Hand And Nails Semiology

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Acral Lentiginous Melanoma (pic)

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Acral Lentiginous Melanoma description

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dark brown discoloration in nail bed

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Beau's Lines Description

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transverse INDENTED lines parallel to lunula
occurs after serious medical illness/infection/surgery

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Beau's Lines (pic)

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Clubbing Description

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Soft tissue growth at the nail bed. Greater ant-post distance vs. distal IP join. Takes months/years to develop.
In response to thoracic disease, think hypoxemias: cyanotic congenital heart disease, cystic fibrosis, pulmonary fibrosis, lung cancer and server hepatic cirrhosis. HAVE TO EXCLUDE OTHER CRITERIA BEFORE ACCEPTING COPD.

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Clubbing (pic)

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Koilonychia description

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"spooning of the nail" - curves up away from the nail bed. Classic finding in iron defeciency anemia.

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koilonychia (pic)

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Lindsay's nail description

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"Half and Half nails" - proximal portion is pale/white, while distal half is brown/pink/red. Associated w/ renal failure

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Mees' lines description

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transverse white band parallel to lunula. described with arsenic intoxication, thallium, lymphoma, malaria, and now most common is cancer chemo.

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Muehrcke's Lines descript

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two or mroe paired transverse white bands assoc w/ severe hypoalbuminemia (<2.2 g/dL)

DDX: Heart failure, Renal failure, decompensated liver failure (and secondary renal failure)

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Nail Pitting descript

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small depressions in the nail that are present in 50% of people with psoriasis (usually more severe cases)

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Onycholysis descript

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irregular separation of the naile plate from hyponychium. Trauma, psoriasis, hyperthryroidism (specifically Grave's Dz).

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Periungual fibroma (aka Koenen tumor) description

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flesh-colored papule of nail folds (usually toes) seen in 50% patients with tuberous sclerosis.

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Quitter's nail descript

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Cig smoking = orange-brown discoloration of nails of fingers holding the ci. A normal proximal nail indicated smoking cessation.

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Splinter Hemorrhages descript

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small brown/red streaks perpendicular to lunula, usually distal nail. Commonly traumatic, but also seen with microembolism from infectious endocarditis, scleroderma, and trichinosis (parasite).

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Terry's Nails Descript

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proximal paleness of anil with only a little preserved pink distal border (can appear dark). Seen with liver cirrhosis and other "severe medical conditions" (heart failure, poorly controlled DM, TB, hepatitis)

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Lindsay's Nails (pic)

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Mees' Lines (pic)

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Muehrcke's Lines (pic)

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nail pitting (pic)

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Onycholysis (pic)

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Periungual Fibroma (pic)

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Quitter's Nail (pic)

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Splinter Hemorrhages (pic)

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Terry's Nails (pic)

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Arachnodactyly

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long fingers assoc w/ Marfans! (wrist circumference<5th finger and thumb)

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Bouchard's Node description

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Bony Protuberance of proximal IP joint w/o inflammation. osteoarthritis

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Boutonniere deformity description

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extension at distal IPJ and flexion at proximal IPJ. severe chronic rheumatoid arthritis

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Dupuytren's contractures description

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shortening of finger flexors in the palm. idiopathic, EtOH abuse/EtOH cirrhosis

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Heberden's Node description

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bony protuberance of distal IPj w/o inflammation. osteoarthritis

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Janeway Lesion description

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painless, red macular lesion of palms/soles produced by embolism due to infectious endocarditis

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Joint hypermobility description

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dorsiflex 5th finger more than 90 degrees and/or appose thumb to flexor of forearm. suggests Ehlers-Danlos syndrome

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Large, fleshy hands description

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if rings don't fit anymore acromegaly

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Mechanic's Hands description

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Thickened, cracked and dirty appearing palmar skin. anti-synthetase syndrome variant of dematomyositis

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Osler node description

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PAINFUL red RAISED lesions on ventral surface of fingers/toes caused by IC deposition. Originally described with subacute bacterial endocarditis.
Hint from Morehead: "it would be painful to follow Osler (because he was so brilliant"

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Pallor of nail beds and palms description

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assoc w/ severe anemia.

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Swan Neck deformity description

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extension of proximal IP and flexion at distal IP. severe chronic RA

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Arachnodactyly (pic)

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Bouchards Node - OsteoA

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Boutonniere deformity - RA

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Dupuytren's contractures

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Heberden's node - OsteoA

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Janeway lesion *PAINLESS*

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Ignore arm thing

Joint hypernmobility - Ehlers-Danlos

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large fleshy hand - acromegaly

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Mechanics Hands - dermatomyositis

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Osler Node *RAISED AND PAINFUL!*

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Pallor of nail beds/palm/hand - anemia

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Swan Neck Deformity - RA

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Difference between Osler Node and Janeway Lesion?

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What to ask/further examine if you suspect Fe Deficiency?

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Examine nails (koilonychia), mouth (angular cheilosis) and tongue (atrophic glossitis). These are all signs of general malnutrition/anemia though.... for specific Fe Def Dx, ask about dysphagia, and especially pica!!!!

Also Chronic GI Blood loss can be assoc w/ Fe def

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You have an IV drug user and you're worried about endocarditis. What would you look for on PE?

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Ventral fingers/toes - Osler node or splinter hemorrhage

Palms/Soles - Janeway lesion

MSK - Septic Joint

Eye exam - Roth spots

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Why important to catch Marfans early?

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Most will have aortic root dilation, predisposing them to aortic dissection

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Findings in Alcoholism

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HTN
Dupuytren's Contractures
Enlarged lacrimal and parotid glands
Xophthalmos
Alcoholic Cardiomyopathy
Tom Wolfe's Sign

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Ulcerative face lesions, acute, with fever, in US:

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More likely blastomycosis than lupus vulgaris