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Derm Phys Lectures > Nails > Flashcards

Nails Flashcards

1
Q

What are Beau’s Lines?

A

Transverse depressions of the nail plate.

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2
Q

What are Beau’s Lines caused by?

A

Secondary to disruption of nail plate formation by the nail matrix. Usually trauma.

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3
Q

If Beau’s Lines are present at the same level in all nails, what is this indicative of?

A

Systemic dz

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4
Q

What are punctate depressions of the nail plate surface?

A

Pitting.

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5
Q

Pitting is due to what?

A

Foci of abnormal keratinization in the proximal nail matrix.

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6
Q

What diseases is pitting seen in?

A

Psoriasis, alopecia areata, and eczema.

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7
Q

What is trachyonychia?

A

Nails with a rough, ridged surface. Caused by proximal nail matrix damage.

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8
Q

What diseases is trachyonychia seen in?

A

Alopecia areata, lichen planus, psoriasis, eczema

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9
Q

What is True Leukonychia?

A

White opaque discoloration in punctate, striate, or diffuse patterns. Due to damage of the distal matrix. Most often caused by trauma.

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10
Q

How do you distinguish true leukonychia from apparent leukonychia?

A

True will be unchanged with pressure aka nail plate is opaque. Apparent will disappear with pressure aka nail plate is normal but nail bed is abnormal.

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11
Q

What are Mees’ Lines?

A

A true leukonychia with transverse white bands associated with arsenic and thallium toxicity.

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12
Q

What is koilonychia?

A

Spoon nails. Thin, flat, spoon-shaped nails.

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13
Q

An iron deficient anemic pt would have what type of nails?

A

Spoon nails (kioilonychia)

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14
Q

What is onycholysis?

A

Distal nail plate detachment from the nail bed. Detached nail looks yellow-white.

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15
Q

What is onycholysis commonly due to?

A

Psoriasis or onychomycosis

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16
Q

What is apparent leukonychia commonly due to?

A

Chemotherapy drugs or systemic dz (e.g. hypoalbuminemia)

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17
Q

What would you call a sliver of extravasated blood visible beneath the nail plate?

A

Splinter hemorrhage…from damage to longitudinally oriented nail bed capillaries.

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18
Q

What is a splinter hemorrhage most commonly associated with? What is the most common systemic association?

A
  1. Trauma 2. Bacterial Endocarditis
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19
Q

What is longitudinal melanonychia?

A

Single or multiple longitudinal brown-black bands due to deposition of pigment. Single: may be a sign of nail melanoma. Multiple: often due to drugs or systemic dz.

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20
Q

What is Hutchinson’s Sign?

A

Longitudinal melanonychia but with extension of pigment on to the nail folds. Raises concern for melanoma.

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21
Q

What is Green Nail Syndrome? What is it caused by?

A

Greenish-black or greenish-blue nail plate discoloration. Due to P. aeruginosa: produces pyocyanin which is a blue-green pigment. Predisoposing factors=exposure to water, detergents, and soaps.

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22
Q

How does psoriasis affect nails?

A

Diagnostic signs of psoriasis with regards to nails=irregular pitting, Salmon patches, or onycholysis with erythematous border. Also, multiple nails will be affected. Psoriatic arthropathy is often associated and Koebner phenomenon worsens nail symptoms.

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23
Q

Lichen planus and nails?

A

Several nails usually affected. Nail thinning and fissuring present.

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24
Q

What is Dorsal Pterygium and what dz is it associated with?

A

Scarring of the proximal nail fold over the nail plate. It is associated with lichen planus.

25
Q

What nail changes are seen with alopecia areata? What patient population is most commonly affected?

A

Geometric pitting and trachyonychia. Children.

26
Q

Eczema and nails?

A

Irregular pitting and Beau’s Lines. Subungal hyperkeratosis. Chronic paronychia.

27
Q

How is clubbing defined?

A

Angle between the proximal nail fold and the nail plate > 180 degrees.

28
Q

What nail abnormality will be seen in cardiopulmonary dz, sarcoidosis, cirrhosis, GI dz, toxin exposures, and trauma?

A

Clubbing

29
Q

What are Muehrcke’s Lines and what dz are they associated with?

A

Apparent leukonychia with transverse white bands. Hypoalbuminism.

30
Q

What are Lindsay’s nails? Terry’s nails? What dz is each associated with?

A

Lindsay’s: white proximally and brown-red distally (half and half). Chronic renal dz. Terry’s: white proximally with bit of brown-red distally. Cirrhosis. Remember: Lindsay (top) is only a half bitch, Terry’s (bottom) a whole bitch who doesn’t deserve a liver.

31
Q

What are common nail changes seen in dermatomyositis and scleroderma?

A

Nail fold capillary abnormalities and cuticular hemorrhages.

32
Q

What is acute paronychia most commonly due to?

A

Staph aureus or Strep pyogenes infection

33
Q

What is chronic paronychia most commonly due to?

A

Candida infection

34
Q

Reccurent episodes of acute paronychia should raise the suspicion of what type of infection?

A

HSV

35
Q

What are warts caused by?

A

HPV. Present on the nail with warts=periungal keratotic papules, hyperkeratosis of the cuticle, onycholysis.

36
Q

What should you suspect if you have really stubborn warts that won’t go away on a patient’s nail?

A

Squamous cell carcinoma

37
Q

What is a fungal infection of the nail called?

A

Onychomycosis

38
Q

An onychomycosis secondary to dermatophyte infection is called what? What organism is most commonly responsible?

A

Tinea unguium. Trichophyton rubrum.

39
Q

What are the 4 basic patterns of onychomycosis?

A
  1. Distal subungal 2. White superficial 3. Proximal subungal (PSO) 4. Candidal onychomycosis
40
Q

***PAY ATTENTION*** PSO type onychomycosis is associated with what?

A

Immunosuppression/HIV infection

41
Q

What is onychoschizia?

A

Distal superficial horizontal splitting of the nail plate aka brittle nails.

42
Q

Nail brittleness results from what?

A

Dehydration of the nail plate from environmental factors such as frequent handwashing.

43
Q

What is chronic paronychia?

A

Proximal nail fold inflammation with absence of the cuticle. Fingernails are affected.

44
Q

What is chronic paronychia usually secondary to?

A

Chronic irritation or Candida infection

45
Q

Onychotillomania

A

Bat shit crazy patients eff with their nails. Cuticle absent and proximal nail fold inflamed with nail plate surface abnormalities. Melanonychia. Hemorrhage and crust. At this point I hate this lecture.

46
Q

Subungal hematoma

A

Self explanatory

47
Q

What is onychogryphosis?

A

Ram’s horn nails due to assymetric growth. Nail plate is thick, hard, yellow-brown. Hallux most frequently affected. Elderly patients.

48
Q

What is an over-curvature of the distal nail plate that is most often due to ill-fitting shoes?

A

Pincer Nails

49
Q

What is onychocryptosis?

A

Ingrown nails

50
Q

What are the 4 benign nail tumors?

A
  1. Pyogenic Granuloma 2. Periungal Fibromas 3. Myxoid Cysts 4. Subungal Exostosis
51
Q

Bleeding angiomatous nodule

A

pyogenic granuloma

52
Q

Pink or skin-colored papules originating from the proximal nail fold

A

periungal fibroma (possible sign of tuberous sclerosis)

53
Q

Proximal nail fold swelling often connected to DIP joint

A

myxoid cyst

54
Q

Benign bony proliferation caused by a hard subungal nodule

A

subungal exostosis

55
Q

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

A

Squamous cell carcinoma

56
Q

What is the clinical presentation of SCC in the nail?

A

Verrucous lesion, ulcerated nodule, onycholysis, nail plate destruction

57
Q

What virus is involved in the development of SCC in the nail?

A

HPV (particularly HPV16)

58
Q

Melanoma is most frequently seen in which digit?

A

Thumb

59
Q

What is seen with melanoma in the nail?

A

Longitudinal melanonychia, nail plate destruction, Hutchinson’s sign

Derm Phys Lectures (8 decks)

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