Hair and Nail Disorders Practice Questions

Q: A female patient presents with diffuse alopecia. She suffered from typhoid fever 4 months back. What is the most probable diagnosis?

Telogen effluvium. ### Explanation **Correct Answer: B. Telogen Effluvium** **Why it is correct:** Telogen effluvium (TE) is a form of non-scarring, diffuse hair loss that occurs when a physiological or emotional stressor prematurely pushes a large number of growing (anagen) hairs into the resting (telogen) phase. * **The Latency Period:** A classic clinical feature of TE is that hair shedding typically occurs **2 to 4 months after the inciting event**. * **The Trigger:** Common triggers include high-grade fever (e.g., Typhoid, Malaria), major surgery, pregnancy (post-partum), and severe nutritional deficiencies. In this case, the history of typhoid fever 4 months prior is the definitive diagnostic clue. **Why incorrect options are wrong:** * **Androgenetic alopecia:** This is a patterned, progressive thinning (vertex and frontal scalp) rather than sudden diffuse shedding, and it is driven by genetics and androgens, not acute systemic illness. * **Anagen effluvium:** This involves the shedding of hairs in the growth phase, usually occurring **1 to 2 weeks** after a trigger. It is most commonly associated with chemotherapy or radiation, not febrile illnesses. * **Alopecia areata:** This typically presents as well-demarcated, **circumscribed patches** of hair loss with "exclamation mark hairs," rather than diffuse thinning across the entire scalp. **NEET-PG High-Yield Pearls:** * **Hair Cycle:** Normal scalp has ~85-90% anagen hairs and ~10-15% telogen hairs. In TE, the telogen count exceeds 20-25%. * **Diagnosis:** TE is often diagnosed via a **Hair Pull Test** (positive if >10% of hairs are pulled) or a trichogram showing increased telogen bulbs (club hairs). * **Prognosis:** Acute TE is self-limiting; hair density usually returns to normal within 6-9 months once the trigger is removed.

Q: What is the condition characterized by the sudden onset of hair turning white overnight?

Alopecia areata. **Explanation:** The phenomenon of hair turning white "overnight" (historically termed *Canities subita*) is a classic clinical presentation of **Alopecia areata**. **Why Alopecia Areata is correct:** Alopecia areata is an autoimmune condition where T-cells attack the hair follicles. It has a specific predilection for **pigmented (black/brown) hairs**. In a diffuse variant of the disease, an acute autoimmune strike causes the sudden shedding of all pigmented hairs, leaving only the pre-existing grey or white hairs behind. This creates the dramatic clinical illusion that the patient’s hair turned white overnight. **Why the other options are incorrect:** * **Vitiligo:** This is a primary demyelinating disorder of the skin. While it can cause localized white hair (**Poliosis**), it is a gradual process and does not involve sudden hair loss. * **Anagen effluvium:** This refers to massive hair shedding (usually due to chemotherapy). It affects all hairs regardless of color and does not specifically result in a "white hair" appearance. * **Albinism:** This is a congenital genetic disorder characterized by a global lack of melanin from birth; it is not an acquired or sudden condition. **High-Yield NEET-PG Pearls:** * **Pathognomonic Sign:** "Exclamation mark" hairs (short, broken hairs thicker at the top than the base) seen at the periphery of patches. * **Nail Changes:** Fine "geometric pitting" is the most common nail finding in Alopecia areata. * **Histology:** Characterized by a **"Swarm of Bees"** appearance (peribulbar lymphocytic infiltrate). * **Treatment:** Intralesional corticosteroids (Triamcinolone) are the first-line treatment for localized patches.

Q: A 30-year-old female presents with a painful, red, warm nail fold of 7 days duration. The patient has tried home remedies such as turmeric powder and warm saline compressions without relief. What is the most probable diagnosis?

Acute paronychia. **Explanation:** The clinical presentation of a painful, red, and warm nail fold of short duration (7 days) is classic for **Acute Paronychia**. This is a localized inflammatory process of the proximal or lateral nail folds, most commonly caused by bacterial infection (predominantly *Staphylococcus aureus*). It often follows minor trauma, such as nail-biting, aggressive manicuring, or hangnails, which breaches the protective barrier between the nail plate and the fold. **Analysis of Options:** * **Acute Paronychia (Correct):** Characterized by rapid onset ( 6 weeks. It presents with boggy swelling, loss of the cuticle, and "bolster-like" hypertrophy of the nail fold, usually without the acute, throbbing pain seen here. * **Ingrowing fingernail:** While common in toes (Onychocryptosis), it is rare in fingernails. It involves the nail plate piercing the lateral fold, leading to granulation tissue rather than generalized fold inflammation. * **Onychomycosis:** This is a fungal infection of the nail plate itself, presenting with discoloration, thickening (subungual hyperkeratosis), and onycholysis, rather than acute inflammation of the surrounding skin. **High-Yield Clinical Pearls for NEET-PG:** * **Most common organism:** *Staphylococcus aureus* (Acute); *Candida albicans* (Chronic). * **Management:** Warm compresses and topical/oral antibiotics for early cases; **Incision and Drainage (I&D)** if an abscess (fluctuance) is present. * **Differential:** Herpetic Whitlow (caused by HSV) can mimic paronychia but presents with grouped vesicles and should *not* be incised.

Q: Cicatricial alopecia is seen in all of the following conditions EXCEPT?

Tinea capitis. **Explanation:** The core concept in this question is the distinction between **Cicatricial (Scarring)** and **Non-cicatricial (Non-scarring)** alopecia. Cicatricial alopecia involves permanent destruction of the hair follicle and its replacement by fibrous tissue, leading to irreversible hair loss and loss of follicular ostia. **Why Tinea Capitis is the correct answer:** Tinea capitis is a fungal infection of the scalp caused by dermatophytes. It is typically a **non-cicatricial** alopecia because the fungus usually invades the hair shaft or the keratinized layer of the follicle without destroying the stem cells in the bulge area. However, a severe inflammatory variant called **Kerion** can occasionally lead to scarring, but in the context of standard NEET-PG questions, Tinea capitis is classified as non-scarring. **Analysis of Incorrect Options:** * **Lichen Planus (Lichen Planopilaris):** This is a classic cause of primary cicatricial alopecia. It involves a lymphocytic inflammation that targets the follicular bulge, leading to permanent scarring. * **Discoid Lupus Erythematosus (DLE):** DLE is one of the most common causes of scarring alopecia. It presents with well-demarcated erythematous plaques, follicular plugging, and eventual atrophy. * **Scleroderma:** Specifically localized scleroderma (Morphea) or "En coup de sabre," causes linear scarring alopecia due to the excessive deposition of collagen which obliterates the hair follicles. **High-Yield Clinical Pearls for NEET-PG:** * **Non-Scarring Alopecia Mnemonic:** "TAP" (Tinea capitis, Alopecia areata, Psoriasis/Pityriasis capitis) and Telogen effluvium. * **Scarring Alopecia Mnemonic:** "LSD" (Lichen planopilaris, Scleroderma, DLE) and Pseudopelade of Brocq. * **Clinical Sign:** The absence of **follicular ostia** (pores) is the hallmark of cicatricial alopecia on physical examination.

Q: Which of the following statements is NOT true regarding the hair cycle?

40% of hair is in the anagen phase at any given time.. **Explanation:** The hair cycle consists of three main phases: **Anagen** (growth), **Catagen** (involution), and **Telogen** (resting). Understanding the physiological distribution of these phases is crucial for diagnosing hair loss disorders. **1. Why Option B is the Correct Answer (The False Statement):** In a healthy human scalp, approximately **85% to 90%** of hair follicles are in the **Anagen phase** at any given time. Stating that only 40% are in Anagen is incorrect. If Anagen percentages drop significantly (e.g., to 40%), it would indicate severe pathological hair loss, such as Anagen Effluvium or advanced Telogen Effluvium. **2. Analysis of Other Options:** * **Option A:** The **Telogen phase** typically lasts for about **3 months (100 days)**. During this time, the hair remains in the follicle until it is pushed out by a new anagen hair. This is why a stressful event often leads to hair shedding (Telogen Effluvium) exactly 3 months later. * **Option C:** The **Catagen phase** is indeed an **involutionary period**. It is the shortest phase (lasting 2–3 weeks) where the hair follicle shrivels, the lower part is destroyed, and the hair bulb becomes "club-shaped." * **Option D:** **Telogen** is correctly defined as the **resting phase** that occurs after catagen and before the follicle re-enters the anagen phase to start a new cycle. **NEET-PG High-Yield Clinical Pearls:** * **Anagen:** Lasts 2–6 years. Determines the maximum length of hair. * **Telogen Effluvium:** A shift of anagen hairs into telogen, leading to diffuse shedding (usually >20% follicles in telogen). * **Exogen:** A newly described fourth phase representing the active shedding of the hair shaft. * **Normal Hair Loss:** Shedding 50–100 hairs per day is considered physiological.

Q: What is the most likely cause of this presentation?

Chemotherapy. ***Chemotherapy*** - Causes **anagen effluvium**, the hallmark diffuse hair loss occurring within days to weeks of treatment initiation. - Results from direct cytotoxic effects on rapidly dividing **hair matrix cells** in the anagen (growth) phase, leading to abrupt cessation of hair production. *Hyperthyroidism* - Typically causes **telogen effluvium** with gradual, diffuse hair thinning over months rather than acute onset. - Hair changes are accompanied by **heat intolerance**, **weight loss**, and **tachycardia**, not the acute presentation seen with chemotherapy. *Nephrotic syndrome* - May cause **telogen effluvium** due to **protein loss** and nutritional deficiencies, but hair loss is gradual. - Associated with **edema**, **proteinuria**, and **hypoalbuminemia**, distinct from chemotherapy-induced anagen effluvium. *Psoriasis* - Can cause **alopecia areata** or **scarring alopecia** in severe scalp involvement, but pattern is typically patchy. - Accompanied by characteristic **silvery scales** and **well-demarcated plaques** on skin, not the diffuse pattern of chemotherapy-induced hair loss.

Q: The time period that elapses between physical or emotional stress and hair loss is approximately:

3 months. ### Explanation The question describes the characteristic timeline of **Telogen Effluvium (TE)**, a common form of non-scarring alopecia. **1. Why 3 Months is Correct:** The underlying medical concept is the **human hair cycle**. Under normal conditions, approximately 90% of scalp hair is in the Anagen (growth) phase and 10% is in the Telogen (resting) phase. When a significant physiological or emotional stressor occurs (e.g., high-grade fever like Typhoid, major surgery, childbirth, or severe psychological trauma), it triggers a large proportion of Anagen hairs to prematurely enter the Telogen phase. The Telogen phase typically lasts for **about 100 days (3 months)**. During this period, the hair remains in the follicle but is no longer growing. Once the new Anagen hair begins to grow underneath, it pushes the old Telogen hair out, resulting in the sudden, diffuse shedding observed by the patient. Therefore, the lag time between the inciting event and the hair loss is approximately 3 months. **2. Why Other Options are Incorrect:** * **21 days / 30 days:** These periods are too short. While the Catagen (transition) phase lasts about 2–3 weeks, the subsequent Telogen phase must be completed before the hair is shed. * **6 months:** This is generally the timeline for **Chronic Telogen Effluvium** or the point where hair regrowth becomes noticeable, rather than the initial onset of shedding. **3. NEET-PG High-Yield Pearls:** * **Pull Test:** Positive in TE (extracting >6 hairs or >10% of hairs pulled). * **Hair Morphology:** TE shows "Club hairs" (bulbar, non-pigmented roots). * **Anagen Effluvium:** Occurs much faster (1–2 weeks) after chemotherapy because it affects actively dividing cells. * **Prognosis:** Acute TE is self-limiting; hair density usually returns to normal within 6–12 months after the stressor is removed.

Q: Coarse pitting of nails is seen in?

Psoriatic arthritis. **Explanation:** **1. Why Psoriatic Arthritis is Correct:** Nail pitting is a classic sign of psoriasis, occurring in approximately 50% of patients with skin involvement and up to 80% of those with **psoriatic arthritis**. Pitting results from focal areas of parakeratosis (retained nuclei in the stratum corneum) within the **proximal nail matrix**. As the nail grows out, these parakeratotic cells shed, leaving behind depressions. In psoriasis, these pits are typically **deep, large (coarse), and irregularly distributed**, distinguishing them from the shallow, geometric pits seen in other conditions. **2. Why the Other Options are Incorrect:** * **Dermatitis Herpetiformis:** This is an autoimmune blistering disease associated with celiac disease. It primarily affects the skin (extensor surfaces) and does not typically present with nail pitting. * **Bullous Pemphigoid:** This is a subepidermal blistering disorder. While it can occasionally cause nail dystrophy due to periungual blistering, pitting is not a characteristic feature. * **Pemphigus Vulgaris:** This is an intraepidermal blistering disease. Nail involvement (like onychomadesis or paronychia) can occur in severe cases, but coarse pitting is not a diagnostic hallmark. **3. Clinical Pearls for NEET-PG:** * **Pitting Patterns:** * **Psoriasis:** Deep, coarse, and irregular pits. * **Alopecia Areata:** Fine, shallow, and "geometric" (grid-like) pits. * **Eczema:** Irregular, wavy pits. * **Other Nail Signs in Psoriasis:** Oil spots (salmon patches), onycholysis, subungual hyperkeratosis, and splinter hemorrhages. * **High-Yield Association:** Nail involvement in psoriasis is a strong clinical predictor for the future development of psoriatic arthritis.

Q: Pterygium of the nail is seen in which of the following conditions?

Lichen planus. **Explanation:** **Pterygium of the nail** (specifically dorsal pterygium) is a classic hallmark of **Lichen Planus (LP)**. It occurs due to scarring and inflammation of the nail matrix, leading to the fusion of the proximal nail fold to the nail bed. This results in a characteristic V-shaped extension of the skin over the nail plate, eventually causing irreversible destruction and splitting of the nail. **Analysis of Options:** * **Lichen Planus (Correct):** Approximately 10% of LP cases involve nails. The "classic triad" includes thinning of the nail plate, longitudinal ridging, and **dorsal pterygium**. * **Psoriasis:** Characterized by **pitting** (deep, irregular), onycholysis (separation of the nail from the bed), "oil spots" (salmon patches), and subungual hyperkeratosis. Pterygium is not a feature. * **Tinea Unguium:** A fungal infection typically presenting with distal subungual hyperkeratosis, yellow-white discoloration, and crumbling of the nail plate. * **Alopecia Areata:** Classically associated with **geometric pitting** (shallow, regularly spaced pits in a grid-like pattern) and "trachyonychia" (rough, sandpaper-like nails). **High-Yield Clinical Pearls for NEET-PG:** 1. **Dorsal Pterygium:** Seen in Lichen Planus (scarring/destructive). 2. **Ventral Pterygium (Pterygium Inversum Unguis):** Seen in **Scleroderma**, SLE, and Leprosy (fusion of the hyponychium to the underside of the nail plate). 3. **Trachyonychia (Twenty-nail dystrophy):** Can be seen in Lichen Planus, Psoriasis, Alopecia Areata, and Eczema. 4. **Nail Pitting:** Psoriasis (deep/irregular) vs. Alopecia Areata (shallow/geometric).

Question 1

A female patient presents with diffuse alopecia. She suffered from typhoid fever 4 months back. What is the most probable diagnosis?

Accepted Answer

Telogen effluvium

Answer

Androgenetic alopecia

Answer

Anagen effluvium

Answer

Alopecia areata

Question 2

What is the condition characterized by the sudden onset of hair turning white overnight?

Accepted Answer

Alopecia areata

Answer

Vitiligo

Answer

Anagen effluvium

Answer

Albinism

Question 3

A 30-year-old female presents with a painful, red, warm nail fold of 7 days duration. The patient has tried home remedies such as turmeric powder and warm saline compressions without relief. What is the most probable diagnosis?

Accepted Answer

Acute paronychia

Answer

Ingrowing fingernail

Answer

Chronic paronychia

Answer

Onychomycosis

Question 4

Cicatricial alopecia is seen in all of the following conditions EXCEPT?

Accepted Answer

Tinea capitis

Answer

Lichen planus

Answer

Discoid lupus erythematosus (DLE)

Answer

Scleroderma

Question 5

Which of the following statements is NOT true regarding the hair cycle?

Accepted Answer

40% of hair is in the anagen phase at any given time.

Answer

The telogen phase lasts for 3 months.

Answer

The catagen phase is an involutionary period.

Answer

Telogen is the resting phase between catagen and the next anagen.

Question 6

What is the most likely cause of this presentation?

Accepted Answer

Chemotherapy

Answer

Hyperthyroidism

Answer

Nephrotic syndrome

Answer

Psoriasis

Question 7

The time period that elapses between physical or emotional stress and hair loss is approximately:

Accepted Answer

3 months

Answer

21 days

Answer

30 days

Answer

6 months

Question 8

Coarse pitting of nails is seen in?

Accepted Answer

Psoriatic arthritis

Answer

Dermatitis herpetiformis

Answer

Bullous pemphigoid

Answer

Pemphigus vulgaris

Question 9

Cicatrising alopecia with perifollicular blue-gray patches of hyperpigmentation is most commonly associated with which of the following clinical findings?

Accepted Answer

Whitish lesions in the buccal mucosa

Answer

Pitting of nails

Answer

Alopecia areata

Answer

Discoid plaques on the face

Question 10

Pterygium of the nail is seen in which of the following conditions?

Accepted Answer

Lichen planus

Answer

Psoriasis

Answer

Tinea unguium

Answer

Alopecia areata

Hair and Nail Disorders — MCQs

Hair and Nail Disorders — MCQs

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