Telogen Effluvium Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Telogen Effluvium. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Telogen Effluvium Indian Medical PG Question 1: HR-180, BP-60/40, temp-39.5°C, ETCO2-65 post induction. Most likely diagnosis:
- A. Thyroid storm
- B. Anaphylaxis
- C. Septic shock
- D. Malignant hyperthermia (Correct Answer)
Telogen Effluvium Explanation: ***Malignant hyperthermia***
- The rapid onset of **tachycardia (HR-180)**, **hyperthermia (temp-39.5°C)**, and profoundly elevated **ETCO2 (65 mmHg)** immediately following anesthetic induction is the classic presentation of malignant hyperthermia.
- This condition is a pharmacogenetic disorder, triggered by volatile anesthetics (e.g., isoflurane) and succinylcholine, leading to uncontrolled skeletal muscle metabolism and hypercapnia.
*Thyroid storm*
- While thyroid storm can cause **tachycardia** and **hyperthermia**, the sudden and dramatic rise in **ETCO2** is not a characteristic feature.
- Onset is typically less abrupt and often associated with pre-existing hyperthyroidism or a precipitating event like surgery or infection, rather than immediate post-induction.
*Anaphylaxis*
- Anaphylaxis typically presents with **hypotension (BP-60/40)**, **tachycardia**, and often features like **bronchospasm**, **rash**, or **angioedema**.
- Although it can cause **bronchospasm** leading to increased ETCO2, the extreme elevation to 65 mmHg is less typical, and **profound hyperthermia** is not a primary symptom.
*Septic shock*
- **Septic shock** is characterized by **hypotension** and **tachycardia**, often accompanied by **fever**, but its onset is usually prolonged over hours to days.
- A sudden increase in **ETCO2** to 65 mmHg immediately post-induction is uncharacteristic for sepsis, which relates to an exaggerated, systemic inflammatory response to infection.
Telogen Effluvium Indian Medical PG Question 2: A 22-year-old woman presents with diffuse hair loss for 1 month. She had a past history of enteric fever 4 months ago. What is the likely cause?
- A. Telogen effluvium (Correct Answer)
- B. Androgenic alopecia
- C. Alopecia areata
- D. Anagen effluvium
Telogen Effluvium Explanation: ***Telogen effluvium***
- **Telogen effluvium** is characterized by diffuse hair shedding, often occurring 2-4 months after a significant physiological or psychological stressor, such as **enteric fever**.
- The stress prematurely shifts a large number of hair follicles from the **anagen (growth)** phase into the **telogen (resting)** phase, leading to synchronized shedding.
*Androgenic alopecia*
- This condition presents as a gradual, patterned hair loss, typically characterized by **receding hairline** and thinning at the crown in men.
- In women, it often appears as **diffuse thinning** over the crown, but it's not usually acute or triggered by an infection in the manner described.
*Alopecia areata*
- **Alopecia areata** is an autoimmune condition causing **sudden, well-demarcated patches of hair loss**, not diffuse shedding.
- It is frequently associated with other autoimmune diseases, and the hair loss pattern is distinct from the patient's presentation.
*Anagen effluvium*
- **Anagen effluvium** causes rapid, diffuse hair loss during the **anagen (growth)** phase, often triggered by chemotherapy or radiation.
- The onset is typically much faster (days to weeks) after the trigger, unlike the delayed onset seen in this case.
Telogen Effluvium Indian Medical PG Question 3: The following patient presented to the OPD with history of hair loss. There was no erythema, scarring or scratching. Diagnosis is:
- A. Trichotillomania
- B. Alopecia areata (Correct Answer)
- C. Telogen effluvium
- D. Tinea infection
Telogen Effluvium Explanation: ***Alopecia areata***
- The image shows **well-demarcated patches of hair loss** with no signs of inflammation or scarring, which is characteristic of alopecia areata.
- This condition is an **autoimmune disorder** where the immune system attacks hair follicles, leading to patchy hair loss.
- Classic presentation includes **smooth, round patches** with no erythema or scarring.
*Trichotillomania*
- This condition involves **compulsive hair pulling**, which typically results in **irregularly shaped patches of hair loss** with hairs of varying lengths.
- Hair loss in trichotillomania often shows **broken hair shafts** and may be associated with signs of trauma or follicular damage.
- The absence of scratching/pulling behavior and the well-defined patches make this less likely.
*Telogen effluvium*
- Telogen effluvium presents as **diffuse hair shedding** (increased shedding of resting phase hairs) rather than the distinct, localized patches seen in the image.
- It usually follows a **stressful event** (e.g., illness, surgery, childbirth) and there's no visible inflammation or scarring.
- Would not present as well-demarcated patches.
*Tinea infection*
- Tinea capitis (ringworm of the scalp) would typically present with **erythema, scaling, inflammation**, and sometimes pustules or kerion formation within the patches of hair loss.
- The patches of hair loss in tinea infections often show **broken hairs** or "black dots" where hairs have broken off at the scalp surface.
- The **absence of erythema** in this case rules out tinea infection.
Telogen Effluvium Indian Medical PG Question 4: Rapid, diffuse, excessive hair loss occurring 3 months after childbirth is due to?
- A. Telogen effluvium (Correct Answer)
- B. Anagen effluvium
- C. Alopecia areata
- D. Androgenetic alopecia
Telogen Effluvium Explanation: ***Telogen effluvium***
- This condition is characterized by an excessive shedding of **club hairs** from the hair follicle, typically occurring 2-4 months after a significant stressor such as **pregnancy and childbirth**.
- During pregnancy, high estrogen levels increase the number of follicles in the anagen (growth) phase; after delivery, estrogen drops, and many follicles simultaneously enter the **telogen (resting) phase**, leading to synchronized shedding.
*Anagen effluvium*
- This type of hair loss is rapid and severe, occurring when a significant percentage of **hair follicles** in the **anagen phase** are abruptly stopped from growing.
- It is often seen with **chemotherapy, radiation therapy**, or exposure to toxins, which damage actively dividing hair matrix cells.
*Alopecia areata*
- This is an **autoimmune condition** where the body's immune system attacks hair follicles, leading to distinct, typically **round patches of hair loss**.
- It can affect any hair-bearing area and is not directly linked to hormonal changes post-pregnancy.
*Androgenetic alopecia*
- Commonly known as **male or female pattern baldness**, this is a genetic condition influenced by androgens, characterized by a progressive **miniaturization of hair follicles**.
- It presents as a characteristic pattern of thinning, such as a receding hairline or thinning at the crown, and is not typically a rapid, diffuse postpartum event.
Telogen Effluvium Indian Medical PG Question 5: A male presents with alopecia and exclamation mark hairs. Diagnosis?
- A. Alopecia areata (Correct Answer)
- B. Telogen effluvium
- C. Androgenic alopecia
- D. Tinea capitis
Telogen Effluvium Explanation: ***Alopecia areata***
- This condition is an **autoimmune disorder** that causes non-scarring hair loss, which can range from small patches to complete hair loss on the scalp (**alopecia totalis**) or entire body (**alopecia universalis**).
- The presence of **exclamation mark hairs** (short hairs that are narrower at the base near the scalp and wider at the tip), along with sudden, patchy hair loss, is a classic diagnostic sign.
*Telogen effluvium*
- This type of hair loss is characterized by **diffuse shedding** of resting (telogen) hairs across the scalp, often triggered by a significant stressor like childbirth, severe illness, or medications.
- While it causes widespread hair thinning, it does not typically present with the focal patches or distinct **exclamation mark hairs** characteristic of alopecia areata.
*Androgenic alopecia*
- Also known as **male-pattern baldness**, this is a common form of progressive hair thinning that typically presents with a receding hairline and thinning at the crown.
- It is a **hereditary condition** influenced by androgens and does not involve inflammation or the presence of exclamation mark hairs.
*Tinea capitis*
- This is a **fungal infection of the scalp** that can cause patches of scaling, inflammation, broken hairs, and sometimes pustules or kerion.
- Unlike alopecia areata, it is an infectious process, and while it causes hair breakage, it does not specifically produce **exclamation mark hairs**; rather, it often shows black dots where hairs have broken off at the scalp surface.
Telogen Effluvium Indian Medical PG Question 6: A female presented with complaints of hair fall. Her delivery was 2 months ago. Physician diagnosed her condition as Telogen Effluvium. All of the following are true regarding telogen effluvium, EXCEPT:
- A. Diffuse hair thinning
- B. Metabolic stress
- C. Scarring (Correct Answer)
- D. Recovery within 6 months
Telogen Effluvium Explanation: ***Scarring***
- **Telogen effluvium** is a **non-scarring alopecia**, meaning it does not cause permanent damage to the hair follicles or lead to scar tissue formation.
- The hair loss is temporary and reversible, as the follicles remain intact and capable of regrowth.
*Diffuse hair thinning*
- Telogen effluvium typically presents as **generalized or diffuse hair thinning** across the scalp, rather than localized patches of baldness.
- This thinning is because a large number of hair follicles prematurely enter the **telogen (resting) phase**, leading to increased shedding.
*Metabolic stress*
- **Metabolic stressors** such as childbirth, severe illness, surgery, significant weight loss, or nutritional deficiencies are common triggers for telogen effluvium.
- These stressors disrupt the normal hair growth cycle, causing a greater proportion of hairs to shift into the resting phase.
*Recovery within 6 months*
- Telogen effluvium is usually a **self-limiting condition**, with hair regrowth typically occurring within 3 to 6 months after the inciting event has passed and the body has recovered.
- Complete recovery of hair density may take longer, but significant improvement is often seen within this timeframe.
Telogen Effluvium Indian Medical PG Question 7: A male presents with alopecia and exclamation mark hairs. Diagnosis?
- A. Telogen effluvium
- B. Tinea capitis
- C. Androgenic alopecia
- D. Alopecia areata (Correct Answer)
Telogen Effluvium Explanation: ***Alopecia areata***
- **Exclamation mark hairs**, which are short, broken hairs that taper near the scalp, are a **pathognomonic sign** of alopecia areata.
- This condition presents with **non-scarring hair loss**, often in **well-demarcated patches**, consistent with the general term "alopecia."
*Telogen effluvium (hair shedding due to stress or other factors)*
- Characterized by **diffuse hair shedding** predominantly in the **telogen (resting)** phase, not specifically focal patches or exclamation mark hairs.
- Often triggered by significant physical or emotional stress, illness, or medications, and **lacks the characteristic exclamation mark hairs**.
*Tinea capitis (fungal infection of the scalp)*
- Presents with patches of **scaling, redness, and inflammation**, sometimes with **black dots** (broken hairs at the scalp surface), but not exclamation mark hairs.
- Often associated with **lymphadenopathy** and can be diagnosed by **KOH preparation** or fungal culture.
*Androgenic alopecia (pattern hair loss)*
- Involves a **gradual miniaturization of hair follicles** leading to a receding hairline and/or thinning crown in men, and diffuse thinning in women, following a specific pattern.
- It does **not typically feature exclamation mark hairs** or discrete patches of complete hair loss.
Telogen Effluvium Indian Medical PG Question 8: Swarm of bees appearance seen in?
- A. Telogen effluvium
- B. Alopecia areata (Correct Answer)
- C. Androgenetic alopecia
- D. Anagen effluvium
Telogen Effluvium Explanation: ***Alopecia areata***
- The "swarm of bees" appearance refers to the characteristic **peribulbar lymphocytic inflammation** seen on scalp biopsy in active alopecia areata.
- This finding represents an **immune response targeting the hair follicles**, leading to non-scarring hair loss.
*Telogen effluvium*
- Histologically, telogen effluvium is characterized by a high proportion of **telogen hairs** in the hair counts and **no significant inflammation** around the follicles.
- The "swarm of bees" peribulbar infiltrate is not a feature of telogen effluvium, which is typically a reaction to a systemic stressor.
*Androgenetic alopecia*
- Androgenetic alopecia is characterized by **follicular miniaturization**, where vellus hairs replace terminal hairs, and a **decrease in the number of hair follicles**.
- It does not show the "swarm of bees" peribulbar lymphocytic infiltrate; instead, there might be subtle inflammation or fibrosis in advanced stages but not the dense peribulbar type.
*Anagen effluvium*
- Anagen effluvium is characterized by the **sudden shedding of hairs in the anagen phase** due to a toxic or inflammatory insult disrupting hair matrix keratinocyte proliferation.
- Histology often shows **dystrophic anagen hairs** and damaged hair shafts, but not the specific "swarm of bees" lymphocytic infiltrate seen in alopecia areata.
Telogen Effluvium Indian Medical PG Question 9: Non-scarring alopecia is associated with all except?
- A. Telogen effluvium
- B. Androgenetic alopecia
- C. Alopecia areata
- D. Frontal fibrosing alopecia (Correct Answer)
Telogen Effluvium Explanation: ***Frontal fibrosing alopecia***
- This condition is a form of **lichen planopilaris**, which causes **scarring alopecia** due to destruction of hair follicles and replacement with fibrous tissue.
- It results in a **receding hairline** and eyebrow loss, with irreversible hair loss.
*Telogen effluvium*
- This is a common cause of **non-scarring alopecia**, characterized by diffuse hair shedding triggered by various stressors like illness, stress, or medications.
- The hair follicles enter the **telogen phase** prematurely, leading to increased shedding but typically regrowth once the trigger is removed.
*Androgenetic alopecia*
- Often referred to as **male or female pattern baldness**, this is a form of **non-scarring alopecia** driven by genetic predisposition and androgens.
- It causes a progressive miniaturization of hair follicles, leading to thinning hair, but the follicles remain present and capable of producing hair.
*Alopecia areata*
- This is an **autoimmune condition** that causes **non-scarring hair loss** in patches on the scalp or other parts of the body.
- The hair follicles are attacked by the immune system but are not permanently destroyed, allowing for potential regrowth.
Telogen Effluvium Indian Medical PG Question 10: Consider the following causes of alopecia: 1. Androgenetic alopecia 2. Alopecia areata 3. Telogen effluvium 4. Lichen planopilaris. Which among the following causes non-scarring alopecia?
- A. 1, 2 and 3 (Correct Answer)
- B. Only 4
- C. 3 and 4
- D. 2, 3 and 4
Telogen Effluvium Explanation: **1, 2, and 3**
- **Androgenetic alopecia**, **alopecia areata**, and **telogen effluvium** are all forms of **non-scarring alopecia**, meaning the hair follicles are primarily affected without permanent destruction.
- In these conditions, there is potential for hair regrowth as the follicular structures remain intact.
*Only 4*
- **Lichen planopilaris** is a type of **scarring alopecia**, characterized by permanent destruction of hair follicles and replacement with fibrous tissue.
- This leads to irreversible hair loss in the affected areas.
*3 and 4*
- While **telogen effluvium** causes non-scarring alopecia, **lichen planopilaris** is a scarring alopecia.
- Therefore, this option incorrectly groups a non-scarring and a scarring condition.
*2, 3, and 4*
- This option correctly identifies **alopecia areata** and **telogen effluvium** as non-scarring but incorrectly includes **lichen planopilaris**, which results in scarring alopecia.
- **Lichen planopilaris** has inflammatory infiltrates that lead to permanent follicular damage.
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