Hair and Nail Disorders Practice Questions

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: 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.

Q: A male presents with alopecia and exclamation mark hairs. Diagnosis?

Alopecia areata. ***Alopecia areata*** - The presence of **exclamation mark hairs** (hairs that are narrower closer to the scalp and wider at the distal end) is a classic dermatoscopic finding specifically associated with **alopecia areata**. - **Alopecia areata** is an autoimmune condition characterized by patchy hair loss and often presents with these peculiar hair shaft abnormalities. *Telogen effluvium* - This condition involves diffuse thinning of hair, often triggered by stress, illness, or hormonal changes, but does not typically present with **exclamation mark hairs**. - It is characterized by an increased shedding of **telogen (resting phase)** hairs, with no specific hair shaft abnormalities like exclamation marks. *Androgenic alopecia* - This is the most common type of hair loss, characterized by a patterned balding (receding hairline, thinning crown), due to the effect of androgens on genetically susceptible hair follicles. - While it causes hair miniaturization, it does not involve the formation of **exclamation mark hairs**. *Tinea capitis* - This is a **fungal infection** of the scalp that typically causes scaly patches, broken hairs, and sometimes inflammation or painful lesions, often with associated **lymphadenopathy**. - The distinctive **exclamation mark hairs** are not a feature of **tinea capitis**; instead, broken-off hairs or "black dots" may be observed.

Q: A 45-year-old woman presents with diffuse hair thinning over her scalp. She denies any scarring or itching. Laboratory tests reveal low serum ferritin levels. What is the most appropriate management?

Iron supplementation. ***Iron supplementation*** - **Low serum ferritin** indicates **iron deficiency**, a common cause of **diffuse hair thinning** (telogen effluvium) in women [1]. - Replenishing iron stores is crucial for hair regrowth and should be the primary treatment [1]. *Topical minoxidil* - This promotes hair growth and is commonly used for **androgenetic alopecia**, but it does not address the underlying nutritional deficiency in this case. - While it can be an adjunctive treatment, addressing the **iron deficiency** is more fundamental for this patient [1]. *Oral finasteride* - This medication is primarily used in **men** for **androgenetic alopecia** as it inhibits 5-alpha-reductase, reducing DHT levels. - It is generally not indicated for women with diffuse hair thinning, especially when an underlying cause like **iron deficiency** is identified. *Systemic corticosteroids* - These are used for inflammatory or autoimmune hair loss conditions like **alopecia areata** or **lichen planopilaris** [1]. - They are not indicated for **iron deficiency-induced hair thinning**, and their side effects outweigh any potential benefits in this scenario.

Q: A 30-year-old woman presents with non-scarring patchy hair loss on her scalp. What is the most likely diagnosis?

Alopecia areata. ***Alopecia areata*** - This condition is characterized by **non-scarring, patchy hair loss**, often described as circular or oval, which fits the description of the patient. - It is an **autoimmune disorder** where the immune system attacks hair follicles, leading to their sudden loss without leaving a scar. - Classic presentation includes **smooth, hairless patches** with "exclamation mark hairs" at the periphery. *Androgenetic alopecia* - This is typical **pattern hair loss**, often presenting as a receding hairline and thinning crown in men, and diffuse thinning over the scalp in women. - It is characterized by progressive miniaturization of hair follicles, leading to finer, shorter hairs, rather than sudden patches. - The hair loss is **gradual and follows a predictable pattern**, not discrete circular patches. *Tinea capitis* - This is a **fungal infection** of the scalp, which typically causes **non-scarring alopecia** with scaling, erythema, and broken hairs. - While it can cause patchy hair loss, the presence of **scaling, inflammation, black dots (broken hairs), and sometimes pustules** would be expected, which are not mentioned in the patient's presentation. - Severe forms (kerion) may lead to scarring if left untreated, but most cases are non-scarring. *Trichotillomania* - This is a **hair-pulling disorder** where individuals compulsively pull out their own hair, resulting in patches of varying hair lengths and often broken hairs. - The patches are typically **irregularly shaped** with hairs of different lengths, and a history of hair pulling or psychological stressors would be evident, which is not stated in the scenario.

Q: Which of the following nail findings is seen in the condition shown below?

Pitting. ***Pitting*** - The image displays multiple small, **punctate depressions** on the nail plate, which are characteristic features of nail pitting. - Nail pitting is a common finding in conditions affecting the **nail matrix**, such as psoriasis. *Pterygium* - **Pterygium** refers to the forward growth of the proximal nail fold onto the nail plate, or the lateral nail folds onto the nail plate, often leading to nail loss. - This is not observed in the image, which primarily shows depressions rather than overgrowth of skin onto the nail. *Pigmentation* - **Nail pigmentation** involves discoloration of the nail plate, appearing as streaks, spots, or diffuse changes in color (e.g., brown, black, blue). - The nail in the image does not show abnormal discoloration but rather surface irregularities. *Ridges* - **Ridges** in nails (longitudinal or transverse) are linear elevations or grooves on the nail surface. - While some linear texture is present, the predominant feature in the image is distinct, small, and scattered depressions, which are consistent with pitting rather than continuous ridges.

Q: Identify the condition shown in the image.

Alopecia areata. ***Alopecia areata*** - This condition presents as **well-demarcated**, **smooth**, and **non-scarring patches of hair loss**, as seen in the image. - It is an **autoimmune condition** where the immune system mistakenly attacks hair follicles, leading to hair shedding. *Sebaceous cyst* - A sebaceous cyst is a **closed sac** occurring under the skin, usually filled with **dead skin cells** and **oily secretions**. - It presents as a **lump or nodule** under the skin, not as a patch of hair loss. *Trichotillomania* - This is a **hair-pulling disorder** characterized by an irresistible urge to pull out one's hair, resulting in **irregular patches of broken hair shafts** of varying lengths. - The patches of hair loss are typically **ill-defined** and often show signs of hair breakage, unlike the smooth patches seen in the image. *Tinea capitis* - Tinea capitis, a **fungal infection of the scalp**, typically causes **scaly, erythematous patches** with associated **hair breakage** or **'black dots'** from fractured hair shafts. - It often involves **inflammation** and **pruritus**, which are not directly suggested by the image's appearance of smooth, clear patches.

Question 1

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 2

The growth phase of hair is

Accepted Answer

Anagen

Answer

Progen

Answer

Metagen

Answer

Telogen

Question 3

Pitting of nails is seen in:

Accepted Answer

Psoriasis

Answer

Arsenic poisoning

Answer

Pemphigus

Answer

Lichen planus

Question 4

Swarm of bees appearance seen in?

Accepted Answer

Alopecia areata

Answer

Telogen effluvium

Answer

Androgenetic alopecia

Answer

Anagen effluvium

Question 5

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

Question 6

A male presents with alopecia and exclamation mark hairs. Diagnosis?

Accepted Answer

Alopecia areata

Answer

Telogen effluvium

Answer

Androgenic alopecia

Answer

Tinea capitis

Question 7

A 45-year-old woman presents with diffuse hair thinning over her scalp. She denies any scarring or itching. Laboratory tests reveal low serum ferritin levels. What is the most appropriate management?

Accepted Answer

Iron supplementation

Answer

Topical minoxidil

Answer

Oral finasteride

Answer

Systemic corticosteroids

Question 8

A 30-year-old woman presents with non-scarring patchy hair loss on her scalp. What is the most likely diagnosis?

Accepted Answer

Alopecia areata

Answer

Androgenetic alopecia

Answer

Tinea capitis

Answer

Trichotillomania

Question 9

Which of the following nail findings is seen in the condition shown below?

Accepted Answer

Pitting

Answer

Pterygium

Answer

Pigmentation

Answer

Ridges

Question 10

Identify the condition shown in the image.

Accepted Answer

Alopecia areata

Answer

Sebaceous cyst

Answer

Trichotillomania

Answer

Tinea capitis

Hair and Nail Disorders — MCQs

Hair and Nail Disorders — MCQs

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