Eight months after having a prosthetic heart valve a patient develops infective endocarditis.
What is the most likely causative organism?
Correct Answer A: Most common cause of endocarditis:
Staphylococcus epidermidis is the most common causative organism in the first two months following surgery.
After this time the spectrum of organisms causing endocarditis returns to normal, with Streptococcus viridans being the most common organism.
Infective endocarditis:
The strongest risk factor for developing infective endocarditis is a previous episode of endocarditis.
The following types of patients are affected:
Causes:
Culture negative causes:
Following prosthetic valve surgery Staphylococcus epidermidis is the most common organism in the first 2 months and is usually the result of perioperative contamination. After 2 months the spectrum of organisms which cause endocarditis return to normal, except with a slight increase in Staph. aureus infections.
Which one of the following is not a recognised treatment in primary pulmonary hypertension?
Correct Answer A:
Endothelin-1 receptor antagonists such as bosentan, not agonists may be used.
Primary pulmonary hypertension:
The classification of pulmonary hypertension is currently changing with the term idiopathic pulmonary arterial hypertension (IPAH) becoming more widely used.
Primary pulmonary hypertension (PPH, now IPAH):
Features:
Investigation:
Management:
Which part of the jugular venous waveform is associated with the fall in atrial pressure during ventricular systole?
Correct Answer C:
JVP: x descent = fall in atrial pressure during ventricular systole.
Jugular venous pulse:
As well as providing information on right atrial pressure, the jugular vein waveform may provide clues to underlying valvular disease. A non-pulsatile JVP is seen in superior vena caval obstruction. Kussmaul's sign describes a paradoxical rise in JVP during inspiration seen in constrictive pericarditis.
'a' wave = atrial contraction:
Cannon 'a' waves:
'c' wave:
'v' wave:
'x' descent = fall in atrial pressure during ventricular systole.
'y' descent = opening of tricuspid valve.
Each one of the following may cause left bundle branch block, except:
Correct Answer B:
Atrial septal defects, both primum and secundum, are associated with right rather than left bundle branch block.
ECG: left bundle branch block:
The diagram below shows the typical features of left bundle branch block (LBBB):
A 37-year-old woman presents for review. She is 26 weeks pregnant and has had no problems with her pregnancy to date. Blood pressure is 144/92 mmHg, a rise from her booking reading of 110/80 mmHg.
Urine dipstick reveals the following:
What is the most appropriate description of her condition?
Hypertension in pregnancy:
Hypertension in pregnancy The classification of hypertension in pregnancy is complicated and varies. Remember, in normal pregnancy:
Hypertension in pregnancy in usually defined as:
After establishing that the patient is hypertensive they should be categorized into one of the following groups:
Click to expand