Best of Five 3.8

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BOF:3.8

A 78-year-old female is admitted with a history of fever, anorexia, malaise and weight loss. She looks thin, has a tachycardia and a soft systolic murmur at the apex. No other abnormalities are detectable. Investigations reveal a polymorphonuclear leucocytosis, an elevated ESR and a high serum alkaline phosphatase. Blood cultures show growth of Streptococcus milleri

In this patient the definitive investigation would be:

a)      Abdominal ultrasound scan

b)     Transoesophageal echocardiogram

c)      ERCP

d)      Colonoscopy

e)      CT Chest

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