Nail bed Assessment

Question 1

3 parts of a normal nail discussed in class

Answer 1

Matrix
Nail bed distal to Lunula
Cuticle

Question 2

What does the matrix of the nail do?

Answer 2

Forms nail plate at proximal end

Question 3

Where does the matrix of the nail begin?

Answer 3

Around 3 mm beneath proximal nail fold

Question 4

How fast do nails grow?

Answer 4

Around 3 mm/month

Question 5

Where does the matrix of the nail end?

Answer 5

To distal end of the lunula

Question 6

Characteristics of nail bed distal to lunula

Answer 6

Highly vascularized and provides nail with pink color

Question 7

What does the cuticle do?

Answer 7

Seals and protects proximal nail fold and nail plate

Question 8

When blanching the nail bed, when should the color return?

Answer 8

In less than 3 seconds

Question 9

What can cause the color to not return to the nail bed in less than 3 seconds?

Answer 9

Arterial insufficiency

Vasospasm

Question 10

Onycholysis

Answer 10

Painless loosening of distal nail plate (fingers and toes can be affected)

Question 11

Causes of onycholysis

Answer 11

Dermatological conditions
Systemic diseases
Medications

Question 12

What dermatological conditions can cause onycholysis?

Answer 12

Dermatitis
Fungal disease
Psoriasis

Question 13

What systemic diseases can cause onycholysis

Answer 13

Myeloma
Neoplasm
Graves disease
Anemia
Reactive arthritis

Question 14

If onycholysis is caused by systemic disease, then…

Answer 14

All nail beds are affected

Question 15

What medications cause onycholysis?

Answer 15

Tetracycline
NSAIDS
Anti-cancer drugs

Question 16

Photo-onycholysis

Answer 16

Onycholysis that develops after exposure to the sun

Question 17

Koilonychia

Answer 17

Thin nails with lateral edges tilted upwards giving a concave appearance

Question 18

Koilonychia is also known as

Answer 18

Spoon nails

Question 19

Characteristics of Koilonychia

Answer 19

Can be congenital or acquired

Question 20

How can Koilonychia be acquired?

Answer 20

Hypochromic anemia (iron deficiency)
Poorly controlled diabetes (>15 years)
Chemical irritants
Thyroid problems
Syphilis
Rheumatic fever
Can be due to local injury

Question 21

Beau’s lines

Answer 21

Transverse groves or ridges across nail plate due to decreased or interrupted nail production by the matrix

Question 22

What can cause Beau’s lines?

Answer 22

Acute illness or systemic insult

Question 23

What kinds of acute illness or systemic insult can cause Beau’s lines?

Answer 23

Chemotherapy
Peripheral vascular disease
Eating disorders
Cirrhosis (chronic alcohol use)
Myocardial infarction (recent)

Question 24

Initial onset of Beau’s lines formula

Answer 24

Distance from cuticle to Beau’s line + 3 = number of weeks since insult

Question 25

Splinter hemorrhages

Answer 25

Red-brown linear streaks found on nail

Question 26

What can cause splinter hemorrhages?

Answer 26

Can be sign of silent MI or result of history of MI
Systemic disorders (*remember multiple nailbeds)
Local trauma (*one or 2 nailbeds)

Question 27

Systemic disorders that can cause splinter hemorrhages

Answer 27

Endocarditis
Vasculitis
Renal failure

Question 28

Where are splinter hemorrhages commonly seen?

Answer 28

In Cardiac Care Units (CCUs)