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J-overview Flashcards

1
Q

What is Onychomycosis? (also known as Tinea Unguium)

A

Fungal Disease that can affect one or more of the anatomical components of the toenails or fingernails.

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2
Q

Dermatophytes

A

Fungal Pathogens that invade and break down the normal keratin of the skin, hair and nails.

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3
Q

Three fungal species of Onychomycosis

A

Dermatophytes, Yeasts, and Nondermatophyte molds

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4
Q

Two most common Dermatophytes

A

T. rubrum and T. Mentagrophytes

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5
Q

Nail Dystrophy

A

Characterized by thickening, scaling, and discoloration of the nail and nail bed.

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6
Q

Keratin

A

Family of durable protein polymers that are found in epethelial cells. They provide structure strength to skin, nails, and hair.

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7
Q

Candida Albicans

A

the fungus that causes onychomycosis in the majority of cases caused by yeast

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8
Q

Non-Dermatophyte Molds

A

most frequently seen among elderly and the immuncompromised. Most common is Scopulariopsis, Acremonium and Fusarium.

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9
Q

Hyponychium

A

Thickened layer of the epidermis beneath the free end of the nail

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10
Q

Nail Unit

A

made up of the proximal nail fold (PNF), the nail matrix, the nail bed, and the hyponychium.

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11
Q

Lunula

A

crescent shaped area visible at the base of the fingernails, active area of nail bed growth

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12
Q

Eponychium

A

Horny structure from which the nail develops

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13
Q

Nail Plate Growth

A

Toenail growth is slower than fingernail growth.

  • fingernails grow appox 1/8inch per month - 6mths for complete
  • toenail grow aprox 1/16 inch per month-* 12-18 months for complete
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14
Q

Types of Onychomycosis

A
  • Distal Lateral Subungual onychomycosis
  • White superficial onychomycosis
  • Proximal subungual onychomycosis
  • Candidal onychomycosis
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15
Q

Distal Lateral Subungual Onychomycosis(DSLO)

A

most common type of onychomycosis. Most often caused by T. rubrum/t. mentagrophytes. Starts as infection of hyponychium and distal or lateral nail bed. Moves subungually under the nail plate from the distal/lateral nail bed into the proximal nail bed and finally upward into the nail plate.

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16
Q

Signs and Symptoms of DSLO

A

-distal/lateral loosening of the nail from the nail bed
-yellow/brown discoloration
-hyperkeratosis(thickening and over growth.
may also progress to total dystrophic onychomycosis

17
Q

Hyperkeratosis

A

overgrowth of the horny layer of the epidermis(thickening of nail and overgrowth)

18
Q

Total Dystrophic Onychomycosis

A

Condition characterized by total destruction of the nail plate

19
Q

White Superficial Onychomycosis (WSO)

A

less common type of onychomycosis than DLSO. Pathogens invades through the nail plate, then moves into the nail bed and hyponychium. Most frequently caused by T. mentagrophytes.

20
Q

Signs and Symptoms of White Superficial Onychomycosis

A

-white dots or tiny punctures speckled across the surface of the nail, which gradually spread to involve the entire nail. Nail plate becomes white and crumbles as infection spreads.

21
Q

Proximal Subungual Onychomycosis

A

Rarely seen, caused primarily by T.rubrum. Invades the nail unit through the stratum corneum of the proximal nail fold. Seen frequently in patients with AIDS. May be presenting signs of AIDS.

22
Q

Signs and Symptoms of Proximal Subungual Onychomycosis

A

-white discoloration under the nail plate in the area of the lunula, with the nail plate remaining intact and the distal end of the nail unit appearing normal.

23
Q

Candidal Onychomycosis

A

Rare condition that may occur only in individuals with a chronic Candida infection of the skin and mucous membranes. Most common pathogen is Candida Albicans.

24
Q

Signs and Symptoms of Candidal Onychomycosis

A
  • Thickening of the nail bed
  • yellow-brown discoloration of the nail plate
  • swelling of the proximal and lateral nail folds that result in a “drumstick” appearance of the digits.
25
Q

Mild Onychomycosis

A

Less than 25% of nail affected by disease

26
Q

Moderate Onychomycosis

A

26% to 74% of nail affected by disease

27
Q

Severe Onychomycosis

A

More than 75% of nail affected by disease

28
Q

Diagnosis of Onychomycosis

A 
Clinical
-Primary Criteria is white/yellow or orange/brown 
 patches or streaks
-Secondary is Onycholysis, Subungual 
 hyperkeratosis/debris, and Nail plate thickening
Lab
-Positive microscopic evidence
-Positive Culture of dermatophyte
29
Q

Onycholysis

A

loosening or detachment of the nail plate from the nail bed

30
Q

Lab Evaluation

A

DLSO- specimen taken from Nail bed and scrapings under nail
WSO-specimen taken from the nail plate
PSO-specimen taken from the proximal nail bed

31
Q

KOH

A

Microscopic evaluation of a potassium hydroxide preparation of the specimen only detects the presence or absence of fungi. Cannot specify which pathogen is present. Stain may help identify presence of fungi.

32
Q

Culture

A

The only method of determining which genus and species of fungi is responsible for the infection.

33
Q

Periodic Acid-Schiff (PAS)

A

Pathologist uses a fungal stain to help identify the presence of fungi. Like KOH, does not identify the specific pathogen.

34
Q

Mycological Cure

A

Negative mycology lab test (negative KOH and negative Culture)

35
Q

Clinical Cure

A

No residual involvement of the target nail
or
a predetermined percentage (80%-100%) of the nail that is visibly free of infection

36
Q

Complete Cure

A

No residual clinical involvement of the target nail
and
mycological cure (negative KOH and negative Culture)

37
Q

Nail Matrix

A

Thickened epitheliun at the base of a fingernail or toenail from which a new nail substance develops.

38
Q

Poor Prognosis for a Cure

A
  • subungual hyperkeratosis >2mm
  • > 50% of the nail infected
  • Lateral nail Disease
  • Total Dystrophic oncyhomycosis
  • Elderly or AIDs patients

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