1.The condition associated with the highest risk of developing infective endocarditis (IE) is

A) Mitral valve prolapse with regurgitation.
B) The presence of a prosthetic heart valve.
C) Rheumatic fever without valvular defects.
D) Intravenous drug abuse.

Answer: B

2.Which of the following organsms is not commonly implicated in infective endocarditis?

A) Streptococcus species
B) Staphylococcus species
C) Enterococcus species
D) Candida species

Answer: D
It is usually caused by a form of Viridans group streptococcus bacteria that normally live in the mouth (Streptococcus mutans, mitis, sanguis or milleri).
Other strains of streptococci can cause subacute endocarditis as well. These include streptococcus intermedius, which can cause acute or subacute infection (about 15% of cases pertaining to infective endocarditis).
Enterococci from urinary tract infections and coagulase negative staphylococci can also be causative agents.[5]

3.A 64-year-old man presents to the emergency department with chest pain, fever, fatigue, and arthralgias. His past medical history is significant for rheumatic heart disease and a dental procedure a few weeks before admission. He currently shows no “stigmata” of endocarditis on physical examination, although endocarditis is suspected. The most likely organism is

A) Viridans streptococci.
B) Staphylococcus aureus.
C) Enterococcus fecalis.
D) Pseudomonas.

Answer : A

4.Based on the recent IE diagnostic criteria, the two most important parameters for the diagnosis of this infection are

A) Laboratory abnormalities and positive blood cultures.
B) Positive blood cultures and echocardiographic changes.
C) ECG changes and positive physical findings.
D) Positive physical findings and positive blood cultures.

Answer: B
• Blood culture test. A blood culture test is used to identify any germs in your bloodstream. Blood culture test results help your doctor choose the most appropriate antibiotic or combination of antibiotics.
• Complete blood count. This blood test can tell your doctor if you have a lot of white blood cells, which can be a sign of infection. A complete blood count can also help diagnose low levels of healthy red blood cells (anemia), which can be a sign of endocarditis. Other blood tests also may be done to help your doctor determine the diagnosis.
• Echocardiogram. An echocardiogram uses sound waves to produce images of your heart while it’s beating. This test shows how your heart’s chambers and valves are pumping blood through your heart. Your doctor may use two different types of echocardiograms to help diagnose endocarditis.

5.A 45-year-old woman is scheduled for a major dental extraction in 3 days. She has a history of rheumatic heart disease with mitral regurgitation. She is allergic to penicillin. Her physician asks whether she should receive antibiotic prophylaxis before her procedure. The most appropriate response is

A) Yes, ampicillin 2 g orally 1 hour before the procedure.
B) Yes, clindamycin 600 mg orally 1 hour before the procedure.
C) Yes, cephalexin 500 mg orally 2 hours before the procedure.
D) No, the most recent guidelines do not recommend prophylaxis in this situation.

Answer : B

6.Which of the following peripheral manifestations causes painful nodules when it occurs?

A) Janeway’s lesions
B) Osler’s nodes
C) Petechiae
D) Splinter hemorrhage

Answer :B
• Red spots on the soles of your feet or the palms of your hands (Janeway lesions)
• Red, tender spots under the skin of your fingers or toes (Osler’s nodes)
• Tiny purple or red spots, called petechiae (puh-TEE-kee-ee), on the skin, in the whites of your eyes or inside your mouth

7.Which of the following is NOT a suitable treatment strategy for bacterial endocarditis?

A. Intravenous antibiotics for the first 5-14 days
B. Broad spectrum antibiotics pending results of blood cultures
C. Long term oral antibiotics based on culture results (e.g., 4 weeks or longer)
D. Immunosuppressive doses of corticosteroids that are tapered over 4 to 6 weeks

Answer : D

8.Endocarditis prophylaxis is recommended in one of the following conditions before extractions;

A. Cardiac pacemakers
B. Mitral valve prolapse without valvular regurgitation
C. Tetralogy of fallot
D. Implanted defibrillators

Answer C

9.Which of the oral procedures will not need any antibiotics prophylaxis to minimize the risk of bacterial endocarditis;

A. Root planing
B. Suture removal
C. Placement of orthodontic bands
D. Intraligamentary injections

Answer B

10.Which of the following assessments is crucial for the diagnosis of IE?

A) Vital signs
B) Hematology tests
C) Erythrocyte sedimentation rate
D) Blood cultures

Answer: D