Hair and Nail Disorders MCQs

1
Hair and Nail disorders

Which 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 is
no 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
2

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 plate
discoloration:
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 with
absence 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

Mees lines
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 condition
which 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 syndrome
3

Triangular lunulae are seen in what disorder?
4

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
4

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 syndrome
5


Which genodermatosis characterized by broad thumbs and this nail disorder pictured below?
5

Rubensteom-Taybi syndrome is characterized by broad thumbs and broad nails or brachyonychia. This
syndrome is characterized by mutations in CREB-binding protein.
5

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?
4

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
6

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 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
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
Spotted 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:
7

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 and
fluorescing 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:
4

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:
4

Trichophyton rubrum
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
8

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


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 anhidrotic
ectodermal 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 a red streak involving the nail plate of the first digit. You make the
diagnosis of longitudinal erythronychia. What is the most common underlying cause:
9

1

Melanoma
2

Myxoid cyst
3

Subungual keratoacanthoma
4

Carbon Monoxide toxicity
5

Onychopapilloma

A 73-year-old man presents with a red streak involving the nail plate of the first digit. You make the
diagnosis 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.
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 short
segments along hair shafts, with each segment covered with its own cuticle. Trichoptilosis refers to
split ends of 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
10

5


Pili trianguli et canaliculi is the characteristic hair fiding in which of the following disoders?
5

Pili trianguli et canaliculi, characterized by a triangular hair shaft with a central longitudinal groove, is the
finding 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
4

5

Waardenburg's syndrome

The combination of a low-set hairline and synophrys is seen in which of the following conditions?
4

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.

11

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 with
rheumatoid 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
2

3

4

Netherton syndrome
5

Naxos syndrome

Which of the following is caused by mutations in gap junction proteins?
2

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
12

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

Onychoschizia

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
2

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.

The "ragged cuticle" seen in dermatomyositis is also known as:
13

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.

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?
2

Lindsays nail is characteristically associated with chronic renal failure.

The defect associated with the hair finding shown in the image is:
14

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:
15

1

Pili multigemini
2

Pili bifurcati
3

Trichoptilosis
4

Trichoschisis
5

Trichothiodystrophy

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

Endonyx onychomycosis is due to:
1

Trichophyton rubrum
2

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
16

5

Distal matrix

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
Disease in the proximal matrix is responsible for producing pitting, onychorrhexis, and Beaus lines.
Changes in the intermediate matrix can cause leukonychia, and the distal matrix may be responsible for
focal onycholysis, thinned nail plate, and erythema of the lunula.

Muehrcke's nails are most often associated with:
1

Hyperthyroidism
2

Hypothyroidism
3

Hypoalbuminemia
4

Hyperalbuminemia
5

None of these answers are correct

Muehrcke's nails are most often associated with:
3

Hypoalbuminemia
Muehrcke's nails are most associated with hypoalbuminemia. They represent transverse double white lines
that are the abnormality of the vascular bed, probably a localized edematous state secondary to the
hypoalbuminemia.

A patient with wooly hair, diffuse palmoplantar keratoderma, and right ventricular arrhythmogenic
cardiomyopathy likely has a mutation in which of the following genes?
1

HHB6
2

Plakoglobin
3

Plakophilin
4

SPINK 5
5

SLURP 1

A patient with wooly hair, diffuse palmoplantar keratoderma, and right ventricular arrhythmogenic
cardiomyopathy likely has a mutation in which of the following genes?
2

Plakoglobin
Naxos syndrome is caused by mutations in the plakoglobin gene. Its clinical features include wooly hair,
17

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
5


Anonychia is not a feature of which of the following syndromes?
5

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
18

2

Lichen planopilaris
3

Central centrifugal cicatricial alopecia
4

Pseudopelade of Brocq
5

Alopecia mucinosa

Best diagnosis of this type of cicatricial alopecia shown in attached image is
3

Central centrifugal cicatricial alopecia is a new term adopted by the NAHRS consensus group to
encompass the terms hot comb alopecia, follicular degeneration syndrome, pseudopelade in African
Americans, and central elliptical pseudopelade in Caucasians.In general, it is a condition that presents with
flesh-colored, noninflammatory cicatricial alopecia of the central scalp that, over time, enlarges
centrifugally. Pseudopelade of Brocq can mimic alopecia areata, lichen planopilaris, and DLE. In addition,
central centrifugal cicatricial alopecia (CCCA), a noninflammatory condition of the central scalp that is
seen primarily in black women. CCCA usually presents as a symmetric patch, unlike the irregularly
bordered, typically atrophic plaques seen in classic pseudopelade of Brocq

A 64-year-old man admitted for an exacerbation of his severe congestive heart failure exhibits blanchable
white horizontal lines beneath 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 64-year-old man admitted for an exacerbation of his severe congestive heart failure exhibits blanchable
white horizontal lines beneath the nail plates of all digits. What is the most likely disorder:
3

Muehrckes lines
Beaus lines are transverse indented nail plate furrows caused by temporary growth arrest of the nail
matrix, often due to chemotherapy or other stressful events and illnesses. Mees lines are transverse
white lines affecting all nails and growing out with the nail; there is no associated indentation. Mees
19

lines may be caused by 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.

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
20

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
21

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
5


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 distal
portion. 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
22

3

Focal Dermal Hypoplasia
4

Rothmund-Thomson Syndrome
5

Bloch-Sulzberger Syndrome

A woman with hypopigmented in lines of Blaschko and scarring alopecia likely suffers which of the
following conditions?
5

Bloch-Sulzberger Syndrome
Bloch-Sulzberger Syndrome (incontinentia pigmenti).

This characteristic nail finding is seen in what disorder?
1

Lichen planus
2

3

Darier's disease
4

COIF syndrome
5


This characteristic nail finding is seen in what disorder?
3

Darier's disease
Alternating red and white longitudinal bands on the nail are characteristic of Dariers disease. Other nail
findings include subungual hyperkeratosis and distal v-shaped nicking.

What nutritional deficiency can lead to this nail finding?
23

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 the one hand-two-foot syndrome?
1

Trichophyton rubrum
2

Trichophyton mentagrophytes ( var. Interdigitale)
3

Candida albicans
4

5

Scopulariopsis brevicaulis

What is the common cause of the one hand-two-foot syndrome?
1

Trichophyton rubrum
This condition is due to T. rubrum in 90% of the cases , T. interdigitale and Scytalidium dimidiatum share
the 10% left.

24

The most common cultured agent in chronic paronychia associated with a black hue of the lateral edge of
the nail plate is:
1

Trichophyton rubrum
2

gram-negative bacteria
3

Candida spp
4

5


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 a
topical 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

Psoriasis
4

Vasculitis
5

25


A commonly known cause of splinter hemorrhages in the nail is endocarditis. Which of the following
would be unlikely to cause splinter hemorrhages?
5

Rheumatoid arthritis is not a cause of splinter hemorrhages of the nail. Endocarditis is the most commonly
thought 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 at
the ventral nail plate.
26

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:
3

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
27

3

Pseudomonas aeruginosa
4

Staphylococcus aureus
5

Trichophyton rubrum

Acute paronychia is most commonly caused by which of the following organisms?
4

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
4

5

Waardenburg's syndrome

Thin hair with premature graying is characteristic of which of the following syndromes?
1

Werner syndrome
Werner 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
3

Lichen planopilaris
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
28

curling and darkening of hair in the frontal and temporal regions of the scalp, followed by androgenetic
alopecia. Secondary syphilis may present as a non-scarring alopecia, typically in a diffuse pattern.

Ferritin levels need to be, at minimum, above which of the serum levels to treat iron-deficiency related
telogen effluvium?
1

20ng/dL
2

40ng/dL
3

60ng/dL
4

30ng/dL
5

10ng/dL

Ferritin levels need to be, at minimum, above which of the serum levels to treat iron-deficiency related
telogen effluvium?
2

40ng/dL
The therapeutic target for iron deficiency related telogen effluvium is greater than 40mg/dL. Other causes
of telogen effluvium include thyroid dysfunction, as well as such medications as beta-blockers,
antihyperlipidemic drugs, and NSAIDs.

A patient with yellow nail syndrome should be evaluated for systemic disease involving which organ
system?
1

Hepatic
2

Renal
3

Pulmonary
4

Cardiovascular
5

Hematologic

A patient with yellow nail syndrome should be evaluated for systemic disease involving which organ
system?
3

Pulmonary
Yellow nail syndrome is characterized by slowly growing, yellow nails that are excessively curved. The
lunulae and cuticles are absent. It has been associated with a array of pulmonary diseases including
tuberculosis, asthma, pleural effusion, bronchiectasis, sinusitis, bronchitis, and COPD.

Black nail is caused by:
1

29

2

Proteus mirabilis
3

Pseudomonas spp.
4

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
3

Trichophyton rubrum
4

5


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
30

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:
1

Trichophyton rubrum
2

3

Epidermophyton floccosum
4

Fusarium oxysporum
5

Scopulariopsis brevicalis

The most common cause for superficial type onychomycosis is:
2

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
31

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

Onychophagia
32

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 rough
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 44-year-old man undergoing chemotherapy for Hodgkins lymphoma presents with horizontal rough
bands involving the nail plates of all digits. What is the most likely disorder:
1

Beaus lines
lines may be caused by 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.

Which part of the nail complex results in nail pits?
1

Proximal nail fold
2

3

Dorsal nail matrix
4

Nail plate
5

Nail bed

Which part of the nail complex results in nail pits?
2

33

Pitting of the nails are punctate depressions that migrate distally and result from defect in the proximal
nail matrix. It may be seen in conditions such as psoriasis, eczema and alopecia areata.

A 24 year-old woman presents with the complaint of hirsutism and asks about therapy. She has a
virilization pattern of hair growth. On questioning, she relates having irregular menstrual periods and
acne. Which of the following is the most likely diagnosis?
1

Pheochromocytoma
2

Polycystic ovarian disease
3

Congenital adrenal hyperplasia
4

Ovarian carcinoma
5

Normal variant

A 24 year-old woman presents with the complaint of hirsutism and asks about therapy. She has a
virilization pattern of hair growth. On questioning, she relates having irregular menstrual periods and
acne. Which of the following is the most likely diagnosis?
2

Polycystic ovarian disease
This patients diagnosis is most reasonably Polycystic Ovarian disease and includes the features listed
above in the question in addition to enlarged cystic ovaries, obesity and amenorrhea. Congenital adrenal
hyperplasia can present with hirsutism and menstrual abnormalities, but usually not obesity. Ovarian
carcinoma, pheochromocytoma and normal variant are not likely causes of this presentation.

A patient with sparse hair, a pear-shaped broad nose and cone-shaped epiphyses likely suffers which of
the following conditions?
1

Focal Dermal Hypoplasia (Goltz syndrome)
2

3

Hay-Wells Syndrome
4

Ectrodactyly-Ectodermal dysplasia-Clefting (EEC)
5

Trichodentoosseous Syndrome

A patient with sparse hair, a pear-shaped broad nose and cone-shaped epiphyses likely suffers which of
the following conditions?
2

Tricho-rhino-phalangeal Syndrome is characterized by sparse hair, a pear-shaped broad nose and cone-
shaped epiphyses.

34

What determines the thickness of the nail plate?
1

Hyponychium
2

Nail matrix
3

Nail bed
4

Proximal nail fold
5

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
35

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.
36

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 finger
transcription 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
37

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:
5

38

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
2

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
39

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. Yellow
nail syndrome is associated with yellow nail plates, edema, and lung disease. The other answer choices are
not commonly associated with nail disease.

Which of the following nutritional deficiencies is associated with perifollicular hemorrhage?
1

Vitamin C
2

Niacin
3

Vitamin B12
4

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 a
periorificial 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 HGPRT
enzyme, are prone to self-mutilating behaviors, including onychophagia. Beaus lines are transverse
indented nail plate furrows caused by temporary growth arrest of the nail matrix, often due to
40

chemotherapy or other stressful events and illnesses. Mees lines are transverse white lines affecting all
nails and growing out with the nail; there is no associated indentation. Mees lines may be caused by
arsenic poisoning, rheumatic fever, or other systemic diseases. Muehrckes lines disappear with
squeezing 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
3

4

Trichophyton rubrum
5


Distal subungual onycholysis associated with paronychia is due to:
3

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.

41

Which of the following is NOT a cause of red lunulae?
1

Endocarditis
2

Psoriasis
3

Carbon monoxide poisoning
4

Imuran
5


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

5

Incontinentia Pigmenti

Which of the following conditions with hair abnormalities is caused by mutations in a DNA helicases?
4

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
42

5

Trichothiodystrophy

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

Trichoptilosis

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 inner
root 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
43

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
2

Systemic sclerosis
3

Cicatricial pemphigoid
4

SJS/TEN
5

Chronic GVHD

Ventral pterygium pictured below is characteristically associated with what disorder?
2

Systemic sclerosis
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 a
yellow hue. Which of the following findings is/are associated?
1

Upper extremity edema
2

Cirrhosis
3

Pleural effusions
4

Chest pain
5

Pulmonary fibrosis

44

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 with black heads on the nose. Examination reveals multiple small
hairs protruding from the same follicle. What is the most likely associated diagnosis:
1

Pili multigemini
2

Pili bifurcati
3

Trichostasis spinulosa
4

Trichoschisis
5

Trichothiodystrophy

A 66-year-old woman presents with black heads on the nose. Examination reveals multiple small
hairs protruding from the same follicle. What is the most likely associated diagnosis:
3

Trichostasis spinulosa
segments along hair shafts, with each segment covered with its own cuticle. Trichostasis spinulosa
refers 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 when
viewed with polarizing light.
45

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
lines 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
4

5

Trichophyton rubrum

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 matrix
2

Proximal matrix
3

Ventral matrix
46

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
3

The 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
47

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:
1

Trichophyton rubrum
2

Trichophyton interdigitale
3

Candida albicans
4

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
48

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?
1

Lichen planopilaris
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.
49


Pili Annulati is associated with which of the following syndromes?
1

Netherton
2

PIBIDS
3

Citrullinemia
4

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 has
been 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 acrolabial
telangectasia, paronychia, phenolphthalein, quinacrine, topical bichloride, and mercury exposure.

Signs of virilization include all of the following EXCEPT:
1

Centripetal obesity
2

Temporal balding
3

Clitoromegaly
4

Increased muscle mass in the limb girdles
5

Acne
50


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.

The best diagnosis for this scarring form of alopecia is
1

Chronic cutaneous lupus erythrematosus
2

Lichen planopilaris
3

Peseudopelade of Broq
4

Perifolliculitis capitis abscedens et suffodiens
5


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 disease
progresses, 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
51

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 Syndrome
Muehrckes 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 as
nephrotic 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 increased
bone density likely has a mutation in which of the following genes?
1

Distal-less homeobox-3 gene (DLX3)
52

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 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
2

3

Tinea capitis
4

Allezandrini syndrome
5

Lichen planopilaris

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
5

Trichothiodystrophy
53

This hair disorder and mutations in ATP7A (MNK) gene are found in what genodermatosis?
2

Menke's kinky hair syndrome
Menke's kinky hair syndrome is characterized by pili torti and mutations in APT7A (MNK) gene.
Bjornstad syndrome, Crandalls syndrome and Bazexs follicular atrophoderma are associated with pili
torti but are not associated with this mutation.

Atrophy of the isthmus is a characteristic histologic finding of which of the following conditions?
1

Discoid lupus erythematosus
2

Lichen planopilaris
3

Parry-Romberg syndrome
4

Folliculitis Decalvans
5

Acne Keloidalis Nuchae

Atrophy of the isthmus is a characteristic histologic finding of which of the following conditions?
2

Lichen planopilaris
Lichen planopilaris is characterized by perifollicular lymphocytic infiltration with atrophy of the isthmus.

Familial alopecia areata is commonly associated with what laboratory abnormality?
1

Hypocalcemia
2

Hypereosinophilia
3

Hyperkalemia
4

Leukopenia
5

Thrombocytopenia
Familial alopecia areata is commonly associated with what laboratory abnormality?
54

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
5


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.
55

Argininosuccinic aciduria is characteristically associated with this hair finding name the condition
pictured below:
1

Pili trianguli et canaliculi
2

Trichoschisis
3

Monilethrix
4

5


Argininosuccinic aciduria is characteristically associated with this hair finding name the condition
pictured below:
4

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
56

arthralgias. Lichen planus is most commonly associated with dorsal, rather than ventral, pterygium.
Multicentric reticulohistiocytosis is associated with deforming arthritis and coral bead nodules around
the proximal nail fold, but not with pterygium.

The common culprit of proximal white subungual onychomycosis is :
1

Candida albicans
2

Trichophyton rubrum
3

Trichophyton interdigitale
4

Scydalidium dimidiatum
5

Fusarium spp

The common culprit of proximal white subungual onychomycosis is :
2

Trichophyton rubrum
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 units
Seager 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:
1

2

Plummer-Vinson syndrome
3

Hemochromatosis
4

Ectodermal dysplasia
57

5

LEOPARD syndrome

Lindsay's nails (distal nail normal, proximal nail white) is characteristic of:
1

Lindsay's nails are characteristic of chronic renal failure and indicate nailbed edema. The remaining
options are causes of koilonychia, a spooning defect of the nail.

Which of the following syndromes can present with woolly or curly hair?
1

Bjornstad syndrome
2

Citrullinemia
3

Menkes syndrome
4

Noonan syndrome
5

Netherton syndrome

Which of the following syndromes can present with woolly or curly hair?
4

Noonan syndrome
Noonan syndrome, Naxos syndrome, Carvajal syndrome, Costello syndrome, and Trichodentoosseous
syndrome can present with curly or woolly hair. Bjornstad syndrome and Menkes syndrome present with
pili torti. Citrullinemia presents with trichorrhexis nodosa.

Pathognomonic nails changes in HOOD syndrome or Hereditary osteoonychodysplasia are:
1

Red and white longitudinal banding
2

Pterygium inversum
3

Yellow nails
4

Pincer nails
5

Triangular lunulae

Pathognomonic nails changes in HOOD syndrome or Hereditary osteoonychodysplasia are:
5

Triangular lunulae
In the HOOD syndrome (Hereditary osteoonychodysplasia) or the Nail-Patella syndrome, patients have
different degrees of nail dysplasia. In general, the thumbs are most severely involved and nail disease
decreases in severity from the second to the fifth digits. Characteristic nail changes include longitudinal
ridging, koilonychia, and splitting. Toenails are rarely involved. Pathognomonic nail change is the V
58

shaped triangular lunulae with the distal peak in the midline.

Choose the correct statement regarding white piedra.
1

Commonly occurs in the tropics
2

Consists of cream-colored colonies attached to hairs
3

Treatment consists of cutting the hair
4

Is caused by piedra hortae
5

Both Consists of cream-colored colonies attached to hairs and Treatment consists of cutting the hair

Choose the correct statement regarding white piedra.
5

Both Consists of cream-colored colonies attached to hairs and Treatment consists of cutting the
hair
White piedra: caused by Trichosporon beiglii, occurs commonly in temperate climates. The culture shows
cream colored, colonies attached to hairs. Treatment consists of cutting hair. Black piedra is caused by
piedra hortae.

An 84-year-old man presents to clinic with atypical fingernails and is diagnosed with hapalonychia. What
defect does this term represent?
1

Long nails
2

White nail plates
3

Edema of the nail bed
4

Broad nails
5

Soft nails

An 84-year-old man presents to clinic with atypical fingernails and is diagnosed with hapalonychia. What
defect does this term represent?
5

Soft nails
Hapalonychia refers to soft nails and is caused by a defect in the nail matrix. Dolichonychia describes
abnormally long, narrow nails, while brachyonchia describes abnormally short, broad nails. Edema of the
nail bed may present as Meurhckes lines.

Which palmoplantar keratoderma is characterized by painful hyperkeratosis?
1

Richner-Hanhart
2

Howell-Evans
59

3

Vohwinkle
4

Unna-thost
5

Mal de Meleda

Which palmoplantar keratoderma is characterized by painful hyperkeratosis?
1

Richner-Hanhart
While most palmoplantar keratodermas are characterized by thick plaques of the palms and soles that are
usually painless, Richner Hanhart is classically associated with painful lesions, rendering it distinctive.
Richner Hanhart is also associated with a painful keratitis and pigment dilution of the hair.

What is the mode of inheritance of this disorder of the hair shaft?
1

Autosomal dominant
2

Autosomal recessive
3

X-linked dominant
4

X-linked recessive
5

Sporadic

What is the mode of inheritance of this disorder of the hair shaft?
1

Autosomal dominant
Monilethrix is an autosomal dominant condition with variable penetrance. The hair shaft has an elliptical
or beaded hair appearance.

Tays syndrome is characterized by this hair condition pictured below identify the condition:
1

2

3

Trichoschisis
4

Monilethrix
60

5


Tays syndrome is characterized by this hair condition pictured below identify the condition:
3

Trichoschisis
Tays syndrome is also known as trichothiodystrophy which is characterized by trichoschisis or clean
fracture of the hair shaft.

A six year old girl presents after being sent home from school for "lice". On examination, there are
structures on the hair which are freely slide along the hair shaft. What is the most likely diagnosis?
1

Pediculosis
2

Hair casts
3

Trichoptilosis
4

Monilithrix
5

Pili annulati

A six year old girl presents after being sent home from school for "lice". On examination, there are
structures on the hair which are freely slide along the hair shaft. What is the most likely diagnosis?
2

Hair casts
Hair casts present most commonly in young girls between the age of 2 and 8 years old. These casts are
freely sliding along the hair shaft and are not adherent. They must be distinguished from nits from
pediculosis capitis which are adherent to the hair and do not slide. Trichoptilosis are "spit ends" that form
from chemical or physical damage to the hair.

A 52 year old male with history of diabetes mellitus with a >3 month history of recurrent warmth,
erythema, and slight pain surrounding the first toenail of the right foot. What is the most likely diagnosis?
1

Acute Paronychia
2

Orf
61

3

Contact Dermatitis
4

Chronic Paronychia
5

Herpetic Whitlow

A 52 year old male with history of diabetes mellitus with a >3 month history of recurrent warmth,
erythema, and slight pain surrounding the first toenail of the right foot. What is the most likely diagnosis?
4

Chronic Paronychia
Paronychia is an inflammatory reaction involving the folds of skin surrounding the nail. It can be
characterized as ACUTE or CHRONIC -Acute paronychia usually due to direct or indirect trauma
followed by separation of eponychium from the nail plate, the causative bacteria usually Staph aureus and
Strep pyogenes. The treatment includes culturing the skin, systemic antibiotics, and draining of abscess if
necessary. -Chronic paranochya is most likely a contact reaction to irritants or allergens. It is characterized
by inflammation of the proximal nail fold with erythema, edema and absence of the cuticle. The most
frequently recovered organism is CANDIDA. It was originally thought to be result of Candida infection
and treatment was based upon antifungal therapy with minimal-moderate response. Newer studies suggest
that it is actually dermatitis of the nail fold COLONIZED by Candida. Treatment now is based on topical
anti-inflammatory steroids

A 4 year-old boy has a single circular alopecic atrophic patch on the vertex of the scalp. This most likely
is due to which of the following conditions?
1

Aplasia cutis congenita
2

Congenital syphilis
3

Keratosis Follicularis Spinulosa Decalvans
4

Morphea en coup de sabre
5

Triangular Alopecia

A 4 year-old boy has a single circular alopecic atrophic patch on the vertex of the scalp. This most likely
is due to which of the following conditions?
1

Aplasia cutis congenita
Aplasia cutis congenita often affects the vertex of the scalp and heals with a circular atrophic alopecic
scar.

Psoriatic onycholysis is caused by psoriasis in which of the following nail subunits?
1

Nail matrix
2

Nail plate
3

Nail bed
4

Proximal nail fold
62

5

Hyponychium

Psoriatic onycholysis is caused by psoriasis in which of the following nail subunits?
3

Nail bed
Nail bed involvement by psoriasis often causes onycholysis.

This hair finding is caused by mutations in what gene?
1

SPINK 5
2

NEMO
3

SERCA2
4

Dyskerin
5

Keratin 16

This hair finding is caused by mutations in what gene?
1

SPINK 5
Mutations in SPINK 5, a serine protease inhibitor leads to Nethertons syndrome which is characterized
by trichorrhexis invaginata or bamboo hair.

Steatocystoma multiplex and natal teeth are associated with which of the following conditions?
1

Jadassohn-Lewandowsky pachyonychia congenita (Type 1)
2

Jackson-Sertole pachyonychia congenita (Type 2)
3

4

5

63


Steatocystoma multiplex and natal teeth are associated with which of the following conditions?
2

Jackson-Sertole pachyonychia congenita (Type 2)
Jackson-Sertole pachyonychia congenita (Type 2) is characterized by thickening of the nailbed and plate,
steatocystoma multiplex, and natal teeth.

Air spaces in the hair shaft lead to this condition pictured below name the condition:
1

2

Pili annulati
3

Trichoschisis
4

Pohl Pinkus constriction
5

Wooly hair

Air spaces in the hair shaft lead to this condition pictured below name the condition:
2

Pili annulati
Pili anulati is caused by air spaces in the hair shaft.

Bjrnstad syndrome is the combination of pili torti and which of the following features?
1

Lentigines
2

White forelock
3

Hypogonadism
4

Deafness
5

Seizures

Bjrnstad syndrome is the combination of pili torti and which of the following features?
4

Deafness
64

Deafness and pili torti are the two cardinal features of Bjrnstad syndrome.

Deposition of mucin in the hair follicle can be associated with which disease?
1

Keratosis Follicularis Spinulosa Decalvans
2

Adams-Oliver Syndrome
3

Mycosis fungoides
4

Acne Keloidalis Nuchae
5

Perifolliculitis Capitis Abscedens et Suffodiens

Deposition of mucin in the hair follicle can be associated with which disease?
3

Mycosis fungoides
Mycosis fungoides can be associated with follicular mucinosis.

Mutations in hair keratins hHB6 and hHB1 cause this characteristic finding pictured below name the
condition:
1

Trichoptilosis
2

Hair casts
3

Tiger-tail hair
4

Trichoschisis
5

Monilethrix

Mutations in hair keratins hHB6 and hHB1 cause this characteristic finding pictured below name the
condition:
5

Monilethrix
Mutations in the hair keratins, hHB6 and hHB 1 cause monilethrix.

Plummer's nails are associated with which of the following disorders?
65

1

Dermatomyositis
2

Systemic sclerosis
3

Lupus erythematosus
4

Hyperthyroidism
5

Lead poisoning

Plummer's nails are associated with which of the following disorders?
4

Hyperthyroidism
Plummer's nails are onycholysis due to hyperthyroidism.

Cutaneous signs of cortisol excess include all of the following EXCEPT:
1

Plethora
2

Atrophic/fragile skin
3

Striae distensae
4

Dorsocervical/Supraclavicular fat pads
5

Peripheral obesity

Cutaneous signs of cortisol excess include all of the following EXCEPT:
5

Peripheral obesity
All of the listed options are signs of cortisol excess except peripheral obesity. The most common pattern
of obesity in patients with cortisol excess is centripetal or central obesity.

Koilonychia is most commonly seen in association with:
1

Renal disease
2

Progressive systemic sclerosis
3

Alopecia areata
4

Impaired iron metabolism
5

Pulmonary disease

Koilonychia is most commonly seen in association with:
4

Impaired iron metabolism
In koilonychia (spoon nails), the nail is a concave shape with raised lateral edges. Iron-deficiency anemia
66

and Plummer-Vinson syndrome have been associated with koilonychia. Involvement of only the first three
fingernails is suggestive of an occupational cause. In early infancy, koilonychia is a normal finding.
Koilonychia is also seen in hemochromatosis, an autosomal recessive condition associated with increased
intestinal iron absorption and increased iron deposition leading to metallic-grey hyperpigmentation of the
skin, hepatomegaly, diabetes, hypogonadism, polyarthritis, and cardiac abnormalities.

A patient with a history of gastrointestinal polyposis presents with alopecia, generalized pigmentation, and
nail dystrophy. Which of the following is the most likely diagnosis?
1

Peutz-Jegher syndrome
2

Gardner syndrome
3

Cronkhite-Canada Syndrome
4

Cowden syndrome
5

Dyskeratosis congenita

A patient with a history of gastrointestinal polyposis presents with alopecia, generalized pigmentation, and
nail dystrophy. Which of the following is the most likely diagnosis?
3

Cronkhite-Canada Syndrome
Cronkhite-Canada Syndrome is a sporadic gastrointestinal polyposis syndrome characterized by alopecia,
generalized pigmentation, and nail dystrophy.

A patient with synophrys, dystopia canthorum, and heterochromia iridum irides likely has which of the
following hair abnormalities?
1

Diffuse thinning
2

Scarring alopecia
3

4

5

White forelock

A patient with synophrys, dystopia canthorum, and heterochromia iridum irides likely has which of the
following hair abnormalities?
5

White forelock
White forelock is a common feature of Waardenburg syndrome.

67

A 52-year-old man presents to clinic with erythematous papules and pustules in the region of the cheeks,
chin, and neck that are worsened by shaving. Examination reveals pseudofolliculitis barbae. With what
disease may this be associated:
1

Cirrhosis
2

Heart Failure
3

Chronic Renal Failure
4

Myeloma
5

Emphysema

A 52-year-old man presents to clinic with erythematous papules and pustules in the region of the cheeks,
chin, and neck that are worsened by shaving. Examination reveals pseudofolliculitis barbae. With what
disease may this be associated:
3

Chronic Renal Failure
Pseudofolliculitis barbae has been associated with renal failure requiring hemodialysis, particularly in
Caucasian patients. Most commonly, this syndrome arises in patients with darker skin types, whose hair
shafts are elliptical in cross section, rather than round. This elliptical nature predisposes the hairs to
kinking and invagination into the skin.

Hair and Nail Disorders MCQs

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