American Board of Internal Medicine (ABIM) Certification Practice Exam

Which procedure requires infective endocarditis prophylaxis according to current recommendations?

1. Routine dental cleaning

2. Respiratory tract incision

3. Cosmetic surgery

4. Elective colonoscopy

The correct answer is: Respiratory tract incision

Infective endocarditis prophylaxis is particularly indicated for certain procedures that pose a risk for patients with specific underlying cardiac conditions. Infections are more likely to occur when bacteria enter the bloodstream, which can happen during invasive procedures. Respiratory tract incision procedures fall under those that necessitate prophylaxis because they can create pathways for bacteria to enter the bloodstream, especially in patients with predisposing heart conditions, such as prosthetic heart valves or previous episodes of infective endocarditis. On the other hand, routine dental cleanings, although they were previously considered a risk for bacteremia, are no longer recommended for prophylaxis in most cases, especially for patients without underlying cardiac conditions that increase the risk. Cosmetic surgery generally does not warrant prophylaxis unless specific circumstances apply. Elective colonoscopies also are not included under current guidelines for needing prophylaxis for infective endocarditis in patients without additional risk factors. Therefore, the procedure that requires infective endocarditis prophylaxis according to current recommendations is the respiratory tract incision, given the potential for hematogenous spread of bacteria during such invasive procedures.