QuestionSBA
QuestionChoice
The transoesophageal echocardiogram is the most sensitive diagnostic test for infective endocarditis. However, the first-line imaging modality performed should be a transthoracic echocardiogram, and whilst it is an important investigation in the work-up of suspected infective endocarditis, this patient's clinical features are highly suggestive of acute sepsis. Indeed, the patient has clammy hands, is hypotensive and tachycardic, and has new onset confusion. This should ring alarm bells for sepsis and should therefore prompt you to order blood cultures before any other investigation. This can be followed by IV antibiotics and fluid resuscitation.
10003527
b
Transoesophageal echocardiogram
QuestionChoice
This patient meets the threshold for a sepsis screen, hence blood cultures should be performed. Blood cultures are also important in the investigation of infective endocarditis, which is the most likely diagnosis in this case.
10003526
a
Blood cultures
QuestionChoice
Whilst you are unsure if the PR interval is prolonged, which could indicate infective endocarditis secondary to aortic root abscess, it would still be more appropriate to order blood cultures at this stage to investigate his sepsis.
10003528
c
Repeat ECG
QuestionChoice
Although a sputum culture is part of the investigative workup for suspected infective endocarditis, it would be more appropriate to order blood cultures at this stage to investigate his sepsis.
10003530
e
Sputum culture
QuestionChoice
Although a 'Urea and Electrolytes' blood test is part of the diagnostic workup for suspected infective endocarditis, it would be more appropriate to order blood cultures at this stage to investigate his sepsis.
10003529
d
Urea and Electrolytes
Concept
Chapter
2693
3710
Infective Endocarditis
Topic
134
Cardiology
13252
A 51-year-old man presents to the critical care unit with new-onset confusion and chest pain. An ECG shows no ST changes or T wave inversion, but you are unsure if the PR interval is prolonged.

He is a known IV drug user and has needle track marks on his arms. His hands are clammy and have painful nodules. He also has non-tender macules on his soles. Exudative haemorrhagic retinal lesions with pale centres are seen on ophthalmoscopy. He is mildly confused.

His observations are: BP 100/75mmHg, HR 116 bpm, Temp 38.3 degrees Celsius.

A urine dip shows raised protein and blood.

What is the most appropriate next investigation?
a