Hair and Nail Disorders Practice Questions

Q: Pterygium of nail is characteristically seen in -

Lichen planus. ***Lichen planus*** - **Pterygium** of the nail, where the **proximal nail fold fuses with the nail matrix**, is a classic feature of nail lichen planus. - This condition can lead to permanent nail deformity or even **nail loss (anonychia)** through progressive scarring. *Alopecia areata* - While alopecia areata can affect nails, it typically causes **pitting, trachyonychia (rough nails)**, or longitudinal ridging, not pterygium. - It's primarily an autoimmune condition targeting **hair follicles**, leading to patchy hair loss. *Tinea unguium* - Tinea unguium (onychomycosis) is a **fungal infection** of the nail, characterized by discoloration, thickening, and subungual hyperkeratosis. - It does not typically cause the specific nail fold fusion seen in pterygium. *Psoriasis* - Nail psoriasis presents with various features like **pitting, oil drops (salmon patches)**, onycholysis, and subungual hyperkeratosis. - While it can cause severe nail dystrophy, **true pterygium** is not a characteristic feature of nail psoriasis.

Q: Which of the following is characteristically seen in alopecia areata?

Exclamatory mark hair. ***Exclamatory mark hair*** - **Exclamatory mark hairs** are short, broken hairs that get progressively narrower towards the scalp, resembling an exclamation mark. - They are a **pathognomonic sign** of **alopecia areata**, indicating active disease where the hair follicle immune attack is occurring. *Fungal infection* - **Fungal infections** of the scalp (tinea capitis) typically present with **scaling**, inflammation, and often **broken hairs** but not typically exclamatory mark hairs. - Diagnosis is usually confirmed by **KOH microscopy** or fungal culture. *Traumatic* - **Traumatic alopecia** (e.g., traction alopecia, trichotillomania) results from physical damage to the hair shafts or follicles. - It usually presents with **irregular patches** and broken hairs of varying lengths, without the specific exclamatory mark morphology. *Scarring* - **Scarring alopecia** (cicatricial alopecia) involves **permanent destruction** of the hair follicles, leading to irreversible hair loss and replacement by fibrous tissue. - The scalp in these conditions often appears **smooth** and devoid of follicular ostia, distinguishing it from non-scarring alopecia like alopecia areata.

Q: What is the characteristic nail finding in lichen planus?

Pterygium. ***Pterygium*** - **Pterygium** in lichen planus refers to the growth of **scar tissue from the proximal nail fold onto the nail plate**, often leading to nail destruction. - This is a highly characteristic sign of **nail lichen planus**, indicating inflammation and scarring of the nail matrix. *Beau's Lines* - **Beau's lines** are transverse depressions across the nail plate, signifying a temporary arrest of nail growth. - They are typically associated with **acute systemic illness**, severe stress, or trauma, rather than chronic inflammatory conditions like lichen planus. *Pitting* - **Nail pitting** presents as small, pinpoint depressions on the nail surface. - It is a classic finding in **psoriasis** and sometimes in alopecia areata, but not a primary feature of lichen planus. *Hyperpigmentation of nails* - **Hyperpigmentation of nails** refers to a darkening of the nail plate, often appearing as longitudinal streaks. - While it can be seen in various conditions, including drug reactions or melanonychia, it is **not a specific or characteristic finding** of lichen planus.

Q: All of the following are true for pseudopelade of Brocq except?

Presence of pustules. ***Presence of pustules*** - Pseudopelade of Brocq is a type of **scarring alopecia** characterized by **atrophic, hairless patches** without significant inflammation or pustules. - The absence of pustules is a distinguishing feature; their presence would suggest a different condition like folliculitis decalvans or dissecting cellulitis. *Foot print in snow appearance is seen* - This description is characteristic of the **atrophic, irregularly shaped** patches of hair loss seen in pseudopelade of Brocq. - The smooth, white, and often depressed areas of skin resemble footprints in freshly fallen snow. *Inflammation is absent* - Pseudopelade of Brocq is known for being a **lymphocytic scarring alopecia** with **minimal to absent clinical inflammation**. - While microscopic inflammation of lymphocytes around the hair follicles is present, it is not outwardly visible, which helps differentiate it from other inflammatory scarring alopecias. *Scarring Alopecia* - Pseudopelade of Brocq is indeed a form of **scarring alopecia**, meaning the hair loss is permanent due to the destruction of hair follicles and subsequent replacement by fibrous tissue. - This leads to irreversible hair loss in the affected areas.

Q: A 22-year-old woman presents with diffuse hair loss for 1 month. She had a past history of enteric fever 4 months ago. What is the likely cause?

Telogen effluvium. ***Telogen effluvium*** - **Telogen effluvium** is characterized by diffuse hair shedding, often occurring 2-4 months after a significant physiological or psychological stressor, such as **enteric fever**. - The stress prematurely shifts a large number of hair follicles from the **anagen (growth)** phase into the **telogen (resting)** phase, leading to synchronized shedding. *Androgenic alopecia* - This condition presents as a gradual, patterned hair loss, typically characterized by **receding hairline** and thinning at the crown in men. - In women, it often appears as **diffuse thinning** over the crown, but it's not usually acute or triggered by an infection in the manner described. *Alopecia areata* - **Alopecia areata** is an autoimmune condition causing **sudden, well-demarcated patches of hair loss**, not diffuse shedding. - It is frequently associated with other autoimmune diseases, and the hair loss pattern is distinct from the patient's presentation. *Anagen effluvium* - **Anagen effluvium** causes rapid, diffuse hair loss during the **anagen (growth)** phase, often triggered by chemotherapy or radiation. - The onset is typically much faster (days to weeks) after the trigger, unlike the delayed onset seen in this case.

Q: The growth phase of hair is

Anagen. ***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.

Q: Pitting of nails is seen in:

Psoriasis. ***Psoriasis*** - **Nail pitting** is a characteristic feature of **psoriasis**, caused by defective keratinization of the nail matrix. - Other nail changes include **onycholysis**, **subungual hyperkeratosis**, and discoloration (oil drop sign). *Arsenic poisoning* - **Arsenic poisoning** is typically associated with **Mee's lines** (transverse white bands) on the nails, not pitting. - It can also cause hyperkeratosis and hyperpigmentation of the skin. *Pemphigus* - **Pemphigus** is an autoimmune blistering disease affecting the skin and mucous membranes, with no specific nail changes like pitting. - Nail involvement, if any, is usually secondary to blistering or infection. *Lichen planus* - **Lichen planus** can affect nails, causing longitudinal ridging, thinning, and in severe cases, pterygium formation or anonychia. - However, **nail pitting** is not a typical or primary feature of lichen planus.

Q: A patient is diagnosed having paronychia. Which of the following would one expect to note during the assessment?

Red shiny skin around the nail fold. ***Red shiny skin around the nail bed*** - **Paronychia** is an infection of the **nail fold**, the skin around the nail. This inflammation results in characteristic redness and swelling. - The skin often appears **shiny** due to underlying inflammation and edema in the perionychial area. *Swelling involving the distal pulp* - Swelling of the **distal pulp** (fingertip pad) is more characteristic of a **felon**, which is a closed-space infection of the fingertip pulp. - While paronychia can be painful, its primary location of swelling is the **nail fold**, not solely the pulp. *Avulsion of nail from its bed* - **Onycholysis** or avulsion (separation) of the nail from its bed can occur in various nail disorders, but it is not a direct or defining feature of acute paronychia. - Nail avulsion is often seen in conditions like **psoriasis**, fungal infections, or trauma. *White taut skin at the finger pulp* - **White and taut skin** surrounding the finger pulp suggests ischemia or necrosis, which is not typical of paronychia. - Such findings might be seen in conditions like **frostbite** or severe vascular compromise.

Q: Swarm of bees appearance seen in?

Alopecia areata. ***Alopecia areata*** - The "swarm of bees" appearance refers to the characteristic **peribulbar lymphocytic inflammation** seen on scalp biopsy in active alopecia areata. - This finding represents an **immune response targeting the hair follicles**, leading to non-scarring hair loss. *Telogen effluvium* - Histologically, telogen effluvium is characterized by a high proportion of **telogen hairs** in the hair counts and **no significant inflammation** around the follicles. - The "swarm of bees" peribulbar infiltrate is not a feature of telogen effluvium, which is typically a reaction to a systemic stressor. *Androgenetic alopecia* - Androgenetic alopecia is characterized by **follicular miniaturization**, where vellus hairs replace terminal hairs, and a **decrease in the number of hair follicles**. - It does not show the "swarm of bees" peribulbar lymphocytic infiltrate; instead, there might be subtle inflammation or fibrosis in advanced stages but not the dense peribulbar type. *Anagen effluvium* - Anagen effluvium is characterized by the **sudden shedding of hairs in the anagen phase** due to a toxic or inflammatory insult disrupting hair matrix keratinocyte proliferation. - Histology often shows **dystrophic anagen hairs** and damaged hair shafts, but not the specific "swarm of bees" lymphocytic infiltrate seen in alopecia areata.

Q: Which pattern of hair loss suggests scarring alopecia?

Loss of follicular ostia. ***Loss of follicular ostia*** - The absence of **follicular ostia** (the openings of hair follicles) is a key clinical sign of scarring alopecia, indicating irreversible destruction of the hair follicle. - This destruction leads to permanent hair loss, as the follicles are replaced by **fibrotic tissue**. *Positive hair pull test* - A positive **hair pull test** suggests active hair shedding, typically seen in non-scarring alopecias like **telogen effluvium** or **androgenetic alopecia**. - It indicates that hairs are easily dislodged from the scalp but does not signify follicular destruction. *Exclamation mark hairs* - **Exclamation mark hairs** (hairs that are narrower at the base and wider at the tip) are a pathognomonic sign of **alopecia areata**. - This condition is a non-scarring autoimmune hair loss characterized by patchy hair loss. *Widened part line* - A **widened part line** is a common clinical feature of **androgenetic alopecia** (female pattern hair loss). - It indicates diffuse thinning over the crown and frontal scalp but does not imply scarring or permanent follicular destruction.

Question 1

Pterygium of nail is characteristically seen in -

Accepted Answer

Lichen planus

Answer

Alopecia areata

Answer

Tinea unguium

Answer

Psoriasis

Question 2

Which of the following is characteristically seen in alopecia areata?

Accepted Answer

Exclamatory mark hair

Answer

Fungal infection

Answer

Traumatic

Answer

Scarring

Question 3

What is the characteristic nail finding in lichen planus?

Accepted Answer

Pterygium

Answer

Beau's Lines

Answer

Pitting

Answer

Hyperpigmentation of nails

Question 4

All of the following are true for pseudopelade of Brocq except?

Accepted Answer

Presence of pustules

Answer

Foot print in snow appearance is seen

Answer

Inflammation is absent

Answer

Scarring Alopecia

Question 5

A 22-year-old woman presents with diffuse hair loss for 1 month. She had a past history of enteric fever 4 months ago. What is the likely cause?

Accepted Answer

Telogen effluvium

Answer

Androgenic alopecia

Answer

Alopecia areata

Answer

Anagen effluvium

Question 6

The growth phase of hair is

Accepted Answer

Anagen

Answer

Progen

Answer

Metagen

Answer

Telogen

Question 7

Pitting of nails is seen in:

Accepted Answer

Psoriasis

Answer

Arsenic poisoning

Answer

Pemphigus

Answer

Lichen planus

Question 8

A patient is diagnosed having paronychia. Which of the following would one expect to note during the assessment?

Accepted Answer

Red shiny skin around the nail fold

Answer

Swelling involving the distal pulp

Answer

Avulsion of nail from its bed

Answer

White taut skin at the finger pulp

Question 9

Swarm of bees appearance seen in?

Accepted Answer

Alopecia areata

Answer

Telogen effluvium

Answer

Androgenetic alopecia

Answer

Anagen effluvium

Question 10

Which pattern of hair loss suggests scarring alopecia?

Accepted Answer

Loss of follicular ostia

Answer

Positive hair pull test

Answer

Exclamation mark hairs

Answer

Widened part line

Hair and Nail Disorders — MCQs

Hair and Nail Disorders — MCQs

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