Hand/Nails

Question 1

Hand and Nails

Answer 1

Ask patient to hold hands out infront of you

Looking at hands and comparing both

Looking for symmetry

Looking for swelling, Bilateraly

Looking at palmar and dorsal surfaces

Describe findings
Pallor - Poor prefussion
Cyanosis - Blueish/purple associated with decreased oxygen
Long thin figers - asosciated with marfans

Question 2

Trauma

Answer 2

For trauma i can observe for

o Biting – Often can cause infection
o Subungual hematoma- crush injury
o Oncycholisis - trauma, diabetes, psoriasis, fungal infection
o Leukonychia- Can indicate iron deficiency

Question 3

Infection

Answer 3

o Paronychia- fungal (yellow pus) Infection of skin around nail

Question 4

Inflammation

Answer 4

o Splinter hemorrhages –infective endocarditis

Question 5

Dermatological

Answer 5

o Eczema- dry cracked skin
o Nail pitting - Psoriasis
o Melanoma- black vertical line in the nail
o Melanonychia- black under the nail

Question 6

Vascular insufficiencies

Answer 6

o Cyanosis – Blue nails, oxygen deficiency
o Raynaud’s Phenomenon – Change in colour distal tips of finger

Question 7

Staining

Answer 7

Staining nails (Nicotine, Fake tan, Occupation)

Question 8

Systemic diseases

Answer 8

o Yellow Nail syndrome - jaundice
o Red Nails- Carbon monoxide poisoning
o Blue Nails- cyanosis

o Nail Clubbing- Lung cancer, IE, HIV, IBS (Schamroth sign) (Shamroth window - diamond shaped gap)

o Nail spooning - Iron deficiency, malnutrition, trauma
o Beaus lines- SLE
o Nail pitting – SLE, Reactive arthritis (Reiter’s)
o Subungual hyperkeratosis
o Mee’s line- renal, cardiac failure
o Terry’s line -liver, heart, renal failure