Hair and Nail Disorders Practice Questions

Q: The image shows presence of:

Onychogryphosis. ***Onychogryphosis*** - The image clearly shows a thickened, **curved**, and discolored nail, often described as resembling a **ram's horn**, which is characteristic of onychogryphosis. - This condition results from an imbalance in nail growth, leading to hypertrophy and abnormal curvature, often seen in the elderly or due to trauma. *Onycholysis* - Onycholysis is the **separation of the nail plate from the nail bed**, typically starting at the distal end. - The image does not show a clear separation of the nail from its bed, but rather a deformed, thickened nail plate. *Trachyonychia* - Trachyonychia is characterized by **rough**, opaque, and sometimes vertically ridged nails, often described as having a "sandpapered" appearance. - While there is some discoloration, the predominant feature in the image is the extreme thickening and curvature, not uniform roughness. *Onychocryptosis* - Onychocryptosis, commonly known as an **ingrown nail**, occurs when the edge of the nail grows into the surrounding skin. - The image does not depict an ingrown nail; instead, it shows a nail with significant hypertrophy and deformation of the nail plate itself.

Q: The image shows presence of:

Muehrcke's nails. ***Muehrcke's nails*** - The image clearly displays characteristic **paired white lines** (leukonychia) separated by normal-appearing nail areas, which are hallmarks of Muehrcke's nails. - These lines are caused by **edema in the nail bed** rather than an abnormality of the nail plate itself, and they do not move with nail growth. *Lindsay nails* - Also known as **"half-and-half" nails**, Lindsay nails feature the **proximal half of the nail plate appearing white** and the **distal half appearing red or pink**, typically associated with chronic kidney disease. - This pattern of discoloration is distinct from the multiple transverse white bands seen in Muehrcke's nails. *Koilonychia* - Koilonychia, or **spoon nails**, describes nails that are **thinned and concave with raised edges**, resembling a spoon. - This condition is often associated with **iron deficiency anemia**, and the appearance in the image does not show this characteristic "spooning." *Beau's lines* - Beau's lines are **transverse depressions or grooves** across the nail plate that occur due to a temporary interruption of nail growth. - They are typically seen as a single, deep furrow that grows out with the nail, unlike the multiple, non-palpable white bands of Muehrcke's nails.

Q: The following patient presented to the OPD with history of hair loss. There was no erythema, scarring or scratching. Diagnosis is:

Alopecia areata. ***Alopecia areata*** - The image shows **well-demarcated patches of hair loss** with no signs of inflammation or scarring, which is characteristic of alopecia areata. - This condition is an **autoimmune disorder** where the immune system attacks hair follicles, leading to patchy hair loss. - Classic presentation includes **smooth, round patches** with no erythema or scarring. *Trichotillomania* - This condition involves **compulsive hair pulling**, which typically results in **irregularly shaped patches of hair loss** with hairs of varying lengths. - Hair loss in trichotillomania often shows **broken hair shafts** and may be associated with signs of trauma or follicular damage. - The absence of scratching/pulling behavior and the well-defined patches make this less likely. *Telogen effluvium* - Telogen effluvium presents as **diffuse hair shedding** (increased shedding of resting phase hairs) rather than the distinct, localized patches seen in the image. - It usually follows a **stressful event** (e.g., illness, surgery, childbirth) and there's no visible inflammation or scarring. - Would not present as well-demarcated patches. *Tinea infection* - Tinea capitis (ringworm of the scalp) would typically present with **erythema, scaling, inflammation**, and sometimes pustules or kerion formation within the patches of hair loss. - The patches of hair loss in tinea infections often show **broken hairs** or "black dots" where hairs have broken off at the scalp surface. - The **absence of erythema** in this case rules out tinea infection.

Q: The nail lesion shown in the image is known as?

Ventral pterygium. ***Ventral pterygium*** - This shows **adhesion of the hyponychium** (distal nail bed epithelium) to the undersurface of the nail plate, creating a forward extension that obliterates the **free nail margin**. - Also known as **pterygium inversum unguis**, it is commonly associated with **scleroderma**, **systemic lupus erythematosus**, and **Raynaud's phenomenon**. *Dorsal pterygium* - This involves the **proximal nail fold fusing** onto the dorsal surface of the nail plate, creating a **V-shaped defect** or longitudinal splitting. - Typically associated with **lichen planus**, **cicatricial pemphigoid**, or severe **nail matrix trauma**. *Tinea unguium* - This is a **fungal infection** of the nail that causes **subungual hyperkeratosis**, yellow-brown discoloration, and nail thickening. - The characteristic **hyponychial adhesion** seen in the image is not a feature of fungal nail infections. *Onychomycosis* - This is the general term for **fungal nail infection**, presenting with various patterns like **distal subungual** or **white superficial** onychomycosis. - The distinct **forward extension of hyponychium** obliterating the free nail margin is not characteristic of fungal infections.

Q: In a patient with the following lesion on scalp, what changes are seen in the nails?

Pitting of nails. ***Pitting of nails*** - The image shows a patch of **alopecia areata** on the scalp. **Nail pitting** is the most common and characteristic nail change associated with alopecia areata, occurring in **10-66% of cases**. - Pitting appears as small depressions or **"ice-pick" marks** on the nail surface, resulting from defective nail matrix keratinization. - Other nail changes in alopecia areata include **trachyonychia (rough nails), red spotted lunulae, onycholysis**, and **Beau's lines**. *Dorsal pterygium of nails* - **Dorsal pterygium** occurs when the proximal nail fold fuses with and extends over the nail plate, creating a wing-like scar. - This is classically associated with **lichen planus, trauma, burns, vasculitis**, and **graft-versus-host disease** — **NOT alopecia areata**. - It can lead to permanent nail dystrophy or nail loss. *Azure nails* - **Azure nails** (blue nails) are typically associated with **Wilson's disease** (copper accumulation) or **minocycline use**, not alopecia areata. - They represent a blue-gray discoloration of the nail bed or lunula. *Yellow nail discolouration* - **Yellow nail syndrome** is a rare condition characterized by slow-growing, thickened, yellow nails, often associated with **lymphedema** and **respiratory problems** (pleural effusions, chronic bronchitis). - It is not linked to alopecia areata.

Q: Consider the following regarding the human hair growth cycle : I. Anagen is a phase of active hair growth II. Telogen is a transitional phase III. Catagen is a resting phase Which of the statements given above is/are correct?

I only. ***I only*** - Statement I is **correct**: **Anagen is the active growth phase** of the hair cycle where hair follicle cells in the matrix rapidly divide and differentiate - The hair shaft actively grows during this phase, which typically lasts **2-7 years** and determines the maximum length of hair - **Only statement I is accurate**, making this the correct answer *III only* - This option is incorrect because statement III claims **Catagen is a resting phase**, which is medically inaccurate - **Catagen is actually the transitional/regression phase** (lasting 2-3 weeks) where hair growth stops and the follicle shrinks - The **resting phase is Telogen**, not Catagen *I, II and III* - This option is incorrect because **both statements II and III contain errors** - Statement II incorrectly identifies **Telogen as a transitional phase** when it is actually the **resting phase** (2-4 months) - Statement III incorrectly identifies **Catagen as a resting phase** when it is actually the **transitional phase** - Only statement I is correct *I and II only* - This option is incorrect because **statement II is inaccurate** - Statement II claims **Telogen is a transitional phase**, but Telogen is actually the **resting phase** where the hair remains in the follicle before shedding - The **transitional phase is Catagen**, not Telogen - Only statement I is correct, not both I and II

Q: Consider the following causes of alopecia: 1. Androgenetic alopecia 2. Alopecia areata 3. Telogen effluvium 4. Lichen planopilaris. Which among the following causes non-scarring alopecia?

1, 2 and 3. **1, 2, and 3** - **Androgenetic alopecia**, **alopecia areata**, and **telogen effluvium** are all forms of **non-scarring alopecia**, meaning the hair follicles are primarily affected without permanent destruction. - In these conditions, there is potential for hair regrowth as the follicular structures remain intact. *Only 4* - **Lichen planopilaris** is a type of **scarring alopecia**, characterized by permanent destruction of hair follicles and replacement with fibrous tissue. - This leads to irreversible hair loss in the affected areas. *3 and 4* - While **telogen effluvium** causes non-scarring alopecia, **lichen planopilaris** is a scarring alopecia. - Therefore, this option incorrectly groups a non-scarring and a scarring condition. *2, 3, and 4* - This option correctly identifies **alopecia areata** and **telogen effluvium** as non-scarring but incorrectly includes **lichen planopilaris**, which results in scarring alopecia. - **Lichen planopilaris** has inflammatory infiltrates that lead to permanent follicular damage.

Q: Non-scarring alopecia is associated with all except?

Frontal fibrosing alopecia. ***Frontal fibrosing alopecia*** - This condition is a form of **lichen planopilaris**, which causes **scarring alopecia** due to destruction of hair follicles and replacement with fibrous tissue. - It results in a **receding hairline** and eyebrow loss, with irreversible hair loss. *Telogen effluvium* - This is a common cause of **non-scarring alopecia**, characterized by diffuse hair shedding triggered by various stressors like illness, stress, or medications. - The hair follicles enter the **telogen phase** prematurely, leading to increased shedding but typically regrowth once the trigger is removed. *Androgenetic alopecia* - Often referred to as **male or female pattern baldness**, this is a form of **non-scarring alopecia** driven by genetic predisposition and androgens. - It causes a progressive miniaturization of hair follicles, leading to thinning hair, but the follicles remain present and capable of producing hair. *Alopecia areata* - This is an **autoimmune condition** that causes **non-scarring hair loss** in patches on the scalp or other parts of the body. - The hair follicles are attacked by the immune system but are not permanently destroyed, allowing for potential regrowth.

Q: Nails are involved in all except:

DLE. ***DLE (Discoid Lupus Erythematosus)*** - **DLE** primarily affects the skin, causing scarring and pigmentary changes, with **minimal and least prominent nail involvement** compared to the other conditions listed. - While nail changes like red lunulae or periungual telangiectasia can occasionally occur, **DLE** is a chronic cutaneous form of lupus where nail manifestations are **uncommon and not a defining feature**. - Among the given options, DLE has the **least clinically significant nail involvement**. *Lichen planus* - **Nail involvement** in lichen planus is common and can be severe, manifesting as longitudinal ridging, thinning, splitting, and pterygium formation. - It results from inflammation affecting the **nail matrix** and nail bed, often leading to permanent nail damage. *Psoriasis* - **Nail psoriasis** is very common (occurs in ~50% of patients), presenting with pitting, onycholysis, subungual hyperkeratosis, and oil drop spots. - It signifies immune-mediated inflammation within the **nail unit** and is a characteristic feature. *Tinea* - **Tinea (onychomycosis)** is a common fungal infection of the nails, causing discoloration, thickening, and brittleness. - It is diagnosed by microscopic examination and culture of **nail clippings**.

Q: Scarring alopecia is seen in:

Lichen planus. ***Lichen planus*** - **Lichen planopilaris**, a follicular variant of lichen planus, is a common cause of **scarring (cicatricial) alopecia**. - It involves lymphohistiocytic inflammation targeting the **hair follicle epithelium**, leading to destruction and permanent hair loss. *T. capitis* - **Tinea capitis** is a fungal infection of the scalp that typically causes **non-scarring alopecia**, usually appearing as broken hairs, scales, and erythema. - While severe, untreated cases can rarely lead to scarring (e.g., in kerion), it is not the primary presentation for scarring alopecia. *Alopecia areata* - **Alopecia areata** is an autoimmune condition causing **non-scarring hair loss** in patches, often with characteristic "exclamation mark" hairs. - The hair follicles are preserved and hair regrowth is possible, which differentiates it from scarring alopecias. *Androgenic alopecia* - **Androgenic alopecia** (male and female pattern baldness) is the most common form of hair loss and is characteristically **non-scarring**. - It is due to the miniaturization of hair follicles under the influence of androgens, but the follicles remain intact.

Question 1

The image shows presence of:

Accepted Answer

Onychogryphosis

Answer

Onycholysis

Answer

Trachyonychia

Answer

Onychocryptosis

Question 2

The image shows presence of:

Accepted Answer

Muehrcke's nails

Answer

Lindsay nails

Answer

Koilonychia

Answer

Beau's lines

Question 3

The following patient presented to the OPD with history of hair loss. There was no erythema, scarring or scratching. Diagnosis is:

Accepted Answer

Alopecia areata

Answer

Trichotillomania

Answer

Telogen effluvium

Answer

Tinea infection

Question 4

The nail lesion shown in the image is known as?

Accepted Answer

Ventral pterygium

Answer

Dorsal pterygium

Answer

Tinea unguium

Answer

Onychomycosis

Question 5

In a patient with the following lesion on scalp, what changes are seen in the nails?

Accepted Answer

Pitting of nails

Answer

Azure nails

Answer

Dorsal pterygium of nails

Answer

Yellow nail discolouration

Question 6

Consider the following regarding the human hair growth cycle :
I. Anagen is a phase of active hair growth
II. Telogen is a transitional phase
III. Catagen is a resting phase

Which of the statements given above is/are correct?

Accepted Answer

I only

Answer

III only

Answer

I, II and III

Answer

I and II only

Question 7

Consider the following causes of alopecia: 1. Androgenetic alopecia 2. Alopecia areata 3. Telogen effluvium 4. Lichen planopilaris. Which among the following causes non-scarring alopecia?

Accepted Answer

1, 2 and 3

Answer

Only 4

Answer

3 and 4

Answer

2, 3 and 4

Question 8

Non-scarring alopecia is associated with all except?

Accepted Answer

Frontal fibrosing alopecia

Answer

Telogen effluvium

Answer

Androgenetic alopecia

Answer

Alopecia areata

Question 9

Nails are involved in all except:

Accepted Answer

DLE

Answer

Lichen planus

Answer

Psoriasis

Answer

Tinea

Question 10

Scarring alopecia is seen in:

Accepted Answer

Lichen planus

Answer

Tinea capitis

Answer

Alopecia areata

Answer

Androgenic alopecia

Hair and Nail Disorders — MCQs

Hair and Nail Disorders — MCQs

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