Uploaded by Roy Johnson

TEST BANK for Little and Falace's Dental Management of the Medically Compromised Patient 9th Edition by James W. Little, Craig Miller, Nelson L. Rhodus Chap

advertisement
TO GET THE FULL TEST BANK OR SOLUTION MANUAL
100% Guarantee Pass email me at mitchiekaranja13@gmail.com
TEST BANK
LITTLE AND FALACE'S DENTAL
MANAGEMENT OF THE MEDICALLY
COMPROMISED PATIENT
9TH EDITION
TO GET THE FULL TEST BANK OR SOLUTION MANUAL
100% Guarantee Pass email me at mitchiekaranja13@gmail.com
TEST BANK
TO GET THE FULL TEST BANK OR SOLUTION MANUAL
100% Guarantee Pass email me at
mitchiekaranja13@gmail.com
Little: Dental Management of the Medically Compromised Patient, 9th Edition Test
Bank
Table of Contents
PART ONE: PATIENT EVALUATION AND RISK ASSESSMENT
Chapter 1: Patient Evaluation and Risk Assessment
PART TWO: CARDIOVASCULAR DISEASE
Chapter 2: Infective Endocarditis
Chapter 3: Hypertension
Chapter 4: Ischemic Heart Disease
Chapter 5: Cardiac Arrhythmias
Chapter 6: Heart Failure (or Congestive Heart Failure)
PART THREE: PULMONARY DISEASE
Chapter 7: Pulmonary Disease
Chapter 8: Smoking and Tobacco Use
Cessation Chapter 9: Sleep-Related Breathing
Disorders PART FOUR: GASTROINTESTIAL
DISEASE
Chapter 10: Liver Disease
Chapter 11: Gastrointestinal Disease
PART FIVE: GENITOURINARY DISEASE
Chapter 12: Chronic Kidney Disease and
Dialysis Chapter 13: Sexually Transmitted
Diseases
PART SIX: ENDOCRINE AND METABOLIC DISEASE
Chapter 14: Diabetes Mellitus
Chapter 15: Adrenal Insufficiency
Chapter 16: Thyroid Diseases
Chapter 17: Pregnancy and Breast Feeding
PART SEVEN: IMMUNOLOGIC DISEASE
Chapter 18: AIDS, HIV Infection, and Related Conditions
Chapter 19: Allergy
Chapter 20: Rheumatologic and Connective Tissue
Disorders Chapter 21: Organ and Bone Marrow
Transplantation
PART EIGHT: HEMATOLOGIC AND ONCOLOGIC DISEASE
Chapter 22: Disorders of Red Blood Cells
Chapter 23: Disorders of White Blood Cells
Chapter 24: Acquired Bleeding and Hypercoagulable
TO GET THE FULL TEST BANK OR SOLUTION MANUAL
100% Guarantee Pass email me at
mitchiekaranja13@gmail.com
Disorders Chapter 25: Congenital Bleeding and
Hypercoagulable Disorders Chapter 26: Cancer and Oral
Care of the Patient
PART NINE: NEUROLOGIC, BEHAVIORAL, AND PSYCHIATRIC DISORDERS
Chapter 27: Neurologic Disorders
Chapter 28: Anxiety, Eating Disorders, and Behavioral Reactions to Illness
Chapter 29: Psychiatric Disorders
Chapter 30: Drug and Alcohol Abuse
WWW.GRADESMORE.COM
Stuvia.com - The Marketplace to Buy and Sell your Study Material
Page 1 of 74
Chapter 01: Patient Evaluation and Risk Assessment
Little: Dental Management of the Medically Compromised Patient, 9th Edition
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. 200/14
0
b. 180/14
c. 0
180/11
d. 160/11
0
0
ANS: C
Elective dental care should be deferred for patients with severe, uncontrolled
hypertension, which is blood pressure greater than or equal to 180/110 mm Hg,
until the condition can be brought under control.
2. The American Heart Association currently recommends antibiotic prophylaxis for a
patient with which of the following cardiac conditions?
Mitral valve prolapse
Prosthetic heart valve
Rheumatic heart disease
Pacemakers for cardiac arrhythmias
a.
b.
c.
d.
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; however, current guidelines omit this recommendation on the basis of
accumulated scientific evidence. If a murmur is due to certain 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.
3. One consequence of chronic hepatitis (B or C) or cirrhosis of the liver is decreased
ability of the body to
a. absorb
b. distribute
c. metabolize
d. excrete
certain drugs, including local anesthetics and analgesics.
ANS: C
Patients also may have chronic hepatitis (B or C) or cirrhosis, with impairment
of liver function. This deficit may result in prolonged bleeding and less efficient
metabolism of certain drugs, including local anesthetics and analgesics.
WWW.NURSYLAB.COM
GRADESMORE.COM
4. Which of the following symptoms and signs is most consistent with allergy?
a. Heart palpitations
b. Itching
c. Vomiting
d. Fainting
WWW.GRADESMORE.COM
Stuvia.com - The Marketplace to Buy and Sell your Study Material
Page 1 of 74
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.
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
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.
6. Vasoconstrictors should be avoided in patients who cocaine or
methamphetamine users because these agents may precipitate
a. severe hypotension
b. severe hypertension
c. respiratory depression
d. cessation of intestinal peristalsis
.
ANS: B
Vasoconstrictors should be avoided in patients who are cocaine or
methamphetamine users because the combination may precipitate arrhythmias, MI,
or severe hypertension.
7. It has been shown that the risk for occurrence of a serious perioperative
cardiovascular event (e.g., MI, heart failure) 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
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. An exercise capacity of 10 to 13 METs indicates excellent physical
conditioning.
WWW.NURSYLAB.COM
GRADESMORE.COM
8. Which of the following alterations in the fingernails is associated with cirrhosis?
a. Yellowing
b. Clubbing
c. White discoloration
d. Splinter hemorrhages
WWW.GRADESMORE.COM
Stuvia.com - The Marketplace to Buy and Sell your Study Material
Page 1 of 74
ANS: C
Alterations in the fingernails, such as clubbing (seen in cardiopulmonary
insufficiency), white discoloration (seen in cirrhosis), yellowing (from malignancy),
and splinter hemorrhages (from infective endocarditis) usually are caused by chronic
disorders.
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
While the radial pulse is palpated, the cuff is inflated until the radial pulse
disappears (approximate systolic pressure); it is then inflated an additional 20 to
30 mm Hg.
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
Patient with severe systemic disease is a constant threat to life (e.g., recent
myocardial infarction, stroke, transient ischemic attach [<3 months], ongoing
cardiac ischemia, severe valve dysfunction, respiratory failure requiring mechanical
ventilation). Serious limitation of daily activity; likely major impact on anesthesia and
surgery.
WWW.NURSYLAB.COM
GRADESMORE.COM
WWW.GRADESMORE.COM
Stuvia.com - The Marketplace to Buy and Sell your Study Material
Page 1 of 74
Chapter 02: Infective Endocarditis
Little: Dental Management of the Medically Compromised Patient, 9th Edition
MULTIPLE CHOICE
1. Which of the following is true concerning infective endocarditis (IE)?
a. IE is always due to a bacterial infection.
b. Since the advent of antibiotics, morbidity and mortality associated with
IE have been virtually eliminated.
c. IE is currently classified as acute or subacute, to reflect the rapidity of
onset and duration.
d. Accumulating evidence questions the validity of antibiotic prophylaxis
in an attempt to prevent IE prior to certain invasive dental
procedures.
ANS: D
Antibiotics have been administered before certain invasive dental procedures in an
attempt to prevent infection. Of note, however, the effectiveness of such prophylaxis
in humans has never been substantiated, and accumulating evidence more and
more questions the validity of this practice.
2. Which of the following is currently the most common underlying condition
predisposing to infective endocarditis (IE)?
Aortic valve disease
Rheumatic heart disease (RHD)
Mitral valve prolapse (MVP)
Tetralogy of Fallot
a.
b.
c.
d.
ANS: C
Mitral valve prolapse, which accounts for 25% to 30% of adult cases of native valve
endocarditis (NVE), is now the most common underlying condition among patients
who acquire IE. Previously, rheumatic heart disease (RHD) was the most common
condition predisposing to endocarditis. In developed countries, however, the
frequency of RHD has markedly declined over the past several decades.
3. The leading cause of death due to infective endocarditis (IE) is
a. chronic obstructive pulmonary disease
b. heart failure
c. pulmonary emboli
d. atheromas
.
ANS: B
The most common complication of IE, and the leading cause of death, is heart failure,
which results from severe valvular dysfunction. This pathologic process most
commonly begins as a problem with aortic valve involvement, followed by mitral and
then tricuspid valve infection. Embolization of vegetation fragments often leads to
further complications, such as stroke.
WWW.NURSYLAB.COM
GRADESMORE.COM
Myocardial infarction can occur as the result of embolism of the coronary arteries,
and distal emboli can produce peripheral metastatic abscesses.
WWW.GRADESMORE.COM
Stuvia.com - The Marketplace to Buy and Sell your Study Material
Page 1 of 74
4. The interval between the presumed initiating bacteremia and the onset of
symptoms of infective endocarditis (IE) is estimated to be less than in more
than 80% of patients with IE.
a. 1 week
b. 2 weeks
c. 1 month
d. 2 months
ANS: B
It is less than two weeks in more than 80% of patients with IE. In many cases of IE that
have been purported to be due to dentally induced bacteremia, the interval between
the dental appointment and the diagnosis of IE has been much longer than 2 weeks
(sometimes months), so it is very unlikely that the initiating bacteremia was
associated with dental treatment.
5. Where are Janeway lesions located?
a. Tricuspid valve
b. Palms of the hands and soles of the feet
c. Pulp of the digits
d. Nail beds
ANS: B
Janeway lesions are small, nontender erythematous or hemorrhagic macular lesions
on the palms and soles. Janeway lesions are one of the peripheral manifestations of
IE due to emboli and/or immunologic responses.
6. Which of the following is true of the magnitude of bacteremia required to cause
infective endocarditis (IE)?
a. The magnitude of bacteremias resulting from dental procedures is more
likely to cause IE than that seen with bacteremias resulting from normal
daily activities.
b. Cases of IE caused by oral bacteria probably result from frequent exposure
to low inocula of bacteria in the bloodstream due to daily activities and
not a dental procedure.
c. The quality of oral hygiene has no appreciable effect on the
magnitude of bacteremia after toothbrushing.
d. The magnitude of bacteremia resulting from dental procedures is greater
than that needed to cause experimental bacterial endocarditis (BE) in
animals.
ANS: B
An assumption often made is that the magnitude of bacteremias resulting from
dental procedures is more likely to cause IE than that seen with bacteremias
resulting from normal daily activities. Published data do not support this contention.
Furthermore, the magnitude of bacteremia resulting from dental procedures is
relatively low (with bacterial counts of fewer than 104 colony-forming units/mL), is
similar to that of bacteremia resulting from normal daily activities, and is far less
than that (106 to 108 colony-forming units/mL) needed to cause experimental BE in
WWW.NURSYLAB.COM
GRADESMORE.COM
animals.
7. Visible bleeding during a dental procedure is a reliable predictor of bacteremia. It is
not clear which dental procedures are more or less likely to cause transient
bacteremia or to result in a greater magnitude of bacteremia than that caused by
routine daily activities such as chewing food, tooth brushing, or flossing.
a. Both statements are true.
WWW.GRADESMORE.COM
Stuvia.com - The Marketplace to Buy and Sell your Study Material
Page 1 of 74
b. Both statements are false.
c. The first statement is true, the second statement is false.
d. The first statement is false, the second statement is true.
ANS: D
It has been shown that visible bleeding during a dental procedure is not a reliable
predictor of bacteremia. Collective published data suggest that the vast majority of
dental office visits result in some degree of bacteremia, and that it is not clear which
dental procedures are more or less likely to cause transient bacteremia or to result in
a greater magnitude of bacteremia than that caused by bacteremia produced by
routine daily activities such as chewing food, tooth brushing, or flossing.
8. Which of the following is true regarding the efficacy of antibiotic prophylaxis?
a. Data show that a reduction in the incidence, nature, and duration of
bacteria caused by antibiotic therapy reduces the risk of or prevents IE.
b. Antibiotics given to at-risk patients before a dental procedure will
prevent or reduce a bacteremia.
c. Prospective randomized, placebo-controlled trials have been conducted to
examine the efficacy of antibiotic prophylaxis for preventing IE in patients
who undergo a dental procedure.
d. Investigators have concluded that dental or other procedures probably
only caused a small fraction of cases of IE, and that prophylaxis would
prevent only a small number of cases, even if it were 100% effective.
ANS: D
This conclusion came as the result of a study from the Netherlands by van der
Meer and colleagues that investigated the efficacy of antibiotic prophylaxis in
preventing IE in dental patients with native or prosthetic cardiac valves
9. The American Heart Association currently recommends antibiotic prophylaxis before
dental treatment to prevent endocarditis for patients with which of the following
cardiac conditions?
a. Mitral valve prolapse with regurgitation
b. Rheumatic heart disease
c. Prosthetic cardiac valve
d. A, B, and C
e. A and C
ANS: C
Prophylaxis with antibiotics before a dental procedure is recommended for a
prosthetic cardiac valve, previous infective endocarditis, and some forms of
congenital heart disease (see Box 2-2.)
10. Which of the following antibiotics is the best choice if a patient who requires
premedication before dental treatment is already taking penicillin for eradication
of an infection?
a. Amoxicillin
WWW.NURSYLAB.COM
GRADESMORE.COM
b. Clindamycin
c. Cephalosporins
d. Keep the patient on the penicillin because the blood level has
already been achieved
ANS: B
WWW.GRADESMORE.COM
Stuvia.com - The Marketplace to Buy and Sell your Study Material
Page 1 of 74
The presence of viridians group streptococci that are relatively resistant to penicillin
or amoxicillin is likely in patients already taking penicillin or amoxicillin for
eradication of an infection. Clindamycin, azithromycin, or clarithromycin should be
selected for prophylaxis if treatment is immediately necessary. Cephalosporins
should be avoided due to cross resistance. Another approach is to wait for at least 10
days after the completion of antibiotic therapy before administration of prophylactic
antibiotics.
WWW.NURSYLAB.COM
GRADESMORE.COM
WWW.GRADESMORE.COM
Stuvia.com - The Marketplace to Buy and Sell your Study Material
Page 1 of 74
Chapter 03: Hypertension
Little: Dental Management of the Medically Compromised Patient, 9th Edition
MULTIPLE CHOICE
1. In prehypertension, diastolic pressure ranges from
a. 80 to 89
b. 90 to 99
c. 100 to 109
d. 110 to 119
mm Hg.
ANS: A
In adults, a sustained systolic blood pressure of 140 mm Hg or greater and/or a
sustained diastolic blood pressure of 90 mm Hg or greater is defined as
hypertension. (Also see Table 3-1.)
2. Which of the following types of health professionals can make the diagnosis of
hypertension and decide on its treatment?
Physician
Dentist
Dental hygienist
A, B, and C
A and C only
a.
b.
c.
d.
e.
ANS: A
Although only a physician can make the diagnosis of hypertension and decide on its
MrOevReE
Metection, Evaluation, and
mRitA
teD
eE
onSP
nt.ioCnO
,D
treatment, Joint National ComG
Treatment of
High Blood Pressure (JNC) guidelines specifically encourage the active
participation of all health care professionals in the detection of hypertension and
the surveillance of treatment compliance. Accordingly, the dental health
professional can play a significant role in the detection and control of
hypertension and may well be the first to detect a patient with an elevation in
blood pressure or with symptoms of hypertensive disease.
3. Which of the following is true about hypertension in America?
a. It is the second-most primary diagnosis behind congestive heart failure.
b. Its prevalence has been steadily increasing 1990.
c. Its prevalence is similar among all races and ethnicities.
d. Its prevalence is similar among men and women.
ANS: D
According to National Health and Nutrition Examination Survey (NHANES) data for
the period 2011 to 2012, at least 75 million adults in the United States have high
blood pressure or are taking antihypertensive medication. This estimate equals
about 29% of the U.S. population, compared with 24% when surveyed between
1988 and 1991. This marked increase is attributed to aging of the population and
the epidemic increase in obesity.
WWW.NURSYLAB.COM
GRADESMORE.COM
Accordingly, a typical practice population of 2000 patients will have about 580
patients who have hypertension.
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.
WWW.GRADESMORE.COM
Stuvia.com - The Marketplace to Buy and Sell your Study Material
Page 1 of 74
a.
b.
c.
d.
less than
1
5
15
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.
5. Which of the following groups is most often the first-line drug category of choice if
lifestyle modification is ineffective at lowering blood pressure?
a. Beta-blockers (BBs), 1-adrenergic blockers, central 2 agonists, as well as
other centrally acting drugs, and direct vasodilators
b. Diuretics, thiazide diuretics, calcium channel blockers (CCBs),
angiotensin receptor blockers, angiotensin-converting enzyme
inhibitors (ACEIs)
c. Any of the above.
d. None of the above; lifestyle modification should continue unless blood pressure is
>140/90 mm Hg
ANS: B
Many drugs are currently available to treat hypertension. The Eighth Report of the
Joint National Committee on Prevention, Detection, Evaluation, and Treatment of
High Blood Pressure (JNC 8) recommends diuretics, angiotensin-converting enzyme
inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and calcium channel
blockers (CCBs) as first-line
choices for the general non-Black population. For the general Black population, a
dA
asDiE
niS
tiM
alOthReE
ra.pC
y.OOMther drugs used as
thiazide diuretic or CCB is recommendGeR
secondary choices
include beta-blockers (BBs), 1-adrenergic blockers, central 2 agonists, as well as
other centrally acting drugs and direct vasodilators.
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. 160/11
c. 0
180/90
d. 180/11
0
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.
WWW.NURSYLAB.COM
GRADESMORE.COM
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.
7. Which of the following is recommended for stress management for dental
patients with hypertension?
a. Afternoon appointments
WWW.GRADESMORE.COM
Stuvia.com - The Marketplace to Buy and Sell your Study Material
Page 1 of 74
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 postdiffusion 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.
8. Why should rapid changes in chair position during dental treatment be avoided
for patients under medication for hypertension?
a. To lessen the chances of endogenous release of catecholamines.
b. Alpha-blockers, alpha–beta-blockers, and diuretics tend to produce
orthostatic hypotension as a side effect.
c. Rapid chair position changes have nothing to do with antihypertensive
medications and drugs used in dental practice.
d. There is a high potential of triggering cardiovascular issues agents for
hypertensive dental patients in moving chairs if local anesthetics are used.
ANS: B
Alpha-blockers, alpha–beta-blockers, and diuretics tend to produce orthostatic
hypotension as a side effect, so rapid changes in chair position during dental
treatment should be avoided.
This effect can be potentiated by the actions of anxiolytic and sedative drugs.
GRADESMORE.CO
M
9. 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.
10. 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
WWW.NURSYLAB.COM
GRADESMORE.COM
hypertension with a nonselective -adrenergic blocking agent?
Hypotension
Hypertension
Respiratory alkalosis
Respiratory acidosis
a.
b.
c.
d.
ANS: B
WWW.GRADESMORE.COM
Stuvia.com - The Marketplace to Buy and Sell your Study Material
Page 1 of 74
The basis for concern with use of nonselective -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.
GRADESMORE.CO
M
WWW.NURSYLAB.COM
GRADESMORE.COM
WWW.GRADESMORE.COM
Stuvia.com - The Marketplace to Buy and Sell your Study Material
Page 1 of 74
Chapter 04: Ischemic Heart Disease
Little: Dental Management of the Medically Compromised Patient, 9th Edition
MULTIPLE CHOICE
1. Which of the following is true concerning the incidence and prevalence of
ischemic heart disease in the United States?
a. About 50% of the population is estimated to have some form of
cardiovascular disease.
b. Cardiovascular disease begins in middle life.
c. The annual mortality rate for cardiovascular diseases has been
declining since 1970.
d. Cancer has replaced coronary heart disease as the leading cause of
death in the United States after age 65.
ANS: C
More than 85 million Americans (about 25% of the population) have some form of
cardiovascular disease, with about 15.5 million having coronary heart disease.
Cardiovascular disease begins early in life, and autopsy studies have shown that one
in six American teenagers already has pathologic intimal thickening of the coronary
arteries. The annual mortality rate for cardiovascular diseases as a group has been
declining since 1970. Despite this decline, cardiovascular diseases continue to be the
leading cause of death in America, accounting for about 31% of all deaths. Coronary
heart disease is the leading cause of death in the United States after age 65, and it is
responsible for 735,000 new or recurrent heart attacks annually, of which more than
40% are fatal.
GRADESMORE.CO
M
2. Which of the following is the single MOST important modifiable risk factor for coronary
heart disease?
Diet high in cholesterol
Failure to exercise
Smoking cigarettes
Smoking cigars
a.
b.
c.
d.
ANS: C
Cigarette smoking is the single most important modifiable risk factor for coronary
heart disease. Multiple prospective studies have clearly documented that, compared
with nonsmokers, persons who smoke 20 or more cigarettes daily have a two- to
fourfold increase in coronary heart disease. This increased risk appears to be
proportionate to the number of cigarettes smoked per day, and quitting has well
documented benefits. Pipe and cigar smoking apparently convey minor risk for
development of heart disease.
3. Which of the following is NOT true of the relationship between periodontal
disease and cardiovascular disease?
a. Studies report the possibility of an association between periodontal
WWW.NURSYLAB.COM
GRADESMORE.COM
disease and cardiovascular disease.
b. A single risk factor—dental caries—has been found to be responsible
for the development of coronary atherosclerosis in patients over 50
years old.
c. Studies indicate a connection between tooth scaling and a
decreased risk of cardiovascular disease outcomes.
WWW.GRADESMORE.COM
Stuvia.com - The Marketplace to Buy and Sell your Study Material
Page 1 of 74
d. There is a hypothesis that the chronic inflammatory burden of periodontal
disease may lead to impaired functioning of the vascular endothelium.
ANS: B
Numerous studies have reported an association between periodontal disease and
cardiovascular disease, raising the question of whether periodontal disease is a risk
factor for cardiovascular disease. Although the mechanism to explain this
relationship is unclear, it is hypothesized that the chronic inflammatory burden of
periodontal disease may lead to impaired functioning of the vascular endothelium.
At present, despite studies showing that tooth scaling is associated with decreased
risk of cardiovascular disease outcomes and improved endothelial function, a direct
relationship (i.e., causation) between periodontal disease and cardiovascular disease
has not been established. Additional studies are required to further elucidate this
relationship.
4. Which of the following types of blood cells engulf lipid molecules to become foam cells?
a. Red blood cells
b. Macrophages
c. Neutrophils
d. Basophils
ANS: B
Atheroma formation is initiated by adherence of monocytes to an area of injured or
altered endothelium. The attached monocytes then migrate into the intima of the
vessel and become macrophages. Lipids derived from LDLs also enter through the
injured or dysfunctional endothelium, forming extracellular deposits or small pools.
Macrophages then engulf lipid molecules to become foam cells, which are
characteristic features of the fatty streak.
imRpA
oD
rtaEnS
t sMyO
mRpE
to.mCoOf M
coronary atherosclerotic heart disease?
5. Which of the following is the G
a. Pitting edema
b. Dysphagia
c. Dyspnea
d. Chest pain
ANS: D
Chest pain is the most important symptom of coronary atherosclerotic heart disease.
The pain may be brief, as in angina pectoris resulting from temporary ischemia of the
myocardium, or it may be prolonged, as in unstable angina or acute MI. Ischemic
myocardial pain results from an imbalance between the oxygen supply and the
oxygen demand of the muscle.
6. New-onset chest pain that increases in frequency or intensity has a changing
pattern, may possibly occur at rest, and is not readily relieved by nitroglycerin.
This best defines
.
a. acute coronary syndrome
b. Prinzmetal’s variant angina
WWW.NURSYLAB.COM
GRADESMORE.COM
c. unstable angina
d. stable angina
ANS: C
WWW.GRADESMORE.COM
Stuvia.com - The Marketplace to Buy and Sell your Study Material
Page 1 of 74
Unstable angina is defined as new-onset pain with increasing frequency or intensity,
and that is precipitated by less effort than before or that occurs at rest. This pain is
not readily relieved by nitroglycerin. Stable angina is pain that is predictably
reproducible, unchanging, and consistent over time. This pain is typically
precipitated by physical effort, such as walking or climbing stairs, but also may occur
with eating or stress. Pain is relieved by cessation of the precipitating activity, by rest,
or with the use of nitroglycerin. Acute coronary syndrome describes a continuum of
myocardial ischemia, and Prinzmetal’s variant angina is a relatively uncommon form
of angina.
7. Which of the following is the most common cause of sudden cardiac death?
a. Ventricular fibrillation
b. Myocardial infarction
c. Coronary atherosclerosis
d. Pulmonary embolism
ANS: A
The most common cause of sudden cardiac death is ventricular fibrillation, a form
of abnormal electrical activity resulting from interruption of the heart’s electrical
conduction system.
8. Which of the following is a serum enzyme determination used to establish the
diagnosis of acute myocardial infarction (MI) and to determine the extent of
infarction?
a. Stress thallium-201 perfusion scintigraphy
b. 3-Hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoA)
c. Troponin I and troponin T
d. Streptokinase (SK)
ANS: C
GRADESMORE.COM
Cardiac serum biomarkers of acute MI include troponin I, troponin T, creatine kinase
isoenzyme (CK-MB), and myoglobin. The troponins and CK-MB are enzymes released
only when cell death (infarction) or injury occurs. Troponins are proteins derived
from the breakdown of myocardial sarcomeres. Troponin assays are the most
sensitive and specific in differentiating cardiac muscle damage from trauma to
skeletal muscle or other organs; and are virtually absent in the plasma of normal
persons and are found only after cardiac injury.
9. Which of the following is true for an MI with ST segment elevation (STEMI)?
a. It is due to partial blockage of coronary blood flow.
b. It is due to complete blockage of coronary blood flow.
c. Early fibrinolytic therapy will not improve the outcome for a patient with STEMI.
d. Morphine use for pain relief is never recommended for STEMI patients.
ANS: B
An MI with ST segment elevation is due to complete blockage of coronary blood
flow and more profound ischemia involving a relatively large area of myocardium.
An MI without ST segment elevation (non-STEMI) is due to partial blockage of
WWW.NURSYLAB.COM
GRADESMORE.COM
coronary blood flow. Early fibrinolytic therapy improves outcomes in STEMI but not
in non-STEMI. Morphine use for pain relief is recommended for STEMI; however, use
of morphine in non-STEMI patients is associated with increased mortality and
should be avoided in these patients.
10. When planning dental treatment for a patient with stable angina or a past
history of MI without ischemic symptoms,
.
WWW.GRADESMORE.COM
Stuvia.com - The Marketplace to Buy and Sell your Study Material
Page 1 of 74
a.
b.
c.
d.
administration of nitrous oxide should be avoided
a pulse oximeter should be used
nitroglycerin should be administered prophylactically
NSAIDs should be avoided
ANS: D
In several studies, the use of NSAIDs in patients with previous MI has been shown to
increase the risk for a subsequent myocardial infarction, even after only 7 days of
NSAID administration. Only naproxen did not increase the risk.
GRADESMORE.CO
M
WWW.NURSYLAB.COM
GRADESMORE.COM
Download