ETAS_MCQ_16 dermatological drugs

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ETAS_MCQ_16 dermatological drugs

  1. 1. Dermatological drugs1) Which of the following antiviral agents is NOT phosphorylated by viral thymidine kinase?A. ValacyclovirB. GancyclovirC. CidofovirCorrect ChoiceD. FamciclovirE. AcyclovirCidofovir is a nucleotide analogue antiviral agent. It does not require phosphorylation by virus, butis converted by host cell kinases to a diphosphate2) Which biologic agent is administered intramuscularly?A. InfliximabB. EfalizumabC. EtanerceptD. AlefaceptCorrect ChoiceE. None of the aboveAlefacept is given intramuscularly3) In addition to minocycline, which of the following drugs has been associated with drug-inducedlupus erythematosus-like syndrome?A. RifampinB. Hydralazine Correct ChoiceC. ItraconazoleD. AmiodaroneE. DoxycyclineDrugs associated with drug-induced SLE include minocycline, hydralazine, procainamide, isonaizid,penicillamine, and anti-convulsants4) One of the main concerns for prescribing azathioprine to a gout patient with a normal level ofthiopurine methyltransferase on chronic allopurinol is:A. Patient may develp photosensitivityB. Azathioprine does not workC. Allopurinol does not workD. Patient may become pancytopenicCorrect ChoiceE. No concernsAllopurinol inhibits xanthine oxidase, an enzyme that catabolizes azathioprine. In patientsconcurrently taking bothe medications, the allopurinol shunts more 6-MP from the xanthine oxidasecatabolic pathway to the hypoxanthine-guanine phosphoribosyltransferase(HGPRT)anabolicpathway, creating an excess of purine analogs. This in turn may lead to to excessiveimmunosuppression and risk of pancytopenia 1
  2. 2. 5) A patient presents with a likely fixed drug eruption. Her medications include glyburide, lisinopril,hydrochlorthiazide, and aspirin, as well as an over-the-counter laxative. Which is the most likelyculprit?A. LaxativeCorrect ChoiceB. HydrochlorthiazideC. LisinoprilD. AspirinE. GlyburidePhenopthalein, found in laxatives, is a known cause of fixed drug eruptions6) Fomivirsen is a single-stranded antisense oligonucleotide FDA-approved for the treatment of:A. HSV infectionB. EBV infectionC. HPV infectionD. CMV infectionCorrect ChoiceE. HIV infectionFomiversen (Vitraene) represents a new class of therapeutic agents known as antisense drugs. It isindicated for the treatment of CMV retinitis in patients with AIDS. The most common adverse effectsare ocular inflammation and increases in intraocular pressure7) Which antihistamine has suppressor T-cell inhibitory activity?A. PromethazineB. FexofenadineC. DoxepinD. Cromolyn sodiumE. CimetidineCorrect ChoiceCimetidine is an H2 antihistamine that has suppressor T-cell inhibitory activity, by competitivelyblocking their H2 receptors. Immunomodulatory effects are useful for treating mucocutaneouscandidiasis, verruca vulgaris, and condyloma acuminata8) A 59 year-old woman is diagnosed with acute myelogenous leukemia. Induction chemotherapy isinitiated. A few days later the patient develops tender erythematous plaques on her face. What isthe most likely culprit drug?A. MethotrexateB. CyclophosphamideC. CytarabineCorrect ChoiceD. 5-fluorouracilE. Hydroxyurea 2
  3. 3. The most likely diagnosis is neutrophilic eccrine hidradenititis. Cytarabine is the usual offendingagent9) Which drug has mucocutaneous side effects which can include stomatitis, chelitis, lichen planus-like eruptions, and pityriasis rosea-like eruptions?A. GoldCorrect ChoiceB. ThalidomideC. ColchicineD. Potassium iodideE. None of the aboveMucocutaneous side effects, which are more common with injectable gold, include stomatitis,cheilitis, lichen planus-like eruptions, and pityriasis rosea-like eruptions10) Which of the following is not a side effect of bleomycin?A. Flagellate hyperpigmentationB. Serpentine supravenous hyperpigmentationCorrect ChoiceC. Pulmonary fibrosisD. AcrosclerosisE. ErythromelalgiaAll of the above are side effects of bleomycin except serpentine supravenous hyperpigmentation.This is a side-effect of 5-fluorouracil11) Side effects from this antihistamine include gynecomastia, impotence, and loss of libido:A. FexofenadineB. PromethazineC. CyproheptadineD. CimetidineCorrect ChoiceE. DoxepinCimetidine, an H2 antihistamine, also competitively inhibits dihydrotestosterone at the androgenreceptor site, with resultant antiandrogen side effects including gynecomastia, impotence, and lossof libido12) Which drug is known to cause an SCLE-like eruption?A. BarbituatesB. CaptoprilC. MinocyclineD. Terbinafine Correct ChoiceE. FurosemideSCLE-like reaction are known to occur most likely from glyburide, griseofulvin, hydrochlorothiazide,penicillamine, piroxicam, and terbinafine 3
  4. 4. 13) Which of the following drugs may cause acute generalized exanthematous pustulosis?A. MercuryB. All of these answers are correctCorrect ChoiceC. CefazolinD. AmpicillinE. AzithromycinAcute generalized exanthematous pustulosis (AGEP) has been associated with beta-lactamantibiotics, macrolide antibiotics, cephalosporins, and mercury.14) What is the most likely congenital defect associated with isotretinoin therapy?A. Ventral septal defectB. Cranial synostosisCorrect ChoiceC. Spina bifidaD. PhocomeliaE. Atrial septal defectIsotretinoin is thought to cause congenital defects by interfering with neural crest development. Themost likely congenital defect is cranial synostosis15) What drug is known to cause scotomas?A. GoldB. DapsoneC. QuinacrineD. IsotretinoinE. Chloroquine Correct ChoiceTrue retinopathy is associated with “bull’s eye” pigment deposition, central scotoma, and diminishedvisual acuity. Chloroquine is at greatest risk of causing retinopathy. Quinacrine is not associatedwith the risk of retinopathy16) Finasteride is a specific inhibitor of:A. AromataseB. Type II 5 alpha reductaseCorrect ChoiceC. Dihydrotesterone reductaseD. Testosterone synthetaseE. Type I 5 alpha reductaseFinasteride, a type II 5 alpha reductase inhibitor, given as a 1mg tablet daily, is effective inpreventing further hair loss and in increasing the hair counts to the point of cosmeticallyappreciatable results in men ages 18 to 41 with mild to moderate hair loss at the vertex, in theanterior midscalp, and the frontal region 4
  5. 5. 17) Which of the following pairings of antifungal agents and their mechanisms of action is NOTcorrect?A. Fluconazole: Inhibits squalene epoxidaseCorrect ChoiceB. Ketoconazole: Blocks conversion of lanosterol to ergosterolC. Itraconazole: Inhibits 14-alpha-demethylaseD. Griseofulvin: Disrupts microtubule mitotic spindle formationE. Terbinafine: Inhibits squalene epoxidaseTerbinafine inhibits squalene epoxidase and blocks the biosynthesis of ergosterol, a sterol essentialto the integrity of fungal cell membranes. Itraconazole inhibits 14-alpha-demethylase, blockinglanosterol conversion to ergosterol. Griseofulvin disrupts microtubule mitotic spindle formationcausing metaphase arrest. Ketoconazole has a mechanism of action similar to itraconazole.Fluconazole also inhibits 14-alpha-demethylase, not squalene epoxidase18) Vascular leak syndrome has been associated with which chemotherapeutic agent?A. BleomycinB. CytarabineC. Denileukin diftitoxCorrect ChoiceD. MethotrexateE. InterferonDenileukin 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. Thechemotherapy is taken up by cells expressing high-affinity IL-2 receptors. Capillary leak syndromepresenting with hypotension, edema, pleural effusions, and weight gain caused by fluid retentionhas been reported in patients receiving denileukin difitox19) Methotrexate toxicity with myelosuppression is treated with what agent?A. Folic acidB. Vitamin EC. Folinic acid Correct ChoiceD. CimetidineE. Oral methylene blueLeukovorin, or folinic acid, is able to bypass dihydrofolate reductase in the cell division pathway. Itis administered under conditions of methotrexate-induced myelosuppression. Leukovorin is alsoavailable 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 ofmethotrexate’s antipsoriatic actions20) Which one of the following antifungals requires an acidic environment for its absorption?A. terbinafineB. fluconazoleC. itraconazoleCorrect Choice 5
  6. 6. D. griseofulvinE. amphotericin BItraconazole is a triazole whose mechanism, like the other azoles, is inhibition of cytochrome P-450enzyme lanosterol 14-alpha demethylase, with resultant inhibition of lanosterol conversion toergosterol. Ergosterol is an essential component of fungal cell membranes. Itraconazole is a weakbase, 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 isoptimized when given with a fatty food. Oral fluconazole is very well absorbed when given orallywith over 90% bioavailability. Terbinafine, though highly lipophilic, has 70 to 80% absorption, whenadministered orally, with a bioavailability not significantly impacted by food intake21) Bone marrow suppression can occur more often in individuals taking azathioprine withgenetically low allele activity of what enzyme?A. Dihydrofolate reductaseB. Inosine monophosphate dehydrogenaseC. Glucose-6-phosphataseD. Epoxide hydroxylaseE. Thiopurine methyltransferase Correct ChoiceNEEDS EXPLANATIONS22) What antifungal is the best choice for a patient with mucocutaneous candidiasis who is currentlytaking antacids?A. GriseofulvinB. Fluconazole Correct ChoiceC. TerbinafineD. ItraconazoleE. KetoconazoleKetoconazole and itraconazole require an acidic environment. Fluconazole, however, does notrequire an acidic environment and can work safely and effectively in patients taking antacids, whichcan raise gastric pH levels23) The treatment of choice for scabies in pregnant women is:A. MalathionB. ThiabendazoleC. 1% permethrinD. Precipitated sulfur 6% Correct ChoiceE. IvermectinNEEDS EXPLANATIONS24) Approximately what percentage of patients with drug hypersensitivity syndrome will have liverfunction test abnormalities?A. Close to 100% 6
  7. 7. B. 25%C. Less than 10%D. 75%E. 50% Correct ChoiceDrug hypersensitivity syndrome is characterized by fever, skin eruption and internal organinvolvement. 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 enzymes25) Weekly CD4 T-cell counts are recommended for psoriasis patients treated with which biologicagent?A. EtanerceptB. None of the aboveC. EfalizumabD. AlefaceptCorrect ChoiceE. InfliximabAlefacept eliminates activated memory T-cells, so weekly CD4 T-cell counts are recommended26) The antihistamine with strong H1 and H2 blockade is:A. CyproheptadineB. CimetidineC. CetirizineD. Doxepin Correct ChoiceE. ChlorpheniramineDoxepin, a tricyclic antidepressant, has H1 and H2 antihistamine activity27) Which of the following statements regarding retinoids is true?A. Tretinoin and isotretinoin are second-generation synthetic retinoidsB. Second-generation retinoids are polyaromatic retinoidsC. Bexarotene is a third-generation retinoidCorrect ChoiceD. Etretinate is a first-generation retinoidE. Tazarotene is a fourth-generation selective retinoidFirst-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 (polyaromatic retinoids) include the arotinoids, tazarotene, adapalene, and bexarotene28) Which of the following antifungal agent works by way of inhibiting ergosterol synthesis byblocking squalene epoxidation:A. Terbinifine NaftifineCorrect ChoiceB. Itraconazole 7
  8. 8. C. NaftifineD. Itraconazole and TerbinifineE. TerbinifineTerbinafine and Naftifine work by way of inhibiting ergosterol synthesis by blocking squaleneepoxidation (B&C). Itraconazole works by inhibiting ergosterol synthesis by blocking Lanosterol 14-alpha demthylase29) At standard dosages, which of the following is fungicidal?A. TerbinafineCorrect ChoiceB. ItraconazoleC. KetoconazoleD. GriseofulvinE. FluconazoleTerbinafine block ergosterol synthesis early in the synthetic pathway by inhibitins squaleneepoxidase. Squalene then accumulates within fungal cells and discupts cell membranes. At standarddosaging, it is believed to be fungicidal. The other choices are fungistatic30) Which drug has been associated with cholestatic hepatitis?A. ClindamycinB. ErythromycinCorrect ChoiceC. DoxycyclineD. RifampinE. AmpicillinThe estolate form of erythromycin has been associated with cholestatic hepatitis31) Clofazamine hyperpigmentation has been described as:A. Red-brown hyperpigmentation within skin lesions Correct ChoiceB. Slate gray-purple hyperpigmentation in a photo-exposed distributionC. Yellow discoloration of the skin, scleraD. Dark hyperpigmented streaks in the nailsE. Blue-gray hyperpigmentation over the anterior shins, palate, earsClofazamine can induce red-brown hyperpigmentation within skin lesions of patients with Hansen’sdisease32) Of the new biologic therapies for psoriasis, which agent requires weekly CD4 T-cell countmonitoring?A. AdalimumabB. EfalizumabC. Alefacept Correct Choice 8
  9. 9. D. InfliximabE. EtanerceptAlefacept is a human LFA-3/IgG fusion protein, which blocks LFA-3 on antigen presenting cells frominteracting with CD-2 on T-cells, preventing T-cell stimulation. Alefacept also eliminates activatedmemory-effector T-cells, so weekly CD4 T-cell counts are required33) Which drug has recently been shown to be of use in chemoprevention of squamous cellcarcinoma in recessive dystrophic epidermolysis bullosa:A. MethotrexateB. Mycophenolate mofetilC. CyclosporineD. IsotretinoinCorrect ChoiceE. Topical tarDespite low therapeutic responses of advanced cancers to retinoids, these drugs appear to have apromising role in chemoprevention. Patients with oral leukoplakia, actinic keratoses, arsenickeratoses, and Bowens disease can benefit from retinoid therapy34) The mechanism of action of podophyllin most closely resembles that of what other drug listedbelow?A. DactinomycinB. PermethrinC. 5-fluorouracilD. ChlorambucilE. Colchicine Correct ChoiceBoth podophyllin and colchicine have antimitotic activity. They bind to tubulin dimers, interferingwith mitotic spindle and microtubule assembly35) Raynaud’s phenomenon is a potential adverse effect of what chemotherapeutic agent?A. DoxorubicinB. HydroxyureaC. Vinca alkaloidsD. 5-fluorouracilE. Bleomycin Correct ChoiceBleomycin use has been associated with Raynaud’s phenomenon occurring in digits treated withintralesional therapy for periungual and plantar warts36) What antihistamine can cause gynecomastia, impotence, and loss of libido?A. DoxepinB. CyproheptadineC. Cimetidine Correct Choice 9
  10. 10. D. FexofendineE. ChlorpheniramineCimetidine competitively inhibits dihydrotestosterone at the androgen receptor site and can exhibitanti-androgen effects.37) Methemoglobinemia is an adverse reaction to treatment with which agent?A. PlaquenilB. DapsoneCorrect ChoiceC. MethotrexateD. CyclophosphamideE. AzathioprineDapsone is a lipid-soluble sulfone drug that is used widely in dermatology in a variety of conditionsincluding dermatitis herpetiformis, leprosy, and neutrophilic dermatoses. Adverse effects fromdapsone are both pharmacologic and idiosyncratic and include hemolytic anemia,methemoglobinemia, agranulocytosis, hypersensitivity syndrome and neuropathy. Of these, the firsttwo 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 tothe N-hydroxy metabolites of dapsone, which are potent oxidants. G6PD-deficient individuals aremore susceptible to oxidative stresses, including those from dapsone metabolites, and a baselineG6PD level is recommended prior to initiation of dapsone therapy. In the event of emergentmethemoglobinemia, oral methylene blue (100-300 mg/day) can be used to decreasemethemoglobin levels. However, if the patient is G6PD deficient, this strategy is ineffective38) Which of the following statements is NOT true regarding the categories for safety of drug use inpregnancy?A. Drugs are category D if controlled studies show risk to human fetus, but in some instancesbenefits may outweigh risksB. Drugs are category A if controlled studies in humans show no risk to the fetusC. Drugs are category B if controlled human studies show no risk to the fetus but may show risk toanimals, or if no risk has been shown in animal studies but no human studies have been conductedD. Category X drugs are contraindicated in pregnancyE. Drugs are category C if risk to the human fetus has been demonstrated, but animal studies areequivocalCorrect ChoiceDrugs are category C if risk to the human fetus cannot be ruled out, studies are lacking, or animalstudies are equivocal. Drugs for which risk to the human fetus has been demonstrated arepregnancy category D39) The risk of pseudotumor cerebri in patients taking isotretinoin is increased by:A. DehydrationB. Comorbid affective disorderC. Doses higher than 1.0 mg/kg/dayD. Concomitant use of tetracycline Correct Choice 10
  11. 11. E. Concomitant use of TMP-SMXThe risk of pseudotumor cerebri is increased in patients on isotretinoin and a tetracycline40) Neutrophilic eccrine hidradenitis is associated most often with which chemotherapeutic agent?A. Vinca alkaloidsB. 5-fluorouracilC. Cytarabine Correct ChoiceD. DactinomycinE. DoxorubicinNeutrophilic eccrine hidradenitis occurs in neutropenic patients with malignancies, usually acutemyelogenous leukemia. Cytarabine is the most commonly associated medication41) Which of the following statements regarding antifungal medications is TRUE?A. Terbinafine is fungistaticB. Griseofulvin is safe for patients with variegate porphyriaC. Griseofulvin is a cytochrome P450 3A4 inhibitorD. Ketoconazole is fungicidalE. Ketoconazole has been associated with gynecomastiaCorrect ChoiceMedications that can precipitate acute attacks in variegate porphyria include barbiturates, estrogen,griseofulvin, sulfonamides and ethanol. Ketoconazole can produce impotence and gynecomastia byinterfering with androgen synthesis. Ketoconazole inhibits cytochrome (CYP) P450 and mostconcerning, can rarely cause fulminant hepatitis. Griseofulvin induces CYP P450, not inhibits it.Terbinafine is fungicidal along with amphotericin B. Ketoconazole is fungistatic42) For which of the following medications is abdominal cramping and watery diarrhea a verycommon side effect that may limit treatment?A. ColchicineCorrect ChoiceB. ChlorambucilC. Potassium iodideD. GoldE. ThalidomideColchicine is an alkaloid with antimitotic activity that is used in dermatology for its effects onneutrophils. The most common side effect from colchicine use is gastrointestinal distress withabdominal cramping and watery diarrhea43) The combination of ethanol and acitretin is potentially problematic because:A. Ethanol inhibits the cytochrome p450 systemB. Ethanol exacerbates the cheilitis caused by acitretinC. Ethanol promotes the conversion of acitretin to etretinateCorrect ChoiceD. Ethanol promotes the metabolism of acitretin 11
  12. 12. E. Acitretin increases the toxicity of ethanolAcitretin is an synthetic retinoid with affinity to the retinoic acid receptor (RAR). It can modulate theproliferation and differentiation of epidermal keratinocytes. The concurrent injestion of ethanol andalcohol increases the formation of etretinate. Unlike acitretin, etretinate is more lipophilic andaccumulates in the fat. It therefore has a much longer elimination half-life, estiimated at 120 days44) The combination of ethanol and acitretin is potentially problematic because:A. Ethanol inhibits the cytochrome p450 systemB. Ethanol exacerbates the cheilitis caused by acitretinC. Ethanol promotes the conversion of acitretin to etretinateCorrect ChoiceD. Ethanol promotes the metabolism of acitretinE. Acitretin increases the toxicity of ethanolAcitretin is an synthetic retinoid with affinity to the retinoic acid receptor (RAR). It can modulate theproliferation and differentiation of epidermal keratinocytes. The concurrent injestion of ethanol andalcohol increases the formation of etretinate. Unlike acitretin, etretinate is more lipophilic andaccumulates in the fat. It therefore has a much longer elimination half-life, estiimated at 120 days45) Which of the following supplements is most likely to decrease hemolysis associated in patientstaking dapsone?A. Vitamin AB. Folic acidC. Vitamin ECorrect ChoiceD. Vitamin B6E. Vitamin DAdverse effects from dapsone are both pharmacologic and idiosyncratic and include hemolyticanemia, methemoglobinemia, agranulocytosis, hypersensitivity syndrome and neuropathy. Of these,the first two are pharmacologic and anticipated, to some degree, in most patients treated withdapsone. 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 tothe N-hydroxy metabolites of dapsone, which are potent oxidants. G6PD-deficient individuals aremore susceptible to oxidative stresses, including those from dapsone metabolites, and a baselineG6PD level is recommended prior to initiation of dapsone therapy. Vitamin E (800 IU/day) has beenshown to provide a small amount of protection against methemoglobinemia and hemolysis,however, the clinical benefit of this strategy is unclear46) Which of the following has been associated with a lichenoid drug eruption?A. AcetaminophenB. SulfasalazineC. Hydrochlorothiazide Correct ChoiceD. ErythromycinE. NicotinamideLichen-planus-like (lichenoid) drug eruptions have been reported with: antimalarials, ?-blockers,captopril, gold, penicillamine, HCTZ, NSAIDs. Lichenoid drug reactions are often photodistributed 12
  13. 13. 47) Which of the following is a side effect of hydroquinone cream?A. TelangiectasiaB. PhotosensitivityC. AtrophyD. OchronosisCorrect ChoiceE. TachyphylaxisExogenous ochronosis is an uncommon complication of irreversible pigmentation due to overuse oftopical hydroquinone (1,4 dihydroxybenzene). Hydroquinone acts to by melanocyte pigmentproduction by auto-oxidation of melanin, tyrosinase and phenol oxidases.48) Which antiparasitic agent is highly flammable?A. MalathionCorrect ChoiceB. LindaneC. Precipitated sulfurD. ThiabendazoleE. PermethrinMalathion, an organophosphate cholinesterase inhibitor used to treat scabies and head lice, isflammable49) Cyclosporine forms a complex to directly interfere with activation of what calcium-dependentprotein?A. Calcineurin Correct ChoiceB. CyclophilinC. Cytochrome P-450D. CalmodulinE. NFAT-1Cyclosporine inhibits calcineurin, a phosphatase activated in the presence of calmodulin andcalcium, by cyclophilin. Cyclosporine forms a complex with cyclophilin, blocking its ability to activatecalcineurin, and thus preventing calcineurin from phosphorylating NFAT-1, a transcription factor.NFAT-1, when phosphorylated can travel to the nucleus of cells, initiate IL-2 production, andstimulate T-cell proliferation50) What is the target antigen for rituximab?A. CD4B. CD22C. CD7D. CD20Correct ChoiceE. CD8Rituximab is an anti-CD20 monoclonal antibody. CD20 is a B-cell marker and is used to treat Non-Hodgkins B-cell lymphoma. It is also approved for the treatment of rheumatoid arthritis 13
  14. 14. 51) What medications mechanism of action is via suppression of the halide-myeloperoxidasesystem?A. HydroxyureaB. MelphalanC. QuinicrineD. DapsoneCorrect ChoiceE. CyclophosphamideDapsone inhibits the neutrophil halide-myeloperoxidase system which results in an impairedrespiratory burst and subsequent tissue damage52) A 56 year-old man presents with blue-gray discoloration on his face, ears, and dorsal hands.What is the most likely offending agent?A. ClofazimineB. QuinacrineC. MinocyclineD. AmiodaroneCorrect ChoiceE. ChloroquineThe patient presents with blue-gray discoloration in sun-exposed areas. The most likely offendingagent is amiodarone. Blue-gray discoloration from minocycline usually occurs on legs. Chloroquineusually causes blue-gray discoloration in the sclerae, teeth, buccal mucosa, nail beds, and pretibialareas. Quinacrine causes yellow discoloration of skin and conjunctiva. CLofazimine usualy causes ared-brown discoloration53) Painful periungual pyogenic granulomas have been associated with what medication?A. Indinavir Correct ChoiceB. KetoconazoleC. DoxycyclineD. ValacyclovirE. TazarotenePeriungual pyogenic granulomas and painful paronychial eruptions have been reported inassociation with various anti-HIV medications including, indinavir, zidovudine, and lamivudine54) Which drug may increase levels of digoxin?A. AmoxicillinB. MinocyclineC. CephalexinD. CiprofloxacinE. ErythromycinCorrect Choice 14
  15. 15. Erythromycin inhibits the cytochrome P-450 system, which may result in increased levels of digoxin,among many other drugs55) A 10 year old child with a seizure disorder develops a morbiliform eruption and elevated LFT’stwo weeks after starting Dilantin therapy. As his physician you:A. Discontinue Dilantin and begin PhenobarbitalB. Continue Dilantin and treat rash with topical corticosteroidsC. Discontinue Dilantin and begin carbamazepineD. Restart Dilantin once the rash resolvesE. Discontinue Dilantin and begin valproic acidCorrect ChoiceAnticonvulsant hypersensitivity syndrome (also drug rash with eosinophilia and systemic symptoms(DRESS0 and dilantin hypersensitivity syndrome) presents with cutaneous eruption accompanied byfever, facial edema, lymphadenopathy, leukocytosis and hepatitis. Cross reactivity is present in allaromatic anticonvulsants including phenytoin, carbamazepine and phenobarbitol. There is no crossreaction with valprioc acid56) Potentially fatal ventricular arrhythmias can occur with concomitant use of cisapride and:A. TerbinafineB. AtorvostatinC. AstemizoleD. Erythromycin Correct ChoiceE. DigoxinCo-administration of erythromycin with the antihistamines terfenedine and astemizole or thegastrointestinal promobility agent cisapride increases the risk of torsade de pointes and iscontraindicated. These drugs are no longer available in the US57) The agent of choice used to acutely lower methemoglobin levels in patients taking dapsone is:A. CimetidineB. Vitamin EC. Oral methylene blue Correct ChoiceD. HomocysteineE. Glucose-6-phosphataseCimetidine and vitamin E have both been known to provide prophylaxis against methemoglobinformation. G6PD-deficient individuals are at greater risk of hematologic toxicity from dapsone58) The most specific marker of drug-induced lupus is:A. Anti-La AbB. ANAC. Anti-ds DNA AbD. Anti-histone Ab Correct Choice 15
  16. 16. E. Anti-Ro AbAnti-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 drug-induced lupus-like syndrome59) Which of the following is the most common adverse effect of Thalidomide therapy?A. DiarrheaB. HypertensionC. PhotosensitivityD. Skin discolorationE. SedationCorrect ChoiceThalidomide was introduced in the late 1950s as a "safe" sleeping aide. It readily penetrates theCNS, where it exerts a hyposedative effect comparable with barbiturates. By far, the most commonadverse effect from thalidomide is sedation, which in many patients may require that primarilynight-time doses be utilized60) Which of the following antiparasitic agents is an organophosphate cholinesterase inhibitor?A. IvermectinB. Precipitated sulfurC. ThiabendazoleD. LindaneE. MalathionCorrect ChoiceMalathion is an organophosphate cholinesterase inhibitor61) The treatment of choice for Wegner’s granulomatosis is:A. MethotrexateB. ChlorambucilC. Cyclophosphamide Correct ChoiceD. AzaithioprineE. Systemic glucocorticosteroidsNEEDS EXPLANATIONS62) Thryoid function tests should be checked before and during therapy with which of the followingmedications?A. AzathioprineB. Potassium iodideCorrect ChoiceC. ThalidomideD. ColchicineE. Gold 16
  17. 17. The Wolff-Chaifkoff effect, which is the inhibition of thyroid hormone synthesis from excess iodideswhich block organic iodides from binding in the thyroid, can be observed in patients on potassiumiodide therapy. In patients with normal thyroid function, autoregulatory mechanisms allow forappropriate escape from this effect. In patients with impaired autoregulatory mechanisms, theWolff-Chaikoff effect can lead to hypothyroidism63) Which of the following is a low sedation metabolite of hydroxyzine?A. FexofenadineB. CyproheptadineC. LoratadineD. CetirizineCorrect ChoiceE. RanitidineCetirizine is a second-generation H1 antihistamine that is a low sedation metabolite of hydroxyzine64) Which of the following statements is not true regarding the tetracycline antiobiotics?A. These antibiotics are effective against Mycoplasma infectionsB. Tetracycline is more phototoxic than demeclocyclineCorrect ChoiceC. Tetracyclines are contraindicated in children less than 9 years of ageD. Ingestion of zinc salts may impair absorption of tetracyclineE. Tetracycline is the most common cause of fixed drug eruptionDemeclocycline and doxycycline are the most phototoxic of all the tetracyclines65) Which of the following is not an ingredient of Castellanis paint?A. Boric AcidB. ResorcinolC. PhenolD. Ethyl acetateCorrect ChoiceE. Industrial methylated spiritCastellanis 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 localanesthetic effects. It has been used to treat inflammatory tinea cruris, leg ulcers, and acuteparonychia66) What is the difference between podophyllin and podophyllotoxin?A. Essentially the same; they are interchangable in terms of treatment and side effectsB. Podophyllin contains kaempherol which is a potent mutagensCorrect ChoiceC. Podophyllotoxin is a phosphodiesterase inhibitorD. Podophyllotoxin contains quercetin which is a potent mutagensE. Podophyllin reversibly binds tubulin inhibiting cells in metaphase 17
  18. 18. Podophyllotoxin, also known as podofilox or Condolox, is a anti-mitotic agent that reversibly bindstubulin, arresting cells in metaphase. It is used topically to treat genital warts. Podophyllin, whichhas 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 Blisterbeetle, is a phosphodiesterase inhibitior67) Which of the following agents is NOT a UVA blocker?A. DioxybenzoneB. AvobenzoneC. Red veterinary petrolatumD. Amyl p-dimethylaminobenzoateCorrect ChoiceE. DibenzoylmethaneDioxybenzone is one of the benzophenones (as in oxybenzone and sulisobenzone), which are UVAblockers. Amyl p-dimethylaminobenzoate is a UVB blocker. Dibenzoylmethane (avobenzone; Parsol1789) is a UVA/UVB blocker. Red veterinary petrolatum is a UVA blocker68) Which of the following class of medications has been associated with acquired brachialdyschromatosis?A. Anti-viralsB. HMG-CoA Reductase inhibitorsC. Non-Steroidal Anti-inflammatory medicationsD. ACE-inhibitorsCorrect ChoiceE. Protease inhibitorsAcquired brachial dyschromatosis is a condition described as asymptomatic, gray-brown patcheswith geographic borders, occasionally interspersed with hypopigmented macules, on the dorsum ofthe forearms, mostly bilaterally and seen in middle aged women. Epidermal atrophy, basal layerhyperpigmentation, elastosis and angiectases were histopathologic features. An association withCivattes poikiloderma as well as hypertension and/or antihypertensive drugs, especially ACE-inhibitors, is suggested69) What is used to reduce bladder toxicity from cyclophosphamide?A. LeukovorinB. CimetidineC. Folic acidD. Mesna Correct ChoiceE. Vitamin EMesna or sodium 2-mercptoethanesulfonate, has been used to reduce bladder toxicity fromcyclophophamide70) The medication most acceptable for usage in patients with renal failure is:A. OxytetracyclineB. Tetracycline 18
  19. 19. C. MinocyclineD. DemeclocyclineE. Doxycycline Correct ChoiceRenal failure may prolong the half-life of most tetracyclines except doxycycline. Doxycycline isexcreted via the GI tract, unlike the other tetracyclines71) Which of the following statements regarding sunscreens is true?A. Photoallergy has not been reported to benzophenonesB. Methyl anthranilate is a UVB absorberC. PABA and its derivates do not cross react with sulfonamidesD. Padimate O is a UVB absorberCorrect ChoiceE. Physical blockers absorb ultraviolet light and convert it to lower energy wavelengthsPhysical blockers reflect and scatter UV rays, whereas chemical sunscreens absorb UV light andconvert the absorbed energy into longer lower energy wavelengths. Methyl anthranilate is a UVAblocker. Padimate O, a PABA derivative, is a UVB blocker. Photoallergy has been reported withincreasing frequency to benzophenones. Allergic contact allergy can occur with PABA and itsderivatives, which can cross react with azodyes, aniline, procaine, benzocaine,paraphenylenediamine, and sulfonamides72) A patient with acute diarrhea is prescribed antibiotic treatment for his symptoms. Hesubsequently suffers from nausea and vomiting after ingesting alcohol. What is the most likelymedication he is taking?A. AzithromycinB. ClindamycinC. MetronidazoleCorrect ChoiceD. CiprofloxacinE. PenicillinThis patient is most likely taking metronidazole for acute diarrhea secondary to giardella.Metronidazole causes antabuse-like reactions with ingestion of alcohol73) What is the half-life of isotretinoin?A. 50 hoursB. 20 hoursCorrect ChoiceC. 30 daysD. 7 hoursE. 120 daysThe half-life of isotretinoin is 20 hours. The half lives of bexarotene, acitretin, etretinate are 7hours, 50 hours, 120 days respectively74) Which of the following systemic agents has been shown to be the most effective in thetreatment of toenail onychomycosis? 19
  20. 20. A. ItraconazoleB. GriseofulvinC. KetoconazoleD. TerbinafineCorrect ChoiceE. FluconazoleCraford et al. reviewed the available literature examining the efficacy of systemic anti-fungals andperformed a meta-analysis. Pooled analysis of cure rates at 11 and 12 months suggested thatterbinafine was more effective than itraconazole75) What is the recommended period for contraception after cessation of acitretin therapy in theUnited States?A. 2 yearsB. 3 monthsC. 3 years Correct ChoiceD. 1 monthE. 1 yearEtretinate has a prolonged half-life of 80-160 days. The levels may persist up to 3 years in thebody. Acitretin can be converted to etretinate in the presence of ethanol76) The SPF of a sunscreen is based on applying the sunscreen at what concentration?A. 5 mg/cm2B. 1 mg/cm2C. 2 mg/cm2Correct ChoiceD. 4 mg/cm2E. 3 mg/cm2A sunscreen SPF is based on using it at a concentration of 2 mg/cm2 which is about 1 ounce or 30grams for the entire average sized body. It also is about 3-5 grams for the head and neck77) How long after isotretinoin therapy can one safely begin trying to conceive?A. Two weeksB. One yearC. Three yearsD. ImmediatelyE. One monthCorrect ChoiceA woman should wait one month before trying to conceive after taking isotretinoin to prevent birthdefects. After taking acitretin a woman should wait three years before trying to conceive78) The following drugs have been implicated in drug-induced subacute cutaneous lupuserythematosus:A. Pravastatin 20
  21. 21. B. TerbinafineC. None of the above are correctD. VerapamilE. All the above are correctCorrect ChoiceAll of the above choices have been implicated in drug-induced subacute cutaneous lupuserythematosus79) Which one of the following sunscreens has an absorption spectrum primarily in the UVA range?A. CinnamatesB. PABA (para-aminobenzoic acid)C. Padimate OD. Octyl SalicylateE. Parsol 1789 (butyl dibenzoylmethane)Correct ChoiceAvobenzone (Parsol 1789) is primarily a UVA blocker. Photostability of avobenzone may be aproblem if it is combined with octyl methoxycinnamate. Salicylates, PABA, Padimate O, andcinnamates are primarily UVB blockers80) What is the half-life of isotretinoin?A. 50 hoursB. 100 daysC. 10 hoursD. 100 hoursE. 20 hoursCorrect ChoiceThe half-life of isotretinoin is 20 hours81) Tazarotene is what category for safety in pregnancy?A. Category X Correct ChoiceB. Category AC. Category CD. Category BE. Category DCategory X drugs include: acitretin, etretinate, estrogens, finasteride, 5-fluorouracil, flutamide,isotretinoin, methotrexate, stanozolol, thalidomide, and tazarotene82) Which antiviral agent has been associated with fatal thrombotic thrombocytopenic purpura inAIDS and transplant patients taking high doses?A. CidofovirB. PenciclovirC. ValacyclovirCorrect Choice 21
  22. 22. D. AcyclovirE. FamciclovirValacyclovir has been associated with severe and even fatal cases of thrombotic thrombocytopenicpurpura / HUS syndrome in AIDS and transplant patients taking high doses83) All of the following statements are true regarding cyclosporin A EXCEPT:A. Adverse effects include hypertrichosis and gingival hyperplasiaB. NSAIDs can potentiate renal toxicity when combined with cyclosporineC. The most common eletrolyte abnormalities are hypokalemia and hypermagnesemiaCorrect ChoiceD. Forms a complex with cyclophilin, blocking its ability to activate calcineurin, thus preventingcalcineurin from phosphorylating NFAT-1E. Metabolized by the hepatic cytochrome P-450 3A4 enzyme systemThe most common electrolyte abnormalities associated with cyclosporin A are hyperkalemia,hyperuricemia, and hypomagnesemia84) Which of the following is a true statement about infliximab?A. FDA-approved for the treatment of psoriasisB. Not effective in psoriatic arthritisC. Increases C-reactive proteinD. Chimeric monoclonal antibody against TNF-alphaCorrect ChoiceE. Indicated for mild to moderate psoriasisInfliximab (brand name Remicade) is a chimeric recombinant fusion protein composed of a humanTNF-alpha receptor with IgG1-Fc. The immunoglobulin portion is derived from a human constantregion and a murine variable region. Infliximab neutralizes both soluble and transmembrane TNF-alpha. This medication has been FDA approved for the treatment of Crohn’s disease, rheumatoidarthritis and ankylosing spondylitis85) Which of the following drugs is correctly matched to its target enzymes?A. Terbinafine-Cytochrome p450B. Acyclovir-DNA polymeraseCorrect ChoiceC. Mycophenolate Mofetil-Phospholipase A2D. Tacrolimus-Thymidine kinaseE. Methotrexate-Inosine monophosphate dehydrogenaseDrug/Specific enzyme inhibitedTacrolimus - CalcineurinMethotrexate - Dihydrofolate reductaseMycophenolate mofetil - Inosine monophosphate dyhydogenaseAcyclovir - DNA PolymeraseTerbinafine - Squalene epoxidase86) The mechanism of action of mycophenolate mofetil most closely resembles that of what otherdrug? 22
  23. 23. A. HydroxyureaB. ChlorambucilC. DoxorubicinD. Azathioprine Correct ChoiceE. CyclophosphamideBoth azaithioprine and mycophenolate mofetil directly interfere with purine synthesis87) Which biologic agent blocks T-cells from egressing the vasculature and entering the skin?A. EfalizumabCorrect ChoiceB. AlefaceptC. InfliximabD. EtanerceptE. None of the aboveEfalizumab blocks LFA-1 on T-cells from interacting with ICAM-1 on antigen presenting cells,endothelial cells, and cells in the dermis and epidermis. It thus blocks T-cells from egressing thevasculature and entering the skin88) Which of the following chemotherapeutic agents causes increased growth of eyelashes?A. MitomycinB. MethotrexateC. CytarabineD. Interleukin 2E. Interferon alphaCorrect ChoiceInterferons can cause increased growth of eyelashes. Trichomegaly has been reported aftertreatment with interferon-alpha in patients with chronic hepatitis, B-cell lymphoma, chronicgranulocytic leukemia, and cutaneous melanoma. Trichomegaly has also been reported inassociatoin with latanoprost, minoxidil, cyclosporine, phenytoin, psoralen, and penicillamine89) For which of the following medications is sedation a very common side effect that may limittreatment?A. GoldB. ColchicineC. ChlorambucilD. ThalidomideCorrect ChoiceE. Potassium iodideSedation is a very common side effect of treatment with thalidomide. It is additive with othersedatives, such as alcohol and barbiturates90) non-pigmenting fixed drug eruption is known to be caused by what agent?A. Phenopthalein 23
  24. 24. B. NaproxenC. TetracyclineD. BarbituratesE. Pseudoephedrine Correct ChoiceAll agents listed are associated with fixed drug eruptions, however, pseudoephedrine hydrochlorideis the one most commonly associated with non-pigmenting fixed drug eruptions91) The Wolff-Chaikoff effect is associated with what medication?A. Potassium iodide Correct ChoiceB. ZidovudineC. BexaroteneD. ThalidomideE. HydroxychloroquineThe Wolff-Chaikoff effect is the inhibition of thyroid hormone synthesis from excess iodides whichblock organic iodides from binding in the thyroid. In patients with normal thyroid function,autoregulatory mechanisms allow for escape from this effect. In patients with impairedautoregulatory mechanisms, the Wolff-Chaikoff effect can lead to hypothyroidism. Thyroid functionshould be evaluated and monitored with patients started on potassium iodide92) Which drug has been associated with an increased incidence of serum sickness in children?A. CefaclorCorrect ChoiceB. ClarithromycinC. CiprofloxacinD. ClindamycinE. RifampinCefaclor has been associated with an increased incidence of serum sickness in children; the otherdrugs have not93) Combination oral contraceptives decrease free testosterone levels by:A. Acting as competitive inhibitors of the androgen receptorB. Directly binding free testosteroneC. Acting as a GnRH antagonistD. Acting as a GnRH agonistE. Increasing SHBG (sex hormone binding globulin) production Correct ChoiceOral contraceptives decrease free testosterone levels by increasing the production of sex hormonebinding globulin (SHBG).94) Thalidomide is most associated with what adverse effect?A. Distal motor neuropathyB. Sensory neuropathy Correct Choice 24
  25. 25. C. Oral ulcerationD. HypothyroidismE. PhotosensitivityThe most common presentation of the neuropathy from thalidomide is a mild proximal muscleweakness with symmetric painful paresthesias of the distal extremities with accompanying lowerlimb sensory loss. Hypothyroidism is a rarely reported adverse effect.95) The mechanism of action of efalizumab in the treatment of psoriasis is:A. Inhibition of p-selectinB. Inhibition of tumor necrosis factor alphaC. Inhibition of T cell trafficking into the skin Correct ChoiceD. Inhibition of e-selectinE. Inhibition of macrophage maturationEfalizumab is a humanized monoclonal antibody directed against CD11a, a component of LFA1.Efalizumab blocks both T cell activation and trafficking of T cells to the skin. It is given once weeklyas a subcutaneous injection. It’s side effects include rare thrombocytopenia and occasional reboundof psoriasis upon its abrupt discontinuation96) All of the following retinoids are excreted in the urine EXCEPT:A. BexaroteneCorrect ChoiceB. EtretinateC. IsotretinoinD. AcitretinE. TretinoinBexarotene is excreted via hepatobiliary excretion. The others are excreted in bile and urine97) The steroid with the least minerocorticoid activity is:A. HydrocortisoneB. PrednisoneC. Methylprednisolone Correct ChoiceD. CortisoneE. PrednisoloneOf the corticosteroids listed, the steroid with the lowest mineralcorticoid activity ismethylprednisolone. Minerocorticoids act on the kidney to decrease the rate of sodium excretion(with accompanying retention of water). Triamcinolone, dexamethasone, and betamethasone alsohave low mineralcorticoid activityThe steroid with the least minerocorticoid activity is:A. HydrocortisoneB. PrednisoneC. Methylprednisolone Correct Choice 25
  26. 26. D. CortisoneE. PrednisoloneOf the corticosteroids listed, the steroid with the lowest mineralcorticoid activity ismethylprednisolone. Minerocorticoids act on the kidney to decrease the rate of sodium excretion(with accompanying retention of water). Triamcinolone, dexamethasone, and betamethasone alsohave low mineralcorticoid activity98) The most common side effect of treatment with interferon-alpha is:A. Liver toxicityB. Flu-like symptomsCorrect ChoiceC. Spastic diplegiaD. Weight lossE. NauseaThe 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-inflammatorymedications may alleviate some of these symptoms99) Which of the following medications is most likely to interefere with the efficacy of oralcontraceptives?A. RifampinCorrect ChoiceB. DoxycyclineC. TetracyclineD. AmoxicillinE. Trimethoprim-sulfamethaxasoleRifampin has been shown to decrease the efficacy of oral contraceptives. It is an inducer ofcytochrome p450 which increases the metabolism of hormones thereby decreasing the efficacy oforal contraceptives. There is no clear decrease in oral contraceptive efficacy with concomitant use ofampicillin, ciprofloxacin, clarithromycin, doxycyline, metronidzole, ofloxacin, or tetracycline100) Which chemical sunscreen has UVB and UVA II absorption capability?A. Titanium dioxideB. Oxybenzone Correct ChoiceC. Methyl anthranilateD. Padimate OE. Octyl salicylateThe benzophenones, oxybenzone and dioxybenzone, have the broadest absorption spectrum of thechemical sunscreens, with UVB and UVA II range. Methyl anthranilate, octyl salicylate, andpadimate O are UVB-absorbing chemicals. Titanium dioxide is not a chemical absorber, it is aphysical blocker101) Alternate-day administration of oral steroids can reduce all of the following side effectsexcept? 26
  27. 27. A. Growth impairmentB. Cataracts Correct ChoiceC. HPA axis suppressionD. Peptic ulcer diseaseE. Opportunisitic infectionAlternate-day corticosteroid dosing regimens does not decrease the risks of posterior subcapsularcataracts, osteoporosis, and possibly osteonecrosis102) Which of the following medications can lead to hematologic toxicity when combined withmethotrexate?A. DapsoneB. None of these answers are correctC. SulfonamidesD. All of these answers are correctCorrect ChoiceE. TrimethoprimAll of the above inhibit the folic acid metabolic pathway, and can lead to hematologic toxicity whencombined with methotrexate103) Terbinafine exerts its antifungal activity by what manner?A. Interference with cell respiratory processesB. Inhibition of 14-a demethylaseC. Inhibition of epoxide hydroxylaseD. Inhibition of squalene epoxidase Correct ChoiceE. Direct binding to membrane sterols, increasing permeabilityTerbinafine, an allylamine, interferes with ergosterol synthesis by inhibiting squalene epoxidase. Theazoles 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 insteadinterferes with cell respiratory processes104) What antifungal is known to cause gynecomastia and impotence?A. Ketoconazole Correct ChoiceB. TerbinafineC. GriseofulvinD. ItraconazoleE. FluconazoleKetoconazole is known to cause gynecomastia and impotence, by interfering with androgen andglucocorticoid synthesis105) All of the following agents exert their function in a cell-cycle specific manner except:A. Hydroxyurea 27
  28. 28. B. MethotrexateC. AzathioprineD. Cyclophosphamide Correct ChoiceE. 5-fluorouracilCyclophosphamide is a cell-cycle nonspecific agent, which produces DNA cross-linkages at any pointin the cell cycle. Methotrexate, azaithioprine, and hydroxyurea are S-phase specific cytotoxicagents. 5-fluorouracil is a cell-cycle specific pyrimidine antagonist106) The t 1/2 of isotretinoin is:A. 7 hoursB. 2 daysC. 1 hourD. 120 daysE. 20 hours Correct ChoiceThe t 1/2 of isotretinoin is 20 hours. The other answers list the t 1/2 times of various retinoids107) All of the following topical antioxidants have demonstrated cutaneous anticarcinogenic effectsin mice except:A. ZincCorrect ChoiceB. SilymarinC. Vitamin ED. Vitamin CE. Tea polyphenoisAnti-oxidants are thought to be protective against photoinjury by neutralizing oxygen radicals.Vitamin C, Vitamin E, tea polyphenois, and silymarin are all anti-oxidants108) A 15 year old boy presents with a 4 month history of pigmented bands on several fingernailsand toenails. The most like etiology is:A. Nevomelanocytic neviB. Peutz-Jeghers syndromeC. Acral lentiginous melanomaD. Chloroquine therapyE. Minocycline therapy Correct ChoiceMelanonychia occurring simultaneously on several nails is most likely to be due to minocyclinetherapy. Blue-black pigmentation may be present in nails, skin, scars and sclerae109) What is the treatment of choice for methemoglobinemia?A. ObservationB. Aspirin 28
  29. 29. C. Methylene blueCorrect ChoiceD. IronE. HydrationMethylene blue is redued in the presnce of NADPH and diaphorase II to leukomethylene blue, whichthen reduces methemoglobin (Fe3+) to hemoglobin (Fe2+)110) Which biologic agent is infused intravenously?A. EtanerceptB. AlefaceptC. InfliximabCorrect ChoiceD. EfalizumabE. None of these answers are correctInfliximab is infused intravenously111) Which medication is the most likely cause of this drug eruption?A. Sulfur based medicationsB. Nonsteroidal anti-inflammatory medicationsC. MethotrexateD. Beta-lactam antibioticsCorrect ChoiceE. Calcium channel blockersAcute generalized exanthematous pustulosis (AGEP)is characterized by small pustules onerythematous base with evenutal desqumation. As opposed to most drug reactions, AGEP mayoccur within one week, 50% occur within the first 24 of exposure112) The mechanism action of this cytotoxic agent is via inhibition of IMP dehydrogenase.A. Mycophenolate mofetilCorrect ChoiceB. AzathioprineC. HydroxyureaD. MethotrexateE. 5-fluorouracilMycophenolate mofetil (cellcept), a purine analog, blocks de novo purine synthesis by inhibiting theenzyme inosine monophosphate dehydrogenase113) All of the following are reported cutaneous side effects of zidovudine EXCEPT:A. TrichomegalyB. Periungual pyogenic granulomasC. Diffuse and oral hyperpigmented maculesD. None of the above (all are reported side effects)Correct Choice 29
  30. 30. E. Hyperpigmented streaks in nailsAll of the following are cutaneous side effects reported with zidovudine, a nucleoside HIV reversetranscriptase inhibitor. Periungal/paronychial eruptions resulting in pyogenic granuloma-like lesionshave also been reported with other HIV medications, including indinavir and lamivudine114) Which of the following biologic therapies is pregnancy category C?A. InfliximabB. AlefaceptC. EtanerceptD. EfalizumabCorrect ChoiceE. AdalimumabAll of the above drugs are pregnancy category B except efalizumab which is category C115) Which of the following may cause an acneiform eruption?A. ACTH Correct ChoiceB. FluoxetineC. FinasterideD. Valproic acidE. MethotrexateMany medications are associated with acneiform eruptions, including halogens (bromide andiodide), androgenic hormones such as testosterone, ACTH, corticosteroids, isoniazid (INH), lithium,phenytoin, and vitamins B2, B6 and B12116) Which cell type is increased by glucocorticoids?A. Neutrophils Correct ChoiceB. MonocytesC. T-cellsD. EosinophilsE. B-cellsGlucocorticoids alter the balance of circulating leukocytes, causing an increase in the number ofpolymorphonuclear leukocytes and diminishing the numbers of lymphocytes, eosinophils, andmonocytes117) Over use of of which medication may lead to this clinical image?A. Topical antibioticB. Topical steroidC. CalcipotrieneD. ImiquimodE. HydroquinoneCorrect Choice 30
  31. 31. Exogenous ochronosis has been reported with prolonged use of high concentration hydroquinone.On pathology, a characteristic ochre colored deposit is noted between the collagen bundles118) Which of the following events is most important in the pathogenesis of this painful eruption?A. Increased expression of FasLCorrect ChoiceB. Reduction in circulating IL-6C. Cleavage of desmoglein 1D. Reduction in circulating tumor necrosis factorE. Overexpression of keratins 6 and 16Toxic epidermal necrolysis is a life threatening drug eruption characterized by widespread epidermalnecrosis. The exact etiology of the keratinocyte necrosis has not been fully elucidated. However,FasL (FasL and Fas are able to trigger apoptosis) has been shown to be upregulated in TEN119) Which antiparasitic agent acts by inhibiting fumarate reductase?A. CidofovirB. ThiabendazoleCorrect ChoiceC. IvermectinD. PermethrinE. LindaneThiabendazole inhibits fumarate reductase, a helminth-specific enzyme. It is used to treat creepingeruption or cutaneous larva migrans and larva currens. Ivermectin blocks glutamate-gated chlorideion channels, and is used to treat strongyloidiasis, onchocerciasis, and Norwegian scabies. Lindaneis 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 membraneof the parasite. Cidofovir is an antiviral nucleotide analogue120) Which chemotherapeutic agent has been reported to cause acral sclerosis with Raynaudsphenomenon?A. BleomycinCorrect ChoiceB. MethotrexateC. InterferonD. ActinomycinE. 5-FluorouracilBleomycin is an antibiotic that induces single strand breaks in the DNA. Reactions to bleomycininclude flagellae hyperpigmentation, acral sclerosis with Reynauds, penile calcification, and amorbilliform eruption121) Which of the following medications is most likely to have caused this reaction?A. LithiumB. DiclofenacC. Vancomycin 31
  32. 32. D. Pseudoephedrine hydrochlorideCorrect ChoiceE. ACE inhibitorFixed drug eruptions occur 30 mintues to 8 hours after ingestion of offending agent. Afterrechallenge with the same agent, the fixed drug eruption will recur. Potential causes of a fixed drugeruption include analgesics, sulfonamides, barbituates, pseudoephedrine and anticonvulsants122) Which of the following chemotherapeutic agents has been linked to acneiform eruptions?A. CetuximabCorrect ChoiceB. DoxorubicinC. CytarabineD. BleomycinE. CisplatinCetuximab is a chimeric anti-epidermal growth factor receptor antibody that is FDA approved totreat advanced colorectal cancer. Acneiform eruptions have been reported to occur in up to 1/3 ofpatients123) What family of medications is associated with xerosis?A. SulfonylureasB. Cholesterol lowering agentsCorrect ChoiceC. Beta blockersD. Loop diureticsE. Calcium channel blockersMedications that alter the lipid composition of the epidermis and stratum corneum may impair thenormal barrier function of the skin. Cholesterol lowering medications like HMG-CoA reductaseinhibitors and niacin may cause xerosis through this mechanism124) Which of the following are retinoid side effects?A. Reversible hyperthyroidismB. Delayed epiphyseal closureC. Diffuse interstitial skeletal hypo-ostosisD. All of these answers are corectE. Pseudotumor cerebriCorrect ChoiceBexarotene has been shown to cause reversible hypothyroidism, not hyperthyroidism. Systemicretinoids have been shown to cause diffuse interstitial skeletal hyperostosis, premature epiphysealclosure, and pseudotumor cerebri (risk increased with concommitant use of tetracyclines125) Which of the following is a potentially irreversible ocular side effects of antimalarial agents?A. PterygiumB. RetinopathyCorrect ChoiceC. Cataracts 32
  33. 33. D. Neuromuscular eye toxicityE. Corneal deposition - causing halos, blurred vision, photophobiaThree types of ocular adverse effects may develop from antimalarials: corneal deposits,neuromuscular eye toxicity and retinopathy. Only retinopathy is potentially irreversible. It isrecommended that a patient be evaluated for retinopathy at baseline, then every 6 months by anophthamologist. Testing visual acuity, visual fields and performing a funduscopic examination areconsidered acceptable for screening purposes126) Clinical evidence of hypothyroidism can be induced by which drug?A. IsotretinoinB. GoldC. Bexarotene Correct ChoiceD. GriseofulvinE. AcitretinBexarotene can cause reversible elevations in TSH levels and reductions in total T4 levels,associated with mild symptoms of hypothyroidism127) Which of the following agents is NOT a UVB blocker?A. SulisobenzoneCorrect ChoiceB. Padimate AC. PABAD. SalicylatesE. CinnamatesSulisobenzone is a benzophenone, a UVA blocker. The others are UVB blockers. Padimate A is aPABA derivative128) Which of the following drugs has been known to cause penile erosions?A. PenciclovirB. AbacavirC. CidofovirD. GancyclovirE. FoscarnetCorrect ChoiceFoscarnet has been reported to cause penile erosions129) Peak vulnerability to thalidomide occurs between which days of gestation?A. Days 15-20B. Days 37-56C. Days 21-36Correct ChoiceD. Days 57-70 33
  34. 34. E. Days 1-14Peak vulnerability to thalidomide occurs between days 21 to 36 of gestation, during which only asingle dose will cause birth defects to occur. Birth defects associated with thalidomide includephocomelia (underdevelopment of arms and legs, the most common birth defect), earmalformation, and gastrointestinal and urogenital defects130) Extension of this blister by application of perpendicular pressure is an example of what?A. Gorlins signB. Hutchinsons signC. Nikolsky signD. Fitzpatrick signE. Asboe-Hansens signCorrect ChoiceToxic epidermal necrolysis is a serious and potentially life threatening reaction to medications. Themost commonly implicated medications include penicillins, NSAIDS, and anti-convulsants. Asboe-Hansens sign results in extension of a blister with perpendicular pressure. Nikolsky sign is theseparation of epidermis from the dermis by application of tangential mechanical pressure131) Which of the following side effects has not been reported in association with intravenousimmune globulin?A. HypotensionB. HeadacheC. Stevens-Johnson syndromeCorrect ChoiceD. AnaphylaxisE. FlushingIVIG is used to treat several diseases including graft versus host disease, connective tissue disease,and autoimmune bullous dermatoses. Adverse effects include infusion reactions (headache,flushing, chills, myalgia, wheezing, achycardia, lower back pain, nausea, or hypotension).Anaphylaxis occurs rarely. Disseminated intravascular coagulation, transient neutropenia, andaseptic meningitis syndrome has been reported. Cutaneous adverse effects include eczematouseruptions and alopecia132) The form of erythromycin most likely to cause jaundice is:A. EstolateCorrect ChoiceB. GluceptateC. LactobionateD. EthylsuccinateE. StearateThe form of erythromycin that most likely causes jaundice is estolate133) Which of the following is known to induce lichen planus-like eruptions?A. DoxepinB. Minocycline 34
  35. 35. C. MercuryD. Gold Correct ChoiceE. DapsoneMucocutaneous side effects of gold include stomatitis, cheilitis, lichen planus- like eruptions, andpityriasis rosea-like eruptions134) Which of the following medications is most likely to result in increased carbamazepine levels?A. RifampinB. MinocyclineC. Erythromycin Correct ChoiceD. AzithromycinE. TMP-SMXEythromycin inhibits the hepatic cytochrome P450 system and can increase serum levels andpotential toxicities of carbamazapene, theophylline, warfarin, digoxin, methylprednisolone135) Which of the following statements regarding drug interactions is true?A. Tobacco induces P-450 enzymesB. All of the above are trueCorrect ChoiceC. Drugs that induce CYP3A enzymes may decrease levels of drugs which act as substrates forCYP3AD. CYP3A inhibitors may increase levels and cause toxicity of drugs metabolized by cytochromeP-450E. Terbinafine is not metabolized by cytochrome P-450The most relevant drug interactions in dermatology involve the hepatic biotransformation pathwayscatalyzed by the cytochrome P-450 isoenzymes from the subfamilies CYP3A3/4. Drugs that induceCYP3A enzymes may decrease levels of drugs which act as substrates for CYP3A. CYP3A inhibitorsmay increase levels and cause toxicity of drugs metabolized by cytochrome P-450. Terbinafine isnot metabolized by cytochrome P-450, but by cytochrome 2B6 instead. Tobacco induces P-450enzymes136) The anti-viral agent used most often for acyclovir-resistent HSV and VZV infections is:A. PencyclovirB. ValacyclovirC. Foscarnet Correct ChoiceD. FamcyclovirE. GancyclovirFoscarnet does not require phosphorylaton for antiviral activity. Thereofre, it is achieve againstviruses resistant to acyclovir, famcyclovir, or gancyclovir on the basis of altered-kinase activities137) What tetracycline is not phototoxic?A. Doxycycline 35
  36. 36. B. TetracyclineC. Minocycline Correct ChoiceD. DemeclocyclineE. OxytetracyclineMinocycline is not phototoxic. Demeclocycline and doxycycline are the most phototoxic of all thetetracyclines. Onycholysis can accompany tetracycline-induced phototoxicity138) Anemia, leg ulcers, poikilodermatous skin changes, hepatitis, renal toxicity, and acralerythema are most commonly associated with what medication?A. 5-fluorouracilB. DoxorubicinC. MethotrexateD. Hydroxyurea Correct ChoiceE. CyclosporineThe constellation of adverse effects is most closely associated with hydroxyurea139) What drug can potentiate bone marrow suppression when used concomitantly withazathioprine?A. SalicylatesB. NSAIDSC. SulfonamidesD. Allopurinol Correct ChoiceE. PhenytoinConcomitant allopurinol use, which inhibits xanthine oxidase, can lead to excess toxic purineanalogs via increased metabolism of azaithioprine via the HGPRT pathway, causing bone marrowsuppression140) What is the mechanism utilized by the co-administration of probenicid to raise blood levels ofpenicillins in patients with infections that require high blood levels?A. Synergistic effect of probenicid with penicillinsB. Displacement of plasma proteinsC. Competitive inhibition of b-lactam binding sitesD. Inhibition of cytochrome P-450 hepatic biotransformation systemE. Prolongs the half-life of penicillins by decreasing renal tubular secretion Correct ChoiceProbenicid is co-administered with penicillin to prolong its half-life through decreased renal tubularsecretion when higher blood levels are warranted141) Which of the following statements regarding the ocular toxicities of the antimalarial drugs isNOT true?A. Chloroquine and hydroxychloroquine should not be given together because of an additive effect on 36
  37. 37. retinotoxicityB. True retinopathy is associated with "bulls eye" pigment deposition, central scotoma, anddiminished visual acuityC. Premaculopathy associated with changes in visual fields without visual loss is reversible if theantimalarial is discontinuedD. The 4-aminoquinolones may have significant associated ocular toxicityE. Risk of retinopathy is greatest for quinacrine, followed by chloroquineCorrect ChoiceRisk of retinopathy is greatest with chloroquine and does not exist for quinacrine142) Which of the following statements regarding podophyllin is NOT correct?A. It arrests cells in telophaseCorrect ChoiceB. It is derived from the May apple plantC. It binds tubulinD. None (all of these statements are true)E. It is contraindicated in pregnancyPodophyllin is a crude cytotoxic extract from the May apple plant. It is antimitotic, arresting cells inmetaphase (not telophase) by binding to the protein tubulin. It may be teratogenic and should notbe used in pregnancy143) Which cutaneous side effect is a common complication of nitrogen mustard therapy?A. TelangiectasiaB. Allergic contact dermatitisCorrect ChoiceC. HyperpigmentationD. Bullous drug eruptionE. Fixed drug eruptionTopical nitrogen mustard, or mechlorethamine, is an antineoplastic agent which works via alkylationthereby inhibiting DNA synthesis. Allergic contact dermatitis occurs in two-thirds of patients who aretreated with topical nitrogen mustard in aqueous solution, but occurs in less than 5% of patientstreated with the ointment based preparation144) Cefaclor has been associated with increased incidence of what in children?A. TransaminitisB. AnaphylaxisC. Generalized tonic-clonic seizuresD. Mononucleosis-like syndromeE. Serum sickness reaction Correct ChoiceThe use of cefaclor has been associated with an increased incidence of serum sickness in children145) Which of the following oral agents has been effective in the treatment of Norwegian scabies?A. Metroniddazole 37
  38. 38. B. IvermectinCorrect ChoiceC. GriseofulvinD. MebendazoleE. ThiabendazoleIvermectin (Stromectol) is an anti-helminthic agent currently FDA-approved for the treatment ofstrongyloides and onchocerciasis. Several publications have reported efficacy of this agent in thetreatment of scabies and head lice. Due to its low rate of adverse effects, its high rate ofeffectiveness, and its ease of administration, some authors consider this agent to be the treatmentof choice for scabies and head lice. The mechanism of action of ivermectin is blockade of glutamate-gated, chloride ion channels, with adverse effects on nerve and muscle resulting in paralysis anddeath of the helminth or mite. The drug has a very low affinity for mammalian chloride channelsresulting in its relatively low toxicity. Adverse effects are rare and have been associated withaccidental intoxication. It should be avoided when there is compromise of the blood-brain-barrier.Ivermectin is pregnancy category C. There are virtually no associated drug interactions with oralivermectin therapy146) Of the medications listed below, the safest to use during pregnancy is:A. NSAIDSB. EstrogensC. Erythromycin estolateD. DoxycyclineE. Penicillin Correct ChoiceErythromycin estolate is contraindicated in pregnancy because of the risk of cholestatic hepatitis.Other forms of erythromycin are safer for use in pregnancy. Tetracyclines are category D andestrogens are category X. NSAIDS may promote persistent fetal circulation or oligohydramnios147) Which of the following antifungal agents is contraindicated in patients with a history ofporphyria?A. KetoconazoleB. TerfinafineC. ItraconazoleD. GriseofulvinCorrect ChoiceE. FluconazoleGriseofulvin has been reported as a potential exacerbator of acute intermittent porphyria, and thusis contraindicated in patients with a history of porphyria148) Which of the following statements regarding dapsone and sulfapyridine is true?A. Sulfapyridine has a similar but often more severe side effect profile than dapsoneB. Dapsone hypersenstivity syndrome is characterized by lymphocytosisC. They exert their anti-inflammatory actions by stimulating the myeloperoxidase activity ofpolymorphonuclear leukocytesD. None of these answers are correct (all are false)Correct ChoiceE. Concomittant administration of cimetidine has been shown to increase the risk of 38
  39. 39. methemoglobinemiaNone of the above statements are true. Dapsone and sulfapyridine exert their anti-inflammatoryactions by inhibiting the myeloperoxidase activity and chemotactic abilities of polymorphonuclearleukocytes. Dapsone hypersenstivity syndrome is characterized by eosinophilia, as well as a severemononucleosis-like reaction, including fever, erythroderma, hepatitis, and even death. Sulfapyridinehas a similar but often less severe side effect profile. Cimetidine has been shown to provide someprotection against methemoglobin formation149) Which of the following statements is true regarding the absorption of antibiotics?A. Tetracycline absorption is impaired by the ingestion of calcium products but not ironB. Doxycycline absorption is impaired by the ingestion of dairy products and calciumC. None of the above (all of the above statements are false)Correct ChoiceD. Minocycline absorption is not significantly impaired by the ingestion of calcium products but itshould be taken on an empty stomachE. Fluoroquinolone absorption is not altered by antacidsAntacids decrease the absorption of fluoroquinolones and should be taken at least 2 hours after thedrug. Tetracycline absorption is impaired by the ingestion of dairy products, calcium, and iron orzinc salts. Minocycline and doxycycline absorption is not impaired by the ingestion of thoseproducts; they may be taken on an empty stomach or with food. Thus, all of the statements arefalse150) Treatment with isotretinoin has been shown to cause increased colonization of the skin withwhich of the following organisms?A. Pseudomonas aeruginosaB. Staphylococcus aureusCorrect ChoiceC. Demodex folliculorumD. Pityrosporum orbiculareE. Streptococcus pyogenesStaphylococcus aureus colonization tends to correlate with isotretinoin-induced reduction in sebumproduction and may lead to infections. This complication may possibly be prevented with pulsedintranasal mupirocen therapy. There has been a report of staphylococcus endocarditis in a patientwith underlying aortic insufficiency151) This retinoid targets RXR receptors:A. EtretinateB. IsotretinoinC. TretinoinD. AcitretinE. BexaroteneCorrect ChoiceBexarotene targets RXR receptors. It is used in the treatment of mycosis fungoides refractory toconventional therapy. Side effects include central hypothyroidism and hyperlipidemia. These shouldbe treated with synthroid, lipitor, and fenofibrate152) Neutrophilic eccrine hidradenitis is a side effect of which therapeutic agent? 39
  40. 40. A. Interferon-alphaB. Granulocyte colony stimulating factorC. Cytarabine Correct ChoiceD. BieomycinE. Intravenous immune globulinNeutrophilic eccrine hidradenitis most commonly occurs in the setting of a patient with acutemyelogenous leukemia being treated with cytarabine. Clinical manifestations include tender,erythematous macules, papuls and plaques on the trunk, neck and extremities which resolve withina few days. Histologically, this drug eruption is defined by the presence of dense neutrophilicinfiltrate within and around eccrine glands, with necrosis of eccrine epithelial cells153) Gray-green discoloration of the mid-portion of permanent teeth is a side effect of?A. DoxycyclineB. FluoroquinolonesC. Minocycline Correct ChoiceD. TetracyclineE. clindamycinIn contrast to tetracycline staining of the teeth, which occurs in childhood and produces a browndiscoloration along the gingival third, minocycline stains the permanent teeth in adults, with a gray-green discoloration of the mid-portion of the tooth154) Side effects of PUVA include all of the following except:A. HeadacheB. NauseaC. PruritusD. NeutropeniaCorrect ChoiceE. InsomniaSide effects of psoralen with ultraviolet A light (PUVA) include side effects which are due tophototoxic effects including pruritus, photoonycholysis, friction blisters, ankle edema andhypertrichosis. In addition, there are adverse effects from methoxypsoralen includinggastrointestinal and neurologic effects, hepatotoxicity and exanthems. Neutropenia is not adescribed side effect of PUVA155) A patient taking daily prednisone is advised to switch to alternate day dosing to decrease therisk of:A. Adrenal crisisCorrect ChoiceB. GlaucomaC. Aseptic bone necrosisD. CataractsE. OsteoporosisLong-term therapy with oral corticosteroids can result in numerous adverse effects, includingelevated risks of glaucoma, cataracts, hypertension, diabetes, osteoporosis, adrenal axis 40
  41. 41. suppression, and aseptic bone necrosis. Alternate-day dosing or oral corticosteroids lowers the rateof adrenal axis suppression. It is hypothesized that during the off day, cell mediated immunity,white blood cells subset levels, and potassium excretion are normalized while the anti-inflammatorybenefits of the drug persist. Alternate-day corticosteroid therapy should be employed once adequatedisease control has been attained with daily dosing. Of note, the risk of cataracts, osteoporosis, andother adverse effects of long-term corticosteroid use are not minimized with alternate-day dosing156) Penile erosions are a reported side effect associated with which medication?A. Trimethoprim-sulfamethoxazoleB. AzaithioprineC. BleomycinD. AcyclovirE. Foscarnet Correct ChoiceNone157) Which of the following biologic agents is pregnancy category C?A. All of these answers are correctB. EtanerceptC. AlefaceptD. InfliximabE. EfalizumabCorrect ChoiceEfalizumab is pregnancy category C. The other drugs listed are pregnancy category B158) Which of the following is NOT known to increase methotrexate levels?A. None of these answers are correct(all are known to increase methotrexate levels)Correct ChoiceB. TetracyclinesC. SalicylatesD. NSAIDsE. PhenothiazinesTetracyclines, phenytoin, phenothiazines, chloramphenicol, NSAIDs, salicylates, and sulfonamides,among other drugs, can all increase methotrexate levels by displacement of plasma proteins159) What is the best medication to lower isotretinoin induced hypertriglyceridemia?A. CholestyramineB. GemfibrozilCorrect ChoiceC. All are equally effectiveD. SimvastatinE. NiacinGemfibrozil generally reduces trygliceride levels to a greater extent than niacin, cholestyramine,and the HMG-CoA reductase inhibitors 41
  42. 42. 160) Keratinocyte differentiation is enhanced by retinoids with all of the following EXCEPT:A. Increased keratohyalin granulesB. Increased filaggrin productionC. Stimulation of ornithine decarboxylaseCorrect ChoiceD. Odland body secretion of lipidsE. Increased keratin filamentsKeratinocyte differentiation is enhanced by retinoids with increased filaggrin production, increasedkeratohyalin granules, keratin filaments, and Odland body secretion of lipids. Retinoids directlyinhibit ornithine decarboxylase and therefore lessen inflammatory hyperplasia161) Which member of the tetracycline family is most likely to have caused this photomediatedreaction?A. DoxycyclineB. OxytetracyclineC. MinocyclineD. DemeclocyclineCorrect ChoiceE. TetracyclineThe tetracycline family of antibiotics are bacteriostatic and act by inhibiting protein synthesis. Eachmember of the family may cause photosensitivity, but demeclocycline is the most photosensitizing162) The treatment of choice for erythema nodosum leprosum (ENL) is:A. Rifampin and clofazamineB. ClofazamineC. RifampinD. Thalidomide Correct ChoiceE. Isoniazid, rifampin and clofazamineNEEDS EXPLANATIONS163) The laboratory abnormality most associated with cyclosporine is:A. Hyperkalemia Correct ChoiceB. HypermagnesemiaC. HypouricemiaD. Increased LDHE. HyponatremiaThe laboratory abnormalities associated with cyclosporine are decreased magnesium, increasedpotassium, and increased uric acid. Renal function and blood pressure must also be monitoredclosely in patients using cyclosporine 42
  43. 43. 164) Concomitant use of methotrexate and what other drug is contraindicated because of thepotential increased risk of pancytopenia?A. TetracyclineB. NSAIDs Correct ChoiceC. Systemic retinoidsD. Folic acidE. AcetaminophenDrugs that simultaneously inhibit the folate metabolic pathway, such as NSAIDS, dapsone, ortrimethoprim-sulfamethoxazole, can increase hematologic toxicity when combined withmethotrexate165) What is the treatment of choice for CMV retinitis?A. GanciclovirB. CombovirC. FoscarnetCorrect ChoiceD. CidofovirE. AcyclovirFoscarnet is indicated for the treatment of CMV retinitis and acyclovir resistant HSV, both of whichcan been seen in HIV patients. Foscarnet acts by inhibiting viral specific DNA polymerase. Unlikeacyclovir, it does not require activation by thymidine kinase. Nephrotoxicity and seizures are majorside effects166) What is the most common cause of nonpigmented fixed drug eruption?A. TetracyclineB. SulfonamidesC. NaproxenD. PhenolphthaleinE. PseudoephedrineCorrect ChoicePigmented incontinence is usually prominent in a fixed drug eruption; yet occasionally, fixed drugreactions do not result in long-lasting hyperpigmentation. The so-called nonpigmented fixed drugeruption is distictive. Pseudoephedrine hydrochloride is by far the most common cause167) Which drug is the most likely to cause these changes in the gingiva?A. DoxycyclineB. AcitretinC. MethotrexateD. CyclosporineCorrect ChoiceE. CephalexinGingival hyperplasia is a well described reaction to multiple medications including cyclosporine,phenytoin, and calcium channel blockers. All of these medications affect the influx of calcium intothe cells which enhances the function of fibroblasts 43
  44. 44. 168) The anti-CD 20 antibody rituximab is FDA-approved for treatment of which of the following?A. Paraneoplastic pemphigusB. Mycosis fungoidsC. Non-Hodgkin’s lymphomaCorrect ChoiceD. PsoriasisE. Metastatic melanomaRituximab (brand name Rituxan) is a monoclonal antibody is approved for the treatment of CD20non-Hodgkin’s lymphoma. Rituximab is a monoclonal antibody directed against B lymphocyteswhich are CD20.169) The combination of doxorubicin and which medications has been reported to cause stickyskin?A. AmphotercinB. G-CSFC. VancomycinD. CisplatinE. KetoconazoleCorrect ChoicePolsen et. al. reported a 29% incidence of sticky skin in patients treated with high doseketoconazole and doxorubicin for prostate cancer. Other medications reported to cause this includeetretinate and tretinoin.Polsen JA, Cohen PR, Sella: Acquired cutaneous adherence in patients with androgen-independentprostate cancer receiving ketoconazole and doxorubicin: medication-induced sticky skin. J Am AcadDermatol: 32 (4):571-5 1995170) Which of the following cytotoxic agents has been associated with poikiloderma of the dorsalhands with a band-like distribution of the fingers and toes?A. Intralesional bleomycinB. HydroxyureaCorrect ChoiceC. AzathioprineD. DoxorubicinE. FlurouracilHydroxyurea has been associated with poikiloderma of the dorsal hands with a band-like distributionof the fingers and toes. It has also been associated with diffuse hyperpigmentation, and with legulcers upon withdrawal171) If a patient develops a dilantin hypersensitivity reaction, which anticonvulsant is the betteralternative therapy?A. PhenobarbitalB. None of these answers are correct 44
  45. 45. C. Valproic acid Correct ChoiceD. PhenytoinE. CarbamezapineCarbamezapine, phenytoin, and phenobarbital are known to cross-react with one another172) Hemorrhagic cystitis is a risk of what chemotherapy?A. ChlorambucilB. HydroxyureaC. Vinca alkaloidsD. Cyclophosphamide Correct ChoiceE. AzaithioprineBladder toxicity is due to the acrolein metabolite of cyclophosphamide. Hemorrhagic cystitis isassociated with the increased risk of transitional cell carcinoma of the bladder. Mesna has been usedto reduce the toxic effect. The risk of cystitis is avoided by adequate fluid intake, frequent voiding,and careful screening for hematuria173) All of the following are true regarding water-soluble retinoids EXCEPT:A. They include bexaroteneB. They include etretinateCorrect ChoiceC. They include isotretinoinD. They are undetectable in the serum after 1 month of stopping therapyE. They have very little lipid depositionIsotretinoin, acitretin, and bexarotene are water-soluble, with very little lipid deposition. Etretinateis 50 times more lipophilic than acitretin, with increased storage in adipose tissueThe anti-HIV medication best known for causing a severe reaction which can result in fatality uponrechallenge is:A. ZidovudineB. IndinavirC. NevirapineD. Abacavir Correct ChoiceE. DidanosineThe hypersensivity reaction associated with abacavir usually resolves with cessation of the drug,however upon rechallenge the reaction can be life-threatening 45

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