Management of Hair and Nail Disorders — MCQs
What is the Drug of Choice (DOC) for Onychomycosis?
What is the primary condition for which calcitriol is used as a treatment?
The drug that can cause hirsutism is
A male patient presents with patchy loss of hair involving the scalp, eyebrows, and beard with presence of grey hair in the affected areas. What is the most likely diagnosis?
A 7 year old boy with boggy swelling of the scalp with multiple discharging sinuses with cervical lymphadenopathy with easily pluckable hair. What would be done for diagnosis?
Griseofulvin is not useful in one of the following
An 8-year-old child has localized non-cicatricial alopecia over scalp with itching and scales. The diagnosis is :
A male presents with alopecia and exclamation mark hairs. Diagnosis?
Which of the following statements is incorrect regarding nail changes in various conditions?
A child presenting with localized patches of complete hair loss with normal appearance of scalp. The diagnosis is:
Management of Hair and Nail Disorders Indian Medical PG Practice Questions and MCQs
Question 1: What is the Drug of Choice (DOC) for Onychomycosis?
- A. Terbinafine (Correct Answer)
- B. Fluconazole
- C. Itraconazole
- D. Nystatin
Explanation: ***Terbinafine*** - **Terbinafine** is considered the **drug of choice** for **onychomycosis** due to its potent fungicidal activity against **dermatophytes**, which are the most common cause of nail infections [1]. - It accumulates in the nail plate at therapeutic levels, leading to high cure rates and a relatively good safety profile [2]. *Fluconazole* - While effective against some fungi, **fluconazole** is primarily fungistatic and generally less effective against dermatophytes compared to terbinafine for onychomycosis, resulting in lower cure rates [1]. - It is often preferred for **mucocutaneous candidiasis** and other systemic fungal infections [1]. *Itraconazole* - **Itraconazole** is an alternative for onychomycosis, often administered in pulse doses, but it can have more significant drug interactions and a higher risk of hepatic toxicity compared to terbinafine [1]. - Its efficacy against dermatophytes is comparable to terbinafine, but its side effect profile makes it a second-line option [1]. *Nystatin* - **Nystatin** is a topical antifungal effective primarily against **Candida species**, and is not effective against **dermatophytes**, which are the main pathogens in onychomycosis. - It is typically used for mucocutaneous candidiasis, such as oral thrush or vaginal yeast infections, and is not absorbed systemically.
Question 2: What is the primary condition for which calcitriol is used as a treatment?
- A. Pemphigus
- B. Secondary hyperparathyroidism (Correct Answer)
- C. Lichen planus
- D. Leprosy
Explanation: Secondary hyperparathyroidism - Calcitriol is the active form of vitamin D (1,25-dihydroxyvitamin D₃), and it is crucial for regulating calcium and phosphate levels in the body [1]. - In secondary hyperparathyroidism, often seen in chronic kidney disease (CKD), the kidneys cannot convert vitamin D to its active form, leading to hypocalcemia and increased PTH secretion [1], [2]. - Calcitriol supplementation helps to increase calcium absorption from the gut and suppress the release of parathyroid hormone (PTH), thereby treating the underlying cause of secondary hyperparathyroidism [1], [2]. - This is the primary therapeutic indication for calcitriol in clinical practice. Lichen planus - This is a chronic inflammatory condition affecting the skin, hair, nails, and mucous membranes - Typically treated with corticosteroids or other immunosuppressants - Calcitriol has no primary role in the treatment of lichen planus; its therapeutic applications are predominantly related to calcium and bone metabolism Pemphigus - Pemphigus is a group of rare autoimmune blistering diseases that affect the skin and mucous membranes - Primary treatment involves immunosuppressants like corticosteroids, often in high doses - Calcitriol is not indicated for the treatment of pemphigus, as its mechanism of action is unrelated to the autoimmune processes characteristic of this disease Leprosy - Leprosy is a chronic infectious disease caused by the bacterium Mycobacterium leprae - Treated with multi-drug therapy (MDT), which includes antibiotics like rifampicin, dapsone, and clofazimine - Calcitriol is not an antibiotic and therefore has no role in treating the bacterial infection responsible for leprosy
Question 3: 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 4: A male patient presents with patchy loss of hair involving the scalp, eyebrows, and beard with presence of grey hair in the affected areas. What is the most likely diagnosis?
- A. Androgenic alopecia
- B. Anagen effluvium
- C. Alopecia areata (Correct Answer)
- D. Telogen effluvium
Explanation: ***Alopecia areata*** - This condition is characterized by **patchy hair loss** that can affect the scalp, eyebrows, and beard, and is often associated with the presence of **grey hairs** in the affected areas. - It is an **autoimmune disorder** where the immune system mistakenly attacks **hair follicles**, leading to non-scarring hair loss. *Androgenic alopecia* - This is commonly known as **male-pattern baldness** and typically presents as a receding hairline and thinning at the crown. - It is primarily driven by **genetics** and **androgen hormones**, and does not usually involve patchy loss or affect eyebrows and beard in the same way. *Anagen effluvium* - This condition is often caused by **chemotherapy** or other strong chemical exposures, leading to an abrupt and widespread loss of hair during the **anagen (growth) phase**. - Hair loss is typically diffuse and rapid, not usually localized to patches or accompanied by grey hair in specific areas. *Telogen effluvium* - This is a common form of **temporary hair loss** that occurs following a stressful event, fever, childbirth, or severe illness, causing premature shedding of hairs in the **telogen (resting) phase**. - It results in diffuse thinning rather than discrete patchy hair loss and is not typically associated with grey hair in the manner described.
Question 5: A 7 year old boy with boggy swelling of the scalp with multiple discharging sinuses with cervical lymphadenopathy with easily pluckable hair. What would be done for diagnosis?
- A. Pus for culture
- B. Biopsy
- C. KOH mount (Correct Answer)
- D. None of the options
Explanation: ***KOH mount*** - A **KOH mount** (potassium hydroxide wet mount) is the most appropriate **initial rapid diagnostic test** for suspected **tinea capitis** with **kerion formation**, allowing immediate visualization of fungal elements (hyphae and spores). - The clinical presentation of boggy scalp swelling, discharging sinuses, cervical lymphadenopathy, and easily pluckable hair is classic for **kerion**, a severe inflammatory form of tinea capitis caused by dermatophytes (commonly *Trichophyton* or *Microsporum* species). - KOH mount is **quick, inexpensive, and readily available**, making it ideal for immediate diagnosis in clinical practice, though fungal culture may be performed subsequently for species identification. *Pus for culture (bacterial)* - While bacterial culture might be performed to rule out **secondary bacterial infection**, it does not diagnose the underlying **fungal etiology** of kerion. - The primary pathogen in kerion is a dermatophyte fungus, not bacteria, though secondary bacterial infection can occur. *Biopsy* - A **biopsy** is usually reserved for cases that are atypical, treatment-resistant, or when there is diagnostic uncertainty with other conditions (e.g., dissecting cellulitis, bacterial abscess). - It is an **invasive procedure** and not the first-line diagnostic approach for a clinically obvious case of kerion. *None of the options* - Given the classic clinical presentation of kerion, a definitive diagnostic method (KOH mount) is required to confirm the fungal infection and guide appropriate systemic antifungal treatment. - Therefore, choosing "None of the options" would be incorrect.
Question 6: Griseofulvin is not useful in one of the following
- A. Tinea capitis
- B. Tinea pedis
- C. Tinea versicolor (Correct Answer)
- D. Tinea cruris
Explanation: ***Tinea versicolor*** - **Griseofulvin** acts by interfering with **microtubule function** and fungal cell division, making it effective against dermatophytes. - **Tinea versicolor** is caused by *Malassezia* species, which are yeasts and not dermatophytes, rendering griseofulvin ineffective. *Tinea capitis* - This **dermatophyte infection** of the scalp responds well to griseofulvin, which accumulates in keratin-rich tissues. - The medication's ability to reach the **hair shaft** is crucial for treating this condition. *Tinea pedis* - Also known as **athlete's foot**, this is a common **dermatophyte infection** of the feet effectively treated by griseofulvin. - Griseofulvin's deposition into the **stratum corneum** and other keratinized structures helps eliminate the fungus. *Tinea Cruris* - This **dermatophyte infection** of the groin ("jock itch") is sensitive to griseofulvin. - Griseofulvin inhibits **fungal growth** by disrupting mitotic spindle formation in dermatophytes.
Question 7: An 8-year-old child has localized non-cicatricial alopecia over scalp with itching and scales. The diagnosis is :
- A. Lichen planus
- B. Tinea Capitis (Correct Answer)
- C. Tinea Barbae
- D. Alopecia areata
Explanation: ***Tinea Capitis*** - **Tinea capitis** typically presents as **localized, non-cicatricial alopecia** with features like **scaling**, **itching**, and broken hairs, which are consistent with the child's symptoms. - It's a common **dermatophyte infection** of the scalp, particularly in children, caused by fungi like *Trichophyton* or *Microsporum*. *Lichen planus* - **Lichen planus** can cause alopecia, but it is typically a **cicatricial (scarring)** alopecia, unlike the non-cicatricial finding described. - It is more commonly associated with **purplish, polygonal, pruritic papules** on the skin and mucous membranes. *Tinea Barbae* - **Tinea barbae** specifically affects the **beard and mustache area** in adult males and would not present as alopecia on the scalp in an 8-year-old child. - It usually involves deep follicular inflammation with **pustules and nodules**. *Alopecia areata* - **Alopecia areata** is characterized by **smooth, circular patches of non-scarring hair loss** without associated scaling or significant itching. - The presence of **scaling and itching** in this case makes alopecia areata less likely.
Question 8: A male presents with alopecia and exclamation mark hairs. Diagnosis?
- A. Alopecia areata (Correct Answer)
- B. Tinea capitis
- C. Telogen effluvium
- D. Androgenic alopecia
Explanation: ***Alopecia areata*** - **Alopecia areata** is characterized by sudden, non-scarring hair loss that can affect any hair-bearing area, including the scalp. - The presence of **exclamation mark hairs** (hairs that are narrower closer to the scalp) is a classic dermatoscopic finding in alopecia areata and is highly suggestive of the diagnosis. *Tinea capitis* - **Tinea capitis** is a fungal infection of the scalp often presenting with scaling, erythema, and broken hairs, but typically not "exclamation mark hairs." - It may cause **patchy alopecia** but is usually associated with inflammation and sometimes pustules. *Telogen effluvium* - **Telogen effluvium** is a diffuse, non-scarring hair shedding that occurs after a stressful event, leading to widespread thinning rather than localized patches. - It primarily involves an increase in the number of hairs in the **telogen (resting) phase** and does not typically feature exclamation mark hairs. *Androgenic alopecia* - **Androgenic alopecia**, or male/female pattern baldness, is characterized by a gradual, patterned hair loss due to genetic and hormonal factors. - It involves the miniaturization of hair follicles and progressive thinning, but it does not present with **exclamation mark hairs** or discrete patches of complete hair loss.
Question 9: Which of the following statements is incorrect regarding nail changes in various conditions?
- A. Onycholysis is seen in Psoriasis.
- B. Mees lines are indicative of Arsenic poisoning.
- C. Pterygium of nails is associated with Lichen Planus.
- D. Koilonychia is associated with Vitamin B12 deficiency. (Correct Answer)
Explanation: ***Koilonychia is associated with Vitamin B12 deficiency.*** - **Koilonychia**, or "spoon nails," is primarily associated with **iron deficiency anemia**, not Vitamin B12 deficiency. - In Koilonychia, the nails become **thin, brittle**, and concave in shape. *Onycholysis is seen in Psoriasis.* - **Onycholysis** refers to the separation of the nail plate from the nail bed, which is a common nail finding in **psoriasis**. - Other nail changes in psoriasis include **pitting**, oil spots, and subungual hyperkeratosis. *Mees lines are indicative of Arsenic poisoning.* - **Mees lines** are transverse white lines or bands that appear across the nail plate, characteristic of severe illness or poisoning. - They are classically associated with **arsenic poisoning**, but can also be seen in other conditions like thallium poisoning or kidney failure. *Pterygium of nails is associated with Lichen Planus.* - **Pterygium unguis** involves the forward growth of the proximal nail fold (cuticle) onto the nail plate, leading to fusion. - It is a prominent and often distinguishing feature of **lichen planus** affecting the nails, which can lead to permanent nail deformity or loss.
Question 10: A child presenting with localized patches of complete hair loss with normal appearance of scalp. The diagnosis is:
- A. Tinea capitis
- B. Cradle cap
- C. Alopecia areata (Correct Answer)
- D. Telogen effluvium
Explanation: ***Alopecia areata*** - This condition is characterized by **localized, well-demarcated patches of complete hair loss** on the scalp. - The underlying skin typically appears **normal, smooth, and healthy**, without inflammation or scaling. *Tinea capitis* - This fungal infection usually presents with **scaly patches**, inflammation, pustules, or "black dots" where hairs have broken off. - The scalp appearance is typically **abnormal** due to scaling and inflammation, unlike the normal scalp seen here. *Cradle cap* - Also known as **seborrheic dermatitis in infants**, it presents as greasy, yellowish, scaly patches on the scalp. - It does not cause **complete hair loss** in localized patches, but rather diffuse scaling and sometimes mild thinning. *Telogen effluvium* - This condition involves **diffuse hair shedding** (increased number of hairs falling out), often triggered by stress, illness, or medications. - It does not present as **localized patches of complete hair loss**, and the hair thinning is generally widespread.
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