CME examination Identification No. 886-101

Instructions for Category 1 CME credit appear in the front advertising section. See last page of Contents for page number.Questions 1-33, Truhan AP, Roenigk HH Jr: J AM ACAD DERMATOL 14:1-18, 1986.

Directions for questions 1-19: Give single bestresponse.

1. The most common cause of hypothyroidism inadults isa. primary idiopathic hypothyroidismb. Hashimoto's thyroiditisc. pituitary failured. hypothalamic failuree. ablative surgery

2. The second most common cause of hypothyroidismin adults isa. primary idiopathic hypothyroidismb. Hashimoto's thyroiditisc. pituitary failured. hypothalamic failuree. ablative surgery

3. In congenital hypothyroidism, myxedema is leastpronounced in which of the following sites?a. Neckb. Armsc. Legsd. Eyelidse. Genitalia

4. All of the following are signs of hypothyroidism,excepta. yellowish discoloration of the palms, soles, and

nasolabial foldsb. increased eccrine activityc. decreased sebaceous activityd. keratotic lesions on the elbows, knees, and

buttockse. eczema craquele

5. All of the following are characteristic of hypothy­roidism, excepta. fine, silky texture of hairb. decreased rate of hair growthc. loss of scalp haird. loss of beard haire. loss of sexual hair

6. All of the following are signs of congenital hy­pothyroidism, except (a)a. cool, mottled, pale skinb. uniformly receding hairlinec. broad, flat nose with thickened lipsd. broad hands with stubby fingerse. short, thickened neck

7. Of the following, the latest change to appear incongenital hypothyroidism is usuallya. respiratory difficultiesb. sluggishnessc. feeding problemsd. myxedemae. unexplained prolongation of physiologic

jaundice8. Graves' disease is characterized by all of the fol­

lowing, except (a)a. diffusely enlarged toxic goiterb. exophthalmiac. pretibial myxedemad. acropachye. decreased levels of serum long-acting thyroid

stimulator

9. Characteristics of the skin in Graves' disease in­clude all of the following, except (a)a. soft and smooth textureb. vasodilatation and increased cutaneous per-

fusionc. rapidly growing nailsd. patchy hyperpigmentatione. exacerbation of acne

10. All of the following resolve following surgicaltreatment for Graves' disease, excepta. facial flushingb. palmar erythemac. pretibial myxedemad. dryness of the skine. alterations in hair texture

11. All of the following statements regarding pretibialmyxedema are correct, except ita. commonly arises after surgical therapy for thy­

rotoxicosisb. commonly arises after radioactive iodine ther­

apy for thyrotoxicosisc. can develop in the absence of hyperthyroidismd. may develop years following treatment for hy­

perthyroidisme. is invariably asymptomatic

12. The overall incidence of pretibial myxedema inGraves' disease is approximatelya. 1%-10%b. 20%-30%c. 40%-55%

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20 CME examination

d. 60%-75%e. 90%-100%

13. Among patients with Graves' disease with exoph­thalmos, the incidence of pretibial myxedema isapproximatelya. 1%-10%b. 20%-30%c. 40%-55%d. 60%-75%e. 90%-100%

14. Of the following, the most likely cause of sclero­myxedema is (a)(an)a. plasma cell dyscrasiab. endocrine imbalancec. liver diseased. renal diseasee. genetic predisposition

15. The paraprotein isolated from patients with sclero­myxedema is usuallya. IgAb. IgG, with kappa light chainc. IgG, with lambda light chaind. IgM, with kappa light chaine. IgM, with lambda light chain

16. Which of the following clinical presentations oflichen myxedematosis is most likely to be asso­ciated with a serum paraprotein?a. Generalized lichenoid papular eruptionb. Discrete papulesc. Localized lichenoid plaquesd. Urticarial plaquese. Nodular eruptions

17. All of the following sites are characteristic of in­volvement with scleromyxedema, except thea. handsb. elbowsc. superior aspect of the trunkd. facee. buccal mucosa

18. The most common site of the large-plaque erup­tions of reticular erythematous mucinosis is thea. groin and lower part of the abdomenb. midline of the upper aspect of the back and chestc. lateral aspects of the neck and the axillaed. lateral aspects of the trunk and lateral aspects

of the thighse. flexor surfaces of the arms and legs

19. The most commonly affected area in follicular mu­cinosis is thea. scalp

Journal of theAmerican Academy of

Dermatology

b. face and neckc. axillae and groind. trunke. arms and legs

Directions for questions 20-23. Select the one let­tered item that is most closely related to each num­bered item.

a. Alcian blue, pH 0.5b. Alcian blue, pH 2.5c. Methylene blued. Mucicarminee. Colloidal iron

20. Stains mucin red2I. Stains dennal mucin blue22. Stains dennal mucin blue-green23. Metachromatic stain for dermal mucin

Directions for questions 24-33: Indicate correctanswers. All, some, or none of the choices maybe correct.24. Metachromasia of dennal. mucin (predominantly

hyaluronic acid) is demonstrated by which of thefollowing tissue stains?a. Toluidine blueb. Methylene bluec. Alcian blue, pH 0.5d. Alcian blue, pH 2.5e. Thiamine

25. Dermal mucin is stained bya. colloidal ironb. mucicarminec. periodic acid-Schiff reagent (PAS)d. alcian blue, pH 0.5e. alcian blue, pH 2.5

26. Which of the following fail to resolve readilyfollowing pharmacologic treatment for Graves'disease?a. Facial flushingb. Palmar erythemac. Dryness of the skind. Exophthalmose. Alterations in hair texture

27. Severe pretibial myxedema tends to occur in pa­tients whoa. have exophthalmosb. develop their pretibial myxedema after surgical

treatmentc. develop their pretibial myxedema after radio­

active iodine treatment

Volume 14Number 1January, 1986

d. develop hypothyroidism after surgical treatmente. develop hypothyroidism after radioactive iodine

treatment28. Sclerornyxedema may be caused by certain

a. drugsb. bacterial infectionsc. fungal infectionsd. environmental factorse. thyroid dysfunctions

29. Current therapeutic modalities considered appro­priate for treatment of scleromyxedema includea. local radiation therapyb. electron beam treatmentc. dermabrasiond. melphalane. cyclophosphamide

30. Sc1eromyxedema has been found In associationwitha. esophageal aperistalsisb. peripheral neuropathyc. cardiovascular diseased. cerebrovascular disease

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e. no systemic disease (except for the sc1ero­myxedema)

31. Which of the following is characteristically alteredin reticular erythematous mucinosis?a. Serum cholesterolb. Serum triglyceridesc. Serum gamma globulinsd. Serum bilirubin levelse. Serum lactate dehydrogenase (LDH)

32. Scleredema tends to occur in association witha. diabetes mellitusb. liver diseasec. intestinal malabsorptiond. monoclonal gammopathye. certain infections

33. Extensive deposition of hyaluronic acid in the der­mis is sometimes present in lesional tissue ina. Degos' diseaseb. neurilemmomasc. neurofibromasd. nodular fasciitise. myxedema