Nail Disorders

Question 1

what is pitting associated with?

3 things

Answer 1

• psoriasis
• eczema
• alopecia areata

Question 2

what is transverse ridging assoicated with?

3 things

Answer 2

• eczema
• paronychia
• psoriasis

Question 3

what is a beau line?

Answer 3

• transverse depression
• affects all nails
• stops nail growth

Question 4

what is a beau line assoicated with?

Answer 4

• acute systemic illness
• high fever, measles, mumps, pneumonia, etc

Question 5

what is onychorrhexis?

Answer 5

longitudinal bridging on the nail plate

Question 6

what is onychorrhexis associated with?

6 things

Answer 6

1. increased age
2. lichen planus
3. psoriasis
4. onychomycosis
5. Darier disease
6. habit of picking

Question 7

what is a longitudinal groove associated with?

2 things, 1 location

Answer 7

• digital myxoid cyst or wart
• overlying the proximal nail matrix

Question 8

how does median canaliform nail dystrophy present?

2 components

Answer 8

• feathery, central, longitudinal ridge with a fir tree pattern
• usually on the thumb nails

Question 9

what is median canaliform nail dystrophy associated with?

1

Answer 9

repetitive trauma

Question 10

what is onychogryphosis?

Answer 10

a thick, hard, curved nail plate in the shape of a Ram’s horn

Question 11

what is onychogryphosis associated with?

3

Answer 11

• increased age
• psoriasis
• trauma

Question 12

what is leukonychia?

Answer 12

white spots on the nails

Question 13

what is leukonychia thought to be from if the white spots are transverse?

Answer 13

manicuring

Question 14

what is leukonychia associated with?

3 things

Answer 14

• familial
• hypoalbuminemia
• chronic renal failure

Question 15

what does koilonychia look like?

Answer 15

thin, spoon shaped nail

Question 16

what is koilonychia associated with?

5 things

Answer 16

• iron deficient anemia
• DM
• protein deficiency
• connective tissue disease
• exposure to solvents

Question 17

Onychomycosis

which fungi/yeast cause this?

2, 1

Answer 17

• Trichphyton rubrum, Tinea interdigitale
• yeast: candida albicans

Question 18

Onychomycosis

common in who?

Answer 18

older age

Question 19

Onychomycosis

often results from?

Answer 19

untreated…
* tinea pedis
* tinea manuum

Question 20

Onychomycosis

clinical presentation

Answer 20

• subungual hyperkeratosis, onycholysis, scaly or flaky patches under the nail, pis ,brittle nails

Question 21

Onychomycosis

Dx

Answer 21

1. KOH exam
2. Periodic Acid-Schiff test (most sens)

Question 22

Onychomycosis

Tx

Boards vs real life vs OTC

Answer 22

1. Boards: terbinafine PO
2. practice: topical antifungals
3. OTC: vicks

Question 23

Paronychia

acute vs chronic

Answer 23

• acute < 6 wks
• chronic > 6 wks

Question 24

Paronychia

inflammation of?

Answer 24

skin around a finger or toenail

Question 25

# Paronychia caused by which bacteria?

Answer 25

* skin flora (staph or strep) * oral flora (nail biting) * candida (chronic)

Question 26

# Paronychia pathophys

Answer 26

comonly occurs after penetrating skin trauma

Question 27

# Paronychia clinical presentation | 3

Answer 27

* rapid onset of painful erythema and swelling to the proximal/lateral nail folds * occurs within 2 to 5 days of local trauma * may have purulent discharge or superficial abscess

Question 28

# Paronychia tx when mild

Answer 28

* warm water * antiseptic soaks (chlorhexidine, povidone-iodine + topical antibacterial agent)

Question 29

# Paronychia tx when moderate

Answer 29

* oral abx (cephalexin, dicloxacillin, augmentin if nail biter)

Question 30

# Paronychia tx if MRSA

Answer 30

* trimethoprim-sulfamethoxazle DS * clindamycin * doxy

Question 31

# Paronychia abscess tx

Answer 31

* incision & drainage * warm soaks * abx if cellulitis

Question 32

# Felon clinical manifestation

Answer 32

severe, throbbing pain, erythema, swelling, and fluctuance to the pad of the fingertip

Question 33

# Felon general overview | 3 things

Answer 33

1. clsoed space infection/abscess 2. can be progression of paronychia 3. most commonly occurs after skin trauma

Question 34

# Felon tx | w & w/out flactuant

Answer 34

* w/out fluctant: elevation, warm water/saline soaks, oral abx (cephalexin) * w/ fluctant: incision & drainage