Difficult Diagnoses at Your Fingertips: A Photo Quiz

Question 1:
A 49-year-old woman noted the gradual onset of reddish blue discoloration under one fingernail. There was both spontaneous pain and tenderness to palpation. The pain may be induced or worsened by exposure to cold.

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Question 2:
The dorsal surface of the left hand of a 37-year-old woman with severe Parkinson disease shows finger joint extensor area hyperpigmentation, most prominent over the proximal interphalangeal joints. Most cases of this patient’s condition are associated with obesity.

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Question 3:
A 32-year-old woman presented with a swollen, painful fourth digit on the right hand. While housecleaning, a traumatic erosion developed on the ipsilateral hyponychium. She continued her chores, putting the finger into dirty environments.

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Question 4:
A 41-year-old woman had pain in the pulp of her fingers and dorsa of her feet. A purplish red maculopapular lesion was noted on the pulp of her finger and was identified as an Osler node.

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Question 5:
A 26-year-old woman was upset about the appearance of her nails, which had been changing over a 6-month period. The 2 changes seen in the depicted nail are small pits and separation of the nail plate from the nail bed, or onycholysis.

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ANSWER KEY:

Question 1. Answer: c

Question 2. Answer: b

Question 3. Answer: a

Question 4. Answer: d

Question 5. Answer: c