Hair and Nail Disorders Practice Questions

Q: Which of the following conditions causes diffuse non-scarring alopecia typically triggered by physiological stress?

Telogen Effluvium. ***Telogen Effluvium*** - This condition is a common cause of **diffuse non-scarring hair loss** where a significant number of **hair follicles** prematurely enter the **telogen phase**, leading to widespread shedding. - It is characteristically **triggered by physiological or emotional stressors** such as childbirth, severe illness, surgery, or significant weight loss, typically occurring **2-3 months after the stressor**. - The condition is usually **self-limiting and reversible** once the underlying cause is addressed, with complete hair regrowth expected. *Alopecia areata* - This is an **autoimmune disorder** that causes **patchy, localized hair loss** on the scalp, not diffuse shedding. - While it is a **non-scarring alopecia**, it presents with well-demarcated round or oval patches rather than generalized thinning. - The pattern is distinctly different from the diffuse hair loss seen in telogen effluvium. *Alopecia totalis* - This is an **autoimmune condition** characterized by **complete loss of all scalp hair**, representing an extensive variant of alopecia areata. - It presents as **total scalp hair loss** rather than diffuse thinning, making it clinically distinct from stress-related diffuse shedding. - Though non-scarring, it is not typically triggered by physiological stressors. *Lichen planopilaris* - This is a **scarring (cicatricial) alopecia** where inflammation around the **hair follicle** leads to its permanent destruction and replacement by **fibrotic tissue**. - Clinically presents with inflamed, scaly patches and **perifollicular erythema**, often with associated symptoms like burning or pruritus. - Results in **permanent hair loss** due to follicular destruction, unlike the reversible nature of telogen effluvium.

Q: Muehrcke lines in nails are seen in:

Nephrotic syndrome. ***Nephrotic syndrome*** - **Muehrcke lines** are characterized by paired, white transverse lines separated by normal pink nail beds, which do not move with nail growth. - They are associated with **hypoalbuminemia**, a hallmark of nephrotic syndrome [1], due to decreased protein synthesis in the nail matrix. *Guillain-Barré syndrome* - This is an **acute demyelinating polyneuropathy** primarily affecting the peripheral nervous system. - It does not typically manifest with nail changes like Muehrcke lines, which are related to systemic metabolic derangements. *Nail-patella syndrome* - This rare genetic disorder is characterized by a **tetrad of abnormalities**: nail dysplasia, patellar hypoplasia/aplasia, elbow abnormalities, and iliac horns. - The nail changes are primarily **dysplastic or absent** rather than the transverse white lines seen in Muehrcke lines. *Acute tubular necrosis (ATN)* - ATN is an intrinsic kidney injury characterized by **damage to the renal tubules**, often leading to acute kidney failure. - While it affects kidney function, it does not typically cause the systemic hypoalbuminemia or nail changes seen in nephrotic syndrome.

Q: Which of the following statements is incorrect regarding nail changes in various conditions?

Koilonychia is associated with Vitamin B12 deficiency.. ***Koilonychia is associated with Vitamin B12 deficiency.*** - **Koilonychia**, or "spoon nails," is primarily associated with **iron deficiency anemia**, not Vitamin B12 deficiency. - In Koilonychia, the nails become **thin, brittle**, and concave in shape. *Onycholysis is seen in Psoriasis.* - **Onycholysis** refers to the separation of the nail plate from the nail bed, which is a common nail finding in **psoriasis**. - Other nail changes in psoriasis include **pitting**, oil spots, and subungual hyperkeratosis. *Mees lines are indicative of Arsenic poisoning.* - **Mees lines** are transverse white lines or bands that appear across the nail plate, characteristic of severe illness or poisoning. - They are classically associated with **arsenic poisoning**, but can also be seen in other conditions like thallium poisoning or kidney failure. *Pterygium of nails is associated with Lichen Planus.* - **Pterygium unguis** involves the forward growth of the proximal nail fold (cuticle) onto the nail plate, leading to fusion. - It is a prominent and often distinguishing feature of **lichen planus** affecting the nails, which can lead to permanent nail deformity or loss.

Q: What phase of hair growth is primarily responsible for the length of eyebrows?

Anagen phase. ***Anagen phase*** - The **anagen phase** is the **active growth phase** where hair follicles rapidly produce hair cells, determining the maximum length hair can achieve. - Eyebrows have a much **shorter anagen phase** (months) compared to scalp hair (years), which explains why they don't grow very long. *Telogen phase* - The **telogen phase** is the **resting phase** where the hair follicle is dormant and no further growth occurs. - Hair in this phase is mature and will eventually shed, but this phase does not contribute to hair length. *Catagen phase* - The **catagen phase** is a **transitional phase** where hair growth stops, and the follicle shrinks in preparation for the resting phase. - This phase marks the end of active growth, so it does not contribute to increasing hair length. *Exogen phase* - The **exogen phase** is a sub-phase of telogen, where **hair shedding** occurs. - This phase is about the release of old hair, not the production or increase in length of new hair.

Q: Pitting of nails can be seen in:

Alopecia areata. ***Alopecia areata*** - Nail pitting, characterized by small depressions in the nail plate, can be seen in patients with **alopecia areata**, reflecting a disturbance in the nail matrix. - Other nail changes in alopecia areata can include **trachyonychia** (roughening of the nail plate) and **longitudinal ridging**. *Tinea unguium* - This is a fungal infection of the nails, also known as onychomycosis, which typically causes **thickening, discoloration, and crumbling** of the nail, rather than pitting. - The nail changes are primarily due to fungal invasion and destruction of the nail plate. *Peripheral vascular disease* - Peripheral vascular disease affects blood flow to the extremities, leading to **trophic changes** in the nails such as thickening, slow growth, and discoloration due to poor circulation. - It does not typically cause **nail pitting**. *Androgenic alopecia* - This is a common form of hair loss (male or female pattern baldness) that affects the scalp and is **not associated with nail changes** like pitting. - The pathophysiology involves hormonal influences on hair follicles, not the nail matrix.

Q: According to the Ferriman Gallwey scoring system, hirsutism is diagnosed when the score is equal to or more than:

8. ***8*** - A Ferriman-Gallwey score equal to or greater than **8** is the standard cutoff for diagnosing hirsutism in most populations. - This threshold indicates an abnormal amount of **terminal hair growth** in androgen-sensitive areas of the body. *12* - While a score of 12 or higher certainly indicates hirsutism, it is **not the lower diagnostic cutoff**. - A score of 12 represents a **more severe degree** of hirsutism, but the diagnosis is established earlier. *16* - A score of 16 is considered **severe hirsutism** and suggests a significant increase in androgenic activity. - However, the diagnosis of hirsutism is made at a **much lower score** according to the established criteria. *20* - A score of 20 would represent **profound hirsutism**, often associated with conditions causing very high androgen levels. - This level is far beyond the **minimum diagnostic threshold** for hirsutism.

Question 1

Which of the following conditions causes diffuse non-scarring alopecia typically triggered by physiological stress?

Accepted Answer

Telogen Effluvium

Answer

Alopecia areata

Answer

Alopecia totalis

Answer

Lichen planopilaris

Question 2

Muehrcke lines in nails are seen in:

Accepted Answer

Nephrotic syndrome

Answer

Guillain-Barré syndrome

Answer

Nail-patella syndrome

Answer

Acute tubular necrosis (ATN)

Question 3

Which of the following statements is incorrect regarding nail changes in various conditions?

Accepted Answer

Koilonychia is associated with Vitamin B12 deficiency.

Answer

Onycholysis is seen in Psoriasis.

Answer

Mees lines are indicative of Arsenic poisoning.

Answer

Pterygium of nails is associated with Lichen Planus.

Question 4

What phase of hair growth is primarily responsible for the length of eyebrows?

Accepted Answer

Anagen phase

Answer

Telogen phase

Answer

Catagen phase

Answer

Exogen phase

Question 5

Pitting of nails can be seen in:

Accepted Answer

Alopecia areata

Answer

Tinea unguium

Answer

Peripheral vascular disease

Answer

Androgenic alopecia

Question 6

According to the Ferriman Gallwey scoring system, hirsutism is diagnosed when the score is equal to or more than:

Accepted Answer

8

Answer

12

Answer

16

Answer

20

Hair and Nail Disorders — MCQs

Hair and Nail Disorders — MCQs

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