Pharm - Random and excess 2 (boards)

27. Albuterol is a short-acting β2-adrenergic agonist that produces bronchoconstriction.

ANS: False Albuterol produces bronchodilation. It is used in the management of an acute asthma attack or respiratory distress accompanying anaphylaxis. REF: p. 296

42. Orally inhaled corticosteroids produce an immediate benefit in an acute asthma attack.

ANS: False Although the steroids produce no immediate benefit in an acute asthmatic attack, they hasten recovery and decrease morbidity in these patients. REF: p. 281

28. Aspirin is generally considered to be the best analgesic to administer during pregnancy.

ANS: False Aspirin can cause a variety of birth defects involving many organs. Acetaminophen is generally considered safe in pregnancy. REF: p. 302

22. Antineoplastic agents stimulate the immune system.

ANS: False Because antineoplastic agents have an immunosuppressant effect, enhanced susceptibility to infection or a second malignancy may occur after treatment. REF: p. 274

22. The predominant feature of anaphylaxis is bronchodilation.

ANS: False Bronchoconstriction is the predominant feature of anaphylaxis. Other symptoms include apprehension, paresthesia, urticaria, edema, choking, cyanosis, coughing, and wheezing. REF: p. 235

33. Bupropion is an effective treatment for alcoholism.

ANS: False Bupropion is used for tobacco cessation. REF: pp. 317-318

23. Evaluation of the need for corticosteroid supplementation before a dental procedure is based primarily on the procedure being performed.

ANS: False Correct: The patient should be evaluated for likelihood of experiencing stress based on the patient's degree of anxiety, not the specific procedure planned. REF: p. 248

21. Corticosteroids increase resistance to infection.

ANS: False Corticosteroids decrease resistance to infection. They can also mask symptoms of infection because of their inflammatory action. REF: p. 244

56. Tooth eruption is delayed in children with diabetes.

ANS: False Diabetic children have been shown to differ from normal children in the median ages at which they lose their deciduous teeth and gain their permanent teeth. REF: p. 254

33. Force should be exerted to open the patient's mouth if muscle spasm is present as a result of tardive dyskinesia.

ANS: False Forces should not be exerted to open the patient's mouth for dental treatment because dislocations of the mandible can occur. REF: p. 227

24. The H1-receptor antagonists have varying cholinergic effects.

ANS: False H1-receptor antagonists have anticholinergic effects. Anticholinergic effects lead to xerostomia which can result in an increased caries rate in patients taking antihistamines. REF: p. 237

18. Herbal products will not interact with conventional drugs.

ANS: False Herbal products can interact with conventional drugs and cause disastrous results. REF: p. 322

20. Triclosan has not been shown to significantly reduce plaque and gingivitis when compared with placebo dentifrice.

ANS: False One triclosan-containing product has received the ADA's Seal of Acceptance for its antigingivitis effect. REF: p. 324

19. The FDA inspects all manufacturing facilities of herbal products for compliance.

ANS: False Only specific manufacturers that have demonstrated unsafe practices are subject to more frequent inspections. REF: p. 323

20. Slowly growing cells are more susceptible to inhibition or destruction by antineoplastic agents.

ANS: False Rapidly growing cells, such as neoplastic cells, are more susceptible to inhibition or destruction by antineoplastic agents. REF: p. 272

34. Chewing tobacco will not lead to cancer because the tobacco is not burned nor the smoke inhaled.

ANS: False Smokeless tobacco use poses significant oral health hazards, including cancer. REF: p. 317

23. The dental health care worker should not recommend any products containing alcohol to patients taking antineoplastic agents because antineoplastic agents produce a disulfiram reaction.

ANS: False The dental health care worker should not recommend any products containing alcohol because alcohol is drying to the oral mucosa. REF: p. 274

26. In managing the pregnant patient, avoiding elective dental treatment is best until the third trimester.

ANS: False The second trimester is the preferred time for dental treatment. REF: p. 300

39. A spacer is often placed between the metered dose inhaler and the mouth to decrease the amount of drug delivered to the lungs.

ANS: False The spacer increases the amount of drug delivered to the lungs. REF: p. 279

28. Most dental offices are well equipped to treat cardiac arrhythmias.

ANS: False The specific arrhythmia should be identified before an antiarrhythmic agent is selected. Most dental offices are not equipped to treat arrhythmias. REF: p. 297

30. Abuse is the use of a drug for a disease state in a way considered inappropriate.

ANS: False The use of a drug for a disease state in a way considered inappropriate is misuse. REF: p. 309

34. Conventional antipsychotics may be used as a chemical restraint in nursing homes.

ANS: False Use of these agents as chemical restraints in nursing homes is unethical. REF: p. 228

16. Most of the herbal products available contain ingredients that produce profound pharmacologic effects.

ANS: True REF: p. 321

59. Acarbose (Precose) slows the breakdown of ingested carbohydrates so that postprandial hyperglycemia is reduced.

ANS: True Acarbose (Precose) is an α-glucosidase inhibitor. It slows the breakdown of ingested carbohydrates so that postprandial hyperglycemia is reduced. REF: p. 259

21. The H2-receptors are responsible for stimulating gastric acid secretion.

ANS: True Agents that block or antagonize the effects at H2-receptors are called H2-blockers. REF: p. 235

27. Although opioids appear in breast milk when analgesic doses are administered, the small amounts appear have an insignificant effect on the nursing infant.

ANS: True Although large doses used by opioid addicts can cause adverse effects on the nursing infant, small analgesic doses appear to be safe. REF: p. 302

19. Antineoplastic agents may be used in the management of diseases with an inflammatory component.

ANS: True Antineoplastic agents were designed to treat malignancies. A relatively new use of these agents is in the management of diseases with an inflammatory component such as psoriasis, rheumatoid arthritis, and systemic lupus erythematosus. REF: p. 269

32. Atypical antipsychotics have fewer side effects than conventional antipsychotics.

ANS: True As with conventional antipsychotics, the atypical antipsychotics are effective against the positive effects associated with psychoses. Unlike conventional antipsychotics, however, the atypical antipsychotics are effective against the negative effects. REF: p. 226

57. Diabetes is the major cause of blindness in adults

ANS: True Because microvascular disease affects the blood supply to the retina, functioning of the retina is impaired in the person with diabetes. REF: p. 254

21. Bisphosphonate-free holidays are not recommended before a dental procedure because these drugs stay in the bone for years.

ANS: True Bisphosphonate therapy is often stopped until the bone heals or the disease progresses to the point that bisphosphonate therapy is necessary. REF: p. 273

40. Nonchlorinated hydrofluoroalkane (HFA) propellants do not deplete the ozone layer.

ANS: True Chlorofluorocarbons, which have ozone-depleting properties, have been phased out as propellants in MDIs. They have been replaced by the nonchlorinataed HFA propellants that do not deplete the ozone layer. REF: p. 279

30. The wives of dental personnel who are exposed to trace amounts of nitrous oxide in the workplace have a higher incidence of spontaneous abortion.

ANS: True Continued exposure to small amounts of nitrous oxide by a man or woman can adversely affect the progress of a subsequent pregnancy. REF: p. 305

35. The chemoreceptor trigger zone (CTZ) is a site of action for prochlorperazine and promethazine.

ANS: True Correct: Prochlorperazine and promethazine are both phenothiazines. They are antiemetic compounds by virtue of their ability to depress the CTZ. REF: p. 228

31. During drug withdrawal, symptoms appear that are opposite of the symptoms of drug use.

ANS: True For instance, excessive parasympathetic action such as diarrhea, lacrimation, and piloerection ("cold turkey") can occur when withdrawing from the opioids. REF: p. 309

20. The precise physiologic function of histamine is not clear.

ANS: True Many of its peripheral actions are well known, but its precise physiologic function, particularly in the CNS, is unclear. REF: p. 234

55. No treatment should be initiated for any patient with a visible goiter, exophthalmos, or a history of taking antithyroid drugs until approval is obtained from the patient's physician

ANS: True Medical management of the condition is important before any elective surgery is performed. A surgical procedure or an acute oral infection could precipitate a crisis. REF: p. 252

38. Researchers have suggested that oxygen be limited to less than 3 L/min for patients with severe COPD.

ANS: True Other literature recommends that oxygen by nasal cannula be used during a dental appointment for patients with severe COPD, especially if pain or stress is anticipated. REF: p. 278

26. The drug of choice for anaphylactic shock is sublingual or intramuscular injection of epinephrine.

ANS: True Parenteral epinephrine is the drug of choice and must be administered immediately in cases of severe anaphylactic shock. It may be given in the deltoid muscle or injected under the tongue. REF: p. 292

23. Sedation with antihistamines is additive with that caused by other CNS depressant drugs.

ANS: True Patients who are given antihistamines should be warned against operating a motor vehicle or signing important documents. REF: p. 237

36. SSRIs tend to produce CNS stimulation rather than CNS depression.

ANS: True SSRIs do not have the sedative actions found within many tricyclic antidepressants. As a class, they tend to be less sedating, although sedation is sometimes seen with some members of this class (e.g., sertraline). REF: p. 231

32. Drug withdrawal from sedative-hypnotic agents can be more life threatening than withdrawal from opioids.

ANS: True Sedative-hypnotic agent withdrawal can lead to life-threatening seizures. REF: p. 316

58. The glycosylated hemoglobin test more accurately measures the patient' overall serum glucose control than the serum glucose test.

ANS: True Serum glucose is a measure of the patient's glucose control at the time that the blood is sampled. It does not reflect the patient's overall glucose control. The glycosylated hemoglobin test more accurately measures the patient's overall serum glucose control because it reflects the glucose control over a 2- to 3-month period. REF: p. 256

29. All NSAIDs carry a warning to avoid use during pregnancy.

ANS: True Studies in animals have not shown adverse effects on the fetus for ibuprofen and naproxen. Diflunisal (category C), but not naproxen (category B), has been shown to be teratogenic in rabbits in large doses. REF: p. 302

22. Most dental patients taking steroids who are having normal dental treatment rendered do not need additional corticosteroids.

ANS: True Supplemental steroids may be required if the patient has severe dental fears or for major surgical procedures. REF: p. 246

19. Levels of endogenous corticosteroids can increase tenfold in response to an especially stressful stimulus.

ANS: True The body can protect itself from a stressful episode by raising the circulating corticosteroid as much as tenfold. REF: p. 242

62. Hormones from the opposite sex are often used to manage prostate, breast, and uterine cancers.

ANS: True The cancer is often stimulated by the patient's own sex hormones. For example, prostate cancer is often stimulated by testosterone, so men with prostate cancer are given estrogens to inhibit the cancer's growth. REF: pp. 266-267

61. Hormonal contraceptives have the potential to cause or aggravate gingival inflammation.

ANS: True The hormones in contraceptives increase gingival fluid, stimulate gingivitis, and are associated with gingival inflammation similar but not as prominent as that seen in pregnancy. REF: p. 265

20. The adverse effects of glucocorticoids are primarily an extension of their therapeutic actions.

ANS: True The immunosuppressant and antiinflammatory actions of glucocorticoids not only serve therapeutic purposes, but also produce many of these agents' most severe adverse effects. REF: p. 243

41. One common mistake that many asthmatics make is to rely on their albuterol inhaler and omit using their steroid inhaler.

ANS: True The reason this mistake occurs is because the albuterol gives an immediate response. REF: p. 279

24. Drugs are not necessary for the proper management of most emergencies.

ANS: True The use of drug therapy is only ancillary to the primary measures of maintaining adequate circulation and respiration. REF: p. 291

25. Some of the antihistamines have an antiemetic action and are used to prevent and treat motion sickness.

ANS: True They also may be used to control postoperative vomiting and vomiting induced by radiation therapy. REF: p. 237

60. Estrogen therapy may promote endometrial carcinoma in postmenopausal women

ANS: True This risk may be canceled out by administration of a progestin for the last 10 days of the cycle. REF: p. 263

17. Labels for DSHEA products can contain claims of effects on the structure or function of the body.

ANS: True Thus a natural product could be said to "increase immunity" without a comment about what that might mean to a person's health. REF: p. 321

25. Convulsions are generally self-limiting, and treatment should include protecting the patient from self-harm.

ANS: True Treatment should include protecting the patient from self-harm, moving any sharp objects out of the patient's reach, and turning the patient's head to the side to prevent aspiration. REF: p. 292

8. A 5-mg oral dose of hydrocortisone would be equivalent to what dose of triamcinolone? a. 1 mg b. 2 mg c. 5 mg d. 10 mg e. 20 mg

ANS: a A 5-mg dose of triamcinolone is equivalent to 20 mg of hydrocortisone with oral dosing. Thus 1 mg of triamcinolone is equivalent to 5 mg of hydrocortisone. REF: p. 242, 246

12. The first line of treatment for intermittent asthma is a: a. Short-acting β2-adrenergic agonist b. Long-acting β2-adrenergic agonist c. Corticosteroid d. Mast cell degranulation inhibitor e. Methylxanthine

ANS: a A short-acting β2-adrenergic agonist is the first line of treatment for intermittent asthma. Short-acting β2-agonists are the drugs of choice for the emergency treatment of an acute asthma attack. These agents should be used primarily for the treatment of acute problems, not for the management of normal breathing function. REF: p. 279

13. Acemannan is available as an over-the-counter (OTC) topical patch to reduce the healing time of: a. Aphthous ulcers b. Oral herpes lesions c. Dullous lesions d. Oral abrasions

ANS: a Acemannan hydrogel is an extract of the aloe vera plant leaf that has immunomodulating properties. It is available as an OTC topical patch to reduce the healing time of aphthous ulcerations. REF: p. 324

18. Which of the following tetracyclines is(are) contraindicated in pregnancy? (1) tetracycline, (2) minocycline, (3) doxycycline a. 1, 2, 3 b. 1, 2 c. 2, 3 d. 1, 3 e. 1 only

ANS: a All tetracyclines are contraindicated during pregnancy because of the potential for adversely affecting the fetus. They cross the placenta and are deposited in fetal teeth and bones. Deciduous teeth may become stained, and fetal bone growth inhibited. REF: p. 305

16. Allopurinol, used to prevent hyperuricemia, can prolong the action and increase the toxicity of all of the following except one. Which is the exception? a. 5-Fluorouracil b. Azathioprine c. Cyclophosphamide d. Mercaptopurine

ANS: a Allopurinol decreases the metabolism and clearance of azathioprine and mercaptopurine, and increases the toxicity of cyclophosphamide. It does not enhance the toxicity of 5-fluorouracil. REF: p. 274

3. The recent trend in the use of natural or herbal substances has been a(an) __________ in the use of these products and the number of people using them. a. Exponential rise b. Steady rise c. Slight decrease d. Marked decline

ANS: a An exponential rise has occurred in the use of these products and the number of people using them. REF: p. 320

3. Asthma may be precipitated by: (1) allergens, (2) exercise, (3) stress a. 1, 2, 3 b. 1, 2 c. 1, 3 d. 2, 3

ANS: a Asthma may be precipitated by allergens, pollution, exercise, stress, or upper respiratory tract infection. REF: p. 277

45. The increase in gingiva inflammation may occur even with a decrease in the amount of plaque. This circumstance may be a result of increased levels of prostaglandin E (PGE), estradiol, and progesterone in the saliva. a. Both statements are true. 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: a Changes in sex hormone levels during the life of the female are related to the development of gingivitis at puberty, during pregnancy, and after menopause. Conscientious plaque control helps to minimize these conditions. REF: p. 264

15. Which of the following statement is true of alcoholism? a. A genetic link for alcoholism exists. b. Inpatient detoxification is required for most alcoholics. c. Penicillin is known to produce a disulfiram-like reaction. d. A patient will vomit if he or she takes naltrexone while consuming alcohol.

ANS: a Correct: A genetic link for alcoholism has been found; children of alcoholics are at much greater risk for becoming alcoholics. Genetic testing may someday be able to identify at-risk children and target this population for intense educational and social intervention for prevention. REF: p. 311

6. The drug of choice for anaphylactic shock is parenteral epinephrine rather than an antihistamine because antihistamines antagonize only one of the mediators released in an anaphylactic response. a. Both the statement and the reason are correct and related. b. Both statements are correct but not related. c. The statement is correct, but the reason is not. d. The statement is not correct, but the reason is accurate. e. Neither the statement nor the reason is correct.

ANS: a Correct: A mild allergic reaction to a drug may be treated with antihistamines in the dental office. If the allergic reaction is severe, epinephrine is the drug of choice. REF: p. 235

34. Acarbose lowers blood glucose by: a. Slowing glucose absorption b. Enhancing insulin secretion c. Decreasing hepatic glucose production d. Increasing peripheral glucose uptake

ANS: a Correct: Acarbose is an -glucosidase inhibitor. Simply stated, it slows the breakdown of ingested fat so that postprandial hyperglycemia is reduced. Incorrect choices: Acarbose works within the GI tract and does not act by enhancing insulin secretion, decreasing hepatic glucose production, or decreasing peripheral glucose uptake. REF: p. 259

18. Which drug is associated with a deficiency of coagulation factors II, VII, IX, and X after chronic abuse? a. Ethyl alcohol b. Nicotine c. Cocaine d. Nitrous oxide

ANS: a Correct: Because of ethyl alcohol-induced hepatic failure, the liver is able to store less vitamin K, which is required for the synthesis of coagulation factors II, VII, IX, and X. Incorrect choices: The other agents do not produce a deficiency in these clotting factors. REF: p. 313

11. Which of the following H1 antihistamines is nonsedating? a. Cetirizine b. Hydroxyzine c. Chlorpheniramine d. Diphenhydramine e. Cyproheptadine

ANS: a Correct: Cetirizine is a newer antihistamine that has limited ability to cross the blood-brain barrier and thus a greatly reduced ability to produce CNS effects such as drowsiness. Incorrect choices: Hydroxyzine a piperazine; chlorpheniramine, an alkylamine; diphenhydramine, an ethanolamine; and cyproheptadine, a piperadine, are all classic H1 antihistamines that produce CNS side effects such as drowsiness. REF: pp. 236, 238

30. Which of the following adverse reactions is common to all of the currently marketed H2-blocking agents? a. Abnormal liver function tests b. Thrombocytopenia c. Slurred speech d. Gynecomastia

ANS: a Correct: Cimetidine, ranitidine, and famotidine all can cause this adverse reaction. Incorrect choices: Others are adverse effects of cimetidine, but neither ranitidine nor famotidine. REF: p. 285

16. Which one of the following drugs can result in oral candidiasis? a. Fluticasone b. Phenytoin c. Acetaminophen d. Metoprolol e. Omeprazole

ANS: a Correct: Fluticasone is a corticosteroid that is inhaled for patients with asthma and respiratory problems. Corticosteroids are known to result in oral candidiasis; therefore make sure the patient rinses after using his or her inhaler. Incorrect choices: Phenytoin is for seizures and can cause gingival hyperplasia. Acetaminophen is an analgesic. Metoprolol is a selective beta-blocker used to treat high blood pressure. Omeprazole is a proton-pump inhibitor used to treat ulcers and gastroesophageal reflux disease (GERD). REF: p. 281

4. Which of the following symptoms is not a pharmacologic effect of histamine? a. Vasoconstriction b. Gastric acid secretion c. Bronchoconstriction d. Pain at cutaneous nerve endings

ANS: a Correct: Histamine causes vasodilation, not vasoconstriction. Incorrect choices: Histamine does increase gastric acid secretion, bronchoconstriction, and itching and pain at the cutaneous nerve endings. REF: p. 234

44. Estrogens are used to treat menstrual disturbances such as uterine bleeding. Estrogen is also used to reduce the symptoms of menopause. a. Both statements are true. 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: a Correct: In addition to their presence in oral contraceptives, estrogens are used to treat menstrual disturbances (dysmenorrhea, dysfunctional uterine bleeding), osteoporosis, atrophic vaginitis, nondevelopment of the ovaries, hirsutism, cancer, and symptoms of menopause. REF: p. 263

41. Which female hormone promotes egg maturation? a. FSH b. LH c. Estrogen d. Progesterone e. Chorionic gonadotropin

ANS: a Correct: In response to increased FSH, an ovarian egg matures, and the follicle in which it is contained grows in size and begins to produce and secrete estrogen. Incorrect choices: LH causes secretory cells of the follicle to develop into the corpus luteum. Estrogen prepares the reproductive system for conception. Progesterone promotes secretory changes in the endometrium and prepares the uterus for implantation of the fertilized ovum. Chorionic gonadotropin is released from trophoblasts after implantation. REF: pp. 262-263

2. Patients with __________ asthma experience symptoms less than two times a month, and the symptoms do not interfere with normal activity. a. Intermittent b. Mild persistent c. Moderate persistent d. Severe persistent

ANS: a Correct: Intermittent asthma is characterized by the presence of symptoms less than two times a month, and the symptoms do not interfere with normal activity. Incorrect choices: Persistent asthma occurs anywhere from more than twice a week to all day long. Persistent asthma can cause minor limitations of normal activities, and severe persistent asthma can severely limit the patient's normal activities. REF: p. 276

35. The following are actions of metoclopramide except for one. Which one is the exception? a. Decreases peristalsis by acting directly on smooth muscle of the gastrointestinal tract b. Blocks the action of dopamine c. Accelerates gastric emptying time d. Increases the tone of the lower esophageal sphincter

ANS: a Correct: Metoclopramide stimulates motility of the upper gastrointestinal tract and increases peristalsis in the duodenum. Incorrect choices: Others are all actions of metoclopramide. REF: p. 286

12. Which of the following choices is not a symptom of ethyl alcohol intoxication? a. Constricted pupils b. Impairment of judgment c. Ataxia d. Emotional lability

ANS: a Correct: Moderate acute intoxication with ethyl alcohol produces dilated pupils, not constricted pupils. Incorrect choices: The other choices are all characteristic of ethyl alcohol intoxication. REF: p. 310

43. What causes ovulation on day 14 of the menstrual cycle? a. An increase in the rate of secretion of FSH and LH b. A decrease in the rate of secretion of FSH and LH c. The release of large quantities of estrogen d. The release of large quantities of progesterone

ANS: a Correct: On approximately day 12, for reasons not entirely understood, the rate of secretion of FSH and LH increase markedly to cause a rapid swelling of the follicle that culminates in ovulation on day 14. Incorrect choices: After ovulation, LH causes the secretory cells of the follicle to develop into a corpus luteum that secretes large quantities of estrogen and progesterone. This action causes a feedback decrease in the secretion of both FSH and LH. REF: p. 263

14. Which PG is used clinically for its oxytocic activity? a. Prostaglandin E2 (PGE2) b. Prostacyclin c. Thromboxane A2 d. Leukotriene B4 e. Prostaglandin H (PGH)

ANS: a Correct: PGE2, as with PGF2 is used as an abortifacient and to induce labor. Incorrect choices: Prostacyclin relaxes uterine smooth muscle. Thromboxane A2 stimulates uterine contraction but is too unstable for clinical use. Leukotriene B4 is not a PG and is not reported to have this activity. PGH is a precursor to PGE2 and PGF2. REF: p. 239

16. Which of the following is true regarding PGs and periodontal disease? a. PGs are thought to be mediators of the inflammatory response in oral soft tissues. b. PGs stimulate the synthesis of new bone by initiating osteoblastic activity. c. PGs decrease capillary permeability. d. Several autocoids, such as PGs, leukotrienes (LTs), and cytokines have been involved in arresting periodontal disease.

ANS: a Correct: PGs are thought to be mediators of the inflammatory response in oral soft tissues and may be involved in this initial stage of periodontal disease. Incorrect choices: PGs prevent the synthesis of new bone by inhibiting osteoblastic activity. Other effects include increased heart rate and cardiac output, increased capillary permeability, increased renal blood flow, sedation, and stimulation of pain fibers. Several autocoids, such as PGs, LTs, and cytokines, have been found to be involved in the production of periodontal disease. REF: p. 239

24. The triad of narcotic overdose is: a. Respiratory depression, pinpoint pupils, and coma b. Hyperactive behavior, dilated pupils, and cardiac arrhythmias c. Elevated blood pressure, blank stare, and rigidity d. Respiratory depression, cardiac depression, and sleep

ANS: a Correct: Respiratory depression, pinpoint pupils, and coma are key signs of opioid overdose. Incorrect choices: The other sets of signs are characteristic of amphetamine overdose, of phencyclidine overdose, and of sedative-hypnotic overdose, respectively. REF: p. 314

21. The following treatments are accepted for malignant hyperthermia, except one. Which one is the exception? a. Succinylcholine b. Baths and aspirin c. Dantrolene d. Fluid replacement e. Sodium bicarbonate

ANS: a Correct: Succinylcholine is an agent that may precipitate malignant hyperthermia, not treat it. Incorrect choices: The other options are all accepted methods of managing malignant hyperthermia. REF: p. 294

3. Which of the following is a method of preventing an emergency in the dental office? a. Taking a complete patient history b. Training of personnel c. Posting the telephone numbers for the closest physician, emergency room, and ambulance service d. Having a well-stocked and up-to-date emergency kit

ANS: a Correct: Taking a complete patient history can minimize and prevent emergencies. Incorrect choices: The other choices are measures to take in case of an emergency but not to prevent an emergency. REF: pp. 290-291

22. Which of the following medications is used to treat persistent asthma and the bronchospasm associated with chronic bronchitis and emphysema? a. Theophylline b. Ipratropium c. Omalizumab d. Cromolyn

ANS: a Correct: Theophylline is used to treat persistent asthma and the bronchospasm associated with chronic bronchitis and emphysema. Bronchodilation is the major therapeutic effect desired. Incorrect choices: Ipratropium is a short-acting anticholinergic available for oral inhalation for people with COPD. Omalizumab is the first in a new class of medications introduced to treat asthma due to allergens. Cromolyn is effective only for the prophylaxis of asthma and not for treatment of an acute attack. REF: p. 282

3. The type of depression that seems to be unrelated to external events is called __________ depression. a. Involutional b. Unipolar c. Manic d. Exogenous e. Reactive

ANS: a Endogenous (involutional) depression seems to be unrelated to external events, whereas exogenous (reactive) depression appears to be related to specific external events. The condition in patients who exhibit only depression is termed unipolar depression. Manic depression is an oxymoron, given that the two terms are opposite one another. REF: p. 224

37. Exenatide (Byetta) is the first of a new class of drugs called: a. Incretin mimetics b. Oral hypoglycemic agents c. Euglycemic agents d. Oral antidiabetic agents

ANS: a Exenatide, an incretin mimetic, has an amino acid sequence similar to human glucagon-like peptide-1 (GLP-1) and in the presence of glucose acts to stimulate insulin secretion. Exenatide is indicated as an alternative to starting insulin in patients with type II diabetes who have not achieved adequate control with metformin, a sulfonylurea, or both. REF: p. 259

1. Which of the following reasons is why people are turning to health supplements? (1) cultural influences, (2) a sense of taking control of one's health, (3) distrust of physicians, (4) lack of health insurance a. 1, 2, 3, 4 b. 1, 2, 3 c. 2, 3, 4 d. 1, 2 e. 3, 4

ANS: a Herbal supplements are available without a prescription, which eliminates the cost and time of visiting a health care professional who can prescribe conventional medicine. Other people have turned to herbal supplements because of cultural influences, a sense of taking control of one's health, distrust of physicians, and a lack of health insurance. REF: p. 320

14. Insulin resistance develops because of prolonged __________ and resulting __________. a. Hyperglycemia, hyperinsulinemia b. Hyperglycemia, hypoinsulinemia c. Hypoglycemia, hyperinsulinemia d. Hypoglycemia, hypoinsulinemia

ANS: a Hyperglycemia and resulting hyperinsulinemia lead to insulin resistance. Tissue insensitivity to insulin, a deficiency of the pancreas's response to glucose, and obesity results in impaired insulin action. In the presence of hyperglycemia, the resistance of the tissues to insulin and the impaired β cells' response are exaggerated. REF: p. 253

11. Which of the following is the NSAID of choice for the nursing mother? a. Ibuprofen b. Naproxen c. Diflunisal d. Ketoprofen

ANS: a Ibuprofen is the NSAID of choice for the nursing mother. All NSAIDs carry a warning to avoid use during pregnancy. REF: p. 302

32. Magnesium sulfate should be used with caution in patients with renal impairment because hypermagnesemia has been reported in patients with renal disease. a. Both the statement and the reason are correct and related. b. Both the statement and the reason are correct, but not related. c. The statement is correct, but the reason is not. d. The statement is not correct, but the reason is correct. e. Neither the statement nor the reason is correct.

ANS: a Magnesium from magnesium sulfate may be absorbed into the body. This magnesium will not be properly excreted through the kidney from patients with renal impairment, and the level of magnesium in the body may become abnormally high. REF: p. 286

3. Antimetabolites such as methotrexate attack the cells at the S phase of the cell cycle because they interfere with purine and pyrimidine biosynthesis. a. Both parts of the statement are true. b. Both parts of the statement are false. c. The first part of statement is true, the second part is false. d. The first part of statement is false, the second part is true.

ANS: a Methotrexate, by inhibiting folic acid synthesis, decreases the ability of cells to make purines and pyrimidines, which are needed for DNA replication during the S (or synthetic) phase of the cell cycle. REF: p. 271

2. Manufacturers of natural or herbal substances do not have to prove efficacy in treating or preventing a specific disease nor can they make that claim. a. Both parts of the statement are true. b. Both parts of the statement are false. c. The first part of the statement is true, the second part is false. d. The first part of the statement is false, the second part is true.

ANS: a Natural or herbal substances are considered to be natural products or dietary supplements. Manufacturers can state that the herbal or natural product can be used for general health and well-being. REF: p. 320

21. Which of the following statements is true of the use of nystatin in either a pregnant woman or a nursing infant? a. Nystatin may be used by either the pregnant woman or nursing infant. b. Nystatin may be used by a pregnant woman, but not by a nursing infant. c. Nystatin may be used by a nursing infant, but not by a pregnant woman. d. Nystatin is not to be used by either a pregnant woman or a nursing infant.

ANS: a Nystatin is safe to use during pregnancy to treat oral Candida infections. It is not absorbed into the systemic circulation when taken orally or applied topically. It also may be used by either the pregnant woman or the nursing infant to treat thrush. REF: p. 305

12. Phenothiazines cause hypotension by blocking which receptor? a. -Adrenergic b. -Adrenergic c. Dopamine d. Acetylcholine

ANS: a Phenothiazines, conventional antipsychotics, cause hypotension by blocking -adrenergic receptors. REF: p. 227

18. The appointment should be scheduled __________ chemotherapy when providing oral care for patients on antineoplastic agents. a. Just before starting b. After the first few days of c. During the course of d. only after

ANS: a Schedule the appointment for oral care for patients on antineoplastic agents just before the next chemotherapy. The procedures should be planned to coincide with the presence of the highest level of formed blood elements. That time would be either just before treatment or on the first few days of treatment. REF: p. 274 TRUE/FALSE

25. The most common adverse reaction associated with any insulin product is: a. Hypoglycemia b. Hyperglycemia c. Intestinal stasis d. Bradycardia

ANS: a The dental health care worker should be most concerned about a hypoglycemic reaction in the dental patient with diabetes who takes insulin. This reaction can be caused by an unintentional overdose of insulin, failure to eat, or increased exercise or stress. REF: p. 257

12. Thromboxane, produced by platelets, stimulates platelet aggregation and is a vasoconstrictor, whereas prostacyclin, produced by the vessel walls, inhibits platelet aggregation and is a vasodilator. a. Both parts of the statement are true. b. Both parts of the statement are false. c. The first part of the statement is true, the second part is false. d. The first part of the statement is false, the second part is true.

ANS: a Thromboxane is produced by platelets and prostacyclin is produced by vessel walls. The former stimulates platelet aggregation, whereas the latter inhibits platelet aggregation. REF: p. 239

18. Which of the following are anticholinergic effects that may be associated with tricyclic antidepressants? a. Xerostomia b. Bradycardia c. Urination d. Both a and b e. Both b and c

ANS: a Tricyclic antidepressants possess distinct anticholinergic effects resulting in xerostomia, blurred vision, tachycardia, constipation, and urinary retention. Some tolerance can develop with continued use. REF: p. 230

14. Anaphylactic shock is characterized by a __________ pulse. a. Weak, rapid b. Weak, slow c. Strong, rapid d. Strong, slow

ANS: a Usually, a weak, rapid pulse and a profound decrease in blood pressure occur with anaphylactic shock. Dyspnea and severe bronchial constriction occur. The reaction usually begins within 5 to 30 minutes after ingestion or administration of the antigen. REF: p. 292

4. Without stress, the normal adult secretes approximately __________ of hydrocortisone daily. a. 20 mg b. 40 mg c. 5 mg d. 40 g e. 10 mg

ANS: a Without stress, the normal adult secretes approximately 20 mg of hydrocortisone daily. REF: pp. 241-242

29. Adverse reactions to metformin occur primarily in the: a. Liver b. GI tract c. Oral cavity d. Cardiovascular system

ANS: b Adverse reactions are primarily related to the GI tract (30%) and include anorexia, dyspepsia, flatulence, nausea, and vomiting. It can produce headache and interfere with vitamin B12 absorption. It accumulates in renal and hepatic impairment. REF: p. 257

31. Which of the following categories of medications has recently been approved for the treatment of bipolar disorder? a. High-potency conventional antipsychotics b. Atypical antipsychotics c. SSRIs d. MAOIs

ANS: b All of the atypical antipsychotics have been approved for the treatment of bipolar disorder, as well as for the acute treatment of bipolar disorder. Olanzapine and aripiprazole are approved for relapse prevention of bipolar disorder. REF: p. 232 TRUE/FALSE

7. Which of the following groups of medications are considered first-line treatment for COPD? a. β-adrenergic agonists b. Anticholinergics c. Methylxanthines d. Leukotriene (LT) antagonists

ANS: b Anticholinergics are considered first-line treatment for chronic bronchitis and emphysema, but β-adrenergic agonists and methylxanthines are also used to produce bronchodilation in these patients. In many instances, patients receive a combination metered-dose inhaler (MDI) with an anticholinergic drug and a β2-adrenergic agonist. REF: p. 278

10. The vast majority of cases of osteonecrosis have been reported in patients with cancer who are receiving __________ bisphosphonates. a. Oral b. Intravenous c. Intramuscular d. Subcutaneous

ANS: b Approximately 94% of all cases of osteonecrosis have been reported in patients with cancer who are receiving intravenous bisphosphonates, particularly pamidronate and zoledronic acid, for multiple myeloma or metastatic carcinoma. The incidence is much lower for patients who are taking oral bisphosphonates. REF: p. 273

1. Asthma is characterized by __________ airway obstruction and is associated with reduction in __________ airflow. a. Reversible, inspiratory b. Reversible, expiratory c. Irreversible, inspiratory d. Irreversible, expiratory

ANS: b Asthma is characterized by reversible airway obstruction and is associated with a reduction in expiratory airflow. Inflammation occurs a few hours later, resulting in an increase in secretions in the lungs and swelling in the bronchioles. REF: p. 276

7. Simple goiter is prevalent in some areas of the world because iodine is abundant in most foods. a. Both the statement and the reason are correct. b. The statement is correct, but the reason is not. c. The statement is not correct, but the reason is correct. d. Neither the statement nor the reason is correct.

ANS: b Because iodine is not abundant in most foods, simple goiter is quite prevalent in some areas of the world. Marine life is the only common food that is naturally rich in iodine. Use of iodized salt has decreased the incidence of simple goiter in many countries. REF: p. 251

26. Bupropion is reserved for patients who are not responsive to other agents because of a potential for: a. Cardiac arrhythmias b. Seizures c. Retinopathy d. Glaucoma

ANS: b Because of its seizure potential, bupropion is reserved for patients who are not responsive to other agents. Approximately 0.4% of patients treated with bupropion have experienced seizures. This incidence may be four times greater than with tricyclic antidepressants and as much as 10 times greater with tricyclic antidepressants at higher doses. REF: p. 231

14. Epinephrine should not be used to treat vasomotor collapse in patients taking conventional antipsychotics because the conventional antipsychotics are: a. α-Adrenergic stimulators b. α-Adrenergic blockers c. β-Adrenergic stimulators d. β-Adrenergic blockers

ANS: b Because the conventional antipsychotics are α-adrenergic blockers, epinephrine should not be used to treat vasomotor collapse because it could cause a further decrease in blood pressure. This occurs as a result of the predominant β-agonist activity of epinephrine in the presence of the conventional antipsychotics (α-blockers). REF: p. 227

14. Chronic alcohol use increases the risk of cancer of the mouth, pharynx, larynx, esophagus, and liver, which may occur with tobacco use in a __________ effect. a. Additive b. Synergistic c. Negative d. Canceling

ANS: b Chronic alcohol use increases the risk of cancer of the mouth, pharynx, larynx, esophagus, and liver, which may occur with tobacco use to make the risk higher than with alcohol alone. REF: p. 311

13. Which of the following atypical antipsychotics is associated with agranulocytosis? a. Aripiprazole b. Clozapine c. Quetiapine d. Risperidone e. Ziprasidone

ANS: b Clozapine should be tried only after several trials of other agents have failed because it produces a potentially life-threatening agranulocytosis. With the release of newer atypical antipsychotic agents, use of this agent has decreased. REF: p. 227

39. Which of the following oral antidiabetic agents is a bile-acid sequestrant used to lower low-density lipoprotein (LDL) cholesterol? a. Pramlintide b. Colesevelam c. DPP-4s d. Glucagon

ANS: b Colesevelam (WelChol) is a bile-acid sequestrant that is used to lower LDL cholesterol. Its mechanism of action in treating type II diabetes is unclear. It has been approved by the FDA as an adjunct to diet and exercise for the treatment of type II diabetes. REF: p. 262

7. Older H1 antihistamines find utility in dentistry for the following effects except for one. Which one is the exception? a. Sedative effects b. Anticholinergic effects c. Antiemetic effects d. Local anesthetic effects

ANS: b Correct: Anticholinergic effects lead to xerostomia, which can cause numerous dental problems. Incorrect choices: Antihistamines can be used to manage postoperative nausea and vomiting, especially when opioid agents have been used. They are also used for preoperative sedation. Antihistamines are also applied topically for their local anesthetic effects (the local anesthetic potency of some antihistamines approximates procaine). REF: pp. 235, 237

4. An example of a cell-cycle nonspecific antineoplastic agent is: a. Bleomycin b. Cisplatin c. Methotrexate d. Vincristine

ANS: b Correct: Cisplatin, an inorganic platinum compound, has antitumor activity that is independent of which cell cycle phase a tumor cell is in. Incorrect choices: The actions of bleomycin, methotrexate, and vincristine are influenced by the phase of the cell cycle a tumor cell is in. REF: p. 272

22. Which of the following tricyclic antidepressants is used for the treatment of obsessive-compulsive disorder? a. Amitriptyline b. Clomipramine c. Doxepin d. Nortriptyline

ANS: b Correct: Clomipramine is used only in the treatment of obsessive-compulsive disorder. Patients with obsessive-compulsive disorder repeatedly perform certain rituals such as hand washing. Incorrect choices: Amitriptyline is used when sedation is desired. Doxepin is used when an antianxiety effect is desired. Nortriptyline or protriptyline can be tried when less sedation is needed. REF: p. 231

8. Which of the following statement is true regarding addiction, habituation, and dependence? a. When comparing drugs of the same group, the time required to produce physical dependence is longest with a rapidly metabolized drug and shortest with a slowly metabolized drug. b. Cross-tolerance may be either partial or complete and is determined more by the pharmacologic effect of the drug than by its chemical structure. c. The longer the half-life of the drug is, the quicker the withdrawal will be. d. A barbiturate can be substituted for an opioid, and vice versa.

ANS: b Correct: Cross-tolerance may be either partial or complete and is determined more by the pharmacologic effect of the drug than by its chemical structure. Incorrect choices: When comparing drugs of the same group, the time required to produce physical dependence is shortest with a rapidly metabolized drug and longest with a slowly metabolized drug. The shorter the half-life is, the quicker the withdrawal will be. If a person is addicted to heroin, an opioid, then other opioids, such as morphine, can prevent withdrawal. However, a barbiturate cannot be substituted for an opioid, and vice versa. REF: pp. 309-310

10. The following are signs of Cushing syndrome except for one. Which one is the exception? a. Moon face b. Hypoglycemia c. Muscle wasting d. Fat deposit on back of neck

ANS: b Correct: Cushing syndrome is caused by an overabundance of corticosteroids. Glucocorticoids increase gluconeogenesis and decrease glucose usage, allowing a higher glucose concentration in the blood. Incorrect choices: Cushing syndrome causes moon (round) face, muscle wasting, and buffalo hump (fat deposit on back of neck). REF: p. 244

16. The following are likely reasons why diabetics have a higher incidence of periodontal disease except one. Which one is the exception? a. Enhanced collagenase activity b. Loss of capillary basement membrane integrity c. Changes in glucose tolerance factor d. Microangiopathy of the tissues e. Altered polymorphonuclear leukocyte (PMNL) function

ANS: b Correct: Diabetes causes a thickening of the capillary basement membrane, not a decrease in its integrity, which may compromise the transport and exchange functions of the capillaries. Incorrect choices: Enhanced collagenase activity will enhance the breakdown of connective tissue. Changes in glucose tolerance factor increases glucose levels. Microangiopathy of the tissues impairs circulation. Altered PMNL function decreases the innate immune response. All of these are considered candidates for the etiology of diabetes-induced periodontal disease. REF: p. 254

9. Which of the following statements is characteristic of diffuse toxic goiter? a. It is also known as Plummer disease. b. It is characterized by a diffusely enlarged, highly vascular thyroid gland. c. It occurs primarily in older patients and usually arises form long-standing nontoxic goiter. d. Both a and b are characteristic. e. Both b and c are characteristic.

ANS: b Correct: Diffuse toxic goiter is characterized by a diffusely enlarged, highly vascular thyroid gland. It is common in young adults and is considered to be a disorder of the immune response. Incorrect choices: Diffuse toxic goiter is called Graves disease. Toxic nodular goiter is called Plummer disease. Toxic nodular goiter is characterized by nodules within the gland that spontaneously secrete excessive amounts of hormone while the rest of the glandular tissue is atrophied. It occurs primarily in older patients and usually arises from long-standing nontoxic goiter. REF: p. 251

10. Which one of the following antihistamines is suggested as an alternative agent to provide local anesthesia when a patient has exhibited allergies to the normally used anesthetic agents? a. Chlorpheniramine (Chlor-Trimeton) b. Diphenhydramine (Benadryl) c. Desloratadine (Clarinex) d. Loratadine (Claritin)

ANS: b Correct: Diphenhydramine can be used by injection to provide some local anesthesia. It not considered as effective as the local anesthetics that are usually chosen. Incorrect choices: Chlorpheniramine is an older antihistamine with anticholinergic activity that produces sedation. Desloratadine and loratadine are newer nonsedating antihistamines. REF: pp. 236, 238

11. Which of the following statements represents the primary disadvantage of the use of MDIs? a. The inhaled dose cannot be properly measured. b. They are difficult to use properly, and they can be abused. c. The onset of action is unpredictable. d. The bronchodilator effect is less than that of a comparable oral dose.

ANS: b Correct: Disadvantages of MDIs are that they are difficult to use properly (particularly for children) and they can be abused, with a resultant decrease in response. Incorrect choices: The inhaled dose can be accurately measured. The onset of action is rapid and predictable (versus unpredictable response with orally administered agents). The bronchodilator effect is greater than a comparable oral dose. REF: p. 279

15. The following agents have been demonstrated to produce skeletal abnormalities in the fetus except one. Which one is the exception? a. Doxycycline b. Erythromycin estolate c. Warfarin d. Aspirin

ANS: b Correct: Erythromycin estolate is not teratogenic. Incorrect choices: Doxycycline can inhibit fetal bone growth, warfarin can cause chondrodysplasia and hypoplastic nasal bridge, and aspirin can cause birth defects involving the skeleton. REF: pp. 303, 305

5. The following statements are descriptive of psychologic dependence except one. Which one is the exception? a. It may vary from mild desire to compulsive obsession. b. It is not as strong as physical dependence. c. It often involves drug-seeking behavior. d. It is a state in which the person feels unable to maintain optimal performance without the drug.

ANS: b Correct: Even though some highly abused drugs have only psychologic dependence, the "need" to use these drugs can be as strong or stronger than drugs with a physical dependence. Incorrect choices: All other statements are characteristic of psychologic dependence. REF: p. 309

10. Exophthalmos is a characteristic sign of: a. Cretinism b. Hyperthyroidism c. Acromegaly d. Dwarfism e. Hyperprolactinemia

ANS: b Correct: Exophthalmos is protrusion of the eyeballs and is characteristic of hyperthyroidism. Incorrect choices: Cretinism is a deficiency of thyroid hormone, acromegaly an overabundance of growth hormone, and dwarfism a deficiency in growth hormone. Neither these nor hyperprolactinemia causes exophthalmos. REF: pp. 251-252

12. Which of the following pancreatic hormones promote fuel mobilization? a. Insulin b. Glucagon c. Islet amyloid polypeptide (IAPP; amylin) d. pancreatic peptide

ANS: b Correct: Glucagon promotes fuel mobilization. Incorrect choices: Insulin promotes fuel storage. The functions of IAPP (amylin) and pancreatic peptide have not yet been elucidated. REF: p. 252

13. For which type of oral lesion would glucocorticoids be contraindicated? a. Desquamative gingivitis b. Herpetic gingivostomatitis c. Pemphigus d. Erythema multiforme e. Benign mucous membrane pemphigoid

ANS: b Correct: Herpes is a viral infection. A lesion of infectious etiology, such as herpes, must be ruled out because glucocorticoids can exacerbate infections. Incorrect choices: Desquamative gingivitis, pemphigus, erythema multiforme, and benign mucous membrane pemphigoid are all noninfectious lesions. REF: p. 245

8. Cretins exhibit all of the following dental abnormalities except one. Which one is the exception? a. Malocclusion b. Large teeth c. Delayed tooth eruption d. Increased tendency to develop periodontal disease

ANS: b Correct: Hypothyroid pregnant women tend to produce offspring with large teeth. Incorrect choices: Cretins do exhibit dental disorders such as malocclusion, delayed tooth eruption, and increased tendency to develop periodontal disease. REF: p. 251

29. Which of the following medications is used to treat bipolar depression? a. Haloperidol b. Lithium c. Clozapine d. paroxetine

ANS: b Correct: Lithium is used in the treatment of bipolar depression, which is characterized by cyclic recurrence of mania alternating with depression. Incorrect choices: Haloperidol is a high-potency conventional antipsychotic. Clozapine is an atypical antidepressant. Paroxetine is an SSRI. REF: p. 232

12. Dental procedures should be performed for a patient taking bisphosphonates: a. During bisphosphonate-free holidays b. Before starting bisphosphonate therapy or within 3 months of beginning therapy c. Only when the course bisphosphonate therapy has been completed d. At any time deemed necessary

ANS: b Correct: Maintenance oral health examinations and any other dental procedure should be performed before starting bisphosphonate therapy or within 3 months of beginning therapy, if possible. Incorrect choices: Bisphosphonate-free holidays are not recommended before a dental procedure because these drugs stay in the bone for years. Bisphosphonate therapy is often stopped until the bone heals or the disease progresses to the point that bisphosphonate therapy is necessary. REF: p. 273

27. Which of the following statements is true of metformin? a. It is a member of the α-glucosidase inhibitor group of antidiabetic agents. b. It lowers blood glucose but, used alone, does not produce hypoglycemia. c. It decreases hepatic and peripheral insulin sensitivity, resulting in increased hepatic glucose production. d. Lactic acidosis is a common, but benign side effect.

ANS: b Correct: Metformin (Glucophage) lowers blood glucose but, used alone, does not produce hypoglycemia. Incorrect choices: Metformin is a member of the biguanide group of antidiabetic agents. It increases hepatic and peripheral insulin sensitivity, resulting in decreased hepatic glucose production. It also increases peripheral skeletal muscle glucose uptake. Lactic acidosis, its most serious side effect, is rare. REF: p. 257

8. Neurologic adverse effects are prevalent in all of the following antineoplastic agents except one. Which one is the exception? a. Asparaginase b. Methotrexate c. Vincristine d. Procarbazine

ANS: b Correct: Methotrexate does not cause any significant neurologic effects. Incorrect choices: Asparaginase can produce seizures, vincristine peripheral neuropathy, and procarbazine psychic disturbances and monoamine oxidase inhibition. REF: p. 273

33. Which of the following agents is the drug of choice for NSAID-induced ulcers? a. Ranitidine b. Misoprostol c. Omeprazole d. Metoclopramide

ANS: b Correct: NSAIDs inhibit PG synthesis, and PGs have a protective effect on the stomach lining. Misoprostol is a PGE2 and can replenish the PG in the stomach. Incorrect choices: Ranitidine and omeprazole reduce the symptoms of NSAID-induced ulcers but do not prevent the ulcers. Metoclopramide is not indicated for the treatment of ulcers. REF: p. 286

20. Tepid baths and aspirin are indicated for: a. Myocardial infarction b. Thyroid storm c. Acute adrenocortical insufficiency d. All of the above e. None of the above

ANS: b Correct: One symptom of thyroid storm is hyperpyrexia. To reduce body temperature, aspirin and tepid baths are indicated. Incorrect choices: An aspirin tablet is indicated for myocardial infarction but not a tepid bath. Neither aspirin nor tepid bath is indicated for acute adrenocortical insufficiency. REF: p. 294

5. The posterior pituitary secretes: a. Prolactin b. Oxytocin c. Corticotrophin-releasing hormone d. All of the above e. None of the above

ANS: b Correct: Oxytocin and vasopressin are synthesized in and secreted from the posterior pituitary. Incorrect choices: Prolactin is found in the anterior pituitary and corticotrophin-releasing hormone is found in the hypothalamus. REF: pp. 250-251

1. Which of the following statements is true regarding management of the pregnant dental patient? a. Avoid elective dental treatment except in the third trimester. b. Oral prophylaxis is best performed during the second trimester. c. The patient should be positioned in the Trendelenburg position during the last trimester. d. Both a and b are true. e. Both b and c are true.

ANS: b Correct: Perform oral prophylaxis before pregnancy or during the second trimester; monitor for periodontal conditions. Incorrect choices: Avoid elective dental treatment except in the second trimester. Position the patient in a recumbent position in the last trimester with the right hip elevated. REF: pp. 299-300

31. Which agent inhibits the H+/K+ ATPase found at the surface of the gastric parietal cell? a. Ketoconazole b. Lansoprazole c. Misoprostol d. Famotidine e. Metronidazole

ANS: b Correct: Proton-pump inhibitors, such as lansoprazole, inhibit the gastric H+/K+ ATPase as their mechanism of action. Incorrect choices: Ketoconazole is an antifungal agent. Misoprostol is prostaglandin E2-alpha PGE2. Famotidine is a histamine2 receptor antagonist. Metronidazole is an antibacterial agent. REF: p. 285

25. Which antidepressant is least likely to cause xerostomia? a. Bupropion b. Sertraline c. Chlorpromazine d. Amitriptyline e. Trazodone

ANS: b Correct: Sertraline, as with other SSRIs, produces a lower incidence of xerostomia than other classes of antidepressants, probably because their anticholinergic activity is significantly weaker. Incorrect Answers: Bupropion, trazodone, and especially amitriptyline have a greater anticholinergic action and incidence of xerostomia. Chlorpromazine is not an antidepressant. REF: p. 231

8. Which of the following adverse effects is associated with smoking? a. Neonatal dependence b. Intrauterine growth retardation, sudden infant death syndrome c. Abnormal development patterns, neonatal withdrawal syndrome d. Increased spontaneous abortion, premature labor, abnormal development, decreased school performance

ANS: b Correct: Smoking is associated with intrauterine growth retardation and sudden infant death syndrome. Incorrect choices: Heroin is associated with neonatal dependence. Amphetamines are associated with abnormal development patterns and neonatal withdrawal syndrome. Cocaine is associated with increased spontaneous abortion, premature labor, abnormal development, and decreased school performance. REF: p. 301

36. Many drugs have a potential to be abused. Certain gastrointestinal drugs such as emetics __________ and have been abused by patients with __________. a. Antiemetics, low blood sugar b. Laxatives, bulimia c. Nitroglycerin, familial hypercholesterolemia d. Antispasmodics, diabetes

ANS: b Correct: Some patients with bulimia abuse emetics to induce vomiting and abuse laxatives to induce bowel movements. Incorrect choices: For other patients, no connection has been established among the drug, the disease, and abuse. REF: p. 286

13. At which stage of ethyl alcohol withdrawal are hallucinations most prevalent? a. Stage 1 b. Stage 2 c. Stage 3 d. Ethyl alcohol withdrawal is not associated with hallucinations

ANS: b Correct: Stage 2 withdrawal includes hallucinations, paranoid behavior, and amnesia. Incorrect choices: Although overlap in symptoms can be considerable, hallucinations generally occur after stage 1 and before stage 3. REF: pp. 310-311

19. Which autocoid is known to stimulate secretion from salivary glands? a. Bradykinin b. Substance P c. Histamine d. PGE e. Pilocarpine

ANS: b Correct: Substance P causes secretion from salivary glands. Incorrect choices: Bradykinin, histamine, and PGE are not known for their ability to stimulate salivation. Pilocarpine does, but it is not an autocoid. REF: p. 240 TRUE/FALSE

1. The potential for abuse of a drug is greatly increased by the following factors except one. Which one is the exception? a. Very potent b. Long duration of action c. Inexpensive d. Easy to distribute

ANS: b Correct: The abuse potential of a drug is increased if it has a quick onset of action. The duration of action of the drug is less important, and a longer duration often reduces the opportunity for a subsequent "rush" and the cycle of repetitive use. Incorrect choices: Potency, cost, and ease of access are all incentives to maintain a drug habit. REF: p. 308

17. Which of the following statements is true concerning adrenal crisis? a. Once adrenal suppression occurs, the adrenal gland will never respond normally again. b. The adrenal crisis occurs because of a relative lack of corticosteroids during stress. c. Administering adrenal steroids may be necessary after a stressful dental procedure to prevent adrenal crisis. d. Problems generally occur with either low or very high doses, not in the mid range

ANS: b Correct: The adrenal crisis occurs because of a relative lack of corticosteroids during stress, such as a dental appointment for a patient with dental phobia. Incorrect choices: Once adrenal suppression occurs, it can take weeks or months for the adrenal gland to respond normally. Adrenal steroids may need to be administered before a stressful dental procedure to prevent crisis. Generally, low and very high doses do not present problems; problems occur with mid-range doses. REF: p. 247

19. Which of the following side effects is the most serious peripheral side effect associated with the use of tricyclic antidepressants? a. Orthostatic hypotension b. Cardiac toxicity c. Urination d. Bradycardia

ANS: b Correct: The most serious peripheral side effect associated with the tricyclic antidepressants is cardiac toxicity. Myocardial infarction and congestive heart failure have occurred during the course of treatment. Incorrect choices: Orthostatic hypotension is associated with antipsychotics. Tricyclic antidepressants are associated with anticholinergic effects such as xerostomia, tachycardia, constipation, and urinary retention. Arrhythmias and episodes of tachycardia can be caused by the antimuscarinic effects of the tricyclic antidepressants. REF: p. 230

21. Which drug syndrome produces symptoms resembling pernicious anemia? a. Chronic alcoholism b. Chronic nitrous oxide use c. Opioid withdrawal d. Chronic tobacco use

ANS: b Correct: The neurologic deficiency seen with chronic nitrous oxide use is similar to that seen in pernicious anemia. Incorrect choices: Chronic alcoholism, opioid withdrawal, and chronic tobacco use do not cause these symptoms. REF: p. 314

12. Which of the following statements is true concerning treatment for a patient who is hyperventilating? a. Opioid analgesics or diazepam will resolve the situation. b. The treatment is calm reassurance. c. Steroids and aminophylline may be administered. d. Parenteral epinephrine is the drug of choice.

ANS: b Correct: The treatment is calm reassurance. The dental professional should encourage patients to hold their breath or "rebreathed" into a paper bag or an unconnected face mask. Incorrect choices: Opioid analgesics or diazepam may be used to treat angina pectoris. Steroids, antibiotics, and aminophylline may be administered for aspiration. Parenteral epinephrine is the drug of choice for anaphylactic shock. REF: p. 292

24. Use of which of the following agents during pregnancy is associated with "floppy infant syndrome?" a. Naproxen b. Diazepam c. Nystatin d. Warfarin

ANS: b Correct: Use of benzodiazepines during pregnancy has produced "floppy infant syndrome." Incorrect choices: Naproxen, nystatin, and warfarin do not cause "floppy infant syndrome." REF: pp. 305-306

21. __________ is the least toxic of all asthma medications. a. Omalizumab b. Cromolyn c. Theophylline d. Fluticasone e. Zileuton

ANS: b Cromolyn is the least toxic asthma medication. It is currently available in a metered-dose form as in the other inhalation agents. REF: p. 282

6. Which of the following choices is a disease or condition produced by an excess of adrenocorticosteroids? a. Addison disease b. Cushing syndrome c. Graves disease d. Parkinson disease

ANS: b Cushing syndrome is produced by an excess of adrenocorticosteroids. Glucocorticoid therapy can give patients an appearance of Cushing's syndrome. REF: pp. 242-244

23. A significant drug interaction occurs between theophylline and __________ that can result in toxic serum levels of theophylline. a. Aspirin b. Erythromycin c. Nifedipine d. Clomiphene

ANS: b Erythromycin can increase the serum levels of theophylline, and toxicity may result. REF: p. 282

6. A drug for which animal studies have failed to demonstrate a risk to the fetus and in which no adequate studies in pregnant women have been found would fall into which U.S. Food and Drug Administration (FDA) pregnancy risk category? a. Category A b. Category B c. Category C d. Category D e. Category X

ANS: b For category A, adequate studies have been performed in humans and animals without demonstrating fetal risk. REF: pp. 300, 302

36. The U.S. Food and Drug Administration (FDA) recommends checking serum alanine aminotransferase (ALT) levels before starting therapy with __________ and periodically thereafter. a. Biguanides b. Thiazolidinediones c. α-Glucosidase inhibitors d. Nonsulfonylurea secretagogues

ANS: b Hepatotoxicity has rarely been reported with rosiglitazone and pioglitazone. The FDA recommends checking serum ALT levels before starting therapy with thiazolidinediones and periodically thereafter. These drugs should not be used in patients with underlying liver disease or with ALT levels greater than 2.5 times the upper limit of normal. REF: p. 259

7. All herbal products must be labeled as a: a. Pharmaceutical b. Dietary supplement c. Medication d. Adjuvant

ANS: b Herbal products must be labeled as a dietary supplement. These products cannot have labels such as "for treatment of hypertension." REF: p. 321

6. The most important component in the treatment of syncope is: a. Placing the patient in the Trendelenburg position b. Exhibiting confidence in action and voice c. Administering spirits of ammonia by inhalation d. Placing the patient's head between their legs

ANS: b If the hygienist shows control over the situation, the patient will be less anxious and apprehensive. REF: p. 291

9. Which of the following treatment options is administered if a hypoglycemic patient lapses into unconsciousness and does not have a swallowing reflex? a. Apple juice or an apple cut into small pieces b. Intravenous dextrose c. Cake icing injected by syringe into the back of the mouth d. A dollop of peanut butter on the tongue

ANS: b If the patient lapses into unconsciousness and has no swallowing reflex, dextrose must be given intravenously. REF: p. 292

8. The drive for ventilation is stimulated by a(an) __________ in the normal person. a. Depression in the partial pressure of carbon dioxide (PaCO2) b. Elevation in PaCO2 c. Depression in the partial pressure of oxygen (PaO2) d. elevation in PaO2

ANS: b In the normal person, the drive for ventilation is stimulated by an elevation in PaCO2. The PaO2 can vary widely without stimulating ventilation in the normal patient. REF: p. 278

9. Which of the following are symptoms of adverse reactions caused by bone marrow suppression? (1) susceptibility to infection, (2) bleeding, (3) high blood pressure, (4) fatigue a. 1, 2, 3, 4 b. 1, 2, 4 c. 1, 3, 4 d. 1, 2 e. 3, 4

ANS: b Inhibition of the bone marrow results in leukopenia or agranulocytosis, thrombocytopenia, and anemia. Symptoms of this adverse reaction may include susceptibility to infection, bleeding, and fatigue. REF: p. 273

22. Insulin is usually administered: a. Orally b. By subcutaneous injection c. By intramuscular injection d. By intravenous injection

ANS: b Insulin is usually administered by subcutaneous injection. Its large molecular size prevents it from being absorbed from the GI tract. REF: p. 256

48. Why is medroxyprogesterone (Provera) used in conjunction with estrogens by postmenopausal women? a. It potentiates estrogen and postmenopausal women require a higher amount. b. It prevents an increase in the risk of uterine cancer that can occur when estrogen is used alone. c. It facilitates the passage of estrogen across membrane surfaces. d. It helps to prevent osteoporosis.

ANS: b It prevents the increase in the risk of uterine cancer that can occur with unopposed estrogen. Women who have had a hysterectomy do not need to take Medroxyprogesterone with estrogens. REF: p. 264

17. The kinins are a group of autocoids that, as with the PGs, are derived from arachidonic acid. They were formerly called slow-reacting substances of anaphylaxis (SRS-A). a. Both statements are true. 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: b Kinins are derived from the polypeptide kininogen, whereas PGs are derived from arachidonic acid. Furthermore, the LTs, not the kinins, were formerly called slow- SRS-A. REF: p. 239

19. LTs are used to manage patients with __________ that is not controlled by β2-agonists and corticosteroid inhibitors. a. Emphysema b. Asthma c. Chronic bronchitis d. Acute bronchitis

ANS: b LTs manage asthma that is not controlled by β2-agonists and corticosteroid inhibitors. Zafirlukast and montelukast are leukotriene receptor antagonists. They are not as effective as the corticosteroid inhalers. Both are effective taken orally. REF: p. 281

15. A leukotriene antagonist would be used to treat: a. Nonsteroidal antiinflammatory drug-induced ulcers b. Asthma and other forms of bronchoconstriction c. Closing of patent ductus arteriosus in the newborn d. Delayed parturition e. Fever

ANS: b Leukotrienes are "slow-reacting substances of anaphylaxis." They are released during an asthma attack or anaphylactic reaction and cause powerful bronchoconstriction. Antagonists of their action or synthesis could be used to prevent or treat these airway conditions. REF: p. 239

9. Which of the following local anesthetics would be the best choice for dental application in the pregnant patient? a. Prilocaine b. Lidocaine c. Bupivacaine d. Mepivacaine

ANS: b Lidocaine is the local anesthetic of first choice for the pregnant woman because it is a category B drug and is not associated with methemoglobinemia, as is prilocaine. Incorrect choices: Unlike lidocaine and prilocaine, bupivacaine and mepivacaine are pregnancy category C. REF: p. 301

14. Liver problems are most likely to occur with which of the following groups of antineoplastic agents? a. Alkylating agents b. Antimetabolites c. Antibiotics d. Hormones e. Immune modulators

ANS: b Liver problems occur principally with the antimetabolites but may occur with other agents as well. REF: p. 273

6. In general, lower potency antipsychotic agents will have more: (1) sedation, (2) peripheral side effects, (3) autonomic effects, (4) extrapyramidal effects a. 1, 2, 3, 4 b. 1, 2, 3 c. 2, 3, 4 d. 1, 2 e. 3, 4

ANS: b Lower potency antipsychotic agents such as chlorpromazine have more sedation, more peripheral side effects, and more autonomic effects. Higher potency agents such as haloperidol have more extrapyramidal effects and less sedation. REF: p. 225

28. Interaction of monoamine oxidase inhibitors (MAOIs) with many drugs such as amphetamines, and with foods such as wines, cheese, and fish, can precipitate: a. Hair loss b. Hypertensive crisis c. Gout d. Dysgeusia

ANS: b MAOIs interaction with many drugs and foods can precipitate a hypertensive crisis and even death. Patients taking MAOIs have detailed food prohibitions because of this chance of food-drug interactions. REF: p. 232

3. When an allergic reaction occurs, __________ degranulate and histamine is released. a. Polymorphonuclear leukocytes b. Mast cells c. Eosinophils d. Macrophages e. Monocytes

ANS: b Mast cells, also called basophils, degranulate and histamine is released. Almost all mammalian tissues contain or can synthesize histamine. In humans, histamine is stored in mast cells in the intestinal mucosa, and in the central nervous system (CNS). REF: p. 234

13. More and more cases of type II diabetes are being reported in persons younger than 20 years because of: a. An increased incidence of autoimmune disorders b. A much more sedentary lifestyle and lack of exercise c. Illicit use of legal drugs d. Environmental changes and global warming

ANS: b More and more cases of type II diabetes in young persons is being attributed to a much more sedentary lifestyle and lack of exercise. Fast foods, video games, and television have replaced physical activity and obesity, a major risk factor for developing type II diabetes, is on the rise. REF: p. 253

17. Which of the following drugs may be used to reduce alcohol craving? a. Metronidazole b. Naltrexone c. Chlordiazepoxide d. Vitamin K

ANS: b Naltrexone is used to reduce alcohol craving. Because naltrexone is partially effective in decreasing craving from alcohol, the logical conclusion is that alcohol stimulates some of the opioid receptors. REF: p. 312

9. The ventilation of a patient with COPD is driven by a(an): a. Increase in PaO2 b. Decrease in PaO2 c. Increase in PaCO2 d. Decrease in PaCO2

ANS: b Patients with COPD experience a gradual rise in PaCO2 over time. Because this mechanism becomes resistant to changes in PaCO2, a new stimulus emerges, the PaO2. The patient's ventilation is then driven by a decrease in PaO2. REF: p. 278

8. The patient with hypoglycemia has a __________ pulse and __________ respiration. a. Rapid, increased b. Rapid, decreased c. Slow, increased d. Slow, decreased

ANS: b Patients with hypoglycemia have a rapid pulse and decreased respiration. They are very talkative (loquacious). Hunger, dizziness, weakness, and occasionally tremor of the hands can occur. Other signs of hypoglycemia include diaphoresis, nausea, and mental confusion. REF: p. 292

12. Which of the following opioids has been associated with teratogenicity? a. Morphine b. Codeine c. Lomotil d. Methadone

ANS: b Retrospective studies have associated the use of codeine during the first trimester with fetal abnormalities involving the respiratory, gastrointestinal, cardiac, and circulatory systems and with inguinal hernia and cleft lip and palate. REF: p. 302

1. Which of the following psychiatric disorders involves a loss of the perception of reality? a. Bipolar affective disorder b. Schizophrenia c. Panic disorder d. Obsessive-compulsive disorder

ANS: b Schizophrenia is derived from the word meaning "splitting" and, in context, refers to patients splitting from reality. The patient's ability to function in society is impaired as a result of altered thinking. REF: pp. 223-224

17. Which of the following drugs is the agent of choice for drug-induced laryngospasm? a. Aminophylline b. Succinylcholine c. Parenteral epinephrine d. Diazepam

ANS: b Succinylcholine, a neuromuscular blocking agent, and positive-pressure oxygen are the agents of choice when drug-induced laryngospasm is present. The operator must have training and equipment to breathe artificially for the patient before succinylcholine is administered. REF: p. 292

34. Sucralfate can be thought of as a "bandage" for ulcers because it inhibits the action of pepsin and absorbs the bile salts. a. Both parts of the statement and the reason are correct and related. b. Both parts of the statement and the reason are correct, but not related. c. Both parts of the statement are correct, but the reason is not. d. Both parts of the statement are not correct, but the reason is correct. e. Neither the statement nor the reason is correct.

ANS: b Sucralfate can be thought of as a "bandage" for ulcers because it combines with proteins, forming a complex that binds preferentially with the ulcer site. Sucralfate also inhibits the action of pepsin and absorbs the bile salts. However, the physical form sucralfate takes and the physical protection it provides the ulcer site make it akin to a bandage. REF: p. 286

27. __________ is a concern when administering local anesthetics with sulfiting agents as a preservative for the vasoconstrictor. a. Tardive dyskinesia b. Bronchoconstriction c. Tachycardia d. Emesis

ANS: b Sulfiting agents in local anesthetic agents with vasoconstrictor can lead to bronchoconstriction. REF: p. 283

4. As a group, the atypical antipsychotics produce __________ nausea and __________ anticholinergic and sedative effects compared with conventional antipsychotics. a. Increased, more b. Increased, fewer c. Decreased; more d. Decreased; fewer

ANS: b The atypical antipsychotics produce increased nausea and fewer anticholinergic and sedative effects than conventional antipsychotics. Many patients are now being treated with the newer "atypical" antipsychotics. REF: p. 225

28. Which oral antidiabetic agent produces lactic acidosis as a significant adverse effect? a. Tolbutamide b. Metformin c. Repaglinide d. Acarbose e. Pioglitazone

ANS: b The biguanides, such as metformin, can cause lactic acidosis as a side effect. Predisposing factors to lactic acidosis include alcoholism, binge drinking, and renal or hepatic dysfunction. Metformin is contraindicated in patients who have these conditions or are fasting. REF: p. 257

4. Which of the following signs is the most common emergency in the dental office? a. Acute airway obstruction b. Syncope c. Hypoglycemia d. Diabetic coma

ANS: b The emergency most often encountered in the dental office is simple syncope or transient unconsciousness. The release of excessive epinephrine results in a pooling of the blood in the peripheral muscles, a decrease in total peripheral resistance, and a sudden fall in blood pressure. REF: p. 291

1. Adrenocorticosteroids are released from the: a. Hypothalamus b. Adrenal cortex c. Pituitary gland d. Adrenal medulla e. Kidney

ANS: b The hypothalamus releases corticotrophin-releasing factor. The pituitary gland releases adrenocorticotropic hormone (ACTH), and the adrenal cortex releases adrenocorticosteroids. The adrenal medulla, which releases adrenaline, and the kidney, under which the adrenal gland is found, are not part of the endocrine pathway for the release of adrenocorticosteroids. REF: p. 241

11. The incidence of alcoholism in the United States is approximately __________. a. 5% b. 10% c. 15% d. 20%

ANS: b The incidence is approximately 10%. Because alcohol is legal, its availability makes it the most often abused drug. The best use of resources for addiction would be to deal with alcoholism as soon as it can be identified. REF: p. 310

11. Patients taking corticosteroids may have mucosal surfaces that are more __________ than other patients. a. Calloused b. Friable c. Pigmented d. Stippled

ANS: b The mucosal surfaces of patients taking corticosteroids heal more slowly, are more likely to have infection, and are more friable. Oral candidiasis may result with the use of oral steroid inhalers for asthma. REF: p. 244

17. Which of the following statements is true concerning oral surgical procedures for the adult patient with diabetes? a. The procedure should be performed before breakfast, and the patient should have taken regular diabetes medication. b. The procedures should be performed 1{1/2} to 2 hours after the patient has eaten a normal breakfast and has taken regular antidiabetes medication. c. The procedure should be performed after lunch, and the patient has taken regular diabetes medication. d. The procedure should be performed after lunch, and the patient should skip regular diabetes medication.

ANS: b The patient should eat a normal breakfast and take the regular antidiabetes medication. After surgery, the patient should receive an adequate caloric intake to prevent hypoglycemia. With general anesthesia, patients are often told to eat nothing by mouth and should take one half of their usual dose of insulin and receive intravenous 5% glucose in distilled water. REF: p. 254

8. Which government entity bears responsibility for proof of misleading labeling of herbal products? a. DEA b. FDA c. DSHEA d. OSHA

ANS: b The responsibility for proof of misleading labeling rests with the FDA. REF: p. 321

4. The pregnant dental patient is most comfortable during which period? a. First trimester b. Second trimester c. Third trimester d. None of the above

ANS: b The second trimester is a good time to administer prophylaxis and any necessary dental treatment because the patient is beyond the morning sickness stages that might be experienced during the first trimester and is still comfortable reclining in the dentist's chair for a moderate duration. REF: p. 300

4. The term __________ has been associated with herbal products because they are primarily derived from plant sources. a. Homeopathic b. Natural c. Unadulterated d. Pure

ANS: b The term natural has been associated with herbal products because they are primarily derived from plant sources. REF: p. 321

51. Some antibiotics are thought to reduce the effectiveness of hormonal contraceptives by: a. Preventing absorption across the membrane surface of the enteric plexus b. Suppressing intestinal flora c. Chelation to form insoluble byproducts d. Forcing progesterone levels to be maintained

ANS: b These antibiotics are thought to do so indirectly by suppressing the intestinal flora and thus diminishing the availability of hydrolytic enzymes to regenerate the parent steroid molecule. Consequently, plasma concentrations of the steroids are said to be abnormally low, and the steroid is cleared more rapidly from the body than under normal circumstances. REF: p. 265

11. Garlic, gingko biloba, and feverfew can __________ when taken in conjunction with antiplatelet drugs or anticoagulants. a. Cause tachycardia b. Increase the risk of bleeding c. Cause postural hypotension d. Cause hypertension

ANS: b These medications can increase the risk of bleeding when taken in conjunction with antiplatelet drugs or anticoagulants. REF: p. 322

7. Tolerance is characterized by the need to __________ the dose continually to achieve a desired effect or providing the same dose that produces a __________ effect. a. Increase, increasing b. Increase, diminishing c. Decrease, increasing d. Decrease, diminishing

ANS: b Tolerance is characterized by the need to increase the dose continually to achieve a desired effect or providing the same dose that produces a diminishing effect. In terminal patients, this tolerance requires ever-increasing doses of opioids even if the pain remains constant. REF: p. 309

5. Treatment for syncope is to place patients: a. Prone on their stomach with their head tilted to one side b. Supine with their head tilted to one side c. Seated with their head tilted back d. Seated with their head tilted forward

ANS: b Treatment for syncope is to place patients supine with their head tilted to one side. They should be tilted back even further in the dental chair so that their head is below the level of the heart and turned to one side. This position causes blood to rush to the head, which has the effect of giving patients a transfusion of whole blood. The old practice of putting the head between the legs should be avoided because venous return is cut off by the slumped position. REF: p. 291

32. The first line of treatment for type II diabetes usually involves a sulfonylurea and/or a: a. Nonsulfonylurea secretagogue b. Biguanide c. α-Glucosidase inhibitor d. Thiazolidinedione

ANS: b Usually, a sulfonylurea and/or a biguanide are the first line of treatment for type II diabetes. These two agents can be used together to lower the blood glucose level more than either one alone. REF: p. 257

6. The Dietary Supplement Health and Education Act (DSHEA) exempts __________ from meaningful FDA regulation. (1) vitamins, (2) minerals, (3) botanical products, (4) domestic products a. 1, 2, 3, 4 b. 1, 2, 3 c. 2, 3, 4 d. 1, 2

ANS: b Vitamins, minerals, and botanical products are exempt from meaningful FDA regulation. REF: p. 321

2. The following symptoms are "negative" (passive) symptoms of psychoses except for one. Which one is the exception? a. Flat affect b. Vocalization of feelings of superhuman strength c. Abstract thinking difficult d. Social withdrawal e. Thought and speech impaired

ANS: b Vocalization of feelings of superhuman strength is considered a "positive" or active symptom of psychoses because it represents some action. The negative symptoms represent one form of withdrawal or other (i.e., the inability to do or feel something rather than an ability to do or feel something untoward). REF: p. 224

2. Advanced Cardiac Life Support (ACLS) training is: a. Necessary for all staff b. Necessary if the office is in a rural setting c. Necessary if the office performs conscious sedation d. Not necessary for a dentist's office e. None of the above

ANS: c ACLS training is required for personnel in dentist's offices in which preoperative or conscious sedation is performed. REF: p. 291

16. Because of the inflammatory activity of the adrenocorticosteroids, they may mask the symptoms of an infection. They decrease a patient's ability to fight infection by suppression of migration of plasma cells. a. Both statements are true. 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: c Adrenocorticosteroids may mask symptoms of an infection, but they decrease a patient's ability to fight infection by suppression of the migration of polymorphonuclear leukocytes. REF: p. 247

13. Albuterol is a bronchodilator that can be administered via an MDI. It is recommended in prophylactically treating (preventing) chronic asthma. a. Both statements are true. 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: c Albuterol is a bronchodilator administered via inhaler. However, it is recommended to treat acute asthma attacks, not in the prevention of asthma. One major mistake that many asthmatics make is to rely on the albuterol inhaler and omit using the steroid inhaler. REF: p. 279

10. Abuse of __________ is the number one public health problem in the United States? a. Opioids b. Stimulants c. Alcohol d. Hallucinogens

ANS: c Alcohol abuse is the number one public health problem in the United States and is associated with many major medical problems. Many "accidental" deaths are associated with the use of alcohol. Two fifths of traffic fatalities involve alcohol. REF: p. 310

16. Erythromycin is concentrated in breast milk. A nursing mother should be given erythromycin only if the breast milk is expressed and discarded during treatment and 48 hours after the last dose. a. Both statements are true. b. Both statements are false. c. The first statement is true, the second is false. d. The first statement is false, the second is true.

ANS: c Although erythromycin is concentrated in the breast milk, it has not been documented to produce problems. REF: p. 305

19. An automated external defibrillator (AED), if administered within the first 5 minutes of cardiac arrest, can save up to __________ of persons experiencing cardiac arrest. a. 10% b. 30% c. 50% d. 70% e. 90%

ANS: c An AED can save up to 50% of persons experiencing cardiac arrest if it is administered within the first 5 minutes of cardiac arrest. In March 2002 the American Dental Association Council on Scientific Affairs recommended that dentists consider purchasing an AED for their dental offices if emergency medical services personnel with defibrillation skills and equipment are not available within a reasonable time period. REF: p. 293

18. Symptoms that differentiate myocardial infarction from angina pectoris include: a. Heaviness in the chest b. Pain that radiates across the chest to other parts of the body c. Pain unrelieved by nitroglycerin d. Rapid pulse

ANS: c Anginal pain is generally relieved by administration of nitroglycerin. If three doses of nitroglycerin do not relieve the pain, then myocardial infarction is strongly suspected. REF: p. 293

31. Which of the following types of medications can react with sulfonylureas to produce a decrease in serum glucose levels? a. Penicillin b. Methotrexate c. Aspirin d. Mepivacaine

ANS: c Aspirin can interact with sulfonylureas to produce a decrease in serum glucose levels, which is not clinically significant unless the diabetic patient is especially brittle. REF: p. 257

6. Antineoplastic agents will have the greatest negative effect on which of the following tissues? a. Integumentary tissue b. Lungs, heart, and liver c. Gastrointestinal tract, bone marrow, and hair follicles d. Sensory tissue such as those for smell, sight, and hearing

ANS: c Because the cells of the gastrointestinal tract, bone marrow, and hair follicles are among the faster growing normal cells, the early side effects are associated with these tissues. REF: p. 273

23. Benzodiazepines are indicated for the treatment of __________ during pregnancy. a. Anxiety b. Restless leg syndrome c. Status epilepticus d. Both a and b e. Both b and c

ANS: c Benzodiazepines are only indicated for the treatment of status epilepticus during pregnancy. No dental use has been established. REF: p. 306

7. Of the following agents listed, which is the most potent in glucocorticoid activity? a. Hydrocortisone b. Fluocinonide c. Betamethasone d. Triamcinolone acetonide

ANS: c Betamethasone is the most potent of the glucocorticoids listed, and hydrocortisone is the least potent. The other agents fall in between betamethasone and hydrocortisone in glucocorticoid potency. REF: pp. 242, 245

19. Which of the following antiinfective agents should be used for dental infections during pregnancy for susceptible anaerobic infections not sensitive to penicillin? a. Amoxicillin b. Cephalosporins c. Clindamycin d. Metronidazole

ANS: c Clindamycin should be used for dental infections during pregnancy for susceptible anaerobic infections not sensitive to penicillin. It also is indicated for prophylaxis of endocarditis in penicillin-allergic patients. No adverse fetal problems have been reported. REF: p. 305

50. Which of the following conditions is a contraindication for the use of oral contraceptives? a. Chronic obstructive pulmonary disease b. Type II diabetes c. Carcinoma of the breast d. Splenectomy

ANS: c Contraindications for the use of oral contraceptives include thromboembolic disorders, significant dysfunction of the liver, known or suspected carcinoma of the breast or other estrogen-dependent neoplasm, and undiagnosed genital bleeding. REF: p. 265

11. Which of the following is usually the drug of choice for treatment of hyperthyroidism in patients older than 21 years? a. Propylthiouracil b. Methimazole c. Radioactive iodide (131I) d. Propranolol

ANS: c Correct: 131I is usually the drug of choice for patients over 21 years. It is taken internally and sequestered by the gland; localized destruction of thyroid tissue results. Both 131I and thyroidectomy usually result in hypothyroidism because a dose that produces an inadequate effect would require repeating the procedure. Incorrect choices: Antithyroid drugs, such as propylthiouracil and methimazole are used in patients who cannot tolerate surgery or treatment with 131I. These drugs inhibit the iodinization of tyrosine moieties and the coupling of the iodotyrosines. Propranolol is often given concomitantly with antithyroid agents. REF: p. 252

16. All of the following actions are indicated for the management of acute airway obstruction except one. Which one is the exception? a. Placing the patient in a Trendelenburg position b. Clearing the pharynx and pulling the tongue forward c. Allowing the patient to sit upright d. Administering the Heimlich maneuver e. Performing cricothyrotomy

ANS: c Correct: Allowing the patient with acute airway obstruction to sit up is contraindicated. Incorrect choices: The other measures may be used to dislodge an acute airway obstruction. REF: p. 292

37. Use of which laxative is able to interfere with the absorption of the fat-soluble vitamins (A, D, E, and K)? a. Bisacodyl b. Dioctyl sodium sulfosuccinate c. Mineral oil d. Magnesium sulfate

ANS: c Correct: Because mineral oil is a hydrophobic oil, fat-soluble vitamins can dissolve in it, and their absorption into the body will be impeded. Incorrect choices: The other choices are all laxatives, but they do not interfere with the absorption of fat-soluble vitamins. REF: p. 287 TRUE/FALSE

2. The following measures should be taken when prescribing drugs to a pregnant woman, except one. Which one is the exception? a. No unnecessary drugs should be administered. b. An adequate health history should be taken at each appointment. c. Schedule morning appointments during the first trimester. d. Closely coordinate with the patient's obstetrician.

ANS: c Correct: Because of potential morning sickness during the first trimester, scheduling appointments in the afternoon is preferred during this period. Incorrect choices: The other options are all prudent measures to be followed with the pregnant dental patient. REF: p. 300

2. Histamine is a(n): a. Peptide b. Amino acid c. Biogenic amine d. Eicosanoid e. None of the above

ANS: c Correct: Biogenic amines are small amine compounds synthesized in the body, many from amino acids that play roles in cell activation and cell-cell communication. Other examples are dopamine, norepinephrine, epinephrine, and serotonin. Incorrect choices: Histamine is not a peptide; it is synthesized from a single amino acid, histidine. It is not an amino acid because it does not have a carboxyl (COOH) group. Finally, it is not an eicosanoid. They are derived from arachidonic acid. REF: p. 234

15. The mineralocorticoid effects of corticosteroids include all of the following except one. Which one is the exception? a. Increased sodium retention b. Decreased potassium retention c. Decreased bone density d. Edema e. Hypertension

ANS: c Correct: Changes in bone density are glucocorticoid effects of corticosteroids. These agents can promote osteoporosis. Incorrect choices: Mineralocorticoids increase sodium retention, decrease potassium retention, and increase blood volume, leading to edema and contributing to hypertension and congestive heart failure. REF: p. 246

46. Increases in estrogen and progestin levels are associated with which oral lesion? a. Aphthous stomatitis b. Caries c. Gingivitis d. Increased tooth mobility e. Lichen planus

ANS: c Correct: Changes in sex hormone levels during a woman's life are related to the development of gingivitis at puberty (puberty gingivitis), during pregnancy (pregnancy gingivitis), and after menopause (chronic desquamative gingivitis). Incorrect choices: Increases in sex hormone levels are not associated with aphthous stomatitis, caries, increased tooth mobility, or lichen planus. REF: p. 264

20. Nitrous oxide abuse: a. Can lead to physical dependence b. Is primarily seen in food service employees c. Can cause infertility d. Can cause myelocytosis

ANS: c Correct: Chronic use can cause mental dysfunction and infertility. Incorrect choices: Nitrous oxide use does not cause physical dependence. Abuse is primarily by dental personnel. Nitrous oxide causes myeloneuropathy, not myelocytosis. REF: p. 314

7. Conventional antipsychotics would have little effect on which of the following symptoms of psychosis? a. Delusions b. Unwanted thoughts c. Flat affect d. Agitation e. Disorganized behavior

ANS: c Correct: Conventional antipsychotics are active against the positive effects of psychosis but have little effect on the negative effects. Negative symptoms of psychosis include flat affect, unemotional, apathetic, passivity, abstract thinking difficult, lacking spontaneity and goals, impaired thought and speech, lack of pleasure, and social withdrawal. Incorrect choices: Positive symptoms of psychosis include hallucinations, delusions, unwanted thoughts, disorganized behavior, agitation, and distorted speech and communication. REF: pp. 224, 226

17. Which of the following choices is recommended to counteract the anticholinergic effects of conventional antipsychotics? a. Caffeine-containing beverages b. Alcohol-containing mouth rinses c. Sugarless products or artificial saliva d. Sugar-containing candy

ANS: c Correct: Conventional antipsychotics are additive with other agents with atropine-like effects. Use of sugarless products or artificial saliva should be encouraged. Incorrect choices: Patients should be encouraged to stay away from caffeine-containing beverages because they can exacerbate dry mouth. They should also avoid alcohol-containing mouth rinses because alcohol can also exacerbate dry mouth. Patients may use sugar-containing candy to counteract xerostomia. Use of sugarless products is recommended. REF: p. 228

8. Conventional antipsychotics are primarily __________ antagonists. a. Acetylcholine b. Norepinephrine c. Dopamine d. Serotonin (5-hydroxytryptamine)

ANS: c Correct: Conventional antipsychotics are primarily dopamine antagonists. Incorrect choices: Atypical antipsychotic agents have action at more than one receptor, for example, the dopamine, serotonin, and norepinephrine receptors. This results in the improved efficacy of these agents. REF: p. 226

3. A physical and/or psychologic state characterized by a compulsion to take a drug is termed: a. Enabling b. Psychologic dependence c. Drug dependence d. Tolerance e. Abstinence syndrome

ANS: c Correct: Drug dependence can be physical or psychologic and is characterized by a compulsion to take a drug to obtain its effects or prevent the abstinence syndrome. Incorrect choices: Enabling is the behavior of family or friends that allow the drug-dependent person to continue his or her habit. The definition applies to more than psychologic dependence. Tolerance often occurs before or during but is not equivalent to drug dependence. Abstinence syndrome or withdrawal is a set of physical and psychologic symptoms that occurs when a drug-dependent person stops taking a drug. One symptom might be the compulsion to take the drug. REF: p. 309

52. Which of the following agents is used for the treatment of cancer of the prostate? a. Methyltestosterone b. Clomiphene c. Finasteride d. Tamoxifen e. Mifepristone

ANS: c Correct: Finasteride is Proscar. It is an antiandrogen that inhibits the 5α-reductase in the androgen synthesis pathway. Incorrect choices: Methyltestosterone is an androgen and would promote an androgen-responsive prostate tumor. Clomiphene is an estrogen partial agonist and may be used for male infertility, tamoxifen is an estrogen antagonist—an androgen antagonist is needed. Mifepristone is RU-486, a progestin antagonist. REF: p. 266

17. Which antiinfective agent is least teratogenic? a. Clarithromycin b. Doxycycline c. Cephalexin d. Metronidazole

ANS: c Correct: First- and second-generation cephalosporins have not been associated with teratogenicity (category B). Incorrect choices: Clarithromycin is category C. Doxycycline is category D. Although metronidazole is category B, it has been shown in animals to produce birth defects. REF: pp. 303, 305

9. Glucocorticoids cause an increase in the circulating levels of which of the following white blood cells? a. T lymphocytes b. B lymphocytes c. Neutrophils d. Basophils e. Monocytes

ANS: c Correct: Glucocorticoids increase the release of neutrophils from the bone marrow and decrease their migration from the circulation. Incorrect choices: Glucocorticoids decrease the circulating levels of T lymphocytes, B lymphocytes, basophils, and monocytes. REF: p. 243

21. Which of the following choices is recommended for the treatment of hypoglycemia if the patient is unconscious and lacks a swallowing reflex? a. Fruit juice b. Cake icing c. Intravenous dextrose (50%) d. Glucose gel

ANS: c Correct: Intravenous dextrose (50%) is the treatment of choice for hypoglycemia if the patient is unconscious and lacks a swallowing reflex. Intravenous glucose fluids and glucagon can be administered. Incorrect choices: When the patient is awake in the early stages of hypoglycemia, the treatment consists of any of the following: fruit juice, cake icing, glucose gel, or soluble carbohydrates. REF: p. 256

3. Leuprolide is used to treat: a. Hyperthyroidism b. Diabetes c. Fertility problems d. Hypothyroidism

ANS: c Correct: Leuprolide is a gonadotropin-releasing hormone (GnRH) analog. It stimulates the pituitary function and is used to treat infertility. Incorrect choices: Leuprolide is not effective at treating hyperthyroidism, diabetes, or hypothyroidism. REF: p. 250

20. Metronidazole: a. Should only be used during the second trimester of pregnancy b. Is expressly contraindicated for the nursing mother c. Has been shown to produce birth defects in animals d. Both a and b e. Both b and c

ANS: c Correct: Metronidazole has been shown to produce birth defects in animals. Incorrect choices: Metronidazole should be used carefully during the first trimester. The nursing mother should be given metronidazole only if breast milk is expressed and discarded during treatment and for 48 hours after the last dose. REF: p. 305

22. The drug of choice for opioid overdose is: a. Intravenous diphenhydramine b. Prochlorperazine c. Naloxone d. Flumazenil

ANS: c Correct: Naloxone is an opioid-receptor antagonist that can specifically reverse the actions of the opioids. Incorrect choices: Diphenhydramine is not a treatment of choice for opioid overdose, although it might reverse some of its actions. Prochlorperazine is not a treatment of choice for opioid overdose and may exacerbate the symptoms. Flumazenil is a benzodiazepine-receptor antagonist and would probably not influence the opioid overdose one way or the other. REF: p. 294

27. Which antidepressant drug carries a "black box" warning regarding its potential to cause life-threatening liver failure? a. Imipramine b. Bupropion c. Nefazodone d. Mirtazapine e. Venlafaxine

ANS: c Correct: Of the antidepressant drugs, nefazodone has the potential to cause fatal hepatic dysfunction. REF: p. 232

14. Which of the following statements is true of oil of cloves? a. It requires a prescription. b. Many published trials confirming its efficacy have been conducted. c. Its proposed mechanism of action is unclear. d. It is found in calcium hydroxide cement.

ANS: c Correct: Oil of cloves has been used for many years as a topical analgesic for dental pain. Its proposed mechanism of action is unclear, but research indicates that pulpal nerves are affected in some way to deaden pain. Incorrect choices: This nonprescription product is used empirically by dental professionals. No published trials that confirm its efficacy have been conducted. It is found in zinc-oxide eugenol cement. REF: p. 324

5. Proving that a drug is teratogenic is difficult because: a. Drugs are uniformly teratogenic. b. The timing of the drug exposure is consistent for each drug. c. One drug can produce a variety of abnormalities, and different drugs can produce the same abnormality. d. Different animal species and human are uniformly consistent in their responses to drugs.

ANS: c Correct: One drug can produce a variety of abnormalities, and different drugs can produce the same abnormality. Incorrect choices: Teratogenic drugs are not uniformly so. Timing of the drug exposure varies with each drug. Different animal species and humans vary among themselves in their responses to drugs. REF: p. 300

30. Patients undergoing lithium therapy should be observed for signs of overdose toxicity, including: a. Hyperpyrexia b. Constipation c. Muscle rigidity and fasciculations d. Loquacious speech

ANS: c Correct: Overdose toxicity may be exhibited by CNS symptoms, including muscle rigidity, hyperactive deep reflexes, excessive tremor, and muscle fasciculations. Incorrect choices: Side effects of treatment with lithium include polyuria, fine hand tremor, thirst, and in more severe cases, slurred speech, ataxia, nausea, vomiting, and diarrhea. REF: p. 232

29. All of the following are true of marijuana use except one. Which one is the exception? a. A common adverse reaction is a panic attack. b. The agent can cause xerostomia. c. Physical dependence, tolerance, and withdrawal symptoms are common. d. Marijuana is effective as an antiemetic.

ANS: c Correct: Physical dependence, tolerance, and withdrawal symptoms are rare. Incorrect choices: Marijuana can cause panic attacks and xerostomia. It also has recognized antiemetic activity. REF: p. 318

23. Human insulin is made from pork insulin by: a. Recombinant DNA synthesis b. Gene splicing in Escherichia coli. c. Transpeptidation d. Transamination e. Glycosylation

ANS: c Correct: Pig insulin has only two amino acids that are different from those in human insulin. The protein can be converted by transpeptidation. Incorrect choices: Recombinant DNA synthesis and gene splicing in E. coli refer to the same process, which is the process for synthesizing human insulin from scratch. Transamination and glycosylation are two biochemical processes that are not used in making human insulin from pork insulin. REF: p. 256

2. Hypopituitarism can produce: a. Goiter b. Acromegaly c. Diabetes insipidus d. Giantism

ANS: c Correct: Primary hypopituitarism can produce a loss of secondary sex characteristics, decreased metabolism, dwarfism, diabetes insipidus, hypothyroidism, Addison disease, loss of pigmentation, thinning and softening of the skin, decreased libido, and retarded dental development. Incorrect choices: Hypersecretion of pituitary hormones can produce sexual precocity, goiter, Cushing disease, acromegaly, and giantism. REF: p. 250

8. Which of the following symptoms is the most common side effect associated with the older antihistamines? (Please note: all are associated, but one is most common) a. Nausea b. Xerostomia c. Sedation d. Constipation

ANS: c Correct: Sedation is the most common side effect associated with the older antihistamines, and it may be accompanied by dizziness, tinnitus, incoordination, blurred vision, and fatigue. Incorrect choices: The gastrointestinal complaints commonly associated with the antihistamines include anorexia, nausea, vomiting, and constipation. Xerostomia is categorized as an anticholinergic adverse reaction. REF: p. 237

26. Which of the following symptoms of hypoglycemia can be explained by glucose deprivation of the brain rather than the adrenal glands? (1) blurred vision, (2) incoherent speech, (3) sweating, (4) tachycardia a. 1, 2, 3, 4 b. 1, 2, 3 c. 1, 2 d. 3, 4

ANS: c Correct: Symptoms of hypoglycemia caused by glucose deprivation of the brain include headache, blurred vision, mental confusion, incoherent speech, and (eventually) coma, convulsions, and death. Incorrect choices: Symptoms of hypoglycemia that can be explained by an increased release of epinephrine from the adrenals include sweating, weakness, nausea, and tachycardia. REF: p. 257

54. Which of the following medications is indicated for the palliative treatment of advanced breast cancer in postmenopausal women? a. Clomiphene b. Leuprolide c. Tamoxifen d. Danazol

ANS: c Correct: Tamoxifen is a competitive inhibitor of estradiol at the receptor. It is indicated in the palliative treatment of advanced breast cancer in postmenopausal women. Incorrect choices: Clomiphene has the ability to induce ovulation in some anovulatory women. Leuprolide is a GnRH analog used intramuscularly in the management of endometriosis and to treat infertility. Danazol possesses weak progestational and androgenic action. REF: p. 267 TRUE/FALSE

2. Agents capable of changing behavior and/or inducing a psychosis-like reaction are termed: a. Psychedelic b. Hallucinogenic c. Psychoactive d. Psychotomimetic

ANS: c Correct: The statement is the definition of psychoactive, which includes drugs with therapeutic value and those without therapeutic value. Incorrect choices: Psychedelic drugs are the subset of psychoactive drugs that have no therapeutic value. Hallucinogenic drugs may produce hallucinations and psychotic-like behavior and are categorized with psychedelic drugs. Psychotomimetic drugs produce effects that mimic psychoses; they exclude several psychoactive drugs that do not mimic psychoses. REF: p. 308

19. Advanced periodontal disease, jaundice, and palmar erythema are signs of: a. Smokeless tobacco use b. Wernicke encephalopathy c. Advanced alcoholic liver disease d. Chronic nitrous oxide use

ANS: c Correct: These three signs point to alcoholic's poor oral hygiene, liver damage, and peripheral vasodilation. Incorrect choices: Smokeless tobacco use would cause periodontal disease but not the other symptoms. Wernicke encephalopathy would cause amnesia. Chronic nitrous oxide use does not produce these signs. REF: pp. 312-313

15. Type I and type II diabetics are at greater risk for caries. This risk is attributed to the higher concentration of glucose in their saliva. a. Both statements are true. 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: c Correct: Uncontrolled diabetes produces a pronounced susceptibility to dental caries, which is caused mainly by decreased salivary flow (xerostomia) related to fluid loss. The loss is secondary to an increase in urination that occurs because of poor use of carbohydrates and the glucose that is excreted via the kidneys (water follows glucose). REF: p. 254

15. Xylitol: a. Is artificially produced in the laboratory b. Is metabolized by Streptococcus mutans to form acids c. Consumption reduces S. mutans levels, leading to antibacterial and cariostatic effects d. Both a and b e. Both b and c

ANS: c Correct: Xylitol consumption reduces S. mutans levels, leading to antibacterial and cariostatic effects. Incorrect choices: Xylitol is a naturally occurring sweetener derived from plants that can be extracted from birch bark, raspberries, plums, and corn fiber. It cannot be metabolized by S. mutans to form acids. REF: p. 324

5. Which of the following agents is classified as an antipsychotic? a. Celexa b. Cephalexin c. Zyprexa d. Lexapro e. Bextra

ANS: c Correct: Zyprexa is the trade name for olanzapine, a newer atypical antipsychotic. Incorrect Answers: Celexa is the trade name for the antidepressant citalopram, and Lexapro is the trade name for its S-isomer. Cephalexin is a cephalosporin antibiotic, and Bextra is the trade name for valdecoxib, the cyclooxygenase-2 (COX-2) selective nonsteroidal antiinflammatory drug. REF: p. 225

20. Which of the following agents prevents the antigen-induced release of histamine from sensitized mast cells? a. LT modifiers b. Corticosteroids c. Cromolyn d. Methylxanthines e. Anti-IgE antibodies

ANS: c Cromolyn prevents the release of histamine from sensitized mast cells, apparently by preventing the influx of calcium provoked by IgE antibody-antigen interaction on the mast cell. REF: p. 282

11. Diazepam may be administered for treatment of which of the following emergencies? a. Hyperglycemia b. Hypoglycemia c. Seizures d. Asthma e. Anaphylactic shock

ANS: c Diazepam may be administered intravenously in some situations for the treatment of convulsions or seizures, but observation of the patient is often sufficient. REF: p. 292

4. Enabling is an inappropriate behavior that requires family therapy because it involves the actions that family or friends take to supply the addict with the drug. a. Both the statement and the reason are correct and related. b. Both the statement and the reason are correct but not related. c. The statement is correct, but the reason is not. d. The statement is not correct, but the reason is correct. e. Neither the statement nor the reason is correct.

ANS: c Enabling is the behavior of family or friends who associate with the addict that results in continued drug abuse. It may have nothing to do with providing the addict with the drug. Thus, because this dysfunctional behavior is counterproductive, the statement is true. However, enabling is much more subtle than actually supplying the drug. REF: p. 309

7. Epinephrine is an FDA category __________ drug. a. A b. B c. C d. D e. X

ANS: c Epinephrine is an FDA category C drug. For these drugs, animal studies have shown an adverse effect on the fetus, and studies in humans have been adequate or no studies are available in either animals or women. Potential benefits may warrant its use. REF: p. 302

2. A patient has a tumor that contains 1010 cancer cells. Treatment includes two consecutive courses of an antineoplastic regimen, and each course kills 99% of the existing cells. Assuming that the tumor did not have time to grow between the two courses, how many tumor cells are left? a. 104 cells b. 105 cells c. 106 cells d. 107 cells e. 108 cells

ANS: c If 99% of cells are killed in one course of therapy, that means that 1% remain (1% of 1010 = 0.01 1010 or 108). If the remaining 108 cells were subjected to another course of therapy and 99% were killed again, 1% of these would remain (1% of 108 = 0.01 108 or 106). That is 1 million cells that remain! REF: p. 271

29. Which histamine-2 (H2)-blocking agent has been associated with dry mouth and taste alterations? a. Cimetidine b. Ranitidine c. Famotidine d. Meclizine

ANS: c Incorrect choices: Cimetidine and ranitidine are H2-blockers that do not cause xerostomia or taste alterations. Meclizine does cause xerostomia, but is an anticholinergic, not an H2-blocker. REF: p. 285

11. Osteonecrosis of the jaw is most likely to occur after which of the following dental procedures? a. Crown preparation b. Endodontic treatment c. Tooth extraction d. Prophylaxis

ANS: c Most of the cases of osteonecrosis of the jaw occurred after tooth extractions and other dental procedures that traumatize the jaw. REF: p. 273

15. __________ effects are associated primarily with administration or vincristine or vinblastine. a. Gastrointestinal b. Dermatologic c. Neurologic d. Immunosuppressant

ANS: c Neurotoxic effects such as peripheral neuropathy, ileus, inappropriate antidiuretic hormone secretion, and convulsions have been associated primarily with vincristine or vinblastine administration. REF: p. 273

15. Which of the following choices would be the correct sequence for administration of emergency drugs for anaphylactic shock? (1) albuterol, (2) parenteral epinephrine, (3) intravenous corticosteroids a. 1, 2, 3 b. 1, 3, 2 c. 2, 1, 3 d. 2, 3, 1 e. 3, 1 ,2

ANS: c Parenteral epinephrine is the drug of choice and must be administered immediately in cases of severe anaphylactic shock. It may be given in the deltoid muscle or injected under the tongue. If bronchoconstriction is predominant, albuterol administered by inhalation or nebulization may suffice. Intravenous corticosteroids, intramuscular diphenhydramine, and aminophylline may also be used after the life-threatening symptoms have been controlled. REF: p. 292

4. In status asthmaticus, patients have persistent life-threatening: a. Tachycardia b. Stomach ulcers c. Bronchospasm d. Electrolyte imbalance

ANS: c Patients have persistent life-threatening bronchospasm in status asthmaticus despite drug therapy. REF: p. 277

26. Pseudoephedrine __________ is used systemically as a nasal decongestant. a. An α-adrenergic agonist b. A β-adrenergic agonist c. An α-adrenergic and β-adrenergic agonist d. Neither an α-adrenergic nor a β-adrenergic agonist

ANS: c Pseudoephedrine is both an α-adrenergic and a β-adrenergic agonist and is used systemically as a nasal decongestant. REF: p. 282

5. The following normal tissues are especially susceptible to the actions of antineoplastic drugs except for one. Which one is the exception? a. Hair follicles b. Bone marrow c. Liver d. Gastrointestinal tract

ANS: c Rapidly growing tissues are most susceptible to the antineoplastic agents. Liver cells grow much more slowly than those in hair follicles, bone marrow, and the gastrointestinal tract. REF: p. 273

28. Signs and symptoms of an acute overdose of amphetamines include: a. Pinpoint pupils b. Hypothermia c. Diaphoresis d. Excessive salivation

ANS: c Signs and symptoms of an acute overdose include dilated pupils, elevated blood pressure, rapid pulse, and cardiac arrhythmias. The patient may exhibit diaphoresis, hyperthermia, fine tremors, and hyperactive behavior. Oral adverse reactions include xerostomia and bruxism. REF: p. 316

18. Patients who are on which of the following corticosteroid regimens should be prescribed supplemental corticosteroids before a stressful dental procedure? a. Currently taking less that 20 mg of hydrocortisone every day b. Currently taking more than 40 mg of hydrocortisone every day c. Currently taking between 20 and 40 mg of hydrocortisone every day d. All of the above e. None of the above

ANS: c Steroid supplementation is sometimes needed for patients taking steroids if they will be subjected to a stressful procedure because of the way exogenous corticosteroids affect the body's ability to produce their own steroids. With both low doses (<20 mg hydrocortisone or 5 mg prednisone) and very high doses (immunosuppressive; >40-60 mg hydrocortisone/day or 10-15 mg prednisone/day), no additional steroid supplementation is needed. With some intermediate doses of steroids (estimated to be between 20 and 40 mg/day hydrocortisone or 5 and 10 mg prednisone/day), additional steroids may be indicated if the procedure will produce severe stress. REF: pp. 247-248 TRUE/FALSE

10. Which of the following symptoms is associated with diabetic coma? a. Decreased pulse b. Increased appetite c. Acetone breath d. Cool, moist skin

ANS: c Symptoms of frequent urination, loss of appetite, nausea, vomiting, and thirst are noted. Acetone breath; hypercapnia; warm, dry skin; rapid pulse; and a decrease in blood pressure can occur. Treatment is undertaken only in a hospital setting and includes insulin after proper laboratory results are obtained. REF: p. 292

1. Autocoids possess widely differing pharmacologic actions and occur in the body naturally. They are formed in certain tissues and are carried to other tissues in which they have their action. a. Both statements are true. 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: c The hallmark of autocoids is that they are "local hormones." They are formed by the tissues on which they act. REF: p. 234

5. When does the maximal secretion of hydrocortisone (cortisol) occur in the body? a. Between 12 PM and 2 PM b. Between 9 AM and 12 AM c. Between 4 AM and 8 AM d. Between 7 AM and 10 AM

ANS: c The maximal secretion of cortisol occurs between 4 AM and 8 AM in people with a normal schedule. REF: p. 242

30. The mechanism of action of the sulfonylureas includes __________ of the release of insulin from the beta cells of the pancreas, __________ of glucose from the liver and serum glucagon levels, and a(an) __________ in the sensitivity of the target tissues to insulin. a. Stimulation, increase, increase b. Stimulation, increase, reduction c. Stimulation, reduction, increase d. Stimulation, reduction, reduction e. Inhibition, reduction, reduction

ANS: c The mechanism of action of sulfonylureas includes stimulation of the release of insulin from the beta cells of the pancreas, reduction of glucose from the liver and serum glucagon levels, and an increase in the sensitivity of the target tissues to insulin. REF: pp. 257-258

7. The most common cause of hypoglycemia is: a. Stress or anxiety b. Insufficient hydration with water c. An excessive dose of insulin in a patient with diabetes d. Cardiac medication

ANS: c The most common cause of hypoglycemia is an excessive dose of insulin in a patient with diabetes. Patients often inject their daily dose of insulin but fail to eat before coming to the dental office. REF: p. 292

1. Which of the following glands is also called the "master gland?" a. Thyroid gland b. Anterior pituitary gland c. Pituitary gland d. Gonads

ANS: c The pituitary gland (hypophysis) is a small endocrine organ located at the base of the brain. It has been called the "master gland" because of its regulatory effect on other endocrine glands and organs of the body. REF: p. 249

23. Toxic reactions to epinephrine occur most often after the placement of a gingival retraction cord. The treatment of choice is to administer an adrenergic-receptor antagonist. a. Both statements are true. b. Both statements are false. c. The first statement is true, the second is false. d. The first statement is false, the second is true.

ANS: c The treatment of choice is to remove the retraction cord and reassure the patient. In a calm patient, the epinephrine will be metabolized, and the episode will not precipitate the release of endogenous epinephrine. REF: p. 294

17. One major concern of the dental health care worker is thrombocytopenia in patients undergoing antineoplastic therapy because this can lead to an increased risk of infections. a. Both parts of the statement are true. b. Both parts of the statement are false. c. The first part of the statement is true, the second part is false. d. The first part of the statement is false, the second part is true.

ANS: c Thrombocytopenia is a concern for the dental health care worker, not because of an increased risk of infection (seen in agranulocytosis), but because of the increased risk of bleeding. REF: p. 274

23. Which of the following types of dental medicaments must be administered with caution to patients taking tricyclic antidepressants? a. Fluoride b. Antibiotics c. Anesthetics d. Analgesics

ANS: c Vasoconstricting drugs in local anesthetic solution must be administered with caution to patients taking tricyclic antidepressants. They may potentiate vasopressor response to epinephrine. The cardiac dose (0.04 mg) can be safely administered to patients who do not have preexisting arrhythmias. REF: p. 231

5. Patients with asthma should bring their fast-acting __________ inhaler to be used prophylactically or in the management of an acute asthmatic attack in the dental office. a. α-Agonist b. β1-Agonist c. β1-Antagonist d. β2-Agonist e. β2-Antagonist

ANS: d A fast-acting β2-agonist should be available to manage an acute asthmatic attack in the dental office. Signs of asthma include shortness of breath and wheezing. REF: p. 277

9. Approximately __________ of incarcerated individuals are there because of drug abuse problems. a. 20% b. 40% c. 60% d. 80%

ANS: d Approximately 80% are incarcerated because of problems with drug abuse. REF: p. 310

18. Which of the following autocoids are known to produce pain? a. Bradykinin b. Substance P c. Histamine d. All of the above e. None of the above

ANS: d Bradykinin apparently mediates pulpal pain. Substance P may be a transmitter that is released from unmyelinated fibers that respond to pain. Histamine causes pain or itching in cutaneous nerve endings. REF: pp. 234, 239-240

25. Prescribing __________ for analgesia is best when treating a dental patient who abuses opioids. a. Tylenol #3 with codeine b. Vicodin c. Percocet d. Nonsteroidal antiinflammatory drugs (NSAIDs)

ANS: d Correct: Alleviating the cause of the pain first and then prescribing NSAIDs for analgesia is best. Incorrect choices: Because an opioid abuser develops tolerance to the analgesic effects of any opioid, treating pain with opioids is ineffective and can cause a recovering addict to begin using opioids again. REF: p. 315

13. The prostaglandins (PGs) have the following actions except for one. Which one is the exception? a. Raising body temperature b. Inhibiting platelet aggregation c. Causing inflammation d. Stimulating bone growth e. Stimulating pain fibers

ANS: d Correct: Certain PGs are known to increase bone resorption and prevent synthesis of new bone, but not to stimulate bone growth. Incorrect choices: PGs can stimulate pain fibers, raise body temperature, cause inflammation, and inhibit platelet aggregation. This feature why aspirin, which inhibits the synthesis of PGs, has analgesic, antipyretic, and antiinflammatory activity and is used as a preventative against myocardial infarction and stroke. REF: p. 239

19. Diabetic gastroparesis can be treated with: a. Amitriptyline b. Carbamazepine c. Ranitidine d. Metoclopramide

ANS: d Correct: Diabetic gastroparesis is atony of the gastrointestinal (GI) tract and is a consequence of diabetic neuropathy. It is treated with metoclopramide, which increases gastric motility. REF: p. 255

16. Disulfiram is an agent used in the treatment of: a. Ethyl alcohol withdrawal b. Opioid withdrawal c. Barbiturate overdose d. Alcoholism

ANS: d Correct: Disulfiram (Antabuse) hinders alcohol metabolism and leads to a rise in acetaldehyde in drinkers. This property acts as a deterrent to drinking and as an incentive to stay sober. Incorrect choices: Disulfiram is not effective in any of the other conditions. REF: p. 312

25. Which of the following statements is true concerning fetal alcohol syndrome (FAS)? a. FAS involves growth retardation, central nervous system (CNS) abnormalities, and flat maxillary area or a thin lip. b. Infants born to mothers who drank throughout pregnancy show more tremors, hypertonia, restlessness, crying, and abnormal reflexes compared with control groups after birth. c. The safe alcohol threshold for the pregnant woman is 2 ounces of alcohol or 24 ounces of beer a day. d. Both a and b are true. e. Both b and c are true.

ANS: d Correct: FAS involves growth retardation, CNS abnormalities, and flat maxillary area or a thin lip. Infants born to mothers who drank throughout pregnancy show more tremors, hypertonia, restlessness, crying, and abnormal reflexes compared with control groups after birth. Incorrect choices: Pregnant dental patients should be encouraged to abstain from the ingestion of alcohol. No safe threshold level is known for the pregnant woman. REF: p. 307

16. Which antipsychotic is available as a long-acting injectable for schizophrenic patients who fail to take their oral medication? a. Chlorpromazine b. Loxapine c. Thioridazine d. Fluphenazine e. Quetiapine

ANS: d Correct: Fluphenazine and haloperidol are two antipsychotic agents available in a long-acting injectable form. They are administered intramuscularly as decanoate salts and require dosing every 3 to 4 weeks. Incorrect Answers: Loxapine, thioridazine, and quetiapine are offered as oral forms only. Chlorpromazine is available as an injectable, but this preparation has a significantly lower duration of action. REF: p. 227

9. Antihistamines such as loratadine are nonsedating because they: a. Stimulate the CNS b. Bind only to H2-receptors c. Are combined with decongestants that have CNS stimulant activity d. Do not cross the blood-brain barrier

ANS: d Correct: For an agent to cause drowsiness and sedation, it needs to penetrate the blood-brain barrier. Incorrect choices: Loratadine does not enter the brain and does not stimulate the CNS. Loratadine is an H1-receptor antagonist, not H2. Loratadine is nonsedating, even when taken in the absence of stimulating decongestants. REF: pp. 237-238

13. For an asthma attack that is unresponsive to topical 2-agonist administration, what treatment recourse does the dental office have available? a. Parenteral or oral aminophylline b. Parenteral corticosteroids c. Parenteral epinephrine d. Inhaled oxygen

ANS: d Correct: For an asthma attack that is unresponsive to topical 2-agonist, hospitalization should be considered for subsequent drug treatment. However, oxygen can and should be administered. Incorrect choices: The other options should be considered at the hospital rather than the dentist's office. REF: p. 292

47. Which of the following statements is true of progesterone during the normal female sexual cycle? a. Progesterone secretion declines if implantation does not occur by the end of the menstrual cycle. b. If implantation takes place, the developing trophoblast secretes chorionic gonadotropin, which sustains the corpus luteum, thus maintaining progesterone and estrogen levels. c. Progesterone stimulates uterine contractility. d. Both a and b are true. e. Both b and c are true.

ANS: d Correct: If implantation does not occur by the end of the menstrual cycle, progesterone secretion declines, and the onset of menstruation occurs. If implantation takes place, the developing trophoblast secretes chorionic gonadotropin, which sustains the corpus luteum, thus maintaining progesterone and estrogen levels and preventing menstruation. Incorrect choices: Other effects of progesterone include suppression of uterine contractility, proliferation of the acini of the mammary gland, and alteration of transplantation immunity to prevent immunologic rejection of the fetus. REF: p. 264

21. Which agent is used to treat nocturnal enuresis? a. Olanzapine b. Fluoxetine c. Metoclopramide d. Imipramine

ANS: d Correct: Imipramine is effective in juvenile bed wetting, likely because of its anticholinergic actions. Incorrect Answers: Olanzapine, fluoxetine, and metoclopramide are not effective for nocturnal enuresis. REF: p. 231

22. Use of which of the following agents during pregnancy is associated with producing an abnormal number of digits in the newborn? a. Alcohol b. Codeine c. Erythromycin d. Ketoconazole

ANS: d Correct: Ketoconazole has been shown to be teratogenic in rats, causing syndactyly and oligodactyly, an abnormal number of digits. Incorrect choices: Alcohol, codeine, and erythromycin are not commonly known to produce an abnormal number of digits in the newborn. REF: pp. 304-305

24. Which form of insulin has a faster onset of action as a consequence of exchanging two amino acids in its structure? a. Pork insulin b. NPH insulin c. Prompt zinc insulin d. Lispro insulin e. Protamine zinc insulin

ANS: d Correct: Lispro, a new insulin, is made by exchanging two amino acids in the structure of human insulin. This change results in an insulin with a faster onset of action. Incorrect choices: Pork insulin differs from human insulin by two amino acids, but it does not have the characteristics of lispro. The other choices have the same peptide sequence as human insulin but are complexed with different ingredients to alter the onset and duration properties of the molecule. REF: p. 256

53. Which of the following agents is categorized as a schedule III controlled substance? a. Medroxyprogesterone b. Tamoxifen c. RU-486 d. Nandrolone e. Danazol

ANS: d Correct: Nandrolone is an androgenic steroid. It is categorized as a schedule III controlled substance because of its illicit use and abuse potential by athletes and body builders. Incorrect choices: The other choices are all noncontrolled prescription drugs. REF: p. 266

33. Which of the following statements is the mechanism of action of nonsulfonylurea secretagogues such as repaglinide (Prandin) and nateglinide (Starlix)? a. They are competitive, reversible inhibitors of GI tract enzymes: intestinal α-glucosidase and pancreatic α-amylase. b. They increase the insulin sensitivity of adipose tissue, skeletal muscle, and the liver. c. They increase hepatic and peripheral insulin sensitivity, resulting in decreased hepatic glucose production. d. They bind to adenosine triphosphate (ATP) sensitive potassium channels on beta cells and increase insulin resistance

ANS: d Correct: Nonsulfonylurea secretagogues, such as repaglinide (Prandin) and nateglinide (Starlix), bind to ATP sensitive potassium channels on beta cells and increases insulin resistance. Incorrect choices: α-Glucosidase inhibitors are competitive, reversible inhibitors of GI tract enzymes: intestinal α-glucosidase and pancreatic α-amylase. Thiazolidinediones increase the insulin sensitivity of adipose tissue, skeletal muscle, and the liver. Metformin, a biguanide, increases hepatic and peripheral insulin sensitivity, resulting in decreased hepatic glucose production. REF: p. 259

13. Which of the following statements is true concerning the effect of opioids such as codeine on an infant after administration to the mother? a. Opioids appear in breast milk when analgesic doses are administered. b. If the mother is addicted, the infant will experience withdrawal symptoms after birth. c. The infant should be observed for signs of euphoria. d. Both a and b are true. e. Both b and c are true.

ANS: d Correct: Opioids appear in breast milk when analgesic doses are administered. The small doses appear to be insignificant. If the mother is addicted, the infant will experience withdrawal symptoms after birth. Incorrect choices: The infant should be observed for signs of sedation and constipation. REF: p. 302

22. Which agent produces a state described as a complete satiation of all drives? a. Ethyl alcohol b. Cocaine c. Nitrous oxide d. Morphine e. Methaqualone

ANS: d Correct: Opioids, such as morphine, elevate the user's mood, cause euphoria, relieve fear and apprehension, and produce a feeling of peace and tranquility. They also suppress hunger, reduce sexual desire, and diminish the response to provocation. Incorrect choices: None of the other drugs mentioned produce the satiation of drives and sense of well-being that opioids can produce. REF: p. 314

35. Which oral antidiabetic agent requires administration for 6 to 14 weeks to achieve maximal therapeutic effect? a. Tolbutamide b. Exenatide c. Metformin d. Rosiglitazone e. Glimepiride

ANS: d Correct: Pioglitazone (Actos) and rosiglitazone (Avandia) can take up to 6 to 14 weeks to achieve maximal effect. Incorrect choices: Tolbutamide, metformin, and glimepiride work much more quickly than the thiazolidinediones. Exenatide is not an oral antidiabetic because it is administered subcutaneously. REF: p. 259

20. Contributing factors to gangrene in the extremities of diabetic patients include: a. Poor eyesight b. Poor circulation c. Reduced sensation in the extremities d. All of the above e. None of the above

ANS: d Correct: Poor eyesight and reduced sensation in the extremities increase the risk of injury that can lead to infection. Poor circulation makes it more difficult for the immune system and systemic drug therapy to reach the site of infection. REF: p. 255

13. Nausea and vomiting caused by antineoplastic agent therapy can by managed by administration of: a. Procarbazine b. Codeine c. Omeprazole d. Prochlorperazine e. Cisplatin

ANS: d Correct: Prochlorperazine (Compazine) is a phenothiazine with marked antiemetic activity. Incorrect choices: Procarbazine and cisplatin are antineoplastic agents. Omeprazole is a proton pump inhibitor, not an antiemetic, and codeine is a narcotic analgesic with nausea and vomiting as a significant side effect. REF: p. 273

28. Which of the following gastrointestinal drugs is used to treat nausea? a. Mineral oil b. Loperamide c. Lansoprazole d. Prochlorperazine e. Ranitidine

ANS: d Correct: Prochlorperazine is used to treat severe nausea. Incorrect choices: Mineral oil is a lubricant that is used to treat constipation. Loperamide is used to treat diarrhea. Lansoprazole is used to treat ulcers and GERD. Ranitidine is used to treat ulcers and GERD. REF: pp. 284, 286-287

9. Which of the following statements is true regarding the safety of herbal and nutritional products? a. Some products may have potential therapeutic effects. b. The vast majority cause adverse effects and drug interactions. c. Noting the use of herbal products by the patient in his or her chart is unnecessary. d. Both a and b are true. e. Both b and c are true.

ANS: d Correct: Some products may have potential therapeutic effects, and the vast majority cause adverse effects and drug interactions. Incorrect choice: Any use of herbal products by the patient should be noted in the patient's chart. REF: p. 321

6. Synthetic analogs of vasopressin are used to: (1) treat pituitary diabetes insipidus, (2) treat hemophilia A and von Willebrand disease, (3) induce labor and postpartum lactation, (4) control postpartum hemorrhage a. 1, 2, 3, 4 b. 1, 2, 3 c. 2, 3, 4 d. 1, 2 e. 3, 4

ANS: d Correct: Synthetic analogs of vasopressin (desmopressin

11. Patients taking conventional antipsychotics can experience severe intermittent temporomandibular joint (TMJ) pain. This pain is a consequence of: a. Hyperalgesia produced by -adrenergic blockade b. Anticholinergic side effects c. Dislocation of the mandible d. Extrapyramidal side effects

ANS: d Correct: The extrapyramidal side effects of conventional antipsychotics can cause severe intermittent pain in the region of the TMJ. This pain is produced by a spasm of the muscles of mastication. Incorrect Answers: -Adrenergic blockade does not produce hyperalgesia, pain is not caused by anticholinergic side effects, and dislocation of the mandible is a possible consequence of a dental practitioner attempting to force open the mouth of a patient who is experiencing a spasm of the muscles of mastication. REF: p. 227

23. Which agent has a withdrawal syndrome characterized by yawning, rhinorrhea, and chills that alternate with excessive sweating? a. Amphetamine b. Diazepam c. Nicotine d. Heroin

ANS: d Correct: The first signs of heroin withdrawal are yawning, lacrimation, rhinorrhea, and diaphoresis, followed by a restless sleep. With further abstinence, anorexia, tremors, irritability, weakness, and excessive gastrointestinal activity occur. The heart rate is rapid, blood pressure is elevated, and chills alternate with excessive sweating. Incorrect choices: Amphetamine withdrawal causes ravenous appetite, aching muscles, and long periods of sleep. Diazepam withdrawal causes insomnia, hyperthermia, and convulsions. Nicotine withdrawal causes drowsiness, headaches, and increased appetite. REF: p. 314

25. Which of the following statements is true of omalizumab? a. It is a recombinant humanized monoclonal antibody b. It prevents IgE from binding to mast cells and basophils c. It is administered by inhalation d. Both a and b are true. e. Both b and c are true.

ANS: d Correct: omalizumab is the first in a new class of medications introduced to treat asthma caused by allergens. It is recombinant humanized monoclonal antibody that prevents IgE from binding to mast cells and basophils, thereby preventing the release of inflammatory mediators after allergen exposure. Incorrect choices: Omalizumab is administered by subcutaneous injection every 2 to 4 weeks. Adverse reactions include pain and bruising at the injection site. REF: p. 282

14. Which of the following drugs used to treat respiratory diseases carries a black box warning about a higher risk of asthma-related deaths as a result of a high number of asthma related deaths reported with salmeterol therapy during a clinical trial? a. Mast cell degranulation inhibitors b. Anti-immunoglobulin E (IgE) antibodies c. Short-acting β2-agonist d. Long-acting β2-agonist

ANS: d Long-acting β2-agonists carry a black box warning. They are best administered in a fixed-dose combination in the same inhaler with an inhaled corticosteroid. REF: p. 281

5. Manufacturers can make claims of curing conditions, and they can make claims of improving structure or function. a. Both parts of the statement are true. b. Both parts of the statement are false. c. The first part of the statement is true, the second part is false. d. The first part of the statement is false, the second part is true.

ANS: d Manufacturers cannot make claims of curing conditions, and they can make claims of improving structure or function. The U.S. Food and Drug Administration (FDA) can allow a qualified health claim if scientific evidence exists to support the claim. REF: p. 321

10. The FDA has investigated over __________ reports of adverse reactions with over 100 different ephedra alkaloid-containing products since 1994. a. 200 b. 400 c. 600 d. 800

ANS: d More than 800 reports were investigated by the FDA since 1994. Adverse effects include insomnia, nervousness, tremor, headaches, hypertension, seizures, arrhythmias, heart attack, stroke, and death. REF: p. 321

10. Which of the following agents can cause premature closure of the patent ductus arteriosus? a. Acetaminophen b. Clindamycin c. Triazolam d. Ibuprofen

ANS: d Nonsteroidal antiinflammatory drugs (NSAIDs) can cause premature closure of the ductus arteriosus. The other choices do not produce this activity. REF: p. 302

9. Tardive dyskinesia is typically seen in men older than age 40 who have been taking large doses of phenothiazine for 6 months or longer. The onset is gradual and the symptoms are exacerbated on drug withdrawal. a. Both statements are true. b. Both statements are false. c. The first statement is true, the second statement is false. d. The first statement is false; the statement second is true.

ANS: d Tardive dyskinesia is typically seen in female patients who are more than 40 years of age and have been taking large doses of the phenothiazine for a minimum of 6 months to 2 years or as long as 20 years. The onset is gradual and the movements are coordinated and rhythmic. This effect is exacerbated by drug withdrawal. REF: p. 226

14. Which of the following antiinfective agents is regarded as safe to use during pregnancy? a. Doxycycline b. Azithromycin c. Minocycline d. Amoxicillin

ANS: d The consensus is that amoxicillin is safe to use during pregnancy. Using amoxicillin for a dental infection that is not controlled by local measures would be acceptable. REF: pp. 303, 305

27. For which of the following agents does treatment of withdrawal involve replacement of the abused drug with an equivalent drug, followed by gradual withdrawal of the equivalent drug? a. Opioid analgesics b. Sedative-hypnotics c. Alcohol d. All of the above e. None of the above

ANS: d The described regimen is an accepted one for all three of the drugs mentioned. REF: pp. 312, 315-316

10. Extrapyramidal reactions caused by phenothiazines: a. Can be treated with anticholinergic agents b. Are disorders of muscle control c. Include akathisia d. All of the above

ANS: d The severity and prevalence of extrapyramidal reactions depends on the balance between acetylcholine and dopamine. Too much dopamine blockade will lead to these side effects. An anticholinergic can partially restore the balance between dopamine and acetylcholine action in specific brain regions associated with muscle control, such as the corpus striatum. Akathisia is an extrapyramidal reaction characterized by increased compulsive motor activity. REF: pp. 226-227

10. If a patient with COPD is given oxygen and the PaO2 rises, the stimulant to breathing is: a. Markedly stimulated b. Slightly stimulated c. Slightly depressed d. Removed

ANS: d The stimulant to breathing is removed if a patient with COPD is given oxygen and the PaO2 rises because the patient's ventilation is driven by a decrease in PaO2. The possibility of inducing apnea exists. REF: p. 278

40. The major female sex hormone(s) is(are): (1) estrogen, (2) androgen, (3) progestin a. 1, 2, 3 b. 1, 2 c. 2, 3 d. 1, 3 e. 1 only

ANS: d The two major female sex hormones are the estrogens and progestins. They are secreted primarily by the ovaries but also by the testes and placenta. They are largely responsible for producing the female sex characteristics, developing the reproductive system, and preparing the reproductive system for conception. REF: p. 262

15. Conventional antipsychotic therapy must often be combined with anti-Parkinson medication of the __________ type to control excessive extrapyramidal stimulation. a. Adrenergic b. Antiadrenergic c. Cholinergic d. Anticholinergic

ANS: d To control excessive extrapyramidal stimulation, conventional antipsychotic therapy must often be combined with anti-Parkinson medication of the anticholinergic type, for example, benztropine. This combination is likely to exacerbate antimuscarinic peripheral effects such as xerostomia, urinary retention, constipation, blurred vision, and inhibition of sweating. REF: p. 227

4. Which of the following is used in infertility to stimulate ovarian follicle development? a. Follicle stimulating hormone (FSH) b. Luteinizing hormone (LH) c. Human chorionic gonadotropin (hCG) d. Human menopausal gonadotropin (hMG)

ANS: d hMG contains FSH and LH and is commercially available as menotropin. This preparation is used in infertility to stimulate ovarian follicle development. When follicular maturation has occurred, the hMG is discontinued and hCG is given to induce ovulation. REF: p. 250

3. What are potential consequences of administering a drug to a pregnant woman? a. Teratogenicity to the fetus b. Spontaneous abortion c. Delayed and long-term physiologic and psychologic consequences d. Adverse reactions in the near-term fetus e. All of the above

ANS: e All of the other answers cover the generally accepted concerns regarding drug administration to a pregnant woman. Spontaneous abortion could occur on early exposure to a toxic agent, followed by teratogenicity, especially if the drug is present while the organs are forming, followed by adverse reactions to the fully formed fetus. Finally, exposure to a drug in utero may lead to adverse consequences that do not emerge until later in life. REF: p. 300

1. Which of the following reasons is why the chance of an emergency occurring in the dental office continues to increase? a. The average age of the dental patient has increased. b. Dental offices are administering more complicated regimens. c. Dental appointments are taking longer than they used to take. d. Dental patients are, on average, getting sicker. e. All of the above are reasons.

ANS: e All statements are correct. REF: p. 290

26. Dental health care workers should have heightened awareness of the issues of drug abuse because: a. Their coworkers may abuse drugs in the workplace. b. "Shoppers" may interact with health care workers in an effort to obtain controlled substances. c. Patients who abuse drugs intravenously are more likely to contract sexually transmitted or blood-borne diseases that are transmissible to the dental health care worker. d. Dentist's offices have prescriptions and abusable substances that need to be safely monitored. e. All of the above

ANS: e All statements are true. REF: p. 315

6. Which of the following respiratory diseases is(are) associated with irreversible airway obstruction? a. Asthma b. Chronic bronchitis c. Emphysema d. Both a and b e. Both b and c

ANS: e Chronic obstructive pulmonary disease (COPD) is characterized by irreversible airway obstruction, which occurs with either chronic bronchitis or emphysema. REF: p. 278

17. Which one of the following recommendations would you not make to your patients with asthma? a. Bring your inhaler (albuterol) to the dental appointment. b. Rinse after using your corticosteroid inhaler. c. Avoid erythromycin. d. Avoid aspirin. e. Avoid acetaminophen.

ANS: e Correct: Acetaminophen and weak narcotic analgesics are probably permissible for asthmatics. Incorrect choices: Definitely have all asthmatics bring their inhaler to the dental appointment and keep it within reach. Given that corticosteroids can promote the growth of oral Candida, patients should rinse with water after using the inhaler. If the patient is taking theophylline, then erythromycin can cause toxicity by inhibiting its metabolism and increasing theophylline's blood levels. Aspirin, nonsteroidal antiinflammatory drugs (NSAIDs), and strong opioids should be avoided in patients with asthma. REF: pp. 281, 283

3. Negative feedback involves the action of adrenocorticosteroids on the: a. Adrenal cortex b. Pituitary gland c. Hypothalamus d. Both a and c e. Both b and c

ANS: e Correct: Adrenocorticosteroids act on both the pituitary gland and the hypothalamus to inhibit the release of CRH and ACTH, respectively. This mechanism is called negative feedback. Incorrect choices: Negative feedback does not involve the action of adrenocorticosteroids on the adrenal cortex. REF: p. 241

24. The drug of first choice for emphysema is: a. Albuterol b. Zileuton c. Theophylline d. Beclomethasone e. Ipratropium

ANS: e Correct: COPD occurs with emphysema. Ipratropium is the drug of choice for long-term management of COPD. Incorrect choices: Albuterol may be used along with ipratropium in some cases but is not drug of first choice for emphysema. Theophylline may also be used in cases of emphysema. Zileuton is a leukotriene synthesis inhibitor that is a second-line asthma drug. Beclomethasone is a corticosteroid used in asthma. REF: pp. 281-282

49. All of the following are side effects associated with oral contraceptives except one. Which one is the exception? a. Blood clot b. Weight gain c. Headache d. Nausea e. Anorexia

ANS: e Correct: Estrogen therapy can increase the incidence of thrombophlebitis. It can also cause weight gain, headache, and nausea. It does not cause anorexia. REF: p. 265

18. Which of the following statement is true of LTs? a. LTs produce bronchodilation and decreased bronchial hyperreactivity b. LTs are produced by cells of inflammation c. LTs produce increased secretion of mucus and mucosal edema. d. Both a and b are true. e. Both b and c are true.

ANS: e Correct: LTs are produced by cells of inflammation and produce increased mucus secretion and mucosal edema. Incorrect choices: LTs produce bronchoconstriction and increased bronchial hyperreactivity. REF: p. 281

18. Which of the following statements is true regarding systemic complications of diabetes? a. Hypolipidemia is common in patients with diabetes. b. Neuropathy is a complication of diabetes. c. Gangrene can occur in peripheral extremities. d. Both a and b are true. e. Both b and c are true.

ANS: e Correct: Neuropathy is a complication of diabetes. It leads to reduced and sometimes absent feelings, especially in the lower extremities. Gangrene can occur in peripheral extremities, especially the feet and legs. This occurs because of the deficiencies of diabetes, depressed immunity, less effective white blood cells, microvascular changes, and neuropathy. Incorrect choices: Hyperlipidemia and atherosclerosis are more common in these patients. REF: p. 254

38. Which of the following statements is true of pramlintide (Symlin)? a. It is an oral dipeptidyl-peptidase-4 (DPP-4) inhibitor. b. Use leads to decreased caloric intake and potential weight loss. c. It is approved for type I diabetes as an adjunct treatment in patients who use mealtime insulin therapy and who have failed to achieve desired glucose control despite optimal insulin therapy. d. Both a and b are true. e. Both b and c are true.

ANS: e Correct: Pramlintide (Symlin) is responsible for modulation of gastric emptying, prevention of the postprandial rise in plasma glucagon, and satiety, which leads to decreased caloric intake and potential weight loss. It is approved for type I diabetes as an adjunct treatment in patients who use mealtime insulin therapy and who have failed to achieve desired glucose control despite optimal insulin therapy. Incorrect choices: It is an amylinomimetic agent. Sitagliptin is an oral DPP-4 inhibitor. REF: p. 262

5. The predominant feature of anaphylaxis is: a. Lapses into unconsciousness b. Convulsions c. Vasodilation d. Decreased blood pressure e. Bronchoconstriction

ANS: e Correct: The key symptom of anaphylaxis is bronchoconstriction with difficulty in breathing. Incorrect choices: Other symptoms can occur during anaphylaxis, but the predominant feature is anaphylaxis. REF: p. 235

12. The most extensive use of the corticosteroids in both medicine and dentistry is in: a. Replacement therapy for corticosteroid deficiency b. Cancer chemotherapy c. To prevent organ transplant rejection d. Osteoporosis e. Inflammatory and allergic conditions

ANS: e Correct: The most extensive use of the corticosteroids in both medicine and dentistry is in the treatment of a wide variety of inflammatory and allergic conditions. Incorrect choices: Replacement therapy for corticosteroid deficiency, cancer chemotherapy, and prevention of organ transplant rejection are all valid uses of corticosteroids, but they account for fewer prescriptions than inflammation and allergy. Corticosteroids can exacerbate osteoporosis and are not used in its treatment. REF: p. 245

14. Which of the following conditions may be exacerbated by corticosteroid use? a. Hypertension b. Glaucoma c. Congestive heart failure d. None of the above e. All of the above

ANS: e Corticosteroids can exacerbate hypertension and congestive heart failure by their mineralocorticoid effects of increasing circulatory volume. They can also directly increase intraocular pressure, and exacerbate glaucoma. REF: p. 246

1. The phase of the cell cycle before mitosis and after the deoxyribonucleic acid (DNA) synthesis phase is: a. G0 b. M c. G1 d. S e. G2

ANS: e G2 is preceded by M phase, in which DNA synthesis takes place, and is followed by M phase, in which mitosis occurs. G0 is the resting stage, in which the cells are "out of cycle" and not in the process of cell division. REF: p. 271

2. ACTH is secreted from the __________ in response to __________. a. Hypothalamus, stress b. Adrenal cortex, corticotropin-releasing hormone (CRH) c. Adrenal cortex, stress d. Hypothalamus, hydrocortisone e. Pituitary gland, CRH

ANS: e Incorrect choices: stress causes the hypothalamus to release CRH, which acts on the pituitary gland. Under the influence of CRH, the pituitary gland secretes ACTH, which stimulates the adrenal cortex to release hydrocortisone. REF: p. 241

15. Which of the following drugs is the most effective long-term treatment for control of symptoms in all patients with mild, moderate, or severe persistent asthma? a. LT modifiers b. Cromolyn c. Long-acting β2-agonists d. Theophylline e. Corticosteroids

ANS: e Inhaled corticosteroids are the most effective. Randomized, controlled clinical trials have demonstrated that inhaled corticosteroids are more effective than LT modifiers, long-acting β2-agonists, cromolyn, or theophylline in improving pulmonary function, preventing symptoms and exacerbations, reducing the need for emergency room visits, and decreasing the number of asthma-related deaths. REF: p. 281

12. Which of the following herbal medications contains ephedrine and can increase heart rate when given with sympathomimetic drugs? a. Yohimbe b. Ephedra c. Comfrey d. Clove e. Ma huang

ANS: e Ma huang contains ephedrine and can increase heart rate when given with sympathomimetic drugs. REF: p. 322

7. Which antineoplastic drug is a potent cardiotoxin? a. Methotrexate b. Vincristine c. Tamoxifen d. Mechlorethamine e. Doxorubicin

ANS: e Of the drugs listed, doxorubicin is a potent cardiotoxin. REF: p. 273

20. Of the tricyclic antidepressants listed, which one is most sedating? a. Imipramine b. Nortriptyline c. Protriptyline d. Desipramine e. Amitriptyline

ANS: e Of the tricyclic antidepressants listed, amitriptyline is generally the most sedating, with desipramine being the least sedating. When sedation is desired, amitriptyline is used. When less sedation is needed, nortriptyline or protriptyline can be tried. REF: pp. 229-231

42. Which of the following anterior pituitary hormones are involved in the female menstrual cycle? (1) thyroid-stimulating hormone (TSH), (2) adrenocorticotropic hormone (ACTH), (3) FSH, (4) LH a. 1, 2, 3, 4 b. 1, 2 c. 1, 3 d. 2, 3 e. 3, 4

ANS: e On day 1 of an average 28-day cycle, when the menstrual flow begins, the secretions of FSH and LH begin to increase. This release is caused by a reduction in the blood levels of estrogen and progesterone, which normally inhibit their release. In response to increased FSH, an ovarian egg matures, and the follicle in which it is contained grows in size and begins to produce and secrete estrogen. REF: pp. 262-263

6. Physical dependence: a. Is a state of mind in which a person believes that he or she is unable to maintain optimal performance without having taken a drug b. Is established by withdrawal syndrome c. Refers to the altered physiologic state that results from constantly increasing drug concentrations d. Both a and b e. Both b and c

ANS: e Physical dependence refers to the altered physiologic state that results from constantly increasing drug concentrations as opposed to psychologic dependence, which is a state of mind in which a person believes that he or she is unable to maintain optimal performance without having taken a drug. It is established by withdrawal syndrome, a combination of many drug-specific symptoms that occur on abrupt discontinuation of drug administration. REF: p. 309

24. Which of the following are adverse reactions associated with selective serotonin reuptake inhibitors (SSRIs)? a. Central nervous system (CNS) depression b. Nausea and diarrhea in approximately 15% to 30% of patients c. Xerostomia in 10% to 15% of the population d. Both a and b e. Both b and c

ANS: e SSRIs are associated with nausea and diarrhea in approximately 15% to 30% of patients. Oral side effects include xerostomia in 10% to 15% of the population, taste changes, aphthous stomatitis, glossitis, and (rarely) increased salivation, salivary gland enlargement, and tongue discoloration or edema. Incorrect choices: SSRIs tend to produce CNS stimulation rather than CNS depression. REF: p. 231

DDAVP, Stimate

and lypressin

Diapid

are used for chronic treatment of pituitary diabetes insipidus and to treat certain clotting disorders (hemophilia A and von Willebrand disease). These two analogs are available as nasal solutions and have the same action as vasopressin but are longer acting. Incorrect choices: Oxytocin, administered either by injection or intranasally, is used to induce labor, control postpartum hemorrhage, and induce postpartum lactation. REF: p. 251