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Endocarditis: Pathology review

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Pathology

Cardiovascular system

Vascular disorders
Congenital heart defects
Cardiac arrhythmias
Valvular disorders
Cardiomyopathies
Heart failure
Cardiac infections
Pericardial disorders
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Cardiovascular system pathology review

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Endocarditis: Pathology review

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Questions

USMLE® Step 1 style questions USMLE

10 questions
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A 67-year-old man presents to the primary care physician with a several week history of worsening fatigue, blurry vision, and rectal bleeding. Medical history is notable for ulcerative colitis, hypertension, and hyperlipidemia. The patient’s last colonoscopy was at age 50. Temperature is 37.6°C (99.7°F), pulse is 96/min, respirations are 18/min, and blood pressure is 122/63 mmHg. BMI is 34 kg/m2. Physical examination demonstrates an obese habitus. The patient’s skin appears pale with noted conjunctival pallor. Cardiopulmonary examination demonstrates a 3/6 holosystolic murmur best at the cardiac apex which was not present at the previous office visit 3 months ago. Retinal examination demonstrates round white spots on the retina surrounded by hemorrhage. Rectal examination is positive for scant blood in the rectal vault. Laboratory values are demonstrated below:  
 

Laboratory value  Result 
Complete Blood Count, Serum 
Hemoglobin  11.5 g/dL 
 Hematocrit  39.5% 
 Leukocyte count  14,100 /mm3 
 Platelet count  155,000/mm3 
Electrolytes, Serum 
                  Sodium                134 mEq/L 
               Potassium                 3.6 mEq/L 
                 Chloride                 97 mEq/L  
              Bicarbonate                 22 mEq/L 
                 Calcium                8.4 mg/dL 
Blood is drawn and sent for culture. Two days later, 3 of 4 blood cultures obtained grow Streptococcus gallolyticus (Streptococcus bovis biotype I). Which of the following studies is most likely to reveal the etiology of this patient’s infection?  

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Transcript

Two people came into the cardiology ward.

One of them was 25 year old Darren, who came in with a fever, chills and fatigue.

On the clinical examination, his fingernails had splinter hemorrhages and the palm of his hands had some erythematous flat lesions.

There were also some track marks on his forearm.

The other one is 75 year old Anna, who also had a fever and the same splinter hemorrhages and erythematous flat lesions that we previously saw.

On auscultation, a heart murmur was heard.

On her history, she said she was at the dentist 2 weeks ago.

Okay, so both people likely have endocarditis, or inflammation of the inner layer of the heart.

Remember that the heart’s wall is made up of three layers, the epicardium being the outermost layer, then the myocardium, and the endocardium, which is the layer that gets inflamed.

The inflammation can affect the heart valves, the mural endocardium or even prosthetic valves!

The most common cases of endocarditis are due to a microbial infection, and this is called infective endocarditis but in some cases, endocarditis can also be non-infective.

For non-infective endocarditis, the first step is usually damage to the endocardium.

Damage exposes the underlying collagen and tissue factor, which causes platelets and fibrin to adhere, which forms tiny blood clots.

This is called Nonbacterial Thrombotic Endocarditis or NBTE.