Question

A 45 year old woman presents to her family physician complaining that the big toe on her right foot is yellow and somewhat painful at times. She noticed the discoloration of her nail last week when she removed her nail polish, and has been avoiding wearing her normal summer sandals because she feels embarrassed. She is otherwise healthy and has no history of diabetes or peripheral vascular disease. Physical exam reveals a thickened, yellow first toenail on the right foot; the other nails appear healthy. Peripheral pulses are strong and equal. There are no rashes or lesions on the surrounding skin. What is the most appropriate initial step in management of this patient?

A. Griseofulvin
B. KOH examination of nail scrapings
C. Reassurance
D. Nail removal
E. Nail biopsy and culture

Answer 1

The most appropriate initial step in managing this patient's yellow and painful big toe is KOH examination of nail scrapings.

Step-by-step explanation:

The most appropriate initial step in managing this patient with a yellow and painful big toe on her right foot is B. KOH examination of nail scrapings. This is because the patient's symptoms and physical examination findings are suggestive of a fungal infection of the nail, also known as onychomycosis. KOH examination of nail scrapings can confirm the presence of fungal elements in the nail, guiding the further management and treatment options.