Test Bank For Little and Falace's Dental Management
of the Medically Compromised Patient,
10th Edition by Craig Miller,
Chapters 1 - 30
,Little: Dental Management of the Medically Compromised Patient, 10th Edition Test Bank
Table of Contents
PART ONE: PATIENT EVALUATION AND RISK ASSESSMENT
Chapter 1: Patient Evaluation and Risk Assessment
PART TWO: CARDIOVASCULAR DISEASE
Chapter 2: Infective Endocarditis
Chapter 3: Hypertension
Chapter 4: Ischemic Heart Disease
Chapter 5: Cardiac Arrhythmias
Chapter 6: Heart Failure (or Congestive Heart Failure)
PART THREE: PULMONARY DISEASE
Chapter 7: Pulmonary Disease
Chapter 8: Smoking and Tobacco Use Cessation
Chapter 9: Sleep-Related Breathing Disorders
PART FOUR: GASTROINTESTIAL DISEASE
Chapter 10: Liver Disease
Chapter 11: Gastrointestinal Disease
PART FIVE: GENITOURINARY DISEASE
Chapter 12: Chronic Kidney Disease and Dialysis
Chapter 13: Sexually Transmitted Diseases
PART SIX: ENDOCRINE AND METABOLIC DISEASE
Chapter 14: Diabetes Mellitus
Chapter 15: Adrenal Insufficiency
Chapter 16: Thyroid Diseases
Chapter 17: Pregnancy and Breast Feeding
PART SEVEN: IMMUNOLOGIC DISEASE
Chapter 18: AIDS, HIV Infection, and Related Conditions
Chapter 19: Allergy
Chapter 20: Rheumatologic and Connective Tissue Disorders
Chapter 21: Organ and Bone Marrow Transplantation
PART EIGHT: HEMATOLOGIC AND ONCOLOGIC DISEASE
Chapter 22: Disorders of Red Blood Cells
Chapter 23: Disorders of White Blood Cells
Chapter 24: Acquired Bleeding and Hypercoagulable Disorders
Chapter 25: Congenital Bleeding and Hypercoagulable Disorders
Chapter 26: Cancer and Oral Care of the Patient
PART NINE: NEUROLOGIC, BEHAVIORAL, AND PSYCHIATRIC DISORDERS
Chapter 27: Neurologic Disorders
Chapter 28: Anxiety, Eating Disorders, and Behavioral Reactions to Illness
Chapter 29: Psychiatric Disorders
Chapter 30: Drug and Alcohol Abuse
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Chapter 01: Patient Evaluation and Risk Assessment
Little: Dental Management of the Medically Compromised Patient, 10th 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
ANSWER: 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
ANSWER: B
Previously, the American Heart Association (AHA) recommended antibiotic prophylaxis for
many patients with heart murmurs caused by valvular disease (e.g., mitral valve prolapse,
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
ANSWER: 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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ANSWER: 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.
ANSWER: 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
d. cessation of intestinal peristalsis
ANSWER: 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
ANSWER: 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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ANSWER: 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
ANSWER: 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?
a. Patient has mild systemic disease.
b. Patient’s disease has significant impact on daily activity.
c. Patient’s disease is unlikely to have impact on anesthesia and surgery.
d. Patient is moribund.
ANSWER: 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, 10th 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.
ANSWER: 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
ANSWER: 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
ANSWER: 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
ANSWER: 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
ANSWER: 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)?
a. The magnitude of bacteremias resulting from dental procedures is more likely to
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.
ANSWER: 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.
ANSWER: 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.
ANSWER: 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
patients with native or prosthetic cardiac valves
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
ANSWER: 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
ANSWER: 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, 10th 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
ANSWER: 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
ANSWER: A
Although only a physician can make the diagnosis of hypertension and decide on its
treatment, Joint National ComG mRitA
teD
eEonSPMrO
evReE
nt.
ioCnO
,DMetection, 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.
ANSWER: 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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