Hair and Nail Disorders Practice Questions

Q: Which of the following conditions does NOT cause nail pitting?

Pityriasis Rosea. ***Pityriasis Rosea*** - This condition primarily affects the **skin**, causing a distinctive rash of oval, pinkish-red patches, often preceded by a **herald patch**. - It characteristically spares the **nails**, meaning nail pitting is not a feature of pityriasis rosea. - Nail changes are not associated with this self-limiting dermatosis. *Lichen planus* - **Nail lichen planus** can cause various nail changes, including **pitting**, longitudinal ridging, pterygium formation, and thinning of the nail plate. - It is an inflammatory condition affecting the skin, hair, nails, and mucous membranes. - Nail involvement occurs in approximately 10% of patients with cutaneous lichen planus. *Psoriasis* - **Nail psoriasis** is common, affecting up to 50% of patients with psoriasis, and **pitting is the most characteristic nail finding**. - Pitting appears as small punctate depressions on the nail surface due to defects in the proximal nail matrix. - Other nail changes include onycholysis (oil drop sign), subungual hyperkeratosis, and salmon patches. *Fungal infection* - **Onychomycosis** (fungal nail infection) typically causes **thickening, discoloration, onycholysis, and crumbling** of the nail. - **True nail pitting is NOT a characteristic feature** of fungal infections, as pitting results from defects in the proximal nail matrix, not fungal invasion. - Fungal infections affect the nail plate and bed differently, causing destruction rather than the punctate depressions seen in pitting.

Q: Which of the following conditions causes diffuse non-scarring alopecia typically triggered by physiological stress?

Telogen Effluvium. ***Telogen Effluvium*** - This condition is a common cause of **diffuse non-scarring hair loss** where a significant number of **hair follicles** prematurely enter the **telogen phase**, leading to widespread shedding. - It is characteristically **triggered by physiological or emotional stressors** such as childbirth, severe illness, surgery, or significant weight loss, typically occurring **2-3 months after the stressor**. - The condition is usually **self-limiting and reversible** once the underlying cause is addressed, with complete hair regrowth expected. *Alopecia areata* - This is an **autoimmune disorder** that causes **patchy, localized hair loss** on the scalp, not diffuse shedding. - While it is a **non-scarring alopecia**, it presents with well-demarcated round or oval patches rather than generalized thinning. - The pattern is distinctly different from the diffuse hair loss seen in telogen effluvium. *Alopecia totalis* - This is an **autoimmune condition** characterized by **complete loss of all scalp hair**, representing an extensive variant of alopecia areata. - It presents as **total scalp hair loss** rather than diffuse thinning, making it clinically distinct from stress-related diffuse shedding. - Though non-scarring, it is not typically triggered by physiological stressors. *Lichen planopilaris* - This is a **scarring (cicatricial) alopecia** where inflammation around the **hair follicle** leads to its permanent destruction and replacement by **fibrotic tissue**. - Clinically presents with inflamed, scaly patches and **perifollicular erythema**, often with associated symptoms like burning or pruritus. - Results in **permanent hair loss** due to follicular destruction, unlike the reversible nature of telogen effluvium.

Q: Which of the following conditions is LEAST likely to cause nail pigmentation changes?

Wilson disease. ***Wilson disease*** - This condition primarily involves **copper accumulation** in the liver and brain, leading to **hepatic dysfunction** and **neurological symptoms**. - While it can cause some dermatological changes like **azure lunulae** (blue discoloration of the nail beds), true nail pigmentation changes (melanonychia) are not a typical or prominent feature. *Peutz-Jeghers syndrome* - Characterized by **mucocutaneous melanin spots** on the lips, buccal mucosa, and digits, which can extend to the nails causing **longitudinal melanonychia**. - These **pigmented macules** are a hallmark of the syndrome and are distinct from other causes of nail pigmentation. *Addison disease* - This is a primary **adrenal insufficiency** leading to increased **ACTH** (adrenocorticotropic hormone) production, which has melanocyte-stimulating properties. - The elevated ACTH stimulates **melanin production**, resulting in widespread hyperpigmentation, including the **nail beds** and **mucous membranes**. *Cushing disease* - Although less common and pronounced than in Addison disease, **Cushing syndrome** (especially when due to an ACTH-producing tumor) can also cause **hyperpigmentation** due to excess ACTH. - This can manifest as **skin darkening** and, in some cases, subtle **nail pigmentation changes**.

Q: Which of the following statements is incorrect regarding nail changes in various conditions?

Koilonychia is associated with Vitamin B12 deficiency.. ***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.

Q: What phase of hair growth is primarily responsible for the length of eyebrows?

Anagen phase. ***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.

Q: Pitting of nails can be seen in:

Alopecia areata. ***Alopecia areata*** - Nail pitting, characterized by small depressions in the nail plate, can be seen in patients with **alopecia areata**, reflecting a disturbance in the nail matrix. - Other nail changes in alopecia areata can include **trachyonychia** (roughening of the nail plate) and **longitudinal ridging**. *Tinea unguium* - This is a fungal infection of the nails, also known as onychomycosis, which typically causes **thickening, discoloration, and crumbling** of the nail, rather than pitting. - The nail changes are primarily due to fungal invasion and destruction of the nail plate. *Peripheral vascular disease* - Peripheral vascular disease affects blood flow to the extremities, leading to **trophic changes** in the nails such as thickening, slow growth, and discoloration due to poor circulation. - It does not typically cause **nail pitting**. *Androgenic alopecia* - This is a common form of hair loss (male or female pattern baldness) that affects the scalp and is **not associated with nail changes** like pitting. - The pathophysiology involves hormonal influences on hair follicles, not the nail matrix.

Q: According to the Ferriman Gallwey scoring system, hirsutism is diagnosed when the score is equal to or more than:

8. ***8*** - A Ferriman-Gallwey score equal to or greater than **8** is the standard cutoff for diagnosing hirsutism in most populations. - This threshold indicates an abnormal amount of **terminal hair growth** in androgen-sensitive areas of the body. *12* - While a score of 12 or higher certainly indicates hirsutism, it is **not the lower diagnostic cutoff**. - A score of 12 represents a **more severe degree** of hirsutism, but the diagnosis is established earlier. *16* - A score of 16 is considered **severe hirsutism** and suggests a significant increase in androgenic activity. - However, the diagnosis of hirsutism is made at a **much lower score** according to the established criteria. *20* - A score of 20 would represent **profound hirsutism**, often associated with conditions causing very high androgen levels. - This level is far beyond the **minimum diagnostic threshold** for hirsutism.

Question 1

Which of the following conditions does NOT cause nail pitting?

Accepted Answer

Pityriasis Rosea

Answer

Lichen planus

Answer

Fungal infection

Answer

Psoriasis

Question 2

Which of the following conditions causes diffuse non-scarring alopecia typically triggered by physiological stress?

Accepted Answer

Telogen Effluvium

Answer

Alopecia areata

Answer

Alopecia totalis

Answer

Lichen planopilaris

Question 3

Which of the following conditions is LEAST likely to cause nail pigmentation changes?

Accepted Answer

Wilson disease

Answer

Peutz-Jeghers syndrome

Answer

Cushing disease

Answer

Addison disease

Question 4

Which of the following statements is incorrect regarding nail changes in various conditions?

Accepted Answer

Koilonychia is associated with Vitamin B12 deficiency.

Answer

Onycholysis is seen in Psoriasis.

Answer

Mees lines are indicative of Arsenic poisoning.

Answer

Pterygium of nails is associated with Lichen Planus.

Question 5

What phase of hair growth is primarily responsible for the length of eyebrows?

Accepted Answer

Anagen phase

Answer

Telogen phase

Answer

Catagen phase

Answer

Exogen phase

Question 6

Pitting of nails can be seen in:

Accepted Answer

Alopecia areata

Answer

Tinea unguium

Answer

Peripheral vascular disease

Answer

Androgenic alopecia

Question 7

According to the Ferriman Gallwey scoring system, hirsutism is diagnosed when the score is equal to or more than:

Accepted Answer

8

Answer

12

Answer

16

Answer

20

Hair and Nail Disorders — MCQs

Hair and Nail Disorders — MCQs

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