Alternative PANRE Test Question: Febrile 43 Year Old

A 43-year-old woman presents for evaluation of fatigue, malaise and pharyngitis. Her fever of 100.7°F started eight days ago after she underwent abscess drainage from her gums. She thought it would get better; however, it is persistent and now she has noticed painless lesions shown on her hands and feet.

During examination, you also notice subungual hemorrhages of her fingers. Chest radiograph shows pulmonary infiltrates. During cardiac auscultation, you hear a murmur suggestive of tricuspid regurgitation that the patient denies having previously been knowledgeable of.

What is the most appropriate intervention?

A. Echocardiogram and blood cultures
B. Antibiotics
C. Anticoagulants
D. Immediate physician referral