Nails Flashcards
If this disappeared when pressed, what systemic problem may be present?
Hypoalbuminemia (apparent leukonychia)
Name 3 diseases that may cause this finding.
Lupus
Scleroderma
Dermatomyositis (then need to screen for CA!!)
(This is cuticular hemorrhaging, which is a sign of autoimmune connective tissue disease)
Most common cause?
Trauma (Beau’s lines)
Condition?
Candidal onychomycosis
You had this finding in someone who was recovering from surgery. Dx?
PE (clubbing is commonly due to cardiopulmonary disease)
Where would you look to distinguish the cause of this finding?
Extensor and flexor surfaces
(Irregular pitting = eczema and psoriasis; flexor = eczema; extensor = psoriasis)
What general disease process may be underlying this finding?
Autoimmune connective tissue disease
(cuticular hemorrhage)
Finding illustrated here?
Pitting - abnormal matrix production that moves distally with nail growth
Which part of the nail plate is affected by this disease?
Ventral (bottom) nail plate
(Distal subungal onychomycosis)
Nail finding?
Koilonychia
(This is hypochromatic microcytic anemia, the most common cause of which is iron deficiency anemia)
Skin histology of this disease would reveal:
Inflammation at the dermal-epidermal junction
(This is lichen planus - scarring of nail fold over nail + fissuring of nail plate)
Histology of this condition would reveal:
Granulation tissue
(Onychocryptosis - ingrown nail)
Name 4 findings on this nail and the disease for which these are characteristic
Eczema
- Paronychia
- Subungal hyperkeratosis
- Irregular pitting
- Trachyonychia
Demographic in whom this finding is most common?
Kids
(Geometric pitting = alopecia areata)
If this patient had this finding since childhood, what testing could be done to distinguish the underlying cause?
Filaggrin mutation
(Irregular pitting = eczema or psoriasis; childhood points to eczema; congenital eczema due to filaggrin defect)
How would the organism cultured from this nail appear on gram stain?
Pointed ends
(P. aeruginosa)
Cause?
Pyocanin secretion by P. aeruginosa
Dx?
Myxoid cyst
(Swelling of nail fold + depression on nail plate + grooves in nail plate)
Tx?
Iron supplementation
First step in management?
UA/LFT
(Lindsay’s nails - half and half apparent leukonychia; points to CKD)
First step in management?
Biopsy for melanoma
(Single longitudinal melanonychia points to melanoma)
Name of this measurement? What does it suggest? What other sign related to this finding would you expect to be abnormal on physical exam?
Lovibond’s angle; >180 degrees suggests cardiopulmonary disease; Shamroth sign
Demographic?
Elderly
If this persists when the nail is pressed, two causes?
Arsenic or thallium poisoning
(True leukonychia)
This patient may have what type of mutation?
BRAF
(Hutchinson’s sign = longitudinal melanonychia runs onto nail fold = melanoma)
Name of this finding? Other related finding?
Muerckle’s lines
Edema
(Apparent leukonychia; hypoalbuminemia)
This “bump” may be attached to:
DIP
(Myxoid cyst)
Dx?
Psoriasis
(Onycholysis with erythematous nail beds)
Factors predisposing to this condition?
Hyperhidrosis, congenital misalignment, improper clipping
Demographic?
African Americans (90%)
(Longitudinal melanonychia)
Name of condition? Cause?
Onychogryphosis - asymmetric nail growth
4 disease which can cause this finding
- Psoriasis
- Onychomycosis
- SCC
- Warts
(Onycholysis)
Tx?
Cisplatin (SCC)
Tx?
Antipsychotics
(Onycotillomania - tic)
Cause?
Compulsive tic
Dx?
Subungal exostosis
(Bony proliferation seen on X ray)
Dx?
Eczema
(Irregular pitting + paronychia)
Your patient presents with this finding 5 times in the past two years. First step in management?
Check for HSV
(Remitting paronychia - HSV)
First step in management?
Check for tuberous sclerosis
(Periungal fibroma - associated with tuberous sclerosis)
Causes?
Congenital or ill-fitting shoes
Finding?
Punctant true leukonychia
Benign or malignant?
Bening
(Pyogenic granuloma = bleeding angiomatous nodule)
Mutation? Potential other causes?
p53, HPV/immunosuppression/chronic inflammation
(SCC)
A kid with this finding may have recently had what other illness?
Staph infection
(Splinter hemorrhage - infective endocarditis - most commonly caused by S. aureus in kids)
Cause?
Bony proliferation
(Subungal exostosis - benign tumor)
How to tell this from a melanoma?
This is a subungal hematoma, which will migrate distally with nail growth
Most common cause?
Cirrhosis
(Terry’s nails - few millimeters of brown-red distally - apparent leukonychia)
Causes?
- Lichen planus
- Psoriasis
- Eczema
- Alopecia areata
(Trachyonychia)
This can be caused by which serotypes of HPV?
2.4
(Common warts)
Cause?
Fungus
(White superficial onychomycosis)
