A 16-year-old female patient enters your dermatology clinic complaining of a rash. She is not
taking any medications and is
well dressed and groomed. You diagnose a mild case of acne vulgaris and notice that the girl's
skin and hair appear unusually oily. Which of the following would be the best treatment for
acne?
A) Calcipotriene
B) Topical dexamethasone
C) Isotretinoin
D) Bexarotene - ANS The answer is C. Isotretinoin is a retinoid that is especially useful in
treating acne; it reduces oil production in the skin.
Calcipotriene is used to treat psoriasis. Bexarotene is a rexinoid used to treat skin disorders, but
not acne.
A 73-year-old woman with breast cancer and history of congestive heart failure is placed on a
chemotherapy regimen that includes the use of methotrexate (MTX) after her mastectomy. This
agent's activity is related to its ability to do what?
A) Carbamylated intracellular macromolecules
B) Indirectly inhibit DNA synthesis
C) Block chromosomal migration and cell differentiation
D) Complex with DNA to form crosslinks - ANS The answer is B. Methotrexate inhibits the
enzyme dihydrofolate reductase, which ultimately decreases the availability of thymidylate to
produce DNA.
Nitrosoureas can carbamylate intracellular molecules. Vinca alkaloids such as vinblastine block
chromosomal migration and cellular differentiation. Cisplatin works primarily by complexing with
DNA to form crosslinks.
A 45-year-old female patient has fasting glucose levels of 147 mg/dL, and with a glucose
tolerance test, you have confirmed the diagnosis of type II diabetes. You begin therapy with
metformin, but her fasting glucose levels remain above 100 mg/dL. You elect to change her
therapy to glyburide. This drug acts to:
A) Increase insulin secretion
B) Decrease glucocorticoid levels
C) Decrease tissue sensitivity to insulin
D) Decrease insulin half-life - ANS The answer is A. Sulfonylureas such as glyburide increase
the release of insulin from the pancreas. They also may cause an increase in insulin receptors,
which increases tissue sensitivity to insulin. They do not slow insulin clearance, and they do not
decrease glucocorticoid levels.
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