Chapter 01: Patient Evaluation and Risk Assessment
Little: Dental Management of the Medically Compromised Patient, 9th Edition

MULTIPLE CHOICE

	1.	Elective dental care should be deferred for patients with severe, uncontrolled hypertension, meaning that the blood pressure is greater than or equal to ________ mm Hg.
a.	200/140	
b.	180/140	
c.	180/110	
d.	160/110	

ANS:	C
Elective dental care should be deferred for patients with severe, uncontrolled hypertension, which is blood pressure greater than or equal to 180/110 mm Hg, until the condition can be brought under control.

	2.	The American Heart Association currently recommends antibiotic prophylaxis for a patient with which of the following cardiac conditions?
a.	Mitral valve prolapse	
b.	Prosthetic heart valve	
c.	Rheumatic heart disease	
d.	Pacemakers for cardiac arrhythmias	

ANS:	B
Previously, the American Heart Association (AHA) recommended antibiotic prophylaxis for many patients with heart murmurs caused by valvular disease (e.g., mitral valve prolapse, rheumatic heart disease) in an effort to prevent infective endocarditis; however, current guidelines omit this recommendation on the basis of accumulated scientific evidence. If a murmur is due to certain specific cardiac conditions (e.g., previous endocarditis, prosthetic heart valve, complex congenital cyanotic heart disease), the AHA continues to recommend antibiotic prophylaxis for most dental procedures.

	3.	One consequence of chronic hepatitis (B or C) or cirrhosis of the liver is decreased ability of the body to _________ certain drugs, including local anesthetics and analgesics.
a.	absorb	
b.	distribute	
c.	metabolize	
d.	excrete	

ANS:	C
Patients also may have chronic hepatitis (B or C) or cirrhosis, with impairment of liver function. This deficit may result in prolonged bleeding and less efficient metabolism of certain drugs, including local anesthetics and analgesics.

	4.	Which of the following symptoms and signs is most consistent with allergy?
a.	Heart palpitations	
b.	Itching	
c.	Vomiting	
d.	Fainting	

ANS:	B
Symptoms and signs consistent with allergy include itching, urticaria (hives), rash, swelling, wheezing, angioedema, runny nose, and tearing eyes. Isolated signs and symptoms such as nausea, vomiting, heart palpitations, and fainting generally are not of an allergic origin but rather are manifestations of drug intolerance, adverse side effects, or psychogenic reactions.

	5.	Which of the following is true of the patient with a history of tuberculosis?
a.	A positive result on skin testing means that the person has active TB.	
b.	Most patients who become positive skin testers develop active disease.	
c.	Patients with acquired immunodeficiency syndrome (AIDS) have a high incidence of tuberculosis.	
d.	A diagnosis of active TB is made by a purified protein derivative (PPD) skin test.	

ANS:	C
The potential coexistence of tuberculosis and acquired immunodeficiency syndrome (AIDS) should be explored because patients with AIDS have a high incidence of tuberculosis. A positive result on skin testing means specifically that the person has at some time been infected with TB, not necessarily that active disease is present. Most patients who become positive skin testers do not develop active disease. A diagnosis of active TB is made by chest x-ray, imaging, sputum culture, and clinical examination.

	6.	Vasoconstrictors should be avoided in patients who cocaine or methamphetamine users because these agents may precipitate _________.
a.	severe hypotension	
b.	severe hypertension	
c.	respiratory depression	
d.	cessation of intestinal peristalsis	

ANS:	B
Vasoconstrictors should be avoided in patients who are cocaine or methamphetamine users because the combination may precipitate arrhythmias, MI, or severe hypertension.

	7.	It has been shown that the risk for occurrence of a serious perioperative cardiovascular event (e.g., MI, heart failure) is increased in patients who are unable to meet a __-MET (metabolic equivalent of task) demand during normal daily activity.
a.	4	
b.	6	
c.	8	
d.	10	

ANS:	A
Daily activities requiring 4 METs include level walking at 4 miles/hour or climbing a flight of stairs. Activities requiring greater than 10 METs include swimming and singles tennis. An exercise capacity of 10 to 13 METs indicates excellent physical conditioning.

	8.	Which of the following alterations in the fingernails is associated with cirrhosis?
a.	Yellowing	
b.	Clubbing	
c.	White discoloration	
d.	Splinter hemorrhages	

ANS:	C
Alterations in the fingernails, such as clubbing (seen in cardiopulmonary insufficiency), white discoloration (seen in cirrhosis), yellowing (from malignancy), and splinter hemorrhages (from infective endocarditis) usually are caused by chronic disorders.

	9.	A blood pressure cuff should be placed on the upper arm and inflated until _________.
a.	the radial pulse disappears	
b.	the radial pulse disappears and then inflated an additional 20 to 30 mm Hg	
c.	two fingers cannot fit comfortably under the cuff	
d.	the pulse no longer can be heard with the stethoscope	

ANS:	B
While the radial pulse is palpated, the cuff is inflated until the radial pulse disappears (approximate systolic pressure); it is then inflated an additional 20 to 30 mm Hg.

	10.	Which of the following is true of a patient classified ASA III according to the American Society of Anesthesiologists (ASA) Physical Status Classification System?
a.	Patient has mild systemic disease.	
b.	Patient’s disease has significant impact on daily activity.	
c.	Patient’s disease is unlikely to have impact on anesthesia and surgery.	
d.	Patient is moribund.	

ANS:	B
Patient with severe systemic disease is a constant threat to life (e.g., recent myocardial infarction, stroke, transient ischemic attach [<3 months], ongoing cardiac ischemia, severe valve dysfunction, respiratory failure requiring mechanical ventilation). Serious limitation of daily activity; likely major impact on anesthesia and surgery.