Pathophys-Day 3 Nails

Question 1

Beau’s lines what?

Answer 1

Transverse depressions of nail plate
Secondary to disrupted nail plate formation by matrix
If present in all fingers, indicates systemic dz

Question 2

Nail pitting is why?

Answer 2

Foci of abnormal keratinization in prox nail matrix

Seen in psoriasis, alopecia areata, eczema

Question 3

Nail pitting is a sign of what?

Answer 3

psoriasis, alopecia areata, eczema

Question 4

Trachyonychia is most commonly associated with:

Answer 4

Lichen planus, also alopecia areata and psoriasis, eczema

Question 5

True leukonychia is commonly associated with?

Answer 5

Arsenic poisoning, also thalium poisoning

Question 6

True leukonychia cause

Answer 6

Damage of distal matrix, usually due to trauma

Question 7

Koilonychia is a sign of

Answer 7

iron deficiency anemia

Question 8

Onycholysis

Answer 8

Distal nail plate detachment from nail bed; most commonly due to psoriasis or fungal nail infections

Question 9

What are some causes of apparent leukonychia?

Answer 9

Chemo or systemic diseases such as hypoalbuminemia

Question 10

What is splinter hemorrhage associated with?

Answer 10

Trauma and bacterial endocarditis

Question 11

Longitudinal melanychia causes

Answer 11

melanocyte activation, non-melanoma tumors, melanoma, melanoma hyperplasia, moles

Question 12

Longitudinal melanychia single vs multiple?

Answer 12

Single more suggestive of melanoma; multiple suggests systemic disease

Question 13

What is Hutchinson’s sign?

Answer 13

extension of pigment on to the nail folds, and it’s presence raises the concern for melanoma

Question 14

What causes a green nail and how do you get it?

Answer 14

Pseudomonas aeruginosa

Water, detergent, etc

Question 15

What is the Koebner phenomenon?

Answer 15

Skin disease occurring at sites of previous skin trauma or injury

Question 16

Psoriasis nail findings

Answer 16

Irregular pitting
Salmon patches / oil drop
Onycholysis with red border

Question 17

What causes lichen planus?

Answer 17

scarring of the proximal nail fold over the nail plate

Question 18

Alopecia areata nail findings

Answer 18

Geometric pitting

Question 19

Eczema nail findings

Answer 19

Beau’s lines
Subungual hyperkeratosis
Chronic paronychia (redness)

Question 20

Digital clubbing associated with

Answer 20

Pulmonary esp TB

Question 21

What are Muehrcke’s lines?

Answer 21

Apparent leukonychia with 2 transverse bands - assoc with hypoalbuminism

Question 22

Terry’s nails

Answer 22

White proximally with brown distal band - cirrhosis

Question 23

Autoimmune CT disorders cause these nail findings

Answer 23

Nail fold capillary issues
Cuticular hemorrhage
Dermatomyosis, scleroderma common to see

Question 24

Acute paronychia causes

Answer 24

S aureus or Strep pyogenes most common

Question 25

Chronic paronychia causes

Answer 25

Candida

Question 26

Recurrent episodes of acute paronychia should prompt -

Answer 26

HSV

Question 27

Warts

Answer 27

HPV
Periungual keratotic papules
Cuticular hyperkeratosis
Onycholysis
If won't go away, consider SCC

Question 28

HIV infection causes what nail finding?

Answer 28

proximal subungual onychomycosis (fungal infection)

Question 29

What is tinea unguium?

Answer 29

Fungal nail infection secondary to dermatophyte infxn, most commonly trichophyton rubrum

Question 30

Four basic patterns of onychomycosis?

Answer 30

Distal subungual
White superficial
PSO
Candidal onychomycosis

Question 31

Onychoschizia causes

Answer 31

(Brittle nails)

Frequent handwashing

Question 32

Chronic paronychia is usually caused by -

Answer 32

Candida

Question 33

Onychotillomania

Answer 33

Trauma-induced absence of cubicle and inflammation of proximal nail fold with abnormal surface abnormalities and maybe hemorrhage

Question 34

Subungual hematoma vs melanoma?

Answer 34

Hematoma moves with plate growth

Question 35

**Onychogryphosis is often seen in __

Answer 35

OLD PEOPLE

Question 36

Onychoryptosis AKA and causes

Answer 36

ingrown toenail

Congenital malalignment
etc

Question 37

Pyogenic granuloma

Answer 37

bleeding nodule, traumatic often cause

Question 38

Periungual fibroma is a sign of _

Answer 38

tuberous sclerosis (Koenen’s tumors)

Question 39

Myxoid cysts be careful because -

Answer 39

May be part of joint bursa so don’t want to pop and introduce infection

Question 40

Subungual exostosis is?

Answer 40

benign bony proliferation causing hard nodule, commonly from trauma, usually on toenails

Question 41

**What is the most frequent tumor of the nail apparatus and a common cause?

Answer 41

SCC, HPV 16

Question 42

Ungual SCC presentation

Answer 42

Verrucuous lesion, ulcerated nodules, onycholysis, nail plate destruction

Question 43

Ungual melanoma facts

Answer 43

Thumb usually
Hutchinson’s sign
Sometimes non-pigmented
Longitudinal melanonchyia

5 year survival just 15%