Clinical Medicine Exam 2

What percent of victims survive with no impairment after a stroke?

A. 10%

B. 20%

C. 30%

D. 50%

E. 60%

A

Thrombolysis and improved neurological outcome has been achieved when medication is administered within how many hours of the onset of the stroke?

A. 1

B. 3

C. 5

D. 8

B

Weakness, tingling, numbness and speech disturbances that usually last less than 10 minutes are known as:

A: reversible ischemic neurologic deficit.

B: transient ischemic attack.

C: stroke-in-evolution.

D: complete stroke.

E: RIND.

B

What is the only approved medication for the acute management of a stroke?

A: Intra-arterial prourokinase

B: IV administration of rt-PA

C: Aspirin

D: IV administration of Heparin

E: Dipyridamole

B

All elective dental treatment is deferred for up to how many months after a stroke?

A: 3 months

B: 6 months

C: 12 months

D: 15 months

E: 18 months

B

Which of the following is significant for rheumatoid arthritis?

A: No systemic involvement

B: Heberden's nodes of distal interphalangeal joints

C: Bouchard's nodes of proximal interphalangeal joints

D: Joint pain without inflammation

C

Sjogrens syndrome is characterized by a triad of clinical conditions that consists of keratoconjunctivitis, a connective tissue disorder and ___________:

A: glossitis.

B: xerostomia.

C: glossodynia.

D: candidiasis

B

The connective tissue disorder from which Sjogrens syndrome develops most often is:

A: fibromyalgia.

B: systemic lupus erythematosus.

C: Raynaud's syndrome.

D: rheumatoid arthritis.

D

ADA regimen for prophylactic antibiotics for non-sensitive to penicillin is:

2g 30-60 mins before dental treatment

A positive Shirmer test is significant for which of the following diseases?

A. Rheumatoid arthritis

B. Systemic lupus erythematosus

C. Sjogrens syndrome

D. Scleroderma

C

Which of the following statements is TRUE regarding assessment of a patient's renal function?

A. Assessing the serum potassium concentration, which should be higher than the concentration of intracellular potassium.

B. Assessing for oliguria, which is excessive urine production, defined as >1L/day of urine production.

C. Assessing serum BUN, which measures concentration of urea in the blood that is produced during the breakdown of carbohydrates.

D. Assessing the serum creatinine, which estimates glomerular filtration by measuring a byproduct of muscle metabolism

D

Which of the following correctly pairs the renal anatomy and physiological function?

A. Proximal convoluted tubule = Receives unfiltered blood from the afferent arteriole

B. Renal artery = Supplies oxygen poor blood to the kidneys

C. Collecting duct = Area responsible for reabsorption of water via ADH action

D. Efferent arteriole = Provides fresh blood to the glomerulus

C

All of the following are functions of the renal system EXCEPT one. Which one is that EXCEPTION?

A. Regulation of water and electrolytes

B. Regulation of arterial blood pressure

C. Regulation of vitamin E production

D. Regulation of red cell production

C

Which of the following statements is TRUE?

A. Acute kidney injury is always irreversible.

B. Chronic kidney disease often accompanies a rapid decrease in intravascular fluid volume.

C. Acute kidney injury is classically graded as Stage 1-5.

D. Chronic kidney disease can be caused by diabetes mellitus or hypertension.

D

When treating a dialysis patient or a post-renal transplant patient, dentists must remember that:

A. NSAIDs should be avoided for renal transplant patients on immunosuppressive medications.

B. the blood pressure cuff must be placed on the arm with the AV shunt in order to obtain an accurate reading.

C. dialysis is always used to treat acute kidney injury, in order to prevent progression of the disease.

D. local anesthetics are absolutely contraindicated as the kidneys are the main site for metabolism of these drugs.

A

A patient presents with a history of DM (diabetes mellitus), HTN (hypertension) and CAD (coronary artery disease). He/she takes 100 units of insulin in divided doses daily.

A: This insulin regimen is c/w a type 1 DM.

B: This insulin regimen is c/w type 2 DM.

C: The amount of insulin does not suggest either type 1 or 2 DM.

D: A type 2 DM does not take insulin.

B

You decide to write a medical consult for a patient that tells you he has had three seizures in the last week. What would be the most appropriate way to organize your medical consultation for this patient?

A: A 30 year old male presents to my office stating he has had an increase in his seizure activity. Please advise if local anesthesia consisting of lidocaine with epinephrine is contraindicated.

B: A 30 year old male presents to my office stating he has had an increase in his seizure activity. Dental restorations are planned. Please advise if this patient can be treated in my dental office.

C: A 30 year old male presents to my office stating he has had an increase in his seizure activity. Please provide what type of seizures he has and what can prevent them.

D: A 30 year old male presents to my office stating he has had an increase in his seizure activity. Please provide a most recent history and physical including history of seizures, medications and recent medication levels.

D

A glycated hemoglobin of 9% corresponds to what value for a fasting blood sugar?

A: 150

B: 180

C: 210

D: 240

C

Which of the following characteristics is consistent with Graves' disease?

A: Decreased appetite

B: Low RAIU

C: Myxedema

D: Proptosis

E: Cardiomegaly

D

Which of the following oral agents can cause hypoglycemia?

A: Glipizide (sulfonylurea)

B: Metformin (biguanides)

C: Acarbose (gamma - glucosidase inhibitors)

D: Pioglitazone (thiazolidinediones)

A

The RAIU is lower in thyroiditis due to which of the following?

A: Thyroid cell destruction

B: Iodine excess

C: Decreased T3

D: Pituitary cell destruction

E: TRH deficiency

A

A patient with multiple sclerosis presents to your general dental office. Which should you consider?

A: Scheduling the patient for elective treatment during times of remission.

B: Be cautious when raising the head of the dental chair secondary to their increased risk of orthostatic hypotension.

C: Using a bite block with dental procedures to prevent spasticity.

D: Limiting local anesthesia secondary to their risk of oral paresthesia.

A

A 28 year old female presents for a dental appointment with a chief complaint of pain radiating to her neck, jaws and ears. She reports that she takes no medications and has no history of hospitalization except for childbirth 7 months ago. Upon palpation of the patient's neck you note an enlargement. These findings suggest which of the following?

A: Hyperthyroidism

B: Thyroiditis

C: Myxedema

D: Carcinoma

E: Graves' disease

B

A 25 year old female comes to your office for an initial consultation. She states she has seizures. What would you most like to know when completing a review of systems?

A: What type of seizures does she have?

B: When was her last seizure?

C: Does anything precipitate her seizures?

D: All of the above

D

The primary concern of a dental provider for patients with thyroid disease is which of the following?

A: Multinodular goiter

B: Hashimoto's thyroiditis

C: Cardiac comorbidity

D: Respiratory failure

E: Iodine deficiency

C

Which of the following statements is true?

A: Broad spectrum antibiotic coverage for dental treatment is the standard of care for patients with Graves' disease.

B: Thyroid screening is indicated in females over the age of 35.

C: The daily thyroid hormone requirement increases by 25% during pregnancy.

D: The most common cause of hypothyroidism is caused by pituitary

malfunction.

E: Drug interactions of concern during dental treatment for patients with Graves' disease include anticoagulants and beta blockers.

E

What is the most common manifestation of systemic lupus erythematosus?

A: Arthritis

B: Oral ulcerations

C: Butterfly rash

D: Pharyngitis

A

The genetic marker, HLA-DR4, and the labial SG histology is significant in the diagnosis which of the following?

A: Rheumatoid arthritis

B: Systemic lupus erythematosus

C: Sjogrens syndrome

D: Scleroderma

C

When comparing Vitamin B12 deficiency with folic acid deficiency, besides differences in B12 and folate levels, which of the following findings is a distinguishing factor?

A: Neurologic symptoms

B: Macrocytosis

C: Hypersegmented neutrophils

D: Glossitis

E: Pancytopenia

A

What are the two distinct parts of the adrenal gland?

A: Adrenal sinusoids and adrenal plates

B: Adrenal cortex and adrenal sinusoids

C: Adrenal medulla and adrenal cortex

D: Adrenal plates and adrenal medulla

C

Risk factors associated with coronary artery disease include:

A: hypokalemia.

B: increased physical activity.

C: hyperlipidemia.

D: diabetes insipidus.

C

The primary steroid that all adrenal cortical hormone synthesis is derived from is:

A: progesterone.

B: cortisol.

C: testosterone.

D: cholesterol.

D

What does the adrenal medulla produce?

A: 50% of norepinephrine

B: 80% of epinephrine

C: Significant amounts of dopamine

D: Small quantities of female sex hormones (progesterone and estrogen)

B

What is the ASA classification where a patient has a single systemic disease which is mild or well controlled?

A: ASA Class I

B: ASA Class II

C: ASA Class III

D: ASA Class IV

B

The zona glomerulosa produces:

A: glucoriticoids.

B: mineralcorticoids.

C: androgens.

D: cortisol.

B

Alzheimer's disease:

A: is a progressive irreversible brain disorder associated with dementia.

B: is associated more with tremor, rigidity, bradykinesia and postural instability.

C: has no familial or genetic component associated with it.

D: as a diagnosis should be made as early as possible with a biopsy of its characteristic brain lesions.

A

When discussing acute coronary syndromes, all of the following are true EXCEPT one. Which one is the EXCEPTION?

A: The goals of managing a suspected ACS patient include minimizing damage to the myocardium.

B: Immediate medical interventions may include thrombolytic therapy.

C: Routine dental care is contraindicated for at least one year following an STEMI.

D: The ADA recommendations for a patient post-ACS include a maximum dose of .04 mg epinephrine per visit.

C

What is an appropriate measure to use for the diagnosis of infective endocarditis?

A: Multiple positive endocardium cultures

B: Multiple positive blood cultures

C: Multiple positive myocardium cultures

D: Multiple positive epicardium cultures

B

Which of the following is common to both Vitamin B12 and folic acid?

A: Involved in the synthesis of thymidine

B: Require intrinsic factor for adequate transport and uptake

C: Deficiency results in neurologic symptoms

D: Deficiency classified as a microcytic anemia

A

A 62 year old male comes to your office for pain associated with his mandibular molars. You take a history on this patient and thoroughly discuss a review of systems. He states he has shortness of breath walking a block and describes the swelling associated with his lower extremities at times. You suspect he may have congestive heart failure. What would most like to ask on your medical consult?

A: A 62 year old patient with possible congestive heart failure presents to our dental clinic. Please provide any contraindications to our dental treatment which includes dental extractions using 2% lidocaine with 1:100,000 epinephrine. Will antibiotic prophylaxis be indicated?

B: A 62 year old patient presents for dental extractions. Are there any contraindications to doing this procedure under local anesthesia? Will antibiotic prophylaxis be indicated?

C: A 62 year old patient presents with tooth pain and history of shortness of breath and swollen ankles. Please provide any contraindications to dental treatment. Please inform of any concerns you may have giving this patient local anesthesia.

D: A 62 year old patient presents with tooth pain and history of shortness of breath on exertion and intermittent swelling of his lower extremities. Please provide the patient's most recent history and physical including any concerns of CHF, recent diagnostic tests including the most recent echocardiogram and any recent laboratory studies.

D

Which of the following is true regarding congestive heart failure?

A: The most useful assessment of left ventricular function is the ejection fraction measured on echocardiogram.

B: A patient with decompensated congestive heart failure will have an ejection fraction ranging from 60-70%.

C: A patient with severe shortness of breath which is not relieved by rest would be a New York Heart Association classification of II.

D: All congestive heart failure patients can be safely treated in a dental clinic setting.

A

A 60 year old patient was diagnosed with an ischemic stroke after presenting to the hospital with left sided weakness and a non-contrast CT scan to rule out hemorrhagic stroke. Which of the following is most likely true?

A: The patient most likely has uncontrolled hypertension.

B: The patient is most likely on Coumadin.

C: The patient most likely has an intracranial aneurysm.

D: The patient is most likely female.

A

Your patient has history of seizures and takes an antiepileptic drug. You are concerned about thrombocytopenia. Which laboratory value would you like to obtain?

A: Basic metabolic panel

B: Complete blood count

C: Coagulation studies

D: Hemoglobin A1C

B

Insulin's biologic effect in the muscle is to promote:

A: glycogen synthesis and storage.

B: triglyceride and cholesterol synthesis.

C: lipoprotein lipase activity.

D: glycolysis and inhibit gluconeogenesis.

A

Which class of agent stimulates insulin secretion and if taken on the day of surgery can increase the likelihood that the patient may become hypoglycemic if they do not eat?

A: Repaglinide (Meglitide)

B: Acarbose (alpha-glucosides)

C: Glimepiride (sulfonylurea)

D: Metformin (Biguanide)

C

When managing a patient with a history of seizures:

A: it is recommended they not eat for 12 hours prior to the appointment.

B: local anesthetics are absolutely contraindicated as they lower the seizure threshold.

C: prolonged tonic-clonic activity should be considered an emergent situation.

D: it is important to inquire about when they stopped taking their Coumadin.

C

Which of the following is associated with left-sided brain damage?

A: Spatial-perceptual deficits

B: Quick, impulsive behavior

C: Language and speech problems

D: Neglect of the left side

C

A neurologic deficit that does not clear within 24 hours but where there is eventual recovery is known as:

A: transient ischemic attack.

B: reversible ischemic neurologic deficit.

C: stroke-in-complete.

D: complete stroke.

B

After being notified that the patient being treated by the dental hygienist may be having a stroke, you promptly go to evaluate the situation. Which of the following are physical signs that you may expect to see?

A: Bilateral facial weakness

B: Wheezing

C: Altered mental status

D: Truncal rigidity

C

Aldosterone has many functions such as promoting:

A: sodium reabsorption and potassium excretion.

B: potassium reabsorption and sodium excretion.

C: excessive water loss that commonly leads to severe dehydration.

D: protein synthesis and stimulating catabolism.

A

Clinical finding associated with Cushing syndrome include:

A: growth spurts commonly seen in children.

B: obesity with moonlike facies.

C: early onset of menstruation cycle and puberty.

D: muscle development with weight loss.

B

Which of the following statements is TRUE?

A: The renal system is primarily responsible for metabolism of drugs

B: The kidneys are supplied with fresh blood via the afferent arteriole.

C: Acetaminophen is contraindicated for use by post-renal transplant patients.

D: Chronic kidney disease is usually reversible if caught early and managed aggressively.

B

Practitioners who are managing the dental treatment of patients with renal disease must be aware that:

A: patients with chronic kidney disease often have hypokalemia due to excessive potassium wasting.

B: NSAIDs and opioid agonists are indicated for managing postoperative dental pain for chronic kidney disease patients.

C: dialysis patients are best treated on days between their scheduled dialysis appointments.

D: antibiotics such as penicillin are primarily excreted hepatically and don't require dosing adjustments for renal disease patients.

C

Parkinson's disease:

A: is highest in Africans Americans and Asians and lowest incidence in whites.

B: clinical symptoms such as pill rolling tremor improve with rest.

C: patients often present with masked facies giving the appearance of depression.

D: pharmacotherapy treatment should begin immediately regardless of symptoms.

C

Which of the following correctly pairs the renal anatomy and physiological function?

A: Proximal convoluted tubule = Receives unfiltered blood from the afferent arteriole

B: Renal artery = Supplies oxygen poor blood to the kidneys

C: Collecting duct = Area responsible for reabsorption of water via ADH action

D: Efferent arteriole = Provides fresh blood to the glomerulus

C

All of the following are functions of the renal system EXCEPT one. Which one is that EXCEPTION?

A: Regulation of water and electrolytes

B: Regulation of arterial blood pressure

C: Regulation of vitamin E production

D: Regulation of red cell production

C

Which of the following statements is TRUE regarding assessment of a patient's renal function?

A: Assessing the serum potassium concentration, which should be higher than the concentration of intracellular potassium.

B: Assessing for oliguria, which is excessive urine production, defined as > 1L/day of urine production.

C: Assessing the serum BUN, which measures the concentration of urea in

the blood that is produced during the breakdown of carbohydrates.

D: Assessing the serum creatinine, which estimates glomerular filtration by measuring a byproduct of muscle metabolism.

D

You would suspect which of the following for a patient being treated with Levothyroxine?

A: Graves disease

B: Goiter

C: Hypothyroidism

D: Malignancy

C

Which of the following statements is TRUE?

A: Acute kidney injury is always irreversible.

B: Chronic kidney disease often accompanies a rapid decrease in intravascular fluid volume.

C: Acute kidney injury is classically graded as Stage 1-5.

D: Chronic kidney disease can be caused by diabetes mellitus or hypertension.

D

Manifestation of thyroid dysfunction can be triggered by which of the following?

A: Drugs

B: Pregnancy

C: Multinodular goiter

D: All of the above

D

When treating a dialysis patient or a post-renal transplant patient, dentists must remember that:

A: NSAIDs should be avoided for renal transplant patients on immunosuppressive medications.

B: the blood pressure cuff must be placed on the arm with the AV shunt in order to obtain an accurate reading.

C: dialysis is always used to treat acute kidney injury, in order to prevent progression of the disease.

D: local anesthetics are absolutely contraindicated as the kidneys are the main site for metabolism of these drugs.

A

In Addison's disease, loss of consciousness occurs because of:

A. grand mal seizures

B. low blood sugar

C. low blood pressure

D. abdominal cramping

C

What is the most common cause of sudden death?

A. cardiac arrhythmia

B. massive stroke

C. cancer

D. aortic aneurysm

A

Which of the following types of seizures are convulsive?

A. simple partial

B. complex partial

C. petit mal/absence

D. tonic-clonic

D

In the review of systems (ROS), a patient describes low BP and skin pigmentation. What is this?

A. hyperthyroidism

B. cushing disease

C. diabetes

D. addison's disease

D

Multiple family deaths at a young age of heart conditions are very significant for what disease?

A. infective endocarditis

B. congestive heart failure

C. coronary artery disease

D. pulmonary hypertension

C

You were just notified by your dental hygienist that she thinks her patient may be suffering from a stroke/cerebral vascular accident (CVA). Which of the following are physical signs that you may expect to see when evaluating the patient?

1. bilateral facial weakness

2. ataxia

3. altered mental status

4. slurred speech

5. truncal rigidity

A. 1, 4

B. 2 only

C. 2, 3, 4

D. 2, 3, 5

C

In systemic lupus, the underlying patholphysiology is B-cell hyperactivity and

A. T-cell hyperactivity

B. too little complement

C. failure of T-cell suppression

D. type IV hypersensitivity

C

Oral ulcers in SLE are characteristically:

A. with rolled borders

B extremely painful

C. caused by trauma

D. painless

D

The pathophysiology of rheumatoid arthritis is the deposition of:

A. crystals into the joint

B. rheumatoid factor-IgG into synovium

C. WBCs and platelets

D. excess cartilage

B

The leading cause of death in scleroderma is:

A. stroke

B. lung abscess

C. malnutrition

D. renal failure

D

Multiple sclerosis is characterized by what type of pathophysiology?

A. autoantibodies to nuclear antigens

B. type III hypersensitivity

C. T-cell mediated destruction

D. antibodies to post-synaptic terminal

C

-also autoimmune demyelination of nerve sheaths

Which of the following medications are used in the treatment of Myasthenia gravis?

A. NSAIDs

B. acetylcholine

C. Edrophonium

D. Acetylcholinesterase inhibitors

D

The area of the brain damaged in Parkinson's disease is the:

A. cerebral cortex

B. central white matter

C. thalamus

D. substantia nigra

D

What nerves are affected in patients with amyotrophic lateral sclerosis (ALS)?

A. peripheral sensory nerves

B. upper and lower motor nerves

C. autonomic and some motor nerves

D. lower spinal cord nerves only

B

The pathophysiology of Type I diabetes is:

A. autoantibodies to nuclear antigens

B. T-cell mediated destruction of beta pancreatic cells

C. insulin resistance and increased hepatic pro...

D. excess cortisol and growth hormone

B

At what blood sugar levels do you start losing glucose in the urine?

A. 250 mg/dL

B. 126 mg/dL

C. 180 mg/dL

D. >500 mg/dL

C

An eye exam (fundoscopic) is important for diabetics because you may see:

A. retinal detachment

B. cataracts

C. exudates and hemorrhages on the retina

D. narrow-angle glaucoma

C

Diabetic ketoacidosis must be treated with large amounts of ______ to correct.

A. fluids (IVF)

B. magnesium

C. insulin

D. glucagon

C

What test is most commonly used as a screening test for thyroid disease?

A. ACTH

B. AST

C. TSH

D. Thyroid binding globulin levels

C

What is the pathophysiology of Graves' disease?

A. inflammation of the thyroid gland

B. IgG stimulation of the TSH receptor

C. adenoma of the anterior pituitary

D. excessive iodine in diet

B

Macroglossia can be seen in which condition?

A. hypothyroidism

B. hyperthyroidism

C. iodine excess states

D. posterior pituitary diseases

A

Which of the following enzymes can produce T3 in the peripheral tissues?

A. Type I deiodenase

B. alpha-1-antitrypsin

C. erythropoietin

D. aldolase

A

Mineralcorticoids, sodium, and potassium exchange occurs mainly in the collecting ducts and the:

A. proximal convoluted tubule

B. juxtaglomerular apparatus

C. distal convoluted tubule

D. glomerulus

C

Which of the following is NOT a feature of Cushing disease?

A. hypertension

B. obesity

C. plethora

D. pigmentation of the tongue

D

Serum creatinine is a fair estimate of GFR due to:

A. constant release from muscle

B. reabsorption in DCT

C. intermittent release from muscle

D. production by the juxtaglomerular apparatus

A

Azotemia by definition is a rise in:

A. erythropoietin release by the kidney

B. glomerular filtration rate

C. serum Cr and BUN

D. serum sodium

C

One of the immediate indications for dialysis is:

A. serum BUN < 10

B. stage 1 chronic kidney disease

C. mild pyelonephritis

D. potassium > 6.5

D

HLA antigens are important for _______ grafting in kidney transplants

A. cadaver kidney

B. living donor

C. arterial anastomosis

D. vein anastomosis

B

Psoriatic arthritis is what type of arthritis?

A. traumatic

B. degenerative

C. inflammatory

D. infectious

C

A pannus is associated with which type of arthritis?

A. osteoarthritis

B. rheumatoid arthritis

C. psoriatic

D. degenerative joint disease

B

A stroke in the posterior circulation may affect the:

A. cerebellum

B. orbital vessels

C. anterior cerebral artery

D. frontal lobe

A

The Cincinnati stroke scale is based upon facial droop, speech, and ________.

A. ataxic gait

B. incontinence

C. motor weakness of arm

D. all of the above

C

In stroke, the "door to treatment time" should be approximately:

A. 10 minutes

B. 60 minutes

C. 120 minutes

D. about 3 hours

B

In cerebral palsy, the motor impairment is:

A. damage to the occipital lobe

B. progressive and worsens with time

C. non-progressive over time

D. due to demyelination of CNS white matter

C

In multiple sclerosis, __________ is/are found within the CSF upon examination.

A. many red blood cells

B. myelin basic protein (MBP)

C. herpes zoster virus

D. epstein-barr virus

B

In Myasthenia Gravis, the auto-antibodies bind to the _____________ to produce muscle weakness.

A. muscle fiber

B. myelin sheath

C. ACh receptors

D. dopaminergic cells

C

In amotrophic lateral sclerosis (ALS), wasting of the __________ muscles may be seen intra-orally.

A. tongue

B. palate

C. buccinators

D. obicularis oris

A

In the thyroid gland, T4 and some T3 are stored as:

A. iodine

B. thyroid binding acids

C. follicular epithelium inclusions

D. thyroglobulin

D