CMP Nail Disorders & Treatment 2 — Questions and Answers
Question 1: A client presents with onycholysis of the big toenail following aggressive pedicure work. What is the most appropriate action?
- Apply nail hardener and polish over the separated area
- Refer the client to a podiatrist and avoid filing under the free edge (Correct answer)
- Soak the nail in bleach solution to prevent infection
- Trim the nail back to where it is attached and continue service
Correct answer: Refer the client to a podiatrist and avoid filing under the free edge
Onycholysis (nail-plate separation) can worsen with trauma under the free edge; referral is warranted if the cause is unclear or spreading.
Question 2: Which condition is characterized by an abnormal thickening and upward curvature of the nail plate, often seen in elderly clients?
- Koilonychia
- Onychogryposis (Correct answer)
- Beau's lines
- Leukonychia
Correct answer: Onychogryposis
Onychogryposis (ram's-horn nail) is a hypertrophic deformity common in older adults caused by poor circulation or repeated trauma.
Question 3: A pedicure client has transverse depressions running across all ten nails at the same relative position. These are most likely caused by:
- Chronic fungal infection of the nail bed
- A systemic illness or physiological stress that temporarily halted nail growth (Correct answer)
- Overuse of gel polish causing dehydration
- Trauma from ill-fitting footwear on each nail
Correct answer: A systemic illness or physiological stress that temporarily halted nail growth
Beau's lines appear across all nails simultaneously when nail growth is disrupted by systemic illness, high fever, or severe stress.
Question 4: When performing a pedicure on a client with mild clubbing of the toenails, a CMP should:
- Perform the service normally since clubbing is a cosmetic issue only
- Recommend cuticle removal to reduce the bulging appearance
- Note the condition, avoid aggressive services, and encourage the client to consult a physician (Correct answer)
- Apply acrylic overlays to reshape the nail
Correct answer: Note the condition, avoid aggressive services, and encourage the client to consult a physician
Nail clubbing can signal underlying cardiopulmonary or systemic disease and warrants medical evaluation.
Question 5: Which antifungal medication is commonly prescribed orally for onychomycosis because it incorporates into the nail plate as it grows?
- Metronidazole
- Terbinafine (Correct answer)
- Clotrimazole
- Fluconazole topical
Correct answer: Terbinafine
Terbinafine (Lamisil) is an oral allylamine antifungal that binds to the nail plate and is the first-line prescription treatment for onychomycosis.
Question 6: A client's toenail shows a dark longitudinal streak (melanonychia striata). The CMP's most appropriate response is:
- Buff the streak away during the pedicure
- Apply a dark polish to camouflage it and proceed with service
- Document it and strongly advise the client to have it evaluated by a dermatologist (Correct answer)
- Soak the nail longer to lift the pigment
Correct answer: Document it and strongly advise the client to have it evaluated by a dermatologist
Longitudinal melanonychia can indicate subungual melanoma, a serious malignancy, and must be referred for medical diagnosis.
Question 7: Pterygium unguis differs from a simple cuticle overgrowth in that it involves:
- Fungal invasion of the nail plate surface
- Permanent forward fusion of the proximal nail fold to the nail plate (Correct answer)
- Separation of the nail plate from the nail bed
- Yellow discoloration caused by lymphatic obstruction
Correct answer: Permanent forward fusion of the proximal nail fold to the nail plate
Pterygium unguis is an irreversible scarring of the proximal nail fold that fuses it to the nail plate, unlike normal cuticle that can be safely pushed back.
CMP Nail Disorders & Treatment 2
A client presents with onycholysis of the big toenail following aggressive pedicure work.
What is the most appropriate action?