Brazil Healthcare Practice Test & Exam Prep

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A 54-year-old male with a history of bicuspid aortic valve presents with 3 weeks of low-grade fever, malaise, night sweats, and a new holosystolic regurgitant murmur at the apex. Physical exam reveals non-tender erythematous macules on the palms (Janeway lesions) and subungual splinter hemorrhages. Blood cultures (3 sets drawn over 2 hours) grow Streptococcus gallolyticus (formerly S. bovis). In addition to targeted antibiotic therapy and echocardiography, what essential diagnostic investigation must be scheduled?

Total colonoscopy to screen for occult colorectal neoplasia or adenomatous polyps. Gastroduodenoscopy to identify occult Helicobacter pylori gastric ulceration. Bone marrow aspirate and biopsy to rule out acute myelogenous leukemia. 24-hour urine copper and ceruloplasmin testing to evaluate Wilson's disease.

Correct Answer:

Total colonoscopy to screen for occult colorectal neoplasia or adenomatous polyps.

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