QUESTION 1:
50 year male HT, DM, smoker with previous history of IHD and MI presented
with exertional shortness of breath. Pulse 90 BP 120/90, JVP elevated, edema
up to the knees and dull right base. Urine shows up albumin.
a)what is the diagnosis?
Congestive cardiac failure
b)enlist 5 useful investigations with expected findings
1. FBC
2. BNP
3. ECG
4. Echo
5. Chest x rays
c)outline treatment plan
1. smoking cessation
2. weight reduction
3. exercise
4. low sodium diet
5. ACE inhibitors…captopril
6. diuretics…furosemide, thiazides
7. Vasodilators…nitrates
8. beta blockers
9. spironolactone
10. implantable defibrillator
QUESTION 2:
30 year male underwent RCT for aching tooth. A week later he presented with
fever & microscopic hematuria.Temp 102F, pulse 120 BP 120/80, clubbing
fundal hemorrhages and petechiae plus an early diastolic murmur at the heart
base.
a)what is the diagnosis?
Infective Endocarditis
b)enlist 5 useful investigations
1. ECG
, 2. X rays
3. FBC
4. Blood cultures
5. Echo
c)enlist 3 other useful signs in hands ,one in abdomen and two in feet
1.HANDS:
a.clubbing b.osler nodes c.splinter hemorrhages
2.ABDOMEN:
a.splenomegaly
3.FEET:
a.janeway lesions b.osler’s nodes
d)outline treatment plan
1. Empiric antibiotic therapy
Acute bacterial endocarditis (ABE)=Vancomycin + Gentamicin
Subacute bacterial endocarditis (SBE):=ceftriaxone + Gentimicin or Benzyl penicillin + Gentamicin
Prosthetic valve IE: Vancomycin + Gentamicin + Rifampicin
2. Specific Antibiotic therapy:
Culture awaited=penicillin + Gentamicin
Staph aureus=Vancomycin+ Gentamicin
Streptoc Viridian =Penicillin + gentamicin
Enterococci Ampicillin/Amoxil + gentamicin
3. Cardiac surgery (debridement) if valve damage leading to heart failure, or abscess formation or
condition not responding to antibiotics
e)enlist 10 complications
1. CARDIAC COMPLICATIONS:
a. ring abscess
b. perforation & rupture
c. myocardial abscess
d. suppurative pericarditis
50 year male HT, DM, smoker with previous history of IHD and MI presented
with exertional shortness of breath. Pulse 90 BP 120/90, JVP elevated, edema
up to the knees and dull right base. Urine shows up albumin.
a)what is the diagnosis?
Congestive cardiac failure
b)enlist 5 useful investigations with expected findings
1. FBC
2. BNP
3. ECG
4. Echo
5. Chest x rays
c)outline treatment plan
1. smoking cessation
2. weight reduction
3. exercise
4. low sodium diet
5. ACE inhibitors…captopril
6. diuretics…furosemide, thiazides
7. Vasodilators…nitrates
8. beta blockers
9. spironolactone
10. implantable defibrillator
QUESTION 2:
30 year male underwent RCT for aching tooth. A week later he presented with
fever & microscopic hematuria.Temp 102F, pulse 120 BP 120/80, clubbing
fundal hemorrhages and petechiae plus an early diastolic murmur at the heart
base.
a)what is the diagnosis?
Infective Endocarditis
b)enlist 5 useful investigations
1. ECG
, 2. X rays
3. FBC
4. Blood cultures
5. Echo
c)enlist 3 other useful signs in hands ,one in abdomen and two in feet
1.HANDS:
a.clubbing b.osler nodes c.splinter hemorrhages
2.ABDOMEN:
a.splenomegaly
3.FEET:
a.janeway lesions b.osler’s nodes
d)outline treatment plan
1. Empiric antibiotic therapy
Acute bacterial endocarditis (ABE)=Vancomycin + Gentamicin
Subacute bacterial endocarditis (SBE):=ceftriaxone + Gentimicin or Benzyl penicillin + Gentamicin
Prosthetic valve IE: Vancomycin + Gentamicin + Rifampicin
2. Specific Antibiotic therapy:
Culture awaited=penicillin + Gentamicin
Staph aureus=Vancomycin+ Gentamicin
Streptoc Viridian =Penicillin + gentamicin
Enterococci Ampicillin/Amoxil + gentamicin
3. Cardiac surgery (debridement) if valve damage leading to heart failure, or abscess formation or
condition not responding to antibiotics
e)enlist 10 complications
1. CARDIAC COMPLICATIONS:
a. ring abscess
b. perforation & rupture
c. myocardial abscess
d. suppurative pericarditis
