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Splinter Haemorrhages — SCE Dermatology MCQ

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HardNail DisordersSplinter HaemorrhagesSCE Dermatology

A man has persistent fever, a new regurgitant murmur, multiple splinter haemorrhages and a focal neurological deficit. Infective endocarditis is suspected. Which immediate diagnostic sequence is most appropriate if he is haemodynamically stable?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Obtain multiple blood-culture sets before antibiotics and arrange urgent echocardiographic assessment

Explanation lettering: D = shown as B · E = shown as D · B = shown as E

A is correct. In a stable patient, multiple blood-culture sets should be obtained before antimicrobial therapy, followed by urgent echocardiographic and specialist assessment; instability must never delay treatment. Fever, a new murmur and embolic neurology create substantial clinical suspicion. Oral empirical treatment and delayed cultures reduce diagnostic yield, traumatic attribution ignores systemic red flags, nail biopsy is not the priority, and anticoagulation may be hazardous when cerebral embolism or haemorrhage is possible. Splinter haemorrhages are supportive peripheral signs but are not themselves a major Duke criterion and should not be mislabelled as one. The original explanation incorrectly classified them within Duke vascular criteria.

Reference: NHS Ayrshire and Arran infective endocarditis antimicrobial guidance: https://aaamedicines.org.uk/guidelines/infections/cardiovascular-infective-endocarditis/