Nail Tumors Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Nail Tumors. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Nail Tumors Indian Medical PG Question 1: All are nail changes seen in cases of psoriasis except:
- A. Subungual hyperkeratosis
- B. Oil drop sign
- C. Mees lines (Correct Answer)
- D. Pitting
Nail Tumors Explanation: ***Mees lines***
- **Mees lines** (or Aldrich-Mees lines) are **transverse white bands** that appear in the nail plate.
- They are typically associated with **heavy metal poisoning** (e.g., arsenic), chemotherapy, or systemic illnesses, not psoriasis.
*Subungual hyperkeratosis*
- This is a common finding in **psoriasis**, characterized by the **thickening of the nail bed** due to excessive keratin production.
- It leads to lifting of the nail plate from the nail bed.
*Oil drop sign*
- The **oil drop sign** (or salmon patch) is a classic psoriatic nail change, presenting as a **translucent, yellowish-red discoloration** under the nail plate.
- It is due to psoriasis of the nail bed.
*Pitting*
- **Nail pitting** refers to the presence of **small depressions or pits** on the nail surface.
- It results from defective keratinization of the nail matrix and is a characteristic sign of nail psoriasis.
Nail Tumors Indian Medical PG Question 2: Nail changes are found in about ______ cases of psoriasis:
- A. Two thirds
- B. One third
- C. One half (Correct Answer)
- D. All cases
Nail Tumors Explanation: ***One half***
- Approximately **50% of patients with psoriasis** will experience nail changes, which can be a key diagnostic feature.
- Nail involvement is even higher, around **80-90%**, in patients with **psoriatic arthritis**.
*Two thirds*
- While a significant proportion, **two-thirds (roughly 66%)** is a slight overestimate of the general prevalence of nail changes in psoriasis.
- This figure might be seen in specific populations or more severe cases, but not overall.
*One third*
- **One-third (roughly 33%)** is an underestimation of the frequency of nail changes in psoriasis.
- Nail involvement is a very common manifestation of the disease.
*All cases*
- It is incorrect to state that **all cases of psoriasis** have nail changes.
- While common, nail involvement is not universal and can range from mild to severe, or be entirely absent.
Nail Tumors Indian Medical PG Question 3: Glomus tumor is seen in -
- A. Rare locations such as retroperitoneum
- B. Long bones and vertebrae
- C. Proximal portion of digits (less common site)
- D. Distal portion of digits (Correct Answer)
Nail Tumors Explanation: ***Distal portion of digits***
- **Glomus tumors** are most commonly found in the **distal extremities**, especially the **subungual region** (under the nail) of the fingers and toes.
- This location accounts for over 75% of all glomus tumors, where they originate from specialized **neuromyoarterial glomus bodies** involved in thermoregulation.
- The classic clinical triad includes **paroxysmal pain, point tenderness, and cold sensitivity**.
*Rare locations such as retroperitoneum*
- While glomus tumors can occur in unusual sites, the **retroperitoneum** is an exceptionally rare location for primary glomus tumors.
- Extradigital glomus tumors account for approximately 25% of cases and can occur in various soft tissue sites.
*Long bones and vertebrae*
- Glomus tumors do not typically arise in **bone tissue** as they originate from glomus bodies in soft tissue.
- Bone involvement, when present, is usually secondary due to pressure erosion from an adjacent soft tissue tumor rather than primary bone origin.
*Proximal portion of digits (less common site)*
- While glomus tumors can occasionally be found in less common digital locations, the **proximal portion of digits** is significantly less frequent than the distal, and particularly the subungual, region.
- Their primary association remains with the **distal phalanx** and nail bed.
Nail Tumors Indian Medical PG Question 4: All are true about psoriasis except –
- A. Auspitz sign positive
- B. Parakeratosis & acanthosis
- C. Joint involvement in 5–10% (Correct Answer)
- D. Pitting of nails
- E. Koebner phenomenon
Nail Tumors Explanation: ***Joint involvement in 5–10%***
- While **psoriasis** is a skin condition, it can involve the joints in about **30% of patients**, leading to **psoriatic arthritis**.
- Therefore, stating that joint involvement occurs in only **5-10%** is incorrect, as the percentage is significantly higher.
- This is the **FALSE statement** in this EXCEPT question.
*Auspitz sign positive*
- The **Auspitz sign** (pinpoint bleeding when scales are removed) is a classic feature of psoriasis.
- It occurs due to the proximity of dilated capillaries to the thinned suprapapillary epidermis.
- This is a **TRUE statement**.
*Parakeratosis & acanthosis*
- **Parakeratosis** (retention of nuclei in the stratum corneum) and **acanthosis** (epidermal hyperplasia) are classic histopathological features of psoriasis.
- These features reflect the **rapid cell turnover** and **thickening of the epidermis** characteristic of psoriatic plaques.
- This is a **TRUE statement**.
*Pitting of nails*
- **Nail pitting** is a common manifestation of psoriasis, affecting up to **50% of patients** with chronic plaque psoriasis and **80% of patients with psoriatic arthritis**.
- Other nail changes include **onycholysis**, **subungual hyperkeratosis**, and discoloration.
- This is a **TRUE statement**.
*Koebner phenomenon*
- **Koebner phenomenon** (isomorphic response) is the development of psoriatic lesions at sites of trauma or injury.
- This is seen in approximately **25% of patients** with psoriasis and is a well-recognized clinical feature.
- This is a **TRUE statement**.
Nail Tumors Indian Medical PG Question 5: A 70 year old farmer, presented to you with complaints of yellowish discolouration of his finger nails for the past 6 months, he also gives history of recurrent episodes of itching in the groin for which he used to take local home made herbal remedy. On examination 3 of his toe nails also show similar change with tunneling. Which among the following is the best test for rapid confirmation of your diagnosis?
- A. Tzanck smear
- B. KOH mount (Correct Answer)
- C. Woods lamp
- D. Biopsy
Nail Tumors Explanation: ***KOH mount***
- A **KOH mount** (potassium hydroxide) dissolves keratinocytes, allowing for direct visualization of fungal elements such as **hyphae** and **spores** under a microscope. This is the **most rapid and cost-effective test** for confirming fungal infections like **onychomycosis**.
- The patient's presentation with **yellowish discoloration** and **"tunneling"** of nails (suggesting onycholysis and subungual hyperkeratosis), along with a history of recurrent groin itching (potentially **tinea cruris**), strongly points to a fungal infection.
*Tzanck smear*
- A **Tzanck smear** is primarily used to detect multinucleated giant cells in **herpesvirus infections** (e.g., herpes simplex, varicella-zoster).
- It is not useful for identifying fungal elements responsible for nail discoloration or suspected onychomycosis.
*Woods lamp*
- A **Woods lamp** uses ultraviolet light to detect specific fluorescent substances, particularly useful for diagnosing certain **bacterial infections** (e.g., *Corynebacterium minutissimum* in erythrasma) or some **tinea capitis** species (*Microsporum*).
- Most common dermatophytes causing onychomycosis **do not fluoresce** under a Wood's lamp, making it an unreliable diagnostic tool in this scenario.
*Biopsy*
- A **nail biopsy** (with histology and special stains like PAS) is a highly accurate diagnostic method for onychomycosis, especially when other tests are inconclusive.
- However, it is an **invasive procedure**, takes more time for results, and is generally not the **most rapid** initial test compared to a KOH mount.
Nail Tumors Indian Medical PG Question 6: A farmer presented with a black mole on the cheek. It increased in size, more than 6mm with irregular borders and a central black lesion, what could be the diagnosis?
- A. Superficial spreading melanoma (Correct Answer)
- B. Acral lentigo melanoma
- C. Lentigo maligna melanoma
- D. Nodular melanoma
Nail Tumors Explanation: ***Superficial spreading melanoma***
- This is the most common type of melanoma and often presents as a **mole with irregular borders**, varying colors, and a diameter greater than 6mm, consistent with the description.
- The lesion typically grows **radially** across the skin surface before beginning vertical growth, indicated by the increase in size.
*Acral lentigo melanoma*
- This type of melanoma primarily affects the **palms, soles, and nail beds**, which is inconsistent with a lesion on the cheek.
- It often appears as a **dark brown or black patch** that slowly enlarges, but its location is characteristic.
*Lentigo maligna melanoma*
- This melanoma typically occurs in **chronically sun-damaged skin** of the elderly, often on the head and neck, but usually presents as a **flat, irregularly shaped, tan or brown patch** with varying shades, which may not fit the description of a central black lesion within a larger mole.
- It has a dominant **radial growth phase** and progresses slowly over many years before developing a nodular component.
*Nodular melanoma*
- This type is characterized by its **rapid vertical growth** and appearance as a **raised, dark, often dome-shaped lesion** from the outset.
- While it can be black, the description of an "increased in size" mole with irregular borders and a central black lesion points more towards a spreading type rather than a rapidly growing nodule from the beginning.
Nail Tumors Indian Medical PG Question 7: Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split.
Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
- A. Statements 1 & 2 are correct, 2 is not explaining 1 (Correct Answer)
- B. Statements 1 and 2 are correct and 2 is the correct explanation for 1
- C. Statements 1 and 2 are incorrect
- D. Statement 1 is incorrect
Nail Tumors Explanation: ***Correct: Statements 1 & 2 are correct, 2 is not explaining 1***
**Analysis of Statement 1:**
- A 59-year-old patient with **flaccid bullae** and **suprabasal acantholytic split** on histopathology is the classic presentation of **Pemphigus vulgaris**
- The flaccid (easily ruptured) nature of bullae distinguishes it from tense bullae seen in bullous pemphigoid
- The suprabasal location of the split (just above the basal layer) with acantholysis (loss of cell-to-cell adhesion) is pathognomonic
- **Statement 1 is CORRECT** ✓
**Analysis of Statement 2:**
- The **"row of tombstones" or "tombstone appearance"** is indeed a diagnostic histopathological feature of Pemphigus vulgaris
- This appearance results from basal keratinocytes remaining attached to the basement membrane while suprabasal cells separate due to acantholysis
- The intact basal cells standing upright resemble a row of tombstones
- **Statement 2 is CORRECT** ✓
**Does Statement 2 explain Statement 1?**
- Statement 2 describes a **histopathological appearance** (tombstone pattern) that is a **consequence** of the suprabasal split
- However, it does NOT explain the **underlying cause** of the flaccid bullae or the suprabasal split
- The true explanation involves **IgG autoantibodies against desmoglein 3 (and desmoglein 1)**, which attack intercellular adhesion structures (desmosomes), causing **acantholysis**
- Therefore, **Statement 2 does NOT explain Statement 1** ✗
*Incorrect: Statement 2 is the correct explanation for Statement 1*
- While both statements describe features of Pemphigus vulgaris, the tombstone appearance is a descriptive finding, not an explanatory mechanism
*Incorrect: Statements 1 and 2 are incorrect*
- Both statements are medically accurate descriptions of Pemphigus vulgaris features
*Incorrect: Statement 1 is incorrect*
- Statement 1 correctly describes the cardinal clinical and histopathological features of Pemphigus vulgaris
Nail Tumors Indian Medical PG Question 8: Which of the following conditions does NOT cause nail pitting?
- A. Lichen planus
- B. Fungal infection
- C. Pityriasis Rosea (Correct Answer)
- D. Psoriasis
Nail Tumors 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 Tumors Indian Medical PG Question 9: 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 Tumors 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 Tumors Indian Medical PG Question 10: A young female presented with lacy linear lesions on tongue for a month with elongation of nail fold beyond the nail bed. What is the diagnosis –
- A. Candidiasis
- B. Psoriasis
- C. Geographic tongue
- D. Lichen planus (Correct Answer)
Nail Tumors Explanation: ***Lichen planus***
- **Lacy linear lesions on the tongue** are characteristic of **Wickham's striae**, a hallmark feature of oral lichen planus.
- **Elongation of the nail fold beyond the nail bed** (known as pterygium formation) is a specific nail finding seen in lichen planus.
*Candidiasis*
- Oral candidiasis typically presents as **white, creamy patches** that can be scraped off, unlike the lacy lesions described.
- It does not typically cause **nail fold elongation** or similar specific nail changes.
*Psoriasis*
- While psoriasis can affect the tongue (geographic tongue-like lesions) and nails, the classic oral lesions are not described as **lacy linear patterns**.
- Nail changes in psoriasis include **pitting, onycholysis, and oil spots**, not usually elongation of the nail fold beyond the nail bed.
*Geographic tongue*
- Geographic tongue presents as **irregular, depapillated red patches with white borders** that migrate over time.
- It is a benign inflammatory condition of the tongue and is not associated with **nail changes** like elongated nail folds.
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