,DOWNLOAD THE Test Bank for Dental Management of the Medically Compr
n n n n n n n n n n
omised Patient 9th Edition Little
n n n n
Chapter 02: Infective Endocarditis
n n n
Little: Dental Management of the Medically Compromised Patient, 9th Edition
n n n n n n n n n
MULTIPLEnCHOICE
1. Whichnofnthenfollowingnisntruenconcerningninfectivenendocarditisn(IE)?
a. IEnisnalwaysnduentonanbacterialninfection.
b. Sincenthenadventnofnantibiotics,nmorbiditynandnmortalitynassociatednwithnIEnhaven
beennvirtuallyneliminated.
c. IEnisncurrentlynclassifiednasnacutenornsubacute,ntonreflectnthenrapiditynofnonsetnandnd
uration.
d. Accumulatingnevidencenquestionsnthenvaliditynofnantibioticnprophylaxisninnann
attemptntonpreventnIEnpriorntoncertainninvasivendentalnprocedures.
ANS:n D
Antibioticsnhavenbeennadministerednbeforencertainninvasivendentalnproceduresninnannattemptntonp
reventninfection.nOfnnote,nhowever,ntheneffectivenessnofnsuchnprophylaxisninnhumansnhasnnevernb
eennsubstantiated,nandnaccumulatingnevidencenmorenandnmorenquestionsnthenvaliditynofnthisnpract
ice.
2. Whichnofnthenfollowingnisncurrentlynthenmostncommonnunderlyingnconditionnpredisposingntoni
nfectivenendocarditisn(IE)?
a. Aorticnvalvendisease
b. Rheumaticnheartndiseasen(RHD)
c. Mitralnvalvenprolapsen(MVP)
d. TetralogynofnFallot
ANS:n C
Mitralnvalvenprolapse,nwhichnaccountsnforn25%nton30%nofnadultncasesnofnnativenvalvenendocardit
isn(NVE),nisnnownthenmostncommonnunderlyingnconditionnamongnpatientsnwhonacquirenIE.nPrevi
ously,nrheumaticnheartndiseasen(RHD)nwasnthenmostncommonnconditionnpredisposingntonendocar
ditis.nInndevelopedncountries,nhowever,nthenfrequencynofnRHDnhasnmarkedlyndeclinednovernthenp
astnseveralndecades.
3. Thenleadingncausenofndeathnduentoninfectivenendocarditisn(IE)nisn .
a. chronicnobstructivenpulmonaryndisease
b. heartnfailure
c. pulmonarynemboli
d. atheromas
ANS:n B
ThenmostncommonncomplicationnofnIE,nandnthenleadingncausenofndeath,nisnheartnfailure,nwhichnres
ultsnfromnseverenvalvularndysfunction.nThisnpathologicnprocessnmostncommonlynbeginsnasnanprobl
emnwithnaorticnvalveninvolvement,nfollowednbynmitralnandnthenntricuspidnvalveninfection.nEmboli
zationnofnvegetationnfragmentsnoftennleadsntonfurtherncomplications,nsuchnasnstroke.
Myocardialninfarctionncannoccurnasnthenresultnofnembolismnofnthencoronarynarteries,nandndistalnemb
olincannproducenperipheralnmetastaticnabscesses.
mynursytest.store
,DOWNLOAD THE Test Bank for Dental Management of the Medically Compr
n n n n n n n n n n
omised Patient 9th Edition Little
n n n n
4. Thenintervalnbetweennthenpresumedninitiatingnbacteremianandnthenonsetnofnsymptomsnofnin
fectivenendocarditisn(IE)nisnestimatedntonbenlessnthann
innmorenthann80%nofn
patientsnwithnIE.
a. 1nweek
b. 2nweeks
c. 1nmonth
d. 2nmonths
ANS:n B
Itnisnlessnthanntwonweeksninnmorenthann80%nofnpatientsnwithnIE.nInnmanyncasesnofnIEnthatnhavenbe
ennpurportedntonbenduentondentallyninducednbacteremia,nthenintervalnbetweennthendentalnappoint
mentnandnthendiagnosisnofnIEnhasnbeennmuchnlongernthann2nweeksn(sometimesnmonths),nsonitnisnv
erynunlikelynthatntheninitiatingnbacteremianwasnassociatednwithndentalntreatment.
5. WherenarenJanewaynlesionsnlocated?
a. Tricuspidnvalve
b. Palmsnofnthenhandsnandnsolesnofnthenfeet
c. Pulpnofnthendigits
d. Nailnbeds
ANS:n B
Janewaynlesionsnarensmall,nnontendernerythematousnornhemorrhagicnmacularnlesionsnonnthenpalm
snandnsoles.nJanewaynlesionsnarenonenofnthenperipheralnmanifestationsnofnIEnduentonembolinand/orni
mmunologicnresponses.
6. Whichnofnthenfollowingnisntruenofnthenmagnitudenofnbacteremianrequiredntoncauseninfectivene
ndocarditisn(IE)?
a. Thenmagnitudenofnbacteremiasnresultingnfromndentalnproceduresnisnmorenlikelyntonc
ausenIEnthannthatnseennwithnbacteremiasnresultingnfromnnormalndailynactivities.
b. CasesnofnIEncausednbynoralnbacterianprobablynresultnfromnfrequentnexposurentonlowni
noculanofnbacterianinnthenbloodstreamnduentondailynactivitiesnandnnotnandentalnproced
ure.
c. Thenqualitynofnoralnhygienenhasnnonappreciableneffectnonnthenmagnitudenofn
bacteremianafterntoothbrushing.
d. Thenmagnitudenofnbacteremianresultingnfromndentalnproceduresnisngreaternthannthatn
neededntoncausenexperimentalnbacterialnendocarditisn(BE)ninnanimals.
ANS:n B
Annassumptionnoftennmadenisnthatnthenmagnitudenofnbacteremiasnresultingnfromndentalnprocedur
esnisnmorenlikelyntoncausenIEnthannthatnseennwithnbacteremiasnresultingnfromnnormalndailynactivit
ies.nPublishedndatandonnotnsupportnthisncontention.nFurthermore,nthenmagnitudenofnbacteremianre
sultingnfromndentalnproceduresnisnrelativelynlown(withnbacterialncountsnofnfewernthann104ncolony
-
formingnunits/mL),nisnsimilarntonthatnofnbacteremianresultingnfromnnormalndailynactivities,nandnis
6 8
nfarnlessnthannthatn(10 nton10 ncolony-
formingnunits/mL)nneededntoncausenexperimentalnBEninnanimals.
7. Visiblenbleedingnduringnandentalnprocedurenisnanreliablenpredictornofnbacteremia.nItnisnnotnclearn
whichndentalnproceduresnarenmorenornlessnlikelyntoncausentransientnbacteremianorntonresultninnang
reaternmagnitudenofnbacteremianthannthatncausednbynroutinendailynactivitiesnsuchnasnchewingnfo
od,ntoothnbrushing,nornflossing.
a. Bothnstatementsnarentrue.
mynursytest.store
, DOWNLOAD THE Test Bank for Dental Management of the Medically Compr
n n n n n n n n n n
omised Patient 9th Edition Little
n n n n
b. Bothnstatementsnarenfalse.
c. Thenfirstnstatementnisntrue,nthensecondnstatementnisnfalse.
d. Thenfirstnstatementnisnfalse,nthensecondnstatementnisntrue.
ANS:n D
Itnhasnbeennshownnthatnvisiblenbleedingnduringnandentalnprocedurenisnnotnanreliablenpredictornofnb
acteremia.nCollectivenpublishedndatansuggestnthatnthenvastnmajoritynofndentalnofficenvisitsnresultni
nnsomendegreenofnbacteremia,nandnthatnitnisnnotnclearnwhichndentalnproceduresnarenmorenornlessnli
kelyntoncausentransientnbacteremianorntonresultninnangreaternmagnitudenofnbacteremianthannthatnca
usednbynbacteremianproducednbynroutinendailynactivitiesnsuchnasnchewingnfood,ntoothnbrushing,n
ornflossing.
8. Whichnofnthenfollowingnisntruenregardingnthenefficacynofnantibioticnprophylaxis?
a. Datanshownthatnanreductionninnthenincidence,nnature,nandndurationnofnbacteriancausednb
ynantibioticntherapynreducesnthenrisknofnornpreventsnIE.
b. Antibioticsngivenntonat-
risknpatientsnbeforenandentalnprocedurenwillnpreventnornreducenanbacteremia.
c. Prospectivenrandomized,nplacebo-
controlledntrialsnhavenbeennconductedntonexaminenthenefficacynofnantibioticnprophyla
xisnfornpreventingnIEninnpatientsnwhonundergonandentalnprocedure.
d. Investigatorsnhavenconcludednthatndentalnornothernproceduresnprobablynonlyncausedn
ansmallnfractionnofncasesnofnIE,nandnthatnprophylaxisnwouldnpreventnonlynansmallnnu
mbernofncases,nevennifnitnweren100%neffective.
ANS:n D
ThisnconclusionncamenasnthenresultnofnanstudynfromnthenNetherlandsnbynvanndernMeernandncolleag
uesnthatninvestigatednthenefficacynofnantibioticnprophylaxisninnpreventingnIEninndentalnpatientsnwi
thnnativenornprostheticncardiacnvalves.
9. ThenAmericannHeartnAssociationncurrentlynrecommendsnantibioticnprophylaxisnbeforendentalntr
eatmentntonpreventnendocarditisnfornpatientsnwithnwhichnofnthenfollowingncardiacnconditions?
a. Mitralnvalvenprolapsenwithnregurgitation
b. Rheumaticnheartndisease
c. Prostheticncardiacnvalve
d. A,nB,nandnC
e. AnandnC
ANS:n C
Prophylaxisnwithnantibioticsnbeforenandentalnprocedurenisnrecommendednfornanprostheticncardiacn
valve,npreviousninfectivenendocarditis,nandnsomenformsnofncongenitalnheartndiseasen(seenBoxn2-
2.)
10. Whichnofnthenfollowingnantibioticsnisnthenbestnchoicenifnanpatientnwhonrequiresnpremedicationnb
eforendentalntreatmentnisnalreadyntakingnpenicillinnforneradicationnofnanninfection?
a. Amoxicillin
b. Clindamycin
c. Cephalosporins
d. Keepnthenpatientnonnthenpenicillinnbecausenthenbloodnlevelnhasnalreadynbeenna
chieved
ANS:n B
mynursytest.store
n n n n n n n n n n
omised Patient 9th Edition Little
n n n n
Chapter 02: Infective Endocarditis
n n n
Little: Dental Management of the Medically Compromised Patient, 9th Edition
n n n n n n n n n
MULTIPLEnCHOICE
1. Whichnofnthenfollowingnisntruenconcerningninfectivenendocarditisn(IE)?
a. IEnisnalwaysnduentonanbacterialninfection.
b. Sincenthenadventnofnantibiotics,nmorbiditynandnmortalitynassociatednwithnIEnhaven
beennvirtuallyneliminated.
c. IEnisncurrentlynclassifiednasnacutenornsubacute,ntonreflectnthenrapiditynofnonsetnandnd
uration.
d. Accumulatingnevidencenquestionsnthenvaliditynofnantibioticnprophylaxisninnann
attemptntonpreventnIEnpriorntoncertainninvasivendentalnprocedures.
ANS:n D
Antibioticsnhavenbeennadministerednbeforencertainninvasivendentalnproceduresninnannattemptntonp
reventninfection.nOfnnote,nhowever,ntheneffectivenessnofnsuchnprophylaxisninnhumansnhasnnevernb
eennsubstantiated,nandnaccumulatingnevidencenmorenandnmorenquestionsnthenvaliditynofnthisnpract
ice.
2. Whichnofnthenfollowingnisncurrentlynthenmostncommonnunderlyingnconditionnpredisposingntoni
nfectivenendocarditisn(IE)?
a. Aorticnvalvendisease
b. Rheumaticnheartndiseasen(RHD)
c. Mitralnvalvenprolapsen(MVP)
d. TetralogynofnFallot
ANS:n C
Mitralnvalvenprolapse,nwhichnaccountsnforn25%nton30%nofnadultncasesnofnnativenvalvenendocardit
isn(NVE),nisnnownthenmostncommonnunderlyingnconditionnamongnpatientsnwhonacquirenIE.nPrevi
ously,nrheumaticnheartndiseasen(RHD)nwasnthenmostncommonnconditionnpredisposingntonendocar
ditis.nInndevelopedncountries,nhowever,nthenfrequencynofnRHDnhasnmarkedlyndeclinednovernthenp
astnseveralndecades.
3. Thenleadingncausenofndeathnduentoninfectivenendocarditisn(IE)nisn .
a. chronicnobstructivenpulmonaryndisease
b. heartnfailure
c. pulmonarynemboli
d. atheromas
ANS:n B
ThenmostncommonncomplicationnofnIE,nandnthenleadingncausenofndeath,nisnheartnfailure,nwhichnres
ultsnfromnseverenvalvularndysfunction.nThisnpathologicnprocessnmostncommonlynbeginsnasnanprobl
emnwithnaorticnvalveninvolvement,nfollowednbynmitralnandnthenntricuspidnvalveninfection.nEmboli
zationnofnvegetationnfragmentsnoftennleadsntonfurtherncomplications,nsuchnasnstroke.
Myocardialninfarctionncannoccurnasnthenresultnofnembolismnofnthencoronarynarteries,nandndistalnemb
olincannproducenperipheralnmetastaticnabscesses.
mynursytest.store
,DOWNLOAD THE Test Bank for Dental Management of the Medically Compr
n n n n n n n n n n
omised Patient 9th Edition Little
n n n n
4. Thenintervalnbetweennthenpresumedninitiatingnbacteremianandnthenonsetnofnsymptomsnofnin
fectivenendocarditisn(IE)nisnestimatedntonbenlessnthann
innmorenthann80%nofn
patientsnwithnIE.
a. 1nweek
b. 2nweeks
c. 1nmonth
d. 2nmonths
ANS:n B
Itnisnlessnthanntwonweeksninnmorenthann80%nofnpatientsnwithnIE.nInnmanyncasesnofnIEnthatnhavenbe
ennpurportedntonbenduentondentallyninducednbacteremia,nthenintervalnbetweennthendentalnappoint
mentnandnthendiagnosisnofnIEnhasnbeennmuchnlongernthann2nweeksn(sometimesnmonths),nsonitnisnv
erynunlikelynthatntheninitiatingnbacteremianwasnassociatednwithndentalntreatment.
5. WherenarenJanewaynlesionsnlocated?
a. Tricuspidnvalve
b. Palmsnofnthenhandsnandnsolesnofnthenfeet
c. Pulpnofnthendigits
d. Nailnbeds
ANS:n B
Janewaynlesionsnarensmall,nnontendernerythematousnornhemorrhagicnmacularnlesionsnonnthenpalm
snandnsoles.nJanewaynlesionsnarenonenofnthenperipheralnmanifestationsnofnIEnduentonembolinand/orni
mmunologicnresponses.
6. Whichnofnthenfollowingnisntruenofnthenmagnitudenofnbacteremianrequiredntoncauseninfectivene
ndocarditisn(IE)?
a. Thenmagnitudenofnbacteremiasnresultingnfromndentalnproceduresnisnmorenlikelyntonc
ausenIEnthannthatnseennwithnbacteremiasnresultingnfromnnormalndailynactivities.
b. CasesnofnIEncausednbynoralnbacterianprobablynresultnfromnfrequentnexposurentonlowni
noculanofnbacterianinnthenbloodstreamnduentondailynactivitiesnandnnotnandentalnproced
ure.
c. Thenqualitynofnoralnhygienenhasnnonappreciableneffectnonnthenmagnitudenofn
bacteremianafterntoothbrushing.
d. Thenmagnitudenofnbacteremianresultingnfromndentalnproceduresnisngreaternthannthatn
neededntoncausenexperimentalnbacterialnendocarditisn(BE)ninnanimals.
ANS:n B
Annassumptionnoftennmadenisnthatnthenmagnitudenofnbacteremiasnresultingnfromndentalnprocedur
esnisnmorenlikelyntoncausenIEnthannthatnseennwithnbacteremiasnresultingnfromnnormalndailynactivit
ies.nPublishedndatandonnotnsupportnthisncontention.nFurthermore,nthenmagnitudenofnbacteremianre
sultingnfromndentalnproceduresnisnrelativelynlown(withnbacterialncountsnofnfewernthann104ncolony
-
formingnunits/mL),nisnsimilarntonthatnofnbacteremianresultingnfromnnormalndailynactivities,nandnis
6 8
nfarnlessnthannthatn(10 nton10 ncolony-
formingnunits/mL)nneededntoncausenexperimentalnBEninnanimals.
7. Visiblenbleedingnduringnandentalnprocedurenisnanreliablenpredictornofnbacteremia.nItnisnnotnclearn
whichndentalnproceduresnarenmorenornlessnlikelyntoncausentransientnbacteremianorntonresultninnang
reaternmagnitudenofnbacteremianthannthatncausednbynroutinendailynactivitiesnsuchnasnchewingnfo
od,ntoothnbrushing,nornflossing.
a. Bothnstatementsnarentrue.
mynursytest.store
, DOWNLOAD THE Test Bank for Dental Management of the Medically Compr
n n n n n n n n n n
omised Patient 9th Edition Little
n n n n
b. Bothnstatementsnarenfalse.
c. Thenfirstnstatementnisntrue,nthensecondnstatementnisnfalse.
d. Thenfirstnstatementnisnfalse,nthensecondnstatementnisntrue.
ANS:n D
Itnhasnbeennshownnthatnvisiblenbleedingnduringnandentalnprocedurenisnnotnanreliablenpredictornofnb
acteremia.nCollectivenpublishedndatansuggestnthatnthenvastnmajoritynofndentalnofficenvisitsnresultni
nnsomendegreenofnbacteremia,nandnthatnitnisnnotnclearnwhichndentalnproceduresnarenmorenornlessnli
kelyntoncausentransientnbacteremianorntonresultninnangreaternmagnitudenofnbacteremianthannthatnca
usednbynbacteremianproducednbynroutinendailynactivitiesnsuchnasnchewingnfood,ntoothnbrushing,n
ornflossing.
8. Whichnofnthenfollowingnisntruenregardingnthenefficacynofnantibioticnprophylaxis?
a. Datanshownthatnanreductionninnthenincidence,nnature,nandndurationnofnbacteriancausednb
ynantibioticntherapynreducesnthenrisknofnornpreventsnIE.
b. Antibioticsngivenntonat-
risknpatientsnbeforenandentalnprocedurenwillnpreventnornreducenanbacteremia.
c. Prospectivenrandomized,nplacebo-
controlledntrialsnhavenbeennconductedntonexaminenthenefficacynofnantibioticnprophyla
xisnfornpreventingnIEninnpatientsnwhonundergonandentalnprocedure.
d. Investigatorsnhavenconcludednthatndentalnornothernproceduresnprobablynonlyncausedn
ansmallnfractionnofncasesnofnIE,nandnthatnprophylaxisnwouldnpreventnonlynansmallnnu
mbernofncases,nevennifnitnweren100%neffective.
ANS:n D
ThisnconclusionncamenasnthenresultnofnanstudynfromnthenNetherlandsnbynvanndernMeernandncolleag
uesnthatninvestigatednthenefficacynofnantibioticnprophylaxisninnpreventingnIEninndentalnpatientsnwi
thnnativenornprostheticncardiacnvalves.
9. ThenAmericannHeartnAssociationncurrentlynrecommendsnantibioticnprophylaxisnbeforendentalntr
eatmentntonpreventnendocarditisnfornpatientsnwithnwhichnofnthenfollowingncardiacnconditions?
a. Mitralnvalvenprolapsenwithnregurgitation
b. Rheumaticnheartndisease
c. Prostheticncardiacnvalve
d. A,nB,nandnC
e. AnandnC
ANS:n C
Prophylaxisnwithnantibioticsnbeforenandentalnprocedurenisnrecommendednfornanprostheticncardiacn
valve,npreviousninfectivenendocarditis,nandnsomenformsnofncongenitalnheartndiseasen(seenBoxn2-
2.)
10. Whichnofnthenfollowingnantibioticsnisnthenbestnchoicenifnanpatientnwhonrequiresnpremedicationnb
eforendentalntreatmentnisnalreadyntakingnpenicillinnforneradicationnofnanninfection?
a. Amoxicillin
b. Clindamycin
c. Cephalosporins
d. Keepnthenpatientnonnthenpenicillinnbecausenthenbloodnlevelnhasnalreadynbeenna
chieved
ANS:n B
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