CME examination Identification No . 879-112

See "Instructions for Category I CME Credit" on page 19Aof the front advertising section.Questions 1-27 , Lang PG: J AM ACAD DERMATOL1:479-492, 1979.

Directions for questions 1-21: Give single best re­sponse.

I . Which laboratory test needs initial evaluation only.prior to beginning treatment with dapsone?a. Complete blood count with differential white

blood cell countb. Platelet countc. Urinalysisd. Glucose-6-phosphate dehydrogenase levele. Methemoglobin level

2. The diaminodiphenylsulfone (DADPS) syndromehas been reported primarily occurring in patientsreceiving sulfones fora. dermatitis herpetiformisb. subcorneal pustular dermatosisc. leprosyd. pemphiguse. bullous disease of childhood

3. A precipitate of structurally altered hemoglobinand other compounds in a red blood cell that hasundergone persistent oxidative stress is known as a(an)a. Auer 's bodyb. Dohle 's bodyc. Heinz bodyd. Howell-Jolly bodye. Russell's body

4. Which of the following is an injectable drug?a. Dapsone (DDS)b. Sulfapyridinec . Salicylazosulfapyridined. Acedapsonee. Diasone

5. A cyanotic appearance unrelated to methemo­globinemia or sulfhemoglobinemia has been re­ported witha. dapsone (DDS)b. sulfapyridinec. salicylazosulfapyridined. acedapsonee. Sulfoxone sodium (Diasone)

6. Simultaneous administration of which of the fol-

lowing decreases the serum half-life of dapsone(DDS)?a. Probenecidb. Tripelennaminec. Nicotinic acidd. Potassium iodidee. Rifampicin

7. Which of the following is most likely to exacerbatedermatitis herpetiformis?a. Dapsone (DDS)b. Sulfapyridinec. Nicotinic acidd. Tripelennaminee. Potassium iodide

8. Which of the following is well absorbed orally?a. Dapsone (DDS)b. Sulfapyridinec. Diasoned. Acedapsonee. None of the above

9. In the liver, deacetylation as well as acetylationoccurs witha. dapsone (DDS)b. sulfapyridinec. hydralazined. isoniazide. none of the above

10. Hemolysis, as a side effect of dapsone (DDS) , ismost likely primarily due to a (an)a. acetylated derivativeb . deacetylated derivativec. oxidized derivatived. reduced derivativee. glucuronated derivative

II. Formation of methemoglobin, as a side effect ofdapsone (DDS), is most likely primarily due to a(an)a. acetylated derivativeb. deacetylated derivativec. oxidized derivatived. reduced derivativee . glucuronated derivative

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494 CME examination

12. Crystalluria leading to renal damage in patientsreceiving sulfapyridine is most likely due to a (an)a. acetylated derivativeb. deacetylated derivativec. oxidized derivatived. reduced derivativee. glucuronated derivative

13. Neuropathy associated with dapsone (DDS) ad­ministration most commonly affects thea. sensory innervation of the lower extremitiesb. sensory innervation of the handsc. sensory innervation of the hands and feetd. motor innervation of the lower extremitiese. motor innervation of the hands

14. In order for clinical cyanosis to be apparent, thepercentage of total hemoglobin that must bemethemoglobin isa. 5%b. 15%c. 30%d.50%e. 70%

IS. The percentage of patients with dermatitis her­petiformis who respond to a dose of 100 mg perday of dapsone (DDS) isa. 10%b.25%c. 50%d.80%e. 95%

16. The percentage of patients with bullous pem­phigoid who respond to dapsone (DDS) or sul­fapyridine isa. 5%b. 15%c. 30%d. 50%e. 75%

17. The average RBC life span in normal subjects re­ceiving 300 to 600 mg per day of dapsone (DDS) isa. greater than 120 daysb. 100 to 110 daysc. 80 to 90 daysd. 60 to 70 dayse. less than 50 days

18. Agranulocytosis, as a complication of sul­fapyridine administration, occurs in one patient pera. 100b. 1,000c. 10,000d. 100,000e. 1,000,000

Journal of theAmerican Academy of

Dermatology

19. Agranulocytosis, as a complication of intermittentdapsone (DDS) administration, usually OCcurswhen after initiation of therapy?a. During the first weekb. I to 3 weeksc. 3 to 12 weeksd. 3 to 6 monthse. 3 to 18 months

20. The threshold dose of dapsone (DDS) above whichthere is a clinically significant progressive increasein side effects, excluding idiosyncratic reactions, isa. 100 mg per dayb. 300 mg per dayc. 600 mg per dayd. 2 to 4 gm per daye. 4 to 6 gm per day

21. The recommended daily therapeutic dose range forsulfapyridine isa. 50 to ISO mgb. ISO to 300 mgc. 600 to 800 mgd. 1 to 2 gme. 2 to 6 gm

Directions for questions 22-27: Indicate correctanswers. All, some, or none may be true.22. On the same day, prior to starting SUlfapyridine, a

complete blood count with differential white cellcount, renal and hepatic function tests, urinalysis,methemoglobin, and glucose-6-phosphate dehy­drogenase levels are obtained on a patient. Whichof the following should be repeated at follow-up onreturn one week later?a. Complete blood countb. Differential white blood cell countc. Renal function testsd. Hepatic function testse. Urinalysis

23. The following disease(s) respond(s) to dapsonIf "d' e orsu apyn me:

a. Pemphigus vulgarisb. Bullous pemphigoidc. Subcorneal pustular dermatosisd. Erythema elevatum diutinume. Pyoderma gangrenosum

24. Patients with bullous pemphigoid Who respond todapsone (DDS) or sulfapyridine, versus those whodo not respond, tend toa. be youngerb. be femalec. have larger bullae

d. show a prepon~erance of polymorphonuclearleukocytes on biopsy

Volume INumber 6December, 1979

CME examination 495

e. be also more responsive to systemic corticoste- c. phagocytosisroid treatment d. superoxide formation

25. An idiosyncratic reaction to sulfapyridine during e. conversion of iodine (12) to sodium iodidethe first week of treatment is especially likely to (Nal)occur in 27. Agranulocytosis, as a complication of administra-a. white male adults tion of dapsone (DDS) (25 mg per day) togetherb. black male adults with primaquine or chloroquine once per week forc. black female adults malaria prophylaxis, has been reported to be asso-d. white male children ciated with which of the following features?e. white female children a. Pharyngitis

26. Laboratory tests on the action of dapsone (DDS) b. Pyodermaon polymorphonuclear leukocytes in vitro have c. Neuropathyshown that it suppresses d. Cholestasisa. random motion e. A leukemia-like appearance of the peripheralb. chemotaxis to a number of attractants blood smear during recovery

Answers for CME examination Identification No. 879-111

November, 1979, issue of the JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

Questions 1-20, Lyell A: JAM ACAD DERMATOL 1:391-407, 1979.

I.c 6.a 11.a 16.b2. c 7. d 12. b 17. d3. d 8. b 13. c 18. b, c, d4. e 9. d 14. c 19. b, c, e5. b 10. e 15. e 20. c, d