photodermatology mcqs

Most fluorescent UV sources are: 1 High pressure xenon arc lamps

2 Low pressure xenon arc lamps

3 Low pressure argon lamps

4 High pressure tungsten lamps

5 Low pressure mercury vapor lamps

Q/Q(M)-474674 Report a ProblemMost fluorescent UV sources are:

5 Low pressure mercury vapor lamps

The mercury vapor in the fluorescent bulbs is excited by electric current. Then the mercury emits radiation at 254 nm. This radiation is absorbed by the phosphor lining the bulb.

Q/Q(M)-474674 Report a Problem

A MED phototest should be read at:

1 2 hours

2 24 hours

3 48 hours

4 12 hours

5 96 hours


A MED phototest should be read at:

2 24 hours

MED testing should be read 24 hours after delivery of the doses. An additional reading at 15 minutes is important when solar urticaria is a consideration.


What is the wavelength of a Wood's light? 1 290nm

2 311nm

3 330nm

4 365nm

5 410nm


What is the wavelength of a Wood's light? 4 365nm

A Wood's light emits ultaviolet light at a wavelenth of 365nm and is produce by bassing light through a Wood's filter which is composed of nickel oxide containing glass.


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All of the following are true about UVA radiation except: 1 10 times more abundant than UVB

2 penetrates to a greater depth in the dermis than UVB

3 responsible for phototoxic drug reactions

4 approximately 50% of exposure occurs in the shade

5 virtually all blocked by car window glass


All of the following are true about UVA radiation except:

5 virtually all blocked by car window glass

The UVA band extends from 320 to 400 nm. This spectrum is further subdivided into UVA-2 (320 to 340 nm) and UVA-1 (340 to 400 nm). The UVA spectrum is recognized as a cause of immediate and delayed tanning reaction of skin, and several other effects including photoaging, skin photosensitization, and immunosuppression. The majority of the ultraviolet radiation at the earth's surface is UVA (95 to 98%) with only 2 to 5% comprised of UVB. As UVC is completely absorbed by the stratospheric ozone layer, it does not comprise ultraviolet radiation hitting the earth's surface. Much of the UV radiation after reaching the atmosphere becomes scattered by the time it hits the earth's surface. Due to this "sky radiation", it is possible to sunburn even if one is exposed only to the shade. Notably, window glass filters out ultraviolet wavelengths shorter than 320 nm, so only UVB (290 to 320 nm) and UVC (200 to 290 nm) are effectively filtered by car window glass. Although UVA penetrates deeper into the dermis than UVB, UVB radiation is much more erythmogenic. Finally, most common photosensitizers have action spectrums in the UVA range, and, as a result, UVA radiation is responsible for most phototoxic drug reactions.


A watt is a measurement of:

1 Power

2 Fluence

3 Energy

4 Heat

5 Distance


A watt is a measurement of:

1 Power

A watt is a measurement of power or irradiance of a UV source. Fluence and energy is measured in joules. These are related by the formula Joules/cm2=Watts/cm2xseconds.


Which of the following statements regarding hereditary PMLE of Native Americans is true? 1 It will remit in puberty

2 Specific HLA types predominate in Native Americans

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3 5-10% of patients have a family history of this eruption

4 Cheilits and conjunctivitis are uncommon

5 Patients have an urticarial erupion.


Which of the following statements regarding hereditary PMLE of Native Americans is true?

2 Specific HLA types predominate in Native Americans

Native Americans have a high rate of PMLE and there is some evidence of a genetic predisposition. It tends to have a specific HLA predominance, continues through adulthood, and commonly presents as a papular, excoriated, eczematous dermatitis predominantly on the face. Cheilitis and conjunctivitis are common. Up to 75% of patients have a positive family history.


The active spectrum for cutaneous vitamin D3 synthesis is: 1 220-290nm

2 290-320nm

3 320-400nm

4 400-410nm

5 Both First and Second Choice


The active spectrum for cutaneous vitamin D3 synthesis is:

5 Both First and Second Choice

The source states that vitamin D3 synthesis occurs at wavelengths < 320 making choices 220-290nm and 290-320nm correct.


Treatment of this condition might include: 1 Azathioprine

2 Cytoxan

3 Cyclosporin

4 Antimalarials

5 All of these answers are correct


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Treatment of this condition might include: 4 Antimalarials

Sun avoidance, sunblocks, protective clothing, and topical steroids are sufficient for most patients with PMLE. Other patients may require hardening with UVB or PUVA. Rare patients require antimalarials.


The best location for phototesting patients suspected of photosensitivity is: 1 Affected skin of the buttock

2 Unaffected skin of the lower back

3 Affected skin of the ventral forearm

4 Unaffected skin of the upper back

5 Unaffected skin of the outer thighs


The best location for phototesting patients suspected of photosensitivity is:

2 Unaffected skin of the lower back

Patients with suspected photosensitivity can be tested on unaffected skin of the buttocks, lower back or ventral forearm. Effected skin should not be used for testing.


A patient presents with signs of porphyria cutanea tarda. Porphyrin screens are negative. Which of the following medications on the patient's medication list is your top choice for discontinuation? 1 Naproxen

2 Fenofibrate

3 Enalapril

4 Chloroquine

5 Multivitamin


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A patient presents with signs of porphyria cutanea tarda. Porphyrin screens are negative. Which of the following medications on the patient's medication list is your top choice for discontinuation?

1 Naproxen

NSAIDs are a frequent offender in causing pseudoporphyria. The other listed medications are not frequent causes of this type of skin reaction.


Which of the following statements is correct regarding antigen presenting cells after UVR exposure?

1 Have increased ability to prime UV-irradiated mice to subcutaneously injected hapten

2UV-irradiated mice have normal antigen presentation, allowing a normal delayed-type hypersensitivity response

3 There is a decrease in the number of antigen presenting cells

4 APC's have increased ability to prime UV-irradiated mice to subcutaneously injected protein

5 APC's have increased ability to prime UV-irradiated mice to applied contact-sensitizing agents

Q/Q(M)-478243 Report a ProblemWhich of the following statements is correct regarding antigen presenting cells after UVR exposure?

3 There is a decrease in the number of antigen presenting cells

APC's have depressed ability to prime UV-irradiated mice to subcutaneously injected hapten or protein and to applied contact-sensitizing agents. UV-irradiated mice have defective antigen presentation, preventing a normal delayed-type hypersensitivity response. There is a REDUCTION in number of antigen presenting cells.


Treatment of polymorphous light eruption includes all of the following EXCEPT: 1 Topical steroids

2 Antimalarials

3 PUVA therapy

4 Systemic corticosteroids

5 None of these answers are correct


Treatment of polymorphous light eruption includes all of the following EXCEPT:


Most patients with PMLE have mild disease that can be treated by sun avoidance and sun protection. Topical steroids can be used to treat clinical lesions. For severe cases, hardening and desensitization can be accomplished with UVB, UVB plus UVA, or PUVA. Antimalarials can be used for resistant cases. A short course of prednisone (20-40 mg) is effective for brief, sunny vacations.


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A patient presents with erythematous pruritic papules on exposed areas that appear in the spring. They appear between 2 hours and 2 days after exposure. Which of the following statements is NOT correct?

1 This is an idiopathic disease that appears in the first three decades of life

2 It is more common in fair-skinned females

3 The pathogenesis is unclear, but may be related to type IV hypersensitivity reactions

4 The diagnosis described above is solar urticaria

5 Vesicles and eczematous dermatitis is uncommon


A patient presents with erythematous pruritic papules on exposed areas that appear in the spring. They appear between 2 hours and 2 days after exposure. Which of the following statements is NOT correct? 4 The diagnosis described above is solar urticaria

The diagnosis described above is polymorphous light eruption. The time to development of lesions is important in distinguishing between PMLE and solar urticaria. Solar urticaria usually develops 10-30 minutes after UVR exposure.


The most helpful phototest to document this photosensitivity disorder would be: 1 Repeated doses of UVA and UVB

2 MEDBB

3 MEDNB

4 Photopatch tests



The most helpful phototest to document this photosensitivity disorder would be: 1 Repeated doses of UVA and UVB

Repeated doses of ultraviolet radiation can sometimes elicit lesions of PMLE. More patients react to UVA radiation than to UVB radiation.


Most bulbs used for PUVA have a peak output predominantly in the following range: 1 290 nm � 320 nm

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2 320 nm � 340 nm

3 340 nm � 400 nm

4 350 nm � 360 nm

5 390 nm � 410 nm


Most bulbs used for PUVA have a peak output predominantly in the following range: 4 350 nm � 360 nm

The UVA emitted by these bulbs is absorbed by psoralens, causing covalent bonding of psoralens to DNA.


A common cause of medication induced photoallergy is:

1 Psoralens

2 Acitretin

3 Ibuprofen

4 Naproxen

5 Piroxicam


A common cause of medication induced photoallergy is:

5 Piroxicam

All of the listed medications are causes of photosensitivity, but only piroxicam is a cause of photoallergy.


Oxsoralen plus UVA results in the following except: 1 Forms monofunctional adducts

2 Binds to purine bases

3 Can form DNA crosslinks

4 Suppresses DNA synthesis

5 Has immunomodulating effects


Oxsoralen plus UVA results in the following except:

2 Binds to purine bases

Oxsoralen, in the presence of UVA, forms covalent bonds to pyrimidine bases on DNA. Q/Q(M)-474694 Report a Problem

Ultraviolet radition has been shown to do all of the following in in vitro and in vivo studies EXCEPT: 1 Alter the ability of antigen-presenting cells to present antigen

2 Suppress the induction of delayed-type hypersensitivity

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3 Increase circulating levels of IL-6

4 Decrease circulating levels of IL-1

5 Induce suppressor T-cells


Ultraviolet radition has been shown to do all of the following in in vitro and in vivo studies EXCEPT: 4 Decrease circulating levels of IL-1

UV-irradiated mice have been shown to have defective antigen presentation and a decreased number of antigen-presenting cells, which prevents a normal delayed-type hypersensitivity response. UVR causes the release of immunosuppressive factors, with induction of suppressor T-cells and increases in circulating levels of cytokines, including IL-1, IL-6, and TNF.


This middle-aged man demonstrates infiltrated, dusky plaques on all sun-exposed areas. The most likely diagnosis is:

1 PMLE

2 CAD

3 Actinic prurigo

4 Drug photosensitivity

5 Photoallergic contact dermatitis


This middle-aged man demonstrates infiltrated, dusky plaques on all sun-exposed areas. The most likely diagnosis is: 2 CAD

The thick, infiltrated plaques on sun-exposed areas are typical of the actinic reticuloid variety of CAD. Q/Q(M)-474955 Report a Problem

The most common cause(s) of topical phototoxicity today in the United States is(are):

1 Psoralens

2 Halogenated salicylanilides

3 Musk ambrette

4 6-methyl-coumarin

5 PABA and non-PABA sunscreen ingredients


The most common cause(s) of topical phototoxicity today in the United States is(are):

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1 Psoralens

Topical phototoxicity is most commonly caused by psoralens. Topical 8-methoxypsoralen is used therapeutically to treated psoriasis, localized vitiligo, and hand/foot eczema. Psoralens in certain plants, fruits, and vegetables can produce phytophotodermatitis. Topical photoallergy has in the past been caused by halogenated salicylanilides, as well as musk ambrette and 6-methyl-coumarin in fragrances. These compounds produced photoallergic contact dermatitis, and have been removed from marketed products. PABA, its esters, and non-PABA sunscreen ingredients are the most common causes of topical photoallergy, not topical phototoxicity


In solar urticaria wheals may be brought on by: 1 UVA

2 UVB

3 UVC

4 Visible light

5 UVA, UVB and Visible light


In solar urticaria wheals may be brought on by: 5 UVA, UVB and Visible light

Some patients react to visible light or UVA or UVB. Others react to combinations of visible light, UVA, and UVB.


The portion of the electromagnetic spectrum that produces a particular biologic effect is known as the:

1 Absorption spectrum

2 Action spectrum

3 Photobiologic spectrum

4 Minimal erythema dose

5 Active spectrum


The portion of the electromagnetic spectrum that produces a particular biologic effect is known as the: 2 Action spectrum

The action spectrum is the portion of the electromagnetic spectrum that products a particular biologic effect (e.g. erythema, delayed tanning). The absorption spectrum is the portion of the electromagnetic spectrum that is absorbed by a particular absorbing molecule, or chromophore. The minimal erythema dose is the dose of UV radiatino that produces barely perceptible erythema during phototesting.


This disease can be brought on by:

1 Visible light

2 UVA II

3 UVA I

4 UVB

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This disease can be brought on by: 5 All of these answers are correct

Solar urticaria can be brought on by UVB or UVA or visible light or combinations of those wavelengths.


A patient with a personal and family history of multiple fibrofolliculomas may have: 1 Birt-Hogg-Dube syndrome

2 Basal cell nevus syndrome

3 Muir-Torre syndrome

4 Gardner's syndrome

5 Tuberous sclerosis


A patient with a personal and family history of multiple fibrofolliculomas may have: 1 Birt-Hogg-Dube syndrome

Fibrofolliculomas are small, benign, yellow or flesh colored papules that are usually inherited in an autosomal dominant fashion and have a predilection for the face, neck and upper trunk. Birt-Hogg-Dube syndrome is an autosomal dominant condition characterized by multiple fibrofolliculomas, trichodiscomas, acrochordons, collagenomas. This condition is important to recognize due to its association with renal cell carcinoma. In addition, lung cysts and bullous emphysema are also features of the condition with spontaneous pneumothorax being a potential complication. Muir-Torre syndrome is an autosomal dominant condition caused by a defect in hMSH2 gene. This condition is associated with sebaceous neoplasms including sebaceous carcinoma, sebaceous hyperplasia, sebaceous epithelioma, sebaceous adenoma as well as keratoacanthomas. These can be markers for underlying malignancy in this condition; notably adenocarcinoma of the colon, breast, urinary tract, lung and endometrium. Gardner syndrome is an autosomal dominant condition caused by a defect in the APC familial adenomatous polyposis gene in which patients have multiple hamartomatous polyps of the colon with a high rate of malignant transformation. Cutaneous clues to the diagnosis include multiple epidermoid cysts, fibromas, and desmoid tumors. Other manifestations include osteomas, supernumary teeth, and congential hypertrophy of the retinal pigment epithelium. Tuberous sclerosis, (TS),also known as Bourneville's syndrome is caused by defects in hamartin and tuberin, found on chromosome 9 and 16, respectively. Patients with TS are at increased risk of muliple neoplasms including retinal hamartomas, angiomyolipomas, and cardiac rhabdomyomas. Cutaneous manifestations include ash-leaf macules, shagreen patchs, café-au-lait macules, confetti macules, facial angiofibromas, and periungual

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fibromas. As the name implies, basal cell nevus syndrome is associated with multiple basal cell carcinomas. In addition palmoplantar pitting, multiple milia and epidermoid cysts are seen. It is autosomal dominantly inherited and caused by a defect in the patched gene.


Narrowband UVB bulbs emit predominantly at: 1 290-320 nm

2 311 nm

3 352 nm

4 305 nm

5 360 nm


Narrowband UVB bulbs emit predominantly at:

2 311 nm

Narrowband UVB (311-312 nm) is more effective than broadband UVB for psoriasis, vitiligo, and other skin disorders.


UVB acts on what compound to form pre-Vitamin D3 ? 1 5-dehydrocholesterol

2 9-hydrocholesterol

3 7-deoxycholesterol

4 7-dehydrocholesterol

5 DNA


UVB acts on what compound to form pre-Vitamin D3 ? 4 7-dehydrocholesterol

UVB converts 7-dehydrocholesterol in the skin to pre-Vitamin D3, which then thermally isomerizes to form Vitamin D3.


Blue-gray pigmentation of the lunulae: 1 Can be seen in patients on amiodarone

2 Occurs only after many years of treatment with chlorpromazine

3 Is seen in argyria and not in most medication photosensitivities

4 Is a rare side effect of treatment with tricyclic antidepressants



Blue-gray pigmentation of the lunulae: 3 Is seen in argyria and not in most medication photosensitivities

Blue-gray pigmentation on sun-exposed areas can be seen during treatment with amiodarone, chlorpromazine, and tricyclic antidepressants. In these medication photosensitivities, there is no

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involvement of the sclera, lunulae, or mucous membranes, as in argyria (prolonged contact with or ingestion of silver salts).


Which of the following statements about UVR and DNA is correct?

1 UVR alters DNA

2 UVA is much more efficient than UVB in inducing DNA damage

3 Cells from patients with actinic keratoses have more DNA repair capacity than controls

4 UVA is most effective in producing pyrimidine dimer

5 Pyrimidine dimers can not activate oncogenes


Which of the following statements about UVR and DNA is correct?

1 UVR alters DNA

UVR alters DNA. UVB is much more efficient than UVA in inducing DNA damage. It can create pyrimidine dimers that may activate oncogenes and lead to cancer. Cells from patients with actinic keratoses have less DNA repair capacity than controls.


Which of the following statements about electromagnetic radiation is MOST correct?

1 Electromagnetic radiation can be conceptualized as packets of power called photons

2 The energy of photons is proportional to the wavelength

3 The energy of photons is inversely proportional to the frequency

4 Longer wavelengths penetrate the skin more deeply

5 Electromagnetic radiation is measured in watts


Which of the following statements about electromagnetic radiation is MOST correct?

4 Longer wavelengths penetrate the skin more deeply

Longer wavelengths penetrate the skin more deeply. Electromagnetic radiation can be conceptualized as packets of ENERGY called photons. The energy of photons is proportional to the FREQUENCY and inversely proportional to WAVELENGTH. Electromagnetic radiation is measured in wavelength.


Hereditary PMLE of Native Americans: 1 Is more similar to PMLE than to actinic prurigo

2 Often presents with chelitis and conjunctivitis

3 Is not treated with thalidomide

4 Rarely persists into adulthood



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Hereditary PMLE of Native Americans:

2 Often presents with chelitis and conjunctivitis

Hereditary PMLE of Native Americans is similar to actinic prurigo but persists much more frequently into adulthood. 75% of patients have a positive family history. It presents with a papular, excoriated, eczematous dermatitis that occurs predominantly on the face. Chelitis and conjunctivitis are common. It may be treated with thalidomide.

Q/Q(M)-476087 Report a ProblemIn solar urticaria wheals typically:

1 Begin at 45 minutes after exposure and last 2 hours (h.)

2 Begin at 1-2 h. and last 2-4 h

3 Begin at 15-30 minutes and last 1 h

4 Begin at 30-60 minutes and last 1-4 h

5 Begin at 15-30 seconds and last about 15 minutes


In solar urticaria wheals typically:

3 Begin at 15-30 minutes and last 1 h

The wheals of solar urticaria begin 10-15 minutes after exposure and last for about an hour. Solar urticaria is usually idiopathic. Rare cases are associated with EPP, SLE, and certain medications.


Which of the following is NOT true regarding polymorphous light eruption? 1 Usually appears in the first three decades

2 May be a manifestation of a type IV hypersensitivity reaction

3 Vesicles and an eczematous dermatitis are a common presentation

4 Not all exposed areas show lesions

5 It may occur through windowglass, which filters out UVB


Which of the following is NOT true regarding polymorphous light eruption?

3 Vesicles and an eczematous dermatitis are a common presentation

Polymorphous light eruption is the most common photodermatosis. It is an idiopathic disease that usually appears in the first three decades. Pathogenesis is unclear but it may be related to a type IV hypersensitivity reaction. Most lesions are erythematous, pruritic papules. The plaque form is less common, and vesicles and an eczematous dermatitis are rare. Not all exposed areas show lesions, but the same areas are affected year after year. It may improve as the summer progresses. It may occur through windowglass, which filters out UVB.


The UVC portion of the electromagnetic spectrum extends from: 1 10-200 nm

2 200-290 nm

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3 290-320 nm

4 400-760 nm



The UVC portion of the electromagnetic spectrum extends from: 2 200-290 nm

Ultraviolet C does not reach the earth's surface. It is filtered out by the ozone layer. It extends from 200-290 nm.


Medication photosensitivity is caused by all except: 1 Thiazides

2 Cephalosporins

3 Phenothiazenes

4 Quinolones

5 Doxycycline

Q/Q(M)-474690 Report a ProblemMedication photosensitivity is caused by all except:

2 Cephalosporins

Cephalosporins do not cause drug photosensitivity. Neither do the penicillins. Q/Q(M)-474690 Report a Problem

Which of the following is true regarding immediate pigment darkening? 1 Contributes to constitutive skin color

2 Caused by UVA radiation

3 Prominent in lightly pigmented individuals

4 Requires the synthesis of new melanin

5 Becomes prominent 48 hr after exposure


Which of the following is true regarding immediate pigment darkening? 2 Caused by UVA radiation

Tanning develops in two phases, early (transitory) and late (stable). The immediate darkening is in response to UVA and is related to photo-oxidation of pre-existing melanin.


Photoonycholysis has been attributed to: 1 Amiodarone

2 Chlorpromazine

3 Quinine

4 Furosemide

5 Tricyclic antidepressants


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Photoonycholysis has been attributed to: 3 Quinine

Photoonycholysis is a manifestation of medication photosensitivity that has been attributed to quinolones, tetracyclines, psoralens, and quinine.


A joule is a measurement of: 1 Energy

2 Power

3 Irradiance

4 Wavelength

5 Distance


A joule is a measurement of: 1 Energy

A joule is a measurement of energy dose or fluence. Power or irradiance is measured in watts. These are related by the formula Joules/cm2=Watts/cm2xseconds.


Which of the following statements about the light sources for phototesting/phototherapy is correct? 1 The most common light sources are incandescent bulbs

2Phototherapy bulbs are low-pressure sulfur vapor lamps with the inner surface coated by a specific phosphor

3 The mercury vapor is excited by electric current and emits a line spectrum of 254 nm

4 The phosphor emits a discoherent spectrum of various wavelengths

5 Broadband UVB bulbs emit throughout the UVB range and also include some UVC


Which of the following statements about the light sources for phototesting/phototherapy is correct? 3 The mercury vapor is excited by electric current and emits a line spectrum of 254 nm

Fluorescent bulbs are commonly used for phototherapy. These bulbs are low-pressure mercury vapor lamps with the inner surface coated by a specific phosphor. The phosphor emits a continuous spectrum of various wavelengths. The mercury vapor is excited by electric current and emits a line spectrum of 254 nm. Broadband UVB bulbs emit throughout the UVB range and also include some UVA, not UVC.


All of the following statements regarding chronic actinic dermatitis are true EXCEPT: 1 The MEDB on phototesting is markedly diminished in patients with this condition

2 Many cases begin as photoallergic contact dermatitis or drug photosensitivity

3 Fluorescent bulbs are safer for these patients than are incandescent bulbs

4 Azathioprine has been used successfully to treat this disorder

5 Many patients have a lowered threshold to shorter wavelength visible light

Q/Q(M)-476089 Report a ProblemAll of the following statements regarding chronic actinic dermatitis are true EXCEPT:

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3 Fluorescent bulbs are safer for these patients than are incandescent bulbs

Chronic actinic dermatitis (CAD) usually occurs in middle-aged to elderly males who present with a chronic, eczematous dermatitis in a photodistribution, though there is no history of current exposure to a photosensitizer. Phototesting is very helpful in diagnosing CAD. The MEDB is markedly diminished, and the MEDB site may show an eczematous or infiltrated appearance. Many of the patients have a lowered MEDA as well, and may have a lowered threshold to shorter wavelength visible light in the blue-violet end of the spectrum. Many cases of this idiopathic disorder are thought to have begun as photoallergic contact dermatitis or as a drug photosensitivity with broadening of the photosensitivity to include the UVB range. It is unclear why photosensitivity persists when the photosensitizer is no longer present. Treatment includes strict sun avoidance and sun protection. Incandescent bulbs with longer wavelengths, far from the blue-violet end of the visible spectrum, should be used instead of fluorescent bulbs, which have significant blue-violet radiation. Topical and oral steroids, oral azathioprine and cyclosporine, and PUVA have all been used to treat patients with CAD.


A patient that rarely burns and usually tans is which of the following skin types? 1 Type I

2 Type II

3 Type III

4 Type IV

5 Type V


A patient that rarely burns and usually tans is which of the following skin types? 3 Type III

Skin type I always burns and never tans Skin type II usually burns and rarely tans Skin type III rarely burns and usually tans Skin type IV never burns and alway tans Skin types V,VI are highly pigmented individuals


Which spectrum of UV is responsible for the conversion of 7-dehydrocholesterol in the skin to pre-vitamin D3? 1 200-290 nm

2 290-320 nm

3 320-340 nm

4 340-400 nm

5 10-200 nm

Q/Q(M)-478227 Report a ProblemWhich spectrum of UV is responsible for the conversion of 7-dehydrocholesterol in the skin to pre-vitamin D3?

2 290-320 nm

Ultraviolet B with the spectrum of 290-320 nm is responsible for the conversion of 7-dehydrocholesterol in the skin to pre-vitamin D3.


The UVAII portion of the electromagnetic spectrum extends from:

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1 200-290 nm

2 290-320 nm

3 320-400 nm

4 320-340 nm


Q/Q(M)-476732 Report a ProblemThe UVAII portion of the electromagnetic spectrum extends from:

4 320-340 nm

UVA extends from 320-400nm. UVA is further subdivided into UVAII (320-340nm) and UVA1 (340-400nm).


The most common presentation of a patient with medication photosensitivity is: 1 Photoonycholysis

2 Lichenoid eruptions

3 Diffuse erythema in sun-exposed areas

4 Pseudoporphyria

5 Fixed erythematous patch


The most common presentation of a patient with medication photosensitivity is: 3 Diffuse erythema in sun-exposed areas

Most patients with medication photosensitivity present with diffuse erythema in sun-exposed areas. In some patients, the eruption is eczematous and covered areas are spared. Photoonycholysis, lichenoid eruptions and pseudoporphyria do occur with mediation photosensitivity, but are not the most common presentation. Fixed erythematous patch is not seen with this type of reaction.


Which of the following is a manifestation of dermatoheliosis? 1 Hydroa vacciniforme

2 Actinic prurigo

3 Chronic actinic dermatitis

4 Brachioradial pruritis

5 Cutis rhomboidalis nuchae


Which of the following is a manifestation of dermatoheliosis? 5 Cutis rhomboidalis nuchae

Dermatoheliosis, also known as photoaging, is induced by chronic sun exposure. Clinical variants include cutis rhomboidalis nuchae, which appears as leathery skin on the posterior neck with exaggerated skin markings. Other variants include striated beaded lines (small yellowish papules and plaques along the sides of the neck), Dubreuilh elastoma (translucent papule which may mimic a basal cell carcinoma), and Favre-Racouchot syndrome (nodular elastoidosis with cysts and comedones). Hydroa vacciniforme, actinic prurigo, chronic actinic dermatitis, and brachioradial pruritis are photosensitivity disorders.


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Which of the following is the most likely cause of photosensitivity? 1 Quinolones

2 Sulfonamides

3 Doxycycline

4 Minocycline

5 Penicillin V


Which of the following is the most likely cause of photosensitivity?

3 Doxycycline

Doxycycline is the tetracycline derivative most likely to cause photosensitivity. Quinolones and sulfonamides will also cause this with ingestion. Minocycline is the least photosensitizing of the tetracycline derivatives. Penicillin is not a common cause of photosensitivity.

Q/Q(M)-478091 Report a ProblemWhich medication reactivates UVB- and PUVA-induced erythema?

1 Dacarbazine

2 5-FU

3 Vinblastine

4 Methotrexate



Which medication reactivates UVB- and PUVA-induced erythema? 4 Methotrexate

Methotrexate reactivates UVB- and PUVA-induced erythema. Q/Q(M)-476736 Report a Problem

The best definition for a MED is:

1The dose of ultraviolet radiation that produces barely perceptible erythema that completely fills the test square

2 The dose of ultraviolet radiation that produces a easily visible "sunburn"

3 The dose of ultraviolet radiation that is one step below the first visible erythema

4The dose of ultraviolet radiation that produces pronounced erythema that completely fills the test square

5 The dose of ultraviolet radiation that produces bullae that completely fills the test square


The best definition for a MED is:

1The dose of ultraviolet radiation that produces barely perceptible erythema that completely fills the test square

An MED is the dose of ultraviolet radiation that produces barely perceptible erythema that completely fills the test square. The remaining options are incorrect.


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Phototesting of PMLE patients reveals: 1 Normal MEDB, reduced MEDA.

2 Normal MEDB, elevated MEDA.

3 Normal MEDB, normal MEDA.

4 Lowered MEDB, lowered MEDA.

5 Lowered MEDB, normal MEDA.


Phototesting of PMLE patients reveals: 3 Normal MEDB, normal MEDA.

The MEDB and MEDA are normal in PMLE patients. Only with multiples of the MEDB or MEDA can one often reproduce the lesions.


A patient presents with onycholysis after sun exposure. Which of the following medications would be least likely as a cause of this presentation?

1 Quinolones

2 Tetracyclines

3 Psoralens

4 Quinine

5 Chlorpromazine


A patient presents with onycholysis after sun exposure. Which of the following medications would be least likely as a cause of this presentation?

5 Chlorpromazine

Chlorpromazine is associated with blue-gray pigmentation on sun-exposed areas and is not associated with photoonycholysis. Quinolones, tetracyclines, psoralens and quinine can cause photoonycholysis.


Oral PUVA has been used to treat which of the following diseases: 1 CTCL

2 Mastocytosis

3 Graft-versus-host disease

4 Generalized granuloma annulare



Oral PUVA has been used to treat which of the following diseases: 5 All of these answers are correct

PUVA has been reported to have helped patients with all the diseases listed. Q/Q(M)-474696 Report a Problem

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Which of the following statements is true regarding UV radiation, erythema, and pigmentation? 1 UVB erythema reaches a maximum in 24-36 hours

2 The chromophores involved with UVB erythema are melanosomes

3 Immediate pigment darkening is brought on by UVA and visible light

4 Immediate pigment darkening fades within 12-24 hours after exposure

5Delayed tanning, which becomes visible about 72 hours after exposure, is largely brought on by UVA.


Which of the following statements is true regarding UV radiation, erythema, and pigmentation? 3 Immediate pigment darkening is brought on by UVA and visible light

UVB in natural sunlight is the main contributor to erythema. UVB erythema reaches a maximum in 6-24 hours. The chromophores involved with UVB erythema are not clear but appear to involve nucleic acids. Immediate pigment darkening is brought on by UVA and visible light, and fades within minutes after exposure. Delayed tanning becomes visible about 72 hours after UVB exposure. UVA contributes to a lesser extent to delayed tanning.


Ultraviolet radiation from the sun cause ALL of the following acute effects EXCEPT? 1 Epidermal thickening

2 Photosynthesis of vitamin D

3 Sunburning

4 Immediate pigment darkening

5 Increased immune surveillance


Ultraviolet radiation from the sun cause ALL of the following acute effects EXCEPT?

5 Increased immune surveillance

UV radiation causes acute effects including: photosynthesis of vitamin D, sunburning, immediate pigment darkening, delayed tanning, epidermal thickening and immunologic effects such as DECREASED immune surveillance.


Patients with chronic actinic dermatitis (CAD) typically show on phototesting: 1 Lowered MEDB, usually lowered MEDA, sometimes positive photopatch tests

2 Lowered MEDB, usually normal MEDA, sometimes positive photopatch tests

3 Normal MEDB, lowered MEDA, sometimes positive photopatch tests

4 Normal MEDB, normal MEDA, sometimes positive photopatch tests

5 None of the above

Q/Q(M)-474684 Report a ProblemPatients with chronic actinic dermatitis (CAD) typically show on phototesting: 1 Lowered MEDB, usually lowered MEDA, sometimes positive photopatch tests

The hallmark of CAD is a lowered MEDB. Often the patients have a lowered MEDA. It is felt that many of CAD patients began with photoallergic contact dermatitis, so some have positive photopatch tests.

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Q/Q(M)-474684 Report a ProblemThe action spectrum for photoallergy is mostly in which spectrum?

1 320-425nm

2 290-320nm

3 311-312nm

4 200-290nm

5 400-760nm

Q/Q(M)-479419 Report a ProblemThe action spectrum for photoallergy is mostly in which spectrum?

1 320-425nm

The action spectrum for photoallergic dermatoses refers to the specific wavelengths of light that evoke the photosensitive reaction. This falls mostly within the UVA region and may spill into the visible light region for photoallergy (320-425nm). 200-290nm refers to the UVC region; 290-320nm refers to the UVB region; 311-312nm refers to narrowband UVB region; and 400-769nm refers to the visible light region.

Q/Q(M)-479419 Report a ProblemRare cases of which photosensitivity disorder have been associated with erythropoietic protoporphyria? 1 Hydroa vacciniforme

2 Solar urticaria

3 Actinic prurigo

4 Polymorphous light eruption



Rare cases of which photosensitivity disorder have been associated with erythropoietic protoporphyria? 2 Solar urticaria

Rare cases of solar urticaria have been associated with erythropoietic protoporphyria (EPP), lupus erythematosus (LE), and with certain drugs. Blood tests for LE and EPP should be performed in patients with this diagnosis.

Q/Q(M)-476088 Report a ProblemWhich of the following statements is true regarding pseudoporphyria?

1 Porphyrins may be normal

2 It has been associated with furosemide

3 Clinically it may be indistinguishable from porphyria cutanea tarda



Q/Q(M)-476096 Report a ProblemWhich of the following statements is true regarding pseudoporphyria? 4 All of these answers are correct

Pseudoporphyria is a phototoxic reaction that clinically and histologically resembles porphyria cutanea tarda. In pseudoporphyria, however, there is no porphyrin abnormality. It has been associated with numerous medications, including nalidixic acid, tetracyclines, amiodarone, furosemide, and ketoprofen.

Q/Q(M)-476096 Report a ProblemUltraviolet light spectrum most completely encompasses which of the following spectrums?

21

1 200 - 400 nm

2 290 - 400 nm

3 10 - 400 nm

4 400 - 700 nm

5 760 - 1200 nm

Q/Q(M)-478221 Report a ProblemUltraviolet light spectrum most completely encompasses which of the following spectrums? 3 10 - 400 nm

The ultraviolet spectrum encompasses Vacuum UV from 10-200nm, UV-C from 200-290nm, UV-B from 290-320nm and UV-A from 320-400nm. The visible light spectrum is from 400-700nm. 700-1200 nm is part of the infrared spectrum.

Q/Q(M)-478221 Report a ProblemInitial treatment of this disease should include: 1 Sun avoidance, sunblocks, beta carotene

2 Sun avoidance, sunblocks, desensitization

3 Hydroxychloroquine

4 Car UV filters, PUVA, sunblocks

5 Sun avoidance, sunblock, antihistamines


Initial treatment of this disease should include: 5 Sun avoidance, sunblock, antihistamines

Treatment of solar urticaria is difficult. Sun avoidance is the most important aspect of treatment. A broad-spectrum sunblock and antihistamines.


Which of the following statements about UVR in vivo is correct? 1 induces skin cancers

2 normalizes Langerhans cell morphology and function

3 decreases circulating levels of cytokins (IL-1, IL-6 and TNF)

4 normalizes cell trafficking

5 normalizes proportions of lymphocyte subtypes in peripheral blood


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Which of the following statements about UVR in vivo is correct? 1 induces skin cancers

UVR can induce skin cancer. UVR in vivo INCREASES circulating levels of cytokins (IL-1, IL-6 and TNF) and alters Langerhans cell morphology, cell trafficking, and the proportion of lymphocyte subtypes in peripheral blood.


Which patient most likely has chronic actinic dermatitis? 1 A 30-year old female with erythematous pruritic papules on the chest that recur each summer

2A girl with excoriated papules and nodules on sun-exposed and non-sun-exposed areas with cheilitis

3 A Native American adult with papules excoriated dermatitis on the face with cheilitis

4 A middle-aged male with recurring wheals that begin 20 min after sun exposure

5 An elderly man with persistent eczematous dermatitis in a photodistribution


Which patient most likely has chronic actinic dermatitis? 5 An elderly man with persistent eczematous dermatitis in a photodistribution

Chronic actinic dermatitis typically affects middle-aged to elderly males and present as a chronic, eczematous dermatitis in a photodistributed area with relative sparing of the upper lids, behind the ears, and submental area. Occasionally non-sun-exposed areas are involved. These patients show histology that resembles mycosis fungoides. Importantly, these patients also have altered phototesting, usually with a diminished MEDb thought MEDa may also be decreased. Recurring erythematous pruritic papules and less likely plaques can be seen in polymorphous light eruption. Children with excoriated papules on sun-exposed and non-sun-exposed areas with cheilis is typical of actinic prurigo. Hereditary polymorphous light eruption of Native Americans presents with an excoriated facial dermatitis. Solar urticaria characteristically begin 10-30 min after exposure and last for about one hour.

Q/Q(M)-482245 Report a ProblemA normal MEDB on untanned Caucasian skin ranges from approximately:

1 2-6 mJ/cm2

2 15-40 mJ/cm2

3 20-70 mJ/cm2

4 70-140 mJ/cm2

5 140-200 mJ/cm2


A normal MEDB on untanned Caucasian skin ranges from approximately: 3 20-70 mJ/cm2

The MEDB can vary from institution to institution. In one institution, it may range from 20-70 mJ/cm2. In another institution, it may range from 30-90 mJ/cm2.


Which of the following hypoglycemics is the most common cause of photosensitivity?

1 Insulin

2 Sulfonylureas

3 Metformin

23

4 Thiazolidinediones (i.e. rosiglitazone)

5 Piroxicam


Which of the following hypoglycemics is the most common cause of photosensitivity? 2 Sulfonylureas

The sulfonylurea hypoglycemics for diabetes are the most common type of medication of this class of medications. Piroxicam is not a hypoglycemic agent, but a common NSAID cause of photoallergy.


Which of the following statements regarding phototesting is correct?

1 The UVB MED is performed using narrowband UVB light sources

2 The UVA MED is performed using a narrowband UVA source

3 To test for a visible light reaction, a slide projector is used as a light source

4Repeated MEDs to UVB or UVA, given to different test sites over several days can be used to reproduce lesions of polymorphous light eruption

5A single large dose of visible light is the best way to reproduce lesions of polymorphous light eruption


Which of the following statements regarding phototesting is correct? 3 To test for a visible light reaction, a slide projector is used as a light source

Phototesting is done prior to initiating phototherapy or during provocative induction. To test for a visible light reaction, a slide projector is used as a light source. The other choices are incorrect. The UVB MED and UVA MED is performed using BROADBAND UVB and BROADBAND UVA light sources respectively. Repeated MED's to UVB or UVA given to the SAME site may be used to reproduce lesions of PMLE. Alternatively a single large dose of UVA or UVB can be used to reproduce PMLE.


The MPD of Oxsoralen plus UVA is:

1 Measured at 24 hours

2 Equal to one-half the patients MEDA

3 Tested on the patient’s calf or abdomen

4 Helpful in starting PUVA therapy



The MPD of Oxsoralen plus UVA is: 4 Helpful in starting PUVA therapy

MPD stands for the minimal phototoxic dose. For Oxsoralen plus UVA, the MPD is measured at 48-72 hours. Testing is done on the upper buttock or forearm.


Of the following which one is most characteristic of photoxocity rather than photoallergy? 1 Onset in hours to days

24

2 Eczematous dermatitis

3 Cross-reactivity to chemically similar agents

4 Often caused by furocoumarins

5 Relatively low incidence


Of the following which one is most characteristic of photoxocity rather than photoallergy?

4 Often caused by furocoumarins

Furocoumarins may cause a phytophotodermatitis that is a phototoxic reaction. Such reactions occurs with high frequency in the population, occur within minutes to hours from exposure, and appear like an exaggerated sunburn. The other answers are common with photoallergy, such as seen with sunscreens, fragrances, and various systemic medications like chlorpromazine.


What is the most likely cause of these lesions on the cheek of this 8 year-old boy? 1 Acne

2 Herpes simplex

3 Varicella

4 Hydroa vacciniforme



What is the most likely cause of these lesions on the cheek of this 8 year-old boy? 4 Hydroa vacciniforme

Hydroa vacciniforme is a rare photodermatosis of childhood which occurs on areas of sun-exposed skin. The lesions leave depressed and atrophic scars. The condition tends to spontaneously resolve in adulthood.

Q/Q(M)-476855 Report a ProblemWhich of the following genodermatoses is NOT worsened by sunlight?

1 Darier's disease

2 Kindler syndrome

3 Hartnup disease

4 Rothmund-Thompson syndrome

5 Job syndrome

Q/Q(M)-478324 Report a ProblemWhich of the following genodermatoses is NOT worsened by sunlight?

25

5 Job syndrome

Many genodermatoses can be exacerbated by sunlight including Darier's, Kindler, Rothmund Thompson, Hartnup (pellagra changes).

Q/Q(M)-478324 Report a ProblemUltraviolet radiation from the sun causes all of the following acute effects in the skin EXCEPT:

1 Redistribution of melanosomes from a perinuclear position into dendrites

2 Epidermal thickening

3 Mast cell degranulation

4 Photooxidation of preexisting melanin


Q/Q(M)-476076 Report a ProblemUltraviolet radiation from the sun causes all of the following acute effects in the skin EXCEPT:


All of these statements are acute effects of UV raditation on the skin. Immediate pigment darkening, which fades within minutes after exposure, is brought on by UVA and visible light. It is caused by photooxidation of preexisting melanin and a redistribution of melanosomes from a perinuclear position into dendrites. Epidermal thickening is mainly a UVB-induced phenomenon. Mast cell degranulation, with release of histamine and other mast cell products, also occurs as a result of UV radiation.

Q/Q(M)-476076 Report a ProblemAs a result of ultraviolet radiation:

1 There is mast cell degranulation and release of histamine

2 Prostaglandins are increased

3 Epidermal thickening occurs




As a result of ultraviolet radiation: 4 All of these answers are correct

Effects of ultraviolet radiation include mast cell degranulation with release of histamine and other mast cell products, increases in certain prostaglandins and interleukins, and epidermal thickening, which is mainly a UVB-induced phenomenon.


Phytophotodermatitis can be seen with the following fruits / vegetables: 1 Potatoes and leeks

2 Tomatoes and bananas

3 Celery and radishes

4 Parsnips and limes

5 Lemons and pears


Phytophotodermatitis can be seen with the following fruits / vegetables: 4 Parsnips and limes

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Psoralens in certain plants, fruits, and vegetables can cause phytophotodermatitis. The most common ones are limes, figs, parsley, parsnip, bergamot oranges, and celery.


Currently the most common cause of photoallergic contact dermatitis is: 1 Halogenated salicylanilides

2 Musk ambrette

3 6-methylcoumarin

4 Sunscreens

5 Mercaptobenzothiazole


Currently the most common cause of photoallergic contact dermatitis is:

4 Sunscreens

Halogenated salicylanilides, musck ambrette and 6-methylcoumarin used to cause most of the cases of photoallergic contact dermatitis. They have been essentially eliminated from soaps and fragrances. Sunscreen ingredients are now the most common cause.


Narrow band UVB consists of what wavelength? 1 300-306nm

2 308-310nm

3 311-313nm

4 312-320nm

5 320-330nm


Narrow band UVB consists of what wavelength? 3 311-313nm

Narrowband UVB is much less erythemogenic with regard to physical units (mJ/cm2) than broadband UVB. Narrowband UVB is 311-313nm.

Q/Q(M)-478593 Report a ProblemCommon side effects of PUVA include all of the following except:

1 Nausea

2 Hair loss

3 Painful erythema

4 Prolonged pruritus

5 Squamous cell carcinoma


Common side effects of PUVA include all of the following except: 2 Hair loss

Alopecia is not a usual side effect of PUVA treatment. Q/Q(M)-474697 Report a Problem

27

Which of the following statements about the hypothetical effect of UVR on cancer induction is correct?

1 UVR induces transformation of keratinocytes with expression of tumor-associated antigens

2 UVR alters APC function, by increasing the number of antigen-presenting cells

3 UVR inhibits the release of immunosuppressive factors

4 Suppressor T-cells are suppressed

5 UVR increases the ability of Langerhans cells to present antigen

Q/Q(M)-478246 Report a ProblemWhich of the following statements about the hypothetical effect of UVR on cancer induction is correct?

1 UVR induces transformation of keratinocytes with expression of tumor-associated antigens

UVR induces transformation of keratinocytes with expression of tumor associated antigens. It alters APC function by reducing the number of antigen presenting cells. It also promotes the release of immunosuppressive factors, induce suppressor t-cells, and decreases the ability of Langerhans cells to present antigen.

Q/Q(M)-478246 Report a ProblemThe main contributor to erythema of the skin with exposure to the sun is: 1 UVC

2 UVB

3 UVA1

4 UVA2

5 Visible light

Q/Q(M)-478229 Report a ProblemThe main contributor to erythema of the skin with exposure to the sun is:

2 UVB

UVB in natural sunlight is the main contributor to erythema. UVB erythema reaches a maximum in 6-24 hours. UVA accounts for 15-20% of sunlight erythema despite that there is much more UVA than UVB in sunlight.


All of the following are true regarding actinic reticuloid except: 1 Affects elderly men

2 CD8+ T cells in lesional skin

3 Is a premalignant condition

4 Atypical dermal mononuclear cell infiltrate

5 Generalized lymphadenopathy common


All of the following are true regarding actinic reticuloid except: 3 Is a premalignant condition

Actinic reticuloid is a type of chronic actinic dermatitis. Ive et al. introduced the disease as a severe dermatosis with no apparent photoallergen. It generally affects elderly males and is characterized by infiltrated erythematous plaques on an eczematous background in exposed sites with lymphadenopathy. Histopathologically, it may resemble cutaneous T cell lymphoma. However, there is a trend towards a lower CD4+/CD8+ ratio. It is not considered a premalignant condition.

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The portion of the electromagnetic spectrum that produces a particular biologic effect is called the: 1 Action Spectrum

2 Absorption Spectrum

3 Cutaneous Effect Spectrum

4 Effective Spectrum

5 Spectral Activity


The portion of the electromagnetic spectrum that produces a particular biologic effect is called the: 1 Action Spectrum

The action spectrum is the wavelengths that produce a certain biologic effect. The action spectrum for photosensitivity from exogenous chemicals is usually in the UVA range. The radiation that is absorbed by those chemicals is called their absorption spectrum.


Solar urticaria:

1 Is an idiopathic, type IV photosensitivity disorder

2 Can present with headache, nausea, and syncope

3 Rarely lasts for more than 6 months to 1 year

4 Usually occurs to only UVB radiation

5 Is not benefitted by antihistamines


Solar urticaria:

2 Can present with headache, nausea, and syncope

Solar urticaria is an idiopathic, type I photosensitivity disorder. Mediator release during widespread whealing may result in headache, nausea, wheezing, faintness, and syncope. It usually lasts for many years. Some patients react with wheals to either visible light or UVA or UVB. Others react to both UVA and visible radiation. Some react to both UVB and UVA, and some patients react to UVB, UVA, and visible radiation. Treatment includes sun avoidance and protection, and H-1 antihistamines may be of partial benefit.


Which of the following drugs is commonly known to produce photosensitivity? 1 Quinidine

2 Sulfonylureas

3 Griseofulvin




Which of the following drugs is commonly known to produce photosensitivity?

29


Quinidine, sulfonlyureas, and griseofulvin are all known to cause photosensitivity. Q/Q(M)-476734 Report a Problem

UVA II encompasses which wavelengths ?

1 290-320 nm

2 320-400 nm

3 400-450 nm

4 320-340 nm

5 340-400 nm

Q/Q(M)-474666 Report a ProblemUVA II encompasses which wavelengths ?

4 320-340 nm

UVA can be divided into UVA II (320-340 nm) and UVA I (340-400 nm). Q/Q(M)-474666 Report a Problem

Which of the following statements about the spectrums of UVR that cause of solar urticaria is MOST correct?

1 Visible light causes solar urticaria

2 UVA causes solar urticaria

3 UVB causes solar urticaria

4 Both UVA and UVB cause solar urticaria

5 Patients can react to visible light, UVA and/or UVB


Which of the following statements about the spectrums of UVR that cause of solar urticaria is MOST correct? 5 Patients can react to visible light, UVA and/or UVB

Some patients react with wheals to either visible light or UVA or UVB. Others react to both UVA and visible radiation. Some react to both UVB and UVA, and some patients react to UVB, UVA and visible light.


Which of the following is the most common photodermatosis? 1 Hydroa vacciniforme


3 Actinic prurigo


5 Solar urticaria


Which of the following is the most common photodermatosis? 4 Polymorphous light eruption

30

Polymorphous light eruption is the most common photodermatosis. It is a idiopathic disease that usually appears in the first three decades of life and is more common in fair-skinned females. The pathogenesis is unclear, but is believed to be related to a type IV hypersensitivity reaction. Most lesions are erythematous pruritic papules, with the plaque form being less common. Lesions appear symetrically on exposed areas after a delay of several hours to several days. Patients with mild disease are treated with sun avoidance and a broad spectrum sunscreen. In more severe cases, hardening and desensitization can be accomplished or antimalarials can be used for resistant cases. For brief, sunny vacations, a short course of prednisone can be helpful. The other options are less common forms of idiopathic photosensitivity disorders.


Which of the following statements is true regarding ultraviolet carcinogenesis?

1Mid-range ultraviolet radiation is less efficient in inducing neoplasia in mice that is long wave UVR

2 Suppressor T-cells arise in UV-irradiated hosts only after tumors have developed

3 Cells from patients with actinic keratoses have normal DNA repair capacity

4 UVA, when added to UVB, may accelerate carcinogenesis

5 UVA is most effective in producing pyrimidine dimers, which may activate oncogenes


Which of the following statements is true regarding ultraviolet carcinogenesis? 4 UVA, when added to UVB, may accelerate carcinogenesis

Mid-range UVR (280-320 nm) is more efficient in inducing neoplasia in mice, but long wave UVA, when added to UVB, may accelerate carcinogenesis. Suppressor T-cells induce susceptibility to tumors, and appear to arise in UV-irradiated hosts prior to tumors developing, thus playing a role in carcinogenesis. Cells from patients with AKs have less DNA repair capacity than controls. UVB is most effective in producing pyrimidine dimers, which may activate oncogenes, particularly in the formation of BCCs and SCCs.


UVB is about how many times more erythermogenic than UVA ?

1 10

2 100

3 1000

4 10000

5 5


UVB is about how many times more erythermogenic than UVA ?

3 1000

Though UVB is 1000 times more erythermogenic than UVA, UVA is much more plentiful in sunlight. Therefore, UVA does contribute to sunlight erythema.


A patient presents with solar urticaria. What tests should be considered initially? 1 ANA

31

2 ANCA

3 Urinalysis

4 CXR

5 ESR


A patient presents with solar urticaria. What tests should be considered initially?

1 ANA

Solar urticaria is an idiopathic, type I photosensitivity disorder. Rare cases have been associated with erythropoietic protoporphyria (EPP) and lupus erythematosus (LE). Blood tests for LE and appropriate screening for EPP should be performed including ANA, Ro/La, Urine & Stool porphyrins.


The highest energy visible photons are in which portion of the visible spectrum? 1 Green

2 Blue-violet

3 Red-Orange

4 Yellow



The highest energy visible photons are in which portion of the visible spectrum? 2 Blue-violet

In the visible spectrum, the blue-violet portion has the shortest wavelength and the highest energy. The red-orange portion has the longest wavelength and the lowest energy.


The xenon arc solar simulator, whose spectrum is in this slide, is useful for: 1 MED-B testing

2 MED-A testing

3 Photopatch testing

4 MED-B testing and MED-A testing

5 MED-B testing, MED-A testing, and Photopatch testing


The xenon arc solar simulator, whose spectrum is in this slide, is useful for:

32

4 MED-B testing and MED-A testing

Solar simulator radiation contains both UVB and UVA in sufficient quantities to be useful for MED-B and MED-A testing. The field size is too small for photopatch testing.


Which of the following conditions would be least likely to be photo-exacerbated? 1 Herpes simplex

2 Pellagra

3 Transient acantholytic dermatosis

4 Psoriasis

5 Pyridoxine deficiency


Which of the following conditions would be least likely to be photo-exacerbated?

4 Psoriasis

Psoriasis is improved by phototherapy, especially at the wavelengths of 311-312 nm in most cases. Photosensitive psoriasis can occur, but is the least likely choice to be photo-exacerbated. The other listed conditions are worsened by UV/sunlight exposure.


A patient presents with blue-gray pigmentation on sun-exposed areas but does not have involvement of the sclerae, lunulae or mucous membranes. Which of the following medications is could be causing this pigmentation? 1 Clindamycin

2 Chlorpromazine

3 Ciprofloxacin

4 Fluoxetine

5 Sertraline


A patient presents with blue-gray pigmentation on sun-exposed areas but does not have involvement of the sclerae, lunulae or mucous membranes. Which of the following medications is could be causing this pigmentation?

2 Chlorpromazine

Amiodarone, chlorpromazine and tricyclic antidepressants all are capable of causing blue-gray pigmentation on sun-exposed areas without involvement of the sclerae, lunulae or mucous membranes.


The potent photosensitizer, 5-methoxypsoralen, is contained in which of the following contact allergens? 1 Oil of Bergamot

2 Balsam of Peru

3 Tuliposide A

4 Usnic acid

33

5 Eugenol


The potent photosensitizer, 5-methoxypsoralen, is contained in which of the following contact allergens? 1 Oil of Bergamot

Oil of Bergamot contains 5-methoxypsoralen and may cause of 'Berloque dermatitis,' an intense post-inflammatory hyperpigmentation due to an antecedent phytophotodermatitis that may be subclinical.


Absorption of UV radiation generates singlet oxygen in the skin by which chromophore? 1 Melanin

2 Urocanic acid

3 Keratin

4 Hemoglobin

5 Water


Absorption of UV radiation generates singlet oxygen in the skin by which chromophore? 2 Urocanic acid

Urocanic acid and DNA are biologically important chromophores. DNA absocrbs uVB directly inducing changes between adjacent pyrimidine bases on one strand of DNA. Cyclopyrimidine dimers, particularly thymine dimers or less commonly (6-4) photoproducts may be generated. Urocanic acid is a second biologically important chromophore in the skin and is a by-product of filaggrin breakdown. One photon of light contains enough energy to generate singlet oxygen.


The following compound exerts immunosuppressive effects in the skin following exposure to UV-radiation: 1 Cis-urocanic acid

2 7-dehydrocholesterol

3 IL-12

4 Delta aminolevulinic acid

5 Amino-levulinic acid


The following compound exerts immunosuppressive effects in the skin following exposure to UV-radiation: 1 Cis-urocanic acid

Trans-urocanic acid is an epidermal chromophore that isomerizes to cis-urocanic acid following exposure to UV radiation. Cis-urocanic acid has been shown to be immunosuppressive, for example, by impairing the induction of contact allergy in mouse models. The mechanism of this immunosuppressive effect is unclear.


Actinic prurigo (AP) differs from PMLE in all of the following except:

34

1 The lesions of AP begin in childhood

2 The lesions of AP occur on all sun-exposed areas

3 Lesions of AP may occur on non-sun exposed areas

4 Cheilitis is rare in AP and common in PMLE

5 Outbreaks of AP are not as clearly related to sun exposure


Actinic prurigo (AP) differs from PMLE in all of the following except: 4 Cheilitis is rare in AP and common in PMLE

Cheilitis is common in actinic prurigo and not a usual accompaniment in PMLE. Q/Q(M)-474681 Report a Problem

Advantages of narrowband UVB over PUVA therapy are the following EXCEPT:

1 No need for protective eyewear

2 No nausea

3 Safe in childhood

4 Safe in pregnancy

5 More effective in treating thick plaques of CTCL


Advantages of narrowband UVB over PUVA therapy are the following EXCEPT: 5 More effective in treating thick plaques of CTCL

UVB, both narrowband and broadband, is less penetrating into the skin than UVA. Therefore, PUVA is more effective for thick plaques of CTCL. The UVB does not reach to the bottom of the plaques.

Q/Q(M)-474692 Report a ProblemUVB converts 7-dehydrocholesterol in the skin to pre-vitamin D3. What is the catalyst of the next step, the conversion to vitamin D3?

1 Thermal isomerization

2 Enzymatic conversion in the skin

3 Cell mediated conversion

4 No catalyst is needed

5 Enzymatic conversion in the liver


UVB converts 7-dehydrocholesterol in the skin to pre-vitamin D3. What is the catalyst of the next step, the conversion to vitamin D3? 1 Thermal isomerization

7-dihydrocholesterol is present in the skin and is converted to previtamin D3 by UV in the spectrum of 290-315 nm. The Previtamin D3 then thermally isomerizes to form vitamin D3 which enters the circulation. 1-hydroxylation occurs in the liver and 25-hydroxylation in the kidney resulting in the final form of 1,25-dihydroxyvitamin D3.


Which of the following cell types induce susceptibility to tumor growth?

35

1 Suppressor T-cells

2 NK cells

3 Helper T-cells

4 Mast cells

5 Langerhans cells


Which of the following cell types induce susceptibility to tumor growth?

1 Suppressor T-cells

The suppressor T-cells induce susceptibility to tumor. These cells appear to arise in UV-irradiated hosts prior to tumor developing, and play a role in carcinogenesis.


The irradiance of a UV source is measured in: 1 Joules

2 Seconds

3 Watts

4 Millijoules

5 Centimeters


The irradiance of a UV source is measured in:

3 Watts

The irradiance of a UV source in watts x the time in seconds equals the UV dose in joules. Q/Q(M)-474668 Report a Problem

UVB converts 7-dehydrocholesterol in the skin to: 1 25-hydroxyvitamin D

2 1,25-dihydroxyvitamin D

3 Calcitriol

4 Previtamin D3

5 None of the above


UVB converts 7-dehydrocholesterol in the skin to:

4 Previtamin D3

UVB converts 7-dehydrocholesterol in the skin to previtamin D3, which then thermally isomerizes to form vitamin D3. It is hydroxylated in the liver and then in the kidney to form 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D, respectively.


Actinic prurigo (AP) differs from polymorphous light eruption (PMLE) in that: 1 Chelitis is more frequently seen in PMLE

36

2 Lesions of AP usually begin after puberty

3 Lesions of PMLE occur on all sun-exposed areas

4 Lesions of AP may persist for months, even into the winter

5 Lesions of PMLE may occur on non-sun-exposed areas

Q/Q(M)-476086 Report a ProblemActinic prurigo (AP) differs from polymorphous light eruption (PMLE) in that:

4 Lesions of AP may persist for months, even into the winter

Actinic prurigo (AP) may be a distinct entity, or an HLA-restricted subset of polymorphous light eruption (PMLE). AP differs from PMLE in that the lesions of AP always begin in childhood and often remit in puberty, the lesions of AP occur on all sun-exposed areas and may persist for months, even into the winter, and the lesions of AP may occur on non-sun-exposed areas. In addition, outbreaks of AP are not as clearly related to sun exposure, and chelitis is frequently seen in AP, not PMLE.


Immediate pigment darkening: 1 Is associated with an increase in melanocyte number

2 Is predominately brought on by UVB

3 Start 45-60 minutes after exposure

4 Is predominately brought on by UVA and visible light

5 Is caused by an increase in tyrosinase activity


Immediate pigment darkening:

4 Is predominately brought on by UVA and visible light

Immediate pigment darkening appears almost as soon as irradiation occurs. It is due to photo-oxidation of preexisting melanin.


Which of the following statements about ultraviolet C is incorrect? 1 UV-C does not reach the earth's surface

2 UV-C is absorbed by atmospheric ozone

3 UV-C has an electromagnetic spectrum from 200-290 nm

4 UV-C has higher energy than UV-B

5 UV-C has a higher wavelength than UV-B


Which of the following statements about ultraviolet C is incorrect? 5 UV-C has a higher wavelength than UV-B

UV-C has wavelengths of 200 - 290 nm. UV-B has wavelengths of 290 - 320 nm. UV-C has a lower wavelength, not higher. All of the other listed statements about UV-C are correct.


Phototoxicity and photoallergy from exogenous agents typically involve absorption of: 1 UVA

37

2 UVB

3 UVB and UVA

4 UVA and visible light

5 UVB, UVA and visible light


Phototoxicity and photoallergy from exogenous agents typically involve absorption of:

1 UVA

Topical and systemic agents that produce phototoxicity and/or photoallergy usually have action spectra in the UVA range.


A patient presents with purple polygonal pruritic papules on sun exposed areas. Which of the following of his medication would not be suspect for causing this eruption?

1 Enalapril

2 Quinidine

3 Fenofibrate

4 Furosemide

5 Hydrochlorothiazide

Q/Q(M)-478257 Report a ProblemA patient presents with purple polygonal pruritic papules on sun exposed areas. Which of the following of his medication would not be suspect for causing this eruption?

4 Furosemide

Furosemide (Lasix) is not a cause of lichenoid drug reactions, but can cause pseudoporphyria. The others listed are causes of lichenoid drug reactions. Others are antimalarials, demethylchlortetracycline and quinine.


What mutation is responsible for this clinical presentation in a patient with thyroid dysfunction and chronic candidal infections? 1 AIRE

2 PTEN

3 TRP1

4 fumarate hydratase

5 LYST


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What mutation is responsible for this clinical presentation in a patient with thyroid dysfunction and chronic candidal infections? 1 AIRE

APECED syndrome named for the clinical features of autoimmune polyendocrinopathy, candidiasis, ectodermal dystrophy and is caused by a mutation in AIRE (autoimmune regulator). 13% of these patient have vitiligo.


Photoexacerbated genodermatoses include all except: 1 Tuberous sclerosis

2 Cockayne's Syndrome

3 Hailey-Hailey Disease

4 Hartnup Disease

5 Darier's Disease

Q/Q(M)-474691 Report a ProblemPhotoexacerbated genodermatoses include all except:

1 Tuberous sclerosis

Tuberous sclerosis is not associated with photosensitivity. Q/Q(M)-474691 Report a Problem

Which of the following is true regarding actinic prurigo?

1 Lesions generally continue through late adulthood

2 Lesions persist for 1-2 days

3 Lesions never occur on non-sun-exposed areas

4 Cheilitis is frequently seen

5 Thalidomide has been ineffective for the majority of patients


Which of the following is true regarding actinic prurigo? 4 Cheilitis is frequently seen

Actinic prurigo is an idiopathic photosensitivity disorder. Lesions are excoriated papules and nodules that begin in childhood and remit in puberty. They can last for several months and may occur on non-sun-exposed areas. Thalidomide has been very effective for treating the majority of patients with actinic

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prurigo. Q/Q(M)-478264 Report a Problem

Which of the following is not true about UVB radiation?

1 Responsible for sunburn

2 More intense in the summer than winter months

3 Peaks at noon

4 Decreased with high wind velocity

5 Virtually all blocked by car window glass

Q/Q(M)-475875 Report a ProblemWhich of the following is not true about UVB radiation?

4 Decreased with high wind velocity

The UVB band extends from 290 to 320 nm. The UVB spectrum is recognized as the primary cause of sunburn, skin cancer, and other harmful effects on human skin. The UVA band extends from 320 to 400 nm. This spectrum is further subdivided into UVA-2 (320 to 340 nm) and UVA-1 (340 to 400 nm). The UVA spectrum is recognized as a cause of immediate and delayed tanning reaction of skin, and several other effects including photoaging, skin photosensitization, and immunosuppression. UVC radiation comprises wavelengths shorter than 290 nm (from 200 to 290 nm). Notably, window glass filters out ultraviolet wavelengths shorter than 320 nm, so both UVB and UVC are effectively filtered by car window glass. UVB radiation is more intense during summer months compared to winter months and peaks during midday hours. It has been postulated that physical factors such as high temperature, high humidity, and wind can all increase susceptibility to UV-induced carcinogenesis.

Q/Q(M)-475875 Report a ProblemA 40-year-old patient presents with widespread plaque-type psoriasis without arthritis. She had already applied potent topical steroids, calcipotriene, and tazarotene. The treatment of choice would be:

1 PUVA

2 Cyclosporine

3 Narrowband UVB

4 Etretinate

5 Methotrexate


A 40-year-old patient presents with widespread plaque-type psoriasis without arthritis. She had already applied potent topical steroids, calcipotriene, and tazarotene. The treatment of choice would be:

3 Narrowband UVB

The other choices involve internal medications and therefore have the potential for more side effects than with narrowband UVB. Phototherapy may be impractical for some patients, and therefore systemic therapies should be offered.


Lumisterol is an inactive epidermal reservoir of which vitamin? 1 A

2 C

3 D

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4 E

5 K


Lumisterol is an inactive epidermal reservoir of which vitamin?

3 D

Lumisterol and tachysterol are inert byproducts created during the biosynthesis of vitamin D. When Previtamin D3 is exposed to light, it can result in photoisomerization of previtamin D3 to lumisterol and tachysterol. If previatmin D3 is depleted, lumisterol and tachysterol can become converted back to previtamin D3.


Fluorescent UVA bulbs used for phototesting or PUVA therapy have a peak emission at: 1 254 nm

2 311 nm

3 312 nm

4 352 nm

5 468 nm


Fluorescent UVA bulbs used for phototesting or PUVA therapy have a peak emission at: 4 352 nm

254 nm is the wavelength of the radiation emitted by mercury vapor lamps. Narrowband UVB emits 311-312 nm. Fluorescent UVA bulbs used for phototesting or PUVA therapy have a peak emission at 352 nm.


When solar urticaria is a consideration for phototesting: 1 7 test squares of increasing UV doses should be exposed

2 The lower back should not be used for testing

3 An MED (B) and MED (A) should not be performed

4 An additional reading at 15 minutes after exposure should be performed

5 Visible light will not evoke the lesions


When solar urticaria is a consideration for phototesting:

4 An additional reading at 15 minutes after exposure should be performed

When solar urticaria is a consideration, an additional reading at 15 minutes after exposure is important, as wheals begin within 10-30 minutes after exposure and last for about one hour. The face and hands may not show lesions as they are chronically exposed to sun. Some patients react to either visible light or UVA or UVB. Others react to both UVB and UVA, both UVA and visible light, or all three.


The differential diagnosis of this patient would include: 1 Photoallergic contact dermatitis

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2 Airborne contact dermatitis


4 Drug photosensitivity



The differential diagnosis of this patient would include: 5 All of these answers are correct

Photoallergic contact, airborne contact, chronic actinic dermatitis, and drug photosensitivity can all result in erythema or eczematous patches in sun exposed areas. Subtle clues may help distinguish them such as involvement of the submental area in a airborne contact dermatitis.


All of the following are true regarding polymorphous light eruption except: 1 Pruritic

2 Abnormal metabolism of arachidonic acid

3 Hardening occurs with subsequent episodes

4 Lesions heal without scarring

5 Anti-Ro antibody positive


All of the following are true regarding polymorphous light eruption except:

5 Anti-Ro antibody positive

Polymorphous light eruption is the most common photodermatosis that is characterized clinically by the abnormal occurrence of pruritic, erythematous, edematous papules following exposure to UV radiation. Lesions heal without scarring. It tends to affect women 2-3x more than men. Positive Anti-ro antibodies should raise the suspicious for subacute cutaneous lupus erythematosus (tends also to be less pruritic).

Q/Q(M)-477203 Report a ProblemThis patient presented with hyperpigmented streaks after a vacation in the Caribbean. The most likely diagnosis is:

1 PMLE

2 CAD

3 Melasma

4 Phytophotodermatitis

5 Actinic prurigo


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This patient presented with hyperpigmented streaks after a vacation in the Caribbean. The most likely diagnosis is: 4 Phytophotodermatitis

Phytophotodermatitis requires exposure to certain plants or fruits followed by sunlight. Parsnips, parsley, figs, limes, celery, bergamot oranges, and others contain psoralens that react with UVA. Initially there is erythema and blistering followed by streaked hyperpigmentation.


The solar simulator is not useful for phototherapy because of its:

1 High output of ultraviolet radiation

2 High output of infrared radiation

3 Low output of UVB

4 Low level of ionizing radiation

5 Small field size


The solar simulator is not useful for phototherapy because of its: 5 Small field size

The coin-sized field of the solar simulator prevents this source from being useful for phototherapy. It is useful in MED testing.


Regarding renal transplant recipients, which of the following statements is correct: 1 Have rates of SCC similar to the general population

2 Have a 36-fold increased risk of BCC

3 Have a 36-fold increased risk of SCC

4 Should have skin cancer screening at the same rate as the general population

5 Have an decreased risk for melanoma


Regarding renal transplant recipients, which of the following statements is correct:

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3 Have a 36-fold increased risk of SCC

The rates of SCC in renal cell transplant recipients is increased at a rate of 36x. The rates of skin cancer are higher than in the general population.


The patient demonstrates a positive photopatch test to musk ambrette and a lowered MEDB. The correct diagnosis is most likely: 1 PMLE

2 Solar urticaria

3 CAD

4 Actinic prurigo



The patient demonstrates a positive photopatch test to musk ambrette and a lowered MEDB. The correct diagnosis is most likely: 3 CAD

Only chronic actinic dermatitis (CAD) has a lowered MEDB. That finding helps distinguish CAD from photoallergic contact dermatitis in which one sees a positive photopatch test also.


Lichen planus like lesions on sun-exposed areas may be seen in patients receiving which medication? 1 Fenofibrate

2 Griseofulvin

3 Alprazolam




Lichen planus like lesions on sun-exposed areas may be seen in patients receiving which medication?

1 Fenofibrate

LP-like lesions (which may be confluent) on sun-exposed areas have been seen in patients receiving antimalarials, thiazides, demethylchlortetracycline, fenofibrate, enalapril, quinine, and quinidine.

Q/Q(M)-476735 Report a ProblemThe main condition on the differential for polymorphous light eruption is lupus erythematosus. Which of the following tests should NOT be performed to help make this distinction?

1 Antinuclear antibody

2 Anti-SSA

3 Anti-SSB

4 Skin biopsy for routine staining and direct immunofluorescence

5 SED rate


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The main condition on the differential for polymorphous light eruption is lupus erythematosus. Which of the following tests should NOT be performed to help make this distinction? 5 SED rate

All of the listed tests are helpful in distinguishing between PMLE and lupus except a SED rate, which is a non-specific marker of systemic inflammation.


What range of ultraviolet radiation has been shown to be most efficient in inducing neoplasia in mice?

1 280-320nm

2 320-340nm

3 340-400nm

4 400-760nm

5 >760nm


What range of ultraviolet radiation has been shown to be most efficient in inducing neoplasia in mice? 1 280-320nm

Midrange UVR 280-320nm (UVB range) has been shown to be most efficient in inducing neoplasia in mice. Long-wave UVA, when added to UVB may accelerate carcinogenesis.


Lesions of PMLE typically appear:

1 About one hour after exposure

2 Hours to days after exposure

3 Days to two weeks after exposure

4 15-30 minutes after exposure

5 Immediately


Lesions of PMLE typically appear: 2 Hours to days after exposure

The history of a delay of several hours to several days after exposure is important to the diagnosis. Q/Q(M)-475942 Report a Problem

Which of the following patients would be the most likely to present with chronic actinic dermatitis?

1 A 4 year-old Native American boy

2 A teenage girl

3 A 64 year-old farmer

4 A 32 year-old woman

5 A 32 year-old man


Which of the following patients would be the most likely to present with chronic actinic dermatitis?

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3 A 64 year-old farmer

Patients with chronic actinic dermatitis are usually middle-aged to elderly males who present with a chronic eczematous dermatitis in a photodistribution without history of current exposure to a photosensitizer.

Q/Q(M)-478269 Report a ProblemLichen planus-like lesions on sun-exposed areas may be seen in patients being treated with:

1 Fenofibrate

2 Ketoprofen

3 Quinolones




Lichen planus-like lesions on sun-exposed areas may be seen in patients being treated with: 1 Fenofibrate

Lichenoid medication photosensitivity, with LP-like lesions on sun-exposed areas has been associated with treatment with antimalarials, thiazides, demethylchlortetracycline, fenofibrate, enalapril, quinine, and quinidine.


Most patients with PMLE require treatment with: 1 Sunscreen and sun avoidance between 11 am and 3pm

2 UVB hardening/desensitization

3 Chloroquine

4 Prednisone

5 Cyclophosphamide


Most patients with PMLE require treatment with:

1 Sunscreen and sun avoidance between 11 am and 3pm

Most patients have mild disease that can be treated by sun avoidance, especially between 11 am and 3pm; a broad spectum sunscreen and clothing with a tight weave. In more severe cases, UV hardening, antimalarials or prednisone can be used. Cyclophosphamide is not used in PMLE.


This malnourished individual presented with crusting and hyperpigmentation in a photodistribution. The best diagnosis is:

1 CAD


3 Scurvy

4 Pellagra

5 PMLE


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This malnourished individual presented with crusting and hyperpigmentation in a photodistribution. The best diagnosis is: 4 Pellagra

Pellagra is characterized by the triad of diarrhea, dermatitis, and dementia. The dermatitis begins as a burning erythema in sun-exposed areas. There may be bullae and erosions. This is followed by a dry, brittle, scaling and hyperpigmented phase. Pellagra is due to a deficiency of niacin and tryptophan.


Treatment of CAD might include: 1 UV filters for car windows

2 Broad spectrum sunblock to which the patient is not allergic

3 Incandescent bulbs for home and office lighting

4 PUVA


Q/Q(M)-474685 Report a ProblemTreatment of CAD might include:


CAD patients are exquisitely sensitive to UVB, often sensitive to UVA, and sometimes sensitive to visible light. Answers a, b, and c are correct because those treatments prevent UV and visible radiation from reaching the patient. PUVA hardens and desensitizes the skin.


Phototoxic reactions: 1 Are immunologically mediated

2 Occur only in predisposed individuals

3 Rarely occur on the first exposure to the chemical

4 Are called "photoreactive" if they produce damage through reactive oxygen species

5 Resolve with hyperpigmentation


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Phototoxic reactions:

5 Resolve with hyperpigmentation

A phototoxic reaction appears as a exaggerated sunburn with erythema and sometimes blistering, resolving with hyperpigmentation. It is a nonimmunologic reaction that could occur in all individuals given enough of the chemical and enough UVR. It can occur on the first exposure to the chemical and the UVR. Phototoxic reactions that produce damage through reactive oxygen species are called "photodynamic."

Q/Q(M)-476091 Report a ProblemThe wavelength range that most effectively induces cutaneous immunosuppression is: 1 200-290nm

2 290-320nm

3 320-340nm

4 340-400nm

5 400-410nm

Q/Q(M)-478145 Report a ProblemThe wavelength range that most effectively induces cutaneous immunosuppression is: 2 290-320nm

290-320nm (UVB) is most effective in suppressing cutaneous immunity; mechanisms include depletion of Langerhans cells, induction of regulatory T cells, and keratinocyte secretion of such immunosuppressive cytokines as IL-10 and TNF-alpha.


Possible treatments for this patient with vitiligo include all of the following except: 1 Topical steroids

2 Narrowband UVB

3 Broadband UVB

4 Oral PUVA

5 Acitretin


Possible treatments for this patient with vitiligo include all of the following except:

5 Acitretin

Topical steroids and all the UV choices have been used to treat vitiligo. Soriatane does not benefit vitiligo.


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Regarding the UVR effects on contact dermatitis and delayed-type hypersensitivity, which of the following statements is correct?

1 Mice exposed to long-term, high-dose UVR demonstrate increased splenic APC function

2 There are increased delayed-type hypersensitivity responses

3 There are diminished contact hypersensitivity responses

4 Induction of sensitization is increased

5 There are increases in production of Th2 type cytokines


Regarding the UVR effects on contact dermatitis and delayed-type hypersensitivity, which of the following statements is correct? 3 There are diminished contact hypersensitivity responses

Mice exposed to short-term, high-dose UVR demonstrate decreased splenic APC function. There are diminished delayed-type hypersensitivity and contact hypersensitivity responses. Induction of sensitization is decreased. Th2 cytokines are not increased following UVR exposure.


The immunologic effects of UVR include all of the following except: 1 Alteration of Langerhans cell morphology

2 Decrease in IL-1, IL-6, TNF-alpha

3 Suppression of delayed-type hypersensitivity

4 Alteration of lymphocyte population

5 Alteration of Langerhans cell function


The immunologic effects of UVR include all of the following except: 2 Decrease in IL-1, IL-6, TNF-alpha

UVR causes an increase of circulating cytokines (IL-1, IL-6, TNF-alpha). Q/Q(M)-474673 Report a Problem

The typical patients with polymorphous light eruption are:

1 Fair-skinned females in their 40’s and 50’s.

2 Type IV-skinned males in their 40’s and 50’s.

3 Type V-skinned females in their 20’s and 30’s.

4 Fair-skinned males in their 20’s and 30’s.

5 Fair-skinned females in their teens and 20’s.


The typical patients with polymorphous light eruption are: 5 Fair-skinned females in their teens and 20’s.

PMLE most commonly appears in fair-skinned females during the first three decades of life. It may be related to type IV hypersensitivity.


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Which of the following is true about UV light: 1 UVA radiation is 1000 times greater than UVB during midday hours

2 UVB radiation is 1000 times more erythrogenic than UVA

3 Sunlight early in the morning and late in the day contains relatively more UVB

4 UVAII light is 340-400nm

5 Clouds absorb most UVA light


Which of the following is true about UV light:

2 UVB radiation is 1000 times more erythrogenic than UVA

UVA light is found b/w 320 and 400nm and is broken up into UVAI(340-400nm) and UVAII((320-340nm). UVB light is found between 290 and 320nm. UVA radiation is 100 times greater than UVB during midday hours and sunlight early in the morning and late in the day contains relatively more UVA. UVB radiation is 1000 times more erythrogenic than UVA. Cloud cover is a poor UV absorber.


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