Rosh Internal Medicine Boost Practice Exam

Which diagnostic test is most sensitive for diagnosing endocarditis symptoms in a patient with a new murmur?

1. Chest computed tomography

2. Electrocardiogram

3. Transesophageal echocardiogram

4. Transthoracic echocardiogram

The correct answer is: Transesophageal echocardiogram

The transesophageal echocardiogram (TEE) is the most sensitive diagnostic test for detecting endocarditis, particularly in patients presenting with new murmurs. This imaging technique provides a clearer and more detailed view of the heart's structure and the valves compared to other imaging modalities. It is particularly useful in visualizing vegetations—large aggregates of platelets, fibrin, and microorganisms that characterize endocarditis—often located on the left-sided heart valves, which can be missed or inadequately assessed with transthoracic echocardiograms (TTE). While TTE is commonly performed as a non-invasive option and is useful in many cases, it has lower sensitivity for certain types of endocarditis, especially in patients with prosthetic valves or when the anatomical structures obscure the view. In contrast, TEE, performed by placing the ultrasound probe in the esophagus, offers better resolution and can detect smaller or less obvious vegetations, as well as the presence of other potential complications such as abscesses or valve perforations. Other tests listed, like chest CT or ECG, do not specifically address the structural abnormalities or vegetative growths associated with endocarditis with the same sensitivity that TEE offers, making TEE the preferred choice