Endocarditis

Dukes Criteria Scoring Tool

• Scoring tool used to determine if an individual has infective endocarditis

Dukes Criteria 

• Details of Dukes criteria including descriptions of pathologic, major and minor findings

American Heart Association Journal 

• Detailed guidelines of diagnosis and management of infection endocarditis

1. What is the primary composition of vegetations in endocarditis? 

a) Low bug density, high oxygen, alkaline environment  

b) High bug density, low oxygen, acidic environment 

c) Moderate bug density, neutral pH, rich nutrient environment 

d) High bug density, high oxygen, alkaline environment 

2. What is the most common pathogen associated with bacterial endocarditis? 

a) Enterococci

b) Streptococci

c) Staph aureus 

d) Coagulase negative staph

3. Which of the following best describes Osler nodes? 

a) Retinal hemorrhage

b) Painful lesion on hands due to immunologic cause

c) Painless lesions on palms due to embolic cause 

d) Painless lesions on palms due to immunologic cause 

4. The following are general principles of antimicrobial therapy in endocarditis EXCEPT? 

a) Bacteriostatic agent preferred

b) Combination therapy prevents resistance 

c) Parenteral therapy required (majority of the time) 

d) High doses of therapy recommended 

5. For a 60-year-old patient (NKDA, no renal dysfunction, no auditory dysfunction) with streptococcal bacterial endocarditis with a prosthetic valve and MIC of 0.05 mg/L, what is the recommended treatment regimen? 

a) Pen G 12 MU/d IV for 2 weeks 

b) Pen G 12 MU/d IV for 4 weeks 

c) Pen G 24 MU/d IV for 6 weeks and gentamicin 3mg/kg IV daily for 2 weeks 

d) Pen G 24 MU/d IV + gentamicin 3mg/kg IV daily for 6 weeks  

6. In a 65-year-old patient (NKDA, no renal dysfunction, no auditory dysfunction) with MSSA bacterial endocarditis (left sided bacterial, native valve), what is the recommended treatment regimen?

a) Vancomycin 15mg/kg IV q12h x 6 weeks 

b) Cloxacillin 2g IV q4h x 2 weeks  

c) Cloxacillin 2g IV q4h x 6 weeks  

d) Cloxacillin 2g IV q4h x 6 weeks + gentamicin 1mg/kg IV q8h x 2 weeks + rifampin 300mg PO TID x 6 weeks