EXAM 2 (chapters 10,12,13, 18,27,29)

15. Which of the following types of breath odor is associated with liver failure? a. Sweet, musty b. Breadlike c. Ammonia d. Garlic

ANS: A A sweet, musty odor to the breath is associated with liver failure, as is jaundiced mucosal tissue.

8. Which of the following is an adverse effect associated with the administration of tricyclic antidepressants? a. Xerostomia b. Diarrhea c. Hypertension d. Bradycardia

ANS: A Adverse effects associated with tricyclics include dry mouth (xerostomia), constipation, cardiac dysrhythmias such as tachycardia, hypotension, blurred vision, allergic reactions, and important drug interactions. Tricyclic drugs should be used with caution in patients with cardiac conditions because of the associated risk for atrial fibrillation, atrial ventricular block, or ventricular tachycardia.

3. Failing kidneys are unable to concentrate and filter the intake of ________. a. sodium b. potassium c. iron d. phosphate

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

17. Afternoon fatigue is most closely associated with which of the following neurologic disorders? a. Multiple sclerosis b. Epilepsy c. Parkinson's disease d. Alzheimer's disease

ANS: A Fatigue is a major symptom of multiple sclerosis (occurring in up to 90%), and worsening fatigue occurs in the afternoon. Symptoms are exacerbated by heat (hot baths, sun exposure) and dehydration and generally emerge over a few days before stabilizing and subsiding a few weeks later. Fatigue is managed with afternoon naps, exercise, and amantadine (Symmetrel) or modafinil

6. Which of the following would be the best choice of restoration for an epileptic patient? a. All-metal fixed prosthesis b. All-porcelain fixed prosthesis c. All-metal removable prosthesis d. All-acrylic removable prosthesis

ANS: A For fixed prostheses, all-metal units should be considered when possible, to minimize the chance of fracture. Generally, a fixed prosthesis is preferable to a removable one. Removable prostheses are nevertheless sometimes constructed for epileptic patients. Metallic palates and bases are preferable to all-acrylic ones. If acrylic is used, it should be reinforced with wire mesh.

14. Which of the following is true of Alzheimer's disease? a. By age 85, more than 40% of persons will have developed Alzheimer's disease. b. Onset of Alzheimer's may occur as early as 20 years of age. c. The cause of Alzheimer's is unknown but appears to involve the loss of sympathetic neurons. d. A and B e. B and C

ANS: A From age 70 years on, the prevalence doubles every 5 years. By age 85, more than 40% of persons will have developed Alzheimer's disease. With the aging of the population in the United States, the prevalence of this disease is predicted to double by 2020.

9. Which of the following statements is true regarding infection with HSV-1 and HSV-2? a. Although the primary site of occurrence of HSV-1 is above the waist and of HSV-2 below the waist, each infection may occur at either site. b. HSV-1 can be differentiated from HSV-2 on the basis of skin lesions and other clinical manifestations. c. HSV-1 cannot be transmitted by sexual contact. d. HSV-2 is transmitted entirely by sexual contact.

ANS: A HSV-1 is the causative agent of most herpetic infections that occur above the waist, especially involving the oral mucosa (i.e., primary herpetic gingivostomatitis, recurrent herpes labialis, and recurrent intra-oral herpes), nasal mucosa, eyes, brain, and skin. Transmission to others usually occurs through close contact, through transfer of infective saliva such as touching, kissing, or via oral sexual contact. Autoinoculation via face, fingers, eyes, and genitalia may also occur. HSV-2 is transmitted predominantly by sexual contact, primarily through contact with an asymptomatic viral shedder, although it may also be transmitted nonsexually.

Chapter 10: Liver Disease MULTIPLE CHOICE 1. Which of the following is a form of infectious (rather than serum) hepatitis? a. Hepatitis a b. Hepatitis b c. Hepatitis c d. Hepatitis d

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

3. Which of the following is/are true of bipolar disorder? a. Men tend to have a greater number of manic episodes, and women, more numerous depressive episodes. b. Diagnosis is made as soon as the patient has one manic episode and one depressive episode. c. It is characterized by manic behavior. d. Each affective episode lasts about 1 week.

ANS: A Men tend to have a greater number of manic episodes, and women, more numerous depressive episodes. Diagnosis is made as soon as the patient has one manic episode, even if that person has never had a depressive episode. The essential feature of a manic (not maniac) episode is a distinct period during which the affected person's mood is elevated and expansive or irritable. Each affective episode lasts about 8 to 9 months.

12. Parkinson's disease is a disorder of neurons that produce which of the following neurotransmitters? a. Dopamine b. Acetylcholine c. Epinephrine d. Endorphin

ANS: A Parkinson's disease is a progressive neurodegenerative disorder of neurons that produce dopamine. Loss of these neurons results in characteristic motor disturbances—resting tremor, muscular rigidity, bradykinesia, and postural instability. Approximately 80% of the dopamine in these neurons must be depleted before symptoms of the disease emerge.

9. Many over-the-counter (OTC) cold remedies should not be prescribed for patients taking monoamine oxidase (MAO) inhibitors because the cold remedies contain _________. a. phenylephrine b. tyramine c. allopurinol d. epinephrine

ANS: A Phenylethylamine and phenylephrine must not be given to patients who are taking MAO inhibitors. MAO metabolizes these agents, and their use with an MAO inhibitor could lead to significant potentiation of their pressor effects.

10. Which of the following is true of the selective serotonin reuptake inhibitors (SSRIs) when contrasted with tricyclic antidepressants (TCAs)? a. SSRIs are now considered first-line drugs for the treatment of depression. b. SSRIs are far more effective than the tricyclic drugs. c. SSRIs generally are more lethal in overdose than the tricyclic antidepressants. d. SSRIs are much less expensive than the traditional tricyclic antidepressants.

ANS: A SSRIs are now considered first-line drugs for the treatment of depression. SSRIs are just as effective as tricyclics, but they are not more effective.

12. It is suggested that no more than _____ cartridges of dental local anesthetic containing (1:100,000) epinephrine be used during an appointment when a patient is taking tricyclic antidepressants. a. 2 b. 4 c. 6 d. 8

ANS: A Small amounts of epinephrine (1:100,000) can be used in patients who are taking heterocyclic antidepressants, monoamine oxidase inhibitors, or antipsychotic drugs, if the dentist aspirates before injecting and injects the anesthetic slowly. No more than 2 cartridges should be injected at any appointment.

7. Which of the following STDs is associated with the Jarisch-Herxheimer reaction? a. Syphilis b. Gonorrhea c. Infectious mononucleosis d. Genital herpes

ANS: A The Jarisch-Herxheimer reaction is an acute febrile reaction that frequently is accompanied by chills, myalgias, hyperventilation, and headache that occur within 24 hours after initiation of therapy for syphilis. It occurs most often after treatment for early syphilis.

4. A chancre is associated with ______ syphilis. a. primary b. secondary c. tertiary d. latent

ANS: A The classic manifestation of primary syphilis is the chancre, a solitary firm, round, granulomatous lesion that develops at the site of inoculation with the infectious organism. The chancre usually occurs within 2 to 3 weeks after exposure.

13. Which of the following medications is the primary agent used to treat Parkinson's disease? a. Carbidopa-levodopa (Sinemet) b. Pramipexole (Mirapex) c. Tolcapone (Tasmar) d. Entacapone (Comtan)

ANS: A The mainstay of treatment for advanced Parkinson's disease is carbidopa-levodopa (Sinemet), an immediate precursor of the neurotransmitter dopamine. Use of this agent generally is reserved for later in the course of the disease because its activity wanes after about 5 to 10 years, and when given over the long term, it produces complicating effects.

7. Which of the following viruses has been reported to be transmitted nosocomially in dialysis centers in the United States? 1. Hepatitis B 2. Hepatitis C 3. Human immunodeficiency virus (HIV) a. 1, 2, 3 b. 1, 2 c. 2, 3 d. 1 only

ANS: B A 2002 national survey reported that among patients maintained on hemodialysis, the prevalence of hepatitis B surface antigen positivity was 1.0%; of hepatitis C seropositive status, 7.8%; and of HIV seropositivity, 1.5%. Although all three viruses constitute a reservoir of potential infection, only hepatitis B and hepatitis C have been reported to be transmitted nosocomially in dialysis centers in the United States.

6. Which of the following types of somatoform disorders occurs when a person views a traumatic event and subsequently becomes blind due to a conflict about acknowledging the event? a. Hypochondriasis b. Conversion disorder c. Factitious disorder d. Somatization disorder

ANS: B A conversion reaction results when a psychological conflict or need is expressed as an alteration or loss of physical function, suggesting a physical disorder. A person who views a traumatic event, for example, but has a conflict about acknowledging that event may develop a conversion disorder of blindness. In this instance, the symptom of blindness has symbolic value and is a representation of and a partial solution to the underlying psychological conflict.

2. How long will an untreated major depression last? a. 4 months b. 8 months c. 4 years d. 8 years

ANS: B A major depression will usually last about 8 to 9 months if the patient is not treated. Dysthymia represents a chronic, milder form of depression with symptoms that last at least 2 years. Depression not otherwise specified (NOS) is a form of depression that falls short of the diagnostic criteria for major depression and has been too brief for dysthymic disorder.

7. Which of the following is/are considered to be negative symptoms of schizophrenia? a. Delusions b. Reduction of affective expression c. Hallucinations d. A and B e. B and C

ANS: B Delusions and hallucinations are referred to as "positive" symptoms, and withdrawal and reduction of affective expression as "negative" symptoms. Delusions usually are bizarre. Hallucinations are prominent and occur throughout the day for several days or several times a week for several weeks.

18. Dysarthria means that the patient will have difficulty _________. a. swallowing b. speaking c. standing d. sitting still

ANS: B Dysarthria produces slow, irregular speech with unusual separation of syllables of words, referred to as scanning speech. The most common oral manifestations of multiple sclerosis (MS) include dysarthria, paresthesia, numbness of the orofacial structures, and trigeminal neuralgia.

4. Which of the following antibiotics should not be administered to a patient who is taking carbamazepine (Tegretol) for management of epilepsy? a. Penicillin b. Erythromycin c. Ciprofloxacin d. Cephalexin

ANS: B Erythromycin and propoxyphene should not be administered to patients who are taking carbamazepine because of interference with metabolism of carbamazepine, which could lead to toxic levels of the anticonvulsant drug. Aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs) should not be administered to patients who are taking valproic acid, because these agents can further decrease platelet aggregation, leading to hemorrhagic episodes.

8. Which of the following is the most important risk factor for intracerebral hemorrhagic stroke? a. High-cholesterol diet b. Hypertension c. Type II diabetes d. Cytomegalovirus

ANS: B Hypertension is the most important risk factor for ischemic and hemorrhagic stroke. The incidence of stroke increases directly in relation to the degree of elevation of systolic and diastolic arterial blood pressure above threshold values. Atherosclerosis and cardiac pathosis (myocardial infarction, atrial fibrillation) increase the risk for thrombolic and embolic strokes. Additional factors that increase the risk for stroke include the occurrence of transient ischemic attacks, a previous stroke, high dietary fat, obesity and elevated blood lipid levels, physical inactivity, uncontrolled hypertension, cardiac abnormalities, diabetes mellitus, elevated homocysteine levels, elevated hematocrit, elevated antiphospholipid antibodies, heavy tobacco smoking, increasing age, and periodontal disease.

10. Which of the following hepatitis viruses is second most likely (following hepatitis B) to be transmitted occupationally to a dental healthcare worker? a. HAV b. HCV c. HEV d. Non-A-E

ANS: B Little to no risk exists for transmission of HAV, HEV, and non-A-E hepatitis viruses from occupational exposure of dental health care workers to persons infected with these viruses. Risk for transmission of HBV is well recognized, and a lesser risk is present for HCV infection after occupational exposure to infected blood or body fluids containing infected blood. After percutaneous or other sharps injury in health care workers involving exposure to contaminated blood, the risk of contracting HBV infection is reported to range from 6% to 30%. The seroconversion rate for accidental blood exposure to HCV is between 2% and 8%

16. Which type of nervous tissue is affected by multiple sclerosis (MS)? a. The dura mater of the brain b. The white matter of the central nervous system (CNS) c. The afferent nerves of the peripheral nervous system (PNS) d. The efferent nerves of the peripheral nervous system (PNS)

ANS: B MS is characterized by chronic and continuous demyelination of the corticospinal tract neurons in two or more regions of the brain and spinal cord. Demyelinated regions are limited to the white matter of the CNS and are randomly located and multiple. The peripheral nervous system is not affected.

Chapter 13: Sexually Transmitted Diseases MULTIPLE CHOICE 1. Which of the following is the most nationally reported STD in the United States today? a. Syphilis b. Chlamydia c. AIDS d. Gonorrhea

ANS: B Of the three nationally reported notifiable STDs (chlamydia, gonorrhea, and syphilis), gonorrhea is the second most common behind chlamydia with an incidence of 350,062 new cases reported in the United States to the CDC in 2014.

4. Which of the following is a characteristic of stage 2 of HIV infection? a. Predomination of opportunistic infections b. Progressive immunosuppression c. HIV antibody-positive d. CD4+ T count approximates 200 cells/μL

ANS: B Stage 2 is characterized by progressive immunosuppression and symptomatic disease. Patients who demonstrate various laboratory changes (i.e., lymphopenia: T helper/T suppressor ratio usually less than 1) in addition to HIV antibody positivity also may show clinical signs or symptoms, such as enlarged lymph nodes, night sweats, weight loss, oral candidiasis, fever, malaise, and diarrhea.

Chapter 18: AIDS, HIV Infection, and Related Conditions MULTIPLE CHOICE 1. The current definition of AIDS is the laboratory-confirmed evidence of HIV infection in a person who has stage 3 HIV infection, meaning that the CD4+ lymphocyte count is less than _______ cells/μL. a. 400 b. 200 c. 100 d. 50

ANS: B Stage 3 HIV infection means that the CD4+ lymphocyte count is less than 200 cells/μ.L. The current definition of AIDS also includes HIV-infected persons whose CD4+ count may be above 200 but who have an AIDS-defining condition.

Chapter 12: Chronic Kidney Disease and Dialysis MULTIPLE CHOICE 1. According to the National Kidney Foundation, which stage of chronic kidney disease (CKD) is characterized by a loss of 50% or more of normal renal function? a. Stage 2 b. Stage 3 c. Stage 4

ANS: B Stage 3 is evidenced as a moderately decreased glomerular filtration rate (GFR), with loss of 50% or more of normal renal function. Stage 4 is defined by a severely decreased GFR. Stage 5 is reflected by renal failure, wherein 75% or more of the approximately 2 million nephrons have lost function.

3. Status epilepticus is __________________. a. the diagnosis of the particular form of epilepsy based on the presence of abnormalities on electroencephalogram (EEG) b. repeated seizures over a short time without a recovery period c. the analysis of the response of motor cortex neurons to long-term drug therapy d. a determination of whether the seizure is partial or generalized

ANS: B Status epilepticus is the occurrence of repeated seizures over a short time without a recovery period. It is a serious acute complication of epilepsy (especially the tonic-clonic type). This condition most frequently is caused by abrupt withdrawal of anticonvulsant medication or an abused substance but may be triggered by infection, neoplasm, or trauma.

12. According to CDC guidelines, what should be done first if a vaccinated health care worker sustains a needlestick or puncture wound involving exposure to blood from a patient known to be HBsAg-positive? a. Nothing, because the health care worker has already been vaccinated. b. The health care worker should be tested for an adequate titer of anti-HBs if those levels are unknown. c. The health care worker should immediately receive an injection of HBIG. d. The health care worker should immediately receive an injection of the hepatitis B vaccine as a booster dose

ANS: B The health care worker should be tested for an adequate titer of anti-HBs. If the levels are inadequate, the worker should immediately receive an injection of HBIG and a vaccine booster dose. If the antibody titer is adequate, however, nothing further is required.

5. What should be done if a patient has an epileptic seizure during a dental procedure? a. The patient should be moved from the chair to the floor. b. The chair should be placed in a supine position. c. The patient should be restrained. d. A and B e. B and C

ANS: B The instruments and the instrument tray should be cleared from the area, and the chair should be placed in a supported supine position. No attempt should be made to move the patient to the floor. The patient's airway should be maintained patent. No attempt should be made to restrain or hold the patient down. Passive restraint should be used only to prevent injury that may result if the patient were to hit nearby objects or fall out of the chair.

2. Which of the following is the most common method of sexual transmission of HIV in the United States? a. Transmission from injection drug use b. Anal intercourse in men who have sex with men (MSM) c. Male-to-female heterosexual transmission d. Female-to-male heterosexual transmission

ANS: B The most common method of sexual transmission in the United States is anal intercourse in MSM, in whom the risk of HIV infection is 40 times higher than in other men and in women. Heterosexual transmission (male to female, or female to male) is the second most common form of transmission in the United States, but it accounts for 80% of the world's HIV infections. Injection drug use is the third most common mode of transmission in the United States.

3. Which of the following is the most reliable prognostic factor in acute hepatic failure due to hepatitis? a. Changes in personality b. The degree of prolongation of prothrombin time c. Serum aminotransferase levels d. Viral titers

ANS: B The most reliable prognostic factor in acute hepatic failure is the degree of prolongation of the prothrombin time; other signs of poor prognosis are persistently worsening jaundice, ascites, and decreases in liver size. Serum aminotransferase levels and viral titers have little prognostic value and often decrease with worsening hepatic failure.

2. In which of the following populations is end-stage renal disease (ESRD) increasing most rapidly? a. Polycystic kidney disease b. Patients over age and in those with diabetes mellitus and hypertension c. Hypertension d. Chronic glomerulonephritis

ANS: B The prevalence of CKD is increasing by approximately 4% per year, most rapidly in patients over age 65 and in those who have diabetes and hypertension. CKD occurs more commonly in men; African, Native, and Asian Americans; and those between the ages of 45 and 64 years. 24.5% of people 60 years and older have CKD, and more than 90% of patients with kidney failure are older than 18 years of age.

7. The risk of HIV transmission from infected patients to health care workers is about ___% in cases in which a needlestick or other sharp instrument transmitted blood from patient to health care worker. a. 0.03 b. 0.3 c. 3.0 d. 30.0

ANS: B The risk of HIV transmission from infected patients to health care workers is very low, reportedly about 3 of every 1000 cases (0.3%) in which a needlestick or other sharp instrument transmitted blood from patient to health care worker. In comparison, the risk of infection from a needlestick is 3% for hepatitis C and 30% for hepatitis B.

. Which of the following is a treponemal test for syphilis? a. Venereal Disease Research Laboratory (VDRL) slide test b. T. pallidum particle agglutination test (TPHA) c. Rapid plasma reagin (RPR) test d. Automated reagin test (ART)

ANS: B Treponemal testing: These include the fluorescent treponemal antibody absorption test (FTA-ABS), T. pallidum particle agglutination assay (TPPA), T. pallidum hemagglutination assay (TPHA), and various immunoassays (i.e., enzyme immunoassays (EIA), chemiluminescent immunoassays (CIA), and microbead immunoassays (MIA). These are highly specific but a positive test cannot differentiate between current and past infection because antibodies remain positive in most patients.

8. What is the estimated prevalence of genital herpes caused by HSV-1 infection in the United States? a. 5% b. 15% c. 25% d. 50%

ANS: C A current conservative estimate for genital herpes caused by HSV-1 infection is 50%, and this translates to a global genital HSV seroprevalence (for 15 to 49 years old) estimated of at least 544 million. The CDC reports approximately 24 million Americans have HSV-2 infection, with greater than 750,000 new infections annually.

11. Antipsychotic drugs appear to work by antagonizing the effects of dopamine in the basal ganglia and limbic portions of the _________. a. cerebellum b. pons c. forebrain d. midbrain

ANS: C Antipsychotic drugs appear to work by antagonizing the effects of dopamine in the basal ganglia and limbic portions of the forebrain. Because of significant adverse reactions associated with their use, these agents should be used only when they are clearly the drugs of choice.

Chapter 29: Psychiatric Disorders MULTIPLE CHOICE 1. About what percentage of persons in the United States will have at least one psychiatric disorder during their lifetime? a. 10 b. 25 c. 33 d. 50

ANS: C Approximately one third of the population in the United States will have at least one psychiatric disorder during their lifetime, and 20% to 30% of adults in the United States will experience one or more psychiatric disorders during a 1-year period.

3. Which of the following is the recommended treatment regimen for gonococcal pharyngitis? a. Cefixime 250 mg (intramuscularly [IM] in a single dose) b. Oral cefixime 200 mg in a single dose c. Ceftriaxone 250 mg single dose plus azithromycin 1 g single oral dose d. A single dose of injectable cephalosporin plus azithromycin 1 g orally

ANS: C Because of antimicrobial sensitivity, the CDC has updated treatment recommendations. It now recommends dual therapy of a single dose of ceftriaxone 250 mg intramuscularly plus a single dose of azithromycin 1 g orally for the treatment of uncomplicated gonococcal infection of the cervix, urethra, pharynx, or rectum in adults.

11. Calcified atherosclerotic plaques seen in the carotid arteries of elderly and diabetic patients on panoramic images warrant referral to the patient's physician because they indicate an increased risk for _________. a. cardiac arrhythmia b. orthostatic hypotension c. stroke d. ventricular fibrillation

ANS: C Calcified atherosclerotic plaques on panoramic films of an elderly or diabetic patient indicate a risk for stroke and warrant referral to the patient's physician for evaluation.

9. Which of the following types of gingival is associated with the HIV-positive patient? a. Papillary gingivitis b. Diffuse gingivitis c. Linear gingival erythema d. Desquamative gingivitis

ANS: C Candidiasis, hairy leukoplakia, specific forms of periodontal disease (i.e., linear gingival erythema and necrotizing ulcerative periodontitis), Kaposi sarcoma, and non-Hodgkin lymphoma are believed to be strongly associated with HIV infection.

9. Which of the following is the most common means of transmission of hepatitis C? a. Maternal-infant b. Sexual exposure c. Injection drug use d. Needlestick accidents

ANS: C Current studies of acute hepatitis C indicate that more than 60% of cases are attributable to injection drug use; 15% to 20% to sexual exposure; and only a small proportion to maternal-infant spread, needlestick accidents, and iatrogenic causes. Approximately 10% of cases are not associated with any history of potential exposure and remain unexplained.

15. Which of the following medications approved by the U.S. Food and Drug Administration (FDA) for the management of moderate to severe Alzheimer's disease? a. Rivastigmine (Exelon) b. Tacrine (Cognex) c. Memantine (Axura) d. Donepezil (Aricept)

ANS: C For the management of moderate to severe Alzheimer's disease, memantine (Axura), an N-methyl-D-aspartate (NMDA) receptor antagonist, has been approved by the U.S. Food and Drug Administration (FDA). This drug works by selectively blocking the excitotoxic effects of abnormal glutamate transmission.

4. (A/An) _______________ syndrome develops during the preicteric phase in approximately 10% to 20% of patients with acute hepatitis. a. chronic fatigue b. irritable bowel c. serum sickness-like d. aspirin triad syndrome

ANS: C In 10% to 20% of patients with acute hepatitis, a serum sickness-like syndrome marked by variable combinations of rash, arthralgias, and fever develops during the preicteric phase. This immune complex-like syndrome often is mistakenly attributed to other illnesses until the onset of jaundice, at which time the fever, hives, and arthralgias quickly resolve.

10. Infective endocarditis occurs in 2% to 9% of patients receiving hemodialysis. The American Heart Association (AHA) 2003 guidelines include a recommendation for prophylactic antibiotics before invasive dental procedures are performed on patients with intravascular access devices to prevent endarteritis or infective endocarditis. 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 Infective endocarditis occurs in 2% to 9% of patients receiving hemodialysis. This rate is significantly higher than that reported in persons with rheumatic heart disease. On the basis of an apparently low risk, the American Heart Association (AHA) 2003 guidelines do not include a recommendation for prophylactic antibiotics before invasive dental procedures are performed on patients with intravascular access devices to prevent endarteritis or infective endocarditis, except if an abscess is being incised and drained.

6. Which of the following is the most common means by which hepatitis A is spread? a. Consumption of shellfish from contaminated waterways b. Fecal contamination of food or water c. Direct person-to-person exposure d. Blood transfusions

ANS: C Investigation of the sources of infection for hepatitis A reveals that most cases are due to direct person-to-person exposure and, to a lesser extent, to direct fecal contamination of food or water. Consumption of shellfish from contaminated waterways is a well-known but quite uncommon means of acquiring hepatitis A. Rare instances of hepatitis A being spread by blood transfusions and administration of pooled plasma products have been described.

6. How do most dialysis patients in the United States receive hemodialysis? a. Continuous cyclic peritoneal dialysis (CCPD) b. Chronic ambulatory peritoneal dialysis (CAPD) c. Through an arteriovenous graft, usually placed in the forearm d. Through a central catheter

ANS: C More than 80% of the people who receive hemodialysis in the United States do so through a permanent and surgically created arteriovenous graft or fistula, usually placed in the forearm. Approximately 18% of patients receive dialysis through a temporary or permanent central catheter, while the permanent access site is healing or when all other access options have been exhausted. The principal use of peritoneal dialysis is in patients in acute renal failure or in those who require only occasional dialysis.

10. Which of the following is true regarding Epstein-Barr virus (EBV) and the epidemiology of infectious mononucleosis? a. The number of sex partners does not influence the risk for acquisition of EBV. b. About 90% of college freshmen in the United States have evidence of previous EBV infection. c. The incidence of EBV in non-hispanic blacks aged 15 to 19 is approximately 78%. d. EBV is much more prevalent among women than men.

ANS: C More than 90% of adults worldwide have been infected with EBV. EBV seroprevalence increases during childhood, with the highest rates in non-hispanic blacks aged 15 to 19 (approximately 78%). No gender predilection has been noted. Having numerous sexual partners increases the risk for acquisition of EBV. Only about 25% of teenagers who are infected with EBV develop IM.

6. Which of the following is a legitimate reason for a general dentist to make a referral of an asymptomatic HIV-positive patient to an endodontist for endodontic treatment of a molar tooth? a. The general dentist simply does not want to treat a person who is HIV-positive. b. The general dentist feels that the patient is immunocompromised, but the patient refuses to undergo testing for HIV. c. The general dentist does not perform endodontic treatment for molar teeth. d. A and B e. B and C

ANS: C No medical or scientific reason exists to justify why patients with AIDS who seek routine dental care may be declined treatment by the dentist, regardless of the practitioner's personal reason. Dental treatment may not be withheld if the patient refuses to undergo testing for HIV exposure. The dentist may refer a patient to another provider who is better suited to provide treatment.

8. Which of the following is true regarding prevaccination screening and booster doses of hepatitis B vaccine? a. Prevaccination screening and booster doses are recommended for all persons receiving the hepatitis B vaccination. b. Prevaccination screening is not recommended; however, booster doses are recommended for all persons receiving the hepatitis B vaccination. c. Prevaccination screening is not recommended except for adults in high-risk groups. Booster doses are not routinely recommended but may be appropriate for persons at high risk if titers of anti-HBs fall below what is considered protective. d. Neither prevaccination screening, nor booster doses of hepatitis B vaccine are recommended for anyone.

ANS: C Prevaccination screening for anti-HBs is not recommended except in adults in high-risk groups. Postvaccination testing for anti-HBs to document seroconversion is not recommended routinely except in persons whose subsequent clinical management depends on knowledge of their immune status, particularly health care and public safety workers. At present, booster doses are not recommended but may be appropriate for persons at high risk if titers of anti-HBs fall below what is considered protective (10 IU/mL). Current guidelines published by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices recommend booster doses only for persons who did not respond to the primary vaccine series.

12. What should be done in regard to routine dental treatment if a patient presents with symptoms of infectious mononucleosis? a. The patient should be treated utilizing standard precautions, just as any other patient. b. The patient should be placed on a course of antibiotics for one week and then treated. c. Treatment should be delayed for about 4 weeks until the patient has recovered. d. Treatment should be delayed until there is a negative result on serologic testing

ANS: C Routine dental treatment should be delayed for about 4 weeks until the patient has recovered. In the meantime, the patient should be referred to a physician for evaluation and treatment.

7. Which of the following is the leading cause of long-term disability in the United States? a. Heart disease b. Renal failure c. Stroke d. Arthritis

ANS: C Stroke is the leading cause of serious, long-term disability in the United States; 5% of the population older than 65 years of age has had one stroke. Seventy-five percent of persons survive their stroke. Even if a stroke is not fatal, the survivor often is to some degree debilitated in motor function, speech, or cognition.

4. Which of the following is the first-line medication for major depression? a. A newer atypical antipsychotic such as clozapine (Clozaril) b. A tricyclic antidepressant such as imipramine c. A selective serotonin reuptake inhibitor (SSRI) such as citalopram d. A monoamine oxidase inhibitor such as phenelzine (Nardil)

ANS: C The first-line medication for major depression is a selective serotonin reuptake inhibitor (SSRI) such as citalopram. Sertraline, venlafaxine, and bupropion are second-line drugs that may be used in patients who fail to achieve remission with citalopram. These agents are used primarily to treat major depression, dysthymic disorder, and depression not otherwise specified (NOS), and have a limited role in depression associated with bipolar disorder that responds to an antipsychotic medication and the standard antidepressant medication fluoxetine.

9. Which of the following is the most classically described osseous change accompanying chronic renal failure? a. "Hair-on-end" appearance b. "Cotton-wool" appearance c. "Ground glass" appearance d. "Swiss cheese" appearance

ANS: C The most classically described osseous change accompanying chronic renal failure is the triad of loss of lamina dura, demineralized bone (resulting in a "ground glass" appearance), and localized radiolucent jaw lesions (central giant cell granulomas also called brown tumors), the latter from secondary hyperparathyroidism.

5. Which of the following is the most widely used mood stabilizer for bipolar disorder? a. Tranylcypromine (Parnate) b. Fluvoxamine (Luvox) c. Lithium carbonate d. Carbamazepine

ANS: C The most widely used mood stabilizer is lithium carbonate. Lithium is most helpful in patients with euphoric mania. When lithium is ineffective, or when medical problems prevent its use, one of the anticonvulsants (valproic acid or divalproex, lamotrigine, or carbamazepine) can be used. Tranylcypromine (Parnate) is a monoamine oxidase inhibitor. Fluvoxamine (Luvox) is a selective serotonin reuptake inhibitor.

5. Which of the following is true of the syphilitic gumma? a. Gummas are nontender. b. Gummas are infectious. c. The oral gumma most commonly involves the tongue and palate. d. Gummas can occur during any stage of syphilis.

ANS: C The oral gumma is a rare lesion that most commonly involves the tongue and palate. It appears as a firm tissue mass with central necrosis. Palatal gummas may perforate into the nasal cavity or maxillary sinus. The benign tertiary stage of syphilis is classically characterized by the formation of gummas. These localized nodular, tender lesions may involve the skin, mucous membranes, bone, nervous tissue, and/or viscera.

4. Which of the following sequences correctly depicts the sequence of osseous changes observed in the patient with renal osteodystrophy? 1. Osteosclerosis 2. Osteomalacia 3. Osteitis fibrosa a. 1, 2, 3 b. 1, 3, 2 c. 2, 3, 1 d. 2, 1, 3

ANS: C The progression of osseous changes is (increased unmineralized bone matrix), followed by osteitis fibrosa (bone resorption with lytic lesions and marrow fibrosis) and then osteosclerosis of variable degree (enhanced bone density).

8. Which of the following represents an acceptable expanded postexposure prophylaxis regimen (PEP) after exposure to HIV-infected blood? 1. Tenofovir plus emtricitabine 2. Zidovudine plus lamivudine 3. Ritonavir-boosted (/r) lopinavir a. 1, 2, 3 b. 1, 2 c. 1, 3 d. 3

ANS: C The recommended basic regimen for HIV PEP is tenofovir plus emtricitabine or zidovudine plus lamivudine. The expanded regimen includes a standard two-drug regimen plus a protease inhibitor such as ritonavir-boosted (/r) lopinavir, darunavir/ratazanavir/or raltegravir. PEP should be continued for 4 weeks, during which time the exposed clinician should be provided expert consultation, and follow-up monitoring for compliance, adverse events, and possible seroconversion. Tests for seroconversion should be performed at 3, 6, and 12 months.

5. Which of the following tests is a measure of muscle breakdown and filtration capacity of the nephron? a. Glomerular filtration rate (GFR) b. Blood urea nitrogen (BUN) c. Serum creatinine d. Creatinine clearance

ANS: C The serum creatinine level is a measure of muscle breakdown and filtration capacity of the nephron. The creatinine concentration is proportional to the glomerular filtration and tubular excretion rates, and this ratio commonly is used as the index of creatinine clearance in a 24-hour urine collection. BUN is a commonly used indicator of kidney function, but the BUN level is not as specific as creatinine clearance or serum creatinine level.

2. Which of the following is thought to be the major factor in the pathogenesis of liver injury? a. Antibody-dependent cellular cytotoxicity b. Proinflammatory cytokines c. Cytotoxic T cell responses d. Natural killer cell activity

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

11. Which of the following is true of the HPV vaccine Gardasil? a. It is a vaccine approved for use with females but not males. b. It is used to treat genital warts but will not prevent infection with human papilloma virus types 6, 11, 16, and 18. c. The vaccine is 95% to 100% effective in preventing infection. d. It has been shown to eliminate and cure HPV infection.

ANS: C This vaccine is 95% to 100% effective in preventing infection and has been approved for use in girls and women aged 9 to 26 years, and boys at 11 or 12 (labeled for genital warts), It is administered in a 3-shot regimen over a 6-month period.

2. Which of the following areas of the oral cavity is most commonly affected by oral gonorrhea? a. Floor of the mouth b. Buccal mucosa c. Pharynx d. Soft palate

ANS: C Within the oral cavity, the pharynx is most commonly affected. Pharyngeal infection is reported to occur in 3% to 7% of heterosexual men, 10% to 20% of heterosexual women, and 10% to 25% of homosexual men. It usually is seen as an asymptomatic infection with diffuse, nonspecific inflammation, or as a mild sore throat. N. gonorrhoeae has been cultured in expectorated saliva from two thirds of patients with oropharyngeal gonorrhea.

14. Which of the following tests is the best way to screen for problems before dental treatment of an alcoholic patient? a. Bilirubin total b. Alkaline phosphatase total c. LDH total d. A complete blood count (CBC)

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

8. Which of the following is an oral manifestation of kidney disease? a. Increased salivary flow due to decreased renal filtration b. Blue discoloration of the cheeks due to reduced hemoglobin-carrying capacity of red blood cells c. Characteristic acetone-like odor of breath d. Discoloration of oral mucosa related to pruritus and carotene-like pigments

ANS: D A common sign is red-orange discoloration of the cheeks and mucosa is caused by pruritus, and deposition of carotene-like pigments appears when renal filtration is decreased. Salivary flow may be diminished, resulting in xerostomia and parotid infections. Patients frequently complain of an altered or metallic taste, and saliva is altered in composition, has a higher pH, and may have a characteristic ammonia-like odor, which results from a high urea content.

5. Which of the following should be a major consideration when planning dental treatment for the patient with HIV infection/AIDS? a. Current CD4+ lymphocyte count b. Immunosuppression level c. Level of viral load d. All of the above.

ANS: D A major consideration in dental treatment of the patient with HIV infection/AIDS involves determining the current CD4+ lymphocyte count and level of immunosuppression of the patient. Another point of emphasis in dental treatment planning is the level of viral load, which may be related to susceptibility to opportunistic infections and rate of progression of AIDS.

9. Reduction of systolic blood pressure by 10 mm Hg is associated with a __% reduction in the risk for ischemic stroke. a. 3 b. 13 c. 23 d. 33

ANS: D A reduction of systolic blood pressure by 10 mm Hg is associated with a one third reduction in risk for stroke. Regimens of aspirin, ticlopidine, or extended-release dipyridamole are accepted preventive therapies for ischemic stroke in patients who have experienced transient ischemic attacks (TIAs) or who have had a stroke.

7. Which of the following is associated with immunity to hepatitis B? a. HBsAg b. HBcAg c. HBeAg d. Anti-HBs e. Anti-HBe

ANS: D Anti-HBs is a long-lasting antibody that is associated with immunity. Generally, HBV DNA, and HBeAg begin to fall at the onset of illness and may be undetectable at the time of peak clinical illness. HBsAg becomes undetectable and anti-HBs appears during recovery, several weeks to months after loss of HBsAg.

10. A deferral of dental treatment is advised for ____________ when treating a patient with a history of stroke or transient ischemic attack (TIA). a. 3 weeks b. 6 weeks c. 3 months d. 6 months

ANS: D Deferral of treatment is advised for 6 months. A degree of caution is indicated in the approach to dental treatment of persons with a history of stroke or TIA because the risk of stroke is greater in a patient who has had a previous stroke or TIA than in a person who has not had either. In fact, up to one third of strokes recur within 1 month of the initial event, and risk remains elevated for at least 6 months.

2. Which of the following is the most common cause of seizures? a. Head trauma b. Cavernous malformation c. Cerebrovascular disease d. Idiopathic

ANS: D Epileptic seizures are idiopathic in more than half of all affected patients. Vascular (cerebrovascular disease) and developmental abnormalities (cavernous malformation), intracranial neoplasms (gliomas), and head trauma are causative in about 35% of adult cases. Other common causes include hypoglycemia, drug withdrawal, infection, and febrile illness (e.g., meningitis, encephalitis).

3. The median time from primary infection to the development of AIDS in untreated patients is about ________ following HIV exposure. a. 2 to 6 weeks b. 6 months c. 2 to 3 years d. 10 years

ANS: D It is about 10 years. About 30% of patients with AIDS can be expected to live approximately 2 to 3 years, with most others living 10 years or longer. Long-term survival with HIV infection (beyond 15 years) occurs and is associated with less virulent HIV strains, lower-level viremia, highly active antiretroviral therapy (HAART), and robust immune responses.

5. Which of the following is true regarding the diagnosis of acute viral hepatitis? a. Acute viral hepatitis is marked by a prominent fibrosis observed during histologic evaluation. b. Immunohistochemical stains for hepatitis antigens are positive during the acute disease. c. There are reliably distinctive features in the liver that separate the five viral forms of acute hepatitis from one another. d. Serologic tests are adequate for the diagnosis of acute viral hepatitis, so liver biopsy is not recommended unless the diagnosis remains unclear and a therapeutic decision is needed.

ANS: D Serologic tests are adequate for diagnosis. If biopsy is required, the histologic pattern in acute viral hepatitis is characterized by widespread parenchymal inflammation and spotty necrosis. Inflammatory cells are predominantly lymphocytes, macrophages, and histiocytes. Fibrosis is absent. Immunohistochemical stains for hepatitis antigens generally are negative during the acute disease, and there are no reliably distinctive anatomic features in the liver that separate the five viral forms of acute hepatitis from each other.

10. What is the most common oral manifestation of HIV infection worldwide? a. Hairy leukoplakia b. Kaposi sarcoma c. Necrotizing stomatitis d. Candidiasis

ANS: D Worldwide, candidiasis is the most common oral manifestation of HIV infection. Oral candidiasis diagnosed in HIV-infected patients with persistent generalized lymphadenopathy may be of predictive value for the subsequent development of AIDS. The erythematous form of candidiasis also indicates progression toward AIDS.

11. Chronic active hepatitis B is diagnosed by the presence of ______ in blood serum. a. HBsAg b. HBcAg c. HBeAg d. A, B, and C e. A and C

ANS: E Chronic active hepatitis B is characterized by HBsAg and HBeAg in the serum, signs and symptoms of chronic liver disease, persistent hepatic cellular necrosis, and elevation of liver enzymes for longer than 6 months.

13. Which of the following is true of the pathophysiology of alcoholic liver disease? a. Fatty liver is not reversible. b. Alcoholic hepatitis may be fatal if damage is widespread. c. In some patients with cirrhosis, blood from bleeding ulcers and esophageal varices is incompletely metabolized to ammonia. d. A and B e. B and C

ANS: E Fatty liver is considered completely reversible. For the most part, alcoholic hepatitis is considered a reversible condition; however, it can be fatal if damage is widespread. In some patients with cirrhosis, blood is metabolized to ammonia, which travels to the brain and contributes to encephalopathy.

Chapter 27: Neurologic Disorders MULTIPLE CHOICE 1. Which of the following is/are true of the epidemiology of epileptic seizures? a. Seizures are most common in adolescents and young adults. b. The incidence of seizures in males is higher at every age. c. Approximately 10% of the population will have at least one epileptic seizure in a lifetime. d. A and B e. B and C

ANS: E The incidence in males is higher at every age. Approximately 10% of the population will have at least one epileptic seizure in a lifetime, and 2% to 4% will experience recurrent seizures at some point. Seizures are most common during childhood, with as many as 4% of children experiencing at least one seizure during the first 15 years of life. Seizures also are common in old age, with an estimated annual incidence of 134 cases per 100,000 people.