Nails

Question 1

How long is the contact time with phenol to destroy the nail matrix?

Answer 1

4 minutes

Question 2

What is the most common cause of erythronychia

Answer 2

onychopapilloma

Question 3

What virus is most likely to be associated with a nail involved SCC?

Answer 3

HPV 16

Question 4

What is the advantage of Bupivacaine over Lidocaine.

Answer 4

longer duration

Question 5

What is the cuticle?

Answer 5

It is the stratum corneum of the proximal nail fold.

Question 6

Where do you inject for a thecal block of the finger.

Answer 6

At the palmar digital crease

Question 7

What is the advantage of Ropivacaine over Bupivacaine?

Answer 7

1. has inherent vasoconstriction.
2. quick onset but long acting as well
3. Less cardiotoxicity

Question 8

80% of the nail plate is made by what?

Answer 8

Proximal nail matrix

Question 9

What is another chemical to destroy the nail matrix that may show faster healing than phenol

Answer 9

90% TCA + 10% NaOH

Question 10

What width of a pigmented band do you need to have more concern.

Answer 10

> 3mm

Question 11

Besides onychopapilloma and glomus tumor what two other growths may cause erythronychia?

Answer 11

warts

Bowens disease.

Question 12

In regards to pigmented bands of nails. What is the difference between activation and proliferation.

Answer 12

Activation is when there are a normal number of melanocytes in the nail matrix, but they over produce pigment. Proliferation is when there is an increase in melanocytes and it could be either a benign (nevi lentigo) or malignant process (melanoma)

Question 13

What % of nail plate melanomas are amelanotic?

Answer 13

25%

Question 14

What are the most common sites of nail plate melanoma.

Answer 14

Thumb/ big toe or index finger.

Question 15

What is the most common nail malignancy.

Answer 15

SCC

Question 16

where are most of the melanocytes found in the nail unit.

Answer 16

Distal nail matrix

Question 17

which finger nerve block has the advantage of only one injection?

Answer 17

thecal nerve block in the digital palmar crease. Push needle down to bone and inject as you are withdrawing.

Question 18

What are the three main anesthetics in nail surgery.

Answer 18

Lidocaine
Bupivacaine
Ropivacaine

Question 19

Which has a better rate of cure for destroying the nail matrix surgery or phenol

Answer 19

Phenol 88%

Question 20

How is erythronychia formed?

Answer 20

There is a focal loss of ventral nail plate. Vascular bed Swelling occurs in the cavity sometimes with splinter hemorrhages. the nail may disintegrate distally.

Question 21

If you have painful erythronychia what should you think of?

Answer 21

glomus tumor.

Question 22

What is the maximum time to have a tourniquet on in nail surgery.

Answer 22

20 minutes.

Question 23

what percent of phenol is used to destroy nail matrix

Answer 23

88%

Question 24

Are nail melanoma more common in dark pigmented races?

Answer 24

Yes

Question 25

where do you inject for a wing block?

Answer 25

start in the proximal nail fold and work out to the lateral nail folds to the tip.

Question 26

Where do you inject for a digital block.

Answer 26

between the web spaces.