Objectives:

• Prescribe anticoagulation in a patient with a mechanical aortic valve
• Use prophylactic antibiotics in patients with valvular or other heart disease

1		You have a patient in your practice who has a bileaflet mechanical aortic valve. She wonders if she really needs anticoagulation. Your advice to this patient is to:
			A)	Use warfarin with a target INR of 2.0–3.0 (goal 2.5) plus aspirin.
			B)	Use warfarin with a target INR of 2.5–3.5 (goal 3.0) plus aspirin.
			C)	Use aspirin only.
			D)	Use warfarin with a target INR of 2.0–3.0.
			E)	None of the above is the best regimen.
2		This patient does well until she needs a procedure done. Then she wants to know if she needs endocarditis prophylaxis. For which of the following procedures is antibiotic prophylaxis not indicated?
			A)	Tooth cleaning.
			B)	Colonoscopy.
			C)	Upper GI endoscopy.
			D)	Joint tap and aspiration.
			E)	All of these procedures would ideally include prophylaxis.
3		Which of the following structural lesions is not an indication for antibiotic prophylaxis when combined with an appropriate procedure?
			A)	Bicuspid aortic valve.
			B)	Complex congenital heart disease such as tetralogy of Fallot.
			C)	Hypertrophic cardiomyopathy.
			D)	Recently repaired intraventricular defect.
			E)	Nonhemodynamically-significant mitral valve prolapse without leaflet thickening.