Cardiology: infective endocarditis with Streptococcus gallolyticus: 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 · Cardiology: infective endocarditis with Streptococcus gallolyticus

Sample item

A 66-year-old man has had fever and weight loss for three weeks. A new aortic regurgitation murmur is heard, and two blood culture sets grow Streptococcus gallolyticus (bovis). Apart from appropriate antibiotics and valve assessment, which additional investigation is most important?

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

The answer and the reasoning

B. Colonoscopy to look for colorectal neoplasia

Endocarditis due to Streptococcus gallolyticus is strongly associated with colonic neoplasia, including adenomas and carcinoma, as the organism gains entry through a diseased colonic mucosa. Any patient with this organism, even with a clear alternative portal, should have a colonoscopy. Detecting and treating the lesion lowers the chance of recurrence and cancer progression.

Option by option

  • A. Bone marrow biopsy to exclude lymphoma

    Lymphoma is not linked to this organism, and fever here is explained by endocarditis.

  • B. Colonoscopy to look for colorectal neoplasia (correct)

    Colonic lesions are the commonest hidden source of S. gallolyticus bacteraemia, so colonoscopy is mandatory.

  • C. Cardiac MRI to exclude myocarditis

    Myocarditis does not explain valve vegetations or the organism, and MRI would not alter management.

  • D. Lumbar puncture to exclude meningitis

    There are no meningeal features, so lumbar puncture is not indicated and carries risk if there are emboli.

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.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Colonoscopy to look for colorectal neoplasia. Endocarditis due to Streptococcus gallolyticus is strongly associated with colonic neoplasia, including adenomas and carcinoma, as the organism gains entry through a diseased colonic mucosa.

Why is "Bone marrow biopsy to exclude lymphoma" not the answer?

Lymphoma is not linked to this organism, and fever here is explained by endocarditis.

Why is "Cardiac MRI to exclude myocarditis" not the answer?

Myocarditis does not explain valve vegetations or the organism, and MRI would not alter management.

Why is "Lumbar puncture to exclude meningitis" not the answer?

There are no meningeal features, so lumbar puncture is not indicated and carries risk if there are emboli.

What concept does this question test?

It tests Cardiology: infective endocarditis with Streptococcus gallolyticus in General Medicine. Any patient with this organism, even with a clear alternative portal, should have a colonoscopy. Detecting and treating the lesion lowers the chance of recurrence and cancer progression.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Cardiology: infective endocarditis with Streptococcus gallolyticus?

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.