skip to main content

IE Surgical Indications — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateInfectious DiseasesIE Surgical IndicationsRACP Adult Medicine

A 30-year-old woman presents with a 6-week history of malaise, arthralgias, and a new heart murmur. She has splinter haemorrhages and Janeway lesions. Blood cultures grow Streptococcus mutans. TTE shows a 12 mm vegetation on the mitral valve with moderate mitral regurgitation. There is no heart failure. What is an indication for early surgery in native valve endocarditis?

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

Reveal the answer and explanation

Correct answer: A — Vegetation >10 mm with embolic events despite antibiotics

Indications for early surgery in native valve IE include: (1) heart failure from valvular dysfunction (most common indication); (2) uncontrolled infection (persistent bacteraemia >7 days, abscess, fistula, enlarging vegetation); (3) prevention of embolism (vegetation >10 mm with ≥1 embolic event, or very large vegetation >15–30 mm). This patient's 12 mm vegetation without embolic events or heart failure does not yet meet surgical criteria – she should continue antibiotics with close monitoring. If an embolic event occurs, surgery should be considered.

Reference: eTG – 2025 – Antibiotic Guidelines; ESC – 2023 – IE Guidelines