,DOWNLOAD THE Test Bank for Dental Management of the MedicallyCompr
z z z z z z z z z z
omised Patient 9th Edition Little
z z z z
Chapter 02: Infective Endocarditis
z z z
Little: Dental Management of the Medically Compromised Patient, 9th Edition
z z z z z z z z z
MULTIPLEzCHOICE
1. Whichzofzthezfollowingzisztruezconcerningzinfectivezendocarditisz(IE)?
a. IEziszalwayszdueztozazbacterialzinfection.
b. Sincezthezadventzofzantibiotics,zmorbidityzandzmortalityzassociatedzwithzIEzhavezb
eenzvirtuallyzeliminated.
c. IEziszcurrentlyzclassifiedzaszacutezorzsubacute,ztozreflectzthezrapidityzofzonsetzandzd
uration.
d. Accumulatingzevidencezquestionszthezvalidityzofzantibioticzprophylaxiszinzanza
ttemptztozpreventzIEzpriorztozcertainzinvasivezdentalzprocedures.
ANS:z D
Antibioticszhavezbeenzadministeredzbeforezcertainzinvasivezdentalzprocedureszinzanzattemptztozpr
eventzinfection.zOfznote,zhowever,zthezeffectivenesszofzsuchzprophylaxiszinzhumanszhaszneverzb
eenzsubstantiated,zandzaccumulatingzevidencezmorezandzmorezquestionszthezvalidityzofzthiszpract
ice.
2. Whichzofzthezfollowingziszcurrentlyzthezmostzcommonzunderlyingzconditionzpredisposingztozin
fectivezendocarditisz(IE)?
a. Aorticzvalvezdisease
b. Rheumaticzheartzdiseasez(RHD)
c. Mitralzvalvezprolapsez(MVP)
d. TetralogyzofzFallot
ANS:z C
Mitralzvalvezprolapse,zwhichzaccountszforz25%ztoz30%zofzadultzcaseszofznativezvalvezendoca
rditisz(NVE),zisznowzthezmostzcommonzunderlyingzconditionzamongzpatientszwhozacquirezI
E.zPreviously,zrheumaticzheartzdiseasez(RHD)zwaszthezmostzcommonzconditionzpredisposin
gztozendocarditis.zInzdevelopedzcountries,zhowever,zthezfrequencyzofzRHDzhaszmarkedlyzdec
linedzoverzthezpastzseveralzdecades.
3. Thezleadingzcausezofzdeathzdueztozinfectivezendocarditisz(IE)zis .
a. chroniczobstructivezpulmonaryzdisease
b. heartzfailure
c. pulmonaryzemboli
d. atheromas
ANS:z B
ThezmostzcommonzcomplicationzofzIE,zandzthezleadingzcausezofzdeath,ziszheartzfailure,zwhichzres
ultszfromzseverezvalvularzdysfunction.zThiszpathologiczprocesszmostzcommonlyzbeginszaszazprob
lemzwithzaorticzvalvezinvolvement,zfollowedzbyzmitralzandzthenztricuspidzvalvezinfection.zEmbol
izationzofzvegetationzfragmentszoftenzleadsztozfurtherzcomplications,zsuchzaszstroke.
Myocardialzinfarctionzcanzoccurzaszthezresultzofzembolismzofzthezcoronaryzarteries,zandzdistalze
mbolizcanzproducezperipheralzmetastaticzabscesses.
mynursytest.store
,DOWNLOAD THE Test Bank for Dental Management of the MedicallyCompr
z z z z z z z z z z
omised Patient 9th Edition Little
z z z z
4. Thezintervalzbetweenzthezpresumedzinitiatingzbacteremiazandzthezonsetzofzsymptomszofzinf
ectivezendocarditisz(IE)ziszestimatedztozbezlesszthan
inzmorezthanz80%zofzpatientszwithzIE.
a. 1zweek
b. 2zweeks
c. 1zmonth
d. 2zmonths
ANS:z B
Itziszlesszthanztwozweekszinzmorezthanz80%zofzpatientszwithzIE.zInzmanyzcaseszofzIEzthatzhavezbee
nzpurportedztozbezdueztozdentallyzinducedzbacteremia,zthezintervalzbetweenzthezdentalzappointme
ntzandzthezdiagnosiszofzIEzhaszbeenzmuchzlongerzthanz2zweeksz(sometimeszmonths),zsozitziszveryzu
nlikelyzthatzthezinitiatingzbacteremiazwaszassociatedzwithzdentalztreatment.
5. WherezarezJanewayzlesionszlocated?
a. Tricuspidzvalve
b. Palmszofzthezhandszandzsoleszofzthezfeet
c. Pulpzofzthezdigits
d. Nailzbeds
ANS:z B
Janewayzlesionszarezsmall,znontenderzerythematouszorzhemorrhagiczmacularzlesionszonzthezpal
mszandzsoles.zJanewayzlesionszarezonezofzthezperipheralzmanifestationszofzIEzdueztozembolizand/o
rzimmunologiczresponses.
6. Whichzofzthezfollowingzisztruezofzthezmagnitudezofzbacteremiazrequiredztozcausezinfectivezen
docarditisz(IE)?
a. Thezmagnitudezofzbacteremiaszresultingzfromzdentalzproceduresziszmorezlikelyztozc
ausezIEzthanzthatzseenzwithzbacteremiaszresultingzfromznormalzdailyzactivities.
b. CaseszofzIEzcausedzbyzoralzbacteriazprobablyzresultzfromzfrequentzexposureztozlowzin
oculazofzbacteriazinzthezbloodstreamzdueztozdailyzactivitieszandznotzazdentalzprocedur
e.
c. Thezqualityzofzoralzhygienezhasznozappreciablezeffectzonzthezmagnitudezofzb
acteremiazafterztoothbrushing.
d. Thezmagnitudezofzbacteremiazresultingzfromzdentalzproceduresziszgreaterzthanzthatzn
eededztozcausezexperimentalzbacterialzendocarditisz(BE)zinzanimals.
ANS:z B
Anzassumptionzoftenzmadeziszthatzthezmagnitudezofzbacteremiaszresultingzfromzdentalzprocedur
esziszmorezlikelyztozcausezIEzthanzthatzseenzwithzbacteremiaszresultingzfromznormalzdailyzactiviti
es.zPublishedzdatazdoznotzsupportzthiszcontention.zFurthermore,zthezmagnitudezofzbacteremiazres
ultingzfromzdentalzproceduresziszrelativelyzlowz(withzbacterialzcountszofzfewerzthanz104zcolony-
formingzunits/mL),ziszsimilarztozthatzofzbacteremiazresultingzfromznormalzdailyzactivities,zandzisz
farzlesszthanzthatz(106ztoz108zcolony-
formingzunits/mL)zneededztozcausezexperimentalzBEzinzanimals.
7. Visiblezbleedingzduringzazdentalzprocedureziszazreliablezpredictorzofzbacteremia.zItzisznotzclearzw
hichzdentalzprocedureszarezmorezorzlesszlikelyztozcauseztransientzbacteremiazorztozresultzinzazgrea
terzmagnitudezofzbacteremiazthanzthatzcausedzbyzroutinezdailyzactivitieszsuchzaszchewingzfood,zt
oothzbrushing,zorzflossing.
a. Bothzstatementszareztrue.
mynursytest.store
, DOWNLOAD THE Test Bank for Dental Management of the MedicallyCompr
z z z z z z z z z z
omised Patient 9th Edition Little
z z z z
b. Bothzstatementszarezfalse.
c. Thezfirstzstatementzisztrue,zthezsecondzstatementziszfalse.
d. Thezfirstzstatementziszfalse,zthezsecondzstatementzisztrue.
ANS:z D
Itzhaszbeenzshownzthatzvisiblezbleedingzduringzazdentalzprocedurezisznotzazreliablezpredictorzofzba
cteremia.zCollectivezpublishedzdatazsuggestzthatzthezvastzmajorityzofzdentalzofficezvisitszresultzin
zsomezdegreezofzbacteremia,zandzthatzitzisznotzclearzwhichzdentalzprocedureszarezmorezorzlesszlikel
yztozcauseztransientzbacteremiazorztozresultzinzazgreaterzmagnitudezofzbacteremiazthanzthatzcause
dzbyzbacteremiazproducedzbyzroutinezdailyzactivitieszsuchzaszchewingzfood,ztoothzbrushing,zorzfl
ossing.
8. Whichzofzthezfollowingzisztruezregardingzthezefficacyzofzantibioticzprophylaxis?
a. Datazshowzthatzazreductionzinzthezincidence,znature,zandzdurationzofzbacteriazcausedzb
yzantibioticztherapyzreduceszthezriskzofzorzpreventszIE.
b. Antibioticszgivenztozat-
riskzpatientszbeforezazdentalzprocedurezwillzpreventzorzreducezazbacteremia.
c. Prospectivezrandomized,zplacebo-
controlledztrialszhavezbeenzconductedztozexaminezthezefficacyzofzantibioticzprophylax
iszforzpreventingzIEzinzpatientszwhozundergozazdentalzprocedure.
d. Investigatorszhavezconcludedzthatzdentalzorzotherzprocedureszprobablyzonlyzcausedzaz
smallzfractionzofzcaseszofzIE,zandzthatzprophylaxiszwouldzpreventzonlyzazsmallznumb
erzofzcases,zevenzifzitzwerez100%zeffective.
ANS:z D
ThiszconclusionzcamezaszthezresultzofzazstudyzfromzthezNetherlandszbyzvanzderzMeerzandzcolle
agueszthatzinvestigatedzthezefficacyzofzantibioticzprophylaxiszinzpreventingzIEzinzdentalzpatient
szwithznativezorzprostheticzcardiaczvalves.
9. ThezAmericanzHeartzAssociationzcurrentlyzrecommendszantibioticzprophylaxiszbeforezdentalztr
eatmentztozpreventzendocarditiszforzpatientszwithzwhichzofzthezfollowingzcardiaczconditions?
a. Mitralzvalvezprolapsezwithzregurgitation
b. Rheumaticzheartzdisease
c. Prostheticzcardiaczvalve
d. A,zB,zandzC
e. AzandzC
ANS:z C
Prophylaxiszwithzantibioticszbeforezazdentalzprocedureziszrecommendedzforzazprostheticzcardiacz
valve,zpreviouszinfectivezendocarditis,zandzsomezformszofzcongenitalzheartzdiseasez(seezBoxz2-2.)
10. Whichzofzthezfollowingzantibioticsziszthezbestzchoicezifzazpatientzwhozrequireszpremedicationzbe
forezdentalztreatmentziszalreadyztakingzpenicillinzforzeradicationzofzanzinfection?
a. Amoxicillin
b. Clindamycin
c. Cephalosporins
d. Keepzthezpatientzonzthezpenicillinzbecausezthezbloodzlevelzhaszalreadyzbeenza
chieved
ANS:z B
mynursytest.store
z z z z z z z z z z
omised Patient 9th Edition Little
z z z z
Chapter 02: Infective Endocarditis
z z z
Little: Dental Management of the Medically Compromised Patient, 9th Edition
z z z z z z z z z
MULTIPLEzCHOICE
1. Whichzofzthezfollowingzisztruezconcerningzinfectivezendocarditisz(IE)?
a. IEziszalwayszdueztozazbacterialzinfection.
b. Sincezthezadventzofzantibiotics,zmorbidityzandzmortalityzassociatedzwithzIEzhavezb
eenzvirtuallyzeliminated.
c. IEziszcurrentlyzclassifiedzaszacutezorzsubacute,ztozreflectzthezrapidityzofzonsetzandzd
uration.
d. Accumulatingzevidencezquestionszthezvalidityzofzantibioticzprophylaxiszinzanza
ttemptztozpreventzIEzpriorztozcertainzinvasivezdentalzprocedures.
ANS:z D
Antibioticszhavezbeenzadministeredzbeforezcertainzinvasivezdentalzprocedureszinzanzattemptztozpr
eventzinfection.zOfznote,zhowever,zthezeffectivenesszofzsuchzprophylaxiszinzhumanszhaszneverzb
eenzsubstantiated,zandzaccumulatingzevidencezmorezandzmorezquestionszthezvalidityzofzthiszpract
ice.
2. Whichzofzthezfollowingziszcurrentlyzthezmostzcommonzunderlyingzconditionzpredisposingztozin
fectivezendocarditisz(IE)?
a. Aorticzvalvezdisease
b. Rheumaticzheartzdiseasez(RHD)
c. Mitralzvalvezprolapsez(MVP)
d. TetralogyzofzFallot
ANS:z C
Mitralzvalvezprolapse,zwhichzaccountszforz25%ztoz30%zofzadultzcaseszofznativezvalvezendoca
rditisz(NVE),zisznowzthezmostzcommonzunderlyingzconditionzamongzpatientszwhozacquirezI
E.zPreviously,zrheumaticzheartzdiseasez(RHD)zwaszthezmostzcommonzconditionzpredisposin
gztozendocarditis.zInzdevelopedzcountries,zhowever,zthezfrequencyzofzRHDzhaszmarkedlyzdec
linedzoverzthezpastzseveralzdecades.
3. Thezleadingzcausezofzdeathzdueztozinfectivezendocarditisz(IE)zis .
a. chroniczobstructivezpulmonaryzdisease
b. heartzfailure
c. pulmonaryzemboli
d. atheromas
ANS:z B
ThezmostzcommonzcomplicationzofzIE,zandzthezleadingzcausezofzdeath,ziszheartzfailure,zwhichzres
ultszfromzseverezvalvularzdysfunction.zThiszpathologiczprocesszmostzcommonlyzbeginszaszazprob
lemzwithzaorticzvalvezinvolvement,zfollowedzbyzmitralzandzthenztricuspidzvalvezinfection.zEmbol
izationzofzvegetationzfragmentszoftenzleadsztozfurtherzcomplications,zsuchzaszstroke.
Myocardialzinfarctionzcanzoccurzaszthezresultzofzembolismzofzthezcoronaryzarteries,zandzdistalze
mbolizcanzproducezperipheralzmetastaticzabscesses.
mynursytest.store
,DOWNLOAD THE Test Bank for Dental Management of the MedicallyCompr
z z z z z z z z z z
omised Patient 9th Edition Little
z z z z
4. Thezintervalzbetweenzthezpresumedzinitiatingzbacteremiazandzthezonsetzofzsymptomszofzinf
ectivezendocarditisz(IE)ziszestimatedztozbezlesszthan
inzmorezthanz80%zofzpatientszwithzIE.
a. 1zweek
b. 2zweeks
c. 1zmonth
d. 2zmonths
ANS:z B
Itziszlesszthanztwozweekszinzmorezthanz80%zofzpatientszwithzIE.zInzmanyzcaseszofzIEzthatzhavezbee
nzpurportedztozbezdueztozdentallyzinducedzbacteremia,zthezintervalzbetweenzthezdentalzappointme
ntzandzthezdiagnosiszofzIEzhaszbeenzmuchzlongerzthanz2zweeksz(sometimeszmonths),zsozitziszveryzu
nlikelyzthatzthezinitiatingzbacteremiazwaszassociatedzwithzdentalztreatment.
5. WherezarezJanewayzlesionszlocated?
a. Tricuspidzvalve
b. Palmszofzthezhandszandzsoleszofzthezfeet
c. Pulpzofzthezdigits
d. Nailzbeds
ANS:z B
Janewayzlesionszarezsmall,znontenderzerythematouszorzhemorrhagiczmacularzlesionszonzthezpal
mszandzsoles.zJanewayzlesionszarezonezofzthezperipheralzmanifestationszofzIEzdueztozembolizand/o
rzimmunologiczresponses.
6. Whichzofzthezfollowingzisztruezofzthezmagnitudezofzbacteremiazrequiredztozcausezinfectivezen
docarditisz(IE)?
a. Thezmagnitudezofzbacteremiaszresultingzfromzdentalzproceduresziszmorezlikelyztozc
ausezIEzthanzthatzseenzwithzbacteremiaszresultingzfromznormalzdailyzactivities.
b. CaseszofzIEzcausedzbyzoralzbacteriazprobablyzresultzfromzfrequentzexposureztozlowzin
oculazofzbacteriazinzthezbloodstreamzdueztozdailyzactivitieszandznotzazdentalzprocedur
e.
c. Thezqualityzofzoralzhygienezhasznozappreciablezeffectzonzthezmagnitudezofzb
acteremiazafterztoothbrushing.
d. Thezmagnitudezofzbacteremiazresultingzfromzdentalzproceduresziszgreaterzthanzthatzn
eededztozcausezexperimentalzbacterialzendocarditisz(BE)zinzanimals.
ANS:z B
Anzassumptionzoftenzmadeziszthatzthezmagnitudezofzbacteremiaszresultingzfromzdentalzprocedur
esziszmorezlikelyztozcausezIEzthanzthatzseenzwithzbacteremiaszresultingzfromznormalzdailyzactiviti
es.zPublishedzdatazdoznotzsupportzthiszcontention.zFurthermore,zthezmagnitudezofzbacteremiazres
ultingzfromzdentalzproceduresziszrelativelyzlowz(withzbacterialzcountszofzfewerzthanz104zcolony-
formingzunits/mL),ziszsimilarztozthatzofzbacteremiazresultingzfromznormalzdailyzactivities,zandzisz
farzlesszthanzthatz(106ztoz108zcolony-
formingzunits/mL)zneededztozcausezexperimentalzBEzinzanimals.
7. Visiblezbleedingzduringzazdentalzprocedureziszazreliablezpredictorzofzbacteremia.zItzisznotzclearzw
hichzdentalzprocedureszarezmorezorzlesszlikelyztozcauseztransientzbacteremiazorztozresultzinzazgrea
terzmagnitudezofzbacteremiazthanzthatzcausedzbyzroutinezdailyzactivitieszsuchzaszchewingzfood,zt
oothzbrushing,zorzflossing.
a. Bothzstatementszareztrue.
mynursytest.store
, DOWNLOAD THE Test Bank for Dental Management of the MedicallyCompr
z z z z z z z z z z
omised Patient 9th Edition Little
z z z z
b. Bothzstatementszarezfalse.
c. Thezfirstzstatementzisztrue,zthezsecondzstatementziszfalse.
d. Thezfirstzstatementziszfalse,zthezsecondzstatementzisztrue.
ANS:z D
Itzhaszbeenzshownzthatzvisiblezbleedingzduringzazdentalzprocedurezisznotzazreliablezpredictorzofzba
cteremia.zCollectivezpublishedzdatazsuggestzthatzthezvastzmajorityzofzdentalzofficezvisitszresultzin
zsomezdegreezofzbacteremia,zandzthatzitzisznotzclearzwhichzdentalzprocedureszarezmorezorzlesszlikel
yztozcauseztransientzbacteremiazorztozresultzinzazgreaterzmagnitudezofzbacteremiazthanzthatzcause
dzbyzbacteremiazproducedzbyzroutinezdailyzactivitieszsuchzaszchewingzfood,ztoothzbrushing,zorzfl
ossing.
8. Whichzofzthezfollowingzisztruezregardingzthezefficacyzofzantibioticzprophylaxis?
a. Datazshowzthatzazreductionzinzthezincidence,znature,zandzdurationzofzbacteriazcausedzb
yzantibioticztherapyzreduceszthezriskzofzorzpreventszIE.
b. Antibioticszgivenztozat-
riskzpatientszbeforezazdentalzprocedurezwillzpreventzorzreducezazbacteremia.
c. Prospectivezrandomized,zplacebo-
controlledztrialszhavezbeenzconductedztozexaminezthezefficacyzofzantibioticzprophylax
iszforzpreventingzIEzinzpatientszwhozundergozazdentalzprocedure.
d. Investigatorszhavezconcludedzthatzdentalzorzotherzprocedureszprobablyzonlyzcausedzaz
smallzfractionzofzcaseszofzIE,zandzthatzprophylaxiszwouldzpreventzonlyzazsmallznumb
erzofzcases,zevenzifzitzwerez100%zeffective.
ANS:z D
ThiszconclusionzcamezaszthezresultzofzazstudyzfromzthezNetherlandszbyzvanzderzMeerzandzcolle
agueszthatzinvestigatedzthezefficacyzofzantibioticzprophylaxiszinzpreventingzIEzinzdentalzpatient
szwithznativezorzprostheticzcardiaczvalves.
9. ThezAmericanzHeartzAssociationzcurrentlyzrecommendszantibioticzprophylaxiszbeforezdentalztr
eatmentztozpreventzendocarditiszforzpatientszwithzwhichzofzthezfollowingzcardiaczconditions?
a. Mitralzvalvezprolapsezwithzregurgitation
b. Rheumaticzheartzdisease
c. Prostheticzcardiaczvalve
d. A,zB,zandzC
e. AzandzC
ANS:z C
Prophylaxiszwithzantibioticszbeforezazdentalzprocedureziszrecommendedzforzazprostheticzcardiacz
valve,zpreviouszinfectivezendocarditis,zandzsomezformszofzcongenitalzheartzdiseasez(seezBoxz2-2.)
10. Whichzofzthezfollowingzantibioticsziszthezbestzchoicezifzazpatientzwhozrequireszpremedicationzbe
forezdentalztreatmentziszalreadyztakingzpenicillinzforzeradicationzofzanzinfection?
a. Amoxicillin
b. Clindamycin
c. Cephalosporins
d. Keepzthezpatientzonzthezpenicillinzbecausezthezbloodzlevelzhaszalreadyzbeenza
chieved
ANS:z B
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