91 - Nail Disorders Flashcards
1
Q
Complete or almost complete lack of the nail
A
Anonychia
Severe hypoplasia
Hyponychia
2
Q
No terminal phalanx and no nail growth
A
Cooks syndrome
Atelephalangia with anonychia
3
Q
Half-side index fingernail hypoplasia and a Y-shaped radiologic alteration of the distal phalanx
A
Iso-Kikuchi syndrome
4
Q
May be a sign of phenytoin and alcohol fetopathy
Constant feature of congenital onychodysplasia of Iso-Kikuchi
A
Micronychia
5
Q
Short wide nail, mostly of the thumb which develops from the age of 12 years
Result of a premature ossification of the epiphysis of the distal phalanx
A
Racket nail
6
Q
Very short nails
May develop in patients under chronic hemodialysis who develop a tertiary hyperparathyroidism with resorption of the bone if the terminal phalanx
A
Brachyonychia
7
Q
Relatively frequent finding in subjects of all races
Nail may be slightly wider and have a slight longitudinal indentation or be discernible as a complete accessory nail
A
Rudimentary double nail of the fifth toe
8
Q
Most common color change of the nail
A
Leukonychia
9
Q
Many longitudinal white bands are characteristic of
A
Hailey-Hailey disease
10
Q
Result of nail bed pallor
May disappear with temperature change or pressure
A
Apparent leukonychia
11
Q
Pair of 2 whitish transverse lines
Sign of hypoalbuminemia
A
Muehrcke lines
12
Q
White surface of the nail, which is infected by fungi
A
Pseudoleukonychia
13
Q
Red nails
A
Erythronychia
14
Q
Multiple red bands are commonly caused by
A
Inflammatory conditions such as lichen planus
15
Q
Single red band may represent
A
Specific tumors such as onychopapilloma or Bowen disease
16
Q
Alternating narrow white and red bands are seen in
A
Darier disease
17
Q
Green nails
A
Chloronychia
18
Q
In almost all cases, chloronychia is caused by
A
Colonization of the nail by Pseudomonas aeruginosa
19
Q
Treatment of choice of P. aeruginosa colonization
A
Soaking in diluted white vinegar, 2 or 3 times daily for 10 minutes, then brushing the fingers dry
20
Q
Y/N: Systemic antibiotics do not reach the site of infection because Pseudomonas mainly colonizes an onycholytic nail
A
Yes
21
Q
Seen developing in persons swimming in water with copper sulfate as a disinfective agent
A
Blue nails or glauconychia
22
Q
Slate-gray to bluish nail matrix is a sign of
A
Argyria
23
Q
Exogenous agents that may stain the nail brown
A
Potassium permanganate
Tobacco smoke
Silver nitrate
24
Q
Multiple melanonychias in several or all digits are common in
A
Dark-skinned individuals and Asians and are a physiologic phenomenon seen in almost all African Americans
25
Association of lenticular labial, oral, and genital mucosal brown spots with melanonychias is characteristic for
Laugier-Hunziker-Baran syndrome
26
Most frequent sign of nail melanoma
Longitudinal nail pigmentation
27
Never reaches into the free margin of the nail plate (one of the most reliable criteria for differential diagnosis)
Does not form a regular longitudinal band
Subungual hematoma
28
Hematomas occupying more than 50% of the nail field are commonly associated with
Fracture of the distal phalanx
29
Narrow red to almost black longitudinal lines in the distal nail bed
Caused by blood that is enclosed in subungual keratin
Splinter hemorrhages
30
_____ splinter hemorrhages may be a sign of trichinosis
Oblique
31
Detachment of the nail from the distal nail bed
Onycholysis
32
Cause of onycholysis semilunaris
Direct trauma resulting from overzealous nail cleaning
33
Sharply delineated proximal margins that may look like a half moon
Onycholysis semilunaris
34
Characteristic for onychomycoses and psoriasis
Subungual hyperkeratosis
35
Subungual hyperkeratosis is virtually always associated with onycholysis, except in
Pachyonychia congenita
36
Nail covers an excessive nail bed hyperkeratosis in a horseshoe-like fashion
Pachyonychia congenita
37
Exaggeration of nail bed and matrix hyperkeratosis
| Often has the shape of a ram’s horn
Onychogryposis
38
Onychogryposis is mainly seen in
Elderly, neglected and debilitated individuals
39
Bridging of the nail pocket by connective tissue, in most cases scars
Very common in lichen planus, but is occasionally seen in bullous pemphigoid and after trauma
Pterygium
40
When the nail plate does not separate correctly from the nail plate at the hyponychium and remains attached, a painful hyperkeratosis obliterates the distal groove
Quite common in acral scleroderma and Raynaud syndrome
Pterygium inversum
41
A temporary slowdown or even arrest of nail formation results in a transverse groove that runs parallel to the lunula border
Beau lines
42
Result of a longer-lasting arrest of nail matrix proliferation that eventually results in a proximal gap in the nail and proximal onycholysis
Onychomadesis
43
Small depressions in the nail surface resulting from minute foci of abnormal keratinization of the apical matrix
Pits
44
Most characteristic and most frequent sign of nail psoriasis
Pitting
45
Rough nails
Trachyonychia
46
Result of pressure on the nail matrix, usually the result of a small tumor in the promixal nailfold
Longitudinal groove
47
Multiple longitudinal fissures, often associated with nail thinning and ridges
Onychorrhexis
48
Lamellar splitting of the nail at its free end
Onychoschizia
49
In babies with _____, onychoschizia is common
Koilonychia
50
The most common type is _____ ingrowing of the edge of the big toenail
Distal-lateral
51
Proximal ingrowing of the nail
| Lunula is no longer present
Retronychia
52
Overcurvature of the nails
Pincer nails
53
Systemic radiographic examination of the toes show that the distal phalanx is asymmetrical and often shows
Distally pointing exophytes
54
Skin disease with the most frequent nail involvement
Psoriasis
55
Y/N: There is an association of human leukocyte antigen (HLA)-C0602 with nail and joint involvement in psoriasis
No - In contrast to skin, there is an association of human leukocyte antigen (HLA)-C0602 with nail and joint involvement
56
_____ pits per nail or more than _____ pits on all nails are seen as proof of nail psoriasis
10
| 50
57
Rarely, _____ are seen in the lunula usually representing a very active psoriasis lesion with dilation of the capillaries and thinning of the suprapapillary plate
Red spots
58
Seen when the psoriatic lesion is in the mid to distal matrix and parakeratotic cells are incorporated into the nail plate
Leukonychia
59
Analogous to Auspitz phenomenon on the skin and result from damage to the dilated capillaries
Splinter hemorrrhages
60
Represent psoriatic plaques in the distal matrix and the nail bed
Salmon spots
61
Yellowish-brownish spot with a red margin
Salmon spot
62
Psoriatic onycholysis typically has a _____ differentiating it from most other causes of onycholysis
Reddish proximal margin
63
Condition closely related to psoriatic arthritis but usually without obvious nail changes
Big toe is considerably thickened and often painful
Psoriatic pachydermoperiostosis
64
3 different forms of pustular psoriasis, all of which also involve the nail
Palmar plantar pustular psoriasis of Barber-Konigsbeck
Generalized pustular psoriasis of von Zumbusch
Acrodermatitis continua suppurativa of Hallopeau
65
A mutation in the gene for _____ leading to a defect in _____ was found in generalized pustular psoriasis and acrodermatitis continua suppurativa
Interleukin-36 receptor antagonist
66
Very similar to pustular psoriasis
Usually have a more brownish tint because of the content of erythrocytes in their pustules
Histopathology also shows spongiform pustules
Reiter disease
67
In nai psoriasis, _____, even though often being rather inconscpicuous, are the most resistant to treatment
Pits
68
A 3-month trial of _____ is warranted in nail psoriasis
Combination of a vitamin D3 derivative with a potent corticosteroid
69
Y/N: The less of the nail is present, the easier is penetration of the drug to the very psoriatic lesion
Yes
70
_____ injections were also given in nail psoriasis with some success; however, this cytostatic drug may slow down nail growth and make an improvement visible only very late
Methotrexate
71
Nummular eczema of the nail region mainly involves the
Proximal nailfold
72
Shiny nails are characteristic in _____ of children and young, and middle-aged adults. These individuals "learned" not to harm their skin by scratching with the free margin of the nails and to relieve the itch by rubbing with the back of the distal phalanx
Chronic itchy atopic dermatitis
73
Desquamation and cracking of the finger and toe tips and is often also a feature of atopic winter feet
Atopic pulpitis sicca
74
Rough nails
| Hallmark of the so-called 20-nail dystrophy
Trachyonychia
75
In the author's experience, most cases of trachyonychia are caused by
Atopic dermatitis
76
The rare occurrence of allergic and irritant contact dermatitis on toenails as compared to fingernails points at the importance of
Nail cosmetics as well as a number of household allergens
77
Painful matrix and nail bed dermatitis is characteristic of _____ allergy
Acrylate
78
The more severe the AA, the (more/less) likely is nail involvement
More
79
Two types of nail alterations are seen in AA
Rough nails that have lost their shine
| Pitted nails with surface shine
80
Sign of very severe in involvement in AA
Koilonychia
81
Y/N: The pathogenesis in AA on the nails in contrast to the hair appears to be variable
Yes - Nails do not fall off in contrast to hair
| Histopathologic pattern of inflammation in hair follicles and nails are different
82
Nail biopsy of AA shows
Spongiotic dermatitis with lymphocyte exocytosis involving the matrix
83
In nail lichen planus, most commonly, the _____ is involved
Apical matrix
84
The similarity of clinical and histopathological nail alerations in _____ with those of lichen planus has supported the view that it is an autoimmune disorder
Graft-versus-host disease
85
Y/N: Once a pterygium has developed, nail lichen planus is no longer amenable to treatment
Yes
86
Most common initial signs of autoimmune bullous diseases affecting the nail unit
Chronic paronychia with oozing and crust formation
87
Perinugual erythema and red lunula may be seen in
Acute lupus erythematosus
88
Pernio-like nonspecific violaceous-blue hue with some telangiectasias to ulceration of the tip of the toe and the nail unit
Chillblain lupus
89
Red streaks in the nail bed, ridging of the nail, and dystrophy
Chronic discoid lupus erythematosus
90
Ulceration of the pulp and narrowing of the tip of the finger
Nail insidiously bends volarly giving the aspect a parrot beak
Scleroderma with its acral variant
91
Most important Herpesviridae affecting the nail
HSV type 1 (HHV1)
HSV type 2 (HHV2)
Varicella-zoster virus (HHV3)
HHV8
92
Y/N: Primary herpes simplex infection usually causes nail lesions
No - rarely
93
Small vesicles are seen to develop that first have a clear content, which, after some days, becomes yellowish while the blisters tend to merge
Visible red streak is commonly seen extending from the finger to the arm; this lymphangitis is usually associated with pain
Herpes virus infection
94
In children, recurrent digital herpes simplex is usually caused by
HHV1
95
In adults, _____ are the causative agents of recurrent digital herpes simplex
HHV1 and HHV2
96
Y/N: There are no controlled studies proving the value of long-term antiviral prophylaxis for herpes virus infections
Yes
97
Common warts: On the proximal nailfold, they are _____ papules with a rough keratotic surface; on the lateral folds they are often _____
Round
| Oval
98
Infection with HPV types _____ is the most common cause for viral warts of the nail unit
1, 2, 3, 4, and 7
99
Intraoral aphthoid lesions that cause less discomfort than common aphthous ulcers, with small vesicles on the palms, soles, and around the nails
Characteristic slightly oval vesicles with a gray blister and a narrow red margin
In ridged skin, the long axis of the vesicles is along the dermatoglyphics
Hand-foot-and-mouth disease
100
In most cases, the cause of hand-foot-and-mouth disease is an infection with
Enterovirus type 71
| Coxsackievirus, mainly type A5 and A16
101
The most characteristic bacterial infection is a _____ that runs around the proximal part of the nail, hence the common term runaround
Bullous impetigo
102
When the infection occurs primarily under the nail it is called a
Subungual whitlow
103
Recurrent digital herpes simplex vs bullous impetigo
More painful
Develops a lymphangitis
Starts with a group of clear blisters that coalesce and later becomes putrid
104
The matrix in children may be permanently damaged within _____ in a subungal whitlow
24 to 48 hours
105
Most frequent nail disorders making up approximately 40% to 50% of all nail diseases
Onychomycoses
106
Vast majority of onychomycoses are _____ subungual onychomycoses
Distal or
| Distal-lateral
107
Condition mostly seen in the toenails as chalky-white patches with no shine of the nail surface
Superficial white onychomycosis
108
When occurring on fingernails, the white discoloration is inhomogeneous and more cloudy, but the nail surface remains shiny; this is the typical form of HIV infections
Superficial white onychomycosis
109
Rare form in which the fungus only grows in the nail plate without affecting the subungual tissue
Dermatoscopy may show air-filled channels in the nail plate
Endonyx onychomycosis
110
The matrix in children may be permanently damaged within _____ in a subungal whitlow
24 to 48 hours
111
Most frequent nail disorders making up approximately 40% to 50% of all nail diseases
Onychomycoses
112
Vast majority of onychomycoses are _____ subungual onychomycoses
Distal or
| Distal-lateral
113
Condition mostly seen in the toenails as chalky-white patches with no shine of the nail surface
Superficial white onychomycosis
114
When occurring on fingernails, the white discoloration is inhomogeneous and more cloudy, but the nail surface remains shiny; this is the typical form of HIV infections
Superficial white onychomycosis
115
Rare form in which the fungus only grows in the nail plate without affecting the subungual tissue
Dermatoscopy may show air-filled channels in the nail plate
Endonyx onychomycosis
116
Primary total dystrophic onychomycosis is characteristic for _____ which represents a group of immune defects with impaired defense against Candida albicans
Chronic mucocutaneous candidiasis
117
Huge amounts of compressed mostly very thick-walled fungi
Dermatophytoma
118
In onychomycosis, the rate of false-negative results, particularly for _____, is very high, commonly between 30% and 60%, but _____ has proved to be doubly sensitivit
Culture
| Histopathology
119
Y/N: Histopathology can distinguish between colonization and true infection
Yes
120
Unilateral clubbing may hint at
Arterial insufficiency of this extremity
121
Condition of toenails, in which onycholysis usually affects 1 corner of the big toenail
Asymmetric gait nail unit syndrome
122
When more than _____% of the nail is affected or the infection reaches the matrix at any point, systemic treatment is indicated
50
123
Characteristic sign of chronic hypoxemia
| Frequently indicates cor pulmonale
Clubbing
124
The angle between the proximal nailfold and the nail plate (_____) is greater than 180 degrees
Angle of Lovibond
125
The nails may turn _____ in Wilson disease
Bluish
126
Unilateral clubbing may hint at
Arterial insufficiency of this extremity
127
Yellow nail syndrome is a characteristic triad of signs
Yellow, thick, extremely slow-growing nails with onycholysis, often also spontaneous nail loss and complete disappearance of the cuticle
Chronic sinus-bronchopulmonary infection
Edema of the distal extremities
128
Periungual erosions with crusting
| Nail edges may break through the epidermis of the nail grooves and cause granulation tissue
Acrodermatitis enteropathica
| Acquired zinc deficiency
129
In severe liver disease, the nails may turn white and opaque
| Distal normal-colored band remains
Terry nails
130
2 parallel white bands in the middle of the nail bed that do not move out
Seen in severe hypoalbuminemia
Muehrcke lines
131
The nails may turn _____ in Wilson disease
Bluish
132
Proximal half of the nail is whitish, the distal half tends to be brownish
Seen in chronic renal insufficiency and under long-term hemodialysis
Half-and-half nails
133
Chewing of the nails
Onychophagia
134
Picking of the periungual skin
Perionychotillomania
135
This habit tic results in a central depression of the nail with a washboard aspect, an unusually long lunula and loss of cuticle
Perionychotillomania
136
Toxic doses of vitamin _____ are destructive of the nail
A
137
Nails are virtually rubbed away
Onychoteiromania
138
Cutting device is used to remove the nail
Onychotemnomania
139
Patients bite on their nails in the lunula or proximal nail bed region to produce pain
Onychodaknomania
140
Has been successfully used in a number of obsessive-compulsive disorders, including autoaggressive nail conditions
N-acetyl cysteine
141
High doses of _____ cause transverse white nail discoloration
Arsenic
142
Toxic doses of vitamin _____ are destructive of the nail
A
143
Some drugs cause characteristic, although rarely specific, nail alterations. They are most often observed under the treatment with
Cytotoxic drugs
144
May cause painful subungual hemorrhagic abscesses that may require withdrawal of the drug
Taxanes
145
Acyclovir induces
Longitudinal melanonychia
146
Retinoids are associated with
Fragile nails
| Paronychia
147
Beta-blockers induce
Acral ischemia
148
Bleomycin may lead to
Digital ischemia
| Permanent nail loss
149
Photochemotherapy with psoralens and UVA can induce _____ in several nails
Multiple longitudinal brown streaks
150
Rarely seen during administration of some tetracyclines and fluoroquinolones, as it is painful, may be hemorrhagic, and occurs in the central nail bed of 1 or more nails
Photoonycholysis
151
Three types of hypohidrotic ectodermal dyplasias
Autosomal recessive
X-linked
Autosomal dominant
152
Group of 5 molecular biologically well-defined diseases of cytokeratosis KRT6a, KRT6b, KRT6c, KRT16, and KRT17
Pachyonychia congenita
153
Painful callus-like palmar and plantar hyperkeratoses, monstrous thickening of the subungual hyperkeratosis that is covered by a horseshoe-like nail usually of normal thickness
Oral leukokeratosis with no potential for malignant degeneration
Natal teeth
Vellus hair cysts
Pachyonychia congenita
154
By definition, ectodermal dysplasia is any hereditary disorder involving at least _____ of the cutaneous adnexa - hair, nails, sweat glands, teeth
2
155
If resolution of congenital malalignment of the big toenail has not started by age _____, it will likely not occur
2 years
156
Systematic radiographic examinations of congenital malalignment of the big toe
Lateral deviation of the distal phalanx (hallux valgus interphalangeus)
157
Three types of hypohidrotic ectodermal dyplasias
Autosomal recessive
X-linked
Autosomal dominant
158
Consequence of repeated blistering of the nail organ and leaves smooth digit tips covered with a shiny epidermis
Anonychia
159
Caused by a mutation in the homeobox gene LMXB1, which is necessary for the anterior-posterior orientation during organogenesis
Nail-patella syndrome
160
Pigmentary abnormalities of the skin, nail dystrophy, oral leukoplakias with a tendency to malignancy degeneration and severe immune deficiency
Dyskeratotis congenita
161
If resolution of congenital malalignment of the big toenail has not started by age _____, it will likely not occur
2 years
162
Systematic radiographic examinations of congenital malalignment of the big toe
Lateral deviation of the distal phalanx (hallux valgus interphalangeus)
163
First described under the name subungual seborrheic keratosis
Longitudinal brownish to dirty-yellow lesion under the nail that shines through the plate
Surgical removal demonstrates an acanthoma histologically made up of mainly basaloid cells
Onychocytic matricoma
164
Fibroepithelial neoplasm originating from the matrix
| At the free end of the nail plate, small holes can be recognized
Onychomatricoma
165
Arises from the distal matrix
Produces a thread of abnormal keratin
Whitish, ivory-colored, yellowish, reddish, or light-brown band in the nail
End-on dermatoscopy shows a circumscribed thinning of the nail plate over the keratotic distal end
V-shaped onycholysis develops in the distal nail bed
Onychopapilloma
166
Whitish to yellowish line of 1 to 2 mm that does not widen with time
Short longitudinal fissure at its free margin
Tiny round keratotic tip is seen under the nail
Subungual filamentous tumor
167
Sausage-like lesions with a keratotic tip
| Most arise from under the proximal nail fold
Ungual fibrokeratoma
168
Multiple ungual fibrokeratomas, so-called _____, are a sign of tuberous sclerosis complex
Koenen tumors
169
Very common pseudotumors of middle-aged and elderly individuals
Most occur in the proximal nailfold
Myxoid pseudocysts
170
Best known nail tumor because of its highly characteristic symptoms
Extremely painful digit tip
Violaceous red spot under the nail, from which a reddish line may sometimes extend distally
Glomus tumor
171
Most frequent malignant neoplasm of the nail
Squamous cell carcinoma
172
Melanonychia is a feature in dark-skinned persons and association with HPV
56
173
Treatment of choice for SCC of the nail
Mohs surgery
174
Very slow growing subungual tumor that clinically presents as a longstanding oozing mass
Onycholemmal carcinoma
175
Most serious nail condition
Nail melanoma
176
Brown streaky pigmentation of the nail
Longitudinal melanonychia
177
Four lesion types that can induce a true LM
Melanocyte activation
Matrix lentigo
Matrix nevus
Melanoma
178
Regular light-brown band on a gray background
Functional LM
179
Regular brown band on a brown background
Lentigo
180
Regular brown band with dark brown spots on brown background
Nevus
181
Irregular brown band with asymmetric, unevenly space lines of variable length, proximal widening of the band
Melanoma
182
Most common sites of ungual melanoma
Thumbs
Big toes
Index fingers
Middle fingers
183
Periungual pigmentation
| Represents periungual spread of the in situ component
Hutchinson sign
184
Indicated rapid growth of ungual melanoma
Proximal widening
185
Y/N: Ultraviolet exposure is associated with nail melanoma
No - not associated
