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Endocarditis causing embolic stroke — SCE Acute Medicine MCQ

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HardSepsis and Infectious EmergenciesEndocarditis causing embolic strokeSCE Acute Medicine

A 55-year-old man presents with fever, systemic upset and acute deterioration. Relevant history includes a plausible infectious exposure or immunocompromising context. On assessment, NEWS2 is elevated and there are features of organ dysfunction. Investigations show fever, new murmur, vegetation and embolic neurological deficit. What is the most appropriate next step in management?

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

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Correct answer: A — Take blood cultures and start intravenous antibiotics with endocarditis team input

The key discriminator is that fever, new murmur, vegetation and embolic neurological deficit, which makes Take blood cultures and start intravenous antibiotics with endocarditis team input the single best answer. Give targeted antidote or reversal therapy is less appropriate because it does not address the dominant acute risk in the vignette; Give intravenous fluids with reassessment would fit a different presentation or later stage of care. Provide supportive care and close monitoring and Call critical care for escalation are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE NG84