Hair Shaft Abnormalities — MCQs

10 questions

A 10-year-old boy presented with painful boggy swelling of scalp, multiple sinuses with purulent discharge, easily pluckable hair, and lymph nodes enlarged in occipital region, which of the following would be most helpful for diagnostic evaluation?

A child presents with multiple patchy areas of hair loss, scales, and itching. The sister also had similar lesions. What is the most likely diagnosis?

A girl presents with primary amenorrhea, grade V thelarche (mature breast), grade II pubarche (sparse growth of pubic hair) and no axillary hair. Likely diagnosis is:

Patchy hair loss with hyperhidrosis of skin points to the diagnosis of -

A patient presents with compulsive hair pulling resulting in irregular patchy hair loss. What is the most likely diagnosis?

Best diagnostic test for fungal skin infection –

HAIR-AN syndrome consists of which of the following?

Exclamation mark hair pattern is seen in

Consider the following regarding the human hair growth cycle : I. Anagen is a phase of active hair growth II. Telogen is a transitional phase III. Catagen is a resting phase Which of the statements given above is/are correct?

Q10

The growth phase of hair is

Hair Shaft Abnormalities Indian Medical PG Practice Questions and MCQs

Question 1: A 10-year-old boy presented with painful boggy swelling of scalp, multiple sinuses with purulent discharge, easily pluckable hair, and lymph nodes enlarged in occipital region, which of the following would be most helpful for diagnostic evaluation?

A. Bacterial culture
B. Biopsy and giemsa staining
C. Patch test, gram staining and Tzank smear
D. KOH mount (Correct Answer)

Explanation: ***KOH mount*** - The symptoms of **painful boggy scalp swelling**, **purulent discharge**, **easily pluckable hair**, and **occipital lymphadenopathy** in a child are highly suggestive of **Tinea capitis**, specifically **Kerion**. - A **KOH mount** is the most direct and rapid method to identify fungal elements (hyphae and spores) in hair shafts and scales, confirming the diagnosis of a dermatophyte infection. *Bacterial culture* - While there is **purulent discharge**, the primary presentation with **boggy swelling** and **hair loss** is more indicative of a fungal etiology. - A bacterial culture would only be useful to rule out secondary bacterial infection, but not as the initial diagnostic step for the described primary fungal condition. *Biopsy and Giemsa staining* - A **biopsy** is an invasive procedure and generally not the first-line diagnostic test for uncomplicated **Tinea capitis/Kerion**, where a non-invasive KOH mount is sufficient. - **Giemsa staining** is primarily used for identifying certain bacteria, parasites, or cellular morphology, but it is not the standard or most efficient method for diagnosing fungal infections of the hair. *Patch test, Gram staining and Tzank smear* - A **patch test** is used to diagnose **allergic contact dermatitis** and is irrelevant to the presented symptoms. - **Gram staining** is for bacterial identification, and a **Tzank smear** is used for viral infections like herpes, neither of which are indicated by the clinical picture of a fungal scalp infection.

Question 2: A child presents with multiple patchy areas of hair loss, scales, and itching. The sister also had similar lesions. What is the most likely diagnosis?

A. Alopecia areata
B. Tinea capitis (Correct Answer)
C. Pediculosis capitis
D. Pyoderma

Explanation: ***Tinea capitis*** - **Tinea capitis** presents with **patchy hair loss**, **scaling**, and **itching** on the scalp, which are classic signs of a fungal infection. - The fact that the sister also had similar lesions indicates a **contagious** condition, consistent with a **dermatophyte infection**. *Alopecia areata* - Characterized by **sudden, non-scarring hair loss** in circular or oval patches, often with no scaling or inflammation. - It is an **autoimmune condition** and typically not associated with itching or contagiousness amongst siblings. *Pediculosis capitis* - This condition involves an **infestation of head lice**, primarily causing **intense itching** of the scalp. - While it is contagious, it typically presents with **nits** (lice eggs) firmly attached to hair shafts and excoriations from scratching, rather than significant hair loss and scaling. *Pyoderma* - **Pyoderma** is a bacterial skin infection, often presenting as **pustules**, **crusts**, or **blisters** on the scalp. - While it can be contagious and cause discomfort, it is primarily characterized by purulent lesions and not the diffuse patchy hair loss and scaling seen in this case.

Question 3: A girl presents with primary amenorrhea, grade V thelarche (mature breast), grade II pubarche (sparse growth of pubic hair) and no axillary hair. Likely diagnosis is:

A. Turner syndrome
B. Testicular feminization (Correct Answer)
C. Gonadal dysgenesis
D. Mullerian agenesis

Explanation: Androgen Insensitivity Syndrome (also known as testicular feminization) is characterized by a phenotype where primary amenorrhea occurs in a girl with mature (Grade V) breast development but sparse or absent pubic and axillary hair (Grade II pubarche). In this condition, androgens are produced but their receptors are non-functional, leading to normal breast development through the peripheral conversion of androgens to estrogens while inhibiting androgen-dependent hair growth [3]. *Turner syndrome* - Characterized by gonadal dysgenesis [1], leading to primary amenorrhea and absent or rudimentary breast development (grade I thelarche). Patients typically present with characteristic physical features such as short stature [1], webbed neck, and coarctation of the aorta, which are not mentioned here. *Gonadal dysgenesis* - This is a broader term for abnormal development of the gonads [2], often leading to primary amenorrhea and lack of secondary sexual characteristics [1]. Unlike the described case, individuals with gonadal dysgenesis would not have mature breast development. *Mullerian agenesis* - Presents with primary amenorrhea due to the absence or hypoplasia of the uterus and upper vagina, but normal ovarian function. Patients with Mullerian agenesis would typically have normal breast development and normal pubic and axillary hair growth, as their androgen receptors are functional.

Question 4: Patchy hair loss with hyperhidrosis of skin points to the diagnosis of -

A. Alopecia areata
B. Trichotillomania
C. Hyperthyroidism (Correct Answer)
D. Adenoma sebaceum

Explanation: ***Hyperthyroidism*** - **Hyperthyroidism** can cause **diffuse hair thinning** or **patchy hair loss**, and increased **sweating (hyperhidrosis)** is a classic symptom due to increased metabolic rate [1]. - Other common symptoms include **heat intolerance**, **tachycardia**, **weight loss**, and **tremors**. *Alopecia areata* - Characterized by **well-demarcated, smooth non-scarring patches of hair loss**, often with **exclamation mark hairs** [1]. - It is an **autoimmune condition** and typically does not present with hyperhidrosis as a primary symptom. *Trichotillomania* - Defined by the **compulsive pulling out of one's hair**, leading to **irregular patches of hair loss** with hairs of varying lengths [1]. - It is a **psychiatric disorder** and does not cause hyperhidrosis. *Adenoma sebaceum* - This term is a misnomer for **facial angiofibromas**, which are small, red-to-flesh-colored papules typically found on the nose and cheeks. - These lesions are a common feature of **Tuberous Sclerosis Complex** and do not cause hair loss or hyperhidrosis.

Question 5: A patient presents with compulsive hair pulling resulting in irregular patchy hair loss. What is the most likely diagnosis?

A. Trichotillomania (Correct Answer)
B. Alopecia areata
C. Telogen effluvium
D. Tinea infection

Explanation: ***Trichotillomania*** - This condition is characterized by **recurrent, irresistible urges to pull out hair**, typically resulting in **noticeable hair loss**. - The resulting patchy hair loss is often **irregular** and can occur in various areas, aligning with the patient's presentation. *Alopecia areata* - This is an **autoimmune condition** that causes smooth, **well-demarcated patches of hair loss**, not typically associated with compulsive pulling. - It usually presents with a sudden onset of hair loss without any preceding trauma or manipulation. *Telogen effluvium* - This condition involves **widespread hair thinning** due to a disturbance in the hair growth cycle, often triggered by stress or illness. - It does not involve compulsive hair pulling and typically results in increased hair shedding rather than patchy hair loss. *Tinea infection* - Also known as **ringworm**, this is a fungal infection that can cause **scaly, itchy patches of hair loss**, sometimes with inflammation and broken hairs. - While it can cause patchy hair loss, it is characterized by dermatological signs of infection (e.g., scaling, erythema) and not compulsive hair pulling.

Question 6: Best diagnostic test for fungal skin infection –

A. KOH test (Correct Answer)
B. Diascopy
C. Patch test
D. Wood's lamp

Explanation: ***Correct: KOH test*** - The **potassium hydroxide (KOH) test** is the **most common and rapid method** for diagnosing dermatophyte infections. - It involves dissolving keratinous material to visualize **fungal hyphae** and **spores** under a microscope. - KOH test is **quick, inexpensive, and can be performed in any outpatient setting**, making it the best first-line diagnostic test. *Incorrect: Diascopy* - **Diascopy** is used to determine if a lesion is **vascular** (erythematous and blanches) or **non-vascular** (purpuric and does not blanch). - It involves pressing a glass slide against the lesion and observing color changes. - This test is not relevant for fungal identification. *Incorrect: Patch test* - A **patch test** is used to identify **allergic contact dermatitis** by applying specific allergens to the skin and observing for a delayed hypersensitivity reaction. - It is not designed to detect or diagnose fungal infections. *Incorrect: Wood's lamp* - A **Wood's lamp** emits ultraviolet light and is used to detect certain skin conditions that fluoresce. - While it can help diagnose some fungal infections like **Tinea capitis** caused by *Microsporum* species (which fluoresces green), it is **not a definitive diagnostic test** for all fungal infections. - Many common dermatophytes do not fluoresce, leading to false negatives.

Question 7: HAIR-AN syndrome consists of which of the following?

A. Acanthosis nigricans
B. Insulin resistance
C. Hyperandrogenism
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - HAIR-AN syndrome is an acronym representing the combination of **HyperAndrogenism**, **Insulin Resistance**, and **Acanthosis Nigricans**. - This syndrome is often associated with **severe hyperinsulinemia** and is considered a severe form of polycystic ovarian syndrome (PCOS) [1]. *Acanthosis nigricans* - While **acanthosis nigricans** is a key component of HAIR-AN syndrome, it does not, by itself, define the entire syndrome. - This condition is characterized by **darkening and thickening of the skin**, particularly in body folds, and is a marker of insulin resistance. *Insulin resistance* - **Insulin resistance** is central to HAIR-AN syndrome, driving many of its metabolic and dermatological manifestations. - However, the definition of HAIR-AN syndrome requires the presence of hyperandrogenism and acanthosis nigricans in addition to insulin resistance to be complete. *Hyperandrogenism* - **Hyperandrogenism**, characterized by elevated androgen levels leading to symptoms like hirsutism and acne, is a critical feature of HAIR-AN syndrome [1]. - Similar to the other components, hyperandrogenism alone does not constitute the full syndrome, which necessitates the presence of insulin resistance and acanthosis nigricans.

Question 8: Exclamation mark hair pattern is seen in

A. Anagen effluvium
B. Telogen effluvium
C. Androgenic alopecia
D. Alopecia areata (Correct Answer)

Explanation: ***Alopecia areata*** - **Exclamation mark hairs** are a classic diagnostic sign of **alopecia areata**, characterized by hairs that are narrower at the bottom near the scalp and wider at the top. - This pattern results from the sudden interruption of hair growth due to an autoimmune attack on the hair follicles. *Anagen effluvium* - This condition involves the shedding of hair due to early termination of the **anagen (growth) phase**, often caused by chemotherapy. - Hairs typically break off at or near the scalp, leading to diffuse hair loss, but do not show the characteristic "exclamation mark" appearance. *Telogen effluvium* - Characterized by the premature shedding of a large number of **telogen (resting) hairs**, usually triggered by significant physiological stress. - The shed hairs are typically mature, club-shaped telogen hairs and do not exhibit the distinctive tapered shape of exclamation mark hairs. *Androgenic alopecia* - Also known as **male- or female-pattern baldness**, this is a genetic and hormonal condition causing progressive thinning of hair. - Hair loss is typically diffuse, miniaturized, and follows a characteristic pattern, but does not present with exclamation mark hairs.

Question 9: Consider the following regarding the human hair growth cycle : I. Anagen is a phase of active hair growth II. Telogen is a transitional phase III. Catagen is a resting phase Which of the statements given above is/are correct?

A. III only
B. I, II and III
C. I only (Correct Answer)
D. I and II only

Explanation: ***I only*** - Statement I is **correct**: **Anagen is the active growth phase** of the hair cycle where hair follicle cells in the matrix rapidly divide and differentiate - The hair shaft actively grows during this phase, which typically lasts **2-7 years** and determines the maximum length of hair - **Only statement I is accurate**, making this the correct answer *III only* - This option is incorrect because statement III claims **Catagen is a resting phase**, which is medically inaccurate - **Catagen is actually the transitional/regression phase** (lasting 2-3 weeks) where hair growth stops and the follicle shrinks - The **resting phase is Telogen**, not Catagen *I, II and III* - This option is incorrect because **both statements II and III contain errors** - Statement II incorrectly identifies **Telogen as a transitional phase** when it is actually the **resting phase** (2-4 months) - Statement III incorrectly identifies **Catagen as a resting phase** when it is actually the **transitional phase** - Only statement I is correct *I and II only* - This option is incorrect because **statement II is inaccurate** - Statement II claims **Telogen is a transitional phase**, but Telogen is actually the **resting phase** where the hair remains in the follicle before shedding - The **transitional phase is Catagen**, not Telogen - Only statement I is correct, not both I and II

Question 10: The growth phase of hair is

A. Progen
B. Metagen
C. Anagen (Correct Answer)
D. Telogen

Explanation: ***Anagen*** - The **anagen phase** is the active growth phase of hair follicles, where hair grows rapidly and continuously. It can last from 2 to 7 years. - During this phase, cells in the hair bulb divide rapidly to produce new hair fibers, pushing older hairs up and out. *Progen* - **"Progen"** is not a recognized term for a phase of hair growth in scientific or medical literature. - This term does not correspond to any known stage in the hair follicle cycle. *Metagen* - **"Metagen"** is not a valid or recognized term for any phase of human hair growth. - The life cycle of hair involves distinct phases such as anagen, catagen, and telogen. *Telogen* - The **telogen phase** is the resting phase of the hair cycle, during which hair follicles are inactive, and hair growth ceases. - This phase typically lasts for about 3 months, after which the hair is shed, and the follicle re-enters the anagen phase.

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