Hands Flashcards
What do you see here? What is it associated with?
Single palmar crease- Down’s syndrome
What do you see here? What is it associated with?
Short fourth finger- Turner’s syndrome
What do you see here?
Nicotine staining of fingers
What do you see here?
Clubbing
What is the definition of clubbing?
Loss of the nail bed angle- nail bed angle >190 degrees or Schamroth’s window sign is absent
What are the causes of clubbing?
Congenital (5-10%) and acquired (further subdivided into thoracic, CV, GI and endocrine)
What are the thoracic (respiratory) causes of clubbing?
Bronchiectasis
Cystic fibrosis
Empyema
Lung abscess
Mesothelioma
Fibroma
Pulmonary fibrosis
What are the cardiovascular causes of clubbing?
Cyanotic congenital heart disease
Infective endocarditis
Arteriovenous shunts and aneurysms
What are the gastrointestinal causes of clubbing?
Cirrhosis
Inflammatory bowel disease
Coeliac disease
What are the endocrine causes of clubbing?
Thyrotoxicosis (thyroid acropachy- Graves’)
What do you see here? What is it associated with?
Macroglossia- acromegaly, amyloidosis and tumour infiltration
What do you see here? What is it associated with?
Angular stomatitis (cheilitis). Numerous causes, including iron deficiency
What do you see here? What is it associated with?
Geographic tongue- often idiopathic, may be associated with B2 (riboflavin) deficiency
What do you see here? What is it associated with?
Glossitis- atrophy of papilla. Common in alcoholics and nutritional deficiency (B12, iron, folate) therefore associated with coeliac disease. May be associated with burning sensation.
What do you see here? What is it associated with?
Leukoplakia- thickened white patch that cannot be scraped off (if can scrape off- candida, associated with immunosuppression). May be pre-malignant
What do you see here? What is it associated with?
High arched palate- Marfans
What do you see here? What is it associated with?
Leukonychia (totalis)- hypoalbuminaemia
What are some causes of leukonychia totalis?
All causes of hypoalbuminaemia:
- Reduced albumin synthesis
- Chronic liver disease
- Urinary protein loss
- Nephrotic syndrome
- Protein-losing enteropathy
- IBD
- Coeliac
- Bacterial overgrowth
- Protein malnutrition
- Kwashiorkor
What do you see here? What is it associated with?
Leukonychia partialis- associated with minor trauma to nail bed e.g. from nail biting
What do you see here? What is it associated with?
Severe systemic illness which results in reduced nail growth
What do you see here? What is it associated with?
Yellow dystrophic nails- yellow nail syndrome (pleural effusions)
What do you see here? What is it associated with?
Splinter haemorrhages- infective endocarditis, trauma
>2 abnormal
What do you see here? What is it associated with?
Half and half nails- white/brown. Associated with CKD.
What do you see here? What is it associated with?
Koilonychia- spoon shaped nails. Associated with IDA and lichen planus
What do you see here? What is it associated with?
Onycholysis- nail separation from nail bed. Psociasis, fungal infection, trauma
What do you see here? What is it associated with?
Onychomycosis
What do you see here? What is it associated with?
Nail pitting- psoriasis, eczema, alopecia areata, lichen planus
What do you see here? What is it associated with?
Raynaud’s disease- pallor then cyanosis then redness (reactive hyperaemia)
Systemic sclerosis (referred to as Raynaud’s phenomenon), SLE, RA, atherosclerosis and vasculitides, iatrogenic (beta blockers, bleomycin) and occupational (prolonged use of vibrating tools)
