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Dental Management of the Medically Compromised Patient 8 Th Ed by Little – Test Bank

Sample Questions

Little: Dental Management of the Medically Compromised Patient,

8th Edition

Chapter 03: Hypertension

Test Bank

MULTIPLE CHOICE

1. In prehypertension, diastolic pressure ranges from ________ mm Hg.

A. 80 to 89

B. 90 to 99

C. 100 to 109

D. 110 to 119
ANS: A
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and
Treatment of High Blood Pressure (JNC 7) introduced the new category of prehypertension, which
encompasses the previously designated categories of normal and borderline hypertension. Normal
blood pressure is 120/80 mm Hg. Prehypertension is systolic blood pressure ranging from 120 to
139 and diastolic pressure ranging from 80 to 89 mm Hg.

PTS: 1 REF: p. 38

2. Which of the following types of health professionals can make the diagnosis of hypertension
and decide on its treatment?
A. physician

B. dentist

C. dental hygienist

D. a, b, and c

E. a and c only

ANS: A
Only a physician can make the diagnosis of hypertension and decide on its treatment. The dentist,
however, should detect abnormal blood pressure measurements, which then become the basis for
referral to or consultation with a physician.

PTS: 1 REF: p. 44

3. Which of the following is the most common cardiac condition in America?

A. congestive heart failure

B. cardiac arrhythmia

C. hypertension

D. angina

ANS: C
With 35 million office visits annually, hypertension is the most common primary diagnosis in
America. According to National Health and Nutrition Examination Survey (NHANES) data for the
period 1999 to 2000, at least 65 million adults in the United States have high blood pressure
(HBP) or are taking antihypertensive medication. This estimate equals about one-fourth of the
population and represents a 30% increase from 1988 to 1994. In a typical practice population of
2,000 patients, therefore, around 500 will have hypertension.

PTS: 1 REF: p. 37
4. It is estimated that about __% of all blood pressure–related deaths from coronary heart
disease occur in persons with blood pressure in the prehypertensive range.
A. less than 1

B. 5

C. 15

D. 25

ANS: C
About 15%. However, the higher the blood pressure, the greater the chances of heart attack, heart
failure, stroke, and kidney disease. For every increase in blood pressure of 20 mm Hg systolic and
10 mm Hg diastolic, a doubling of mortality related to ischemic heart disease and stroke occurs.

PTS: 1 REF: p. 39

5. Which of the following is most often the first drug category of choice if lifestyle modification is
ineffective at lowering blood pressure?
A. beta blockers (BBs)

B. thiazide diuretics

C. angiotensin-converting enzyme inhibitors (ACEIs)

D. angiotensin receptor blockers (ARBs)

ANS: B
Thiazide diuretics are most often the first drugs of choice, given either alone or in combination with
ACEIs, ARBs, BBs, or calcium channel blockers (CCBs), depending on the degree of elevation of
blood pressure. For early stage 1 hypertension, single-drug therapy may be effective; however, for
later stage 1 and for stage 2 hypertension, two or more drug combinations are necessary. The
presence of certain comorbid conditions or factors, such as heart failure, previous MI, diabetes, or
kidney disease, may be a compelling reason to select specific drugs or classes of drugs that have
been found to be beneficial in clinical trials.

PTS: 1 REF: p. 41

6. Deferral of elective dental care and referral to a physician for evaluation and treatment within 1
week are indicated for patients found to have asymptomatic blood pressure of greater than or
equal to ________ mm Hg.
A. 160/90

B. 160/110
 C. 180/90

D. 180/110

ANS: D
Patients with blood pressures less than 180/110 mm Hg can undergo any necessary dental
treatment, both surgical and nonsurgical, with very little risk of an adverse outcome. For patients
found to have asymptomatic blood pressure of 180/110 mm Hg or greater (uncontrolled
hypertension), elective dental care should be deferred, and physician referral for evaluation and
treatment within 1 week is indicated. Patients with uncontrolled blood pressure associated with
symptoms such as headache, shortness of breath, or chest pain should be referred to a physician
for immediate evaluation.

PTS: 1 REF: p. 46

7. Which of the following is recommended for stress management for dental patients with
hypertension?
A. afternoon appointments

B. premedication with a barbiturate

C. nitrous oxide plus oxygen for inhalation sedation

D. keeping the dental chair in an upright position during treatment

ANS: C
Nitrous oxide plus oxygen for inhalation sedation is an excellent intraoperative anxiolytic for use in
patients with hypertension. Care is indicated to ensure adequate oxygenation at all times, avoiding
post-diffusion hypoxia at the termination of administration. Short morning appointments seem best
tolerated. Oral premedication with a short-acting benzodiazepine can reduce anxiety for many
patients. Because many of the antihypertensive agents tend to produce orthostatic hypotension as
a side effect, rapid changes in chair position during dental treatment should be avoided.

PTS: 1 REF: p. 46

8. Use of how many cartridges of 2% lidocaine with 1:100,000 epinephrine at one time is
considered to have little clinical risk for dental treatment of a patient with hypertension?
A. 2

B. 4

C. 6

D. 8

ANS: A
The existing evidence indicates that use of modest doses (one or two cartridges of 2% lidocaine
with 1:100,000 epinephrine) carries little clinical risk in patients with hypertension, the benefits of
its use far outweighing any potential problems. Use of more than this amount at one time may be
tolerated well enough but with increasing risk for adverse hemodynamic changes.

PTS: 1 REF: p. 48

9. Which of the following is an adverse drug interaction that may occur if a dental anesthetic
containing a vasoconstrictor is administered to a patient being treated for hypertension with a
non-selective β-adrenergic blocking agent?
A. hypotension

B. hypertension

C. respiratory alkalosis

D. respiratory acidosis

ANS: B
The basis for concern with use of non-selective β-adrenergic blocking agents (e.g., propranolol) is
that the normal compensatory vasodilation of skeletal muscle vasculature mediated by beta 2
receptors is inhibited by these drugs, and injection of epinephrine, levonordefrin, or any other
pressor agent may result in uncompensated peripheral vasoconstriction because of unopposed
stimulation of alpha 1 receptors. This vasoconstrictive effect could potentially cause a significant
elevation in blood pressure and a compensatory bradycardia.

PTS: 1 REF: p. 48
Little: Dental Management of the Medically Compromised Patient,
8th Edition

Chapter 05: Cardiac Arrhythmias

Test Bank

MULTIPLE CHOICE

1. Which of the following is the most common type of persistent arrhythmia?

A. sinus arrhythmia

B. premature atrial complexes

C. atrial fibrillation

D. ventricular flutter and fibrillation

ANS: C
The most common type of persistent arrhythmia is atrial fibrillation (AF), which affects
approximately 2.6 million people. It is characterized by rapid, disorganized, and ineffective atrial
contractions that occur at a rate of 350 to 600 beats per minute. To manage their arrhythmias,
more than 500,000 people in North America have implanted pacemakers.

PTS: 1 REF: p. 67

2. Which of the following sequences correctly depicts the normal pattern of sequential
depolarization of the structures of the heart? (1) right and left bundle branches, (2) sinoatrial
(SA) node, (3) subendocardial Purkinje network, (4) bundle of His, (5) atrioventricular (AV)
node
A. 5, 2, 4, 1, 3

B. 2, 5, 4, 1, 3

C. 2, 3, 4, 1, 5

D. 2, 5, 3, 1, 4

ANS: B
The normal pattern of sequential depolarization involves the structures of the heart in the following
order: sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle
branches, subendocardial Purkinje network. The electrocardiogram (ECG) is a recording of this
electrical activity. The primary anatomic pacemaker for the heart is the SA node, a crescent-
shaped structure 9 to 15 mm long that is located at the junction of the superior vena cava and the
right atrium.

PTS: 1 REF: p. 67

3. Tachycardia in an adult is defined as a heart rate greater then ___ beats per minute, with
otherwise normal findings on the ECG.
A. 100

B. 125

C. 150

D. 175

ANS: A
Tachycardia in an adult is a heart rate greater than 100 beats per minute. The rate usually is
between 100 and 180 beats per minute. This condition most often is a physiologic response to
exercise, anxiety, stress, or emotion. Pathophysiologic causes include fever, hypertension,
hypoxia, infection, anemia, hyperthyroidism, and heart failure. Drugs that may cause sinus
tachycardia include atropine, epinephrine, alcohol, nicotine, and caffeine.

PTS: 1 REF: p. 69
4. Which of the following is a disorder of repolarization?
A. Mobitz type I (Wenckebach)

B. Wolff-Parkinson-White syndrome

C. long QT syndrome

D. torsades de pointes

ANS: C
Long QT syndrome is a disorder of the conduction system in which the recharging of the heart
during repolarization (i.e., the QT interval) is delayed. It is caused by a genetic mutation in
myocardial ion channels and by certain drugs, or it may be the result of a stroke. Mobitz type I
(Wenckebach) is a form of second-degree heart block. Wolff-Parkinson-White syndrome is
tachycardia involving the AV junction. Torsades de pointes is a variant of ventricular tachycardia.

PTS: 1 REF: pp. 69

5. Which of the following is an advantage of implantable cardioverter-defibrillators (ICDs) in

contrast to pacemakers?
A. ICDs generally are smaller than pacemakers.

B. ICDs are capable of providing antitachycardia pacing (ATP) and ventricular bradycardia pacing, while pacem
capable of providing such pacing.

C. ICDs have batteries that last much longer than pacemakers.

D. ICDs do not require antibiotic prophylaxis prior to dental treatment whereas pacemakers do.

ANS: B
ICDs are capable not only of delivering a shock but of providing antitachycardia pacing (ATP) and
ventricular bradycardia pacing. ICDs generally are larger than pacemakers, and their batteries do
not last as long as those of a pacemaker. Antibiotic prophylaxis for dental treatment is not
recommended for either a pacemaker or a cardioverter-defibrillator.

PTS: 1 REF: pp. 74

6. Which of the following dental devices has produced electromagnetic interference (EMI) with
pacemakers and ICDs in studies performed in vitro?
A. battery-operated curing lights

B. electrical pulp testers and apex locators

C. handpieces
 D. electric toothbrushes

ANS: A
In studies performed in vitro, electrosurgery units, ultrasonic bath cleaners, ultrasonic scaling
devices, and battery-operated curing lights have produced EMI with pacemakers and ICDs.
Amalgamators, electrical pulp testers and apex locators, handpieces, electric toothbrushes,
microwave ovens, and x-ray units did not cause any significant EMI with the pacemakers and ICDs
tested.

PTS: 1 REF: pp. 74

7. Which of the following is classified as a significant arrhythmia according to the ACC/AHA

guidelines?
A. pathologic Q waves

B. left bundle branch block

C. high-grade AV block

D. ST-T wave abnormalities

ANS: C
Patients with high-grade AV block, symptomatic ventricular arrhythmias in the presence of
cardiovascular disease, and supraventricular arrhythmias with an uncontrolled ventricular rate are
at major risk for complications and are not candidates for elective dental care. The presence of
pathologic Q waves is a clinical predictor of intermediate risk for perioperative complications. Left
ventricular hypertrophy, left bundle branch block, and ST-T wave abnormalities are associated
with minor perioperative risk.

PTS: 1 REF: p. 76

8. If a vasoconstrictor in local anesthetic is deemed necessary, patients in the low to intermediate

risk category and those taking nonselective beta blockers can safely be given up to ____
cartridge(s) containing 1:100,000 epinephrine.
A. one

B. two

C. three

D. zero—epinephrine is an absolute contraindication

ANS: B
These patients can safely be given up to 0.036 mg epinephrine, which is the amount in two
cartridges containing 1:100,000 epinephrine. Greater quantities of vasoconstrictor may well be
tolerated, but increasing quantities are associated with increased risk for adverse cardiovascular
effects.

PTS: 1 REF: p. 77
Little: Dental Management of the Medically Compromised Patient,
8th Edition

Chapter 11: Gastrointestinal Disease

Test Bank

MULTIPLE CHOICE

1. Which is the most common location for peptic ulcers in Western populations?
A. stomach

B. duodenum

C. jejunum

D. ileum

ANS: B
The first portion of the duodenum is the location of most ulcers in Western populations, whereas
gastric ulcers are more frequent in Asia. The upper jejunum rarely is involved. Peptic ulcers
develop principally in regions of the gastrointestinal tract that are proximal to acid and pepsin
secretions.

PTS: 1 REF: p. 169

2. Which of the following is the most common cause of peptic ulcer disease?
A. cytomegalovirus infection

B. acid hypersecretion

C. H. pylori infection

D. use of nonsteroidal anti-inflammatory medication

ANS: C
The primary etiologic factor is H. pylori. This organism is present in 60% to 90% of duodenal
ulcers and in 50% to 70% of gastric ulcers. Use of NSAIDs is the second most common cause of
peptic ulcer disease. Other aggressive factors include acid hypersecretion, cigarette smoking, and
psychological and physical stress. Cytomegalovirus infection is a rare cause noted in human
immunodeficiency virus (HIV)–positive patients. Non-NSAID non-H. pylori peptic ulcers are
infrequent and occur more often in elderly persons.

PTS: 1 REF: p. 69-170

3. Which of the following is characteristic of gastric peptic ulcers rather than duodenal peptic
ulcers?
A. epigastric pain that is long-standing

B. diffuse rather than localized epigastric pain

C. symptoms rapidly relieved in most cases by ingestion of food, milk, or antacids

D. pain that most commonly manifests 90 minutes to 3 hours after eating

ANS: A
Many patients with an active peptic ulcer report no ulcer symptoms; however, most experience
epigastric pain that is long-standing and sharply localized. The pain is described as burning or
gnawing, but may be ill-defined or aching. The discomfort of a duodenal ulcer manifests most
commonly on an empty stomach, usually 90 minutes to 3 hours after eating, and frequently
awakens the patient in the middle of the night. Ingestion of food, milk, or antacids provides rapid
relief in most cases. By contrast, patients with gastric ulcers are unpredictable in their response to
food; in fact, eating may precipitate abdominal pain.

PTS: 1 REF: p. 171-172

4. Which of the following is/are components of currently recommended therapy when a peptic
ulcer is confirmed and H. pylori is present?
A. inhibitors of gastric acid secretion

B. dissection of the vagus nerves from the gastric fundus

C. antimicrobial agents

D. a, b, and c

E. a and c

ANS: E
Combination therapy is recommended because antisecretory drugs, such as histamine H 2 receptor
antagonists and PPIs, provide rapid relief of pain and accelerate healing, and antibiotics are
effective in eradicating H. pylori. Combination treatment accelerates healing and produces an
ulcer-free state in 92% to 99% of treated patients. Elective surgical intervention largely has been
abandoned in the management of peptic ulcer disease. Today, surgery is reserved primarily for
complications of peptic ulcer disease, such as significant bleeding, perforation, and gastric outlet
obstruction.

PTS: 1 REF: p. 172

5. Which of the following is true of Crohn’s disease?

 A. Crohn’s disease is limited to the large intestine and the rectum.

B. Crohn’s disease affects men and women equally.

C. Crohn’s disease occurs more often in smokers.

D. Most patients who have Crohn’s disease require at least one operation for their condition.

ANS: D
Most patients with Crohn’s disease require at least one operation. Crohn’s disease is a transmural
process that may produce “patchy” ulcerations at any point along the alimentary canal, from the
mouth to the anus, but most commonly involves the terminal ileum. Ulcerative colitis affects men
and women equally, whereas Crohn’s disease is slightly more common among women. Crohn’s
disease occurs more often in nonsmokers, whereas smoking protects against ulcerative colitis.

PTS: 1 REF: pp. 177

6. Patients with IBD who have fewer than __ bowel movements per day with little or no blood, no
fever, few symptoms, and a sedimentation rate below 20 mm/hour are considered to have mild
disease and can receive dental care in the dentist’s office.
A. 2

B. 4

C. 6

D. 8

ANS: B
Patients with fewer than 4 bowel movements per day can receive dental care in the dentist’s
office. Patients with moderate disease or severe disease—the latter defined as having 6 or more
bowel movements per day with blood, fever, anemia, and a sedimentation rate higher than 30
mm/hour—are poor candidates for dental care and should be referred to their physician.

PTS: 1 REF: p. 179

7. Which of the following is the most common oral complication associated with inflammatory
bowel disease (IBD)?
A. petechiae

B. vascular pools

C. sialadenitis

D. aphthous ulcer-like lesions

ANS: D
Aphthous ulcer-like lesions occur in up to 20% of patients with ulcerative colitis. They typically are
located on the alveolar, labial, and buccal mucosa, as well as the soft palate, uvula, and
retromolar trigone, and they may be difficult to distinguish from aphthous lesions. Pyostomatitis
vegetans also can affect patients with ulcerative colitis and may aid in the diagnosis. Unique oral
manifestations of Crohn’s disease occur in approximately 20% of patients and may precede the
diagnosis of gastrointestinal disease by several years. Features include atypical mucosal
ulcerations and diffuse swelling of the lips and cheeks.

PTS: 1 REF: pp. 179

8. Which of the following organisms is the causative agent in 90% to 99% of cases of
pseudomembranous colitis?
A. H. pylori

B. C. difficile

C. S. aureus

D. C. albicans

ANS: B
Pseudomembranous colitis is a severe and sometimes fatal form of colitis that results from the
overgrowth of Clostridium difficile in the large colon. C. difficile is a gram-positive, spore-forming
anaerobic rod that has been found in sand, soil, and feces. C. difficile produces and releases
potent enterotoxins that induce colitis and diarrhea.

PTS: 1 REF: p. 180

9. Which of the following is the most common presenting manifestation of pseudomembranous

colitis?
A. “red man” syndrome

B. diarrhea

C. peptic ulcer

D. acute hypertension

ANS: B
Diarrhea is the most common presenting manifestation of pseudomembranous colitis. In mild
cases, the stool is watery and loose. In severe cases, bloody diarrhea is accompanied by
abdominal cramps, tenderness, and fever. Severe dehydration, metabolic acidosis, hypotension,
peritonitis, and toxic megacolon are serious complications of untreated disease.

PTS: 1 REF: p. 181