The "Medical Street game" - Part 2

This is the second part of "Medical Street game." The previous one was about how to diagnose diseases based on the patient's gait. This article may help you to diagnose by observing a person's nails and its surrounding tissue.

Firstly, focusing on the color of the nail may give us an idea of the underlying disorder.

  1. Pink/Red nail beds: Logically more red blood, gives red nail beds.
    More RBCs (Polycythemia vera).
    Inflammation leading to RBC sedimentation (Systemic lupus erythematosis),
    Increased oxygen retention by hemoglobin (CO poisoning).
  2. Yellow nails: Jaundice, diabetes mellitus
  3. Brown nails: Vitamin B12 deficiency, diabetes melliitus, syphilis.
  4. White: Anemia, kidney and liver problems.
    Horizontal white lines called Mee's lines occur in arsenic poisoning and kidney problems. They also occur in Ca deficiency

    Look for the following deformities in the nail:
  • Onycho-dystrophy happens post usage of bleomycin, hydroxyurea, or 5-fluorouracil. 
  • Onycho-madesis is the separation and falling off of a nail from the nail bed.
    Severe systemic illness is prone to cause the nail to fall off. It is sometimes a side effect of chemotherapy or radiotherapy.
  • Onycho-ptosis is the periodic shedding of nails and occurs in syphilis.
  • Koilonychia is spoon-shaped nails due to an iron or B12 deficiency.
  • Nail Pemphigus, is pemphigus of nails.
  • Nail clubbing is curved fingertips with bulging nailbeds associated with atherosclerosis and myocardial infarction.
  • Pitting nails is associated with Psoriasis.
Apart from these features brittleness, splitting and fraying are associated with various kinds of vitamin deficiencies.

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