Cardiac catheterization would not be useful in this situation.Īnswer C: Electrocardiograms are also nondiagnostic in infective endocarditis. The patient is young and has no other risk factors for early coronary artery disease. This is not uncommon to see in a patient with tricuspid valve endocarditis and significant valvular regurgitation. This is a patient presenting with a history consistent with tricuspid valve endocarditis and right-sided heart failure as a result of valve incompetence. The most accurate diagnostic test is a TEE.Īnswer B: Patients with acute coronary syndrome, refractory stable angina, and new cardiomyopathy may benefit from left heart catheterization. Open Access Image/Vincent P, Davis R, Roy D – J Med Case Rep (2012)ĭid you get it right? The correct answer is: D Incorrect Answer ExplanationsĪnswer A: CT scans can be useful in detecting pulmonary embolization, which is a consequence of infective endocarditis, although this is not the best test at identifying valvular vegetation. The image below demonstrates a transesophageal echocardiogram of a patient with tricuspid valve endocarditis: A fundoscopic exam may further reveal Roth spots, which are exudative lesions in the retina. Left-sided endocarditis findings include splinter hemorrhages, which are linear emboli under the nails, Osler nodes that are painful raised lesions on the palms and soles, and Janeway lesions, which are painless erythematous lesions on the palms and soles. Embolization to the lungs can result in further respiratory decompensation in right-sided endocarditis. As the vegetation grows on the affected valve, the patient will develop signs and symptoms of heart failure, which is a result of the insufficient valve. Patients with infective endocarditis may initially experience nonspecific symptoms such as fevers, malaise, and anorexia, as seen in this patient. aureus is responsible for 80-90% of tricuspid valve endocarditis. aureus) is a common skin pathogen and is seen often with intravenous drug use. This patient is at high risk of tricuspid endocarditis given his intravenous drug use. TEE has a 90% sensitivity for detecting vegetation. Transesophageal echocardiogram (TEE) is the diagnostic test of choice in a patient with a high probability of endocarditis. The patient is presenting with signs of decompensated heart failure, which is a result of infective endocarditis. transthoracic echocardiogram of the heart Answer and Explanation transesophageal echocardiogram of the heartĮ. The most accurate diagnostic test to confirm this patient’s diagnosis isĭ. Blood cultures over the next 2 days grow Staphylococcus aureus. There is pitting pedal edema extending into his mid-thigh. A new holosystolic cardiac murmur at the left lower sternal border is observed. Physical examination reveals distended jugular veins bilaterally and clear lungs bilaterally. Vital signs reveal a blood pressure of 150/80 mmHg, heart rate of 105/min, respiratory rate of 25/min, oxygen saturation of 96% on room air, and temperature of 38.9☌ (102☏). He does report a significant history of intravenous drug use. There is no known family history of heart disease. The patient had no known prior medical problems. Prior to the current complaints, he has been experiencing fevers, malaise, and anorexia for one week. Your First Free NBME Sample QuestionĪ 35-year-old male presents to the emergency department with rapidly progressive dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and peripheral edema over the last 2 days. Below is a free NBME sample question so you can see first-hand what we mean. That’s why we have high-yield NBME practice questions written and screened by high-performing physician authors that are updated on a regular basis to ensure our SmartBanks stay up-to-date with exam blueprint changes. At TrueLearn, we understand that it’s all about the content. See why TrueLearn is a trusted resource for thousands of medical students and residents.
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