CME examination Identification No, 888-107

Instructions for Category 1 CME credit appear in the front advertising section. See last page of Contents for page number.

Questions 1-33, Feingold K_R, Elias PM. J AM ACAO DERMA'rOL 1988;19:1-20.

Directions for questions 1-14." Give single best response.

1. The chief manifestation of adrenal insufficiency is a. hair loss b. fibrosis and calcification of cartilage of the

external ear c. vitiligo d. mucocutaneous eandidiasis e. hyperpigmentation

2. The chief cutaneous manifestation of a pheochro- mocytoma is a. neurofibromas b. sweating c. facial flushing d. mucosal neuromas e. acanthosis nigricans

3. A patient, who 12 years previously had undergone bilateral adrenalectomies for the treatment of Cushing's disease, when first seen by you, has recent onset of hyperpigmentation. The most likely diagnosis is a. recurrent Cushing's disease b. aeromegaly c. Nelson's syndrome d. multiple endocrine neoplasia, type I e. lung cancer

4. A patient with the earcinoid syndrome develops a hyperkeratotic rash with scaling and pigmentation in a sun-exposed area. The most likely cause of this lesion is a. niacin deficiency b. excess histamine c. excess serotonin d. excess bradyldnin e. local metastases

5. The most common cutaneous lesion associated with polyglandular autoimmune syndrome, type I is a. acanthosis nigricans b. xanthomas c. vitiligo d. chronic mucocutaneous eandidiasis e. alopecia

6. The most sensitive sign of increased androgen levels is a. increased hair b. increased muscle mass

c. menstrual disturbances d. increased sweating e. flushing

7. The most common endocrine abnormality associat- ed with the polyneuropathy, organomegaly, endo- crinopathy, M protein, and constant skin involve- ment (POEMS) syndrome is a. acromegaly b. hyperparathyroidism c. pheoehromocytoma d. gonadal failure e. adrenal insufficiency

8. All of the following differentiate "steroid acne" from typical acne vulgaris, except a. absence of acne comedones b. less involvement of the face c. poor response to antibiotics d. lesions all in the same stage of development e. poor response to topical isotretinoin

9. A patient with Addison's disease and vitiligo is most likely to have which of the following endocrinologic disorders? a. Hypoparathyroidism b. Hyperparathyroidism c. Diabetes insipidus d. Diabetes mellitus e. Pheochromocytoma

10. A patient with a medullary carcinoma of the thyroid and pheochromocytoma is most likely to have which of the following cutaneous lesions? a. Mucosal neuromas b. Epidermolysis buUosa acquisita c. Alopecia d. Chronic mucocutaneous candidiasis e. Vitiligo

11. Elevated plasma triglyceride levels are most likely to produce which of the following? a. Eruptive xanthomas b. Tendinous xanthomas c. Tuberous xanthomas d. Planar xanthomas e. Xanthelasma

12. Partial 21-hydroxylase deficiency is especially com- mon in a. Scandinavians b. Jews of European descent

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22 C M E examination Journal of the

American Academy of Dermatology

c. Blacks d. Orientals e. individuals of Mediterranean region descent

13. A characteristic fine wrinkling of skin around the eyes and lips is observed in older men with a. Cushing's syndrome b. acromegaly c. Addison's disease d. androgen deficiency e. estrogen deficiency

14. Of the following, the cancer most commonly found in association with acanthosis nigricans is that of the a. liver b. lung c. kidney d. stomach e. thyroid gland

Directions for questions 15-33: Indicate correct answers. All, some, or none of the choices may be correct.

15. Cushing's syndrome is associated with a. increased pigmentation b. osteoporosis c. plethoric facies d. thickening of the epidermis e. purpura

16. Androgen deficiency is associated with a. vasomotor phenomena b. acne vulgaris c. male pattern baldness d. pallor of the skin e. tendinous xanthomas

17. Acanthosis nigricans is associated with a. gastric cancer b. acromegaly c. polycystic ovarian disease d. obesity e. Cushing's syndrome

18. Eruptive xanthomas are associated with a. oral contraceptives b. adrenal insufficiency c. androgen deficiency d. poorly controiled diabetes me]titus e. hyperthyroidism

19. Multiple endocrine neoplasia syndrome, type I includes a. pheochromocytomas b. islet cell tumors c. cardiac myxomas

d. multiple lipomas e. pituitary tumors

20. The POEMS syndrome includes a. myxomas b. hyperpigmentation c. blue nevi d. thickening of the skin e. parathyroid tumors

21. The systemic absorption of steroids is enhanced if (they are) a. the skin barrier is disturbed by disease b. occlusive wraps are applied r applied to the scrotal region d. applied to the hands e. applied intensively to a small area

22. Multiple endocrine neoplasia, type III, syndrome includes a. pituitary tumors b. pheochromocytomas c. neurofibromatosis d. hyperparathyroidism e. multiple mucosal neuromas

23. The carcinoid syndrome is associated with a. diarrhea b. flushing c. cardiac disease d. vitiligo e. hyperkeratosis

24. Androgen excess in women can cause a. vasomotor phenomena b. xanthomas c. menstrual disturbances d. palmar erythema e. ache vulgaris

25. Polyglandular autoimmune failure, type II, may be associated with a. chronic mucocutaneous candidiasis b, Addison's disease c. thyroid disease d. diabetes mellitus e, hyperparathyroidism

26, Tendinous xanthomas are associated with a. acromegaly b. oral contraceptives c. pheochromocytomas d. Cushing's syndrome e. hypothyroidism

2]. Hirsutism is associated with a. hyperparathyroidism b. Cushing's syndrome c. acromegaly

Volume 19 Number 1, Part 1 July 1988

CME examination 23

d. hypothyroidism e. hyperthyroidism

28, Estrogen excess is associated with a. palmar erythema b. vitiligo c. gynecomastia d. hyperkeratosis e. spider angiomas

29. Cushing's syndrome is associated with a. acne b. purplish mottling of the lower extremities c. cutaneous fungal infections d. facial telangiectasis e. fibrosis and calcification of the external aspect

of the ear

30. Pregnancy is associated with a. vitiligo b. skin tags c. acne d. palmar erythema e. melasma

31. Eruptive xanthomas (are)

32.

33.

a. usually asymptomatic b, disappear slowly c. located on extensor surfaces d. enlarge slowly e. associated with xanthelasma

A patient is noted to have cutaneous myxomas, spotty mucocutaneous pigmentation, and multiple cardiac myxomas. Endocrinologic disorders associ- ated with these abnormalities include a, testicular tumors b, Cushing's syndrome c. acromegaly d. hypothyroidism e. hypcrparathyroidism

Congenital adrenal hyperplasia (is) a. invariably causes symptoms in childhood b. associated with increased plasma 17-OH proges-

terone levels c. associated with reduced 5-o~-reductase activity d. the cause of hirsutism in 50% of cases e. can be treated with glucocorticoid replacement