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Prosthetic valve endocarditis — MCCQE Part 1 MCQ

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HardFeverProsthetic valve endocarditisMCCQE Part 1

A 75-year-old man with prosthetic aortic valve has fever x 2 weeks, new regurgitant murmur, Janeway lesions, splinter haemorrhages. Blood cultures: Enterococcus faecalis. TEE: 12mm vegetation. Most appropriate treatment?

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Correct answer: A — IV ampicillin plus gentamicin for 6 weeks

PVE with Enterococcus: prolonged IV ampicillin + gentamicin (synergy). 6 weeks for prosthetic valve (vs 4-6 for native). Surgical indications: HF, uncontrolled infection, large/mobile vegetations with embolic risk.

Reference: CCS Endocarditis Guidelines