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Dermatology path > Nails > Flashcards

Nails Flashcards

1
Q

What is protects the nail matrix

A

proximal nail fold

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2
Q

cuticle

A

eponychium

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3
Q

what is the nail matrix

A

germinative cells that produce the nail plate

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4
Q

What produces the dorsal nail plate

A

proximal matrix

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5
Q

What produces the ventral nail plate

A

distal matrix (lunula)

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6
Q

What are diseases due to abnormal matrix function?

A

Koilonychia (spoon nails); true leukonychia; trachyonychia; pitting; Beau’s lines

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7
Q

What are often traumatic transverse depression of the nail plate?

A

Beau’s lines

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8
Q

What is the secondary cause of Beau’s lines?

A

disruption of nail plate formation by nail matrix

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9
Q

How would Beau’s lines indicate systemic cause?

A

presence at same level in all nails

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10
Q

What are punctuate depression of the nail plate surface?

A

pitting (migrates distally with growth)

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11
Q

pathogenesis of pitting

A

due to foci of abnormal keratinization in proximal nail matrix

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12
Q

patients typically presenting w/ pitting

A

psoriasis; alopecia; areata; eczema

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13
Q

What are nails with a rough, ridged surface?

A

trachyonychia

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14
Q

patients with trachyonychia are damaged via what? what diseases are associated?

A

proximal nail matrix damage => alopecia areata; lichen planus; psoriasis; eczema

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15
Q

What is True leukonychia? what causes it?

A

white opaque discoloration => traumatic damage of distal matrix

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16
Q

What are Mees’ lines?

A

true leukonychia w/ transverse white bands that are associated with arsenic and thallium toxicity

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17
Q

What differentiates true leukonychia from apparent leukonychia?

A

press on the nail => true remains unchanged with pressure

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18
Q

What are thin, flat, spoon shaped nails?

A

kiolonychia

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19
Q

What is the pathogenesis of koilonychia

A

hereditary or acquired causes such as iron deficiency anemia

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20
Q

What are nail bed disorders?

A

onycholysis; apparent leukonychia; splinter hemorrhage

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21
Q

What is a splinter hemorrhage?

A

sliver of extravasated blood visible beneath nail plate

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22
Q

How are Splinter hemorrhages caused?

A

damage to longitudinally oriented nail bed capillaries commonly from trauma

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23
Q

Splinter hemorrhages are common in what systemic disease?

A

systemic association is bacterial endocarditis

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24
Q

What is apparent leukonychia?

A

white discoloration that fades with pressure while nail plate transparency maintained

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25
Q

What is an often cuase of apparent leukonychia?

A

drugs (CTX) or systemic diseases

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26
Q

What is a distal nail plate detachment from the nail bed?

A

onycholysis (looks yellow-white)

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27
Q

What is a common cause of onycholysis

A

psoriasis or onychomycosis

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28
Q

What are nail signs due to deposition of pigment?

A

longitudinal melanonychia; green nail syndrome

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29
Q

What causes longitudinal melanonychia?

A

melanocyte activation, non-melanocytic tumors, melanocyte hyperplasia, nevi, melanoma

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30
Q

If a single band is on a nail, what is the likely cause?

A

melanoma

31
Q

If multiple bands are on the nail, what is the likely cause?

A

drugs or systemic disease

32
Q

What is the epidemiology of longitudinal melanoychia?

A

90% in african americans

33
Q

What is Hutchinson’s sign?

A

extension of pigment on to the nail folds and presence raises concern for melanoma

34
Q

Green nail syndrome is typically associated with what?

A

discolored bc of pyocyanin due to pseudomonas aeruginosa

35
Q

What are predisposing factors for green nail syndrome?

A

water exposure; detergents; soaps

36
Q

What are the diagnostic nail signs of psoriasis?

A

irregular pitting; salmon patches; onycholysis with erythematous border

37
Q

What are the diagnostic nail signs of lichen planus?

A

multiple nails suffering from thinning and fissuring caused by dorsal pterygium

38
Q

What is dorsal pterygium?

A

scarring of proximal nail fold over the nail plate

39
Q

What are nail diagnostic signs of alopecia areata?

A

geometric pitting most commonly seen in children with associated trachyonychia

40
Q

What are signs of eczema associated with nails?

A

irregular pitting and Beau’s lines; subungual hyperkeratosis; chronic paronychia

41
Q

What is Lovibond’s angle?

A

angle between proximal nail fold and nail plate

42
Q

If Lovibonds angle is greater than 180*, what is the Dx?

A

clubbing

43
Q

Clubbing is associated with what diseases

A

CP disease; sarcoidosis; cirrhosis; GI disease; toxin exposures; trauma

44
Q

Muehrckes lines are seen as what?

A

apparent leukonychia with transverse white bands that disappear with pressure

45
Q

What are Muehrcke’s line associated with?

A

hypoalbuminism

46
Q

if a patient has recurrent episodes of acute paronychia, what may be the cause?

A

HSV infection

47
Q

If a patient presents with nails being white proximally and red distally, what disease is associated?

A

chronic renal disease showing Lindsay’s nails of apparent leukonychia

48
Q

A patient with cirrhosis will have what type of nails?

A

terry’s nails: white proximally with 1mm of brown-red distally

49
Q

If a patient has an autoimmune connective tissue disorder, how will the nails present? what are these typical diseases?

A

nail fold capillary abnormalities; cuticular hemorrhages => dermatomyositis and scleroderma

50
Q

What is acute paronychia?

A

swollen, red and painful compression of nail fold producing purulent drainage

51
Q

what is acute paronychia commonly due to?

A

bacteria (S. aureus or S. pyogenes)

52
Q

Chronic paronychia is commonly due to what

A

candida infection

53
Q

How will HPV present on the skin?

A

warts; periungual keratotic papules; hyperkeratosis of cuticle; onycholysis of nail bed

54
Q

If recalcitrant lesions occur associated with HPV, what could be associated?

A

squamous cell carcinoma

55
Q

What is fungal infection of the nail?

A

onychomycosis

56
Q

Trichophyton rubrum causes what type of infection?

A

tinea unguium that is secondary to dermatophyte infection

57
Q

What are the 4 patterns of onychomycosis?

A

distal subungual; white superficial; proximal subungual; candidal onychomycosis

58
Q

If onychomycosis presents as proximal subungual (PSO), what association does it have?

A

immunosuppresion/HIV infection

59
Q

What is onychoschizia? cause?

A

distal superficial splitting of nail plate from dehydration and frequent hand washing

60
Q

What is chronic paronychia? cause?

A

proximal nail fold inflammation w/ absence of cuticle => chronic irritation of Candida infection

61
Q

What is onychotillomania?

A

no cuticle and proximal nail fold inflammation with nail plate surface abnormalities associated with melanonychia

62
Q

What is the cause of subungual hematoma?

A

acute trauma leading to blood under nail plate and pigment moves distally w/ growth

63
Q

What is onychogryphosis?

A

Ram’s horn nails that is favored by chronic trauma and elderly patients

64
Q

What are pincer nails? cause?

A

over curvature of distal nail plate => hereditary or acquired (bad fitting shoes)

65
Q

Onychocryptosis cause?

A

ingrown nails from improper nail cutting and hyperhidrosis with growth of granulation tissue

66
Q

What is a pyogenic granuloma?

A

benign bleeding angiomatous nodule that is periungual or subungual => cause is trauma

67
Q

What are Periungual fibromas?

A

papules from proximal nail fold that may compress nail matrix leaving a longitudinal groove in nail plate

68
Q

What is periungual fibromas a possible sign of?

A

tuberous sclerosis => Koenen’s tumors

69
Q

What are myxoid cysts?

A

proximal nail fold swelling from nail plate depression and grooves => connected to DIP join and drain fluid

70
Q

What are subungual exostosis?

A

benign bony proliferation causes subungual, hard nodule usually from trauma

71
Q

***What is the most frequent malignant tumor of the nail apparatus?

A

squamous cell carcinoma***

72
Q

What relationship does SCC and HPV have?

A

causative role of HPV suggests tumor development

73
Q

What is the clinical presentation of SCC?

A

verrucous lesion; ulcerated nodule; onycholysis; nail plate destruction

74
Q

Melanoma most frequent site of nail?

A

thumb leading to nail plate destruction => Hutchinson’s sign

Dermatology path (11 decks)

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