Rosh Emergency Medicine Practice Test

What is the most common physical exam finding in a patient suspected of having infective endocarditis?

1. Heart murmur

2. Janeway lesions

3. Pericardial friction rub

4. Splinter hemorrhages

The correct answer is: Heart murmur

The most common physical exam finding in a patient suspected of having infective endocarditis is a heart murmur. This is primarily because infective endocarditis typically affects the heart valves, leading to changes in blood flow across these structures. As the abnormal blood flow occurs due to valve regurgitation or stenosis resulting from the infection, a murmur is created that can often be auscultated during a physical examination. Monitoring for specific changes in heart sounds, including new murmurs or changes in previous murmurs, can provide important clues in diagnosing the condition. While Janeway lesions, pericardial friction rubs, and splinter hemorrhages are notable findings in infective endocarditis, they are not as universally observed as heart murmurs. Janeway lesions and splinter hemorrhages are more specific markers and may not always be present, while a pericardial friction rub is often associated with pericarditis rather than endocarditis directly. Thus, the presence of a heart murmur remains the most prevalent and clinically significant finding in the assessment of suspected infective endocarditis.