Return to Diagnosis ListShow Learning Points most relevant to Phase 1:

Fever and a new murmur

Clinical Discipline(s)/Organ System(s)
Cardiology, Cardiovascular System, Infectious Diseases, Microbiology
Progress Test Topic(s)
Cardiovascular, Infectious disease
A 39 year old Samoan/Niuean man presents with a fever and lethargy for the past 2 weeks. On examination he has a fever, splinter haemorrhages and an early diastolic murmur.
Progress Test-Type Questions:   Question 1
Applied Science for Medicine 
   - Anatomy of the heart and cardiovascular system
   - Physiology of the cardiac cycle and murmur generation
   - Pathogenesis of rheumatic fever
   - Common causes and pathology of bacterial endocarditis
   - Pharmacology of penicillins, cephalosporins and vancomycin
Clinical and Communication Skills 
   - History from a patient with fever
   - History from a patient with a murmur and risk factors for endocarditis
   - Perform an examination of a patient with a fever
   - Examine the cardiovascular system and recognise the peripheral signs of endocarditis
   - Diagnostic criteria for endocarditis (Duke criteria)
   - Interpret blood cultures, midstream urine, ECG, echocardiogram
   - Suggest appropriate antibiotic regimens for endocarditis; dual therapy
   - Role of surgery in the management of endocarditis
   - Complications of endocarditis
   - Situations where prophylactic antibiotics are required to prevent endocarditis
   - Discuss the long-term impacts: e.g. warfarin post-valve replacement
Personal and Professional Skills 
   - Discuss the need for the patient to continue long-term therapy, even when clinically improved and impact this will have on daily living (including work, sport)
Hauora Māori 
   - Ability to cater for differential health literacy needs of Māori patients and whānau
   - Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in New Zealand presenting with heart murmurs
   - Understanding of inequities in rheumatic heart disease outcomes for Māori compared with non-Māori, and application of this to clinical decision making and management
   - Understanding of the role of kaupapa Māori health policies, services and research in reducing rheumatic heart disease inequalities
Population Health 
   - Epidemiology of rheumatic fever
   - Screening for rheumatic fever (and sequalae)
   - Primary and secondary prevention of rheumatic fever
   - Sequelae of rheumatic fever and screening and/or treatment options
   - Screening for congenital heart defects
   - Endocarditis prophylaxis
Conditions to be considered relating to this scenario
bacterial endocarditis (Staphylococcus aureus, Viridans streptococci, Enterococcus faecalis), rheumatic fever, flow murmur
Less common but 'important not to miss'
Haemophilus/Actinobacillus/Cardiobacterium/Eikenella/Kingella (HACEK), pericarditis, myocarditis, severe sepsis/septicaemia
congenital heart disease, non-bacterial endocarditis, atrial myxoma
Related Scenarios
[Valvular heart disease]