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Endocarditis: Pathology review




Cardiovascular system

Vascular disorders
Congenital heart defects
Cardiac arrhythmias
Valvular disorders
Heart failure
Cardiac infections
Pericardial disorders
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Cardiovascular system pathology review

Endocarditis: Pathology review


1 / 9 complete

USMLE® Step 1 style questions USMLE

9 questions

A 36-year-old man presents to the emergency department with fever, chills, and cough of three days duration. The patient uses intravenous heroin regularly and reports he last used heroin earlier today. He is currently living in a homeless shelter. Temperature of 38.7 °C (101.6 °F), pulse is 105/min, respirations are 22/min, blood pressure is 100/63 mmHg, and oxygen saturation is 91% on room air. On physical examination, the patient appears disheveled. Erythematous lesions are noted on the chest and arms bilaterally. Rales are appreciated in the lungs bilaterally, and a holosystolic murmur is appreciated at the left lower sternal border. Laboratory values are demonstrated below:  

 Laboratory value  Result 
Complete Blood Count, Serum 
 Hemoglobin  12.5 g/dL 
 Hematocrit  40.5% 
 Leukocyte count  18,100 /mm3 
 Platelet count  250,000/mm3 
Inflammatory Markers, Serum 
ESR                 44 mm/hr 
 CRP  18 mg/L 
Electrolytes, Serum 
                  Sodium                131 mEq/L 
               Potassium                 3.6 mEq/L 
                 Chloride                 94 mEq/L  
              Bicarbonate                 20 mEq/L 
                 Calcium                8.4 mg/dL 
Blood is drawn and sent for culture, and the patient is started on empiric antibiotics. Three days later, 3 of 4 blood cultures obtained on admission grow Gram-positive, coagulase-positive bacteria. Which of the following is the most common initial site of infection in this patient?