Hair and Nail Disorders Practice Questions

Q: Nail pitting is associated with all of the following conditions except?

Pityriasis rosea. **Explanation:** **Nail pitting** is a common clinical finding caused by defective keratinization of the **proximal nail matrix**. This results in focal areas of parakeratotic cells that are easily shed, leaving behind small punctate depressions (pits) on the nail plate surface. **Why Pityriasis Rosea is the Correct Answer:** Pityriasis rosea is an acute, self-limiting inflammatory skin disease characterized by a "herald patch" and a "Christmas tree" distribution of scaly plaques. Crucially, it **does not involve the nail matrix**. Therefore, nail changes, including pitting, are not a feature of this condition. **Analysis of Incorrect Options:** * **Lichen Planus:** While more commonly associated with pterygium formation and longitudinal ridging, Lichen Planus can involve the nail matrix, leading to thinning, brittleness, and occasionally **fine, shallow pitting**. * **Hyperthyroidism:** Systemic endocrine disorders can affect nail growth. Hyperthyroidism is associated with various nail changes, including **Plummer’s nails** (onycholysis) and occasionally pitting or ridging due to altered metabolic states affecting the matrix. * **Fungal Infection (Onychomycosis):** While subungual hyperkeratosis and discoloration are more typical, fungal invasion of the nail plate and matrix can lead to structural irregularities, including **irregular pitting**. **NEET-PG High-Yield Pearls:** 1. **Psoriasis:** The most common cause of nail pitting. Pits are typically **deep, large, and irregularly distributed** ("thimble pitting"). 2. **Alopecia Areata:** Characterized by **fine, geometric, "grid-like" pitting**. 3. **Eczema:** Often presents with **coarse, irregular pitting** and transverse ridging (Beau’s lines). 4. **Reiter’s Syndrome:** Can present with pits similar to psoriasis.

Q: The Hamilton Norwood scale is used for assessing the extent of which condition?

Male androgenetic alopecia. **Explanation:** The **Hamilton-Norwood scale** is the gold-standard clinical classification system used to measure the extent of **Male Androgenetic Alopecia (MAGA)**. It categorizes hair loss into seven stages (I to VII) based on two primary patterns: recession at the temples and thinning at the vertex (crown). This scale is essential for documenting disease progression and planning surgical or medical interventions. **Analysis of Options:** * **A. Male Androgenetic Alopecia (Correct):** Characterized by the action of Dihydrotestosterone (DHT) on genetically susceptible hair follicles, leading to follicular miniaturization in a specific pattern defined by this scale. * **B. Female Androgenetic Alopecia:** While also androgen-dependent, the pattern in women is different (diffuse thinning with preservation of the frontal hairline). It is assessed using the **Ludwig Scale** or the **Sinclair Scale**. * **C. Alopecia Areata:** This is an autoimmune condition characterized by non-scarring, "patchy" hair loss. Severity is typically assessed using the **SALT (Severity of Alopecia Tool) score**. * **D. Telogen Effluvium:** This involves diffuse hair shedding across the entire scalp due to a shift in the hair cycle (premature entry into the telogen phase). It does not follow a patterned scale like Hamilton-Norwood. **High-Yield Clinical Pearls for NEET-PG:** * **Ludwig Scale:** Used for Female Pattern Hair Loss (FPHL). * **Grades of MAGA:** Stage I is minimal loss; Stage VII is the most severe (only a horseshoe-shaped fringe remains). * **Treatment of Choice:** Topical **Minoxidil** (vasodilator) and oral **Finasteride** (5-alpha reductase inhibitor). * **Key Histology:** Increased vellus hairs and decreased terminal hairs (Terminal:Vellus ratio < 4:1).

Q: A 35-year-old male presents with bald patches and no scars. The patches are well demarcated with broken hair at the edges. What is the diagnosis?

Alopecia areata. ### Explanation **Correct Answer: A. Alopecia Areata** The clinical presentation of **well-demarcated, non-scarring bald patches** is classic for Alopecia Areata. The hallmark sign mentioned—**broken hair at the edges**—refers to **"Exclamation mark hairs"** (pathognomonic). These are short, fractured hairs where the proximal shaft is thinner than the distal end. It is an autoimmune condition where T-cells attack the hair bulb (anagen phase), leading to sudden hair loss without follicular destruction (non-scarring). **Why other options are incorrect:** * **Androgenic Alopecia:** Presents as progressive thinning in a patterned distribution (receding hairline or vertex thinning) rather than discrete patches. It is driven by dihydrotestosterone (DHT). * **Discoid Lupus Erythematosus (DLE):** This is a form of **cicatricial (scarring) alopecia**. It presents with erythematous plaques, scaling, and permanent loss of follicular ostia, unlike the smooth, non-scarring patches seen here. * **Telogen Effluvium:** Characterized by **diffuse** thinning of hair across the entire scalp, usually triggered by stress, pregnancy, or illness. It does not present with localized patches or exclamation mark hairs. **High-Yield Clinical Pearls for NEET-PG:** * **Trichoscopy:** Look for "Exclamation mark hairs," yellow dots (sebum in follicular openings), and black dots (cadaverized hairs). * **Nail Findings:** "Geometric pitting" (regular, fine pits) is a common association in 10-20% of cases. * **Prognosis:** Poor prognostic factors include **Ophiasis pattern** (hair loss along the temporal/occipital hairline), nail involvement, and early age of onset. * **Treatment:** First-line for localized patches is **Intralesional Triamcinolone acetonide**.

Q: Which of the following drugs does NOT cause hirsutism?

Penicillamine. **Explanation:** The correct answer is **Penicillamine**. To answer this question, it is essential to distinguish between **Hirsutism** (excessive terminal hair growth in women in a male-pattern distribution due to increased androgens) and **Hypertrichosis** (generalized excessive hair growth not localized to androgen-dependent areas). **1. Why Penicillamine is the correct answer:** Penicillamine is actually associated with **Hypertrichosis**, not hirsutism. It is a chelating agent used in Wilson’s disease. While it causes excessive hair growth, it does not involve the androgenic pathways required to define the condition as hirsutism. **2. Analysis of Incorrect Options:** The other three options are known to cause **Hirsutism** primarily through the induction of **Hyperprolactinemia**. Prolactin stimulates the adrenal cortex to produce dehydroepiandrosterone sulfate (DHEAS), an androgen that leads to male-pattern hair growth. * **Methyldopa:** An antihypertensive that acts as a centrally acting alpha-2 agonist; it inhibits dopamine, leading to increased prolactin. * **Phenothiazines:** Antipsychotics that block dopamine (D2) receptors in the tuberoinfundibular pathway, causing a rise in prolactin levels. * **Metoclopramide:** A prokinetic/antiemetic that also acts as a dopamine antagonist, resulting in hyperprolactinemia-induced hirsutism. **High-Yield Clinical Pearls for NEET-PG:** * **Common Drugs causing Hirsutism:** Anabolic steroids, Danazol, Progestins, and drugs causing Hyperprolactinemia (Antipsychotics, Metoclopramide, Methyldopa). * **Common Drugs causing Hypertrichosis:** Minoxidil, Cyclosporine, Phenytoin, Psoralens, and Penicillamine. * **Mnemonic for Hypertrichosis:** **"P**enicillamine, **P**henytoin, **P**soralens, **C**yclosporine, **M**inoxidil" (**P-P-P-C-M**). * **Key Distinction:** Hirsutism is **Androgen-dependent**; Hypertrichosis is **Androgen-independent**.

Q: What is the most likely diagnosis in this 50-year-old woman?

Metastasis. ***Metastasis*** - **Subungual metastasis** in a 50-year-old woman often presents as a **pigmented nail lesion** or **nail dystrophy**, commonly from **breast**, **lung**, or **melanoma** primaries. - The **acral location** and patient's age group make metastatic disease more likely than benign conditions, requiring urgent **biopsy** for diagnosis. *Onychomycosis* - Fungal nail infections typically cause **yellow-white discoloration** and **nail thickening** starting from the distal edge. - Usually affects **multiple nails** and responds to **KOH testing** showing fungal elements, unlike the presentation of metastasis. *Psoriasis* - Nail psoriasis presents with **nail pitting**, **oil drop sign**, and **onycholysis** (nail separation from bed). - Often associated with **skin plaques** and **joint involvement**, which would be evident on examination. *Thromboangiitis obliterans* - **Buerger's disease** primarily affects **young male smoers** and involves **digital ischemia** and **ulceration**. - Presents with **claudication**, **Raynaud's phenomenon**, and **gangrene** rather than isolated nail changes.

Q: Androgenic alopecia in females is caused by which of the following conditions?

Stein-Leventhal syndrome. **Explanation:** **Stein-Leventhal Syndrome (Polycystic Ovary Syndrome - PCOS)** is the correct answer because it is the most common cause of hyperandrogenism in females. Female Pattern Hair Loss (FPHL) or androgenic alopecia is driven by the sensitivity of hair follicles to circulating androgens. In PCOS, there is an excess of ovarian androgens (androstenedione and testosterone), which are converted to **Dihydrotestosterone (DHT)** by the enzyme 5-alpha reductase. DHT causes the miniaturization of hair follicles, leading to thinning, typically in a diffuse pattern over the mid-frontal scalp with preservation of the frontal hairline (Ludwig classification). **Analysis of Incorrect Options:** * **Myxedema (Hypothyroidism):** Characterized by dry, brittle hair and a classic sign called **Hertoghe’s sign** (loss of the outer third of the eyebrows), but it does not cause androgen-mediated alopecia. * **Cushing Disease:** While it involves excess cortisol and can lead to hirsutism (excess terminal hair in a male distribution), the primary clinical feature is not typically androgenic alopecia, but rather "moon facies," "buffalo hump," and striae. * **Addison’s Disease:** This is primary adrenal insufficiency (low cortisol/aldosterone). It typically presents with hyperpigmentation and loss of axillary/pubic hair in females due to decreased adrenal androgens, the opposite of androgenic alopecia. **High-Yield Clinical Pearls for NEET-PG:** * **Ludwig Classification:** Used to grade the severity of female pattern hair loss (Stages I, II, and III). * **Hamilton-Norwood Scale:** Used for male pattern baldness. * **Treatment of Choice:** Topical **Minoxidil (2% or 5%)** is the first-line treatment for FPHL. Anti-androgens like Spironolactone or Finasteride are used if PCOS is the underlying cause. * **Key Lab Finding:** Elevated **LH:FSH ratio (>2:1)** is often seen in Stein-Leventhal syndrome.

Q: An elderly female undergoing chemotherapy for breast cancer is experiencing significant hair loss. What is the most likely cause of her condition?

Anagen Effluvium. ***Anagen Effluvium***- This condition is the abrupt cessation of cell division in the rapidly proliferating hair matrix, directly caused by cytotoxic agents (chemotherapy) used to treat **breast cancer**.- It results in the hair shaft narrowing and fracturing, leading to massive, acute hair shedding (often non-scarring) that occurs within days to weeks of starting the **chemotherapy treatment**.*Telogen Effluvium*- This type of hair loss involves premature shifting of hairs from the growth (anagen) to the resting (telogen) phase due to a major stressor (e.g., severe illness, childbirth).- The shedding typically appears **2 to 4 months after** the initial precipitating event, which is too delayed for the immediate hair loss associated with most chemotherapy regimens.*Trichotillomania*- This is a psychological disorder characterized by recurrent, irresistible urges to **pull out one's hair**, leading to hair loss.- The resulting alopecia is typically patchy, irregular, and features hairs of different lengths due to continuous pulling, contrasting sharply with the diffuse loss from chemotherapy.*Alopecia Areata*- This is an **autoimmune** disorder where T-lymphocytes attack the anagen hair follicles, resulting in distinct, usually circular or oval, non-scarring patches of hair loss.- It classically presents with "exclamation mark" hairs (hairs that are narrower near the scalp) and is not directly induced by cytotoxic chemotherapy.

Q: Identify the lesion: (Recent NEET Pattern 2016-17)

Koenen tumor. ***Koenen tumor*** - Koenen tumors, also known as **periungual fibromas**, are small, benign growths that emerge from beneath the nail fold or nail plate. - They are a classic cutaneous manifestation of **tuberous sclerosis complex**, characterized by firm, flesh-colored papules or nodules, often at the base or sides of the nails, as seen in the image. *Onychomycosis* - This is a fungal infection of the nail, typically causing **thickening**, **discoloration (yellow, brown, white)**, and **crumbling of the nail plate**. - While some discoloration is present, the prominent **periungual nodule** is not characteristic of onychomycosis alone. *Onychodystrophy* - This is a general term for any condition that results in abnormal nail appearance or growth, often due to trauma, systemic disease, or local pathology. - It describes the state of the nails, but does not identify the **specific proliferative lesion** at the nail fold. *Onychogryphosis* - Also known as "ram's horn nail," this condition involves **marked thickening and curvature of the nail plate**, often due to chronic trauma or neglect. - The nails in the image show some thickening and discoloration, but the characteristic **overgrowth and extreme curvature** of onychogryphosis are not the primary feature, nor is the periungual growth explained by this term.

Question 1

Nail pitting is associated with all of the following conditions except?

Accepted Answer

Pityriasis rosea

Answer

Lichen planus

Answer

Hyperthyroidism

Answer

Fungal infection

Question 2

A patient presents with scarring alopecia, thinned nails, and hypopigmented macular lesions over the trunk and oral mucosa. What is the diagnosis?

Accepted Answer

Lichen planus

Answer

Psoriasis

Answer

Leprosy

Answer

Pemphigus

Question 3

The Hamilton Norwood scale is used for assessing the extent of which condition?

Accepted Answer

Male androgenetic alopecia

Answer

Female androgenetic alopecia

Answer

Alopecia areata

Answer

Telogen effluvium

Question 4

The "half-and-half" nail or "half-nail" sign, seen in uremia, is primarily caused by which of the following?

Accepted Answer

Increased capillary density in the proximal half of the nail bed

Answer

Melanin deposition in the nail bed

Answer

Hypoproteinemia leading to edema

Answer

Accumulation of circulating toxins affecting nail matrix

Question 5

A 35-year-old male presents with bald patches and no scars. The patches are well demarcated with broken hair at the edges. What is the diagnosis?

Accepted Answer

Alopecia areata

Answer

Androgenic alopecia

Answer

Discoid lupus erythematosus (DLE)

Answer

Telogen effluvium

Question 6

Which of the following drugs does NOT cause hirsutism?

Accepted Answer

Penicillamine

Answer

Methyldopa

Answer

Phenothiazines

Answer

Metoclopramide

Question 7

What is the most likely diagnosis in this 50-year-old woman?

Accepted Answer

Metastasis

Answer

Onychomycosis

Answer

Psoriasis

Answer

Thromboangiitis obliterans

Question 8

Androgenic alopecia in females is caused by which of the following conditions?

Accepted Answer

Stein-Leventhal syndrome

Answer

Myxedema

Answer

Cushing disease

Answer

Addison's disease

Question 9

An elderly female undergoing chemotherapy for breast cancer is experiencing significant hair loss. What is the most likely cause of her condition?

Accepted Answer

Anagen Effluvium

Answer

Alopecia Areata

Answer

Trichotillomania

Answer

Telogen Effluvium

Question 10

Identify the lesion: (Recent NEET Pattern 2016-17)

Accepted Answer

Koenen tumor

Answer

Onychomycosis

Answer

Onychodystrophy

Answer

Onychogryphosis

Hair and Nail Disorders — MCQs

Hair and Nail Disorders — MCQs

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