Infective endocarditis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Infective endocarditis

Sample item

A 28-year-old man who injects drugs has had fever for two weeks. He is haemodynamically stable, has a new regurgitant murmur and splinter haemorrhages. What is the most appropriate next step before starting antibiotics?

AChest radiographBErythrocyte sedimentation rateCA single blood culture sampleDMultiple sets of blood cultures from separate venepunctures

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Multiple sets of blood cultures from separate venepunctures

Suspected infective endocarditis needs several blood culture sets, ideally before antibiotics, because bacteraemia is continuous and the organism guides therapy. Echocardiography is done alongside. In a stable patient, a short delay to take cultures is acceptable.

Option by option

A. Chest radiograph
A chest film may show septic emboli but does not identify the causative organism.
B. Erythrocyte sedimentation rate
A raised ESR is nonspecific and neither confirms the diagnosis nor guides treatment.
C. A single blood culture sample
One sample may miss the organism and does not meet the standard for diagnosing endocarditis.
D. Multiple sets of blood cultures from separate venepunctures (correct)
Correct. Several sets raise the yield and identify the organism and its sensitivities.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Multiple sets of blood cultures from separate venepunctures. Suspected infective endocarditis needs several blood culture sets, ideally before antibiotics, because bacteraemia is continuous and the organism guides therapy.

Why is "Chest radiograph" not the answer?

A chest film may show septic emboli but does not identify the causative organism.

Why is "Erythrocyte sedimentation rate" not the answer?

A raised ESR is nonspecific and neither confirms the diagnosis nor guides treatment.

Why is "A single blood culture sample" not the answer?

One sample may miss the organism and does not meet the standard for diagnosing endocarditis.

What concept does this question test?

It tests Infective endocarditis in General Medicine. Echocardiography is done alongside. In a stable patient, a short delay to take cultures is acceptable.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Infective endocarditis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.