A fictional 52-year-old with fever and a new murmur develops expressive dysphasia. Blood cultures have been taken and echocardiography is being arranged.
Listen for the assumption.
I will start the standard endocarditis antibiotics and stop all antithrombotics now.
Which parts require urgent senior multidisciplinary decisions rather than blanket rules?
I need microbiology, cardiology/endocarditis, stroke and cardiac-surgery input; cultures and imaging should guide the plan.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- Fever with a new regurgitant murmur
- Focal neurological deficit
- Multiple blood cultures obtained before antibiotics where this does not delay emergency care
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
Secure cultures and urgent imaging, then communicate the neurological trajectory and valve findings across teams.
Endocarditis with stroke is a multidisciplinary emergency. Do not promise a fixed timing for intervention in a teaching case.
My handover will state cultures, antimicrobial plan, echo/imaging status and named decision-makers.
What must remain explicit.
- Follow local endocarditis and stroke pathways.
- Escalate reduced consciousness, haemodynamic instability or acute valve failure immediately.
- Do not use fixed antibiotic or antithrombotic rules in isolation.
Where reasoning fails.
- One-team ownership
- Blanket anticoagulant decisions
- Delaying cultures or imaging coordination
Suspected IE with [neurological trajectory], cultures [taken/results], echo [status], antimicrobial [plan] and multidisciplinary contacts [names].
How would you explain the uncertainty of a surgery or antithrombotic decision to the family?