Which endocarditis skin lesion is non-tender on the palms or soles?

• A. Janeway lesions
• B. Osler nodes
• C. Petechiae
• D. Splinter hemorrhages

Answer: (A)

Infective endocarditis can produce several skin manifestations, but the key distinction here is pain and location. Janeway lesions are painless, non-tender, hemorrhagic or erythematous macules that appear on the palms and soles. They arise from septic microemboli traveling to the skin and forming microabscesses, so they tend to be flat and non-tender.

Osler nodes, by contrast, are tender, raised nodules usually on the fingertips or toes, caused by immune complex deposition rather than embolic injury. Petechiae are tiny pinpoint hemorrhages that can appear anywhere on the body, not specifically on the palms and soles, and Splinter hemorrhages are linear streaks under the nails.

So, the non-tender lesion on the palms or soles is Janeway lesions.