Hirsutism and Hypertrichosis — MCQs
A 35-year-old obese female presents with worsening hirsutism and elevated testosterone levels. Which of the following is true?
The drug that can cause hirsutism is
Seal like limbs i.e. phocomelia is a specific side effect of -
Congenital adrenal hyperplasia is the most common cause of
Congenital adrenal hyperplasia most commonly presents as
HAIR-AN syndrome consists of which of the following?
A 24-year-old male presents with a lesion at the site shown in the image for 4 years. He says it has increased in thickness over the years. Diagnosis is:
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?
Hirsutism and Hypertrichosis Indian Medical PG Practice Questions and MCQs
Question 1: A 35-year-old obese female presents with worsening hirsutism and elevated testosterone levels. Which of the following is true?
- A. She is at risk of cervical cancer
- B. She is at risk of endometrial cancer (Correct Answer)
- C. She is at risk of ovarian cancer
- D. None of the above
Explanation: ***She is at risk of endometrial cancer*** - The combination of **obesity**, **hirsutism**, and **high testosterone** in a 35-year-old female is highly suggestive of **Polycystic Ovary Syndrome (PCOS)**. - PCOS is associated with **anovulation**, leading to unopposed estrogen exposure which increases the risk of **endometrial hyperplasia** and **cancer**. *She is at risk of cervical cancer* - **Cervical cancer** is primarily caused by persistent infection with **high-risk human papillomavirus (HPV)**. - The patient's presentation of hirsutism and high testosterone does not directly indicate an increased risk of cervical cancer. *She is at risk of ovarian cancer* - While PCOS is a risk factor for some types of cancer, it is not consistently linked to an increased risk of common **epithelial ovarian cancers**. - There is a debated, but not strongly established, link between PCOS and certain **sex cord stromal tumors** of the ovary, but not the more common forms of ovarian cancer. *None of the above* - This option is incorrect because the clinical picture strongly points to a condition (PCOS) that significantly increases the risk for endometrial cancer.
Question 2: The drug that can cause hirsutism is
- A. Dactinomycin
- B. Cycloserine
- C. Minoxidil (Correct Answer)
- D. Valsartan
Explanation: ***Minoxidil*** - **Minoxidil** is a potent **vasodilator** that can cause **hirsutism** as a common side effect, especially when used orally. - Due to its hair growth stimulating effect, it is also topically used to treat **androgenetic alopecia** [1]. *Dactinomycin* - **Dactinomycin** is an **antineoplastic antibiotic** primarily used in cancer chemotherapy. - Its main side effects include **myelosuppression**, nausea, vomiting, and mucositis, not hirsutism. *Cycloserine* - **Cycloserine** is an antibiotic mainly used to treat **tuberculosis** [2]. - Its adverse effects are predominantly **neurological** and psychiatric, such as seizures and psychosis, not affecting hair growth [2]. *Valsartan* - **Valsartan** is an **angiotensin receptor blocker (ARB)** used to treat hypertension and heart failure. - Common side effects include dizziness and hyperkalemia; it does not cause hirsutism.
Question 3: Seal like limbs i.e. phocomelia is a specific side effect of -
- A. Doxorubicin
- B. Thalidomide (Correct Answer)
- C. Cyclophosphamide
- D. Terazosin
Explanation: ***Thalidomide*** - **Phocomelia**, characterized by severely shortened or absent limbs resembling those of a seal, is a classic and well-documented **teratogenic effect** of thalidomide. - This drug, when taken during early pregnancy (especially between weeks 4 and 8), disrupts limb bud development. *Doxorubicin* - **Doxorubicin** is an **anthracycline antibiotic** used in cancer chemotherapy, known for its significant **cardiotoxicity**, leading to dilated cardiomyopathy. - While it has various side effects, **phocomelia** is not a reported teratogenic effect of doxorubicin. *Cyclophosphamide* - **Cyclophosphamide** is an **alkylating agent** used in chemotherapy and immunosuppression, with notable side effects including **hemorrhagic cystitis** and **myelosuppression**. - Although it is a teratogen and can cause various fetal malformations, it is not specifically associated with **phocomelia**. *Terazosin* - **Terazosin** is an **alpha-1 blocker** primarily used to treat hypertension and benign prostatic hyperplasia (BPH). - Its main side effects include **orthostatic hypotension** and dizziness; it is not known to be teratogenic or associated with **phocomelia**.
Question 4: Congenital adrenal hyperplasia is the most common cause of
- A. True hermaphroditism
- B. Female pseudohermaphroditism (androgenized female 46XX) (Correct Answer)
- C. Male pseudohermaphroditism (underandrogenized male 46XY)
- D. Turner's syndrome
Explanation: ***Female pseudohermaphroditism (androgenized female 46XX)*** - Congenital adrenal hyperplasia (CAH), particularly **21-hydroxylase deficiency**, leads to overproduction of **adrenal androgens**. [3] - In a 46,XX fetus, this excess androgen exposure results in masculinization of external genitalia, while internal female organs (uterus, ovaries) are present, defining **female pseudohermaphroditism**. [3] *True hermaphroditism* - Characterized by the presence of both **ovarian and testicular tissue** in the same individual. [2] - This condition is rare and not directly caused by the hormonal imbalances seen in CAH. *Male pseudohermaphroditism (underandrogenized male 46XY)* - Occurs in individuals with a **46,XY karyotype** who have testes but whose external genitalia are ambiguous or female due to **insufficient androgen production or action**. - Conditions like **androgen insensitivity syndrome** or defects in testosterone synthesis cause this, not CAH. [3] *Turner's syndrome* - A chromosomal disorder with a **45,XO karyotype**, primarily affecting females. [1] - It is characterized by features such as **short stature**, gonadal dysgenesis (streak gonads), and various congenital anomalies, and it is not a form of pseudohermaphroditism related to adrenal function. [1]
Question 5: Congenital adrenal hyperplasia most commonly presents as
- A. 46,XY DSD
- B. Ovotesticular DSD
- C. 46,XX DSD with virilization (Correct Answer)
- D. 46,XY DSD with undervirilization
Explanation: ***46,XX DSD with virilization*** (formerly female pseudohermaphroditism) - This is the **most common presentation** of congenital adrenal hyperplasia (CAH), particularly due to **21-hydroxylase deficiency**, which accounts for >90% of CAH cases. - Affects genetically female (46,XX) individuals with excess **androgens** produced by hyperplastic adrenal glands leading to **virilization** of external genitalia. - Clinical features include **clitoromegaly, labioscrotal fusion**, and varying degrees of masculinization, while **internal female organs (uterus, ovaries, fallopian tubes) remain normal**. - This is the classic presentation that brings CAH to clinical attention in newborn screening programs. *46,XY DSD* (formerly 46,XY intersex) - This terminology refers to conditions where genetically male individuals (46,XY) have atypical genital development. - Common causes include **androgen insensitivity syndrome** or disorders of testosterone synthesis (5α-reductase deficiency, 17β-hydroxysteroid dehydrogenase deficiency). - CAH in 46,XY individuals typically presents with **isosexual precocious pseudopuberty** (early virilization) in simple virilizing forms or **salt-wasting adrenal crisis** in severe forms, not undervirilization. *Ovotesticular DSD* (formerly true hermaphroditism) - Very rare condition where an individual has **both ovarian and testicular tissue**, either as separate gonads or combined as ovotestes. - Often involves complex chromosomal patterns including **46,XX/46,XY mosaicism** or 46,XX with SRY translocation. - Not related to CAH pathophysiology, which involves enzymatic defects in steroidogenesis. *46,XY DSD with undervirilization* (formerly male pseudohermaphroditism) - Occurs when 46,XY individuals have **undervirilized or ambiguous external genitalia** due to impaired androgen synthesis or action. - Causes include disorders of testicular development, androgen biosynthesis defects, or **androgen insensitivity**. - While CAH can affect males, it causes **excess androgens** leading to precocious puberty, not undervirilization.
Question 6: 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 7: A 24-year-old male presents with a lesion at the site shown in the image for 4 years. He says it has increased in thickness over the years. Diagnosis is:
- A. Spitz nevus
- B. Hyper-melanosis of Ito
- C. Becker's nevus (Correct Answer)
- D. Congenital melanocytic nevus
Explanation: ***Becker's nevus*** - This lesion typically presents as a **unilateral, hyperpigmented patch** that often appears during childhood or adolescence, increasing in size and thickness with associated **hypertrichosis** (increased hair growth). The image shows a large, irregularly shaped, hyperpigmented area on the torso of a young male, consistent with this description. - The history of increasing thickness over four years further supports **Becker's nevus**, as it is known to progress in thickness and texture, often becoming more indurated and sometimes verrucous. *Spitz nevus* - Spitz nevus is a benign melanocytic nevus typically presenting as a **pink or red, dome-shaped papule or nodule**, commonly on the face or limbs. - It rapidly grows but does not typically present as a large, hyperpigmented patch with associated hypertrichosis like the lesion shown. *Hyper-melanosis of Ito* - Hypermelanosis of Ito (also known as incontinentia pigmenti achromians) is characterized by **streaky or whorled hypopigmented (lighter) skin lesions**, often present at birth or in early infancy. - The image clearly shows a **hyperpigmented (darker) lesion**, which directly contradicts the characteristic hypopigmentation of hypermelanosis of Ito. *Congenital melanocytic nevus* - Congenital melanocytic nevi are typically present **at birth** or become apparent shortly thereafter. While they can be large and hyperpigmented, they usually do not have the prominent feature of increasing thickness and hypertrichosis developing many years later in adolescence or early adulthood in the same way as Becker's nevus. - The description of a lesion appearing during adolescence and increasing in thickness and hairiness for four years makes Becker's nevus a more specific diagnosis than a general congenital melanocytic nevus.
Question 8: 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 9: 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 10: 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)**.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free