Infective Endocarditis MCQ Questions and Answers

1.

The most commonly affected in IE is?
- A.
  
  Valve leaflets
- B.
  
  Chordae
- C.
  
  Chamber walls
- D.
  
  Periprosthetic tissue
Correct Answer
A. Valve leaflets

Explanation
Infective Endocarditis (IE) primarily affects the heart valves, particularly the valve leaflets. The infection typically leads to the formation of vegetations, which are clumps of platelets, fibrin, microorganisms, and inflammatory cells. These vegetations can cause significant damage to the valve leaflets, leading to complications such as valve stenosis or regurgitation. Chordae tendineae, chamber walls, and periprosthetic tissues can also be involved, but the valve leaflets are the most commonly and severely affected.

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2.

The majority of organisms in vegetation are
- A.
  
  Inactive and non-growing
- B.
  
  Inactive metabolically but grow rapidly
- C.
  
  Very active metabolically but do not grow
- D.
  
  Very active metabolically and grows rapidly
Correct Answer
C. Very active metabolically but do not grow

Explanation
In the vegetation of Infective Endocarditis (IE), the organisms are typically very active metabolically. This metabolic activity is crucial for their survival and pathogenicity, especially as they produce factors that help them adhere to the valve leaflets and evade the immune system. However, despite their metabolic activity, they do not grow or replicate rapidly within the vegetation. This slow growth is partially due to the limited nutrient supply in the blood and the effects of the host's immune responses, which inhibit replication but not metabolic activity. This characteristic makes treating IE challenging, as the bacteria can be less susceptible to antibiotics due to their slow growth and dormancy-like state in the vegetation.

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3.

The clinical manifestations of IE result from
- A.
  
  Cytokines
- B.
  
  Intracardiac infection
- C.
  
  Embolization
- D.
  
  Immunological phenomenon
- E.
  
  All of the above
Correct Answer
E. All of the above

Explanation
Infective Endocarditis (IE) primarily affects heart valve leaflets, with vegetation formed from clumps of microorganisms and inflammatory cells. These organisms are metabolically active but do not replicate rapidly, complicating antibiotic treatment. Clinical manifestations arise from the infection, embolization of vegetation fragments, immune responses, and cytokine-induced inflammation. These factors collectively contribute to IE's complex symptoms, necessitating comprehensive management strategies.

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4.

Modified Duke Criteria for IE
- A.
  
  Highly sensitive
- B.
  
  Highly specific
- C.
  
  Both
- D.
  
  Neither
Correct Answer
C. Both

Explanation
The Modified Duke Criteria for Infective Endocarditis (IE) are highly sensitive and specific, designed to accurately diagnose IE using a combination of clinical and echocardiographic findings. These criteria classify IE cases into definite, possible, or rejected categories based on major criteria, including typical microorganisms in separate blood cultures and endocardial involvement on echocardiograms, and minor criteria like predisposition and fever. The precision of these criteria ensures effective identification and minimizes false diagnoses, making them essential for managing IE.

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5.

Antimicrobial therapy in IE – True statement
- A.
  
  Vegetations are highly vascular
- B.
  
  Bacteria in vegetation are rapidly growing
- C.
  
  All bacteria in the vegetation need not be killed
- D.
  
  None
Correct Answer
C. All bacteria in the vegetation need not be killed

Explanation
In the treatment of Infective Endocarditis (IE), antimicrobial therapy aims to reduce the bacterial load within vegetation to a level manageable by the patient's immune system, rather than achieving complete bacterial eradication. This strategy is necessary because the vegetations have a poor blood supply that impedes antibiotic delivery, and the bacteria present are in a low-growth state, making them inherently less susceptible to antibiotics. Therefore, the objective is to suppress the infection to a point where the body’s immune defenses can effectively control and eliminate the remaining bacteria.

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6.

Which species of bacteria typically causes infective endocarditis?
- A.
  
  Staphylococcus
- B.
  
  Helicobacter
- C.
  
  Bacillus
- D.
  
  None of the above
Correct Answer
A. Staphylococcus

Explanation
Staphylococcus is the correct answer because it is the most common species of bacteria that causes infective endocarditis. This bacterium is commonly found on the skin and in the nasal passages, making it more likely to enter the bloodstream and infect the heart valves. Staphylococcus can cause severe infections in individuals with weakened immune systems or those who have undergone invasive medical procedures. Helicobacter is primarily associated with gastrointestinal infections, while Bacillus is more commonly associated with food poisoning. Therefore, neither of these bacteria are typically responsible for causing infective endocarditis.

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7.

In children with CHD, Group A streptococci rarely cause infective endocarditis.
- A.
  
  True
- B.
  
  False
Correct Answer
A. True

Explanation
True. In children with congenital heart disease (CHD), Group A Streptococci (Streptococcus pyogenes) rarely cause infective endocarditis. While Group A Streptococci can cause various infections, including strep throat and skin infections, it is not a common causative agent for infective endocarditis in individuals with CHD. Infective endocarditis is more commonly associated with other bacteria, such as viridans streptococci or staphylococci, in individuals with underlying heart conditions.

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8.

______ is effective in diagnosing infective endocarditis in patients with congenital heart disease.
- A.
  
  Presence of Janeway lesions
- B.
  
  Duke criteria
- C.
  
  Electrocardiography
- D.
  
  None of the above
Correct Answer
C. Electrocardiography

Explanation
Electrocardiography is effective in diagnosing infective endocarditis in patients with congenital heart disease because it can help identify any abnormal electrical activity in the heart. This can be indicative of an infection in the heart valves, which is a common complication in patients with congenital heart disease. By analyzing the electrical patterns and rhythms of the heart, electrocardiography can provide valuable information to aid in the diagnosis of infective endocarditis.

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9.

Which of the following Duke criteria is a major criteria for infective endocarditis?
- A.
  
  Immunologic findings such as glomerulonephritis
- B.
  
  Predisposing heart condition or intravenous drug use
- C.
  
  Blood cultures positive for typical infective endocarditis organisms
- D.
  
  All of the above
Correct Answer
C. Blood cultures positive for typical infective endocarditis organisms

Explanation
Blood cultures positive for typical infective endocarditis organisms is a major criterion for infective endocarditis according to the Duke criteria. This criterion refers to the identification of microorganisms in the blood that are commonly associated with infective endocarditis, such as Streptococcus viridans, Staphylococcus aureus, and Enterococcus species. The presence of these organisms in the blood indicates an active infection involving the heart valves, which is a key diagnostic feature of infective endocarditis. The other options listed, predisposing heart condition or intravenous drug use and immunologic findings such as glomerulonephritis, are not major criteria for diagnosing infective endocarditis.

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10.

Which trial shows the significant benefit of early surgery in patients at high risk for emboli and with large vegetations?
- A.
  
  EASE
- B.
  
  ICE
- C.
  
  ASE
- D.
  
  ESE
Correct Answer
A. EASE

Explanation
The trial that shows the significant benefit of early surgery in patients at high risk for emboli and with large vegetations is the EASE trial.

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Infective Endocarditis MCQ Questions And Answers

Infective Endocarditis Questions and Answers

The most commonly affected in IE is?

The majority of organisms in vegetation are

The clinical manifestations of IE result from

Modified Duke Criteria for IE

Antimicrobial therapy in IE – True statement

Which species of bacteria typically causes infective endocarditis?

In children with CHD, Group A streptococci rarely cause infective endocarditis.

______ is effective in diagnosing infective endocarditis in patients with congenital heart disease.

Which of the following Duke criteria is a major criteria for infective endocarditis?

Which trial shows the significant benefit of early surgery in patients at high risk for emboli and with large vegetations?