HAV vaccine preferred over immunoglobulin.
          • Immunocompromised individuals or those with chronic liver disease: HAV vaccine + immunoglobulin.
    • Hepatitis B (HBV): Transmitted via sex, blood, or body fluids.
      • Clinical manifestations:
        • Acute or chronic infections: Dark urine, clay-colored stools, may appear before jaundice.
      • Diagnostics:
        • HBsAg (surface antigen): Positive in acute and chronic infections.
        • Anti-HBs (surface antibody): Positive in recovered or immunized individuals.
        • Anti-HBc (core antibody):
          • Acute infection: IgM
          • Chronic or recovered: IgG
        • HbeAg (envelope antigen): Replicative (chronic infection)
        • Anti-Hbe (envelope antibody): Non-replicative (chronic infection)
        • LFTs:
          • Acute infection: AST/ALT in the thousands, bilirubin elevated.
          • Chronic infection: AST/ALT in the hundreds, bilirubin elevated.
        • HBV DNA: Best way to assess viral replication activity.
        • Liver biopsy
      • Management:
        • Supportive care: Most patients will not become chronically infected.
        • Chronic HBV management: Antiviral therapy indicated in patients with persistent symptoms, severe jaundice (bilirubin > 10), inflammation on liver biopsy, or elevated ALT or positive HB envelope antigen.
          • Entecavir and tenofovir are recommended for chronic HBV.
          • Treatment may be stopped if HBsAg has cleared.
      • HBV Vaccine:
        • Infant immunization: Given at birth, 1-2 months of age, and 6-18 months of age.
        • Adult: Three doses given at 0, 1, and 6 months.
    • Hepatitis C (HCV): Transmitted mainly via blood (IVDU is most common).
      • Clinical manifestations: - Jaundice, RUQ pain, fatigue - Some will have a "silent" infection with no symptoms at all
      • Diagnostics: Screening test for HCV antibodies.
    • Management:
      • Supportive treatment.
      • Antiviral treatment: Direct-acting antivirals (DAAs), like sofosbuvir and ledipasvir, are highly effective in treating HCV.

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