63
Dermatological drugs 1) Which of the following antiviral agents is NOT phosphorylated by viral thymidine kinase? A. Valacyclovir B. Gancyclovir C. CidofovirCorrect Choice D. Famciclovir E. Acyclovir Cidofovir is a nucleotide analogue antiviral agent. It does not require phosphorylation by virus, but is converted by host cell kinases to a diphosphate 2) Which biologic agent is administered intramuscularly? A. Infliximab B. Efalizumab C. Etanercept D. AlefaceptCorrect Choice E. None of the above Alefacept is given intramuscularly 3) In addition to minocycline, which of the following drugs has been associated with drug-induced lupus erythematosus-like syndrome? A. Rifampin B. Hydralazine Correct Choice C. Itraconazole D. Amiodarone E. Doxycycline Drugs associated with drug-induced SLE include minocycline, hydralazine, procainamide, isonaizid, penicillamine, and anti-convulsants 1

ETAS_MCQ_16 dermatological drugs

  • Upload
    derma202

  • View
    2.821

  • Download
    11

Embed Size (px)

Citation preview

Page 1: ETAS_MCQ_16 dermatological drugs

Dermatological drugs1) Which of the following antiviral agents is NOT phosphorylated by viral thymidine kinase?

A. Valacyclovir

B. Gancyclovir

C. CidofovirCorrect Choice

D. Famciclovir

E. Acyclovir

Cidofovir is a nucleotide analogue antiviral agent. It does not require phosphorylation by virus, but is converted by host cell kinases to a diphosphate

2) Which biologic agent is administered intramuscularly?

A. Infliximab

B. Efalizumab

C. Etanercept

D. AlefaceptCorrect Choice

E. None of the above

Alefacept is given intramuscularly

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

A. Rifampin

B. Hydralazine Correct Choice

C. Itraconazole

D. Amiodarone

E. Doxycycline

Drugs associated with drug-induced SLE include minocycline, hydralazine, procainamide, isonaizid, penicillamine, and anti-convulsants

4) One of the main concerns for prescribing azathioprine to a gout patient with a normal level of thiopurine methyltransferase on chronic allopurinol is:

1

Page 2: ETAS_MCQ_16 dermatological drugs

A. Patient may develp photosensitivity

B. Azathioprine does not work

C. Allopurinol does not work

D. Patient may become pancytopenicCorrect Choice

E. No concerns

Allopurinol inhibits xanthine oxidase, an enzyme that catabolizes azathioprine. In patients concurrently taking bothe medications, the allopurinol shunts more 6-MP from the xanthine oxidase catabolic pathway to the hypoxanthine-guanine phosphoribosyltransferase(HGPRT)anabolic pathway, creating an excess of purine analogs. This in turn may lead to to excessive immunosuppression and risk of pancytopenia

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 likely culprit?

A. LaxativeCorrect Choice

B. Hydrochlorthiazide

C. Lisinopril

D. Aspirin

E. Glyburide

Phenopthalein, found in laxatives, is a known cause of fixed drug eruptions

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

A. HSV infection

B. EBV infection

C. HPV infection

D. CMV infectionCorrect Choice

E. HIV infection

Fomiversen (Vitraene) represents a new class of therapeutic agents known as antisense drugs. It is indicated for the treatment of CMV retinitis in patients with AIDS. The most common adverse effects are ocular inflammation and increases in intraocular pressure

7) Which antihistamine has suppressor T-cell inhibitory activity?

2

Page 3: ETAS_MCQ_16 dermatological drugs

A. Promethazine

B. Fexofenadine

C. Doxepin

D. Cromolyn sodium

E. CimetidineCorrect Choice

Cimetidine is an H2 antihistamine that has suppressor T-cell inhibitory activity, by competitively blocking their H2 receptors. Immunomodulatory effects are useful for treating mucocutaneous candidiasis, verruca vulgaris, and condyloma acuminata

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

A. Methotrexate

B. Cyclophosphamide

C. CytarabineCorrect Choice

D. 5-fluorouracil

E. Hydroxyurea

The most likely diagnosis is neutrophilic eccrine hidradenititis. Cytarabine is the usual offending agent

9) Which drug has mucocutaneous side effects which can include stomatitis, chelitis, lichen planus-like eruptions, and pityriasis rosea-like eruptions?

A. GoldCorrect Choice

B. Thalidomide

C. Colchicine

D. Potassium iodide

E. None of the above

Mucocutaneous side effects, which are more common with injectable gold, include stomatitis, cheilitis, lichen planus-like eruptions, and pityriasis rosea-like eruptions

10) Which of the following is not a side effect of bleomycin?

A. Flagellate hyperpigmentation

3

Page 4: ETAS_MCQ_16 dermatological drugs

B. Serpentine supravenous hyperpigmentationCorrect Choice

C. Pulmonary fibrosis

D. Acrosclerosis

E. Erythromelalgia

All of the above are side effects of bleomycin except serpentine supravenous hyperpigmentation. This is a side-effect of 5-fluorouracil

11) Side effects from this antihistamine include gynecomastia, impotence, and loss of libido:

A. Fexofenadine

B. Promethazine

C. Cyproheptadine

D. CimetidineCorrect Choice

E. Doxepin

Cimetidine, an H2 antihistamine, also competitively inhibits dihydrotestosterone at the androgen receptor site, with resultant antiandrogen side effects including gynecomastia, impotence, and loss of libido

12) Which drug is known to cause an SCLE-like eruption?

A. Barbituates

B. Captopril

C. Minocycline

D. Terbinafine Correct Choice

E. Furosemide

SCLE-like reaction are known to occur most likely from glyburide, griseofulvin, hydrochlorothiazide, penicillamine, piroxicam, and terbinafine

13) Which of the following drugs may cause acute generalized exanthematous pustulosis?

A. Mercury

B. All of these answers are correctCorrect Choice

C. Cefazolin

4

Page 5: ETAS_MCQ_16 dermatological drugs

D. Ampicillin

E. Azithromycin

Acute generalized exanthematous pustulosis (AGEP) has been associated with beta-lactam antibiotics, macrolide antibiotics, cephalosporins, and mercury.

14) What is the most likely congenital defect associated with isotretinoin therapy?

A. Ventral septal defect

B. Cranial synostosisCorrect Choice

C. Spina bifida

D. Phocomelia

E. Atrial septal defect

Isotretinoin is thought to cause congenital defects by interfering with neural crest development. The most likely congenital defect is cranial synostosis

15) What drug is known to cause scotomas?

A. Gold

B. Dapsone

C. Quinacrine

D. Isotretinoin

E. Chloroquine Correct Choice

True retinopathy is associated with “bull’s eye” pigment deposition, central scotoma, and diminished visual acuity. Chloroquine is at greatest risk of causing retinopathy. Quinacrine is not associated with the risk of retinopathy

16) Finasteride is a specific inhibitor of:

A. Aromatase

B. Type II 5 alpha reductaseCorrect Choice

C. Dihydrotesterone reductase

D. Testosterone synthetase

E. Type I 5 alpha reductase

5

Page 6: ETAS_MCQ_16 dermatological drugs

Finasteride, a type II 5 alpha reductase inhibitor, given as a 1mg tablet daily, is effective in preventing further hair loss and in increasing the hair counts to the point of cosmetically appreciatable results in men ages 18 to 41 with mild to moderate hair loss at the vertex, in the anterior midscalp, and the frontal region

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

A. Fluconazole: Inhibits squalene epoxidaseCorrect Choice

B. Ketoconazole: Blocks conversion of lanosterol to ergosterol

C. Itraconazole: Inhibits 14-alpha-demethylase

D. Griseofulvin: Disrupts microtubule mitotic spindle formation

E. Terbinafine: Inhibits squalene epoxidase

Terbinafine inhibits squalene epoxidase and blocks the biosynthesis of ergosterol, a sterol essential to the integrity of fungal cell membranes. Itraconazole inhibits 14-alpha-demethylase, blocking lanosterol conversion to ergosterol. Griseofulvin disrupts microtubule mitotic spindle formation causing metaphase arrest. Ketoconazole has a mechanism of action similar to itraconazole. Fluconazole also inhibits 14-alpha-demethylase, not squalene epoxidase

18) Vascular leak syndrome has been associated with which chemotherapeutic agent?

A. Bleomycin

B. Cytarabine

C. Denileukin diftitoxCorrect Choice

D. Methotrexate

E. Interferon

Denileukin difitox (brand name Ontak) is approved for the treatment of cutaneous T-cell lymphoma. Denileukin difitox is a fusion protein composed from a portion of IL-2 with diphtheria toxin. The chemotherapy is taken up by cells expressing high-affinity IL-2 receptors. Capillary leak syndrome presenting with hypotension, edema, pleural effusions, and weight gain caused by fluid retention has been reported in patients receiving denileukin difitox

19) Methotrexate toxicity with myelosuppression is treated with what agent?

A. Folic acid

B. Vitamin E

C. Folinic acid Correct Choice

D. Cimetidine

6

Page 7: ETAS_MCQ_16 dermatological drugs

E. Oral methylene blue

Leukovorin, or folinic acid, is able to bypass dihydrofolate reductase in the cell division pathway. It is administered under conditions of methotrexate-induced myelosuppression. Leukovorin is also available as an oral form, and may be administered as a continual part of methotrexate therapy, instead of folic acid. It is now believed that neither folic acid nor folinic acid inhibit the efficacy of methotrexate’s antipsoriatic actions

20) Which one of the following antifungals requires an acidic environment for its absorption?

A. terbinafine

B. fluconazole

C. itraconazoleCorrect Choice

D. griseofulvin

E. amphotericin B

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

21) Bone marrow suppression can occur more often in individuals taking azathioprine with genetically low allele activity of what enzyme?

A. Dihydrofolate reductase

B. Inosine monophosphate dehydrogenase

C. Glucose-6-phosphatase

D. Epoxide hydroxylase

E. Thiopurine methyltransferase Correct Choice

NEEDS EXPLANATIONS

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

A. Griseofulvin

B. Fluconazole Correct Choice

7

Page 8: ETAS_MCQ_16 dermatological drugs

C. Terbinafine

D. Itraconazole

E. Ketoconazole

Ketoconazole and itraconazole require an acidic environment. Fluconazole, however, does not require an acidic environment and can work safely and effectively in patients taking antacids, which can raise gastric pH levels

23) The treatment of choice for scabies in pregnant women is:

A. Malathion

B. Thiabendazole

C. 1% permethrin

D. Precipitated sulfur 6% Correct Choice

E. Ivermectin

NEEDS EXPLANATIONS

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

A. Close to 100%

B. 25%

C. Less than 10%

D. 75%

E. 50% Correct Choice

Drug hypersensitivity syndrome is characterized by fever, skin eruption and internal organ involvement. Drugs associated with drug hypersensitivity syndrome include sulfonamindes, dapsone, anticonvulsants (carbamezapine, phenobarbitol, lamotrigine), anti-retrovirals (ritonovir, nevirapine) and minocycline. Approximately 50% of patients will have abnormal liver enzymes

25) Weekly CD4 T-cell counts are recommended for psoriasis patients treated with which biologic agent?

A. Etanercept

B. None of the above

C. Efalizumab

8

Page 9: ETAS_MCQ_16 dermatological drugs

D. AlefaceptCorrect Choice

E. Infliximab

Alefacept eliminates activated memory T-cells, so weekly CD4 T-cell counts are recommended

26) The antihistamine with strong H1 and H2 blockade is:

A. Cyproheptadine

B. Cimetidine

C. Cetirizine

D. Doxepin Correct Choice

E. Chlorpheniramine

Doxepin, a tricyclic antidepressant, has H1 and H2 antihistamine activity

27) Which of the following statements regarding retinoids is true?

A. Tretinoin and isotretinoin are second-generation synthetic retinoids

B. Second-generation retinoids are polyaromatic retinoids

C. Bexarotene is a third-generation retinoidCorrect Choice

D. Etretinate is a first-generation retinoid

E. Tazarotene is a fourth-generation selective retinoid

First-generation retinoids are tretinoin (all-trans RA) and isotretinoin (13-cis RA). Second-generation synthetic retinoids are etretinate, which was replaced by its metabolite acitretin. Third-generation (polyaromatic retinoids) include the arotinoids, tazarotene, adapalene, and bexarotene

28) Which of the following antifungal agent works by way of inhibiting ergosterol synthesis by blocking squalene epoxidation:

A. Terbinifine NaftifineCorrect Choice

B. Itraconazole

C. Naftifine

D. Itraconazole and Terbinifine

E. Terbinifine

9

Page 10: ETAS_MCQ_16 dermatological drugs

Terbinafine and Naftifine work by way of inhibiting ergosterol synthesis by blocking squalene epoxidation (B&C). Itraconazole works by inhibiting ergosterol synthesis by blocking Lanosterol 14-alpha demthylase

29) At standard dosages, which of the following is fungicidal?

A. TerbinafineCorrect Choice

B. Itraconazole

C. Ketoconazole

D. Griseofulvin

E. Fluconazole

Terbinafine block ergosterol synthesis early in the synthetic pathway by inhibitins squalene epoxidase. Squalene then accumulates within fungal cells and discupts cell membranes. At standard dosaging, it is believed to be fungicidal. The other choices are fungistatic

30) Which drug has been associated with cholestatic hepatitis?

A. Clindamycin

B. ErythromycinCorrect Choice

C. Doxycycline

D. Rifampin

E. Ampicillin

The estolate form of erythromycin has been associated with cholestatic hepatitis

31) Clofazamine hyperpigmentation has been described as:

A. Red-brown hyperpigmentation within skin lesions Correct Choice

B. Slate gray-purple hyperpigmentation in a photo-exposed distribution

C. Yellow discoloration of the skin, sclera

D. Dark hyperpigmented streaks in the nails

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

Clofazamine can induce red-brown hyperpigmentation within skin lesions of patients with Hansen’s disease

32) Of the new biologic therapies for psoriasis, which agent requires weekly CD4 T-cell count monitoring?

10

Page 11: ETAS_MCQ_16 dermatological drugs

A. Adalimumab

B. Efalizumab

C. Alefacept Correct Choice

D. Infliximab

E. Etanercept

Alefacept is a human LFA-3/IgG fusion protein, which blocks LFA-3 on antigen presenting cells from interacting with CD-2 on T-cells, preventing T-cell stimulation. Alefacept also eliminates activated memory-effector T-cells, so weekly CD4 T-cell counts are required

33) Which drug has recently been shown to be of use in chemoprevention of squamous cell carcinoma in recessive dystrophic epidermolysis bullosa:

A. Methotrexate

B. Mycophenolate mofetil

C. Cyclosporine

D. IsotretinoinCorrect Choice

E. Topical tar

Despite low therapeutic responses of advanced cancers to retinoids, these drugs appear to have a promising role in chemoprevention. Patients with oral leukoplakia, actinic keratoses, arsenic keratoses, and Bowen's disease can benefit from retinoid therapy

34) The mechanism of action of podophyllin most closely resembles that of what other drug listed below?

A. Dactinomycin

B. Permethrin

C. 5-fluorouracil

D. Chlorambucil

E. Colchicine Correct Choice

Both podophyllin and colchicine have antimitotic activity. They bind to tubulin dimers, interfering with mitotic spindle and microtubule assembly

35) Raynaud’s phenomenon is a potential adverse effect of what chemotherapeutic agent?

A. Doxorubicin

11

Page 12: ETAS_MCQ_16 dermatological drugs

B. Hydroxyurea

C. Vinca alkaloids

D. 5-fluorouracil

E. Bleomycin Correct Choice

Bleomycin use has been associated with Raynaud’s phenomenon occurring in digits treated with intralesional therapy for periungual and plantar warts

36) What antihistamine can cause gynecomastia, impotence, and loss of libido?

A. Doxepin

B. Cyproheptadine

C. Cimetidine Correct Choice

D. Fexofendine

E. Chlorpheniramine

Cimetidine competitively inhibits dihydrotestosterone at the androgen receptor site and can exhibit anti-androgen effects.

37) Methemoglobinemia is an adverse reaction to treatment with which agent?

A. Plaquenil

B. DapsoneCorrect Choice

C. Methotrexate

D. Cyclophosphamide

E. Azathioprine

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

12

Page 13: ETAS_MCQ_16 dermatological drugs

38) Which of the following statements is NOT true regarding the categories for safety of drug use in pregnancy?

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

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

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

D. Category X drugs are contraindicated in pregnancy

E. Drugs are category C if risk to the human fetus has been demonstrated, but animal studies are equivocalCorrect Choice

Drugs are category C if risk to the human fetus cannot be ruled out, studies are lacking, or animal studies are equivocal. Drugs for which risk to the human fetus has been demonstrated are pregnancy category D

39) The risk of pseudotumor cerebri in patients taking isotretinoin is increased by:

A. Dehydration

B. Comorbid affective disorder

C. Doses higher than 1.0 mg/kg/day

D. Concomitant use of tetracycline Correct Choice

E. Concomitant use of TMP-SMX

The risk of pseudotumor cerebri is increased in patients on isotretinoin and a tetracycline

40) Neutrophilic eccrine hidradenitis is associated most often with which chemotherapeutic agent?

A. Vinca alkaloids

B. 5-fluorouracil

C. Cytarabine Correct Choice

D. Dactinomycin

E. Doxorubicin

Neutrophilic eccrine hidradenitis occurs in neutropenic patients with malignancies, usually acute myelogenous leukemia. Cytarabine is the most commonly associated medication

41) Which of the following statements regarding antifungal medications is TRUE?

13

Page 14: ETAS_MCQ_16 dermatological drugs

A. Terbinafine is fungistatic

B. Griseofulvin is safe for patients with variegate porphyria

C. Griseofulvin is a cytochrome P450 3A4 inhibitor

D. Ketoconazole is fungicidal

E. Ketoconazole has been associated with gynecomastiaCorrect Choice

Medications that can precipitate acute attacks in variegate porphyria include barbiturates, estrogen, griseofulvin, sulfonamides and ethanol. Ketoconazole can produce impotence and gynecomastia by interfering with androgen synthesis. Ketoconazole inhibits cytochrome (CYP) P450 and most concerning, can rarely cause fulminant hepatitis. Griseofulvin induces CYP P450, not inhibits it. Terbinafine is fungicidal along with amphotericin B. Ketoconazole is fungistatic

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

A. ColchicineCorrect Choice

B. Chlorambucil

C. Potassium iodide

D. Gold

E. Thalidomide

Colchicine is an alkaloid with antimitotic activity that is used in dermatology for its effects on neutrophils. The most common side effect from colchicine use is gastrointestinal distress with abdominal cramping and watery diarrhea

43) The combination of ethanol and acitretin is potentially problematic because:

A. Ethanol inhibits the cytochrome p450 system

B. Ethanol exacerbates the cheilitis caused by acitretin

C. Ethanol promotes the conversion of acitretin to etretinateCorrect Choice

D. Ethanol promotes the metabolism of acitretin

E. Acitretin increases the toxicity of ethanol

Acitretin is an synthetic retinoid with affinity to the retinoic acid receptor (RAR). It can modulate the proliferation and differentiation of epidermal keratinocytes. The concurrent injestion of ethanol and alcohol increases the formation of etretinate. Unlike acitretin, etretinate is more lipophilic and accumulates in the fat. It therefore has a much longer elimination half-life, estiimated at 120 days

44) The combination of ethanol and acitretin is potentially problematic because:

14

Page 15: ETAS_MCQ_16 dermatological drugs

A. Ethanol inhibits the cytochrome p450 system

B. Ethanol exacerbates the cheilitis caused by acitretin

C. Ethanol promotes the conversion of acitretin to etretinateCorrect Choice

D. Ethanol promotes the metabolism of acitretin

E. Acitretin increases the toxicity of ethanol

Acitretin is an synthetic retinoid with affinity to the retinoic acid receptor (RAR). It can modulate the proliferation and differentiation of epidermal keratinocytes. The concurrent injestion of ethanol and alcohol increases the formation of etretinate. Unlike acitretin, etretinate is more lipophilic and accumulates in the fat. It therefore has a much longer elimination half-life, estiimated at 120 days

45) Which of the following supplements is most likely to decrease hemolysis associated in patients taking dapsone?

A. Vitamin A

B. Folic acid

C. Vitamin ECorrect Choice

D. Vitamin B6

E. Vitamin D

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

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

A. Acetaminophen

B. Sulfasalazine

C. Hydrochlorothiazide Correct Choice

D. Erythromycin

E. Nicotinamide

15

Page 16: ETAS_MCQ_16 dermatological drugs

Lichen-planus-like (lichenoid) drug eruptions have been reported with: antimalarials, ?-blockers, captopril, gold, penicillamine, HCTZ, NSAIDs. Lichenoid drug reactions are often photodistributed

47) Which of the following is a side effect of hydroquinone cream?

A. Telangiectasia

B. Photosensitivity

C. Atrophy

D. OchronosisCorrect Choice

E. Tachyphylaxis

Exogenous ochronosis is an uncommon complication of irreversible pigmentation due to overuse of topical hydroquinone (1,4 dihydroxybenzene). Hydroquinone acts to by melanocyte pigment production by auto-oxidation of melanin, tyrosinase and phenol oxidases.

48) Which antiparasitic agent is highly flammable?

A. MalathionCorrect Choice

B. Lindane

C. Precipitated sulfur

D. Thiabendazole

E. Permethrin

Malathion, an organophosphate cholinesterase inhibitor used to treat scabies and head lice, is flammable

49) Cyclosporine forms a complex to directly interfere with activation of what calcium-dependent protein?

A. Calcineurin Correct Choice

B. Cyclophilin

C. Cytochrome P-450

D. Calmodulin

E. NFAT-1

Cyclosporine inhibits calcineurin, a phosphatase activated in the presence of calmodulin and calcium, by cyclophilin. Cyclosporine forms a complex with cyclophilin, blocking its ability to activate calcineurin, and thus preventing calcineurin from phosphorylating NFAT-1, a transcription factor.

16

Page 17: ETAS_MCQ_16 dermatological drugs

NFAT-1, when phosphorylated can travel to the nucleus of cells, initiate IL-2 production, and stimulate T-cell proliferation

50) What is the target antigen for rituximab?

A. CD4

B. CD22

C. CD7

D. CD20Correct Choice

E. CD8

Rituximab 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

51) What medication's mechanism of action is via suppression of the halide-myeloperoxidase system?

A. Hydroxyurea

B. Melphalan

C. Quinicrine

D. DapsoneCorrect Choice

E. Cyclophosphamide

Dapsone inhibits the neutrophil halide-myeloperoxidase system which results in an impaired respiratory burst and subsequent tissue damage

52) 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. Clofazimine

B. Quinacrine

C. Minocycline

D. AmiodaroneCorrect Choice

E. Chloroquine

The patient presents with blue-gray discoloration in sun-exposed areas. The most likely offending agent is amiodarone. Blue-gray discoloration from minocycline usually occurs on legs. Chloroquine usually causes blue-gray discoloration in the sclerae, teeth, buccal mucosa, nail beds, and pretibial

17

Page 18: ETAS_MCQ_16 dermatological drugs

areas. Quinacrine causes yellow discoloration of skin and conjunctiva. CLofazimine usualy causes a red-brown discoloration

53) Painful periungual pyogenic granulomas have been associated with what medication?

A. Indinavir Correct Choice

B. Ketoconazole

C. Doxycycline

D. Valacyclovir

E. Tazarotene

Periungual pyogenic granulomas and painful paronychial eruptions have been reported in association with various anti-HIV medications including, indinavir, zidovudine, and lamivudine

54) Which drug may increase levels of digoxin?

A. Amoxicillin

B. Minocycline

C. Cephalexin

D. Ciprofloxacin

E. ErythromycinCorrect Choice

Erythromycin inhibits the cytochrome P-450 system, which may result in increased levels of digoxin, among many other drugs

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

A. Discontinue Dilantin and begin Phenobarbital

B. Continue Dilantin and treat rash with topical corticosteroids

C. Discontinue Dilantin and begin carbamazepine

D. Restart Dilantin once the rash resolves

E. Discontinue Dilantin and begin valproic acidCorrect Choice

Anticonvulsant hypersensitivity syndrome (also drug rash with eosinophilia and systemic symptoms (DRESS0 and dilantin hypersensitivity syndrome) presents with cutaneous eruption accompanied by fever, facial edema, lymphadenopathy, leukocytosis and hepatitis. Cross reactivity is present in all aromatic anticonvulsants including phenytoin, carbamazepine and phenobarbitol. There is no cross reaction with valprioc acid

18

Page 19: ETAS_MCQ_16 dermatological drugs

56) Potentially fatal ventricular arrhythmias can occur with concomitant use of cisapride and:

A. Terbinafine

B. Atorvostatin

C. Astemizole

D. Erythromycin Correct Choice

E. Digoxin

Co-administration of erythromycin with the antihistamines terfenedine and astemizole or the gastrointestinal promobility agent cisapride increases the risk of torsade de pointes and is contraindicated. These drugs are no longer available in the US

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

A. Cimetidine

B. Vitamin E

C. Oral methylene blue Correct Choice

D. Homocysteine

E. Glucose-6-phosphatase

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

58) The most specific marker of drug-induced lupus is:

A. Anti-La Ab

B. ANA

C. Anti-ds DNA Ab

D. Anti-histone Ab Correct Choice

E. Anti-Ro Ab

Anti-histone Ab is most specific for drug-induced lupus. In addition to minocycline, hydralazine, procainamide, isonaizid (INH), penicillamine and anti-convulsants have been associated with drug-induced lupus-like syndrome

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

19

Page 20: ETAS_MCQ_16 dermatological drugs

A. Diarrhea

B. Hypertension

C. Photosensitivity

D. Skin discoloration

E. SedationCorrect Choice

Thalidomide was introduced in the late 1950's as a "safe" sleeping aide. It readily penetrates the CNS, where it exerts a hyposedative effect comparable with barbiturates. By far, the most common adverse effect from thalidomide is sedation, which in many patients may require that primarily night-time doses be utilized

60) Which of the following antiparasitic agents is an organophosphate cholinesterase inhibitor?

A. Ivermectin

B. Precipitated sulfur

C. Thiabendazole

D. Lindane

E. MalathionCorrect Choice

Malathion is an organophosphate cholinesterase inhibitor

61) The treatment of choice for Wegner’s granulomatosis is:

A. Methotrexate

B. Chlorambucil

C. Cyclophosphamide Correct Choice

D. Azaithioprine

E. Systemic glucocorticosteroids

NEEDS EXPLANATIONS

62) Thryoid function tests should be checked before and during therapy with which of the following medications?

A. Azathioprine

B. Potassium iodideCorrect Choice

20

Page 21: ETAS_MCQ_16 dermatological drugs

C. Thalidomide

D. Colchicine

E. Gold

The Wolff-Chaifkoff effect, which is the inhibition of thyroid hormone synthesis from excess iodides which block organic iodides from binding in the thyroid, can be observed in patients on potassium iodide therapy. In patients with normal thyroid function, autoregulatory mechanisms allow for appropriate escape from this effect. In patients with impaired autoregulatory mechanisms, the Wolff-Chaikoff effect can lead to hypothyroidism

63) Which of the following is a low sedation metabolite of hydroxyzine?

A. Fexofenadine

B. Cyproheptadine

C. Loratadine

D. CetirizineCorrect Choice

E. Ranitidine

Cetirizine is a second-generation H1 antihistamine that is a low sedation metabolite of hydroxyzine

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

A. These antibiotics are effective against Mycoplasma infections

B. Tetracycline is more phototoxic than demeclocyclineCorrect Choice

C. Tetracyclines are contraindicated in children less than 9 years of age

D. Ingestion of zinc salts may impair absorption of tetracycline

E. Tetracycline is the most common cause of fixed drug eruption

Demeclocycline and doxycycline are the most phototoxic of all the tetracyclines

65) Which of the following is not an ingredient of Castellani's paint?

A. Boric Acid

B. Resorcinol

C. Phenol

D. Ethyl acetateCorrect Choice

21

Page 22: ETAS_MCQ_16 dermatological drugs

E. Industrial methylated spirit

Castellani's paint was named after Sir Aldo Castellani and contains resorcinol, acetone, magenta, phenol, boric acid, industrial methylated spirit, and water. It is fungicidal and bactericidal with local anesthetic effects. It has been used to treat inflammatory tinea cruris, leg ulcers, and acute paronychia

66) What is the difference between podophyllin and podophyllotoxin?

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

B. Podophyllin contains kaempherol which is a potent mutagensCorrect Choice

C. Podophyllotoxin is a phosphodiesterase inhibitor

D. Podophyllotoxin contains quercetin which is a potent mutagens

E. Podophyllin reversibly binds tubulin inhibiting cells in metaphase

Podophyllotoxin, also known as podofilox or Condolox, is a anti-mitotic agent that reversibly binds tubulin, arresting cells in metaphase. It is used topically to treat genital warts. Podophyllin, which has the same mechanism of action, contains kaempero and quercetin which are potent mutagens. Both are derived from the May Apple plant. Cantharin, an antiviral agent derived from the Blister beetle, is a phosphodiesterase inhibitior

67) Which of the following agents is NOT a UVA blocker?

A. Dioxybenzone

B. Avobenzone

C. Red veterinary petrolatum

D. Amyl p-dimethylaminobenzoateCorrect Choice

E. Dibenzoylmethane

Dioxybenzone is one of the benzophenones (as in oxybenzone and sulisobenzone), which are UVA blockers. Amyl p-dimethylaminobenzoate is a UVB blocker. Dibenzoylmethane (avobenzone; Parsol 1789) is a UVA/UVB blocker. Red veterinary petrolatum is a UVA blocker

68) Which of the following class of medications has been associated with acquired brachial dyschromatosis?

A. Anti-virals

B. HMG-CoA Reductase inhibitors

C. Non-Steroidal Anti-inflammatory medications

22

Page 23: ETAS_MCQ_16 dermatological drugs

D. ACE-inhibitorsCorrect Choice

E. Protease inhibitors

Acquired brachial dyschromatosis is a condition described as asymptomatic, gray-brown patches with geographic borders, occasionally interspersed with hypopigmented macules, on the dorsum of the forearms, mostly bilaterally and seen in middle aged women. Epidermal atrophy, basal layer hyperpigmentation, elastosis and angiectases were histopathologic features. An association with Civatte's poikiloderma as well as hypertension and/or antihypertensive drugs, especially ACE-inhibitors, is suggested

69) What is used to reduce bladder toxicity from cyclophosphamide?

A. Leukovorin

B. Cimetidine

C. Folic acid

D. Mesna Correct Choice

E. Vitamin E

Mesna or sodium 2-mercptoethanesulfonate, has been used to reduce bladder toxicity from cyclophophamide

70) The medication most acceptable for usage in patients with renal failure is:

A. Oxytetracycline

B. Tetracycline

C. Minocycline

D. Demeclocycline

E. Doxycycline Correct Choice

Renal failure may prolong the half-life of most tetracyclines except doxycycline. Doxycycline is excreted via the GI tract, unlike the other tetracyclines

71) Which of the following statements regarding sunscreens is true?

A. Photoallergy has not been reported to benzophenones

B. Methyl anthranilate is a UVB absorber

C. PABA and its derivates do not cross react with sulfonamides

D. Padimate O is a UVB absorberCorrect Choice

23

Page 24: ETAS_MCQ_16 dermatological drugs

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

Physical blockers reflect and scatter UV rays, whereas chemical sunscreens absorb UV light and convert the absorbed energy into longer lower energy wavelengths. Methyl anthranilate is a UVA blocker. Padimate O, a PABA derivative, is a UVB blocker. Photoallergy has been reported with increasing frequency to benzophenones. Allergic contact allergy can occur with PABA and its derivatives, which can cross react with azodyes, aniline, procaine, benzocaine, paraphenylenediamine, and sulfonamides

72) A patient with acute diarrhea is prescribed antibiotic treatment for his symptoms. He subsequently suffers from nausea and vomiting after ingesting alcohol. What is the most likely medication he is taking?

A. Azithromycin

B. Clindamycin

C. MetronidazoleCorrect Choice

D. Ciprofloxacin

E. Penicillin

This patient is most likely taking metronidazole for acute diarrhea secondary to giardella. Metronidazole causes antabuse-like reactions with ingestion of alcohol

73) What is the half-life of isotretinoin?

A. 50 hours

B. 20 hoursCorrect Choice

C. 30 days

D. 7 hours

E. 120 days

The half-life of isotretinoin is 20 hours. The half lives of bexarotene, acitretin, etretinate are 7 hours, 50 hours, 120 days respectively

74) Which of the following systemic agents has been shown to be the most effective in the treatment of toenail onychomycosis?

A. Itraconazole

B. Griseofulvin

C. Ketoconazole

24

Page 25: ETAS_MCQ_16 dermatological drugs

D. TerbinafineCorrect Choice

E. Fluconazole

Craford et al. reviewed the available literature examining the efficacy of systemic anti-fungals and performed a meta-analysis. Pooled analysis of cure rates at 11 and 12 months suggested that terbinafine was more effective than itraconazole

75) What is the recommended period for contraception after cessation of acitretin therapy in the United States?

A. 2 years

B. 3 months

C. 3 years Correct Choice

D. 1 month

E. 1 year

Etretinate has a prolonged half-life of 80-160 days. The levels may persist up to 3 years in the body. Acitretin can be converted to etretinate in the presence of ethanol

76) The SPF of a sunscreen is based on applying the sunscreen at what concentration?

A. 5 mg/cm2

B. 1 mg/cm2

C. 2 mg/cm2Correct Choice

D. 4 mg/cm2

E. 3 mg/cm2

A sunscreen SPF is based on using it at a concentration of 2 mg/cm2 which is about 1 ounce or 30 grams for the entire average sized body. It also is about 3-5 grams for the head and neck

77) How long after isotretinoin therapy can one safely begin trying to conceive?

A. Two weeks

B. One year

C. Three years

D. Immediately

25

Page 26: ETAS_MCQ_16 dermatological drugs

E. One monthCorrect Choice

A woman should wait one month before trying to conceive after taking isotretinoin to prevent birth defects. After taking acitretin a woman should wait three years before trying to conceive

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

A. Pravastatin

B. Terbinafine

C. None of the above are correct

D. Verapamil

E. All the above are correctCorrect Choice

All of the above choices have been implicated in drug-induced subacute cutaneous lupus erythematosus

79) Which one of the following sunscreens has an absorption spectrum primarily in the UVA range?

A. Cinnamates

B. PABA (para-aminobenzoic acid)

C. Padimate O

D. Octyl Salicylate

E. Parsol 1789 (butyl dibenzoylmethane)Correct Choice

Avobenzone (Parsol 1789) is primarily a UVA blocker. Photostability of avobenzone may be a problem if it is combined with octyl methoxycinnamate. Salicylates, PABA, Padimate O, and cinnamates are primarily UVB blockers

80) What is the half-life of isotretinoin?

A. 50 hours

B. 100 days

C. 10 hours

D. 100 hours

E. 20 hoursCorrect Choice

The half-life of isotretinoin is 20 hours

26

Page 27: ETAS_MCQ_16 dermatological drugs

81) Tazarotene is what category for safety in pregnancy?

A. Category X Correct Choice

B. Category A

C. Category C

D. Category B

E. Category D

Category X drugs include: acitretin, etretinate, estrogens, finasteride, 5-fluorouracil, flutamide, isotretinoin, methotrexate, stanozolol, thalidomide, and tazarotene

82) Which antiviral agent has been associated with fatal thrombotic thrombocytopenic purpura in AIDS and transplant patients taking high doses?

A. Cidofovir

B. Penciclovir

C. ValacyclovirCorrect Choice

D. Acyclovir

E. Famciclovir

Valacyclovir has been associated with severe and even fatal cases of thrombotic thrombocytopenic purpura / HUS syndrome in AIDS and transplant patients taking high doses

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

A. Adverse effects include hypertrichosis and gingival hyperplasia

B. NSAIDs can potentiate renal toxicity when combined with cyclosporine

C. The most common eletrolyte abnormalities are hypokalemia and hypermagnesemiaCorrect Choice

D. Forms a complex with cyclophilin, blocking its ability to activate calcineurin, thus preventing calcineurin from phosphorylating NFAT-1

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

The most common electrolyte abnormalities associated with cyclosporin A are hyperkalemia, hyperuricemia, and hypomagnesemia

84) Which of the following is a true statement about infliximab?

27

Page 28: ETAS_MCQ_16 dermatological drugs

A. FDA-approved for the treatment of psoriasis

B. Not effective in psoriatic arthritis

C. Increases C-reactive protein

D. Chimeric monoclonal antibody against TNF-alphaCorrect Choice

E. Indicated for mild to moderate psoriasis

Infliximab (brand name Remicade) is a chimeric recombinant fusion protein composed of a human TNF-alpha receptor with IgG1-Fc. The immunoglobulin portion is derived from a human constant region 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, rheumatoid arthritis and ankylosing spondylitis

85) Which of the following drugs is correctly matched to its target enzymes?

A. Terbinafine-Cytochrome p450

B. Acyclovir-DNA polymeraseCorrect Choice

C. Mycophenolate Mofetil-Phospholipase A2

D. Tacrolimus-Thymidine kinase

E. Methotrexate-Inosine monophosphate dehydrogenase

Drug/Specific enzyme inhibitedTacrolimus - CalcineurinMethotrexate - Dihydrofolate reductaseMycophenolate mofetil - Inosine monophosphate dyhydogenaseAcyclovir - DNA PolymeraseTerbinafine - Squalene epoxidase

86) The mechanism of action of mycophenolate mofetil most closely resembles that of what other drug?

A. Hydroxyurea

B. Chlorambucil

C. Doxorubicin

D. Azathioprine Correct Choice

E. Cyclophosphamide

Both azaithioprine and mycophenolate mofetil directly interfere with purine synthesis

87) Which biologic agent blocks T-cells from egressing the vasculature and entering the skin?

28

Page 29: ETAS_MCQ_16 dermatological drugs

A. EfalizumabCorrect Choice

B. Alefacept

C. Infliximab

D. Etanercept

E. None of the above

Efalizumab 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 the vasculature and entering the skin

88) Which of the following chemotherapeutic agents causes increased growth of eyelashes?

A. Mitomycin

B. Methotrexate

C. Cytarabine

D. Interleukin 2

E. Interferon alphaCorrect Choice

Interferons can cause increased growth of eyelashes. Trichomegaly has been reported after treatment with interferon-alpha in patients with chronic hepatitis, B-cell lymphoma, chronic granulocytic leukemia, and cutaneous melanoma. Trichomegaly has also been reported in associatoin with latanoprost, minoxidil, cyclosporine, phenytoin, psoralen, and penicillamine

89) For which of the following medications is sedation a very common side effect that may limit treatment?

A. Gold

B. Colchicine

C. Chlorambucil

D. ThalidomideCorrect Choice

E. Potassium iodide

Sedation is a very common side effect of treatment with thalidomide. It is additive with other sedatives, such as alcohol and barbiturates

90) non-pigmenting fixed drug eruption is known to be caused by what agent?

A. Phenopthalein

29

Page 30: ETAS_MCQ_16 dermatological drugs

B. Naproxen

C. Tetracycline

D. Barbiturates

E. Pseudoephedrine Correct Choice

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

91) The Wolff-Chaikoff effect is associated with what medication?

A. Potassium iodide Correct Choice

B. Zidovudine

C. Bexarotene

D. Thalidomide

E. Hydroxychloroquine

The Wolff-Chaikoff effect is the inhibition of thyroid hormone synthesis from excess iodides which block organic iodides from binding in the thyroid. In patients with normal thyroid function, autoregulatory mechanisms allow for escape from this effect. In patients with impaired autoregulatory mechanisms, the Wolff-Chaikoff effect can lead to hypothyroidism. Thyroid function should be evaluated and monitored with patients started on potassium iodide

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

A. CefaclorCorrect Choice

B. Clarithromycin

C. Ciprofloxacin

D. Clindamycin

E. Rifampin

Cefaclor has been associated with an increased incidence of serum sickness in children; the other drugs have not

93) Combination oral contraceptives decrease free testosterone levels by:

A. Acting as competitive inhibitors of the androgen receptor

B. Directly binding free testosterone

30

Page 31: ETAS_MCQ_16 dermatological drugs

C. Acting as a GnRH antagonist

D. Acting as a GnRH agonist

E. Increasing SHBG (sex hormone binding globulin) production Correct Choice

Oral contraceptives decrease free testosterone levels by increasing the production of sex hormone binding globulin (SHBG).

94) Thalidomide is most associated with what adverse effect?

A. Distal motor neuropathy

B. Sensory neuropathy Correct Choice

C. Oral ulceration

D. Hypothyroidism

E. Photosensitivity

The most common presentation of the neuropathy from thalidomide is a mild proximal muscle weakness with symmetric painful paresthesias of the distal extremities with accompanying lower limb sensory loss. Hypothyroidism is a rarely reported adverse effect.

95) The mechanism of action of efalizumab in the treatment of psoriasis is:

A. Inhibition of p-selectin

B. Inhibition of tumor necrosis factor alpha

C. Inhibition of T cell trafficking into the skin Correct Choice

D. Inhibition of e-selectin

E. Inhibition of macrophage maturation

Efalizumab 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 weekly as a subcutaneous injection. It’s side effects include rare thrombocytopenia and occasional rebound of psoriasis upon its abrupt discontinuation

96) All of the following retinoids are excreted in the urine EXCEPT:

A. BexaroteneCorrect Choice

B. Etretinate

C. Isotretinoin

31

Page 32: ETAS_MCQ_16 dermatological drugs

D. Acitretin

E. Tretinoin

Bexarotene is excreted via hepatobiliary excretion. The others are excreted in bile and urine

97) The steroid with the least minerocorticoid activity is:

A. Hydrocortisone

B. Prednisone

C. Methylprednisolone Correct Choice

D. Cortisone

E. Prednisolone

Of the corticosteroids listed, the steroid with the lowest mineralcorticoid activity is methylprednisolone. Minerocorticoids act on the kidney to decrease the rate of sodium excretion (with accompanying retention of water). Triamcinolone, dexamethasone, and betamethasone also have low mineralcorticoid activityThe steroid with the least minerocorticoid activity is:

A. Hydrocortisone

B. Prednisone

C. Methylprednisolone Correct Choice

D. Cortisone

E. Prednisolone

Of the corticosteroids listed, the steroid with the lowest mineralcorticoid activity is methylprednisolone. Minerocorticoids act on the kidney to decrease the rate of sodium excretion (with accompanying retention of water). Triamcinolone, dexamethasone, and betamethasone also have low mineralcorticoid activity

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

A. Liver toxicity

B. Flu-like symptomsCorrect Choice

C. Spastic diplegia

D. Weight loss

32

Page 33: ETAS_MCQ_16 dermatological drugs

E. Nausea

The most common side effect of treatment with interferon-alpha is flu-like symptoms of fever, chills, myalgias, headache and arthralgias. Prophylactic administration of non steroidal anti-inflammatory medications may alleviate some of these symptoms

99) Which of the following medications is most likely to interefere with the efficacy of oral contraceptives?

A. RifampinCorrect Choice

B. Doxycycline

C. Tetracycline

D. Amoxicillin

E. Trimethoprim-sulfamethaxasole

Rifampin has been shown to decrease the efficacy of oral contraceptives. It is an inducer of cytochrome p450 which increases the metabolism of hormones thereby decreasing the efficacy of oral contraceptives. There is no clear decrease in oral contraceptive efficacy with concomitant use of ampicillin, ciprofloxacin, clarithromycin, doxycyline, metronidzole, ofloxacin, or tetracycline

100) Which chemical sunscreen has UVB and UVA II absorption capability?

A. Titanium dioxide

B. Oxybenzone Correct Choice

C. Methyl anthranilate

D. Padimate O

E. Octyl salicylate

The benzophenones, oxybenzone and dioxybenzone, have the broadest absorption spectrum of the chemical sunscreens, with UVB and UVA II range. Methyl anthranilate, octyl salicylate, and padimate O are UVB-absorbing chemicals. Titanium dioxide is not a chemical absorber, it is a physical blocker

101) Alternate-day administration of oral steroids can reduce all of the following side effects except?

A. Growth impairment

B. Cataracts Correct Choice

C. HPA axis suppression

D. Peptic ulcer disease

33

Page 34: ETAS_MCQ_16 dermatological drugs

E. Opportunisitic infection

Alternate-day corticosteroid dosing regimens does not decrease the risks of posterior subcapsular cataracts, osteoporosis, and possibly osteonecrosis

102) Which of the following medications can lead to hematologic toxicity when combined with methotrexate?

A. Dapsone

B. None of these answers are correct

C. Sulfonamides

D. All of these answers are correctCorrect Choice

E. Trimethoprim

All of the above inhibit the folic acid metabolic pathway, and can lead to hematologic toxicity when combined with methotrexate

103) Terbinafine exerts its antifungal activity by what manner?

A. Interference with cell respiratory processes

B. Inhibition of 14-a demethylase

C. Inhibition of epoxide hydroxylase

D. Inhibition of squalene epoxidase Correct Choice

E. Direct binding to membrane sterols, increasing permeability

Terbinafine, an allylamine, interferes with ergosterol synthesis by inhibiting squalene epoxidase. The azoles inhibit 14-a demethylase. Nystatin is a polyene which binds irreversibly to membrane sterols, resulting in a permeability shift. Ciclopirox does not appear to affect sterol biosynthesis but instead interferes with cell respiratory processes

104) What antifungal is known to cause gynecomastia and impotence?

A. Ketoconazole Correct Choice

B. Terbinafine

C. Griseofulvin

D. Itraconazole

E. Fluconazole

34

Page 35: ETAS_MCQ_16 dermatological drugs

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

105) All of the following agents exert their function in a cell-cycle specific manner except:

A. Hydroxyurea

B. Methotrexate

C. Azathioprine

D. Cyclophosphamide Correct Choice

E. 5-fluorouracil

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

106) The t 1/2 of isotretinoin is:

A. 7 hours

B. 2 days

C. 1 hour

D. 120 days

E. 20 hours Correct Choice

The t 1/2 of isotretinoin is 20 hours. The other answers list the t 1/2 times of various retinoids

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

A. ZincCorrect Choice

B. Silymarin

C. Vitamin E

D. Vitamin C

E. Tea polyphenois

Anti-oxidants are thought to be protective against photoinjury by neutralizing oxygen radicals. Vitamin C, Vitamin E, tea polyphenois, and silymarin are all anti-oxidants

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

35

Page 36: ETAS_MCQ_16 dermatological drugs

A. Nevomelanocytic nevi

B. Peutz-Jeghers syndrome

C. Acral lentiginous melanoma

D. Chloroquine therapy

E. Minocycline therapy Correct Choice

Melanonychia occurring simultaneously on several nails is most likely to be due to minocycline therapy. Blue-black pigmentation may be present in nails, skin, scars and sclerae

109) What is the treatment of choice for methemoglobinemia?

A. Observation

B. Aspirin

C. Methylene blueCorrect Choice

D. Iron

E. Hydration

Methylene blue is redued in the presnce of NADPH and diaphorase II to leukomethylene blue, which then reduces methemoglobin (Fe3+) to hemoglobin (Fe2+)

110) Which biologic agent is infused intravenously?

A. Etanercept

B. Alefacept

C. InfliximabCorrect Choice

D. Efalizumab

E. None of these answers are correct

Infliximab is infused intravenously

111) Which medication is the most likely cause of this drug eruption?

A. Sulfur based medications

B. Nonsteroidal anti-inflammatory medications

36

Page 37: ETAS_MCQ_16 dermatological drugs

C. Methotrexate

D. Beta-lactam antibioticsCorrect Choice

E. Calcium channel blockers

Acute generalized exanthematous pustulosis (AGEP)is characterized by small pustules on erythematous base with evenutal desqumation. As opposed to most drug reactions, AGEP may occur within one week, 50% occur within the first 24 of exposure

112) The mechanism action of this cytotoxic agent is via inhibition of IMP dehydrogenase.

A. Mycophenolate mofetilCorrect Choice

B. Azathioprine

C. Hydroxyurea

D. Methotrexate

E. 5-fluorouracil

Mycophenolate mofetil (cellcept), a purine analog, blocks de novo purine synthesis by inhibiting the enzyme inosine monophosphate dehydrogenase

113) All of the following are reported cutaneous side effects of zidovudine EXCEPT:

A. Trichomegaly

B. Periungual pyogenic granulomas

C. Diffuse and oral hyperpigmented macules

D. None of the above (all are reported side effects)Correct Choice

E. Hyperpigmented streaks in nails

All of the following are cutaneous side effects reported with zidovudine, a nucleoside HIV reverse transcriptase inhibitor. Periungal/paronychial eruptions resulting in pyogenic granuloma-like lesions have also been reported with other HIV medications, including indinavir and lamivudine

114) Which of the following biologic therapies is pregnancy category C?

A. Infliximab

B. Alefacept

C. Etanercept

37

Page 38: ETAS_MCQ_16 dermatological drugs

D. EfalizumabCorrect Choice

E. Adalimumab

All of the above drugs are pregnancy category B except efalizumab which is category C

115) Which of the following may cause an acneiform eruption?

A. ACTH Correct Choice

B. Fluoxetine

C. Finasteride

D. Valproic acid

E. Methotrexate

Many medications are associated with acneiform eruptions, including halogens (bromide and iodide), androgenic hormones such as testosterone, ACTH, corticosteroids, isoniazid (INH), lithium, phenytoin, and vitamins B2, B6 and B12

116) Which cell type is increased by glucocorticoids?

A. Neutrophils Correct Choice

B. Monocytes

C. T-cells

D. Eosinophils

E. B-cells

Glucocorticoids alter the balance of circulating leukocytes, causing an increase in the number of polymorphonuclear leukocytes and diminishing the numbers of lymphocytes, eosinophils, and monocytes

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

A. Topical antibiotic

B. Topical steroid

C. Calcipotriene

D. Imiquimod

E. HydroquinoneCorrect Choice

38

Page 39: ETAS_MCQ_16 dermatological drugs

Exogenous ochronosis has been reported with prolonged use of high concentration hydroquinone. On pathology, a characteristic ochre colored deposit is noted between the collagen bundles

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

A. Increased expression of FasLCorrect Choice

B. Reduction in circulating IL-6

C. Cleavage of desmoglein 1

D. Reduction in circulating tumor necrosis factor

E. Overexpression of keratins 6 and 16

Toxic epidermal necrolysis is a life threatening drug eruption characterized by widespread epidermal necrosis. The exact etiology of the keratinocyte necrosis has not been fully elucidated. However, FasL (FasL and Fas are able to trigger apoptosis) has been shown to be upregulated in TEN

119) Which antiparasitic agent acts by inhibiting fumarate reductase?

A. Cidofovir

B. ThiabendazoleCorrect Choice

C. Ivermectin

D. Permethrin

E. Lindane

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

120) Which chemotherapeutic agent has been reported to cause acral sclerosis with Raynaud's phenomenon?

A. BleomycinCorrect Choice

B. Methotrexate

C. Interferon

D. Actinomycin

E. 5-Fluorouracil

39

Page 40: ETAS_MCQ_16 dermatological drugs

Bleomycin is an antibiotic that induces single strand breaks in the DNA. Reactions to bleomycin include flagellae hyperpigmentation, acral sclerosis with Reynaud's, penile calcification, and a morbilliform eruption

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

A. Lithium

B. Diclofenac

C. Vancomycin

D. Pseudoephedrine hydrochlorideCorrect Choice

E. ACE inhibitor

Fixed drug eruptions occur 30 mintues to 8 hours after ingestion of offending agent. After rechallenge with the same agent, the fixed drug eruption will recur. Potential causes of a fixed drug eruption include analgesics, sulfonamides, barbituates, pseudoephedrine and anticonvulsants

122) Which of the following chemotherapeutic agents has been linked to acneiform eruptions?

A. CetuximabCorrect Choice

B. Doxorubicin

C. Cytarabine

D. Bleomycin

E. Cisplatin

Cetuximab is a chimeric anti-epidermal growth factor receptor antibody that is FDA approved to treat advanced colorectal cancer. Acneiform eruptions have been reported to occur in up to 1/3 of patients

123) What family of medications is associated with xerosis?

A. Sulfonylureas

B. Cholesterol lowering agentsCorrect Choice

C. Beta blockers

D. Loop diuretics

E. Calcium channel blockers

Medications that alter the lipid composition of the epidermis and stratum corneum may impair the normal barrier function of the skin. Cholesterol lowering medications like HMG-CoA reductase inhibitors and niacin may cause xerosis through this mechanism

40

Page 41: ETAS_MCQ_16 dermatological drugs

124) Which of the following are retinoid side effects?

A. Reversible hyperthyroidism

B. Delayed epiphyseal closure

C. Diffuse interstitial skeletal hypo-ostosis

D. All of these answers are corect

E. Pseudotumor cerebriCorrect Choice

Bexarotene has been shown to cause reversible hypothyroidism, not hyperthyroidism. Systemic retinoids have been shown to cause diffuse interstitial skeletal hyperostosis, premature epiphyseal closure, and pseudotumor cerebri (risk increased with concommitant use of tetracyclines

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

A. Pterygium

B. RetinopathyCorrect Choice

C. Cataracts

D. Neuromuscular eye toxicity

E. Corneal deposition - causing halos, blurred vision, photophobia

Three types of ocular adverse effects may develop from antimalarials: corneal deposits, neuromuscular eye toxicity and retinopathy. Only retinopathy is potentially irreversible. It is recommended that a patient be evaluated for retinopathy at baseline, then every 6 months by an ophthamologist. Testing visual acuity, visual fields and performing a funduscopic examination are considered acceptable for screening purposes

126) Clinical evidence of hypothyroidism can be induced by which drug?

A. Isotretinoin

B. Gold

C. Bexarotene Correct Choice

D. Griseofulvin

E. Acitretin

Bexarotene can cause reversible elevations in TSH levels and reductions in total T4 levels, associated with mild symptoms of hypothyroidism

127) Which of the following agents is NOT a UVB blocker?

41

Page 42: ETAS_MCQ_16 dermatological drugs

A. SulisobenzoneCorrect Choice

B. Padimate A

C. PABA

D. Salicylates

E. Cinnamates

Sulisobenzone is a benzophenone, a UVA blocker. The others are UVB blockers. Padimate A is a PABA derivative

128) Which of the following drugs has been known to cause penile erosions?

A. Penciclovir

B. Abacavir

C. Cidofovir

D. Gancyclovir

E. FoscarnetCorrect Choice

Foscarnet has been reported to cause penile erosions

129) Peak vulnerability to thalidomide occurs between which days of gestation?

A. Days 15-20

B. Days 37-56

C. Days 21-36Correct Choice

D. Days 57-70

E. Days 1-14

Peak vulnerability to thalidomide occurs between days 21 to 36 of gestation, during which only a single dose will cause birth defects to occur. Birth defects associated with thalidomide include phocomelia (underdevelopment of arms and legs, the most common birth defect), ear malformation, and gastrointestinal and urogenital defects

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

A. Gorlin's sign

B. Hutchinson's sign

42

Page 43: ETAS_MCQ_16 dermatological drugs

C. Nikolsky sign

D. Fitzpatrick sign

E. Asboe-Hansen's signCorrect Choice

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

131) Which of the following side effects has not been reported in association with intravenous immune globulin?

A. Hypotension

B. Headache

C. Stevens-Johnson syndromeCorrect Choice

D. Anaphylaxis

E. Flushing

IVIG 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, and aseptic meningitis syndrome has been reported. Cutaneous adverse effects include eczematous eruptions and alopecia

132) The form of erythromycin most likely to cause jaundice is:

A. EstolateCorrect Choice

B. Gluceptate

C. Lactobionate

D. Ethylsuccinate

E. Stearate

The form of erythromycin that most likely causes jaundice is estolate

133) Which of the following is known to induce lichen planus-like eruptions?

A. Doxepin

B. Minocycline

43

Page 44: ETAS_MCQ_16 dermatological drugs

C. Mercury

D. Gold Correct Choice

E. Dapsone

Mucocutaneous side effects of gold include stomatitis, cheilitis, lichen planus- like eruptions, and pityriasis rosea-like eruptions

134) Which of the following medications is most likely to result in increased carbamazepine levels?

A. Rifampin

B. Minocycline

C. Erythromycin Correct Choice

D. Azithromycin

E. TMP-SMX

Eythromycin inhibits the hepatic cytochrome P450 system and can increase serum levels and potential toxicities of carbamazapene, theophylline, warfarin, digoxin, methylprednisolone

135) Which of the following statements regarding drug interactions is true?

A. Tobacco induces P-450 enzymes

B. All of the above are trueCorrect Choice

C. Drugs that induce CYP3A enzymes may decrease levels of drugs which act as substrates for CYP3A

D. CYP3A inhibitors may increase levels and cause toxicity of drugs metabolized by cytochrome P-450

E. Terbinafine is not metabolized by cytochrome P-450

The most relevant drug interactions in dermatology involve the hepatic biotransformation pathways catalyzed by the cytochrome P-450 isoenzymes from the subfamilies CYP3A3/4. Drugs that induce CYP3A enzymes may decrease levels of drugs which act as substrates for CYP3A. CYP3A inhibitors may increase levels and cause toxicity of drugs metabolized by cytochrome P-450. Terbinafine is not metabolized by cytochrome P-450, but by cytochrome 2B6 instead. Tobacco induces P-450 enzymes

136) The anti-viral agent used most often for acyclovir-resistent HSV and VZV infections is:

A. Pencyclovir

B. Valacyclovir

44

Page 45: ETAS_MCQ_16 dermatological drugs

C. Foscarnet Correct Choice

D. Famcyclovir

E. Gancyclovir

Foscarnet does not require phosphorylaton for antiviral activity. Thereofre, it is achieve against viruses resistant to acyclovir, famcyclovir, or gancyclovir on the basis of altered-kinase activities

137) What tetracycline is not phototoxic?

A. Doxycycline

B. Tetracycline

C. Minocycline Correct Choice

D. Demeclocycline

E. Oxytetracycline

Minocycline is not phototoxic. Demeclocycline and doxycycline are the most phototoxic of all the tetracyclines. Onycholysis can accompany tetracycline-induced phototoxicity

138) Anemia, leg ulcers, poikilodermatous skin changes, hepatitis, renal toxicity, and acral erythema are most commonly associated with what medication?

A. 5-fluorouracil

B. Doxorubicin

C. Methotrexate

D. Hydroxyurea Correct Choice

E. Cyclosporine

The constellation of adverse effects is most closely associated with hydroxyurea

139) What drug can potentiate bone marrow suppression when used concomitantly with azathioprine?

A. Salicylates

B. NSAIDS

C. Sulfonamides

D. Allopurinol Correct Choice

45

Page 46: ETAS_MCQ_16 dermatological drugs

E. Phenytoin

Concomitant allopurinol use, which inhibits xanthine oxidase, can lead to excess toxic purine analogs via increased metabolism of azaithioprine via the HGPRT pathway, causing bone marrow suppression

140) What is the mechanism utilized by the co-administration of probenicid to raise blood levels of penicillins in patients with infections that require high blood levels?

A. Synergistic effect of probenicid with penicillins

B. Displacement of plasma proteins

C. Competitive inhibition of b-lactam binding sites

D. Inhibition of cytochrome P-450 hepatic biotransformation system

E. Prolongs the half-life of penicillins by decreasing renal tubular secretion Correct Choice

Probenicid is co-administered with penicillin to prolong its half-life through decreased renal tubular secretion when higher blood levels are warranted

141) Which of the following statements regarding the ocular toxicities of the antimalarial drugs is NOT true?

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

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

C. Premaculopathy associated with changes in visual fields without visual loss is reversible if the antimalarial is discontinued

D. The 4-aminoquinolones may have significant associated ocular toxicity

E. Risk of retinopathy is greatest for quinacrine, followed by chloroquineCorrect Choice

Risk of retinopathy is greatest with chloroquine and does not exist for quinacrine

142) Which of the following statements regarding podophyllin is NOT correct?

A. It arrests cells in telophaseCorrect Choice

B. It is derived from the May apple plant

C. It binds tubulin

D. None (all of these statements are true)

46

Page 47: ETAS_MCQ_16 dermatological drugs

E. It is contraindicated in pregnancy

Podophyllin is a crude cytotoxic extract from the May apple plant. It is antimitotic, arresting cells in metaphase (not telophase) by binding to the protein tubulin. It may be teratogenic and should not be used in pregnancy

143) Which cutaneous side effect is a common complication of nitrogen mustard therapy?

A. Telangiectasia

B. Allergic contact dermatitisCorrect Choice

C. Hyperpigmentation

D. Bullous drug eruption

E. Fixed drug eruption

Topical nitrogen mustard, or mechlorethamine, is an antineoplastic agent which works via alkylation thereby inhibiting DNA synthesis. Allergic contact dermatitis occurs in two-thirds of patients who are treated with topical nitrogen mustard in aqueous solution, but occurs in less than 5% of patients treated with the ointment based preparation

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

A. Transaminitis

B. Anaphylaxis

C. Generalized tonic-clonic seizures

D. Mononucleosis-like syndrome

E. Serum sickness reaction Correct Choice

The use of cefaclor has been associated with an increased incidence of serum sickness in children

145) Which of the following oral agents has been effective in the treatment of Norwegian scabies?

A. Metroniddazole

B. IvermectinCorrect Choice

C. Griseofulvin

D. Mebendazole

E. Thiabendazole

Ivermectin (Stromectol) is an anti-helminthic agent currently FDA-approved for the treatment of strongyloides and onchocerciasis. Several publications have reported efficacy of this agent in the

47

Page 48: ETAS_MCQ_16 dermatological drugs

treatment of scabies and head lice. Due to its low rate of adverse effects, its high rate of effectiveness, and its ease of administration, some authors consider this agent to be the treatment of choice for scabies and head lice. The mechanism of action of ivermectin is blockade of glutamate-gated, chloride ion channels, with adverse effects on nerve and muscle resulting in paralysis and death of the helminth or mite. The drug has a very low affinity for mammalian chloride channels resulting in its relatively low toxicity. Adverse effects are rare and have been associated with accidental 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 oral ivermectin therapy

146) Of the medications listed below, the safest to use during pregnancy is:

A. NSAIDS

B. Estrogens

C. Erythromycin estolate

D. Doxycycline

E. Penicillin Correct Choice

Erythromycin 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 and estrogens are category X. NSAIDS may promote persistent fetal circulation or oligohydramnios

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

A. Ketoconazole

B. Terfinafine

C. Itraconazole

D. GriseofulvinCorrect Choice

E. Fluconazole

Griseofulvin has been reported as a potential exacerbator of acute intermittent porphyria, and thus is contraindicated in patients with a history of porphyria

148) Which of the following statements regarding dapsone and sulfapyridine is true?

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

B. Dapsone hypersenstivity syndrome is characterized by lymphocytosis

C. They exert their anti-inflammatory actions by stimulating the myeloperoxidase activity of polymorphonuclear leukocytes

48

Page 49: ETAS_MCQ_16 dermatological drugs

D. None of these answers are correct (all are false)Correct Choice

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

None of the above statements are true. Dapsone and sulfapyridine exert their anti-inflammatory actions by inhibiting the myeloperoxidase activity and chemotactic abilities of polymorphonuclear leukocytes. Dapsone hypersenstivity syndrome is characterized by eosinophilia, as well as a severe mononucleosis-like reaction, including fever, erythroderma, hepatitis, and even death. Sulfapyridine has a similar but often less severe side effect profile. Cimetidine has been shown to provide some protection against methemoglobin formation

149) 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 iron

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

C. None of the above (all of the above statements are false)Correct Choice

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

E. Fluoroquinolone absorption is not altered by antacids

Antacids decrease the absorption of fluoroquinolones and should be taken at least 2 hours after the drug. Tetracycline absorption is impaired by the ingestion of dairy products, calcium, and iron or zinc salts. Minocycline and doxycycline absorption is not impaired by the ingestion of those products; they may be taken on an empty stomach or with food. Thus, all of the statements are false

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

A. Pseudomonas aeruginosa

B. Staphylococcus aureusCorrect Choice

C. Demodex folliculorum

D. Pityrosporum orbiculare

E. Streptococcus pyogenes

Staphylococcus aureus colonization tends to correlate with isotretinoin-induced reduction in sebum production and may lead to infections. This complication may possibly be prevented with pulsed intranasal mupirocen therapy. There has been a report of staphylococcus endocarditis in a patient with underlying aortic insufficiency

151) This retinoid targets RXR receptors:

A. Etretinate

49

Page 50: ETAS_MCQ_16 dermatological drugs

B. Isotretinoin

C. Tretinoin

D. Acitretin

E. BexaroteneCorrect Choice

Bexarotene targets RXR receptors. It is used in the treatment of mycosis fungoides refractory to conventional therapy. Side effects include central hypothyroidism and hyperlipidemia. These should be treated with synthroid, lipitor, and fenofibrate

152) Neutrophilic eccrine hidradenitis is a side effect of which therapeutic agent?

A. Interferon-alpha

B. Granulocyte colony stimulating factor

C. Cytarabine Correct Choice

D. Bieomycin

E. Intravenous immune globulin

Neutrophilic eccrine hidradenitis most commonly occurs in the setting of a patient with acute myelogenous leukemia being treated with cytarabine. Clinical manifestations include tender, erythematous macules, papuls and plaques on the trunk, neck and extremities which resolve within a few days. Histologically, this drug eruption is defined by the presence of dense neutrophilic infiltrate within and around eccrine glands, with necrosis of eccrine epithelial cells

153) Gray-green discoloration of the mid-portion of permanent teeth is a side effect of?

A. Doxycycline

B. Fluoroquinolones

C. Minocycline Correct Choice

D. Tetracycline

E. clindamycin

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

154) Side effects of PUVA include all of the following except:

A. Headache

50

Page 51: ETAS_MCQ_16 dermatological drugs

B. Nausea

C. Pruritus

D. NeutropeniaCorrect Choice

E. Insomnia

Side effects of psoralen with ultraviolet A light (PUVA) include side effects which are due to phototoxic effects including pruritus, photoonycholysis, friction blisters, ankle edema and hypertrichosis. In addition, there are adverse effects from methoxypsoralen including gastrointestinal and neurologic effects, hepatotoxicity and exanthems. Neutropenia is not a described side effect of PUVA

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

A. Adrenal crisisCorrect Choice

B. Glaucoma

C. Aseptic bone necrosis

D. Cataracts

E. Osteoporosis

Long-term therapy with oral corticosteroids can result in numerous adverse effects, including elevated risks of glaucoma, cataracts, hypertension, diabetes, osteoporosis, adrenal axis suppression, and aseptic bone necrosis. Alternate-day dosing or oral corticosteroids lowers the rate of adrenal axis suppression. It is hypothesized that during the off day, cell mediated immunity, white blood cells subset levels, and potassium excretion are normalized while the anti-inflammatory benefits of the drug persist. Alternate-day corticosteroid therapy should be employed once adequate disease control has been attained with daily dosing. Of note, the risk of cataracts, osteoporosis, and other adverse effects of long-term corticosteroid use are not minimized with alternate-day dosing

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

A. Trimethoprim-sulfamethoxazole

B. Azaithioprine

C. Bleomycin

D. Acyclovir

E. Foscarnet Correct Choice

None

157) Which of the following biologic agents is pregnancy category C?

51

Page 52: ETAS_MCQ_16 dermatological drugs

A. All of these answers are correct

B. Etanercept

C. Alefacept

D. Infliximab

E. EfalizumabCorrect Choice

Efalizumab is pregnancy category C. The other drugs listed are pregnancy category B

158) 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 Choice

B. Tetracyclines

C. Salicylates

D. NSAIDs

E. Phenothiazines

Tetracyclines, phenytoin, phenothiazines, chloramphenicol, NSAIDs, salicylates, and sulfonamides, among other drugs, can all increase methotrexate levels by displacement of plasma proteins

159) What is the best medication to lower isotretinoin induced hypertriglyceridemia?

A. Cholestyramine

B. GemfibrozilCorrect Choice

C. All are equally effective

D. Simvastatin

E. Niacin

Gemfibrozil generally reduces trygliceride levels to a greater extent than niacin, cholestyramine, and the HMG-CoA reductase inhibitors

160) Keratinocyte differentiation is enhanced by retinoids with all of the following EXCEPT:

A. Increased keratohyalin granules

B. Increased filaggrin production

52

Page 53: ETAS_MCQ_16 dermatological drugs

C. Stimulation of ornithine decarboxylaseCorrect Choice

D. Odland body secretion of lipids

E. Increased keratin filaments

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

161) Which member of the tetracycline family is most likely to have caused this photomediated reaction?

A. Doxycycline

B. Oxytetracycline

C. Minocycline

D. DemeclocyclineCorrect Choice

E. Tetracycline

The tetracycline family of antibiotics are bacteriostatic and act by inhibiting protein synthesis. Each member of the family may cause photosensitivity, but demeclocycline is the most photosensitizing

162) The treatment of choice for erythema nodosum leprosum (ENL) is:

A. Rifampin and clofazamine

B. Clofazamine

C. Rifampin

D. Thalidomide Correct Choice

E. Isoniazid, rifampin and clofazamine

NEEDS EXPLANATIONS

163) The laboratory abnormality most associated with cyclosporine is:

A. Hyperkalemia Correct Choice

B. Hypermagnesemia

C. Hypouricemia

D. Increased LDH

53

Page 54: ETAS_MCQ_16 dermatological drugs

E. Hyponatremia

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

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

A. Tetracycline

B. NSAIDs Correct Choice

C. Systemic retinoids

D. Folic acid

E. Acetaminophen

Drugs that simultaneously inhibit the folate metabolic pathway, such as NSAIDS, dapsone, or trimethoprim-sulfamethoxazole, can increase hematologic toxicity when combined with methotrexate

165) What is the treatment of choice for CMV retinitis?

A. Ganciclovir

B. Combovir

C. FoscarnetCorrect Choice

D. Cidofovir

E. Acyclovir

Foscarnet is indicated for the treatment of CMV retinitis and acyclovir resistant HSV, both of which can been seen in HIV patients. Foscarnet acts by inhibiting viral specific DNA polymerase. Unlike acyclovir, it does not require activation by thymidine kinase. Nephrotoxicity and seizures are major side effects

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

A. Tetracycline

B. Sulfonamides

C. Naproxen

D. Phenolphthalein

54

Page 55: ETAS_MCQ_16 dermatological drugs

E. PseudoephedrineCorrect Choice

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

167) Which drug is the most likely to cause these changes in the gingiva?

A. Doxycycline

B. Acitretin

C. Methotrexate

D. CyclosporineCorrect Choice

E. Cephalexin

Gingival 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 into the cells which enhances the function of fibroblasts

168) The anti-CD 20 antibody rituximab is FDA-approved for treatment of which of the following?

A. Paraneoplastic pemphigus

B. Mycosis fungoids

C. Non-Hodgkin’s lymphomaCorrect Choice

D. Psoriasis

E. Metastatic melanoma

Rituximab (brand name Rituxan) is a monoclonal antibody is approved for the treatment of CD20 non-Hodgkin’s lymphoma. Rituximab is a monoclonal antibody directed against B lymphocytes which are CD20.

169) The combination of doxorubicin and which medications has been reported to cause sticky skin?

A. Amphotercin

B. G-CSF

C. Vancomycin

D. Cisplatin

E. KetoconazoleCorrect Choice

55

Page 56: ETAS_MCQ_16 dermatological drugs

Polsen et. al. reported a 29% incidence of sticky skin in patients treated with high dose ketoconazole and doxorubicin for prostate cancer. Other medications reported to cause this include etretinate and tretinoin.

Polsen JA, Cohen PR, Sella: Acquired cutaneous adherence in patients with androgen-independent prostate cancer receiving ketoconazole and doxorubicin: medication-induced sticky skin. J Am Acad Dermatol: 32 (4):571-5 1995

170) Which of the following cytotoxic agents has been associated with poikiloderma of the dorsal hands with a band-like distribution of the fingers and toes?

A. Intralesional bleomycin

B. HydroxyureaCorrect Choice

C. Azathioprine

D. Doxorubicin

E. Flurouracil

Hydroxyurea has been associated with poikiloderma of the dorsal hands with a band-like distribution of the fingers and toes. It has also been associated with diffuse hyperpigmentation, and with leg ulcers upon withdrawal

171) If a patient develops a dilantin hypersensitivity reaction, which anticonvulsant is the better alternative therapy?

A. Phenobarbital

B. None of these answers are correct

C. Valproic acid Correct Choice

D. Phenytoin

E. Carbamezapine

Carbamezapine, phenytoin, and phenobarbital are known to cross-react with one another

172) Hemorrhagic cystitis is a risk of what chemotherapy?

A. Chlorambucil

B. Hydroxyurea

C. Vinca alkaloids

D. Cyclophosphamide Correct Choice

56

Page 57: ETAS_MCQ_16 dermatological drugs

E. Azaithioprine

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

173) All of the following are true regarding water-soluble retinoids EXCEPT:

A. They include bexarotene

B. They include etretinateCorrect Choice

C. They include isotretinoin

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

E. They have very little lipid deposition

Isotretinoin, acitretin, and bexarotene are water-soluble, with very little lipid deposition. Etretinate is 50 times more lipophilic than acitretin, with increased storage in adipose tissue

The anti-HIV medication best known for causing a severe reaction which can result in fatality upon rechallenge is:

A. Zidovudine

B. Indinavir

C. Nevirapine

D. Abacavir Correct Choice

E. Didanosine

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

57