Spot the diagnosis, differencial diagnosis and treatment.

May be useful for General practitioners and Medical Students. Common Nail Findings associated with diseases. 1. BEAU'S Lines- These are transverse grooves or depressions parallel to the lunula. Caused by the conditions that cause the nail to grow slowly or even cease to grow for short intervals. The point of arrested growth is seen as a transverse groove. Often associated with - infections (Typhus, Acute Rheumatic Fever, AIDS) -Protein deficiency -Pellagra -Raynauds disease -Diabetes -Hypothyroidism -Hypocalcemia -Chronic Pancreatitis 2. MEES' Bands- White transverse line or band parallel to lunula resulting from poisoning or systemic illness.seen in -Chronic arsenic poisoning -Hodgkins disease -CHF -Leprosy 3. LINDSAY'S Nails- also called half & half nails. Proximal portion of Nail bed is whitish whereas distal part is red or pink. commonly associated with -Chronic Renal Failure -Azotemia 4. TERRY'S Nails - are white nail beds to within 1 to 2 mm of distal border of nail associated with -Hepatic Failure -Cirrhosis -Hypoalbuminemia -Chronic CHF -Hyoerthyroidism 5. SPLINTER HAEMORRHAGE. These are formed by extravasation of blood from longitudinal nail bed blood vessels to adjacent troughs. These are most often related to local, light trauma. Classically associated with -Subacute Bacterial Endocarditis. May be seen in -Leukemia -Vasculitis -Rheumatoid Arthritis -SLE 6. KOILONYCHIA - Spoon Nail is a dystrophic state in which the nail plate thins and a cup like depression. develops. Commonly associated with - Iron deficiency Anemia. 7. CLUBBING - Angle between the normal nail bed and finger is approx 160 degrees and nail bed is firm. This angle is referred to as LOVIBOND'S angle. When clubbing develops, this angle straightens out to be greater than 180 degrees & nail bed becomes spongy and has a bullous shape with exaggerated horizontal and longitudinal curvature. Most commonly associated with -Congenital Cyanotic Heart Disease -Cystic Fibrosis -Mesothelioma of Pleura -Pulmonary Neoplasms -Bronchogenic Carcinoma. 8. PITTING of Nails is seen in Psoriasis. SOURCE. TEXTBOOK OF PHYSICAL DIAGNOSIS. MARK. H. SWARTZ.

52 yr old female pt came wt pus discharge from gingival.. fbs 506 mg

54 years male patient complains of pain and swelling in the right lower thumb. since 6 months he is a diabetic patient hba1c is 8.3 cbc is normal uric acid is increased a bit no other systemic disease he is a driver by occupation doppler reports are attached. he is a chronic smoker. there is change in colour at the thumb region compared to the normal side what cud be the provisional diagnosis

65yr elderly man agriculturalist by occupatio, presented with history of flexion deformity of both hands. able to stretch the fingers partly with pain and difficulty. What is the diagnosis and treatment?