.
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Chapter 01: Patient Evaluation and Risk Assessment
f f f f f f
Little: Dental Management of the Medically Compromised Patient, 10th Edition
f f f f f f f f f
MULTIPLE CHOICE f
1. Elective dental care should be deferred for patients with severe, uncontrolled hypertension,
f f f f f f f f f f f
meaning that the blood pressure is greater than or equal to
f f f f f f f f f f f mm Hg. f
a. 200/140
b. 180/140
c. 180/110
d. 160/110
ANS: C f
Elective dental care should be deferred for patients with severe, uncontrolled hypertension,
f f f f f f f f f f f
which is blood pressure greater than or equal to 180/110 mm Hg, until the condition can be
f f f f f f f f f f f f f f f f f
brought under control.
f f f
2. The American Heart Association currently recommends antibiotic prophylaxis for a patient
f f f f f f f f f f
with which of the following cardiac conditions?
f f f f f f f
a. Mitral valve prolapse f f
b. Prosthetic heart valve f f
c. Rheumatic heart disease f f
d. Pacemakers for cardiac arrhythmias f f f
ANS: B f
Previously, the American Heart Association (AHA) recommended antibiotic prophylaxis for
f f f f f f f f f
many patients with heart murmurs caused by valvular disease (e.g., mitral valve prolapse,
f f f f f f f f f f f f f
rheumatic heart disease) in an effort to prevent infective endocarditis; however, current
f f f f f f f f f f f f
guidelines omit this recommendation on the basis of accumulated scientific evidence. If a
f f f f f f f f f f f f f
murmur is due to certain specific cardiac conditions (e.g., previous endocarditis, prosthetic
f f f f f f f f f f f f
heart valve, complex congenital cyanotic heart disease), the AHA continues to recommend
f f f f f f f f f f f f
antibiotic prophylaxis for most dental procedures.
f f f f f f
3. One consequence of chronic hepatitis (B or C) or cirrhosis of the liver is decreased ability of
f f f f f f f f f f f f f f f f
the body to
f f f certain drugs, including local anesthetics and analgesics.
f f f f f f
a. absorb
b. distribute
c. metabolize
d. excrete
ANS: C f
Patients also may have chronic hepatitis (B or C) or cirrhosis, with impairment of liver
f f f f f f f f f f f f f f
function. This deficit may result in prolonged bleeding and less efficient metabolism of
f f f f f f f f f f f f f
certain drugs, including local anesthetics and analgesics.
f f f f f f f
4. Which of the following symptoms and signs is most consistent with allergy?
f f f f f f f f f f f
a. Heart palpitations f
b. Itching
c. Vomiting
d. Fainting
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ANS: B f
Symptoms and signs consistent with allergy include itching, urticaria (hives), rash, swelling,
f f f f f f f f f f f
wheezing, angioedema, runny nose, and tearing eyes. Isolated signs and symptoms such as
f f f f f f f f f f f f f
nausea, vomiting, heart palpitations, and fainting generally are not of an allergic origin but
f f f f f f f f f f f f f f
rather are manifestations of drug intolerance, adverse side effects, or psychogenic reactions.
f f f f f f f f f f f f
5. Which of the following is true of the patient with a history of tuberculosis?
f f f f f f f f f f f f f
a. A positive result on skin testing means that the person has active TB.
f f f f f f f f f f f f
b. Most patients who become positive skin testers develop active disease.
f f f f f f f f f
c. Patients with acquired immunodeficiency syndrome (AIDS) have a high incidence
f f f f f f f f f
f of tuberculosis.
f
d. A diagnosis of active TB is made by a purified protein derivative (PPD) skin test.
f f f f f f f f f f f f f f
ANS: C f
The potential coexistence of tuberculosis and acquired immunodeficiency syndrome (AIDS)
f f f f f f f f f
should be explored because patients with AIDS have a high incidence of tuberculosis. A
f f f f f f f f f f f f f f
positive result on skin testing means specifically that the person has at some time been
f f f f f f f f f f f f f f f
infected with TB, not necessarily that active disease is present. Most patients who become
f f f f f f f f f f f f f f
positive skin testers do not develop active disease. A diagnosis of active TB is made by chest x-
f f f f f f f f f f f f f f f f f f
ray, imaging, sputum culture, and clinical examination.
f f f f f f
6. Vasoconstrictors should be avoided in patients who cocaine or methamphetamine users f f f f f f f f f f
because these agents may precipitate
f f f f f .
a. severe hypotension f
b. severe hypertension f
c. respiratory depression f
d. cessation of intestinal peristalsis f f f
ANS: B f
Vasoconstrictors should be avoided in patients who are cocaine or methamphetamine users because f f f f f f f f f f f f
the combination may precipitate arrhythmias, MI, or severe hypertension.
f f f f f f f f f
7. It has been shown that the risk for occurrence of a serious perioperative cardiovascular event
f f f f f f f f f f f f f f
(e.g., MI, heart failure) is increased in patients who are unable to meet a -MET (metabolic
f f f f f f f f f f f f f f f f
equivalent of task) demand during normal daily activity.
f f f f f f f f
a. 4
b. 6
c. 8
d. 10
ANS: A f
Daily activities requiring 4 METs include level walking at 4 miles/hour or climbing a flight of
f f f f f f f f f f f f f f f
stairs. Activities requiring greater than 10 METs include swimming and singles tennis. An
f f f f f f f f f f f f f
exercise capacity of 10 to 13 METs indicates excellent physical conditioning.
f f f f f f f f f f f
8. Which of the following alterations in the fingernails is associated with cirrhosis?
f f f f f f f f f f f
a. Yellowing
b. Clubbing
c. White discoloration f
d. Splinter hemorrhages f
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ANS: C f
Alterations in the fingernails, such as clubbing (seen in cardiopulmonary insufficiency), white
f f f f f f f f f f f
discoloration (seen in cirrhosis), yellowing (from malignancy), and splinter hemorrhages (from
f f f f f f f f f f f
infective endocarditis) usually are caused by chronic disorders.
f f f f f f f f
9. A blood pressure cuff should be placed on the upper arm and inflated until
f f f f f f f f f f f f f .
a. the radial pulse disappears
f f f
b. the radial pulse disappears and then inflated an additional 20 to 30 mm Hg
f f f f f f f f f f f f f
c. two fingers cannot fit comfortably under the cuff
f f f f f f f
d. the pulse no longer can be heard with the stethoscope
f f f f f f f f f
ANS: B f
While the radial pulse is palpated, the cuff is inflated until the radial pulse disappears (approximate
f f f f f f f f f f f f f f f
systolic pressure); it is then inflated an additional 20 to 30 mm Hg.
f f f f f f f f f f f f f
10. Which of the following is true of a patient classified ASA III according to the American
f f f f f f f f f f f f f f f
fSociety of Anesthesiologists (ASA) Physical Status Classification System?
f f f f f f f
a. Patient has mild systemic disease. f f f f
b. Patient’s disease has significant impact on daily activity.
f f f f f f f
c. Patient’s disease is unlikely to have impact on anesthesia and surgery.
f f f f f f f f f f
d. Patient is moribund. f f
ANS: B f
Patient with severe systemic disease is a constant threat to life (e.g., recent myocardial
f f f f f f f f f f f f f
infarction, stroke, transient ischemic attach [<3 months], ongoing cardiac ischemia, severe
f f f f f f f f f f f
valve dysfunction, respiratory failure requiring mechanical ventilation). Serious limitation of
f f f f f f f f f f
daily activity; likely major impact on anesthesia and surgery.
f f f f f f f f f
, WWW.GRADESMORE.COM
Stuvia.com f- fThe fMarketplace fto fBuy fand fSell fyour fStudy fMaterial
Chapter 01: Patient Evaluation and Risk Assessment
f f f f f f
Little: Dental Management of the Medically Compromised Patient, 10th Edition
f f f f f f f f f
MULTIPLE CHOICE f
1. Elective dental care should be deferred for patients with severe, uncontrolled hypertension,
f f f f f f f f f f f
meaning that the blood pressure is greater than or equal to
f f f f f f f f f f f mm Hg. f
a. 200/140
b. 180/140
c. 180/110
d. 160/110
ANS: C f
Elective dental care should be deferred for patients with severe, uncontrolled hypertension,
f f f f f f f f f f f
which is blood pressure greater than or equal to 180/110 mm Hg, until the condition can be
f f f f f f f f f f f f f f f f f
brought under control.
f f f
2. The American Heart Association currently recommends antibiotic prophylaxis for a patient
f f f f f f f f f f
with which of the following cardiac conditions?
f f f f f f f
a. Mitral valve prolapse f f
b. Prosthetic heart valve f f
c. Rheumatic heart disease f f
d. Pacemakers for cardiac arrhythmias f f f
ANS: B f
Previously, the American Heart Association (AHA) recommended antibiotic prophylaxis for
f f f f f f f f f
many patients with heart murmurs caused by valvular disease (e.g., mitral valve prolapse,
f f f f f f f f f f f f f
rheumatic heart disease) in an effort to prevent infective endocarditis; however, current
f f f f f f f f f f f f
guidelines omit this recommendation on the basis of accumulated scientific evidence. If a
f f f f f f f f f f f f f
murmur is due to certain specific cardiac conditions (e.g., previous endocarditis, prosthetic
f f f f f f f f f f f f
heart valve, complex congenital cyanotic heart disease), the AHA continues to recommend
f f f f f f f f f f f f
antibiotic prophylaxis for most dental procedures.
f f f f f f
3. One consequence of chronic hepatitis (B or C) or cirrhosis of the liver is decreased ability of
f f f f f f f f f f f f f f f f
the body to
f f f certain drugs, including local anesthetics and analgesics.
f f f f f f
a. absorb
b. distribute
c. metabolize
d. excrete
ANS: C f
Patients also may have chronic hepatitis (B or C) or cirrhosis, with impairment of liver
f f f f f f f f f f f f f f
function. This deficit may result in prolonged bleeding and less efficient metabolism of
f f f f f f f f f f f f f
certain drugs, including local anesthetics and analgesics.
f f f f f f f
4. Which of the following symptoms and signs is most consistent with allergy?
f f f f f f f f f f f
a. Heart palpitations f
b. Itching
c. Vomiting
d. Fainting
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ANS: B f
Symptoms and signs consistent with allergy include itching, urticaria (hives), rash, swelling,
f f f f f f f f f f f
wheezing, angioedema, runny nose, and tearing eyes. Isolated signs and symptoms such as
f f f f f f f f f f f f f
nausea, vomiting, heart palpitations, and fainting generally are not of an allergic origin but
f f f f f f f f f f f f f f
rather are manifestations of drug intolerance, adverse side effects, or psychogenic reactions.
f f f f f f f f f f f f
5. Which of the following is true of the patient with a history of tuberculosis?
f f f f f f f f f f f f f
a. A positive result on skin testing means that the person has active TB.
f f f f f f f f f f f f
b. Most patients who become positive skin testers develop active disease.
f f f f f f f f f
c. Patients with acquired immunodeficiency syndrome (AIDS) have a high incidence
f f f f f f f f f
f of tuberculosis.
f
d. A diagnosis of active TB is made by a purified protein derivative (PPD) skin test.
f f f f f f f f f f f f f f
ANS: C f
The potential coexistence of tuberculosis and acquired immunodeficiency syndrome (AIDS)
f f f f f f f f f
should be explored because patients with AIDS have a high incidence of tuberculosis. A
f f f f f f f f f f f f f f
positive result on skin testing means specifically that the person has at some time been
f f f f f f f f f f f f f f f
infected with TB, not necessarily that active disease is present. Most patients who become
f f f f f f f f f f f f f f
positive skin testers do not develop active disease. A diagnosis of active TB is made by chest x-
f f f f f f f f f f f f f f f f f f
ray, imaging, sputum culture, and clinical examination.
f f f f f f
6. Vasoconstrictors should be avoided in patients who cocaine or methamphetamine users f f f f f f f f f f
because these agents may precipitate
f f f f f .
a. severe hypotension f
b. severe hypertension f
c. respiratory depression f
d. cessation of intestinal peristalsis f f f
ANS: B f
Vasoconstrictors should be avoided in patients who are cocaine or methamphetamine users because f f f f f f f f f f f f
the combination may precipitate arrhythmias, MI, or severe hypertension.
f f f f f f f f f
7. It has been shown that the risk for occurrence of a serious perioperative cardiovascular event
f f f f f f f f f f f f f f
(e.g., MI, heart failure) is increased in patients who are unable to meet a -MET (metabolic
f f f f f f f f f f f f f f f f
equivalent of task) demand during normal daily activity.
f f f f f f f f
a. 4
b. 6
c. 8
d. 10
ANS: A f
Daily activities requiring 4 METs include level walking at 4 miles/hour or climbing a flight of
f f f f f f f f f f f f f f f
stairs. Activities requiring greater than 10 METs include swimming and singles tennis. An
f f f f f f f f f f f f f
exercise capacity of 10 to 13 METs indicates excellent physical conditioning.
f f f f f f f f f f f
8. Which of the following alterations in the fingernails is associated with cirrhosis?
f f f f f f f f f f f
a. Yellowing
b. Clubbing
c. White discoloration f
d. Splinter hemorrhages f
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ANS: C f
Alterations in the fingernails, such as clubbing (seen in cardiopulmonary insufficiency), white
f f f f f f f f f f f
discoloration (seen in cirrhosis), yellowing (from malignancy), and splinter hemorrhages (from
f f f f f f f f f f f
infective endocarditis) usually are caused by chronic disorders.
f f f f f f f f
9. A blood pressure cuff should be placed on the upper arm and inflated until
f f f f f f f f f f f f f .
a. the radial pulse disappears
f f f
b. the radial pulse disappears and then inflated an additional 20 to 30 mm Hg
f f f f f f f f f f f f f
c. two fingers cannot fit comfortably under the cuff
f f f f f f f
d. the pulse no longer can be heard with the stethoscope
f f f f f f f f f
ANS: B f
While the radial pulse is palpated, the cuff is inflated until the radial pulse disappears (approximate
f f f f f f f f f f f f f f f
systolic pressure); it is then inflated an additional 20 to 30 mm Hg.
f f f f f f f f f f f f f
10. Which of the following is true of a patient classified ASA III according to the American
f f f f f f f f f f f f f f f
fSociety of Anesthesiologists (ASA) Physical Status Classification System?
f f f f f f f
a. Patient has mild systemic disease. f f f f
b. Patient’s disease has significant impact on daily activity.
f f f f f f f
c. Patient’s disease is unlikely to have impact on anesthesia and surgery.
f f f f f f f f f f
d. Patient is moribund. f f
ANS: B f
Patient with severe systemic disease is a constant threat to life (e.g., recent myocardial
f f f f f f f f f f f f f
infarction, stroke, transient ischemic attach [<3 months], ongoing cardiac ischemia, severe
f f f f f f f f f f f
valve dysfunction, respiratory failure requiring mechanical ventilation). Serious limitation of
f f f f f f f f f f
daily activity; likely major impact on anesthesia and surgery.
f f f f f f f f f
