AssessmentsEndocarditis: Pathology review
USMLE® Step 1 style questions USMLE
A 67-year-old man presents to the primary care physician with a several week history of worsening fatigue, blurry vision, and rectal bleeding. Medical history is notable for ulcerative colitis, hypertension, and hyperlipidemia. The patient’s last colonoscopy was at age 50. Temperature is 37.6°C (99.7°F), pulse is 96/min, respirations are 18/min, and blood pressure is 122/63 mmHg. BMI is 34 kg/m2. Physical examination demonstrates an obese habitus. The patient’s skin appears pale with noted conjunctival pallor. Cardiopulmonary examination demonstrates a 3/6 holosystolic murmur best at the cardiac apex which was not present at the previous office visit 3 months ago. Retinal examination demonstrates round white spots on the retina surrounded by hemorrhage. Rectal examination is positive for scant blood in the rectal vault. Laboratory values are demonstrated below:
|Complete Blood Count, Serum|
|Leukocyte count||14,100 /mm3|
Two people came into the cardiology ward.
One of them was 25 year old Darren, who came in with a fever, chills and fatigue.
On the clinical examination, his fingernails had splinter hemorrhages and the palm of his hands had some erythematous flat lesions.
There were also some track marks on his forearm.
The other one is 75 year old Anna, who also had a fever and the same splinter hemorrhages and erythematous flat lesions that we previously saw.
On auscultation, a heart murmur was heard.
On her history, she said she was at the dentist 2 weeks ago.
Okay, so both people likely have endocarditis, or inflammation of the inner layer of the heart.
Damage exposes the underlying collagen and tissue factor, which causes platelets and fibrin to adhere, which forms tiny blood clots.