Pathology EMQ

Name: Shrawan Patel

Theme: PUO & Endocarditis

 

OPTION LIST

 

A	Acute Bacterial Endocarditis	I	Libman-Sacks Endocarditis
B	AIDS	J	Mitral Valve Stenosis
C	Congenital ASD	K	Nonbacterial Thrombotic Endocarditis
D	Congenital Heart Disease	L	Rheumatic Fever
E	Congenital VSD	M	Rheumatoid Arthritis
F	Decreased Compliance	N	Risk of Thromboembolism
G	Illicit Drug Use	O	Subacute Bacterial Endocarditis
H	Infectious Etiology	P	Systemic Lupus Erythematous

 

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

 

1.  A 40 y/o woman presents to A&E with a fever. Chest x-ray shows multiple patchy infiltrates in both lungs. Blood cultures and echocardiography suggest acute bacterial endocarditis limited to the tricuspid valve. Which of the above is the most probable etiology? 

 

2.  Tricuspid endocarditis must be considered in evaluating PUO in patients with a history of which of the above?

 

3.  In a hospital cardiac care unit, there are three patients with different cardiac conditions: a 52-year-old man with dilated cardiomyopathy, an 18-year-old girl with mitral valve prolapse, and a 30-year-old man with infective endocarditis of the mitral valve. Which of the following features do all these patients most likely share? 

 

4.  A 45 y/o woman was admitted to A&E at 11pm with painful hard swellings on her fingers and toes. On physical examination she also presented with boat-shaped retinal haemorrhages and painless erythematous blanching seen on her palmer surface. Which one of the above would tie these physical signs together?

 

 

5. A 19 y/o woman sees her physician because of a severe sore throat. Three weeks later, she complains of fever, pains in the knees and a rash on the arms that consists of a circular ring of erythema around normal skin. Other findings on examination include bibasilar inspiritory crackles, an S3 heart sound and a pansystolic murmur at the apex that radiates into the axilla. The heart murmur and S3 heart sound increase in intensity on expiration and her blood cultures were negative. Which of the above is the most likely diagnosis?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS

1. G

2. G

3. N

4. A

5. L

 

1.  G is the most probable etiology of bacterial endocarditis involving the tricuspid valve. Drug use can introduce skin organisms into the venous system that then attack the tricuspid valve. Staphylococcus aureus accounts for between 60% and 90% of cases of endocarditis in IV drug users.

D has associated endocarditis, however it typically involves either damaged valves or atrial or ventricular septal defects.

The endocarditis associated with J most commonly damages the mitral and aortic valves, and tricuspid damage is usually less severe and seen only when the mitral and aortic valves are heavily involved.

P can produce small, aseptic vegetations on valves, but is not associated with bacterial endocarditis.

 

3.   Thromboembolism may develop in each of these patients. Vegetations associated with infective endocarditis may undergo fragmentation. Stasis develops in dilated ventricles and thrombi may form within the left atrium in the presence of mitral valve prolapse.

 

5.   Rheumatic Fever is an acute, immune-mediated multisystem disease that follows a group A strep pharyngitis after an interval of a few weeks. Antibodies against group A strep cross-react with similar human tissue proteins causing a Type II hypersensitivity reaction. Blood cultures were negative therefore ruling out acute bacterial endocarditis or subacute bacterial endocarditis. As this woman displays none of the classic findings of SLE and Libman-Sacks endocarditis occurs in a minority of patients who suffer from SLE, I would be false.