A 52-Year-Old Active Smoker Comes to the Office Due to a 2-Week

A 52-year-old active smoker comes to the office due to a 2-week history of malaise, shortness of breath, and decreased appetite.  The patient has a history of bicuspid aortic valve and hypertension.  His temperature is 39 C (102.2 F) , blood pressure is 140/80 mm Hg, and pulse is 110/min.  On examination, the patient has a systolic ejection murmur at the right upper sternal border that is unchanged from previous visits; there is a new decrescendo diastolic murmur best heard in the third intercostal space at the left sternal border.  Laboratory studies show hemoglobin is 9.3 g/dL and leukocytes are 16,500/mm³.  Blood cultures are positive for Streptococcus gallolyticus (formerly S bovis) .  Additional workup for this patient should focus on which of the following conditions?

A) Colonic neoplasia
B) Intravenous drug use
C) Lung cancer
D) Oral infection
E) Urinary tract infection

Correct Answer:

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