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DES Car endocarditis and cardiac imaging

A highly detailed illustration of a heart with signs of endocarditis and various cardiac imaging techniques, including echocardiography and CT scans, in a medical context.

Endocarditis and Cardiac Imaging Quiz

Test your knowledge on the intricacies of endocarditis and the various cardiac imaging techniques involved in its diagnosis and management. This quiz includes 31 challenging multiple-choice questions aimed at reinforcing your understanding of key concepts.

Whether you're a medical student, a healthcare professional, or simply interested in cardiology, this quiz is designed to enhance your learning experience.

Assess your knowledge on endocarditis causes and symptoms.
Explore cardiac imaging methods and their indications.
Learn about the latest findings and best practices.

31 Questions8 MinutesCreated by StudyingHeart712

1. A 38-year-old IV drug abuser presents with a 1-week history of malaise, fatigue, and rigors. His temperature on admission was 38.5°C. Examination revealed a pan-systolic murmur which was loudest at the left sternal edge. Three sets of blood cultures were taken. Transthoracic echocardiography showed vegetation on the tricuspid valve with moderate tricuspid regurgitation. Which one of the following organisms is most likely to be positive in blood cultures?

A. Streptococcus sanguis

B. Enterococcus faecium

C. Coxiella burnetii

D. Staphylococcus aureus

E. Kingella kingae

2. A 59-year-old man with a bicuspid aortic valve and a background of benign prostatic hypertrophy presents with a 1-week history of fever and lethargy. His physician had treated him with oral antibiotics for a urinary tract infection (UTI) a week prior to admission. On examination, an ejection systolic murmur was audible on auscultation. As part of his initial investigations routine bloods and blood and urine cultures were taken. His urine culture sent by his GP has grown Escherichia coli. The admitting team suspects endocarditis. What is the next step of management?

A. Treat UTI with different antibiotics than those used previously

B. Arrange a transthoracic echocardiogram (TTE)

C. Arrange a transoesophageal echocardiogram as aortic valve vegetations are poorly visualized on TTE

D. Repeat urine culture

E. Arrange cardiac MRI to rule out endocarditis

3. A patient is receiving treatment for infective endocarditis. The patient has a history of intravenous drug use and underwent mitral valve replacement a year ago. The patient is scheduled for a transesophageal echocardiogram tomorrow. On assessment, you find tender, red lesions on the patient’s hands and feet. You know that this is a common finding in patients with infective endocarditis and is known as?

A. Janeway lesions

B. Roth spots

C. Osler’s nodes

D. Trousseau’s sign

E. Babinski’s sign

4. A patient with endocarditis has listed in their medical history “Roth Spots”. You know that this is a complication of infective endocarditis and presents as?

A. Non-tender spots found on the feet and hands

B. Red and tender lesions found in the eyes

C. Retinal hemorrhages with white centers

D. Purplish spots found on the forearms and groin

E. Painful, raised lesions of fingers and toes

5. Which one of the following is a predictor of poor outcome in patients with infective endocarditis?

A. Insulin-dependent diabetes mellitus

C. Echocardiographic evidence of peri-annular complications

B. Renal failure

D. Staphylococcus aureus in blood cultures

E. All the above

6. A patient is admitted with sepsis. The patient has a temperature of 39°C and is experiencing chills. On assessment, you note a mitral murmur, which the patient states they’ve never had before, and dark, small lines on the patient’s fingernails. The patient has a history of IV drug use in the past. However, the patient states they are no longer using drugs. The physician suspects possible infective endocarditis. What diagnostic test do you expect the physician to order in order to confirm the presence of infective endocarditis?

A. Abdominal ultrasound

B. Heart catheterization

C. Transesophageal echocardiogram

D. White blood cell count

E. Heart CT scan

7. An 80-year-old woman with a background of moderate aortic stenosis presents with a 2-week history of fatigue, weight loss, and night sweats. She has a history of nausea and altered bowel habit. Bloods revealed Hb 9.9 g/dL, white cell count 16.0 × 109/L, and CRP 187 mg/L. Blood cultures were taken on admission and she was commenced on empirical antibiotics. TTE demonstrated an aortic valve vegetation. The presence of which one of the following organisms would prompt gastrointestinal investigations?

A. Haemophilus para-influenzae

B. Cardiobacterium hominis

C. Streptococcus bovis

D. Enterococcus faecalis

E. Coagulase-negative staphylococci

8. A patient being treated for infective endocarditis is complaining of very sharp radiating abdominal pain that goes to the left shoulder and back. Regarding the complications of infective endocarditis, what do you suspect is the most appropriate cause of this patient finding?

A. Renal embolic event

B. Pulmonary embolic event

C. Central nervous system embolic event

D. Splenic embolic event

E. Hepatic embolic event

9. A 71-year-old man presents 10 months after aortic valve replacement with fatigue, weight loss, and fever. Six weeks previously he had had treatment for a dental abscess. Whilst results from blood culture were awaited, a transthoracic echocardiogram revealed an aortic valve vegetation. Which of the following is the most appropriate next step?

A. Start vancomycin with gentamicin and rifampicin

B. Arrange urgent transthoracic echocardiography (TTE)

C. Wait for identification and sensitivities of cultures

D. Repeat TTE in 1 week

E. Start amoxicillin plus clavulanic acid and gentamycin, and arrange urgent transthoracic echocardiography

10. A 51-year-old farmer presents with low-grade fever and a recent history of weight loss. He has been investigated by his general physicians but no cause has been identified for his symptoms. His inflammatory markers are raised and a TTE shows a 0.5 × 0.3 cm echogenic mass attached to the non-coronary cusp of the aortic valve. Endocarditis is suspected, although multiple blood cultures are negative. Which one of the following organisms is the most likely cause of persistently negative cultures?

A. Streptococcus constellatus

B. Coagulase-negative staphylococci

C. Cardiobacterium hominis

D. Streptococus sanguis

E. Coxiella burnetii

11. Which of the following is the most appropriate statement for the known risk factors for infective endocarditis?

A.Intravenous drug use

B. Young age

C. Female

D.Patient receiving intravenous cytotoxic chemotherapy

E. Patient with rheumatoid arthritis

12. In which one of the following is ECG-gated coronary CT angiography not indicated?

A. Exclusion of significant coronary artery disease in patients with a low to intermediate pre-test probability of disease

B. Diagnosis and delineation of the course of anomalous coronary arteries

C. Following a failed catheter intubation of a coronary artery

D. Diagnosis of significant coronary artery disease in patients with a high pre-test probability of disease

E. Coronary artery bypass graft assessment

13. Which one of the following patient characteristics is ideal for performance of a good quality coronary CT angiogram?

A. Atrial fibrillation with a low ventricular response

B. High body mass index

C. Contraindication to oral or IV beta-blockade

D. Ability to breath hold for 2 seconds to 3 seconds maximum

E. Ability to hold arms straight above the head

14. Concerning heart rate in cardiac CT, which of the following statements is true?

A. On-table intravenous metoprolol may not be administered

B. 50–100 mg of oral metoprolol 2 hours prior to the study is recommended

C. On-table oral beta-blocker is useful

D. Heart rate of >65 bpm is ideal

E. Non-ionic low-osmolar intravenous contrast has been reported to have an antiarrhythmic effect on administration

15. WhichofthefollowingcomplicationsdoesnotoccurwithCTangiography?

A. Nephrogenic systemic fibrosis

B. Anaphylaxis

C. Compartment syndrome of the arm

D. Contrast induced nephropathy

E. Bradycardia

16. Which of the following is a stochastic effect from ionizing radiation?

A. Radiationburns

B. Cancer

C. Permanent sterility

D. Radiation sickness

E. Cataracts

17. A 52 year old woman with hypertension and dyslipidemia presents to the emergency department with worsening chest discomfort on minimal exertion. Her ECG was non-diagnostic and two sets of troponin were negative. She underwent coronary CTA. This image demonstrates:

A. Anomalous left coronary artery arising from the right Sinus of Valsalva with an interarterial course

B. Severe aortic regurgitation due to aortic dissection

C. Severe stenosis in the mid right coronary artery

D. Sinus venosus atrial septal defect

E. Unroofed coronary sinus

18. A 47 year old man presents for CTA to investigate first presentation of intermittent chest discomfort. He is a current smoker and has a past history of Type II diabetes on Metformin, dyslipidemia on Atorvastatin, erectile dysfunction on vardenafi l and benign prostatic hypertrophy. On examination his heart rate is 79 bpm, he has a harsh ejection systolic murmur which becomes louder with the Valsalva maneuver and clear lung fields. Which of the following is not advised when performing CTA for this patient?

A. Withhold Metformin for 48 hours post CTA

B. Administration of metoprolol to achieve heart rate of 60–65 bpm

C. Administration of iodinated contrast for the coronary CTA

D. Administration of sublingual nitrates for coronary vasodilation to improve CTA accuracy

E. All the above can be advised or given

19. Concerning ionizing radiation in cardiac CT, which one of the following statements is true?

A. Cardiac CT is always performed in >2 mSv

B. A patient with a low BMI will have a higher radiation dose

C. Reducing the kilovoltage will reduce the radiation dose

D. Prospective ECG gating gives a higher dose to the patient than retrospective ECG gating

E. Calcium scoring has a higher radiation dose than coronary CT angiography

20. Concerning coronary artery calcification, which one of the following statements is true?

A. The coronary calcium score is a good independent predictor of future cardiac events

B. A normal coronary calcium score excludes flow-limiting coronary disease

C. A high coronary calcium score will increase the negative predictive value of coronary CT angiography

D. Coronary calcium doesn’t result in partial volume artefact

E. The coronary calcium score doesn’t correlate with total plaque burden

21. Review the MPR images of a coronary artery shown in the following .Which one of the following do the images indicate?

A. >50% stenosed non-calcified plaque in the circumflex artery

B. >50% stenosed mixed morphology plaque in the left anterior descending artery

C. <50% stenosed mixed morphology plaque in the left anterior descending artery

D. >50% stenosed non-calcified plaque in the first diagnonal artery

E. <50% stenosed mixed-morphology plaque in the first diagonal artery

22. Concerning aortic valve disease, which one of the following statements is true?

A. The degree of aortic valve leaflet calcification, as quantified by CT, correlates closely with the severity of aortic stenosis

B. Aortic valve planimetry measured using CT does not correlate well with transesophageal echocardiogram

C. Severity of valve regurgitation can easily be assessed using cardiac CT

D. Peri-prosthetic aortic valve replacement abscesses can be well delineated using CT

E. Significant coronary artery disease cannot be reliably excluded prior to aortic valve replacement using CT

23. A 55-year-old woman presents to the emergency department with recent-onset central chest pain presenting intermittently at rest, relieved by GTN, but not exacerbated by exertion. Her troponin I level and resting ECG are normal. She has no significant risk factors for coronary artery disease. According to the NICE guidelines, what is the most appropriate subsequent management?

A. Exercise treadmill test

B. Stress perfusion imaging

C. Catheter coronary angiography

D. CT coronary angiography

E. CT coronary calcium score

24. A 78-year-old male ex-smoker was referred to the cardiology department with a history of COPD, dizziness, syncope, and exertional symptoms suggestive of angina. He had a suboptimal exercise tolerance test due to dyspnoea and could not tolerate dobutamine during stress echocardiography. He was referred for a cardiac CT. A CT coronary calcium score was performed first and this is shown in the following figure According to NICE guidelines, what is the most appropriate next step in management?

A. Proceed to CT coronary angiography

B. Catheter coronary angiography

C. Adenosine stress perfusion MRI

D. Lung function tests

E. Discharge with no further investigation

25. A 65-year-old man presents with angina to the outpatient clinic. There is a past history of myocardial infarction 10 years earlier. You list him to have an angiogram. The angiogram demonstrates an occluded left anterior descending artery and a 90% stenosis of the right coronary artery. A CMR is requested to assess viability prior to any potential intervention. The late myocardial enhancement is shown in the following figure.Which of the following statements is correct?

A. The LAD territory is non-viable

B. The entire lateral wall is infarcted

C. The RCA territory is non-viable

D. Both LAD and RCA territories show >50% wall-thickness infarction.

E. There is right ventricular infarction

26. You are asked to arrange a cardiac MRI to assess the left ventricular function of a patient following incomplete revascularization by percutaneous coronary intervention and stent implantation. At what stage following the stent implantation is it safe to perform the scan?

A. Immediately—there is no time limit

B. Never—the static magnetic field will displace the bare metal stent

C. Three months, to allow for endothelization of the stent struts

D. After 4 weeks following cessation of clopidogrel

E. None of the above

27. Which one of the following is an absolute contraindication for an MRI scan?

A. An all-metal aortic valve replacement

B. A St Jude mitral valve replacement

C. A total hip replacement

D. A bare metal stent in the LMS

E. A cerebral aneurysm clip of unknown source

28. A 60-year-old man presents with angina and heart failure. His estimated ejection fraction by echocardiography is 25%. An invasive coronary angiogram demonstrates widespread severe three-vessel coronary disease with good distal targets. A CMR study shows an ejection fraction of 22% and <25% myocardial wall thickness of hyper-enhancement in the mid and apical inferior segments. Which one of the following statements is correct?

A. The chance of functional recovery in the LAD territory is <20%

B. The patient should not be offered revascularization because of the poor chance of functional and prognostic improvement

C. The RCA territory has a >60% chance of functional recovery if revascularized

D. He should be offered PCI to the RCA only

E. His prognosis is better if he is treated medically than if he is completely revascularized

29. A 55-year-old man presents with a 2-week history of dyspnoea following an episode of severe chest pain. An invasive coronary angiogram shows a 95% stenosis in the proximal LAD and an akinetic anterior wall. He is referred for a cardiac MRI viability study prior to percutaneous revascularization. Which one of the following statements is correct?

A. He should have a stent implanted anyway without the MRI

B. 100% hyper-enhancement suggests that he should go forward for PCI to the LAD

C. The scan should be done following the PCI

D. Severe hypokinesis of the anterior wall suggest that the LAD territory is non-viable

E. If a transmural infarct (100% enhancement) is present he should not have a PCI but should have medical therapy

30. A 45-year-old man presents with chest pain radiating to his left arm of duration 2 hours. There is no relevant past medical history. Troponin levels were measured at 1434 ng/L. The ECG and the late myocardial enhancement images are shown in the following figure.What is the diagnosis?

A. STEMI

B. Takotsubo

C. NSTEMI

D. Myocarditis

E. Hypertrophic cardiomyopathy

31. A 63-year-old man presents with a non ST-elevation acute coronary syndrome. His troponin is elevated at 650 ng/L. The ECG is unremarkable. He has a past medical history of familial hypercholesterolemia but is taking no medication. His cholesterol level is 11.3 mmol/L. He undergoes coronary angiography which reveals triple- vessel disease. A CMR is undertaken to assess myocardial viability. The late myocardial enhancement images are shown in the following figure.Which of the following statements is correct?

A. There is right ventricular infarction

B. The Cx territory is viable

C. The LAD territory is infarcted

D. There is a significant pericardial effusion present

E. The RCA territory is non-viable

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