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Infective endocarditis — USMLE Step 2 CK MCQ

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ModerateInternal MedicineInfective endocarditisUSMLE Step 2 CK

A 62-year-old Middle Eastern woman comes to the hospital because of progressive symptoms. History and focused examination are notable for fever, new murmur, splinter hemorrhages, and positive blood cultures. Temperature is 102.2°F (39.0°C), blood pressure is 108/66 mmHg, pulse is 112/min, respirations are 22/min, and oxygen saturation is 94% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and initial testing support the clinical pattern described in the stem. Which of the following is the most likely cause of this patient's condition?

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

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Correct answer: D — Bacterial adherence to damaged endocardium with vegetation formation

The vignette describes Infective endocarditis, supported by fever, new murmur, splinter hemorrhages, and positive blood cultures. Bacterial adherence to damaged endocardium with vegetation formation is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: https://professional.heart.org/en/guidelines-and-statements#stage-9-order-22