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Flashcards in Nails Deck (74):
1

What is protects the nail matrix

proximal nail fold

2

cuticle

eponychium

3

what is the nail matrix

germinative cells that produce the nail plate

4

What produces the dorsal nail plate

proximal matrix

5

What produces the ventral nail plate

distal matrix (lunula)

6

What are diseases due to abnormal matrix function?

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

7

What are often traumatic transverse depression of the nail plate?

Beau's lines

8

What is the secondary cause of Beau's lines?

disruption of nail plate formation by nail matrix

9

How would Beau's lines indicate systemic cause?

presence at same level in all nails

10

What are punctuate depression of the nail plate surface?

pitting (migrates distally with growth)

11

pathogenesis of pitting

due to foci of abnormal keratinization in proximal nail matrix

12

patients typically presenting w/ pitting

psoriasis; alopecia; areata; eczema

13

What are nails with a rough, ridged surface?

trachyonychia

14

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

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

15

What is True leukonychia? what causes it?

white opaque discoloration => traumatic damage of distal matrix

16

What are Mees' lines?

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

17

What differentiates true leukonychia from apparent leukonychia?

press on the nail => true remains unchanged with pressure

18

What are thin, flat, spoon shaped nails?

kiolonychia

19

What is the pathogenesis of koilonychia

hereditary or acquired causes such as iron deficiency anemia

20

What are nail bed disorders?

onycholysis; apparent leukonychia; splinter hemorrhage

21

What is a splinter hemorrhage?

sliver of extravasated blood visible beneath nail plate

22

How are Splinter hemorrhages caused?

damage to longitudinally oriented nail bed capillaries commonly from trauma

23

Splinter hemorrhages are common in what systemic disease?

systemic association is bacterial endocarditis

24

What is apparent leukonychia?

white discoloration that fades with pressure while nail plate transparency maintained

25

What is an often cuase of apparent leukonychia?

drugs (CTX) or systemic diseases

26

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

onycholysis (looks yellow-white)

27

What is a common cause of onycholysis

psoriasis or onychomycosis

28

What are nail signs due to deposition of pigment?

longitudinal melanonychia; green nail syndrome

29

What causes longitudinal melanonychia?

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

30

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

melanoma

31

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

drugs or systemic disease

32

What is the epidemiology of longitudinal melanoychia?

90% in african americans

33

What is Hutchinson's sign?

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

34

Green nail syndrome is typically associated with what?

discolored bc of pyocyanin due to pseudomonas aeruginosa

35

What are predisposing factors for green nail syndrome?

water exposure; detergents; soaps

36

What are the diagnostic nail signs of psoriasis?

irregular pitting; salmon patches; onycholysis with erythematous border

37

What are the diagnostic nail signs of lichen planus?

multiple nails suffering from thinning and fissuring caused by dorsal pterygium

38

What is dorsal pterygium?

scarring of proximal nail fold over the nail plate

39

What are nail diagnostic signs of alopecia areata?

geometric pitting most commonly seen in children with associated trachyonychia

40

What are signs of eczema associated with nails?

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

41

What is Lovibond's angle?

angle between proximal nail fold and nail plate

42

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

clubbing

43

Clubbing is associated with what diseases

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

44

Muehrckes lines are seen as what?

apparent leukonychia with transverse white bands that disappear with pressure

45

What are Muehrcke's line associated with?

hypoalbuminism

46

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

HSV infection

47

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

chronic renal disease showing Lindsay's nails of apparent leukonychia

48

A patient with cirrhosis will have what type of nails?

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

49

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

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

50

What is acute paronychia?

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

51

what is acute paronychia commonly due to?

bacteria (S. aureus or S. pyogenes)

52

Chronic paronychia is commonly due to what

candida infection

53

How will HPV present on the skin?

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

54

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

squamous cell carcinoma

55

What is fungal infection of the nail?

onychomycosis

56

Trichophyton rubrum causes what type of infection?

tinea unguium that is secondary to dermatophyte infection

57

What are the 4 patterns of onychomycosis?

distal subungual; white superficial; proximal subungual; candidal onychomycosis

58

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

immunosuppresion/HIV infection

59

What is onychoschizia? cause?

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

60

What is chronic paronychia? cause?

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

61

What is onychotillomania?

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

62

What is the cause of subungual hematoma?

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

63

What is onychogryphosis?

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

64

What are pincer nails? cause?

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

65

Onychocryptosis cause?

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

66

What is a pyogenic granuloma?

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

67

What are Periungual fibromas?

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

68

What is periungual fibromas a possible sign of?

tuberous sclerosis => Koenen's tumors

69

What are myxoid cysts?

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

70

What are subungual exostosis?

benign bony proliferation causes subungual, hard nodule usually from trauma

71

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

squamous cell carcinoma***

72

What relationship does SCC and HPV have?

causative role of HPV suggests tumor development

73

What is the clinical presentation of SCC?

verrucous lesion; ulcerated nodule; onycholysis; nail plate destruction

74

Melanoma most frequent site of nail?

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