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I O U R N A L O [ t h e

A m e R I c a N A c a D e m y OF

D e r M a T O L O G Y II I IIIII I • II

In the June and December issues each year, CME questions based on articles in the preceding volume of the JOURNAL will appear. Two hours o f Category 1 CME credit can be earned by reading the text material, reporting the answers on the perforated answer sheet, and following instructions for Category 1 CME credit. --Editor

CME examination for volume 6* Identification No. 882-312

See "Instructions for Category 1 CME Credit" on page 33A of the front advertising section. Answers appear on page 43A of this issue.

Directions for questions 1-21: Give single best response.

1. Incontinentia pigmenti achromians is said to have been initially reported by a. Dohi b. Ota c. Ito d. Kitamura e. Kimura

2. Porphyria cutanea tarda is due to a deficiency of a. coproporphyrinogen oxidase b. uroporphyrinogen I synthetase c. uroporphyrinogen III cosynthetase d. uroporphyrinogen decarboxylase e. 8-aminolevulinic acid dehydratase

3. Antibody of which of the following types has been shown to have specificity for suppressor T lym- phocytes? a. Leu 3A b. OKT3 c. OKT 4 d. OKT 6 e. OKT 8

4. Antibody-dependent cellular cytotoxicity (ADCC) is thought to be mediated by a. neutrophils b. macrophages c. B ceils d. T cells e. K cells

5. Topical application of dinitrochlorobenzene pri- marily stimulates a(an)

*Includes entire volume with the exception of CME articles.

a. IgA immune reaction b. IgE immune reaction c. IgG immune reaction d. IgM immune reaction e. T cell immune reaction

6. The most prevalent agent responsible for myce- toma in the United States is a. Acremonium (Cephalosporium) faleiforme b. Petriellidium (Alleseheria) boydii c. Madurella mycetomatis d. Noeardia asteroides e. Actinomadura (Nocardia) madurae

7. Bacilli of Mycobacterium tuberculosis are least plentiful in lesions of a. lupus vulgaris b. tuberculosis verrucosa cutis c. tuberculosis cutis colliquativa d. tuberculosis cutis orificialis e. tuberculosis cutis miliaris disseminata

8. A "railroad track" or "school of fish" pattern, consisting of organisms lying in parallel chains, is characteristically observed on microscopic exami- nation of the pathogen responsible for a. chancroid b. granuloma inguinale c. lymphogranuloma venereum d. erysipeloid e. erythrasma

9. The earliest changes in development of a decubitus ulcer have been found to occur in the a. epidermis b. ground substance and connective tissue of the

papillary dermis c. vessels of the papillary dermis d. ground substance and connective tissue of the

reticular dermis e. vessels of the reticular dermis

35A

38A CME examination for volume 6 Journal of the

American Academy of Dermatology

10. Which of the following is characteristic of papular acrodermatitis of childhood (the Gianotti-Crosti syndrome)? a. Pruritus b. Systemic symptoms c. Coalescence of skin lesions d. Lymphadenopathy e. Mucous membrane lesions

11. In approximately what proportion of patients with anogenital lesions of lichen sclerosus et atro- phicans have typical lesions of the disease been noted elsewhere on the skin? a. 10% b. 2O% c, 40% d. 60% e. 80%

12. An isolated finding of a focus of cutaneous gonorrhea located on the ventral penoscrotal raphe is most likely due to a. hematogenous spread of subclinical gonorrhea b, Iymphatic spread of subclinical gonorrhea c. direct implantation of the organism into normal

skin d. direct implantation of the organism into a con-

genital defect of the raphe e. direct implantation of the organism into a con-

genital defect of the urethra

13. Dermatitis in loco minoris resistentiae refers to an eczematoid process occurring in (a)(an) a. previously damaged skin b. congenital nevus c. site of steroid-induced atrophy d. host with a chromosome breakage syndrome

(e.g., ataxia telangiectasia) e. immunologically compromised host

14. Acrodermatitis enteropathica a. is transmitted by sex-linked inheritance b. is associated with increased absorption of zinc

from the small intestine c. is associated with a selective deficiency of the

cellular immune system, with the humoral im- mune system essentially intact

d. becomes more severe as the patient ages e. may be associated with an increased incidence

of cancer as the patient ages

15. Blanching cutaneous nodules are a sign of a cu- taneous a. neuroblastoma b. Wilms' tumor c. glomus tumor

d. neurilemmoma e. focus of brown fat

16. In which of the following disorders is nail dys- trophy characteristically present? a. Franceschetti-Jadassohn-Naegeli syndrome b. Dyskeratosis congenita c. Cantu's syndrome d. Berlin's syndrome e. Greither's syndrome

17. Tropical anhidrotic asthenia is a complication of treatment with a. chloroquine b. hydroxychloroquine c. quinacrine d. gold therapy e. systemic corticosteroids

18. All of the following statements regarding Langer- hans cells are true, except (they) a. probably originate in the bone marrow b. were first discovered in the epidermis c. remain fixed without further migration once in

place in the skin d. appear to play a role in immune surveillance e. appear to play a role in contact allergy

19. Patients with systemic lupus erythematosus who have antibody to cytoplasmic Ro antigen usually have all of the following characteristics, except a. photosensitivity b. dermatosis c. hypergammaglobulinemia d. positive fluorescent antinuclear antibody (con-

ventional methods) e, positive rheumatoid factor (conventional

methods)

20. D-Penicillamine has been found to be effective in the treatment of all of the following, except a. Wilson's disease b. cystinuria c. lead poisoning d. pemphigus erythematosus e. rheumatoid arthritis

21. Drugs that have been reported to be of benefit in the treatment of atrophic blanche include all of the following, except a. phenformin b. ethylestrenol c. dipyridamole d. aspirin in low doses e. aspirin in high doses

Directions for questions 22-24: For each num-

40 A CME examination for vohtme 6 Journal of the

American Academy of Dermatology

bered item choose the appropriate lettered item. a. Bullous pemphigoid b. Pemphigus vulgaris c. Both d. Neither

22. The mortality rate is approximately 5% 23, The most common cause of death is systemic in-

fection, particularly with Staphylococcus aureus 24. Bactericidal activity and chemotaxis in neutrophils

are depressed

Directions ,for questions 25-27: For each num- bered item choose the appropriate lettered item.

a. Griseofulvin b. Ketoconazole c. Both d. Neither

25. Inhibits demethylation of lanosterol 26. Inactivated in vitro by mycelia via demethylation 27. Static antifungal agent active only on growing

mycelia

Directions for questions 28-33: Indicate correct answers. All, some, o1" none o f the choices may be correc t ,

28. Which of the following offer significant protection from the effects of sunlight on a patient taking psoralens? a. Dense cloud cover b. Window glass c. Sunscreens containing para-aminobenzoic acid

(PABA) d. Sunscreens containing benzophenones e. Opaque sunscreens

29. Delayed hypersensitivity reactions to tattoos may be due to allergy to

a, cadmium b. chromium c. cobalt d. manganese e. mercury

30. In a patient with a facial ulcer and definite evi- dence of damage to the sensory root of the trigemi- nal nerve, the differential diagnosis of the ulcer should include (the) a. trigeminal trophic syndrome b. leprous trigeminal neuritis c. syphilis d. herpesvirus infection e. dermatitis artefacta

31. Findings that have been associated with dys- keratosis congenita include a. hyperhidrosis of the palms and soles b. bullae c. acrocyanosis d, low intelligence e. aplastic anemia

32. Epidermolysis bullosa acquisita may occur in as- sociation with a. ulcerative colitis b. Crohn's disease c. systemic amyloidosis d, multiple myeloma e, diabetes mellitus

33. Ketoconazole has been reported to be of benefit in the treatment of a. chronic mucocutaneous candidiasis b. coccidioidomycosis c. paracoccidioidomycosis d, histoplasmosis e. pityriasis versicolor