TEST BANK For Little and Falace's Dental Management of the Medically Compromised Patient, 10th Edition by Craig Miller, Verified Chapters /fully//, Complete Newest Version

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Chapter 01: Patient Evaluation and Risk Assessment
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Little: Dental Management of the Medically Compromised Patient, 10th Edition
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MULTIPLE CHOICE n




1. Elective dental care should be deferred for patients with severe, uncontrolled hypertension,
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meaning that the blood pressure is greater than or equal to
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a. 200/140
b. 180/140
c. 180/110
d. 160/110
ANS: C n


Elective dental care should be deferred for patients with severe, uncontrolled hypertension,
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which is blood pressure greater than or equal to 180/110 mm Hg, until the condition can be
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brought under control.
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2. The American Heart Association currently recommends antibiotic prophylaxis for a patient
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with which of the following cardiac conditions?
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a. Mitral valve prolapse n n


b. Prosthetic heart valve n n


c. Rheumatic heart disease n n


d. Pacemakers for cardiac arrhythmias n n n




ANS: B n


Previously, the American Heart Association (AHA) recommended antibiotic prophylaxis for
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many patients with heart murmurs caused by valvular disease (e.g., mitral valve prolapse,
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rheumatic heart disease) in an effort to prevent infective endocarditis; however, current
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guidelines omit this recommendation on the basis of accumulated scientific evidence. If a
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murmur is due to certain specific cardiac conditions (e.g., previous endocarditis, prosthetic
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heart valve, complex congenital cyanotic heart disease), the AHA continues to recommend
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antibiotic prophylaxis for most dental procedures.
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3. One consequence of chronic hepatitis (B or C) or cirrhosis of the liver is decreased ability of
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the body to
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a. absorb
b. distribute
c. metabolize
d. excrete
ANS: C n


Patients also may have chronic hepatitis (B or C) or cirrhosis, with impairment of liver
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function. This deficit may result in prolonged bleeding and less efficient metabolism of
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certain drugs, including local anesthetics and analgesics.
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4. Which of the following symptoms and signs is most consistent with allergy?
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a. Heart palpitations n


b. Itching
c. Vomiting
d. Fainting




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ANS: B n


Symptoms and signs consistent with allergy include itching, urticaria (hives), rash, swelling,
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wheezing, angioedema, runny nose, and tearing eyes. Isolated signs and symptoms such as
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nausea, vomiting, heart palpitations, and fainting generally are not of an allergic origin but
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rather are manifestations of drug intolerance, adverse side effects, or psychogenic reactions.
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5. Which of the following is true of the patient with a history of tuberculosis?
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a. A positive result on skin testing means that the person has active TB.
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b. Most patients who become positive skin testers develop active disease.
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c. Patients with acquired immunodeficiency syndrome (AIDS) have a high incidence
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of tuberculosis.
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d. A diagnosis of active TB is made by a purified protein derivative (PPD) skin test.
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ANS: C n


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


b. severe hypertension n


c. respiratory depression n


d. cessation of intestinal peristalsis n n n




ANS: B n


Vasoconstrictors should be avoided in patients who are cocaine or methamphetamine users
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because the combination may precipitate arrhythmias, MI, or severe hypertension.
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7. It has been shown that the risk for occurrence of a serious perioperative cardiovascular event
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(e.g., MI, heart failure) is increased in patients who are unable to meet a -MET (metabolic
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equivalent of task) demand during normal daily activity.
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a. 4
b. 6
c. 8
d. 10
ANS: A n


Daily activities requiring 4 METs include level walking at 4 miles/hour or climbing a flight of
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stairs. Activities requiring greater than 10 METs include swimming and singles tennis. An
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exercise capacity of 10 to 13 METs indicates excellent physical conditioning.
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8. Which of the following alterations in the fingernails is associated with cirrhosis?
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a. Yellowing
b. Clubbing
c. White discoloration n


d. Splinter hemorrhages n




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ANS: C n


Alterations in the fingernails, such as clubbing (seen in cardiopulmonary insufficiency), white
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discoloration (seen in cirrhosis), yellowing (from malignancy), and splinter hemorrhages
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(from infective endocarditis) usually are caused by chronic disorders.
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9. A blood pressure cuff should be placed on the upper arm and inflated until
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a. the radial pulse disappears
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b. the radial pulse disappears and then inflated an additional 20 to 30 mm Hg
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c. two fingers cannot fit comfortably under the cuff
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d. the pulse no longer can be heard with the stethoscope
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ANS: B n


While the radial pulse is palpated, the cuff is inflated until the radial pulse disappears
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(approximate systolic pressure); it is then inflated an additional 20 to 30 mm Hg.
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10. Which of the following is true of a patient classified ASA III according to the American
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nSociety of Anesthesiologists (ASA) Physical Status Classification System?
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a. Patient has mild systemic disease.
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b. Patient’s disease has significant impact on daily activity.
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c. Patient’s disease is unlikely to have impact on anesthesia and surgery.
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d. Patient is moribund. n n




ANS: B n


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