1. Clubbing
2. Koilonychia
3. Onycholysispittingthickening
4. Colors: leuconychiayellowbluered Terry'smelanonychia
5. Nail bed: pallortelangiectasia
6. Splinter hemorrhages
7. Bands: Beau'sMees'Muehrke's

Clubbing

• What: when view fingernail from sideangle of base of nail is >160°.
• DDx: CLUBBING:
  • Cyanotic heart dz
  • Lung dz: hypoxialung CAbronchiectasisCF
  • UCCrohn's
  • Biliary cirrhosis
  • Birth defect [harmless]
  • IE
  • Neoplasm [esp. Hodgkins]
  • GI malabsorption
• Staging:
  1: Loss of normal 160° angle at base of nail. Schamroth's windowtest: pt's holds 2 index finger nails touching each together: if normalwill show a diamond-shaped window.
  2: AP curvature increased.
  3: Bouncyspongy nail when examiner presses down on nail.
  4: Drumstick shaped fingertip.
  5: Pt has wrist pain and wrist onion skinning.
  6: Hypertrophic osteopathy.

Koilonychia

• What: misshapenspoon-shaped nails.
• DDx:
  • Iron deficiency
  • Birth abnormalityrarely

Onycholysis

• What: distal nail separation.
• DDx:
  • Trauma
  • Psoriasis
  • Thyrotoxicosis

Pitting

• DDx:
  • Psoriasis
  • Atopic eczema
  • Allopeica areata

Thickening

• What: extremely thickened nailesp. great toe
• DDx:
  • Geriatric pt: onychogryphosis
  • Psoriasis
  • Local fungal infection 

Nail color: leuconychia

• What: leuco- means whitelike a leucocyte.
• DDx:
  • Hypoalbuminemia

Nail color: yellow

• DDx:
  • Nicotine stains
  • Yellow nail syndrome [peripheral edemabronchiectasispleuraleffusion] 

Nail color: blue

• DDx:
  • Cyanosis
  • Ochonosis
  • Wilson's [esp. lulunae of nails]
  • Blue-red: polycythemia

Nail colour: red

• DDx:
  • Cherry red: CO poisoning

Nail colour: Terry's nails

• What: distal half is brown-redwhile proximal half is white-pink.
• DDx:
  • Cirrhosis
  • Chronic renal failure

Nail color: melanonychia

• What: multiplebrownishlongitudinal streaks
• DDx:
  • Black pt: normal
  • White pt: melanoma under fingernails 

Nail bed pallor

• What: pallor of the flesh underneath the nails.
• DDx:
  • Anemia. See Anemias Reference.

Nail bed erythema/ telangiectasia

• What: flushed skin or distended blood capillaries below and around nailesp at nail base. See Skin Lesion Terminology Reference.
• DDx:
  • SLE

Splinter hemorrhages

• What: smalllinear hemorrhages under the nail.
• DDx: SPLINT:
  • Sepsis elsewhere
  • PAN/SLE/RA
  • Limey [vitamin C deficiency]
  • IE
  • Neoplasm [hematologic]
  • Trauma

Bands: Beau's lines

• What: multipleunpigmentedtransverse linesfrom an illness severeenough to transiently stop nail growth.
• DDx:
  • Shock Hx
  • Malnutrition Hx
  • Weight loss Hx

Bands: Mees's lines

• What: solitarywhitetransverse band
• DDx:
  • Renal failure
  • Chemotherapy
  • Arsenic ingestion

Bands: Muehrke's

• What: multipleopaquetransverse bands
• DDx:
  • Hypoalbuminemia
  • Chemotherapy

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