Hair and Nail Disorders Practice Questions

Q: A patient presents with focal hair loss accompanied by pruritus and scalp scaling. Which of the following treatments is most suitable?

Oral antifungals. ***Oral antifungals*** - The clinical presentation of focal hair loss, pruritus, and scaling is highly characteristic of **tinea capitis**, a dermatophyte infection of the scalp. - **Griseofulvin** or **terbinafine** are the gold-standard systemic treatments required to penetrate the hair shaft and successfully eradicate the fungal infection. *Methotrexate* - This is an **immunosuppressive agent** typically reserved for severe inflammatory conditions like psoriasis or rheumatoid arthritis. - It has no role in treating common fungal scalp infections and could potentially worsen the condition by causing immunosuppression. *Topical corticosteroids* - While these may alleviate itching and inflammation, they do not treat the underlying fungal pathogen in **tinea capitis**. - Using steroids alone can lead to **tinea incognito**, where the infection continues to spread and proliferate while the classic appearance is masked by the steroid effect. *Oral antibiotics* - Antibiotics are indicated for **bacterial infections**, such as impetigo or secondary folliculitis, not fungal etiologies. - They are ineffective against dermatophytes and contribute to unnecessary antibiotic resistance.

Q: Onycholysis is seen in all of the following conditions, except:

Nephrotic syndrome. **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.

Q: Whitening of the nail plates may be due to deficiency of?

Albumin. **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).

Q: Which of the following medications is used in the treatment of male pattern alopecia?

Finasteride. **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.

Q: Nail deformities commonly seen in lichen planus include all of the following EXCEPT:

Beau's lines. **Explanation:** Lichen Planus (LP) is an inflammatory condition that affects the skin, mucous membranes, and nails. Nail involvement occurs in approximately 10% of cases and is primarily due to inflammation of the **nail matrix**. **Why Beau’s lines is the correct answer:** **Beau’s lines** are transverse depressions across the nail plate caused by a *temporary* systemic insult (e.g., high fever, chemotherapy, or severe illness) that briefly halts nail growth. While LP causes permanent or chronic damage to the matrix, it typically manifests as longitudinal (vertical) changes rather than temporary transverse arrests. **Analysis of incorrect options:** * **Pterygium (Dorsal):** This is the **hallmark** of nail Lichen Planus. It occurs when the proximal nail fold fuses with the nail bed due to scarring and destruction of the matrix, resulting in a V-shaped extension of skin over the nail. * **Longitudinal grooves:** These are very common in LP. Chronic inflammation of the matrix leads to thinning of the nail plate, resulting in vertical ridges, grooves, and "roughness" (trachyonychia). * **Onycholysis:** While less specific than pterygium, the inflammatory process in LP can involve the nail bed, leading to the separation of the nail plate from the bed. **NEET-PG High-Yield Pearls:** * **Twenty-nail dystrophy (Trachyonychia):** When all 20 nails are involved with a "sandpaper" appearance; LP is a major cause. * **Pterygium formation:** Dorsal pterygium is seen in **Lichen Planus**, whereas ventral pterygium (hyponychium sticking to the plate) is seen in **Scleroderma** or **SLE**. * **Management:** Intralesional or systemic steroids are required urgently to prevent permanent scarring and **Anonychia** (complete loss of the nail).

Q: A 30-year-old female developed diffuse hair loss 3 months after the delivery of her first child. What is the probable diagnosis?

Telogen effluvium. **Explanation:** The correct diagnosis is **Telogen Effluvium (TE)**. This is a form of non-scarring, diffuse hair loss that occurs when a significant number of hair follicles are prematurely pushed into the telogen (resting) phase due to a systemic stressor. **Why Telogen Effluvium is correct:** During pregnancy, high levels of estrogen prolong the **anagen (growth) phase**, leading to thicker hair. Following delivery, the sudden drop in estrogen levels triggers a synchronized shift of these follicles into the telogen phase. Hair shedding typically begins **2 to 4 months after the inciting event** (postpartum, high fever, major surgery, or severe stress), matching the timeline in this clinical scenario. **Analysis of Incorrect Options:** * **Androgenic Alopecia:** Characterized by patterned hair loss (widening of the central part in females) due to follicular miniaturization, rather than sudden diffuse shedding. * **Endocrinal Alopecia:** While hormonal imbalances (like hypothyroidism) cause hair loss, the specific postpartum timing makes TE the most classic and likely diagnosis. * **Systemic Lupus Erythematosus (SLE):** SLE can cause "lupus hair" (thin, friable frontal hair) or scarring alopecia, but it is usually accompanied by systemic symptoms (rash, joint pain) and is not specifically triggered by childbirth. **High-Yield Clinical Pearls for NEET-PG:** * **The "Hair Pull Test":** Positive in TE (usually >6 hairs extracted). * **Trichoscopy:** Shows decreased hair density without significant variation in hair shaft diameter (unlike androgenic alopecia). * **Prognosis:** TE is self-limiting; hair density usually returns to normal within 6–12 months. * **Common Triggers:** "4 Ms"—Metabolic (Iron deficiency), Medical (Post-febrile), Mental stress, and Maternity.

Q: Which of the following is NOT a cause of cicatricial alopecia?

Androgenetic alopecia. **Explanation:** Alopecia is broadly classified into two categories: **Cicatricial (Scarring)** and **Non-Cicatricial (Non-scarring)**. The fundamental difference lies in the fate of the hair follicle; in cicatricial alopecia, the follicle is permanently destroyed and replaced by fibrous tissue, leading to irreversible hair loss. **Why Androgenetic Alopecia is the correct answer:** Androgenetic alopecia (Option D) is the most common cause of **non-cicatricial** alopecia. It is characterized by follicular miniaturization driven by dihydrotestosterone (DHT), where terminal hairs transform into vellus-like hairs. Crucially, the follicular ostia (openings) remain intact, and there is no clinical or histological evidence of scarring or inflammation. **Analysis of Incorrect Options (Cicatricial Causes):** * **Lichen Planopilaris (Lichen Planus):** A primary lymphocytic cicatricial alopecia. It typically presents with "perifollicular scaling" and "perifollicular erythema." * **Discoid Lupus Erythematosus (DLE):** A common cause of primary scarring alopecia. It presents with well-demarcated erythematous plaques, atrophy, and "follicular plugging." * **Pseudopelade of Brocq:** An idiopathic, end-stage scarring alopecia characterized by small, flesh-colored patches that look like "footprints in the snow." **High-Yield NEET-PG Pearls:** * **Clinical Sign:** The absence of follicular ostia (smooth, shiny scalp) is the hallmark of cicatricial alopecia. * **Other Non-Cicatricial causes:** Alopecia areata, Telogen effluvium, Trichotillomania, and Syphilitic alopecia. * **Other Cicatricial causes:** Folliculitis decalvans, Frontal fibrosing alopecia, and Keratosis follicularis spinulosa decalvans. * **Diagnostic Tool:** Trichoscopy is essential to differentiate between the two; look for "yellow dots" in non-scarring and "white dots/loss of ostia" in scarring types.

Q: Thimble pitting of nails is seen in which of the following conditions?

Psoriasis. **Explanation:** **Thimble pitting** refers to the presence of multiple, deep, and irregularly spaced pits on the nail plate, resembling the surface of a tailor’s thimble. **1. Why Psoriasis is correct:** Pitting is the most common nail finding in psoriasis. It occurs due to **parakeratosis of the proximal nail matrix**. As the nail grows out, these clusters of parakeratotic cells are shed from the nail plate surface, leaving behind characteristic depressions or "pits." In psoriasis, these pits are typically deep, large, and randomly distributed. **2. Analysis of Incorrect Options:** * **Alopecia areata:** While pitting *can* occur here, it is typically **shallow, fine, and arranged in a regular, geometric (grid-like) pattern**, unlike the deep, irregular thimble pitting of psoriasis. * **Lichen planus:** The hallmark nail finding is **pterygium formation** (v-shaped scarring of the proximal nail fold onto the bed) and longitudinal ridging. It leads to nail thinning and atrophy, not discrete thimble pitting. * **Pemphigus:** Nail involvement is rare and usually manifests as paronychia or onychomadesis (nail shedding) due to acantholysis, but not classic pitting. **3. Clinical Pearls for NEET-PG:** * **Oil drop sign (Salmon patch):** Pathognomonic for nail psoriasis (due to exocytosis of leukocytes under the nail plate). * **Distal Onycholysis:** Separation of the nail plate from the bed, often with a yellowish margin. * **Nail Psoriasis & Arthritis:** Nail involvement is a strong clinical predictor for **Psoriatic Arthritis**, particularly involving the Distal Interphalangeal (DIP) joints. * **Twenty-nail dystrophy (Trachyonychia):** Rough, sandpaper-like nails seen in Alopecia areata, Lichen planus, or Psoriasis.

Q: Nail's involvement is NOT a feature of which of the following conditions?

Discoid Lupus Erythematosus (DLE). **Explanation:** The correct answer is **Discoid Lupus Erythematosus (DLE)**. While DLE is a chronic cutaneous form of Lupus that primarily affects sun-exposed areas (scalp, face, and ears) leading to scarring alopecia, it **characteristically spares the nails**. In contrast, Systemic Lupus Erythematosus (SLE) frequently involves the nails (showing periungual telangiectasia or splinter hemorrhages), but pure DLE does not. **Analysis of other options:** * **Psoriasis:** Nail involvement is extremely common (up to 50% of patients). High-yield features include **pitting** (most common), **onycholysis**, **oil spots** (salmon patches), and subungual hyperkeratosis. * **Lichen Planus (LP):** Nail LP occurs in 10% of cases. The hallmark is the **Pterygium formation** (V-shaped extension of the proximal nail fold onto the nail bed), which leads to permanent scarring and nail destruction. Other features include longitudinal ridging and "angel wing" deformity. * **Dermatomyositis:** This condition presents with pathognomonic nail fold changes, specifically **Gottron’s papules** over the knuckles and **periungual telangiectasia** (Keining’s sign) with ragged cuticles. **NEET-PG High-Yield Pearls:** * **Pterygium:** Seen in Lichen Planus (dorsal) and Peripheral Vascular Disease (ventral). * **Geometric Pitting:** Characteristic of Alopecia Areata (regularly spaced pits). * **Oil Spot Sign:** Pathognomonic for Psoriasis. * **Twenty-nail dystrophy (Trachyonychia):** Can be an isolated finding or associated with Alopecia Areata, Psoriasis, or Lichen Planus.

Question 1

A patient presents with focal hair loss accompanied by pruritus and scalp scaling. Which of the
following treatments is most suitable?

Accepted Answer

Oral antifungals

Answer

Methotrexate

Answer

Topical corticosteroids

Answer

Oral antibiotics

Question 2

Onycholysis is seen in all of the following conditions, except:

Accepted Answer

Nephrotic syndrome

Answer

Allergic dermatitis

Answer

Psoriasis

Answer

Antineoplastic therapy

Question 3

Whitening of the nail plates may be due to deficiency of?

Accepted Answer

Albumin

Answer

Iron

Answer

Zinc

Answer

Copper

Question 4

Which of the following medications is used in the treatment of male pattern alopecia?

Accepted Answer

Finasteride

Answer

Potassium channel blocker

Answer

Fulvestrant

Answer

Dexamethasone

Question 5

Non-cicatricial alopecia can be present in which skin disease?

Accepted Answer

Alopecia areata

Answer

Scleroderma

Answer

Lichen planus

Answer

Syphilis

Question 6

Nail deformities commonly seen in lichen planus include all of the following EXCEPT:

Accepted Answer

Beau's lines

Answer

Pterygium

Answer

Longitudinal grooves

Answer

Onycholysis

Question 7

A 30-year-old female developed diffuse hair loss 3 months after the delivery of her first child. What is the probable diagnosis?

Accepted Answer

Telogen effluvium

Answer

Androgenic alopecia

Answer

Endocrinal alopecia

Answer

Systemic Lupus Erythematosus

Question 8

Which of the following is NOT a cause of cicatricial alopecia?

Accepted Answer

Androgenetic alopecia

Answer

Lichen planus

Answer

Discoid lupus erythematosus (DLE)

Answer

Pseudopelade

Question 9

Thimble pitting of nails is seen in which of the following conditions?

Accepted Answer

Psoriasis

Answer

Pemphigus

Answer

Lichen planus

Answer

Alopecia areata

Question 10

Nail's involvement is NOT a feature of which of the following conditions?

Accepted Answer

Discoid Lupus Erythematosus (DLE)

Answer

Psoriasis

Answer

Dermatomyositis

Answer

Lichen planus

Hair and Nail Disorders — MCQs

Hair and Nail Disorders — MCQs

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