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Dental Management Of The Medically Compromised Patient 8E by Little – Test Bank

Sample Questions

Little: Dental Management of the Medically Compromised Patient,

8th Edition

Chapter 03: Hypertension

Test Bank

MULTIPLE CHOICE

1. In prehypertension, diastolic pressure ranges from ________ mm Hg.

A. 80 to 89

B. 90 to 99

C. 100 to 109

D. 110 to 119

ANS: A

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and
Treatment of High Blood Pressure (JNC 7) introduced the new category of prehypertension,
which encompasses the previously designated categories of normal and borderline hypertension.
Normal blood pressure is 120/80 mm Hg. Prehypertension is systolic blood pressure ranging
from 120 to 139 and diastolic pressure ranging from 80 to 89 mm Hg.

PTS: 1 REF: p. 38

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

A. physician

B. dentist

C. dental hygienist

D. a, b, and c

E. a and c only
ANS: A

Only a physician can make the diagnosis of hypertension and decide on its treatment. The
dentist, however, should detect abnormal blood pressure measurements, which then become the
basis for referral to or consultation with a physician.

PTS: 1 REF: p. 44

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

A. congestive heart failure

B. cardiac arrhythmia

C. hypertension

D. angina

ANS: C

With 35 million office visits annually, hypertension is the most common primary diagnosis in
America. According to National Health and Nutrition Examination Survey (NHANES) data for
the period 1999 to 2000, at least 65 million adults in the United States have high blood pressure
(HBP) or are taking antihypertensive medication. This estimate equals about one-fourth of the
population and represents a 30% increase from 1988 to 1994. In a typical practice population of
2,000 patients, therefore, around 500 will have hypertension.

PTS: 1 REF: p. 37

4. It is estimated that about __% of all blood pressure–related deaths from coronary heart disease
occur in persons with blood pressure in the prehypertensive range.
A. less than 1

B. 5

C. 15

D. 25

ANS: C

About 15%. However, the higher the blood pressure, the greater the chances of heart attack, heart
failure, stroke, and kidney disease. For every increase in blood pressure of 20 mm Hg systolic
and 10 mm Hg diastolic, a doubling of mortality related to ischemic heart disease and stroke
occurs.

PTS: 1 REF: p. 39

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

A. beta blockers (BBs)

B. thiazide diuretics

C. angiotensin-converting enzyme inhibitors (ACEIs)

D. angiotensin receptor blockers (ARBs)

ANS: B

Thiazide diuretics are most often the first drugs of choice, given either alone or in combination
with ACEIs, ARBs, BBs, or calcium channel blockers (CCBs), depending on the degree of
elevation of blood pressure. For early stage 1 hypertension, single-drug therapy may be effective;
however, for later stage 1 and for stage 2 hypertension, two or more drug combinations are
necessary. The presence of certain comorbid conditions or factors, such as heart failure, previous
MI, diabetes, or kidney disease, may be a compelling reason to select specific drugs or classes of
drugs that have been found to be beneficial in clinical trials.
PTS: 1 REF: p. 41

6. Deferral of elective dental care and referral to a physician for evaluation and treatment within 1
week are indicated for patients found to have asymptomatic blood pressure of greater than or
equal to ________ mm Hg.

A. 160/90

B. 160/110

C. 180/90

D. 180/110

ANS: D

Patients with blood pressures less than 180/110 mm Hg can undergo any necessary dental
treatment, both surgical and nonsurgical, with very little risk of an adverse outcome. For patients
found to have asymptomatic blood pressure of 180/110 mm Hg or greater (uncontrolled
hypertension), elective dental care should be deferred, and physician referral for evaluation and
treatment within 1 week is indicated. Patients with uncontrolled blood pressure associated with
symptoms such as headache, shortness of breath, or chest pain should be referred to a physician
for immediate evaluation.

PTS: 1 REF: p. 46

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

A. afternoon appointments

B. premedication with a barbiturate

C. nitrous oxide plus oxygen for inhalation sedation

D. keeping the dental chair in an upright position during treatment

ANS: C

Nitrous oxide plus oxygen for inhalation sedation is an excellent intraoperative anxiolytic for use
in patients with hypertension. Care is indicated to ensure adequate oxygenation at all times,
avoiding post-diffusion hypoxia at the termination of administration. Short morning
appointments seem best tolerated. Oral premedication with a short-acting benzodiazepine can
reduce anxiety for many patients. Because many of the antihypertensive agents tend to produce
orthostatic hypotension as a side effect, rapid changes in chair position during dental treatment
should be avoided.

PTS: 1 REF: p. 46

8. Use of how many cartridges of 2% lidocaine with 1:100,000 epinephrine at one time is
considered to have little clinical risk for dental treatment of a patient with hypertension?

A. 2

B. 4

C. 6

D. 8

ANS: A

The existing evidence indicates that use of modest doses (one or two cartridges of 2% lidocaine
with 1:100,000 epinephrine) carries little clinical risk in patients with hypertension, the benefits
of its use far outweighing any potential problems. Use of more than this amount at one time may
be tolerated well enough but with increasing risk for adverse hemodynamic changes.

PTS: 1 REF: p. 48

9. Which of the following is an adverse drug interaction that may occur if a dental anesthetic
containing a vasoconstrictor is administered to a patient being treated for hypertension with a
non-selective β-adrenergic blocking agent?

A. hypotension
B. hypertension

C. respiratory alkalosis

D. respiratory acidosis

ANS: B

The basis for concern with use of non-selective β-adrenergic blocking agents (e.g., propranolol)
is that the normal compensatory vasodilation of skeletal muscle vasculature mediated by beta 2
receptors is inhibited by these drugs, and injection of epinephrine, levonordefrin, or any other
pressor agent may result in uncompensated peripheral vasoconstriction because of unopposed
stimulation of alpha 1 receptors. This vasoconstrictive effect could potentially cause a significant
elevation in blood pressure and a compensatory bradycardia.

PTS: 1 REF: p. 48

Little: Dental Management of the Medically Compromised Patient,

8th Edition

Chapter 05: Cardiac Arrhythmias

Test Bank

MULTIPLE CHOICE

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

A. sinus arrhythmia

B. premature atrial complexes

C. atrial fibrillation

D. ventricular flutter and fibrillation

ANS: C

The most common type of persistent arrhythmia is atrial fibrillation (AF), which affects
approximately 2.6 million people. It is characterized by rapid, disorganized, and ineffective atrial
contractions that occur at a rate of 350 to 600 beats per minute. To manage their arrhythmias,
more than 500,000 people in North America have implanted pacemakers.

PTS: 1 REF: p. 67

2. Which of the following sequences correctly depicts the normal pattern of sequential
depolarization of the structures of the heart? (1) right and left bundle branches, (2) sinoatrial
(SA) node, (3) subendocardial Purkinje network, (4) bundle of His, (5) atrioventricular (AV) node

A. 5, 2, 4, 1, 3

B. 2, 5, 4, 1, 3

C. 2, 3, 4, 1, 5

D. 2, 5, 3, 1, 4

ANS: B

The normal pattern of sequential depolarization involves the structures of the heart in the
following order: sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left
bundle branches, subendocardial Purkinje network. The electrocardiogram (ECG) is a recording
of this electrical activity. The primary anatomic pacemaker for the heart is the SA node, a
crescent-shaped structure 9 to 15 mm long that is located at the junction of the superior vena
cava and the right atrium.

PTS: 1 REF: p. 67
 3. Tachycardia in an adult is defined as a heart rate greater then ___ beats per minute, with
otherwise normal findings on the ECG.

A. 100

B. 125

C. 150

D. 175

ANS: A

Tachycardia in an adult is a heart rate greater than 100 beats per minute. The rate usually is
between 100 and 180 beats per minute. This condition most often is a physiologic response to
exercise, anxiety, stress, or emotion. Pathophysiologic causes include fever, hypertension,
hypoxia, infection, anemia, hyperthyroidism, and heart failure. Drugs that may cause sinus
tachycardia include atropine, epinephrine, alcohol, nicotine, and caffeine.

PTS: 1 REF: p. 69

4. Which of the following is a disorder of repolarization?

A. Mobitz type I (Wenckebach)

B. Wolff-Parkinson-White syndrome

C. long QT syndrome

D. torsades de pointes

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

PTS: 1 REF: pp. 69

5. Which of the following is an advantage of implantable cardioverter-defibrillators (ICDs) in

contrast to pacemakers?

A. ICDs generally are smaller than pacemakers.

ICDs are capable of providing antitachycardia pacing (ATP) and ventricular bradycardia
B.
pacing, while pacemakers are not capable of providing such pacing.

C. ICDs have batteries that last much longer than pacemakers.

ICDs do not require antibiotic prophylaxis prior to dental treatment whereas pacemakers
D.
do.

ANS: B

ICDs are capable not only of delivering a shock but of providing antitachycardia pacing (ATP)
and ventricular bradycardia pacing. ICDs generally are larger than pacemakers, and their
batteries do not last as long as those of a pacemaker. Antibiotic prophylaxis for dental treatment
is not recommended for either a pacemaker or a cardioverter-defibrillator.

PTS: 1 REF: pp. 74

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

A. battery-operated curing lights

B. electrical pulp testers and apex locators

C. handpieces

D. electric toothbrushes

ANS: A

In studies performed in vitro, electrosurgery units, ultrasonic bath cleaners, ultrasonic scaling
devices, and battery-operated curing lights have produced EMI with pacemakers and ICDs.
Amalgamators, electrical pulp testers and apex locators, handpieces, electric toothbrushes,
microwave ovens, and x-ray units did not cause any significant EMI with the pacemakers and
ICDs tested.

PTS: 1 REF: pp. 74

7. Which of the following is classified as a significant arrhythmia according to the ACC/AHA

guidelines?

A. pathologic Q waves

B. left bundle branch block

C. high-grade AV block

D. ST-T wave abnormalities

ANS: C

Patients with high-grade AV block, symptomatic ventricular arrhythmias in the presence of

cardiovascular disease, and supraventricular arrhythmias with an uncontrolled ventricular rate
are at major risk for complications and are not candidates for elective dental care. The presence
of pathologic Q waves is a clinical predictor of intermediate risk for perioperative complications.
Left ventricular hypertrophy, left bundle branch block, and ST-T wave abnormalities are
associated with minor perioperative risk.

PTS: 1 REF: p. 76
 8. If a vasoconstrictor in local anesthetic is deemed necessary, patients in the low to intermediate
risk category and those taking nonselective beta blockers can safely be given up to ____
cartridge(s) containing 1:100,000 epinephrine.

A. one

B. two

C. three

D. zero—epinephrine is an absolute contraindication

ANS: B

These patients can safely be given up to 0.036 mg epinephrine, which is the amount in two
cartridges containing 1:100,000 epinephrine. Greater quantities of vasoconstrictor may well be
tolerated, but increasing quantities are associated with increased risk for adverse cardiovascular
effects.

PTS: 1 REF: p. 77

Little: Dental Management of the Medically Compromised Patient,

8th Edition

Chapter 09: Sleep-Related Breathing Disorders

Test Bank

MULTIPLE CHOICE

1. Which of the following is true about primary snoring?

A. Primary snoring is associated with fragmentation of sleep architecture.

B. Primary snoring is not associated with disrupted sleep or complaints of daytime sleepiness.

C. Primary snoring is also known as upper airway resistance syndrome (UARS).

Primary snoring is characterized by episodes of complete cessation of breathing due to

D.
airway obstruction during sleep.

ANS: B

Primary snoring is sometimes referred to as simple snoring or benign snoring. Findings on an

overnight sleep study are normal. UARS is a clinical entity midway between primary snoring
and obstructive sleep apnea (OSA) that is characterized by snoring, complaints of daytime
sleepiness, and fragmentation of sleep. OSA is characterized by loud snoring and excessive
daytime sleepiness with episodes of complete cessation of breathing (apnea) or significantly
decreased ventilation (hypopnea) due to airway obstruction during sleep, along with significant
fragmentation of sleep architecture.

PTS: 1 REF: p. 128

2. Which of the following are the most common sites of airway narrowing or closure during sleep
for a patient with obstructive sleep apnea (OSA)?

A. the retropalatal and retroglossal regions

B. septal deviation and enlarged turbinates

C. hypertrophic adenoids and tonsils

D. redundant parapharyngeal folds

ANS: A

The most common sites of airway narrowing or closure during sleep are the retropalatal and
retroglossal regions. Anatomic narrowing may occur at any site in the upper airway, from the
nasal cavity to the larynx. Most patients with OSA have more than one site of narrowing.
PTS: 1 REF: p. 129

3. Which of the following is characteristic of REM sleep?

A. synchronous brain waves

B. low-voltage EEG waves

C. mental inactivity

D. physiologic stability

ANS: B

A key feature of REM sleep is the presence of periodic rapid movement of the eyes with low-
voltage EEG waves resembling those typical of wakefulness. REM sleep is characterized by
asynchronous brain waves, an active brain, physiologic instability, and muscular inactivity. The
REM sleep state often is described as “an active brain in a paralyzed body.” Dreaming occurs
during REM sleep.

PTS: 1 REF: p. 130

4. Most people who snore do not have OSA, but almost all patients with OSA snore.

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

In the Wisconsin Sleep Cohort Study of subjects aged 30 to 60 years, 44% of men and 28% of
women were habitual snorers, but only 4% of the men and 2% of the women had OSA.
PTS: 1 REF: p. 132

5. Which of the following components of a polysomnogram (PSG) is used to monitor eye

movements?

A. ECG

B. EEG

C. EMG

D. EOG

ANS: D

The electrooculogram (EOG) is used to monitor eye movements. The electrocardiogram (ECG)
monitors heart rate and rhythm, the electroencephalogram (EEG) is used to monitor brain waves,
and the electromyogram (EMG) is used to monitor jaw muscular activity.

PTS: 1 REF: p. 133

6. Approximately what percentage of patients who try positive airway pressure (PAP) for treatment
of obstructive sleep apnea (OSA) are able to tolerate it?

A. 100

B. 75

C. 50

D. 25

ANS: C
Compliance with PAP has long been a problem, with only about 50% of patients who try it able
to tolerate it. Of those who do use PAP, the average patient uses it for only about 4 to 5 hours per
night and for only about 5 nights per week. Adverse effects with PAP are common and include
mask leaks, skin ulceration or irritation under the mask, epistaxis, rhinorrhea, nasal congestion,
sinus congestion, dry eyes, conjunctivitis, ear pain, and claustrophobia.

PTS: 1 REF: p. 136

7. Which of the following is true of tongue-retaining devices (TRDs) used to treat patients with
sleep-related breathing disorders?

They typically are made of acrylic resin and are composed of two pieces that cover the
A. upper and lower dental arches.

Over 70 different types of TRDs have been approved by the FDA for treatment of
B.
obstructive sleep apnea (OSA).

C. TRDs are capable of providing continuous positive airway pressure (CPAP).

D. TRDs generally are made of silicone in the shape of a bulb or cavity.

ANS: D

The tongue is stuck into the bulb, which is then squeezed and released, producing a suction that
holds the tongue forward in the bulb. Mandibular advancement devices (MADs) typically are
made of acrylic resin and cover the upper and lower dental arches. Only one design of tongue-
retaining device has been approved by the FDA for treatment of OSA.

PTS: 1 REF: p. 138

8. Which of the following is the most successful surgical treatment for OSA in children?

A. uvulopalatopharyngoplasty (UPPP)

B. radiofrequency volumetric tissue reduction (RVTR)

C. adenotonsillectomy
D. laser-assisted uvulopalatoplasty (LAUP)

ANS: C

Adenotonsillar hypertrophy is the most common cause of upper airway obstruction in children;
adenotonsillectomy is curative in 75% to 100% of such cases.

PTS: 1 REF: p. 140