Pharmacology MCQs

Which of the following is considered most safe in pregnancy? 1

Benzoyl peroxide

2

Epinephrine

3

Methotrexate

4

Azelaic Acid

5

Isotretinoin

Q/Q(M)-482562 Report a Problem Which of the following is considered most safe in pregnancy? 4

Azelaic Acid

Azelaic Acid is pregnancy category B. The other choices ar e in less safe pregnancy categories. cate gories. Epinephrine is category C, Benzoyl peroxide is category C, and Methotrexate and Isotretinoin are category X. Q/Q(M)-482562 Report a Problem A patient presents with a likely likel y fixed drug eruption. Her medications include glyburide, lisinopril, hydrochlorthiazide, and aspirin, as well as an over-the-counter laxative. Which is the most likely culprit? 1

Glyburide

2

Lisinopril

3

Hydrochlorthiazide

4

Aspirin

5

Laxative

Q/Q(M)-475925 Report a Problem A patient presents with a likely likel y fixed drug eruption. Her medications include glyburide, lisinopril, hydrochlorthiazide, and aspirin, as well as an over-the-counter laxative. Which is the most likely culprit? 5

Laxative

Phenopthalein, found in laxatives, is a known cause of fixed drug eruptions. Q/Q(M)-475925 Report a Problem A non-pigmenting fixed drug eruption is known to be caused by what agent? 1

Tetracycline

2

Barbiturates

3

Phenopthalein

4

Naproxen

5

Pseudoephedrine

Q/Q(M)-474460 Report a Problem A non-pigmenting fixed drug eruption is known to be caused by what agent? 5

Pseudoephedrine

All agents listed are associated asso ciated with fixed drug eruptions, however, pseudoephedrine hydrochloride is the one most commonly associated with non-pigmenting fixed drug eruptions. 1

Q/Q(M)-474460 Report a Problem Which of the following drugs is correctly matched to its target enzymes? 1

Tacrolimus-Thymidine kinase

2

Methotrexate-Inosine monophosphate dehydrogenase

3

Mycophenolate Mofetil-Phospholipase A2

4

Acyclovir-DNA polymerase

5

Terbinafine-Cytochrome p450

Q/Q(M)-478611 Report a Problem Which of the following drugs is correctly matched to its target enzymes? 4

Acyclovir-DNA polymerase

Drug/Specific enzyme inhibited Tacrolimus - Calcineurin Methotrexate - Dihydrofolate reductase Mycophenolate mofetil - Inosine monophosphate dyhydogenase Acyclovir - DNA Polymerase Terbinafine - Squalene epoxidase Q/Q(M)-478611 Report a Problem Which of the following agents is NOT a UVB blocker? 1

Sulisobenzone

2

PABA

3

Cinnamates

4

Salicylates

5

Padimate A

Q/Q(M)-475902 Report a Problem Which of the following agents is NOT a UVB blocker? 1

Sulisobenzone

Sulisobenzone is a benzophenone, a UVA blocker. The others are UVB blockers. Padimate A is a PABA derivative. Q/Q(M)-475902 Report a Problem Which of the following is not a side effect of bleomycin? 1

Erythromelalgia

2

Pulmonary fibrosis

3

Flagellate hyperpigmentation

4

Serpentine supravenous hyperpigmentation

5

Acrosclerosis

Q/Q(M)-477725 Report a Problem Which of the following is not a side effect of bleomycin? 4

Serpentine supravenous hyperpigmentation

All of the above are side effects effe cts of bleomycin except serpentine supravenous hyperpigmentation. This is a side-effect of 5-fluorouracil. Q/Q(M)-477725 Report a Problem 2

Which one of the following antifungals requires an acidic environment for it s absorption? 1

amphotericin B

2

fluconazole

3

griseofulvin

4

terbinafine

5

itraconazole

Q/Q(M)-475859 Report a Problem Which one of the following antifungals requires an acidic environment for it s absorption? 5

itraconazole

Itraconazole is a triazole tria zole whose mechanism, like the other azoles, is inhibition of cytochrome P-450 enzyme lanosterol 14-alpha demethylase, with resultant inhibition of lanosterol conversion to ergosterol. Ergosterol is an essential component of fungal cell membranes. Itraconazole is a weak base, which is highly lipophilic and virtually insoluble in water. It is ionized only at a low pH. Griseofulvin is administered in divided doses for the treatment of tinea capitus. Its absorption is optimized when given with a fatty food. Oral fluconazole is very well absorbed when given orally with over 90%  bioavailability. Terbinafine, though highly highly lipophilic, has 70 to 80% absorption, absorption, when administered orally, with a bioavailability not significantly impacted by food intake. Q/Q(M)-475859 Report a Problem  Neutrophilic eccrine hidradenitis is associated most often with which chemotherapeutic agent? 1

5-fluorouracil

2

Cytarabine

3

Dactinomycin

4

Doxorubicin

5

Vinca alkaloids

Q/Q(M)-474471 Report a Problem  Neutrophilic eccrine hidradenitis is associated most often with which chemotherapeutic agent? 2

Cytarabine

 Neutrophilic eccrine hidradenitis occurs in neutropenic patients with malignancies, usually acute myelogenous leukemia. Cytarabine is the most commonly associated medication. Q/Q(M)-474471 Report a Problem A 10 year old child with a seizure disorder develops a morbiliform eruption and elevated LFT's two weeks after starting Dilantin therapy. As his physician you: 1

Continue Dilantin and treat rash with topical corticosteroids

2

Discontinue Dilantin and begin Phenobarbital

3

Discontinue Dilantin and begin carbamazepine

4

Restart Dilantin once the rash resolves

5

Discontinue Dilantin and begin valproic acid Q/Q(M)-477332 Report a Problem

3

A 10 year old child with a seizure disorder develops a morbiliform eruption and elevated LFT's two weeks after starting Dilantin therapy. As his physician you: 5

Discontinue Dilantin and begin valproic acid

Anticonvulsant hypersensitivity syndrome (also drug rash with eosinophilia and systemic symptoms (DRESS0 and dilantin hypersensitivity syndrome) presents with cutaneous eruption accompanied by fever, facial edema, lymphadenopathy, leukocytosis and hepatitis. Cross reactivity is present in all aromatic anticonvulsants including phenytoin, carbamazepine and phenobarbitol. There is no cross reaction with valprioc acid. Q/Q(M)-477332 Report a Problem If a patient develops a dilantin hypersensitivity reaction, which anticonvulsant is the better alternative therapy? 1

Carbamezapine

2

Phenytoin

3

Phenobarbital

4

Valproic acid

5

None of these answers are correct

Q/Q(M)-474123 Report a Problem If a patient develops a dilantin hypersensitivity reaction, which anticonvulsant is the better alternative therapy? 4

Valproic acid

Carbamezapine, phenytoin, and phenobarbital are known to cross-react with one another. Q/Q(M)-474123 Report a Problem Which of the following systemic corticosteroids has the highest glucocorticoid activity? 1

Betamethasone

2

Methylprednisolone

3

Triamcinolone

4

Cortisone

5

Hydrocortisone

Q/Q(M)-482746 Report a Problem Which of the following systemic corticosteroids has the highest glucocorticoid activity? 1

Betamethasone

Systemic corticosteroids are commonly used in dermatology. Short acting steroids, cortisone and hydrocortisone, have the greatest mineralocorticoid activity, while cortisone has the lowest glucocorticoid activity. Intermediate and long-acting steroids, methylprednisolone, triamcinolone, dexamethasone, and betamethasone, have virtually no mineralocorticoid activity. Dexamethasone and  betamethasone have the highest glucocorticoid activity. Q/Q(M)-482746 Report a Problem You see a patient with dark streaking in the nails, diffuse and oral hyperpigmented macules and trichomegaly. Which of the following medication are they taking? 1

Imatinib

2

Zidovudine

4

3

Hydroxyurea

4

Cyclophosphamide

5

Bleomycin

Q/Q(M)-480140 Report a Problem You see a patient with dark streaking in the nails, diffuse and oral hyperpigmented macules and trichomegaly. Which of the following medication are they taking? 2

Zidovudine

All of the listed medications have been reported to cause nail hyperpigmentation, but the addition of oral hyperpigmented macules and trichomegaly (lengthened anagen phase of the eyelashes). AZT can also cause bone marrow suppression with subsequent anemia and granulocytopenia. Q/Q(M)-480140 Report a Problem Which chemical sunscreen has UVB and UVA II absorption capabilit y? 1

Methyl anthranilate

2

Oxybenzone

3

Octyl salicylate

4

Titanium dioxide

5

Padimate O

Q/Q(M)-474462 Report a Problem Which chemical sunscreen has UVB and UVA II absorption capabilit y? 2

Oxybenzone

The benzophenones, oxybenzone and dioxybenzone, have the broadest absorption spectrum of the chemical sunscreens, with UVB and UVA II range. Methyl anthranilate absorbs UVA II, and octyl salicylate, and padimate O are UVB-absorbing chemicals. Titanium dioxide is not a chemical absorber, it is a physical blocker. Q/Q(M)-474462 Report a Problem Which of the following retinoids is most lipophilic? 1

Etretinate

2

Acitretin

3

Tretinoin

4

Bexarotene

5

Isotretinoin

Q/Q(M)-482755 Report a Problem Which of the following retinoids is most lipophilic? 1

Etretinate

Isotretinoin, acitretin, and bexarotene are water-soluble, with very little lipid deposition. Water-soluble retinoids are undetectable in the serum 1 month af ter stopping therapy. Etretinate is 50 times more lipophilic than acitretin. It can last several years in fatty tissues. Q/Q(M)-482755 Report a Problem Which of the following may cause an acneiform eruption? 1

Fluoxetine 5

2

Valproic acid

3

ACTH

4

Finasteride

5

Methotrexate

Q/Q(M)-474316 Report a Problem Which of the following may cause an acneiform eruption? 3

ACTH

Many medications are associated with acneiform acneif orm eruptions, including halogens (bromide and iodide), androgenic hormones such as testosterone, ACTH, corticosteroids, isoniazid (INH), lithium, phenytoin, and vitamins B2, B6 and B12. Q/Q(M)-474316 Report a Problem Which drug has been associated with cholestatic hepatitis? 1

Clindamycin

2

Erythromycin

3

Rifampin

4

Doxycycline

5

Ampicillin

Q/Q(M)-475198 Report a Problem Which drug has been associated with cholestatic hepatitis? 2

Erythromycin

The estolate form of erythromycin has been associated with cholestatic hepatitis. Q/Q(M)-475198 Report a Problem What antihistamine can cause gynecomastia, impotence, and loss of libido? 1

Cyproheptadine

2

Chlorpheniramine

3

Cimetidine

4

Doxepin

5

Fexofendine

Q/Q(M)-474465 Report a Problem What antihistamine can cause gynecomastia, impotence, and loss of libido? 3

Cimetidine

Cimetidine competitively inhibits dihydrotestosterone at the androgen receptor site and can exhibit anti androgen effects. Q/Q(M)-474465 Report a Problem Which of the following is NOT known to increase methotrexate levels? 1

Salicylates

2

Tetracyclines

3

Phenothiazines 6

4

NSAIDs

5

None of these answers are correct(all are known to increase methotrexate levels)

Q/Q(M)-475209 Report a Problem Which of the following is NOT known to increase methotrexate levels? 5

None of these answers are correct(all are known to increase methotrexate levels)

Tetracyclines, phenytoin, phenothiazines, chloramphenicol, NSAIDs, salicylates, and sulfonamides, among other drugs, can all increase methotrexate l evels by displacement of plasma proteins. Q/Q(M)-475209 Report a Problem A patient with a long standing history of nodulocystic acne vulgaris on isotretinoin should avoid tetracyclines with the drug to avoid complications such as: 1

Vitamine A exaggerated effect

2

Pseudotumor cerebri

3

Hepatotoxicity

4

Elevated triglycerides

5

Arthralgias

Q/Q(M)-482903 Report a Problem A patient with a long standing history of nodulocystic acne vulgaris on isotretinoin should avoid tetracyclines with the drug to avoid complications such as: 2

Pseudotumor cerebri

Isotretinoin is a oral retinoid that t hat helps with nodulocystic acne. When isotretinoin is combined with tetracycline there is an increased risk for pseudotumor cerebri. It should not be used together or in  patients with a history of pseudotumor cerebri that has been diagnosed diagnosed by a neurologist. Pseudotumor cerebri can be diagnosed by measuring the intraocular pressure, in which it will be elevated. Q/Q(M)-482903 Report a Problem How long after isotretinoin therapy can one safel y begin trying to conceive? 1

Immediately

2

Two weeks

3

One month

4

One year

5

Three years

Q/Q(M)-477507 Report a Problem How long after isotretinoin therapy can one safel y begin trying to conceive? 3

One month

A woman should wait one month before trying to conceive after taking isotreti noin to prevent birth defects. After taking acitretin acitreti n a woman should wait three years before trying tr ying to conceive. Q/Q(M)-477507 Report a Problem What is the best medication to lower isotretinoin induced hypertriglyceridemia? 1

Simvastatin 7

2

Gemfibrozil

3

Niacin

4

Cholestyramine

5

All are equally effective

Q/Q(M)-476701 Report a Problem What is the best medication to lower isotretinoin induced hypertriglyceridemia? 2

Gemfibrozil

Gemfibrozil generally reduces trygliceride levels to a greater extent than niacin, cholestyramine, and the HMG-CoA reductase inhibitors. Q/Q(M)-476701 Report a Problem A patient who has been on dapsone for dermatitis herpetiformis develops c yanosis and appears symptomatic. This patient is diagnosed with methemoglobinemia by his primary care doctor after doing a complete blood count and hemoglobin. The deficiency that this patient most likely has is: 1

Glucose-6-phosphate dehydrogenase (G6PD)

2

Agranulocytosis

3

Aplastic Anemia

4

Pancytopenia

5

Xanthine Oxidase Deficiency

Q/Q(M)-482901 Report a Problem A patient who has been on dapsone for dermatitis herpetiformis develops c yanosis and appears symptomatic. This patient is diagnosed with methemoglobinemia by his primary care doctor after doing a complete blood count and hemoglobin. The deficiency that this patient most likely has is: 1

Glucose-6-phosphate dehydrogenase (G6PD)

Dapsone is used in the treatment of dermatitis herpetiformis. Contraindications include severe cardiovascular disease, marked renal insufficiency, and sulfonamide allergy. Patients need to be screened for glucose-6-phosphate dehydrogenase (G6PD) deficiency. This is common among blacks and Asians. Q/Q(M)-482901 Report a Problem Which of the following sclerotherapy agents can have a disulfiram like reaction? 1

polidocanol

2

sodium morrhuate

3

glycerin

4

hypertonic saline

5

sodium tetradecyl sulfate

Q/Q(M)-482919 Report a Problem Which of the following sclerotherapy agents can have a disulfiram like reaction? 1

polidocanol

Polidocanol is a detergent type of sclera agent a gent and can have a disulfiram like reaction. reacti on. It also has a very rare risk of anaphylaxis. Sodium morrhuate is also a detergent sclera agent and has the highest hi ghest risk of anaphylaxis. Q/Q(M)-482919 Report a Problem The medication most acceptable for usage in patients with renal failure is: 8

1

Tetracycline

2

Minocycline

3

Demeclocycline

4

Oxytetracycline

5

Doxycycline

Q/Q(M)-474118 Report a Problem The medication most acceptable for usage in patients with renal failure is: 5

Doxycycline

Renal failure may prolong the half-life of most tetracyclines except doxycycline. Doxycycline is excreted via the GI tract, unlike the other tetracyclines. Q/Q(M)-474118 Report a Problem Which of the following is a low sedation metabolite of hydroxyzine? 1

Fexofenadine

2

Cetirizine

3

Loratadine

4

Cyproheptadine

5

Ranitidine

Q/Q(M)-475911 Report a Problem Which of the following is a low sedation metabolite of hydroxyzine? 2

Cetirizine

Cetirizine is a second-generation H1 antihistamine that is a low sedation metabolite of hydroxyzine. Q/Q(M)-475911 Report a Problem What is used to reduce bladder toxicity from cyclophosphamide? 1

Mesna

2

Leukovorin

3

Cimetidine

4

Vitamin E

5

Folic acid

Q/Q(M)-474452 Report a Problem What is used to reduce bladder toxicity from cyclophosphamide? 1

Mesna

Mesna or sodium 2-mercptoethanesulfonate, has been used to reduce bladder toxicity from cyclophosphamide. Q/Q(M)-474452 Report a Problem What is the difference between podophyllin and podophyllotoxin? 1

Essentially the same; they are interchangable in terms of treatment and side effects

2

Podophyllotoxin contains quercetin which is a potent mutagens

3

Podophyllin contains kaempherol which is a potent mutagens 9

4

Podophyllotoxin is a phosphodiesterase inhibitor

5

Podophyllin reversibly binds tubulin inhibiting cells in metaphase

Q/Q(M)-477637 Report a Problem What is the difference between podophyllin and podophyllotoxin? 3

Podophyllin contains kaempherol which is a potent mutagens

Podophyllotoxin, also known as podofilox or Condolox, is a anti -mitotic agent that reversibly reversi bly binds tubulin, arresting cells in metaphase. It is i s used topically to treat genital warts. w arts. Podophyllin, which has the same mechanism of action, contains kaempero and quercetin which are potent mutagens. Both are derived from the May Apple plant. Cantharin, an antiviral agent derived from the Blister beetle, is a  phosphodiesterase inhibitior. Q/Q(M)-477637 Report a Problem Imiquimod is FDA approved for the treatment of which of the following? 1

Actinic keratosis

2

Squamous cell carcinoma in situ

3

Infiltrative basal cell carcinoma

4

Superficial spreading melanoma

5

Psoriasis vulgaris

Q/Q(M)-482821 Report a Problem Imiquimod is FDA approved for the treatment of which of the following? 1

Actinic keratosis

Imiquimod is FDA approved for the treatment of actinic keratoses, s uperficial basal carcinomas, and condyloma acuminate. It is not used to treat infiltr ative basal cell carcinomas, squamous cell carcinoma in situ, superficial spreading melanoma, or psoriasis . Off label uses include common warts, molluscum contagiosum, Bowen �s disease (SCCIS), and keloids. Q/Q(M)-482821 Report a Problem Combination oral contraceptives decrease free testosterone levels by: 1

Directly binding free testosterone

2

Increasing SHBG (sex hormone binding globulin) production

3

Acting as competitive inhibitors of the androgen receptor

4

Acting as a GnRH agonist

5

Acting as a GnRH antagonist

Q/Q(M)-474322 Report a Problem Combination oral contraceptives decrease free testosterone levels by: 2

Increasing SHBG (sex hormone binding globulin) production

Oral contraceptives decrease free testosterone levels by increasing the production of sex hormone  binding globulin (SHBG). (SHBG). Q/Q(M)-474322 Report a Problem Which of the following antifungal agent works by way of inhibiting ergosterol synthesis by blocking squalene epoxidation: 1

Itraconazole 10

2

Terbinifine

3

Naftifine

4

Itraconazole and Terbinifine

5

Terbinifine and Naftifine

Q/Q(M)-478622 Report a Problem Which of the following antifungal agent works by way of inhibiting ergosterol synthesis by blocking squalene epoxidation: 5

Terbinifine and Naftifine

Terbinafine and Naftifine work by way of inhibiting ergosterol synthesis by blocking squalene epoxidation (B&C). Itraconazole works by inhibiting ergosterol synthesis by blocking Lanosterol 14alpha demthylase. Q/Q(M)-478622 Report a Problem Anemia, leg ulcers, poikilodermatous skin changes, hepatitis, renal toxicity, and acral erythema are most commonly associated with what medication? 1

5-fluorouracil

2

Hydroxyurea

3

Cyclosporine

4

Methotrexate

5

Doxorubicin

Q/Q(M)-474131 Report a Problem Anemia, leg ulcers, poikilodermatous skin changes, hepatitis, renal toxicit y, and acral erythema are most commonly associated with what medication? 2

Hydroxyurea

The constellation of adverse effects is most closely associated with hydroxyurea. Q/Q(M)-474131 Report a Problem Which of the following are retinoid side effects? 1

Reversible hypothyroidism

2

Diffuse interstitial skeletal hyperostosis

3

Premature epiphyseal closure

4

Pseudotumor cerebri

5

All of these answers are correct

Q/Q(M)-475619 Report a Problem Which of the following are retinoid side effects? 5

All of these answers are correct

Bexarotene has been shown to cause reversible h ypothyroidism, not hyperthyroidism. hyperthyroidism. Systemic retinoids have been shown to cause diffuse interstitial skeletal hyperostosis, premature epiphyseal closure, and  pseudotumor cerebri (risk increased with concommitant use of tetracyclines). Q/Q(M)-475619 Report a Problem A 58-year old female receives thio-TEPA (trietheylenethiophosphoramide) for adenocarcinoma of the  breast. Which of the following cutaneous side effects might she expect? 11

1

Generalized hyperpigmentation sparing the palmar creases and mucous membranes

2

Hyperpigmentation of the teeth with permanent pigmentation of the gingival margin

3

Intense flushing of the skin

4

Hyperpigmentation of the axillae

5

Alternating colors of hair

Q/Q(M)-482270 Report a Problem A 58-year old female receives thio-TEPA (trietheylenethiophosphoramide) for adenocarcinoma of the  breast. Which of the following cutaneous side effects might she expect? 4

Hyperpigmentation of the axillae

Thio-TEPA is an alkylating agent used in a variety of cancers. It can cause pruritus, urticaria, angioedema, and hyperpigmentation localized to occluded areas. Generalized Addisonianhyperpigmentation may be caused by busulfan. Hyperpigmentation of the teeth with discoloration of the gingival margins is associated with cyclophosphamide. c yclophosphamide. Intense Intense flushing of the skin is usually seen with dacarbazine and carmustine. Alternating colors of hair, representing the "flag sign," can be seen se en with methotrexate. Q/Q(M)-482270 Report a Problem Which of the following statements regarding antifungal medications is TRUE? 1

Griseofulvin is safe for patients with variegate porphyria

2

Ketoconazole has been associated with gynecomastia

3

Griseofulvin is a cytochrome P450 3A4 inhibitor

4

Terbinafine is fungistatic

5

Ketoconazole is fungicidal

Q/Q(M)-477568 Report a Problem Which of the following statements regarding antifungal medications is TRUE? 2

Ketoconazole has been associated with gynecomastia

Medications that can precipitate acute attacks in variegate porphyria include barbiturates, estro gen, griseofulvin, sulfonamides and ethanol. Ketoconazole can produce impotence and gynecomastia by interfering with androgen synthesis. Ketoconazole inhibits cytochrome (CYP) P450 and most concerning, can rarely cause fulminant hepatitis. Griseofulvin induces CYP P450, not inhibits it. Terbinafine is fungicidal along with amphotericin B. Ketoconazole is fungistati c. Q/Q(M)-477568 Report a Problem The following drugs have been implicated in drug-induced subacute cutaneous lupus erythematosus: 1

Terbinafine

2

Verapamil

3

Pravastatin

4

All the above are correct

5

None of the above are correct Q/Q(M)-477727 Report a Problem

The following drugs have been implicated in drug-induced subacute cutaneous lupus erythematosus:

12

4

All the above are correct

All of the above choices have been implicated in drug-induced subacute cutaneous lupus erythematosus. Q/Q(M)-477727 Report a Problem Which of the following medications is most likely to have caused this reaction? 1

Pseudoephedrine hydrochloride

2

Vancomycin

3

Lithium

4

ACE inhibitor

5

Diclofenac Q/Q(M)-476869 Report a Problem

Which of the following medications is most likely to have caused this reaction? 1

Pseudoephedrine hydrochloride

Fixed drug eruptions occur 30 mintues to 8 hours after ingestion of offending agent. After rechallenge with the same agent, the fixed drug eruption will recur. Potential causes of a fixed drug eruption include analgesics, sulfonamides, barbituates, pseudoephedrine and anticonvulsants. Q/Q(M)-476869 Report a Problem Which site of the body has the highest penetration ability when topical medications applied 1

Face

2

Eyelids

3

Scrotum

4

Mucous membrane

5

Upper arms and legs Q/Q(M)-482114 Report a Problem

Which site of the body has the highest penetration ability when topical medications applied 4

Mucous membrane

Drug penetration varies depending on body site and thickness of stratum corneum. An important consideration in topical therapy is that abnormal skin may have an alt ered (increased, decreased, or absent) stratum corneum, thus changing the body site's barrier function. Regional penetration of topical therapy is ranked from highest penetration to less penetration as following: Mucous membrane > scrotum > eyelids > face > chest and back > upper arms and legs > dorsal hands and feet > palms and 13

soles > nails Q/Q(M)-482114 Report a Problem The mechanism of action of mycophenolate mofetil most closel y resembles that of what other drug? 1

Cyclophosphamide

2

Doxorubicin

3

Azathioprine

4

Hydroxyurea

5

Chlorambucil Q/Q(M)-474127 Report a Problem

The mechanism of action of mycophenolate mofetil most closel y resembles that of what other drug? 3

Azathioprine

Both azaithioprine and mycophenolate mofetil directly interfere with purine synthesis. Q/Q(M)-474127 Report a Problem Which drug has been associated with an increased incidence of serum sickness in children? 1

Rifampin

2

Clarithromycin

3

Ciprofloxacin

4

Clindamycin

5

Cefaclor Q/Q(M)-475196 Report a Problem

Which drug has been associated with an increased incidence of serum sickness in children? 5

Cefaclor

Cefaclor has been associated with an increased incidence of serum sickness in children; the other drugs have not. Q/Q(M)-475196 Report a Problem Which of the following drugs may cause acute generalized exanthematous pustulosis? 1

Ampicillin

2

Azithromycin

3

Cefazolin

4

Mercury

5

All of these answers are correct Q/Q(M)-475924 Report a Problem

Which of the following medications would you not want a woman using an IUD as her only source of contraception to take? 14

1

Ibuprofen

2

Cefalexin

3

Etanercept

4

Infliximab

5

Lidocaine

Q/Q(M)-480143 Report a Problem Which of the following medications would you not want a woman using an IUD as her only source of contraception to take? 1

Ibuprofen

 NSAIDS (including ibuprofen) ibuprofen) and Azathiprine have been associated with IUD failure. The other listed medications are all pregnancy category B and should be safe for use in this patient. Q/Q(M)-480143 Report a Problem What is the treatment of choice for methemoglobinemia? 1

Methylene blue

2

Aspirin

3

Iron

4

Hydration

5

Observation Q/Q(M)-476557 Report a Problem

What is the treatment of choice for methemoglobinemia? 1

Methylene blue

Methylene blue is reduced in the presence of NADPH and diaphorase II to leukomethylene blue, which then reduces methemoglobin (Fe3+) to hemoglobin (Fe2+) Q/Q(M)-476557 Report a Problem The anti-HIV medication best known for causing a severe reacti on which can result in fatality fatalit y upon rechallenge is: 1

Indinavir

2

Didanosine

3

Zidovudine

4

Abacavir

5

Nevirapine Q/Q(M)-474124 Report a Problem

The anti-HIV medication best known for causing a severe reacti on which can result in fatality fatalit y upon rechallenge is: 4

Abacavir

The hypersensivity reaction associated with abacavir usually resolves with cessation of the drug, however upon rechallenge the reaction can be life-threatening. 15

Q/Q(M)-474124 Report a Problem This retinoid targets RXR receptors: 1

Tretinoin

2

Isotretinoin

3

Acitretin

4

Bexarotene

5

Etretinate Q/Q(M)-477674 Report a Problem

This retinoid targets RXR receptors: 4

Bexarotene

Bexarotene targets RXR receptors. It is used in the treatment of mycosis fungoides refractory ref ractory to conventional therapy. Side effects include central hypothyroidism and hyperlipidemia. These should be treated with synthroid, lipitor, and fenofibrate. Q/Q(M)-477674 Report a Problem Peak vulnerability to thalidomide occurs between which days of gestation? 1

Days 1-14

2

Days 15-20

3

Days 21-36

4

Days 37-56

5

Days 57-70

Q/Q(M)-475920 Report a Problem Peak vulnerability to thalidomide occurs between which days of gestation? 3

Days 21-36

Peak vulnerability to thalidomide occurs between days 21 to 36 of gestation, during which only a single dose will cause birth defects to occur. Birth defects associated associat ed with thalidomide include phocomelia (underdevelopment of arms and legs, the most common birth defect), ear malformation, and gastrointestinal and urogenital defects. Q/Q(M)-475920 Report a Problem Which of the following drugs binds iron and thereby significantly prevents absorption? 1

Methotrexate

2

Azathioprine

3

Cyclosporine

4

Mycophenolate mofetil

5

Tacrolimus Q/Q(M)-477437 Report a Problem

Which of the following drugs binds iron and thereby significantly prevents absorption? 16

4

Mycophenolate mofetil

Mycophenolate mofetil binds with Fe preparations preventing its absorption. Oral iron supplements markedly reduce absorption of mycophenolate mofetil (CellCept �). It is recommended that iron be taken four to six hours before, or two hours after mycophenolate mofetil. Q/Q(M)-477437 Report a Problem The combination of ethanol and acitretin is potentially problematic because: 1

Ethanol exacerbates the cheilitis caused by acitretin

2

Acitretin increases the toxicity of ethanol

3

Ethanol inhibits the cytochrome p450 system

4

Ethanol promotes the conversion of acitretin to etretinate

5

Ethanol promotes the metabolism of acitretin

Q/Q(M)-476626 Report a Problem The combination of ethanol and acitretin is potentially problematic because: 4

Ethanol promotes the conversion of acitretin to etretinate

Acitretin is an synthetic retinoid with affinity to the retinoic acid receptor (RAR). It can modulate the  proliferation and differentiation of epidermal keratinocytes. The concurrent injestion of ethanol and alcohol increases the formation of etretinate. Unlike acitretin, etretinate is more lipophilic and accumulates in the fat. It therefore has a much longer elimination half-life, estiimated at 120 days. Q/Q(M)-476626 Report a Problem Onycholysis is a potential side effect of treatment with which therapy? 1

Dapsone

2

Ketaconazole

3

Chloroquine

4

Tetracycline

5

Retinoids Q/Q(M)-477201 Report a Problem

Onycholysis is a potential side effect of treatment with which therapy? 4

Tetracycline

Tetracycline has been associated with onycholysis and photo-onycholysis. Chloroquine may cause a  blue-brown discoloration of the nail bed and and retinoids are associated with paronychia. Q/Q(M)-477201 Report a Problem Vascular leak syndrome has been associated with which chemotherapeutic agent? 1

Denileukin diftitox

2

Cytarabine

3

Methotrexate

4

Bleomycin

17

5

Interferon

Q/Q(M)-477151 Report a Problem Vascular leak syndrome has been associated with which chemotherapeutic agent? 1

Denileukin diftitox

Denileukin difitox (brand name Ontak) is approved for the treatment of cutaneous T-cell lymphoma. Denileukin difitox is a fusion protein composed from a portion of IL-2 with diphtheria toxin. The chemotherapy is taken up by cells expressing high-affinity IL-2 receptors. Capillary leak syndrome  presenting with hypotension, edema, pleural effusions, and weight gain caused by fluid retention has  been reported in patients receiving denileukin difitox. Q/Q(M)-477151 Report a Problem Which antibiotic is the treatment of choice for pregnant patients with Rocky Mountain Spotted Fever? 1

Amoxicillin

2

Doxycycline

3

Erythromycin

4

Chloramphenicol

5

Trimethoprim

Q/Q(M)-482677 Report a Problem Which antibiotic is the treatment of choice for pregnant patients with Rocky Mountain Spotted Fever? 4

Chloramphenicol

Chloramphenicol is the treatment of choice for pregnant patients with Rocky Mountain Spotted Fever. In non-pregnant patients, the treatment of choice is Doxycycline. Q/Q(M)-482677 Report a Problem Which of the following is known to induce lichen planus-like eruptions? 1

Dapsone

2

Doxepin

3

Minocycline

4

Gold

5

Mercury

Q/Q(M)-474477 Report a Problem Which of the following is known to induce lichen planus-like eruptions? 4

Gold

Mucocutaneous side effects of gold include stomatitis , cheilitis, lichen planus- like eruptions, and  pityriasis rosea-like eruptions. Q/Q(M)-474477 Report a Problem Which biologic agent is infused intravenously? 1

Alefacept

2

Etanercept

3

Efalizumab

4

Infliximab

5

None of these answers are correct Q/Q(M)-475917 Report a Problem 18

Which biologic agent is infused intravenously? 4

Infliximab

Infliximab is infused intravenously. Q/Q(M)-475917 Report a Problem Which of the following events is most important in the pathogenesis of this painful eruption? 1

Increased expression of FasL

2

Reduction in circulating tumor necrosis factor

3

Reduction in circulating IL-6

4

Overexpression of keratins 6 and 16

5

Cleavage of desmoglein 1 Q/Q(M)-476748 Report a Problem

Which of the following events is most important in the pathogenesis of this painful eruption? 1

Increased expression of FasL

Toxic epidermal necrolysis is a life l ife threatening drug eruption characterized by widespread epidermal necrosis. The exact etiology of the keratinocyte necrosis has not been fully elucidated. However, FasL (FasL and Fas are able to trigger tr igger apoptosis) has been shown to be upregulated in TEN. Q/Q(M)-476748 Report a Problem Which of the following supplements is most likely to decrease hemol ysis associated in patients taking dapsone? 1

Vitamin A

2

Vitamin B6

3

Folic acid

4

Vitamin D

5

Vitamin E

Q/Q(M)-476959 Report a Problem Which of the following supplements is most likely to decrease hemol ysis associated in patients taking dapsone?

19

5

Vitamin E

Adverse effects from dapsone are both pharmacologic and idiosyncratic and include hemolytic anemia, methemoglobinemia, agranulocytosis, hypersensitivity syndrome and neuropathy. Of these, the first two are pharmacologic and anticipated, to some degree, in most patients treated with dapsone. However, the magnitude of toxicity varies greatly among individuals on the drug. Methemoglobinemia is the formation of methemoglobin in the blood, which has a decreased oxygen-carrying capacity compared with hemoglobin and can result in cyanosis. The reaction is related to the N-hydroxy metabolites of dapsone, which are potent oxidants. G6PD-deficient individuals are more susceptible to oxidati ve stresses, including those from dapsone metabolites, and a baseline G6PD level is recommended prior to initiation of dapsone therapy. Vitamin E (800 IU/day) has been shown to provide a small amount of  protection against methemoglobinemia and hemolysis, hemolysis, however, the clinical benefit of this strategy is unclear. Q/Q(M)-476959 Report a Problem Which of the following class of medications has been associated with acquired brachial dyschromatosis? 1

Non-Steroidal Anti-inflammatory medications

2

ACE-inhibitors

3

Anti-virals

4

HMG-CoA Reductase inhibitors

5

Protease inhibitors

Q/Q(M)-477443 Report a Problem Which of the following class of medications has been associated with acquired brachial dyschromatosis? 2

ACE-inhibitors

Acquired brachial dyschromatosis is a condition described as asymptomatic, gray-brown patches with geographic borders, occasionally interspersed with hypopigmented macules, on the dorsum of the forearms, mostly bilaterally and seen in middle aged women. Epidermal atrophy, basal layer hyperpigmentation, elastosis and angiectases were histopathologic features. An association with Civatte's poikiloderma as well as hypertension and/or antihypertensive drugs, especially ACE-inhibitors, is suggested. Q/Q(M)-477443 Report a Problem Which antiparasitic agent acts by inhibiting fumarate reductase? 1

Ivermectin

2

Lindane

3

Permethrin

4

Thiabendazole

5

Cidofovir

Q/Q(M)-475909 Report a Problem Which antiparasitic agent acts by inhibiting fumarate reductase? 4

Thiabendazole

Thiabendazole inhibits fumarate reductase, a helminth-specific enzyme. It is used to treat creeping eruption or cutaneous larva migrans and larva currens. Ivermectin blocks glutamate-gated chloride ion channels, and is used to treat strongyloidiasis, onchocerciasis, and Norwegian scabies. Lindane is an organochloride which blocks neural transmission, and is effective against scabies, pubic lice, head lice, and body lice. Permethrin disables sodium transport channels in the nerve cell membrane of the parasite. 20

Cidofovir is an antiviral nucleotide analogue. Q/Q(M)-475909 Report a Problem Which one of the following is not true about the mechanism of action or eff ects of glucocorticoids? 1

Decrease fibroblast production of collagen

2

Increase blood glucose

3

Decrease transcription of AP-1

4

Increase transcription of NF-kB

5

Form complexes with intracellular receptors

Q/Q(M)-482381 Report a Problem Which one of the following is not true about the mechanism of action or eff ects of glucocorticoids? 4

Increase transcription of NF-kB

Glucocorticoids play a diverse role in the human body. They modulate transcription of specific genes that lead to an increase or decrease in the levels of specific proteins, ie they decrease transcription of AP-1 and NF-kB. All the other statements are true . Side effects include osteoporosis, hyperglycemia, hypertension, poor wound healing, peptic ulcers, Cushingoid features, and muscle weakness. Q/Q(M)-482381 Report a Problem What drug is known to cause scotomas? 1

Dapsone

2

Isotretinoin

3

Quinacrine

4

Chloroquine

5

Gold

Q/Q(M)-474458 Report a Problem What drug is known to cause scotomas? 4

Chloroquine

True retinopathy is associated with "bull's eye" pigment deposition, central scotoma, and diminished visual acuity. Chloroquine is at greatest risk of causing retinopathy. Quinacrine is not associated with the risk of retinopathy. Q/Q(M)-474458 Report a Problem Clofazamine hyperpigmentation has been described as: 1

Dark hyperpigmented streaks in the nails

2

Red-brown hyperpigmentation within skin lesions

3

Blue-gray hyperpigmentation over the anterior shins, palate, ears

4

Slate gray-purple hyperpigmentation in a photo-exposed distribution

5

Yellow discoloration of the skin, sclera Q/Q(M)-474130 Report a Problem

Clofazamine hyperpigmentation has been described as: 2

Red-brown hyperpigmentation within skin lesions

Clofazamine can induce red-brown hyperpigmentation within skin lesions of patients with Hansen's 21

disease. Q/Q(M)-474130 Report a Problem What is the half-life of isotretinoin? 1

7 hours

2

20 hours

3

50 hours

4

30 days

5

120 days Q/Q(M)-477613 Report a Problem

What is the half-life of isotretinoin? 2

20 hours

The half-life of isotretinoin is 20 hours. The half lives of bexarotene, acitretin, etret inate are 7 hours, 50 hours, 120 days respectively. Q/Q(M)-477613 Report a Problem Which of the following statements is NOT true regarding the categories for safety of drug use in  pregnancy? 1

Drugs are category A if controlled studies in humans show no risk to the fetus

2

Drugs are category B if controlled human studies show no risk to the fetus but may show risk to animals, or if no risk has been shown in animal st udies but no human studies have been conducted

3

Drugs are category C if risk to the t he human fetus has been demonstrated, but animal studies are equivocal

4

Drugs are category D if controlled studies show risk to human fetus, but in some instances  benefits may outweigh risks

5

Category X drugs are contraindicated in pregnancy

Q/Q(M)-474082 Report a Problem Which of the following statements is NOT true regarding the categories for safety of drug use in  pregnancy? Drugs are category C if risk to the human fetus has been demonstrated, but animal studies are 3 equivocal Drugs are category C if risk to the human fetus cannot be ruled out, studies are lacking, or animal studies are equivocal. Drugs for which risk to the human fetus has been demonstrated are pregnancy category D. Q/Q(M)-474082 Report a Problem Which of the following pairings of antifungal agents and their mechanisms of action is NOT correct? 1

Terbinafine: Inhibits squalene epoxidase

2

Itraconazole: Inhibits 14-alpha-demethylase

3

Griseofulvin: Disrupts microtubule mitotic spindle formation

4

Ketoconazole: Blocks conversion of lanosterol to ergosterol

5

Fluconazole: Inhibits squalene epoxidase Q/Q(M)-475206 Report a Problem 22

Which of the following pairings of antifungal agents and their mechanisms of action is NOT correct? 5

Fluconazole: Inhibits squalene epoxidase

Terbinafine inhibits squalene epoxidase and blocks the biosynthesis of ergosterol, a sterol essential to the integrity of fungal cell membranes. Itraconazole inhibits 14-alpha-demethylase, blocking lanosterol conversion to ergosterol. Griseofulvin disrupts microtubule mitotic spindle formation causing metaphase arrest. Ketoconazole has a mechanism of action similar to itraconazole. Fluconazole also inhibits 14alpha-demethylase, not squalene epoxidase. Q/Q(M)-475206 Report a Problem A patient being treated for aspergillosis develops altered vision. What is the most likely medication he is taking? 1

Caspofungin

2

Voriconazole

3

Amphotericin B

4

Itraconazole

5

Griseofulvin

Q/Q(M)-482462 Report a Problem A patient being treated for aspergillosis develops altered vision. What is the most likely medication he is taking? 2

Voriconazole

Voriconazole blocks ergosterol synthesis by inhibiting 14-alpha-demethylase. Side effects include visual disturbances in 30%, headaches, nausea, vomiting, fever, and peripheral edema. Q/Q(M)-482462 Report a Problem Concomitant use of methotrexate and what other drug is contraindicated because of the potential increased risk of pancytopenia? 1

Folic acid

2

NSAIDs

3

Tetracycline

4

Acetaminophen

5

Systemic retinoids Q/Q(M)-474115 Report a Problem

Concomitant use of methotrexate and what other drug is contraindicated because of the potential increased risk of pancytopenia? 2

NSAIDs

Drugs that simultaneously inhibit the folate metabolic pathway, such as NSAIDS, dapsone, or trimethoprim-sulfamethoxazole, can increase hematologic toxicity when combined with methotrexate. Q/Q(M)-474115 Report a Problem Raynaud's phenomenon is a potential adverse effect of what chemotherapeutic agent? 1

5-fluorouracil

2

Doxorubicin 23

3

Bleomycin

4

Vinca alkaloids

5

Hydroxyurea

Q/Q(M)-474474 Report a Problem Raynaud's phenomenon is a potential adverse effect of what chemotherapeutic agent? 3

Bleomycin

Bleomycin use has been associated with Raynaud's Ra ynaud's phenomenon occurring in digits treated with intralesional therapy for periungual and plantar warts. Q/Q(M)-474474 Report a Problem Penile erosions are a reported side effect associated with which medication? 1

Trimethoprim-sulfamethoxazole

2

Acyclovir

3

Foscarnet

4

Azaithioprine

5

Bleomycin Q/Q(M)-474126 Report a Problem

Penile erosions are a reported side effect associated with which medication? 3

Foscarnet

Genital ulcers have been reported as a complication of foscarnet therapy. Q/Q(M)-474126 Report a Problem Which of the following is correct regarding mycophenolate mofetil? 1

It is pregnancy category C drug

2

Metronidazole has been shown to increase the bioavailability of mycophenolate mofetil

3

It depletes the de novo production of guanosine nucleotides

4

It can be toxic in individuals with TPMT deficiency

5

The most common side effect is anemia.

Q/Q(M)-482520 Report a Problem Which of the following is correct regarding mycophenolate mofetil? 3

It depletes the de novo production of guanosine nucleotides

Mycophenolate mofetil is a lymphocyte selective immunosuppressive agent that inhibits de novo purine synthesis. Specifically, it depletes guanosine nucleotides by inhibiting inosine monophosphate monophosphate dehydrogenase. The most commonly reported side effects are GI and are dose -dependent. Fluoroquinolones, rifampin, and metronidazole have been shown to decrease the bioavailability of mycophenolate mofetil, which may result in lower circulating levels. Medications that result in elevated concentrations of mycophenolate mofetil include salicylates and probenecid. There is also a possibility of reduced concentration of nevirapine when coadministered with mycophenolate mofetil. It is cur rently classified as FDA pregnancy category D. Azathioprine can be toxic in individuals with TPMT deficiency, not mycophenolate mofetil. Q/Q(M)-482520 Report a Problem 24

Finasteride is a specific inhibitor of: 1

Dihydrotesterone reductase

2

Type I 5 alpha reductase

3

Type II 5 alpha reductase

4

Aromatase

5

Testosterone synthetase

Q/Q(M)-478601 Report a Problem Finasteride is a specific inhibitor of: 3

Type II 5 alpha reductase

Finasteride, a type II 5 alpha reductase inhibitor, given as a 1mg tablet daily, is effecti ve in preventing further hair loss and in increasing the hair counts to the point of cosmetically appreciatable r esults in men ages 18 to 41 with mild to moderate hair loss at the vertex, in the anterior midscalp, and the f rontal region. Q/Q(M)-478601 Report a Problem The most common side effect of azathioprine is: 1

Bone marrow suppression

2

Neuropathy

3

Hepatotoxicity

4

Nephorotoxicity

5

Myopathy

Q/Q(M)-478603 Report a Problem The most common side effect of azathioprine is: 1

Bone marrow suppression

The most common side effect of azathioprine (Imuran) is bone marrow suppresion (Pancytopenia). It is a rare adverse event resulting resul ting from excessive immunosuppression by azathioprine. To prevent catastrophic bone marrow failure, regular complete blood counts should be checked. Q/Q(M)-478603 Report a Problem Keratinocyte differentiation is enhanced by retinoids with all of the following EXCEPT: 1

Increased filaggrin production

2

Increased keratohyalin granules

3

Stimulation of ornithine decarboxylase

4

Odland body secretion of lipids

5

Increased keratin filaments

Q/Q(M)-475615 Report a Problem Keratinocyte differentiation is enhanced by retinoids with all of the following EXCEPT: 3

Stimulation of ornithine decarboxylase

Keratinocyte differentiation is enhanced by retinoids with increased f ilaggrin production, increased keratohyalin granules, keratin filaments, and Odland body secretion of lipids. Retinoids directly inhibit ornithine decarboxylase and therefore lessen inflammatory hyperplasia. 25

Q/Q(M)-475615 Report a Problem Which of the following biologic agents is pregnancy category C? 1

Alefacept

2

Infliximab

3

Efalizumab

4

Etanercept

5

All of these answers are correct Q/Q(M)-475202 Report a Problem

Which of the following biologic agents is pregnancy category C? 3

Efalizumab

Efalizumab is pregnancy category C. The other drugs listed are pregnancy category B. Q/Q(M)-475202 Report a Problem Extension of this blister by application of perpendicular pressure is an example of what? 1

Fitzpatrick sign

2

Nikolsky sign

3

Asboe-Hansen's sign

4

Hutchinson's sign

5

Gorlin's sign Q/Q(M)-476752 Report a Problem

Extension of this blister by application of perpendicular pressure is an example of what? 3

Asboe-Hansen's sign

Toxic epidermal necrolysis is a serious and potentially life threatening reaction to medications. The most commonly implicated medications include penicillins, NSAIDS, and anti-convulsants. Asboe-Hansen's sign results in extension of a blister with perpendicular pressure. Nikolsky sign is the separation of epidermis from the dermis by application of tangential mechanical pressure. 26

Q/Q(M)-476752 Report a Problem Which biologic agent is administered intramuscularly? 1

Alefacept

2

Efalizumab

3

Etanercept

4

Infliximab

5

None of the above

Q/Q(M)-475916 Report a Problem Which biologic agent is administered intramuscularly? 1

Alefacept

Alefacept is given intramuscularly. Q/Q(M)-475916 Report a Problem What drug can potentiate bone marrow suppression when used concomitantly with azathioprine? 1

NSAIDS

2

Salicylates

3

Sulfonamides

4

Phenytoin

5

Allopurinol

Q/Q(M)-474456 Report a Problem What drug can potentiate bone marrow suppression when used concomitantly with azathioprine? 5

Allopurinol

Concomitant allopurinol use, which inhibits xanthine oxidase, can lead to excess toxic purine analogs via increased metabolism of azaithioprine via the HGPRT pathway, causing bone marrow suppression. Q/Q(M)-474456 Report a Problem A patient taking azathioprine for bullous pemphigoid develops a hypersensitivity hypersensiti vity syndrome characterized by fever and shock. Approximately how long ago did the patient start this medication? 1

14 days

2

24 hours

3

3-4 days

4

6 weeks

5

1 week

Q/Q(M)-482750 Report a Problem A patient taking azathioprine for bullous pemphigoid develops a hypersensitivity hypersensiti vity syndrome characterized by fever and shock. Approximately how long ago did the patient start this medication? 1

14 days

Azathioprine is a purine analog which is used to treat multiple inflammatory disorders, including autoimmune bullous disease, vasculitis, and severe dermatitis. A hypersensitivity syndrome with fever and shock can occur at around 14 days. Q/Q(M)-482750 Report a Problem 27

A patient is taking 15 mg of methotrexate each week f or psoriasis. Which of the following medications would be safe for use in this patient? pati ent? 1

Tetracyclines

2

Phenytoin

3

Ibuprofen

4

Aspirin

5

Acetaminophen

Q/Q(M)-480141 Report a Problem A patient is taking 15 mg of methotrexate each week f or psoriasis. Which of the following medications would be safe for use in this patient? pati ent? 5

Acetaminophen

Methotrexate is a S-phase specific antimetabolite which competitively and irreversibly blocks dihydrofolate reductase from catalyzing the formation of tet rahydrofolate, an important cofactor in thymidylate and purine synthesis. Tetrac yclines, phenytoin, phenothiazines, chloramphenicol, NSAIDs, salicylates, and sulfonamides can all increase methotrexate levels by displacement of plasma proteins. Acetaminophen is safe for concurrent use with methotrexate. Q/Q(M)-480141 Report a Problem Which of the following is not an ingredient of Castellani's paint? 1

Resorcinol

2

Industrial methylated spirit

3

Phenol

4

Boric Acid

5

Ethyl acetate

Q/Q(M)-476677 Report a Problem Which of the following is not an ingredient of Castellani's paint? 5

Ethyl acetate

Castellani's paint was named after Sir Aldo Castellani and contains resorcinol, acetone, magenta, phenol,  boric acid, industrial methylated spirit, and water. It is fungicidal and bactericidal with local anesthetic effects. It has been used to treat inflammatory tinea cruris, leg ulcers, and acute paronychia. Q/Q(M)-476677 Report a Problem Which of the following systemic agents has been shown to be the most effective in the treatment treat ment of toenail onychomycosis? 1

Ketoconazole

2

Griseofulvin

3

Itraconazole

4

Fluconazole

5

Terbinafine

Q/Q(M)-477346 Report a Problem Which of the following systemic agents has been shown to be the most effective in the treatment of toenail onychomycosis? 28

5

Terbinafine

Craford et al. reviewed the available literature examining the efficacy of systemic anti-fungals and  performed a meta-analysis. Pooled analysis of cure rates at 11 and 12 months suggested suggested that terbinafine was more effective than itraconazole. Q/Q(M)-477346 Report a Problem The t 1/2 of isotretinoin is: 1

1 hour

2

7 hours

3

20 hours

4

2 days

5

120 days

Q/Q(M)-474327 Report a Problem The t 1/2 of isotretinoin is: 3

20 hours

The t 1/2 of isotretinoin is 20 hours. The other answers list the t 1/2 times of various retinoids. Q/Q(M)-474327 Report a Problem For which of the following medications is sedation a very common side effect that may limit treatment? 1

Colchicine

2

Gold

3

Potassium iodide

4

Thalidomide

5

Chlorambucil

Q/Q(M)-475921 Report a Problem For which of the following medications is sedation a very common side effect that may limit treatment? 4

Thalidomide

Sedation is a very common side effect of treatment with thalidomide. It is additive with other sedatives, such as alcohol and barbiturates. Q/Q(M)-475921 Report a Problem Which of the following is a side effect of hydroquinone cream? 1

Telangiectasia

2

Photosensitivity

3

Ochronosis

4

Tachyphylaxis

5

Atrophy

Q/Q(M)-477171 Report a Problem Which of the following is a side effect of hydroquinone cream? 3

Ochronosis

Exogenous ochronosis is an uncommon complication of irreversi ble pigmentation due to overuse of 29

topical hydroquinone (1,4 dihydroxybenzene). Hydroquinone Hydroquinone acts to by melanocyte pigment production  by auto-oxidation of melanin, tyrosinase and phenol oxidases. Q/Q(M)-477171 Report a Problem A 52 year old male presents from home 5 days after excision of a basal cell carcinoma on his left shin with pain, erythema, and a purulent discharge from the surgical site . He is placed on Cephalexin for a total of 10 days. Two days later, he complains of worsening pain, redness, and discharge. Which of t he following is the best antibiotic choice? 1

Doxycycline

2

Amoxicillin

3

Azithromycin

4

Polymixin B

5

Ciprofloxacin

Q/Q(M)-482827 Report a Problem A 52 year old male presents from home 5 days after excision of a basal cell carcinoma on his left shin with pain, erythema, and a purulent discharge from the surgical site . He is placed on Cephalexin for a total of 10 days. Two days later, he complains of worsening pain, redness, and discharge. Which of the following is the best antibiotic choice? 1

Doxycycline

This patient presents with a surgical wound infection unresponsive to cephalexin. This is likely secondary to community acquired MRSA infection. Doxycycline is the best choice for community acquired MRSA infection. Bactrim, not listed, is another option. Amoxicillin, Azithromycin, and Ciprofloxacin are not typically used to treat MRSA infections as resistance is high with these medications. Polymixin B is a topical antibiotic with a nti-pseudomonal properties. Q/Q(M)-482827 Report a Problem What is the mechanism utilized by the co-administration of probenicid to raise blood levels of  penicillins in patients with infections that require high blood levels? 1

Inhibition of cytochrome P-450 hepatic biotransformation system

2

Competitive inhibition of b-lactam binding sites

3

Displacement of plasma proteins

4

Synergistic effect of probenicid with penicillins

5

Prolongs the half-life of penicillins by decreasing renal tubular secretion

Q/Q(M)-474470 Report a Problem What is the mechanism utilized by the co-administration of probenicid to raise blood levels of  penicillins in patients with infections that require high blood levels? 5

Prolongs the half-life of penicillins by decreasing renal tubular secretion

Probenicid is co-administered with penicillin to prolong its half-life through decreased renal tubular secretion when higher blood levels are warranted. Q/Q(M)-474470 Report a Problem Which of the following medications is most likely to result in increased carbamazepine levels? 1

Minocycline

2

Rifampin

3

Erythromycin 30

4

Azithromycin

5

TMP-SMX

Q/Q(M)-474311 Report a Problem Which of the following medications is most likely to result in increased carbamazepine levels? 3

Erythromycin

Eythromycin inhibits the hepatic cytochrome P450 system and can increase serum levels and potential toxicities of carbamazapene, theophylline, warfarin, digoxin, methylprednisolone. Q/Q(M)-474311 Report a Problem What is the most likely congenital defect associated with isotretinoin therapy? 1

Atrial septal defect

2

Ventral septal defect

3

Cranial synostosis

4

Spina bifida

5

Phocomelia

Q/Q(M)-477657 Report a Problem What is the most likely congenital defect associated with isotretinoin therapy? 3

Cranial synostosis

Isotretinoin is thought to cause congenital defects by interferin g with neural crest development. The most likely congenital defect is cranial synostosis. Q/Q(M)-477657 Report a Problem A patient takes oral clindamycin for a deep soft tissue infection due to a gram -positive organism. The mechanism of action of clindamycin is most similar to which of the following antibiotics? 1

Erythromycin

2

Levofloxacin

3

Doxycycline

4

Penicillin

5

Rifampin

Q/Q(M)-482741 Report a Problem A patient takes oral clindamycin for a deep soft tissue infection due to a gram -positive organism. The mechanism of action of clindamycin is most similar to which of the following antibiotics? 1

Erythromycin

Clindamycin is particularly effective against anaerobic and gram-positive organisms, particularly those causing deep tissue infections. It works by binding to the 50S ribosomal subunit thereby inhibiting  protein synthesis. Macrolide antibiotics such as erythromycin also work by this mechanism. Fluoroquinolones block DNA gyrase. Tetracyclines inhibit the 30S subunit of ribosomes. Penicillin  blocks transpeptidation of the bacterial cell wall. Q/Q(M)-482741 Report a Problem Of the new biologic therapies for psoriasis, which agent requires weekly CD4 T-cell count monitoring?

31

1

Efalizumab

2

Alefacept

3

Infliximab

4

Etanercept

5

Adalimumab

Q/Q(M)-474461 Report a Problem Of the new biologic therapies for psoriasis, which agent requires weekly CD4 T-cell count monitoring? 2

Alefacept

Alefacept is a human LFA-3/IgG fusion protein, which blocks LFA-3 on antigen presenting cells from interacting with CD-2 on T-cells, preventing T-cell stimulation. Alefacept also eliminates activated memory-effector T-cells, so weekly CD4 T-cell counts are required. Q/Q(M)-474461 Report a Problem Thalidomide is most associated with what adverse effect? 1

Sensory neuropathy

2

Distal motor neuropathy

3

Oral ulceration

4

Photosensitivity

5

Hypothyroidism

Q/Q(M)-474119 Report a Problem Thalidomide is most associated with what adverse effect? 1

Sensory neuropathy

The most common presentation of the neuropathy from thalidomide is a mild proximal muscle weakness with symmetric painful paresthesias of the distal extremities with accompanying lower limb sensory loss. Hypothyroidism is a rarely reported adverse effect. Q/Q(M)-474119 Report a Problem Which of the following statements regarding podophyllin is NOT correct? 1

It is derived from the May apple plant

2

It binds tubulin

3

It arrests cells in telophase

4

It is contraindicated in pregnancy

5

None (all of these statements are true)

Q/Q(M)-475205 Report a Problem Which of the following statements regarding podophyllin is NOT correct? 3

It arrests cells in telophase

Podophyllin is a crude cytotoxic extract from the May apple plant. It is antimitotic, arresting cells in metaphase (not telophase) by binding to the protein tubulin. It may be terat ogenic and should not be used in pregnancy. Q/Q(M)-475205 Report a Problem The most common side effect of treatment with interferon-alpha is: 32

1

Weight loss

2

Nausea

3

Liver toxicity

4

Flu-like symptoms

5

Spastic diplegia Q/Q(M)-477169 Report a Problem

The most common side effect of treatment with interferon-alpha is: 4

Flu-like symptoms

The most common side effect of treatment with interferon-alpha is flu-like symptoms of fever, chills, myalgias, headache and arthralgias. Prophylactic administration of non steroidal anti-inflammatory medications may alleviate some of these symptoms. Q/Q(M)-477169 Report a Problem Which of the following medications mechanism of action is through inhibition of DNA-dependent RNA  polymerase? 1

Penicillin G

2

Cephalexin

3

Tetracycline

4

Ciprofloxacin

5

Rifampin Q/Q(M)-480138 Report a Problem

Which of the following medications mechanism of action is through inhibition of DNA-dependent RNA  polymerase? 5

Rifampin

Rifampin is an antibiotic used frequently for M. leprae l eprae and M. tuberculosis. It is the only onl y drug  bactericidal to M. leprae. Its mechanism of action is by inhibiting RNA synthesis synthesis by inhibiting DNAdependent RNA polymerase. Penicillin G inhibits bacterial cell wall synthesis by blocking the transpeptidation step. Cephalosporins have a similar mechanism of action, possessing a beta-lactam ring. Tetracycline inhibits protein synthesis by binding and inhibiting the 30S ribosome while the fluoroquinolone family inhibits DNA gyrase. Q/Q(M)-480138 Report a Problem Terfinadine is an antihistamine that has been used in the past. However, it is no longer available in the USA due to issues with : 1

Life-threatening cardiac arrhythmias

2

Thyroid cancer

3

Seizures

4

Cyanosis

5

Agranulocytosis Q/Q(M)-482902 Report a Problem

33

Terfinadine is an antihistamine that has been used in the past. However, it is no longer available in the USA due to issues with : 1

Life-threatening cardiac arrhythmias

Terfenadine is an anti-histamine that was one of the first nonsedating antihistamines. It is no longer available in the USA because of its propensity to cause life-threatening cardiac car diac arrhythmias. The  problem is worsen by interaction with macrolide antibiotics and imidazole antifungals. Q/Q(M)-482902 Report a Problem Which of the following is true of the live attenuated att enuated varicella vaccine when given to healthy adults? 1

It was marginally effective

2

It provides only short term protection (6 months)

3

It protects even individuals who never had serconversion or whose antibody levels were undetectable from severe varicella zoster viral disease

4

The disease process will be accelerated

5

Disseminated zoster is frequently seen

Q/Q(M)-478739 Report a Problem Which of the following is true of the live attenuated att enuated varicella vaccine when given to healthy adults? 3

It protects even individuals who never had serconversion or whose antibody levels were undetectable from severe varicella zoster viral disease

When live attenuated varicella vaccine is given to healthy adults, it protects even individuals who never had serconversion or whose antibody levels were undetectable from severe varicella zoster viral disease. Q/Q(M)-478739 Report a Problem A middle aged gentleman with pemphigus vulgaris is managed with azathioprine. Which of the following substances is the active metabolite? 1

6-thioguanine

2

Azathioprine

3

6-mercaptopurine

4

Thiouric acid

5

6-thioinosine monophosphate Q/Q(M)-482749 Report a Problem

A middle aged gentleman with pemphigus vulgaris is managed with azathioprine. Which of the following substances is the active metabolite? 1

6-thioguanine

Azathioprine is a purine analog that is used as a steroid-sparing agent in a variety v ariety of dermatologic inflammatory disorders. Azathioprine is converted into 6-mercaptopurine before being converted into the active metabolite, 6-thioguanine, by the hypoxanthine guanine phosphoribosyltransferase pathway. Other inactive metabolites are produced via xanthine oxidase and thiopurine methyltransferase. Q/Q(M)-482749 Report a Problem The anti-viral agent used most often for acyclovir-resistent ac yclovir-resistent HSV and VZV infections is: 1

Valacyclovir

34

2

Gancyclovir

3

Foscarnet

4

Famcyclovir

5

Pencyclovir Q/Q(M)-474472 Report a Problem

The anti-viral agent used most often for acyclovir-resistent ac yclovir-resistent HSV and VZV infections is: 3

Foscarnet

Foscarnet does not require phosphorylaton for antiviral activity. Thereofre, it is achieve against viruses resistant to acyclovir, famcyclovir, or gancyclovir on the basis of altered-kinase activities. Q/Q(M)-474472 Report a Problem Potentially fatal ventricular arrhythmias can occur with concomitant use of cisapride and: 1

Astemizole

2

Digoxin

3

Terbinafine

4

Erythromycin

5

Atorvostatin

Q/Q(M)-474309 Report a Problem Potentially fatal ventricular arrhythmias can occur with concomitant use of cisapride and: 4

Erythromycin

Co-administration of erythromycin with the antihistamines terfenedine and ast emizole or the gastrointestinal promobility agent cisapride increases the risk of torsade de pointes and is contraindicated. These drugs are no longer available in the US. Q/Q(M)-474309 Report a Problem A patient with acute diarrhea is prescribed antibiotic treatment for his symptoms. He subsequently suffers from nausea and vomiting after ingesting alcohol. What i s the most likely medication he is taking? 1

Ciprofloxacin

2

Azithromycin

3

Penicillin

4

Clindamycin

5

Metronidazole

Q/Q(M)-477673 Report a Problem A patient with acute diarrhea is prescribed antibiotic treatment for his symptoms. He subsequently suffers from nausea and vomiting after ingesting alcohol. What i s the most likely medication he is taking? 5

Metronidazole

This patient is most likely taking metronidazole for acute diarrhea secondary to giardella. Metronidazole causes antabuse-like reactions with ingestion of alcohol. Q/Q(M)-477673 Report a Problem 35

Which of the following is the most common adverse effect of Thalidomide therapy? 1

Diarrhea

2

Sedation

3

Skin discoloration

4

Photosensitivity

5

Hypertension Q/Q(M)-478627 Report a Problem

Which of the following is the most common adverse effect of Thalidomide therapy? 2

Sedation

Thalidomide was introduced in the late 1950's as a "safe " sleeping aide. It readily penetrates the CNS, where it exerts a hyposedative effect comparable with barbiturates. By far, the most common adverse effect from thalidomide is sedation, which in many patients ma y require that primarily night-time doses  be utilized. Q/Q(M)-478627 Report a Problem Which of the following biologic therapies is pregnancy category C? 1

Etanercept

2

Alefacept

3

Infliximab

4

Efalizumab

5

Adalimumab Q/Q(M)-477654 Report a Problem

Which of the following biologic therapies is pregnancy category C? 4

Efalizumab

All of the above drugs are pregnancy category B except efaliz umab which is category C. Q/Q(M)-477654 Report a Problem Which of the following statements regarding drug interactions is true? Drugs that induce CYP3A enzymes may decrease levels of drugs which act as substrates for 1 CYP3A 2

CYP3A inhibitors may increase levels and cause toxic ity of drugs metabolized by cytochrome P450

3

Terbinafine is not metabolized by cytochrome P-450

4

Tobacco induces P-450 enzymes

5

All of the above are true Q/Q(M)-475923 Report a Problem

Which of the following statements regarding drug interactions is true? 5

All of the above are true

The most relevant drug interactions in dermatology involve the hepatic biotransformation pathways 36

catalyzed by the cytochrome P-450 isoenzymes from the subfamilies CYP3A3/4. Drugs that induce CYP3A enzymes may decrease levels of drugs which act as substrates for CYP3A. CYP3A inhibitors may increase levels and cause toxicity of drugs metabolized by cytochrome P-450. Terbinafine is not metabolized by cytochrome P-450, but inhibits CYP2D6-mediated metabolism. Tobacco induces P-450 enzymes. Q/Q(M)-475923 Report a Problem In addition to minocycline, which of the following drugs has been associated with drug-induced lupus erythematosus-like syndrome? 1

Amiodarone

2

Itraconazole

3

Rifampin

4

Doxycycline

5

Hydralazine Q/Q(M)-474317 Report a Problem

In addition to minocycline, which of the following drugs has been associated with drug-induced lupus erythematosus-like syndrome? 5

Hydralazine

Drugs associated with drug-induced SLE include minocycline, hydralazine, procainamide, isonaizid,  penicillamine, and anti-convulsants. Q/Q(M)-474317 Report a Problem A female patient with adult acne is i s place on spironolactone for her acne vulgaris. As a physician, you warn her that there is a black box warning against patients with a : 1

Personal history of breast cancer

2

Personal history of thyroid cancer

3

Personal history of bladder cancer

4

Personal history of colon cancer

5

Personal history of rectal cancer Q/Q(M)-482899 Report a Problem

A female patient with adult acne is i s place on spironolactone for her acne vulgaris. As a physician, you warn her that there is a black box warning against patients with a : 1

Personal history of breast cancer

Spironolactone is an antiandrogenic potassium sparing diuretic. It can be used for women with adult acne that is recalcitrant to treatment. Although it is not first line, it helps to block androgens that cause acne in the jawline. Spironolactone has a black box warning against patient with a personal history of  breast cancer or family history of breast cancer. Q/Q(M)-482899 Report a Problem Approximately what percentage of patients with drug hypersensitivity syndrome will have liver function test abnormalities? 1

Less than 10% 37

2

25%

3

50%

4

75%

5

Close to 100% Q/Q(M)-474318 Report a Problem

Approximately what percentage of patients with drug hypersensitivity syndrome will have liver function test abnormalities? 3

50%

Drug hypersensitivity syndrome is characterized by fever, skin eruption and internal organ involvement. Drugs associated with drug hypersensitivity syndrome include sulfonamindes, dapsone, anticonvulsants (carbamezapine, phenobarbitol, lamotrigine), anti-retrovirals (ritonovir, nevirapine) and minocycline. Approximately 50% of patients will have abnormal liver enzymes. Q/Q(M)-474318 Report a Problem A patient is being treated by a dermatologist. Yell owish changes of his sclera and yellowish discoloration of his dorsal hands and feet is noted. Which medication is most likely responsible? 1

Quinacrine

2

Minocycline

3

Hydroxychloroquine

4

Terbinafine

5

Prednisone Q/Q(M)-482753 Report a Problem

A patient is being treated by a dermatologist. Yell owish changes of his sclera and yellowish discoloration of his dorsal hands and feet is noted. Which medication is most likely responsible? 1

Quinacrine

Quinacrine frequently produces a yellow discoloration of the scler a and skin, especially over the dorsal hands and feet. Minocycline and hydroxychloroquine can cause bluish-gray hyperpigmentation. Terbinafine and prednisone are not associated with alter ation of cutaneous pigmentation. Q/Q(M)-482753 Report a Problem The Mazzotti reaction is most closely associated with administration of which of the following medications? 1

capecitabine

2

diethylcarbamazine

3

penicillamine

4

cisplatin

5

ipilimumab Q/Q(M)-482830 Report a Problem

The Mazzotti reaction is most closely associated with administration of which of the following medications? 38

2

diethylcarbamazine

The Mazzotti reaction is characterized by urticaria, fever, chills, sweats, abdominal pain, arthralgias, and lymphadenopathy. Hypotension Hypotension and tachycardia may also be present, and the reaction can be life threatening. Mazzotti reactions are most often associated with the administration of diethylcarbamazine for the treatment of onchocerciasis, but may be seen during treatment with other anti-helminthics, such as suramin. The pathogenesis of Mazzotti reactions is thought to be consequent to abrupt release of  parasitic antigens during cell death, prompting an intense inflammatory cascade. Currently, ivermectin is the treatment of choice for onchocerciasis, which has a lower incidence of associated Mazzotti reactions (approximately 10%). Q/Q(M)-482830 Report a Problem Terbinafine exerts its antifungal activity by what manner? 1

Inhibition of 14-a demethylase

2

Inhibition of squalene epoxidase

3

Inhibition of epoxide hydroxylase

4

Interference with cell respiratory processes

5

Direct binding to membrane sterols, increasing permeability Q/Q(M)-474121 Report a Problem

Terbinafine exerts its antifungal activity by what manner? 2

Inhibition of squalene epoxidase

Terbinafine, an allylamine, interferes with ergosterol synthesis by inhibiting squalene epoxidase. The azoles inhibit 14-a demethylase. Nystatin is a polyene which binds irreversibly to membrane sterols, resulting in a permeability shift. Ciclopirox does not appear to affect sterol biosynthesis but instead interferes with cell respiratory processes. Q/Q(M)-474121 Report a Problem Which of the following chemotherapeutic agents causes increased growth of e yelashes? 1

Interleukin 2

2

Interferon alpha

3

Mitomycin

4

Cytarabine

5

Methotrexate Q/Q(M)-476709 Report a Problem

Which of the following chemotherapeutic agents causes increased growth of e yelashes? 2

Interferon alpha

Interferons can cause increased growth of eyelashes. Trichomegaly has been reported after treatment with interferon-alpha in patients with chronic hepatiti s, B-cell lymphoma, chronic granulocytic leukemia, and cutaneous melanoma. Trichomegaly has also been reported in associato in with latanoprost, minoxidil, cyclosporine, phenytoin, psoralen, and penicillamine. Q/Q(M)-476709 Report a Problem Which chemotherapeutic agent has been reported to cause acral sclerosis with Raynaud's phenomenon? 39

1

Bleomycin

2

5-Fluorouracil

3

Methotrexate

4

Actinomycin

5

Interferon

Q/Q(M)-476719 Report a Problem Which chemotherapeutic agent has been reported to cause acral sclerosis with Raynaud's phenomenon? 1

Bleomycin

Bleomycin is an antibiotic that induces single strand breaks in the DNA. Reactions to bleomycin include flagellae hyperpigmentation, acral sclerosis with Reynaud's, penile calcification, and a morbilliform eruption. Q/Q(M)-476719 Report a Problem Cefaclor has been associated with increased incidence of what in children? 1

Mononucleosis-like syndrome

2

Anaphylaxis

3

Transaminitis

4

Serum sickness reaction

5

Generalized tonic-clonic seizures Q/Q(M)-474451 Report a Problem

Cefaclor has been associated with increased incidence of what in children? 4

Serum sickness reaction

The use of cefaclor has been associated with an increased incidence of serum sickness in children. Q/Q(M)-474451 Report a Problem What medication's mechanism of action is via suppression of the halide-myeloperoxidase system? 1

Cyclophosphamide

2

Quinicrine

3

Dapsone

4

Melphalan

5

Hydroxyurea

Q/Q(M)-477116 Report a Problem What medication's mechanism of action is via suppression of the halide-myeloperoxidase system? 3

Dapsone

Dapsone inhibits the neutrophil halide-myeloperoxidase system which results in an impaired respiratory  burst and subsequent tissue damage. Q/Q(M)-477116 Report a Problem The anti-CD 20 antibody rituximab is FDA-approved for treatment of which of the following? 40

1

Mycosis fungoids

2

Metastatic melanoma

3

Psoriasis

4

Paraneoplastic pemphigus

5

 Non-Hodgkin�s lymphoma Q/Q(M)-477154 Report a Problem

The anti-CD 20 antibody rituximab is FDA-approved for treatment of which of the following?  Non-Hodgkin�s lymphoma

5

Rituximab (brand name Rituxan) is a monoclonal antibody is approved for the treatment of CD20 nonHodgkin�s lymphoma. Rituximab is a monoclonal antibody directed against B lymphocytes which are CD20. Q/Q(M)-477154 Report a Problem All of the following topical antioxidants have demonstrated cutaneous anticarcinogenic effects in mice except: 1

Zinc

2

Vitamin C

3

Tea polyphenois

4

Vitamin E

5

Silymarin Q/Q(M)-477218 Report a Problem

All of the following topical antioxidants have demonstrated cutaneous anticarcinogenic effects in mice except: 1

Zinc

Anti-oxidants are thought to be protective against photoinjury by neutralizing oxygen radicals. Vitamin C, Vitamin E, tea polyphenois, and silymarin are all anti -oxidants. Q/Q(M)-477218 Report a Problem What antifungal is the best choice for a patient with mucocutaneous candidiasis who is currently taking antacids? 1

Itraconazole

2

Fluconazole

3

Ketoconazole

4

Terbinafine

5

Griseofulvin Q/Q(M)-474473 Report a Problem

What antifungal is the best choice for a patient with mucocutaneous candidiasis who is currently taking antacids? 2

Fluconazole 41

Ketoconazole and itraconazole require an acidic environment. Fluconazole, however, does not require an acidic environment and can work safely and effectively effecti vely in patients taking antacids, which can raise gastric pH levels. Q/Q(M)-474473 Report a Problem Which of the following is the highest potency topical corticosteroid? 1

Halobetasol propionate cream 0.05%

2

Triamcinolone acetonide ointment 0.1%

3

Fluocinolone acetonide cream 0.025%

4

Hydrocortisone valerate ointment 0.2%

5

Mometasone furoate ointment 0.1% Q/Q(M)-482833 Report a Problem

Which of the following is the highest potency topical corticosteroid? 1

Halobetasol propionate cream 0.05%

Halobetasol propionate cream 0.05% is a superpotent Class 1 topical steroid. Triamcinolone acetonide ointment 0.1% and hydrocortisone valerate ointment 0.2% are medium potency class 4 topical steroids. Fluocinolone acetonide cream 0.025% is a medium potency class 4 topical steroid. Mometasone fu roate ointment 0.1% is a high potency class 2 topical steroid. Q/Q(M)-482833 Report a Problem Which of the following medications would be safe for use in pregnancy? 1

Tazarotene

2

Finasteride

3

Etretinate

4

Azeleic acid

5

5-fluorouracil topically

Q/Q(M)-480142 Report a Problem Which of the following medications would be safe for use in pregnancy? 4

Azeleic acid

All of the listed medications except azeleic acid are pregnancy pre gnancy category X. Azeleic acid is a pregnancy category B medication, meaning that there are controlled human studies t hat show no risk to fetus but may show risk to animals, or no risk in animals wi th no human studies conducted. Q/Q(M)-480142 Report a Problem Painful periungual pyogenic granulomas have been associated with what medication? 1

Ketoconazole

2

Indinavir

3

Doxycycline

4

Tazarotene

5

Valacyclovir

Q/Q(M)-474125 Report a Problem Painful periungual pyogenic granulomas have been associated with what medication? 42

2

Indinavir

Periungual pyogenic granulomas and painful paronychial eruptions have been reported in association with various anti-HIV medications including, indinavir, zidovudine, and lamivudine. Q/Q(M)-474125 Report a Problem Fomivirsen is a single-stranded antisense oligonucleotide FDA-approved for the treatment of: 1

HSV infection

2

HIV infection

3

EBV infection

4

CMV infection

5

HPV infection Q/Q(M)-477212 Report a Problem

Fomivirsen is a single-stranded antisense oligonucleotide FDA-approved for the treatment of: 4

CMV infection

Fomiversen (Vitraene) represents a new class cla ss of therapeutic agents known as antisense antise nse drugs. It is indicated for the treatment of CMV retinitis in patients with AIDS. The most common adverse effects are ocular inflammation and increases in intraocular pressure. Q/Q(M)-477212 Report a Problem Concomitant administration of retinoid or ketoconazole with doxorubicin may lead to which side effect? 1

Dermatomyositis-like reaction

2

Papulopustular eruption

3

Capillary leak syndrome

4

Sticky skin

5

Leg ulcers Q/Q(M)-482271 Report a Problem

Concomitant administration of retinoid or ketoconazole with doxorubicin may lead to which side effect? 4

Sticky skin

Doxorubicin when given with retinoids or ketoconazole may lead to sticky skin. A dermatomyositis-like reaction and leg ulcers may be seen with wit h hydroxyurea. Epidermal growth factor receptors such as erlotinib and cetuximab can produce papulopustular eruptions. Capillary leak syndrome is seen with interleukins. Q/Q(M)-482271 Report a Problem What tetracycline is not phototoxic? 1

Minocycline

2

Doxycycline

3

Oxytetracycline

4

Tetracycline

5

Demeclocycline 43

Q/Q(M)-474475 Report a Problem What tetracycline is not phototoxic? 1

Minocycline

Minocycline is not phototoxic. Demeclocycline and doxycycline are the most phototoxic of all the tetracyclines. Onycholysis can accompany tetracycline-induced phototoxicity. Q/Q(M)-474475 Report a Problem All of the following are reported cutaneous side e ffects of zidovudine EXCEPT: 1

Trichomegaly

2

Diffuse and oral hyperpigmented macules

3

Hyperpigmented streaks in nails

4

Periungual pyogenic granulomas

5

None of the above (all are reported side effects)

Q/Q(M)-475204 Report a Problem All of the following are reported cutaneous side e ffects of zidovudine EXCEPT: 5

None of the above (all are reported side effects)

All of the following are cutaneous side effects reported with zidovudine, a nucleoside HIV reverse transcriptase inhibitor. Periungal/paronychial eruptions resulting in pyogenic granuloma-like lesions have also been reported with other HIV medications, including indinavir and lamivudine. Q/Q(M)-475204 Report a Problem What is the target antigen for rituximab? 1

CD4

2

CD7

3

CD8

4

CD20

5

CD22

Q/Q(M)-477742 Report a Problem What is the target antigen for rituximab? 4

CD20

Rituximab is an anti-CD20 monoclonal antibody. CD20 is a B-cell marker and is used to treat NonHodgkins B-cell lymphoma. It is also approved for the treatment of r heumatoid arthritis. Q/Q(M)-477742 Report a Problem What drug can induce native SLE? 1

Hydralazine

2

Procainamide

3

Isoniazide

4

TNF inhibitor

5

Minocycline

Q/Q(M)-482851 Report a Problem What drug can induce native SLE? 4

TNF inhibitor 44

Drug induced lupus consists of systemic lupus type symptoms with anti-histone antibodies. Common culprit drugs are hydralazine, procainamide, isoniazid, and minocycline. Cessation of the medication usually results in improvement of symptoms. The TNF inhibitors also induce systemic lupus, but this typically is an unmasking of native lupus that is not associated with anti-histone antibodies and does not remit with cessation of treatment. Q/Q(M)-482851 Report a Problem The mechanism of action of podophyllin most closely resembles that of what other drug listed below? 1

Chlorambucil

2

Dactinomycin

3

Colchicine

4

5-fluorouracil

5

Permethrin

Q/Q(M)-474476 Report a Problem The mechanism of action of podophyllin most closely resembles that of what other drug listed below? 3

Colchicine

Both podophyllin and colchicine have antimitotic activity. They bind to tubulin dimers, interfering with mitotic spindle and microtubule assembly. Q/Q(M)-474476 Report a Problem Which antiviral agent has been associated with fatal thrombotic thrombocytopenic purpura in AIDS and transplant patients taking high doses? 1

Acyclovir

2

Valacyclovir

3

Famciclovir

4

Penciclovir

5

Cidofovir

Q/Q(M)-475203 Report a Problem Which antiviral agent has been associated with fatal thrombotic thrombocytopenic purpura in AIDS and transplant patients taking high doses? 2

Valacyclovir

Valacyclovir has been associated with severe se vere and even fatal cases of thrombotic thrombocytopenic  purpura / HUS syndrome in AIDS AIDS and transplant patients taking high doses. doses. Q/Q(M)-475203 Report a Problem A patient has a single oval erythematous patch on his abdomen. Biopsy reveals pigment incontinence and basal vacuolization. A diagnosis of fixed drug eruption is made. What is the most common cause of fixed drug eruption? 1

Tetracycline

2

NSAIDs

3

Phenylephrine

4

Amoxicillin

5

Simvastatin 45

Q/Q(M)-482739 Report a Problem A patient has a single oval erythematous patch on his abdomen. Biopsy reveals pigment incontinence and basal vacuolization. A diagnosis of fixed drug eruption is made. What is the most common cause of fixed drug eruption? 1

Tetracycline

A fixed drug eruption is a single or multiple oval or annular er ythematous patches that arise as a result of exposure to a systemic medication. Repeat exposure to the offending drug can cause reappearance of the lesions in the same location. Tetracycline Tetra cycline is the most common cause of fixed drug eruption. Q/Q(M)-482739 Report a Problem A patient presents with tingling and burning of their lateral upper l ip. They report that blisters will form which then crust and heal. She gets these episodes once or twice each year. You prescribe ac yclovir. What is the mechanism of action of acyclovir when treating this type of infection? 1

Acts on viral thymidine kinase

2

Inhibits viral DNA polymerase

3

Inhibits viral RNA polymerase

4

Enhances CD8+ T-cell function leading to immune destruction of the virally infected cells

5

Is a non-competitive inhibitor of viral DNA polymerase at the pyrophosphate binding site Q/Q(M)-480139 Report a Problem

A patient presents with tingling and burning of their lateral upper l ip. They report that blisters will form which then crust and heal. She gets these episodes once or twice each year. You prescribe acyclovir. ac yclovir. What is the mechanism of action of acyclovir when treating this type of infection? 2

Inhibits viral DNA polymerase

Acyclovir relies upon the fact that thymidine kinase is produced at a higher rate in herpes infected cells than in noninfected cells. It is a guanosine analog that is preferentially phosphorylated by viral thymidine kinase which then inhibits viral DNA polymerase, thus halting viral DNA synthesis by chain termination. Acyclovir does not inhibit viral RNA polymerase or boost immune destruction of infected cells. It is not a non-competitive non-competiti ve inhibitor of viral DNA polymerase at the pyrophosphate binding site  –  this mechanism of action is that of Foscarnet, also an antiviral active against HSV. Q/Q(M)-480139 Report a Problem Gray-green discoloration of the mid-portion of permanent teeth is a side effect of? 1

Doxycycline

2

Tetracycline

3

Minocycline

4

Fluoroquinolones

5

clindamycin

Q/Q(M)-474450 Report a Problem Gray-green discoloration of the mid-portion of permanent teeth is a side effect of? 3

Minocycline

In contrast to tetracycline tetrac ycline staining of the teeth, which occurs in childhood and produces a brown discoloration along the gingival third, minocycline stains the permanent teeth in adults, with a graygreen discoloration of the mid-portion of the tooth. 46

Q/Q(M)-474450 Report a Problem Which one of the following sunscreens has an absorption spectrum primarily in the UVA range? 1

Padimate O

2

Octyl Salicylate

3

Parsol 1789 (butyl dibenzoylmethane)

4

PABA (para-aminobenzoic acid)

5

Cinnamates

Q/Q(M)-477366 Report a Problem Which one of the following sunscreens has an absorption spectrum primarily in the UVA range? 3

Parsol 1789 (butyl dibenzoylmethane)

Avobenzone (Parsol 1789) is primarily a UVA blocker. Photostability of avobenzone may be a problem if it is combined with octyl methoxycinnamate. Salicylates, PABA, Padimate O, and cinnamates are  primarily UVB blockers. Q/Q(M)-477366 Report a Problem Tazarotene is what category for safety sa fety in pregnancy? 1

Category A

2

Category B

3

Category C

4

Category D

5

Category X

Q/Q(M)-474482 Report a Problem Tazarotene is what category for safet y in pregnancy? 5

Category X

Category X drugs include: acitretin, etretinate, estrogens, finasteride, 5-fluorouracil, flutamide, isotretinoin, methotrexate, stanozolol, thalidomide, and tazarotene. Q/Q(M)-474482 Report a Problem Hemorrhagic cystitis is a risk of what chemotherapy? 1

Chlorambucil

2

Cyclophosphamide

3

Vinca alkaloids

4

Hydroxyurea

5

Azaithioprine

Q/Q(M)-474481 Report a Problem Hemorrhagic cystitis is a risk of what chemotherapy? 2

Cyclophosphamide

Bladder toxicity is due to the acrolein metabolite of cyclophosphamide. Hemorrhagic cystitis is associated with the increased risk of transitional cell carcinoma of the bladder. Mesna has been used to reduce the toxic effect. The risk of cystitis is avoided by adequate fluid intake, frequent voiding, and careful screening for hematuria. 47

Q/Q(M)-474481 Report a Problem For which of the following medications is abdominal cramping and watery diarrhea a very common side effect that may limit treatment? 1

Colchicine

2

Gold

3

Potassium iodide

4

Thalidomide

5

Chlorambucil Q/Q(M)-475922 Report a Problem

For which of the following medications is abdominal cramping and watery diarrhea a very common side effect that may limit treatment? 1

Colchicine

Colchicine is an alkaloid with antimitotic activity that is used in dermatology for its effe cts on neutrophils. The most common side effect from colchicine use is gastrointestinal distress with abdominal cramping and watery diarrhea. Q/Q(M)-475922 Report a Problem What is the recommended period for contraception after ces sation of acitretin therapy in the United States? 1

1 month

2

3 months

3

1 year

4

2 years

5

3 years Q/Q(M)-474120 Report a Problem

What is the recommended period for contraception after ces sation of acitretin therapy in the United States? 5

3 years

Etretinate has a prolonged half-life of 80-160 days. The levels m ay persist up to 3 years in the body. Acitretin can be converted to etretinate in the presence of ethanol. Q/Q(M)-474120 Report a Problem A 56 year-old man presents with blue-gray discoloration on his face, ears, and dorsal hands. What is the most likely offending agent? 1

Minocycline

2

Amiodarone

3

Chloroquine

4

Quinacrine 48

5

Clofazimine

Q/Q(M)-477726 Report a Problem A 56 year-old man presents with blue-gray discoloration on his face, ears, and dorsal hands. What is the most likely offending agent? 2

Amiodarone

The patient presents with blue-gray discoloration in sun-exposed areas. The most likely offending agent is amiodarone. Blue-gray discoloration from minocycline usually occurs on legs. Chloroquine usually causes blue-gray discoloration in the sclerae, teeth, buccal mucosa, nail beds, and pretibial areas. Quinacrine causes yellow discoloration of skin and conjunctiva. CLofazimine usualy causes a red-brown discoloration. Q/Q(M)-477726 Report a Problem Which of the following medications is most likely to interefer e with the efficacy of oral contraceptives? contr aceptives? 1

Rifampin

2

Tetracycline

3

Doxycycline

4

Trimethoprim-sulfamethaxasole

5

Amoxicillin Q/Q(M)-476723 Report a Problem

Which of the following medications is most likely to interefer e with the efficacy of oral contraceptives? contr aceptives? 1

Rifampin

Rifampin has been shown to decrease the efficacy effic acy of oral contraceptives. It is an a n inducer of cytochrome  p450 which increases the metabolism of hormones thereby decreasing the efficacy of oral contraceptives. There is no clear decrease in oral contraceptive efficacy with concomitant use of ampicillin, ciprofloxacin, clarithromycin, doxycyline, metronidzole, ofloxacin, or tetracycline. Q/Q(M)-476723 Report a Problem A patient taking daily prednisone is advised to switch to alternate day dosing to decrease the risk of: 1

Glaucoma

2

Aseptic bone necrosis

3

Cataracts

4

Adrenal crisis

5

Osteoporosis Q/Q(M)-475860 Report a Problem

A patient taking daily prednisone is advised to switch to alternate day dosing to decrease the risk of: 4

Adrenal crisis

Long-term therapy with oral corticosteroids can result in numerous adverse effects, including elevated risks of glaucoma, cataracts, hypertension, h ypertension, diabetes, osteoporosis, adrenal axis suppression, and aseptic  bone necrosis. Alternate-day dosing or oral corticosteroids lowers the rate of adrenal axis suppression. It is hypothesized that during the off day, cell mediated immunity, white blood cells subset levels, and 49

 potassium excretion are normalized while the anti-inflammatory benefits of the drug persist. Alternateday corticosteroid therapy should be employed once adequate disease control has been attained with daily dosing. Of note, the risk of cataracts, osteoporosis, and other adverse effects of long-term corticosteroid use are not minimized with alternate-day al ternate-day dosing. Q/Q(M)-475860 Report a Problem Which of the following is an adverse effect of oral retinoid therapy? 1

Mania

2

Fibroydysplasia ossicficans progressiva

3

Vascular calcification

4

Hypertension

5

Hypertrichosis

Q/Q(M)-478616 Report a Problem Which of the following is an adverse effect of oral retinoid therapy? 2

Fibroydysplasia ossicficans progressiva

Adverse effects of oral retinoid re tinoid therapy: Cutaneous: Xerosis, palmoplantar digital desquamation, retinoid dermatitis, photosensitivity, pyogenic granulomas, stickiness sensation, Staph aureus infxns Hair: Teolgen effluvian, abnormal hair texture, dryness Nails: Fragility with nail softening, paronychia, onycholysis Occular: Dry eyes w/visual blurriness, Blepharoconjunctivitis, Photophobia Oral: Cheilitis, dry mouth, sore mouth and tongue Nasal: Nasal mucosal dryness, decreased mucous secretion, epistaxis Musculoskeletal: Arthralgias, myalgias, fatigue and muscle weakness, tendinitis Neurological: Headache, mild depression Gatrointestinal: N/V/D, adb pain Q/Q(M)-478616 Report a Problem Which of the following retinoid medications is a second-generation synthetic retinoid? 1

Acitretin

2

Isotretinoin

3

Tretinoin

4

Adapalene

5

Bexarotene Q/Q(M)-482754 Report a Problem

Which of the following retinoid medications is a second-generation synthetic retinoid? 1

Acitretin

First generation synthetic retinoids include tretinoin and isotretinoin. Second generation synthetic retinoids are etretinate and acitretin. Tazarotene, adapalene, and bexarotene are third generation. Q/Q(M)-482754 Report a Problem Which of the following has been associated with a lichenoid drug eruption? 1

Sulfasalazine

2

Hydrochlorothiazide

3

Acetaminophen

4

Erythromycin

5

Nicotinamide Q/Q(M)-474329 Report a Problem 50

Which of the following has been associated with a lichenoid drug eruption? 2

Hydrochlorothiazide

Lichen-planus-like (lichenoid) drug eruptions have been reported with: antimalarials, ? -blockers, captopril, gold, penicillamine, HCTZ, NSAIDs. Lichenoid drug reactions are often photodistributed. Q/Q(M)-474329 Report a Problem Thryoid function tests should be checked before and during therapy with which of the following medications? 1

Colchicine

2

Gold

3

Potassium iodide

4

Thalidomide

5

Azathioprine

Q/Q(M)-475919 Report a Problem Thryoid function tests should be checked before and during therapy with which of the following medications? 3

Potassium iodide

The Wolff-Chaifkoff effect, which is the inhibition of thyroid hormone synthesis from excess i odides which block organic iodides from binding in the thyroid, can be observed in patients on potassium iodide therapy. In patients with normal thyroid function, autoregulatory mechanisms allow for appropriate escape from this effect. In patients with impaired autoregulatory mechanisms, the WolffChaikoff effect can lead to hypothyroidism. Q/Q(M)-475919 Report a Problem One of the main concerns for prescribing azathioprine to a gout patient with a normal level of thiopurine methyltransferase on chronic allopurinol is: 1

Azathioprine does not work

2

Allopurinol does not work

3

Patient may develp photosensitivity

4

Patient may become pancytopenic

5

No concerns

Q/Q(M)-477423 Report a Problem One of the main concerns for prescribing azathioprine to a gout patient with a normal level of thiopurine methyltransferase on chronic allopurinol is: 4

Patient may become pancytopenic

Allopurinol inhibits xanthine oxidase, an enzyme that catabolizes az athioprine. In patients concurrently taking bothe medications, the allopurinol shunts more 6-MP from the xanthine oxidase catabolic  pathway to the hypoxanthine-guanine hypoxanthine-guanine phosphoribosyltransferase(HGPRT)anabolic pathway, creating an excess of purine analogs. This in turn may lead to to excessive immunosuppression and risk of  pancytopenia. Q/Q(M)-477423 Report a Problem The form of erythromycin most likely to cause jaundice is: 1

Ethylsuccinate 51

2

Estolate

3

Stearate

4

Gluceptate

5

Lactobionate

Q/Q(M)-478604 Report a Problem The form of erythromycin most likely to cause jaundice is: 2

Estolate

The form of erythromycin that most likely causes jaundice is estolate. Q/Q(M)-478604 Report a Problem Bone marrow suppression can occur more often in individuals taking azathioprine with genetically low allele activity of what enzyme? 1

Inosine monophosphate dehydrogenase

2

Thiopurine methyltransferase

3

Glucose-6-phosphatase

4

Dihydrofolate reductase

5

Epoxide hydroxylase hydroxylase

Q/Q(M)-474467 Report a Problem Bone marrow suppression can occur more often in individuals taking azathioprine with genetically low allele activity of what enzyme? 2

Thiopurine methyltransferase

Thiopurine methyltransferase is one of three enzymes that metabolize azathioprine along with xanthine oxidase and HGPRT. Decreased activity of TPMT leads to heightened metabolism by HGPRT into the active 6-thioguanine. This may lead to increased toxicity including bone marrow suppression. Q/Q(M)-474467 Report a Problem Which of the following best describes the contents of a cream? 1

A semisolid emulsion of oil in water

2

A semisolid transparent emulsion

3

An aqueous or alcohol-based substance that may contain a salt in solution

4

A semisolid grease/oil, sometimes also containing powder, but little or now water

5

An ointment with a high proportion of powder

Q/Q(M)-482382 Report a Problem Which of the following best describes the contents of a cream? 1

A semisolid emulsion of oil in water

A cream is a semisolid emulsion of oil in water that contains a preservative to prevent overgrowth of microorganisms. A gel is a semisolid transparent, nongreasy emulsion. A lotion is a liquid vehicle that is aqueous or alcohol-based that may contain a salt i n solution. An ointment is a semisolid grease/oil, sometimes also containing powder, but little or now water; usually there is no preservative needed. A  paste is an ointment with a high proportion of of powder that gives it a stiff consistency. Q/Q(M)-482382 Report a Problem The combination of doxorubicin and which medications has been reported to cause sticky skin? 1

Vancomycin 52

2

Amphotercin

3

Ketoconazole

4

G-CSF

5

Cisplatin

Q/Q(M)-476715 Report a Problem The combination of doxorubicin and which medications has been reported to cause sticky skin? 3

Ketoconazole

Polsen et. al. reported a 29% incidence of sticky st icky skin in patients treated with high dose ketoconazole and doxorubicin for prostate cancer. Other medications reported to cause t his include etretinate and tretinoin. treti noin. Polsen JA, Cohen PR, Sella: Acquired cutaneous adherence in patients with androgen-independent  prostate cancer receiving ketoconazole and doxorubicin: medication-induced sticky skin. J Am Acad Dermatol: 32 (4):571-5 1995 Q/Q(M)-476715 Report a Problem A 21-year old male presents with a sudden onset of fever, rash, facial edema, leukocytosis and hepatitis four weeks after starting phenytoin for seizures. This patient most likely had which risk factor for developing this skin condition: 1

Slow acetylator

2

Deficiency of epoxide hydroxylase

3

Renal failure

4

Recent vaccination

5

Thyroid disease Q/Q(M)-482273 Report a Problem

A 21-year old male presents with a sudden onset of fever, rash, facial edema, leukocytosis and hepatitis four weeks after starting phenytoin for seizures. This patient most likely had which risk factor for developing this skin condition: 2

Deficiency of epoxide hydroxylase

This patient has anticonvulsant hypersensitivity syndrome most likely resulting from a deficiency of epoxide hydroxylase. Slow acetylators are also predisposed to this condition after being given sulfonamides. Renal failure is a risk ris k factor with allopurinol administration. Recent vaccination and thyroid disease are not known risk factors. Q/Q(M)-482273 Report a Problem What antifungal is known to cause gynecomastia and impotence? 1

Griseofulvin

2

Itraconazole

3

Terbinafine

4

Ketoconazole

5

Fluconazole

Q/Q(M)-474453 Report a Problem What antifungal is known to cause gynecomastia and impotence? 4

Ketoconazole

Ketoconazole is known to cause gynecomastia and impotence, by interfering with androgen and glucocorticoid synthesis. 53

Q/Q(M)-474453 Report a Problem Which one of the following agents when used prophylactically has demonstrated efficacy in reducing skin cancer in organ transplant patients? 1

Tacrolimus

2

Acitretin

3

Imiquimod

4

Interleukin-2

5

Cyclosporine

Q/Q(M)-477198 Report a Problem Which one of the following agents when used prophylactically has demonstrated efficacy in reducing skin cancer in organ transplant patients? 2

Acitretin

Systemic retinoids like acitretin have been used in the chemoprophylaxis of skin cancers. Several studies have suggested a beneficial effect of retinoids with lowered incidences of skin cancer. However, following cessation of the retinoids, the incidence normalizes. Q/Q(M)-477198 Report a Problem Which of the following drugs has been known to cause penile erosions? 1

Gancyclovir

2

Cidofovir

3

Foscarnet

4

Penciclovir

5

Abacavir

Q/Q(M)-475200 Report a Problem Which of the following drugs has been known to cause penile erosions? 3

Foscarnet

Foscarnet has been reported to cause penile erosions. Q/Q(M)-475200 Report a Problem The agent of choice used to acutely lower methemoglobin levels in patients taking dapsone is: 1

Cimetidine

2

Oral methylene blue

3

Homocysteine

4

Vitamin E

5

Glucose-6-phosphatase Q/Q(M)-474466 Report a Problem

The agent of choice used to acutely lower methemoglobin levels in patients taking dapsone is: 2

Oral methylene blue

Cimetidine and vitamin E have both been known to provide prophylaxis against methemoglobin formation. G6PD-deficient individuals are at greater risk of hematologic toxicity from dapsone. 54

Q/Q(M)-474466 Report a Problem A patient with AIDS is given combination anti-retroviral therapy. Which of the following antiviral medications used for HIV is associated with lipodystrophy with abnormal fatty deposits? 1

Indinavir

2

Abacavir

3

Didanosine

4

Zidovudine

5

Foscarnet Q/Q(M)-482745 Report a Problem

A patient with AIDS is given combination anti-retroviral therapy. Which of the following antiviral medications used for HIV is associated with lipodystrophy with abnormal fatty deposits? 1

Indinavir

Indinavir is a protease inhibitor used for the treatment of HIV. The protease enzyme is responible for the final assembly of new viral proteins. The protease inhibitors, particularly indinavir, have been associated with lipodystrophy, which manifests as abnormal fatty deposits known as the \"buffalo hump\" and \"protease pouch.\" Q/Q(M)-482745 Report a Problem Which antifungal medication has a black box warning for CHF? 3

Itraconazole

Itraconazole should be avoided in heart patients due to i ts black box warning against CHF. Other reported adverse effects from itraconazole it raconazole include photosensitivity and COPD. Q/Q(M)-482458 Report a Problem An 87 year old female with chronic lymphocytic leukemia develops disseminated varicel la-zoster infection. She is hospitalized for treatment. Rapid intravenous infusion of acyclovir has been associated with what complication? 1

Reversible obstructive nephropathy

2

Disseminated intravascular coagulation

3

Thrombocytopenia

4

Pulmonary fibrosis

5

Serum sickness Q/Q(M)-482743 Report a Problem

An 87 year old female with chronic lymphocytic leukemia develops disseminated varicella -zoster infection. She is hospitalized for treatment. Rapid intravenous infusion of acyclovir has been associated with what complication? 1

Reversible obstructive nephropathy

Acyclovir is a guanosine analog. It is preferentiall y phosphorylated by viral thymidine kinase. It inhibits viral DNA polymerase, halting viral DNA synthesis by chain termination. Rapid intravenous infusion of acyclovir has been associated with a reverisble obstructive nephropathy. 55

Q/Q(M)-482743 Report a Problem The antihistamine with strong H1 and H2 blockade is: 1

Chlorpheniramine

2

Cetirizine

3

Cimetidine

4

Cyproheptadine

5

Doxepin Q/Q(M)-474479 Report a Problem

The antihistamine with strong H1 and H2 blockade is: 5

Doxepin

Doxepin, a tricyclic antidepressant, has H1 and H2 antihistamine acti vity. Q/Q(M)-474479 Report a Problem Methemoglobinemia is an adverse reaction to treatment with which agent? 1

Dapsone

2

Methotrexate

3

Plaquenil

4

Azathioprine

5

Cyclophosphamide

Q/Q(M)-475871 Report a Problem Methemoglobinemia is an adverse reaction to treatment with which agent? 1

Dapsone

Dapsone is a lipid-soluble sulfone drug that is used widely in dermatology in a variety of conditions including dermatitis herpetiformis, leprosy, and neutrophilic dermatoses. Adverse effects from dapsone are both pharmacologic and idiosyncratic and include hemolytic anemia, methemoglobinemia, agranulocytosis, hypersensitivity syndrome and neuropathy. Of these, the first two are pharmacologic and anticipated, to some degree, in most patients t reated with dapsone. However, the magnitude of toxicity varies greatly among individuals on the drug. Methemoglobinemia is the formation of methemoglobin in the blood, which has a decreased oxygen-carrying capacity compared with hemoglobin and can result in cyanosis. The reaction is related to the N-hydroxy metabolites of dapsone, which are potent oxidants. G6PD-deficient individuals are more susceptible to oxidative stresses, including those from dapsone metabolites, and a baseline G6PD level is recommended prior to initiation of dapsone therapy. In the event of emergent methemoglobinemia, oral methylene blue (100-300 mg/day) can be used to decrease methemoglobin levels. However, if the patient is G6PD deficient, this strategy is ineffective. Q/Q(M)-475871 Report a Problem Clinical evidence of hypothyroidism can be induced by which drug? 1

Bexarotene

2

Gold 56

3

Griseofulvin

4

Acitretin

5

Isotretinoin Q/Q(M)-474128 Report a Problem

Clinical evidence of hypothyroidism can be induced by which drug? 1

Bexarotene

Bexarotene can cause a central hypothyroidism with low TSH and T4. Q/Q(M)-474128 Report a Problem A 59 year-old woman is diagnosed with acute myelogenous leukemia. Induction chemotherapy is initiated. A few days later the patient develops tender erythematous plaques on her face. What is the most likely culprit drug? 1

Methotrexate

2

Cytarabine

3

5-fluorouracil

4

Cyclophosphamide

5

Hydroxyurea Q/Q(M)-477675 Report a Problem

A 59 year-old woman is diagnosed with acute myelogenous leukemia. Induction chemotherapy is initiated. A few days later the patient develops tender erythematous plaques on her face. What is the most likely culprit drug? 2

Cytarabine

The most likely diagnosis is neutrophilic eccrine hidradenititis. Cytarabine is the usual offending agent. Q/Q(M)-477675 Report a Problem What is the most common cause of nonpigmented fixed drug eruption? 1

Naproxen

2

Tetracycline

3

Sulfonamides

4

Phenolphthalein

5

Pseudoephedrine Q/Q(M)-477446 Report a Problem

What is the most common cause of nonpigmented fixed drug eruption? 5

Pseudoephedrine

Pigmented incontinence is usually prominent in a fixed drug eruption; yet occasionally, fixed drug reactions do not result in long-lasting hyperpigmentation. The so-called nonpigmented fixed drug eruption is distictive. Pseudoephedrine hydrochloride is by far the most common cause. Q/Q(M)-477446 Report a Problem 57

Which of the following statements is not true regarding the tetracycline antiobiotics? 1

Ingestion of zinc salts may impair absorption of tetracycline

2

Tetracycline is the most common cause of fixed drug eruption

3

Tetracycline is more phototoxic than demeclocycline

4

These antibiotics are effective against Mycoplasma infections

5

Tetracyclines are contraindicated in children less than 9 years of age Q/Q(M)-475194 Report a Problem

Which of the following statements is not true regarding the tetracycline antiobiotics? 3

Tetracycline is more phototoxic than demeclocycline

Demeclocycline and doxycycline are the most phototoxic of all the tetracyclines. Q/Q(M)-475194 Report a Problem Which cutaneous side effect is a common complication of nitrogen mustard therapy? 1

Bullous drug eruption

2

Telangiectasia

3

Hyperpigmentation

4

Allergic contact dermatitis

5

Fixed drug eruption

Q/Q(M)-477136 Report a Problem Which cutaneous side effect is a common complication of nitrogen mustard therapy? 4

Allergic contact dermatitis

Topical nitrogen mustard, or mechlorethamine, is an antineoplastic agent which works via alkylation thereby inhibiting DNA synthesis. Allergic contact dermatitis occurs in two -thirds of patients who are treated with topical nitrogen mustard in aqueous solution, but occurs in l ess than 5% of patients treated with the ointment based preparation. Q/Q(M)-477136 Report a Problem Which of the following side effects has not been reported in association with intravenous immune globulin? 1

Headache

2

Flushing

3

Hypotension

4

Stevens-Johnson syndrome

5

Anaphylaxis

Q/Q(M)-477186 Report a Problem Which of the following side effects has not been reported in association with intravenous immune globulin? 4

Stevens-Johnson syndrome

IVIG is used to treat several diseases including graft versus host disease, connective tissue disease, and 58

autoimmune bullous dermatoses. Adverse effects include infusion reactions (headache, flushing, chill s, myalgia, wheezing, achycardia, lower back pain, nausea, or hypotension). Anaphylaxis occurs rarely. Disseminated intravascular coagulation, transient neutropenia, and aseptic meningitis syndrome has  been reported. Cutaneous adverse effects include eczematous eruptions and alopecia. Q/Q(M)-477186 Report a Problem A 44 year old female with HIV/AIDS develops grouped painful vesicles in a T4 dermatomal distribution. Valacyclovir is prescribed. What severe reaction has been associated with the use of valacyclovir in AIDS patients? 1

Thrombotic thrombocytopenia purpura/hemolytic uremic syndrome

2

Stevens-Johnson syndrome

3

Acute renal failure

4

Jarisch-Herxheimer reaction

5

Disseminated intravascular coagulation

Q/Q(M)-482744 Report a Problem A 44 year old female with HIV/AIDS develops grouped painful vesicles in a T4 dermatomal distribution. Valacyclovir is prescribed. What severe reaction has been associated with the use of valacyclovir in AIDS patients? 1

Thrombotic thrombocytopenia purpura/hemolytic uremic syndrome

Valacyclovir is a prodrug of acyclovir, and has enhanced bioavailability and converts rapidly and completely to acyclovir. Severe and even fatal cas es of thrombotic thrombocytopenia purpura/hemolytic uremic syndrome have been reported in AIDS and transplant patients taking high doses of valacyclovir. Q/Q(M)-482744 Report a Problem After exposure to a tick, a patient develops a rickettsial infection, requiring a tetracycline-class antibiotic. A review of systems reveals that he has a history of chronic renal insufficiency. Which is the only tetracycline that can be used in patients with renal failure? 1

Doxycycline

2

Minocycline

3

Tetracycline

4

Demeclocycline

5

Azithromycin

Q/Q(M)-482740 Report a Problem After exposure to a tick, a patient develops a rickettsial infection, requiring a tetracycline-class antibiotic. A review of systems reveals that t hat he has a history of chronic renal insufficiency. Which is the only tetracycline that can be used in patients with renal failure? 1

Doxycycline

Tetracycline antibiotics inhibit protein synthesis by binding to the 30S ribosomal subunit. They are effective against gram positive and negative organisms, Mycoplasma, Chlamydia, Rickettsia, and others. Doxycycline, which is excreted by the Gi tract, is t he only tetracycline for use in patients with renal r enal failure. Q/Q(M)-482740 Report a Problem Which of the following is not associated with calcipotriene? 59

1

Inactivation by basic pH

2

Increase in interleukin-10

3

Decrease in interleukin-2

4

Potential risk for photosensitivity

5

Inhibition of NF-kB

Q/Q(M)-482269 Report a Problem Which of the following is not associated with calcipotriene? 1

Inactivation by basic pH

Calcipotriene is relatively unstable and inactivated by acidic pH, ie with ammonium lactate and salicylic acid. The other statements are true. Psoriasis is classically a TH1 disease and this medicine upregulates TH2 cytokines it is commonly used to treat this condition. It has mild a nti-inflammatory properties via its inhibition of NF-kB. It also inhibits cell proliferation and induces cell differentiation. Q/Q(M)-482269 Report a Problem Which of the following medications is associated wit h painful symmetrical erythema and paresthesias of the palms and soles? 1

sorafenib

2

cetuximab

3

bortezomib

4

erlotinib

5

gefitinib

Q/Q(M)-482519 Report a Problem Which of the following medications is associated wit h painful symmetrical erythema and paresthesias of the palms and soles? 1

sorafenib

Sorafenib is a small-molecule multi-kinase inhibitor used in the treatment of renal cell cancer and hepatocellular cancer. Notably it inhibits Raf kinase, which functions in the Ras signaling pathway, in addition to blocking VEGFR-2, VEGFR-3, FLT3, and PDGFRb signaling. Reports of hand and foot syndrome have been noted, characterized by acral er ythema and paresthesias. This side effect seems to resolve rapidly after discontinuation of treatment. Q/Q(M)-482519 Report a Problem Alternate-day administration of oral steroids can reduce all of the following side effects except? 1

Growth impairment

2

HPA axis suppression

3

Cataracts

4

Peptic ulcer disease

5

Opportunisitic infection

Q/Q(M)-474455 Report a Problem Alternate-day administration of oral steroids can reduce all of the following side effects except?

60

3

Cataracts

Alternate-day corticosteroid dosing regimens does not decrease the risks of posterior subcapsular cataracts, osteoporosis, and possibly osteonecrosis. Q/Q(M)-474455 Report a Problem All of the following statements are true regarding cyclosporin A EXCEPT: 1

Adverse effects include hypertrichosis and gingival hyperplasia

2

The most common eletrolyte abnormalities are hypokalemia and hypermagnesemia

3

Forms a complex with cyclophilin, blocking its ability to activate calcineuri n, thus preventing calcineurin from de-phosphorylation NFAT-1

4

Metabolized by the hepatic cytochrome P-450 3A4 enzyme system

5

NSAIDs can potentiate renal toxicity when combined with cyclosporine Q/Q(M)-475611 Report a Problem

All of the following statements are true regarding cyclosporin A EXCEPT: 2

The most common eletrolyte abnormalities are hypokalemia and hypermagnesemia

The most common electrolyte abnormalities associated with cyclosporin A are hyperkalemia, hyperuricemia, and hypomagnesemia. Q/Q(M)-475611 Report a Problem

All of the following retinoids are excreted in the urine EXCEPT: 1

Bexarotene

2

Etretinate

3

Isotretinoin

4

Tretinoin

5

Acitretin

Q/Q(M)-475618 Report a Problem All of the following retinoids are excreted in the urine EXCEPT: 1

Bexarotene

Bexarotene is excreted via hepatobiliary excretion. The others are excreted in bile and urine. Q/Q(M)-475618 Report a Problem At standard dosages, which of the following is fungicidal? 1

Terbinafine

2

Fluconazole

3

Ketoconazole

4

Itraconazole

5

Griseofulvin

Q/Q(M)-476687 Report a Problem At standard dosages, which of the following is fungicidal?

61

1

Terbinafine

Terbinafine block ergosterol synthesis early in the synthetic pathway by inhibitins squalene epoxidase. Squalene then accumulates within fungal cells and discupts cell membranes. At standard dosaging, it is  believed to be fungicidal. The other choices choices are fungistatic. Q/Q(M)-476687 Report a Problem The most specific marker of drug-induced lupus is: 1

Anti-histone Ab

2

ANA

3

Anti-Ro Ab

4

Anti-La Ab

5

Anti-ds DNA Ab

Q/Q(M)-474310 Report a Problem The most specific marker of drug-induced lupus is: 1

Anti-histone Ab

Anti-histone Ab is most specific for drug-induced lupus. In addition to minocycline, hydralazine,  procainamide, isonaizid (INH), penicillamine and anti-convulsants have been associated with druginduced lupus-like syndrome. Q/Q(M)-474310 Report a Problem Which antiparasitic agent is highly flammable? 1

Lindane

2

Permethrin

3

Precipitated sulfur

4

Thiabendazole

5

Malathion

Q/Q(M)-475910 Report a Problem Which antiparasitic agent is highly flammable? 5

Malathion

Malathion, an organophosphate cholinesterase inhibitor used to treat scabies and head lice, is flammable. Q/Q(M)-475910 Report a Problem Side effects from this antihistamine include gynecomastia, impotence, and loss of libido: 1

Doxepin

2

Cyproheptadine

3

Promethazine

4

Fexofenadine

5

Cimetidine

Q/Q(M)-475913 Report a Problem Side effects from this antihistamine include gynecomastia, impotence, and loss of libido: 5

Cimetidine

Cimetidine, an H2 antihistamine, also competitively inhibits dih ydrotestosterone at the androgen 62

receptor site, with resultant antiandrogen side effects including gynecomastia, impotence, and loss of libido. Q/Q(M)-475913 Report a Problem The risk of pseudotumor cerebri in patients taking isotretinoin is increased by: 1

Dehydration

2

Concomitant use of tetracycline

3

Concomitant use of TMP-SMX

4

Doses higher than 1.0 mg/kg/day

5

Comorbid affective disorder

Q/Q(M)-474324 Report a Problem The risk of pseudotumor cerebri in patients taking isotretinoin is increased by: 2

Concomitant use of tetracycline

The risk of pseudotumor cerebri is increased in pat ients on isotretinoin and a tetrac ycline. Q/Q(M)-474324 Report a Problem Which cell type is increased by glucocorticoids? 1

Neutrophils

2

Monocytes

3

T-cells

4

B-cells

5

Eosinophils

Q/Q(M)-474454 Report a Problem Which cell type is increased by glucocorticoids? 1

Neutrophils

Glucocorticoids alter the balance of circulating cir culating leukocytes, causing an increase in the number of  polymorphonuclear leukocytes leukocytes and diminishing the numbers of lymphocytes, eosinophils, eosinophils, and monocytes. Q/Q(M)-474454 Report a Problem Which of the following vehicles is correctly defined 1

Ointment-water in oil emulsion

2

Gel-oil in water emulsion

3

Cream-Semisolid emulsion in alcohol base

4

Lotion/Solution-Cream in water

5

Foam - powder in cream Q/Q(M)-478612 Report a Problem

Which of the following vehicles is correctly defined 1

Ointment-water in oil emulsion

Various vehicles are used for different clinical situations. Ointments are water in oil emulsions. Creams 63

are oil in water emulsion. Gels are semisolid emulsion in alcohol base . Lotions/Solutions are powder in water (some oil). Foams are liquid and/or solid materials in a gaseous medium. e. All are correct (false) Q/Q(M)-478612 Report a Problem What family of medications is associated with xerosis? 1

Sulfonylureas

2

Beta blockers

3

Calcium channel blockers

4

Loop diuretics

5

Cholesterol lowering agents Q/Q(M)-476690 Report a Problem

What family of medications is associated with xerosis? 5

Cholesterol lowering agents

Medications that alter the lipid composition of the epidermis and stratum corneum may impair the normal barrier function of the skin. Cholesterol lowering medications like HMG-CoA reductase inhibitors and niacin may cause xerosis through this mechanism. Q/Q(M)-476690 Report a Problem The steroid with the least minerocorticoid activity is: 1

Hydrocortisone

2

Cortisone

3

Prednisone

4

Methylprednisolone

5

Prednisolone

Q/Q(M)-474122 Report a Problem The steroid with the least minerocorticoid activity is: 4

Methylprednisolone

Of the corticosteroids listed, the steroid with the lowest mineralcorticoid activity act ivity is methylprednisolone. Minerocorticoids act on the kidney to decrease the rate of sodium excretion (with accompanying retention of water). Triamcinolone, dexamethasone, and betamethasone also have low mineralcorticoid activity. Q/Q(M)-474122 Report a Problem Cyclosporin A should not be consumed with grapefruit juice due to: 1

Induction of CYP2D6 by grapefruit juice

2

Inhibition of CYP2D6 by grapefruit juice

3

Induction of CYP3A4 by grapefruit juice

4

Inhibition of CYP3A4 by grapefruit juice

5

Grapefruit juice binds cyclosporine, inactivating it in the GI tract.

Q/Q(M)-480137 Report a Problem Cyclosporin A should not be consumed with grapefruit juice due to: 64

4

Inhibition of CYP3A4 by grapefruit juice

Grapefruit juice is an inhibitor of CYP3A4 at the intestinal mucosal membrane. The intestinal CYP3A4 is involved in "first pass" metabolism - thus with inhibition of this enzyme in the gut, less c yclosporine is metabolized, allowing for greater absorption of cyclosporine. Saquinivir also can be affected by this "first pass" inhibition by grapefruit juice. Q/Q(M)-480137 Report a Problem The mechanism action of this cytotoxic agent is via inhibition of IMP dehydrogenase. 1

Azathioprine

2

Methotrexate

3

Hydroxyurea

4

5-fluorouracil

5

Mycophenolate mofetil

Q/Q(M)-477676 Report a Problem The mechanism action of this cytotoxic agent is via inhibition of IMP dehydrogenase. 5

Mycophenolate mofetil

Mycophenolate mofetil (cellcept), a purine analog, blocks de novo purine synthesis by inhibiting the enzyme inosine monophosphate dehydrogenase. Q/Q(M)-477676 Report a Problem Over use of of which medication may lead to this clinical image? 1

Topical steroid

2

Topical antibiotic

3

Calcipotriene

4

Imiquimod

5

Hydroquinone Q/Q(M)-476871 Report a Problem

Over use of of which medication may lead to this clinical image? 5

Hydroquinone

Exogenous ochronosis has been reported with prolonged use of high concentration hydroquinone. On  pathology, a characteristic ochre colored deposit is noted between the collagen bundles. bundles. Q/Q(M)-476871 Report a Problem What feature best distinguishes lichen li chen planus from lichenoid drug eruption? 1

segmental hypergranulosis 65

2

parakeratosis

3

eosinophils

4

spongiosis

5

saw tooth pattern

Q/Q(M)-482857 Report a Problem What feature best distinguishes lichen li chen planus from lichenoid drug eruption? 2

parakeratosis

Lichenoid drug reaction and lichen planus are best distinguished clinically. However, there are clues to lichenoid drug, including parakeratosis and eosinophils. The presence of parakeratosis has been shown to be more sensitive than eosinophils in the diagnosis of lichenoid drug reaction. Q/Q(M)-482857 Report a Problem Which of the following is a potentially irreversible ocular side effects of antimalarial agents? 1

Corneal deposition - causing halos, blurred vision, photophobia

2

Neuromuscular eye toxicity

3

Retinopathy

4

Cataracts

5

Pterygium Q/Q(M)-477440 Report a Problem

Which of the following is a potentially irreversible ocular side effects of antimalarial agents? 3

Retinopathy

Three types of ocular adverse effects may develop from antimalarials: corneal deposits, neuromuscular eye toxicity and retinopathy. Only retinopathy is potentially irreversible. It is recommended that a  patient be evaluated for retinopathy at baseline, then every 6 months months by an ophthamologist. Testing visual acuity, visual fields and performing a funduscopic examination are considered acceptable for screening purposes. Q/Q(M)-477440 Report a Problem Which of the following statements regarding the ocular toxicities of the antimalarial drugs is NOT true? 1

Premaculopathy associated with changes in visual fields without visual loss is reversible if the t he antimalarial is discontinued

2

True retinopathy is associated with "bull's eye" pigment deposition, central scotoma, and diminished visual acuity

3

Risk of retinopathy is greatest for quinacrine, followed by chloroquine

4

Chloroquine and hydroxychloroquine should not be given together because of an additive effect on retinotoxicity

5

The 4-aminoquinolones may have significant associated ocular toxicity

Q/Q(M)-475613 Report a Problem Which of the following statements regarding the ocular toxicities of the antimalarial drugs is NOT true? 3

Risk of retinopathy is greatest for quinacrine, followed by chloroquine

Risk of retinopathy is greatest with chloroquine and does not exist for quinacrine. Q/Q(M)-475613 Report a Problem

66

A 15 year old boy presents with a 4 month history of pigmented bands on several fingernails and toenails. The most like etiology is: 1

Peutz-Jeghers syndrome

2

Chloroquine therapy

3

Minocycline therapy

4

Nevomelanocytic nevi

5

Acral lentiginous melanoma

Q/Q(M)-477321 Report a Problem A 15 year old boy presents with a 4 month history of pigmented bands on several fingernails and toenails. The most like etiology is: 3

Minocycline therapy

Melanonychia occurring simultaneously on several nails is most likel y to be due to minocycline therapy. Blue-black pigmentation may be present in nails, skin, scars and sclerae. Q/Q(M)-477321 Report a Problem Which drug has mucocutaneous side effects which can include stomatitis, chelitis, lichen planus-like eruptions, and pityriasis rosea-like eruptions? 1

Colchicine

2

Gold

3

Potassium iodide

4

Thalidomide

5

None of the above

Q/Q(M)-475918 Report a Problem Which drug has mucocutaneous side effects which can include stomatitis, chelitis, lichen planus-like eruptions, and pityriasis rosea-like eruptions? 2

Gold

Mucocutaneous side effects, which are more common with injectable gold, include stomatitis, cheilitis, lichen planus-like eruptions, and pityriasis rosea-like eruptions. Q/Q(M)-475918 Report a Problem Which antifungal is fungicidal? 1

Itraconazole

2

Terbinafine

3

Fluconazole

4

Clotrimazole

5

Griseofulvin

Q/Q(M)-482332 Report a Problem Which antifungal is fungicidal? 2

Terbinafine

Terbinafine is an allylamine antifungal that is fungicidal. It works via noncompetitive inhibition of squalene epoxydation. Amphotericin is also fungicidal. The azoles are fungistatic and inhibit 14-alpha67

demthylase to prevent ergosterol synthesis. Griseofulvin disrupts micr otubule formation. Q/Q(M)-482332 Report a Problem Which of the following oral agents has been effective in the treatment of Norwegian scabies? 1

Thiabendazole

2

Ivermectin

3

Mebendazole

4

Griseofulvin

5

Metroniddazole

Q/Q(M)-475856 Report a Problem Which of the following oral agents has been effective in the treatment of Norwegian scabies? 2

Ivermectin

Ivermectin (Stromectol) is an anti-helminthic agent currently FDA-approved for the treatment of strongyloides and onchocerciasis. Several publications have reported efficacy of this agent in the treatment of scabies and head lice. Due to its low rate of adverse effects, its high rate of effectiveness, and its ease of administration, some authors consider this agent to be the treatment of choice for scabies and head lice. The mechanism of action of ivermecti n is blockade of glutamate-gated, chloride ion channels, with adverse effects on nerve and muscle resulting in paralysis and death of the helminth or mite. The drug has a very low affinity for mammalia n chloride channels resulting in its relatively relativel y low toxicity. Adverse effects are rare and have been associated with accidental intoxication. i ntoxication. It should be avoided when there is compromise of the blood-brain-barrier. Ivermectin i s pregnancy category C. There are virtually no associated drug interactions with oral ivermectin therapy. Q/Q(M)-475856 Report a Problem Dihydroxyacetone is found in which of the following products? 1

Rubber accelerators

2

Shampoos

3

Artificial nails

4

Hair dyes

5

Sunless tanning preparations

Q/Q(M)-482295 Report a Problem Dihydroxyacetone is found in which of the following products? 5

Sunless tanning preparations

Dihydroxyacetone is the active ingredient in sunless tanning preparations. Upon oxidation it turns orange-brown and binds to the stratum corneum. Rubber accelerators contain mercaptobenthothiazole, carba mix, thiuram mix, or mercapto mix. Shampoos, especially "tear -free" ones, may contain cocamidopropyl betaine. Artificial nails may contain methyl methacr ylate or ethyl acrylate. Hair dyes often have paraphenylenediamine. Q/Q(M)-482295 Report a Problem What testing can be performed to asses for methotrexate induced liver fibrosis, in lieu of liver biopsy? 1

AST/ALT ratio

2

Alkaline phosphatase level

3

procollagen 3 testing 68

4

procollagen 1 testing

5

procollagen 4 testing

Q/Q(M)-482847 Report a Problem What testing can be performed to asses for methotrexate induced liver fibrosis, in lieu of liver biopsy? 3

procollagen 3 testing

 procollagen 3 testing. Procollagen 3 has been shown shown to be a sensitive marker for methotrexate induced liver fibrosis. Procollagen 1 is a marker for AFX. Q/Q(M)-482847 Report a Problem  Neutrophilic eccrine hidradenitis is a side effect of which therapeutic agent? 1

Interferon-alpha

2

Cytarabine

3

Interferon type I

4

Intravenous immune globulin

5

Granulocyte colony stimulating factor

Q/Q(M)-477318 Report a Problem  Neutrophilic eccrine hidradenitis is a side effect of which therapeutic agent? 2

Cytarabine

 Neutrophilic eccrine hidradenitis most commonly occurs in the setting of a patient patient with acute myelogenous leukemia being treated with cytarabine. Clinical manifestations include tender, erythematous macules, papuls and plaques on the trunk, neck and extremities which resolve within a few days. Histologically, this drug eruption is defined by the presence of dense neutrophilic infiltrate within and around eccrine glands, with necrosis of eccrine epithelial cells. Q/Q(M)-477318 Report a Problem What is the half-life of isotretinoin? 1

100 days

2

100 hours

3

50 hours

4

20 hours

5

10 hours

Q/Q(M)-475614 Report a Problem What is the half-life of isotretinoin? 4

20 hours

The half-life of isotretinoin is 20 hours. Q/Q(M)-475614 Report a Problem Which of the following medicines reduces the formation of methemoglobin? 1

Dapsone

2

Cimetidine

3

Azathioprine

69

4

Cyclosporine

5

Rifampin

Q/Q(M)-482268 Report a Problem Which of the following medicines reduces the formation of methemoglobin? 2

Cimetidine

Cimetidine and vitamin E can reduces the formation of methemoglobin, thereby increasing tolerance t o dapsone which can lead to methemoglobinemia. Azathioprine can cause hepatitis, l ymphoproliferative ymphoproliferative malignancy, infections, and hypersensitivity syndrome. s yndrome. Cyclosporine can lead to renal dysfunction, d ysfunction, hypertension, and ginvigal hyperplasia. Rifampin can cause decreased effectiveness of oral contraceptives. Q/Q(M)-482268 Report a Problem Which of the following medications can lead to hematologic toxicity when combined with methotrexate? 1

Trimethoprim

2

Sulfonamides

3

Dapsone

4

All of these answers are correct

5

None of these answers are correct

Q/Q(M)-475208 Report a Problem Which of the following medications can lead to hematologic toxicity when combined with methotrexate? 4

All of these answers are correct

All of the above inhibit the folic acid metabolic met abolic pathway, and can lead to hematologic toxicity when combined with methotrexate. Q/Q(M)-475208 Report a Problem Which of the following cytotoxic agents has been associated with poikiloderma of the dorsal hands with a band-like distribution of the fingers and toes? 1

Intralesional bleomycin

2

Doxorubicin

3

Flurouracil

4

Azathioprine

5

Hydroxyurea

Q/Q(M)-475207 Report a Problem Which of the following cytotoxic agents has been associated with poikiloderma of the dorsal hands with a band-like distribution of the fingers and toes? 5

Hydroxyurea

Hydroxyurea has been associated with poikiloderma of the dorsal hands with a band-like distribution of the fingers and toes. It has also a lso been associated with diffuse hyperpigmentation, and with leg ulcers upon withdrawal. Q/Q(M)-475207 Report a Problem Imiquimod has proven beneficial in the treatment of all of the following lesions except:

70

1

Erythroplasia of Queyrat

2

Superficial basal cell carcinoma

3

Actinic keratoses

4

Squamous cell carcinoma

5

Extramammary Paget�s disease

Q/Q(M)-477226 Report a Problem Imiquimod has proven beneficial in the treatment of all of the following lesions except: 4

Squamous cell carcinoma

Imiquimod is an immune response modifier that acts via the toll like receptor 7. It induces c ytokines including interferon alpha, interleukins 1, 5, 6, 8, 10, and tumor necrosis factor. It has been used to treat Erythroplasia of Queyrat, superficial basal cell carcinomas, actinic keratoses, extramammary Paget�s disease, and warts. Q/Q(M)-477226 Report a Problem All of the following are true regarding water-solu ble retinoids EXCEPT: 1

They are undetectable in the serum after 1 month of stopping therapy

2

They include isotretinoin

3

They include etretinate

4

They include bexarotene

5

They have very little lipid deposition

Q/Q(M)-475617 Report a Problem All of the following are true regarding water-solu ble retinoids EXCEPT: 3

They include etretinate

Isotretinoin, acitretin, and bexarotene are water-soluble, with very little lipid deposition. Etretinate is 50 times more lipophilic than acitretin, with increased storage in adipose tissue. Q/Q(M)-475617 Report a Problem Which of the following antiparasitic agents is an or ganophosphate cholinesterase inhibitor? 1

Precipitated sulfur

2

Thiabendazole

3

Ivermectin

4

Lindane

5

Malathion

Q/Q(M)-475908 Report a Problem Which of the following antiparasitic agents is an or ganophosphate cholinesterase inhibitor? 5

Malathion

Malathion is an organophosphate cholinesterase inhibitor. Q/Q(M)-475908 Report a Problem The Wolff-Chaikoff effect is associated with what medication? 1

Bexarotene

2

Zidovudine

71

3

Potassium iodide

4

Hydroxychloroquine

5

Thalidomide

Q/Q(M)-474480 Report a Problem The Wolff-Chaikoff effect is associated with what medication? 3

Potassium iodide

The Wolff-Chaikoff effect is the inhibition of thyroid hormone synthesis from excess iodides which  block organic iodides from binding in the thyroid. In patients with normal thyroid thyroid function, autoregulatory mechanisms allow for escape from this effect. In patients with impaired autoregulatory mechanisms, the Wolff-Chaikoff effect can lead to hypothyroidism. Thyroid function should be evaluated and monitored with patients started on potassium iodide. Q/Q(M)-474480 Report a Problem In regards to liposuction, what is the maximum amount of tumescent anesthesi a (lidocaine) recommended for an adult? 1

15 mg/kg

2

25 mg/kg

3

35 mg/kg

4

45 mg/kg

5

55 mg/kg

Q/Q(M)-482346 Report a Problem In regards to liposuction, what is the maximum amount of tumescent anesthesi a (lidocaine) recommended for an adult? 5

55 mg/kg

Technically, 35 mg/kg is considered the safe and average amount recommended. However, maximum amount of lidocaine has been reported to be 55 mg/kg. Tumescent anesthesia is a method where dilute lidocaine is injected into subcutaneous fat for the liposuction procedure. Q/Q(M)-482346 Report a Problem The SPF of a sunscreen is based on applying the sunscreen at what concentration? 1

1 mg/cm2

2

2 mg/cm2

3

3 mg/cm2

4

4 mg/cm2

5

5 mg/cm2

Q/Q(M)-477493 Report a Problem The SPF of a sunscreen is based on applying the sunscreen at what concentration? 2

2 mg/cm2

A sunscreen SPF is based on using it at a concentration of 2 mg/cm2 which is about 1 ounce or 30 grams for the entire average sized body. It also is about 3-5 grams for the head and neck. Q/Q(M)-477493 Report a Problem Which of the following chemotherapeutic agents is not cell c ycle specific? 1

Methotrexate 72

2

5-fluorouracil

3

Cyclophosphamide

4

Azathioprine

5

Hydroxyurea

Q/Q(M)-482195 Report a Problem Which of the following chemotherapeutic agents is not cell c ycle specific? 3

Cyclophosphamide

Cyclophosphamide is an alkylating agent that cross links DNA at any point during the cell cycle. Methotrexate, 5-fluorouracil, azathioprine, and hydroxyurea are S-phase specific c ytotoxic agents. Methotrexate is a folic acid analog that blocks dihydrofolate reductase. 5-FU is a pyrimidine analog that  prevents the conversion of deoxyuridine monophosphate monophosphate to deoxythymidine deoxythymidine monophosphate in DNA synthesis. Azathioprine is a purine analog that is converted into the active metabolite 6-thioguanine bit hypoxanthine guanine phosphoribosyltransferase. Hydroxyurea inhibits ribonucleotide reductase which normally converts ribonucleotides to deoxyribonucleotides in DNA synthesis. Q/Q(M)-482195 Report a Problem Which of the following statements regarding sunscreens is true? 1

Physical blockers absorb ultraviolet light and convert it to lower energy wavelengths

2

Methyl anthranilate is a UVB absorber

3

Padimate O is a UVB absorber

4

Photoallergy has not been reported to benzophenones

5

PABA and its derivates do not cross react with sulfonamides

Q/Q(M)-475899 Report a Problem Which of the following statements regarding sunscreens is true? 3

Padimate O is a UVB absorber

Physical blockers reflect and scatter UV rays, whereas chemical sunscreens absorb UV li ght and convert the absorbed energy into longer lower energy wavelengths. Methyl anthranilate is a UVA blocker. Padimate O, a PABA derivative, is a UVB blocker. Photoallergy has been reported with increasing frequency to benzophenones. Allergic contact allergy can occur with PABA and its derivatives, whic h can cross react with azodyes, az odyes, aniline, procaine, benzocaine, paraphenylenediamine, and sulfonamides. Q/Q(M)-475899 Report a Problem Which of the following medications is associated wit h anti-myeloperoxidase antibodies? 1

Isoniazid

2

Minocycline

3

Penicillamine

4

TNF-alpha inhibitors

5

Griseofulvin Q/Q(M)-482509 Report a Problem

Which of the following medications is associated wit h anti-myeloperoxidase antibodies? 2

Minocycline

Minocycline, which is widely used in the treatment of acne, of ten without adequate supervision, may induce arthritis and livedo vasculitis associated with anti-MPO (pANCA). (O Elkayam. Ann Rheum Dis. 73

1996) Isoniazid most often causes drug-induced lupus associated with anti-hitone antibodies. Penicillamine and TNF-inhibitors are associated with anti-dsDNA antibodies. Griseofulvin can exacerbate lupus but is most often associated with drug-induced SCLE and anti-Ro antibodies. Q/Q(M)-482509 Report a Problem Which of the following is true regarding the use of cyclosporine? 1

Guidelines limit the continuous use of cyclosporine in the US to 5 years

2

Cyclosporine should not be used together with methotrexate

3

Cyclosporine is not an effective treatment for psoriatic arthritis

4

Cyclosporine inhibits the activation of antigen presenting cells

5

Cyclosporine has not shown efficacy in the treatment of chronic urticaria

Q/Q(M)-482511 Report a Problem Which of the following is true regarding the use of cyclosporine? 4

Cyclosporine inhibits the activation of antigen presenting cells

Cyclosporine binds to cyclophilin, an intracellular immunophilin, and inhibits the activity of calcineurin  phosphatase, which is then unable to phosphorylate phosphorylate NFAT. Guidelines limit the use of cyclosporine in the US to one year. Cyclosporine is an effective treatment for psoriatic arthritis, alone or in combination with methotrexate. Cyclosporine inhibits the activation of T-cells, NK cells, and antigen presenting cells. And cyclosporine has shown some efficacy in histamine resistant chronic urticaria. Q/Q(M)-482511 Report a Problem This patient also has a diagnosis of acne vulgaris (diagnosed 10 years ago). What is the most likely explanation for these cutaneous changes? 1

Peripheral vascular disease

2

Diabetes mellitus

3

Drugs hypersensitivity reaction to penicillin

4

Minocycline-induced hyperpigmentation

5

Leukocytoclastic vasculitis Q/Q(M)-480555 Report a Problem

This patient also has a diagnosis of acne vulgaris (diagnosed 10 years ago). What is the most likely explanation for these cutaneous changes? 4

Minocycline-induced hyperpigmentation

This patient has minocyclin-induced hyperpigmentation. Hyperpigmentation is one of the most 74

commonly observed side effects of minocycline and occurs regardless of dosage or treatment duration (although most often seen in patients after long-term treatment with the drug). Three distributions can be seen: Type I (blue-black pigmentation in sites of inflammation/scars), Type II (blue-black pigmentation on the anterior lower legs, and Type III (muddy brown diffuse pigmentation on normal, sun-exposed skin). This patient has Type II pigmentation. Q/Q(M)-480555 Report a Problem

Which member of the tetracycline family famil y is most likely to have caused this photomediated reaction? 1

Demeclocycline

2

Doxycycline

3

Minocycline

4

Oxytetracycline

5

Tetracycline Q/Q(M)-476862 Report a Problem

Which member of the tetracycline family famil y is most likely to have caused this photomediated reaction? 1

Demeclocycline

The tetracycline family of antibiotics are bacteriostatic and act by inhibiting protein synthesis. Each member of the family may cause photosensitivity, but demeclocycline is the most photosensitizing. Q/Q(M)-476862 Report a Problem Which of the following medications used in dermatology is known to increase the risk for bone fractures? 1

Dapsone

2

Isotretinoin

3

Acitretin

4

Prednisone

5

Doxycycline Q/Q(M)-482190 Report a Problem

Which of the following medications used in dermatology is known to increase the risk for bone fractures? 4

Prednisone 75

Long term use of oral corticosteroids has been shown to decrease bone mineral density (BMD). This decrease in BMD leads to an increased risk for fractures. It was originally thought that Vitamin A analogues such as isotretinoin and acitretin may also increase the risk of fracture but in a large casecontrolled study published in the May 2010 Archives illustrates that risk of fr acture is not associated with Vitamin A analogues. Vitamin A analogues have been associated with hyperostosis. Q/Q(M)-482190 Report a Problem

A child with systemic medium-vessel vasculitis vasculiti s is treated with a cytotoxic agent. While in the hospital, he develops new-onset generalized tonic-clonic seizures. Which cytotoxic agent is associated with tonicclonic seizures? 1

Chlorambucil

2

Cyclophosphamide

3

Methotrexate

4

Doxorubicin

5

Hydroxyurea

Q/Q(M)-482748 Report a Problem A child with systemic medium-vessel vasculitis vasculiti s is treated with a cytotoxic agent. While in the hospital, he develops new-onset generalized tonic-clonic seizures. Which cytotoxic agent is associated with tonicclonic seizures? 1

Chlorambucil

Chlorambucil is a nitrogen mustard derivative that is used as a steroid sparing agent in vasculitis, Behcet\'s disease, dermatomyositis, and sarcoidosis. In children with nephritic syndrome or adults with a seizure history, it can cause generalized tonic-clonic seizures. Q/Q(M)-482748 Report a Problem Which drug is known to cause an SCLE-like eruption? 1

Captopril

2

Minocycline

3

Barbituates

4

Furosemide

5

Terbinafine

Q/Q(M)-474129 Report a Problem Which drug is known to cause an SCLE-like eruption? 5

Terbinafine

SCLE-like reaction are known to occur most likely from fr om glyburide, griseofulvin, hydrochlorothiazide,  penicillamine, piroxicam, and terbinafine. Q/Q(M)-474129 Report a Problem A 66 year old female presents with palpable purplish lesions and small necrotic ulcers of the extremities. Additional workup reveals renal and hepatic involvement, and a diagnosis of Wegener\'s granulomatosis is made. Which of the following cytotoxic agents is the treatment of choice for Wegener\'s granulomatosis? 1

Cyclophosphamide

2

Chlorambucil

3

Methotrexate 76

4

Bleomycin

5

Mycophenolate mofetil

Q/Q(M)-482747 Report a Problem A 66 year old female presents with palpable purplish lesions and small necrotic ulcers of the extremities. Additional workup reveals renal and hepatic involvement, and a diagnosis of Wegener\'s granulomatosis is made. Which of the following cytotoxic agents is the treatment of choice for Wegener\'s granulomatosis? 1

Cyclophosphamide

Cyclophosphamide is a nitrogen mustard derivative. It is cell -cycle nonspecifc and works by producing DNA cross-linkages at any point in the cell cycle. It is the treatment of choice for Wegener\'s granulomatosis. Q/Q(M)-482747 Report a Problem A patient has recalcitrant Sweet\'s syndrome. Hydroxyurea is initiated. Hydroxyurea works by inhibiting which enzyme? 1

Ribonucleotide reductase

2

DNA gyrase

3

Dihydrofolate reductase

4

Inosine monophosphate dehydrogenase

5

Thymidine kinase Q/Q(M)-482751 Report a Problem

A patient has recalcitrant Sweet\'s syndrome. Hydroxyurea is initiated. Hydroxyurea works by inhibiting which enzyme? 1

Ribonucleotide reductase

Hydroxyurea is a S-phase specific cytotoxic agent which inhibits ribonucleotide reductase, an enzyme responsible for converting ribonucleotides to deoxyribonucleotides in DNA synthesis. Anemia, hepatitis, and renal toxicity are associated adverse advers e effects. Fluoroquinolones inhibit DNA gyrase. Methotrexate inhibits dihydrofolate reductase. Mycophenolate M ycophenolate mofetil inhibits inosine monophosphate dehydrogenase. dehydrogenase. Acyclovir utitilizes thymidine kinase to interrupt viral replication. Q/Q(M)-482751 Report a Problem Weekly CD4 T-cell counts are recommended for psoriasis patients treated with which biologic agent? 1

Alefacept

2

Etanercept

3

Efalizumab

4

Infliximab

5

None of the above

Q/Q(M)-475914 Report a Problem Weekly CD4 T-cell counts are recommended for psoriasis patients treated with which biologic agent? 1

Alefacept

Alefacept eliminates activated memory T-cells, so weekly CD4 T-cell counts are recommended. Q/Q(M)-475914 Report a Problem

77

A 25 year old female patient has a recurrent pustule that occurs in the same place on the lower lip. The drug that she can use is the drug that is the prodrug of acyclovir. It is used for the infection of HSV-1 and HSV-2 and can be used for recurrent infections: 1

Valacyclovir

2

Brivudin

3

Famciclovir

4

Griseofulvin

5

Dapsone

Q/Q(M)-482900 Report a Problem A 25 year old female patient has a recurrent pustule that occurs in the same place on the lower lip. The drug that she can use is the drug that is the prodrug of acyclovir. It is used for the infection of HSV- 1 and HSV-2 and can be used for recurrent infections: 1

Valacyclovir

Valacyclovir is a prodrug of acyclovir and is used in acute HSV 1 and 2 infections. It is converted in first pass through gastrointestinal tract and liver to acyclovir. It is probably better for z oster than acyclovir. It is not approved in immunosuppressed patients. Q/Q(M)-482900 Report a Problem Which of the following inhibits bacterial cell wall synthesis by complexing with the carrier protein C55 prenol pyrophosphatase. 1

Bacitracin

2

Polymyxin

3

Neomycin

4

Mupirocin

5

Silver sulfadiazine

Q/Q(M)-477441 Report a Problem Which of the following inhibits bacterial cell wall synthesis by complexing with the carrier protein C55 prenol pyrophosphatase. 1

Bacitracin

Bacitracin is a polypeptide antibiotic produced by the Trace y I stain of Bacillus subtilis. It inhibits  bacterial cell wall synthesis by complexing with the carrier protein C55-prenol pyrophosphatase, pyrophosphatase, which is involved in the transfer of polysaccharides, liposacchari des, and peptidoglycans to a growing cell wall. Q/Q(M)-477441 Report a Problem What is a possible metabolic abnormality with long term systemic glucocorticosteroid therapy? 1

Hyperlipidemia

2

Hypoglycemia

3

Hyperkalemia

4

Hypercalcemia

5

Hypokalemic acidosis Q/Q(M)-482831 Report a Problem 78

What is a possible metabolic abnormality with long term systemic glucocorticosteroid therapy? 1

Hyperlipidemia

Long term systemic steroid therapy can result in hyperlipidemia, especially Hypertriglyceridemia. Hyperglycemia, not hypoglycemia may occur with steroid therapy. Hypokalemic alkalosis may result from long term steroid use. Uncommonly, hypocalcemia may develop with resultant tetany. Q/Q(M)-482831 Report a Problem The treatment of choice for Wegner's granulomatosis is: 1

Chlorambucil

2

Systemic glucocorticosteroids

3

Cyclophosphamide

4

Methotrexate

5

Azaithioprine Q/Q(M)-474468 Report a Problem

The treatment of choice for Wegner's granulomatosis is: 3

Cyclophosphamide

Wegener granulomatosis is an idiopathic disorder characteriz ed by necrotizing granulomatous vasculitis of the upper and lower respiratory tract, glomerulonephritis, and a variab le degree of small-vessel vasculitis. Testing for c-ANCA is 90% sensitive for the diagnosis when the presentation is classi c. Cyclophosphamide has been used very effectively and now is the usual drug of choice for induction of remission. Q/Q(M)-474468 Report a Problem Treatment with isotretinoin has been shown to cause increased colonization of the skin with which of the following organisms? 1

Streptococcus pyogenes

2

Pseudomonas aeruginosa

3

Staphylococcus aureus

4

Pityrosporum orbiculare

5

Demodex folliculorum Q/Q(M)-477195 Report a Problem

Treatment with isotretinoin has been shown to cause increased colonization of the skin with which of the following organisms? 3

Staphylococcus aureus

Staphylococcus aureus colonization tends to correlate with isotretinoin-induced reduction in sebum  production and may lead to infections. This This complication may possibly be prevented with with pulsed intranasal mupirocen therapy. There has been a report of staphylococcus endocarditis in a patient with underlying aortic insufficiency. Q/Q(M)-477195 Report a Problem Which of the following substances is not found in Castellani's paint? 1

Resorcinol

2

Acetone

3

Magenta 79

4

Phenol

5

Lactic acid

Q/Q(M)-482383 Report a Problem Which of the following substances is not found in Castellani's paint? 5

Lactic acid

Castellani's paint is a fungicidal and bactericidal agent. It contains boric acid, resorcinol, acetone, water, industrial methylated spirit, magenta, and phenol. Magenta may stain clothi ng and skin while phenol may be toxic in children. Q/Q(M)-482383 Report a Problem Which drug has recently been shown to be of use in chemoprevention of squamous cell carcinoma i n recessive dystrophic epidermolysis bullosa: 1

Isotretinoin

2

Cyclosporine

3

Mycophenolate mofetil

4

Methotrexate

5

Topical tar

Q/Q(M)-478600 Report a Problem Which drug has recently been shown to be of use in chemoprevention of squamous cell carcinoma i n recessive dystrophic epidermolysis bullosa: 1

Isotretinoin

Despite low therapeutic responses of advanced cancers to retinoids, these drugs appear to have a  promising role in chemoprevention. Patients with oral oral leukoplakia, actinic keratoses, arsenic keratoses, and Bowen's disease can benefit from retinoid therapy. therap y. Q/Q(M)-478600 Report a Problem Which of the following antibiotics is the only drug that is bactericidal to Mycobacterium leprae? 1

Rifampin

2

Levofloxacin

3

Minocycline

4

Amikacin

5

Pentavalent antimony Q/Q(M)-482742 Report a Problem

Which of the following antibiotics is the only drug that is bactericidal to Mycobacterium leprae? 1

Rifampin

Rifampin inhibits RNA synthesis by blocking DNA-dependent RNA polymerase. It is effective in tuberculosis and atypical mycobacterial infections. It is the only drug that is bactericidal to to Mycobacterium leprae. Cutaneous leishmaniasis and rhinoscleroma also respond to rifampin. Q/Q(M)-482742 Report a Problem Methotrexate toxicity with myelosuppression is treated with what agent? 1

Folinic acid

80

2

Folic acid

3

Oral methylene blue

4

Cimetidine

5

Vitamin E

Q/Q(M)-474478 Report a Problem Methotrexate toxicity with myelosuppression is treated with what agent? 1

Folinic acid

Leukovorin, or folinic acid, is able to bypass dihydrofolate reductase in the cell division pathway. It is administered under conditions of methotrexate-induced myelosuppression. Leukovorin is also available as an oral form, and may be administered as a continual part of methotrexate therapy, instead of folic acid. It is now believed that neither folic acid nor folinic acid inhibit the efficacy of methotrexate�s antipsoriatic actions. Q/Q(M)-474478 Report a Problem Which of the following statements regarding dapsone and sulfapyridine is true? 1

They exert their anti-inflammatory actions by stimulating the m yeloperoxidase activity of  polymorphonuclear leukocytes leukocytes

2

Dapsone hypersenstivity syndrome is characterized by lymphocytosis

3

Sulfapyridine has a similar but often more severe side effect profile than dapsone

4

Concomittant administration of cimetidine has been shown to increase the risk of methemoglobinemia

5

None of these answers are correct (all are false)

Q/Q(M)-475612 Report a Problem Which of the following statements regarding dapsone and sulfapyridine is true? 5

None of these answers are correct (all are false)

 None of the above statements are true. Dapsone and sulfapyridine exert their anti-inflammatory actions  by inhibiting the myeloperoxidase activity and chemotactic abilities of polymorphonuclear leukocytes. Dapsone hypersenstivity syndrome is characterized by eosinophilia, as well as a severe mononucleosislike reaction, including fever, erythroderma, hepatitis, and even death. Sulfapyridine has a similar but often less severe side effect e ffect profile. Cimetidine has been shown to provide some protection against methemoglobin formation. Q/Q(M)-475612 Report a Problem Which of the following statements regarding retinoids is true? 1

Tretinoin and isotretinoin are second-generation synthetic retinoids

2

Etretinate is a first-generation retinoid

3

Second-generation retinoids are polyaromatic retinoids

4

Tazarotene is a fourth-generation selective retinoid

5

Bexarotene is a third-generation retinoid

Q/Q(M)-475616 Report a Problem Which of the following statements regarding retinoids is true? 5

Bexarotene is a third-generation retinoid

First-generation retinoids are tretinoin (all-trans RA) and isotretinoin (13-cis RA). Second-generation synthetic retinoids are etretinate, which was replaced by its metabolite acitretin. Third-generation 81

(polyaromatic retinoids) include the arotinoids, tazarotene, adapalene, and bexarotene. Q/Q(M)-475616 Report a Problem Ketoconazole and itraconazole are potent inhibitors of which one of the following cytochrome p450 isozymes? 1

2C9

2

2D6

3

3A4

4

1A2

5

2C18

Q/Q(M)-478602 Report a Problem Ketoconazole and itraconazole are potent inhibitors of which one of the following cytochrome p450 isozymes? 3

3A4

Ketoconazole has been shown to be the strongest inhibitor of c ytochrome p450 (CYP) 3A4. Itraconazole is an inhibitor of CYP 3A4, whereas fluconazole inhibites CYP 2C9 significantly more than minimal inhibitory role of CYP 3A4. Terbinafine inhibits CYP 2D6. Q/Q(M)-478602 Report a Problem The treatment of choice for erythema nodosum leprosum (ENL) is: 1

Thalidomide

2

Clofazamine

3

Rifampin

4

Rifampin and clofazamine

5

Isoniazid, rifampin and clofazamine

Q/Q(M)-474464 Report a Problem The treatment of choice for erythema nodosum leprosum (ENL) is: 1

Thalidomide

Erythema Nodosum Leprosum is a type 2 reaction of leprosy. It most commmonly ocurrs in lepromatous leprosy. Clinically, it presents as painful nodules and is associated with fever, malaise, anorexia, and arthralgias. The treatment of choice is thalidomide. Q/Q(M)-474464 Report a Problem Of the medications listed below, the safest to use during pregnancy is: 1

Penicillin

2

Erythromycin estolate

3

Doxycycline

4

Estrogens

5

NSAIDS

Q/Q(M)-474117 Report a Problem Of the medications listed below, the safest to use during pregnancy is: 1

Penicillin

Erythromycin estolate is contraindicated in pregnancy because of the ri sk of cholestatic hepatitis. Other 82

forms of erythromycin are safer for use in pregnancy. Tetracyclines are category cate gory D and estrogens are category X. NSAIDS may promote persistent fetal circulation or oli gohydramnios. Q/Q(M)-474117 Report a Problem Which antihistamine has suppressor T-cell inhibitory i nhibitory activity? 1

Doxepin

2

Promethazine

3

Fexofenadine

4

Cimetidine

5

Cromolyn sodium

Q/Q(M)-475912 Report a Problem Which antihistamine has suppressor T-cell inhibitory i nhibitory activity? 4

Cimetidine

Cimetidine is an H2 antihistamine that has suppressor T-cell inhibitory activity, by competitively  blocking their H2 receptors. Immunomodulatory Immunomodulatory effects are useful for treating mucocutaneous candidiasis, verruca vulgaris, and condyloma acuminata. Q/Q(M)-475912 Report a Problem Which of the following bones will develop the most dramatic changes in density following oral glucocorticoids? 1

Femur of 72 year old female

2

Femur of 72 year old male

3

Vertebrae of 22 year old male

4

Vertebrae of 22 year old female

5

Vertebrae of 72 year old female

Q/Q(M)-482224 Report a Problem Which of the following bones will develop the most dramatic changes in density following oral glucocorticoids? 3

Vertebrae of 22 year old male

Although post menopausal women are at greatest risk for fract ures from steroid therapy (they have the weakest bones to begin with), it is young men who have have the most dramatic decrease decreas e in bone density. Young men have the highest bone density on average and therefore will show the greatest change with steroid therapy. Trabecular bone (ribs, vertebrae) are more affected than cortical bones (long bones) due to higher metabolic rate of the former. Also, most demineralization occurs during the first 6-12 months of therapy. This highlights the fact that even young men who are not traditionaly at risk for fractures, need prophylaxis for osteroperosis while on systemic steroids. Q/Q(M)-482224 Report a Problem Which medication should be avoided in pregnant women with acne? 1

Isotretinoin

2

Azelaic acid

3

Clindamycin lotion

4

Erythromycin gel

5

Azithromycin Q/Q(M)-482812 Report a Problem 83

Which medication should be avoided in pregnant women with acne? 1

Isotretinoin

Isotretinoin is absolutely contraindicated in pregnancy and is categor y X. All other alternatives are safe in pregnancy. Q/Q(M)-482812 Report a Problem Which of the following locations has the highest percutaneous absorption of topical corticoste roids? 1

Scrotum

2

Axilla

3

Back

4

Arm

5

Palm

Q/Q(M)-482832 Report a Problem Which of the following locations has the highest percutaneous absorption of topical corticoste roids? 1

Scrotum

Absorption through the scrotum is about 42 times greater than the ventral forearm. Although less, other occluded sites such as the axilla have increased percutaneous absorption. The palms and soles have the least due to the thick stratum corneum. Q/Q(M)-482832 Report a Problem Which one of the following sites has the highest percutaneous absorption of topical drugs? 1

Scrotum

2

Eyelid

3

Chest

4

Acral area

5

Mucous membrane Q/Q(M)-482293 Report a Problem

Which one of the following sites has the highest percutaneous absorption of topical drugs? 5

Mucous membrane

Mucous membranes have the highest absorption of topical medicines. Percutaneous absorption, from highest to lowest, is as follows: mucous membrane > scrotum > eyelids > face > chest and back > upper extremity > lower extremity > acral. Q/Q(M)-482293 Report a Problem Which of the following antifungal agents is contraindicated in patients with a history of porphyria? 1

Griseofulvin

2

Ketoconazole

3

Fluconazole

4

Itraconazole

5

Terfinafine Q/Q(M)-475210 Report a Problem 84

Which of the following antifungal agents is contraindicated in patients with a history of porphyria? 1

Griseofulvin

Griseofulvin has been reported as a potential ex acerbator of acute intermittent porphyria, and thus is contraindicated in patients with a history of porphyria. Q/Q(M)-475210 Report a Problem Which of the following statements is true regarding re garding the absorption of antibiotics? 1

Fluoroquinolone absorption is not altered by antacids

2

Tetracycline absorption is impaired by the ingestion of calcium products but not iron

3

Minocycline absorption is not significantly impaired by the ingestion of calcium products but it should be taken on an empty stomach

4

Doxycycline absorption is impaired by the ingestion of dairy products and calcium

5

None of the above (all of the above statements are false)

Q/Q(M)-475199 Report a Problem Which of the following statements is true regarding re garding the absorption of antibiotics? 5

None of the above (all of the above statements are false)

Antacids decrease the absorption of fluoroquinolones and should be taken at least 2 hours aft er the drug. Tetracycline absorption is impaired by the ingestion of dair y products, calcium, and iron or zinc salts. Minocycline and doxycycline absorption is not impaired by the ingestion of those products; they may be taken on an empty stomach or with food. Thus, all of the statements are false. Q/Q(M)-475199 Report a Problem Dapsone is used for a patient with dermatitis herpetiformis. Dapsone induces anti-inflammatory effects  by primarily inhibiting what type type of cell? 1

Polymorphonuclear leukocyte

2

T cell lymphocyte

3

Macrophage

4

Mast cell

5

Langerhans cell

Q/Q(M)-482752 Report a Problem Dapsone is used for a patient with dermatitis herpetiformis. Dapsone induces anti-inflammatory effects  by primarily inhibiting what type type of cell? 1

Polymorphonuclear Polymorphonuclear leukocyte

Dapsone is used to treat a wide variety of dermatoses, including dermatitis herpetiformis, bullous SLE, erythema elevatum diunitum, Sweet\'s syndrome, and others. The anti-inflammtory effect of this medication is most effective against neutrophils because of inhibition of myeloperoxidase activity and chemotactic abilities. Q/Q(M)-482752 Report a Problem Side effects of PUVA include all of the t he following except: 1

Headache

2

Pruritus

3

Neutropenia

4

Insomnia 85

5

Nausea

Q/Q(M)-477337 Report a Problem Side effects of PUVA include all of the t he following except: 3

Neutropenia

Side effects of psoralen with ultraviolet A light (PUVA) include side effects which are ar e due to phototoxic effects including pruritus, photoonycholysis, friction blisters, ankle edema and hypertrichosis. In addition, there are adverse effects from methoxypsoralen including gastrointestinal and neurologic effects, hepatotoxicity and exanthems. Neutropenia is not a described side effect of PUVA. Q/Q(M)-477337 Report a Problem Which of the following chemotherapeutic agents has been linked to acneiform eruptions? 1

Bleomycin

2

Cytarabine

3

Cisplatin

4

Doxorubicin

5

Cetuximab

Q/Q(M)-476711 Report a Problem Which of the following chemotherapeutic agents has been linked to acneiform eruptions? 5

Cetuximab

Cetuximab is a chimeric anti-epidermal growth factor receptor antibody that is FDA approved to treat advanced colorectal cancer. Acneiform eruptions have been reported to occur in up to 1/3 of patients. Q/Q(M)-476711 Report a Problem Which of the following antiviral agents is NOT phosphorylated by viral thymidine kinase? 1

Acyclovir

2

Famciclovir

3

Gancyclovir

4

Cidofovir

5

Valacyclovir

Q/Q(M)-475201 Report a Problem Which of the following antiviral agents is NOT phosphorylated by viral thymidine kinase? 4

Cidofovir

Cidofovir is a nucleotide analogue antiviral agent. It does not require phosphorylation by virus, but is converted by host cell kinases to a diphosphate. Q/Q(M)-475201 Report a Problem Which drug may increase levels of digoxin? 1

Amoxicillin

2

Ciprofloxacin

3

Erythromycin

4

Minocycline

5

Cephalexin

Q/Q(M)-475197 Report a Problem Which drug may increase levels of digoxin? 86

3

Erythromycin

Erythromycin inhibits the cytochrome P-450 system, which may result in increased levels of digoxin, among many other drugs. Q/Q(M)-475197 Report a Problem The treatment of choice for scabies in pregnant women is: 1

Malathion

2

1% permethrin

3

Thiabendazole

4

Precipitated sulfur 6%

5

Ivermectin

Q/Q(M)-474463 Report a Problem The treatment of choice for scabies in pregnant women is: 4

Precipitated sulfur 6%

Many authors consider precipitated sulfur to be the drug of choice for the treament of scabies in  pregnant women, although there there are no published studies for this indication (see Wolverton). Permethrin of note is category B in pregnancy. Q/Q(M)-474463 Report a Problem Which of the following agents is NOT a UVA blocker? 1

Dioxybenzone

2

Amyl p-dimethylaminobenzoate

3

Dibenzoylmethane

4

Avobenzone

5

Red veterinary petrolatum

Q/Q(M)-475901 Report a Problem Which of the following agents is NOT a UVA blocker? 2

Amyl p-dimethylaminobenzoate

Dioxybenzone is one of the benzophenones (as in oxybenzone and sulisobenzone), which are UVA  blockers. Amyl p-dimethylaminobenzoate is a UVB blocker. blocker. Dibenzoylmethane (avobenzone; Parsol 1789) is a UVA/UVB blocker. Red veterinary petrolatum is a UVA blocker. Q/Q(M)-475901 Report a Problem The laboratory abnormality most associated with cyclosporine is: 1

Hypermagnesemia

2

Hyponatremia

3

Hyperkalemia

4

Hypouricemia

5

Increased LDH

Q/Q(M)-474116 Report a Problem The laboratory abnormality most associated with cyclosporine is: 3

Hyperkalemia

The laboratory abnormalities associated with cyclosporine are decreased magnesium, increased  potassium, and increased uric acid. Renal function and blood pressure pressure must also be monitored closely in 87

 patients using cyclosporine. Q/Q(M)-474116 Report a Problem A 40 year old man with acute promyelocytic leukemia develops scrotal ulcers 1 month after starting therapy. All tests for STD causes of ulcers as well as CMV and EBV are negative. What is the most likely cause? 1

All-trans retinoic acid

2

Daunorubicin

3

Methotrexate

4

6-mercaptopurine

5

Cytarabine

Q/Q(M)-482557 Report a Problem A 40 year old man with acute promyelocytic leukemia develops scrotal ulcers 1 month after starting therapy. All tests for STD causes of ulcers as well as CMV and EBV are negative. What is the most likely cause? 1

All-trans retinoic acid

All-trans-retinoic acid (ATRA) has been shown to improve the outcome of patients with acute  promyelocytic leukemia (APL). However, various adverse adverse effects of ATRA treatment have been noted, such as scrotal and genital ulcers. Q/Q(M)-482557 Report a Problem All of the following agents exert their function in a cell-cycle specific manner except: 1

Cyclophosphamide

2

Methotrexate

3

Azathioprine

4

Hydroxyurea

5

5-fluorouracil

Q/Q(M)-474469 Report a Problem All of the following agents exert their function in a cell-cycle specific manner except: 1

Cyclophosphamide

Cyclophosphamide is a cell-cycle nonspecific agent, which produces DNA cross -linkages at any point in the cell cycle. Methotrexate, azaithioprine, and hydroxyurea are S-phase specific cytotoxic agents. 5fluorouracil is a cell-cycle specific pyrimidine antagonist. Q/Q(M)-474469 Report a Problem

88