ETAS_MCQ_13 photobiology and photosensitivity disorders
Upcoming SlideShare
Loading in...5
×
 

ETAS_MCQ_13 photobiology and photosensitivity disorders

on

  • 1,297 views

 

Statistics

Views

Total Views
1,297
Views on SlideShare
1,297
Embed Views
0

Actions

Likes
1
Downloads
84
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Microsoft Word

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

ETAS_MCQ_13 photobiology and photosensitivity disorders Document Transcript

  • 1. Photobiology and Photosensitivity Disorders1) What mutation is responsible for this clinical presentation in a patient with thyroid dysfunctionand chronic candidal infections?A. LYSTB. PTENC. AIRECorrect ChoiceD. TRP1E. fumarate hydrataseAPECED syndrome named for the clinical features of autoimmune polyendocrinopathy, candidiasis,ectodermal dystrophy and is caused by a mutation in AIRE (autoimmune regulator). 13% of thesepatient have vitigo2) Treatment of this condition might include:A. CyclosporinB. Antimalarials Correct ChoiceC. CytoxanD. AzathioprineE. All of these answers are correctSun avoidance, sunblocks, protective clothing, and topical steroids are sufficient for most patientswith PMLE. Other patients may require hardening with UVB or PUVA. Rare patients requireantimalarials3) Immediate pigment darkening:A. Is caused by an increase in tyrosinase activityB. Is predominately brought on by UVA and visible light Correct ChoiceC. Is associated with an increase in melanocyte numberD. Start 45-60 minutes after exposureE. Is predominately brought on by UVBImmediate pigment darkening appears almost as soon as irradiation occurs. It is due to photo-oxidation of preexisting melanin4) A patient present with blue-gray pigmentation on sun-exposed areas but does not haveinvolvement of the sclerae, lunulae or mucous membranes. Which of the following medications iscould be causing this pigmentation?A. SertralineB. FluoxetineC. ChlorpromazineCorrect ChoiceD. ClindamycinE. Ciprofloxacin 1
  • 2. Amiodarone, chlorpromazine and tricyclic antidepressants all are capable of causing blue-graypigmentation on sun-exposed areas without involvement of the sclerae, lunulae or mucousmembranes5) UVB acts on what compound to form pre-Vitamin D3 ?A. 7-deoxycholesterolB. 9-hydrocholesterolC. 5-dehydrocholesterolD. 7-hydrocholesterol Correct ChoiceE. DNAUVB converts 7-dehydrocholesterol in the skin to pre-Vitamin D3, which then thermally isomerizesto form Vitamin D36) Which of the following statements regarding phototesting is correct?A. To test for a visible light reaction, a slide projector is used as a light sourceCorrect ChoiceB. Repeated MEDs to UVB or UVA, given to different test sites over several days can be used toreproduce lesions of polymorphous light eruptionC. The UVA MED is performed using a narrowband UVA sourceD. A single large dose of visible light is the best way to reproduce lesions of polymorphous lighteruptionE. The UVB MED is performed using narrowband UVB light sourcesPhototesting is done prior to initiating phototherapy or during provocative induction. To test for avisible light reaction, a slide projector is used as a light source. The other choices are incorrect. TheUVB MED and UVA MED is performed using BROADBAND UVB and BROADBAND UVA light sourcesrespectively. Repeated MEDs to UVB or UVA given to the SAME site may be used to reproducelesions of PMLE. Alternatively a single large dose of UVA or UVB can be used to reproduce PMLE7) The main contributor to erythema of the skin with exposure to the sun is:A. UVCB. Visible lightC. UVA2D. UVA1E. UVBCorrect ChoiceUVB in natural sunlight is the main contributor to erythema. UVB erythema reaches a maximum in6-24 hours. UVA accounts for 15-20% of sunlight erythema despite that there is much more UVAthan UVB in sunlight8) Treatment of CAD might include:A. All of these answers are correctCorrect ChoiceB. PUVAC. UV filters for car windows 2
  • 3. D. Incandescent bulbs for home and office lightingE. Broad spectrum sunblock to which the patient is not allergicCAD patients are exquisitely sensitive to UVB, often sensitive to UVA, and sometimes sensitive tovisible light. Answers a, b, and c are correct because those treatments prevent UV and visibleradiation from reaching the patient. PUVA hardens and desensitizes the skin9) The xenon arc solar simulator, whose spectrum is in this slide, is useful for:A. MED-B testing and MED-A testing Correct ChoiceB. MED-A testingC. Photopatch testingD. MED-B testing, MED-A testing, and Photopatch testingE. MED-B testingSolar simulator radiation contains both UVB and UVA in sufficient quantities to be useful for MED-Band MED-A testing. The field size is too small for photopatch testing10) Rare cases of which photosensitivity disorder have been associated with erythropoieticprotoporphyria?A. Solar urticariaCorrect ChoiceB. Chronic actinic dermatitisC. Actinic prurigoD. Hydroa vacciniformeE. Polymorphous light eruptionRare cases of solar urticaria have been associated with erythropoietic protoporphyria (EPP), lupuserythematosus (LE), and with certain drugs. Blood tests for LE and EPP should be performed inpatients with this diagnosis11) Fluorescent UVA bulbs used for phototesting or PUVA therapy have a peak emission at:A. 254 nmB. 468 nmC. 311 nmD. 312 nmE. 352 nmCorrect Choice254 nm is the wavelength of the radiation emitted by mercury vapor lamps. Narrowband UVB emits311-312 nm. Fluorescent UVA bulbs used for phototesting or PUVA therapy have a peak emission at352 nm12) A patient that rarely burns and usually tans is which of the following skin types?A. Type IVB. Type IIICorrect ChoiceC. Type I 3
  • 4. D. Type VE. Type IISkin type I always burns and never tansSkin type II usually burns and rarely tansSkin type III rarely burns and usually tansSkin type IV never burns and alway tansSkin types V,VI are highly pigmented individuals13) The wavelength range that most effectively induces cutaneous immunosuppression is:A. 400-410nmB. 320-340nmC. 290-320nmCorrect ChoiceD. 340-400nmE. 200-290nm290-320nm (UVB) is most effective in suppressing cutaneous immunity; mechanisms includedepletion of Langerhans cells, induction of regulatory T cells, and keratinocyte secretion of suchimmunosuppressive cytokines as IL-10 and TNF-alph14) Which of the following statements is true regarding pseudoporphyria?A. None of these answers are correctB. It has been associated with furosemideC. All of these answers are correctCorrect ChoiceD. Clinically it may be indistinguishable from porphyria cutanea tardaE. Porphyrins may be normalPseudoporphyria is a phototoxic reaction that clinically and histologically resembles porphyriacutanea tarda. In pseudoporphyria, however, there is no porphyrin abnormality. It has beenassociated with numerous medications, including nalidixic acid, tetracyclines, amiodarone,furosemide, and ketoprofen15) Oral PUVA has been used to treat which of the following diseases:A. All of these answers are correctCorrect ChoiceB. Graft-versus-host diseaseC. CTCLD. MastocytosisE. Generalized granuloma annularePUVA has been reported to have helped patients with all the diseases listed16) Regarding renal transplant recipients, which of the following statements is correct:A. Should have skin cancer screening at the same rate as the general populationB. Have a 36-fold increased risk of BCC 4
  • 5. C. Have rates of SCC similar to the general populationD. Have an decreased risk for melanomaE. Have a 36-fold increased risk of SCCCorrect ChoiceThe rates of SCC in renal cell transplant recipients is increased at a rate of 36x. The rates of skincancer are higher than in the general population17) The usual dose of UVR given for photopatch testing is approximately:A. 10 Joules of UVAB. 4 millijoules of UVBC. 4 Joules of UVBD. 2 Joules of UVA Correct ChoiceE. 10 Joules of UVBUVA is absorbed by the chemicals that cause photoallergic contact dermatitis; therefore, it is UVAthat is used for photopatch testing. In patients who are UVA-sensitive, one-half of their MEDA isused for photopatch testing18) A patient presents with signs of porphyria cutanea tarda. Porphyrin screens are negative. Whichof the following medications on the patients medication list is your top choice for discontinuation?A. FenofibrateB. MultivitaminC. NaproxenCorrect ChoiceD. ChloroquineE. EnalaprilNSAIDs are a frequent offender in causing pseudoporphyria. The other listed medications are notfrequent causes of this type of skin reaction19) The typical patients with polymorphous light eruption are:A. Fair-skinned females in their teens and 20’s. Correct ChoiceB. Type V-skinned females in their 20’s and 30’s.C. Fair-skinned males in their 20’s and 30’s.D. Fair-skinned females in their 40’s and 50’s.E. Type IV-skinned males in their 40’s and 50’s.PMLE most commonly appears in fair-skinned females during the first three decades of life. It maybe related to type IV hypersensitivity20) All of the following statements regarding chronic actinic dermatitis are true EXCEPT:A. Azathioprine has been used successfully to treat this disorderB. The MEDB on phototesting is markedly diminished in patients with this conditionC. Many cases begin as photoallergic contact dermatitis or drug photosensitivity 5
  • 6. D. Fluorescent bulbs are safer for these patients than are incandescent bulbsCorrect ChoiceE. Many patients have a lowered threshold to shorter wavelength visible lightChronic actinic dermatitis (CAD) usually occurs in middle-aged to elderly males who present with achronic, eczematous dermatitis in a photodistribution, though there is no history of currentexposure to a photosensitizer. Phototesting is very helpful in diagnosing CAD. The MEDB ismarkedly diminished, and the MEDB site may show an eczematous or infiltrated appearance. Manyof the patients have a lowered MEDA as well, and may have a lowered threshold to shorterwavelength visible light in the blue-violet end of the spectrum. Many cases of this idiopathicdisorder are thought to have begun as photoallergic contact dermatitis or as a drug photosensitivitywith broadening of the photosensitivity to include the UVB range. It is unclear why photosensitivitypersists when the photosensitizer is no longer present. Treatment includes strict sun avoidance andsun protection. Incandescent bulbs with longer wavelengths, far from the blue-violet end of thevisible spectrum, should be used instead of fluorescent bulbs, which have significant blue-violetradiation. Topical and oral steroids, oral azathioprine and cyclosporine, and PUVA have all been usedto treat patients with CAD21) Treatment of polymorphous light eruption includes all of the following EXCEPT:A. None of these answers are correctCorrect ChoiceB. PUVA therapyC. Systemic corticosteroidsD. AntimalarialsE. Topical steroidsMost patients with PMLE have mild disease that can be treated by sun avoidance and sunprotection. Topical steroids can be used to treat clinical lesions. For severe cases, hardening anddesensitization can be accomplished with UVB, UVB plus UVA, or PUVA. Antimalarials can be usedfor resistant cases. A short course of prednisone (20-40 mg) is effective for brief, sunny vacations22) Which of the following statements about ultraviolet C is incorrect?A. UV-C is absorbed by atmospheric ozoneB. UV-C has an electromagnetic spectrum from 200-290 nmC. UV-C has a higher wavelength than UV-BCorrect ChoiceD. UV-C has higher energy than UV-BE. UV-C does not reach the earths surfaceUV-C has wavelengths of 200 - 290 nm. UV-B has wavelengths of 290 - 320 nm. UV-C has a lowerwavelength, not higher. All of the other listed statements about UV-C are correct23) Which of the following statements about the spectrums of UVR that cause of solar urticaria isMOST correct?A. Visible light causes solar urticariaB. UVA causes solar urticariaC. UVB causes solar urticariaD. Both UVA and UVB cause solar urticariaE. Patients can react to visible light, UVA and/or UVBCorrect Choice 6
  • 7. Some patients react with wheals to either visible light or UVA or UVB. Others react to both UVA andvisible radiation. Some react to both UVB and UVA, and some patients react to UVB, UVA and visiblelight24) Patients with chronic actinic dermatitis (CAD) typically show on phototesting:A. Lowered MEDB, usually normal MEDA, sometimes positive photopatch testsB. Lowered MEDB, usually lowered MEDA, sometimes positive photopatch tests Correct ChoiceC. Normal MEDB, lowered MEDA, sometimes positive photopatch testsD. Normal MEDB, normal MEDA, sometimes positive photopatch testsE. None of the aboveThe hallmark of CAD is a lowered MEDB. Often the patients have a lowered MEDA. It is felt thatmany of CAD patients began with photoallergic contact dermatitis, so some have positivephotopatch tests25) Most patients with PMLE require treatment with:A. Sunscreen and sun avoidance between 11 am and 3pmCorrect ChoiceB. CyclophosphamideC. ChloroquineD. UVB hardening/desensitizationE. PrednisoneMost patients have mild disease that can be treated by sun avoidance, especially between 11 amand 3pm; a broad spectum sunscreen and clothing with a tight weave. In more severe cases, UVhardening, antimalarials or prednisone can be used. Cyclophosphamide is not used in PMLE26) The histology of the patient in question 42 is the following slide. It mimics the histology of:A. CTCL Correct ChoiceB. Pityriasis roseaC. PsoriasisD. Tuberculoid leprosyE. SLEThe histology of the actinic reticuloid variety of CAD mimics that of mycosis fungoides with a band-like infiltrate with atypical mononuclear cells27) The highest energy visible photons are in which portion of the visible spectrum?A. All of these answers are correctB. GreenC. YellowD. Blue-violet Correct ChoiceE. Red-Orange 7
  • 8. In the visible spectrum, the blue-violet portion has the shortest wavelength and the highest energy.The red-orange portion has the longest wavelength and the lowest energy28) In solar urticaria wheals typically:A. Begin at 1-2 h. and last 2-4 hB. Begin at 15-30 minutes and last 1 h Correct ChoiceC. Begin at 45 minutes after exposure and last 2 hours (h.)D. Begin at 15-30 seconds and last about 15 minutesE. Begin at 30-60 minutes and last 1-4 hThe wheals of solar urticaria begin 10-15 minutes after exposure and last for about an hour. Solarurticaria is usually idiopathic. Rare cases are associated with EPP, SLE, and certain medications29) Currently the most common cause of photoallergic contact dermatitis is:A. Musk ambretteB. Halogenated salicylanilidesC. MercaptobenzothiazoleD. 6-methylcoumarinE. Sunscreens Correct ChoiceHalogenated salicylanilides, musck ambrette and 6-methylcoumarin used to cause most of the casesof photoallergic contact dermatitis. They have been essentially eliminated from soaps andfragrances. Sunscreen ingredients are now the most common cause30) The potent photosensitizer, 5-methoxypsoralen, is contained in which of the following contactallergens?A. EugenolB. Oil of BergamotCorrect ChoiceC. Usnic acidD. Balsam of PeruE. Tuliposide AOil of Bergamot contains 5-methoxypsoralen and may cause of Berloque dermatitis, an intensepost-inflammatory hyperpigmentation due to an antecedent phytophotodermatitis that may besubclinical31) A common cause of medication induced photoallergy is:A. NaproxenB. AcitretinC. PsoralensD. PiroxicamCorrect ChoiceE. Ibuprofen 8
  • 9. All of the listed medications are causes of photosensitivity, but only piroxicam is a cause ofphotoallergy32) Phototesting of PMLE patients reveals:A. Normal MEDB, reduced MEDA.B. Normal MEDB, elevated MEDA.C. Normal MEDB, normal MEDA. Correct ChoiceD. Lowered MEDB, normal MEDA.E. Lowered MEDB, lowered MEDA.The MEDB and MEDA are normal in PMLE patients. Only with multiples of the MEDB or MEDA canone often reproduce the lesions33) Ultraviolet radiation from the sun cause which of the following acute effects EXCEPT?A. Increased immune surveillance Correct ChoiceB. Immediate pigment darkeningC. Epidermal thickeningD. SunburningE. Photosynthesis of vitamin DUV radiation causes acute effects including: photosynthesis of vitamin D, sunburning, immediatepigment darkening, delayed tanning, epidermal thickening and immunologic effects such asDECREASED immune surveillance34) A 40-year-old patient presents with widespread plaque-type psoriasis without arthritis. She hadalready applied potent topical steroids, calcipotriene, and tazarotene. The treatment of choice wouldbe:A. MethotrexateB. Narrowband UVB Correct ChoiceC. EtretinateD. CyclosporineE. PUVAThe other choices involve internal medications and therefore have the potential for more side effectsthan with narrowband UVB. Phototherapy may be impractical for some patients, and thereforesystemic therapies should be offered35) Which of the following is true regarding actinic prurigo?A. Lesions generally continue through late adulthoodB. Cheilitis is frequently seenCorrect ChoiceC. Thalidomide has been ineffective for the majority of patientsD. Lesions persist for 1-2 daysE. Lesions never occur on non-sun-exposed areas 9
  • 10. Actinic prurigo is an idiopathic photosensitivity disorder. Lesions are excoriated papules and nodulesthat begin in childhood and remit in puberty. They can last for several months and may occur onnon-sun-exposed areas. Thalidomide has been very effective for treating the majority of patientswith actinic prurigo.36) The irradiance of a UV source is measured in:A. JoulesB. SecondsC. MillijoulesD. CentimetersE. Watts Correct ChoiceThe irradiance of a UV source in watts x the time in seconds equals the UV dose in joules37) A patient presents with solar urticaria. What tests should be considered initially?A. ESRB. ANACorrect ChoiceC. CXRD. ANCAE. UrinalysisSolar urticaria is an idiopathic, type I photosensitivity disorder. Rare cases have been associatedwith erythropoietic protoporphyria (EPP) and lupus erythematosus (LE). Blood tests for LE andappropriate screening for EPP should be performed including ANA, Ro/La, Urine & Stool porphyrins38) The best location for phototesting patients suspected of photosensitivity is:A. Unaffected skin of the upper backB. Effected skin of the ventral forearmC. Effected skin of the buttockD. Unaffected skin of the lower backCorrect ChoiceE. Unaffected skin of the outer thighsPatients with suspected photosensitivity can be tested on unaffected skin of the buttocks, lowerback or ventral forearm. Effected skin should not be used for testing39) Blue-gray pigmentation of the lunulae:A. Is a rare side effect of treatment with tricyclic antidepressantsB. None of these answers are correctC. Occurs only after many years of treatment with chlorpromazineD. Is seen in argyria and not in most medication photosensitivitiesCorrect ChoiceE. Can be seen in patients on amiodaroneBlue-gray pigmentation on sun-exposed areas can be seen during treatment with amiodarone,chlorpromazine, and tricyclic antidepressants. In these medication photosensitivities, there is no 10
  • 11. involvement of the sclera, lunulae, or mucous membranes, as in argyria (prolonged contact with oringestion of silver salts40) The best definition for a MED is:A. The dose of ultraviolet radiation that produces pronounced erythema that completely fills the testsquareB. The dose of ultraviolet radiation that is one step below the first visible erythemaC. The dose of ultraviolet radiation that produces bullae that completely fills the test squareD. The dose of ultraviolet radiation that produces a easily visible "sunburn"E. The dose of ultraviolet radiation that produces barely perceptible erythema that completely fillsthe test squareCorrect ChoiceAn MED is the dose of ultraviolet radiation that produces barely perceptible erythema thatcompletely fills the test square. The remaining options are incorrect41) The image shown is diagnostic of which of the following conditions?A. Bullous pemphigoidB. Pemphigus vulgarisC. Chronic actinic dermatitisD. Polymorphous light eruptionCorrect ChoiceE. Pseudoporphria cutanea tardaThe pathologic image shown is that of polymorphous light eruption. The histology shows alymphocytic infiltrate around the superficial vascular plexuses with subepidermal edema andminimal epidermal changes are present42) Photoexacerbated genodermatoses include all except:A. Hartnup DiseaseB. Dariers DiseaseC. Hailey-Hailey DiseaseD. Cockaynes SyndromeE. Tuberous sclerosis Correct ChoiceTuberous sclerosis is not associated with photosensitivity43) Which of the following statements is correct regarding antigen presenting cells after UVRexposure?A. Have increased ability to prime UV-irradiated mice to subcutaneously injected haptenB. UV-irradiated mice have normal antigen presentation, allowing a normal delayed-typehypersensitivity responseC. APCs have increased ability to prime UV-irradiated mice to subcutaneously injected proteinD. APCs have increased ability to prime UV-irradiated mice to applied contact-sensitizing agentsE. There is a decrease in the number of antigen presenting cellsCorrect Choice 11
  • 12. APCs have depressed ability to prime UV-irradiated mice to subcutaneously injected hapten orprotein and to applied contact-sensitizing agents. UV-irradiated mice have defective antigenpresentation, preventing a normal delayed-type hypersensitivity response. There is a REDUCTION innumber of antigen presenting cells44) The UVAII portion of the electromagnetic spectrum extends from:A. 290-320 nmB. 320-340 nmCorrect ChoiceC. 320-400 nmD. None of these answers are correctE. 200-290 nmUVA extends from 320-400nm. UVA is further subdivided into UVAII (320-340nm) and UVA1(340-400nm45) Which of the following statements about UVR and DNA is correct?A. Pyrimidine dimers can not activate oncogenesB. UVA is most effective in producing pyrimidine dimerC. UVA is much more efficient than UVB in inducing DNA damageD. Cells from patients with actinic keratoses have more DNA repair capacity than controlsE. UVR alters DNACorrect ChoiceUVR alters DNA. UVB is much more efficient than UVA in inducing DNA damage. It can createpyrimidine dimers that may activate oncogenes and lead to cancer. Cells from patients with actinickeratoses have less DNA repair capacity than controls46) Ultraviolet light spectrum most completely encompasses which of the following spectrums?A. 760 - 1200 nmB. 290 - 400 nmC. 10 - 400 nmCorrect ChoiceD. 400 - 700 nmE. 200 - 400 nmThe ultraviolet spectrum encompasses Vacuum UV from 10-200nm, UV-C from 200-290nm, UV-Bfrom 290-320nm and UV-A from 320-400nm. The visible light spectrum is from 400-700nm.700-1200 nm is part of the infrared spectrum47) Which of the following is true about UV light:A. Clouds absorb most UVA lightB. Sunlight early in the morning and late in the day contains relatively more UVBC. UVB radiation is 1000 times more erythrogenic than UVACorrect ChoiceD. UVAII light is 340-400nmE. UVA radiation is 1000 times greater than UVB during midday hours 12
  • 13. UVA light is found b/w 320 and 400nm and is broken up into UVAI(340-400nm) andUVAII((320-340nm). UVB light is found between 290 and 320nm. UVA radiation is 100 timesgreater than UVB during midday hours and sunlight early in the morning and late in the daycontains relatively more UVA. UVB radiation is 1000 times more erythrogenic than UVA. Cloud coveris a poor UV absorber48) Which of the following hypoglycemics is the most common cause of photosensitivity?A. Thiazolidinediones (i.e. rosiglitazone)B. MetforminC. InsulinD. PiroxicamE. SulfonylureasCorrect ChoiceThe sulfonylurea hypoglycemics for diabetes are the most common type of medication of this classof medications. Piroxicam is not a hypoglycemic agent, but a common NSAID cause of photoallergy49) The most helpful phototest to document this photosensitivity disorder would be:A. MEDBBB. Repeated doses of UVA and UVB Correct ChoiceC. Photopatch testsD. MEDNBE. All of these answers are correctRepeated doses of ultraviolet radiation can sometimes elicit lesions of PMLE. More patients react toUVA radiation than to UVB radiation50) Hereditary PMLE of Native Americans:A. Often presents with chelitis and conjunctivitisCorrect ChoiceB. Rarely persists into adulthoodC. All of these answers are correctD. Is not treated with thalidomideE. Is more similar to PMLE than to actinic prurigoHereditary PMLE of Native Americans is similar to actinic prurigo but persists much more frequentlyinto adulthood. 75% of patients have a positive family history. It presents with a papular,excoriated, eczematous dermatitis that occurs predominantly on the face. Chelitis and conjunctivitisare common. It may be treated with thalidomide51) Solar urticaria:A. Rarely lasts for more than 6 months to 1 yearB. Is not benefitted by antihistaminesC. Can present with headache, nausea, and syncopeCorrect ChoiceD. Is an idiopathic, type IV photosensitivity disorder 13
  • 14. E. Usually occurs to only UVB radiationSolar urticaria is an idiopathic, type I photosensitivity disorder. Mediator release during widespreadwhealing may result in headache, nausea, wheezing, faintness, and syncope. It usually lasts formany years. Some patients react with wheals to either visible light or UVA or UVB. Others react toboth UVA and visible radiation. Some react to both UVB and UVA, and some patients react to UVB,UVA, and visible radiation. Treatment includes sun avoidance and protection, and H-1antihistamines may be of partial benefit52) Most bulbs used for PUVA have a peak output predominantly in the following range:A. 320 nm – 340 nmB. 390 nm – 410 nmC. 340 nm – 400 nmD. 350 nm – 360 nm Correct ChoiceE. 290 nm – 320 nmThe UVA emitted by these bulbs is absorbed by psoralens, causing covalent bonding of psoralens toDNA53) The active spectrum for cutaneous vitamin D3 synthesis is:A. 320-400nmB. 400-410nmC. 290-320nmCorrect ChoiceD. 410-450nmE. 220-290nmThe source states that vitamin D3 synthesis occurs at wavelengths < 320 making choices220-290nm and 290-320nm correct54) When solar urticaria is a consideration for phototesting:A. 7 test squares of increasing UV doses should be exposedB. An MED (B) and MED (A) should not be performedC. The lower back should not be used for testingD. Visible light will not evoke the lesionsE. An additional reading at 15 minutes after exposure should be performedCorrect ChoiceWhen solar urticaria is a consideration, an additional reading at 15 minutes after exposure isimportant, as wheals begin within 10-30 minutes after exposure and last for about one hour. Theface and hands may not show lesions as they are chronically exposed to sun. Some patients react toeither visible light or UVA or UVB. Others react to both UVB and UVA, both UVA and visible light, orall three55) Which of the following statements regarding hereditary PMLE of Native Americans is true?A. Specific HLA types predominate in Native AmericansCorrect ChoiceB. Cheilits and conjunctivitis are uncommon 14
  • 15. C. 5-10% of patients have a family history of this eruptionD. It will remit in pubertyE. Patients have an urticarial erupion.Native Americans have a high rate of PMLE and there is some evidence of a genetic predisposition.It tends to have a specific HLA predominance, continues through adulthood, and commonly presentsas a papular, excoriated, eczematous dermatitis predominantly on the face. Cheilitis andconjunctivitis are common. Up to 75% of patients have a positive family history56) The portion of the electromagnetic spectrum that produces a particular biologic effect is knownas the:A. Photobiologic spectrumB. Minimal erythema doseC. Active spectrumD. Action spectrumCorrect ChoiceE. Absorption spectrumThe action spectrum is the portion of the electromagnetic spectrum that products a particularbiologic effect (e.g. erythema, delayed tanning). The absorption spectrum is the portion of theelectromagnetic spectrum that is absorbed by a particular absorbing molecule, or chromophore. Theminimal erythema dose is the dose of UV radiatino that produces barely perceptible erythemaduring phototesting57) A patient presents with onycholysis after sun exposure. Which of the following medicationswould you rule out as a cause of this presentation?A. QuinolonesB. QuinineC. ChlorpromazineCorrect ChoiceD. TetracyclinesE. PsoralensChlorpromazine is associated with blue-gray pigmentation on sun-exposed areas and is notassociated with photoonycholysis. Quinolones, tetracyclines, psoralens and quinine can causephotoonycholysis58) Phytophotodermatitis can be seen with the following fruits / vegetables:A. Potatoes and leeksB. Tomatoes and bananasC. Celery and radishesD. Parsnips and limesCorrect ChoiceE. Lemons and pearsPsoralens in certain plants, fruits, and vegetables can cause phytophotodermatitis. The mostcommon ones are limes, figs, parsley, parsnip, bergamot oranges, and celery59) Narrow band UVB consists of what wavelength? 15
  • 16. A. 308-310nmB. 311-313nmCorrect ChoiceC. 300-306nmD. 312-320nmE. 320-330nmNarrowband UVB is much less erythemogenic with regard to physical units (mJ/cm2) thanbroadband UVB. Narrowband UVB is 311-313nm60) Absorption of UV radiation generates singlet oxygen in the skin by which chromophore?A. MelaninB. WaterC. HemoglobinD. KeratinE. Urocanic acidCorrect ChoiceUrocanic acid and DNA are biologically important chromophores. DNA absocrbs uVB directly inducingchanges between adjacent pyrimidine bases on one strand of DNA. Cyclopyrimidine dimers,particularly thymine dimers or less commonly (6-4) photoproducts may be generated. Urocanic acidis a second biologically important chromophore in the skin and is a by-product of filaggrinbreakdown. One photon of light contains enough energy to generate singlet oxygen.61) Which of the following cell types induce susceptibility to tumor growth?A. NK cellsB. Langerhans cellsC. Helper T-cellsD. Suppressor T-cellsCorrect ChoiceE. Mast cellsThe suppressor T-cells induce susceptibility to tumor. These cells appear to arise in UV-irradiatedhosts prior to tumor developing, and play a role in carcinogenesis62) Possible treatments for this patient with vitiligo include all of the following except:A. Topical steroidsB. AcitretinCorrect ChoiceC. Narrowband UVBD. Oral PUVAE. Broadband UVBTopical steroids and all the UV choices have been used to treat vitiligo. Soriatane does not benefitvitiligo63) The solar simulator is not useful for phototherapy because of its:A. Low output of UVB 16
  • 17. B. High output of infrared radiationC. Small field sizeCorrect ChoiceD. Low level of ionizing radiationE. High output of ultraviolet radiationThe coin-sized field of the solar simulator prevents this source from being useful for phototherapy.It is useful in MED testing64) All of the following are true regarding actinic reticuloid except:A. Is a premalignant conditionCorrect ChoiceB. CD8+ T cells in lesional skinC. Generalized lymphadenopathy commonD. Atypical dermal mononuclear cell infiltrateE. Affects elderly menActinic reticuloid is a type of chronic actinic dermatitis. Ive et al. introduced the disease as a severedermatosis with no apparent photoallergen. It generally affects elderly males and is characterizedby infiltrated erythematous plaques on an eczematous background in exposed sites withlymphadenopathy. Histopathologically, it may resemble cutaneous T cell lymphoma. However, thereis a trend towards a lower CD4+/CD8+ ratio. It is not considered a premalignant condition65) Which medication reactivates UVB- and PUVA-induced erythema?A. MethotrexateCorrect ChoiceB. 5-FUC. None of these answers are correctD. DacarbazineE. VinblastineMethotrexate reactivates UVB- and PUVA-induced erythema66) The patient demonstrates a positive photopatch test to musk ambrette and a lowered MEDB.The correct diagnosis is most likely:A. Solar urticariaB. Photoallergic contact dermatitisC. CAD Correct ChoiceD. Actinic prurigoE. PMLEOnly chronic actinic dermatitis (CAD) has a lowered MEDB. That finding helps distinguish CAD fromphotoallergic contact dermatitis in which one sees a positive photopatch test also67) A joule is a measurement of:A. WavelengthB. Power 17
  • 18. C. EnergyCorrect ChoiceD. IrradianceE. DistanceA joule is a measurement of energy dose or fluence. Power or irradiance is measured in watts.These are related by the formula Joules/cm2=Watts/cm2xseconds68) What is the most likely cause of these lesions on the cheek of this 8 year-old boy?A. VaricellaB. Herpes simplexC. Polymorphous light eruptionD. AcneE. Hydroa vacciniformeCorrect ChoiceHydroa vacciniforme is a rare photodermatosis of childhood which occurs on areas of sun-exposedskin. The lesions leave depressed and atrophic scars. The condition tends to spontaneously resolvein adulthood69) Lesions of PMLE typically appear:A. ImmediatelyB. Hours to days after exposureCorrect ChoiceC. About one hour after exposureD. Days to two weeks after exposureE. 15-30 minutes after exposureThe history of a delay of several hours to several days after exposure is important to the diagnosis70) The following compound exerts immunosuppressive effects in the skin following exposure toUV-radiation:A. Cis-urocanic acidCorrect ChoiceB. Delta aminolevulinic acidC. IL-12D. Amino-levulinic acidE. 7-dehydrocholesterolTrans-urocanic acid is an epidermal chromophore that isomerizes to cis-urocanic acid followingexposure to UV radiation. Cis-urocanic acid has been shown to be immunosuppressive, for example,by impairing the induction of contact allergy in mouse models. The mechanism of thisimmunosuppressive effect is unclear71) UVA II encompasses which wavelengths ?A. 290-320 nmB. 340-400 nmC. 400-450 nm 18
  • 19. D. 320-340 nm Correct ChoiceE. 320-400 nmUVA can be divided into UVA II (320-340 nm) and UVA I (340-400 nm)72) In solar urticaria wheals may be brought on by:A. UVA, UVB and Visible light Correct ChoiceB. UVBC. UVCD. UVAE. Visible lightSome patients react to visible light or UVA or UVB. Others react to combinations of visible light,UVA, and UVB73) All of the following are true about UVA radiation except:A. penetrates to a greater depth in the dermis than UVBB. virtually all blocked by car window glassCorrect ChoiceC. responsible for phototoxic drug reactionsD. 10 times more abundant than UVBE. approximately 50% of exposure occurs in the shadeThe UVA band extends from 320 to 400 nm. This spectrum is further subdivided into UVA-2 (320 to340 nm) and UVA-1 (340 to 400 nm). The UVA spectrum is recognized as a cause of immediate anddelayed tanning reaction of skin, and several other effects including photoaging, skinphotosensitization, and immunosuppression. The majority of the ultraviolet radiation at the earthssurface is UVA (95 to 98%) with only 2 to 5% comprised of UVB. As UVC is completely absorbed bythe stratospheric ozone layer, it does not comprise ultraviolet radiation hitting the earths surface.Much of the UV radiation after reaching the atmosphere becomes scattered by the time it hits theearths surface. Due to this "sky radiation", it is possible to sunburn even if one is exposed only tothe shade. Notably, window glass filters out ultraviolet wavelengths shorter than 320 nm, so onlyUVB (290 to 320 nm) and UVC (200 to 290 nm) are effectively filtered by car window glass.Although UVA penetrates deeper into the dermis than UVB, UVB radiation is much moreerythmogenic. Finally, most common photosensitizers have action spectrums in the UVA range, and,as a result, UVA radiation is responsible for most phototoxic drug reactions74) This malnourished individual presented with crusting and hyperpigmentation in aphotodistribution. The best diagnosis is:A. PMLEB. Photoallergic contact dermatitisC. ScurvyD. CADE. Pellagra Correct ChoicePellagra is characterized by the triad of diarrhea, dermatitis, and dementia. The dermatitis begins asa burning erythema in sun-exposed areas. There may be bullae and erosions. This is followed by adry, brittle, scaling and hyperpigmented phase. Pellagra is due to a deficiency of niacin andtryptophan 19
  • 20. 75) Medication photosensitivity is caused by all except:A. Cephalosporins Correct ChoiceB. ThiazidesC. PhenothiazenesD. DoxycyclineE. QuinolonesCephalosporins do not cause drug photosensitivity. Neither do the penicillins76) Which of the following statements about electromagnetic radiation is MOST correct?A. Electromagnetic radiation is measured in wattsB. The energy of photons is proportional to the wavelengthC. The energy of photons is inversely proportional to the frequencyD. Longer wavelengths penetrate the skin more deeplyCorrect ChoiceE. Electromagnetic radiation can be conceptualized as packets of power called photonsLonger wavelengths penetrate the skin more deeply. Electromagnetic radiation can beconceptualized as packets of ENERGY called photons. The energy of photons is proportional to theFREQUENCY and inversely proportional to WAVELENGTH. Electromagnetic radiation is measured inwavelength77) A MED phototest should be read at:A. 24 hoursCorrect ChoiceB. 12 hoursC. 48 hoursD. 96 hoursE. 2 hoursMED testing should be read 24 hours after delivery of the doses. An additional reading at 15minutes is important when solar urticaria is a consideration78) Lichen planus-like lesions on sun-exposed areas may be seen in patients being treated with:A. None of these answers are correctB. All of these answers are correctC. QuinolonesD. KetoprofenE. FenofibrateCorrect ChoiceLichenoid medication photosensitivity, with LP-like lesions on sun-exposed areas has beenassociated with treatment with antimalarials, thiazides, demethylchlortetracycline, fenofibrate,enalapril, quinine, and quinidine79) Photoonycholysis has been attributed to: 20
  • 21. A. Tricyclic antidepressantsB. QuinineCorrect ChoiceC. FurosemideD. ChlorpromazineE. AmiodaronePhotoonycholysis is a manifestation of medication photosensitivity that has been attributed toquinolones, tetracyclines, psoralens, and quinine80) The immunologic effects of UVR include all of the following except:A. Decrease in IL-1, IL-6, TNF-á Correct ChoiceB. Alteration of lymphocyte populationC. Suppression of delayed-type hypersensitivityD. Alteration of Langerhans cell functionE. Alteration of Langerhans cell morphologyUVR causes an increase of circulating cytokines (IL-1, IL-6, TNF-a).81) Regarding the UVR effects on contact dermatitis and delayed-type hypersensitivity, which of thefollowing statements is correct?A. There are increases in production of Th2 type cytokinesB. There are increased delayed-type hypersensitivity responsesC. Induction of sensitization is increasedD. Mice exposed to long-term, high-dose UVR demonstrate increased splenic APC functionE. There are diminished contact hypersensitivity responsesCorrect ChoiceMice exposed to short-term, high-dose UVR demonstrate decreased splenic APC function. There arediminished delayed-type hypersensitivity and contact hypersensitivity responses. Induction ofsensitization is decreased. Th2 cytokines are not increased following UVR exposure82) This patient’s MEDB was less than 1 mJ/cm2. His medications were Lipitor, digoxin, andCoumadin. The most likely diagnosis is:A. Photoallergic contact dermatitisB. SLEC. CAD Correct ChoiceD. PMLE testedE. Drug photosensitivityCAD is the most likely cause of such a low MEDB. Drug photosensitivity can show a lowered MEDAand on occasion a lowered MEDB, but none of the patient’s drugs cause photosensitivity83) Phototoxic reactions:A. Rarely occur on the first exposure to the chemical 21
  • 22. B. Resolve with hyperpigmentationCorrect ChoiceC. Occur only in predisposed individualsD. Are immunologically mediatedE. Are called "photoreactive" if they produce damage through reactive oxygen speciesA phototoxic reaction appears as a exaggerated sunburn with erythema and sometimes blistering,resolving with hyperpigmentation. It is a nonimmunologic reaction that could occur in all individualsgiven enough of the chemical and enough UVR. It can occur on the first exposure to the chemicaland the UVR. Phototoxic reactions that produce damage through reactive oxygen species are called"photodynamic."84) Initial treatment of this disease should include:A. HydroxychloroquineB. Sun avoidance, sunblocks, desensitizationC. Car UV filters, PUVA, sunblocksD. Sun avoidance, sunblocks, beta caroteneE. Sun avoidance, sunblock, antihistamines Correct ChoiceTreatment of solar urticaria is difficult. Sun avoidance is the most important aspect of treatment. Abroad-spectrum sunblock and antihistamines85) UVB converts 7-dehydrocholesterol in the skin to:A. Previtamin D3Correct ChoiceB. CalcitriolC. 1,25-dihydroxyvitamin DD. None of the aboveE. 25-hydroxyvitamin DUVB converts 7-dehydrocholesterol in the skin to previtamin D3, which then thermally isomerizes toform vitamin D3. It is hydroxylated in the liver and then in the kidney to form 25-hydroxyvitamin Dand 1,25-dihydroxyvitamin D, respectively86) Lichen planus like lesions on sun-exposed areas may be seen in patients receiving whichmedication?A. AlprazolamB. GriseofulvinC. FenofibrateCorrect ChoiceD. All of these answers are correctE. None of these answers are correctLP-like lesions (which may be confluent) on sun-exposed areas have been seen in patients receivingantimalarials, thiazides, demethylchlortetracycline, fenofibrate, enalapril, quinine, and quinidine87) Common side effects of PUVA include all of the following except: 22
  • 23. A. Painful erythemaB. Squamous cell carcinomaC. Hair loss Correct ChoiceD. Prolonged pruritusE. NauseaAlopecia is not a usual side effect of PUVA treatment88) Which of the following statements about the light sources for phototesting/phototherapy iscorrect?A. The mercury vapor is excited by electric current and emits a line spectrum of 254 nmCorrectChoiceB. Phototherapy bulbs are low-pressure sulfur vapor lamps with the inner surface coated by aspecific phosphorC. The phosphor emits a discoherent spectrum of various wavelengthsD. The most common light sources are incandescent bulbsE. Broadband UVB bulbs emit throughout the UVB range and also include some UVCFluorescent bulbs are commonly used for phototherapy. These bulbs are low-pressure mercuryvapor lamps with the inner surface coated by a specific phosphor. The phosphor emits a continuousspectrum of various wavelengths. The mercury vapor is excited by electric current and emits a linespectrum of 254 nm. Broadband UVB bulbs emit throughout the UVB range and also include someUVA, not UVC.89) Lumisterol is an inactive epidermal reservoir of which vitamin?A. EB. KC. AD. DCorrect ChoiceE. CLumisterol and tachysterol are inert byproducts created during the biosynthesis of vitamin D. WhenPrevitamin D3 is exposed to light, it can result in photoisomerization of previtamin D3 to lumisteroland tachysterol. If previatmin D3 is depleted, lumisterol and tachysterol can become converted backto previtamin D390) Oxsoralen plus UVA results in the following except:A. Has immunomodulating effectsB. Suppresses DNA synthesisC. Forms monofunctional adductsD. Binds to purine bases Correct ChoiceE. Can form DNA crosslinksOxsoralen, in the presence of UVA, forms covalent bonds to pyrimidine bases on DNA 23
  • 24. 91) Advantages of narrowband UVB over PUVA therapy are the following except:A. No nauseaB. Safe in pregnancyC. No need for protective eyewearD. Safe in childhoodE. More effective in treating thick plaques of CTCL Correct ChoiceUVB, both narrowband and broadband, is less penetrating into the skin than UVA. Therefore, PUVAis more effective for thick plaques of CTCL. The UVB does not reach to the bottom of the plaques92) This middle-aged man demonstrates infiltrated, dusky plaques on all sun-exposed areas. Themost likely diagnosis is:A. Actinic prurigoB. CAD Correct ChoiceC. Drug photosensitivityD. Photoallergic contact dermatitisE. PMLEThe thick, infiltrated plaques on sun-exposed areas are typical of the actinic reticuloid variety ofCAD93) Which of the following statements about the hypothetical effect of UVR on cancer induction iscorrect?A. UVR alters APC function, by increasing the number of antigen-presenting cellsB. Suppressor T-cells are suppressedC. UVR induces transformation of keratinocytes with expression of tumor-associated antigensCorrectChoiceD. UVR increases the ability of Langerhans cells to present antigenE. UVR inhibits the release of immunosuppressive factorsUVR induces transformation of keratinocytes with expression of tumor associated antigens. It altersAPC function by reducing the number of antigen presenting cells. It also promotes the release ofimmunosuppressive factors, induce suppressor t-cells, and decreases the ability of Langerhans cellsto present antigen94) A watt is a measurement of:A. PowerCorrect ChoiceB. FluenceC. EnergyD. DistanceE. IrradianceA watt is a measurement of power or irradiance of a UV source. Fluence and energy is measured injoules. These are related by the formula Joules/cm2=Watts/cm2xseconds 24
  • 25. 95) A patient presents with erythematous pruritic papules on exposed areas that appear in thespring. They appear between 2 hours and 2 days after exposure. Which of the following statementsis NOT correct?A. The pathogenesis is unclear, but may be related to type IV hypersensitivity reactionsB. It is more common in fair-skinned femalesC. Vesicles and eczematous dermatitis is uncommonD. The diagnosis described above is solar urticariaCorrect ChoiceE. This is an idiopathic disease that appears in the first three decades of lifeThe diagnosis described above is polymorphous light eruption. The time to development of lesions isimportant in distinguishing between PMLE and solar urticaria. Solar urticaria usually develops 10-30minutes after UVR exposure96) Ultraviolet radiation from the sun causes all of the following acute effects in the skin EXCEPT:A. Photooxidation of preexisting melaninB. Redistribution of melanosomes from a perinuclear position into dendritesC. Epidermal thickeningD. Mast cell degranulationE. None of these answers are correct Correct ChoiceAll of these statements are acute effects of UV raditation on the skin. Immediate pigmentdarkening, which fades within minutes after exposure, is brought on by UVA and visible light. It iscaused by photooxidation of preexisting melanin and a redistribution of melanosomes from aperinuclear position into dendrites. Epidermal thickening is mainly a UVB-induced phenomenon.Mast cell degranulation, with release of histamine and other mast cell products, also occurs as aresult of UV radiation97) The portion of the electromagnetic spectrum that produces a particular biologic effect is calledthe:A. Spectral ActivityB. Cutaneous Effect SpectrumC. Action Spectrum Correct ChoiceD. Effective SpectrumE. Absorption SpectrumThe action spectrum is the wavelengths that produce a certain biologic effect. The action spectrumfor photosensitivity from exogenous chemicals is usually in the UVA range. The radiation that isabsorbed by those chemicals is called their absorption spectrum98) Which of the following genodermatoses is NOT worsened by sunlight?A. Dariers diseaseB. Kindler syndromeC. Rothmund-Thompson syndrome 25
  • 26. D. Hartnup diseaseE. Job syndromeCorrect ChoiceMany genodermatoses can be exacerbated by sunlight including Dariers, Kindler, RothmundThompson, Hartnup (pellagra changes99) Actinic prurigo (AP) differs from PMLE in all of the following except:A. Cheilitis is rare in AP and common in PMLE Correct ChoiceB. The lesions of AP occur on all sun-exposed areasC. Outbreaks of AP are not as clearly related to sun exposureD. Lesions of AP may occur on non-sun exposed areasE. The lesions of AP begin in childhoodCheilitis is common in actinic prurigo and not a usual accompaniment in PMLE.100) The MPD of Oxsoralen plus UVA is:A. Tested on the patient’s calf or abdomenB. Equal to one-half the patients MEDAC. None of these answers are correctD. Helpful in starting PUVA therapy Correct ChoiceE. Measured at 24 hoursMPD stands for the minimal phototoxic dose. For Oxsoralen plus UVA, the MPD is measured at48-72 hours. Testing is done on the upper buttock or forearm101) The most common presentation of a patient with medication photosensitivity is:A. Lichenoid eruptionsB. PhotoonycholysisC. Fixed erythematous patchD. PseudoporphyriaE. Diffuse erythema in sun-exposed areasCorrect ChoiceMost patients with medication photosensitivity present with diffuse erythema in sun-exposed areas.In some patients, the eruption is eczematous and covered areas are spared. Photoonycholysis,lichenoid eruptions and pseudoporphyria do occur with mediation photosensitivity, but are not themost common presentation. Fixed erythematous patch is not seen with this type of reaction102) Which of the following is the most common photodermatosis?A. Polymorphous light eruptionCorrect ChoiceB. Hydroa vacciniformeC. Solar urticariaD. Actinic prurigoE. Chronic actinic dermatitis 26
  • 27. Polymorphous light eruption is the most common photodermatosis. It is a idiopathic disease thatusually appears in the first three decades of life and is more common in fair-skinned females. Thepathogenesis is unclear, but is believed to be related to a type IV hypersensitivity reaction. Mostlesions are erythematous pruritic papules, with the plaque form being less common. Lesions appearsymetrically on exposed areas after a delay of several hours to several days. Patients with milddisease are treated with sun avoidance and a broad spectrum sunscreen. In more severe cases,hardening and desensitization can be accomplished or antimalarials can be used for resistant cases.For brief, sunny vacations, a short course of prednisone can be helpful.The other options are less common forms of idiopathic photosensitivity disorders103) UVB is about how many times more erythermogenic than UVA ?A. 1000 Correct ChoiceB. 5C. 10000D. 10E. 100Though UVB is 1000 times more erythermogenic than UVA, UVA is much more plentiful in sunlight.Therefore, UVA does contribute to sunlight erythema104) Phototoxicity and photoallergy from exogenous agents typically involve absorption of:A. UVB, UVA and visible lightB. UVA Correct ChoiceC. UVBD. UVA and visible lightE. UVB and UVATopical and systemic agents that produce phototoxicity and/or photoallergy usually have actionspectra in the UVA range105) The UVC portion of the electromagnetic spectrum extends from:A. 10-200 nmB. 200-290 nmCorrect ChoiceC. 400-760 nmD. None of these answers are correctE. 290-320 nmUltraviolet C does not reach the earths surface. It is filtered out by the ozone layer. It extends from200-290 nm106) Ultraviolet radition has been shown to do all of the following in in vitro and in vivo studiesEXCEPT:A. Increase circulating levels of IL-6B. Suppress the induction of delayed-type hypersensitivity 27
  • 28. C. Decrease circulating levels of IL-1Correct ChoiceD. Induce suppressor T-cellsE. Alter the ability of antigen-presenting cells to present antigenUV-irradiated mice have been shown to have defective antigen presentation and a decreasednumber of antigen-presenting cells, which prevents a normal delayed-type hypersensitivityresponse. UVR causes the release of immunosuppressive factors, with induction of suppressor T-cells and increases in circulating levels of cytokines, including IL-1, IL-6, and TNF107) Narrowband UVB bulbs emit predominantly at:A. 290-320 nmB. 305 nmC. 360 nmD. 311 nm Correct ChoiceE. 352 nmNarrowband UVB (311-312 nm) is more effective than broadband UVB for psoriasis, vitiligo, andother skin disorders108) Which of the following is not true about UVB radiation?A. Responsible for sunburnB. Decreased with high wind velocityCorrect ChoiceC. Virtually all blocked by car window glassD. Peaks at noonE. More intense in the summer than winter monthsThe UVB band extends from 290 to 320 nm. The UVB spectrum is recognized as the primary causeof sunburn, skin cancer, and other harmful effects on humanskin. The UVA band extends from 320 to 400 nm. This spectrum is further subdivided into UVA-2(320 to 340 nm) and UVA-1 (340 to 400 nm). The UVA spectrum is recognized as a cause ofimmediate and delayed tanning reaction of skin, and several other effects including photoaging, skinphotosensitization, and immunosuppression. UVC radiation comprises wavelengths shorter than 290nm (from 200 to 290 nm). Notably, window glass filters out ultraviolet wavelengths shorter than320 nm, so both UVB and UVC are effectively filtered by car window glass. UVB radiation is moreintense during summer months compared to winter months and peaks during midday hours. It hasbeen postulated that physical factors such as high temperature, high humidity, and wind can allincrease susceptibility to UV-induced carcinogenesis109) Which of the following statements about UVR in vivo is correct?A. decreases circulating levels of cytokins (IL-1, IL-6 and TNF)B. normalizes Langerhans cell morphology and functionC. normalizes cell traffickingD. normalizes proportions of lymphocyte subtypes in peripheral bloodE. induces skin cancersCorrect ChoiceUVR can induce skin cancer. UVR in vivo INCREASES circulating levels of cytokins (IL-1, IL-6 andTNF) and alters Langerhans cell morphology, cell trafficking, and the proportion of lymphocytesubtypes in peripheral blood 28
  • 29. 110) Which of the following is NOT true regarding polymorphous light eruption?A. It may occur through windowglass, which filters out UVBB. Usually appears in the first three decadesC. Not all exposed areas show lesionsD. May be a manifestation of a type IV hypersensitivity reactionE. Vesicles and an eczematous dermatitis are a common presentationCorrect ChoicePolymorphous light eruption is the most common photodermatosis. It is an idiopathic disease thatusually appears in the first three decades. Pathogenesis is unclear but it may be related to a type IVhypersensitivity reaction. Most lesions are erythematous, pruritic papules. The plaque form is lesscommon, and vesicles and an eczematous dermatitis are rare. Not all exposed areas show lesions,but the same areas are affected year after year. It may improve as the summer progresses. It mayoccur through windowglass, which filters out UVB111) What is the wavelength of a Woods light?A. 365nmCorrect ChoiceB. 410nmC. 290nmD. 311nmE. 330nmA Woods light emits ultaviolet light at a wavelenth of 365nm and is produce by bassing lightthrough a Woods filter which is composed of nickel oxide containing glass112) The most common cause(s) of topical phototoxicity today in the United States is(are):A. 6-methyl-coumarinB. Musk ambretteC. PABA and non-PABA sunscreen ingredientsD. PsoralensCorrect ChoiceE. Halogenated salicylanilidesTopical phototoxicity is most commonly caused by psoralens. Topical 8-methoxypsoralen is usedtherapeutically to treated psoriasis, localized vitiligo, and hand/foot eczema. Psoralens in certainplants, fruits, and vegetables can produce phytophotodermatitis. Topical photoallergy has in thepast been caused by halogenated salicylanilides, as well as musk ambrette and 6-methyl-coumarinin fragrances. These compounds produced photoallergic contact dermatitis, and have been removedfrom marketed products. PABA, its esters, and non-PABA sunscreen ingredients are the mostcommon causes of topical photoallergy, not topical phototoxicity113) Which of the following statements is true regarding ultraviolet carcinogenesis?A. UVA is most effective in producing pyrimidine dimers, which may activate oncogenesB. Cells from patients with actinic keratoses have normal DNA repair capacityC. Suppressor T-cells arise in UV-irradiated hosts only after tumors have developed 29
  • 30. D. UVA, when added to UVB, may accelerate carcinogenesisCorrect ChoiceE. Mid-range ultraviolet radiation is less efficient in inducing neoplasia in mice that is long wave UVRMid-range UVR (280-320 nm) is more efficient in inducing neoplasia in mice, but long wave UVA,when added to UVB, may accelerate carcinogenesis. Suppressor T-cells induce susceptibility totumors, and appear to arise in UV-irradiated hosts prior to tumors developing, thus playing a role incarcinogenesis. Cells from patients with AKs have less DNA repair capacity than controls. UVB ismost effective in producing pyrimidine dimers, which may activate oncogenes, particularly in theformation of BCCs and SCCs114) A patient presents with purple polygonal pruritic papules on sun exposed areas. Which of thefollowing of his medication would not be suspect for causing this eruption?A. HydrochlorothiazideB. EnalaprilC. QuinidineD. FurosemideCorrect ChoiceE. FenofibrateFurosemide (Lasix) is not a cause of lichenoid drug reactions, but can cause pseudoporphyria. Theothers listed are causes of lichenoid drug reactions. Others are antimalarials,demethylchlortetracycline and quinine115) Which of the following drugs is commonly known to produce photosensitivity?A. GriseofulvinB. All of these answers are correctCorrect ChoiceC. SulfonylureasD. QuinidineE. None of these answers are correctQuinidine, sulfonlyureas, and griseofulvin are all known to cause photosensitivity116) The differential diagnosis of this patient would include:A. Chronic actinic dermatitisB. All of these answers are correct Correct ChoiceC. Airborne contact dermatitisD. Photoallergic contact dermatitisE. Drug photosensitivityNEEDS EXPLANATION117) The action spectrum for photoallergy is mostly in which spectrum?A. 400-760nmB. 311-312nmC. 200-290nm 30
  • 31. D. 290-320nmE. 320-425nmCorrect ChoiceThe action spectrum for photoallergic dermatoses refers to the specific wavelengths of light thatevoke the photosensitive reaction. This falls mostly within the UVA region and may spill into thevisible light region for photoallergy (320-425nm). 200-290nm refers to the UVC region; 290-320nmrefers to the UVB region; 311-312nm refers to narrowband UVB region; and 400-769nm refers tothe visible light region118) This disease can be brought on by:A. UVA IB. All of these answers are correctCorrect ChoiceC. Visible lightD. UVA IIE. UVBSolar urticaria can be brought on by UVB or UVA or visible light or combinations of thosewavelengths119) All of the following are true regarding polymorphous light eruption except:A. Anti-Ro antibody positiveCorrect ChoiceB. Hardening occurs with subsequent episodesC. Abnormal metabolism of arachidonic acidD. PruriticE. Lesions heal without scarringPolymorphous light eruption is the most common photodermatosis that is characterized clinically bythe abnormal occurrence of pruritic, erythematous, edematous papules following exposure to UVradiation. Lesions heal without scarring. It tends to affect women 2-3x more than men. PositiveAnti-ro antibodies should raise the suspicious for subacute cutaneous lupus erythematosus (tendsalso to be less pruritic120) Most fluorescent UV sources are:A. Low pressure xenon arc lampsB. Low pressure mercury vapor lamps Correct ChoiceC. Low pressure argon lampsD. High pressure tungsten lampsE. High pressure xenon arc lampsThe mercury vapor in the fluorescent bulbs is excited by electric current. Then the mercury emitsradiation at 254 nm. This radiation is absorbed by the phosphor lining the bulb121) Actinic prurigo (AP) differs from polymorphous light eruption (PMLE) in that:A. Lesions of PMLE occur on all sun-exposed areasB. Lesions of AP usually begin after puberty 31
  • 32. C. Lesions of AP may persist for months, even into the winterCorrect ChoiceD. Chelitis is more frequently seen in PMLEE. Lesions of PMLE may occur on non-sun-exposed areasActinic prurigo (AP) may be a distinct entity, or an HLA-restricted subset of polymorphous lighteruption (PMLE). AP differs from PMLE in that the lesions of AP always begin in childhood and oftenremit in puberty, the lesions of AP occur on all sun-exposed areas and may persist for months, eveninto the winter, and the lesions of AP may occur on non-sun-exposed areas. In addition, outbreaksof AP are not as clearly related to sun exposure, and chelitis is frequently seen in AP, not PMLE122) This patient presented with hyperpigmented streaks after a vacation in the Caribbean. Themost likely diagnosis is:A. Actinic prurigoB. CADC. PMLED. Phytophotodermatitis Correct ChoiceE. MelasmaPhytophotodermatitis requires exposure to certain plants or fruits followed by sunlight. Parsnips,parsley, figs, limes, celery, bergamot oranges, and others contain psoralens that react with UVA.Initially there is erythema and blistering followed by streaked hyperpigmentation123) Which of the following is the most likely cause of photosensitivity?A. Penicillin VB. QuinolonesC. SulfonamidesD. DoxycyclineCorrect ChoiceE. MinocyclineDoxycycline is the tetracycline derivative most likely to cause photosensitivity. Quinolones andsulfonamides will also cause this with ingestion. Minocycline is the least photosensitizing of thetetracycline derivatives. Penicillin is not a common cause of photosensitivity124) Which of the following is true regarding immediate pigment darkening?A. Becomes prominent 48 hr after exposureB. Contributes to constitutive skin colorC. Caused by UVA radiationCorrect ChoiceD. Requires the synthesis of new melaninE. Prominent in lightly pigmented individualsTanning develops in two phases, early (transitory) and late (stable). The immediate darkening is inresponse to UVA and is related to photo-oxidation of pre-existing melanin125) Which of the following statements is true regarding UV radiation, erythema, andpigmentation? 32
  • 33. A. Delayed tanning, which becomes visible about 72 hours after exposure, is largely brought on byUVA.B. UVB erythema reaches a maximum in 24-36 hoursC. The chromophores involved with UVB erythema are melanosomesD. Immediate pigment darkening is brought on by UVA and visible lightCorrect ChoiceE. Immediate pigment darkening fades within 12-24 hours after exposureUVB in natural sunlight is the main contributor to erythema. UVB erythema reaches a maximum in6-24 hours. The chromophores involved with UVB erythema are not clear but appear to involvenucleic acids. Immediate pigment darkening is brought on by UVA and visible light, and fades withinminutes after exposure. Delayed tanning becomes visible about 72 hours after UVB exposure. UVAcontributes to a lesser extent to delayed tanning126) The main condition on the differential for polymorphous light eruption is lupus erythematosus.Which of the following tests should NOT be performed to help make this distinction?A. Anti-SSAB. Antinuclear antibodyC. SED rateCorrect ChoiceD. Anti-SSBE. Skin biopsy for routine staining and direct immunofluorescenceAll of the listed tests are helpful in distinguishing between PMLE and lupus except a SED rate, whichis a non-specific marker of systemic inflammation127) As a result of ultraviolet radiation:A. Prostaglandins are increasedB. None of these answers are correctC. There is mast cell degranulation and release of histamineD. Epidermal thickening occursE. All of these answers are correctCorrect ChoiceEffects of ultraviolet radiation include mast cell degranulation with release of histamine and othermast cell products, increases in certain prostaglandins and interleukins, and epidermal thickening,which is mainly a UVB-induced phenomenon128) Which spectrum of UV is responsible for the conversion of 7-dehydrocholesterol in the skin topre-vitamin D3?A. 290-320 nmCorrect ChoiceB. 10-200 nmC. 340-400 nmD. 320-340 nmE. 200-290 nmUltraviolet B with the spectrum of 290-320 nm is responsible for the conversion of 7-dehydrocholesterol in the skin to pre-vitamin D3 33
  • 34. 129) What range of ultraviolet radiation has been shown to be most efficient in inducing neoplasiain mice?A. 280-320nmCorrect ChoiceB. >760nmC. 400-760nmD. 340-400nmE. 320-340nmMidrange UVR 280-320nm (UVB range) has been shown to be most efficient in inducing neoplasia inmice. Long-wave UVA, when added to UVB may accelerate carcinogenesis130) A normal MEDB on untanned Caucasian skin ranges from approximately:A. 20-70 mJ/cm2 Correct ChoiceB. 2-6 mJ/cm2C. 140-200 mJ/cm2D. 15-40 mJ/cm2E. 70-140 mJ/cm2The MEDB can vary from institution to institution. In one institution, it may range from 20-70mJ/cm2. In another institution, it may range from 30-90 mJ/cm2131) Phototoxicity from exogenous agents is characterized by all of the following except:A. There may be apoptotic cells histologicallyB. There is cross-reactivity to similar exogenous agents Correct ChoiceC. It appears as an exaggerated sunburn and heals with hyperpigmentationD. Occurs in most individuals given enough of the drug and enough UVRE. It can occur on first exposure to drug and UVRWith photoallergy, not phototoxicity, there can be cross-reactivity among similar agents132) A patient with a personal and family history of multiple fibrofolliculomas may have:A. Tuberous sclerosisB. Muir-Torre syndromeC. Gardners syndromeD. Birt-Hogg-Dube syndromeCorrect ChoiceE. Basal cell nevus syndromeFibrofolliculomas are small, benign, yellow or flesh colored papules that are usually inherited in anautosomal dominant fashion and have a predilection for the face, neck and upper trunk. Birt-Hogg-Dube syndrome is an autosomal dominant condition characterized by multiple fibrofolliculomas,trichodiscomas, acrochordons, collagenomas. This condition is important to recognize due to itsassociation with renal cell carcinoma. In addition, lung cysts and bullous emphysema are alsofeatures of the condition with spontaneous pneumothorax being a potential complication.Muir-Torre syndrome is an autosomal dominant condition caused by a defect in hMSH2 gene. Thiscondition is associated with sebaceous neoplasms including sebaceous carcinoma, sebaceous 34
  • 35. hyperplasia, sebaceous epithelioma, sebaceous adenoma as well as keratoacanthomas. These canbe markers for underlying malignancy in this condition; notably adenocarcinoma of the colon,breast, urinary tract, lung and endometrium.Gardner syndrome is an autosomal dominant condition caused by a defect in the APC familialadenomatous polyposis gene in which patients have multiple hamartomatous polyps of the colonwith a high rate of malignant transformation. Cutaneous clues to the diagnosis include multipleepidermoid cysts, fibromas, and desmoid tumors. Other manifestations include osteomas,supernumary teeth, and congential hypertrophy of the retinal pigment epithelium.Tuberous sclerosis, (TS),also known as Bournevilles syndrome is caused by defects in hamartin andtuberin, found on chromosome 9 and 16, respectively. Patients with TS are at increased risk ofmuliple neoplasms including retinal hamartomas, angiomyolipomas, and cardiac rhabdomyomas.Cutaneous manifestations include ash-leaf macules, shagreen patchs, café-au-lait macules, confettimacules, facial angiofibromas, and periungual fibromas.As the name implies, basal cell nevus syndrome is associated with multiple basal cell carcinomas. Inaddition palmoplantar pitting, multiple milia and epidermoid cysts are seen. It is autosomaldominantly inherited and caused by a defect in the patched gene 35