Cardiology: Libman-Sacks 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 · Cardiology: Libman-Sacks endocarditis

Sample item

A 26-year-old woman with a malar rash, arthritis and proteinuria develops a new regurgitant murmur. Echocardiography shows small sterile vegetations on both surfaces of the mitral valve, and blood cultures remain negative. What is the most likely diagnosis?

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

The answer and the reasoning

A. Libman-Sacks endocarditis

Verrucous sterile vegetations on either surface of the mitral or aortic valve in a patient with lupus are Libman-Sacks endocarditis. They are linked to immune complex deposition and antiphospholipid antibodies. Marantic vegetations occur in malignancy and lie along the closure line of the leaflets.

Option by option

  • A. Libman-Sacks endocarditis (correct)

    Correct. Sterile verrucous lesions on both valve surfaces in lupus define Libman-Sacks endocarditis.

  • B. Acute rheumatic valvulitis

    Acute rheumatic valvulitis follows streptococcal infection and gives small vegetations along the closure line, with a recent sore throat.

  • C. Marantic endocarditis

    Marantic endocarditis occurs in advanced cancer or hypercoagulable states, with vegetations at the closure line.

  • D. Infective endocarditis due to viridans streptococci

    Infective endocarditis would give positive blood cultures and bulky vegetations on the low-pressure side.

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 A, Libman-Sacks endocarditis. Verrucous sterile vegetations on either surface of the mitral or aortic valve in a patient with lupus are Libman-Sacks endocarditis.

Why is "Acute rheumatic valvulitis" not the answer?

Acute rheumatic valvulitis follows streptococcal infection and gives small vegetations along the closure line, with a recent sore throat.

Why is "Marantic endocarditis" not the answer?

Marantic endocarditis occurs in advanced cancer or hypercoagulable states, with vegetations at the closure line.

Why is "Infective endocarditis due to viridans streptococci" not the answer?

Infective endocarditis would give positive blood cultures and bulky vegetations on the low-pressure side.

What concept does this question test?

It tests Cardiology: Libman-Sacks endocarditis in General Medicine. They are linked to immune complex deposition and antiphospholipid antibodies. Marantic vegetations occur in malignancy and lie along the closure line of the leaflets.

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 Cardiology: Libman-Sacks 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.