PAINE #PANCE Pearl – Cardiovascular


What are the 3 eponymous physical exam findings in patients with bacterial endocarditis and who were they named after?


Osler Nodes

  • Painful, erythematous nodules of the hands and feet
  • Named after Sir William Osler in 1908.


Janeway Lesions

  • Nontender, erythematous or hemorrhagic macular or nodular lesions on the palms or soles
  • Named after Theodore Caldwell Janeway in the late 1800s.


Roth Spots

  • Retinal hemorrhages with white or pale centers.
  • Named after Swiss pathologist Mortiz Roth in 1872



  1. Osler W.  Chronic Infectious Endocarditis.  Quarterly Journal of Medicine.  1908;2:219-230.
  2. Ruiz-García J, Canal-Fontcuberta I. Diagnosis of Active Infective Endocarditis from Examination of the Toes and Soles. The American Journal of Cardiology. 2016;118(7):1094. [pubmed]
  3. Khanna N, Roy A, Bahl VK. Janeway lesions: an old sign revisited. Circulation. 2013;127(7):861. [pubmed]
  4. Sethi K, Buckley J, de Wolff J. Splinter haemorrhages, Osler’s nodes, Janeway lesions and Roth spots: the peripheral stigmata of endocarditis. British Journal of Hospital Medicine. 2013;74(9):C139-42. [pubmed]

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