A patient just came in to the ER department complaining of small streaky areas of reddish black patches under the fingernails for months prior to consult. She went to a beauty shop to have her some manicure, assuming the patches will disappear after manicure. But to her dismay, those patches are still there, hence the ER consult.
Splinter Hemorrhages on the fingernails (image from wikimedia.org)
Being a junior intern on duty, what are you going to ask to your patient?
The first thing to ask to your patient is if she had a very recent trauma or injury to her hands prior to her observation of those streaky areas of reddish black patches under her fingernails. If she said yes, then you can consider those as secondary to trauma.
Those small streaky areas of reddish black patches under the fingernails is actually called splinter hemorrhages. The most common cause of splinter hemorrhages is trauma to the fingernails or toenails. Other causes possibly are bacterial endocarditis, scleroderma, trichinosis, systemic lupus erythematosus (SLE), rheumatoid arthritis, psoriatic nails, antiphospholipid syndrome or malignancy.