Osler nodes are best described as which of the following?

• A. Painful nodules on fingertip or toe pulp
• B. Non-tender lesions on palms or soles
• C. Retinal hemorrhages with pale centers
• D. Subungual splinter hemorrhages

Answer: (A)

Osler nodes are painful, tender subcutaneous nodules on the pads of the fingers and toes, produced by immune complex–mediated vasculitis in infectious endocarditis. This explains why the best choice is the description of painful nodules on fingertip or toe pulp. In contrast, other classic IE signs include Janeway lesions, which are non‑tender lesions on the palms or soles; Roth spots, retinal hemorrhages with pale centers; and splinter hemorrhages under the nails. Recognizing that Osler nodes are painful, immune‑related nodules helps distinguishing them from the painless embolic lesions and from retinal or nail findings.