hair and nail disorders mcqs

8/11/2019 Hair and Nail Disorders MCQs

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Hair and Nail disordersWhich of the following syndromes does not have Dorsal pterygium as a feature:

1 Lichen planus

2 Lesch-Nyhan syndrome

3 Cicatricial pemphigoid

4 Chronic GVHD

5 Lamellar ichthyosis

Q/Q(M)-478121 Report a Problem

Which of the following syndromes does not have Dorsal pterygium as a feature:

5 Lamellar ichthyosis

Dorsal pterygium (scarring of the proximal nail fold) is caused by lichen planus, acrosclerosis,

onychotillomania, Lesch-Nyhan syndrome, chronic GVHD, SJS/TEN and cicatricial pemphigoid. All of

the listed items are correct except lamellar ichthyosis. It does not have this nail finding.


The best test for Cushing syndrome is:

1 Plasma LH

2 Plasma testosterone

3 Plasma prolactin

4 Plasma DHEA

5 Overnight dexamethasone suppresion test


The best test for Cushing syndrome is:

5 Overnight dexamethasone suppresion test

The overnight dexamethasone suppression test is the test of choice for diagnosis of Cushing syndrome. In

this test, a dose of dexamethasone is given at 11pm and the plasma cortisol level is drawn the following

morning. If the Cushing syndrome is from an adrenal tumor or an ectopic ACTH producing tumor, there isno change in cortisol secretion. A normal response is suppression of the cortisol level by the extra

dexamethasone. If the Cushings is from a pituitary tumor, at low doses of dexamethasone there are no

changes in cortisol levels while at high doses of dexamethasone there will be a normal suppression. The

other listed items are not used for diagnosis of Cushing syndrome.


A 34-year-old man presents with a jet-black nail plate involving the right index finger. Hutchinsons sign

is negative and the patient denies antecedent trauma. What is the most likely etiology of the nail plate

discoloration:

1 Multiple Myeloma

2 Wilsons disease


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3 Congenital Oncychodysplasia of the Index Figner (COIF)

4 Pseudomonas infection

5 Proteus Infection


A 34-year-old man presents with a jet-black nail plate involving the right index finger. Hutchinsons sign

is negative and the patient denies antecedent trauma. What is the most likely etiology of the nail platediscoloration:

5 Proteus Infection

Proteus infection of the nail is associated with black discoloration of the nail plate. Multiple myeloma may

be associated with anonychia. Wilsons disease classically exhibits blue lunulae. COIF presents withabsence of the nail plate. Pseudomonal infections of the subunguium may produce a green discoloration

due to production of pyocyanin pigment.


An 18 year-old girl who was hospitalized last month after a serious car accident is noted to have white

transverse grooves on her fingernails and toenails. The most likely diagnosis is:

1 Twenty-nail dystrophy

2 Beaus lines

3 Half-and-half nails

4 Meeslines

5 Terrys nails


An 18 year-old girl who was hospitalized last month after a serious car accident is noted to have white

transverse grooves on her fingernails and toenails. The most likely diagnosis is:

2 Beaus lines

Beaus lines are transverse grooves in the nails. They are caused by a generalized systemic conditionwhich disrupts nail formation. Conditions may include infection, myocardial infection, neurologic events

and cytotoxic medications.


Triangular lunulae are seen in what disorder?

1 Dyskeratosis congentia

2 Neurofibromatosis II

3 Gorlins syndrome

4 Nail-patella syndrome

5 Papillon-Lefevre syndromeQ/Q(M)-474578 Report a Problem


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Triangular lunulae are seen in what disorder?

4 Nail-patella syndrome

Triangular lunulae are seen in nail-patella syndrome which is characterized by mutation in LMX1b.


Blue lunulae are characteristic of which disease?

1 Yellow nail syndrome

2 Wilson's disease

3 Rubenstein-Taybi syndrome

4 Hypertrophic pulmonary osteoarthropathy

5 Clubbing


Blue lunulae are characteristic of which disease?

2 Wilson's disease

Wilson's disease is associated with characteristic blue lunulae.


A patient with diffuse severe sudden hair loss developing 3 months after hospitalization for septicemia

likely has which of the following conditions?

1 Anagen effluvium

2 Catagen effluvium

3 Telogen effluvium

4 Loose anagen syndrome

5 Uncombable hair syndrome


A patient with diffuse severe sudden hair loss developing 3 months after hospitalization for septicemia

likely has which of the following conditions?

3 Telogen effluvium

Telogen effluvium typically ensues stressful events after a 2-3 month period.


How long should the last wash-out period before performing mycologic investigations in a clinically

recurrent onychomycosis treated by terbinafine, itraconazole or fluconazole:

1 One month


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2 Two months

3 Three months

4 Four months

5 Six months


How long should the last wash-out period before performing mycologic investigations in a clinically

recurrent onychomycosis treated by terbinafine, itraconazole or fluconazole:

3 Three months

This is an interesting point, because we know that these systemic antifungals are retained in the keratin of

the toenails up to six months after the treatment has been stopped. Therefore this answer could have been

debatable were it not for the presence of fungi in the nail bed (which is the primary location of the disease)

and where the scraping should be properly performed for mycologic testing after removal of a piece of

nail as proximal as possible.


Which genodermatosis characterized by broad thumbs and this nail disorder pictured below?

1 Rothmund-Thompson

2 Tuberous sclerosis

3 Pachyonychia congenita

4 Proteus syndrome5 Rubenstein-Taybi syndrome


Which genodermatosis characterized by broad thumbs and this nail disorder pictured below?

5 Rubenstein-Taybi syndrome

Rubensteom-Taybi syndrome is characterized by broad thumbs and broad nails or brachyonychia. This

syndrome is characterized by mutations in CREB-binding protein.Q/Q(M)-475936 Report a Problem


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The combination of poliosis, uveitis, deafness, and vitiligo are characteristic of which of the following

conditions?

1 Piebaldism

2 Waardernburg syndrome

3 Cronkhite-Canada syndrome

4 Vogt-Koyanagi-Harada syndrome

5 Cornelia de Lange Syndrome


The combination of poliosis, uveitis, deafness, and vitiligo are characteristic of which of the following

conditions?


Vogt-Koyanagi-Harada syndrome is characterized by poliosis, uveitis, deafness, and Vitiligo.


Tricholemmoma is which type of hair follicle tumor?

1 Tumor of the hair germ cells

2 Tumors of matrical differentiation

3 Tumors of the external root sheath

4 Tumor of isthmus differentiation

5 Tumor of the internal root sheath


Tricholemmoma is which type of hair follicle tumor?

3 Tumors of the external root sheath

Tricholemmoma is a tumor of the external root sheath. Tumors of the hair germ cells include

trichoblastoma and trichoepithelioma. Tumors of matrical differentiation include pilomatricoma. Tumors

of the external root sheath include pilar cyst, proliferating tricholemmal cyst, tricholemmoma,

tricholemmal carcinoma. Tumor of the isthmus differentiation include tumor of the follicular

infundibulum.


A 42 year-old woman presents with the complaint of excess hair growth on her face. She has normal

menses and has recently had her "annual" exam and the note relates normal sized ovaries. What is the

most logical next step?

1 Check plasma levels of androstenedione and testosterone

2 Send a 21-hydroxylase enzyme deficiency test

3 Biopsy from the most affected area


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4 Refer her to endocrinology

5 Order a CT of the abdomen


A 42 year-old woman presents with the complaint of excess hair growth on her face. She has normalmenses and has recently had her "annual" exam and the note relates normal sized ovaries. What is the

most logical next step?

1 Check plasma levels of androstenedione and testosterone

Women with idiopathic hirsutism will have evidence of androgen excess but with normal menses, normal-

sized ovaries and no evidence of tumors of adrenal or ovary and normal adrenal function. They will often

have slight elevations of plasma androstenedione and testosterone. Check the blood levels of the plasma

steroids would be a logical first step.


Spotted red lunulae are absent in which of the following conditions?

1 Alopecia areata

2 Keratosis follicularis

3 Systemic lupus erythematosus

4 Rheumatoid arthritis

5 Lichen planus

Q/Q(M)-478099 Report a ProblemSpotted red lunulae are absent in which of the following conditions?

2 Keratosis follicularis

Keratosis follicularis has nail findings of v-shaped nicking of the distal nail, subungual hyperkeratosis and

red/white alternating longitudinal bands. In addition to those listed above, psoriasis can also cause spotted

red lunulae.


Proximal white subungual onychomycosis with polydactylous involvement needs at least one laboratory

test:

1 Blood count

2 Sedimentation rate

3 T-helper CD4 lymphocytes

4 Liver enzymes

5 HIV


Proximal white subungual onychomycosis with polydactylous involvement needs at least one laboratory

test:


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5 HIV

This type of onychomycosis has a prognostic value: It means that the CD4 lymphocytes are below 450.


The syndrome including mental and physical retardation, convulsions, episodic unconsciousness, liver

enlargement, skin lesions, and dry and brittle hair showing trichorrhexis nodosa microscopically andfluorescing red. is:

1 Bazex Follicular Atrophoderma

2 Crandall's syndrome

3 Citrullinemia

4 Argininosuccinic aciduria

5 Bjornstad's syndrome


The syndrome including mental and physical retardation, convulsions, episodic unconsciousness, liver

enlargement, skin lesions, and dry and brittle hair showing trichorrhexis nodosa microscopically and

fluorescing red. is:


Argininosuccinic aciduria has the features listed including trichorrhexis nodosa and red fluorescence of

the hair. Bazex's follicular atrophoderma and Crandall syndrome both have findings of pili torti and

citrullinemia has trichorrhexis nodosa. None of the other options have red fluorescence as a feature.


Distal subungual onychomycosis is most often caused by:

1 Trichophyton mentagrophytes

2 Epidermophyton floccosum

3 Trichophyton schoenleinii

4 Trichophyton rubrum

5 Trichophyton megninii


Distal subungual onychomycosis is most often caused by:


Trichophyton rubrum is the most common organism involved in distal subungual onychomycosis.


Mee's lines are:

1 Double white transverse lines from abnormal vascular bed


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2 Brownish macules beneath the nail plate

3 Local or diffuse hyperkeratotic tissue that develops on the lateral or proximal nail folds

4 Transverse white lines that affect all nails, grow out with nail growth

5 Vertical black lines on a single or multiple nails


Mee's lines are:

4 Transverse white lines that affect all nails, grow out with nail growth

Mee's lines are transverse white lines that affect all nails, grow out with nail growth. They are seen in

arsenic poisoning, rheumatic fever, congenital heart failure, leprosy and with significant systemic disease.

Brownish macules beneath the nail plate are oil spots, seen in psoriasis. Onychophosis is the local or

diffuse hyperkeratotic tissue that develops on the lateral or proximal nail folds. The double white

transverse lines from abnormal vascular bed are Muehrcke's lines which are caused by a nephrotic

syndrome, low albumin, liver disease or malnutrition.


Frontal bossing, saddle nose, hypoplastic midface, peg shaped or conical teeth and hypopigmented short

sparse scalp and body hair are prominent features of which of the following

1 Christ Siemens Touraine syndrome

2 Hidrotic ectodermal dysplasia

3 Arginosuccinic aciduria

4 Monilethrix

5 Pachyonychia congenita


Frontal bossing, saddle nose, hypoplastic midface, peg shaped or conical teeth and hypopigmented short

sparse scalp and body hair are prominent features of which of the following

1 Christ Siemens Touraine syndrome

Chrsit Siemens Touraine syndrome also known as Hypohidrotic ectodermal dysplaisa or anhidroticectodermal dysplasia is X-linked recessive disroder that presents in infancy to early childhood. Features

include hypo-anhidrosis with increased body temperature, hypopigmented sparse scalp and body hair,

frontal bossing, saddle nose, hypoplastic midface, abnormal ears, hypo-anodontia, and increased

bronchopulmonary inections. Cloustons syndrome or hidrotic ectodermal dysplasia is AD and associated

with palmoplantar keratoderma, nail dystrophy, short sparse scalp hair, and tufting of the terminal

phalanges. Arginosuccinic aciduria is associated with seizures, trichorrhexis nodosa, failure to thrive, and

hyperammonemia. Monelothrix is associated with beaded hairs and keratosis pilaris. Pachyonychia

congenita is associated with nail dystrophy and focal palmoplantar keratoderma.


A 73-year-old man presents with ared streakinvolving the nail plate of the first digit. You make thediagnosis of longitudinal erythronychia. What is the most common underlying cause:


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1 Melanoma

2 Myxoid cyst

3 Subungual keratoacanthoma

4 Carbon Monoxide toxicity

5 Onychopapilloma


A 73-year-old man presents with ared streakinvolving the nail plate of the first digit. You make thediagnosis of longitudinal erythronychia. What is the most common underlying cause:

5 Onychopapilloma

Onychopapilloma represents a benign tumor of the nail unit and is the most common etiology of

longitudinal melanonychia. Myxcoid cysts are mucin-filled pseudocysts that may be connected to the joint

space and often present as longitudinal grooving of the nail plate. Carbon Monoxide toxicity may present

with a red lunula.Q/Q(M)-482924 Report a Problem

A 36-year-old woman presents with hair loss. Examination of a single follicle reveals multiple hair shafts

protruding, each surrounded by its own cuticle. What is the most likely diagnosis:

1 Pili multigemini

2 Pili bifurcati

3 Trichoptilosis

4 Trichoschisis

5 Trichothiodystrophy


A 36-year-old woman presents with hair loss. Examination of a single follicle reveals multiple hair shafts

protruding, each surrounded by its own cuticle. What is the most likely diagnosis:

1 Pili multigemini

Pili multigemini refers to a rare disorder of multiple divided hair matrices, with multiple hair shafts each

with their own cuticle all arising from one follicle. Pili bifucarti exhibits hair shaft bifurcation into shortsegments along hair shafts, with each segment covered with its own cuticle. Trichoptilosis refers tosplit endsof the distal portion of the hair shaft. Trichoschisis is a clean fracture of the hair shaft.Trichothiodystrophy is a disorder of beaded hair when viewed with polarizing light.


Pili trianguli et canaliculi is the characteristic hair fiding in which of the following disoders?

1 Monilethrix

2 Pili annulati

3 Naxos syndrome

4 Anhidrotic ectodermal dysplasia


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Pili trianguli et canaliculi is the characteristic hair fiding in which of the following disoders?


Pili trianguli et canaliculi, characterized by a triangular hair shaft with a central longitudinal groove, is thefinding seen in uncombable hair syndrome.


The combination of a low-set hairline and synophrys is seen in which of the following conditions?

1 Werner syndrome

2 Turner Syndrome

3 Noonan Syndrome


5 Waardenburg's syndrome


The combination of a low-set hairline and synophrys is seen in which of the following conditions?


Cornelia de Lange Syndrome is a sporadic disorder that may be caused by mutations in nipped-Beta-like

gene. Clinically, patients have cutis marmorata, hirsutism, synophrys, mental retardation, short stature,GU abnormalities, hearing loss, and congenital heart defects.


What is the gene defect that causes red hair?

1 Tyrosinase

2 P protein

3 Melanocortin 1 receptor

4 Tyrosine aminotransferase

5 Tyrosinase-related protein 1


What is the gene defect that causes red hair?

3 Melanocortin 1 receptor

Defects in melanocortin 1 receptor lead to the phenotypic appearance of red hair. Individuals with red hair

have increased ratio of pheomelanin to eumelanin and are at increased risk for melanoma.Q/Q(M)-476535 Report a Problem


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Yellow nail syndrome has been associated with use of which of the following treatments for Rheumatoid

Arthritis?

1 D-penicillamine

2 Methotrexate

3 Infliximab

4 Etanercept

5 Adalimumab


Yellow nail syndrome has been associated with use of which of the following treatments for Rheumatoid

Arthritis?

1 D-penicillamine

D-penicillamine has been associated with the development of yellow nail syndrome in patiens withrheumatoid arthritis. The other options are used to treat RA, but have not been associated with

development of this syndrome.


Which of the following is caused by mutations in gap junction proteins?

1 Rothmund-Thompson syndrome



4 Netherton syndrome

5 Naxos syndrome


Which of the following is caused by mutations in gap junction proteins?


Hidrotic ectodermal dysplasia is caused by mutations in connexin 30, which is a gap junction protein.


Congenital generalized hypertrichosis is associated with which of the following symptoms?

1 Androgen-secreting ovarian tumors

2 Pituitary insufficiency

3 Distichiasis

4 Methimazole teratogenicity

5 Gingival fibromatosis



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Congenital generalized hypertrichosis is associated with which of the following symptoms?

5 Gingival fibromatosis

Gingival fibromatosis. Congenital Generalized Hypertrichosis with Gingival Fibromatosis is a genetic

condition with hypertrichosis on the face and upper body and gingival hyperplasia and fibromatosis.


Which of the following is an example of an apparent leukonychia?

1 Terry's lines

2 Mee's lines

3 Muehrcke's lines

4 Hutchinson's lines

5 OnychoschiziaQ/Q(M)-476751 Report a Problem

Which of the following is an example of an apparent leukonychia?

3 Muehrcke's lines

An apparent leukonychia disappears with pressure and is a problem with nail bed, not nail plate. Apparent

leukonychia may be indicative of overall health compromise. Muehrcke's lines are paired white bands and

are a type of apparent leukonychia.


Trichobezoar is is a potentially life-threatening complication of:

1 Alopecia areata


3 Trichotillomania

4 Discoid lupus

5 Lichen planopilaris


Trichobezoar is is a potentially life-threatening complication of:

3 Trichotillomania

Trichophagia is more common in individuals who have richotillomania. This chewing behavior frequently

can lead to the formation of trichobezoars in the stomach or small intestines. Trichobezoars can result in

anemia, abdominal pain, hematemesis, nausea and/or vomiting, bowel obstruction, perforation,

gastrointestinal (GI) bleeding, acute pancreatitis, and obstructive jaundice.Q/Q(M)-477345 Report a Problem

The "ragged cuticle" seen in dermatomyositis is also known as:


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1 Samitz sign

2 Ventral pterygium

3 Plummers sign

4 Candy-cane nails

5 Emperipolesis


The "ragged cuticle" seen in dermatomyositis is also known as:

1 Samitz sign

Cuticular fraying from dermatomyositis is called the Samitz sign or "ragged cuticle". The other options are

not associated with dermatomyositis. A ventral pterygium can be seen in systemic sclerosis. There is no

such sign as Plummers sign. Candy-cane nails are seen in Darier's disease. Emperipolesis is seen in Rosai-

Dorfman disease and is not a nail finding.Q/Q(M)-478101 Report a Problem

This nail finding is characteristically associated with what disorder?

1 Congenital heart failure

2 Chronic renal failure

3 Anemia

4 Hyperthyroidism

5 Cirrhosis


This nail finding is characteristically associated with what disorder?


Lindsays nail is characteristically associated with chronic renal failure.


The defect associated with the hair finding shown in the image is:


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1 hHB6/hHB1

2 hHB7/hHB2

3 hHB8/hHB3

4 hHB9/hHB4

5 hHB10/hHB5


The defect associated with the hair finding shown in the image is:

1 hHB6/hHB1

hHB6/hHB1 keratins are associated with Monilethrix. Other findings include: short, brittle hair, extensor

keratosis pilaris, mental retardation, syndactyly, cataracts, and nail/teeth abnormalities.


Which autoantibody is associated with these cuticular changes, shawl sign, and overall favorable

prognosis?

1 Mi-2

2 Jo-1

3 High titered ANA with speckled pattern

4 Scl-70

5 Ro


Which autoantibody is associated with these cuticular changes, shawl sign, and overall favorable

prognosis?

1 Mi-2

Dermatomyositis has many different cutaneous manifestations including heliotrope rash, Gottron's papules

and sign, mechanic's hand and poikiloderma atrophicans vasculare. Antibodies to Mi-2 in dermatomyositis

are associated with cuticular changes, shawl sign and a overall favorable prognosis.


A 26-year-old woman presents with hair loss. Examination of a single shaft reveals division into two

shafts in short segments, with each individually covered with a complete cuticle. What is the most likely

diagnosis:


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1 Pili multigemini

2 Pili bifurcati

3 Trichoptilosis

4 Trichoschisis



A 26-year-old woman presents with hair loss. Examination of a single shaft reveals division into two

shafts in short segments, with each individually covered with a complete cuticle. What is the most likely

diagnosis:

2 Pili bifurcati


with their own cuticle all arising from one follicle. Pili bifucarti exhibits hair shaft bifurcation into shortsegments along hair shafts, with each segment covered with its own cuticle. Trichoptilosis refers tosplit endsof the distal portion of the hair shaft. Trichoschisis is a clean fracture of the hair shaft.Trichothiodystrophy is a disorder of beaded hair when viewed with polarizing light.


Endonyx onychomycosis is due to:



3 Trichophyton soudanense

4 Scytalidium dimidiatum

5 Scopuliaropsis


Endonyx onychomycosis is due to:

3 Trichophyton soudanense

Endonyx onychomycosis may also be observed with T. violaceum. This is the equivalent of endothrix

infection of the hair associated with tinea capitis.


A patient with psoriasis has pitting of the nails. This finding is due to involvement of which part of the

nail unit?

1 Proximal matrix

2 Nail bed

3 Hyponychium

4 Proximal nail fold


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diffuse palmoplantar keratoderma, and right ventricular arrhythmogenic cardiomyopathy.


Anonychia is not a feature of which of the following syndromes?

1 Nail-Patella syndrome

2 Coffin-Siris syndrome

3 DOOR syndrome

4 COIF syndrome



Anonychia is not a feature of which of the following syndromes?


Hidrotic ectodermal dysplasia features hyperconvex nails, micronychia and nail dystrophy. All of the

other listed options can cause anonychia. COIF syndrome is Congenital Onychodysplasia of the Index

Finger and DOOR syndrome is Deafness, Congenital Onychodystrophy Recessive Form. Coffin-Siris

syndrome is characterized by: nail onychodysplasia or aplasia (usually of the fifth finger or toe), coarse

facies including bushy eyebrows, scant scalp hair, full lips, and microcephaly, mental/growth deficiency,

short distal phalanges, and other abnormalities.


Yellow nail syndrome can be associated with:

1 D-penicillamine use in patients with rheumatoid arthritis

2 Wilsons disease

3 Alopecia areata

4 Doxorubicin

5 Minocycline use in acne patients


Yellow nail syndrome can be associated with:

1 D-penicillamine use in patients with rheumatoid arthritis

D-penicillamine use in patients with rheumatoid arthritis. Yellow nail syndrome has been described in

patients with rheumatoid arthritis receiving thiol compounds including D-penicillamine and bucillamine.

Reversal of the condition has been described after discontinuation of the drug.


Best diagnosis of this type of cicatricial alopecia shown in attached image is

1 Chronic cutaneous lupus erythematosus


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lines may be caused by arsenic poisoning, rheumatic fever, or other systemic diseases. Muehrckes linesdisappear with squeezing of the nail and are due to disorders of low albumin. Oncyhophagia refers to nail

biting. Dolichonychia exhibits long, slender nails, and is associated with Ehlers-Danlos and Marfans.


A rapid onset of hair growth with or without accompanying virilization can occur in all of the following

conditions EXCEPT:

1 Adrenal adenoma

2 Adrenal carcinoma

3 Arrhenoblastoma

4 Krukenburg tumor of the ovary

5 Ovarian cyst


A rapid onset of hair growth with or without accompanying virilization can occur in all of the following

conditions EXCEPT:

5 Ovarian cyst

All of these options except an ovarian cyst can cause a rapid onset of hair growth with or without

accompanying virilization. An Arrhenoblastoma is a tumor of the ovary that secretes testosterone.


Acquired progressive kinking of hair is a complication of which of the following medications?

1 Antimetabolites

2 Antimalarials

3 Retinoids

4 Slfonamides

5 Dapsone


Acquired progressive kinking of hair is a complication of which of the following medications?

3 Retinoids

Retinoids can cause acquired progressive kinking of hair.


The epithelium that lies on the volar surface of the digit is the:

1 Nail bed

2 Nail matrix


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3 Nail plate

4 Hyponychium

5 Eponychium


The epithelium that lies on the volar surface of the digit is the:

4 Hyponychium

The epithelium that lies on the volar surface of the digit is the hyponychium. The nail plate is the actual

nail made up of tightly packed onychocytes. The nail matrix is the epithelium which starts mid distal

phalanx which generated the nail plate. It keratinizes without a granular layer and determines the thickness

of the nail plate. The nail bed is the thin epithelium immeduately beneath the nail plate.


A subungual hematoma covering 50% of the nailbed should be managed by which of the following?

1 No treatment

2 Removal of the nail plate

3 Trephination of the nail plate

4 Needle aspiration of the hematoma

5 Pressure dressing


A subungual hematoma covering 50% of the nailbed should be managed by which of the following?

2 Removal of the nail plate

Removal of the nail plate is necessary for management of hematomas covering more than 25% of the

nailbed.


The most common enzyme abnormality in congenital adrenal hyperplasia is:

1 3-beta-hydroxysteroid dehydrogenase isomerase

2 11-beta-hydroxylase

3 21-hydroxylase

4 15-hydroxylase

5 17-hydroxylase


The most common enzyme abnormality in congenital adrenal hyperplasia is:3 21-hydroxylase

21-hydroxylase deficiency is present in 95% of cases of congenital adrenal hyperplasia. This defect in


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adrenal steroidogenesis can occur at any point in life, but affected girls will generally present around

puberty with hirsutism and mentsrual irregularity/primary amenorrhea. The key feature is excess androgen

production.


Mutations in c-kit are associated with which of the following conditions?

1 Waardenburg syndrome

2 Piebaldism

3 Tuberous sclerosis

4 Vogt-koyanagi-harada



Mutations in c-kit are associated with which of the following conditions?

2 Piebaldism

Piebaldism is caused by mutations in c-kit.


A patient with cirrhosis has noticed that the proximal aspect of his nails have become white. This

characteristic finding is called:

1 Half-and-half nails

2 Mees' lines

3 Beau's lines

4 Terry's lines

5 Muehrcke's lines


A patient with cirrhosis has noticed that the proximal aspect of his nails have become white. This

characteristic finding is called:

4 Terry's lines

Terrys lines are described as an abnormal white appearance of the nail except for the most distalportion. It has been described in association with cirrhosis, congestive heart failure, and diabetes mellitus.


A woman with hypopigmented in lines of Blaschko and scarring alopecia likely suffers which of the

following conditions?

1 Chondrodysplasis punctata

2 Anhidrotic Ectodermal Dysplasia


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1 Vitamin B12

2 Vitamin C

3 Iron

4 Magnesium

5 Thiamine


What nutritional deficiency can lead to this nail finding?

3 Iron

Iron deficiency can lead to spoon nail deformity or koilonychias.


What is the common cause of theone hand-two-footsyndrome?


2 Trichophyton mentagrophytes ( var. Interdigitale)

3 Candida albicans


5 Scopulariopsis brevicaulis


What is the common cause of theone hand-two-footsyndrome?


This condition is due to T. rubrum in 90% of the cases , T. interdigitale and Scytalidium dimidiatum share

the 10% left.



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The most common cultured agent in chronic paronychia associated with a black hue of the lateral edge of

the nail plate is:


2 gram-negative bacteria

3 Candida spp

4 Scytalidium dimidiatum5 Scopulariopsis brevicaulis


The most common cultured agent in chronic paronychia associated with a black hue of the lateral edge of

the nail plate is:

3 Candida spp

Chronic paronychia is likely a condition that represents a contact reaction to allergens or irritants. It often

is superinfected with candida. This underlies the importance of treatment with both an antifungal and atopical steroid.


Which of the following is not a feature of Bazex-Dupre-Christol Syndrome?

1 peripheral vasodilation with cyanosis

2 BCC

3 hypohidrosis

4 milia

5 epidermoid cysts


Which of the following is not a feature of Bazex-Dupre-Christol Syndrome?

1 peripheral vasodilation with cyanosis

Peripheral vasodilation with cyanosis is not found in BDC Syndrome. This is a feature of Rombo

Syndrom. Bazex-Dupre-Christol Syndrome includes BCC, follicular atrophoderma, hypohidrosis, milia,

epidermoid cysts, and hypotrichosis.


A commonly known cause of splinter hemorrhages in the nail is endocarditis. Which of the following

would be unlikely to cause splinter hemorrhages?

1 Trichinosis

2 Trauma

3 Psoriasis4 Vasculitis



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A commonly known cause of splinter hemorrhages in the nail is endocarditis. Which of the following

would be unlikely to cause splinter hemorrhages?


Rheumatoid arthritis is not a cause of splinter hemorrhages of the nail. Endocarditis is the most commonlythought of cause of splinter hemorrhages. Trichinosis, trauma, psoriasis and vasculitis also can be causes

of this also and should be considered when splinter hemorrhages are seen.


Which of the following medication is a cause of hirsutism without virilization?

1 Dapsone

2 Diazoxide

3 Diazepam

4 Dinitrochlorobenzene

5 Dantrolene


Which of the following medication is a cause of hirsutism without virilization?

2 Diazoxide

Phenytoin, diazoxide, cyclosporine and hexachlorobenzene all can cause increased hair growth in patients.

In addition, oral (and topical) minoxidil can cause hirsutism. The other listed medications do not cause

hirsutism.


The distal nail matrix is visible at the following portion of the nail unit:

1 Onychodermal band

2 Hyponychium

3 Lunula

4 Cuticle

5 Lateral nailfold


The distal nail matrix is visible at the following portion of the nail unit:

3 Lunula

The distal nail matrix is located at the lunula, which is visible as the half-moon structure at the base of the

nail. The proximal matrix is located under the proximal nailfold. Damage to the proximal nail matrix

produces defects at the dorsal nailplate, and damage to the distal nail matrix produces produces defects atthe ventral nail plate.



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The visible portion of the nail matrix is called the:

1 Eponychium

2 Lunula

3 Cuticle

4 Hyponychium

5 Nail plate


The visible portion of the nail matrix is called the:

2 Lunula

The nail unit is comprised of six major components including the nail matrix, nail plate, cuticle, nail bed,anchoring portion, and the framing portion (proximal/lateral/distal folds). The lunula is a component of

the distal matrix. It is grayish white because of the nature of the keratinization of its epithelium.


A 6-year old girl with atopic dermatitis presents with patchy non-scarring alopecia and nail pitting. You

make the diagnosis of alopecia areata. What portion of the nail unit is responsible for her nail plate pitting:

1 Hyponychium

2 Proximal nail plate

3 Proximal nail matrix

4 Distal nail matrix

5 Eponychium


A 6-year old girl with atopic dermatitis presents with patchy non-scarring alopecia and nail pitting. You

make the diagnosis of alopecia areata. What portion of the nail unit is responsible for her nail plate pitting:


The proximal nail matrix produce the dorsal nail plate. Defective keratinization in this region is therefore

responsible for the pitting seen in alopecia areata, psoriasis, eczema, and other cutaneous diseases. The

distal nail matrix produces the ventral nail plate and is visible as the lunula.


Acute paronychia is most commonly caused by which of the following organisms?

1 Candida albicans

2 Candida tropicalis


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3 Pseudomonas aeruginosa

4 Staphylococcus aureus



Acute paronychia is most commonly caused by which of the following organisms?


Staphylococcus aureus is the most common cause of acute paronychia.


Thin hair with premature graying is characteristic of which of the following syndromes?

1 Werner syndrome

2 Turner Syndrome

3 Noonan Syndrome


5 Waardenburg's syndrome


Thin hair with premature graying is characteristic of which of the following syndromes?

1 Werner syndromeWerner syndrome is characterized by premature degeneration of major organs that loosely mimics

premature aging. It is associated with sclerodermoid changes, leg ulcerations, premature graying,

cataracts, premature atherosclerosis,a dn diabetes. It is associated with defects in the helicase RecQL2.


A 32-year-old male presents with progressive curliness of the temporal scalp hairs that seem to precede

hair loss. What is the most likely associated etiology?

1 Secondary syphilis

2 Systemic tuberculosis


4 Hodgkins lymphoma

5 HIV


A 32-year-old male presents with progressive curliness of the temporal scalp hairs that seem to precede

hair loss. What is the most likely associated etiology?

5 HIV

HIV and retinoids are associated with acquired progressive kinking. This syndrome presents with gradual


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2 Proteus mirabilis

3 Pseudomonas spp.


5 Hortaea werneckii


Black nail is caused by:

2 Proteus mirabilis

Nail infections with Proteus mirabilis. T. mentag causes white discoloration of the nail and Pseudomonas

will cause a green or yellow/green discoloration. Hortaea werneckii causes tinea nigra. S. aureus does not

cause black nails.


Primary total dystrophic onychomycosis is due to:

1 Candida spp

2 Fusarium





Primary total dystrophic onychomycosis is due to:

1 Candida spp

The main characteristic of this immunologic disorder the simultaneous involvement of all the tissues of

the nail unit.


The combination of ankyloblepharon, ectodermal dysplasia, and cleft palate with wiry sparse hair is

characteristic of which of the following syndromes?

1 Focal Dermal Hypoplasia (Goltz syndrome)

2 Tricho-rhino-phalangeal Syndrome

3 Hay-Wells Syndrome

4 Ectrodactyly-Ectodermal dysplasia-Clefting (EEC)

5 Trichodentoosseous Syndrome


The combination of ankyloblepharon, ectodermal dysplasia, and cleft palate with wiry sparse hair is

characteristic of which of the following syndromes?

3 Hay-Wells Syndrome


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Hay-Wells Syndrome, also known as AEC (Ankyloblepharon-Ectodermal dysplasia-Clefting) is

characterized by wiry, sparse hair or alopecia, ankyloblepharon, PPK, partial anhidrosis, cleft lip, palate,

absent, and dystrophic nails.


The most common cause for superficial type onychomycosis is:



3 Epidermophyton floccosum

4 Fusarium oxysporum

5 Scopulariopsis brevicalis


The most common cause for superficial type onychomycosis is:


T. mentagrophytes is the most common cause of superficial type onychomycosis. Other causes include:

Fusarium, Acremonium and Aspergillus spp.


Which of the following are characteristics of Trichorhinophalangeal syndrome?

1 Kinky hair, frontal bossing, small widely spaced teeth with poor enamel

2 Palmoplantar keratoderma, trichorrhexis nodosa, sinus infections

3 Shortened phalanges, sparse hair, bulbous nose

4 Brittle hair, short stature, cerebellar ataxia

5 Sparse fine hair, Short extremities, Immunodeficiency


Which of the following are characteristics of Trichorhinophalangeal syndrome?

3 Shortened phalanges, sparse hair, bulbous nose

Characteristic features of trichorhinophalangeal syndrome are shortened phalanges, sparse hair, and

bulbous nose.


A 28-year-old male presents with three coin-shaped areas of scalp alopecia without scaling or erythema.

Which of the following is most likely to be associated with alopecia areata?

1 Hypothyroidism


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2 Seborrheic dermatitis

3 Tinea capitis

4 Congestive heart failure

5 Chronic kidney disease


A 28-year-old male presents with three coin-shaped areas of scalp alopecia without scaling or erythema.

Which of the following is most likely to be associated with alopecia areata?

1 Hypothyroidism

Alopecia area is associated with autoimmune diseases, especially thyroid disease, hypo- or

hyperthyroidism. It presents with well-defined patches of alopecia without scale or erythema. Seborrheic

dermatitis may result in temporary hair thinning, but does not result in coin-shaped patches of alopecia.

Tinea capitis presents with itchy scale on the scalp and possibly temporary poorly defined alopecia.

Congestive heart failure and chronic kidney disease are not associated with alopecia areata.


Follicular atrophoderma is a feature of which of the following conditions?

1 Bazex syndrome

2 Menkes kinky hair syndrome

3 Papular atrichia

4 Tricho-dento-osseous syndrome

5 Tricho-rhino-phalangeal syndrome


Follicular atrophoderma is a feature of which of the following conditions?

1 Bazex syndrome

Bazex syndrome is characterized by follicular atrophoderma, hypotrichosis, hypohidrosis, and mutiple

basal cell carcinomas of face.


A patient has hyperkeratotic tissue on the lateral and proximal nails folds. What is the diagnosis?

1 Onychophosis

2 Onychomadesis

3 Hapalonychia

4 Onychocryptosis

5 OnychophagiaQ/Q(M)-482369 Report a Problem


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A patient has hyperkeratotic tissue on the lateral and proximal nails folds. What is the diagnosis?

1 Onychophosis

Onychophosis describes hyperkeratosis tissue on the lateral and proximal nails folds. Onychomadesis is

shedding of the nail starting at the proximal end. Hapalonychia refers to soft, bendable nails.

Onychocryptosis refers to an ingrown toenails. Onychophagia means nail biting.


A 44-year-old man undergoing chemotherapy for Hodgkins lymphoma presents with horizontal roughbands involving the nail plates of all digits. What is the most likely disorder:

1 Beaus lines

2 Mees lines

3 Muehrckes lines

4 Onychophagia

5 Dolichonychia


A 44-year-old man undergoing chemotherapy for Hodgkins lymphoma presents with horizontal roughbands involving the nail plates of all digits. What is the most likely disorder:

1 Beaus lines

Beaus lines are transverse indented nail plate furrows caused by temporary growth arrest of the nailmatrix, often due to chemotherapy or other stressful events and illnesses. Mees lines are transversewhite lines affecting all nails and growing out with the nail; there is no associated indentation. Meeslines may be caused by arsenic poisoning, rheumatic fever, or other systemic diseases. Muehrckes linesdisappear with squeezing of the nail and are due to disorders of low albumin. Oncyhophagia refers to nail

biting. Dolichonychia exhibits long, slender nails, and is associated with Ehlers-Danlos and Marfans.


Which part of the nail complex results in nail pits?

1 Proximal nail fold


3 Dorsal nail matrix

4 Nail plate

5 Nail bed


Which part of the nail complex results in nail pits?



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What determines the thickness of the nail plate?

1 Hyponychium

2 Nail matrix

3 Nail bed

4 Proximal nail fold5 Nail plate


What determines the thickness of the nail plate?

2 Nail matrix

The nail matrix determines the thickness of the nail plate.


Which is the most effective for the treatment of onychomycosis?

1 Oral terbinafine

2 Terbinafine cream

3 Econazole cream

4 Clobetasol ointment

5 Oral ketoconazole


Which is the most effective for the treatment of onychomycosis?

1 Oral terbinafine

Terbinafine, a squalene epoxidase inhibitor, is the treatment of choice for onychomycosis. The treatment

is with 250 mg by mouth daily for 12 weeks for toenails and 6 weeks for fingernails. Other treatment

options include oral itraconazole. Topicals such as terbinafine cream and econazole cream are good

choices for tinea pedis, but are not successful in treating onychomycosis. Topical corticosteroids such as

clobetasol ointment are not effective in treating fungal infections. Oral ketoconazole is ineffective for

onychomycosis.


A significantly increased number of "club hairs" on a pull test is indicative of:

1 Anagen effluvium

2 Telogen effluvium

3 Normal hair anatomy

4 Alopecia areata

5 Angrogenetic alopecia



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A significantly increased number of "club hairs" on a pull test is indicative of:

2 Telogen effluvium

Telogen hairs are characteristically club shaped. An increased number of telogen hairs on hair pull would

be suggestive of telogen effluvium. Anagen hairs have a curled appearance at the root. While a small

number of telogen hairs are normal, a significantly increased number would not be normal hair anatomy.


Terry's nails are seen in which of the following conditions?

1 Renal failure

2 Pulmonary fibrosis

3 Diabetes

4 Bladder carcinoma

5 Aerodigestive carcinoma


Terry's nails are seen in which of the following conditions?

3 Diabetes

Terry's nails are described as all but the distal 2mm of each nail evenly white due to a defect in the nail

bed. It can be seen in cirrhosis, congenital heart failure and diabetes.


Triangular lunulae are:

1 Part of the syndrome caused by a LMX1b mutation

2 Associated with hyperplastic patellae

3 Associated with a renal cell carcinoma

4 Associated with a mutation of ATP2C1

5 Associated with a mutation of SERCA2


Triangular lunulae are:

1 Part of the syndrome caused by a LMX1b mutation

Triangular lunulae are part of the Nail-Patella syndrome. Findings in this syndrome include LMX1b

mutation, hypoplastic or absent patellae, nephropathy, a "Lester Iris" - hyperpigmentation of the pupillary

margin, cataracts, heterochromia irides and glaucoma. ATP2C1 and SERCA2 are associated with Hailey-Hailey and Darier-White disease respectively.



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A child presents with sparse, fine hair, thin nails and loose skin in infancy. He has a pear-shaped, broad

nose and on X-ray has cone-shaped epiphyses. Which of the following genes is mutated in this syndrome?

1 P63

2 DLX3

3 RMRP

4 TRPS1

5 ABCC6


A child presents with sparse, fine hair, thin nails and loose skin in infancy. He has a pear-shaped, broad

nose and on X-ray has cone-shaped epiphyses. Which of the following genes is mutated in this syndrome?

4 TRPS1

TRPS1 is the gene mutated in Tricho-rhino-phalangeal syndrome. TRPS1 is a putative zinc fingertranscription factor that is passed in an autosomal dominant fashion. P63 is mutated in Hay-Wells

syndrome and Ectrodactyly-ectodermal dysplasia-clefting (EEC) dyndrome. DLX3 (distal-less homeobox-

3) gene is associated with Trichodentoosseous syndrome. RMRP (RNA component of RNase MRP) is

defective in Cartilage-Hair hypoplasia syndrome. ABCC6 is defective in pseudoxanthoma elasticum.


Fraying of the cuticles is a sign of which of the following conditions?

1 Dermatomyositis

2 Systemic sclerosis

3 Lupus erythematosus

4 Hypothyroidism

5 Lead poisoning


Fraying of the cuticles is a sign of which of the following conditions?

1 Dermatomyositis

Dermatomyositis can be associated with fraying of the cuticles (Samitz sign).


Which of the following is the predominant dermatoscopic finding seen in alopecia areata?

1 Diffuse white knots and a brush-pattern

2 Perifollicular arborizing vessels

3 Yellow dots


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4 Reduction of follicular ostia

5 Small oval nodes


Which of the following is the predominant dermatoscopic finding seen in alopecia areata?

3 Yellow dots

Dermatoscopic findings of alopecia areata include yellow dots, dystrophic hair shafts features, and

hypopigmented vellus hairs. Diffuse white knots and a brush pattern is seen in trichorrhexis nodosa. In

lichen planopilaris, a reduction to absence of follicular ostia, perifollicular scale and arborizing vessels,

pigmented networks, and white to blue-gray dots can be observed. Small oval nodes are seen in

monilethrix.


Splinter hemorrhage of the nail can be seen with which of the following parasitic infections?

1 Scabies

2 Trichinosis

3 Sparganosis

4 Dracunculiasis

5 Gnathostomiasis


Splinter hemorrhage of the nail can be seen with which of the following parasitic infections?

2 Trichinosis

Trichinosis can cause splinter hemorrhage of the nails.


The hair finding characterized by an invagination of the distal hair shaft into the cup formed by the

proximal hair shaft is:

1 Trichoschisis

2 Pili torti

3 Pili triangulati

4 Trichorrhexis nodosa

5 Trichorrhexis invaginata


The hair finding characterized by an invagination of the distal hair shaft into the cup formed by the

proximal hair shaft is:



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The above description is that of trichorrhexis invaginata, which is characteristic of Netherton syndrome.

Other findings include: ichthyosis linearis circumflexa and atopy. It is caused by the mutation of the serine

protease inhibitor, SPINK5.


Which of the following syndromes does NOT have the finding shown in the image as part of the

spectrum?

1 Crandall


3 Citrullinemia

4 Menke's Kinky Hair

5 Netherton


Which of the following syndromes does NOT have the finding shown in the image as part of the

spectrum?

1 Crandall

Crandall syndrome has pili torti as its hair finding. The other options all have trichorrhexis nodosa as one

of the hair findings in the syndrome. Trichorrhexis nodosa is the fraying of hair ends so that the resemble

a "broom-stick" or "paint brush".


A 7-year old girl presents to clinic with onychomadesis afflicting all nails. Her mother reports that she has

been healthy other than a self-limited illness two months prior. What is the most likely causative etiology:

1 Rheumatic fever

2 Kawasaki disease

3 Systemic T cell lymphoma

4 Yellow nail syndrome

5 Hand, Foot, and Mouth Disease



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A 7-year old girl presents to clinic with onychomadesis afflicting all nails. Her mother reports that she has

been healthy other than a self-limited illness two months prior. What is the most likely causative etiology:

5 Hand, Foot, and Mouth Disease

Coxsackievirus, the virus most associated with hand, foot, and mouth disease, is a well-known cause of

onychomadesis in children. Rheumatic fever has been associated with Mees lines of the nail. Yellownail syndrome is associated with yellow nail plates, edema, and lung disease. The other answer choices arenot commonly associated with nail disease.


Which of the following nutritional deficiencies is associated with perifollicular hemorrhage?

1 Vitamin C

2 Niacin

3 Vitamin B124 Folate

5 Zinc


Which of the following nutritional deficiencies is associated with perifollicular hemorrhage?

1 Vitamin C

Vitamin C deficiency, or scurvy, may lead to perifollicular hemorrhage. Niacin deficiency may result in a

photo-distributed eruption, diarrhea, and psychiatric symptoms (diarrhea, dermatitis, and dementia).

Vitamin B12 may lead to glossitis with a shiny, painful tongue. Zinc deficiency may result in aperiorificial dermatitis.


A 24-year-old man with Lesch-Nyhan syndrome is most likely to present with what nail disorder:

1 Beaus lines

2 Mees lines

3 Muehrckes lines

4 Onychophagia

5 Dolichonychia


A 24-year-old man with Lesch-Nyhan syndrome is most likely to present with what nail disorder:

4 Onychophagia

Oncyhophagia refers to nail biting. Patients with Lesch-Nyhan syndrome, caused by defective HGPRTenzyme, are prone to self-mutilating behaviors, including onychophagia. Beaus lines are transverseindented nail plate furrows caused by temporary growth arrest of the nail matrix, often due to


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chemotherapy or other stressful events and illnesses. Mees lines are transverse white lines affecting allnails and growing out with the nail; there is no associated indentation. Mees lines may be caused byarsenic poisoning, rheumatic fever, or other systemic diseases. Muehrckes lines disappear withsqueezing of the nail and are due to disorders of low albumin. Dolichonychia exhibits long, slender nails,

and is associated with Ehlers-Danlos and Marfans.


Distal subungual onycholysis associated with paronychia is due to:

1 Candida spp

2 Fusarium spp





Distal subungual onycholysis associated with paronychia is due to:


This mold is the only one responsible for paronychia in DLSO and is more often observed in finger than in

toenails.


Which of the following are findings associated with Nail-Patella Syndrome?

1 Glomerulonephritis

2 Alopecia

3 Bladder diverticuli

4 Photosensitivity

5 Hip dysplasia


Which of the following are findings associated with Nail-Patella Syndrome?

1 Glomerulonephritis

Nail patella syndrome is a rare, AD syndrome associated with nail hypoplasia, absent or hypoplastic

patella, posterior iliac horns, glaucoma, hyperpigmentation of the pupillary margin or Lester iris, and

glomerulonephritis and nephrotic syndrome. Glomerulonephritis and renal failure are features seen in nail

patella syndrome. This syndrome is also known as HOOD syndrome or hereditary osteoonychodysplasia.



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Which of the following is NOT a cause of red lunulae?

1 Endocarditis

2 Psoriasis

3 Carbon monoxide poisoning

4 Imuran



Which of the following is NOT a cause of red lunulae?

1 Endocarditis

Endocarditis is not a cause of red lunulae. Alopecia areata, psoriasis, prednisone for connective tissue

diseases, carbon monoxide poisoning, cardiac failure, SLE, RA, COPD, CO2, cirrhosis, imuran and

radiation are the causes of this condition.


Which of the following conditions with hair abnormalities is caused by mutations in a DNA helicases?

1 Anhidrotic Ectodermal Dysplasia

2 Hidrotic Ectodermal Dysplasia

3 KID Syndrome

4 Rothmund-Thomson Syndrome

5 Incontinentia Pigmenti


Which of the following conditions with hair abnormalities is caused by mutations in a DNA helicases?

4 Rothmund-Thomson Syndrome

Rothmund-Thopmson syndrome is casued by mutations in RecQL4. Key clinical features include

poikiloderma, photosensitivity, dystrophic nails, hypoplastic thumbs, cataracts, and reports of

osteosarcoma. Anhidrotic ectodermal dysplasia is associated with mutations in ectodysplasin. Hidrotic

ectodermal dysplasia is associated with mutations in connexin 30. Kid syndrome is associated with

mutations in connexin 26 and IP with NEMO.


A 16-year-old woman presents with hair breakage. Examination of a single shaft reveals division into two

shafts at the distal-most portion of the hair. What is the most likely diagnosis:

1 Pili multigemini

2 Pili bifurcati

3 Trichoptilosis

4 Trichoschisis


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A 16-year-old woman presents with hair breakage. Examination of a single shaft reveals division into two

shafts at the distal-most portion of the hair. What is the most likely diagnosis:

3 TrichoptilosisPili multigemini refers to a rare disorder of multiple divided hair matrices, with multiple hair shafts each

with their own cuticle all arising from one follicle. Pili bifucarti exhibits hair shaft bifurcation into short

segments along hair shafts, with each segment covered with its own cuticle. Trichoptilosis refers tosplit endsof the distal portion of the hair shaft. Trichoschisis is a clean fracture of the hair shaft.Trichothiodystrophy is a disorder of beaded hair when viewed with polarizing light.


Which part of the hair follicle is the first to cornify?1 Huxleys layer of inner root sheath

2 Henleys layer of inner root sheath

3 Outer root sheath

4 Medulla

5 Cuticle


Which part of the hair follicle is the first to cornify?

2 Henleys layer of inner root sheath

Henleys layer of inner root sheath. Henleys layer is the outer layer of the inner root sheath. The innerroot sheath is keratinized with trichohyaline granules and is shed with the growing hair shaft at the level of

the isthmus


A defect in which part of the nail cause a true leukonychia?1 Cuticle

2 Hyponychium

3 Lunula

4 Nail bed

5 Nail plate


A defect in which part of the nail cause a true leukonychia?

5 Nail plate


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True leukonychia is caused by an acute stress to the nail and manifests in the nail plate. Examples include

Terry's nails and Mee's lines. Apparent leukonychia, on the other hand, are a result of problems in the nail

bed and are indicative of overall health compromise. Examples of apparent leukonychia include Lindsay's

and Muehrcke's nail.


Ventral pterygium pictured below is characteristically associated with what disorder?

1 Lichen planus


3 Cicatricial pemphigoid

4 SJS/TEN

5 Chronic GVHD


Ventral pterygium pictured below is characteristically associated with what disorder?


Ventral pterygium is most characteristically associated with systemic sclerosis. All other choices are

associated with dorsal pterygium.


A patient presents with 20 nails with absent cuticles and lunulae, slow growth, dystrophic shape and ayellow hue. Which of the following findings is/are associated?

1 Upper extremity edema

2 Cirrhosis

3 Pleural effusions

4 Chest pain

5 Pulmonary fibrosis



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A patient presents with 20 nails with absent cuticles and lunulae, slow growth, dystrophic shape and a

yellow hue. Which of the following findings is/are associated?

3 Pleural effusions

Yellow Nail syndrome has been associated with lower extremity edema, bronchiectasis and pleural

effusions. The other listed findings are not part of Yellow Nail syndrome.


Papular atrichia is caused by mutations in which gene?

1 Wingless

2 Patched

3 Hairless

4 Fox forehead

5 Distal-less homebobox


Papular atrichia is caused by mutations in which gene?

3 Hairless

Hairless gene mutations cause papular atrichia.


A 66-year-old woman presents withblack headson the nose. Examination reveals multiple smallhairs protruding from the same follicle. What is the most likely associated diagnosis:

1 Pili multigemini

2 Pili bifurcati

3 Trichostasis spinulosa

4 Trichoschisis



A 66-year-old woman presents withblack headson the nose. Examination reveals multiple smallhairs protruding from the same follicle. What is the most likely associated diagnosis:

3 Trichostasis spinulosa


with their own cuticle all arising from one follicle. Pili bifucarti exhibits hair shaft bifurcation into short

segments along hair shafts, with each segment covered with its own cuticle. Trichostasis spinulosarefers to follicles filled with bundles of vellus hairs. This disorder may be associated with renal failure.

Trichoschisis is a clean fracture of the hair shaft. Trichothiodystrophy is a disorder of beaded hair whenviewed with polarizing light.



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A 34-year-old man undergoing chemotherapy for acute myelogenous leukemia presents with smooth

white horizontal bands involving the nail plates of all digits. What is the most likely disorder:

1 Beaus lines

2 Mees lines

3 Muehrckes lines

4 Onychophagia

5 Dolichonychia


A 34-year-old man undergoing chemotherapy for acute myelogenous leukemia presents with smooth

white horizontal bands involving the nail plates of all digits. What is the most likely disorder:

2 Mees lines

Beaus lines are transverse indented nail plate furrows caused by temporary growth arrest of the nailmatrix, often due to chemotherapy or other stressful events and illnesses. Mees lines are transversewhite lines affecting all nails and growing out with the nail; there is no associated indentation. Meeslines may be caused by chemotherapy, arsenic poisoning, rheumatic fever, or other systemic diseases.

Muehrckes lines disappear with squeezing of the nail and are due to disorders of low albumin.Oncyhophagia refers to nail biting. Dolichonychia exhibits long, slender nails, and is associated with

Ehlers-Danlos and Marfans.


Chronic paronychia is most commonly caused by which of the following organisms?

1 Candida albicans

2 Candida tropicalis

3 Pseudomonas aeruginosa




Chronic paronychia is most commonly caused by which of the following organisms?

1 Candida albicans

Candida albicans is the most common pathogen associated with chronic paronychia.


Which part of the matrix gives rise to the dorsal nail plate?

1 Distal matrix2 Proximal matrix

3 Ventral matrix


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4 Dorsal matrix

5 Lateral matrix


Which part of the matrix gives rise to the dorsal nail plate?

2 Proximal matrix

The proximal matrix gives rise to the dorsal nail plate, while the distal matrix gives rise to the ventral nail

plate.


Regarding androgens in women, which of the following statements is NOT correct?

1 Testosterone binds the androgen receptor

2 Eyebrows, eyelashes and vellus hairs are androgen-dependent

3The hair follicle requires conversion of testosterone to dihydrotestosterone for expression of

androgen action

4 Dihydrotestosterone binds the androgen receptor

5 There are no differences in eyelashes, eyebrows and vellus hair-bearing areas in men and women


Regarding androgens in women, which of the following statements is NOT correct?

2 Eyebrows, eyelashes and vellus hairs are androgen-dependent

Only testosterone and dihydrotestosterone bind the androgen receptor, Eyebrows, eyelashes and vellus

hairs are NOT androgen-dependent, thus there are no differences between these areas in men and women,

and the hair follicle requires conversion of testosterone to dihydrotestosterone for expression of androgen

action.


Yellow nails can be seen in each of the following syndromes except:

1 Bronchiectasis

2 Hyperlipidemia

3 Tobacco use

4 Thyroid disease

5 Penicillamine


Yellow nails can be seen in each of the following syndromes except:

2 Hyperlipidemia

Yellow discoloration of the nail plate can be associated with bronchiectasis or underlying pulmonary


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disease such as COPD. Other associated conditions include lymphedema, rheumatoid arthritis, thyroid

disease, malignancies, penicillamine, and chronic sinusitis or bronchitis. Hyperlipidemia is not associated

with nail changes.


Fungal finger onycholysis usually results from:


2 Trichophyton interdigitale

3 Candida albicans


5 Fusarium spp


Fungal finger onycholysis usually results from:

3 Candida albicans

It is widely accepted that C. albicans acts as colonizer that has found an ideal environment.


How long do hairs stay in telogen before they are released?

1 3-4 weeks

2 3-4 months

3 3-4 years

4 3-4 days

5 3-4 hours


How long do hairs stay in telogen before they are released?

2 3-4 months

Hairs remain in telogen phase for 3-4 months before they are released. The length of anagen phase varies

for hairs of different parts of the body and determines the ultimate length of the hair. Scalp hair may

remain in anagen for 3-5 years. The duration of catagen phase is typically 3-4 weeks.


Arsenical poisoning is associated with what nail finding?

1 Muehrcke's lines

2 Mee's lines

3 Hapalonychia


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4 Onycholysis

5 Oil spots


Arsenical poisoning is associated with what nail finding?

2 Mee's lines

Arsenical poisoning is characteristically associated with Mee's lines.


Scalp biopsy of which of the following types of hair loss will reveal increased telogen hairs?


2 Discoid lupus erythematosis

3 Central centrifugal alopecia

4 Dissecting cellulitis

5 Androgenetic alopecia


Scalp biopsy of which of the following types of hair loss will reveal increased telogen hairs?

5 Androgenetic alopecia

Androgenetic alopecia, telogen effluvium, and alopecia areata all have an increased fraction of telogen

hairs. Lichen planopilaris and discoid lupus typically reveal a chronic inflammatory alopecia on biopsy.

Dissecting cellulitis typically exhibits chronic inflammation with hypertrophic scar tissue intervening

between suppurative follicles.


Yellow nail syndrome is associated with which of the following?

1 Multiple myeloma

2 Panhypopituitarism

3 Diabetes mellitus

4 Dermatophyte infection

5 Lymphedema and bronchiectasis


Yellow nail syndrome is associated with which of the following?

5 Lymphedema and bronchiectasis

Lymphedema and bronchiectasis are associated with yellow nail syndrome.


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Pili Annulati is associated with which of the following syndromes?

1 Netherton

2 PIBIDS

3 Citrullinemia


5 Alopecia areata


Pili Annulati is associated with which of the following syndromes?

5 Alopecia areata

Pili Annulati is the alternating light and dark bands secondary to air-spaces seen in normal light and hasbeen associated with Alopecia areata. The "tiger-tail" pattern seen in trichothiodystrophy (PIBIDS) is only

seen with polarized light. Netherton and Citrullinemia do not have this hair finding associated.


Blue lunulae are associated with each of the following except:

1 Argyria

2 Cardiac failure

3 Quinacrine

4 Wilsons disease

5 Phenolphthalein


Blue lunulae are associated with each of the following except:

2 Cardiac failure

Blue lunulae have been reported in association with argyria, Wilsons disease, hereditary acrolabialtelangectasia, paronychia, phenolphthalein, quinacrine, topical bichloride, and mercury exposure.


Signs of virilization include all of the following EXCEPT:

1 Centripetal obesity

2 Temporal balding

3 Clitoromegaly4 Increased muscle mass in the limb girdles

5 Acne


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Signs of virilization include all of the following EXCEPT:

1 Centripetal obesity

Centripetal obesity is a sign of cortisol excess not of virilization. In addition to the those listed above,

irregular or absent menses and deepening of the voice are signs of virilization.Q/Q(M)-478085 Report a Problem

The best diagnosis for this scarring form of alopecia is

1 Chronic cutaneous lupus erythrematosus


3 Peseudopelade of Broq

4 Perifolliculitis capitis abscedens et suffodiens

5 Central centrifugal cicatricial alopecia


The best diagnosis for this scarring form of alopecia is

4 Perifolliculitis capitis abscedens et suffodiens

Perifolliculitis capitis abscedens et suffodiens is also known as dissecting cellulitis of scalp is uncommon

chronic suppurative disorder that most often affects young black men. Together with acne conglobata,

hidradenitis suppurativa and pilonidal cysts, it is a component of the 'follicular occlusion tetrad'. Patients

present with multiple painful inflammatory nodules and fluctuant abscesses of the scalp, which are often

interconnected via sinus tracts. The vertex and occiput are the sites of predilection. As the diseaseprogresses, scarring alopecia may develop. All other choices can cause scarring alopecia but with different

clinical picture.


A 68-year old man presents with double white transverse lines on all nails that disappear with

compression of the nail plate. What is the most likely associated systemic disease:

1 Ehlers-Danlos Syndrome

2 Arsenic poisoning

3 Rheumatic Fever

4 Neurofibromatosis


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5 Nephrotic Syndrome


A 68-year old man presents with double white transverse lines on all nails that disappear with

compression of the nail plate. What is the most likely associated systemic disease:

5 Nephrotic SyndromeMuehrckes lines are white transverse lines from an abnormal vascular bed. They disappear with

pressure on the nail plate. Muehrckes lines are associated with disorders causing low albumin, such asnephrotic syndrome, liver disease, and malnutrition.


Transverse white bands on one or two nails is caused by:

1 Trauma to the matrix

2 Alopecia areata

3 Psoriasis

4 Systemic lupus erythematosis

5 Lichen planus


Transverse white bands on one or two nails is caused by:

1 Trauma to the matrix

Longitudinal leukonychia or transverse white bands are caused by trauma to the nail matrix. AA,

psoriasis, SLE and LP all cause spotted red lunulae, not transverse white bands.


A patient with curly hair that straightened after puberty, enamel hypoplasia, dental pits, and increased

bone density likely has a mutation in which of the following genes?

1 Distal-less homeobox-3 gene (DLX3)

2 Vascular-endothelial growth factor receptor 3

3 Bone morphogenetic protein type 2

4 SLURP 1

5 SPINK 5


A patient with curly hair that straightened after puberty, enamel hypoplasia, dental pits, and increasedbone density likely has a mutation in which of the following genes?

1 Distal-less homeobox-3 gene (DLX3)


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Distal-less homeobox-3 gene (DLX3) mutations cause trichodentoosseous syndrome, which is

characterized by curly hair that straightens in the 2nd-3rd decades, enamel hypoplasia, dental pits, and

increased bone density.


A 24-year-old man reports that he has developed white patches of scalp hair that seem to migrate acrosshis scalp. Examination reveals three 1cm foci of poliosis with surrounding normally pigmented hair. He

has a history of hypothyroidism, but no other systemic diseases. What is the most likely etiology:

1 Form fruste of alopecia areata


3 Tinea capitis

4 Allezandrini syndrome



A 24-year-old man reports that he has developed white patches of scalp hair that seem to migrate across

his scalp. Examination reveals three 1cm foci of poliosis with surrounding normally pigmented hair. He

has a history of hypothyroidism, but no other systemic diseases. What is the most likely etiology:

1 Form fruste of alopecia areata

Forme fruste, or limited, alopecia areata, may present with migratory poliosis due to destruction of

follicular melanocytes but survival of the hair-producing bulb. Vogt-Koyanagi-Harada syndrome presents

as meningoencephalitis followed by visual and hearing deficits and poliosis of the periorbital region. The

other answer choices are not typically associated with migratory poliosis.


This hair disorder and mutations in ATP7A (MNK) gene are found in what genodermatosis?

1 Bjornstad syndrome

2 Menke's kinky hair syndrome

3 Crandall's syndrome

4 Bazex's follicular atrophoderma




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5 Thrombocytopenia

Familial alopecia areata has been associated with persistent thrombocytopenia. Alopecia areata has

recently been linked to the ULBP3 gene. Alopecia areata is associated with other autoimmune disorders

such as thyroid disease and vitiligo.


What condition most likely describes a hair defect with ruffled cuticle in 4-year old female with blond

hair?

1 Pili torti

2 Pili annulati

3 Wooly hair

4 Loose anagen hair syndrome

5 Monilethrix


What condition most likely describes a hair defect with ruffled cuticle in 4-year old female with blond

hair?

4 Loose anagen hair syndrome

Loose anagen hair syndrom occurs primarily in young, females with blond hair. The defect results in early

keratinization of the inner root sheath which leads to poor anchoring. Examination of hair shaft reveals

ruffled proximal cuticle.


A patient with diffuse hair loss developing after a thallium scan likely has which of the following

conditions?

1 Anagen effluvium

2 Catagen effluvium

3 Telogen effluvium

4 Loose anagen syndrome



A patient with diffuse hair loss developing after a thallium scan likely has which of the following

conditions?

1 Anagen effluvium

Anagen effluvium can result from infusions of thallium.



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Argininosuccinic aciduria is characteristically associated with this hair findingname the conditionpictured below:

1 Pili trianguli et canaliculi

2 Trichoschisis3 Monilethrix




Argininosuccinic aciduria is characteristically associated with this hair findingname the condition

pictured below:


Trichorrhexis nodosa is a finding in argininosuccinic aciduria.


A 36-year-old woman presents with arthralgias and three fingernails exhibiting adherence of the ventral

surface of the distal nail plate to the hyponychium. What is the most likely associated disease:

1 Psoriasis

2 Lichen Planus

3 Systemic Sclerosis

4 Yellow Nail Syndrome

5 Multicentric Reticulohistiocytosis


A 36-year-old woman presents with arthralgias and three fingernails exhibiting adherence of the ventral

surface of the distal nail plate to the hyponychium. What is the most likely associated disease:

3 Systemic Sclerosis

The most common cause of ventral pterygium is systemic sclerosis, which often first presents with


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arthralgias. Lichen planus is most commonly associated with dorsal, rather than ventral, pterygium.

Multicentric reticulohistiocytosis is associated with deforming arthritis andcoral beadnodules aroundthe proximal nail fold, but not with pterygium.


The common culprit of proximal white subungual onychomycosis is :

1 Candida albicans


3 Trichophyton interdigitale

4 Scydalidium dimidiatum

5 Fusarium spp


The common culprit of proximal white subungual onychomycosis is :


T. rubrum is responsible for more than 95% of these cases.


Highest graft survival in hair transplantation is achieved through the use of:

1 4-5 mm plugs

2 Minigrafts

3 Single hairs

4 Follicular units

5 Micrografts


Highest graft survival in hair transplantation is achieved through the use of:

4 Follicular unitsSeager et. al examined the survival rate of single hair grafts and compared them to follicular unit grafts in

a single patient. They found that there was a much higher survival rate in the follicular unit grafts. They

hypothesized that the extra tissue surrounding the follicular unit grafts protected them from crush injury.


Lindsay's nails (distal nail normal, proximal nail white) is characteristic of:


2 Plummer-Vinson syndrome

3 Hemochromatosis

4 Ectodermal dysplasia

8/11/2019 Hair and N

hair and nail disorders mcqs

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