Update your Knowledge with MKSAP Q&A

For nearly 60 years, ACP’s Medical Knowledge Self-Assessment Program^SM (MKSAP ^SM) has been the most trusted resource in self-assessment and continuous learning for internal medicine physicians and residents. The tradition continues with ACP MKSAP^SM. The all-digital, subscription-based program provides continually updated clinical information, a robust question bank, and the opportunity to unlock additional questions and earn badges through ACP MKSAP CORE^TM. ACP Members enjoy discounted pricing on their one-year or three-year subscriptions.

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ACP MKSAP Infectious Diseases

A 55-year-old man is evaluated in the hospital 2 days after being admitted for fever and chills. At admission, a transthoracic echocardiogram showed an aortic valve with a 0.5-cm mobile vegetation; an ECG did not show evidence of conduction abnormalities. Empiric vancomycin and ceftriaxone were initiated. Medical history is otherwise unremarkable.

On physical examination, the patient is improved. Temperature is 38.0 °C (100.4 °F), blood pressure is 110/68 mm Hg, and pulse rate is 95/min. Cardiac auscultation reveals a grade 3/6 systolic murmur over the right upper sternal border. The remainder of the examination is unremarkable.

Two sets of blood cultures obtained on admission are growing Streptococcus gallolyticus.

Vancomycin is discontinued.

Which of the following is the most appropriate additional diagnostic test?

A: Colonoscopy
B: Dental radiography
C: PET CT
D: Transesophageal echocardiography

Answer and Critique

Back to the September 2025 issue of ACP Global