Endocarditis Quiz: Ace Your Exams

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A 45-year-old male currently experiencing homelessness presents to the emergency department with fever, chills, shortness of breath and cough of 4-days duration. The patient reports he has also noticed several new skin lesions that were not present before, some of which are painful to the touch. The patient uses intravenous heroin and reports he last used heroin yesterday. Temperature is 38.7°C (101.6°F), pulse is 106/min, respirations are 24/min, and blood pressure is 100/62 mmHg. On physical examination the patient appears disheveled. Erythematous lesions are noted on the chest, arms, and hands bilaterally, some of which are painful to palpation. An image of the non-tender lesions is demonstrated below. Nail examination is notable for small ecchymotic lesions of the upper nail beds bilaterally. Rales are appreciated in the lungs bilaterally, and a holosystolic murmur is appreciated at the left lower sternal border. Which of the following clinical features is required for the diagnosis of this patient’s condition?  


Reproduced from: Wikipedia

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