1. How many Americans have atopic dermatitis?
A. 10 million
B. 20 million
C. 30 million
D. 40 million
E. Unsure
2. Which of the following describes atopic dermatitis?
A. Most people with AD (about 70%) have mild disease, usually treatable in primary care settings
B. Clinicians recognize AD quickly and usually treat it aggressively, appropriately, and quickly
C. Poor adherence, treatment complexity, and formulary access are rarely problems for patients with AD
D. AD is generally a steadily progressive disease, with severity increasing over time
E. Unsure
3. Jacie is a 22-year-old female with poorly controlled AD, a problem she has experienced since infancy. She has a flare on her hands that is so itchy, it's keeping her awake all night. She is moisturizing multiple times daily and using fluticasone propionate ointment 0.005% twice daily. What would be the BEST change to her regimen?
A. Switch fluticasone propionate ointment 0.005% to desonide gel 0.05%
B. Switch fluticasone propionate ointment 0.005% to hydrocortisone valerate ointment 0.2%
C. Have her apply the fluticasone propionate ointment 0.005% twice daily followed by a tepid bath
D. Switch fluticasone propionate ointment 0.005% to halcinonide ointment 0.1%
E. Unsure
4. Which of the following lists topical medications in the order they would be tried in a 9-year-old patient who has AD?
A. Tacrolimus 0.03%, crisaborole, triamcinolone acetonide ointment
B. Triamcinolone acetonide ointment twice daily for maintenance, desoximetasone gel 0.05% for flares
C. Hydrocortisone cream, triamcinolone acetonide ointment, crisaborole
D. Crisaborole, triamcinolone acetonide ointment, hydrocortisone cream
E. Unsure
5. Jacie steps up her TCS and uses wet wrap therapy to help address her itchy flare. Her skin is not responding, and she says that she has not been able to tolerate the TCNIs in the past. Her SCORAD index is 53. What is the BEST next step?
A. Call the dermatologist and suggest she change Jacie's medication to methotrexate weekly for at least 8 weeks to ensure any response will be fast and enduring
B. Suggest that Jacie add crisaborole lotion as a moisturizer, applying it as needed and under wet wraps to increase skin hydration
C. Explain that with a SCORAD index of 53, she now has severe AD and will need to consider systemic therapy
D. Use motivational interviewing to ensure that Jacie is completely adherent, and ask her to come back in a week
E. Unsure
6. Which of the following patients may need systemic treatment with an immunomodulatory drug or biologic?
A. A 35-year-old man (SCORAD = 33) who experiences TCS-responsive flares once annually, usually in the winter
B. A 25-year-old woman (SCORAD = 47) who has used TCSs for many years and can no longer tolerate them and who refuses to use TCNIs
C. A newly diagnosed 4-month-old infant who has a typical AD presentation for his age and is treatment-naive
D. A 19-year-old college student who indicated during motivational interviewing that she has not followed her AD action plan
E. Unsure
7. Gary is experiencing a significant flare. He is responding to his TCS, but not as quickly or as well as usual. Which step may occlude his TCA, increase penetration, and reduce excoriation?
A. Wet Wrap therapy
B. Phototherapy
C. Bleach baths
D. Evening primrose oil
E. Unsure
8. Leo is a 9-year-old boy who has AD. His caregivers have been able to control his AD with fluocinolone acetonide ointment 0.025% until recently. He complains about the feel of the ointment, and applying it has been a struggle. The pharmacist counsels Leo and his family about TCAs, and encourages them to continue using the current medication. Select the answer that provides the BEST evaluation of this strategy.
A. The pharmacist's strategy is faulty because when patients find a product pharmaceutically inelegant, they are likely to become nonadherent
B. The pharmacist's strategy is appropriate because nonadherence is a primary reason that patients don't respond to treatments for AD.
C. The pharmacist's strategy is faulty because he should have also stressed the need for frequent moisturization and appropriate cleansing
D. The pharmacist's strategy is appropriate because patients generally prefer ointments over other delivery vehicles, so switching will not help
E. Unsure
9. Charlotte is a 17-year-old adolescent who continues to experience severe symptoms of AD following optimization of topical therapy. She did not respond to a 12-week trial of methotrexate. She has sunlight-response AD, responds somewhat to phototherapy and plans to continue; and is allergic to most sunscreen products. Which of the following immunomodulatory agents is most appropriate for her?
A. Cyclosporine
B. Azathioprine
C. Pimecrolimus
D. Dupilumab
E. Unsure
10. Jack, a middle-aged man, is considering dupilumab for his severe AD, but he is very fearful that he will not be able to self-inject. Which of the following questions is appropriate to address his misconception that dupilumab injections are painful and difficult?
A. “I know that the process of self-injecting may seem scary, but what do you have to lose?”
B. “May I say something about injecting dupilumab that I learned in a class recently?”
C. “You said that constant itching at night is very disruptive, so why are you giving up?”
D. “You didn't read this ridiculous information on the Internet, did you?
E. Unsure
