Test Bank For Dental Management of the Medically Compromised Patient, 9th Edition by James W.
Little
Chapter 01: Patient Evaluation and Risk Assessment
Little: Dental Management of the Medically Compromised Patient, 9th 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
ANS: 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
ANS: 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
ANS: 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
, Test Bank For Dental Management of the Medically Compromised Patient, 9th Edition by James W.
Little
d. Fainting
ANS: 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.
ANS: 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
ANS: 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
ANS: 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
, Test Bank For Dental Management of the Medically Compromised Patient, 9th Edition by James W.
Little
ANS: 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
ANS: 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.
ANS: 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.
Chapter 02: Infective Endocarditis
Little: Dental Management of the Medically Compromised Patient, 9th 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.
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)
, Test Bank For Dental Management of the Medically Compromised Patient, 9th Edition by James W.
Little
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.
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.
Little
Chapter 01: Patient Evaluation and Risk Assessment
Little: Dental Management of the Medically Compromised Patient, 9th 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
ANS: 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
ANS: 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
ANS: 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
, Test Bank For Dental Management of the Medically Compromised Patient, 9th Edition by James W.
Little
d. Fainting
ANS: 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.
ANS: 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
ANS: 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
ANS: 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
, Test Bank For Dental Management of the Medically Compromised Patient, 9th Edition by James W.
Little
ANS: 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
ANS: 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.
ANS: 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.
Chapter 02: Infective Endocarditis
Little: Dental Management of the Medically Compromised Patient, 9th 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.
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)
, Test Bank For Dental Management of the Medically Compromised Patient, 9th Edition by James W.
Little
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.
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.
