American Board of Internal Medicine (ABIM) Certification Practice Exam

Who requires infective endocarditis prophylaxis for dental procedures?

1. Patients with a single episode of heart failure

2. Patients with a history of arrhythmia

3. Patients with a prosthetic cardiac valve

4. Patients with hypertension

The correct answer is: Patients with a prosthetic cardiac valve

Infective endocarditis prophylaxis is primarily recommended for patients at the highest risk of developing this serious infection as a result of dental procedures that may cause bacteremia. A prosthetic cardiac valve is considered a significant risk factor because individuals with such valves have a higher likelihood of bacteria adhering to the artificial surface if it enters the bloodstream. Patients who have a prosthetic valve are at risk because the materials used in these valves do not have the same immune response capabilities as natural valves. Consequently, if bacteria enter the bloodstream during dental treatments, they can colonize on the prosthetic valve, leading to infective endocarditis. Therefore, prophylactic antibiotics are recommended before dental procedures for these patients. In contrast, conditions such as a single episode of heart failure, a history of arrhythmia, and hypertension do not typically confer the same level of risk for infective endocarditis when dental procedures are performed. Thus, while these conditions may indicate certain precautions in medical management, they do not necessitate prophylactic antibiotics in the context of dental care in the same way that a prosthetic cardiac valve does.