Which statement about embolic phenomena in infective endocarditis is true?

Which statement about embolic phenomena in infective endocarditis is true?

• A. Janeway lesions are indicative.
• B. Splinter hemorrhages under nails indicate embolic phenomena.
• C. Osler nodes indicate hepatic emboli.
• D. Roth spots indicate pulmonary emboli.

Answer: (B)

In infective endocarditis, fragments from a valve vegetation can break off and travel through the bloodstream, causing embolic phenomena in distant sites. Splinter hemorrhages under the nails are tiny emboli lodging in the nail bed capillaries, producing visible linear red-brown streaks. This is a clear, direct sign that emboli are circulating, which is exactly what the statement is describing. Janeway lesions are also related to emboli (painless macular lesions on the palms and soles from septic emboli), but the nail bed splinter hemorrhages are a more classic, straightforward marker of distal embolization. Osler nodes are tender nodules from immune complex deposition rather than true emboli, so they don’t indicate embolic seeding. Roth spots are retinal hemorrhages with pallid centers and don’t specifically signal pulmonary emboli; pulmonary emboli would more likely be tied to right-sided endocarditis with clots traveling to the lungs, not retinal signs. Therefore, splinter hemorrhages under the nails most directly reflect embolic phenomena in infective endocarditis.

In infective endocarditis, fragments from a valve vegetation can break off and travel through the bloodstream, causing embolic phenomena in distant sites. Splinter hemorrhages under the nails are tiny emboli lodging in the nail bed capillaries, producing visible linear red-brown streaks. This is a clear, direct sign that emboli are circulating, which is exactly what the statement is describing.

Janeway lesions are also related to emboli (painless macular lesions on the palms and soles from septic emboli), but the nail bed splinter hemorrhages are a more classic, straightforward marker of distal embolization. Osler nodes are tender nodules from immune complex deposition rather than true emboli, so they don’t indicate embolic seeding. Roth spots are retinal hemorrhages with pallid centers and don’t specifically signal pulmonary emboli; pulmonary emboli would more likely be tied to right-sided endocarditis with clots traveling to the lungs, not retinal signs.

Therefore, splinter hemorrhages under the nails most directly reflect embolic phenomena in infective endocarditis.