Nail Psoriasis and Other Inflammatory Nail Disorders Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Nail Psoriasis and Other Inflammatory Nail Disorders. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Nail Psoriasis and Other Inflammatory Nail Disorders Indian Medical PG Question 1: All are true about psoriasis except:
- A. Parakeratosis & acanthosis
- B. Pitting of nails
- C. Very pruritic (Correct Answer)
- D. Joint involvement in 5–30%
Nail Psoriasis and Other Inflammatory Nail Disorders Explanation: ***Very pruritic***
- While psoriasis can be itchy, it is generally not characterized as "very pruritic" compared to other dermatological conditions like **eczema** or **scabies**.
- **Pruritus** in psoriasis tends to be mild to moderate, and it is not a defining characteristic that differentiates it from other skin disorders.
*Parakeratosis & acanthosis*
- **Parakeratosis** (retention of nuclei in the stratum corneum) and **acanthosis** (epidermal hyperplasia) are classic histopathological hallmarks of psoriasis.
- These features reflect the rapid epidermal turnover characteristic of the condition.
*Pitting of nails*
- **Nail pitting**, onycholysis, and subungual hyperkeratosis are common and characteristic manifestations of psoriasis, affecting up to 50% of patients.
- These nail changes are highly indicative of **psoriatic involvement**.
*Joint involvement in 5–10%*
- **Psoriatic arthritis**, involving inflammation of the joints, affects approximately 5-30% of individuals with psoriasis.
- This statistic makes joint involvement a significant comorbidity of psoriasis.
Nail Psoriasis and Other Inflammatory Nail Disorders Indian Medical PG Question 2: Pitting of nails is seen in:
- A. Psoriasis and Alopecia areata (Correct Answer)
- B. Psoriasis only
- C. Psoriasis and Lichen planus
- D. Alopecia areata and Eczema
Nail Psoriasis and Other Inflammatory Nail Disorders Explanation: ***Psoriasis and Alopecia areata***
- **Nail pitting** is a very common and characteristic finding in **psoriasis**, resulting from defective keratinization of the nail matrix.
- While less common, nail pitting can also occur in **alopecia areata**, typically due to inflammation affecting the nail matrix.
*Psoriasis only*
- While **psoriasis** is a primary cause of nail pitting, stating it as "only" is incorrect as other conditions also present with this sign.
- This option incorrectly limits the differential diagnosis for nail pitting.
*Psoriasis and Lichen planus*
- **Psoriasis** does cause nail pitting, but **lichen planus** typically causes **longitudinal ridging**, splitting, subungual hyperkeratosis, and sometimes pterygium formation, rather than classic pitting.
- This option includes a condition that usually manifests with different nail changes.
*Alopecia areata and Eczema*
- **Alopecia areata** can cause nail pitting, but **eczema** of the hands or fingers more commonly leads to **nail plate dystrophy**, discoloration, ridging, or thickening, rather than distinct pitting.
- While eczema can affect nails, pitting is not its characteristic nail manifestation.
Nail Psoriasis and Other Inflammatory Nail Disorders Indian Medical PG Question 3: Which of the following conditions is characterized by specific nail changes such as pitting, onycholysis, and oil spots?
- A. Lichen planus
- B. Psoriasis (Correct Answer)
- C. Darier disease
- D. Onychomycosis
Nail Psoriasis and Other Inflammatory Nail Disorders Explanation: ***Psoriasis***
- **Psoriasis** characteristically causes several specific nail changes, including **pitting**, **onycholysis** (separation of the nail plate from the nail bed), and **oil spots** (yellow-brown discoloration resembling an oil drop under the nail).
- These nail manifestations are often indicative of underlying psoriatic disease, even in the absence of extensive skin lesions.
*Lichen planus*
- **Lichen planus** can affect the nails, causing longitudinal ridging, thinning, and sometimes pterygium formation, but typically not pitting, onycholysis, or oil spots.
- In severe cases, it can lead to permanent nail loss or scarring.
*Darier disease*
- **Darier disease** (keratosis follicularis) is characterized by specific nail findings such as longitudinal red and white streaks, V-shaped notching at the distal nail edge, and subungual hyperkeratosis.
- It does not present with the classic triad of pitting, onycholysis, and oil spots.
*Onychomycosis*
- **Onychomycosis** is a fungal infection of the nail that typically causes thickening, discoloration (yellow, brown, white), and crumbling of the nail plate.
- While it can cause onycholysis, it does not typically produce pitting or oil spots, which are more specific to psoriasis.
Nail Psoriasis and Other Inflammatory Nail Disorders Indian Medical PG Question 4: All are true about lichen planus EXCEPT:
- A. Spares oral mucosa (Correct Answer)
- B. Wickham's striae present
- C. Violaceous flat papules
- D. Koebner phenomenon positive
Nail Psoriasis and Other Inflammatory Nail Disorders Explanation: ***Spares oral mucosa***
- This statement is incorrect because **lichen planus frequently involves the oral mucosa**, presenting as white reticular lesions, erosions, or plaques.
- Oral involvement is common and can be the only manifestation of lichen planus.
*Wickham's striae present*
- **Wickham's striae** are characteristic **white, lacy reticular patterns** seen on the surface of lichen planus lesions, especially on the oral mucosa and cutaneous papules.
- Their presence is a classic diagnostic feature of lichen planus.
*Violaceous flat papules*
- Cutaneous lesions of lichen planus are typically described as **pruritic, polygonal, planar (flat-topped), purple (violaceous) papules and plaques**.
- This classic description helps in the clinical diagnosis of the condition.
*Koebner phenomenon positive*
- The **Koebner phenomenon**, or isomorphic response, refers to the development of new skin lesions in areas of trauma or injury.
- This phenomenon is often observed in lichen planus, where scratching or irritation can precipitate new lesions along the lines of trauma.
Nail Psoriasis and Other Inflammatory Nail Disorders Indian Medical PG Question 5: Pterygium of nail is seen in?
- A. Pemphigoid
- B. Psoriasis
- C. Pemphigus
- D. Lichen planus (Correct Answer)
Nail Psoriasis and Other Inflammatory Nail Disorders Explanation: ***Lichen planus***
- **Pterygium of the nail** refers to the forward growth of the proximal nail fold over the nail plate, often seen as a V-shaped scarring, which is a characteristic feature of severe **nail lichen planus**.
- Other nail changes in lichen planus can include **longitudinal ridging**, thinning, splitting, and anonychia.
*Pemphigoid*
- Bullous pemphigoid typically affects the **skin with tense blisters** and rarely involves the nails significantly.
- Nail changes are uncommon but if present, are usually non-specific, such as **subungual hematomas** or **onycholysis**, not pterygium.
*Psoriasis*
- Nail psoriasis presents with characteristic features like **pitting**, **onycholysis**, **oil-drop spots**, and **subungual hyperkeratosis**.
- While significant nail dystrophy can occur, true pterygium formation from the proximal nail fold is **not a typical finding** in psoriasis.
*Pemphigus*
- Pemphigus is an autoimmune blistering disorder characterized by **flaccid blisters** and erosions, primarily affecting the skin and mucous membranes.
- **Nail involvement is rare** and usually secondary to periungual blistering, leading to non-specific changes like paronychia or onychomadesis, not pterygium.
Nail Psoriasis and Other Inflammatory Nail Disorders Indian Medical PG Question 6: A patient presents with focal alopecia areata. All of the following are associations of alopecia areata except:
- A. Atopy
- B. Exclamatory mark
- C. Nail pitting
- D. Geographic tongue (Correct Answer)
Nail Psoriasis and Other Inflammatory Nail Disorders Explanation: ***Geographic tongue***
- **Geographic tongue** (benign migratory glossitis) is a benign inflammatory condition of the tongue and is generally not associated with alopecia areata.
- While its exact cause is unknown, it's typically linked to genetic factors or sensitivities rather than autoimmune hair loss.
*Atopy*
- **Atopy**, including conditions like **eczema**, **asthma**, and **allergic rhinitis**, is a well-established association with alopecia areata, suggesting a shared immune dysregulation.
- Patients with alopecia areata often have a higher prevalence of **atopic diathesis**.
*Exclamatory mark*
- The presence of **exclamatory mark hairs** (short, broken hairs that are narrower near the scalp) is a **pathognomonic sign** of active alopecia areata.
- These hairs indicate ongoing inflammation and destruction of the hair follicles.
*Nail pitting*
- **Nail pitting**, characterized by small depressions in the nail plate, is a common finding in patients with alopecia areata, reflecting an immune-mediated attack on the **nail matrix**.
- Other nail changes, such as **trachyonychia** (roughened nails), can also occur.
Nail Psoriasis and Other Inflammatory Nail Disorders Indian Medical PG Question 7: Which of the following conditions does NOT cause nail pitting?
- A. Lichen planus
- B. Fungal infection
- C. Pityriasis Rosea (Correct Answer)
- D. Psoriasis
Nail Psoriasis and Other Inflammatory Nail Disorders Explanation: ***Pityriasis Rosea***
- This condition primarily affects the **skin**, causing a distinctive rash of oval, pinkish-red patches, often preceded by a **herald patch**.
- It characteristically spares the **nails**, meaning nail pitting is not a feature of pityriasis rosea.
- Nail changes are not associated with this self-limiting dermatosis.
*Lichen planus*
- **Nail lichen planus** can cause various nail changes, including **pitting**, longitudinal ridging, pterygium formation, and thinning of the nail plate.
- It is an inflammatory condition affecting the skin, hair, nails, and mucous membranes.
- Nail involvement occurs in approximately 10% of patients with cutaneous lichen planus.
*Psoriasis*
- **Nail psoriasis** is common, affecting up to 50% of patients with psoriasis, and **pitting is the most characteristic nail finding**.
- Pitting appears as small punctate depressions on the nail surface due to defects in the proximal nail matrix.
- Other nail changes include onycholysis (oil drop sign), subungual hyperkeratosis, and salmon patches.
*Fungal infection*
- **Onychomycosis** (fungal nail infection) typically causes **thickening, discoloration, onycholysis, and crumbling** of the nail.
- **True nail pitting is NOT a characteristic feature** of fungal infections, as pitting results from defects in the proximal nail matrix, not fungal invasion.
- Fungal infections affect the nail plate and bed differently, causing destruction rather than the punctate depressions seen in pitting.
Nail Psoriasis and Other Inflammatory Nail Disorders Indian Medical PG Question 8: Which of the following statements is incorrect regarding nail changes in various conditions?
- A. Onycholysis is seen in Psoriasis.
- B. Mees lines are indicative of Arsenic poisoning.
- C. Pterygium of nails is associated with Lichen Planus.
- D. Koilonychia is associated with Vitamin B12 deficiency. (Correct Answer)
Nail Psoriasis and Other Inflammatory Nail Disorders Explanation: ***Koilonychia is associated with Vitamin B12 deficiency.***
- **Koilonychia**, or "spoon nails," is primarily associated with **iron deficiency anemia**, not Vitamin B12 deficiency.
- In Koilonychia, the nails become **thin, brittle**, and concave in shape.
*Onycholysis is seen in Psoriasis.*
- **Onycholysis** refers to the separation of the nail plate from the nail bed, which is a common nail finding in **psoriasis**.
- Other nail changes in psoriasis include **pitting**, oil spots, and subungual hyperkeratosis.
*Mees lines are indicative of Arsenic poisoning.*
- **Mees lines** are transverse white lines or bands that appear across the nail plate, characteristic of severe illness or poisoning.
- They are classically associated with **arsenic poisoning**, but can also be seen in other conditions like thallium poisoning or kidney failure.
*Pterygium of nails is associated with Lichen Planus.*
- **Pterygium unguis** involves the forward growth of the proximal nail fold (cuticle) onto the nail plate, leading to fusion.
- It is a prominent and often distinguishing feature of **lichen planus** affecting the nails, which can lead to permanent nail deformity or loss.
Nail Psoriasis and Other Inflammatory Nail Disorders Indian Medical PG Question 9: Keratoderma blennorrhagica is seen in?
- A. Rheumatoid arthritis
- B. Psoriatic arthritis
- C. Ankylosing spondylitis
- D. Reactive arthritis (Correct Answer)
Nail Psoriasis and Other Inflammatory Nail Disorders Explanation: ***Reactive arthritis***
- **Keratoderma blennorrhagica** is a classic mucocutaneous manifestation of reactive arthritis, presenting as hyperkeratotic lesions on the palms and soles.
- Reactive arthritis is also associated with a preceding infection, asymmetric oligoarthritis, enthesitis, and often **HLA-B27 positivity**.
*Rheumatoid arthritis*
- This condition is characterized by chronic symmetrical polyarthritis, primarily affecting small joints, and is associated with **rheumatoid factor (RF)** and **anti-CCP antibodies**.
- Skin manifestations in rheumatoid arthritis are typically rheumatoid nodules, vasculitis, or neutrophilic dermatoses, not keratoderma blennorrhagica.
*Psoriatic arthritis*
- While it can involve skin lesions (psoriasis), these are typically well-demarcated erythematous plaques with silvery scales, distinct from **keratoderma blennorrhagica**.
- Psoriatic arthritis often presents with dactylitis, enthesitis, and nail pitting, but keratoderma blennorrhagica is not a typical feature.
*Ankylosing spondylitis*
- This is a chronic inflammatory disease primarily affecting the axial skeleton, leading to **sacroiliitis** and spondylitis.
- Skin manifestations like keratoderma blennorrhagica are not associated with ankylosing spondylitis.
Nail Psoriasis and Other Inflammatory Nail Disorders Indian Medical PG Question 10: A 25-year-old presents with silvery scales on elbows and knees. Likely diagnosis?
- A. Psoriasis (Correct Answer)
- B. Atopic dermatitis
- C. Pityriasis rosea
- D. Lichen planus
Nail Psoriasis and Other Inflammatory Nail Disorders Explanation: ***Psoriasis***
- **Silvery scales** on **extensor surfaces** like elbows and knees are classic presentations of plaque psoriasis.
- This chronic inflammatory skin condition is characterized by **accelerated epidermal turnover**.
*Atopic dermatitis*
- Typically presents as **eczematous lesions** characterized by **red, itchy, and often oozing or crusted patches**, mainly on flexural surfaces in adults.
- It is strongly associated with a history of **allergies, asthma, or hay fever**.
*Pityriasis rosea*
- Usually starts with a **herald patch** followed by smaller, oval, pinkish-orange macules and patches with fine scales in a **Christmas tree pattern** on the trunk.
- It is distinguished from psoriasis by its distribution and appearance of scales.
*Lichen planus*
- Characterized by **pruritic, purple, polygonal, planar papules and plaques** (the "6 P's") often with fine, white lacy streaks called **Wickham's striae**, typically affecting flexor surfaces, wrists, and oral mucosa.
- It does not present with silvery scales on extensor surfaces.
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