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Answers for CME examination
CME examination
ldentificatlon No.
885-105
Instructions for Category 1 CME credit appear in the front advertising section. See last page of contents for page number. Questions 1-33, McDonald CJ: J AM ACAD DERMATOL12:753-775, 1985.
Directions for questions 1-12: Choose the single best response. 1, Methotrexate exerts its greatest effect in which of the following stages of the cell cycle? a. Go b. Gj e. G~ d.S e. M 2. The most biologically important target molecule of alkylating agents is cellular a. nucleic acid precursor molecules b. ribonucleic acid (RNA) c. deoxyribonucleic acid (DNA) d. protein e. lipid 3. Which of the following is an analog of folic acid? a. Bleomycin b. Methotrexate c, Cyclophosphamide d. Azathioprine e, Allopurinol 4. Acyclovir, in its active form, is a potent inhibitor of herpes simplex virus-coded a. thymidine kinase b. thymidylate synthetase c. DNA polymerase d. RNA polymerase e, xanthine oxidase 5. Which internal organ, in addition to skin, is particularly sensitive to the action of bleomycin? a. Liver b. Lung c. Kidney d. Colon e. Adrenal glands 6. The degree of myelosuppression indicative of an optimal immunosuppressive effect using cyclophosphamide is a. none b. slight c. moderate d. moderate but transient e. marked but transient 7. Which one of the following is currently considered an appropriate regimen for initial administration of methotrexate for psoriasis? 776
a. 15 rag, given orally once per day, administered daily b. 5 rag, given orally three times per day, administered daily c. 15 rag, given orally at three 12-hour intervals (total dose 45 rag), administered once per week d. 15 nag, given intravenously at three 12-hour intervals (total dose 45 rag), administered once per week e. 45 rag, given intramuscularly in a single dose, administered once per week 8. The most frequently encountered toxicity in idoxuridine therapy is a. nausea, anorexia, and vomiting b. hepatic injury c, alopecia d. stomatitis and gastrointestinal ulcerations e. myelosuppression 9. Which of the following toxic effects of fluorouracil would you expect to see soonest after administration of the drug has begun'? a. Myelosuppression b. Pharyngitis c. Proctitis d. Stomatitis, gastroenteritis, and gastrointestinal ulcerations e. Nausea, anorexia, and vomiting 10. A patient with which of the following conditions is most likely to develop non-Hodgkin's lymphoma secondary to treatment for the condition with immunosuppressive drugs? a. Pemphigus b. Vasculitis c. Psoriasis d. Progressive systemic sclerosis e. Renal transplant 11. Toxic effects of methotrexate include all of the following, except a. nausea and vomiting after administration of the drug b. nausea and vomiting before administration of the drug c. stomatitis and gastrointestinal ulceration d. hypertrichosis e. myelosuppression 12. Factors that appear to predispose to development of hepatic fibrosis in psoriatic patients chronically
Volume 12 Number 5, Part I
CME examination
May, 1985
treated with methotrexate include all of the following, except a. pretreatment abnormalities in liver architecture (in the absence of other hepatic disease) b. prolonged treatment with methotrexate c. obesity d. alcoholism e. diabetes mellitus
Directions for questions 13-17: For each of the following numbered drugs, choose the one lettered item corresponding to an enzyme activity that is inhibited, directly or indirectly, by the drug. Where a drug affects more than one enzyme activity, choose the one most a/letted among those listed. Each lettered item may be used once, more titan once, or not at all. a. Ribonucleotide reductase b. Thymidine kinase c. Thymidylate synthetase d. 5'-Phosphoribosyl-l-pyrophosphate amidotransferase e. Xanthine oxidase 13. Altopurinol 14. Azathioprine 15. Idoxuridine 16. 5-Fluorouracil 17. Methotrexate Directions for questions 18-22: For each of the following numbered disorders, choose the single lettered drug that has proved most usefid, among those listed, for its treatment. Each lettered drug may be used once, more than once, or not at all. a. Acyclovir b. Allopurinol c. Vinblastine d. Bleornycin e. Fluorouracil 18. Actinic keratoses t9. Gout 20. Kaposi's sarcoma 21. Herpes simplex 22. Psoriasis Directions for questions 23-27: For each of the following numbered items, choose the single most appropriate lettered response. a. Mechlorethamine (Mustargen) b. Cyclophosphamide (Cytoxan)
23. 24. 25. 26. 27.
777
c. Both d. Neither Metabolically activated in the liver by the cytochrome P450mixed function oxidase system Severe local gastrointestinal reactions often occur after oral administration Nausea, vomiting, and diarrhea may occur in the absence of manifest mucosal injury Sterile hemorrhagic cystitis is a complication Amenorrhea, azoospermia, and long-lasting sterility may occur after prolonged treatment
Directions for questions 28-33: Choose as many answers as are appropriate, All, some, or none of the choices may be correct. 28. Alkylating agents may bind to DNA at the a. l-nitrogen of adenine b. 3-nitrogen of adenine e. 3-nitrogen of cytosine d. 6-oxygen of guanine e. 7-nitrogen of guanine 29. Biochemical abnormalities that may result from alkylation include a. abnormal base pairing leading to genetic miscoding b. cross-linking of two nucleic acid chains c. cross-linking of nucleic acid and protein d. depurination and depyrimidination (i.e., removal of bases from nucleic acid chains) e. scission of nucleic acid chains 30. Which of the following is (are) used primarily as an antiviral agent(s)? a. Acyclovir b. Fluorouracil c. Idoxuridine d. Hydroxyurea e. Bleomycin 31. Topical mechlorethamine produces remissions in 80% to 100% of patients in which of the following stages of mycosis fungoides? a. Eczematous b. Plaque-type c. Nodular d. Ulcerative e. Tumorous 32. Which of the following drugs potentiate(s) methotrexate effectiveness/toxicity by displacing it from plasma proteins? a. Sulfonamides b. Salicylates c. Diphenylhydantoin
Journal of the American Academy of Dermatology
CME examination
a. b. c. d. e.
d. Phenylbutazone e. Tetracyclines 33. There is clear evidence that a patient treated with immunosuppressive drugs for which of the following conditions is at increased risk for development of cutaneous basal cell carcinoma as a result of the treatment?
Pemphigus Vasculitis Psoriasis Sarcoidosis Lymphoma
Answers for CME examination*
Identification No. 885-104
April, 1985, issue of the JOURNAL.Or THEAMERICANACADEMYOF DERMATOLOGY Questions 1-33, Fox B J, Odom RB: J AM ACAD DERMATOL 12:597-624, 1985.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.
b a a c e a c d d a d b b b c c
(p 607, c 2, pa 5--p 608, c i, pa 1) (p 597, c 2, pa 2) (p 598, c 2, pa 3) (p 607, c 2, pa 4) (p 610, c 1, pa 2) (p611, c2, pa4) (p 606, c 2, pa 3) (p 602, c 1, pa 2) (p 604, Fig 14; p 610, c 2, pa 2) (p599, c2, pa6) (p598, c2, pa3) (p610, c2, p a 3 - - p 6 1 1 , c 1, p a l ; p a 4 ) (p598, c l , pa3) (p615, c l , pa3) (p613, c l , pa3) (p597, c 2, pa2; p 599, c 1, pa 1 ; p 6 0 1 , c 1, pa 1; p 602, c 1, pa 3; p 613, c 1, pa 2) 17. b (p599, c l , p a l ) 18. c (p 613, c 2, pa 2) 19. e (p 598, c 1, pa 2) 20. d (p605, c l , pa2) 21. a (p 606, c 2, pa 4 p 607, c 1, pa 1) *p: page; c: column;pa: paragraph;Fig: figure. 778
22. b 23. c 24. c 25. a 26. b 27. a
28. c 29. a , b , c , d , e 30. a , d 31. a, d 32. None of the answers is correct 33. None of the answers is correct
(p 607, c 2, pa 5) (p 619, c 1, pa 3) (p 597, c 2, pa 2; p 605, c 2, pa 1; p 606, c 2, pa I) (p 598, c 2, pa 3; p 605, c 1, pa 2; p 606, c 2, pa 1) (p 602, c 1, pa 3--c 2, pa 1; p 606, c l , p a l ; c 2 , pa 1) (p 602, c 1, pa 3---c 2, pa 1; p 605, c 2, pa 2--606, c 1, pa 1; c 2, pa 1) (p 602, c 1, pa 3; p 606, c 1, pa 1; p 606, c 2, pa 1) (p611, c 2 , pa~ p612, c l, pa 1; pa 2) (p 601, c 1, pa 1) (p 599, c 1, pa 1) (p 606, c 2, pa 1)
(p 608, c 2, pa 4)
ldentificatlon No.
885-105
Instructions for Category 1 CME credit appear in the front advertising section. See last page of contents for page number. Questions 1-33, McDonald CJ: J AM ACAD DERMATOL12:753-775, 1985.
Directions for questions 1-12: Choose the single best response. 1, Methotrexate exerts its greatest effect in which of the following stages of the cell cycle? a. Go b. Gj e. G~ d.S e. M 2. The most biologically important target molecule of alkylating agents is cellular a. nucleic acid precursor molecules b. ribonucleic acid (RNA) c. deoxyribonucleic acid (DNA) d. protein e. lipid 3. Which of the following is an analog of folic acid? a. Bleomycin b. Methotrexate c, Cyclophosphamide d. Azathioprine e, Allopurinol 4. Acyclovir, in its active form, is a potent inhibitor of herpes simplex virus-coded a. thymidine kinase b. thymidylate synthetase c. DNA polymerase d. RNA polymerase e, xanthine oxidase 5. Which internal organ, in addition to skin, is particularly sensitive to the action of bleomycin? a. Liver b. Lung c. Kidney d. Colon e. Adrenal glands 6. The degree of myelosuppression indicative of an optimal immunosuppressive effect using cyclophosphamide is a. none b. slight c. moderate d. moderate but transient e. marked but transient 7. Which one of the following is currently considered an appropriate regimen for initial administration of methotrexate for psoriasis? 776
a. 15 rag, given orally once per day, administered daily b. 5 rag, given orally three times per day, administered daily c. 15 rag, given orally at three 12-hour intervals (total dose 45 rag), administered once per week d. 15 nag, given intravenously at three 12-hour intervals (total dose 45 rag), administered once per week e. 45 rag, given intramuscularly in a single dose, administered once per week 8. The most frequently encountered toxicity in idoxuridine therapy is a. nausea, anorexia, and vomiting b. hepatic injury c, alopecia d. stomatitis and gastrointestinal ulcerations e. myelosuppression 9. Which of the following toxic effects of fluorouracil would you expect to see soonest after administration of the drug has begun'? a. Myelosuppression b. Pharyngitis c. Proctitis d. Stomatitis, gastroenteritis, and gastrointestinal ulcerations e. Nausea, anorexia, and vomiting 10. A patient with which of the following conditions is most likely to develop non-Hodgkin's lymphoma secondary to treatment for the condition with immunosuppressive drugs? a. Pemphigus b. Vasculitis c. Psoriasis d. Progressive systemic sclerosis e. Renal transplant 11. Toxic effects of methotrexate include all of the following, except a. nausea and vomiting after administration of the drug b. nausea and vomiting before administration of the drug c. stomatitis and gastrointestinal ulceration d. hypertrichosis e. myelosuppression 12. Factors that appear to predispose to development of hepatic fibrosis in psoriatic patients chronically
Volume 12 Number 5, Part I
CME examination
May, 1985
treated with methotrexate include all of the following, except a. pretreatment abnormalities in liver architecture (in the absence of other hepatic disease) b. prolonged treatment with methotrexate c. obesity d. alcoholism e. diabetes mellitus
Directions for questions 13-17: For each of the following numbered drugs, choose the one lettered item corresponding to an enzyme activity that is inhibited, directly or indirectly, by the drug. Where a drug affects more than one enzyme activity, choose the one most a/letted among those listed. Each lettered item may be used once, more titan once, or not at all. a. Ribonucleotide reductase b. Thymidine kinase c. Thymidylate synthetase d. 5'-Phosphoribosyl-l-pyrophosphate amidotransferase e. Xanthine oxidase 13. Altopurinol 14. Azathioprine 15. Idoxuridine 16. 5-Fluorouracil 17. Methotrexate Directions for questions 18-22: For each of the following numbered disorders, choose the single lettered drug that has proved most usefid, among those listed, for its treatment. Each lettered drug may be used once, more than once, or not at all. a. Acyclovir b. Allopurinol c. Vinblastine d. Bleornycin e. Fluorouracil 18. Actinic keratoses t9. Gout 20. Kaposi's sarcoma 21. Herpes simplex 22. Psoriasis Directions for questions 23-27: For each of the following numbered items, choose the single most appropriate lettered response. a. Mechlorethamine (Mustargen) b. Cyclophosphamide (Cytoxan)
23. 24. 25. 26. 27.
777
c. Both d. Neither Metabolically activated in the liver by the cytochrome P450mixed function oxidase system Severe local gastrointestinal reactions often occur after oral administration Nausea, vomiting, and diarrhea may occur in the absence of manifest mucosal injury Sterile hemorrhagic cystitis is a complication Amenorrhea, azoospermia, and long-lasting sterility may occur after prolonged treatment
Directions for questions 28-33: Choose as many answers as are appropriate, All, some, or none of the choices may be correct. 28. Alkylating agents may bind to DNA at the a. l-nitrogen of adenine b. 3-nitrogen of adenine e. 3-nitrogen of cytosine d. 6-oxygen of guanine e. 7-nitrogen of guanine 29. Biochemical abnormalities that may result from alkylation include a. abnormal base pairing leading to genetic miscoding b. cross-linking of two nucleic acid chains c. cross-linking of nucleic acid and protein d. depurination and depyrimidination (i.e., removal of bases from nucleic acid chains) e. scission of nucleic acid chains 30. Which of the following is (are) used primarily as an antiviral agent(s)? a. Acyclovir b. Fluorouracil c. Idoxuridine d. Hydroxyurea e. Bleomycin 31. Topical mechlorethamine produces remissions in 80% to 100% of patients in which of the following stages of mycosis fungoides? a. Eczematous b. Plaque-type c. Nodular d. Ulcerative e. Tumorous 32. Which of the following drugs potentiate(s) methotrexate effectiveness/toxicity by displacing it from plasma proteins? a. Sulfonamides b. Salicylates c. Diphenylhydantoin
Journal of the American Academy of Dermatology
CME examination
a. b. c. d. e.
d. Phenylbutazone e. Tetracyclines 33. There is clear evidence that a patient treated with immunosuppressive drugs for which of the following conditions is at increased risk for development of cutaneous basal cell carcinoma as a result of the treatment?
Pemphigus Vasculitis Psoriasis Sarcoidosis Lymphoma
Answers for CME examination*
Identification No. 885-104
April, 1985, issue of the JOURNAL.Or THEAMERICANACADEMYOF DERMATOLOGY Questions 1-33, Fox B J, Odom RB: J AM ACAD DERMATOL 12:597-624, 1985.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.
b a a c e a c d d a d b b b c c
(p 607, c 2, pa 5--p 608, c i, pa 1) (p 597, c 2, pa 2) (p 598, c 2, pa 3) (p 607, c 2, pa 4) (p 610, c 1, pa 2) (p611, c2, pa4) (p 606, c 2, pa 3) (p 602, c 1, pa 2) (p 604, Fig 14; p 610, c 2, pa 2) (p599, c2, pa6) (p598, c2, pa3) (p610, c2, p a 3 - - p 6 1 1 , c 1, p a l ; p a 4 ) (p598, c l , pa3) (p615, c l , pa3) (p613, c l , pa3) (p597, c 2, pa2; p 599, c 1, pa 1 ; p 6 0 1 , c 1, pa 1; p 602, c 1, pa 3; p 613, c 1, pa 2) 17. b (p599, c l , p a l ) 18. c (p 613, c 2, pa 2) 19. e (p 598, c 1, pa 2) 20. d (p605, c l , pa2) 21. a (p 606, c 2, pa 4 p 607, c 1, pa 1) *p: page; c: column;pa: paragraph;Fig: figure. 778
22. b 23. c 24. c 25. a 26. b 27. a
28. c 29. a , b , c , d , e 30. a , d 31. a, d 32. None of the answers is correct 33. None of the answers is correct
(p 607, c 2, pa 5) (p 619, c 1, pa 3) (p 597, c 2, pa 2; p 605, c 2, pa 1; p 606, c 2, pa I) (p 598, c 2, pa 3; p 605, c 1, pa 2; p 606, c 2, pa 1) (p 602, c 1, pa 3--c 2, pa 1; p 606, c l , p a l ; c 2 , pa 1) (p 602, c 1, pa 3---c 2, pa 1; p 605, c 2, pa 2--606, c 1, pa 1; c 2, pa 1) (p 602, c 1, pa 3; p 606, c 1, pa 1; p 606, c 2, pa 1) (p611, c 2 , pa~ p612, c l, pa 1; pa 2) (p 601, c 1, pa 1) (p 599, c 1, pa 1) (p 606, c 2, pa 1)
(p 608, c 2, pa 4)