Hair and Nail Disorders — MCQs
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Non-cicatricial alopecia is present in which of the following conditions?
All of the following conditions cause non-scarring alopecia, EXCEPT:
Dermatophytes can affect which of the following structures?
Onycholysis is seen in all of the following conditions, except:
Whitening of the nail plates may be due to deficiency of?
Which of the following medications is used in the treatment of male pattern alopecia?
What is the treatment for alopecia areata?
"Bamboo hair" is seen in which of the following conditions?
What is the most common type of non-scarring alopecia?
Which of the following conditions is characterized by exclamation mark hairs?
Hair and Nail Disorders Indian Medical PG Practice Questions and MCQs
Question 1: Non-cicatricial alopecia is present in which of the following conditions?
- A. Scleroderma
- B. Lichen planus
- C. Psoriasis (Correct Answer)
- D. Parvovirus
Explanation: **Explanation:** The distinction between **cicatricial (scarring)** and **non-cicatricial (non-scarring)** alopecia is a high-yield concept in dermatology. **Correct Option: C. Psoriasis** Psoriasis is a chronic inflammatory condition characterized by epidermal hyperproliferation. While scalp psoriasis is common and can lead to hair thinning or loss due to the mechanical trauma of removing thick scales (Pityriasis amantacea) or severe inflammation, it **does not destroy the hair follicles**. Once the inflammation subsides and the plaques clear, the hair typically regrows. Therefore, it is classified as a non-cicatricial alopecia. **Incorrect Options:** * **A. Scleroderma:** Specifically, the "en coup de sabre" variant of localized scleroderma (morphea) causes fibrosis and destruction of the hair follicles, leading to permanent, cicatricial alopecia. * **B. Lichen Planus:** When it affects the scalp, it is known as **Lichen Planopilaris (LPP)**. It is a classic cause of primary cicatricial alopecia, characterized by follicular plugging and permanent scarring. * **D. Parvovirus:** Parvovirus B19 is typically associated with Erythema Infectiosum (Fifth disease). It is not a primary cause of alopecia, though any severe systemic viral illness can occasionally trigger *Telogen Effluvium* (which is non-cicatricial, but Psoriasis is the more definitive dermatological answer in this context). **NEET-PG High-Yield Pearls:** * **Non-Cicatricial Alopecia:** Alopecia areata, Telogen effluvium, Androgenetic alopecia, Trichotillomania, and Psoriasis. * **Cicatricial Alopecia:** Lichen planopilaris, Discoid Lupus Erythematosus (DLE), Pseudopelade of Brocq, and Scleroderma. * **Auspitz Sign:** Pinpoint bleeding upon removal of a psoriasis scale (due to thinning of the suprapapillary dermis).
Question 2: All of the following conditions cause non-scarring alopecia, EXCEPT:
- A. Tinea capitis
- B. Androgenic alopecia
- C. Alopecia areata
- D. Lichen planus (Correct Answer)
Explanation: **Explanation:** The fundamental distinction in clinical trichology is between **Non-scarring (Non-cicatricial)** and **Scarring (Cicatricial) alopecia**. **1. Why Lichen Planus is the Correct Answer:** Lichen planus, specifically its variant **Lichen Planopilaris (LPP)**, is a classic cause of **primary scarring alopecia**. In this condition, an inflammatory lymphocytic infiltrate targets the hair follicle bulge (where stem cells reside). This leads to the irreversible destruction of the follicle and its replacement by fibrous/scar tissue. Clinically, this presents as "smooth" patches of hair loss where follicular orifices are absent. **2. Analysis of Incorrect Options (Non-scarring):** * **Tinea Capitis:** This is a fungal infection. While it can cause significant hair breakage and inflammation (especially the Kerion type), it is generally classified as non-scarring because the follicles remain intact once the infection is treated. * **Androgenic Alopecia:** This is the most common cause of hair loss, characterized by follicular miniaturization due to Dihydrotestosterone (DHT). The follicles shrink but are not replaced by scars. * **Alopecia Areata:** An autoimmune condition where T-cells attack the hair bulb. It causes "swarm of bees" inflammation but does not destroy the stem cells; therefore, the hair has the potential to regrow. **Clinical Pearls for NEET-PG:** * **Scarring Alopecia Mnemonic (L-D-S):** **L**ichen Planopilaris, **D**iscoid Lupus Erythematosus (DLE), **S**pseudopelade of Brocq. * **Exclamation Mark Hairs:** Pathognomonic for Alopecia Areata. * **Lichen Planopilaris:** Look for "Perifollicular scaling" and "Violaceous erythema" at the edge of expanding bald patches. * **Key Diagnostic Step:** If follicular ostia (pores) are absent, it is scarring; if present, it is non-scarring.
Question 3: Dermatophytes can affect which of the following structures?
- A. Hair
- B. Nail
- C. Scalp
- D. All of the above (Correct Answer)
Explanation: **Explanation:** Dermatophytes are a group of fungi that require **keratin** for growth. They belong to three main genera: *Trichophyton*, *Microsporum*, and *Epidermophyton*. Because keratin is the primary structural protein of the integumentary system, these fungi are restricted to the non-living cornified layers of the skin, hair, and nails. * **Hair (Option A):** Dermatophytes cause **Tinea capitis** (scalp hair) and **Tinea barbae** (beard hair). They can invade the hair shaft in three patterns: Ectothrix (spores outside the shaft), Endothrix (spores inside the shaft), and Favus. * **Nail (Option B):** Infection of the nail apparatus by dermatophytes is termed **Tinea unguium** (a subset of Onychomycosis). *Trichophyton rubrum* is the most common causative agent globally. * **Scalp (Option C):** The scalp is a common site for dermatophytosis (Tinea capitis), where the fungi infect the stratum corneum of the epidermis. Since dermatophytes possess **keratinolytic enzymes** (keratinases), they can colonize and infect all keratinized tissues. Therefore, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** 1. **Epidermophyton** is unique because it infects skin and nails but **never infects hair**. 2. **Trichophyton rubrum** is the most common cause of dermatophytosis worldwide (Tinea corporis, cruris, and pedis). 3. **Wood’s Lamp Examination:** Useful for Tinea capitis; *Microsporum* species typically show a brilliant green fluorescence. 4. **Diagnosis:** The gold standard screening is **KOH mount** (showing translucent branching hyphae), and the most sensitive medium for culture is **Sabouraud’s Dextrose Agar (SDA)**.
Question 4: Onycholysis is seen in all of the following conditions, except:
- A. Allergic dermatitis
- B. Psoriasis
- C. Antineoplastic therapy
- D. Nephrotic syndrome (Correct Answer)
Explanation: **Explanation:** **Onycholysis** is the painless separation of the nail plate from the underlying nail bed, starting from the distal or lateral margins. **Why Nephrotic Syndrome is the correct answer:** Nephrotic syndrome is typically associated with **Muehrcke’s lines** (paired white transverse bands) or **Beau’s lines** due to hypoalbuminemia and metabolic stress. It does not cause the physical separation of the nail plate from the bed. Therefore, it is the "except" option. **Analysis of other options:** * **Allergic Contact Dermatitis:** Inflammatory conditions involving the fingertips (e.g., reaction to nail cosmetics or acrylates) can cause subungual inflammation leading to distal onycholysis. * **Psoriasis:** This is the most common dermatological cause of onycholysis. It occurs due to the involvement of the nail bed, often accompanied by "oil spots" (salmon patches) and subungual hyperkeratosis. * **Antineoplastic Therapy:** Many chemotherapy agents (like Taxanes or Doxorubicin) are toxic to the nail apparatus. They can cause "photo-onycholysis" or direct damage to the nail bed, leading to separation. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of Onycholysis:** Psoriasis. * **Systemic causes:** Hyperthyroidism (Plummer’s nails) and Iron deficiency anemia. * **Drug-induced Photo-onycholysis:** Tetracyclines (most common), Psoralens, and Fluoroquinolones. * **Microbial association:** *Candida albicans* and *Pseudomonas* (which produces a characteristic green pigment). * **Terry’s Nails:** Seen in Liver Cirrhosis (proximal 2/3rd white, distal 1/3rd pink). * **Lindsay’s Nails (Half-and-half nails):** Seen in Chronic Renal Failure.
Question 5: Whitening of the nail plates may be due to deficiency of?
- A. Iron
- B. Zinc
- C. Albumin (Correct Answer)
- D. Copper
Explanation: **Explanation:** The correct answer is **Albumin**. Whitening of the nail plate, known as **Leukonychia**, can be classified into true leukonychia (pathology in the nail matrix) and apparent leukonychia (pathology in the underlying nail bed). **Why Albumin is correct:** Low serum albumin levels (Hypoalbuminemia) lead to a specific type of apparent leukonychia known as **Muehrcke’s lines**. These appear as paired, white transverse bands that run parallel to the lunula. They are caused by localized edema in the nail bed exerting pressure on the vascular network, which alters the light-reflecting properties of the nail. Because the pathology is in the bed, not the plate, these lines do not move distally as the nail grows and disappear when the nail is compressed. **Analysis of Incorrect Options:** * **Iron:** Deficiency typically leads to **Koilonychia** (spoon-shaped nails), commonly seen in Iron Deficiency Anemia and Plummer-Vinson Syndrome. * **Zinc:** Deficiency (as seen in Acrodermatitis Enteropathica) is associated with **Beau’s lines** (transverse depressions) and paronychia, rather than generalized whitening. * **Copper:** Deficiency is rare but is classically associated with **Menkes Kinky Hair Syndrome**, affecting hair texture and pigmentation rather than causing leukonychia. **High-Yield Clinical Pearls for NEET-PG:** * **Terry’s Nails:** The proximal 2/3rd of the nail is white while the distal 1/3rd is pink/brown. Classically seen in **Liver Cirrhosis**. * **Lindsay’s Nails (Half-and-half nails):** Proximal half is white, distal half is red/brown. Classically seen in **Chronic Renal Failure**. * **Mee’s Lines:** Single transverse white bands caused by **Arsenic poisoning** or Hodgkin’s disease (True leukonychia).
Question 6: Which of the following medications is used in the treatment of male pattern alopecia?
- A. Finasteride (Correct Answer)
- B. Potassium channel blocker
- C. Fulvestrant
- D. Dexamethasone
Explanation: **Explanation:** **Male Pattern Alopecia (Androgenetic Alopecia)** is characterized by the progressive thinning of hair in a defined pattern, driven by the androgen **Dihydrotestosterone (DHT)**. **1. Why Finasteride is Correct:** Finasteride is a **Type II 5-alpha reductase inhibitor**. It prevents the conversion of Testosterone to Dihydrotestosterone (DHT). Since DHT is responsible for the miniaturization of hair follicles in genetically predisposed individuals, reducing its levels helps arrest hair loss and promotes regrowth. It is FDA-approved for male pattern baldness at a dose of **1 mg/day**. **2. Analysis of Incorrect Options:** * **Potassium channel blocker:** This is a distractor. The other mainstay for alopecia is **Minoxidil**, which is a **Potassium channel opener** (not blocker). It acts as a vasodilator and prolongs the anagen (growth) phase. * **Fulvestrant:** This is a selective estrogen receptor degrader (SERD) used primarily in breast cancer management; it has no role in treating androgenetic alopecia. * **Dexamethasone:** This is a potent corticosteroid. While steroids are used in *Alopecia Areata* (an autoimmune condition), they are not indicated for androgenetic alopecia. **High-Yield Clinical Pearls for NEET-PG:** * **Dutasteride:** A more potent inhibitor that blocks both Type I and Type II 5-alpha reductase. * **Side Effects of Finasteride:** May cause erectile dysfunction, decreased libido, and gynaecomastia (Post-Finasteride Syndrome). * **Contraindication:** Finasteride is strictly **contraindicated in pregnancy** (Category X) as it can cause feminization of a male fetus. * **Hamilton-Norwood Scale:** Used to grade the severity of Male Pattern Alopecia.
Question 7: What is the treatment for alopecia areata?
- A. Minoxidil (Correct Answer)
- B. Tranquilizers
- C. Whitfield's ointment
- D. Parenteral penicillin
Explanation: **Explanation:** **Alopecia Areata (AA)** is an autoimmune condition characterized by non-scarring, patchy hair loss, often associated with "exclamation mark" hairs. The treatment strategy depends on the extent of involvement. **Why Option A is Correct:** **Minoxidil (5%)** is a potent vasodilator and potassium channel opener that prolongs the anagen (growth) phase of the hair follicle. While corticosteroids (topical, intralesional, or systemic) are the first-line treatment for AA to suppress the immune attack, **Minoxidil** is frequently used as an adjuvant therapy to stimulate hair regrowth. In the context of the given options, it is the only recognized treatment for hair loss. **Why Other Options are Incorrect:** * **B. Tranquilizers:** While stress can be a trigger for AA, tranquilizers have no direct therapeutic effect on hair follicle recovery or the autoimmune process. * **C. Whitfield’s Ointment:** This is a keratolytic agent (containing salicylic acid and benzoic acid) used primarily for fungal infections like Tinea pedis; it has no role in treating alopecia. * **D. Parenteral Penicillin:** This is an antibiotic used for bacterial infections (e.g., Syphilis or Streptococcal infections). AA is autoimmune, not bacterial. **High-Yield Clinical Pearls for NEET-PG:** * **First-line treatment:** Intralesional steroids (e.g., **Triamcinolone acetonide**) are the treatment of choice for localized patches. * **Severe cases:** For Alopecia Totalis or Universalis, systemic steroids or **Topical Immunotherapy** (e.g., DPCP - Diphencyprone) are preferred. * **Nail findings:** "Geometric pitting" or "thimble pitting" is a classic association. * **Prognosis:** Poor prognostic factors include ophiasis pattern (hair loss at the occipital margin), childhood onset, and association with atopy.
Question 8: "Bamboo hair" is seen in which of the following conditions?
- A. Trichorrhexis nodosa
- B. Netherton syndrome (Correct Answer)
- C. Kinky hair syndrome
- D. Uncombable hair syndrome
Explanation: **Explanation:** **Bamboo hair**, medically known as **Trichorrhexis invaginata**, is the pathognomonic hair shaft abnormality seen in **Netherton syndrome**. This condition occurs due to a mutation in the *SPINK5* gene, which encodes the serine protease inhibitor LEKTI. The lack of this inhibitor leads to premature desquamation and structural weakness of the hair shaft, causing the distal shaft to invaginate into the proximal portion (a "ball-and-socket" appearance), resembling the nodes of a bamboo stick. **Analysis of Options:** * **Netherton Syndrome (Correct):** Characterized by a classic triad of **Trichorrhexis invaginata**, **Ichthyosis linearis circumflexa**, and **Atopic features** (elevated IgE). * **Trichorrhexis nodosa:** The most common hair shaft defect, characterized by "brush-like" fractures at nodes. It is seen in Menkes disease, argininosuccinic aciduria, and physical/chemical trauma. * **Kinky hair syndrome (Menkes disease):** Associated with **Pili torti** (twisted hair). It is an X-linked recessive disorder of copper metabolism (*ATP7A* gene). * **Uncombable hair syndrome (Pili trianguli et canaliculi):** Characterized by hair with a triangular cross-section and a longitudinal groove, making it impossible to brush flat. **High-Yield Clinical Pearls for NEET-PG:** * **Netherton Syndrome Triad:** Bamboo hair + Ichthyosis linearis circumflexa + Atopy. * **Pili Torti:** Seen in Menkes disease, Björnstad syndrome, and Crandall syndrome. * **Monilethrix:** "Beaded hair" (regularly spaced nodes) due to Keratin gene mutations (*KRT81/83/86*). * **Pohl-Pinkus marks:** Constrictions in hair shafts due to systemic illness (similar to Beau’s lines in nails).
Question 9: What is the most common type of non-scarring alopecia?
- A. Androgenic alopecia (Correct Answer)
- B. Alopecia areata
- C. Tinea capitis
- D. Traction alopecia
Explanation: **Explanation:** **Androgenic Alopecia (AGA)** is the most common type of non-scarring alopecia worldwide, affecting both men and women. It is a genetically determined, androgen-dependent process characterized by the progressive **miniaturization of hair follicles**. In this condition, terminal hairs are transformed into vellus-like hairs under the influence of Dihydrotestosterone (DHT), leading to a predictable pattern of hair loss (Hamilton-Norwood scale in men and Ludwig scale in women). **Analysis of Incorrect Options:** * **B. Alopecia Areata:** This is the most common **autoimmune** cause of non-scarring hair loss, characterized by well-demarcated patches and "exclamation mark" hairs. While frequent, its prevalence is significantly lower than AGA. * **C. Tinea Capitis:** This is the most common cause of hair loss in **children**. It can be non-scarring (ectothrix) or scarring (endothrix/kerion), but it is an infectious etiology rather than a physiological/genetic one. * **D. Traction Alopecia:** This is a form of hair loss caused by chronic tension on the hair shaft (e.g., tight hairstyles). While common in specific populations, it is not the leading cause of alopecia globally and can eventually lead to permanent scarring if the tension persists. **High-Yield Clinical Pearls for NEET-PG:** * **Key Enzyme:** 5-alpha reductase converts Testosterone to DHT (the primary culprit in AGA). * **Treatment of Choice:** Oral **Finasteride** (5-alpha reductase inhibitor) and topical **Minoxidil** (vasodilator that prolongs the anagen phase). * **Scarring vs. Non-scarring:** In non-scarring alopecia, follicular ostia (pores) are preserved. In scarring (cicatricial) alopecia, ostia are lost and replaced by fibrosis. * **Most common cause of scarring alopecia:** Lichen Planopilaris (LPP) or Discoid Lupus Erythematosus (DLE).
Question 10: Which of the following conditions is characterized by exclamation mark hairs?
- A. Syphilis
- B. Alopecia areata (Correct Answer)
- C. Psoriasis
- D. Dermatophytosis
Explanation: **Explanation:** **Alopecia Areata (AA)** is an autoimmune condition characterized by non-scarring, well-demarcated patches of hair loss. The hallmark clinical sign is the **"Exclamation Mark Hair."** These are short, broken hairs (2–3 mm) that are thicker at the top and taper down toward a thin, depigmented base near the scalp. They are typically found at the active periphery of an expanding patch, indicating that the hair follicle is under immune attack (lymphocytic "swarm of bees" infiltrate) but not yet destroyed. **Analysis of Incorrect Options:** * **Syphilis (Secondary):** Characterized by **"Moth-eaten alopecia,"** which presents as small, ragged, patchy areas of hair loss, primarily in the occipital and temporal regions. * **Psoriasis:** Scalp psoriasis typically presents with well-defined erythematous plaques with silvery scales. While it can cause temporary hair loss (**sebopsoriasis**), it does not feature exclamation mark hairs. Pits in nails are common here. * **Dermatophytosis (Tinea Capitis):** Fungal infections usually present with scaling, inflammation, or **"Black dot" alopecia** (where hairs break at the scalp surface). **High-Yield Clinical Pearls for NEET-PG:** * **Histopathology:** Characterized by a **peribulbar lymphocytic infiltrate** (the "Swarm of Bees" appearance). * **Nail Findings:** Fine, regular, **geometric pitting** is a classic association in AA. * **Prognostic Variants:** **Ophiasis pattern** (hair loss along the temporal/occipital hairline) carries a poorer prognosis compared to localized patches. * **First-line Treatment:** Intralesional corticosteroids (e.g., Triamcinolone acetonide).
Practice by Chapter
Hair Growth Cycle and Anatomy
Practice Questions
Alopecia Areata
Practice Questions
Androgenetic Alopecia
Practice Questions
Telogen Effluvium
Practice Questions
Scarring Alopecias
Practice Questions
Hair Shaft Abnormalities
Practice Questions
Hirsutism and Hypertrichosis
Practice Questions
Nail Anatomy and Growth
Practice Questions
Nail Infections
Practice Questions
Nail Psoriasis and Other Inflammatory Nail Disorders
Practice Questions
Nail Tumors
Practice Questions
Management of Hair and Nail Disorders
Practice Questions
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