Hair and Nail Disorders Practice Questions

Q: Onycholysis is seen in all of the following conditions, except:

Nephrotic syndrome. **Explanation:** **Onycholysis** is the painless separation of the nail plate from the underlying nail bed, starting from the distal or lateral margins. **Why Nephrotic Syndrome is the correct answer:** Nephrotic syndrome is typically associated with **Muehrcke’s lines** (paired white transverse bands) or **Beau’s lines** due to hypoalbuminemia and metabolic stress. It does not cause the physical separation of the nail plate from the bed. Therefore, it is the "except" option. **Analysis of other options:** * **Allergic Contact Dermatitis:** Inflammatory conditions involving the fingertips (e.g., reaction to nail cosmetics or acrylates) can cause subungual inflammation leading to distal onycholysis. * **Psoriasis:** This is the most common dermatological cause of onycholysis. It occurs due to the involvement of the nail bed, often accompanied by "oil spots" (salmon patches) and subungual hyperkeratosis. * **Antineoplastic Therapy:** Many chemotherapy agents (like Taxanes or Doxorubicin) are toxic to the nail apparatus. They can cause "photo-onycholysis" or direct damage to the nail bed, leading to separation. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of Onycholysis:** Psoriasis. * **Systemic causes:** Hyperthyroidism (Plummer’s nails) and Iron deficiency anemia. * **Drug-induced Photo-onycholysis:** Tetracyclines (most common), Psoralens, and Fluoroquinolones. * **Microbial association:** *Candida albicans* and *Pseudomonas* (which produces a characteristic green pigment). * **Terry’s Nails:** Seen in Liver Cirrhosis (proximal 2/3rd white, distal 1/3rd pink). * **Lindsay’s Nails (Half-and-half nails):** Seen in Chronic Renal Failure.

Q: Whitening of the nail plates may be due to deficiency of?

Albumin. **Explanation:** The correct answer is **Albumin**. Whitening of the nail plate, known as **Leukonychia**, can be classified into true leukonychia (pathology in the nail matrix) and apparent leukonychia (pathology in the underlying nail bed). **Why Albumin is correct:** Low serum albumin levels (Hypoalbuminemia) lead to a specific type of apparent leukonychia known as **Muehrcke’s lines**. These appear as paired, white transverse bands that run parallel to the lunula. They are caused by localized edema in the nail bed exerting pressure on the vascular network, which alters the light-reflecting properties of the nail. Because the pathology is in the bed, not the plate, these lines do not move distally as the nail grows and disappear when the nail is compressed. **Analysis of Incorrect Options:** * **Iron:** Deficiency typically leads to **Koilonychia** (spoon-shaped nails), commonly seen in Iron Deficiency Anemia and Plummer-Vinson Syndrome. * **Zinc:** Deficiency (as seen in Acrodermatitis Enteropathica) is associated with **Beau’s lines** (transverse depressions) and paronychia, rather than generalized whitening. * **Copper:** Deficiency is rare but is classically associated with **Menkes Kinky Hair Syndrome**, affecting hair texture and pigmentation rather than causing leukonychia. **High-Yield Clinical Pearls for NEET-PG:** * **Terry’s Nails:** The proximal 2/3rd of the nail is white while the distal 1/3rd is pink/brown. Classically seen in **Liver Cirrhosis**. * **Lindsay’s Nails (Half-and-half nails):** Proximal half is white, distal half is red/brown. Classically seen in **Chronic Renal Failure**. * **Mee’s Lines:** Single transverse white bands caused by **Arsenic poisoning** or Hodgkin’s disease (True leukonychia).

Q: Which of the following medications is used in the treatment of male pattern alopecia?

Finasteride. **Explanation:** **Male Pattern Alopecia (Androgenetic Alopecia)** is characterized by the progressive thinning of hair in a defined pattern, driven by the androgen **Dihydrotestosterone (DHT)**. **1. Why Finasteride is Correct:** Finasteride is a **Type II 5-alpha reductase inhibitor**. It prevents the conversion of Testosterone to Dihydrotestosterone (DHT). Since DHT is responsible for the miniaturization of hair follicles in genetically predisposed individuals, reducing its levels helps arrest hair loss and promotes regrowth. It is FDA-approved for male pattern baldness at a dose of **1 mg/day**. **2. Analysis of Incorrect Options:** * **Potassium channel blocker:** This is a distractor. The other mainstay for alopecia is **Minoxidil**, which is a **Potassium channel opener** (not blocker). It acts as a vasodilator and prolongs the anagen (growth) phase. * **Fulvestrant:** This is a selective estrogen receptor degrader (SERD) used primarily in breast cancer management; it has no role in treating androgenetic alopecia. * **Dexamethasone:** This is a potent corticosteroid. While steroids are used in *Alopecia Areata* (an autoimmune condition), they are not indicated for androgenetic alopecia. **High-Yield Clinical Pearls for NEET-PG:** * **Dutasteride:** A more potent inhibitor that blocks both Type I and Type II 5-alpha reductase. * **Side Effects of Finasteride:** May cause erectile dysfunction, decreased libido, and gynaecomastia (Post-Finasteride Syndrome). * **Contraindication:** Finasteride is strictly **contraindicated in pregnancy** (Category X) as it can cause feminization of a male fetus. * **Hamilton-Norwood Scale:** Used to grade the severity of Male Pattern Alopecia.

Q: Nail deformities commonly seen in lichen planus include all of the following EXCEPT:

Beau's lines. **Explanation:** Lichen Planus (LP) is an inflammatory condition that affects the skin, mucous membranes, and nails. Nail involvement occurs in approximately 10% of cases and is primarily due to inflammation of the **nail matrix**. **Why Beau’s lines is the correct answer:** **Beau’s lines** are transverse depressions across the nail plate caused by a *temporary* systemic insult (e.g., high fever, chemotherapy, or severe illness) that briefly halts nail growth. While LP causes permanent or chronic damage to the matrix, it typically manifests as longitudinal (vertical) changes rather than temporary transverse arrests. **Analysis of incorrect options:** * **Pterygium (Dorsal):** This is the **hallmark** of nail Lichen Planus. It occurs when the proximal nail fold fuses with the nail bed due to scarring and destruction of the matrix, resulting in a V-shaped extension of skin over the nail. * **Longitudinal grooves:** These are very common in LP. Chronic inflammation of the matrix leads to thinning of the nail plate, resulting in vertical ridges, grooves, and "roughness" (trachyonychia). * **Onycholysis:** While less specific than pterygium, the inflammatory process in LP can involve the nail bed, leading to the separation of the nail plate from the bed. **NEET-PG High-Yield Pearls:** * **Twenty-nail dystrophy (Trachyonychia):** When all 20 nails are involved with a "sandpaper" appearance; LP is a major cause. * **Pterygium formation:** Dorsal pterygium is seen in **Lichen Planus**, whereas ventral pterygium (hyponychium sticking to the plate) is seen in **Scleroderma** or **SLE**. * **Management:** Intralesional or systemic steroids are required urgently to prevent permanent scarring and **Anonychia** (complete loss of the nail).

Question 1

Onycholysis is seen in all of the following conditions, except:

Accepted Answer

Nephrotic syndrome

Answer

Allergic dermatitis

Answer

Psoriasis

Answer

Antineoplastic therapy

Question 2

Whitening of the nail plates may be due to deficiency of?

Accepted Answer

Albumin

Answer

Iron

Answer

Zinc

Answer

Copper

Question 3

Which of the following medications is used in the treatment of male pattern alopecia?

Accepted Answer

Finasteride

Answer

Potassium channel blocker

Answer

Fulvestrant

Answer

Dexamethasone

Question 4

Non-cicatricial alopecia can be present in which skin disease?

Accepted Answer

Alopecia areata

Answer

Scleroderma

Answer

Lichen planus

Answer

Syphilis

Question 5

Nail deformities commonly seen in lichen planus include all of the following EXCEPT:

Accepted Answer

Beau's lines

Answer

Pterygium

Answer

Longitudinal grooves

Answer

Onycholysis

Hair and Nail Disorders — MCQs

Hair and Nail Disorders — MCQs

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