Which of the following conditions is associated with nails?

AIIMS M.Sc. Nsg Entrance exam-2026

Medical & Surgical Nursing

Medium

Appeared in: AIIMS M.Sc. Nsg Entrance exam-2026

Explanation

The image shows splinter hemorrhages, which are thin, reddish-brown vertical lines under the nail plate.
These are a classic peripheral sign of infective endocarditis.
They are formed by microemboli (small blood clots) that travel from infected heart valves and damage the capillaries in the nail bed.
While trauma is a common cause, in a clinical context with other symptoms (like fever), they are highly suggestive of endocarditis.

Option A: Iron deficiency anemia is classically associated with koilonychia (spoon nails), where the nails are soft, thin, and have a concave shape, not with splinter hemorrhages.
Option B: Psoriasis is associated with several nail changes, including pitting (small depressions), onycholysis (nail separation), and oil drop spots, but not typically splinter hemorrhages as a primary sign.
Option D: Kidney disease is associated with other specific nail findings, such as Lindsay's nails (half-and-half nails) or Muehrcke's lines (transverse white bands), not splinter hemorrhages.

Visual 1: Diagram - An infographic comparing different nail abnormalities (Koilonychia, Beau's lines, Lindsay's nails, Pitting, Splinter hemorrhages) and their corresponding systemic diseases.
Visual 2: Image - A side-by-side comparison of a healthy nail and a nail with splinter hemorrhages to highlight the abnormality.
Visual 3: Flowchart - A diagnostic flowchart starting with 'Patient presents with nail changes' and branching out based on the type of change to suggest potential underlying conditions.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification of nail abnormalities and their association with systemic diseases as background academic context rather than a clinical decision trigger.
A thorough nail examination is a crucial and non-invasive part of a physical assessment that can provide vital clues to underlying systemic diseases.
Nurses are often the first to notice subtle changes like splinter hemorrhages during routine care. Promptly recognizing and reporting these findings can lead to earlier diagnosis and treatment of serious conditions like infective endocarditis.
What if? If the lines on the nail were white and ran horizontally across the nail, this would suggest Muehrcke's lines. This finding points towards severe hypoalbuminemia, which could be caused by kidney disease (nephrotic syndrome) or liver disease, shifting the diagnostic focus away from infective endocarditis.

How to Approach the Question

First, carefully examine the image to identify the specific abnormality presented. In this case, the key finding is the presence of thin, vertical, reddish-brown lines under the nail.
Identify this finding by its clinical name: splinter hemorrhages.
Next, review the provided options, which are all systemic diseases.
Recall or deduce the characteristic nail signs associated with each disease. For example, link iron deficiency to 'spoon nails' and psoriasis to 'pitting'.
Match the identified sign (splinter hemorrhages) with the most strongly associated condition. Splinter hemorrhages are a classic sign of infective endocarditis due to microemboli.
Eliminate the other options because their associated nail findings (koilonychia, pitting, Lindsay's nails) do not match what is shown in the image.

Concept Tested & Keywords

Concept Tested: Identification of nail abnormalities and their association with systemic diseases.
Stem keywords: nails, condition
Lead-in keywords: Which
Clinical cues: Visual identification of splinter hemorrhages in the provided image.

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