Hair and Nail Disorders Practice Questions

Q: Exclamation mark hairs are seen in which condition?

Alopecia areata. **Explanation:** **Alopecia Areata (Option A)** is an autoimmune, non-scarring type of hair loss. **Exclamation mark hairs** are the pathognomonic clinical sign of this condition. They are short (3–4 mm), broken hairs that are thicker at the distal end and narrower at the proximal base (near the scalp). This occurs because the inflammatory infiltrate (the "swarm of bees" around the hair bulb) causes sudden attenuation of the hair shaft, leading to structural weakness and breakage. Their presence indicates **active disease** and peripheral expansion of the bald patch. **Why other options are incorrect:** * **Traumatic Alopecia (Option B):** This includes conditions like Trichotillomania. Here, one typically sees hairs of varying lengths and "broken-off" hairs, but they lack the specific proximal tapering seen in exclamation mark hairs. * **Lichen Planus (Option C):** Specifically Lichen Planopilaris, this is a **cicatricial (scarring)** alopecia. It is characterized by perifollicular erythema, scaling, and permanent destruction of the follicle, rather than the specific shaft morphology seen in areata. **High-Yield Clinical Pearls for NEET-PG:** * **Dermoscopy:** Shows "yellow dots" (follicular plugs), "black dots" (cadaveric hairs), and exclamation mark hairs. * **Nail changes:** The most common nail finding in Alopecia Areata is **fine, geometric pitting** (regularly spaced pits). * **Histopathology:** Characterized by a **peribulbar lymphocytic infiltrate**, famously described as a **"swarm of bees."** * **Treatment of choice:** Intralesional corticosteroids (e.g., Triamcinolone acetonide) for localized patches.

Q: What is the recommended duration of griseofulvin treatment for fingernail dermatophytosis?

3 months. **Explanation:** The correct answer is **3 months (Option D)**. Griseofulvin is a fungistatic antibiotic that works by binding to tubulin and interfering with microtubule function, thereby inhibiting mitosis. Its efficacy in treating onychomycosis (dermatophytosis of the nails) depends on the drug being incorporated into the keratin precursor cells. Because the drug only prevents new infection and does not kill fungi in existing keratin, treatment must continue until the infected nail is completely replaced by healthy growth. * **Fingernails** grow at an average rate of 3 mm/month and typically require **4–6 months** for complete replacement; however, the standard pharmacological recommendation for Griseofulvin is a minimum of **3–6 months** to ensure clinical cure. * **Toenails** grow much slower (1 mm/month) and require a longer duration of **6–12 months**. **Why other options are incorrect:** * **Options A & B (4–6 weeks):** This duration is sufficient for Tinea corporis or Tinea capitis, but inadequate for nail infections due to the slow turnover of keratin in the nail plate. * **Option C (2 months):** While improvement may be seen, 2 months is generally insufficient to ensure the entire infected fingernail plate has been shed and replaced, leading to high relapse rates. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice:** While Griseofulvin was the historical standard, **Terbinafine** (Allylamine) is now the DOC for onychomycosis due to higher cure rates and shorter duration (6 weeks for fingernails, 12 weeks for toenails). * **Absorption:** Griseofulvin absorption is significantly increased when taken with a **fatty meal**. * **Side Effects:** Most common is headache; it is also a potent **cytochrome P450 inducer** (interacts with warfarin and OCPs). * **Contraindication:** It is strictly contraindicated in **Porphyria** and pregnancy.

Q: Alopecia areata is presumed to be:

Autoimmune in etiology. ### Explanation **Correct Answer: B. Autoimmune in etiology** Alopecia Areata (AA) is a chronic inflammatory disease characterized by non-scarring hair loss. It is considered an **autoimmune disorder** mediated by T-cells. The underlying pathophysiology involves the **collapse of the "immune privilege"** of the hair follicle. Normally, hair follicles in the anagen (growth) phase are protected from immune recognition. In AA, this privilege is lost, leading to a lymphocytic infiltration (described as a **"swarm of bees"** appearance on histology) around the hair bulb, causing the hair to enter the telogen (resting) phase prematurely. **Why other options are incorrect:** * **A. Androgenic in nature:** This refers to Androgenetic Alopecia (pattern baldness), which is driven by genetic predisposition and the effects of dihydrotestosterone (DHT) on follicles, not an immune response. * **C. Infective in etiology:** AA is not caused by fungi (like Tinea capitis), bacteria, or viruses. It is an endogenous inflammatory process. * **D. Part of the lichenoid spectrum:** Lichen planopilaris is a lichenoid disorder that causes *scarring* (cicatricial) alopecia. AA is strictly *non-scarring*. **Clinical Pearls for NEET-PG:** * **Clinical Hallmark:** Sudden onset of smooth, circumscribed, non-scarring patches of hair loss. * **Pathognomonic Sign:** **Exclamation mark hairs** (short broken hairs that are narrower at the base) seen at the periphery of expanding patches. * **Nail Changes:** **Geometric pitting** (fine, uniform pits) is the most common nail finding in AA. * **Associations:** Frequently associated with other autoimmune conditions like **Vitiligo** and **Hashimoto’s thyroiditis**. * **Treatment:** First-line treatment for localized patches is **intralesional corticosteroids** (e.g., Triamcinolone acetonide).

Q: Patchy hair loss with velvety skin points to which diagnosis?

Hyperthyroidism. **Explanation:** The correct answer is **Hyperthyroidism**. In patients with thyrotoxicosis, the skin often becomes thin, warm, moist, and classically described as **"velvety"** in texture. This is due to increased cutaneous blood flow and sweat gland activity. The associated hair loss is typically a diffuse thinning (Telogen effluvium), but it can also present as **patchy alopecia**. Additionally, hyperthyroidism is frequently associated with autoimmune conditions like **Alopecia areata**, which presents with well-demarcated patches of hair loss. **Analysis of Incorrect Options:** * **Alopecia areata:** While this causes patchy hair loss (non-scarring, "exclamation mark" hairs), it does not typically cause a change in the overall skin texture to "velvety." * **Trichotillomania:** This is a psychiatric impulse-control disorder characterized by the urge to pull out one's hair. It presents with irregular patches of hair loss with broken hairs of varying lengths, but the underlying skin remains normal. * **Adenoma sebaceum:** This is a misnomer for **angiofibromas** seen in Tuberous Sclerosis. These are firm, reddish papules in a butterfly distribution on the face, not associated with patchy hair loss or velvety skin. **NEET-PG High-Yield Pearls:** * **Plummer’s Nail:** Distal onycholysis (separation of the nail bed) specifically associated with hyperthyroidism. * **Pretibial Myxedema:** Non-pitting edema with a "peau d'orange" appearance, seen in Graves' disease. * **Hypothyroidism:** Conversely, presents with **dry, coarse, "sandpaper" skin** and loss of the outer third of the eyebrows (Madarosis/Queen Anne’s sign).

Q: Pterygium of the nail is seen in which of the following conditions?

Lichen planus. **Explanation:** **Pterygium of the nail** (specifically dorsal pterygium) is a classic hallmark of **Lichen Planus (LP)**. It occurs due to scarring and inflammation of the nail matrix, leading to the fusion of the proximal nail fold to the nail bed. This results in a characteristic V-shaped extension of the skin over the nail plate, eventually causing irreversible destruction and splitting of the nail. **Analysis of Options:** * **Lichen Planus (Correct):** Approximately 10% of LP cases involve nails. The "classic triad" includes thinning of the nail plate, longitudinal ridging, and **dorsal pterygium**. * **Psoriasis:** Characterized by **pitting** (deep, irregular), onycholysis (separation of the nail from the bed), "oil spots" (salmon patches), and subungual hyperkeratosis. Pterygium is not a feature. * **Tinea Unguium:** A fungal infection typically presenting with distal subungual hyperkeratosis, yellow-white discoloration, and crumbling of the nail plate. * **Alopecia Areata:** Classically associated with **geometric pitting** (shallow, regularly spaced pits in a grid-like pattern) and "trachyonychia" (rough, sandpaper-like nails). **High-Yield Clinical Pearls for NEET-PG:** 1. **Dorsal Pterygium:** Seen in Lichen Planus (scarring/destructive). 2. **Ventral Pterygium (Pterygium Inversum Unguis):** Seen in **Scleroderma**, SLE, and Leprosy (fusion of the hyponychium to the underside of the nail plate). 3. **Trachyonychia (Twenty-nail dystrophy):** Can be seen in Lichen Planus, Psoriasis, Alopecia Areata, and Eczema. 4. **Nail Pitting:** Psoriasis (deep/irregular) vs. Alopecia Areata (shallow/geometric).

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: Trichology is the study of:

Hair. **Explanation:** **Trichology** is the specialized branch of dermatology that deals with the scientific study of the health of the **hair** and scalp. The term is derived from the Greek word *'trikhos'* (hair). It encompasses the anatomy, physiology, and pathology of human hair, including disorders like alopecia, hirsutism, and hair shaft abnormalities. **Analysis of Options:** * **A. Hair (Correct):** Trichology focuses on the hair follicle and shaft. In NEET-PG, understanding the hair cycle (Anagen, Catagen, Telogen) is fundamental to this field. * **B. Nail:** The study of nails is known as **Onychology**. Nail disorders (e.g., lichen planus, psoriasis, or onychomycosis) are frequent topics in dermatology. * **C. Skin:** The study of skin is **Dermatology**. While trichology is a sub-specialty of dermatology, the term specifically refers to hair. * **D. Bones:** The study of bones is **Osteology**, a branch of anatomy and orthopedics. **Clinical Pearls for NEET-PG:** * **Hair Cycle Ratios:** In a normal scalp, approximately 85-90% of hairs are in the **Anagen** (growth) phase, while 10-15% are in the **Telogen** (resting) phase. * **Exogen:** This is the specific phase of the hair cycle where the hair shaft is actively shed. * **Trichoscopy:** A high-yield diagnostic tool (dermoscopy of the hair/scalp) used to differentiate between conditions like Alopecia Areata (exclamation mark hairs) and Trichotillomania (broken hairs of varying lengths). * **Club Hair:** A fully keratinized, dead hair formed at the end of the Telogen phase.

Question 1

Exclamation mark hairs are seen in which condition?

Accepted Answer

Alopecia areata

Answer

Traumatic alopecia

Answer

Lichen planus

Answer

All of the above

Question 2

What is the recommended duration of griseofulvin treatment for fingernail dermatophytosis?

Accepted Answer

3 months

Answer

4 weeks

Answer

6 weeks

Answer

2 months

Question 3

Alopecia areata is presumed to be:

Accepted Answer

Autoimmune in etiology

Answer

Androgenic in nature

Answer

Infective in etiology

Answer

Part of the lichenoid spectrum

Question 4

What is Harvey's sign?

Accepted Answer

Related to the venous filling after emptying a length of vein.

Answer

A transmitted pressure wave on coughing in a peripheral vein.

Answer

Loss of hairs from eyebrows.

Answer

None of the above.

Question 5

Patchy hair loss with velvety skin points to which diagnosis?

Accepted Answer

Hyperthyroidism

Answer

Alopecia areata

Answer

Trichotillomania

Answer

Adenoma sebaceum

Question 6

Cicatrising alopecia with perifollicular blue-gray patches of hyperpigmentation is most commonly associated with which of the following clinical findings?

Accepted Answer

Whitish lesions in the buccal mucosa

Answer

Pitting of nails

Answer

Alopecia areata

Answer

Discoid plaques on the face

Question 7

Pterygium of the nail is seen in which of the following conditions?

Accepted Answer

Lichen planus

Answer

Psoriasis

Answer

Tinea unguium

Answer

Alopecia areata

Question 8

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

Accepted Answer

Pityriasis rosea

Answer

Lichen planus

Answer

Hyperthyroidism

Answer

Fungal infection

Question 9

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 10

Trichology is the study of:

Accepted Answer

Hair

Answer

Nail

Answer

Skin

Answer

Bones

Hair and Nail Disorders — MCQs

Hair and Nail Disorders — MCQs

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