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CME examination for volume 9
IOURNAL 0 [ | h e
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DeFMaTOLOGY
~br MA'~~176 Z
In the June and D e c e m b e r issues each year, C M E questions the preceding v o l u m e o f the JOURNAL will appear. T w o hours credit can be earned by reading the text material, reporting perforated answer sheet, and following instructions for credit.--Editor
C M E e x a m i n a t i o n for volume 9*
IdentificationNo. 884-306
See "Instructions for Category 1 CME Credit" on page 27A of the front advertising section. Answers appear on page 35A of this issue. Directions f o r questions 1-17: Give single best response. 1. The founder of Japanese dermatology is considered to be a. Keozo Dohi b. Kanehiko Kitamura c. Shinichi Matsumoto d. Kensuke Mitsuda e. Hiroku Takebe 2. Monoclonal antibody OKT6, which binds to Iapositive epidermal cells (i.e., Langerhans cells), also binds to a large proportion of a. intrathymic lymphocytes b. peripheral blood T cells c. peripheral blood B cells d. monocytes e. keratinocytes 3. Immunohistochemical studies have shown S-100 protein in all of the following, except a. junctional, intradermal, and compound nevi b. Spitz nevi c. halo nevi d. fibrous papules e. melanomas 4. The quality, on histology, of being acid-fast (Ziehl-Neelsen, Fite-Faraco, and auramine fluorescence methods) a. depends upon the presence of a specific mucopolysaccharide seen only in cell walls of certain microorganisms b. depends upon the presence of a specific side chain that is found in mucopolysaccharides present only in cell wails of certain microorganisms *Includesentire volumewith the exceptionof CME articles.
based on articles in of Category 1 C M E the answers o n the Category 1 C M E
5.
6.
7.
8.
c. although not dependent on the presence of a single specific side chain or macromolecule, is specific for a certain class of mucopolysaccharides present only in cell walls of certain microorganisms d. is limited to the cell walls of certain microorganisms e. is not chemically specific and depends upon standardized methods to have meaning Complete absence of C4 due to genetic deficiency has been reported in association with a. systemic lupus erythematosus b. Goodpasture's syndrome c. myasthenia gravis d. Graves' disease e. hereditary angioneurotic edema Becket's melanosis (nevus) a. is usually congenital b. is more common in female than in male individuals c. has been described only in Caucasians and Orientals d. may be associated with bony and soft tissue abnormalities e. gives rise to melanoma in a significant proportion of cases Which of the following is most frequently found on clinical evaluation of patients with congenital lupus erythematosus? a. Glomerulonephritis b. Pneumonitis c. Pericarditis d. Heart block e. Encephalitis Tuboreticular inclusions found in cutaneous lesions of systemic or discoid lupus erythematosus, once thought to represent paramyxovirus nucleocapsids, are now believed to be part o f the rough endoplasmic reticulum. They are most abundant in 29A
Volume 10 Number 6 June, 1984
9.
10.
11.
I2.
13.
a. keratinocytes b. Langerhans cells c. Merkel cells d. fibroblasts e. endothelial cells The most characteristic histologic change observed to date in biopsies of keratosis palmoplantaris nummularis is a. acantholytic dyskeratosis b. epidermolytic hyperkeratosis c. orthokeratotic hyperkeratosis d. parakeratotic hyperkeratosis e. "dilapidated brick wall" acantholysis Erythema multiforrne most frequently occurs in association with a a. primary episode of herpes labialis due to type 1 virus b. primary episode of herpes labialis due to type 2 virus c. secondary episode of herpes labialis due to type 1 virus d. primary episode of herpes genitalis due to type 2 virus e. secondary episode of herpes genitalis due to type 2 virus All of the following statements regarding complications of varicella (chickenpox) are true, except a. serious complications may be seen with increased frequency in adults, compared with children with the disease b. serious complications are more likely to occur in association with the hemorrhagic variant of the disease c. serious complications are more likely to occur in association with the bullous variant of the disease d. in most adult patients with varicella pneumonia, the pulmonary disease is not severe e. varicella encephalitis is an important complication The rate-limiting barrier to diffusion of a topically applied drug from the surface of the skin into the systemic circulation is generally acknowledged to be the a. stratum corneum b. stratum granulosum c. stratum malpighii d. epidermal basement membrane e. papillary dermis Bleomycin, used in the intralesional injection of warts,
CME examination for volume 9
14.
15.
16.
17.
31A
a. binds primarily to ribonucleic acid (RNA), possibly by intercalating between stacked base pairs b. is most effective against cells in the G1 and S phases of the cell cycle c. is activated by a hydrolase, which shows increased activity in skin and lungs d. is markedly mutagenic in the Ames test e. is currently licensed in Canada for use on plantar and periungual warts Which of the following statements regarding allsodium cromoglycate, used for treatment of mast cell disease, is correct? a. It has been shown in vitro to decrease intracellular levels of cyclic adenosine monophosphate (cAMP). b. It has been shown to block mast cell degranulation in vitro. c. It has been found to decrease urinary histamine levels in patients with mast cell disease. d. It has been found to decrease urinary serotonin levels in patients with mast cell disease. Most of the complications of both isotretinoin and etretinate simulate those of excess administration of a. vitamin A b. vitamin D c. vitamin E d. certain essential amino acids e. certain mucopolysaccharides Which of the following known complications of oral D-penicillamine therapy is most likely to occur in a patient with primary biliary cirrhosis treated with this drug? a. Pemphigus vulgaris b. Mucous membrane pemphigoid c. Lichen planus d. Epidermolysis bullosa acquisita e. Elastosis perforans serpiginosa Most comparison studies have shown that the most effective and least toxic surgical antiseptic overall is a. isopropanol b. benzalkonium chloride c. chlorhexidine gluconate d. hexachlorophene e. povidine-iodine
Directions for questions 18-22: For each of the following numbered cutaneous manifestations, select the one most closely associated lettered recta-
32A
CME exammatton for volume 9
bohc disorder. Each lettered item may be used once, more than once, or not at all. a. Hartnup disease b. Bionn-responsive multiple carboxylase deficiency c. Prolidase deficiency d. Phenylketonuria e. Tyrosinemia, type II (Richner-Hanhart syndrome) 18. Erosive, focal, palmar-plantar keratoderma 19. Hypoplgmentation, atopic dermatitis, and focal scleroderma 20. Photosensitivity, alopecia, premature graying, and nail streaks 21. Skin fragility and chronic dermatitis 22. Sparse hair and periorificial dermatitis Dtrections for questions 23-25: For each numbered item, select the most appropriate lettered item. a Ultraviolet A (UVA) light irradiation b. Ultraviolet B (UVB) light irradiation c. Both d. Neither 23. Has a relatively greater effect on the dermis than on the epidermis of human skin 24. Causes a reduction in the numbers of Langerhans cells in the epidermis of human skin 25. A 2.5 minimal erythema dose (MED) to normal human skin produces a neutrophilic infiltrate Directions for questions 26 and 27: For each o f the following numbered items, select the one most appropriate lettered item. a. Epidermoid cyst b Tricbalemmal cyst c. Both d Neither 26 Related to the follicular xsthmus 27. Related to the follicular infundibulum Directions for questions 28-32: Indicate correct answers. All, some, or none of the choices may be correct.
Journal of the American Academy of Dermatology
28. Congemtal nevocellular nevi a. usually extend into the deep dermis up to or into subcutaneous fat b. usually show infiltration into or around dermal collagen, adnexae, vessels, and nerves c. occur more frequently in male than in female individuals d. occur more frequently on the trunk than noncongenital nevoceUular nevl e. if very large, g,ve rise to melanomas in a sxgnificant proportion of cases 29. Apoptotic keratinocytes are found in a. lichen planus b. erythema multiforme c. graft-versus-host reactions d. basal cell carcinomas e. Bowen's disease 30. Leprosy, in the United States, is endemic in certain areas of a. Kentucky b. Arkansas c. Lomsiana d. Alabama e. Texas 31. Melanoma occurring together with vitlligo-like leukoderma a. is observed at a greater than expected frequency m humans b. is observed at a greater than expected frequency m certain strains of animals c is associated with a better prognosis than melanoma occumng alone d. is assocmted with a relatively high frequency of ocular pigmentary disturbances e. is associated with a relatwely high frequency of uveins 32. Reported complications of psoralens plus ultraviolet A light (PUVA) therapy include a. acneiform eruptions b. hypertnchosls c herpes s~mplex d. pustular psoriasis e vltiligo
AmemcaN
AAD
AcaDemY
oF
DeFMaTOLOGY
~br MA'~~176 Z
In the June and D e c e m b e r issues each year, C M E questions the preceding v o l u m e o f the JOURNAL will appear. T w o hours credit can be earned by reading the text material, reporting perforated answer sheet, and following instructions for credit.--Editor
C M E e x a m i n a t i o n for volume 9*
IdentificationNo. 884-306
See "Instructions for Category 1 CME Credit" on page 27A of the front advertising section. Answers appear on page 35A of this issue. Directions f o r questions 1-17: Give single best response. 1. The founder of Japanese dermatology is considered to be a. Keozo Dohi b. Kanehiko Kitamura c. Shinichi Matsumoto d. Kensuke Mitsuda e. Hiroku Takebe 2. Monoclonal antibody OKT6, which binds to Iapositive epidermal cells (i.e., Langerhans cells), also binds to a large proportion of a. intrathymic lymphocytes b. peripheral blood T cells c. peripheral blood B cells d. monocytes e. keratinocytes 3. Immunohistochemical studies have shown S-100 protein in all of the following, except a. junctional, intradermal, and compound nevi b. Spitz nevi c. halo nevi d. fibrous papules e. melanomas 4. The quality, on histology, of being acid-fast (Ziehl-Neelsen, Fite-Faraco, and auramine fluorescence methods) a. depends upon the presence of a specific mucopolysaccharide seen only in cell walls of certain microorganisms b. depends upon the presence of a specific side chain that is found in mucopolysaccharides present only in cell wails of certain microorganisms *Includesentire volumewith the exceptionof CME articles.
based on articles in of Category 1 C M E the answers o n the Category 1 C M E
5.
6.
7.
8.
c. although not dependent on the presence of a single specific side chain or macromolecule, is specific for a certain class of mucopolysaccharides present only in cell walls of certain microorganisms d. is limited to the cell walls of certain microorganisms e. is not chemically specific and depends upon standardized methods to have meaning Complete absence of C4 due to genetic deficiency has been reported in association with a. systemic lupus erythematosus b. Goodpasture's syndrome c. myasthenia gravis d. Graves' disease e. hereditary angioneurotic edema Becket's melanosis (nevus) a. is usually congenital b. is more common in female than in male individuals c. has been described only in Caucasians and Orientals d. may be associated with bony and soft tissue abnormalities e. gives rise to melanoma in a significant proportion of cases Which of the following is most frequently found on clinical evaluation of patients with congenital lupus erythematosus? a. Glomerulonephritis b. Pneumonitis c. Pericarditis d. Heart block e. Encephalitis Tuboreticular inclusions found in cutaneous lesions of systemic or discoid lupus erythematosus, once thought to represent paramyxovirus nucleocapsids, are now believed to be part o f the rough endoplasmic reticulum. They are most abundant in 29A
Volume 10 Number 6 June, 1984
9.
10.
11.
I2.
13.
a. keratinocytes b. Langerhans cells c. Merkel cells d. fibroblasts e. endothelial cells The most characteristic histologic change observed to date in biopsies of keratosis palmoplantaris nummularis is a. acantholytic dyskeratosis b. epidermolytic hyperkeratosis c. orthokeratotic hyperkeratosis d. parakeratotic hyperkeratosis e. "dilapidated brick wall" acantholysis Erythema multiforrne most frequently occurs in association with a a. primary episode of herpes labialis due to type 1 virus b. primary episode of herpes labialis due to type 2 virus c. secondary episode of herpes labialis due to type 1 virus d. primary episode of herpes genitalis due to type 2 virus e. secondary episode of herpes genitalis due to type 2 virus All of the following statements regarding complications of varicella (chickenpox) are true, except a. serious complications may be seen with increased frequency in adults, compared with children with the disease b. serious complications are more likely to occur in association with the hemorrhagic variant of the disease c. serious complications are more likely to occur in association with the bullous variant of the disease d. in most adult patients with varicella pneumonia, the pulmonary disease is not severe e. varicella encephalitis is an important complication The rate-limiting barrier to diffusion of a topically applied drug from the surface of the skin into the systemic circulation is generally acknowledged to be the a. stratum corneum b. stratum granulosum c. stratum malpighii d. epidermal basement membrane e. papillary dermis Bleomycin, used in the intralesional injection of warts,
CME examination for volume 9
14.
15.
16.
17.
31A
a. binds primarily to ribonucleic acid (RNA), possibly by intercalating between stacked base pairs b. is most effective against cells in the G1 and S phases of the cell cycle c. is activated by a hydrolase, which shows increased activity in skin and lungs d. is markedly mutagenic in the Ames test e. is currently licensed in Canada for use on plantar and periungual warts Which of the following statements regarding allsodium cromoglycate, used for treatment of mast cell disease, is correct? a. It has been shown in vitro to decrease intracellular levels of cyclic adenosine monophosphate (cAMP). b. It has been shown to block mast cell degranulation in vitro. c. It has been found to decrease urinary histamine levels in patients with mast cell disease. d. It has been found to decrease urinary serotonin levels in patients with mast cell disease. Most of the complications of both isotretinoin and etretinate simulate those of excess administration of a. vitamin A b. vitamin D c. vitamin E d. certain essential amino acids e. certain mucopolysaccharides Which of the following known complications of oral D-penicillamine therapy is most likely to occur in a patient with primary biliary cirrhosis treated with this drug? a. Pemphigus vulgaris b. Mucous membrane pemphigoid c. Lichen planus d. Epidermolysis bullosa acquisita e. Elastosis perforans serpiginosa Most comparison studies have shown that the most effective and least toxic surgical antiseptic overall is a. isopropanol b. benzalkonium chloride c. chlorhexidine gluconate d. hexachlorophene e. povidine-iodine
Directions for questions 18-22: For each of the following numbered cutaneous manifestations, select the one most closely associated lettered recta-
32A
CME exammatton for volume 9
bohc disorder. Each lettered item may be used once, more than once, or not at all. a. Hartnup disease b. Bionn-responsive multiple carboxylase deficiency c. Prolidase deficiency d. Phenylketonuria e. Tyrosinemia, type II (Richner-Hanhart syndrome) 18. Erosive, focal, palmar-plantar keratoderma 19. Hypoplgmentation, atopic dermatitis, and focal scleroderma 20. Photosensitivity, alopecia, premature graying, and nail streaks 21. Skin fragility and chronic dermatitis 22. Sparse hair and periorificial dermatitis Dtrections for questions 23-25: For each numbered item, select the most appropriate lettered item. a Ultraviolet A (UVA) light irradiation b. Ultraviolet B (UVB) light irradiation c. Both d. Neither 23. Has a relatively greater effect on the dermis than on the epidermis of human skin 24. Causes a reduction in the numbers of Langerhans cells in the epidermis of human skin 25. A 2.5 minimal erythema dose (MED) to normal human skin produces a neutrophilic infiltrate Directions for questions 26 and 27: For each o f the following numbered items, select the one most appropriate lettered item. a. Epidermoid cyst b Tricbalemmal cyst c. Both d Neither 26 Related to the follicular xsthmus 27. Related to the follicular infundibulum Directions for questions 28-32: Indicate correct answers. All, some, or none of the choices may be correct.
Journal of the American Academy of Dermatology
28. Congemtal nevocellular nevi a. usually extend into the deep dermis up to or into subcutaneous fat b. usually show infiltration into or around dermal collagen, adnexae, vessels, and nerves c. occur more frequently in male than in female individuals d. occur more frequently on the trunk than noncongenital nevoceUular nevl e. if very large, g,ve rise to melanomas in a sxgnificant proportion of cases 29. Apoptotic keratinocytes are found in a. lichen planus b. erythema multiforme c. graft-versus-host reactions d. basal cell carcinomas e. Bowen's disease 30. Leprosy, in the United States, is endemic in certain areas of a. Kentucky b. Arkansas c. Lomsiana d. Alabama e. Texas 31. Melanoma occurring together with vitlligo-like leukoderma a. is observed at a greater than expected frequency m humans b. is observed at a greater than expected frequency m certain strains of animals c is associated with a better prognosis than melanoma occumng alone d. is assocmted with a relatively high frequency of ocular pigmentary disturbances e. is associated with a relatwely high frequency of uveins 32. Reported complications of psoralens plus ultraviolet A light (PUVA) therapy include a. acneiform eruptions b. hypertnchosls c herpes s~mplex d. pustular psoriasis e vltiligo