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Foundations of Podiatric Practice > Nail Anatomy and Pathology > Flashcards

Nail Anatomy and Pathology Flashcards

1
Q

What is Onychauxis (Hypertrophied Nail)

A

Uniform thickening of the nail plate from nail base to free edge
Aetiology - Damage to the nail Matrix with one or more causes
1. Fungal infection of the nail
2. Poor peripheral circulation
3. Single major trauma from a heavy blow
4. repeated minor trauma from ill fitting footwear
Pathology
* Changes in the nail fold main cause of hypertrophy

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2
Q

Onychogryphosis

A
  • Thickened nail with a distortion in the direction of growth
  • Longitudinal transverse ridges
  • Rams Horn

Aetiology:
* same as Onychauxis
* fungal infection
* Single trauma
* poor peripheral circulation

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3
Q

What is Onycholysis

A
  • Seperation of nail from the nail bed often Distal to Proximal
  • white apperance from air getting underneath the nail
    Aetiology:
  • Onychomycosis
  • Trauma
  • Systemic involvement possible ie poor circulation
    Pathology:
  • increased pressure of the nail bed can cause infection and inflamattion
  • Hard keratinogenous material gather underneath the nail
    Treatment
  • Cut nail back in stages
  • referal to GP if systemic
  • Treat any fungal involvement
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4
Q

Whatv is Onychomadesis

A

Seperationn of nail form nail bed proximal to distal

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5
Q

What is Onychocryptosis

A
  • Ingrowing toe nail - A spike or splinter edge of the nail penetrates the sulcus entring the dermal tissue
  • Bi Lateral or unilateral
    Aetiology:
  • cutting nails too short
  • Cutting obliquely
  • Hyperdydrosis causes surrounding tissue to become macerated/soaked in mositure making the surrounding tissue less resistant to pressure form the nail
  • Pressure form ill fitting footwear
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6
Q

What is Involution

A

Increased transverse curvature of the nail plate unilateral or bi lateral
Aetiology:
* ill fitting footwear
* Trauma
* poor nail cutting
* systemic diseases
Pathoogy:
* Trauma to the nail plate causes increased transverse curvature
* Sysetmic/malnutriton disease of the extremities leads to alteration of the cell division between layer in the nail plate causing distortion in growth
Treatment:
* Cut the nail accordingly to release pressure in the sulci
* Partial or total nail removal may be long term option

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7
Q

What is a Splinter Heamorage

A

Longitudinal plum coloured linear haemorage under the nail plate

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8
Q

What is Paronychia

A

Inflamattion of the tissue surrounding the nail

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9
Q

What is Onychomycosis

A

Fungal Infection of the nail plate caused by Dermatophytes, non dermatophytes and yeasts

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10
Q

What is Chromonychia

A

Abnormal colouration of the nail tissue

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11
Q

What is Koilonychia

A

Transverse and longitudinal concave nail dystrophy
Spoon shaped nail

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12
Q

What are Dermatophytes

A

Pathogenic Fungus that can invade the nail infecting keratinous tissue

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13
Q

List three types of dermaphytes

A

Trichophyton
Epidermophyton
Microsporum

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14
Q

What are the most common Dermatophytes associated with Onychomycosis

A

Trichophyton rubrum and T interdigitale

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15
Q

What are the non dermataphytes that cause Onychomycosis

A

Moulds - Scorpularis Brevicaulis
Yeasts - Candida Albicans

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16
Q

What are the predisposing factors causing Onychmycosis

A

Old age
Trauma
Diabetes
Immunosupresed patients
Previous history of nail psoriasis and tinea pedis

17
Q

Pneumonic for classifications of onychomycosis

A

Endor
Died Last Sunday
Susan Whepped
Propper Suprised
Totally Distraught

18
Q

List the 5 types/ classifications of Onychomycosis

A

Endonyx
Distal & Lateral Subungal Onychomycosis
Superficial white Onychomycosis
Proximal Subungal Onychomycosis
Total Dytrophic Onychomycosis

19
Q

What are the features of Superficial White Onychomycosis

A

Mainly affects the toe nails
White patches on the superficial part of the toenail
Doesnt respond well to topical treatment

20
Q

What are the features of Proximal subungal onychomycosis

A

More common in toenails than fingernails
Area of infection Proximal nail fold and nail plate
White appearance spreading distally
dermaphytes involved commonly T - Rubrum
No thickening of the nail plate
High prevelance in HIV and Aids patients

21
Q

What are the features of Endonyx Onychomycosis

A

Caused by T Soudansense
Area of infection = margian of the nail plate
White in apperance no seperation of the nail from the nail bed (onycholysis) or no chalky substance underneath the nail (subungal Hyperkeratosis)

22
Q

What are the clinical features of Onychmycosis

A

Thickened Naill
Crumbly Nial
Rough/Irregular appearance
Varying in colour white, yellow, brown black
Can be painful but usually affects patient confidence due to apperance

23
Q

Give the name of a topical anti fungal treantment used to treat Onychomycosis

A

Amoroline - Loycerel, Curanail

24
Q

Define Pathology

A

Science of the casuses and effects of disease

25
Q

What is the Perionychium

A

The tissue surrounding the nail

26
Q

What is the nail plate

A
  • The nail plate is a hard protective structure made from transluscent keratin
  • Contains a rich vascular network
27
Q

What is the Eponychium

A

Also reffered to as the cuticle helps to prevent the entry of bacteria to the Ventral Proximal Nail fold

28
Q

What is the Hyponichium

A
  • Distal to the nail bed underneath the free edge of the nail plate
  • It forms a seal that protects the nail bed
29
Q

What is the lunula

A

White half moon apperance due to the reflection of the light between the nail and the nail bed
Nail plate is thinner here

30
Q

What is the Nail Matrix

A

The nail matrix produces new cells which become the nail plate
It also determines the width and thickness of the nail

31
Q

What is the germinal matrix

A
  • The germinal matrix is collective term given to the root and sinus of the nail
  • The growth of the nail starts here
32
Q

What is the Nial Bed

A
  • Also reffered to as the sterile matrix
  • lies underneath the nail plate has a rich vascular supply
  • Extends from the nail matrix to the Hyponichium
  • No subcutaneus tissue beneath the nail bed so it attaches directly to the periosteum of the distal phalanx
33
Q

What is Total Nail Dystrophic Onychomycosis

A
  • Infection of the whole nail plate
  • Yellow irregular appearance causing total destruction of the nail
  • Usually a cobination of Candida and dermatophytes
  • Seen in immunosupressed patients
34
Q

What are the conservative management treatments for onychmycosis

A

Conservattive - Topical treatments include:
* Amorolfine
* Terbinafine
* Triconazole

35
Q

What are the Systemic oral treatments for Onychomycosis

A

Systemic - Oral treatments
* Grisofulvin - in children
* Terbinafine and Itraconazole
* Fluconazole - for Candida infection

36
Q

Describe the pathology of Onychocryptosis

A

Pathology:
* Normal healing is distrupted by the continued penetration of the spike causing hypergranulation
* This excessive growth of tissue results in the nail fold overlapping the nail plate
* Pus is frequentley presnet and can exude for the sulcus or pool in the pocket lying beneath the sulcus

37
Q

What are the three stages of Onychocryptosis

A

Stage 1 - minimal injury to sulcus
symptoms of pain, slight swelling oedema (fluid build up)
Stage 2 - Acute Pain, erythema (redness) hyperhydrolosis, granulation tissue with odour
Stage 3 - Consistent with stage 2 plus epidermal overgrowth, hypergranulation

38
Q

What is Subungal Extosis

A

Small outgrowth of bone underneath the nail plate distally near the free edge
Symptoms - Include Pain and nail plate deformation
**Aetiology **- Unknown although it is thought that a history of trauma and microtrauma may play a part
Treatment:
* Protective padding and advice on footwear
* Surgical Excision

Foundations of Podiatric Practice (7 decks)

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