CMEexamination Identification No. 890-110

Instructions for Category I CME credit appear in the front advertising seetior.. Seelast page of Contents for page number,

Questions 1-33,Rothe MJ, Nowak M, Kerdel FA. J AM ACAD DERMATOL 1990;23:615-24.

Directions for questions 1-19: Give single bestresponse.

1. Which of the following is presentin all mast cellsbe­fore degranulation?a. Heparinb. Histaminec. Chondroitin sulfate Ed. Chymasee. Iodine

2. Which of the following is present in large numbersinmast cells of both connective tissue and mucosaltypes?a. IgE Fe receptorsb. Interleukin (IL) 1 receptorsc. Interleukin (IL) 2 receptorsd. Desmosomese. Intercellular gap junctions

3. Immunologic activation of mast cells requiresa. bindingof antigen to an IgE molecule, whichthen

binds to the mast cell surfaceb. bindingof an IgE molecule to themast cell surface

followed by binding to antigenc. binding of an antigen first to an IgM molecule,

then to an IgE molecule on the mast cell sur­face

d. bindingofan antigenfirst to anIgG molecule, thento an IgE molecule on the mast cell surface

e. binding of two IgE molecules on the mast cellsur­face

4. In " transgranulation,"a. mast cellsdevelop specialized cell-to-cell contacts

with fibroblastsor endothelialcells, allowing themto transfer their granules

b. mast cells of the connective tissue type developspecializedcell-to-cell contacts with mast cellsofthe mucosal type, allowingthem to transfer theirgranules

c. mast cell granules containing heparin and hista­mine become altered and contain predominantlychondroitin sulfate E

d. mast cellgranulescontainingpredominantlychon­droitin sulfate E, noheparin, andsmall amountsofhistamine become altered to contain heparin andlarge amounts of histamine

e. mast cell granules are extended one at a timethrough the plasma membrane into the extracel­lular environment

5. Mast cells are best recognized for causingcutaneous

a. type I hypersensitivity reactionb. typeII hypersensitivity reactionc. typeIII hypersensitivity reactiond. type IV hypersensitivity reactione. typeV hypersensitivity reaction

6. The role of H3 receptors in the central nervous sys­tem is thought to be (a)a. decrease in lymphotoxicityb. decrease in neutrophil chemotoxinsc. decrease in eosinophil chemotoxinsd. control of histamine formation and releasee. control of IgE-mediated basophil histamine re­

lease7. The participation of mast cells in allergic contact

dermatitis is thought to be dependent ona. basophilsb. eosinophilsc. T lymphocytesd. B lymphocytese. macrophages

8. Separation of the dermoepidermal attachment inbullous pemphigoid isthought to becaused by prod­ucts derived froma. serumb. lymphocytese. mast cellsd. neutrophils and eosinophilse. macrophages

9. Mast cell numbers in lesions of psoriasis have beenshown to decrease after treatment witha. PUVAb. corticosteroidsc. anthralind. PCryA or anthralin, but not corticosteroidse. corticosteroids or PUVA, but not anthralin

10. Mast cells are often found, sometimesin large num­bers, in cases ofa. dermatofibromab. neurofibromac. dermatofibrosarcoma protuberansd. neurothekeomae. Kaposi's sarcoma

11. Which of the following binds strongly to heparin?a. IL-3b. IL-4c. Fibroblast growth factord. Tumor necrosis factore. Platelet activating factor

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626 CME examination

12. Each of the following statements regarding keloids iscorrect excepta. keloids contain increased numbers of mast cellsb. mast cell numbers are significantly greater in hy­

pertrophic scars than in granulation tissue or ma­ture scars

c. mast cell numbers are reduced in hypertrophicscars after treatment with mechanical pressure

d. fibroblasts from keloids show a greater response(mitogenesis) to histamine in vitro than fibroblastsfrom normal human skin

e. patients with hypertrophic scars and keloidshavea significantly increased tendency to allergy

13. Each of the followingis characteristicof changesseenin the tight skin (TSK) mouse model for sclerodermaexcepta. cutaneous indurationb. dermal hypertrophyc. subcutaneous fibrosisd. loss of appendagese. firm anchorage of subcutaneous tissue to deeper

tissue

14. The endothelial cytotoxicity in scleroderma may bedue to the action ofa. IL-3b. IL-4c. mast cell-derived proteasesd. mast cell-derived histaminee. mast cell-derived heparin

15. Each of the following changes is characteristic ofscleroderma excepta. the presence of autoantibodiesb. increased T lymphocytes in the dermal infiltratec. increased T lymphocytes in the peripheral bloodd. endothelial cell cytotoxicitye. increased collagen synthesis

16. Each of the following is a consistent finding ineosinophilic fasciitis excepta. rapidly progressive edemab. subsequent induration of involved areas (after a)c. tissue eosinophiliad. peripheral blood eosinophiliae. involvement of the subcutaneous tissues of the ex­

tremities

17. Fibrosis, in systemic mastocytosis, is least likely to befound in thea. skinb. kidneyc. liverd. spleene. heart

18. Pruritus associated with increased numbers of de­rived mast cells in patients with polycythemia verahas been found to be relieved by

Journal of theAmerican Academy of

Dermatology

a. HI antagonistsb. H2 antagonistsc. aspirind. HI and H2 antagonists, but not aspirine. H2 antagonists and aspirin, but not HI antagonists

19. The pruritus associated with increased numbers ofdermal mast cellsin patients with polycythemia verais thought to be due, at least in part, to release ofmast cella. histamineb. heparinc. prostaglandinsd. fibroblast growth factore. tumor necrosis factor

Directions for questions 20-24: Select the onelettered item that is most closely related to eachnumbered item.

a. Reserpineb. Disodium cromoglycatec. Protamined. Corticosteroidse. Compound 48/80

20. Heparin antagonist

21. Inhibitor of mast cell degranulation

22. Promoter of mast cell degranulation

23. Reduces number of mast cells in cases of urticariapigmentosa

24. Inhibits effects of T-cell function in delayed type hy­persensitivity

Directionsfor questions 25-29: For each numbereditem choose the appropriate lettered item.

a. HI receptorb. H2 receptorc. Bothd. Neither

25. Stimulated by histamine

26. Stimulation leads to venular permeability

27. Stimulation leads to neutrophil chemotaxis

28. Stimulation leads to eosinophil chemotaxis29. Stimulation leads to increased T-cell suppression

function

Directions for questions 30-33: Indicate correctanswers. All, some, or none of the choices may becorrect.30. Which of the following statements is (are) true of in­

teractions between mast cells and other cell types?a. Fibroblasts influence synthesis of mast cell gran­

ulesb. Fibroblasts influence mast cell degranulationc. Mast cell mediators can stimulate fibroblast mi­

togenesis

Volume 23Number 4, Part IOctober 1990

d. Mast cellmediatorscan stimulate fibroblast syn­thetic activity

e. T-cell-dependent growth, differentiation and de­granulation of mast cells have been observed

31. Increased numbers of mast cells havebeenreportedin lesions ofa. sclerodermab. porphyria cutanea tardac. eosinophilic fasciitisd. chronicgraft-versus-host diseasee. hypertrophic scars

32. Secretion products of mast cells includea. a tumor necrosis factor-like substanceb. platelet activatingfactor

CME examination 627

c. products chemotacticfor eosinophils and neutro­phils

d. smooth muscle-contracting and vasoactive sub­stances

e. proteoglycans33. Theincreasednumbers of mast cellsin activelesions

ofpsoriasis are reduced to normal levels by treatmentwitha. heparinb. aspirinc. PUVAd. anthraline. corticosteroids