Nail Anatomy and Growth — MCQs
All are nail changes seen in cases of psoriasis except:
Nail changes are found in about ______ cases of psoriasis:
All are true about psoriasis except:
The distal nail matrix forms which of the following?
Pterygium of nail is seen in?
All are true about psoriasis except –
Which of the following is a characteristic of Yellow-nail syndrome?
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?
The growth phase of hair is
What phase of hair growth is primarily responsible for the length of eyebrows?
Nail Anatomy and Growth Indian Medical PG Practice Questions and MCQs
Question 1: All are nail changes seen in cases of psoriasis except:
- A. Subungual hyperkeratosis
- B. Oil drop sign
- C. Mees lines (Correct Answer)
- D. Pitting
Explanation: ***Mees lines*** - **Mees lines** (or Aldrich-Mees lines) are **transverse white bands** that appear in the nail plate. - They are typically associated with **heavy metal poisoning** (e.g., arsenic), chemotherapy, or systemic illnesses, not psoriasis. *Subungual hyperkeratosis* - This is a common finding in **psoriasis**, characterized by the **thickening of the nail bed** due to excessive keratin production. - It leads to lifting of the nail plate from the nail bed. *Oil drop sign* - The **oil drop sign** (or salmon patch) is a classic psoriatic nail change, presenting as a **translucent, yellowish-red discoloration** under the nail plate. - It is due to psoriasis of the nail bed. *Pitting* - **Nail pitting** refers to the presence of **small depressions or pits** on the nail surface. - It results from defective keratinization of the nail matrix and is a characteristic sign of nail psoriasis.
Question 2: Nail changes are found in about ______ cases of psoriasis:
- A. Two thirds
- B. One third
- C. One half (Correct Answer)
- D. All cases
Explanation: ***One half*** - Approximately **50% of patients with psoriasis** will experience nail changes, which can be a key diagnostic feature. - Nail involvement is even higher, around **80-90%**, in patients with **psoriatic arthritis**. *Two thirds* - While a significant proportion, **two-thirds (roughly 66%)** is a slight overestimate of the general prevalence of nail changes in psoriasis. - This figure might be seen in specific populations or more severe cases, but not overall. *One third* - **One-third (roughly 33%)** is an underestimation of the frequency of nail changes in psoriasis. - Nail involvement is a very common manifestation of the disease. *All cases* - It is incorrect to state that **all cases of psoriasis** have nail changes. - While common, nail involvement is not universal and can range from mild to severe, or be entirely absent.
Question 3: All are true about psoriasis except:
- A. Parakeratosis & acanthosis
- B. Pitting of nails
- C. Very pruritic (Correct Answer)
- D. Joint involvement in 5–30%
Explanation: ***Very pruritic*** - While psoriasis can be itchy, it is generally not characterized as "very pruritic" compared to other dermatological conditions like **eczema** or **scabies**. - **Pruritus** in psoriasis tends to be mild to moderate, and it is not a defining characteristic that differentiates it from other skin disorders. *Parakeratosis & acanthosis* - **Parakeratosis** (retention of nuclei in the stratum corneum) and **acanthosis** (epidermal hyperplasia) are classic histopathological hallmarks of psoriasis. - These features reflect the rapid epidermal turnover characteristic of the condition. *Pitting of nails* - **Nail pitting**, onycholysis, and subungual hyperkeratosis are common and characteristic manifestations of psoriasis, affecting up to 50% of patients. - These nail changes are highly indicative of **psoriatic involvement**. *Joint involvement in 5–10%* - **Psoriatic arthritis**, involving inflammation of the joints, affects approximately 5-30% of individuals with psoriasis. - This statistic makes joint involvement a significant comorbidity of psoriasis.
Question 4: The distal nail matrix forms which of the following?
- A. Ventral Portion of nail plate (Correct Answer)
- B. Dorsal Portion of nail plate
- C. Both of the options
- D. None of the options
Explanation: ***Ventral Portion of nail plate*** The **distal nail matrix** is the primary contributor to the bulk of the **nail plate**, specifically forming its **ventral (inferior/deeper) portion**. This region is responsible for the rapid proliferation and keratinization of cells that give the nail its thickness and strength. The distal matrix accounts for approximately **80-90% of the nail plate volume**. *Dorsal Portion of nail plate* The **dorsal (superficial/top) portion of the nail plate** is predominantly formed by the **proximal nail matrix**, not the distal matrix. This part contributes to the smooth, shiny superficial layer of the nail. *Both of the options* This is incorrect because the **distal and proximal nail matrices** have distinct and separate roles in forming specific parts of the nail plate. The distal matrix forms only the ventral portion, while the proximal matrix forms the dorsal portion. *None of the options* This is incorrect as the **distal nail matrix** clearly has a specific and significant role in **nail plate formation**, specifically forming the ventral portion.
Question 5: Pterygium of nail is seen in?
- A. Pemphigoid
- B. Psoriasis
- C. Pemphigus
- D. Lichen planus (Correct Answer)
Explanation: ***Lichen planus*** - **Pterygium of the nail** refers to the forward growth of the proximal nail fold over the nail plate, often seen as a V-shaped scarring, which is a characteristic feature of severe **nail lichen planus**. - Other nail changes in lichen planus can include **longitudinal ridging**, thinning, splitting, and anonychia. *Pemphigoid* - Bullous pemphigoid typically affects the **skin with tense blisters** and rarely involves the nails significantly. - Nail changes are uncommon but if present, are usually non-specific, such as **subungual hematomas** or **onycholysis**, not pterygium. *Psoriasis* - Nail psoriasis presents with characteristic features like **pitting**, **onycholysis**, **oil-drop spots**, and **subungual hyperkeratosis**. - While significant nail dystrophy can occur, true pterygium formation from the proximal nail fold is **not a typical finding** in psoriasis. *Pemphigus* - Pemphigus is an autoimmune blistering disorder characterized by **flaccid blisters** and erosions, primarily affecting the skin and mucous membranes. - **Nail involvement is rare** and usually secondary to periungual blistering, leading to non-specific changes like paronychia or onychomadesis, not pterygium.
Question 6: All are true about psoriasis except –
- A. Auspitz sign positive
- B. Parakeratosis & acanthosis
- C. Joint involvement in 5–10% (Correct Answer)
- D. Pitting of nails
- E. Koebner phenomenon
Explanation: ***Joint involvement in 5–10%*** - While **psoriasis** is a skin condition, it can involve the joints in about **30% of patients**, leading to **psoriatic arthritis**. - Therefore, stating that joint involvement occurs in only **5-10%** is incorrect, as the percentage is significantly higher. - This is the **FALSE statement** in this EXCEPT question. *Auspitz sign positive* - The **Auspitz sign** (pinpoint bleeding when scales are removed) is a classic feature of psoriasis. - It occurs due to the proximity of dilated capillaries to the thinned suprapapillary epidermis. - This is a **TRUE statement**. *Parakeratosis & acanthosis* - **Parakeratosis** (retention of nuclei in the stratum corneum) and **acanthosis** (epidermal hyperplasia) are classic histopathological features of psoriasis. - These features reflect the **rapid cell turnover** and **thickening of the epidermis** characteristic of psoriatic plaques. - This is a **TRUE statement**. *Pitting of nails* - **Nail pitting** is a common manifestation of psoriasis, affecting up to **50% of patients** with chronic plaque psoriasis and **80% of patients with psoriatic arthritis**. - Other nail changes include **onycholysis**, **subungual hyperkeratosis**, and discoloration. - This is a **TRUE statement**. *Koebner phenomenon* - **Koebner phenomenon** (isomorphic response) is the development of psoriatic lesions at sites of trauma or injury. - This is seen in approximately **25% of patients** with psoriasis and is a well-recognized clinical feature. - This is a **TRUE statement**.
Question 7: Which of the following is a characteristic of Yellow-nail syndrome?
- A. Knee joint effusion and lymphedema, associated with discolored nails
- B. Pericardial effusion and lymphedema, associated with discolored nails
- C. Pleural effusion and lymphedema, associated with discolored nails (Correct Answer)
- D. Peritoneal effusion and lymphedema, associated with discolored nails
Explanation: ***Pleural effusion and lymphedema, associated with discolored nails*** - Yellow-nail syndrome is characterized by the triad of **yellow, thickened, slow-growing nails**, **lymphedema**, and **pleural effusions**. - **Pleural effusions** are the most common respiratory manifestation, often chronic and recurrent. *Knee joint effusion and lymphedema, associated with discolored nails* - While **lymphedema** is a feature of Yellow-nail syndrome, **knee joint effusion** is not a primary or defining characteristic of the syndrome. - Joint effusions can occur in various conditions, but Yellow-nail syndrome is specifically associated with serous effusions in cavities like the pleura. *Pericardial effusion and lymphedema, associated with discolored nails* - **Pericardial effusion** is a rare manifestation of Yellow-nail syndrome, not a defining characteristic. - The classic triad includes **pleural effusions**, not pericardial. *Per peritoneal effusion and lymphedema, associated with discolored nails* - **Peritoneal effusion** (ascites) is another rare manifestation of Yellow-nail syndrome, not typically included in its core diagnostic criteria. - The syndrome is predominantly associated with effusions in the **pleural space**.
Question 8: 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 9: 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.
Question 10: What phase of hair growth is primarily responsible for the length of eyebrows?
- A. Anagen phase (Correct Answer)
- B. Telogen phase
- C. Catagen phase
- D. Exogen phase
Explanation: ***Anagen phase*** - The **anagen phase** is the **active growth phase** where hair follicles rapidly produce hair cells, determining the maximum length hair can achieve. - Eyebrows have a much **shorter anagen phase** (months) compared to scalp hair (years), which explains why they don't grow very long. *Telogen phase* - The **telogen phase** is the **resting phase** where the hair follicle is dormant and no further growth occurs. - Hair in this phase is mature and will eventually shed, but this phase does not contribute to hair length. *Catagen phase* - The **catagen phase** is a **transitional phase** where hair growth stops, and the follicle shrinks in preparation for the resting phase. - This phase marks the end of active growth, so it does not contribute to increasing hair length. *Exogen phase* - The **exogen phase** is a sub-phase of telogen, where **hair shedding** occurs. - This phase is about the release of old hair, not the production or increase in length of new hair.
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