Infections: bacterial, viral, fungal, parasitic: proximal subungual onychomycosis: practice question

A Dermatology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Dermatology · Infections: bacterial, viral, fungal, parasitic: proximal subungual onychomycosis

Sample item

An adult has white discolouration beginning beneath the proximal nail plate and spreading distally, with an intact nail surface. Which underlying condition should be actively looked for?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. HIV infection

Proximal subungual onychomycosis, usually due to Trichophyton rubrum entering via the proximal nail fold, is uncommon in healthy people. It is a recognised marker of immunosuppression, particularly HIV infection, so testing is advised.

Option by option

  • A. Chronic liver disease

    Chronic liver disease causes leukonychia, as in Terry nails, with no fungal invasion.

  • B. Hypothyroidism

    Hypothyroidism causes dry brittle nails but not this pattern of dermatophyte invasion.

  • C. HIV infection (correct)

    Correct. This pattern of onychomycosis is a cutaneous clue to HIV infection.

  • D. Iron deficiency

    Iron deficiency causes koilonychia and brittle nails rather than proximal fungal invasion.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Dermatology question

What is the answer to this Dermatology question?

The best answer is C, HIV infection. Proximal subungual onychomycosis, usually due to Trichophyton rubrum entering via the proximal nail fold, is uncommon in healthy people.

Why is "Chronic liver disease" not the answer?

Chronic liver disease causes leukonychia, as in Terry nails, with no fungal invasion.

Why is "Hypothyroidism" not the answer?

Hypothyroidism causes dry brittle nails but not this pattern of dermatophyte invasion.

Why is "Iron deficiency" not the answer?

Iron deficiency causes koilonychia and brittle nails rather than proximal fungal invasion.

What concept does this question test?

It tests Infections: bacterial, viral, fungal, parasitic: proximal subungual onychomycosis in Dermatology. It is a recognised marker of immunosuppression, particularly HIV infection, so testing is advised.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Infections: bacterial, viral, fungal, parasitic: proximal subungual onychomycosis?

Learn each condition by its primary lesion, site and signature sign. Then use the flashcards and the other Dermatology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.