Dental Management of the Medically Compromised Patient 9th Edition Little Test Bank

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Chapter 01: Patient Evaluation and Risk Assessment Little: Dental Management of the Medically Compromised Patient, 9th Edition MULTIPLE CHOICE 1. Elective dental care should be deferred for patients with severe, uncontrolled hypertension,

meaning that the blood pressure is greater than or equal to ________ mm Hg. a. 200/140 b. 180/140 c. 180/110 d. 160/110 ANS: C

Elective dental care should be deferred for patients with severe, uncontrolled hypertension, which is blood pressure greater than or equal to 180/110 mm Hg, until the condition can be brought under control.

2. The American Heart Association currently recommends antibiotic prophylaxis for a patient

with which of the following cardiac conditions? a. Mitral valve prolapse b. Prosthetic heart valve c. Rheumatic heart disease d. Pacemakers for cardiac arrhythmias ANS: B

Previously, the American Heart Association (AHA) recommended antibiotic prophylaxis for GRAcaused DESMO E.COMdisease (e.g., mitral valve prolapse, many patients with heart murmurs byRvalvular rheumatic heart disease) in an effort to prevent infective endocarditis; however, current guidelines omit this recommendation on the basis of accumulated scientific evidence. If a murmur is due to certain specific cardiac conditions (e.g., previous endocarditis, prosthetic heart valve, complex congenital cyanotic heart disease), the AHA continues to recommend antibiotic prophylaxis for most dental procedures.

3. One consequence of chronic hepatitis (B or C) or cirrhosis of the liver is decreased ability of

the body to _________ certain drugs, including local anesthetics and analgesics. a. absorb b. distribute c. metabolize d. excrete ANS: C

Patients also may have chronic hepatitis (B or C) or cirrhosis, with impairment of liver function. This deficit may result in prolonged bleeding and less efficient metabolism of certain drugs, including local anesthetics and analgesics.

4. Which of the following symptoms and signs is most consistent with allergy? a. Heart palpitations b. Itching c. Vomiting d. Fainting

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ANS: B

Symptoms and signs consistent with allergy include itching, urticaria (hives), rash, swelling, wheezing, angioedema, runny nose, and tearing eyes. Isolated signs and symptoms such as nausea, vomiting, heart palpitations, and fainting generally are not of an allergic origin but rather are manifestations of drug intolerance, adverse side effects, or psychogenic reactions.

5. Which of the following is true of the patient with a history of tuberculosis? a. A positive result on skin testing means that the person has active TB. b. Most patients who become positive skin testers develop active disease. c. Patients with acquired immunodeficiency syndrome (AIDS) have a high incidence

of tuberculosis. d. A diagnosis of active TB is made by a purified protein derivative (PPD) skin test.

ANS: C

The potential coexistence of tuberculosis and acquired immunodeficiency syndrome (AIDS) should be explored because patients with AIDS have a high incidence of tuberculosis. A positive result on skin testing means specifically that the person has at some time been infected with TB, not necessarily that active disease is present. Most patients who become positive skin testers do not develop active disease. A diagnosis of active TB is made by chest x-ray, imaging, sputum culture, and clinical examination.

6. Vasoconstrictors should be avoided in patients who cocaine or methamphetamine users

because these agents may precipitate _________. a. severe hypotension b. severe hypertension c. respiratory depression GRADESMORE.COM d. cessation of intestinal peristalsis ANS: B

Vasoconstrictors should be avoided in patients who are cocaine or methamphetamine users because the combination may precipitate arrhythmias, MI, or severe hypertension.

7. It has been shown that the risk for occurrence of a serious perioperative cardiovascular event

(e.g., MI, heart failure) is increased in patients who are unable to meet a __-MET (metabolic equivalent of task) demand during normal daily activity. a. 4 b. 6 c. 8 d. 10 ANS: A

Daily activities requiring 4 METs include level walking at 4 miles/hour or climbing a flight of stairs. Activities requiring greater than 10 METs include swimming and singles tennis. An exercise capacity of 10 to 13 METs indicates excellent physical conditioning.

8. Which of the following alterations in the fingernails is associated with cirrhosis? a. Yellowing b. Clubbing c. White discoloration d. Splinter hemorrhages

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ANS: C

Alterations in the fingernails, such as clubbing (seen in cardiopulmonary insufficiency), white discoloration (seen in cirrhosis), yellowing (from malignancy), and splinter hemorrhages (from infective endocarditis) usually are caused by chronic disorders.

9. A blood pressure cuff should be placed on the upper arm and inflated until _________. a. the radial pulse disappears b. the radial pulse disappears and then inflated an additional 20 to 30 mm Hg c. two fingers cannot fit comfortably under the cuff d. the pulse no longer can be heard with the stethoscope ANS: B

While the radial pulse is palpated, the cuff is inflated until the radial pulse disappears (approximate systolic pressure); it is then inflated an additional 20 to 30 mm Hg. 10. Which of the following is true of a patient classified ASA III according to the American

Society of Anesthesiologists (ASA) Physical Status Classification System?

Patient has mild systemic disease.

Patient’s disease has significant impact on daily activity.

Patient’s disease is unlikely to have impact on anesthesia and surgery.

Patient is moribund.

a. b. c. d.

ANS: B

Patient with severe systemic disease is a constant threat to life (e.g., recent myocardial infarction, stroke, transient ischemic attach [<3 months], ongoing cardiac ischemia, severe valve dysfunction, respiratory failure requiring mechanical ventilation). Serious limitation of daily activity; likely major impact on anesthesia and surgery.

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Chapter 02: Infective Endocarditis Little: Dental Management of the Medically Compromised Patient, 9th Edition MULTIPLE CHOICE 1. Which of the following is true concerning infective endocarditis (IE)? a. IE is always due to a bacterial infection. b. Since the advent of antibiotics, morbidity and mortality associated with IE have

been virtually eliminated. c. IE is currently classified as acute or subacute, to reflect the rapidity of onset and

duration. d. Accumulating evidence questions the validity of antibiotic prophylaxis in an

attempt to prevent IE prior to certain invasive dental procedures.

ANS: D

Antibiotics have been administered before certain invasive dental procedures in an attempt to prevent infection. Of note, however, the effectiveness of such prophylaxis in humans has never been substantiated, and accumulating evidence more and more questions the validity of this practice.

2. Which of the following is currently the most common underlying condition predisposing to

infective endocarditis (IE)? a. Aortic valve disease b. Rheumatic heart disease (RHD) c. Mitral valve prolapse (MVP) d. Tetralogy of Fallot GRADESMORE.COM ANS: C

Mitral valve prolapse, which accounts for 25% to 30% of adult cases of native valve endocarditis (NVE), is now the most common underlying condition among patients who acquire IE. Previously, rheumatic heart disease (RHD) was the most common condition predisposing to endocarditis. In developed countries, however, the frequency of RHD has markedly declined over the past several decades.

3. The leading cause of death due to infective endocarditis (IE) is __________. a. chronic obstructive pulmonary disease b. heart failure c. pulmonary emboli d. atheromas ANS: B

The most common complication of IE, and the leading cause of death, is heart failure, which results from severe valvular dysfunction. This pathologic process most commonly begins as a problem with aortic valve involvement, followed by mitral and then tricuspid valve infection.

Embolization of vegetation fragments often leads to further complications, such as stroke.

Myocardial infarction can occur as the result of embolism of the coronary arteries, and distal emboli can produce peripheral metastatic abscesses.

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4. The interval between the presumed initiating bacteremia and the onset of symptoms of

infective endocarditis (IE) is estimated to be less than __________ in more than 80% of patients with IE. a. 1 week b. 2 weeks c. 1 month d. 2 months ANS: B

It is less than two weeks in more than 80% of patients with IE. In many cases of IE that have been purported to be due to dentally induced bacteremia, the interval between the dental appointment and the diagnosis of IE has been much longer than 2 weeks (sometimes months), so it is very unlikely that the initiating bacteremia was associated with dental treatment.

5. Where are Janeway lesions located? a. Tricuspid valve b. Palms of the hands and soles of the feet c. Pulp of the digits d. Nail beds ANS: B

Janeway lesions are small, nontender erythematous or hemorrhagic macular lesions on the palms and soles. Janeway lesions are one of the peripheral manifestations of IE due to emboli and/or immunologic responses.

6. Which of the following is true of the magnitude of bacteremia required to cause infective

endocarditis (IE)?

GRAresulting DESMOR E.Cdental OM procedures is more likely to a. The magnitude of bacteremias from cause IE than that seen with bacteremias resulting from normal daily activities. b. Cases of IE caused by oral bacteria probably result from frequent exposure to low inocula of bacteria in the bloodstream due to daily activities and not a dental procedure. c. The quality of oral hygiene has no appreciable effect on the magnitude of bacteremia after toothbrushing. d. The magnitude of bacteremia resulting from dental procedures is greater than that needed to cause experimental bacterial endocarditis (BE) in animals.

ANS: B

An assumption often made is that the magnitude of bacteremias resulting from dental procedures is more likely to cause IE than that seen with bacteremias resulting from normal daily activities. Published data do not support this contention. Furthermore, the magnitude of bacteremia resulting from dental procedures is relatively low (with bacterial counts of fewer than 104 colony-forming units/mL), is similar to that of bacteremia resulting from normal daily activities, and is far less than that (106 to 108 colony-forming units/mL) needed to cause experimental BE in animals.

7. Visible bleeding during a dental procedure is a reliable predictor of bacteremia. It is not clear

which dental procedures are more or less likely to cause transient bacteremia or to result in a greater magnitude of bacteremia than that caused by routine daily activities such as chewing food, tooth brushing, or flossing. a. Both statements are true.

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b. Both statements are false. c. The first statement is true, the second statement is false. d. The first statement is false, the second statement is true.

ANS: D

It has been shown that visible bleeding during a dental procedure is not a reliable predictor of bacteremia. Collective published data suggest that the vast majority of dental office visits result in some degree of bacteremia, and that it is not clear which dental procedures are more or less likely to cause transient bacteremia or to result in a greater magnitude of bacteremia than that caused by bacteremia produced by routine daily activities such as chewing food, tooth brushing, or flossing.

8. Which of the following is true regarding the efficacy of antibiotic prophylaxis? a. Data show that a reduction in the incidence, nature, and duration of bacteria caused

by antibiotic therapy reduces the risk of or prevents IE. b. Antibiotics given to at-risk patients before a dental procedure will prevent or

reduce a bacteremia. c. Prospective randomized, placebo-controlled trials have been conducted to examine the efficacy of antibiotic prophylaxis for preventing IE in patients who undergo a dental procedure. d. Investigators have concluded that dental or other procedures probably only caused a small fraction of cases of IE, and that prophylaxis would prevent only a small number of cases, even if it were 100% effective.

ANS: D

This conclusion came as the result of a study from the Netherlands by van der Meer and colleagues that investigated the efficacy of antibiotic prophylaxis in preventing IE in dental GRA DESMvalves.

ORE.COM patients with native or prosthetic cardiac 9. The American Heart Association currently recommends antibiotic prophylaxis before dental

treatment to prevent endocarditis for patients with which of the following cardiac conditions? a. Mitral valve prolapse with regurgitation b. Rheumatic heart disease c. Prosthetic cardiac valve d. A, B, and C e. A and C ANS: C

Prophylaxis with antibiotics before a dental procedure is recommended for a prosthetic cardiac valve, previous infective endocarditis, and some forms of congenital heart disease (see Box 2-2.)

10. Which of the following antibiotics is the best choice if a patient who requires premedication

before dental treatment is already taking penicillin for eradication of an infection? a. Amoxicillin b. Clindamycin c. Cephalosporins d. Keep the patient on the penicillin because the blood level has already been achieved ANS: B

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The presence of viridians group streptococci that are relatively resistant to penicillin or amoxicillin is likely in patients already taking penicillin or amoxicillin for eradication of an infection. Clindamycin, azithromycin, or clarithromycin should be selected for prophylaxis if treatment is immediately necessary. Cephalosporins should be avoided due to cross resistance.

Another approach is to wait for at least 10 days after the completion of antibiotic therapy before administration of prophylactic antibiotics.

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Chapter 03: Hypertension Little: Dental Management of the Medically Compromised Patient, 9th Edition MULTIPLE CHOICE 1. In prehypertension, diastolic pressure ranges from ________ mm Hg. a. 80 to 89 b. 90 to 99 c. 100 to 109 d. 110 to 119 ANS: A

In adults, a sustained systolic blood pressure of 140 mm Hg or greater and/or a sustained diastolic blood pressure of 90 mm Hg or greater is defined as hypertension. (Also see Table 3-1.)

2. Which of the following types of health professionals can make the diagnosis of hypertension

and decide on its treatment? a. Physician b. Dentist c. Dental hygienist d. A, B, and C e. A and C only ANS: A

Although only a physician can make the diagnosis of hypertension and decide on its GRADE MORE.CODetection, M treatment, Joint National Committee onSPrevention, Evaluation, and Treatment of High Blood Pressure (JNC) guidelines specifically encourage the active participation of all health care professionals in the detection of hypertension and the surveillance of treatment compliance. Accordingly, the dental health professional can play a significant role in the detection and control of hypertension and may well be the first to detect a patient with an elevation in blood pressure or with symptoms of hypertensive disease.

3. Which of the following is true about hypertension in America? a. It is the second-most primary diagnosis behind congestive heart failure. b. Its prevalence has been steadily increasing 1990. c. Its prevalence is similar among all races and ethnicities. d. Its prevalence is similar among men and women.

ANS: D

According to National Health and Nutrition Examination Survey (NHANES) data for the period 2011 to 2012, at least 75 million adults in the United States have high blood pressure or are taking antihypertensive medication. This estimate equals about 29% of the U.S. population, compared with 24% when surveyed between 1988 and 1991. This marked increase is attributed to aging of the population and the epidemic increase in obesity.

Accordingly, a typical practice population of 2000 patients will have about 580 patients who have hypertension.

4. It is estimated that about __% of all blood pressure–related deaths from coronary heart disease

occur in persons with blood pressure in the prehypertensive range.

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a. b. c. d.

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less than 1 5 15 25

ANS: C

About 15%. However, the higher the blood pressure, the greater the chances of heart attack, heart failure, stroke, and kidney disease. For every increase in blood pressure of 20 mm Hg systolic and 10 mm Hg diastolic, a doubling of mortality related to ischemic heart disease and stroke occurs.

5. Which of the following groups is most often the first-line drug category of choice if lifestyle

modification is ineffective at lowering blood pressure? a. Beta-blockers (BBs), 1-adrenergic blockers, central 2 agonists, as well as other centrally acting drugs, and direct vasodilators b. Diuretics, thiazide diuretics, calcium channel blockers (CCBs), angiotensin receptor blockers, angiotensin-converting enzyme inhibitors (ACEIs) c. Any of the above. d. None of the above; lifestyle modification should continue unless blood pressure is >140/90 mm Hg ANS: B

Many drugs are currently available to treat hypertension. The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8) recommends diuretics, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and calcium channel blockers (CCBs) as first-line choices for the general non-Black population. For the general Black population, a thiazide GRA ESMOtherapy.

RE.COOther M drugs used as secondary choices diuretic or CCB is recommended asDinitial include beta-blockers (BBs), 1-adrenergic blockers, central 2 agonists, as well as other centrally acting drugs and direct vasodilators.

6. Deferral of elective dental care and referral to a physician for evaluation and treatment within

1 week are indicated for patients found to have asymptomatic blood pressure of greater than or equal to ________ mm Hg. a. 160/90 b. 160/110 c. 180/90 d. 180/110 ANS: D

Patients with blood pressures less than 180/110 mm Hg can undergo any necessary dental treatment, both surgical and nonsurgical, with very little risk of an adverse outcome. For patients found to have asymptomatic blood pressure of 180/110 mm Hg or greater (uncontrolled hypertension), elective dental care should be deferred, and physician referral for evaluation and treatment within 1 week is indicated. Patients with uncontrolled blood pressure associated with symptoms such as headache, shortness of breath, or chest pain should be referred to a physician for immediate evaluation.

7. Which of the following is recommended for stress management for dental patients with

hypertension? a. Afternoon appointments

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b. Premedication with a barbiturate c. Nitrous oxide plus oxygen for inhalation sedation d. Keeping the dental chair in an upright position during treatment ANS: C

Nitrous oxide plus oxygen for inhalation sedation is an excellent intraoperative anxiolytic for use in patients with hypertension. Care is indicated to ensure adequate oxygenation at all times, avoiding postdiffusion hypoxia at the termination of administration. Short morning appointments seem best tolerated. Oral premedication with a short-acting benzodiazepine can reduce anxiety for many patients. Because many of the antihypertensive agents tend to produce orthostatic hypotension as a side effect, rapid changes in chair position during dental treatment should be avoided.

8. Why should rapid changes in chair position during dental treatment be avoided for patients

under medication for hypertension? a. To lessen the chances of endogenous release of catecholamines. b. Alpha-blockers, alpha–beta-blockers, and diuretics tend to produce orthostatic hypotension as a side effect. c. Rapid chair position changes have nothing to do with antihypertensive medications and drugs used in dental practice. d. There is a high potential of triggering cardiovascular issues agents for hypertensive dental patients in moving chairs if local anesthetics are used.

ANS: B

Alpha-blockers, alpha–beta-blockers, and diuretics tend to produce orthostatic hypotension as a side effect, so rapid changes in chair position during dental treatment should be avoided.

This effect can be potentiated by the actions of anxiolytic and sedative drugs.

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9. Use of how many cartridges of 2% lidocaine with 1:100,000 epinephrine at one time is

considered to have little clinical risk for dental treatment of a patient with hypertension? a. 2 b. 4 c. 6 d. 8 ANS: A

The existing evidence indicates that use of modest doses (one or two cartridges of 2% lidocaine with 1:100,000 epinephrine) carries little clinical risk in patients with hypertension, the benefits of its use far outweighing any potential problems. Use of more than this amount at one time may be tolerated well enough but with increasing risk for adverse hemodynamic changes.

10. Which of the following is an adverse drug interaction that may occur if a dental anesthetic

containing a vasoconstrictor is administered to a patient being treated for hypertension with a nonselective -adrenergic blocking agent? a. Hypotension b. Hypertension c. Respiratory alkalosis d. Respiratory acidosis ANS: B

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The basis for concern with use of nonselective -adrenergic blocking agents (e.g., propranolol) is that the normal compensatory vasodilation of skeletal muscle vasculature mediated by beta 2 receptors is inhibited by these drugs, and injection of epinephrine, levonordefrin, or any other pressor agent may result in uncompensated peripheral vasoconstriction because of unopposed stimulation of alpha 1 receptors. This vasoconstrictive effect could potentially cause a significant elevation in blood pressure and a compensatory bradycardia.

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Chapter 04: Ischemic Heart Disease Little: Dental Management of the Medically Compromised Patient, 9th Edition MULTIPLE CHOICE 1. Which of the following is true concerning the incidence and prevalence of ischemic heart

disease in the United States? a. About 50% of the population is estimated to have some form of cardiovascular disease. b. Cardiovascular disease begins in middle life. c. The annual mortality rate for cardiovascular diseases has been declining since 1970. d. Cancer has replaced coronary heart disease as the leading cause of death in the United States after age 65.

ANS: C

More than 85 million Americans (about 25% of the population) have some form of cardiovascular disease, with about 15.5 million having coronary heart disease. Cardiovascular disease begins early in life, and autopsy studies have shown that one in six American teenagers already has pathologic intimal thickening of the coronary arteries. The annual mortality rate for cardiovascular diseases as a group has been declining since 1970. Despite this decline, cardiovascular diseases continue to be the leading cause of death in America, accounting for about 31% of all deaths. Coronary heart disease is the leading cause of death in the United States after age 65, and it is responsible for 735,000 new or recurrent heart attacks annually, of which more than 40% are fatal.

GRADESMORE.COM 2. Which of the following is the single MOST important modifiable risk factor for coronary

heart disease? a. Diet high in cholesterol b. Failure to exercise c. Smoking cigarettes d. Smoking cigars ANS: C

Cigarette smoking is the single most important modifiable risk factor for coronary heart disease. Multiple prospective studies have clearly documented that, compared with nonsmokers, persons who smoke 20 or more cigarettes daily have a two- to fourfold increase in coronary heart disease. This increased risk appears to be proportionate to the number of cigarettes smoked per day, and quitting has well documented benefits. Pipe and cigar smoking apparently convey minor risk for development of heart disease.

3. Which of the following is NOT true of the relationship between periodontal disease and

cardiovascular disease? a. Studies report the possibility of an association between periodontal disease and cardiovascular disease. b. A single risk factor—dental caries—has been found to be responsible for the development of coronary atherosclerosis in patients over 50 years old. c. Studies indicate a connection between tooth scaling and a decreased risk of cardiovascular disease outcomes.

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d. There is a hypothesis that the chronic inflammatory burden of periodontal disease

may lead to impaired functioning of the vascular endothelium.

ANS: B

Numerous studies have reported an association between periodontal disease and cardiovascular disease, raising the question of whether periodontal disease is a risk factor for cardiovascular disease. Although the mechanism to explain this relationship is unclear, it is hypothesized that the chronic inflammatory burden of periodontal disease may lead to impaired functioning of the vascular endothelium. At present, despite studies showing that tooth scaling is associated with decreased risk of cardiovascular disease outcomes and improved endothelial function, a direct relationship (i.e., causation) between periodontal disease and cardiovascular disease has not been established. Additional studies are required to further elucidate this relationship.

4. Which of the following types of blood cells engulf lipid molecules to become foam cells? a. Red blood cells b. Macrophages c. Neutrophils d. Basophils ANS: B

Atheroma formation is initiated by adherence of monocytes to an area of injured or altered endothelium. The attached monocytes then migrate into the intima of the vessel and become macrophages. Lipids derived from LDLs also enter through the injured or dysfunctional endothelium, forming extracellular deposits or small pools. Macrophages then engulf lipid molecules to become foam cells, which are characteristic features of the fatty streak.

RADESsymptom MORE.Cof OMcoronary atherosclerotic heart disease?

5. Which of the following is the G important a. Pitting edema b. Dysphagia c. Dyspnea d. Chest pain ANS: D

Chest pain is the most important symptom of coronary atherosclerotic heart disease. The pain may be brief, as in angina pectoris resulting from temporary ischemia of the myocardium, or it may be prolonged, as in unstable angina or acute MI. Ischemic myocardial pain results from an imbalance between the oxygen supply and the oxygen demand of the muscle.

6. New-onset chest pain that increases in frequency or intensity has a changing pattern, may

possibly occur at rest, and is not readily relieved by nitroglycerin. This best defines _________. a. acute coronary syndrome b. Prinzmetal’s variant angina c. unstable angina d. stable angina ANS: C

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Dental Management of the Medically Compromised Patient 9th Edition Little Test Bank Full ACCESS Test Bank From Link Below https://nursylab.com/products/dental-management-of-the-med ically-compromised-patient-9th-edition-little-test-bank/ TestBank Directly From The publisher, 100% Verified Answers.

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