Nails

Question 1

Several nails with thinning and fissuring, and with dorsal pterygium

Answer 1

lichen planus

(dorsal pterygium = scarring of the proximal nail fold over the nail plate)

Question 2

White discoloration that fades with pressure; often due to chemo or systemic disease

Answer 2

apparent leukonychia

Question 2

What causes Green Nail Syndrome (a greenish-black or greenish-blue nail plate discoloration)

Answer 2

Pyocyanin, a blue–green pigment produced by Pseudomonas aeruginosa

Question 3

White, opaque discoloration due to damage of the distal matrix; no changes with pressure.

Answer 3

true leukonychia

Question 4

Transverse nail plate depression, resulting from (traumatic) disruption of the nail plate formation by the nail matrix.

Answer 4

Beau’s lines

Question 4

Affected area often connected to DIP joint and may drain joint fluid

Answer 4

Myxoid cysts (Digital Mucous Cyst)

Question 5

Associated with cardiopulmonary disease, sarcoidosis, cirrhosis, gastrointestinal disease, toxin exposures, trauma

Answer 5

clubbing

Question 6

Pitting is due to foci of abnormal keratinization in the (proximal/distal) nail matrix.

Answer 6

proximal

Question 7

Rough, rigid surface and proximal nail matrix damage associated with alopecia areata, lichen planus, psoriasis, eczema.

Answer 7

trachyonychia

Question 8

White proximally and brown-red distally; associated with chronic renal disease

Answer 8

Lindsay’s nails

Question 8

Nail fold capillary abnormalities and cuticular hemorrhages

Answer 8

A/I CT Disorders

common in dermatomyositis and scleroderma

Question 8

Fungal infection associated with immunocompromise (HIV)

Answer 8

Proximal subungual onychomycosis, most commonly from Trichophyton rubrum

Question 10

Transverse white bands usually associated with arsenic and thallium toxicity. Unchanged with pressure

Answer 10

Mees’ lines

Question 10

Over-curvature of the distal nail plate; can be hereditary or acquired

Answer 10

Pincer Nails

Question 11

Acute trauma > accumulation of blood under the nail plate; pigmentation moves distally with nail growth

Answer 11

Subungual Hematoma

Question 13

Multiple longitudinal brown-black bands

Answer 13

Longitudinal Melanonychia, often due to drugs or systemic disease

Question 14

Pink or skin-colored papules originating from the proximal nail fold; fibroma may compress the nail matrix, which produces a longitudinal groove in the nail plate

Answer 14

Periungual Fibromas

Question 15

Benign bony proliferation causes subungual, hard nodule; often due to trauma and confirmed with XR

Answer 15

Subungual Exostosis

Question 16

Proximal nail fold inflammation associated with absence of the cuticle; fingernails affected

Answer 16

Chronic Paronychia

*chronic irritation vs Candida

Question 17

distal superficial splitting (horizontally) of the nail plate

Answer 17

Onychoschizia

Question 18

Nail plate destruction and longitudinal melanonychia, most frequently in thumb

Answer 18

melanoma

Question 21

Foci of abn keratinization in the proximal nail matrix; characteristic of psoriasis, alopecia, areata, eczema.

Answer 21

pitting

Question 22

Irregulat pitting, Beau’s lines, subungal hyperkeratosis, chronic paronychia

Answer 22

Eczema

Question 23

Cuticle absent and proximal nail fold inflamed
Nail plate surface abnormalities (e.g. longitudinal central depression)
Melanonychia, hemorrhage and crust

Answer 23

Onychotillomania

Question 24

Distal nail plate detachment from the nail bed; often due to psoriasis or fungal inf.

Answer 24

onycholysis

Question 25

ingrown nails

Answer 25

Onychocryptosis

Question 27

Periungual keratotic papules, hyperkeratosis of the cuticle and onycholysis

Answer 27

Warts, from HPV

Question 28

Geometric pitting and trachyonychia (rough/ridges) Often in children

Answer 28

Alopecia Areata

Question 29

Verrucous lesion, ulcerated nodule, onycholysis, and nail plate destruction Often due to HPV

Answer 29

Squamous Cell Carcinoma

Question 30

White proximally with 1-few mm of brown-red distally; associated with cirrhosis

Answer 30

terry's nails

Question 31

"Spoon nails"; hereditary or caused by iron deficiency anemia.

Answer 31

koilonychia

Question 32

Multiple nails with pitting, Salmon patches, and nycholysis with erythematous border

Answer 32

psoriasis

Question 33

Apparent leukonychia with transverse white bands, associated with hypoalbuminism

Answer 33

Muehrcke’s lines

Question 34

Proximal matrix forms the ____ nail plate. Distal matrix forms the _____ nail plate.

Answer 34

dorsal ventral (disTal\>venTral)

Question 35

Often traumatic bleeding angiomatous nodule (periungual or subungual)

Answer 35

Pyogenic Granuloma

Question 36

Ram's horn nails, likely due to trauma and likely in elderly pts

Answer 36

Onychogryphosis

Question 37

_Acute_ swollen, red and painful digit; compression of the nail fold may produce purulent drainage.

Answer 37

Acute Paronychia, commonly due to Staphylococcus aureus or Streptococcus pyogenes

Question 38

Extravasated blood visible beneath nail plate caused by damage to longitudunally oriented nail bed capillaries. Associated with bacterial endocarditis

Answer 38

splinter hemorrhage

Question 39

Single longitudinal brown-black band

Answer 39

Longitudinal Melanonychia, possibly due to nail melanoma