nails pathophys Flashcards by M K

what is show in image?

what are they?

how do they occur?

how do they often arise

what does this pathology present at the same level in all nails indicate?

Beau’s lines

defined as transverse depression of nail plate

secondary to discruption of nail plate formation by the nail matrix

traumatic

presence at same level = systemic cause

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what is the function of the proximal nail fold

what is the function of the nail matrix?

know: proximal nail matrix –> dorsal nail plate
know: distal matrix(lunula) –> ventral nail plate

what is the function of nail bed?

proximal nail fold = protects nail

nail matrix - germinative cells that produce the nail plate

nail plate adhesion

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what is the nail growth rate of finger nails, toe nails?

finger - 3mm/month

toe - 1 mm/month

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unguis =

nail

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ungual =

relating to the nail

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onyx =

denoting a fingernail or toe nail

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nail signs can be characterized into which three major categories:

nail signs due to abnormal matrix function

nail signs due to nail bed disorders

nail signs due to deposition of pigment within the nail plate

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nail sign due to abnormal matrix function: this is a punctate depression of the nail plate surface

it migrates distally with nail growth

what is it due to?

in which pathologies(3) is it seen?

pitting

due to: foci of abnormal keratinization in the promixmal nail matrix

seen in: psoriasis, alopecia areata, eczema

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nail signs due to abnormal nail matrix function: defined as nails with rough, ridged surface

what is condition?

test question: 2. what is it associated with?(3)

trachyonychia

associated with: alopecia areata, LICHEN PLANUS, psoriaris , eczema

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nail signs due to abnormal matrix functions

what is a white opaque discoloration (punctaate, striate or diffuse) due to damage of the distal matrix that is most often traumatic?

Test question: _____are true leukonychia with transverse white bands that have been associated with _______ and _____ toxicity

how do you differentiate true from apparent leukonychia?

true luekonychia

Mees’ lines are a true leukonychia with transverse white bands that have been traditionally associated with arsenic and thallium toxicity

Differentiate from “apparent leukonychia” by pressing on nail:
True: unchanged with pressure (nail plate is opaque)
Apparent: disappears with pressure (nail plate normal; abnormal nail bed)

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what is shown in image?

TEST question: what is it associated with?

koilonychia (spoon nails)

associated with iron deficiency anemia

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this is a distal nail plate detachment from the nail bed and the detachmed nail looks yellow white.

TEST question: what is it commonly due to?

onycholysis

psoriasis or onychomycosis

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what is a white disocoloration that fades with pressure in which the nail plate transparency is maintained?

what is apparent leukonychia most commonly due to?

apparent leukoncychia

drugs (chemo agents), systemic diseases like hypoalbunemia

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a condition due to damage to longitundianlly oriented nail bed capillaries that is most commonly associated with trauma

what is the most common systemic cause?

splinter hemorrhage

bacterial endocarditis

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what is shown in the image below?

clues:

single or multiple ongitudinal brown-black bands
causes inlcude melanocyte activation, non-melanocytic tumors, melanocyte hyperplasia, nevi, and melanoma
single band may be a sing of __________
mulitple bands often due to _________or _________
seen in ______ of AA
Hutchinson’s sign. What is it? what does its presence raise concer for?

longitudinal melanonychia

single band = sign of nail melanoma

multiple bands = drugs or systemici disease

seen in 90% of AA

Hutchinson’s sign is the extension of pigment on to the nail folds, and it’s presence raises the concern for melanoma

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what is the condition?

Greenish-black or greenish-blue nail plate discoloration

Nail is discolored because of __________a blue–green pigment produced by____________

Predisposing factors include exposure to water, detergents, and soaps

green nail syndrome

Greenish-black or greenish-blue nail plate discoloration

Nail is discolored because of pyocyanin, a blue–green pigment produced by Pseudomonas aeruginosa.

Predisposing factors include exposure to water, detergents, and soaps

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which condition?

Multiple nails affected
Diagnostic signs :
Irregular pitting
Salmon patches (‘oil drop’ changes)
Onycholysis with erythematous border
Psoriatic arthropathy is often associated

Koebner phenomenon worsens nail symptoms

psoriasis

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which condition?

Several nails usually affected

Nail thinning and fissuring

Dorsal pterygium: scarring of the proximal nail fold over the nail plate

lichen planus

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which condition?

Geometric pitting
Children are most commonly affected
Trachyonychia(nails w/rough, ridged surface)

alopecia areata

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which condition?

Irregular pitting and Beau’s lines
Subungual hyperkeratosis
Chronic paronychia(skin infection around the nails)

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eczema(dermatitis)

which condition?

Lovibond’s angle: angle between the proximal nail fold and the nail plate
Normal: ~160°
__________: >180°
Associated with cardiopulmonary disease, sarcoidosis, cirrhosis, gastrointestinal disease, toxin exposures, trauma

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clubbing

what is clubbing usually associated with?

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cardiopulmonary disease

what are muehrcke’s lines? which condition are they associated with?

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Apparent leukonychia with transverse white bands
“Apparent” because they disappear with pressure
Associated with hypoalbuminism

what are three examples of apparent leukonychia in systemic disease?

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muehrcke’s lines, lindsday’s nails(half and half nails), terry’s nails

which condition? which disease is associated?

**_Lindsay’s nails (half-and-half nails)_** White proximally and brown-red distally Associated with **_chronic renal disease_**

which apparent leukonychia? associated with which condtion?

Terry’s nails White proximally with 1-few mm of brown-red distally Associated with cirrhosis

autoimmune connective tissue disorders: common nail abnormalities in which two condition?

Nail fold capillary abnormalities **_Cuticular hemorrhages_** Common in **_dermatomyositis and scleroderma_**

what are three common nail infections?

acute paronychia warts onychomycosis

what is the condition below? the affected digit is usually \_\_\_\_\_\_\_and \_\_\_\_\_\_ compression of the nail fold may produce \_\_\_\_\_\_\_\_\_\_ condition is most commonly due to which two bacteria? **chronic** _________ is most commonly due to \_\_\_\_\_\_\_\_\_\_infection \*\*\*\*\*\*recurrent episodes of actue paronychia should raise the suspicion of an \_\_\_\_\_\_\_\_infection

acute paronychia The affected digit **_Swollen, red and painful._** Compression of the nail fold may produce **_purulent drainage._** Acute paronychia is most commonly due to bacteria, especially **_Staphylococcus aureus or Streptococcus pyogenes_** Chronic paronychia is most commonly due to **_Candida infection_** Recurrent episodes of acute paronychia should raise the suspicion of an **_HSV infection_**

1. what is the condition below? 2. what causes this conditon? 3. what does it look like? 4. in recalcitrant lesions of this conditions, what should you consider?

WARTS 2.Caused by **_Human papillomavirus (HPV)_** 2. Periungual keratotic papules 3. Hyperkeratosis of the cuticle Onycholysis 4. In recalcitrant lesions, consider the possibility of **_squamous cell carcinoma_**

what is the condtion below? \*\*\*\*what is the term used when it is secondary to a dermatophyte infection? what are the four basic patterns of this condition? KNOW:PSO is associated with _______ and \_\_\_\_\_\_

onychomycosis Defined as fungal infection of the nail **_Tinea unguium_** is the term used when it’s secondary to dermatophyte infection Most commonly caused by Trichophyton rubrum * *Four basic patterns:** * *Distal subungual** * *White superficial** * *Proximal subungual (PSO)** * *Candidal onychomycosis** * *_PSO_** is associated with **_immunosuppression/HIV infection_**

defined as distal superficial splitting (horizontally) of the nail plate

onychoschizia

Nail brittleness results from __________ of the nail plate as a result of environmental factors such as \_\_\_\_\_\_\_\_

Nail brittleness results from **_dehydration_** of the nail plate as a result of environmental factors such as frequent **_handwashing._**

what is the condition in picture? what is absent? what is condition usually secondary to?

**_Proximal nail fold inflammation_** Absence of the cuticle **_Fingernails affected_** **_Chronic paronychia i_**s usually **secondary** to **c****_hronic irritation or Candida infection_**

what is a median nail dystrophy due to habitual tic? what is absent in this condition? what does it look like?

Onychotillomania Cuticle absent and proximal nail fold inflamed Nail plate surface abnormalities, e.g. longitudinal central depression Melanonychia Hemorrhage and crust

what is the condition? what causes the condition and what does it lead to? how does the pigmentation move in this condition?

subungal hematoma **_History of acute trauma_** Leads to **_accumulation of blood under the nail plate_** **Purple–red to black in color** **Pigmentation moves distally with nail growth**

which condition? what causes this condition? which toe is most frequently affected? KNOW: who does this condition most commonly present in?

ONYCHOGRYPHOSIS Ram's horn nails **_Due to asymmetric growth_** Thick, hard, yellow–brown nail plate **_Hallux most frequently affected_** Favored by chronic trauma **_know: Elderly patients_**

Over-curvature of the distal nail plate Can be hereditary or acquired Acquired is most commonly due to ill-fitting shoes

Pincer Nails (Trumpet Nails)

Defined as ingrown nails Congenital malalignment often present Precipitated by improper nail cutting and hyperhidrosis(excessive sweating) Painful inflammation of the lateral fold Growth of granulation tissue

Onychocryptosis

Bleeding angiomatous nodule Periungual or subungual Often traumatic which condition? benign or malignant?

Bleeding angiomatous nodule Periungual or subungual Often traumatic

Pink or skin-colored papules originating from the proximal nail fold The fibroma may compress the nail matrix, which produces a longitudinal groove in the nail plate Possible sign of tuberous sclerosis which condition? benign or malignant? in the setting of \_\_\_\_\_\_, this condition is known as \_\_\_\_\_\_

**_periungual fibroma_** Possible sign of tuberous sclerosis **_Koenen's tumors - in the setting of tuberous sclerosis_**

Proximal nail fold swelling Nail plate depression and grooves Cysts are often connected to DIP joint and may drain joint fluid

Myxoid cysts (Digital Mucous Cyst)

Benign bony proliferation causes subungual, hard nodule Commonly precipitated by trauma Seen mainly on toenails Confirm with X-ray which condition?

subungual exostosis

condition? what is the most frequent maligant tumor of nail appartus? which virus may play a role in this tumor? what is the clinical presentation of this tumor?

**_Squamous cell carcinoma_** **Most frequent malignant tumor** of the nail apparatus Causative role of **_HPV, (mostly HPV16) suggested in the development of this tumor_** Clinical presentation: Verrucous lesion Ulcerated nodule Onycholysis Nail plate destruction

which condition?

melanoma

nail apparatus melanoma accounts for Accounts for \_\_\_\_\_\_\_\_\_\_\_\_of all melanomas but 5 year survival rate is \_\_\_\_\_\_\_

Accounts for _________ of all melanomas but 5 year survival rate is \_\_\_\_\_\_\_

what is the most frequent site of nail melanoma? what does it look like?

Longitudinal melanonychia Thumb is most frequent site Nail plate destruction

KNOW: which sign is associated with nail melanoma?

Hutchinson's sign

how often is nail melanoma amelanotic?

Amelanotic (non-pigmented) in 25% of cases

nails pathophys Flashcards

(49 cards)