Splinter haemorrhage

For medical students, always start examination from the periphery unless told not too in a short case. The nail is one of the most important clue. We saw clubbing previously and this is the diagram of a splinter haemorrhage.
The most common cause for splinter haemorrhage is trauma. Yes, it is not infective endocarditis. But you must not forget IE as one of the cause.

Can any medical students tell me in 'comments' other signs of infective endocarditis ?

The answer is
Osler nodes, Janeway lesion, Roth spot, clubbing.

Worth remembering !

Modified Duke criteria

Pathological criteria

• Positive histology or microbiology of pathological material obtained at autopsy or cardiac surgery (valve tissue, vegetations, embolic fragments, or intracardiac abscess content)
  

Major criteria

• Two positive blood cultures showing typical organisms consistent with infective endocarditis, such as Streptococcus viridans and the HACEK group OR
  
• Persistent bacteraemia from two blood cultures taken > 12 hours apart or three or more positive blood cultures where the pathogen is less specific, such as Staphylococcus aureus and Staph epidermidis OR
  
• Positive serology for Coxiella burnetti, Bartonella species, or Chlamydia psittaci OR
  
• Positive molecular assays for specific gene targets
  
• Positive echocardiogram showing oscillating structures, abscess formation, new valvular regurgitation, or dehiscence of prosthetic valves
  

Minor criteria

• Predisposing heart disease
  
• Fever > 38°C
  
• Immunological phenomena such as glomerulonephritis, Osler's nodes, Roth spots, or positive rheumatoid factor
  
• Microbiological evidence not fitting major criteria
  
• Elevated C reactive protein or erythrocyte sedimentation rate
  
• Vascular phenomena such as major emboli, splenomegaly, clubbing, splinter haemorrhages, petechiae, or purpura
  

Definite infective endocarditis

• Pathological criteria positive OR
  
• Two major criteria OR
  
• One major and two minor criteria OR
  
• Five minor criteria