CARDIOVASCULAR SYSTEMppt.pptx

3 continuous prophylaxis against recurrent rf with

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3. CONTINUOUS PROPHYLAXIS AGAINST RECURRENT RF WITH INJ. BENZATHINE PENICILLIN 1.2 MILLION UNITS IM EVERY 3–4 WEEKS. 4. IN PATIENTS ALLERGIC TO PENICILLIN, TAB. SULFADIAZINE 1 GM DAILY OR TAB. ERYTHROMYCIN 250 MG TWICE DAILY MAY BE GIVEN. 5. PROPHYLAXIS MUST CONTINUE, UP TO THE AGE OF 25 YEARS OR 5 YEARS AFTER THE LAST ATTACK, WHICHEVER IS LONGER. 170
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489 171 B " Sulfadiazine or sufisoxazole" is appropriate for patients allergic to penicillin.
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172
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INFECTIVE ENDOCARDITIS IT IS THE COLONISATION OF THE HEART VALVES WITH MICROBIOLOGIC ORGANISMS , LEADING TO THE FORMATION OF FRIABLE, INFECTED VEGETATIONS AND FREQUENTLY VALVE INJURY. 173
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TYPES: 1. ACUTE INFECTIVE ENDOCARDITIS : CAUSED BY HIGHLY VIRULENT ORGANISMS MAINLY S. AUREUS (20–30%) , SEEDING A PREVIOUSLY NORMAL VALVE. 2. SUBACUTE INFECTIVE ENDOCARDITIS : CAUSED BY ORGANISMS OF MODERATE OR LOW VIRULENCE MAINLY STREPTOCOCCI (60–70%) , SEEDING AN ABNORMAL OR PREVIOUSLY INJURED VALVE. 3. ENDOCARDITIS OCCURRING IN IV DRUG ABUSERS : CAUSED PREDOMINANTLY BY ORGANISMS FOUND ON THE SKIN (S. AUREUS, CANDIDA ) AND AFFECTING THE VALVES ON THE RIGHT SIDE OF THE HEART. 174
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4. PROSTHETIC VALVE ENDOCARDITIS : THIS MAY BE EARLY ( SYMPTOMS APPEARING WITHIN 60 DAYS OF VALVE INSERTION ), DUE TO INTRAOPERATIVE INFECTION OF THE VALVE OR INSERTION OF AN INFECTED VALVE OR LATE (SYMPTOMS APPEARING AFTER 60 DAYS OF VALVE INSERTION ), DUE TO LATE BACTERAEMIA OR EARLIER INFECTION WITH MICROORGANISMS HAVING A LONG INCUBATION PERIOD . 175
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MOST COMMON CAUSE OF BACTERIAL ENDOCARDITIS :- NATIVE VALVE COMMUNITY ACQUIRED STREPTOCOCCI HOSPITAL ACQUIRED STAPHYLOCOCCUS PROSTHETIC HEART VALVES COAGULASE NEGATIVE STAPHYLOCOCCI I.V. DRUG USERS STAPHYLOCOCCUS AUREUS STAPHYLOCCUS ALBUS (STAPHYLOCOCCUS EPIDERMIDIS):- "STAPHYLOCOCCUS EPIDERMIDIS WAS FORMERLY CALLED STAPHYLOCOCCUS ALBUS “. "STAPHYLOCOCCUS EPIDERMIDIS (COAGULASE NEGATIVE STAPHYLOCOCCUS) IS MOST COMMON CAUSE OF ENDOCARDITIS IN PROSTHETIC VALVES. " 177
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492 178 C
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THE PATHOGENS IN INFECTIVE ENDOCARDITIS S. AUREUS 31% VIRIDANS GROUP STREPTOCOCCI 17% ENTEROCOCCI 11% COAGULASE NEGATIVE STAPHYLOCOCCI 11% STREPTOCOCCUS BOVIS 7% OTHER STREPTOCOCCI 5% NON HACEK GRAM NEGATIVE BACTERIA 2% FUNGI 2% HACEK 2% 179
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496 180
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PREDISPOSING FACTORS TO DEVELOPMENT OF INFECTIVE ENDOCARDITIS 1. CONGENITAL CARDIAC ANOMALIES (SHUNTS OR STENOSIS WITH JET STREAMS) 2. RHEUMATIC HEART DISEASE 3. MITRAL VALVE PROLAPSE 4. DEGENERATIVE CALCIFIC STENOSIS 5. BICUSPID AORTIC VALVE 6. PROSTHETIC VALVES 7. INDWELLING CATHETERS. 181
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496 182
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183
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496 184 Ans. is 'c' i.e., Valvular Aortic regurgitation [Ref API 61h/e p. 355].
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185
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498 186 Ans. is 'c' i.e., Tip of palms and soles [Ref Harrison 171h/ep. 791 & 161h/e p. 733-734]
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187
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499 188 Ans. is 'a' i.e., Infective Endocarditis [Ref Harrison l7h/ep. 791; Macleod's Clinical Examination 12th/ep. 32 7] • Roth 's spots (lesion) are oval retinal haemorrhages with a clear pale center that are typically seen in patients with subacute bacterial endocarditis.
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  • Winter '16
  • jean grey
  • Cardiology, Ans., Constrictive pericarditis

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