Board Review DH227, Lisa Mayo, RDH, BSDH
Medical Emergency Test
1. A known Type II diabetic begins to act confused in your office. They are conscious but disoriented,
sweating, shaking. Their blood pressure is 140/88mmhg, pulse 92. The best treatment is:
a. Insulin
b. Epinephrine
c. Oral sugar
d. Glucagon
2. Which of the following is the most important factor in determining whether someone will survive a
cardiac arrest?
a. Proper hand position and compression depth during chest compressions
b. Administering fibrinolytics within one hour
c. Performing CPR within 4-6min of arrest
d. Defibrillating within 4-6min of arrest
3. A contraindication to the administration of nitroglycerine is:
a. BP greater than 120
b. BP less than 90
c. Heart rate greater than 150
d. Heart rate less than 60
4. Numbness in the fingers and toes is consistent with which medical problem?
a. CVA
b. Epilepsy
c. Hyperventilation
d. Acute Myocardial Infarction
5. A 63yr old patient starts slurring his speech and presents with a right side facial droop. Local
anesthesia was not given. The most likely diagnosis is:
a. Acute Hypoglycemia
b. Myocardial Infarction
c. Cerebrovascular Accident
d. Acute Hyperglycemia
6. Have a patient chew 325mg of aspirin is indicated for the management of
a. Asthma
b. Stroke
c. Myocardial Infarction
d. Hypoglycemia
7. A patient should be suspected of having a Myocardial Infarction of angina if the following occurs:
a. The pain is not relieved with 40% nitrous oxide
b. The pain is relived with your nitroglycerine, but not the patient’s own nitro
c. The pain is occurring in a patient with no prior chest pain history
d. The pain is radiating down the arm and to the jaw
8. A diabetic person becomes unconscious. The best treatment now is:
a. Admin Benadryl IM
b. Call EMS
c. Admin epi IV
d. Admin an oral sugar
9. The patient is breathing rapidly and wheezing. The patient is
a. Having an asthma attack, admin Albuterol
b. Having an asthma attack, admin epi
c. Hyperventilating, admin oxygen
d. Hyperventilating, admin CO2
10. Treating fear and anxiety will likely reduce the incidence of which medical emergency?
a. Vasodepressor syncope
b. Hyperventilation syndrome
c. Non-allergic asthma
d. All the above
11. To check a baby’s pulse during CPR, you would check the ____ artery.
a. Carotid
b. Femoral
c. Brachial
d. Temporal
12. If a person is hyperventilating in the operatory, the first thing you should do is:
a. Give her oxygen by nasal canula
b. Give her a paper bag to breath in
c. Have her breathe into her cupped hands
d. Perform BLS CPR
13. If a patient is suffering from bradycardia, his heart rate will be
a. 90-100 beats per min
b. 100+ beats per min
c. Less than 60 beats per min
d. 60-80 beats per min
14. A syncopal episode can best be described as
a. The patient became dizzy as he sat up in the chair
b. A transient lack of blood to the brain
c. A postictal state
d. Difficulty in breathing
15. According to the AHA, once you have established a person (adult) is unconscious, the next step
should be to
a. Establish an airway
b. Check for breathing
c. Point to someone to call 911
d. Cover the patient to keep them warm
16. A diabetic patient who initially appeared normal suddenly becomes confused and diaphoretic. He
then lapses into unconsciousness. This patient is ailing from
a. Ketoacidosis
b. Diabetic coma
c. Hyperglycemia
d. Insulin shock
17. A patient suddenly has difficulty breathing and has audible inspirations that sound like wheezes.
She is suffering from:
a. Chronic bronchitis
b. Emphysema
c. Asthma
d. Left-sided heart failure
18. A patient is in your chair, and during the polishing, suddenly states that the paste tastes different.
This patient may be
a. Hypoglycemia
b. Experiencing aura before a seizure
c. Experiencing a transient ischemic attack
d. None of the above
19. A patient begins to have sudden chest pain that radiates up into his mandible and neck. This may
be a symptom of
a. RT-sided heart failure
b. A mandibular tooth abscess
c. Myocardial infarction
d. Cerebrovascular accident
20. Which of the following is not a type of shock?
a. Hypovolemia
b. Septicemia
c. Chiasma
d. Psychogenic
21. You are not sure if a patient is having a hypoglycemic or hyperglycemic attack. You should
a. Give her sugar anyway
b. Wait until the paramedics arrive to test the patient’s blood sugar
c. Admin 50% dextrose
d. wait until she becomes unconscious to know that it is hypoglycemia and then give
her sugar
22. The drug of choice for someone suffering from an acute attack would be:
a. Retrovit
b. Albuterol
c. Diphenhydramine
d. Dramamine
23. Hyperventilation can cause
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis
24. A patient who is not producing enough glucocortoid becomes confused, diaphoretic, tachycardic,
and hypotensive during a difficult extraction. 911 has been called, but now the patient becomes
unconscious. This patient is suffering from
a. Hypoglycemia
b. Cerebrovascular accident
c. Adrenal crisis
d. Drug overdose
25. A patient who has pitting peripheral edema suffers from
a. RT-sided heart failure
b. LF-sided heart failure
c. Obesity
d. None of the above
26. A patient who has been in the dental chair for over 2 hours stands up suddenly becomes dizzy. This
patient has experienced:
a. A syncopal episode
b. Orthostatic hypotension
c. Supine hypotensive syndrome
d. Shock
27. your perfectly cooperative patient suddenly has slurred speech with unequal pupils. He attempts to
get up from the chair but cannot seem to use one leg. Your patient has experienced:
a. Allergic rxn
b. Drug overdose
c. Cerebrovascular accident
d. Thyroid storm
28. All the following could cause hypertension except:
a. Not taking one’s blood pressure medication
b. Hurrying in after being caught in traffic
c. Regular exercise
d. Having a patient with Down’s syndrome and a parents who is an invalid
29. you patient has had no symptoms of being ill. Suddenly, he loses consciousness and becomes
pulseless, cyanotic, and apnic. Your patient is suffering from
a. Hyperventilation
b. Myocardial infarction
c. Adrenal crisis
d. Sudden death
30. When taking a medical hx on a patient, which of the following questions is not necessary?
a. Do you take any medications?
b. Do you have any allergies?
c. Do you exercise?
d. Do you have a history of bleeding?
e. All of the above
31. A patient has taken too much codeine for pain and is suffering from shallow breathing of 10 breaths
per min, a pulse rate of 56 and blood pressure of 96/50 and is diaphoretic. Which of the following drugs
would you administer?
a. Atropine sulfate
b. Naloxone
c. Albuterol
d. Epinephrine
32. If your patient has a blood pressure of 146/98, what would be your plan for dental treatment?
a. Recheck annually
b. Recheck next 3 visits and refer for medical consultation if unchanged
c. Recheck in 5min and if unchanged refer for medical consultation
d. No dental treatment, refer for medical consultation
33. Your patient has a pulse rate of 102, a respiratory rate of 24, and a blood pressure of 122/76.
Which of the following statements is true?
a. All readings are within normal limits
b. Pulse rate is high, resp rate is normal, blood pressure is high
c. Pulse rate is normal, resp rate is high, blood pressure is normal
d. Pulse rate is high, resp rate is high, blood pressure is normal
34. Which of the following hormones is released in the body during times of stress?
a. Prolactin
b. Thyroxin
c. Cortisol
d. Calcitonin
35. Blood pressure may increase because of each of the following EXCEPT:
a. Increased age of patient
b. Rest
c. Exercise
d. Certain medications
36. The first step in treating an unresponsive person is:
a. Activate EMS
b. Open the airway
c. Perform rescue breathing
d. Perform cardiac compressions
37. The appropriate depth of chest compression for a child is
a. ½ - 1in
b. 1-1.5in
c. 1.5-2in
d. 2-2.5in
38. Unconsciousness may be a result of each of the following EXCEPT
a. Inadequate cerebral circulation
b. Metabolic disorder altering quality of blood flow to the brain
c. Psychogenic (fear, anxiety)
d. Hypoglycemia
e. All the above
39. Anaphylactic shock is caused by
a. Inadequate blood volume
b. An acute allergic rxn
c. Heart failure
d. A psychogenic or neurological disorder
e. All the above
40. In addition to chest pain associated with a myocardial infarction, the victim may experience,
a. Sweating
b. Nausea
c. Shortness of breathe
d. Weakness
e. All the above
41. Congestive heart failure may be a result of each of the following EXCEPT
a. Anaphylaxis
b. Hypertension
c. Valvular heart disease
d. Coronary artery disease
42. Cerebrovascular accident results from
a. Blood clot blocking the cerebral blood vessel
b. Hemorrhage from the cerebral blood vessels
c. Low blood sugar
d. A, B
e. A, C
43. Signs of acute fluoride toxicity include all the following EXCEPT
a. Nausea
b. Abdominal pain
c. Decreased salivation
d. Vomiting and diarrhea
e. All the above
44. The cause for seizures include
a. Tumors and congenital abnormalities
b. Tumors and trauma to the head
c. Tumors, congenital abnormalities, and trauma to the head
d. Congenital abnormalities, trauma to the head, drugs
e. All the above
45. Hyperventilation as a response to administration of local anesthetic may manifest by
a. Increased respiratory rate and respiratory depression
b. Increased respiratory rate and syncope
c. Increased respiratory rate, syncope, respiratory depression
d. Slow pulse
Case Study Questions
25-yr old female with history of diabetes present for periodontal maintenance appointments. She took
her regular dose of insulin and ate a light breakfast. She also walked 12 blocks prior to her dental
appointment. Initially she appears to be feeling fine, but once you begin treatment she complains of a
headache and dizziness. Questions 45-49 pertain to this situation.
46. This patient is likely experiencing
a. Hyperglycemia
b. Hypoglycemia
c. Hyperventilation
d. Adrenal insufficiency
47. The appropriate treatment is
a. Administer insulin based on patient’s body weight
b. Administer water
c. Administer sugar in the form of orange juice or cola
d. Administer oxygen
48. How could this patient have prevented this adverse reaction?
a. Eaten a regular breakfast instead of a light breakfast and taken a small dose of insulin
b. Eaten a regular breakfast instead of a light and not walked 12 blocks
c. Taken a smaller dose of insulin and not walked 12 blocks
d. Taken a smaller dose of insulin, not walked 12 blocks, and made appointment later in
the day
e. All the above
49. The patient’s symptoms are a result of
a. Too much insulin available
b. Blood glucose under 50mg/dcl
c. A combination of A and B
50. An avulsed tooth should be
a. Handled by the crown only and reimplanted as soon as possible
b. Handled by crown only, reimplanted as soon as possible and wrapped in dry clots for
transportation to ER
c. Handled by root only and reimplanted asap
d. Handled by root only, reimplanted asap, wrapped in dry clots for transportation to ER
Case Study
An elderly patient arrives to your office for her 3 month continuing care appointment. She is on
multiple medications but all vitals are within normal limits and she is eager to begin care. As you begin
treatment, an instrument tip breaks off in her mouth. Questions 51-54 refer to this situation.
51. Aspiration of materials is preventable by
a. Not working on developmentally disabled person
b. Use of a rubber dam
c. Stopping patient’s medications prior to procedures
d. Working on patient in the upright position
52. The initial treatment for a broken instrument tip is
a. Radiographs of the suspected lesion
b. Use gentle instrumentation to explore the suspected location if in the sulcus
c. Immediate consultation with the dentist
d. Use high powered suction to dislodge the tip
53. In this case, it would be BEST to
a. Inform the patient of the situation
b. Proceed as if nothing is wrong so the patient is not alerted to the situation
c. Have the patient swish and spit
54. Efforts to minimize instrument breakage include all the following EXCEPT
a. Frequent inspection of all instruments
b. Disposal of instruments deemed too think to withstand the stress of instrumentation
c. Careful sharpening
d. Disposal of an instrument after it has been sharpened 5 times
55. The force exerted during ventricular contraction (heart beat) is known as:
a. Pulse pressure
b. Diastolic pressure
c. Systolic pressure
56. An oral temperature reading may be inaccurate if the patient has recently been
a. Eating
b. Drinking
c. Smoking
d. All the above
57. In an emergency situation involving an adult, a pulse rate should be determined by palpating the
a. Carotid artery
b. Femoral artery
c. Brachial artery
d. Radial artery
58. Biological death is permanent cellular damage and will occur if CPR is not initiated within
a. 1-2min
b. 2-4min
c. 4-6min
d. 6-8min
59. External cardiac compressions on a child are performed by placing the heel of one hand on the
a. Xiphoid process
b. Lower half of the sternum
c. Upper half of the sternum
d. Any of the above
60. A person with a partial airway obstruction but good air exchanges should
a. Lie down on his back
b. Be treated with the Heimlich maneuver
c. Be treated with sharp back blows
d. Be encouraged to cough and breathe deeply
61. Syncope may be avoided by each of the following EXCEPT
a. Placing the person in Trendelenburg position
b. Obtaining a good health history
c. Creating a low-stress environment
d. Giving each patient a glucose-containing snack
Case Study
A 59-yr old man with a history of high blood pressure complains of a little pain in his chest. His blood
prrssure is 145/95mmhg and pulse 95. Within the next couple of minutes, he starts to sweat and have
labored breathing. He then starts to complain about a squeezing sensation in the chest. The client has
his medications with him including hydrochlorothiazide, nitroglycerine, and nifedipine. Questions 62-63
refer to this situation.
62. This man may be experiencing which of the following?
a. Hyperventilation and angina pectoris
b. Congestive heart failure and angina pectoris
c. Congestive heart failure and myocardial infarction
d. Angina pectoris and myocardial infarction
63. This man should be encouraged to
a. Take his nitroglycerine as he was directed by his MD
b. Take nitroglycerine tablets from the dental office emergency kit
c. Do nothing but rest
64. When treating a person with a history of a seizure disorder, each of the following is appropriate
EXCEPT
a. Administer nitrous oxide to reduce anxiety
b. Schedule short appointments
c. Schedule appointments early in the day
d. All the above
65. The preferred transport medium for an avulsed tooth is
a. Tap water
b. Under the tongue of the patient
c. Hydrogen peroxide
d. Milk
Case Study
Your last patient of the day is a 65-year old man with multiple medical problems including diabetes,
hypertension, obesity, and a past history of a myocardial infarction. As he sits for his vital to be taken,
he is markedly short of breath and diaphoretic (sweating). He says he has not been feeling well over the
past couple of weeks and it has been a very stressful morning so he did not take his meds. As you being
vitals, he loses consciousness. Questions 66-70 pertain to this situation.
66. The appropriate sequence for treating this man is
a. Establish airway, determine level of consciousness, take 5-10sec to check carotid
pulse, begin chest compressions
b. Take 5-10sec to check carotid pulse, begin chest compressions, determine level of
consciousness, establish airway
c. Determine levels of consciousness, establish airway, take 5-10sec to check carotid
pulse, begin chest compressions
d. Take 5-10sec to check carotid pulse, establish airway, determine level consciousness,
begin chest compressions
67. If rescue breathing is necessary it should be performed
a. At a rate of 16-20 breaths/min
b. With adequate volume 800-1200ml/breath
c. At a rate of 20-24 breaths/min
68. This person has no palpable pulse. Cardiac compressions should be initiated by placing the heel of
the hand on the
a. Xiphoid process
b. Lower half of the sternum
c. Upper half of the sternum
69. Compression rate for 2 person rescue should be _______ compressions/min.
a. 40-60
b. 60-80
c. 80-100
d. 100-120
70. Treating an obstructive airway in an unconscious person can be achieved by
a. Kneeling astride the victim and performing 6-10 abdominal thrusts
b. Kneeling astride the victim and performing 6-10 chest compressions
c. Performing finger sweeps if the victim is a child
71. Toxic overdose of local anesthetic may occur as a result of all EXCEPT:
a. Delayed biotransformation of the agent
b. Increased elimination of the agent
c. Excessive dose of the agent
d. Intravascular injection of the agent
Case Study
A 15-yr old female arrives for her morning dental hygiene appointment. She has normal vitals and is
feeling fine. She then starts to complain of a very weird smell and suddenly loses consciousness and
begin having involuntary muscular contractions. Questions 72-76 refer to this situation.
72. The first thing that should be done is
a. Lower the dental chair and clear the area of all sharp and dangerous objects
b. Restrain the person to prevent injury
c. Place a bite block in mouth
d. Administer oxygen
73. This woman is most likely experiencing a(an)
a. Complex partial seizure
b. Stroke
c. Anaphylactic reaction
d. Gran mal seizure
e. Diabetic emergency
74. Another associated sign or symptom this woman may experience is
a. Blank stare
b. Epileptic cry
c. Polydipsia
d. Unilateral weakness
75. If breathing foes not spontaneously return
a. Evaluate for foreign body obstruction
b. Admin oxygen
c. Admin nitrous oxide
d. Allow the person to rest
76. Once the woman regains consciousness she may
a. Have a headache
b. Have muscle aches
c. Be drowsy
d. All the above
ANSWERS
1.C
2.D
3.B
4.C
5.C
6.C
7.C
8.B
9.A
10.D
11.C
12.C
13.C
14.B
15.C
16.D
17.C
18.B
19.C
20.C
21.A
22.B
23.D
24.C
25.A
26.B
27.C
28.C
29.D
30.E
31.B
32.B
33.D
34.C
35.B
36.A
37.B
38.E
39.B
40.E
41.A
42.D
43.C
44.E
45.B
46.B
47.C
48.B
49.C
50.A
51.B
52.B
53.A
54.D
55.C
56.D
57.A
58.C
59.B
60.D
61.D
62.D
63.A
64.A
65.B
66.C
67.B
68.B
69.C
70.A
71.B
72.A
73.D
74.B
75.D
76.D