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USMLE2

Pediatric Heart Disease

QuestionAnswer
Regular healthy person gets endocarditis. What is the organism and what is the treatment? Staph aureus. [(Nafcillin OR Oxacillin) + 5d gent] x 4-6 weeks
Person with pre-existing heart disease gets endocarditis. What is the organism and what is the treatment? Strep viridans. Tx with PCN G x 4 wks OR PCN (or CTX) + gent x 2 wks
What tx to give person with endocarditis with cardiac prosthetic device infected with S. aureus? Vanc + gent (+/- rifampin) x 4-6wks
Person gets endocarditis after dental procedure. What is the organism and what is the treatment? Strep viridans. Tx with PCN G x 4 wks OR PCN (or CTX) + gent x 2 wks
Pt s/p bowel or GU manipulation gets endocarditis. What is the organism and what is the treatment? What if the pt is PCN allergic? Enterococci (Grp D Strep). Tx with ampicillin + gent x 4-6 wks. If PCN allergic: vanc + gent x 4-6 wks
IVDU pt gets endocarditis. What are the organisms it could be? Can be Pseudomonas or Serratia.
Pt s/p open heart surg gets endocarditis. What is the organism? Fungi
Pt with indwelling IV catheter gets endocarditis. What is the organism? Staph - coag neg.
Person with MRSA endocarditis. What is Tx? Vanc +/- TMP/SMX x 4-6wks
Person with Staph Epi endocarditis. What is Tx? Vanc +/- rifampin x 6wks
What are HACEK organisms? slow-growing G- org that are part of nl flora
Person with HACEK endocarditis. What is Tx? Does tx change if they have a prosthetic heart valve? CTX x 4 wks. If prosthetic, then same but x 6 wks.
Name the HACEK organisms. Hemophilus spp, Actinobacillus, Actinomycetemcomitans, Cardiobacterium hominus, Eikenella corrodens, Kingella kingae
Prophylaxis for endocarditis in oral/esophageal/resp procedures Amox if PO, if NPO then ampicillin. If PCN allergic: Clinda OR Cephalosporin (CTX) OR Macrolide (Azithromycin)
Pts with high risk of developing endocarditis. What do you prophylax with? What to use if PCN allergic? Pts with prosthetic valves, prior endocarditis, complex cong heart disease, pulm shunts. Tx with ampicillin and gentamicin. If PCN allergic: vanc AND gent
Pts with moderate risk of developing endocarditis. What do you prophylax with? Congenital heart disease, acquired valvular disease, aortic stenosis, MVP with regurg or thick valves. Amox OR ampicillin. If PCN allergic: Vanc
Need endocarditis prophylaxis? MVP with no regurg or thick valves no
Need endocarditis prophylaxis? tonsillectomy yes
Need endocarditis prophylaxis? repair of ASD/VSD/PDA no
Need endocarditis prophylaxis? Rigid bronch yes
Need endocarditis prophylaxis? Coronary artery bypass no
Diagnosis Criteria for Acute Rheumatic Fever JONES. MAJOR: J - Joints (migratory polyarthritis), O (O-antigen, carditis), N (subQ nodules), E (erythema marginatum), S (Sydenham chorea). MINOR: arthralgia (can't use if have arthritis), fever, increased ESR < CRP, EKG with long PR.
How many criteria needed to make ARF diagnosis? Must have evidence of prior Strep infection. PLUS Chorea by itself OR 2 major OR 1 major and 2 minor OR 5 minor. Can't use arthralgia if already have major arthritis.
Treatment for ARF penicillin or erythromycin to get rid of bug, ASA as anti-inflammatory (tx arthritis and carditis), but if have CHF with carditis, give prednisone.
Created by: christinapham