Little: Dental Management of the Medically Compromised Patient, 8th
Edition
Chapter 01: Patient Evaluation and Risk Assessment
Test Bank
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 of greater than or equal to 180/110 mm Hg, until
the condition can be brought under control.
PTS: 1 REF: p. 4
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; current
guidelines omit this recommendation on the basis of accumulated scientific evidence. If a
murmur is due to 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. Patients with pacemakers do not
require antibiotic prophylaxis.
Copyright © 2013 by Mosby, an imprint of Elsevier Inc.
, Test Bank 1-2
PTS: 1 REF: pp. 4-5
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 with chronic hepatitis (B or C) or cirrhosis have an associated impairment of
liver function. This deficit may result in prolonged bleeding and less efficient metabolism
of certain drugs, including local anesthetics and analgesics.
PTS: 1 REF: p. 6
4. Which of the following symptoms and signs is most consistent with allergy?
A. heart palpitations
B. itching
C. vomiting
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.
PTS: 1 REF: p. 6
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
Copyright © 2013 by Mosby, an imprint of Elsevier Inc.
, Test Bank 1-3
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.
PTS: 1 REF: p. 6-7
6. Vasoconstrictors should be avoided in patients who are using cocaine or
methamphetamine because these agents may precipitate .
A. severe hypotension
B. severe hypertension
C. respiratory depression
D. cessation of intestinal peristalsis
ANS: B
Vasoconstrictors may precipitate cardiac arrhythmias or severe hypertension in patients
who are using cocaine or methamphetamine. Respiratory depression is associated with
the use of opioids.
PTS: 1 REF: p. 8
7. It has been shown that the risk for occurrence of a serious perioperative cardiovascular
event 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
Risk is increased in patients unable to meet a 4-MET demand. 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.
PTS: 1 REF: p. 9
8. Which of the following alterations in the fingernails is associated with cirrhosis?
A. yellowing
B. clubbing
Copyright © 2013 by Mosby, an imprint of Elsevier Inc.
, Test Bank 1-4
C. white discoloration
D. splinter hemorrhages
ANS: C
White discoloration is seen in cirrhosis. Yellowing is from malignancy, clubbing is seen
in cardiopulmonary insufficiency, and splinter hemorrhages are associated with infective
endocarditis.
PTS: 1 REF: p. 9
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
The cuff is placed snugly on the upper arm, with the lower border appearing
approximately an inch above the antecubital fossa. While the radial pulse is palpated, the
cuff is inflated until the radial pulse disappears; it is then inflated an additional 20 to 30
mm Hg.
PTS: 1 REF: p. 13
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
An ASA III patient is a person with significant or severe systemic disease that limits daily
activity (e.g., hemodialysis, class 2 heart failure). This disease has a significant impact on
daily activity and a probable impact on anesthesia and surgery.
PTS: 1 REF: p. 16
Copyright © 2013 by Mosby, an imprint of Elsevier Inc.
Edition
Chapter 01: Patient Evaluation and Risk Assessment
Test Bank
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 of greater than or equal to 180/110 mm Hg, until
the condition can be brought under control.
PTS: 1 REF: p. 4
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; current
guidelines omit this recommendation on the basis of accumulated scientific evidence. If a
murmur is due to 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. Patients with pacemakers do not
require antibiotic prophylaxis.
Copyright © 2013 by Mosby, an imprint of Elsevier Inc.
, Test Bank 1-2
PTS: 1 REF: pp. 4-5
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 with chronic hepatitis (B or C) or cirrhosis have an associated impairment of
liver function. This deficit may result in prolonged bleeding and less efficient metabolism
of certain drugs, including local anesthetics and analgesics.
PTS: 1 REF: p. 6
4. Which of the following symptoms and signs is most consistent with allergy?
A. heart palpitations
B. itching
C. vomiting
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.
PTS: 1 REF: p. 6
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
Copyright © 2013 by Mosby, an imprint of Elsevier Inc.
, Test Bank 1-3
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.
PTS: 1 REF: p. 6-7
6. Vasoconstrictors should be avoided in patients who are using cocaine or
methamphetamine because these agents may precipitate .
A. severe hypotension
B. severe hypertension
C. respiratory depression
D. cessation of intestinal peristalsis
ANS: B
Vasoconstrictors may precipitate cardiac arrhythmias or severe hypertension in patients
who are using cocaine or methamphetamine. Respiratory depression is associated with
the use of opioids.
PTS: 1 REF: p. 8
7. It has been shown that the risk for occurrence of a serious perioperative cardiovascular
event 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
Risk is increased in patients unable to meet a 4-MET demand. 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.
PTS: 1 REF: p. 9
8. Which of the following alterations in the fingernails is associated with cirrhosis?
A. yellowing
B. clubbing
Copyright © 2013 by Mosby, an imprint of Elsevier Inc.
, Test Bank 1-4
C. white discoloration
D. splinter hemorrhages
ANS: C
White discoloration is seen in cirrhosis. Yellowing is from malignancy, clubbing is seen
in cardiopulmonary insufficiency, and splinter hemorrhages are associated with infective
endocarditis.
PTS: 1 REF: p. 9
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
The cuff is placed snugly on the upper arm, with the lower border appearing
approximately an inch above the antecubital fossa. While the radial pulse is palpated, the
cuff is inflated until the radial pulse disappears; it is then inflated an additional 20 to 30
mm Hg.
PTS: 1 REF: p. 13
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
An ASA III patient is a person with significant or severe systemic disease that limits daily
activity (e.g., hemodialysis, class 2 heart failure). This disease has a significant impact on
daily activity and a probable impact on anesthesia and surgery.
PTS: 1 REF: p. 16
Copyright © 2013 by Mosby, an imprint of Elsevier Inc.
