Question
A 42-year-old man with known valvular heart disease develops a fever for 1 week. He appears unwell; findings include a pan systolic murmur at the apex that radiates to the axilla and a soft S1 sound. He has petechiae on his conjunctival sac, linear hemorrhages under a few finger-nails, and painful, tender, and erythematous nodules on some of the distal fingertips. Which of the following is the most responsible mechanism for these physical findings?
| A. | direct bacterial invasion |
| B. |
immune response |
| C. |
vascular phenomena |
| D. |
valvular damage |
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