IOURNAL O[ the A m e m c a N A c a D e m y OF

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

In the June and December issues each year, CME questions based on articles in the preceding vo lume o f the JOURNAL appear. Two hours o f Category 1 C M E credit can be earned by reading the text material , reporting the answers on the per fora ted answer sheet, and fo l lowing instructions for Category 1 CME credit.--Editor

CME examination for volume 15" Identification No. 887-306

Instructions for Category I CME credit and answers to this examination appear in the front advertising section. See last page of Contents for page number.

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

1. Features found in most patients with the Papillon- Lef~vre syndrome include a. premature loss of permanent but not deciduous

teeth b. diffuse palmoplantar keratoderma c. hair defects d. nail defects e. autosomal dominant inheritance

2. Features of the Hermansky-Pudlak syndrome in- clude all of the following, except a, usual occurrence in Scandinavians b. albinism c. bleeding problems d. eye anomalies e. bowel or pulmonary disease

3. In approximately what proportion of cases of pyo- derma gangrenosum is no associated systemic dis- ease found? a, 1/10 b, 1/5 c. 1/2 d. 2/3 e. 4/5

4. Epidemiologic studies of melanoma indicate that all of the following are true, except a. persons who bum easily, rather than tan, in

response to sunlight are at increased risk of developing melanoma

*Includes entire volume with the exception of CME articles.

28A

b. habitual but intermittent sun exposure during recreational activities is a predisposing factor

c. painful or blistering sunburns are a predisposing factor

d. use of sunscreens does not reduce the incidence of melanoma

e. women are more likely than men to develop melanomas on their legs

5. The skin lesions of atopic dermatitis are heavily colonized with a. Staphylococcus aureus b. Streptococcus hemolyticus c. Escherichia coli d. Pseudomonas aeruginosa e. Pityrosporum orbiculare

6. Exogenous ochronosis has been reported to result from application or administration of a. guinine b. antimalarials c. phenol d. ampicillin e. hydroquinone-containing bleaching creams

7. The most important cause of pseudomembranous colitis induced by clindamycin treatment is a. Bacteroides fragilis b. Clostridium difficile c. Escherichia coli d. Staphylococcus aureus e. no organism is causative

8. Results obtained to date from experiments in ani- mals and cell cultures indicate that the primary physiologic role of retinoic acid is in a. inhibition of cellular glucose metabolism b. stimulation of cellular ribosome synthesis c. inhibition of cellular ribosome synthesis d. modulating cellular differentiation e. promotion of cellular apoptosis

9. Plasma levels of yon Willebrand coagulation factor are maintained by release from

Volume 16 Number 6 June 1987 CME examination for volume 15 31A

a. megakaryocytes b. platelets c. monocytes d. endothelial cells e. hepatocytes

10. Clinical features of subacute cutaneous lupus er- ythematosus include all of the following, except a. erythema b. telangiectasias c. scale d. atrophy e. annularity

l 1. A trichodiscoma characteristically shows all of the following histologic features, except a. Merkel cells b. association with a hair follicle c. fibrovascular architecture d. good demarcation but lack of a capsule e. alcian blue (pH 2.5)-positive material

12. Indeterminate cells, as have been found in patients showing multiple skin tumors of such cells, show all of the following features, except a. dendritic structure b. Birbeck granules c. Ia-like antigen d, T4 antigen (in some cases) e. T6 antigen

13. The synthetic analog, N-formyl-methionyl-leucyl- phenylalanine, is used in experimental studies pri- marily as a a. chemotaxin for monocytes and neutrophils b. migration inhibitory factor for monocytes c. migration inhibitory factor for neutrophils d. precipitation factor for immune complexes e. toxin with specificity for macrophages

14. The most potent naturally occurring lipid chemo- taxin for neutrophils and monocytes in humans is a. prostaglandin A2 b. prostaglandin DE C. prostaglandin E2 d. leukotriene B4 e. leukotriene D4

15. AIDS (acquired immunodeficiency syndrome) is thought to result from selective destruction of lym- phocytes bearing the marker a. Leu-1 b. Leu-4 c. Leu-5 d. T4 e. T9

16. Which of the following monoclonal antibodies is

specific for interleukin 2 (T cell growth factor) receptor (CD25 antigen)? a. Ki-67 b. Anti-Tac c. OKT6 d. EMBl l e. KB90

17. A nuclear antigen found in proliferating cells is identified by which of the following monoclonal antibodies? a. Ki-67 b. Anti-Tac c. OKT6 d, EMBl l e. KB90

18. All of the following are considered to be activation antigens, antigens that appear on cells with im- munocompetent differentiation following activa- tion, stimulation, or transformation, except a. HLA-DR b. HLA-DQ c. Tac d. Leu-4/Leu-5 e. T9

19. Circulating IgA antiendomysial antibody has been detected in patients with a. bullous pemphigoid b. linear IgA dermatosis c. dermatitis herpetiformis d. pemphigus e. ulcerative colitis

20. Sparganosis is usually acquired by a. contact with infected cattle b. contact with infected cats or dogs c. inhalation of infected dust particles d. eating contaminated food e. drinking contaminated water

21. Cheyletosis is usually acquired by a. contact with infected cattle b. contact with infected cats or dogs c. inhalation of infected dust particles d. eating contaminated food e. drinking contaminated water

Directions for questions 22-26: For each num- bered item choose the most appropriate lettered response. Each lettered response may be used once, more than once, or not at all.

a. Niacin (nicotinic acid) and/or nicotinamide b. Ascorbic acid c. Thiamine

34A CME examination for volume 15 American Academy of

Dermatology

d. Biotin e. Cobalamin

22. Burns of large areas of skin are associated with deficiency of this vitamin

23. Deficiency results in pellagra 24. Deficiency results in beriberi 25. Deficiency results from excessive ingestion of raw

egg white 26. Hartnup disease shows skin changes similar to

those due to deficiency of this vitamin

Directions for questions 27-31: For each num- bered item choose the single most appropriate let- tered response.

a. Cutaneous T cell lymphoma b. Adult T cell leukemia-lymphoma c. Both d. Neither

27. The major cell population in lesional tissue consists of T helper lyrnphocytes

28. Hypercalcemia occurs in about half of patients 29. Bone marrow involvement is an early complication 30. HTLV-I (virus) can be demonstrated in some cases 31. Antibodies reactive against HTLV-I can be dem-

onstrated in almost all cases

Directions for questions 32 and 33: lndicate cor- rect answers. All, some, or none of the choices may be correct.

32. Tumors that occur in multiple form as autosomal dominant genodermatoses, but more commonly occur as solitary or systematized nonhereditary le- sions, include a. trichoepithelioma b. trichilemmoma c. cylindroma d. eccrine poroma e. sebaceous adenoma

33. Treatments tested and approved for management of chancroid, and to which more than half of iso- lates of Ducrey's bacillus are reactive, include a. tetracycline, 500 mg four times a day for 14

days b. erythromycin, 500 mg four times a day for 14

days c. ampicillin, 500 mg four times a day for 14 days d. trimethoprin 160 mg and sulfamethoxazole 800

mg (Bactrim DS), one tablet every 12 hours for 14 days

e. ceftriaxone, 250 mg four times a day for 7 days

A doctor ought to be able to tell when a dying patient has stopped suffering so that he can direct his attention to the suffering family.*

Eugene A. Stead, Jr., M.D.

The more well you are, the more drugs you can take without getting sick. That's why doctors don't get into more trouble than they do with therapy.*

Eugene A. Stead, Jr., M.D.

*Wagner GS, Cebe B, Rozear MP. E. A. Stead, Jr. What this patient *Wagner GS, Cebe B, Rozear MP. E. A. Stead, Jr. What this patient needs is a doctor. Durham: Carolina Academic Press, 1978:13. needs is a doctor. Durham: Carolina Academic Press, I978:80.