2

Which of the following is the most classically described osseous change accompanying chronic renal failure?

"ground glass" appearance

Which of the following viruses has been reported to be transmitted nosocomially in dialysis centers in the United States? 1. hepatitis B 2. hepatitis C 3. human immunodeficiency virus (HIV)

1 and 2

Tachycardia in an adult is defined as a heart rate greater then ___ beats per minute, with otherwise normal findings on the ECG.

100

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.

180/120

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.

180/120

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?

2

How many weeks does it usually take for endothelium to cover coronary artery stents?

2 weeks

The interval between the presumed initiating bacteremia and the onset of symptoms of infective endocarditis is estimated to be less than ______ in the more than 80% of patients with infective endocarditis.

2 weeks

Which of the following sequences correctly depicts the sequence of osseous changes observed in the patient with renal osteodystrophy? 1. osteosclerosis 2. osteomalacia 3. osteitis fibrosa

2, 3, 1

Your patient has a history of COPD and PO2 of 92%. At which of the following rates should humidified oxygen be administered during the appointment?

2-3 L/minute

A patient with a recent myocardial infarction has had a heart attack within the last ___________ .

30 days

It has been shown that the risk for occurrence of a serious perioperative cardiovascular event is increased in patients who are unable to meet a __-MET (metabolic equivalent of task) demand during normal daily activity.

4

Which of the following Blood Tests are most commonly needed before dental treatment?

A and B a) The Common Pathway b) The Extrinsic Pathway c) The Intrinsic Pathway d) a & b e) a & c

The INR measures deficiencies in the:

A and B a) The Common Pathway b) The Extrinsic Pathway c) The Intrinsic Pathway d) A & B e) A & C

Chronic active hepatitis B is diagnosed by the presence of ______ in blood serum.

A and C A. HBsAg B. HBcAg C. HBeAg D. a, b, and c E. a and c

Clopidogrel acts by inhibiting which of the following?

ADP mediated platelet aggregation

Which the following is true concerning infective endocarditis (IE)?

Accumulating evidence questions the validity of antibiotic prophylaxis in an attempt to prevent infective endocarditis prior to certain and dental procedures.

Which of the following is true regarding laboratory tests for tuberculosis?

All dentists should undergo annual tuberculin skin testing.

Intraoperative management of patients with bleeding disorders involves:

All of the above a)Vasoconstrictors b) Gel-Foam/Surgicel c) Electrocautery d) Topical Thrombin e) All of the above

Losartan, an angiotensin receptor blocker, reduces blood pressure by blocking _________ .

Angiotensin 2 binding

Which of the following is associated with immunity to hepatitis B?

Anti-HBs

Which of the following chronic inflammatory diseases of the airways is characterized by reversible episodes of increased airway hyper-responsiveness?

Asthma

Which of the following is true of the pathophysiology of alcoholic liver disease?

B and C A. Fatty liver is not reversible. B. Alcoholic hepatitis may be fatal if damage is widespread. C. In some patients with cirrhosis, blood from bleeding ulcers and esophageal varices is incompletely metabolized to ammonia. D. a and b E. b and c Fatty liver is considered completely reversible. For the most part, alcoholic hepatitis is considered a reversible condition; however, it can be fatal if damage is widespread. In some patients with cirrhosis, blood is metabolized to ammonia, which travels to the brain and contributes to encephalopathy.

Post-operative management of patients with bleeding disorders involves

B and C a) Admission to a hospital for management b) Gauze, pressure, time c) Continued factor, Amicar or Stimate as recommended d) b& c e) a & c

Which of the following medications is most affected by anti-retroviral drugs?

Bupropion

Which of the following is true of the magnitude of bacteremia required to cause infective endocarditis?

Cases of IE caused by oral bacteria probably result from frequent exposure to low inoculum of bacteria in the blood stream due to daily activities and not a dental procedure.

Which of the following is the most important symptom of coronary atherosclerotic heart disease?

Chest pain

Which of the following NYHA classes of heart failure patients should not receive epinephrine or other pressor amines during dental treatment?

Class III and IV The ACC/AHA guidelines indicate that decompensated HF constitutes a major risk for the occurrence of a serious event (acute MI, unstable angina, or sudden death) during treatment. Patients with symptoms of uncompensated HF - NYHA classes II, III, IV are generally not candidates for elective dental care until medical consult is obtained. Even afterwords, classes III and IV should usually be treated in a hospital dental clinic or other setting where continuous cardiac monitoring and advanced cardiac care is available. Such patients would not usually be good candidates for the use of vasoconstrictors due to the possibility of cardiac stress. See pages 89-90 in Ch. 6 for more explanation.

Which of the following antibiotics is the best choice if the patient who requires premedication before dental treatment is already taking penicillin for eradication of an infection?

Clindamycin

Which of the following is the most common underlying cause of heart failure in the United States?

Coronary heart failure

Which of the following agents is currently regarded as the first-line medication for long-term control of asthma?

Corticosteroids

Aspirin may precipitate an asthmatic attack by blocking which of the following?

Cyclooxygenase pathway

Which of the following is thought to be the major factor in the pathogenesis of liver injury?

Cytotoxic T cell responses The timing and histologic appearance of hepatocyte injury in viral hepatitis suggest that immune responses, particularly cytotoxic T cell responses to viral antigens expressed on hepatocyte cell membranes, may be the major effectors of injury. Other proinflammatory cytokines, natural killer cell activity, and antibody-dependent cellular cytotoxicity also may play modulating roles in cell injury and inflammation during acute viral hepatitis infection.

Any time a patient demonstrates unexplained, persistent signs or symptoms that may be suggestive of TB, or has a positive result on skin testing or IGRA, and has not been given follow-up medical care, _________.

Dental care should not be rendered, and the patient should be referred to a physician for evaluation

A blood pressure taken with a B.P. cuff that is too small will yield _______ values

Falsely elevated

Which of the following is a form of infectious (rather than serum) hepatitis?

Hepatitis A Hepatitis A and hepatitis E are forms of infectious hepatitis; they are spread largely by the fecal-oral route, are associated with poor sanitary conditions, are highly contagious, occur in outbreaks as well as sporadically, and cause self-limited hepatitis only. Hepatitis B, hepatitis C, and hepatitis D are forms of serum hepatitis, are spread largely by parenteral routes and less commonly by intimate or sexual exposure, and are not highly contagious but instead occur sporadically and rarely cause outbreaks.

Which of the following is classified as a significant arrhythmia according to the ACC/AHA guidelines?

High-grade AV block

Which of the following is the most common cardiac condition in America?

Hypertension

Which of the following is the most common means of transmission of hepatitis C?

Injection drug use

Which of the following is true regarding the efficacy of antibiotic prophylaxis?

Investigators have concluded that dental or other procedures probably only cause a small fraction of cases of i.e., and that prophylaxis would prevent only a small number of cases, even if it were 100% effective.

Which of the following symptoms and signs is most consistent with allergy?

Itching

Most of the acquired disorders that lead to heart failure result in initial failure of the ________.

Left ventricle

In the 2017 "elevated blood pressure" category, the diastolic range is ________ mm Hg.

Less than 80

Angiotensin Converting Enzyme (ACE) is primarily found in the ____________ .

Lungs

One consequence of chronic hepatitis (B or C) or cirrhosis of the liver is decreased ability of the body to _________ certain drugs, including local anesthetics and analgesics.

Metabolize

A pregnant patient desperately wants to quit smoking. Which of the following is an FDA approved therapy?

NONE of these 1. Over-the-counter Nicotine patch 2. Prescription varenicline 3. Prescription bupropion

Which of the following is true when planning dental treatment for a patient with stable angina or a past history of MI without ischemic symptoms?

NSAIDs should be avoided in patients with established cardiovascular disease.

Which of the following nicotine replacement therapies is available by prescription?

Nicotine inhaler

Which of the following tobacco cessation pharmaceuticals has the best side effect profile?

Nicotine patch

Which of the following is recommended for stress management for dental patients with hypertension?

Nitrous oxide plus oxygen inhalation sedation

Which of the following is true of unstable angina?

Pain is NOT relieved by nitroglycerin

Which of the following is true of stable angina?

Pain may radiate to left jaw

Varenicline is a _________________ .

Partial nicotine receptor agonist

Which of the following is true of a patient classified ASA III according to the American Society of Anesthesiologists (ASA) Physical Status Classification System?

Patient's disease has significant impact on daily activity.

Which of the following is true of the patient with a history of tuberculosis?

Patients with acquired immunodeficiency syndrome (AIDS) have a high incidence of tuberculosis.

Which of the following types of health professionals can make the diagnosis of hypertension and decide on its treatment?

Physician

Rupture of an arterial atheroma primarily results in which of the following?

Platelet aggregation

The American Heart Association currently recommends antibiotic prophylaxis before dental treatment to prevent endocarditis for patient's with which of the following cardiac conditions?

Prosthetic cardiac valve

Which of the following is the drug of choice for relief of an acute asthma attack?

Short-acting inhaled β2-adrenergic agonist

Which of the following is the single most important modifiable risk factor for coronary heart disease?

Smoking cigarettes

Failing kidneys are unable to concentrate and filter the intake of ________.

Sodium Failing kidneys are unable to concentrate and filter the intake of sodium, which contributes to the drop in urine output, development of fluid overload, hypertension, and risk for severe electrolyte disturbances and cardiac disease.

According to the National Kidney Foundation, which stage of chronic kidney disease (CKD) is characterized by a loss of 50% or more of normal renal function?

Stage 3

The use of local anesthetic without epinephrine or levonordefrin may be advisable for patients with moderate to severe asthma because _________ preservatives are found in local anesthetic solutions that contain epinephrine or levonordefrin.

Sulfite

Which of the following conditions do not have bleeding implications?

Systemic Sclerosis

Which of the following is true of dental management for a patient with COPD?

The appointment should be rescheduled if pulse oximetry finds the oxygen saturation level to be less than 91%.

Which of the following is true about interventions for smoking cessation?

The chance for success increases when more than one option is used.

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 a routine daily activities such as chewing food, toothbrushing, or flossing.

The first statement is FALSE, the second statement is TRUE.

The most important cause of chronic obstructive pulmonary disease (COPD) in the world is ______________ .

Tobacco smoking

Your complete denture patient smokes 1 pack of cigarettes per day. She reports a history of mild seizures following a car accident 3 years ago. She has tried several times to quit smoking on her own by but re-started after each attempt. Which of the following would be best to prescribe for her next attempt?

Varenicline

Which of the following is the most common cause of sudden cardiac death?

Ventricular fibrillation

Which of the following tests is the best way to screen for problems before dental treatment of an alcoholic patient?

a complete blood count (CBC) with differential A CBC with differential and determinations of AST and ALT, bleeding time, thrombin time, and prothrombin time are sufficient to screen for potential problems. Abnormal laboratory values, on a background of suggestive findings on the clinical examination or a positive history, constitute the basis for referral to a physician for definitive diagnosis and treatment.

Pre-operative management of patients with bleeding disorders involves

a) Accessing Risk, Minimizing Risk, Consultation

Which of the following is the most common type of persistent arrhythmia?

atrial fibrillation

Which of the following dental devices has produced electromagnetic interference (EMI) with pacemakers and ICDs in studies performed in vitro?

battery-operated curing lights In studies performed in vitro, electrosurgery units, ultrasonic bath cleaners, ultrasonic scaling devices, and battery-operated curing lights have produced EMI with pacemakers and ICDs.

Many of the side effects of angiotensin-converting enzyme inhibitors (ACEIs) are due to an increase in ___________ .

bradykinin

The three drugs or drug categories most associated with gingival hyperplasia are?

calcium channel blockers, phenytoin, cyclosporine

Which of the following is the most common cause of end-stage renal disease (ESRD)?

diabetes mellitus

The outstanding symptom of left ventricular heart failure is ________.

dyspnea The outstanding symptom is dyspnea, which results from the accumulation or congestion of blood in the pulmonary vessels—hence the designation congestive. Acute pulmonary edema often is the result of left ventricular failure. Left-sided heart failure leads to pulmonary hypertension, which increases the work of the right ventricle, pumping against increased pressure, often culminating in right-sided heart failure.

Which of the following is the most common reason for decompensation of previously well-compensated heart failure during dental treatment?

failure to take medications are perscribed

The leading cause of death from infective endocarditis is_______?

heart failure

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 hypertension with a non-selective β-adrenergic blocking agent?

hypertension

Which of the following is a disorder of repolarization?

long QT syndrome Long QT syndrome is a disorder of the conduction system in which the recharging of the heart during repolarization (i.e., the QT interval) is delayed. It is caused by a genetic mutation in myocardial ion channels and by certain drugs, or it may be the result of a stroke. Mobitz type I (Wenckebach) is a form of second-degree heart block. Wolff-Parkinson-White syndrome is tachycardia involving the AV junction. Torsades de pointes is a variant of ventricular tachycardia.

Which of the following is currently the most common underlying condition predisposing to infective endocarditis?

mitral valve prolapse

Which of the following is an oral manifestation of kidney disease?

pallor of oral mucosa related to anemia

The American Heart Association currently recommends antibiotic prophylaxis for a patient with which of the following cardiac conditions?

prosthetic heart valve

Patients with cardiovascular disease are most likely to experience _______________ with nicotine replacement therapy.

tachycardia

Where are Janeway lesions located?

the palms of hands and soles of the feet.

A blood pressure cuff should be placed on the upper arm and inflated until _________.

the radial pulse disappears and then inflated an additional 20 to 30 mm Hg

Which of the following is most often the first drug category of choice if lifestyle modification is ineffective at lowering blood pressure?

thiazide diuretics

How do most dialysis patients in the United States receive hemodialysis?

through an arteriovenous graft, usually placed in the forearm

Which of the following alterations in the fingernails is associated with cirrhosis?

white discoloration