Physical exam-bacterial endocarditis

• Cardiac murmur (85%), s/s of new HF (pulmonary edema, JVP elevation, edema)
• Skin/ocular changes (uncommon but highly specific) Janeway lesions (painless hemorrhagic macules on palms/ soles due to septic emboli) Osler’s nodes (painful nodules on pads of digits due to immune complex deposition) Splinter hemorrhages in fingernails or toenails Roth spots (retinal hemorrhages)
• MSK: point tenderness along spine, red/hot joints
• Neurologic deficits c/f embolic stroke; vertebral tenderness c/f osteo or epidural abscess
• Devices: evaluate CVCs, PM/ICD pocket, and sites of other hardware/ prosthetics