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A 56-year-old woman presents with a nonpainful abnormal appearing second great toenail. She reports that this has been present for many years and denies a history of trauma. Examination reveals a thickened and yellow nail with multiple holes at the distal margin. Surgical exploration reveals a soft filiform papule in the matrix and cavities in the nail plate. Pathological examination of the tumor is most likely to reveal which diagnosis:

A. Blue nevus

B. Glomus tumor

C. Myxoid cyst

D. Onychomatricoma

E. Squamous cell carcinoma

D (onychomatricoma). Onychomatricoma is an uncommon benign tumor of the nail matrix that produces characteristic changes in the nail plate. Glomus tumors are usually painful. Myxoid cysts can be stable but will not produce a filiform tumor and usually present with a groove in the nail plate. Squamous cell carcinoma is usually progressive.

Paronychia, periungual pyogenic granulomas, and xerosis are associated with which of the following medications?

A. Epidermal growth factor receptor inhibitors

B. Hedgehog signaling pathway inhibitors

C. Histone deacetylase inhibitors

D. Serine/threonine-specific protein kinase inhibitors

E. Tumor necrosis factor inhibitors

E (tumor necrosis factor inhibitors). Paronychia, periungual pyogenic granulomas, and xerosis are associated with epidermal growth factor receptor inhibitors.

Dorsal pterygium is associated with which of the following diseases?

A. Alopecia areata

B. Lichen planus

C. Lupus

D. Psoriasis

E. Scleroderma

B (lichen planus). Dorsal pterygium is associated with lichen planus. Pterygium inversum unguis is associated with scleroderma and lupus.

A 60-year-old man develops diffuse yellow thickening of all his nails. The most appropriate consultation would be to:

A. Cardiologist

B. Dentist

C. Gastroenterologist

D. Nephrologist

E. Pulmonologist

E (pulmonologist). Yellow nail syndrome has an unknown pathogenesis, but is associated with chronic respiratory disorders. It can also be associated with lymphedema.

What is the approximate growth rate of normal toenails?


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