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Fitz 9th > 91 - Nail Disorders > Flashcards

91 - Nail Disorders Flashcards

1
Q

Complete or almost complete lack of the nail

A

Anonychia
Severe hypoplasia
Hyponychia

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2
Q

No terminal phalanx and no nail growth

A

Cooks syndrome

Atelephalangia with anonychia

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3
Q

Half-side index fingernail hypoplasia and a Y-shaped radiologic alteration of the distal phalanx

A

Iso-Kikuchi syndrome

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4
Q

May be a sign of phenytoin and alcohol fetopathy

Constant feature of congenital onychodysplasia of Iso-Kikuchi

A

Micronychia

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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

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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

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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

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8
Q

Most common color change of the nail

A

Leukonychia

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9
Q

Many longitudinal white bands are characteristic of

A

Hailey-Hailey disease

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10
Q

Result of nail bed pallor

May disappear with temperature change or pressure

A

Apparent leukonychia

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11
Q

Pair of 2 whitish transverse lines

Sign of hypoalbuminemia

A

Muehrcke lines

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12
Q

White surface of the nail, which is infected by fungi

A

Pseudoleukonychia

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13
Q

Red nails

A

Erythronychia

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14
Q

Multiple red bands are commonly caused by

A

Inflammatory conditions such as lichen planus

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15
Q

Single red band may represent

A

Specific tumors such as onychopapilloma or Bowen disease

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16
Q

Alternating narrow white and red bands are seen in

A

Darier disease

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17
Q

Green nails

A

Chloronychia

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18
Q

In almost all cases, chloronychia is caused by

A

Colonization of the nail by Pseudomonas aeruginosa

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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

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20
Q

Y/N: Systemic antibiotics do not reach the site of infection because Pseudomonas mainly colonizes an onycholytic nail

A

Yes

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21
Q

Seen developing in persons swimming in water with copper sulfate as a disinfective agent

A

Blue nails or glauconychia

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22
Q

Slate-gray to bluish nail matrix is a sign of

A

Argyria

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23
Q

Exogenous agents that may stain the nail brown

A

Potassium permanganate
Tobacco smoke
Silver nitrate

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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

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25
Q

Association of lenticular labial, oral, and genital mucosal brown spots with melanonychias is characteristic for

A

Laugier-Hunziker-Baran syndrome

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26
Q

Most frequent sign of nail melanoma

A

Longitudinal nail pigmentation

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27
Q

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

A

Subungual hematoma

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28
Q

Hematomas occupying more than 50% of the nail field are commonly associated with

A

Fracture of the distal phalanx

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29
Q

Narrow red to almost black longitudinal lines in the distal nail bed
Caused by blood that is enclosed in subungual keratin

A

Splinter hemorrhages

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30
Q

_____ splinter hemorrhages may be a sign of trichinosis

A

Oblique

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31
Q

Detachment of the nail from the distal nail bed

A

Onycholysis

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32
Q

Cause of onycholysis semilunaris

A

Direct trauma resulting from overzealous nail cleaning

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33
Q

Sharply delineated proximal margins that may look like a half moon

A

Onycholysis semilunaris

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34
Q

Characteristic for onychomycoses and psoriasis

A

Subungual hyperkeratosis

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35
Q

Subungual hyperkeratosis is virtually always associated with onycholysis, except in

A

Pachyonychia congenita

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36
Q

Nail covers an excessive nail bed hyperkeratosis in a horseshoe-like fashion

A

Pachyonychia congenita

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37
Q

Exaggeration of nail bed and matrix hyperkeratosis

Often has the shape of a ram’s horn

A

Onychogryposis

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38
Q

Onychogryposis is mainly seen in

A

Elderly, neglected and debilitated individuals

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39
Q

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

A

Pterygium

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40
Q

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

A

Pterygium inversum

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41
Q

A temporary slowdown or even arrest of nail formation results in a transverse groove that runs parallel to the lunula border

A

Beau lines

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42
Q

Result of a longer-lasting arrest of nail matrix proliferation that eventually results in a proximal gap in the nail and proximal onycholysis

A

Onychomadesis

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43
Q

Small depressions in the nail surface resulting from minute foci of abnormal keratinization of the apical matrix

A

Pits

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44
Q

Most characteristic and most frequent sign of nail psoriasis

A

Pitting

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45
Q

Rough nails

A

Trachyonychia

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46
Q

Result of pressure on the nail matrix, usually the result of a small tumor in the promixal nailfold

A

Longitudinal groove

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47
Q

Multiple longitudinal fissures, often associated with nail thinning and ridges

A

Onychorrhexis

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48
Q

Lamellar splitting of the nail at its free end

A

Onychoschizia

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49
Q

In babies with _____, onychoschizia is common

A

Koilonychia

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50
Q

The most common type is _____ ingrowing of the edge of the big toenail

A

Distal-lateral

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51
Q

Proximal ingrowing of the nail

Lunula is no longer present

A

Retronychia

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52
Q

Overcurvature of the nails

A

Pincer nails

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53
Q

Systemic radiographic examination of the toes show that the distal phalanx is asymmetrical and often shows

A

Distally pointing exophytes

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54
Q

Skin disease with the most frequent nail involvement

A

Psoriasis

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55
Q

Y/N: There is an association of human leukocyte antigen (HLA)-C0602 with nail and joint involvement in psoriasis

A

No - In contrast to skin, there is an association of human leukocyte antigen (HLA)-C0602 with nail and joint involvement

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56
Q

_____ pits per nail or more than _____ pits on all nails are seen as proof of nail psoriasis

A

10

50

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57
Q

Rarely, _____ are seen in the lunula usually representing a very active psoriasis lesion with dilation of the capillaries and thinning of the suprapapillary plate

A

Red spots

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58
Q

Seen when the psoriatic lesion is in the mid to distal matrix and parakeratotic cells are incorporated into the nail plate

A

Leukonychia

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59
Q

Analogous to Auspitz phenomenon on the skin and result from damage to the dilated capillaries

A

Splinter hemorrrhages

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60
Q

Represent psoriatic plaques in the distal matrix and the nail bed

A

Salmon spots

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61
Q

Yellowish-brownish spot with a red margin

A

Salmon spot

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62
Q

Psoriatic onycholysis typically has a _____ differentiating it from most other causes of onycholysis

A

Reddish proximal margin

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63
Q

Condition closely related to psoriatic arthritis but usually without obvious nail changes
Big toe is considerably thickened and often painful

A

Psoriatic pachydermoperiostosis

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64
Q

3 different forms of pustular psoriasis, all of which also involve the nail

A

Palmar plantar pustular psoriasis of Barber-Konigsbeck
Generalized pustular psoriasis of von Zumbusch
Acrodermatitis continua suppurativa of Hallopeau

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65
Q

A mutation in the gene for _____ leading to a defect in _____ was found in generalized pustular psoriasis and acrodermatitis continua suppurativa

A

Interleukin-36 receptor antagonist

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66
Q

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

A

Reiter disease

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67
Q

In nai psoriasis, _____, even though often being rather inconscpicuous, are the most resistant to treatment

A

Pits

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68
Q

A 3-month trial of _____ is warranted in nail psoriasis

A

Combination of a vitamin D3 derivative with a potent corticosteroid

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69
Q

Y/N: The less of the nail is present, the easier is penetration of the drug to the very psoriatic lesion

A

Yes

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70
Q

_____ 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

A

Methotrexate

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71
Q

Nummular eczema of the nail region mainly involves the

A

Proximal nailfold

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72
Q

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

A

Chronic itchy atopic dermatitis

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73
Q

Desquamation and cracking of the finger and toe tips and is often also a feature of atopic winter feet

A

Atopic pulpitis sicca

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74
Q

Rough nails

Hallmark of the so-called 20-nail dystrophy

A

Trachyonychia

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75
Q

In the author’s experience, most cases of trachyonychia are caused by

A

Atopic dermatitis

76
Q

The rare occurrence of allergic and irritant contact dermatitis on toenails as compared to fingernails points at the importance of

A

Nail cosmetics as well as a number of household allergens

77
Q

Painful matrix and nail bed dermatitis is characteristic of _____ allergy

A

Acrylate

78
Q

The more severe the AA, the (more/less) likely is nail involvement

A

More

79
Q

Two types of nail alterations are seen in AA

A

Rough nails that have lost their shine

Pitted nails with surface shine

80
Q

Sign of very severe in involvement in AA

A

Koilonychia

81
Q

Y/N: The pathogenesis in AA on the nails in contrast to the hair appears to be variable

A

Yes - Nails do not fall off in contrast to hair

Histopathologic pattern of inflammation in hair follicles and nails are different

82
Q

Nail biopsy of AA shows

A

Spongiotic dermatitis with lymphocyte exocytosis involving the matrix

83
Q

In nail lichen planus, most commonly, the _____ is involved

A

Apical matrix

84
Q

The similarity of clinical and histopathological nail alerations in _____ with those of lichen planus has supported the view that it is an autoimmune disorder

A

Graft-versus-host disease

85
Q

Y/N: Once a pterygium has developed, nail lichen planus is no longer amenable to treatment

A

Yes

86
Q

Most common initial signs of autoimmune bullous diseases affecting the nail unit

A

Chronic paronychia with oozing and crust formation

87
Q

Perinugual erythema and red lunula may be seen in

A

Acute lupus erythematosus

88
Q

Pernio-like nonspecific violaceous-blue hue with some telangiectasias to ulceration of the tip of the toe and the nail unit

A

Chillblain lupus

89
Q

Red streaks in the nail bed, ridging of the nail, and dystrophy

A

Chronic discoid lupus erythematosus

90
Q

Ulceration of the pulp and narrowing of the tip of the finger
Nail insidiously bends volarly giving the aspect a parrot beak

A

Scleroderma with its acral variant

91
Q

Most important Herpesviridae affecting the nail

A

HSV type 1 (HHV1)
HSV type 2 (HHV2)
Varicella-zoster virus (HHV3)
HHV8

92
Q

Y/N: Primary herpes simplex infection usually causes nail lesions

A

No - rarely

93
Q

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

A

Herpes virus infection

94
Q

In children, recurrent digital herpes simplex is usually caused by

A

HHV1

95
Q

In adults, _____ are the causative agents of recurrent digital herpes simplex

A

HHV1 and HHV2

96
Q

Y/N: There are no controlled studies proving the value of long-term antiviral prophylaxis for herpes virus infections

A

Yes

97
Q

Common warts: On the proximal nailfold, they are _____ papules with a rough keratotic surface; on the lateral folds they are often _____

A

Round

Oval

98
Q

Infection with HPV types _____ is the most common cause for viral warts of the nail unit

A

1, 2, 3, 4, and 7

99
Q

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

A

Hand-foot-and-mouth disease

100
Q

In most cases, the cause of hand-foot-and-mouth disease is an infection with

A

Enterovirus type 71

Coxsackievirus, mainly type A5 and A16

101
Q

The most characteristic bacterial infection is a _____ that runs around the proximal part of the nail, hence the common term runaround

A

Bullous impetigo

102
Q

When the infection occurs primarily under the nail it is called a

A

Subungual whitlow

103
Q

Recurrent digital herpes simplex vs bullous impetigo

A

More painful
Develops a lymphangitis
Starts with a group of clear blisters that coalesce and later becomes putrid

104
Q

The matrix in children may be permanently damaged within _____ in a subungal whitlow

A

24 to 48 hours

105
Q

Most frequent nail disorders making up approximately 40% to 50% of all nail diseases

A

Onychomycoses

106
Q

Vast majority of onychomycoses are _____ subungual onychomycoses

A

Distal or

Distal-lateral

107
Q

Condition mostly seen in the toenails as chalky-white patches with no shine of the nail surface

A

Superficial white onychomycosis

108
Q

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

A

Superficial white onychomycosis

109
Q

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

A

Endonyx onychomycosis

110
Q

The matrix in children may be permanently damaged within _____ in a subungal whitlow

A

24 to 48 hours

111
Q

Most frequent nail disorders making up approximately 40% to 50% of all nail diseases

A

Onychomycoses

112
Q

Vast majority of onychomycoses are _____ subungual onychomycoses

A

Distal or

Distal-lateral

113
Q

Condition mostly seen in the toenails as chalky-white patches with no shine of the nail surface

A

Superficial white onychomycosis

114
Q

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

A

Superficial white onychomycosis

115
Q

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

A

Endonyx onychomycosis

116
Q

Primary total dystrophic onychomycosis is characteristic for _____ which represents a group of immune defects with impaired defense against Candida albicans

A

Chronic mucocutaneous candidiasis

117
Q

Huge amounts of compressed mostly very thick-walled fungi

A

Dermatophytoma

118
Q

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

A

Culture

Histopathology

119
Q

Y/N: Histopathology can distinguish between colonization and true infection

A

Yes

120
Q

Unilateral clubbing may hint at

A

Arterial insufficiency of this extremity

121
Q

Condition of toenails, in which onycholysis usually affects 1 corner of the big toenail

A

Asymmetric gait nail unit syndrome

122
Q

When more than _____% of the nail is affected or the infection reaches the matrix at any point, systemic treatment is indicated

A

50

123
Q

Characteristic sign of chronic hypoxemia

Frequently indicates cor pulmonale

A

Clubbing

124
Q

The angle between the proximal nailfold and the nail plate (_____) is greater than 180 degrees

A

Angle of Lovibond

125
Q

The nails may turn _____ in Wilson disease

A

Bluish

126
Q

Unilateral clubbing may hint at

A

Arterial insufficiency of this extremity

127
Q

Yellow nail syndrome is a characteristic triad of signs

A

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
Q

Periungual erosions with crusting

Nail edges may break through the epidermis of the nail grooves and cause granulation tissue

A

Acrodermatitis enteropathica

Acquired zinc deficiency

129
Q

In severe liver disease, the nails may turn white and opaque

Distal normal-colored band remains

A

Terry nails

130
Q

2 parallel white bands in the middle of the nail bed that do not move out
Seen in severe hypoalbuminemia

A

Muehrcke lines

131
Q

The nails may turn _____ in Wilson disease

A

Bluish

132
Q

Proximal half of the nail is whitish, the distal half tends to be brownish
Seen in chronic renal insufficiency and under long-term hemodialysis

A

Half-and-half nails

133
Q

Chewing of the nails

A

Onychophagia

134
Q

Picking of the periungual skin

A

Perionychotillomania

135
Q

This habit tic results in a central depression of the nail with a washboard aspect, an unusually long lunula and loss of cuticle

A

Perionychotillomania

136
Q

Toxic doses of vitamin _____ are destructive of the nail

A

A

137
Q

Nails are virtually rubbed away

A

Onychoteiromania

138
Q

Cutting device is used to remove the nail

A

Onychotemnomania

139
Q

Patients bite on their nails in the lunula or proximal nail bed region to produce pain

A

Onychodaknomania

140
Q

Has been successfully used in a number of obsessive-compulsive disorders, including autoaggressive nail conditions

A

N-acetyl cysteine

141
Q

High doses of _____ cause transverse white nail discoloration

A

Arsenic

142
Q

Toxic doses of vitamin _____ are destructive of the nail

A

A

143
Q

Some drugs cause characteristic, although rarely specific, nail alterations. They are most often observed under the treatment with

A

Cytotoxic drugs

144
Q

May cause painful subungual hemorrhagic abscesses that may require withdrawal of the drug

A

Taxanes

145
Q

Acyclovir induces

A

Longitudinal melanonychia

146
Q

Retinoids are associated with

A

Fragile nails

Paronychia

147
Q

Beta-blockers induce

A

Acral ischemia

148
Q

Bleomycin may lead to

A

Digital ischemia

Permanent nail loss

149
Q

Photochemotherapy with psoralens and UVA can induce _____ in several nails

A

Multiple longitudinal brown streaks

150
Q

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

A

Photoonycholysis

151
Q

Three types of hypohidrotic ectodermal dyplasias

A

Autosomal recessive
X-linked
Autosomal dominant

152
Q

Group of 5 molecular biologically well-defined diseases of cytokeratosis KRT6a, KRT6b, KRT6c, KRT16, and KRT17

A

Pachyonychia congenita

153
Q

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

A

Pachyonychia congenita

154
Q

By definition, ectodermal dysplasia is any hereditary disorder involving at least _____ of the cutaneous adnexa - hair, nails, sweat glands, teeth

A

2

155
Q

If resolution of congenital malalignment of the big toenail has not started by age _____, it will likely not occur

A

2 years

156
Q

Systematic radiographic examinations of congenital malalignment of the big toe

A

Lateral deviation of the distal phalanx (hallux valgus interphalangeus)

157
Q

Three types of hypohidrotic ectodermal dyplasias

A

Autosomal recessive
X-linked
Autosomal dominant

158
Q

Consequence of repeated blistering of the nail organ and leaves smooth digit tips covered with a shiny epidermis

A

Anonychia

159
Q

Caused by a mutation in the homeobox gene LMXB1, which is necessary for the anterior-posterior orientation during organogenesis

A

Nail-patella syndrome

160
Q

Pigmentary abnormalities of the skin, nail dystrophy, oral leukoplakias with a tendency to malignancy degeneration and severe immune deficiency

A

Dyskeratotis congenita

161
Q

If resolution of congenital malalignment of the big toenail has not started by age _____, it will likely not occur

A

2 years

162
Q

Systematic radiographic examinations of congenital malalignment of the big toe

A

Lateral deviation of the distal phalanx (hallux valgus interphalangeus)

163
Q

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

A

Onychocytic matricoma

164
Q

Fibroepithelial neoplasm originating from the matrix

At the free end of the nail plate, small holes can be recognized

A

Onychomatricoma

165
Q

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

A

Onychopapilloma

166
Q

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

A

Subungual filamentous tumor

167
Q

Sausage-like lesions with a keratotic tip

Most arise from under the proximal nail fold

A

Ungual fibrokeratoma

168
Q

Multiple ungual fibrokeratomas, so-called _____, are a sign of tuberous sclerosis complex

A

Koenen tumors

169
Q

Very common pseudotumors of middle-aged and elderly individuals
Most occur in the proximal nailfold

A

Myxoid pseudocysts

170
Q

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

A

Glomus tumor

171
Q

Most frequent malignant neoplasm of the nail

A

Squamous cell carcinoma

172
Q

Melanonychia is a feature in dark-skinned persons and association with HPV

A

56

173
Q

Treatment of choice for SCC of the nail

A

Mohs surgery

174
Q

Very slow growing subungual tumor that clinically presents as a longstanding oozing mass

A

Onycholemmal carcinoma

175
Q

Most serious nail condition

A

Nail melanoma

176
Q

Brown streaky pigmentation of the nail

A

Longitudinal melanonychia

177
Q

Four lesion types that can induce a true LM

A

Melanocyte activation
Matrix lentigo
Matrix nevus
Melanoma

178
Q

Regular light-brown band on a gray background

A

Functional LM

179
Q

Regular brown band on a brown background

A

Lentigo

180
Q

Regular brown band with dark brown spots on brown background

A

Nevus

181
Q

Irregular brown band with asymmetric, unevenly space lines of variable length, proximal widening of the band

A

Melanoma

182
Q

Most common sites of ungual melanoma

A

Thumbs
Big toes
Index fingers
Middle fingers

183
Q

Periungual pigmentation

Represents periungual spread of the in situ component

A

Hutchinson sign

184
Q

Indicated rapid growth of ungual melanoma

A

Proximal widening

185
Q

Y/N: Ultraviolet exposure is associated with nail melanoma

A

No - not associated

Fitz 9th (108 decks)

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