DENTAL MANAGEMENT OF THE MEDICALLY COMPROMISED PATIENTS 9TH EDITION

DENTAL MANAGEMENT OF THE MEDICALLY COMPROMISED PATIENTS 9TH EDITION 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 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. 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.