Nail Pathology Study

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Questions and Answers

Which of the following best describes the physical manifestation of nail clubbing?

Horizontal ridges extending across the nail plate.

A thinning of the nail plate with visible pitting.

Enlargement of the distal digit and a bulbous appearance of the nail. (correct)

A spoon-shaped depression in the nail plate.

A patient presents with koilonychia. Which of these is least likely to be an underlying cause?

Exposure to certain chemicals

Psoriasis

Iron-deficiency anaemia

Cardiovascular disease (correct)

What is the primary pathology behind the spoon-shaped appearance of the nail in koilonychia?

Hypertrophic changes of the soft tissue underneath the nail plate.

An interruption to the normal growth pattern at the lunula.

The distal part of the nail matrix is lower than the proximal part. (correct)

A thickening of the nail matrix causing lateral compression.

Beau's lines typically manifest due to a temporary disruption in the nail's growth. Approximately how long after the initiating event does a Beau's line become visible on the nail plate?

Around one month following the initiating stress. Signup and view all the answers

Which condition is LEAST likely to cause Beau's lines on all nails?

A localized trauma to one nail Signup and view all the answers

What is the primary visual indicator of a subungual exostosis when observed beneath the nail plate?

A pink or cherry-red color that blanches under pressure. Signup and view all the answers

Which anatomical structure is primarily involved in the development of a subungual exostosis?

The dorsal aspect of the distal phalanx bone. Signup and view all the answers

Which of the following is a characteristic of the pain associated with subungual exostosis?

Constant and excruciating pain. Signup and view all the answers

What is the term for the surgical procedure to remove a subungual exostosis?

Exostectomy. Signup and view all the answers

Which of the following is NOT an etiology of a subungual exostosis?

Chronic fungal infection of the nail bed. Signup and view all the answers

What cellular components are primarily found in the 'mushroom-like' bony formation of a subungual exostosis?

Osteoblasts and osteocytes. Signup and view all the answers

Which nail pathology is characterized by a thickening of the nail plate?

Onychauxis Signup and view all the answers

In addition to signs and symptoms, what imaging technique is most directly used in diagnosing subungual exostosis?

X-ray imaging. Signup and view all the answers

Which of these is a key differentiator between acral fibromyxoma and subungual exostosis?

One is a bone outgrowth, the other is a soft tissue tumor. Signup and view all the answers

Which of the following nail conditions is most likely to result from repetitive trauma or ill-fitting footwear?

Subungual Haematoma Signup and view all the answers

What term describes a nail plate that curves inwards at the lateral edges, potentially leading to discomfort?

Involution Signup and view all the answers

A patient presents with transverse depressions across their nails. Which of the following nail pathologies is the most likely cause?

Beau's Lines Signup and view all the answers

Which of the following best describes the term 'onychocryptosis'?

An ingrown toenail Signup and view all the answers

Which of the following is NOT categorised as an acquired cause of nail pathology?

Congenital Signup and view all the answers

Where is the 'dorsal nail matrix' located in relation to the nail?

Proximal to the proximal nail fold Signup and view all the answers

What is the role of the hyponychium in nail anatomy?

It's the skin beneath the free edge of the nail plate Signup and view all the answers

Which of the following best describes a chronic injury?

An injury that develops gradually over time due to continuous trauma. Signup and view all the answers

What is the podiatry abbreviation for onychauxis?

O/X Signup and view all the answers

Which of the following is typically associated with the appearance of an onychauxic nail?

Yellow or brown discoloration of the nail plate Signup and view all the answers

What structural change in the nail is most directly responsible for the increased thickness in onychauxis?

Increased angle between the root matrices, causing vertical growth Signup and view all the answers

What is the impact of a shortened proximal nail fold in the pathogenesis of onychauxis?

Increases the angle between root matrices and changes nail growth direction Signup and view all the answers

Which of these factors is least likely to result in onychauxis?

Properly fitted footwear Signup and view all the answers

Besides observation of signs and symptoms, what is another important part of diagnosing onychauxis?

A comprehensive patient history Signup and view all the answers

What is the primary initial treatment method for managing onychauxis?

Nail reduction with nail nippers Signup and view all the answers

What is a key feature that differentiates involution from onychocryptosis?

Increased transverse curvature of the nail plate without skin penetration. Signup and view all the answers

Which of the following is the MOST appropriate initial treatment for onychocryptosis?

Removal of the nail spicule with or without local anesthesia. Signup and view all the answers

What does the term 'paronychia' specifically describe in the context of onychocryptosis?

Inflammation of the skin surrounding the nail. Signup and view all the answers

Which of the following is LEAST likely to be a cause of onychocryptosis?

Appropriate footwear. Signup and view all the answers

What is a defining characteristic of hypergranulation tissue associated with onychocryptosis?

It is prone to bleeding due to its vascular nature. Signup and view all the answers

If conservative measures for onychocryptosis fail, what is the next surgical option, after partial or total nail avulsion with phenolisation, in the treatment approach?

Skin surgery matrixectomy. Signup and view all the answers

What does the term 'sulci' refer to in the context of nail anatomy related to onychocryptosis?

The lateral folds of skin surrounding the nail edge. Signup and view all the answers

What is the expected first step after removing a nail spicule from the sulci during the conservative treatment of onychocryptosis?

Irrigation with sterile saline followed by dressing. Signup and view all the answers

What is the relationship between involution and onychocryptosis?

Involution may predispose an individual to onychocryptosis. Signup and view all the answers

In the progression of onychocryptosis, what is the result of the nail spike preventing wound closure?

Formation of hypergranulation tissue. Signup and view all the answers

Which of the following best describes the initial step in treating onychogryphosis?

Reduction of the nail using nail nippers Signup and view all the answers

What is the primary distinguishing characteristic of onychomadesis compared to onycholysis?

Onychomadesis involves proximal detachment of the nail plate. Signup and view all the answers

Which of these factors is LEAST likely to be an aetiological factor for onychogryphosis?

Sudden blunt force trauma Signup and view all the answers

What is the typical initial visual presentation of a subungual hematoma?

A red appearance from diffused blood. Signup and view all the answers

In the context of nail pathology, what does 'O/G' refer to?

Onychogryphosis Signup and view all the answers

What is the underlying cause of the uneven nail growth direction in onychogryphosis?

Uneven production of new cells due to damage to the nail matrix Signup and view all the answers

Which of these is a common feature of onycholysis?

White appearance caused by air trapped under the nail plate. Signup and view all the answers

What is the primary reason for potential discomfort associated with onychogryphosis?

Curvature of the nail into surrounding tissues or affecting other digits Signup and view all the answers

Which is the best description of the primary characteristic that defines onychauxis?

A thickened and deformed toenail that grows distally. Signup and view all the answers

Which is the most common initial complaint related to onychogryphosis amongst patients?

Difficulty managing nail care and fitting the nail into footwear Signup and view all the answers

What is the typical appearance of the nail surface in onychogryphosis?

Irregular and opaque Signup and view all the answers

After reducing the nail of a patient with onychogryphosis, what else needs to be done in treatment?

Remove any callus or debris around the sulci Signup and view all the answers

What treatment approach is typically recommended for onycholysis, besides trimming the detached nail back?

Treat any fungal involvement and moisture concerns Signup and view all the answers

What is the typical course of onychauxis if left untreated without surgical intervention?

The condition will recur Signup and view all the answers

How does increased pressure on the nail bed affect onycholysis?

It may cause inflammation and occasionally infection Signup and view all the answers

Study Notes

Nail Pathology

This is a study of nail conditions and abnormalities.

Learning Objectives

Understand nail terminology, presentation, causes and management of common nail pathologies.
Key pathologies include: Onychauxis, Onychogryphosis, Involution, Subungual Exostosis, Beau's Lines, Koilonychia, Onychocryptosis, Onychomycosis, Subungual Haematoma, Clubbing.

Nail Anatomy

Images and detailed drawings illustrating the structure and parts of the nail, including the dorsal plate, ventral nail plate, nail matrix, eponychium, proximal nail fold, distal nail fold, lunula, nail bed, hyponychium, and ventral nail matrix.

Causes of Nail Diseases

The causes of nail diseases are categorized as acquired and congenital problems.
Acquired: Trauma, infection, dermatological change, vascular issues, and tumours can contribute.
Congenital: Conditions present from birth.

Acute Trauma: Single, sudden injuries, such as stubbing a toe or being stepped on.
Chronic Trauma: Frequent injuries over a span of time, such as improper nail cutting, lack of maintenance, or ill-fitting footwear.
Anatomical changes may also be factors.

Onychauxis

Characterized by thickened toenails.
Podiatry abbreviation: O/X.
Possible causes: Fungal infection, vascular insufficiency, neglect/poor care, dermatological factors, microtrauma, and traumatic episodes.
Signs: Discoloration (brown/yellow), possible partial detachment from the nail base or subungual breakdown, abnormal thickening (hypertrophy) localized primarily on distal portion of nail, as well as possible transverse ridges.
Pathogenesis: Disorganized nail plate and proximal nail fold, shortened proximal nail fold, reduced strength to act against forces, increased angle between matrixes and increased vertical nail thickness.
Diagnosis: Visual observation of signs and symptoms, patient history, and potential lab tests
Treatment: Reduction with nail nippers/files first, then drill, and/or removal of debris/callus. Nail surgery might not be required.
Prognosis: Recurrence but manageable.

Onychogryphosis

Characterized by ridged, enlarged nail sulci, and discolouration of the nail.
Gross deformity, mimicking a ram's horn.
Possible causes: Trauma, peripheral vascular disease (PVD), fungal infections, eczema, psoriasis, poor nail care

Onycholysis

Refers to detachment of the nail plate from the nail bed.
Signs: Detachment of the nail, distal-to-proximal detachment, presence of half moon shape, and detachment from lateral edges.
Moisture and debris accumulation below the nail plate.
Discoloration may be yellow/brown if fungal infection present.
Underlying conditions may contribute
Possible causes: Trauma, fungal infection, psoriasis, allergic reactions, and systemic issues
Treatment: Nail trimming to proximal attachment, removing detached nail, addressing fungal involvement, and moisture concerns if necessary. Allergic responses should be assessed and allergens removed.
Prognosis: If trauma is addressed, the nail will likely regrow on its own; but can be recurring and involve a larger area.

Onychocryptosis

Ingrown nail with embedded spicule.
Podiatry abbreviation: O/C
Signs: Inflammation, oedema, bleeding/discharge, unpleasant odour, erythema (redness), heat; May be painful
Underlying conditions may contribute
Causes: Poor nail cutting techniques (picking of nails and skin, dermatillomania), trauma, involution of a more flexible nail, hyperhidrosis, maceration, ill-fitting shoes

Subungual Haematoma

Bleeding beneath the nail plate, often following trauma.
Signs: Initial redness, then black/purple discoloration from blood coagulation and oxidation.
Localized inflammation may be visible.
Pain may be present due to pressure buildup.
Possible causes: Sudden trauma, sport-related activities, systemic conditions (e.g., haemophilia).
Diagnosis: Observation of signs and symptoms, thorough history gathering, specifics about how it happened

Involution

Increased transverse curvature of the nail plate, possibly unilateral or bilateral.
May pinch into the skin, potentially a precursor to onychocryptosis
Treatment: Removing pressure, trimming/resection of offending portion, and possibly nail surgery (PNA/TNA with phenolisation).
Advice: Appropriate footwear, hygiene, and regular nail care.

Onychomycosis

Fungal infection of the nail plate.
Podiatry abbreviation: O/M
Can involve total dystrophic O/M, superficial white O/M, or distal medial and lateral O/M.
Pathogenesis: Fungi produce keratinase, breaks down keratin and affects the healthy nail plate
Causes: Dermatophytes (most common), yeasts, and molds.
Diagnosis: Visual signs & symptoms, laboratory testing (microscopy and culture).
Treatment: Topical, systemic (oral medications, e.g., terbinafine), possibly destructive treatments.

Subungual Exostosis

Bone outgrowth beneath the nail plate, commonly on the hallux.
Often very painful.
Possible causes: Idiopathic, trauma, ill-fitting shoes.
Could be associated with severe trauma to the hallux.
Diagnosis: X-rays
Treatments: Surgical removal (exostectomy)

Nail Clubbing

Distal enlargement of the digit, bulbous appearance to the nail plate.
No abnormality to the underlying phalanx.
Hypertrophic changes to surrounding soft tissues.
Possible causes: Certain cardiovascular disease, smoking, malnutrition, endocrine disorders, and aortic aneurysm.

Koilonychia

Spoon-shaped contour to the nail plate.
No changes to nail thickness
Possible causes: Iron deficiency anemia, dermatological conditions (psoriasis), occupational exposure to chemicals, some infections (onychomycosis)

Beau's Lines

Horizontal ridges or dents on one or more nails.
Appear at the lunula and then progress, typically superficial.
Possible causes: Systemic illness, trauma, severe mental stress, certain infections, toxins
Occurs about 1 month after initiating trauma.

Onychorrhexis

Brittle, vertical ridges form on the nail plate

Nail Pitting

Small, round depressions or notches in the nails.
Associated with some skin and autoimmune diseases (e.g., psoriasis, eczema.)

Chromonychia

Abnormality in nail color and pigmentation.
Examples include Leuconychia, Yellow Nail, Green Nail, Melanonychia.

Further Nail Pathologies

Onychophosis, Durlacher's Corn, Subungual Heloma Durum, Paronychia, Onychoschizia/onychoschisis, Onychomadesis, Pachyonychia, Onychotillomania, Onychopapilloma,

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Description

Explore the various conditions and abnormalities of nails in this comprehensive quiz on nail pathology. Learn about key terms, common pathologies, and the anatomy of nails, as well as the causes of nail diseases. Perfect for students and professionals in dermatology and related fields.