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Chapterss01:ssPatientssEvaluationssand ssRiskssAssessment
Little: ssDental ssManagement ssof ssthe ssMedically ssCompromised ssPatient, ss9thssEdition
MULTIPLE s s CHOICE
1. Elective ssdental sscare ssshould ssbe ssdeferred ssfor sspatients sswith sssevere,
ssuncontrolled sshypertension,ffmeaning ssthat ssthe ssblood sspressure ssis ssgreater
ssthan ssor ssequal ssto ssmm ssHg.
a. 200/140
b. 180/140
c. 180/110
d. 160/110
ANS: ssC
Elective ssdental sscare ssshould ssbe ssdeferred ssfor sspatients sswith sssevere, ssuncontrolled
sshypertension,which ssis ssblood sspressure ssgreater ssthan ssor ssequal ssto ss180/110 ssmm ssHg,
ssuntil ssthe sscondition sscan ssbebrought ssunder sscontrol.
2. The ssAmerican ssHeart ssAssociation sscurrently ssrecommends ssantibiotic ssprophylaxis
for ssa sspatientffwith sswhich ssof ssthe ssfollowing sscardiac ssconditions?
ss
a. Mitral ssvalve ssprolapse
b. Prosthetic ssheart ssvalve
c. Rheumatic ssheart ssdisease
d. Pacemakers ssfor sscardiac ssarrhythmias
ANS: ssB
Previously, ssthe ssAmerican ssHeart ssAssociation ss(AHA) ssrecommended ssantibiotic
ssprophylaxis ssformany sspatients sswith ssheart ssmurmurs sscaused ssby ssvalvular ssdisease ss(e.g.,
ssmitral ssvalve ssprolapse, ssrheumatic ssheart ssdisease) ssin ssan sseffort ssto ssprevent ssinfective
ssendocarditis; sshowever, sscurrent ssguidelines ssomit ssthis ssrecommendation sson ssthe ssbasis
ssof ssaccumulated ssscientific ssevidence. ssIf ssa ssmurmur ssis ssdue ssto sscertain ssspecific sscardiac
ssconditions ss(e.g., ssprevious ssendocarditis, ssprosthetic ssheart ssvalve, sscomplex sscongenital
sscyanotic ssheart ssdisease), ssthe ssAHA sscontinues ssto ssrecommend ssantibiotic ssprophylaxis ssfor
ssmost ssdental ssprocedures.
3. One ssconsequence ssof sschronic sshepatitis ss(B ssor ssC) ssor sscirrhosis ssof ssthe ssliver ssis ssdecreased
ability ssofffthe ssbody ssto
ss certain ssdrugs, ssincluding sslocal ssanesthetics ssand ssanalgesics.
a. absorb
b. distribute
c. metabolize
d. excrete
ANS: ssC
Patients s s also s s may sshave s s chronic sshepatitis s s (B ssor s s C) ssor s s cirrhosis, s s with
ssimpairment s s of ssliver ssfunction. ssThis ssdeficit ssmay ssresult ssin ssprolonged ssbleeding ssand
ssless ssefficient ssmetabolism ssofcertain ssdrugs, ssincluding sslocal ssanesthetics ssand
ssanalgesics.
4. Which ssof ssthe ssfollowing sssymptoms s s and sssigns ss is ssmost ssconsistent ss with ssallergy?
a. Heart sspalpitations
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c. Vomiting
d. Fainting
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ANS: ssB
Symptoms ssand sssigns ssconsistent sswith ssallergy ssinclude ssitching, ssurticaria ss(hives), ssrash,
ssswelling,wheezing, ssangioedema, ssrunny ssnose, ssand sstearing sseyes. ssIsolated sssigns ssand
sssymptoms sssuch ssas ssnausea, ssvomiting, ssheart sspalpitations, ssand ssfainting ssgenerally ssare
ssnot ssof s s an ssallergic ssorigin ssbut ssrather ssare ssmanifestations ssof ssdrug ssintolerance,
ssadverse ssside sseffects, ssor sspsychogenic ssreactions.
5. Which ssof ssthe ssfollowing ssis sstrue ssof ssthe sspatient sswith s s a sshistory ssof sstuberculosis?
a. A sspositive ssresult ss on ssskin ss testing ssmeans ss that ssthe ssperson sshas ss active ssTB.
b. Most sspatients ss who ssbecome sspositive ssskin sstesters ssdevelop ssactive ssdisease.
c. Patients sswith ssacquired ssimmunodeficiency sssyndrome ss(AIDS) sshave ssa
sshigh ssincidenceffof sstuberculosis.
d. A ssdiagnosis ss of ss active ssTB ssis s s made ssby ssa ss purified ssprotein ssderivative ss(PPD) ssskin sstest.
ANS: s s C
The sspotential sscoexistence ssof sstuberculosis ssand ssacquired ssimmunodeficiency sssyndrome
ss(AIDS) ssshould ssbe ssexplored ssbecause sspatients sswith ssAIDS sshave ssa sshigh ssincidence ssof
sstuberculosis. ssA sspositive ssresult sson ssskin sstesting ssmeans ssspecifically ssthat ssthe ssperson
sshas ssat sssome sstime ssbeen ssinfected sswith ssTB, ssnot ssnecessarily ssthat ssactive ssdisease ssis
sspresent. ssMost sspatients sswho ssbecome sspositive ssskin sstesters ssdo ssnot ssdevelop ssactive
ssdisease. ssA ssdiagnosis ssof ssactive ssTB ssis ssmade ssby sschestx-ray, ssimaging, sssputum ssculture,
ssand ssclinical ssexamination.
6. Vasoconstrictors ssshould ssbe ssavoided ssin sspatients sswho sscocaine ssor
methamphetamine ssusersbecause ssthese ssagents ssmay ssprecipitate
ss .
a. severe sshypotension
b. severe sshypertension
c. respiratory ssdepression
d. cessation ssof ssintestinal ssperistalsis
ANS: ssB
Vasoconstrictors ssshould ssbe ssavoided ssin sspatients sswho ssare sscocaine ssor ssmethamphetamine
ssusersbecause ssthe sscombination ssmay ssprecipitate ssarrhythmias, ssMI, ssor sssevere sshypertension.
7. It sshas ssbeen ssshown ssthat ssthe ssrisk ssfor ssoccurrence ssof ssa ssserious ssperioperative
sscardiovascular sseventff(e.g., ssMI, ssheart ssfailure) ssis ssincreased ssin sspatients sswho ssare
ssunable ssto ssmeet ssa ss-MET ss(metabolic ssequivalent ssof sstask) ssdemand ssduring ssnormal
ssdaily ssactivity.
a. 4
b. 6
c. 8
d. 10
ANS: ssA
Daily ssactivities ssrequiring ss4 ssMETs ssinclude sslevel sswalking ssat ss4 ssmiles/hour ssor ssclimbing ssa ssflight
ssofstairs. ssActivities ssrequiring ssgreater ssthan ss10 ssMETs ssinclude ssswimming ssand sssingles sstennis.
ssAn ssexercise sscapacity ssof ss10 ssto ss13 ssMETs ssindicates ssexcellent ssphysical ssconditioning.
8. Which ssof ssthe ssfollowing ssalterations ssin ssthe ssfingernails ssis ssassociated ss with sscirrhosis?
a. Yellowing
b. Clubbing
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74
Chapterss01:ssPatientssEvaluationssand ssRiskssAssessment
Little: ssDental ssManagement ssof ssthe ssMedically ssCompromised ssPatient, ss9thssEdition
MULTIPLE s s CHOICE
1. Elective ssdental sscare ssshould ssbe ssdeferred ssfor sspatients sswith sssevere,
ssuncontrolled sshypertension,ffmeaning ssthat ssthe ssblood sspressure ssis ssgreater
ssthan ssor ssequal ssto ssmm ssHg.
a. 200/140
b. 180/140
c. 180/110
d. 160/110
ANS: ssC
Elective ssdental sscare ssshould ssbe ssdeferred ssfor sspatients sswith sssevere, ssuncontrolled
sshypertension,which ssis ssblood sspressure ssgreater ssthan ssor ssequal ssto ss180/110 ssmm ssHg,
ssuntil ssthe sscondition sscan ssbebrought ssunder sscontrol.
2. The ssAmerican ssHeart ssAssociation sscurrently ssrecommends ssantibiotic ssprophylaxis
for ssa sspatientffwith sswhich ssof ssthe ssfollowing sscardiac ssconditions?
ss
a. Mitral ssvalve ssprolapse
b. Prosthetic ssheart ssvalve
c. Rheumatic ssheart ssdisease
d. Pacemakers ssfor sscardiac ssarrhythmias
ANS: ssB
Previously, ssthe ssAmerican ssHeart ssAssociation ss(AHA) ssrecommended ssantibiotic
ssprophylaxis ssformany sspatients sswith ssheart ssmurmurs sscaused ssby ssvalvular ssdisease ss(e.g.,
ssmitral ssvalve ssprolapse, ssrheumatic ssheart ssdisease) ssin ssan sseffort ssto ssprevent ssinfective
ssendocarditis; sshowever, sscurrent ssguidelines ssomit ssthis ssrecommendation sson ssthe ssbasis
ssof ssaccumulated ssscientific ssevidence. ssIf ssa ssmurmur ssis ssdue ssto sscertain ssspecific sscardiac
ssconditions ss(e.g., ssprevious ssendocarditis, ssprosthetic ssheart ssvalve, sscomplex sscongenital
sscyanotic ssheart ssdisease), ssthe ssAHA sscontinues ssto ssrecommend ssantibiotic ssprophylaxis ssfor
ssmost ssdental ssprocedures.
3. One ssconsequence ssof sschronic sshepatitis ss(B ssor ssC) ssor sscirrhosis ssof ssthe ssliver ssis ssdecreased
ability ssofffthe ssbody ssto
ss certain ssdrugs, ssincluding sslocal ssanesthetics ssand ssanalgesics.
a. absorb
b. distribute
c. metabolize
d. excrete
ANS: ssC
Patients s s also s s may sshave s s chronic sshepatitis s s (B ssor s s C) ssor s s cirrhosis, s s with
ssimpairment s s of ssliver ssfunction. ssThis ssdeficit ssmay ssresult ssin ssprolonged ssbleeding ssand
ssless ssefficient ssmetabolism ssofcertain ssdrugs, ssincluding sslocal ssanesthetics ssand
ssanalgesics.
4. Which ssof ssthe ssfollowing sssymptoms s s and sssigns ss is ssmost ssconsistent ss with ssallergy?
a. Heart sspalpitations
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b. Itching 74
c. Vomiting
d. Fainting
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ANS: ssB
Symptoms ssand sssigns ssconsistent sswith ssallergy ssinclude ssitching, ssurticaria ss(hives), ssrash,
ssswelling,wheezing, ssangioedema, ssrunny ssnose, ssand sstearing sseyes. ssIsolated sssigns ssand
sssymptoms sssuch ssas ssnausea, ssvomiting, ssheart sspalpitations, ssand ssfainting ssgenerally ssare
ssnot ssof s s an ssallergic ssorigin ssbut ssrather ssare ssmanifestations ssof ssdrug ssintolerance,
ssadverse ssside sseffects, ssor sspsychogenic ssreactions.
5. Which ssof ssthe ssfollowing ssis sstrue ssof ssthe sspatient sswith s s a sshistory ssof sstuberculosis?
a. A sspositive ssresult ss on ssskin ss testing ssmeans ss that ssthe ssperson sshas ss active ssTB.
b. Most sspatients ss who ssbecome sspositive ssskin sstesters ssdevelop ssactive ssdisease.
c. Patients sswith ssacquired ssimmunodeficiency sssyndrome ss(AIDS) sshave ssa
sshigh ssincidenceffof sstuberculosis.
d. A ssdiagnosis ss of ss active ssTB ssis s s made ssby ssa ss purified ssprotein ssderivative ss(PPD) ssskin sstest.
ANS: s s C
The sspotential sscoexistence ssof sstuberculosis ssand ssacquired ssimmunodeficiency sssyndrome
ss(AIDS) ssshould ssbe ssexplored ssbecause sspatients sswith ssAIDS sshave ssa sshigh ssincidence ssof
sstuberculosis. ssA sspositive ssresult sson ssskin sstesting ssmeans ssspecifically ssthat ssthe ssperson
sshas ssat sssome sstime ssbeen ssinfected sswith ssTB, ssnot ssnecessarily ssthat ssactive ssdisease ssis
sspresent. ssMost sspatients sswho ssbecome sspositive ssskin sstesters ssdo ssnot ssdevelop ssactive
ssdisease. ssA ssdiagnosis ssof ssactive ssTB ssis ssmade ssby sschestx-ray, ssimaging, sssputum ssculture,
ssand ssclinical ssexamination.
6. Vasoconstrictors ssshould ssbe ssavoided ssin sspatients sswho sscocaine ssor
methamphetamine ssusersbecause ssthese ssagents ssmay ssprecipitate
ss .
a. severe sshypotension
b. severe sshypertension
c. respiratory ssdepression
d. cessation ssof ssintestinal ssperistalsis
ANS: ssB
Vasoconstrictors ssshould ssbe ssavoided ssin sspatients sswho ssare sscocaine ssor ssmethamphetamine
ssusersbecause ssthe sscombination ssmay ssprecipitate ssarrhythmias, ssMI, ssor sssevere sshypertension.
7. It sshas ssbeen ssshown ssthat ssthe ssrisk ssfor ssoccurrence ssof ssa ssserious ssperioperative
sscardiovascular sseventff(e.g., ssMI, ssheart ssfailure) ssis ssincreased ssin sspatients sswho ssare
ssunable ssto ssmeet ssa ss-MET ss(metabolic ssequivalent ssof sstask) ssdemand ssduring ssnormal
ssdaily ssactivity.
a. 4
b. 6
c. 8
d. 10
ANS: ssA
Daily ssactivities ssrequiring ss4 ssMETs ssinclude sslevel sswalking ssat ss4 ssmiles/hour ssor ssclimbing ssa ssflight
ssofstairs. ssActivities ssrequiring ssgreater ssthan ss10 ssMETs ssinclude ssswimming ssand sssingles sstennis.
ssAn ssexercise sscapacity ssof ss10 ssto ss13 ssMETs ssindicates ssexcellent ssphysical ssconditioning.
8. Which ssof ssthe ssfollowing ssalterations ssin ssthe ssfingernails ssis ssassociated ss with sscirrhosis?
a. Yellowing
b. Clubbing
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