Nails

Question 1

Beau’s Lines

Answer 1

• Transverse depression in nail plate surface

- Assoc: severe systemic event; trauma/disease of matrix

Question 2

Hapalonychia

Answer 2

-Soft nail plate

Question 3

Koilonychia

Answer 3

• (spoon nails)
• thin, concave nails w/ eversion of free nail edge
• Assoc: hereditary, physiologic (children), iron deficiency, thyroid abnormality

Question 4

Leukonychia, diffuse

Answer 4

• opaque or completely white nail plate

- Assoc. chemotherapy, white superficial onychomycosis, congenital disease

Question 5

Leukonychia, punctate

Answer 5

• white macules on nail plate

- Assoc: psoriasis, trauma to matrix

Question 6

Leukonychia, transverse

Answer 6

• narrow white transverse lines along nail plate

- Assoc: trauma to matrix

Question 7

Mee’s Lines

Answer 7

• tranverse lines of entire nail breadth in all nails

- Assoc: arsenic poisoning, trauma, medications, severe illness, psoriasis (flare)

Question 8

Onychomadesis

Answer 8

• detachment of nail plate from proximal nail fold –> shedding of nail
• Assoc: traumatic, medications (chemo), drug reaction (TEN), autoimmune diseases, systemic illness

Question 9

Onychorhexxis

Answer 9

-longitudinal ridging +/- fissuring of plate

_Assoc: lichen planus, chronic trauma, repeated wet/dry cycles, NORMAL WITH AGING

Question 10

Pitting

Answer 10

• punctate depression of nail plate surface (elkonyxis= large 2mm pits)
• Assoc: psoriasis, alopecia areata, eczema

Question 11

Red lunula

Answer 11

• pink to red spots within lunula

- Assoc: alopecia areata, RA, LE, CHF, CO poisoning

Question 12

Trachyonychia

Answer 12

• aka 20 nail dystrophy
• rough, thinned nails with longitudinal ridging
• Assoc: alopecia areata, lichen planus, psoriasis, eczema

Question 13

Apparent leukonychia

Answer 13

• white discoloration (fades w/ pressure); nail plate looks white but normal color
• Assoc: drugs (chemo) or systemic disease

Question 14

Oil spots

Answer 14

• brown spots under nail plate

- Assoc: psoriasis

Question 15

Onycholysis

Answer 15

• white discoloration at distal end where nail plate separated from bed
• Assoc: psoriasis, trauma, onychomycosis, medications (TCN, NSAID, PUVA), tumors, systemic diseases (hyperthyroidism), pregnancy

Question 16

Splinter hemorrhages

Answer 16

• thin, longitudinal red-brown lines along nail plate

- Assoc: trauma, psoriasis, fungal (distal), endocarditits, vasculitis, trichinosis (proximal)

Question 17

Half and half nails

Answer 17

• aka Lindsay’s nails)
• proximal halfe with white zone, distal half w/ red-brown zone
• Assoc: chronic renal disease

Question 18

Hutchinson’s sign

Answer 18

• periungual black discoloration

- Assoc: melanoma

Question 19

Muehrcke’s bands

Answer 19

• transverse white bands parallel to lunula

- Assoc: hypoalbuminemia, chemotherapy

Question 20

Melanonychia

Answer 20

• partial or diffuse

- Assoc: drugs, melanoma, Laugier-Hunziker

Question 21

Longitudinal melanonychia

Answer 21

• aka melanonychia striata
• vertical brown-black band (proximal to distal margin)
• Assoc: nevus, lentigo, drugs, trauma, melanoma

Question 22

Terry’s nails

Answer 22

• proximal 2/3 white nail color, distal 1/3 brown-pink band

- Assoc: cirrhosis, hypoalbuminemia, diabetes, cardiac disease

Question 23

Absent Lunula

Answer 23

• no visible lunula

- Assoc: yellow nail syndrome, renal failure, trauma

Question 24

Anonychia

Answer 24

• absence of nail

- Assoc: nail patella syndroem, COIF (congenital onychodysplasia of the index finger), scarring

Question 25

Blue lunula

Answer 25

- blue discoloration of lunula | - Assoc: Wilson's, drugs, PUVA, argyria, etc

Question 26

Brachyonychia

Answer 26

- short, wide nails | - Assoc: Rubinstein-Taybi syndrome, psoriasis

Question 27

Clubbing

Answer 27

- increase nail curvature w/ bulbous grwoth of tip of digit | - Assoc: chronic pulmonary disease, idiopathic, familial, systemic disease

Question 28

Dolichonychia

Answer 28

- long nails | - Assoc: Marfans, Ehlers Danlos, etc

Question 29

Dorsal pterygium

Answer 29

- wing-like growth fusing PNF w/ nail bed/matrix | - Assoc: lichen planus, epidermal bullosa, TEN, GVHD, TEN, cicatricial pemphigoid

Question 30

Habit tic deformity

Answer 30

- parallel horizontal grooves | - Assoc: caused by repetitive trauma to cuticle

Question 31

Macronychia

Answer 31

- large nails | - Assoc: congenital abnormality

Question 32

Median canaliform dystrophy

Answer 32

- inverted 'fir tree' (oblique lines from midline defect) | - Assoc: idiopathic or inherited

Question 33

Micronychia

Answer 33

- small nails | - Assoc: congenital defect (ie COIF- congenital onychodysplasia of the index finger)

Question 34

Onychauxis

Answer 34

- hypertrophic nail plate | - Assoc: may be due to chronic trauma

Question 35

Onychoatrophy

Answer 35

- reduction in size and thicness of nail plate | - Assoc: LP vascular insufficiency, systemic disorders, medications

Question 36

Onychocryptosis

Answer 36

-ingrown nail

Question 37

Onychogryphosis

Answer 37

- grossly thickened and long nail, resembling claw | - Assoc: inability to cut toenails, long-term pressure (shoes), neglect

Question 38

Onychophagia

Answer 38

-nail biting

Question 39

-Onychoschizia

Answer 39

- lamellar nail splitting | - distal lamellar separation into horizontal layers

Question 40

Onychotillomania

Answer 40

-chronic picking of nail

Question 41

Pachyonychia

Answer 41

- thickened nails | - Assoc: pachyonychia congenita

Question 42

Pincer nails

Answer 42

- overcurvature lateral portion | - Assoc: pressure (ill-fitting shoes), hereditary

Question 43

Platyonychia

Answer 43

- flat nail | - Assoc: inherited or acquired

Question 44

Racket nails

Answer 44

- distal phalanx short/wide | - Assoc: form of brachyonychia

Question 45

Subungual exostosis

Answer 45

- painful, bony subungual growth elevating nail plate | - Assoc: form of brachyonychia

Question 46

Triangular lunula

Answer 46

- triangular shape of lunula | - Assoc: nail-patella syndrome

Question 47

Ventral pterygium

Answer 47

- aka Pterygium inversum unguis - fusion of hyponychium to distal nail plate - Assoc: familial, trauma, systemic sclerosis, lupus erythematosis

Question 48

Yellow nails

Answer 48

- yellow color to nail plate | - Assoc: yellow nail syndrome, drugs, chronic enamel

Question 49

Yellow nail syndrome

Answer 49

-pulmonary disorder + lymphedema + yellow, slow growing nails with absent lunulae

Question 50

V-shaped nicking

Answer 50

- V-shaped nick at free margin | - Assoc: Darier disease