Term
_____ only is usually not enough to make the diagnosis with nail disorders.
Therapy is often difficult or unsuccessful |
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Definition
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Term
Nails protect the distal phalanx
Used for scratching and fine grasping
Diagnosis of disease can be difficult because a single disease can have variable presentations and a given nail malformation can be due to a variety of diseases. |
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Definition
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Term
Numerous disorders can affect the nails
- Drugs
- Physical factors
- Hereditary disorders
- Infections
- Tumors
- Systemic diseases
- Cutaneous diseases |
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Definition
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Term
| Confirm the diagnosis of fungal infection of the nails with ___ or ____. Cure requires ____ therapy |
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Definition
culture or KOH preparation
oral |
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Term
| ___ & ____ are synonyms for infection of the nail with dermatophytic fungi. |
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Definition
| Onychomycosis and tinea unguium |
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Term
| The most common etiologic dermatophytes in nail fungal infections are ____ & _____ |
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Definition
| Trichophyton rubrum and Trichophyton mentagrophytes |
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Term
Nail fungal infection Incidence
22 per 1000 = 2.2%
20% of the population in the USA between 40 and 60 years old have ___
Most common site are ____, especially in the ___ |
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Definition
onychomycosis
toenails
elderly |
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Term
Nail Fungal Infection History:
Onset is ___ and insidious
Often ____
____ is possible, may cause nail trimming problems and discomfort in shoes due to the thick, hypertrophic nail
May cause embarrassment because of nails’ distorted appearance |
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Definition
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Term
Nail Fungal Infection Physical Examination:
Dermatophytes most often infect the undersurface of the ____ nail
Resulting white/yellow/brown discoloration and accumulation of subungal debris with separation of the nail plate from the nail bed
Less often can infect the top surface of the nail and cause a white crumbly surface: superficial white onychomycosis
______ infection is a marker of HIV infection
Onychomycosis is associated with ____ & ____ |
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Definition
distal
Proximal
tinea pedis and tinea manuum |
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Term
| toenails or fingernails more commonly infected by fungi? |
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Definition
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Term
| Nail Fungal Infection Differential Diagnosis: (4) |
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Definition
Psoriasis
Eczema of the digits
Trauma
Aging |
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Term
Nail Fungal Infection Laboratory and Biopsy:
____ or _____ should be done before therapy because therapy is expensive and can have unwanted side effects with the ___.
More time must be allow for the KOH to dissolve the nail specimens compared to hair- otherwise microscopic examination may appear negative
Nail scraping should be obtained from .... |
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Definition
Fungal culture or KOH prep
liver
...as far back under the nail as possible |
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Term
Nail Fungal Infection Therapy:
____ antifungal agents ineffective due to poor penetration of nail plate
Oral therapy with (4)....
Retreatment only if fingernails unimproved after __ months and toenails after __ months because the antifungal medicine remains in the nail for months
Periodic monitoring of __ & ___ functions recommended -> Do a baseline then repeat it in one month |
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Definition
Topical
terbinafine, Lamisil, itraconazole, Sporanox.
6
12
hepatic and hematopoietic |
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Term
| ASYMPTOMATIC ONYCHOMYCOSIS OF TOENAILS NEEDS ___ TREATMENT |
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Definition
NO
- Risks and cost outweigh benefit |
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Term
Nail Fungal Infection Course and Complications:
____ and difficult to eradicate
20-30% failure rate with ___ therapy
Residual fungal ___ in shoes and environment likely responsible for recurrence
Topical antifungal (____ & _____) applied to the feet every week may be helpful for long term prophylaxis |
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Definition
Chronic
oral
spores
Tinactin, Lamisil |
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Term
Nail Fungal Infections Pathogenesis:
Direct extension of fungal involvement of the surrounding digital skin
Invasion and deformity of the nail are facilitated by fungal ____, which disrupt the keratin structure of the plate. |
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Definition
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Term
| Psoriatric nails can mimic _____ |
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Definition
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Term
| Psoriatric nails Definition: |
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Definition
| Nail dystrophy caused by psoriasis is the result of abnormal keratinization of the nail matrix and bed secondary to involvement of the structures with psoriasis |
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Term
______: Brown discolored nail with distal separation. Nail plate is thick and pitted. The epidermis is thick with hyperkeratosis
w/ psoriasis – the skin cells are turning over too fast – some are accelerated and some are normal so that’s where you get the different levels and ridges |
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Definition
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Term
Psoriasis Incidence
___ involvement in patients with psoriasis is common
10-50% |
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Definition
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Term
Psoriatic Nails History:
Usually _____
Cosmetic liability
Deformity of the toenails may cause ___ secondary to pressure from shoes |
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Definition
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Term
Psoriatic Nails Physical Examination:
All or a few nails involved
Unusual to involve only the nails, <5% with nail involvement alone
Small multiple ___ are characteristic
Brownish discoloration (_______)
___ of the nail plate, _____ (lifting of the nail), distal crumbling and _______. |
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Definition
pits
oil stain
Thickening
onycholysis
splinter hemorrahges. |
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Term
| toenails or fingernails affected more often in psoriatic nails? |
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Definition
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Term
Psoriatic Nails Differential Diagnosis: (6)
Note: nail pitting is occasionally associated with ___ |
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Definition
Onychomycosis
Trauma
Aging
Dystrophy secondary to eczema or other inflammatory process in nail fold area
Rule out fungal infection with KOH preparation and culture
Rule out Psoriasis- look for erythematous plaques with silvery scale on the scalp, elbows, knees, intergluteal fold
alopecia areata |
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Term
psoriatic nails Laboratory and Biopsy
___ rarely done |
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Definition
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Term
psoriatic nails Therapy:
Difficult and unsatisfactory
Often not recommended
Systemic medications (Methotrexate, Enbrel, Humira, etc.) not justified for nail disease alone
Trimming and cosmetics -> ____ |
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Definition
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Term
psoriatic nails Course and Complications:
Chronic
Waxing and waning
Associated with ____ _____ ______ ______
Secondary infections with ___ or ___ |
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Definition
distal interphalangeal joint arthritis
candida albicans or pseudomonas aeruginosa |
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Term
Secondary Infections in Psoriatic Nails:
Pseudomonas infection is easily recognized by ___ discoloration, treated with _____ solutions, 1-2 gtts TID. |
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Definition
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Term
Psoriatic Nails Pathogenesis:
Marked acceleration of the rate of epidermal cell replication resulting in proliferation of ____
When this occurs in the nail bed, excess keratin is trapped under the nail plate and _____ results
“_____” appearance is produced by keratinous debris and inflammation in the nail bed
Nail pits result from involvement of the nail ___ in which the psoriasis produce small defective ___ in the nail plate- as the nail plate advance, these defective portions fall out leaving behind the characteristic pits |
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Definition
keratinocytes
onycholysis
oil stain
matrix foci |
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Term
Acute paronychia is a ____ _____infection
Chronic paronychia is a ____ ____ infection |
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Definition
primary bacterial
secondary candidal |
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Term
|
Definition
| Inflammatory process of the nail fold |
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Term
Paronychia
Acute – bacterial – most often _________
Chronic- fungal – most often ___________ |
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Definition
Staphylococcus aureus
Candida albicans |
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Term
Predisposing factor in chronic paronychia is ___ or maceration producing a break in the cuticle which acts as a seal between the nail fold and the nail plate.
This break produces a pocket that holds ____ and promotes the growth of ___. |
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Definition
trauma
moisture
pathogens |
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Term
Paronychia Incidence:
Children who ......
Adults who do “____” work- ___, ____ & ____ |
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Definition
habitually suck their thumbs/ fingers
wet
homemakers, bartenders, janitors |
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Term
Paronychia History:
Acute paronychia develops ____ with marker ____ of the nail fold
Chronic develops ____ and initially goes unnoticed by patient- history of finger sucking or manicuring and wet work |
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Definition
rapidly
tenderness
insidiously |
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Term
Paronychia Physical Examination:
___ & ___ digits most commonly affected
____ paronychia is painful, red, swollen nail fold that may be accompanied by abscess or cellulitis
____ is characterized by loss of the cuticle, slight tenderness, swelling, erythema, and sometimes lifting of the nail. A purulent or cheesy discharge and deformity of the nail plate may be seen. |
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Definition
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Term
| Paronychia Differential Diagnosis: (1) |
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Definition
| Herpetic whitlow- Rule out with Tzanck preparation and viral culture |
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Term
Paronychia Laboratory and Biopsy
Acute paronychia that does not respond to appropriate antibiotic therapy should be cultured and possibly x-rayed to rule out ____
Chronic paronychia- Confirm with ___ examination of debris taken from under the cuticle
Culture if taken often reveals mixed flora, ___, and ____ species |
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Definition
osteomyelitis
KOH
bacteria
Candida |
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Term
acute Paronychia Therapy:
Acute paronychia should be incised and drained if fluctuant
Antibiotics: (3) |
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Definition
| cephalexin (Keflex), erythromycin, or dicloxacillin |
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Term
Chronic paronychia Treatment:
requires ___ of prolonged exposure to wetness
Gloves are mandatory, preferably cotton gloves under rubber or vinyl gloves
Avoid frequent washing and manicures
_____(clotrimazole and betamethasone) applied to affected area twice daily
TRAUMA, IRRITANTS AND EXPOSURE TO WATER MUST BE STOPPED TO CURE CHRONIC PARONYCHIA |
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Definition
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Term
Paronychia Course and Complications:
Acute paronychia is usually not a precursor of chronic paronychia
Will resolve after appropriate ____ therapy and incision and drainage
Chronic paronychia continues because of ____ mechanical trauma and water exposure predisposes it to the chronic infectious and inflammatory process |
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Definition
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Term
Paronychia Pathogenesis
_____ paronychia is caused by microorganism that produce swelling and inflammation of the nail fold
Interruption of the cuticle and wetness create an environment that foster the growth of yeast and bacteria
These microorganisms also cause inflammation of the nail ____ resulting in abnormal nail formation and subsequent nail _____ |
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Definition
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Term
Ingrown toenail causes a _______ reaction
Nail avulsion and matrix destruction is ____ |
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Definition
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Term
| Ingrown Toenail Definition: |
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Definition
| Ingrown toes nail occurs when the lateral portion of the nail plate grows into the lateral nail fold resulting in an inflammatory response |
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Term
Ingrown Toenail Incidence:
Common with the ____ toenails most commonly affected |
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Definition
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Term
Ingrown Toenail History:
____ & ____ are the symptoms that cause patients to seek medical attention. Usually problem has been present for weeks or months with an acute flare which may signal a ____ infection. |
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Definition
pain and swelling
secondary |
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Term
Ingrown Toenail Physical Examination:
Lateral nail fold is ____, ____ and has weeping ____ tissue. Nail plate is penetrating into the lateral nail fold. |
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Definition
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Term
Ingrown Toenail Differential Diagnosis:
Diagnosis seldom difficult because of typical presentation |
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Definition
|
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Term
| Ingrown Toenail Laboratory and Biopsy: |
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Definition
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Term
Ingrown Toenail Therapy:
Mild to Moderate- wear ____ shoes, trim nail plate straight across, antiseptics, _____ under nail may help.
Severe- ____ intervention necessary when conservative treatment fails or condition is severe. Partial or total nail plate avulsion followed by surgical or chemical (____) nail matrix destruction is usually curative. _____ tissue can be excised or cauterized. |
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Definition
wide
cotton pledget = run dental floss underneath to lift it out
operative
85% aqueous phenol
Granulation |
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Term
Ingrown Toenail Course and Complications:
Chronic
Pain, swelling, interferes with ____
_____ of the toe |
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Definition
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Term
Ingrown Toenail Pathogenesis:
Ingrown nail plate acts as a ______
Causes inflammatory reaction in the ____ nail fold |
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Definition
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Term
Which of the follow statements is true regarding onychomycosis?
Onychomycosis is associated with tinea pedis.
Onychomycosis is associated with eczema.
Onychomycosis is associated with histoplasmosis.
Onychomycosis is associated with oral thrush.
Onychomycosis is associated with psoriasis. |
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Definition
|
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Term
2. Psoriatic nails have all of the following except:
Pits
Deformed cuticle with pus pocket
Onycholysis (separation of the nail plate from the nail bed)
Thickening of the nail plate
Oil spots |
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Definition
| Deformed cuticle with pus pocket |
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Term
3. Concerning paronychia, which of the following statements is false?
Acute paronychia is a primary bacterial infection.
Chronic paronychia is a secondary candidal infection.
Acute paronychia is usually caused by Streptococcus pneumoniae.
Acute paronychia is usually caused by Staphylococcus aureus.
Interruption of the cuticle and wetness create an environment that foster the growth of yeast and bacteria. |
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Definition
| Streptococcus pneumoniae. |
|
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Term
5. Which of the following is false regarding fungal infection of the nail?
The physical appearance of the nail can be used reliably to make a diagnosis.
Confirm the diagnosis with culture or KOH preparation.
Cure may require oral therapy.
Onychomycosis is associated with tinea pedis and tinea manuum.
Therapy is often difficult or unsuccessful. |
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Definition
| The physical appearance of the nail can be used reliably to make a diagnosis |
|
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Term
| Clubbing of the nails due to ___ from heart or lung disease. |
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Definition
|
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Term
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Definition
|
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Term
|
Definition
|
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Term
|
Definition
|
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Term
|
Definition
|
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Term
|
Definition
| proximal fungal infection |
|
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Term
|
Definition
| psoriatic nails - candida infection |
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Term
|
Definition
| psoriatic nails pseudomonas infection |
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Term
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Definition
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