An attending physician is conducting bedside rounds in the infectious disease unit and discussing a newly admitted patient with a history of intravenous drug use. The patient presents with a two-week history of fever, fatigue, and a new-onset cardiac murmur, raising high clinical suspicion for infective endocarditis. The physician asks the medical team to evaluate for classic peripheral stigmata of this disease during the physical examination. Which of the following physical examination findings are highly characteristic of this condition? (Select all that apply.)
- Tender, violaceous nodules located on the pads of the fingers and toesAnswer
- Painless, erythematous macules distributed on the palms and solesAnswer
- CFirm, painless subcutaneous nodules positioned over the extensor surfaces of the elbows
- DBlanching, salmon-colored macular rash on the trunk that worsens concurrently with temperature spikes
- Linear, dark red streaks appearing beneath the nail bedsAnswer
Answer
The correct physical examination findings are tender nodules on the finger pads (Osler nodes), painless macules on the palms and soles (Janeway lesions), and linear red streaks under the nails (splinter hemorrhages).
The correct selections represent the classic peripheral stigmata of infective endocarditis. Osler nodes are tender, violaceous subcutaneous nodules typically found on the pads of the fingers and toes, caused by immune complex deposition. Janeway lesions are painless, erythematous macules located on the palms and soles, caused by septic microemboli. Splinter hemorrhages are dark red, linear streaks in the nail beds resulting from capillary damage and microembolization. The presence of these findings strongly supports the clinical diagnosis of infective endocarditis in a febrile patient with a new murmur.
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Key Concept
Physical stigmata of infective endocarditis