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39 Cards in this Set
- Front
- Back
what is the cardiac damage seen with acute rheumatic fever?
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mitral valve stenosis
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why do we do a strep test?
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because it is associated with acute rheumatic fever! so you want to prevent that shit
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Define acute rheumatic fever (ARF)
OBJECTIVE *** |
Delayed nonsupporative disease (no puss)
Occurs after an antecedant Group A streptococcal infection Characterized by proliferative inflammatory lesions in the connective tissue of joints, heart, skin and central nervous tissue |
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how long does it take for strep to infect?
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18 days
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what months does ARF (acute rheumatic fever) occur?
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cooler months!
March or April in the NE fall months in the SW |
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how do streptococci appear under microscopy
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chains of gram positive cocci
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are strep catalase positive or negative?
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negative
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do strep need enrichment with blood to support growth or not?
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Need enrichment with blood to support growth
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group a Strep undergoes what type of hemolysis?
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Beta
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• Understand the pathogenic mechanism of ARF
OBJECTIVE |
Evidence supports an autoimmune phenomenom – molecular mimicry
examples: Immunoglobulin and complement deposits Heart reactive antibodies in sera Patients demonstrate greater hyperimmune response to streptococcal antigens Rheumatic heart valves have been shown to contain infiltrates of T-cells |
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is there a strong genetic predisposition to ARF?
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not really 2-3%
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can ARF reoccur?
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yes, HIGH PROBABILITY of this
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what must you have before looking at Jones Criteria?
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Antecedent group A infection
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How do you clinically Diagnose ARF?
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lab evidence of recent strep infection + the presence of 2 major or 1 major and 2 minor Jones Criteria
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Carditis
Polyarthritis Erythema marginatum Subcutaneous nodules Sydenham’s chorea are examples of what? |
Major Jones Criteria
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Arthralgia
Fever Previous rheumatic fever Prolonged P-R interval on ECG Elevated erythrocyte sedimentation rate, C-reactive protein or leucocytosis are examples of what? |
Minor Jones Criteria
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what major jones criteria is most common in ARF? 2nd?
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Polyarthritis most common (80% of cases)
Carditis (40-50%) |
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How do you make a laboratory diagnosis of ARF?
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Screen with Streptozyme test, if pos do ASO (>500 units)
Acute phase reactants - elevated in any inflammatory condition, i.e. increased ESR, CRP, PMN’s, etc. |
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When do you give a patient prednizone?
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when they have ARF with severe carditis
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what is the typical treatment for ARF?
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Salicylates
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how do you prevent primary attacks of ARF?
***Objective |
prompt recognition and treatment of strep throat
Throat cultures for Grp A strep Rapid latex test DOC: penicillin |
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how do you prevent secondary attacks of ARF?
***Objective |
long-term prophylaxis with penicillin
these people will keep getting strep throat over and over after having ARF once, so you treat them to prevent this so they don't get ARF again |
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what is PANDAS?
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Pediatric Autoimmune Neurologic Disorders Associated with Streptococcus
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what will make you likely to get infective endocarditis?? (most important risk factor)
***** |
PRIOR HEART DAMAGE--VALVE DAMAGE
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please describe Infective endocarditis (IE)
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Infective endocarditis (IE) is an infection of the native or prosthetic valve or endocardium
It occurs most often in patients with recognized heart disease Hearts of such patients undergo an edematous, cellular distortion resulting in non-bacterial thrombocytic endocarditis (NBTE) lesions |
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what are the 4 classifications of infective endocarditis?
****KNOW |
Acute infective endocarditis (AIE)
Subacute infective endocarditis (SIE) IV drug use infective endocarditis Prosthetic valve endocarditis (PVE) ---Early onset ---Late onset |
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what is the common organism that causes Acute Infective Endocarditis
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Staphylococcus aureus
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what is the common organism that causes Subacute Infective Endocarditis
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Streptococcus “viridans” grp (α)
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what is the common organism that causes endocarditis from Intravenous Drug Users
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Staphylococcus aureus
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what is the common organism that causes Early Prosthetic Valve Endocarditis
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Staphylococcus epidermidis
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what is the common organism that causes Late Prosthetic Valve Endocarditis
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Streptococcus “viridans”
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Read this
Traumatized valves and role of nonbacterial thrombotic vegetations: Endothelial damage → tissue denuded of collagen → platelets aggragate → fibrin deposits → bacteria colonize → form vegetations → stimulate thrombi → vegetations enlarge (sanctuary for organisms) |
it was a pathogenesis slide
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vegetations from endothelial damge provides what for organisms?
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SANCTURARY
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your pt presents with fever, rigors, prostration, and leucocytosis
Skin may show evidence of embolic pustules or hemorrhage (DIC) Occassionally, Janeway lesions what does this person have ***** |
Acute Infective Endocarditis
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pt comes in and says they are tired and not feeling well. They report weight loss, and have a heart murmor. The patient also has Roth spots in the eye
what do they have? ***** |
subacute endocarditis
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The patient has splinter hemorrhages and feels ill. What do they have?
**** |
subacute endocarditis
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will you be able to easily isolate the organism responsible for AIE? what about SIE?
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Easy for AIE
Difficult for SIE |
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in treatment of infective endocarditis, what type of antibiotics should you use?
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bactericidial
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what should your blood to serum bactericidal levels be in treatment of IE?
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1:8
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