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  {
    "id": "frank-sign",
    "kind": "image",
    "title": "Frank s sign.jpg",
    "filename": "frank-sign.jpg",
    "caption": "Diagonal earlobe crease (Frank sign). An association clue, not a test for obstructive coronary disease.",
    "creator": "Med Chaos",
    "license": "CC BY-SA 3.0",
    "licenseUrl": "https://creativecommons.org/licenses/by-sa/3.0",
    "sourceUrl": "https://commons.wikimedia.org/wiki/File:Frank_s_sign.jpg",
    "downloadUrl": "https://upload.wikimedia.org/wikipedia/commons/f/fe/Frank_s_sign.jpg",
    "originalDescription": "The earlobe crease of the Japanese angina patient",
    "width": 715,
    "height": 960,
    "modifications": "None; original Commons file downloaded unchanged.",
    "checkedDate": "2026-09-05",
    "sha256": "6b755ec3ff06276c6ef64e616f9d5ff66a18dfe9677aaae6eb01d6581fb76ad8",
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    "file": "frank-sign.jpg"
  },
  {
    "id": "clubbing-profile",
    "kind": "image",
    "title": "Clubbing fingers 1.jpg",
    "filename": "clubbing-profile.jpg",
    "caption": "Digital clubbing seen from above: broad bulbous fingertips and curved nails.",
    "creator": "Wesalius",
    "license": "CC BY-SA 4.0",
    "licenseUrl": "https://creativecommons.org/licenses/by-sa/4.0",
    "sourceUrl": "https://commons.wikimedia.org/wiki/File:Clubbing_fingers_1.jpg",
    "downloadUrl": "https://upload.wikimedia.org/wikipedia/commons/3/3f/Clubbing_fingers_1.jpg",
    "originalDescription": "clubbing fingers",
    "width": 3264,
    "height": 1836,
    "modifications": "None; original Commons file downloaded unchanged.",
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    "file": "clubbing-profile.jpg"
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  {
    "id": "clubbing-fingers",
    "kind": "image",
    "title": "Clubbing fingers 2.jpg",
    "filename": "clubbing-fingers.jpg",
    "caption": "Oblique close view of digital clubbing, highlighting nail curvature and bulbous fingertips.",
    "creator": "Wesalius",
    "license": "CC BY-SA 4.0",
    "licenseUrl": "https://creativecommons.org/licenses/by-sa/4.0",
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    "downloadUrl": "https://upload.wikimedia.org/wikipedia/commons/5/59/Clubbing_fingers_2.jpg",
    "originalDescription": "clubbing fingers",
    "width": 3264,
    "height": 1836,
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    "sha256": "d399016e025c1ec2676a41cf50d4a60d25d82f6f456be88abbe05f255272db51",
    "file": "clubbing-fingers.jpg"
  },
  {
    "id": "splinter-hemorrhage",
    "kind": "image",
    "title": "Splinter hemorrhage.jpg",
    "filename": "splinter-hemorrhage.jpg",
    "caption": "Longitudinal subungual splinter hemorrhage. This finding alone does not establish endocarditis.",
    "creator": "Splarka",
    "license": "Public domain",
    "licenseUrl": "https://commons.wikimedia.org/wiki/Template:PD-self",
    "sourceUrl": "https://commons.wikimedia.org/wiki/File:Splinter_hemorrhage.jpg",
    "downloadUrl": "https://upload.wikimedia.org/wikipedia/commons/a/ac/Splinter_hemorrhage.jpg",
    "originalDescription": "w:Splinter hemorrhage under fingernail.",
    "width": 563,
    "height": 611,
    "modifications": "None; original Commons file downloaded unchanged.",
    "checkedDate": "2026-09-05",
    "sha256": "da27d7e01cb34e03619e5d9ea0bd8aeb6f4318ce68cb895f8bcc1d7cb40ac1d6",
    "bytes": 91421,
    "file": "splinter-hemorrhage.jpg"
  },
  {
    "id": "xanthelasma",
    "kind": "image",
    "title": "Xanthelasma.jpg",
    "filename": "xanthelasma.jpg",
    "caption": "Xanthelasma palpebrarum; visible eyelid lipid deposits can occur with normal lipid concentrations.",
    "creator": "Klaus D. Peter, Wiehl, Germany",
    "license": "CC BY 3.0 de",
    "licenseUrl": "https://creativecommons.org/licenses/by/3.0/de/deed.en",
    "sourceUrl": "https://commons.wikimedia.org/wiki/File:Xanthelasma.jpg",
    "downloadUrl": "https://upload.wikimedia.org/wikipedia/commons/2/25/Xanthelasma.jpg",
    "originalDescription": "Xanthelasma palpebrarum.",
    "width": 2051,
    "height": 1300,
    "modifications": "None; original Commons file downloaded unchanged.",
    "checkedDate": "2026-09-05",
    "sha256": "c28500921fe7098386a9876eb2fcfb1e3a612caa96f185d8a5b287512f0e65cb",
    "bytes": 173824,
    "file": "xanthelasma.jpg"
  },
  {
    "id": "osler-nodes-hand",
    "kind": "image",
    "title": "Osler Nodules Hand.jpg",
    "filename": "osler-nodes-hand.jpg",
    "caption": "Lesions described by the source as Osler nodes in a patient with subacute bacterial endocarditis.",
    "creator": "Roberto J. Galindo",
    "license": "CC BY-SA 4.0",
    "licenseUrl": "https://creativecommons.org/licenses/by-sa/4.0",
    "sourceUrl": "https://commons.wikimedia.org/wiki/File:Osler_Nodules_Hand.jpg",
    "downloadUrl": "https://upload.wikimedia.org/wikipedia/commons/0/07/Osler_Nodules_Hand.jpg",
    "originalDescription": "Osler's nodes on left hand from a 43 year old male with subacute bacterial endocarditis. Same patient as Osler Spots foot.jpg.",
    "width": 3472,
    "height": 2604,
    "modifications": "None; original Commons file downloaded unchanged.",
    "checkedDate": "2026-09-05",
    "bytes": 1693171,
    "sha256": "f5379d00434ed56397bec718875b1964413922b36932c6ac1c0f7be578f0de0e",
    "file": "osler-nodes-hand.jpg"
  },
  {
    "id": "osler-nodes-foot",
    "kind": "image",
    "title": "Osler Spots foot.jpg",
    "filename": "osler-nodes-foot.jpg",
    "caption": "Lesions described by the source as Osler lesions of the foot in the same endocarditis patient.",
    "creator": "Roberto J. Galindo",
    "license": "CC BY-SA 4.0",
    "licenseUrl": "https://creativecommons.org/licenses/by-sa/4.0",
    "sourceUrl": "https://commons.wikimedia.org/wiki/File:Osler_Spots_foot.jpg",
    "downloadUrl": "https://upload.wikimedia.org/wikipedia/commons/d/d5/Osler_Spots_foot.jpg",
    "originalDescription": "Osler's lesions on left foot and first toe from a 43 year old male with subacute bacterial endocarditis. Same patient as Osler Nodules Hand.jpg",
    "width": 2604,
    "height": 3472,
    "modifications": "None; original Commons file downloaded unchanged.",
    "checkedDate": "2026-09-05",
    "bytes": 1407932,
    "sha256": "021f29cefd81963384773ece89ba18ea9c48190189a0ef79d3ecd0f8ced07f25",
    "file": "osler-nodes-foot.jpg"
  },
  {
    "id": "cyanosis-hand",
    "kind": "image",
    "title": "Cynosis.JPG",
    "filename": "cyanosis-hand.jpg",
    "caption": "Cyanotic hand in a patient described by the source as having low oxygen saturation.",
    "creator": "James Heilman, MD",
    "license": "CC BY-SA 3.0",
    "licenseUrl": "https://creativecommons.org/licenses/by-sa/3.0",
    "sourceUrl": "https://commons.wikimedia.org/wiki/File:Cynosis.JPG",
    "downloadUrl": "https://upload.wikimedia.org/wikipedia/commons/d/dc/Cynosis.JPG",
    "originalDescription": "Cyanosis of the hand in someone with low oxygen saturations",
    "width": 4320,
    "height": 3240,
    "modifications": "None; original Commons file downloaded unchanged.",
    "checkedDate": "2026-09-05",
    "bytes": 3308085,
    "sha256": "93e37d3a9ca36a4200b057434adbcfbcdbd5a811d3f882f5026f928309e34fbc",
    "file": "cyanosis-hand.jpg"
  },
  {
    "id": "raynaud-cyanotic-fingertips",
    "kind": "image",
    "title": "Cyanosis-adult fingertips.PNG",
    "filename": "raynaud-cyanotic-fingertips.png",
    "caption": "Cyanotic phase of Raynaud phenomenon: a peripheral vascular color change.",
    "creator": "7mike5000 (derivative); Patrick Callahan / Tcal (original photograph)",
    "license": "CC BY-SA 3.0",
    "licenseUrl": "https://creativecommons.org/licenses/by-sa/3.0",
    "sourceUrl": "https://commons.wikimedia.org/wiki/File:Cyanosis-adult_fingertips.PNG",
    "downloadUrl": "https://upload.wikimedia.org/wikipedia/commons/8/85/Cyanosis-adult_fingertips.PNG",
    "originalDescription": "Cyanosis of the fingertips of an adult. This example shows the cyanotic phase of Raynaud's phenonemon.",
    "width": 435,
    "height": 332,
    "modifications": "None by this guide; source is an existing crop/derivative of Raynaud’s Syndrome.jpg.",
    "checkedDate": "2026-09-05",
    "bytes": 239284,
    "sha256": "2f2ea416b62348f4927eac5690bd02c4d0d575072af435eac480b45ff7247280",
    "originalSourceUrl": "https://commons.wikimedia.org/wiki/File:Raynaud%27s_Syndrome.jpg",
    "file": "raynaud-cyanotic-fingertips.png"
  },
  {
    "id": "pitting-edema",
    "kind": "image",
    "title": "Combinpedal.jpg",
    "filename": "pitting-edema.jpg",
    "caption": "Pitting edema during application of digital pressure (left) and after pressure is released (right).",
    "creator": "James Heilman, MD",
    "license": "CC BY-SA 3.0",
    "licenseUrl": "https://creativecommons.org/licenses/by-sa/3.0",
    "sourceUrl": "https://commons.wikimedia.org/wiki/File:Combinpedal.jpg",
    "downloadUrl": "https://upload.wikimedia.org/wikipedia/commons/8/84/Combinpedal.jpg",
    "originalDescription": "Pitting edema during and after the application of pressure to the skin.",
    "width": 4060,
    "height": 3985,
    "modifications": "None; original Commons file downloaded unchanged.",
    "checkedDate": "2026-09-05",
    "bytes": 2767815,
    "sha256": "319213abc606d38be8ac45a35989e47c61278957823545527cfd0afc6d1eb0df",
    "file": "pitting-edema.jpg"
  },
  {
    "id": "external-jugular-distention",
    "kind": "image",
    "title": "Jugular Venous Distention (JVD).JPG",
    "filename": "external-jugular-distention.jpg",
    "caption": "Visible external jugular distention in a patient with severe tricuspid regurgitation, sitting nearly upright.",
    "creator": "Ferencga",
    "license": "CC BY-SA 3.0",
    "licenseUrl": "https://creativecommons.org/licenses/by-sa/3.0",
    "sourceUrl": "https://commons.wikimedia.org/wiki/File:Jugular_Venous_Distention_(JVD).JPG",
    "downloadUrl": "https://upload.wikimedia.org/wikipedia/commons/2/20/Jugular_Venous_Distention_%28JVD%29.JPG",
    "originalDescription": "This photo represents obvious external jugular venous distention in a patient with severe tricuspid regurgitation. Note the ropy vein that courses almost vertical in this patient who is sitting almost upright.",
    "width": 1940,
    "height": 1940,
    "modifications": "None; original Commons file downloaded unchanged.",
    "checkedDate": "2026-09-05",
    "bytes": 1112058,
    "sha256": "8f46ca488a2d220bcc53e85494856e3edb481d7430ff77129d5bee727b0a93c3",
    "file": "external-jugular-distention.jpg"
  },
  {
    "id": "elevated-jvp",
    "kind": "image",
    "title": "Elevated JVP.JPG",
    "filename": "elevated-jvp.jpg",
    "caption": "Marked neck venous distention. The source arrow identifies the external jugular vein; bedside JVP height is generally assessed from the internal jugular venous pulsation.",
    "creator": "James Heilman, MD",
    "license": "CC BY-SA 3.0",
    "licenseUrl": "https://creativecommons.org/licenses/by-sa/3.0",
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    "downloadUrl": "https://upload.wikimedia.org/wikipedia/commons/4/4d/Elevated_JVP.JPG",
    "originalDescription": "A person with congestive heart failure who presented with an exceedingly elevated JVP, the arrow is pointing to the external jugular vein (marked by the arrow) however, JVD is measured by the internal jugular vein which can also be seen here",
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    "height": 1997,
    "modifications": "None; original Commons file downloaded unchanged.",
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    "file": "elevated-jvp.jpg"
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    "id": "stills-murmur-apex",
    "kind": "audio",
    "title": "Still murmur at the apex",
    "filename": "stills-murmur-apex.wav",
    "caption": "Clinical recording; short excerpt of a musical innocent murmur.",
    "creator": "Vladimir Kudriavtsev, Vladimir Polyshchuk, Douglas L. Roy",
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    "kind": "audio",
    "title": "Still murmur at the upper left sternal border",
    "filename": "stills-murmur-lusb.wav",
    "caption": "Clinical recording; recorded at the second left interspace.",
    "creator": "Vladimir Kudriavtsev, Vladimir Polyshchuk, Douglas L. Roy",
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    "id": "simulated-s2-splitting",
    "kind": "audio",
    "title": "S2 split demonstration (simulated)",
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    "caption": "A deliberately simulated test signal with two split intervals; not a patient recording or a complete cardiac cycle.",
    "creator": "Vladimir Kudriavtsev, Vladimir Polyshchuk, Douglas L. Roy",
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    "id": "mitral-valve-prolapse-clicks",
    "kind": "audio",
    "title": "Mitral valve prolapse with clicks",
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    "caption": "Clinical recording with three clicks in the source example.",
    "creator": "Vladimir Kudriavtsev, Vladimir Polyshchuk, Douglas L. Roy",
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  {
    "id": "aortic-stenosis",
    "kind": "audio",
    "title": "Aortic stenosis",
    "filename": "aortic-stenosis.wav",
    "caption": "Clinical recording from the publication; a very short teaching excerpt.",
    "creator": "Vladimir Kudriavtsev, Vladimir Polyshchuk, Douglas L. Roy",
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    "title": "Pulmonary stenosis",
    "filename": "pulmonary-stenosis.wav",
    "caption": "Clinical recording from the publication; a very short teaching excerpt.",
    "creator": "Vladimir Kudriavtsev, Vladimir Polyshchuk, Douglas L. Roy",
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    "id": "tetralogy-of-fallot",
    "kind": "audio",
    "title": "Tetralogy of Fallot (acyanotic)",
    "filename": "tetralogy-of-fallot.wav",
    "caption": "Clinical recording labeled acyanotic tetralogy of Fallot in the source.",
    "creator": "Vladimir Kudriavtsev, Vladimir Polyshchuk, Douglas L. Roy",
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    "title": "Ventricular septal defect",
    "filename": "ventricular-septal-defect.wav",
    "caption": "Clinical recording of a VSD murmur accompanying the supplemental analysis.",
    "creator": "Vladimir Kudriavtsev, Vladimir Polyshchuk, Douglas L. Roy",
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  {
    "id": "tendon-xanthomas",
    "kind": "image",
    "title": "Multiple hand xanthomas",
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    "caption": "Multiple hand and tendon xanthomas in a young adult with familial hypercholesterolemia.",
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