Sx1: Nails

Front 1

The nail tissue is derived from

Back 1

Ectoderm

Front 2

What is it called on the side of the nail where it bends down towards the side of the toe?

Back 2

lateral nail fold

Front 3

What is the white part on the nail?

Back 3

Nail plate, Lunula

Front 4

The nail plate r lunula pushes out into "what"?

Back 4

The nail field.

Front 5

What is the pt of the nail at the distal end, inferior side, where it contacts the epidermis of the toe?

Back 5

The hyponichium

Front 6

Back 6

Front 7

Back 7

Front 8

Back 8

Front 9

Back 9

Front 10

Back 10

Front 11

Back 11

Front 12

Back 12

Front 13

Back 13

Front 14

Back 14

Front 15

Back 15

Front 16

What makes the nail so hard?

Back 16

Low water content, high sulfur content

Front 17

Nail functions to do what to tactile sense? Why?

Back 17

Nail augmetnts tactiel function by allowing for counter pressure during touch.

Front 18

What is the cellular makeup of the nail?

Back 18

it is a specialized Keratinized appendage

Front 19

Onychauxis

Back 19

Onychauxis presents with thickened nails without deformity, and this simple thickening may be the result of trauma, acromegaly, Darier's disease, psoriasis, or pityriasis rubra pilaris, or, in some cases, hereditary.[1]:783[2]

Front 20

Onychomycosis

Back 20

means fungal infection of the nail

Front 21

What sort of problems may require nail surgery?

Back 21

Onychauxis, onychomycosis, Diabetes mellitus, trauma, PVD, crummy environment,

Front 22

Onychogryphosis

Back 22

Rams horn growth of the fingernail

Front 23

Onychocryptosis

Back 23

Ingrown toenail

Front 24

What are the 6 etiologies of onychocryptosis?

Back 24

Trauma/microtrauma
Improper self care
Congenital,
osteochondroma/SUX
Ill fitting Shoes

Front 25

Paronychia

Back 25

The nail disease paronychia , is an often-tender bacterial or fungal hand infection or foot infection where the nail and skin meet at the side or the base of a finger or toenail. The infection can start suddenly (acute paronychia) or gradually (chronic paronychia).

Front 26

term for this appearane?

Back 26

Subungual Hematoma

Front 27

Pt Presents with this. Be sure to ? Why?

Back 27

Sub-ungual Hematoma, Xray, >50% of nail damaged should be examined for fractures

Front 28

Sub-Ungual Hematoma Etiologies?

Back 28

Trauma/microtrauma

Front 29

A pt presents with a subungual hematoma >50% of the nail, What is statistically involved, and what other dx should you consider?

Back 29

Generally >50%= fracture, should think nail bed laceration

Front 30

What is the most common skin cancer among people with deeper skin color?

Back 30

Acryl-lentiginous Melanoma

Front 31

Where does Acryl-Lentiginous Melanoma usually develop? What is its appearance?

Back 31

Palms, Soles, Nails, Appears brown or black with irregular boders

Front 32

Hutchinsons's sign is usually associated with what disease? what is the appearance?

Back 32

Acryl-lentiginous Melanoma, Spread of pigment into nail fold with resultant longitudinal dark stripe

Front 33

What is Black Heel? What causes it?

Back 33

punctuate hemorrhages on the heels of athleets who pay sports that involve frequent starts and stops. Resolves on its own.

Front 34

What are three trademark signs of psoriatic nails?

Back 34

Pitting, Oil Spots, Lysing

Front 35

What pre-op antibacterial is mentioned in lecture?

Back 35

Betadine swabsticks

Front 36

What is Dr. Jenkin's favorite tool for hemostasis?

Back 36

Tornicot

Front 37

What instrumentation is used in ingrown toenail procedures, in the proper order.

Back 37

Spatula or Freer elevator
English anvil
Beaver w/ #62 blade
Hemostat
Curette
Q-tip (for matrixectomy)

Front 38

Possible diagnosis?

Back 38

Psoriatic nails (actual)
could be fungal infection- (review pt. history)

Front 39

What dis?

Back 39

English Anvil/nial splitter

Front 40

What are the indications for a partial nail avulsion?

Back 40

Acute onychocryptosis
where only the borders are pathologic
Stage I for a II part permanent procedure (depending on infxn)

Front 41

According to Dr. Jenkins: should you wear gloves when giving injections, as if they are impermeable to needles.

Back 41

YES!!!

Front 42

Partial matrixectomy - ???= Partial evulsion

Back 42

Acid

Front 43

Indications for a total nail avulsion?

Back 43

Entire nail is pathologic
Underlying injuries (S.H, Laceration)
nail bed lesion (melanoma)
SUX sx

Front 44

What underlying nail injuries would be indicative of a total nail avulsion?

Back 44

An enromo subungual hematoma,
A laceration to nail bed

Front 45

What are the two Sx that are listed as indicative of total nail avulsion in the lecture?

Back 45

Part of tumor removal,
Distal symes amputation

Front 46

What are some Diseases that may necessitate a total avulsion?

Back 46

onychomycosis,
psoriatic nails
onychogryphosis

Front 47

Indications of a partial matrixectomy

Back 47

only nail borders are pathologic
CHRONIC onychryptosis?
site generally non-infected
When permanent change is preffered.

Front 48

What is a matrixectomy?

Back 48

Permanent remvoal of the matrix for all or a portion of the nail

Front 49

What are some methods of destroying matrix cells in matrixectomy?

Back 49

Surgical excision, chemical cauterization, laser, cryotherapy, radio waves (like AM radio ?!?)

Front 50

What are the two common chemicals used in matrixectomies?

Back 50

Phenol
Sodium Hydroxide

Front 51

How do you dilute the two most common chemcals used in matrixectomies

Back 51

Phenol- Alcohol
Sodium Hydroxide- Vinegar

Front 52

What is the application schedule for Phenol vs NaoH?

Back 52

3x60
vs
1x45

Front 53

Most general post op instructions.

Back 53

Keep clean and dry

Front 54

What are the two common chemicals used in matrixectomies?

Back 54

Phenol
Sodium Hydroxide

Front 55

Post-op Saline soak routine?

Back 55

3x/day
20min each
1Tblsp NaCL/ 1qt H2O
then cover that thang!

Front 56

How do you dilute the two most common chemcals used in matrixectomies

Back 56

Phenol- Alcohol
Sodium Hydroxide- Vinegar

Front 57

Does everyone have to soak post op?

Back 57

Yes... I mean, no.
could simply apply topical antibiotics and/or corticosteroids
Can use antibacterial gels also

Front 58

What is the application schedule for Phenol vs NaoH?

Back 58

3x60
vs
1x45

Front 59

what is the activity recommendation post Nail op?

Back 59

Activity as tolerated.

Front 60

Most general post op instructions.

Back 60

Keep clean and dry

Front 61

What is routine recommendation for pain post nail-op?

Back 61

Acetominaphen or ibuprofen are adequate

Front 62

Post-op Saline soak routine?

Back 62

3x/day
20min each
1Tblsp NaCL/ 1qt H2O
then cover that thang!

Front 63

What are some matrixectomy complications? Why?

Back 63

Infection/delayed healing/reoccurance
Strongly compliance related

Front 64

Does everyone have to soak post op?

Back 64

Yes... I mean, no.
could simply apply topical antibiotics and/or corticosteroids
Can use antibacterial gels also

Front 65

What are two reasons for issue reocurrance after nail procedure?

Back 65

Chemical/other are ineffective
Insufficient nail was removed

Front 66

what is the activity recommendation post Nail op?

Back 66

Activity as tolerated.

Front 67

What is routine recommendation for pain post nail-op?

Back 67

Acetominaphen or ibuprofen are adequate

Front 68

What are some matrixectomy complications? Why?

Back 68

Infection/delayed healing/reoccurance
Strongly compliance related

Front 69

What are two reasons for issue reocurrance after nail procedure?

Back 69

Chemical/other are ineffective
Insufficient nail was removed

Front 70

What are contraindications for Nail Surgeries?

Back 70

blood thinners/anticoagulants
Diabetics
PAD
Preggo
PM vs Avulsion

Front 71

How does insurance "see" the tx of nail infection surgeries?

Back 71

Not elective

Front 72

What are some indications for "sharp" nail surgery?

Back 72

Failed chemical/other
condition also requires tissue reduction (eg. Hypertrophic ungulabia)
MUST BE INFECTION FREE!

Front 73

What are the three Sharp procedures for nail reduction?

Back 73

Winograd
Frost
Whitney Acisional

Front 74

Explain Winograd Sx.

Back 74

Excision of matrix w/secondary purpose of debulking the excess tissue, use sutures that must be removed

Front 75

what is the Frost Technique?

Back 75

Same indications as winograd, uses sutures,
Cut nail plate, then cut L-shaped flap in eponychium, wedge incision to remove the offending nail plate, bed, matrix.Sutures to close

Front 76

Winograd - ?? = Whitney Acisional?

Back 76

Essential a winograd without incising the eponychium,
no sutures

Front 77

What are two procedures for a total nail matrixectomy?

Back 77

Zadik, Terminal Symes

Front 78

What is the zadik teqnique

Back 78

leave a proximal and distal flap to close the area where nail was removed.

Front 79

What is the terminal symes technique?

Back 79

No flaps like zadic, you just scrunch everything together and sew it up, toe looks considerably shorter.

Front 80

Procedure? Why do you think that?

Back 80

Terminal symes: just scruch everything together, toe becomes shortened.

Front 81

Procedure? How do you know that?

Back 81

Zadik: Has two flaps that are joined.

Front 82

Describe the Frost procedure

Back 82

Front 83

What is this? What type of nail Sx?

Back 83

SUX: total avulsion (unless you don't need to post bone Sx)

Front 84

What are post op care instructions for Sharp Matrixectomies?

Back 84

No soaking, clean and dry, refrain from activity please, more painflu.

Front 85

What are sharp matrixectomy complications?

Back 85

Infection/Pain/ Reocurrence
all have a higher rate with sharp techniques, but still strongly compliance related.