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Proc Derm 2020 > Nail Surgery > Flashcards

Nail Surgery Flashcards

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Dermatology Board Prep flashcards
1
Q

The fingers and toes have paired sensory volar and dorsal digital nerves.

A

T

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2
Q

The dorsal nerves reach the distal phalanx of only the 2nd-4th digits.

A

F 1st and 5th only.

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3
Q

The distal nail bed attaches to the dorsal aspect of the processus unguicularis, a horshoe shaped rough bone excrescence at the tip of the distal phalanx.

A

T

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4
Q

The interosseous ligaments attach to the lateral spines of the processus unguicularis.

A

T

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5
Q

The germinative part of the nail unit is the cuticle and eponychium.

A

F Matrix and nail bed.

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6
Q

the distal or ventral matrix is the most proximal portion of the nail bed epithelium.

A

T

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7
Q

The nail bed extends from the matrix to the onychodermal band.

A

T

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8
Q

The nail plate is the product of the nail bed.

A

F Product of nail matrix.

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9
Q

Blood glucose levels are unimportant in diabetic patients undergoing toenail surgery.

A

F Need to be well controlled prior to toe surgery.

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10
Q

2-3mL of plain 2% lignocaine or prilocaine can be used per digit when performing a proximal digital block.

A

T

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11
Q

Splinting of the finger may be indicated after complex nail surgery

A

T

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12
Q

After nail surgery, it is not necessary to elevate the extremity.

A

F Should elevate for two days.

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13
Q

A transthecal block is performed from the dorsal crease of the MCP joint.

A

F Volar crease.

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14
Q

In a distal wing block, the injection points are distal to the DIP joint creases.

A

T

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15
Q

There is a general rule that the more superficial a nail change is, the more proximal the pathogenic process must be.

A

T

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16
Q

Nail clippings do not need to contain subungual hyperkeratosis.

A

F Should contain as much as possible.

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17
Q

Clippings performed for H&E give almost double the rate of positives compared to mycological culture.

A

T

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18
Q

A lateral longitudinal nail biopsy is appropriate for all diagnostic purposes, provided the nail pathology is in the lateral portion of the nail apparatus.

A

T

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19
Q

In a lateral longitudinal nail biopsy, a straight longitudinal incision starting at the distal crease of the DIP joint is carried to the tip about 2mm centrally from the lateral nail plate margin, and a second incision parallel to the first one along the lateral nail margin in the depth of the nail groove.

A

T

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20
Q

The lateral fold should be included in a longitudinal nail biopsy.

A

F

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21
Q

Matrix biopsies are the most important for most nail diseases.

A

T

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22
Q

A superficial matrix biopsy is unhelpful for diagnosing longitudinal melanonychia.

A

F

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23
Q

There will be no post-operative nail dystrophy after a superficial matrix biopsy, provided the biopsy is less than 1mm thick.

A

T

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24
Q

Biopsies of the proximal nail fold can be performed as a 2mm punch or as a narrow wedge with its base being at the free margin of the nail fold.

A

T

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25
Q

Distal nail avulsion is the classical method of nail avulsion.

A

T

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26
Q

During maneuvers in distal nail avulsion, the blunt tip of the elevator points away from the nail plate.

A

F Always points to the nail plate.

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27
Q

Distal nail avulsion is less traumatic than proximal nail avulsion.

A

F

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28
Q

Proximal nail avulsion is particularly useful when there is thick sunbungual hyperkeratosis.

A

T

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29
Q

Repeated nail avulsion causes thickening and overcurvature of the nail plate or nail dystrophy.

A

T

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30
Q

Matricectomy is the complete removal of the germinal matrix.

A

T

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31
Q

Nail ablation is definitive extirpation of the entire nail organ.

A

T

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32
Q

Matricectomy can be performed with surgery or adjunctive phenolisation, electroradiosurgery or carbon dioxide laser.

A

T

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33
Q

With total nail ablation, the incision is made just inferior to the hyponychium.

A

F Down to bone.

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34
Q

Large nail haematomas do not require any further investigation prior to treatment.

A

F x-rays are mandatory.

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35
Q

After trauma the nail plate is removed for appropriate examination of the mail bed and matrix, cleansed and stored under sterile conditions

A

T

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36
Q

Wet gauze only should be used to clean blood from the nail bed and matrix after nail trauma

A

F Sometimes 3% hydrogen peroxide is needed for cleaning

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37
Q

Approximately 20% of severe nail bed injuries have an accompanying fracture.

A

F 50%

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38
Q

Common sequelae of trauma of trauma on onycholysis, split mail, ptertgium, various nail dystrophies, hook nail and malalignment

A

T

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39
Q

Foreign bodies under the nail plate are generally not painful

A

F Intense pain.

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40
Q

Tetanus prophylaxis should be considered if wooden splinters are lodged under the nail plate.

A

T

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41
Q

Periodical clipping of the gryphotic nail is often adequate to keep it under control.

A

T Can perform warm foot bath to soften nail, or use 40% urea, 50% KI ointment.

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42
Q

Gryphotic nails tend to be firmly attached to the nail bed.

A

F Loosely attached.

43
Q

Phenolisation is ineffective for avulsing a gryphotic nail.

A

F Safest and easiest method.

44
Q

Nail avulsion with phenol involves vigorously rubbing liquefied phenol into the matrix and sulci for 2-3 minutes once the nail plate is removed.

A

T

45
Q

Pain after nail avulsion with phenol is typically severe.

A

F minimal

46
Q

Healing after nail avulsion with phenol takes 2-3 weeks.

A

T Should do daily foot baths while healing.

47
Q

50% sodium hydroxide can be used as an alternative to phenol for nail avulsion of the gryphotic nail.

A

F 10% sodium hydroxide.

48
Q

Nail spicules can occur if the lateral matrix horns are incompletely removed following surgical matricectomy.

A

T

49
Q

The most successful treatment for pachyonychia congenita is vigorous curettage plus electrodessication of the matrix.

A

T

50
Q

In pachyonychia congenita keratins 6a/16 and 6b/17 are present in the nail bed but not in the matrix

A

T 6a/16 – PC of Jadassohn-Lewandowsky
6b/17 – PC of Jackson-Lawler
Therefore a nail plate has normal structure but overlies a huge nail bed hyperkeratosis

51
Q

In pachyonychia congenital the nail plate production has to be eliminated because the nail plate formed in a correct manner by the matrix cannon adhere to the pathological nail bed

A

T

52
Q

Lateral longitudinal nail biopsies are used to narrow racket nails.

A

T

53
Q

Ingrown toenails are most commonly seen in neonates, infants and the elderly. .

A

F Adolescents and young adults

54
Q

Neonatal ingrown toenails should be treated aggressively.

A

F Conservatively. Daily massage with lubricant.

55
Q

Neonatal ingrown toenails are due to a distal nail wall resulting from too short a nail plate.

A

T

56
Q

Congenital hypertrophic lip of the hallux is characterised by a grossly hypertrophic medial nail fold

A

T

57
Q

Congenital hypertrophic lip of the hallux tends to disappear spontaneously after several months.

A

T

58
Q

Congenital malalignment of the great toenail refers to medial deviation of the long axis of the great toenail.

A

F Lateral deviation.

59
Q

Ingrown toenails in adolescents occur due to a wide curved nail and a narrow nail bed.

A

T

60
Q

In congenital malalignment of the great toenail, the malpositioned nail has no attachment with the nail bed.

A

T

61
Q

In congenital malalignment of the great toenail if the nail reattaches it will take on a normal appearance and its axis will be normal

A

F Axis will remain oblique

62
Q

Aside from its deviation, nails with congenital malalignment of the great toe nail otherwise appear normal.

A

F Grayish-green discolouration, oyster-shell like appearance.

63
Q

Oncyholysis is most important for the prognosis of congenital malalignment of the great toenail.
.

A

T

64
Q

Surgery is deemed necessary if there is no substantial improvement in congenital malalignment of the great toenail by the age of 2 years.

A

T

65
Q

Repair of congenital malalignment of the great toenail involves performed a cresenteric rotation flap

A

T

66
Q

Untreated nail malalignment inevitably will spontaneously resolve.

A

F Develops into early onychogryphosis.

67
Q

The mechanisms responsible for formation of a juvenile ingrown nail all lead to a relative compression of the tip of the toe, so that the distal end of the nail has no more room and grows into the lateral nail folds.

A

T

68
Q

There are three clinical stages of a juvenile ingrown toenail: 1. Erythema, oedema, pain on pressure 2. Infection and drainage 3. Granulation tissue and lateral nail wall hypertrophy.

A

T

69
Q

For the adolescent-type ingrown nail, surgical avulsion of the nail alone has a cure rate of 70%.

A

F Recurrence rate of 70%.

70
Q

Phenol cautery should not be used for treating adolescent-type ingrown nails due to its high recurrence rate.

A

F Has very low recurrence rate.

71
Q

A distal wall is commonly the consequence of avulsion of the big toenail or when it was cut very short for too long a time.

A

T

72
Q

Surgical treatment of a distal nail wall involves a fish mouth incision parallel to the distal groove around the tip of the toe.

A

T

73
Q

Treatment for retronychia is generally conservative.

A

F Nail avulsion by proximal approach.

74
Q

Pincer nails are characterised by transverse overcurvature increasing distally along the longitudinal axis of the nail.

A

T

75
Q

The pain associated with a pincer nail is usually unbearable.

A

F Surprisingly mild.

76
Q

Pincer nails can either have symmetrical or asymmetrical involvement.

A

T

77
Q

Surgical treatment of a pincer nail is aimed at flattening it.

A

T

78
Q

If acute paronychia does not improve after 2 days of treatment with antibiotics, surgical treatment is necessary.

A

T The nail matrix of children can be destroyed within 48 hrs of acute bacterial infection.

79
Q

Acute paronychia involves removal of the distal one-third of the nail.

A

F Proximal.

80
Q

Chronic paronychia is usually painful

.

A

F

81
Q

Chronic paronychia manifests with retraction of the perionychial tissue, detachement of the nail from the overlying thickened nail fold, and loss of the cuticle.

A

T

82
Q

Viral warts are the most common reactive tumours of the nail apparatus

A

T

83
Q

Cryotherapy of nail warts should be performed at 6 weekly intervals.

A

F Weekly or biweekly.

84
Q

Excision of ungual fibrokeratomas should be carried out around its base down to the bone.

A

T

85
Q

Subungual exostoses are commonly seen on the distal medial aspect of the terminal phalanx of the great toe.

A

T But may occur at any other digit.

86
Q

Myxoid cysts generally occur in the absence of any bone pathology.

A

F Assoc with degenerative OA of the DIP joint.

87
Q

There are no methods of determining whether a myxoid cyst is attached to the distal interphalangeal joint.

A

F Intra-articular injection of methylene blue will show connection.

88
Q

Epidermoid carcinoma (IEC and SCC) is the most frequent malignant nail tumour.

A

F Second most frequent. Melanoma is most frequent.

89
Q

Epidermoid carcinoma of the nail can present as longitudinal melanonychia.

A

T

90
Q

Metastases are common from epidermoid carcinomas of the nail.

A

F Rare.

91
Q

Carcinoma cauniculatum is a variant of verrucous carcinoma that rarely occurs under the nail. It should be excised with Mohs due to the high risk of metastasis.

A

F Almost never metastasizes, but everything else is true.

92
Q

Unugual melanomas are always pigmented.

A

F 66-75% are pigmented.

93
Q

Amputation of the digit in cases of ungual melanomas is associated with better survival rates.

A

F Conservatively operated pts have longer disease-free survival times.

94
Q

The treatment of unugual melanomas should also include sentinel lymph node biopsy.

A

F No unanimous opinion on this.

95
Q

The classical repair of a split nail is excision of the scar and meticulous repair.

A

T

96
Q

Matrix grafting is the treatment of choice for wide nail splits and most cases of pterygium.

A

T

97
Q

In nail surgery, tourniquets can be left on up to a maximum of 30 minutes.

A

F 20 minutes.

98
Q

Pain after nail surgery is common and may sometimes be excruciating

A

T

99
Q

Pain after nail surgery typically develops after 24-48hrs.

A

F This is suspicious for an infection.

100
Q

Pain starting 10 days or longer after nail surgery is suspicious for reflex sympathetic dystrophy and requires intensive treatment to prevent it from becoming chronic.

A

T

101
Q

Necrosis can occur after nail surgery if the sutures are too tight and not removed in time.

A

T

102
Q

Stiffening of the distal interphalangeal joint after nail surgery is uncommon.

A

F Common – pts should hold finger in physiologic flexion.

103
Q

The classical split nail repair is excision of the scar and meticulous repair. A narrow strip of nail is avulsed over the split, leaving the lateral portions attaches to the matrix and nail bed

A

T Great toe nail may be a superior donor site

104
Q

In repair of matrix defects in the case of a pterygium the depth of the proximal groove is recreated

A

T

Proc Derm 2020 (50 decks)

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