Pericardial disease

1. Question

In patients with cardiovascular diseases undergoing oro-dental procedures, which group of individuals is recommended to receive general prevention measures for infective endocarditis?

1. Individuals with low risk for IE
2. Individuals at high risk for IE only
3. Individuals at intermediate risk for IE only
4. Individuals at high and intermediate risk for IE*
5. All individuals undergoing oro-dental procedures

2. Question

In patients with cardiovascular diseases undergoing oro-dental procedures, antibiotic prophylaxis is recommended for which group of patients?

1. Patients with a history of heart transplant
2. Patients with previous infective endocarditis (IE)*
3. Patients with a prosthetic heart valve
4. Patients with congenital heart disease
5. Patients with rheumatic heart disease

3. Question

In patients with cardiovascular diseases undergoing oro-dental procedures, which group is recommended to receive antibiotic prophylaxis to prevent infective endocarditis?

1. Patients with a history of rheumatic fever
2. Patients with surgically implanted prosthetic valves and any material used for surgical cardiac valve repair*
3. Patients with a family history of cardiovascular disease
4. Patients with controlled hypertension
5. Patients with a history of stroke

4. Question

In patients with cardiovascular diseases undergoing oro-dental procedures, which of the following is recommended for those with transcatheter implanted aortic and pulmonary valvular prostheses?

1. Antifungal prophylaxis
2. Antiviral prophylaxis
3. Antibiotic prophylaxis*
4. Anticoagulant therapy
5. Antiplatelet therapy

5. Question

In patients with cardiovascular diseases undergoing oro-dental procedures, for which of the following conditions is antibiotic prophylaxis recommended?

1. Patients with untreated cyanotic congenital heart disease (CHD)
2. Patients treated with surgery or transcatheter procedures with post-operative palliative shunts, conduits, or other prostheses
3. Patients with surgical repair in the absence of residual defects or valve prostheses, for the first 6 months after the procedure
4. Patients with a history of infective endocarditis
5. All of the above*

6. Question

For patients with cardiovascular diseases undergoing oro-dental procedures at increased risk for infective endocarditis, which patient population is recommended to receive antibiotic prophylaxis?

1. Patients with coronary artery disease
2. Patients with hypertension
3. Patients with ventricular assist devices*
4. Patients with peripheral artery disease
5. Patients with a history of stroke

7. Question

In patients with cardiovascular diseases undergoing oro-dental procedures who are at increased risk for infective endocarditis, in which specific patient group should antibiotic prophylaxis be considered?

1. Patients with aortic valve repair
2. Patients with pacemakers
3. Patients with stent placements
4. Patients with transcatheter mitral and tricuspid valve repair*
5. Patients with coronary artery bypass grafts

8. Question

In patients with cardiovascular diseases undergoing oro-dental procedures at increased risk for infective endocarditis, which of the following groups may be considered for antibiotic prophylaxis?

1. Patients with a history of myocardial infarction
2. Recipients of heart transplant*
3. Patients with stable angina
4. Individuals with controlled hypertension
5. Patients with aortic aneurysm

9. Question

Is antibiotic prophylaxis recommended for patients at low risk for infective endocarditis (IE) undergoing oro-dental procedures?

1. Yes, for all patients.
2. Yes, only for patients with cardiovascular diseases.
3. No, it is not recommended for any patients.
4. Yes, but only for patients with a history of IE.
5. No, it is not recommended for patients at low risk for IE.*

10. Question

In patients at high risk for infective endocarditis, for which of the following procedures is antibiotic prophylaxis recommended?

1. Routine dental cleanings
2. Dental extractions*
3. Simple dental fillings
4. Routine teeth whitening
5. Application of dental sealants

11. Question

Under which circumstances may systemic antibiotic prophylaxis be considered for high-risk patients according to the guideline recommendations for infective endocarditis prevention?

1. For all patients undergoing any medical procedure
2. Only for patients with a history of endocarditis undergoing dental procedures
3. For high-risk patients undergoing an invasive diagnostic or therapeutic procedure of the respiratory, gastrointestinal, genitourinary tract, skin, or musculoskeletal systems*
4. For any patient undergoing elective surgery
5. Only for patients with implanted cardiac devices undergoing any procedure

12. Question

What is recommended before elective cardiac surgery or transcatheter valve implantation to treat carriers?

1. Pre-operative screening for nasal carriage of S. aureus
2. Post-operative screening for nasal carriage of S. aureus
3. Pre-operative screening for nasal carriage of S. pneumoniae
4. Post-operative screening for nasal carriage of S. pneumoniae
5. Pre-operative screening for oral carriage of S. aureus

13. Question

What is recommended for the prevention of infective endocarditis before the placement of a CIED?

1. Peri-operative antibiotic prophylaxis
2. Post-operative antibiotic therapy
3. No antibiotic prophylaxis required
4. Only pre-operative antibiotic prophylaxis
5. Only post-operative antibiotic prophylaxis

14. Question

Which of the following measures is recommended to prevent CIED infections during cardiac procedures?

1. Using broad-spectrum antibiotics post-procedure
2. Implementing optimal pre-procedural aseptic measures of the site of implantation*
3. Limiting the duration of the procedure to under one hour
4. Ensuring patient fasting 12 hours before the procedure
5. Administering antiviral prophylaxis before the procedure

15. Question

For which of the following procedures is periprocedural antibiotic prophylaxis recommended according to the guidelines for infective endocarditis prevention?

1. Coronary artery bypass graft (CABG) surgery
2. Pericardiocentesis
3. Surgical implantation of a prosthetic valve*
4. Electrophysiological study (EPS)
5. Implantation of a permanent pacemaker

16. Question

What measure is recommended during the insertion and manipulation of catheters in the catheterization laboratory environment to prevent infective endocarditis?

1. Use of prophylactic antibiotics
2. Routine hand washing
3. Surgical standard aseptic measures*
4. Regular use of antiseptic solutions
5. Mandatory use of sterile gloves only

17. Question

Prior to implantation of a prosthetic valve or other intracardiac or intravascular foreign material, how long before the procedure should potential sources of sepsis be eliminated, except in urgent procedures?

1. At least 1 week
2. At least 2 weeks*
3. At least 3 weeks
4. At least 4 weeks
5. At least 5 weeks

18. Question

In the context of infective endocarditis prevention in cardiac procedures, what is recommended before TAVI and other transcatheter valvular procedures?

1. Routine administration of antifungal prophylaxis
2. Antibiotic prophylaxis covering for common skin flora includingEnterococcusspp. andS. aureus*
3. Administration of antiviral medications
4. No prophylaxis is needed
5. Prophylaxis with broad-spectrum antibiotics covering all potential pathogens

19. Question

According to the clinical practice guidelines, what is the recommendation regarding systematic skin or nasal decolonization without screening for S. aureus in the context of infective endocarditis prevention in cardiac procedures?

1. It is strongly recommended.
2. It is recommended only in high-risk patients.
3. It is recommended for all patients.
4. It is not recommended.*
5. It is optional based on physician discretion.

20. Question

In the management of patients with complicated infective endocarditis (IE), which of the following is recommended to improve outcomes?

1. Referral to a general hospital without surgical facilities
2. Diagnosis and management at an early stage in a Heart Valve Centre with immediate surgical facilities and an 'Endocarditis Team'*
3. Delayed management at a specialized cardiology clinic
4. Diagnosis and management solely by a primary care physician
5. Treatment in a remote facility without specialized teams

21. Question

For patients with uncomplicated infective endocarditis (IE) managed in a Referring Centre, what is recommended to improve the outcomes of the patients?

1. Regular surgical interventions
2. Early and regular communication between the local and the Heart Valve Centre endocarditis teams*
3. Immediate transfer to a specialized hospital
4. Daily monitoring of blood cultures
5. Continuous antibiotic therapy without interruption

22. Question

Which imaging modality is recommended as the first-line for suspected infective endocarditis (IE)?

1. MRI
2. CT scan
3. PET scan
4. Transesophageal echocardiography (TEE)
5. Transthoracic echocardiography (TTE)*

23. Question

What is recommended for all patients with clinical suspicion of infective endocarditis (IE) and a negative or non-diagnostic transthoracic echocardiogram (TTE)?

1. TOE is not recommended in these patients.
2. TOE is recommended only if TTE is positive.
3. TOE is recommended in all patients with clinical suspicion of IE and a negative or non-diagnostic TTE. *
4. TTE should be repeated instead of performing TOE.
5. No further echocardiographic evaluation is necessary.

24. Question

In patients with clinical suspicion of infective endocarditis (IE), when is transoesophageal echocardiography (TOE) recommended?

1. When there is no history of heart disease.
2. When a prosthetic heart valve or an intracardiac device is present.*
3. Only in patients with a high fever.
4. Only in patients with a history of rheumatic fever.
5. In all patients regardless of specific conditions.

25. Question

In cases of initially negative or inconclusive examination when clinical suspicion of infective endocarditis (IE) remains high, what is the recommended time frame for repeating TTE and/or TOE?

1. 35 days
2. *57 days*
3. 710 days
4. 1014 days
5. 1421 days

26. Question

In patients with suspected infective endocarditis (IE), when is TOE recommended even if TTE is positive?

1. In all cases of suspected IE regardless of TTE results
2. Only in cases with positive TTE and poor quality examination
3. In all cases except isolated right-sided native valve IE with good quality TTE examination and unequivocal echocardiographic findings*
4. Only in cases with negative TTE results
5. In all cases of right-sided native valve IE

27. Question

For which types of bacteraemia should performing an echocardiography be considered?

1. Pseudomonas aeruginosa and Klebsiella pneumoniae
2. Staphylococcus aureus, Escherichia coli, and Streptococcus pneumoniae
3. Staphylococcus aureus, Enterococcus faecalis, and some Streptococcus spp.*
4. Escherichia coli and Pseudomonas aeruginosa
5. Klebsiella pneumoniae and Streptococcus pyogenes

28. Question

When is repeating TTE and/or TOE recommended in the follow-up of infective endocarditis under medical therapy?

1. Only at the end of the treatment course
2. When a new murmur is detected*
3. After every 24 hours regardless of symptoms
4. Only if the patient exhibits signs of heart failure
5. When the initial TTE or TOE results are inconclusive

29. Question

When managing a stable patient with infective endocarditis, what is recommended before switching from intravenous to oral antibiotic therapy?

1. Routine blood cultures
2. TOE (Transoesophageal echocardiography)
3. Chest X-ray
4. Complete blood count
5. Electrocardiogram

30. Question

During follow-up of uncomplicated infective endocarditis (IE), what should be considered to detect new silent complications?

1. Routine blood tests
2. Regular chest X-rays
3. Repeat TTE and/or TOE*
4. Continuous ECG monitoring
5. Frequent physical examinations

31. Question

According to clinical practice guidelines, what is recommended for all cases of infective endocarditis requiring surgery?

1. Pre-operative echocardiography
2. Post-operative echocardiography
3. Periodic echocardiography
4. Intra-operative echocardiography*
5. No echocardiography

32. Question

What is recommended at the completion of antibiotic therapy for evaluation of cardiac and valve morphology and function in patients with infective endocarditis (IE) who did not undergo heart valve surgery?

1. MRI
2. CT scan
3. TTE and/or TOE*
4. PET scan
5. ECG

33. Question

In patients with possible native valve endocarditis (NVE), which imaging modality is recommended to detect valvular lesions and confirm the diagnosis of infective endocarditis (IE)?

1. Echocardiography
2. Cardiac MRI
3. Cardiac CT angiography (CTA)*
4. Nuclear imaging
5. Positron emission tomography (PET)

34. Question

Which imaging modalities are recommended in possible prosthetic valve endocarditis (PVE) to detect valvular lesions and confirm the diagnosis of infective endocarditis (IE)?

1. [18F]FDG-PET/CT(A) and cardiac MRI
2. [18F]FDG-PET/CT(A) and cardiac CTA*
3. Cardiac MRI and cardiac CTA
4. [18F]FDG-PET/CT(A) and SPECT
5. Cardiac CTA and SPECT

35. Question

In the management of infective endocarditis, when is cardiac CTA recommended?

1. To diagnose paravalvular or periprosthetic complications in NVE and PVE if echocardiography is inconclusive.*
2. As the first-line imaging technique for all cases of infective endocarditis.
3. Only for diagnosing NVE when echocardiography is conclusive.
4. For routine follow-up in patients with a history of infective endocarditis.
5. To replace echocardiography for initial diagnosis of infective endocarditis.

36. Question

In symptomatic patients with NVE and PVE, which imaging modalities are recommended to detect peripheral lesions or add minor diagnostic criteria?

1. Ultrasound, X-ray, and CT
2. Brain and whole-body imaging (CT, [18F]FDG-PET/CT, and/or MRI)*
3. Echocardiography, MRI, and PET
4. X-ray, MRI, and PET
5. Doppler ultrasound, CT, and MRI

37. Question

In patients with high clinical suspicion of prosthetic valve endocarditis (PVE), which imaging modality should be considered when echocardiography is negative or inconclusive and PET/CT is unavailable?

1. MRI
2. WBC SPECT/CT*
3. Ultrasound
4. X-ray
5. Coronary angiography

38. Question

In the context of infective endocarditis (IE), what imaging modality may be considered to confirm the diagnosis of possible cardiac implantable electronic device (CIED)-related IE?

1. MRI
2. Ultrasound
3. Echocardiography
4. [18F]FDG-PET/CT*
5. X-ray

39. Question

In patients with native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE), what imaging modalities may be considered for screening of peripheral lesions in asymptomatic patients?

1. Echocardiography and chest X-ray
2. Brain and whole-body imaging (CT, [18F]FDG-PET/CT, and MRI)*
3. Ultrasound and D-dimer testing
4. Angiography and electrocardiogram (ECG)
5. Cardiac MRI and stress test

40. Question

Outpatient parenteral antibiotic treatment should be considered in patients with left-sided IE caused by which of the following organisms, provided they meet specific clinical criteria?

1. Pseudomonas aeruginosa
2. Streptococcus spp.*
3. Klebsiella pneumoniae
4. Escherichia coli
5. Clostridium difficile

41. Question

Which of the following conditions does NOT warrant avoiding outpatient parenteral antibiotic treatment in patients with infective endocarditis (IE)?

1. Highly difficult-to-treat microorganisms
2. Liver cirrhosis (Child-Pugh B or C)
3. Severe cerebral nervous system emboli
4. Untreated large extracardiac abscesses
5. Mild post-surgical complications*

42. Question

In the case of severe acute regurgitation, obstruction, or fistula causing refractory pulmonary edema or cardiogenic shock in aortic or mitral NVE or PVE, which of the following interventions is recommended?

1. Elective surgery
2. Conservative medical management
3. Emergency surgery*
4. Observation with follow-up
5. Cardioversion

43. Question

In patients with aortic or mitral native valve endocarditis (NVE) or prosthetic valve endocarditis (PVE) presenting with severe acute regurgitation or obstruction, what is the recommended course of action when symptoms of heart failure (HF) or echocardiographic signs of poor hemodynamic tolerance are observed?

1. Delayed surgery
2. Conservative medical management
3. Urgent surgery
4. Elective surgery
5. No intervention required

44. Question

Which of the following conditions indicates the need for urgent surgery in patients with infective endocarditis due to uncontrolled infection?

1. Fever without a clear source
2. Bruising or petechiae
3. Localized abscess*
4. Mild heart murmur
5. Stable vegetation on echocardiogram

45. Question

Under what circumstances is surgery recommended for infective endocarditis caused by fungi or multiresistant organisms?

1. Only when the patient is hemodynamically stable.
2. Only when the patient is hemodynamically unstable.
3. Urgent or non-urgent surgery is recommended regardless of the patient's hemodynamic condition.
4. Urgent or non-urgent surgery is recommended according to the hemodynamic condition of the patient.*
5. Surgery is not recommended for infective endocarditis caused by fungi or multiresistant organisms.

46. Question

In infective endocarditis (IE), under what condition should urgent surgery be considered according to clinical practice guidelines?

1. Persistently negative blood cultures for over 1 week
2. Persistent sepsis despite appropriate antibiotic therapy and adequate control of metastatic foci*
3. Immediate positive response to antibiotic therapy
4. Absence of sepsis after 1 week of treatment
5. Initial negative blood cultures followed by positive results

47. Question

In the context of infective endocarditis, particularly prosthetic valve endocarditis (PVE), which of the following scenarios warrants urgent surgery according to clinical practice guidelines?

1. PVE caused by HACEK organisms
2. PVE caused by non-HACEK Gram-negative bacteria*
3. PVE caused by Streptococcus viridans
4. PVE caused by Enterococcus faecalis
5. PVE caused by Coagulase-negative Staphylococcus

48. Question

In patients with aortic or mitral native valve endocarditis (NVE) or prosthetic valve endocarditis (PVE) with persistent vegetations 10 mm after one or more embolic episodes despite appropriate antibiotic therapy, what is the recommended course of action?

1. Increase the dosage of antibiotic therapy.
2. Initiate anticoagulation therapy.
3. Perform urgent surgery.*
4. Implement long-term antibiotic prophylaxis.
5. Perform elective surgery.

49. Question

In the context of infective endocarditis (IE) with vegetation, what is the recommended course of action for vegetation 10 mm with other indications for surgery?

1. Elective surgery
2. No surgery
3. Urgent surgery*
4. Antibiotic therapy only
5. Wait and watch approach

50. Question

In the context of infective endocarditis (IE) involving the aortic or mitral valve, urgent surgery may be considered under which of the following conditions?

1. Vegetation 10 mm with severe valve dysfunction and clinical evidence of embolism
2. Vegetation 10 mm and without severe valve dysfunction, without clinical evidence of embolism, and with low surgical risk*
3. Vegetation <10 mm with severe valve dysfunction and high surgical risk
4. Vegetation 10 mm with clinical evidence of embolism and high surgical risk
5. No vegetation present, but with severe valve dysfunction and clinical evidence of embolism

51. Question

In patients with infective endocarditis (IE) and suspected infective cerebral aneurysms, which imaging modality is recommended?

1. Echocardiogram
2. Chest X-ray
3. Brain CT or MRA*
4. Abdominal ultrasound
5. Electrocardiogram

52. Question

In the treatment of neurological complications of infective endocarditis, which of the following scenarios recommends neurosurgery or endovascular therapy?

1. Small aneurysms with no growth
2. Large aneurysms with continuous growth despite optimal antibiotic therapy*
3. Unruptured intracranial infective cerebral aneurysms
4. Aneurysms resolved with antibiotic therapy
5. Small aneurysms with intermittent growth

53. Question

In the context of treating neurological complications of infective endocarditis, what should be considered if non-invasive techniques are negative but the suspicion of an infective aneurysm remains?

1. Discontinue further testing
2. Initiate broad-spectrum antibiotics
3. Schedule a follow-up in 6 months
4. Conduct invasive angiography*
5. Perform a lumbar puncture

54. Question

In the treatment of embolic stroke associated with infective endocarditis, which intervention may be considered if expertise is available in a timely manner?

1. Intravenous thrombolysis
2. Anticoagulant therapy
3. Mechanical thrombectomy*
4. Surgical embolectomy
5. Carotid endarterectomy

55. Question

In the treatment of embolic stroke due to infective endocarditis (IE), which of the following therapies is NOT recommended?

1. Anticoagulant therapy
2. Thrombolytic therapy*
3. Antiplatelet therapy
4. Surgical intervention
5. Antibiotic therapy

56. Question

In patients undergoing surgery for valvular infective endocarditis and complete atrioventricular block, immediate epicardial pacemaker implantation should be considered if which of the following predictors of persistent AVB is present?

1. Pre-operative conduction abnormality
2. S. pneumoniae infection
3. Aortic root abscess
4. Tricuspid valve involvement
5. Previous valvular surgery

57. Question

Which imaging modalities are recommended for patients with suspected spondylodiscitis and vertebral osteomyelitis complicating infective endocarditis (IE)?

1. X-ray
2. Ultrasound
3. MRI or PET/CT*
4. Echocardiography
5. Bone Scan

58. Question

In patients with spondylodiscitis and/or septic arthritis with positive blood cultures for typical IE microorganisms, which diagnostic procedure is recommended to rule out infective endocarditis?

1. MRI of the spine
2. CT scan of the affected joints
3. TTE/TOE*
4. Blood culture repetition
5. PET scan

59. Question

In patients with osteoarticular infective endocarditis-related lesions caused by difficult-to-treat microorganisms, such as S. aureus or Candida spp., and/or complicated with severe vertebral destruction or abscesses, what is the recommended duration of antibiotic therapy?

1. Less than 2 weeks
2. Exactly 4 weeks
3. More than 6 weeks*
4. 5 weeks
5. 3 weeks

60. Question

For haemodynamically stable patients with aortic valve vegetations who require cardiac surgery and are high risk for CAD, which diagnostic method is recommended?

1. Echocardiogram
2. High-resolution multislice coronary CTA*
3. Magnetic Resonance Imaging (MRI)
4. Single-photon Emission Computed Tomography (SPECT)
5. Positron Emission Tomography (PET) Scan

61. Question

In patients requiring heart surgery for infective endocarditis, under what condition is invasive coronary angiography recommended?

1. In all patients regardless of CAD risk
2. Only in patients with aortic valve vegetations
3. In patients who are high risk for CAD, in the absence of aortic valve vegetations*
4. In patients with low risk for CAD, regardless of aortic valve vegetations
5. In patients requiring any type of cardiac surgery

62. Question

In emergency situations, what is the recommended approach to pre-operative coronary anatomy assessment for patients requiring valvular surgery for infective endocarditis, regardless of CAD risk?

1. Always perform pre-operative coronary anatomy assessment.
2. Perform pre-operative coronary anatomy assessment only if the patient has a high CAD risk.
3. Perform pre-operative coronary anatomy assessment only if the patient is hemodynamically stable.
4. Consider valvular surgery without pre-operative coronary anatomy assessment regardless of CAD risk.*
5. Delay surgery until pre-operative coronary anatomy assessment can be performed.

63. Question

In patients with known or high risk of significant obstructive CAD requiring surgery for infective endocarditis, what pre-operative coronary anatomy assessment is recommended despite the presence of aortic valve vegetations?

1. Non-invasive imaging techniques
2. Stress testing
3. Invasive coronary angiography*
4. CT coronary angiography
5. Echocardiography

64. Question

In the context of neurological complications in active infective endocarditis, what is the recommended timing for cardiac surgery after a transient ischemic attack, if surgery is indicated?

1. Within 24 hours
2. Within 48 hours
3. Within 72 hours
4. After a week
5. Without delay*

65. Question

After a stroke in a patient with active infective endocarditis, under which conditions is cardiac surgery recommended without any delay?

1. When there is the presence of HF, uncontrolled infection, abscess, or persistent high embolic risk, as long as coma is absent and cerebral haemorrhage has been excluded by cranial CT or MRI.*
2. Only if the patient has HF and no signs of infection.
3. If there is a high embolic risk and the patient is in a coma.
4. When cerebral haemorrhage is confirmed by cranial CT or MRI.
5. If there is uncontrolled infection, abscess, and the patient has not undergone cranial imaging.

66. Question

In patients with active infective endocarditis who have experienced an intracranial hemorrhage, what is the recommended approach regarding the timing of cardiac surgery?

1. Immediate cardiac surgery should be performed.
2. Delay cardiac surgery for 1-2 weeks.
3. Delay cardiac surgery for >1 month, if possible, with frequent reassessment of the patients clinical condition and imaging.*
4. Proceed with cardiac surgery within 24 hours regardless of the hemorrhage.
5. Delay cardiac surgery for 6 months.

67. Question

In patients with intracranial haemorrhage and unstable clinical status due to heart failure, uncontrolled infection, or persistent high embolic risk, what should be considered to weigh the likelihood of a meaningful neurological outcome?

1. Delayed elective surgery
2. Urgent or emergency surgery*
3. Conservative medical management
4. Immediate anticoagulation therapy
5. Long-term antibiotic therapy

68. Question

What is recommended during follow-up for patient education on the risk of recurrence and preventive measures?

1. Emphasis on physical exercise and diet, based on the individual risk profile
2. Education on medication adherence and lifestyle changes, with emphasis on regular check-ups
3. Patient education on the risk of recurrence and preventive measures, with emphasis on dental health, and based on the individual risk profile*
4. Education on mental health and stress management, tailored to the individual
5. Emphasis on genetic testing and family history, with preventive measures based on these factors

69. Question

What is recommended for patients following PWID-related IE?

1. Regular exercise
2. Dietary modifications
3. Addiction treatment*
4. Routine imaging
5. Blood pressure monitoring

70. Question

Which of the following is recommended for clinically stable patients based on an individual assessment for post-discharge follow-up?

1. Medication adjustment
2. Cardiac rehabilitation including physical exercise training*
3. Dietary supplements
4. Psychological counseling
5. Home health care services

71. Question

Which of the following is recommended for integration in follow-up care for post-discharge patients, according to clinical practice guidelines?

1. Routine physical therapy sessions
2. Dietary counseling for weight management
3. Regular blood pressure monitoring
4. Psychosocial support, including screening for anxiety and depression, and referral to relevant psychological treatment*
5. Genetic testing for familial cardiovascular conditions

72. Question

According to the clinical practice guidelines, what is the recommended management for early prosthetic valve endocarditis (PVE) occurring within 6 months of valve surgery?

1. Antibiotic therapy only
2. Observation and regular follow-up
3. Surgery with new valve replacement and complete debridement*
4. Delayed surgery after 12 months
5. Anticoagulation therapy only

73. Question

Which of the following is recommended for CIED implantation according to the guidelines for cardiovascular implanted electronic device-related infective endocarditis?

1. Routine use of antifungal agents
2. Prophylaxis with antiviral medication
3. Antibiotic prophylaxis covering S. aureus*
4. No prophylaxis required
5. Prophylaxis with broad-spectrum antibiotics

74. Question

In cases of suspected cardiovascular implanted electronic device (CIED)-related infective endocarditis (IE), which diagnostic methods are recommended to identify vegetations?

1. Only TTE is recommended.
2. Only TOE is recommended.
3. TTE and TOE are both recommended to identify vegetations.*
4. Neither TTE nor TOE are recommended.
5. TTE is recommended, but TOE is not.

75. Question

In patients with definite cardiovascular implanted electronic device (CIED)-related infective endocarditis (IE) under initial empirical antibiotic therapy, what is recommended?

1. Delay system extraction until antibiotic therapy is completed
2. Complete system extraction without delay*
3. Continue antibiotic therapy for at least 6 weeks before extraction
4. Perform partial system extraction and observe
5. Wait for culture results before deciding on system extraction

76. Question

According to the clinical practice guidelines, how many sets of blood cultures should be obtained before the initiation of empirical antibiotic therapy for CIED infection?

1. One set
2. Two sets
3. At least three sets*
4. Four sets
5. Five sets

77. Question

In the context of cardiovascular implanted electronic device (CIED)-related infective endocarditis (IE), when is it recommended to perform CIED reimplantation after extraction due to infection?

1. Immediately after extraction
2. As soon as blood cultures are negative for 48 hours
3. At the original site as soon as possible
4. At a different site, once signs and symptoms of infection have abated and blood cultures are negative for at least 72 hours in the absence of vegetations, and negative for at least 2 weeks if vegetations were visualized*
5. Within 24 hours of extraction, regardless of infection status

78. Question

What is the recommended action for managing cardiovascular implanted electronic device (CIED) in cases of valvular infective endocarditis (IE) even without definite lead involvement?

1. Monitor the patient closely without CIED removal.
2. Perform partial CIED extraction.
3. Administer antibiotics without CIED intervention.
4. Consider complete CIED extraction, taking into account the identified pathogen and requirement for valve surgery.*
5. Only remove the CIED if the leads are definitely involved.

79. Question

In cases of possible CIED-related IE with occult Gram-positive bacteraemia or fungaemia, what should be considered if bacteraemia/fungaemia persists after a course of antimicrobial therapy?

1. Immediate reimplantation of a new CIED
2. Increasing the dosage of antimicrobial therapy
3. Switching to a different class of antibiotics
4. Complete system removal*
5. Reducing the duration of antimicrobial therapy

80. Question

In the context of cardiovascular implanted electronic device (CIED)-related infective endocarditis, what is the recommended duration for antibiotic treatment following device extraction in the presence of septic emboli or prosthetic valves?

1. 1-2 weeks
2. 2-3 weeks
3. 3-4 weeks
4. 4-6 weeks*
5. 6-8 weeks

81. Question

In the context of cardiovascular implanted electronic device (CIED) reimplantation, which intervention may be considered in selected high-risk patients to reduce the risk of infection?

1. Routine use of antifungal medication
2. Use of an antibiotic envelope
3. Administration of intravenous immunoglobulin
4. Daily oral antibiotic prophylaxis
5. Regular use of antiseptic dressings

82. Question

In cases of possible CIED-related infective endocarditis (IE) with occult Gram-negative bacteraemia, what action may be considered in case of persistent/relapsing bacteraemia after a course of antimicrobial therapy?

1. Immediate antibiotic therapy adjustment
2. Only monitoring the patient closely
3. Partial system removal
4. Complete system removal*
5. Additional diagnostic tests

83. Question

In cases of non-S. aureus CIED-related endocarditis without valve involvement or lead vegetations, and with negative follow-up blood cultures without septic emboli, what is the recommended duration of antibiotic treatment following device extraction?

1. 1 week
2. 2 weeks*
3. 3 weeks
4. 4 weeks
5. 6 weeks

84. Question

In the context of cardiovascular implanted electronic device-related infective endocarditis, what is recommended when there is a single positive blood culture with no other clinical evidence of infection?

1. Immediate removal of the CIED
2. Removal of the CIED after confirming infection through additional tests
3. Removal of the CIED after a single positive blood culture
4. *Not recommended to remove the CIED after a single positive blood culture*
5. Removal of the CIED only if there are multiple positive blood cultures

85. Question

What is the recommended surgical treatment for right ventricular dysfunction secondary to acute severe tricuspid regurgitation non-responsive to diuretics?

1. Valve replacement
2. Valve repair
3. Conservative management with continued diuretics
4. Immediate surgical intervention
5. Observation and monitoring

86. Question

In the context of surgical treatment of right-sided infective endocarditis, which of the following conditions warrants surgical intervention according to the clinical practice guidelines?

1. New onset of atrial fibrillation
2. Persistent vegetation with respiratory insufficiency requiring ventilatory support after recurrent pulmonary emboli*
3. Mild tricuspid regurgitation without symptoms
4. Presence of right ventricular hypertrophy without vegetations
5. Isolated fever without any other complications

87. Question

In the surgical treatment of right-sided infective endocarditis, what is the recommended action for large residual tricuspid vegetations (>20 mm) after recurrent septic pulmonary emboli?

1. Monitor the patient with regular follow-ups
2. Initiate antibiotic therapy
3. Perform surgical intervention
4. Increase the dosage of current medication
5. Refer the patient to a pulmonologist

88. Question

Which patients are recommended for surgical treatment of right-sided infective endocarditis?

1. Patients with isolated right-heart involvement.
2. Patients with simultaneous involvement of left-heart structures.*
3. Patients with no heart involvement.
4. Patients with resolved endocarditis.
5. Patients with left-heart involvement only.

89. Question

According to the guidelines for the surgical treatment of right-sided infective endocarditis, which procedure should be considered when possible?

1. Valve replacement
2. Tricuspid valve repair*
3. Mitral valve repair
4. Aortic valve replacement
5. Pulmonary valve replacement

90. Question

In the context of right-sided infective endocarditis (IE), under what condition should surgery be considered for patients receiving appropriate antibiotic therapy?

1. Only if there is evidence of heart failure
2. When there is persistent bacteremia/sepsis after at least 1 week of appropriate antibiotic therapy*
3. In all cases of right-sided IE regardless of response to antibiotics
4. If the patient has a history of recurrent IE
5. Only if the antibiotic therapy fails after 2 weeks

91. Question

What is recommended for prophylactic management during tricuspid valve surgical procedures in patients with right-sided infective endocarditis?

1. Placement of an epicardial pacing lead should be avoided.
2. Placement of a temporary transvenous pacing lead should be considered.
3. Prophylactic placement of an epicardial pacing lead should be considered.*
4. Administration of intravenous antibiotics should be initiated.
5. Placement of a permanent pacemaker should be considered.

92. Question

In the context of right-sided infective endocarditis, what treatment may be considered for selected patients who are high risk for surgery?

1. Antibiotic therapy
2. Valve replacement
3. Debulking of right intra-atrial septic masses by aspiration*
4. Use of anticoagulants
5. Left ventricular assist device (LVAD) implantation

93. Question

In the context of infective endocarditis, what is recommended regarding antiplatelet or anticoagulant therapy in the presence of major bleeding, including intracranial haemorrhage?

1. Continuation of antiplatelet or anticoagulant therapy with caution
2. Increase in antiplatelet or anticoagulant dosage
3. Interruption of antiplatelet or anticoagulant therapy*
4. Switching from antiplatelet to anticoagulant therapy
5. Decrease in antiplatelet or anticoagulant dosage

94. Question

In patients with intracranial haemorrhage and a mechanical valve, what is recommended regarding the reinitiation of unfractionated heparin?

1. It should never be reinitiated.
2. It should be reinitiated immediately without any discussion.
3. It should be reinitiated only after 6 months.
4. It should be considered as soon as possible following multidisciplinary discussion.*
5. It should be reinitiated only if there are no other treatment options available.

95. Question

In the absence of stroke, what should be considered in cases where indication for surgery is likely (e.g., S. aureus IE) regarding antithrombotic therapy?

1. Continuation of oral anticoagulant therapy without any changes
2. Replacement of oral anticoagulant therapy by low molecular weight heparin under close monitoring
3. Discontinuation of all anticoagulant therapy
4. Replacement of oral anticoagulant therapy by unfractionated heparin under close monitoring*
5. Initiation of dual antiplatelet therapy

96. Question

In patients with infective endocarditis (IE), which of the following therapies is not recommended?

1. Anticoagulant therapy
2. Antiplatelet therapy
3. Thrombolytic therapy*
4. Beta-blocker therapy
5. Calcium channel blocker therapy

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