Nails

Question 1

What is protects the nail matrix

Answer 1

proximal nail fold

Question 2

cuticle

Answer 2

eponychium

Question 3

what is the nail matrix

Answer 3

germinative cells that produce the nail plate

Question 4

What produces the dorsal nail plate

Answer 4

proximal matrix

Question 5

What produces the ventral nail plate

Answer 5

distal matrix (lunula)

Question 6

What are diseases due to abnormal matrix function?

Answer 6

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

Question 7

What are often traumatic transverse depression of the nail plate?

Answer 7

Beau’s lines

Question 8

What is the secondary cause of Beau’s lines?

Answer 8

disruption of nail plate formation by nail matrix

Question 9

How would Beau’s lines indicate systemic cause?

Answer 9

presence at same level in all nails

Question 10

What are punctuate depression of the nail plate surface?

Answer 10

pitting (migrates distally with growth)

Question 11

pathogenesis of pitting

Answer 11

due to foci of abnormal keratinization in proximal nail matrix

Question 12

patients typically presenting w/ pitting

Answer 12

psoriasis; alopecia; areata; eczema

Question 13

What are nails with a rough, ridged surface?

Answer 13

trachyonychia

Question 14

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

Answer 14

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

Question 15

What is True leukonychia? what causes it?

Answer 15

white opaque discoloration => traumatic damage of distal matrix

Question 16

What are Mees’ lines?

Answer 16

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

Question 17

What differentiates true leukonychia from apparent leukonychia?

Answer 17

press on the nail => true remains unchanged with pressure

Question 18

What are thin, flat, spoon shaped nails?

Answer 18

kiolonychia

Question 19

What is the pathogenesis of koilonychia

Answer 19

hereditary or acquired causes such as iron deficiency anemia

Question 20

What are nail bed disorders?

Answer 20

onycholysis; apparent leukonychia; splinter hemorrhage

Question 21

What is a splinter hemorrhage?

Answer 21

sliver of extravasated blood visible beneath nail plate

Question 22

How are Splinter hemorrhages caused?

Answer 22

damage to longitudinally oriented nail bed capillaries commonly from trauma

Question 23

Splinter hemorrhages are common in what systemic disease?

Answer 23

systemic association is bacterial endocarditis

Question 24

What is apparent leukonychia?

Answer 24

white discoloration that fades with pressure while nail plate transparency maintained

Question 25

What is an often cuase of apparent leukonychia?

Answer 25

drugs (CTX) or systemic diseases

Question 26

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

Answer 26

onycholysis (looks yellow-white)

Question 27

What is a common cause of onycholysis

Answer 27

psoriasis or onychomycosis

Question 28

What are nail signs due to deposition of pigment?

Answer 28

longitudinal melanonychia; green nail syndrome

Question 29

What causes longitudinal melanonychia?

Answer 29

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

Question 30

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

Answer 30

melanoma

Question 31

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

Answer 31

drugs or systemic disease

Question 32

What is the epidemiology of longitudinal melanoychia?

Answer 32

90% in african americans

Question 33

What is Hutchinson's sign?

Answer 33

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

Question 34

Green nail syndrome is typically associated with what?

Answer 34

discolored bc of pyocyanin due to pseudomonas aeruginosa

Question 35

What are predisposing factors for green nail syndrome?

Answer 35

water exposure; detergents; soaps

Question 36

What are the diagnostic nail signs of psoriasis?

Answer 36

irregular pitting; salmon patches; onycholysis with erythematous border

Question 37

What are the diagnostic nail signs of lichen planus?

Answer 37

multiple nails suffering from thinning and fissuring caused by dorsal pterygium

Question 38

What is dorsal pterygium?

Answer 38

scarring of proximal nail fold over the nail plate

Question 39

What are nail diagnostic signs of alopecia areata?

Answer 39

geometric pitting most commonly seen in children with associated trachyonychia

Question 40

What are signs of eczema associated with nails?

Answer 40

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

Question 41

What is Lovibond's angle?

Answer 41

angle between proximal nail fold and nail plate

Question 42

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

Answer 42

clubbing

Question 43

Clubbing is associated with what diseases

Answer 43

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

Question 44

Muehrckes lines are seen as what?

Answer 44

apparent leukonychia with transverse white bands that disappear with pressure

Question 45

What are Muehrcke's line associated with?

Answer 45

hypoalbuminism

Question 46

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

Answer 46

HSV infection

Question 47

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

Answer 47

chronic renal disease showing Lindsay's nails of apparent leukonychia

Question 48

A patient with cirrhosis will have what type of nails?

Answer 48

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

Question 49

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

Answer 49

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

Question 50

What is acute paronychia?

Answer 50

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

Question 51

what is acute paronychia commonly due to?

Answer 51

bacteria (S. aureus or S. pyogenes)

Question 52

Chronic paronychia is commonly due to what

Answer 52

candida infection

Question 53

How will HPV present on the skin?

Answer 53

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

Question 54

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

Answer 54

squamous cell carcinoma

Question 55

What is fungal infection of the nail?

Answer 55

onychomycosis

Question 56

Trichophyton rubrum causes what type of infection?

Answer 56

tinea unguium that is secondary to dermatophyte infection

Question 57

What are the 4 patterns of onychomycosis?

Answer 57

distal subungual; white superficial; proximal subungual; candidal onychomycosis

Question 58

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

Answer 58

immunosuppresion/HIV infection

Question 59

What is onychoschizia? cause?

Answer 59

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

Question 60

What is chronic paronychia? cause?

Answer 60

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

Question 61

What is onychotillomania?

Answer 61

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

Question 62

What is the cause of subungual hematoma?

Answer 62

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

Question 63

What is onychogryphosis?

Answer 63

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

Question 64

What are pincer nails? cause?

Answer 64

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

Question 65

Onychocryptosis cause?

Answer 65

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

Question 66

What is a pyogenic granuloma?

Answer 66

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

Question 67

What are Periungual fibromas?

Answer 67

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

Question 68

What is periungual fibromas a possible sign of?

Answer 68

tuberous sclerosis => Koenen's tumors

Question 69

What are myxoid cysts?

Answer 69

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

Question 70

What are subungual exostosis?

Answer 70

benign bony proliferation causes subungual, hard nodule usually from trauma

Question 71

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

Answer 71

squamous cell carcinoma***

Question 72

What relationship does SCC and HPV have?

Answer 72

causative role of HPV suggests tumor development

Question 73

What is the clinical presentation of SCC?

Answer 73

verrucous lesion; ulcerated nodule; onycholysis; nail plate destruction

Question 74

Melanoma most frequent site of nail?

Answer 74

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