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 nof nthe nfollowing nis ntrue nof nthe npatient nwith na nhistory nof ntuberculosis?
a. A npositive nresult non nskin ntesting nmeans nthat nthe nperson nhas nactive nTB.
b. Most npatients nwho nbecome npositive nskin ntesters ndevelop nactive ndisease.
c. Patients nwith nacquired nimmunodeficiency nsyndrome n(AIDS) nhave na nhigh
incidence nof ntuberculosis.
n
d. A ndiagnosis nof nactive nTB nis nmade nby na npurified nprotein nderivative n(PPD) nskin ntest.
ANSWER: n C
The npotential ncoexistence nof ntuberculosis nand nacquired nimmunodeficiency nsyndrome
n(AIDS) nshould nbe nexplored nbecause npatients nwith nAIDS nhave na nhigh nincidence nof
ntuberculosis. nA npositive nresult non nskin ntesting nmeans nspecifically nthat nthe nperson nhas nat
nsome ntime nbeen ninfected nwith nTB, nnot nnecessarily nthat nactive ndisease nis npresent. nMost
npatients nwho nbecome npositive nskin ntesters ndo nnot ndevelop nactive ndisease. nA ndiagnosis nof
nactive nTB nis nmade nby nchest nx-ray, nimaging, nsputum nculture, nand nclinical nexamination.
6. Vasoconstrictors nshould nbe navoided nin npatients nwho ncocaine nor nmethamphetamine
users nbecause nthese nagents nmay nprecipitate
n .
a. severe nhypotension
b. severe nhypertension
c. respiratory ndepression
d. cessation nof nintestinal nperistalsis
ANSWER: n B
Vasoconstrictors nshould nbe navoided nin npatients nwho nare ncocaine nor nmethamphetamine nusers
nbecause nthe ncombination nmay nprecipitate narrhythmias, nMI, nor nsevere nhypertension.
7. It nhas nbeen nshown nthat nthe nrisk nfor noccurrence nof na nserious nperioperative ncardiovascular
nevent n(e.g., nMI, nheart nfailure) nis nincreased nin npatients nwho nare nunable nto nmeet na n-MET
n(metabolic nequivalent nof ntask) ndemand nduring nnormal ndaily nactivity.
a. 4
b. 6
c. 8
d. 10
ANSWER: n A
Daily nactivities nrequiring n4 nMETs ninclude nlevel nwalking nat n4 nmiles/hour nor nclimbing na nflight nof
nstairs. nActivities nrequiring ngreater nthan n10 nMETs ninclude nswimming nand nsingles ntennis. nAn
nexercise ncapacity nof n10 nto n13 nMETs nindicates nexcellent nphysical nconditioning.
8. Which nof nthe nfollowing nalterations nin nthe nfingernails nis nassociated nwith ncirrhosis?
a. Yellowing
b. Clubbing
c. White ndiscoloration
d. Splinter nhemorrhages
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ANSWER: n C
Alterations nin nthe nfingernails, nsuch nas nclubbing n(seen nin ncardiopulmonary ninsufficiency),
nwhite ndiscoloration n(seen nin ncirrhosis), n yellowing n(from nmalignancy), nand nsplinter
nhemorrhages n(from ninfective nendocarditis) nusually nare ncaused nby nchronic ndisorders.
9. A nblood npressure ncuff nshould nbe nplaced non nthe nupper narm nand ninflated nuntil .
a. the nradial npulse ndisappears
b. the nradial npulse ndisappears nand nthen ninflated nan nadditional n20 nto n30 nmm nHg
c. two nfingers ncannot nfit ncomfortably nunder nthe ncuff
d. the npulse nno nlonger ncan nbe nheard nwith nthe nstethoscope
ANSWER: n B
While nthe nradial npulse nis npalpated, nthe ncuff nis ninflated nuntil nthe nradial npulse ndisappears
n(approximate nsystolic npressure); nit nis nthen ninflated nan nadditional n20 nto n30 nmm nHg.
10. Which nof nthe nfollowing nis ntrue nof na npatient nclassified nASA nIII naccording nto nthe
nAmerican nSociety nof nAnesthesiologists n(ASA) nPhysical nStatus nClassification nSystem?
a. Patient nhas nmild nsystemic ndisease.
b. Patient’s ndisease nhas nsignificant nimpact non ndaily nactivity.
c. Patient’s ndisease nis nunlikely nto nhave nimpact non nanesthesia nand nsurgery.
d. Patient nis nmoribund.
ANSWER: n B
Patient nwith nsevere nsystemic ndisease nis na nconstant nthreat nto nlife n(e.g., nrecent nmyocardial
ninfarction, nstroke, ntransient nischemic nattach n[<3 nmonths], nongoing ncardiac nischemia, nsevere
nvalve ndysfunction, nrespiratory nfailure nrequiring nmechanical nventilation). nSerious nlimitation
nof ndaily nactivity; nlikely nmajor nimpact non nanesthesia nand nsurgery.
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Chapter 02: Infective Endocarditis
n n n
Little: Dental Management of the Medically Compromised Patient, 10th Edition
n n n n n n n n n
MULTIPLE nCHOICE
1. Which nof nthe nfollowing nis ntrue nconcerning ninfective nendocarditis n(IE)?
a. IE nis nalways ndue nto na nbacterial ninfection.
b. Since nthe nadvent nof nantibiotics, nmorbidity nand nmortality nassociated nwith nIE
n have nbeen nvirtually neliminated.
c. IE nis ncurrently nclassified nas nacute nor nsubacute, nto nreflect nthe nrapidity nof nonset
n and nduration.
d. Accumulating nevidence nquestions nthe nvalidity nof nantibiotic nprophylaxis nin
n an nattempt nto nprevent nIE nprior nto ncertain ninvasive ndental nprocedures.
ANSWER: n D
Antibiotics nhave nbeen nadministered nbefore ncertain ninvasive ndental nprocedures nin nan nattempt
nto nprevent ninfection. nOf nnote, nhowever, nthe neffectiveness nof nsuch nprophylaxis nin nhumans nhas
nnever nbeen nsubstantiated, nand naccumulating nevidence nmore nand nmore nquestions nthe nvalidity
nof nthis npractice.
2. Which nof nthe nfollowing nis ncurrently nthe nmost ncommon nunderlying ncondition npredisposing
to ninfective nendocarditis n(IE)?
n
a. Aortic nvalve ndisease
b. Rheumatic nheart ndisease n(RHD)
c. Mitral nvalve nprolapse n(MVP)
d. Tetralogynof nFallot
ANSWER: n C
Mitral nvalve nprolapse, nwhich naccounts nfor n25% nto n30% nof nadult ncases nof nnative nvalve
nendocarditis n(NVE), nis nnow nthe nmost ncommon nunderlying ncondition namong npatients nwho
nacquire n IE. nPreviously, nrheumatic nheart ndisease n(RHD) nwas nthe nmost ncommon ncondition
npredisposing nto nendocarditis. nIn ndeveloped ncountries, nhowever, nthe nfrequency nof nRHD nhas
nmarkedly ndeclined nover nthe npast nseveral ndecades.
3. The nleading ncause nof ndeath ndue nto ninfective nendocarditis n(IE) nis .
a. chronic nobstructive npulmonary ndisease
b. heart nfailure
c. pulmonary nemboli
d. atheromas
ANSWER: n B
The nmost ncommon ncomplication nof nIE, nand nthe nleading ncause nof ndeath, nis nheart nfailure, nwhich
nresults nfrom nsevere nvalvular ndysfunction. nThis npathologic nprocess nmost ncommonly nbegins nas na
nproblem nwith naortic nvalve ninvolvement, nfollowed nby nmitral nand nthen ntricuspid nvalve ninfection.
nEmbolization nof nvegetation nfragments noften nleads nto nfurther ncomplications, nsuch nas nstroke.
Myocardial ninfarction ncan noccur nas nthe nresult nof nembolism nof nthe ncoronary narteries, nand ndistal
nemboli ncan nproduce nperipheral nmetastatic nabscesses.
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4. The ninterval nbetween nthe npresumed ninitiating nbacteremia nand nthe nonset nof nsymptoms
nof ninfective nendocarditis n(IE) nis nestimated nto nbe nless nthan in nmore nthan n80% nof
npatients nwith nIE.
a. 1 nweek
b. 2 nweeks
c. 1 nmonth
d. 2 nmonths
ANSWER: n B
It nis nless nthan ntwo nweeks nin nmore nthan n80% nof npatients nwith nIE. nIn nmany ncases nof nIE nthat
nhave nbeen npurported nto nbe ndue nto ndentally ninduced nbacteremia, nthe ninterval nbetween nthe
ndental nappointment nand nthe ndiagnosis nof nIE nhas nbeen nmuch nlonger nthan n2 nweeks n(sometimes
nmonths), nso nit nis nvery nunlikely nthat nthe ninitiating nbacteremia nwas nassociated nwith ndental
ntreatment.
5. Where nare nJaneway nlesions nlocated?
a. Tricuspid nvalve
b. Palms nof nthe nhands nand nsoles nof nthe nfeet
c. Pulp nof nthe ndigits
d. Nail nbeds
ANSWER: n B
Janeway nlesions nare nsmall, nnontender nerythematous nor nhemorrhagic nmacular nlesions non nthe
npalms nand nsoles. nJaneway nlesions nare none nof nthe nperipheral nmanifestations nof nIE ndue nto
nemboli nand/or nimmunologic nresponses.
6. Which nof nthe nfollowing nis ntrue nof nthe nmagnitude nof nbacteremia nrequired nto ncause
infective nendocarditis n(IE)?
n
a. The nmagnitude nof nbacteremias nresulting nfrom ndental nprocedures nis nmore nlikely
nto ncause nIE nthan nthat nseen nwith nbacteremias nresulting nfrom nnormal ndaily
nactivities.
b. Cases nof nIE ncaused nby noral nbacteria nprobably nresult nfrom nfrequent nexposure nto
nlow ninocula nof nbacteria nin nthe nbloodstream ndue nto ndaily nactivities nand nnot na
ndental nprocedure.
c. The nquality nof noral nhygiene nhas nno nappreciable neffect non nthe nmagnitude
nof nbacteremia nafter ntoothbrushing.
d. The nmagnitude nof nbacteremia nresulting nfrom ndental nprocedures nis ngreater nthan
nthat nneeded nto ncause nexperimental nbacterial nendocarditis n(BE) nin nanimals.
ANSWER: n B
An nassumption noften nmade nis nthat nthe nmagnitude nof nbacteremias nresulting nfrom ndental
nprocedures nis nmore nlikely nto ncause nIE nthan nthat nseen nwith nbacteremias nresulting nfrom
nnormal ndaily nactivities. nPublished ndata ndo nnot nsupport nthis ncontention. nFurthermore, nthe
nmagnitude nof nbacteremia nresulting nfrom ndental nprocedures nis nrelatively nlow n(with nbacterial
4
ncounts nof nfewer nthan n10 ncolony-forming nunits/mL), nis nsimilar nto nthat nof nbacteremia
6 8
nresulting nfrom nnormal ndaily nactivities, nand nis nfar nless nthan nthat n(10 nto n10 ncolony-forming
nunits/mL) nneeded nto ncause nexperimental nBE nin nanimals.
7. Visible nbleeding nduring na ndental nprocedure nis na nreliable npredictor nof nbacteremia. nIt nis nnot
nclear nwhich ndental nprocedures nare nmore nor nless nlikely nto ncause ntransient nbacteremia nor nto
nresult nin na ngreater nmagnitude nof nbacteremia nthan nthat ncaused nby nroutine ndaily nactivities
nsuch nas nchewing nfood, ntooth nbrushing, nor nflossing.
a. Both nstatements nare ntrue.
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b. Both nstatements nare nfalse.
c. The nfirst nstatement nis ntrue, nthe nsecond nstatement nis nfalse.
d. The nfirst nstatement nis nfalse, nthe nsecond nstatement nis ntrue.
ANSWER: n D
It nhas nbeen nshown nthat nvisible nbleeding nduring na ndental nprocedure nis nnot na nreliable npredictor
nof nbacteremia. nCollective npublished ndata nsuggest nthat nthe nvast nmajority nof ndental noffice
nvisits nresult nin nsome ndegree nof nbacteremia, nand nthat nit nis nnot nclear nwhich ndental nprocedures
nare nmore nor nless nlikely nto ncause ntransient nbacteremia nor nto nresult nin na ngreater nmagnitude nof
nbacteremia nthan nthat ncaused nby nbacteremia nproduced nby nroutine ndaily nactivities nsuch nas
nchewing nfood, ntooth nbrushing, nor nflossing.
8. Which nof nthe nfollowing nis ntrue nregarding nthe nefficacy nof nantibiotic nprophylaxis?
a. Data nshow nthat na nreduction nin nthe nincidence, nnature, nand nduration nof nbacteria
caused nby nantibiotic ntherapy nreduces nthe nrisk nof nor nprevents nIE.
n
b. Antibiotics ngiven nto nat-risk npatients nbefore na ndental nprocedure nwill nprevent
nor nreduce na nbacteremia.
c. Prospective nrandomized, nplacebo-controlled ntrials nhave nbeen nconducted nto
nexamine nthe nefficacy nof nantibiotic nprophylaxis nfor npreventing n IE nin npatients nwho
nundergo na ndental nprocedure.
d. Investigators nhave nconcluded nthat ndental nor nother nprocedures nprobably nonly
ncaused na nsmall nfraction nof ncases nof nIE, nand nthat nprophylaxis nwould nprevent nonly
na nsmall nnumber nof ncases, neven nif nit nwere n100% neffective.
ANSWER: nD
This nconclusion ncame nas nthe nresult nof na nstudy nfrom nthe nNetherlands nby nvan nder nMeer nand
ncolleagues nthat ninvestigated nthe nefficacy nof nantibiotic nprophylaxis nin npreventing nIE nin ndental
npatients nwith nnative nor nprosthetic ncardiac nvalves
9. The nAmerican nHeart nAssociation ncurrently nrecommends nantibiotic nprophylaxis nbefore
n dental ntreatment nto nprevent nendocarditis nfor npatients nwith nwhich nof nthe nfollowing ncardiac
nconditions?
a. Mitral nvalve nprolapse nwith nregurgitation
b. Rheumatic nheart ndisease
c. Prosthetic ncardiac nvalve
d. A, nB, nand nC
e. A nand nC
ANSWER: n C
Prophylaxis nwith nantibiotics nbefore na ndental nprocedure nis nrecommended nfor na nprosthetic
ncardiac nvalve, nprevious ninfective nendocarditis, nand nsome nforms nof ncongenital nheart ndisease
n(see nBox n2-2.)
10. Which nof nthe nfollowing nantibiotics nis nthe nbest nchoice nif na npatient nwho nrequires
npremedication nbefore ndental ntreatment nis nalready ntaking npenicillin nfor neradication nof nan
ninfection?
a. Amoxicillin
b. Clindamycin
c. Cephalosporins
d. Keep nthe npatient non nthe npenicillin nbecause nthe nblood nlevel nhas nalready
nbeen nachieved
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ANSWER: n B
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The npresence nof nviridians ngroup nstreptococci nthat nare nrelatively nresistant nto npenicillin nor
namoxicillin nis nlikely nin npatients nalready ntaking npenicillin nor namoxicillin nfor neradication nof nan
ninfection. nClindamycin, nazithromycin, nor nclarithromycin nshould nbe nselected nfor nprophylaxis
nif ntreatment nis nimmediately nnecessary. nCephalosporins nshould nbe navoided ndue nto ncross
nresistance. nAnother napproach nis nto nwait nfor nat nleast n10 ndays nafter nthe ncompletion nof nantibiotic
ntherapy nbefore nadministration nof nprophylactic nantibiotics.
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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 nof nthe nfollowing nis ntrue nof nthe npatient nwith na nhistory nof ntuberculosis?
a. A npositive nresult non nskin ntesting nmeans nthat nthe nperson nhas nactive nTB.
b. Most npatients nwho nbecome npositive nskin ntesters ndevelop nactive ndisease.
c. Patients nwith nacquired nimmunodeficiency nsyndrome n(AIDS) nhave na nhigh
incidence nof ntuberculosis.
n
d. A ndiagnosis nof nactive nTB nis nmade nby na npurified nprotein nderivative n(PPD) nskin ntest.
ANSWER: n C
The npotential ncoexistence nof ntuberculosis nand nacquired nimmunodeficiency nsyndrome
n(AIDS) nshould nbe nexplored nbecause npatients nwith nAIDS nhave na nhigh nincidence nof
ntuberculosis. nA npositive nresult non nskin ntesting nmeans nspecifically nthat nthe nperson nhas nat
nsome ntime nbeen ninfected nwith nTB, nnot nnecessarily nthat nactive ndisease nis npresent. nMost
npatients nwho nbecome npositive nskin ntesters ndo nnot ndevelop nactive ndisease. nA ndiagnosis nof
nactive nTB nis nmade nby nchest nx-ray, nimaging, nsputum nculture, nand nclinical nexamination.
6. Vasoconstrictors nshould nbe navoided nin npatients nwho ncocaine nor nmethamphetamine
users nbecause nthese nagents nmay nprecipitate
n .
a. severe nhypotension
b. severe nhypertension
c. respiratory ndepression
d. cessation nof nintestinal nperistalsis
ANSWER: n B
Vasoconstrictors nshould nbe navoided nin npatients nwho nare ncocaine nor nmethamphetamine nusers
nbecause nthe ncombination nmay nprecipitate narrhythmias, nMI, nor nsevere nhypertension.
7. It nhas nbeen nshown nthat nthe nrisk nfor noccurrence nof na nserious nperioperative ncardiovascular
nevent n(e.g., nMI, nheart nfailure) nis nincreased nin npatients nwho nare nunable nto nmeet na n-MET
n(metabolic nequivalent nof ntask) ndemand nduring nnormal ndaily nactivity.
a. 4
b. 6
c. 8
d. 10
ANSWER: n A
Daily nactivities nrequiring n4 nMETs ninclude nlevel nwalking nat n4 nmiles/hour nor nclimbing na nflight nof
nstairs. nActivities nrequiring ngreater nthan n10 nMETs ninclude nswimming nand nsingles ntennis. nAn
nexercise ncapacity nof n10 nto n13 nMETs nindicates nexcellent nphysical nconditioning.
8. Which nof nthe nfollowing nalterations nin nthe nfingernails nis nassociated nwith ncirrhosis?
a. Yellowing
b. Clubbing
c. White ndiscoloration
d. Splinter nhemorrhages
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ANSWER: n C
Alterations nin nthe nfingernails, nsuch nas nclubbing n(seen nin ncardiopulmonary ninsufficiency),
nwhite ndiscoloration n(seen nin ncirrhosis), n yellowing n(from nmalignancy), nand nsplinter
nhemorrhages n(from ninfective nendocarditis) nusually nare ncaused nby nchronic ndisorders.
9. A nblood npressure ncuff nshould nbe nplaced non nthe nupper narm nand ninflated nuntil .
a. the nradial npulse ndisappears
b. the nradial npulse ndisappears nand nthen ninflated nan nadditional n20 nto n30 nmm nHg
c. two nfingers ncannot nfit ncomfortably nunder nthe ncuff
d. the npulse nno nlonger ncan nbe nheard nwith nthe nstethoscope
ANSWER: n B
While nthe nradial npulse nis npalpated, nthe ncuff nis ninflated nuntil nthe nradial npulse ndisappears
n(approximate nsystolic npressure); nit nis nthen ninflated nan nadditional n20 nto n30 nmm nHg.
10. Which nof nthe nfollowing nis ntrue nof na npatient nclassified nASA nIII naccording nto nthe
nAmerican nSociety nof nAnesthesiologists n(ASA) nPhysical nStatus nClassification nSystem?
a. Patient nhas nmild nsystemic ndisease.
b. Patient’s ndisease nhas nsignificant nimpact non ndaily nactivity.
c. Patient’s ndisease nis nunlikely nto nhave nimpact non nanesthesia nand nsurgery.
d. Patient nis nmoribund.
ANSWER: n B
Patient nwith nsevere nsystemic ndisease nis na nconstant nthreat nto nlife n(e.g., nrecent nmyocardial
ninfarction, nstroke, ntransient nischemic nattach n[<3 nmonths], nongoing ncardiac nischemia, nsevere
nvalve ndysfunction, nrespiratory nfailure nrequiring nmechanical nventilation). nSerious nlimitation
nof ndaily nactivity; nlikely nmajor nimpact non nanesthesia nand nsurgery.
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Chapter 02: Infective Endocarditis
n n n
Little: Dental Management of the Medically Compromised Patient, 10th Edition
n n n n n n n n n
MULTIPLE nCHOICE
1. Which nof nthe nfollowing nis ntrue nconcerning ninfective nendocarditis n(IE)?
a. IE nis nalways ndue nto na nbacterial ninfection.
b. Since nthe nadvent nof nantibiotics, nmorbidity nand nmortality nassociated nwith nIE
n have nbeen nvirtually neliminated.
c. IE nis ncurrently nclassified nas nacute nor nsubacute, nto nreflect nthe nrapidity nof nonset
n and nduration.
d. Accumulating nevidence nquestions nthe nvalidity nof nantibiotic nprophylaxis nin
n an nattempt nto nprevent nIE nprior nto ncertain ninvasive ndental nprocedures.
ANSWER: n D
Antibiotics nhave nbeen nadministered nbefore ncertain ninvasive ndental nprocedures nin nan nattempt
nto nprevent ninfection. nOf nnote, nhowever, nthe neffectiveness nof nsuch nprophylaxis nin nhumans nhas
nnever nbeen nsubstantiated, nand naccumulating nevidence nmore nand nmore nquestions nthe nvalidity
nof nthis npractice.
2. Which nof nthe nfollowing nis ncurrently nthe nmost ncommon nunderlying ncondition npredisposing
to ninfective nendocarditis n(IE)?
n
a. Aortic nvalve ndisease
b. Rheumatic nheart ndisease n(RHD)
c. Mitral nvalve nprolapse n(MVP)
d. Tetralogynof nFallot
ANSWER: n C
Mitral nvalve nprolapse, nwhich naccounts nfor n25% nto n30% nof nadult ncases nof nnative nvalve
nendocarditis n(NVE), nis nnow nthe nmost ncommon nunderlying ncondition namong npatients nwho
nacquire n IE. nPreviously, nrheumatic nheart ndisease n(RHD) nwas nthe nmost ncommon ncondition
npredisposing nto nendocarditis. nIn ndeveloped ncountries, nhowever, nthe nfrequency nof nRHD nhas
nmarkedly ndeclined nover nthe npast nseveral ndecades.
3. The nleading ncause nof ndeath ndue nto ninfective nendocarditis n(IE) nis .
a. chronic nobstructive npulmonary ndisease
b. heart nfailure
c. pulmonary nemboli
d. atheromas
ANSWER: n B
The nmost ncommon ncomplication nof nIE, nand nthe nleading ncause nof ndeath, nis nheart nfailure, nwhich
nresults nfrom nsevere nvalvular ndysfunction. nThis npathologic nprocess nmost ncommonly nbegins nas na
nproblem nwith naortic nvalve ninvolvement, nfollowed nby nmitral nand nthen ntricuspid nvalve ninfection.
nEmbolization nof nvegetation nfragments noften nleads nto nfurther ncomplications, nsuch nas nstroke.
Myocardial ninfarction ncan noccur nas nthe nresult nof nembolism nof nthe ncoronary narteries, nand ndistal
nemboli ncan nproduce nperipheral nmetastatic nabscesses.
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4. The ninterval nbetween nthe npresumed ninitiating nbacteremia nand nthe nonset nof nsymptoms
nof ninfective nendocarditis n(IE) nis nestimated nto nbe nless nthan in nmore nthan n80% nof
npatients nwith nIE.
a. 1 nweek
b. 2 nweeks
c. 1 nmonth
d. 2 nmonths
ANSWER: n B
It nis nless nthan ntwo nweeks nin nmore nthan n80% nof npatients nwith nIE. nIn nmany ncases nof nIE nthat
nhave nbeen npurported nto nbe ndue nto ndentally ninduced nbacteremia, nthe ninterval nbetween nthe
ndental nappointment nand nthe ndiagnosis nof nIE nhas nbeen nmuch nlonger nthan n2 nweeks n(sometimes
nmonths), nso nit nis nvery nunlikely nthat nthe ninitiating nbacteremia nwas nassociated nwith ndental
ntreatment.
5. Where nare nJaneway nlesions nlocated?
a. Tricuspid nvalve
b. Palms nof nthe nhands nand nsoles nof nthe nfeet
c. Pulp nof nthe ndigits
d. Nail nbeds
ANSWER: n B
Janeway nlesions nare nsmall, nnontender nerythematous nor nhemorrhagic nmacular nlesions non nthe
npalms nand nsoles. nJaneway nlesions nare none nof nthe nperipheral nmanifestations nof nIE ndue nto
nemboli nand/or nimmunologic nresponses.
6. Which nof nthe nfollowing nis ntrue nof nthe nmagnitude nof nbacteremia nrequired nto ncause
infective nendocarditis n(IE)?
n
a. The nmagnitude nof nbacteremias nresulting nfrom ndental nprocedures nis nmore nlikely
nto ncause nIE nthan nthat nseen nwith nbacteremias nresulting nfrom nnormal ndaily
nactivities.
b. Cases nof nIE ncaused nby noral nbacteria nprobably nresult nfrom nfrequent nexposure nto
nlow ninocula nof nbacteria nin nthe nbloodstream ndue nto ndaily nactivities nand nnot na
ndental nprocedure.
c. The nquality nof noral nhygiene nhas nno nappreciable neffect non nthe nmagnitude
nof nbacteremia nafter ntoothbrushing.
d. The nmagnitude nof nbacteremia nresulting nfrom ndental nprocedures nis ngreater nthan
nthat nneeded nto ncause nexperimental nbacterial nendocarditis n(BE) nin nanimals.
ANSWER: n B
An nassumption noften nmade nis nthat nthe nmagnitude nof nbacteremias nresulting nfrom ndental
nprocedures nis nmore nlikely nto ncause nIE nthan nthat nseen nwith nbacteremias nresulting nfrom
nnormal ndaily nactivities. nPublished ndata ndo nnot nsupport nthis ncontention. nFurthermore, nthe
nmagnitude nof nbacteremia nresulting nfrom ndental nprocedures nis nrelatively nlow n(with nbacterial
4
ncounts nof nfewer nthan n10 ncolony-forming nunits/mL), nis nsimilar nto nthat nof nbacteremia
6 8
nresulting nfrom nnormal ndaily nactivities, nand nis nfar nless nthan nthat n(10 nto n10 ncolony-forming
nunits/mL) nneeded nto ncause nexperimental nBE nin nanimals.
7. Visible nbleeding nduring na ndental nprocedure nis na nreliable npredictor nof nbacteremia. nIt nis nnot
nclear nwhich ndental nprocedures nare nmore nor nless nlikely nto ncause ntransient nbacteremia nor nto
nresult nin na ngreater nmagnitude nof nbacteremia nthan nthat ncaused nby nroutine ndaily nactivities
nsuch nas nchewing nfood, ntooth nbrushing, nor nflossing.
a. Both nstatements nare ntrue.
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b. Both nstatements nare nfalse.
c. The nfirst nstatement nis ntrue, nthe nsecond nstatement nis nfalse.
d. The nfirst nstatement nis nfalse, nthe nsecond nstatement nis ntrue.
ANSWER: n D
It nhas nbeen nshown nthat nvisible nbleeding nduring na ndental nprocedure nis nnot na nreliable npredictor
nof nbacteremia. nCollective npublished ndata nsuggest nthat nthe nvast nmajority nof ndental noffice
nvisits nresult nin nsome ndegree nof nbacteremia, nand nthat nit nis nnot nclear nwhich ndental nprocedures
nare nmore nor nless nlikely nto ncause ntransient nbacteremia nor nto nresult nin na ngreater nmagnitude nof
nbacteremia nthan nthat ncaused nby nbacteremia nproduced nby nroutine ndaily nactivities nsuch nas
nchewing nfood, ntooth nbrushing, nor nflossing.
8. Which nof nthe nfollowing nis ntrue nregarding nthe nefficacy nof nantibiotic nprophylaxis?
a. Data nshow nthat na nreduction nin nthe nincidence, nnature, nand nduration nof nbacteria
caused nby nantibiotic ntherapy nreduces nthe nrisk nof nor nprevents nIE.
n
b. Antibiotics ngiven nto nat-risk npatients nbefore na ndental nprocedure nwill nprevent
nor nreduce na nbacteremia.
c. Prospective nrandomized, nplacebo-controlled ntrials nhave nbeen nconducted nto
nexamine nthe nefficacy nof nantibiotic nprophylaxis nfor npreventing n IE nin npatients nwho
nundergo na ndental nprocedure.
d. Investigators nhave nconcluded nthat ndental nor nother nprocedures nprobably nonly
ncaused na nsmall nfraction nof ncases nof nIE, nand nthat nprophylaxis nwould nprevent nonly
na nsmall nnumber nof ncases, neven nif nit nwere n100% neffective.
ANSWER: nD
This nconclusion ncame nas nthe nresult nof na nstudy nfrom nthe nNetherlands nby nvan nder nMeer nand
ncolleagues nthat ninvestigated nthe nefficacy nof nantibiotic nprophylaxis nin npreventing nIE nin ndental
npatients nwith nnative nor nprosthetic ncardiac nvalves
9. The nAmerican nHeart nAssociation ncurrently nrecommends nantibiotic nprophylaxis nbefore
n dental ntreatment nto nprevent nendocarditis nfor npatients nwith nwhich nof nthe nfollowing ncardiac
nconditions?
a. Mitral nvalve nprolapse nwith nregurgitation
b. Rheumatic nheart ndisease
c. Prosthetic ncardiac nvalve
d. A, nB, nand nC
e. A nand nC
ANSWER: n C
Prophylaxis nwith nantibiotics nbefore na ndental nprocedure nis nrecommended nfor na nprosthetic
ncardiac nvalve, nprevious ninfective nendocarditis, nand nsome nforms nof ncongenital nheart ndisease
n(see nBox n2-2.)
10. Which nof nthe nfollowing nantibiotics nis nthe nbest nchoice nif na npatient nwho nrequires
npremedication nbefore ndental ntreatment nis nalready ntaking npenicillin nfor neradication nof nan
ninfection?
a. Amoxicillin
b. Clindamycin
c. Cephalosporins
d. Keep nthe npatient non nthe npenicillin nbecause nthe nblood nlevel nhas nalready
nbeen nachieved
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ANSWER: n B
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The npresence nof nviridians ngroup nstreptococci nthat nare nrelatively nresistant nto npenicillin nor
namoxicillin nis nlikely nin npatients nalready ntaking npenicillin nor namoxicillin nfor neradication nof nan
ninfection. nClindamycin, nazithromycin, nor nclarithromycin nshould nbe nselected nfor nprophylaxis
nif ntreatment nis nimmediately nnecessary. nCephalosporins nshould nbe navoided ndue nto ncross
nresistance. nAnother napproach nis nto nwait nfor nat nleast n10 ndays nafter nthe ncompletion nof nantibiotic
ntherapy nbefore nadministration nof nprophylactic nantibiotics.
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