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CME examination for volume 25
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In the June a n d D e c e m b e r issues each year, C M E questions based on articles in the preceding volume of the JOURNAL appear. Two hours of Category I C M E credit can be earned by reading the text material, reporting the answers on the perforated answer sheet, and following instructions for C a t e g o r y I C M E credit.----Editor
CME examination for volume 25* IdentificationNo. 892-306 Instructionsfor Category I CME credit and answers to this examination appear in the front advertising section. See last page of Contents for page number.
Directions f o r questions 1-25." Give single best response. 1. Facial skin of persons with more sun exposure, compared with that of persons of the same age with less sun exposure, tends to have each of the following, ex-
cept a. more yellowing b. more wrinkles c. more severe elastosis d. increased elastin e. increased collagen 2. A 58-year-old black man has mild ache vulgaris. During physical examination you note the presence of ephilis-like, depressed macules in a reticulated pattern on the extensor surfaces of the hands and feet, with palmar pitting and interruption of the epidermal ridge pattern. The correct diagnosis is a. ephilides b. lentigo senilis c. forme fruste of basal cell nevus syndrome d. a type of Golitz syndrome e. reticulate acropigmentation of Kitamura 3. Livedo racemosa and purple discoloration of the skin are features of a. cryofibrinogenemia b. monoclonal cryoglobulinemia c. anti-phospholipid antibody syndrome d. thrombotic thrombocytopenic purpura e. purpura fulminans 4. Fibrinoid necrosis of blood vessel walls is a feature of a. lymphocytic vasculitis b. Schamberg's purpura c. Majocchi's purpura d. Gougerot-Blum purpura e. lichen aureus
*Includesentirevolumewiththe exceptionof CME articles. 28A
5. Each of the following is true of subacute cutaneous lupus erythematosus, except a. cutaneous lesions may be annular or papulosquamous b. many cutaneous lesions heal with scarring c. many patients have the class II M H C antigen DR3 d. many patients have autoantibodies directed against SS-A/Ro antigen e. most patients are sensitive to light 6. Typical features of the Proteus syndrome include each of the following, except a. progressive and asymmetric megalodactyly b. tracheonychia c. localized eerebroid thickening of the palms and soles d. hemihypertrophy e. linear skin lesions 7. Each of the following is a component of the Sipple syndrome, except a. autosomal recessive inheritance b. hyperplasia of the parafollicular cells of the thyroid c. parathyroid hyperplasia d. adrenal medullary hyperplasia e. pheochromocytoma 8. The most common site of occurrence of necrobiotic xanthogranuloma is the a. axillae and perineum b. scalp c. eyelids and periorbital structures d. trunk and cervical region e. dorsal aspects of the distal extremities 9. Xanthoma disseminatum typically consists of skin and mucous membrane xanthomas, often associated with a. diabetes mellitus b. diabetes insipidus c. biliary cirrhosis d. hypercholesterolemia e. hypertriglyceridemia 10. A 24-year-old woman, previously in good health, develops fever, hepatosplenomegaly, generalized lymphadenopathy, anemia, thrombocytopenia, leukopenia, and a coagulopathy. She has several subcu-
Continued on page 31A June 1992
Volume 26 Number 6 June 1992
taneous nodules, from which biopsy specimens reveal cytophagic histiocytic panniculitis. You should suspect that this patient may also have a. Epstein-Barr virus infection b. cytomegalovirus infection c. non-Hodgldn's B-cell lymphoma d. non-Hodgldn's T-cell lymphoma e. Hodgkin's disease 11. Which of the following is characteristic of the hyaline-vascular type but not the plasma-cell type of Castleman's disease? a. Frequent association with a localized mediastinal mass
b. Progression to a lymphoma c. Association with pemphigus vulgaris d. Elevated erythrocyte sedimentation rate, anemia, and thrombocytopenia e. Histologically, numerous large follicles containing hyperplastic germinal centers 12. Lymphoblastic lymphomas a. are usually of the B-cell type b. histologically show predominantly large lymphoid cells with immature nuclear chromatin c. occur predominantly in elderly persons d. appear with cutaneous lesions in fewer than one fifth of patients e. preferentially involve the trunk and legs when skin is involved 13. Slate-gray hyperpigmentation has been reported in association with administration of amiodarone, imipramine, and a. tetracyclines b. penicillamine c. chloropromazine d. isoniazid e. acyclovir 14. The most common site of localized tissue necrosis after treatment with Zyderm or Zyplast Collagen Implants is the a. glabella b. tip of the nose c. lateral canthus d. perioral region e. mental region 15. The most serious side effects of administration of cyclosporine are a. nephrotoxicity and hepatotoxicity b. nephrotoxicity and hypertension c. hepatotoxicity and hypertension d. hepatotoxicity and peripheral neuropathy e. none of the above 16. A drug is unlikely to cause toxic epidermal necrolysis (TEN) if its administration was begun more than 3 weeks before onset of TEN. An exception to this is
C M E examination f o r volume 25
31A
a. sulfonamides b. ampicillin c. allopurinol d. phenytoin e. nonsteroidal antiinflammatory agents 17. Side effects of lindane, which occur almost entirely when it is not used properly or is ingested, affect mainly the a. liver b. renal system c. hematopoietic system d. immune system e. central nervous system 18. In the standard photopatch test, topical application of the test substance is followed by irradiation with a. UVA radiation (320 to 400 nm) b. UVB radiation (280 to 320 nm) c. UVA + UVB radiation (280 to 400 nm) d. a range of different wavelengths beginning with UVB (280 to 320 nm) and extending through the visible spectrum e. a range of different wavelengths beginning with UVA (320 to 400 nm) and extending through the visible spectrum 19. Lesions of hydroa vacciniforme can consistently be reproduced in patients with the disease by repeated exposure to a. Soret band irradiation b. UVA irradiation c. UVB irradiation d. UVC irradiation e. none of these choices is correct 20. Peptide T is thought to counteract the dissemination of human immunodefieiency virus infection by a. binding to the gpl20 glycoprotein or viral envelopes b. binding to free gpl20 glycoprotein in the serum c. blocking virus and gp 120 glycoprotein binding at the CD4 receptor d. blocking virus and gpl20 glycoprotein binding at the CD8 receptor e. blocking binding of vasoactive intestinal polypeptide 21. Examination of nongenital cutaneous squamous cell carcinomas for human papillomaviruses (HPV) in patients with epidermodysplasia verruciformis usually demonstrates the presence of a. HPV type 5 (HPV-5) b. HPV-14 c. HPV-16 d. HPV-18 e. no HPV 22. The most potent chemotactic factor for eosinophils in
Continued on page 34A
34A
CME examination for volume 25
the late phase response of a cutaneous allergic reaction is a . platelet-activating factor b. eosinophil chemotactic factor of anaphylaxis c. eosinophil peroxidase d. eosinophil major basic protein e. leukotriene C4 23. Whichofthefollowingreactionsis (are) catalyzed by thrombin? a, Fibrinogen to D-monomer b. Fibrinogen to fibrin monomer c. Fibrin monomer to cross-linked fibrin d. Cross-linked fibrin to D-dimer e. Both fibrinogen to D-monomer and cross-linked fibrin to D-dimer 24. Which of the following reactions is (are) catalyzed by fibrin? a. Fibrinogen to D-monomer b. Fibrinogen to fibrin monomer c. Fibrin monomer to cross-linked fibrin d. Cross-linked fibrin to D-dimer e. Both fibrinogen to D-monomer and cross-linked fibrin to D-dimer 25. A gene for the cutaneous malignant melanoma-dysplastic nevus syndrome has been demonstrated on chromosome a. 1 b. 2 c. 7 d. 9 e. 14
Directions for questions 26-28: Select the one lettered item most closely related to each numbered item.
Journal of the American Academy of Dermatology
a. C D l a (OKT6) b. CD3 (anti-Leu-4) c. CD4 (anti-Leu-3a) d. CD8 (OKT8) e. CD38 (OKT 10) 26. Activated lymphocytes (regardless of type) 27. Mature T cells (regardless of type) 28. Langerhans cells
Directions for questions 29-31: Select the one lettered item most closely related to each numbered item. a. Laugier-Hunziker syndrome b. Labial melanotic macules c, Both d. Neither 29. Lesions are often present on the lower lip, 30. Multiple lesions are usuaUy present. 31. Histologie examination shows an increased number of suprabasal melanocytes.
Directions for questions 32 and 33: Select the one lettered item most closely related to each numbered item. a. Acitretin b. Etretinate c, Both d. Neither 32. Must be metabolized to another compound to become active. 33. Elimination half-life is similar to that of 13-cis-ret. inDic acid.
"Or
]OURNAL of the
v,
AmeRIcaN
AAD
AcaDemy
OF
DerMaTOLOGY I I I
III
I
II
I
In the June a n d D e c e m b e r issues each year, C M E questions based on articles in the preceding volume of the JOURNAL appear. Two hours of Category I C M E credit can be earned by reading the text material, reporting the answers on the perforated answer sheet, and following instructions for C a t e g o r y I C M E credit.----Editor
CME examination for volume 25* IdentificationNo. 892-306 Instructionsfor Category I CME credit and answers to this examination appear in the front advertising section. See last page of Contents for page number.
Directions f o r questions 1-25." Give single best response. 1. Facial skin of persons with more sun exposure, compared with that of persons of the same age with less sun exposure, tends to have each of the following, ex-
cept a. more yellowing b. more wrinkles c. more severe elastosis d. increased elastin e. increased collagen 2. A 58-year-old black man has mild ache vulgaris. During physical examination you note the presence of ephilis-like, depressed macules in a reticulated pattern on the extensor surfaces of the hands and feet, with palmar pitting and interruption of the epidermal ridge pattern. The correct diagnosis is a. ephilides b. lentigo senilis c. forme fruste of basal cell nevus syndrome d. a type of Golitz syndrome e. reticulate acropigmentation of Kitamura 3. Livedo racemosa and purple discoloration of the skin are features of a. cryofibrinogenemia b. monoclonal cryoglobulinemia c. anti-phospholipid antibody syndrome d. thrombotic thrombocytopenic purpura e. purpura fulminans 4. Fibrinoid necrosis of blood vessel walls is a feature of a. lymphocytic vasculitis b. Schamberg's purpura c. Majocchi's purpura d. Gougerot-Blum purpura e. lichen aureus
*Includesentirevolumewiththe exceptionof CME articles. 28A
5. Each of the following is true of subacute cutaneous lupus erythematosus, except a. cutaneous lesions may be annular or papulosquamous b. many cutaneous lesions heal with scarring c. many patients have the class II M H C antigen DR3 d. many patients have autoantibodies directed against SS-A/Ro antigen e. most patients are sensitive to light 6. Typical features of the Proteus syndrome include each of the following, except a. progressive and asymmetric megalodactyly b. tracheonychia c. localized eerebroid thickening of the palms and soles d. hemihypertrophy e. linear skin lesions 7. Each of the following is a component of the Sipple syndrome, except a. autosomal recessive inheritance b. hyperplasia of the parafollicular cells of the thyroid c. parathyroid hyperplasia d. adrenal medullary hyperplasia e. pheochromocytoma 8. The most common site of occurrence of necrobiotic xanthogranuloma is the a. axillae and perineum b. scalp c. eyelids and periorbital structures d. trunk and cervical region e. dorsal aspects of the distal extremities 9. Xanthoma disseminatum typically consists of skin and mucous membrane xanthomas, often associated with a. diabetes mellitus b. diabetes insipidus c. biliary cirrhosis d. hypercholesterolemia e. hypertriglyceridemia 10. A 24-year-old woman, previously in good health, develops fever, hepatosplenomegaly, generalized lymphadenopathy, anemia, thrombocytopenia, leukopenia, and a coagulopathy. She has several subcu-
Continued on page 31A June 1992
Volume 26 Number 6 June 1992
taneous nodules, from which biopsy specimens reveal cytophagic histiocytic panniculitis. You should suspect that this patient may also have a. Epstein-Barr virus infection b. cytomegalovirus infection c. non-Hodgldn's B-cell lymphoma d. non-Hodgldn's T-cell lymphoma e. Hodgkin's disease 11. Which of the following is characteristic of the hyaline-vascular type but not the plasma-cell type of Castleman's disease? a. Frequent association with a localized mediastinal mass
b. Progression to a lymphoma c. Association with pemphigus vulgaris d. Elevated erythrocyte sedimentation rate, anemia, and thrombocytopenia e. Histologically, numerous large follicles containing hyperplastic germinal centers 12. Lymphoblastic lymphomas a. are usually of the B-cell type b. histologically show predominantly large lymphoid cells with immature nuclear chromatin c. occur predominantly in elderly persons d. appear with cutaneous lesions in fewer than one fifth of patients e. preferentially involve the trunk and legs when skin is involved 13. Slate-gray hyperpigmentation has been reported in association with administration of amiodarone, imipramine, and a. tetracyclines b. penicillamine c. chloropromazine d. isoniazid e. acyclovir 14. The most common site of localized tissue necrosis after treatment with Zyderm or Zyplast Collagen Implants is the a. glabella b. tip of the nose c. lateral canthus d. perioral region e. mental region 15. The most serious side effects of administration of cyclosporine are a. nephrotoxicity and hepatotoxicity b. nephrotoxicity and hypertension c. hepatotoxicity and hypertension d. hepatotoxicity and peripheral neuropathy e. none of the above 16. A drug is unlikely to cause toxic epidermal necrolysis (TEN) if its administration was begun more than 3 weeks before onset of TEN. An exception to this is
C M E examination f o r volume 25
31A
a. sulfonamides b. ampicillin c. allopurinol d. phenytoin e. nonsteroidal antiinflammatory agents 17. Side effects of lindane, which occur almost entirely when it is not used properly or is ingested, affect mainly the a. liver b. renal system c. hematopoietic system d. immune system e. central nervous system 18. In the standard photopatch test, topical application of the test substance is followed by irradiation with a. UVA radiation (320 to 400 nm) b. UVB radiation (280 to 320 nm) c. UVA + UVB radiation (280 to 400 nm) d. a range of different wavelengths beginning with UVB (280 to 320 nm) and extending through the visible spectrum e. a range of different wavelengths beginning with UVA (320 to 400 nm) and extending through the visible spectrum 19. Lesions of hydroa vacciniforme can consistently be reproduced in patients with the disease by repeated exposure to a. Soret band irradiation b. UVA irradiation c. UVB irradiation d. UVC irradiation e. none of these choices is correct 20. Peptide T is thought to counteract the dissemination of human immunodefieiency virus infection by a. binding to the gpl20 glycoprotein or viral envelopes b. binding to free gpl20 glycoprotein in the serum c. blocking virus and gp 120 glycoprotein binding at the CD4 receptor d. blocking virus and gpl20 glycoprotein binding at the CD8 receptor e. blocking binding of vasoactive intestinal polypeptide 21. Examination of nongenital cutaneous squamous cell carcinomas for human papillomaviruses (HPV) in patients with epidermodysplasia verruciformis usually demonstrates the presence of a. HPV type 5 (HPV-5) b. HPV-14 c. HPV-16 d. HPV-18 e. no HPV 22. The most potent chemotactic factor for eosinophils in
Continued on page 34A
34A
CME examination for volume 25
the late phase response of a cutaneous allergic reaction is a . platelet-activating factor b. eosinophil chemotactic factor of anaphylaxis c. eosinophil peroxidase d. eosinophil major basic protein e. leukotriene C4 23. Whichofthefollowingreactionsis (are) catalyzed by thrombin? a, Fibrinogen to D-monomer b. Fibrinogen to fibrin monomer c. Fibrin monomer to cross-linked fibrin d. Cross-linked fibrin to D-dimer e. Both fibrinogen to D-monomer and cross-linked fibrin to D-dimer 24. Which of the following reactions is (are) catalyzed by fibrin? a. Fibrinogen to D-monomer b. Fibrinogen to fibrin monomer c. Fibrin monomer to cross-linked fibrin d. Cross-linked fibrin to D-dimer e. Both fibrinogen to D-monomer and cross-linked fibrin to D-dimer 25. A gene for the cutaneous malignant melanoma-dysplastic nevus syndrome has been demonstrated on chromosome a. 1 b. 2 c. 7 d. 9 e. 14
Directions for questions 26-28: Select the one lettered item most closely related to each numbered item.
Journal of the American Academy of Dermatology
a. C D l a (OKT6) b. CD3 (anti-Leu-4) c. CD4 (anti-Leu-3a) d. CD8 (OKT8) e. CD38 (OKT 10) 26. Activated lymphocytes (regardless of type) 27. Mature T cells (regardless of type) 28. Langerhans cells
Directions for questions 29-31: Select the one lettered item most closely related to each numbered item. a. Laugier-Hunziker syndrome b. Labial melanotic macules c, Both d. Neither 29. Lesions are often present on the lower lip, 30. Multiple lesions are usuaUy present. 31. Histologie examination shows an increased number of suprabasal melanocytes.
Directions for questions 32 and 33: Select the one lettered item most closely related to each numbered item. a. Acitretin b. Etretinate c, Both d. Neither 32. Must be metabolized to another compound to become active. 33. Elimination half-life is similar to that of 13-cis-ret. inDic acid.