Endocarditis in a patient with prosthetic valve ?viridians

Discussion in 'MRCP Forum' started by Guest, Jun 15, 2006.

  1. Guest

    Guest Guest

    diabetic pt. Gangrene in his big toe. Next investigation

    1. Normal XRay
    2.CT scan
    3. MRI
    4. Isotope scan
    Endocarditis in a patient with prosthetic valve. The possible micro organism is
    1. strept viridians

    2. Staph epidemidis
    3. candida
    4. staph aureus
    coeliac disease positive test 40 negative test 10
    Non celiac disease positive test 60 negative test 840

    need sensitivity?

    40%
    80%
    :
    Scaly patches on the scalp in a 16 year old boy with non scarring allopecia

    1. Discoid lupus
    2. Psoriasis
    Profuse watery diarrheoa even in fasting state

    1 VIPOMA


    following questions were posted by csngiu

    girl ate in chinese restaurant, presented with V ANd D, what is the organism...B. cereus, E coli, (old question)

    unkempt guy, came to a school claiming to save children from ill of the world, dia ...
    40s lady presented with some sort of rash over extensor surface, buttock, what investigation u wish to order: viral swap from skin

    lady 30-40, presented with proximal myopathy, rash over body. inve ...
    . Mother presented with a few days history of rash over the body and arthralgia. Also have similar history among her children days/weeks ago, diagnosis: rubella, IM.......

    40s lady presented with some sort of rash over extensor surface, buttock, what investigation u wish to order: viral swap from skin

    lady 30-40, presented with proximal myopathy, rash over body. investigation noted raised CPK: SLE, dermatomyositis, RA........

    features most suggestive of adult onset still's disease: marked raised ESR

    eldery lady in nursing home with genital discharge, vaginal swap noted N. gonorrhea, and was treated, what you want to proceed: contact tracing, inform family, non-official inquiry.............

    HIV positive with 2 months of cough, fever weight loss, which organism if grow from sputum suggestive of AIDS: TB...............

    Known IVDU on methadone for post-hepatitis immunization workupg, noted + HBsAg, - HBsIG, + HCV. what is the cause of failed immunization: HIV +, chronic hepatitis C, Methadone interaction...........

    Man came from form summer holiday in Jerman, presented with CN lesions: cuases: Lyme ds..............
    . Cause of monooclar Blindness in AIDS patient:
    CMV/Toxoplasmosis/Mycobacterium

    2. Most important side effect of Amiodarone:
    Phototoxicity/QT Interval prolongation/Hypothyroidism/Corneal deposits/
    NO lung fibrosis in the choice.

    3. 22 yr old male come with h/o rashes on his face and hands last 2 years. He claims there is one ointment that that cure his problem but he has not been able to find any proprietary medication that worked. Examination is normal. What is the diagnosis:
    delusional disorder/somatoform disorder/hypochondriasis/obsessive compulsive disorder
    1- Hypokalemia with acidosis, Low HC03, Nephrocalcinosis - TYPE 1 RTA.

    2 - Splicing of RNA - Nucleus/ Ribosome/ peroxisome/ lysosome/ golgi

    3) Postural Hypotension with ataxia with parkinsonism features, recurrent falls -- Multisystem atrophy/

    4) Number needed to treat.

    5) Sensitivity

    6) Postive predictive value

    7) asymptomatic with Essential thrombocytosis - platelet count > 800 - Treatment - Aspirin/ hydroxurea/ Platelet pheresis/ radioactive substance/ observation

    Prosthetic valve a month ago - MCC of IE - Stap epidermidis

    9) % of DM type 1 developing diabetic nephropathy -

    10) Marfan disorder - fibrillin

    11) anticipation

    12) BIH

    13) GBS - Enmg finding

    14) Rifampicin and OCPs

    15) action of N acetyl cystiene
    the specific antibody in SLE : anti Sm(there was no antiDs)
    - thyrotoxic A.F,immediate management : I.V amiodarone(100),cardioversion,anticoagulation
    -Inf MI,bradycardia,hypotension,cvp 4 : temp pacing,dobutamine,I.V fluids
    Pregnant lady 14 wks found HTN, ECG lt vent. hypertrophy

    1. Eclampsia
    2. Pre eclampsia
    3. essential Hypertension
    Patient with facial reddness and itching. Nothing found by doctor

    1. Somatoform
    2. Hypochondriasis
    H/O Chest infection, took clarythromycin, Lt Supraventricular LN. Cold haemaglutinin

    1. NHL (non hodgkin lymphoma??)
    Asthmatic on intermittent high prednisolone, c/o of hip pain 4 or 8 wks
    can't tolerate weight bearing

    1. avascular necrosis
    2. osteoporosis with fracture
    Patient with heart failure and diabetes
    Drug C/I

    1. Rosiglitazone
    Mechanism of action of Amiodarone

    1. Potassium chanel blocker
    2. Sodium Chanel blocker
    How can diagnose Empyema in a fast way

    1. Aspirate culture
    2. Ph of aspirate
    Diagnosis of Insulinoma??
    72 hr fastig
    Nephropathy, mildly elevated creatinine, protienuria >3.8 gm
    Treatment?
    1.ACE
    Glomerulonephritis treatment??
    1. Prednisolone + cyclophosphamide
    Clinical Pharmacology
    1. Amiodarone Class III agent -> K channel blocker
    2. Cuases of lymphadenopathy -> Phenytoin
    3. which term best describe the affinity of drug for its receptor -> ? Selectivity ? potency

    Cardiac
    1. sinus bradycardia with hypotension -> ? transvenous pacing
    2. Criteria for thrombolysis in AMI
    3. Case with AMI and malignant hypertension -> ? primary PTCA
    1. Where does the RNA splicing take place - nucleus.
    2. Test to confirm adult Still's disease - not ANA, not RF, but ESR.
    3. Diagnosis of DH in patient without diarrhoea - IF of paralesional skin. Small intestine biopsy was an option.
    4. Mechanism of action of Ondansetron - 5-HT3 inhibitor.
    5. Which drug is an ion channel opener - Nicorandil (K channel opener)
    6. Mechanism of action of Amiodarone - K channel blocker.
    7. A case of sporadic colonic carcinoma, mechanism in tumorogenesis - p27 deletion. The other four options were impossible because they showed either tumour supressor gene up-regulation or protoncogene down-regulation. A killer question!
    8. Which enzyme is high in Gaucher's disease - Acid phosphatase.
    9. A lady post CS, given 3 U of blood, 30 min later shock - ABO incompatibility.
    10. A man bitten by a dog, infection, causative organism - Pasteurella multocida.
    11. Cat scratch disease with lymphadenitis, cause - Bartonella henselae.
    12. Cocaine induced MI - Rx PTCA, not thrombolysis; the mechanism here is vasoconstriction rather than clot formation.
    13. Food poisoning after tuna and wine, vomiting + facial flushing, cause - scombrotoxin.
    14. What is the lifetime risk for nephropathy in Type 1 DM in a 27 year-old man- between 20-39%. Kalra actually says 30% risk over 40 years in Type 1 DM.
    15. Man with IgA nephropathy, doubled Cr for a year, outcome - CRF without ESRD.
    16. A case of osteomyelitis, after 2 weeks, most useful test - X-ray.
    17. A case of Bartter's syndrome with high urine potassium.
    18. A case of delayed puberty with low FSH, low LH, low testosterone - Kallman's syndrome. Nothing mentioned about anosmia but remember Kallman= hypogonadotrophic hypogonadism= low FSH, low LH, low testosterone, whereas Kleinfelter- hypergonadotrophic hypogonadism= high FSH, high LH, low testosterone.
    19. A lady with fever, arthropathy, kids with rash a week ago - Parvovirus B19.
    20. Typical feature of PBC - peripheral neuropathy (because of lipid infiltration).
    21. Antibody used in follicular B-NHL - anti CD 20.
    22. A case for NNT, PPV and RRR.
    23. First sign in CPA tumour - loss of corneal reflex.
    24. Acute retention of urine, hypovolaemic - 0.9% saline before catheterisation.
    25. Criteria for thrombolysis - >1 mm ST elevation in two or more limb leads.
    26. Refeeding syndrome, cause - low phoshpate.
    27. Asymptomatic 75 year old with high Ca, low PO4, no evidence for MM -primary hyperparathyroidism.
    1.PT ALLERGIC TO PENICILLIN : DONT GIVE : CEPHRADINE <CROSS ALLERGY>
    2.ASSOCIATION WITH SYSTEMIC SCLEROSIS: PUL HTN
    3.ABS IN CREST : ANTI CENTROMERE ABS
    4..MOST LIKELY ASSOC OF PBC:VITILIGO
    5.CAUSE OF CHB AFTER MI: RT CORONARY ARTEY OCCLUSION
    6TREATMENT FOR POLYCYTHEMIA: HYDROXYUREA
    7.MOST COMMON CAUSE OD DEATH IN ACROMEGALY: LVF
    8.P20 PROTEIN IS IMP B/C : CAUSES EXPULSION OF CYTOTOXIC DRUGS
    9.MOST IMP SIGN OF IDIO PARKINSONISM: ASSYMET REST TREMOR
    10.NONSUSTAINED VT TREATMENT: MG+ I/V
    11.PT WITH CCF AND A LARGE BOUT OF P/R BLEEDING.UPPER GI ENDOSC NORMAL DX ANGIODYSPLASIA
    12.MAN WITH MEDIASTINAL LN ENLAGEMENT HAS STRIDOR ANND LN OBST BRONCH WAT TO DO MEDIASTINOSCOPY.
    13MALT RT ERADICATION THERAPY
    14 EPO IMPROVES : EXERCISE TOLERANCE
    15.FEMALE WITH BULKY STOOLS AND BLOATING IBS
    16 ENDOCARDITIS MONITORING : BLOOD CULTURES
    17.PT WITH HEART VALVE RX AND SMALL VEG ON ECHO DX:STAPH EPIDERMIDIS
    18> FEMALE WITH HYPOGLYCEMIC EPISODE: STOP DRIVING FOR 3 MNTHS..I HOPE
    19>ISOLATED SENSORY LOSS IN A PT>LACUNAR INFARCT
    20.DETERIORATING CONSC IN A FEMALE WITH AD:SUBDURAL HEAMATOMA
    21CHILD UNDERGOING TOOTH EXTRACTON SUFFERS UNCONSC,JERKS AND INCONT OF URINE: DX TONIC CLONIC SEIZURES
    22 O2 GIVEN TO A PT AND HIIS SAT FALLS FOR SOME TIME WHY? B/C OF PUL ARTEY RELAXATION CAUSING MISMATCH B/W PERFUSION AND VENT
    23 INC KCO CAUSE ALV HMG
    24PT WITH PRGO SOB CAUSE :pUL THROMBIEMBOLISM
    25 Q OS PIT APOPLEXY
    26 MANY OPTH QS
    1.AC GLAUCOMA PAIN SUDDEN 6/60 VA
    2.RA PT WITH SEVERE PAIN NORMAL VA: ANT UVEITIS
    27 SCHIZOPHRENIC REFUSES INTUB WAT TO DO..CONSENT FM KITH AND KIN
    28 WAT TO DO IN A PT WITH SSRI RESISTANCE NOT RESPONDING TO IT:LITHIUM ADDITION
    29Q OF MESENTERIC ISCHEMIA
    30.PT OF HYPOMANIA PRESSURIZZED SPEECH
    31.PT OF SCHIZOPHRENIA
    32STATS SENSITIVITY WAS 60
    33STATS RANDOMIZATION AWFUL ONE
    34 STATS PAIRED COMPARSON WITH MEDIAN AS REF/? CHI SQ?
    35STATS POSITIVE PREDICTIVE VALUE AWFUL
    36DERMA SCARRING ALOPECIA DLE
    37DERM INCOGNITO
    38 RENAL BARTER SYNDROME HYPOKALEMIA WITHOUT HTN Q
    39 TYPE 1 RTA NEPHROCALCINOSIS AND ETC
    40 PT OF HYPERVENTILATION SYNDROME WAT WAS UT THEY ASKED?
    41 METABOLIC ACIDISIS FINDINGS IN A Q
    42 RELAXATON RT FOR A PT OF PANIC ATTACK RIGHT?
    43 PHARMA NICORANDIL OPENS ANN ION CHANNEL
    44.CLIPPING OF NAIL FUNFGAL INFECTION DX
    45 SOB WITH NORMAL KCO ASTHMA'
    46SINGLE CAVITATING LESION PNEUMONIA : KLEBSIELLA
    47.CF ORGANISM: PEUDOMONAS
    48.FEMALE WITH GIANT CELL ARTERITIS
    40FTN OF FEMORAL N : ADDUCTOR
    50ULNAR ENTRAPMENT
    51.BOORHAVE DISEASE
    52.TENSION HEADACHE
    53.KLINEFELTER SYNDROME
    54.AIDS PT ORG BURHOLDERIA
    55PT OF AIDS WITH BRAIN ATROPHY?AIDS ENCEPHALOPATHY AS ALL OTHERS CAUSED LESIONS AND NO LESION IN THIS CASE
    56 UNILAT VISUAL LOSS IN AIDS PT TOXOCARA
    57 PROPHLAXIS OF SPLENECTOMY INFLUENZAE ..ONLY VIRAL ORG
    58.SIADH
    59.CRANIAL DI
    60 POOR PXIC FACTOR I ALL 9:22
    61 SAME IN AML?
    62.BULIMIA NERVOSA
    63 LITHIUM TOXICITY
    64 MANTOUX TEST
    65SCDSC
    66.OSTEOSCLERTIC LESION
    67 CAUDA EQUIA SYNDROME
    68.MAEMOCHROMATOSIS
    69S/E OF ROSIGLTAZONE
    70ANTICIPATIO
    71 CAT SCRATCH DISEASE
    72 VARICELLA ZOSTER
    73SCROMBOTOXIN
    774 CEA FOR COLRECTAL CA
    75 PS3 UPREG COLON CA SPORADIC
    76 N ACETYLCYSTEINE?DEC GLUTATHIONE REDUCTSAE?
    BACILLUS CEREUS TOXICTY
    77RENAL BIOPSY
    78LICHEN PLANUS
    79 CRITERIA OF MI
    SOMATIZATION SYNDROME
    80 MEDIAN NERVE
    81AIP
    82 ODANSETRON
    83DERMATOMYOSTIS
    84 REFEEDING SYNDROME
    ENDOCARDITIS MONITORING : BLOOD CULTURES (I believe CRP is the answer)


    MAN WITH MEDIASTINAL LN ENLAGEMENT HAS STRIDOR ANND LN OBST BRONCH WAT TO DO MEDIASTINOSCOPY (I believe predinisolone is the answer)


    FEMALE WITH HYPOGLYCEMIC EPISODE: STOP DRIVING FOR 3 MNTHS (I believe that sending her for diabetic education is the answer, am not sure about admitting her for 72 hours)


    21CHILD UNDERGOING TOOTH EXTRACTON SUFFERS UNCONSC,JERKS AND INCONT OF URINE: DX TONIC CLONIC SEIZURES (no, this is a classic case for vasovagal syncope! and he is suffering from perhaps a complex symcope)


    O2 GIVEN TO A PT AND HIIS SAT FALLS FOR SOME TIME WHY? B/C OF PUL ARTEY RELAXATION CAUSING MISMATCH B/W PERFUSION AND VENT
    (I disagree, i think it is because when you administer nebulisers you usually do not administer oxygen at the same time...that is why your p02 falls)


    RA PT WITH SEVERE PAIN NORMAL VA ANT UVEITIS (epscleritis)


    SCHIZOPHRENIC REFUSES INTUB WAT TO DO..CONSENT FM KITH AND KIN (there is no such thing in england as taking consent from next of kin in england...plus by the time they take consent the patient would have died, so i think the answer was acting on behalf of the patient's best interests)


    28 WAT TO DO IN A PT WITH SSRI RESISTANCE NOT RESPONDING TO IT:LITHIUM ADDITION (personally i think addition of lithium is not an easy thing because it is a dangerous drug that requires monitoring and he does not suffer from bipolar disorder to require it so i think giving him a trial on an alternative class like TCA would be the choice - i am not sure if this is the right answer )


    PROPHLAXIS OF SPLENECTOMY (encapsulated organisms like strep pneumonia)


    anyway, i hope some of my answers have been helpful, i am open for discussion!

    pinkfeets!



    1.PT ALLERGIC TO PENICILLIN : DONT GIVE : CEPHRADINE <CROSS ALLERGY>
    2.ASSOCIATION WITH SYSTEMIC SCLEROSIS: PUL HTN
    3.ABS IN CREST : ANTI CENTROMERE ABS
    4..MOST LIKELY ASSOC OF PBC:VITILIGO
    5.CAUSE OF CHB AFTER MI: RT CORONARY ARTEY OCCLUSION
    6TREATMENT FOR POLYCYTHEMIA: HYDROXYUREA
    7.MOST COMMON CAUSE OD DEATH IN ACROMEGALY: LVF
    8.P20 PROTEIN IS IMP B/C : CAUSES EXPULSION OF CYTOTOXIC DRUGS
    9.MOST IMP SIGN OF IDIO PARKINSONISM: ASSYMET REST TREMOR
    10.NONSUSTAINED VT TREATMENT: MG+ I/V
    11.PT WITH CCF AND A LARGE BOUT OF P/R BLEEDING.UPPER GI ENDOSC NORMAL DX ANGIODYSPLASIA
    12.MAN WITH MEDIASTINAL LN ENLAGEMENT HAS STRIDOR ANND LN OBST BRONCH WAT TO DO MEDIASTINOSCOPY. (
    13MALT RT ERADICATION THERAPY
    14 EPO IMPROVES : EXERCISE TOLERANCE
    15.FEMALE WITH BULKY STOOLS AND BLOATING IBS
    16 ENDOCARDITIS MONITORING : BLOOD CULTURES
    17.PT WITH HEART VALVE RX AND SMALL VEG ON ECHO DX:STAPH EPIDERMIDIS
    18> FEMALE WITH HYPOGLYCEMIC EPISODE: STOP DRIVING FOR 3 MNTHS..I HOPE
    19>ISOLATED SENSORY LOSS IN A PT>LACUNAR INFARCT
    20.DETERIORATING CONSC IN A FEMALE WITH AD:SUBDURAL HEAMATOMA
    21CHILD UNDERGOING TOOTH EXTRACTON SUFFERS UNCONSC,JERKS AND INCONT OF URINE: DX TONIC CLONIC SEIZURES
    22 O2 GIVEN TO A PT AND HIIS SAT FALLS FOR SOME TIME WHY? B/C OF PUL ARTEY RELAXATION CAUSING MISMATCH B/W PERFUSION AND VENT
    23 INC KCO CAUSE ALV HMG
    24PT WITH PRGO SOB CAUSE :pUL THROMBIEMBOLISM
    25 Q OS PIT APOPLEXY
    26 MANY OPTH QS
    1.AC GLAUCOMA PAIN SUDDEN 6/60 VA
    2.RA PT WITH SEVERE PAIN NORMAL VA: ANT UVEITIS
    27 SCHIZOPHRENIC REFUSES INTUB WAT TO DO..CONSENT FM KITH AND KIN
    28 WAT TO DO IN A PT WITH SSRI RESISTANCE NOT RESPONDING TO IT:LITHIUM ADDITION
    29Q OF MESENTERIC ISCHEMIA
    30.PT OF HYPOMANIA PRESSURIZZED SPEECH
    31.PT OF SCHIZOPHRENIA
    32STATS SENSITIVITY WAS 60
    33STATS RANDOMIZATION AWFUL ONE
    34 STATS PAIRED COMPARSON WITH MEDIAN AS REF/? CHI SQ?
    35STATS POSITIVE PREDICTIVE VALUE AWFUL
    36DERMA SCARRING ALOPECIA DLE
    37DERM INCOGNITO
    38 RENAL BARTER SYNDROME HYPOKALEMIA WITHOUT HTN Q
    39 TYPE 1 RTA NEPHROCALCINOSIS AND ETC
    40 PT OF HYPERVENTILATION SYNDROME WAT WAS UT THEY ASKED?
    41 METABOLIC ACIDISIS FINDINGS IN A Q
    42 RELAXATON RT FOR A PT OF PANIC ATTACK RIGHT?
    43 PHARMA NICORANDIL OPENS ANN ION CHANNEL
    44.CLIPPING OF NAIL FUNFGAL INFECTION DX
    45 SOB WITH NORMAL KCO ASTHMA'
    46SINGLE CAVITATING LESION PNEUMONIA : KLEBSIELLA
    47.CF ORGANISM: PEUDOMONAS
    48.FEMALE WITH GIANT CELL ARTERITIS
    40FTN OF FEMORAL N : ADDUCTOR
    50ULNAR ENTRAPMENT
    51.BOORHAVE DISEASE
    52.TENSION HEADACHE
    53.KLINEFELTER SYNDROME
    54.AIDS PT ORG BURHOLDERIA
    55PT OF AIDS WITH BRAIN ATROPHY?AIDS ENCEPHALOPATHY AS ALL OTHERS CAUSED LESIONS AND NO LESION IN THIS CASE
    56 UNILAT VISUAL LOSS IN AIDS PT TOXOCARA
    57 PROPHLAXIS OF SPLENECTOMY INFLUENZAE ..ONLY VIRAL ORG
    58.SIADH
    59.CRANIAL DI
    60 POOR PXIC FACTOR I ALL 9:22
    61 SAME IN AML?
    62.BULIMIA NERVOSA
    63 LITHIUM TOXICITY
    64 MANTOUX TEST
    65SCDSC
    66.OSTEOSCLERTIC LESION
    67 CAUDA EQUIA SYNDROME
    68.MAEMOCHROMATOSIS
    69S/E OF ROSIGLTAZONE
    70ANTICIPATIO
    71 CAT SCRATCH DISEASE
    72 VARICELLA ZOSTER
    73SCROMBOTOXIN
    774 CEA FOR COLRECTAL CA
    75 PS3 UPREG COLON CA SPORADIC
    76 N ACETYLCYSTEINE?DEC GLUTATHIONE REDUCTSAE?
    BACILLUS CEREUS TOXICTY
    77RENAL BIOPSY
    78LICHEN PLANUS
    79 CRITERIA OF MI
    SOMATIZATION SYNDROME
    80 MEDIAN NERVE
    81AIP
    82 ODANSETRON
    83DERMATOMYOSTIS
    84 REFEEDING SYNDROME
    A 28 year old man who had had tuberculosis of the mediastinal lymph nodes diagnosed two weeks previously and who had been started on chemotherapy with rifampicin, isoniazid and pyrazinamide was admitted because of the increasing dyspnoea and stridor.
    Chest X-ray showed compression of both main bronchi by carinal lymph node enlargement.
    What is the next step in management?

    1. Start prednisolone
    2. Mediastinoscopy and biopsy
    3. Refer for stent insertion/tracheostomy
    4. Refer for urgent CT scan of the mediastinum
    5. The addition of ethambutol
    Answer Start prednisolone - (No. 1)
    Comments:
    The treatment of TB mediatinal lymphadenitis is the same as pulmonary TB. The nodes may enlarge during or after treatment as a result of hypersensitivity. Corticosteroids is effective in reducing the enlargement and hence will help the stridor and breathlessness.

    Gastric mucosa-associated lymphoid tissue (MALT) lymphoma arises from mucosal lymphoid tissue that is acquired usually as a reaction to Helicobacter pylori infection. Eradication of H. pylori leads to complete regression of gastric MALT lymphoma in 75% of cases. However, prolonged follow-up is necessary to determine whether a lymphoma responds to therapy
  2. Guest

    Guest Guest

    Endocarditis in a patient with prosthetic valve viridians

    There are two areas where you need to make sure the correct info is entered for a prosthesis. First, on the claim it usually asks if this is Initial placement or reason for replacement. Second, and this is the one we would miss, is in the CHART module, under the procedures for the patient it also needs to be entered as well. Double click on the procedure and on the left side of the new window is the area that you maybe missing the info. If its not these two areas, Im stumped.

    Jim

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