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Table of Contents
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PART ONE: PATIENT EVALUATION AND RISK ASSESSMENT
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Chapter 1: Patient Evaluation and Risk Assessment
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PART TWO: CARDIOVASCULAR DISEASE
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Chapter 2: Infective Endocarditis
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Chapter 3: Hypertension
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Chapter 4: Ischemic Heart Disease
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Chapter 5: Cardiac Arrhythmias
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Chapter 6: Heart Failure (or Congestive Heart Failure)
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PART THREE: PULMONARY DISEASE
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Chapter 7: PulmonaryDisease
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Chapter 8: Smoking and Tobacco Use Cessation
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Chapter 9: Sleep-Related Breathing Disorders
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PART FOUR: GASTROINTESTIAL DISEASE
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Chapter 10: Liver Disease
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Chapter 11: Gastrointestinal Disease
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PART FIVE: GENITOURINARY DISEASE
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Chapter 12: Chronic Kidney Disease and Dialysis
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Chapter 13: SexuallyTransmitted Diseases
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PART SIX: ENDOCRINE AND METABOLIC DISEASE
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Chapter 14: Diabetes Mellitus
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Chapter 15: Adrenal Insufficiency
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Chapter 16: Thyroid Diseases
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Chapter 17: Pregnancy and Breast Feeding
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PART SEVEN: IMMUNOLOGIC DISEASE
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Chapter 18: AIDS, HIV Infection, and Related Conditions
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Chapter 19: Allergy
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Chapter20: Rheumatologic and Connective Tissue Disorders
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Chapter 21: Organ and Bone Marrow Transplantation
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PART EIGHT: HEMATOLOGIC AND ONCOLOGIC DISEASE
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Chapter 22: Disorders of Red Blood Cells
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Chapter 23: Disorders of White Blood Cells
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Chapter 24: Acquired Bleeding and Hypercoagulable Disorders
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Chapter25: Congenital Bleeding and Hypercoagulable Disorders
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Chapter 26: Cancer and Oral Care of the Patient
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PART NINE: NEUROLOGIC, BEHAVIORAL, AND PSYCHIATRIC DISORDERS
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Chapter 27: Neurologic Disorders
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Chapter 28: Anxiety, Eating Disorders, and Behavioral Reactions to Illness
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Chapter 29: Psychiatric Disorders
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Chapter 30: Drugand Alcohol Abuse
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Chapter01:PatientEvaluationandRiskAssessment
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Little:DentalManagementoftheMedically CompromisedPatient,10thEdition
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MULTIPLECHOICE n
1. Electivedentalcareshould bedeferred forpatientswithsevere, uncontrolledhypertension,
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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
ANSWER: 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 brought
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under control.
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2. TheAmerican Heart Association currentlyrecommends antibiotic prophylaxis forapatient with
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nwhich of the following cardiac conditions?
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a. Mitralvalve prolapse n n
b. Prostheticheart valve n n
c. Rheumaticheartdisease n n
d. Pacemakers forcardiac arrhythmias n n n
ANSWER: B n
Previously,the American HeartAssociation(AHA) recommended antibioticprophylaxisfor many
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patients with heart murmurs caused by valvular disease (e.g., mitral valve prolapse, rheumatic heart
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disease) in an effort to prevent infective endocarditis; however, current guidelines omit this
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recommendation on the basis of accumulated scientific evidence. If a murmur is due to certain
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specific cardiac conditions (e.g., previous endocarditis, prosthetic heart valve, complex congenital
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cyanotic heart disease), the AHA continues to recommend antibiotic prophylaxis for most dental
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procedures.
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3. Oneconsequence of chronic hepatitis (Bor C) or cirrhosis of the liver is decreased abilityof the body
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nto certain drugs, including local anesthetics and analgesics.
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a. absorb
b. distribute
c. metabolize
d. excrete
ANSWER: 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. Whichofthe following symptoms and signs is most consistent with allergy?
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a. Heartpalpitations n
b. Itching
c. Vomiting
d. Fainting
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ANSWER: B n
Symptoms and signs consistent with allergyincludeitching, urticaria (hives), rash, swelling, n n n n n n n n n n n
wheezing, angioedema, runny nose, and tearing eyes. Isolated signs and symptoms such as nausea,
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vomiting, heart palpitations, and fainting generally are not of an allergic origin but rather are
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manifestations of drug intolerance, adverse side effects, or psychogenic reactions.
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5. Which ofthe following is true of the patient with ahistoryof tuberculosis?
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a. Apositive result on skintesting means that theperson has active TB.
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b. Mostpatients who become positive skin testers develop active disease.
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c. Patientswith acquiredimmunodeficiencysyndrome(AIDS)have ahigh incidence of n n n n n n n n n n
ntuberculosis.
d. Adiagnosis of active TB is madebya purified protein derivative (PPD)skin test.
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ANSWER: 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 positive
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result on skin testing means specifically that the person has at some time been infected with TB, not
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necessarily that active disease is present. Most patients who become positive skin testers do not
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develop active disease. A diagnosis of active TBis made bychest x-ray, imaging, sputum culture,
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and clinical examination.
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6. Vasoconstrictors should beavoided in patients who cocaine ormethamphetamineusers n n n n n n n n n n
because these agents may precipitate
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a. severehypotension n
b. severehypertension n
c. respiratory depression n
d. cessationof intestinal peristalsis n n n
ANSWER: B n
Vasoconstrictors should beavoided in patients who arecocaine or methamphetamine users n n n n n n n n n n n
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 (e.g.,
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MI, heart failure) is increased in patients who are unable to meet a -MET (metabolic equivalent of
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task) demand during normal daily activity.
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a. 4
b. 6
c. 8
d. 10
ANSWER: A n
Dailyactivities requiring 4 METs include level walkingat 4 miles/hour or climbinga flight of stairs.
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Activities requiring greater than 10 METs include swimming and singles tennis. An exercise capacity
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of 10 to 13 METs indicates excellent physical conditioning.
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8. Whichofthe following alterations in the fingernails isassociated with cirrhosis?
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a. Yellowing
b. Clubbing
c. White discoloration n
d. Splinterhemorrhages n
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