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