Fingernail Quiz Res1

pl 2010

 Here is a little quiz which I hope you will enjoy and should be educational too! Medicine is a lot of fun as well as being a hard slog Go thro the slides and write down what you see and medical conditions the nail changes are associated with The second part of the PP presentation gives the slides again with the answers You may find you will be able to catch out some of your tutors. Probably the physcians not the surgeons!! Modified from Medscape thanks to them

 Fingernail abnormalities are commonly caused by skin diseases + infections but May also indicate more general medical causes Here are some examples: describe the changes seen and the possible cause [s]

No 1

No 2

No 3

No 4

No 5

No6

No 7

No 8

No 9

No 10

No 11

No 12

No 13

No 14

No 15

No 16

No 17

No 18

No19

No 20

No 21

No 22

And dont forget the toe nails

No 1

Clubbed fingernails
Softening of nail bed Loss of angle between nailbed and fold Increase in nail fold convexity Thickening of end of finger [drumstick]

Loss of diamond shaped window

Causes of Clubbing
Pulmonary and Cardiovascular cause [80%]
eg lung cancer,lung abcess, interstitial fibrosis, sarcoid,SBE aortic aneurism,pulm AV fistula

GI causes [5%]
eg IBD, sprue,neoplasms [oesophagus,liver,bowel]

Hyperthyroidism [1%]

No 2

Koilonychia [Spoon nail]

Concave nail normal in children Water drop test Iron deficiency anaemia [but also: diabetes,protein deficiency, SLE, Raynaulds disease]

No 3

Beaus Growth Arrest Lines

Transverse lines in substance of nail Indicate previous acute illness Causes include severe infection,MI, hypotension/shock, hypocalcaemia and surgery

No 4

Longitudinal striations
Called onychorrhexis Sign of advanced age or Rh A,PVD, Lichen planus ,Dariers Disease Central ridges occur in Fe defic,folic acid deficiency,protein deficiency

No 5

Central Nail canal [median nail dystrophy]

Associated with arterial disease Malnutrition Trauma

No6

Longitudinal brown lines

caused by increased melanin production by melanocytes of nail matrix
found in Addisons Disease breast cancer melanoma

No 7

Central nail canal with Fir tree

PVD

No 8

Nail Pitting
Small punctate depressions caused by nail matrix inflammation Psoriasis,alopecia.eczema,lichen planus

No 9

Nail Beading
Beads drip down like wax Diabetes,thyroid disorders,Addisons diasese vit B defic

No 10

Onycholysis
Distal separation of nail plate from nail bed Thyrotoxicosis,psoriasis,trauma,tetracycline eczema

No 11

Splinter haemhorrages
Caused by haemhorrage in the distal capillary loop Occur in: SBE,SLE,trichoniasis,pityriasis,psoriasis renal failure

No 12

Terrys half and half nail

proximal part is white and distal part dark
indicates renal or liver disease

No 12

Leuconychia White nails

Occur in
Anaemia,renal failure,cirrhosis,diabetes chemotherapy

No13

Mees Transverse White Lines

Any acute illness can cause these Seen in heavy metal poisoning [arsenic] chemotherapy

No 15

Black nails
occur with fungal infections haematoma beware the sub ungual melanoma

No 16

Black green nails

Occur in: trauma- haematoma use of topical preparations containing chlorophyl,methyl green and silver nitrate chronic pseudomonas infection [on R]

No 17

Yellow nails
may suggest:
diabetis mellitus,amyloidosis jaundice cigarette smoking median /ulnar nerve injury

No 18

Thickened nails
slow nail growth leads to thickened nails
associated with: fungal infections,eczema, pvd psoriasis, yellow nail syndrome

No 19

Abnormalities of lunula
absent suggests anaemia ,malnutrition
pale blue suggests diabetes pyramidal suggests trauma [xs manicure]

red suggests CV disease,collogen vasc disease or haematological malignancy

No 20

Peri ungal telangectasia

caused by dilated capillary loops with atrophy of the cuticle associated with collogen vascular disease SLE /scleroderma/ dermatomyositis

No 21

paronychia
associated with separation of the seal between the nail fold and nail plate this acts a portal of entry for bacteria with acute or chronic sepsis

No 22

Painted nails

Vanity, Vanity, Thy name is woman Shakespeare

PLEASE DO NOT THINK YOU HAVE TO KNOW ALL OF THESE

AND THE CAUSES!! Just the more common ones

I hope you enjoyed the quiz

pl 2010

No 21

No 21