Onychomycosis

Question 1

The most common causative organism in fungal infection of the nail?

Answer 1

Trichophyton rubrum (T. rubrum) – dermatophytes

Question 2

What is the most common subtype of onychomycosis?

Answer 2

DLSO - distal and lateral sublingual onychomycosis

Question 3

DLSO onychomycosis presents with ____________ __________ debris under nail edge

Answer 3

crumbling yellow

Question 4

This subtype of onychomycosis is seen in immunosuppressed patients (marker for AIDS)

Answer 4

PSO - proximal subungal onychomycosis

Question 5

This subtype of onychomycosis is most common in children - it appears to have white and powdery patches on the nail

Answer 5

SWO - superficial white onychomycosis

Question 6

Chronic paronychia ( yeast onychomycosis ) is common in what type of occupation ?

Answer 6

frequent hand immersion in water

Question 7

Distal nail candidal infection is common with some forms of ?

Answer 7

PVD

Question 8

Chronic mucocutaneous candidasis (yeast onychomycosis) is often seen in ?

Answer 8

immunocompromised patients

Question 9

Topical therapy +/- debridement is first line in onychomycosis if:
1.
2.
3.minimal thickening
4. nail surface only
5. early DLSO or SWO
6. no previous topical therapy failure

Answer 9

1. < 2 nails
2. < 1/3 distal edge

Question 10

If someone is not a candidate for topical therapy onychomycosis what lab tests should be performed prior to initiating oral therapy ?

Answer 10

LFTs

Question 11

After LFT tests are done for someone who is not a candidate for topical onychomycosis therapy, what treatment should they receive if they have >60 % nail involvement ?

Answer 11

Oral Terbinafine

Question 12

After LFT tests are done for someone who is not a candidate for topical onychomycosis therapy, what treatment should they receive if they have <60 % nail involvement ?

Answer 12

Topical efinaconazole +/- Oral terbinafine ( if > 3 nails)

Question 13

Non drug options for prevention of onychomycosis?
1.
2.
3.

Answer 13

wear footwear/socks that minimize humidity
dry feat thoroughly after washing
keep nails clean and short

dont share clippers, wear gloves if hands often immersed, avoid barefoot in shared public spaces, apply emollients on cracked skin

Question 14

Which topical agent for the treatment of fungal nail infection has the highest mycotic and clinical cure rates?

Answer 14

Efinaconazole

Question 15

Ciclopirox - how often should the nails be cleaned ?

Answer 15

Weekly with isopropyl alcohol

Question 16

How long should topical therapy be for fungal nail infection?

Answer 16

48 weeks

Question 17

What is the preferred treatment for NON-DERMATOPHYTE nail infection ?

Answer 17

Itraconazole

Question 18

Between the 3 oral agents for treatment of nail infection which two require close monitoring due to CYP3A4 interactions?

Answer 18

Itraconazole and Fluconazole

Question 19

Serious adverse affect associated with fluconazole ?

Answer 19

QT prolongation

Question 20

When should fluconazole be used in treatment of fungal nail infections?

Answer 20

If Terbanfine or Itraconazole fail