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Diseases » Paronychia » Tests

Diagnostic Tests for Paronychia

Contents

Paronychia Tests: Book Excerpts

Paronychia Diagnosis: Book Excerpts

Diagnostic Tests for Paronychia: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the diagnostic tests for Paronychia.

NAIL ABNORMALITIES: DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)

Focal abnormalities of one nail warrant a culture and sensitivity of any scrapings or exudates from the area, as well as an x-ray of the digit or extremity. A CBC and sedimentation rate will help identify an infectious process. A glucose tolerance test will help identify diabetes mellitus. Careful assessment of the area for vascular insufficiency includes Doppler studies and possibly arteriography. A nerve conduction velocity study and EMG may be necessary if peripheral neuropathy is suspected. A skin or nail biopsy may be helpful.

Routine tests for diffuse nail changes include a CBC, sedimentation rate, chemistry panel, VDRL test, ANA, thyroid profile, chest x-ray, and EKG. Arterial blood gases and pulmonary function studies should be done if clubbing is suspected. Other tests for clubbing will be found on page 82 . Serial blood cultures should be done if subacute bacterial endocarditis is suspected. Trichinella skin test or antibody titer should be done in cases in which there are splintered nails with negative cultures for subacute bacterial endocarditis. Muscle or skin biopsy will be useful not only for trichinosis but also for collagen disease. Nerve conduction velocity studies and EMGs will be helpful in diagnosing peripheral neuropathy.

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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003

Nail Phenomena/Clubbing: Diagnostic Approach
(Field Guide to Bedside Diagnosis)

Nails contain an archive of information about physiologic conditions affecting their growth, similar to the way tree rings record the weather of summers past. If examined closely, they may also contain the subtlest of clues to important
systemic illness, such as endocarditis.

Clubbing is most sensitively detected by loss of the normal nail angle when seen in profile, or by putting corresponding fingers back to back and looking for loss of the diamond of light. Springiness or ballotability of the base of the nail is another early sign. The overlying skin is smooth and shiny, and the nailbeds are cyanotic. Nails of patients with chronic paronychia may be confused with clubbing.

When clubbing is present, specifically examine for findings of associated illness including peripheral stigmata of endocarditis, murmurs, splenomegaly, jaundice, wheezes, rales, pleural effusion, supraclavicular adenopathy, hepatomegaly, abdominal mass, thyromegaly, and ophthalmopathy.

Unilateral clubbing may be caused by impairment of the vascular supply to the arm. Causes include aortic or subclavian artery aneurysm, anomalous aortic arch, pulmonary hypertension with patent ductus arteriosus, brachial arteriovenous fistula, superior sulcus lung tumor, and recurrent shoulder dislocation. Unidigital clubbing may be caused by median nerve injury or sarcoidosis. Clubbing of toes without fingers can be seen in coarctation of the aorta.

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Source: Field Guide to Bedside Diagnosis, 2007