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Infective endocarditis — SCE Acute Medicine MCQ

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ModerateSepsis and Infectious EmergenciesInfective endocarditisSCE Acute Medicine

A 46-year-old man is assessed on the acute medical unit. He has fever, malaise and a new murmur 3 weeks after dental infection. There are splinter haemorrhages and microscopic haematuria. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate investigation?

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Correct answer: E — Blood cultures before antibiotics

Blood cultures before antibiotics is the best answer because multiple blood cultures before antibiotics are central to diagnosing endocarditis when the patient is not crashing. Lumbar puncture after cranial imaging is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Blood-culture yield falls quickly after empirical antibiotics.

Reference: https://cks.nice.org.uk/#acute-medicine-order-40-1