10-19-2008, 03:55 AM
A 44-year-old man comes to the emergency department because of a 7-day history of fever and a
2-day history of red spots on his eyes. He also reports some lethargy and fatigue. His past medical
history is otherwise unremarkable. He does state that when he was a teenager a physician once told
him that he had a "heart valve problem" that would require him to take antibiotics on dental visits. His
temperature is 38.0 C (99.4F), blood pressure is 140/75 mm Hg, pulse is 92/min, and respirations are
16/min. He has bilateral conjunctival hemorrhages and small indurations present on the dorsal surface
of his hands. He has a 1/6 systolic ejection murmur heard best at the apex. The finding most likely to
confirm the diagnosis is
A. echocardiograph showing mitral regurgitation
B. echocardiograph showing valvular mass
C. elevated erythrocyte sedimentation rate
D. positive V/Q scan
E. single positive blood culture
2-day history of red spots on his eyes. He also reports some lethargy and fatigue. His past medical
history is otherwise unremarkable. He does state that when he was a teenager a physician once told
him that he had a "heart valve problem" that would require him to take antibiotics on dental visits. His
temperature is 38.0 C (99.4F), blood pressure is 140/75 mm Hg, pulse is 92/min, and respirations are
16/min. He has bilateral conjunctival hemorrhages and small indurations present on the dorsal surface
of his hands. He has a 1/6 systolic ejection murmur heard best at the apex. The finding most likely to
confirm the diagnosis is
A. echocardiograph showing mitral regurgitation
B. echocardiograph showing valvular mass
C. elevated erythrocyte sedimentation rate
D. positive V/Q scan
E. single positive blood culture