Endocarditis Quiz

1. This phonocardiogram image is most consistent with which of the following?

A. Systolic regurgitant quality murmur; Mitral valve regurgitation
B. Systolic ejection quality murmur; Aortic stenosis
C. Diastolic decrescendo murmur; Aortic regurgitation
D. Continuous murmur; Patent ductus arteriosus

2. Which of the following clinical scenarios would most increase your degree of suspicion for bacterial endocarditis in a dog?

a. Fever, new cardiac murmur, shifting leg lameness
b. Low BUN, elevated albumin, sudden onset stifle swelling
c. Positive Lyme titer, progressively louder heart murmur, marked hepatomegaly
d. Positive Anaplasma titer, hypothermia, thrombocytopenia

3. 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

4. Which of the following is NOT a recognized predisposing factor for bacterial endocarditis?

a. Subaortic stenosis in a dog
b. Recent immunosuppression
c. Recent surgery or IV catheter placement
d. Hypertrophic cardiomyopathy in a cat

5.Which of the following statements about bacterial endocarditis is FALSE?

a. Bacterial endocarditis can be seen in dogs, cats, horses and cattle.
b. The right AV valve is most commonly affected in ruminants.
c. The mitral valve and/or aortic valves are most commonly affected in the dog and cat.
d. Bacterial endocarditis is commonly due to Lyme disease (Borellia beurgdorferi).

6. A dog is presented for general illness and anorexia, and you find fever and a new cardiac murmur, which sounds like a diastolic decrescendo murmur. Arterial pulses are bounding and the dog is identified to have a high white blood cell count and monocytosis. With these clinical findings in mind, which of the following diagnoses should be high on your differential list?

a. Myxomatous valvular degeneration and concurrent lower urinary tract infection
b. Neoplasia on the right auricular appendage
c. Patent ductus arteriosus with pneumonia
d. Bacterial endocarditis of the aortic valve

7. Which of the following statements about bacterial endocarditis is FALSE?

a. Fever, lameness, and cardiac murmurs are common clinical signs in animals with bacterial endocarditis.
b. Intermittent shedding of bacteria from infected valves could lead to metastatic infection in tissues and resulting tissue dysfunction.
c. Degenerative valvular disease in dogs is strongly associated with predisposition to getting bacterial endocarditis.
d. The source of the infection and resulting bacteremia is often difficult to determine.

8. Which of the following bacterial endocarditis etiologic agents is incorrectly paired with the affected species?

a. Streptococcus zooepidemicus – Horse
b. Aspergillus – Dog
c. Bartonella – Cat
d. Erysipelothrix – Swine

9. All of the following worsen the prognosis for bacterial endocarditis EXCEPT:

a. Large vegetative lesions are present
b. The white blood cell count is normal
c. Gram negative sepsis is present
d. Aortic valve endocarditis with aortic insufficiency is present

10. Which of the following statements is least correct about the diagnosis of bacterial endocarditis?

a.Blood cultures are a key diagnostic test for establishing a specific bacterial agent.
b. Left atrial or ventricular enlargement may be seen on radiographs.
c. Bacterial endocarditis can be effectively ruled out if no vegetative lesions are seen on echocardiography.
d. Clinical findings can include congestive heart failure or evidence of sepsis.
e. Conduction disturbances or cardiac arrhythmias may be seen on ECG.