Nails and Disorders of the Nail Apparatus

Question 1

Clubbing definition/etiology and associated disease

Answer 1

Proximal nail plate has greater than 180° angle to nail fold, watch-glass nails, bulbous digits

Cyanotic heart disease, bacterial endocarditis, pulmonary disorders, GI disorders, etc.

Question 2

Koilonychia definition/etiology and associated disease

Answer 2

Spoon shaped nails

Iron deficiency, malnutrition, DM

Question 3

Onycholysis definition/etiology and associated disease

Answer 3

Separation of nail plate from nail bed

Psoriasis, dermatophytes, thyroid disease

Question 4

Onychogryphosis definition/etiology and associated disease

Answer 4

Hypertrophy of the nail plate producing a curved, claw-like deformity

Poor circulation, chronic inflammation, tinea

Question 5

Onychohemia definition/etiology and associated disease

Answer 5

Subungual hematoma

trauma to nail bed

Question 6

Onychomycosis definition/etiology and associated disease

Answer 6

Fungal infection of nail (e.g. dermatophyte yeast, mould)

HIV, DM, peripheral arterial disease

Question 7

Onychocryptosis definition/etiology and associated disease

Answer 7

Ingrown toenail often hallux with congenital malalignment, painful inflammation, granulation tissue

Tight fitting shoes, excessive nail clipping

Question 8

V-shaped nicking definition/etiology and associated disease

Answer 8

Distal margin has v shaped loss of the nail plate

Darier’s disease (keratosis follicularis

Question 9

Pterygium inversus unguium definition/etiology and associated disease

Answer 9

Distal nail plate does not separate from underlying nail bed

Scleroderma

Question 10

Pitting definition/etiology and associated disease

Answer 10

Punctate depressions that migrate distally with growth

Psoriasis (random pattern), alopecia areata (geometric grid shaped arrangement), eczema

Question 11

Transverse ridging definition/etiology and associated disease

Answer 11

Transverse depressions often more in central portion of nail plate

Serious acute illness slows nail growth (when present in all nails = Beau’s lines), eczema, chronic paronychia, trauma

Question 12

Transverse white lines definition/etiology and associated disease

Answer 12

Bands of white discolouration

Poisons, hypoalbuminemia (Muehrcke’s lines)

Question 13

Yellow nail colour associated disease

Answer 13

Tinea, jaundice, tetracycline, pityriasis rubra pilaris, yellow nail syndrome, psoriasis tobacco use

Question 14

Green nail colour associated disease

Answer 14

Pseudomonas

Question 15

Black nail colour associated disease

Answer 15

Melanoma, hematoma

Question 16

Brown nail colour associated diseases

Answer 16

Nicotine use, psoriasis, poisons, longitudinal melanonychia (ethnic)

Question 17

Splinter hemorrhages definition/etiology and associated disease

Answer 17

Extravasation of blood from longitudinal vessels of nail bed, blood attaches to overlying nail plate and moves distally as it grows

Trauma, bacterial endocarditis, blood dyscrasias, psoriasis

Question 18

Oil spots definition/etiology and associated disease

Answer 18

Brown-yellow discolouration

Psoriasis

Question 19

Herpetic whitlow definition/etiology and associated disease

Answer 19

HSV infection of distal phalanx

HSV infection

Question 20

Paronychia definition/etiology and associated disease

Answer 20

Local inflammation of the nail fold around the nail bed

Acute: painful infection Chronic: constant wetting (e.g. dishwashing, thumbsucking)

Question 21

Nail fold telangiectasias definition/etiology and associated disease

Answer 21

Cuticular hemorrhages, roughness, capillary changes

Scleroderma, SLE, dermatomyositis