1
What is the most common cause of death for people with diabetes mellitus?
A. Unintentional injuries or accidents B. Pancreatic cancer
C. Cardiovascular disease D. Hypoglycemia
Diabetes mellitus is a significant risk factor for cardiovascular disease, which is the most
common cause of death among adults with diabetes mellitus.
According to the Virchow triad, which of the following contributes to development of a venous
thromboembolism?
A. Presence of telangiectasias B. Venous stasis
C. Hypocoagulability D. Vasodilation
The Virchow triad proposes that venous thromboembolism is a result of alterations in blood flow
(stasis), vascular endothelial injury, and alterations in the components of the blood (inherited or
acquired hypercoagulable state). Telangiectasias are superficial “spider veins” that do not cause
deep vein or superficial thrombosis. Hypocoagulability would contribute to bleeding rather than
embolism. Vasodilation—the widening of blood vessels—increases blood flow, which is
typically not a condition contributing to thrombus formation and is not a part of Virchow’s triad.
A patient presents for a routine check-up complaining of mild symptoms such as fatigue and
dyspnea while walking or climbing stairs rapidly. The patient reports a slight limitation of
physical activity but feels comfortable at rest. These symptoms suggest which of the following
New York Heart Association (NYHA) Functional Classifications of heart failure?
A. I B. II C. III D. IV
The NYHA Functional Classification is used to describe the functional status of patients with
heart failure, with severity ranging from Class I to Class IV. Class I is characterized by no
symptoms and no limitation in physical activity; Class II involves mild symptoms and slight
limitation during ordinary activity; Class III involves marked limitation in activity due to
symptoms (even when walking short distances) but comfort at rest; Class IV is characterized by
severe limitations and experiencing symptoms at rest.
The echocardiogram of a patient with heart failure with left ventricular (LV) dysfunction reveals
an ejection fraction (EF) of 55%. This constitutes which of the following?
A. Heart failure with preserved ejection fraction (HFpEF)
B. Heart failure with mid-range ejection fraction (HFmrEF)
C. Right-sided heart failure
D. Heart failure with reduced ejection fraction (HFrEF)
Heart failure caused by LV dysfunction is categorized by LV EF: HFrEF is defined as an EF of
40% or less (systolic heart failure); heart failure with EF of 41% to 49% is defined as HFmrEF;
and HFpEF is defined as an EF of 50% or higher (diastolic heart failure). Left-sided heart failure
is primarily caused by left heart pathologies (LV, mitral valve, or aortic valve dysfunction).
Right-sided heart failure is caused by right heart conditions (pulmonary hypertension; right
ventricle, pulmonic valve, or tricuspid dysfunction).
, 2
An older adult male patient with past medical history significant for tobacco use presents for a
routine physical examination. A pulsatile abdominal mass is palpated on routine physical
examination. The patient denies any symptoms. Which of the following is the recommended
initial diagnostic modality based on this patient presentation?
A. CT of the abdomen B. MRI
C. FAST exam D. Abdominal ultrasound
This patient is presenting with clinical features suggestive of an abdominal aortic aneurysm
(AAA). Male sex, older age, and smoking history increase the risk. Many patients with AAA
have no symptoms. Often, a palpated pulsatile abdominal mass is noted on routine physical
examination (30% of asymptomatic AAAs). The abdominal ultrasound is recommended as the
first diagnostic modality for most asymptomatic patients; it is noninvasive and cost-effective for
diagnosis in asymptomatic patients. For symptomatic patients who are hemodynamically stable,
a CT of the abdomen (preferably with contrast) is recommended as the initial diagnostic
modality. For symptomatic patients who are hemodynamically unstable, the FAST exam is
recommended. FAST is an ultrasound technique used to evaluate both abdominal and thoracic
cavities. It is used to detect the presence of blood or fluid (effusion) in the pericardial space. An
MRI is not usually indicated as first line due to its cost, availability, and time restraints.
Which of the following is the most common microbial cause of infective endocarditis in the
United States and most developed countries?
A. Pseudomonas aeruginosa B. Staphylococcus aureus
C. Escherichia coli D. Klebsiella pneumoniae
Worldwide, the three most common causes of infective endocarditis are staphylococci,
streptococci, and enterococci. S. aureus is the most common cause of infective endocarditis in
the United States and most developed countries. Streptococci is a common cause in community-
acquired infective endocarditis, and staphylococci is a common cause of healthcare-associated
infective endocarditis
In which of the following scenarios is antibiotic prophylaxis indicated for the prevention of
infective endocarditis?
A. A patient with a prosthetic heart valve receiving placement of orthodontic brackets
B. A cardiac transplant recipient with no cardiac valvopathy who plans to have a tooth extracted
C. A patient with previous infective endocarditis who plans to have a dental abscess
drained
D. A patient with a ventricular assist device who presents with bleeding from trauma to the oral
mucosa
Patients with a high-risk condition or implanted device are recommended to receive antibiotic
prophylaxis prior to invasive dental or oral procedures. Placement of orthodontic brackets is not
an invasive procedure. Cardiac transplant recipients who plan to have a tooth extracted require
antibiotic prophylaxis only if they have developed cardiac valvopathy.
What is the most common cause of death for people with diabetes mellitus?
A. Unintentional injuries or accidents B. Pancreatic cancer
C. Cardiovascular disease D. Hypoglycemia
Diabetes mellitus is a significant risk factor for cardiovascular disease, which is the most
common cause of death among adults with diabetes mellitus.
According to the Virchow triad, which of the following contributes to development of a venous
thromboembolism?
A. Presence of telangiectasias B. Venous stasis
C. Hypocoagulability D. Vasodilation
The Virchow triad proposes that venous thromboembolism is a result of alterations in blood flow
(stasis), vascular endothelial injury, and alterations in the components of the blood (inherited or
acquired hypercoagulable state). Telangiectasias are superficial “spider veins” that do not cause
deep vein or superficial thrombosis. Hypocoagulability would contribute to bleeding rather than
embolism. Vasodilation—the widening of blood vessels—increases blood flow, which is
typically not a condition contributing to thrombus formation and is not a part of Virchow’s triad.
A patient presents for a routine check-up complaining of mild symptoms such as fatigue and
dyspnea while walking or climbing stairs rapidly. The patient reports a slight limitation of
physical activity but feels comfortable at rest. These symptoms suggest which of the following
New York Heart Association (NYHA) Functional Classifications of heart failure?
A. I B. II C. III D. IV
The NYHA Functional Classification is used to describe the functional status of patients with
heart failure, with severity ranging from Class I to Class IV. Class I is characterized by no
symptoms and no limitation in physical activity; Class II involves mild symptoms and slight
limitation during ordinary activity; Class III involves marked limitation in activity due to
symptoms (even when walking short distances) but comfort at rest; Class IV is characterized by
severe limitations and experiencing symptoms at rest.
The echocardiogram of a patient with heart failure with left ventricular (LV) dysfunction reveals
an ejection fraction (EF) of 55%. This constitutes which of the following?
A. Heart failure with preserved ejection fraction (HFpEF)
B. Heart failure with mid-range ejection fraction (HFmrEF)
C. Right-sided heart failure
D. Heart failure with reduced ejection fraction (HFrEF)
Heart failure caused by LV dysfunction is categorized by LV EF: HFrEF is defined as an EF of
40% or less (systolic heart failure); heart failure with EF of 41% to 49% is defined as HFmrEF;
and HFpEF is defined as an EF of 50% or higher (diastolic heart failure). Left-sided heart failure
is primarily caused by left heart pathologies (LV, mitral valve, or aortic valve dysfunction).
Right-sided heart failure is caused by right heart conditions (pulmonary hypertension; right
ventricle, pulmonic valve, or tricuspid dysfunction).
, 2
An older adult male patient with past medical history significant for tobacco use presents for a
routine physical examination. A pulsatile abdominal mass is palpated on routine physical
examination. The patient denies any symptoms. Which of the following is the recommended
initial diagnostic modality based on this patient presentation?
A. CT of the abdomen B. MRI
C. FAST exam D. Abdominal ultrasound
This patient is presenting with clinical features suggestive of an abdominal aortic aneurysm
(AAA). Male sex, older age, and smoking history increase the risk. Many patients with AAA
have no symptoms. Often, a palpated pulsatile abdominal mass is noted on routine physical
examination (30% of asymptomatic AAAs). The abdominal ultrasound is recommended as the
first diagnostic modality for most asymptomatic patients; it is noninvasive and cost-effective for
diagnosis in asymptomatic patients. For symptomatic patients who are hemodynamically stable,
a CT of the abdomen (preferably with contrast) is recommended as the initial diagnostic
modality. For symptomatic patients who are hemodynamically unstable, the FAST exam is
recommended. FAST is an ultrasound technique used to evaluate both abdominal and thoracic
cavities. It is used to detect the presence of blood or fluid (effusion) in the pericardial space. An
MRI is not usually indicated as first line due to its cost, availability, and time restraints.
Which of the following is the most common microbial cause of infective endocarditis in the
United States and most developed countries?
A. Pseudomonas aeruginosa B. Staphylococcus aureus
C. Escherichia coli D. Klebsiella pneumoniae
Worldwide, the three most common causes of infective endocarditis are staphylococci,
streptococci, and enterococci. S. aureus is the most common cause of infective endocarditis in
the United States and most developed countries. Streptococci is a common cause in community-
acquired infective endocarditis, and staphylococci is a common cause of healthcare-associated
infective endocarditis
In which of the following scenarios is antibiotic prophylaxis indicated for the prevention of
infective endocarditis?
A. A patient with a prosthetic heart valve receiving placement of orthodontic brackets
B. A cardiac transplant recipient with no cardiac valvopathy who plans to have a tooth extracted
C. A patient with previous infective endocarditis who plans to have a dental abscess
drained
D. A patient with a ventricular assist device who presents with bleeding from trauma to the oral
mucosa
Patients with a high-risk condition or implanted device are recommended to receive antibiotic
prophylaxis prior to invasive dental or oral procedures. Placement of orthodontic brackets is not
an invasive procedure. Cardiac transplant recipients who plan to have a tooth extracted require
antibiotic prophylaxis only if they have developed cardiac valvopathy.
