Clinical Medicine Exam 3

Dental management considerations of patients with psychiatric disease will include all of the following EXCEPT:

A. caries risk

B. antisialogogues

C. diet counseling

D. fluoride pastes and varnishes

B

Which clinical finding is suggestive of a platelet disorder?

A. ecchymosis

B. hemarthrosis

C. petechiae

D. delayed surgical bleeding

C

Which of the following is a hypercoagulable state?

A. thrombocytopenia

B. hereditary hemorrhagic telangiectasia

C. hemophilia A

D. protein C deficiency

D

Patients with bipolar disorders will:

A. report an increased need for sleep

B. have no family history of bipolar disorder

C. present with distinct periods of euphoric mania

D. require pain management with NSAIDs only

C

Which factors are considered to be vitamin K dependent?

A. factors 7, 9

B. factors 9, 11

C. factors 7, 11

D. factors 8, 10

A

Factors II, VII, IX, X are vitamin K-dependent

For which patient is DDAVP the initial agent used to promote hemostasis?

A. moderate hemophilia A

B. von Willebrand disease

C. idiopathic thrombocytopenia

D. liver disease

B

Schizophrenia:

A. has a lifetime prevalence of 1.1% and occurs later in life

B. responds well to treatment with lithium

C. has a definite genetic cause

D. is characterized by disordered thinking, delusions or hallucinations

D

Pharmacologic adverse effects which are NOT of concern when managing patients with psychiatric disorders are:

A. orthostatic hypertension

B. hypotension with use of epinephrine

C. tardive dyskinesia

D. agranulocytosis

A

Which of the following represents appropriate management of a patient who is scheduled for the extraction of 2 maxillary anterior teeth?

A. discontinue aspirin 3-5 days prior to surgery

B. obtain and INRR 24 hrs prior to surgery for a patient who is taking LMWH (low molecular weight heparin)

C. consider using adjunctive hemostatic agents (ex. fibrillar collagen) for the patient taking Plavix

D. proceed with surgery in the patient with A. Fibrillation if INR is therapeutic b/w 2.5-3

C and D

Mood disorders:

A. are more common among men than among women

B. are characterized by extreme exaggeration and disturbance of mood and affect

C. include depression, bipolar disorder, and schizophrenia

D. affect 7% of adults in the US

B

A patient who is malingering is:

A. making a child sick

B. making themselves sick

C. deliberately feigning illness

C

In the development of a RBC, once a normoblast loses its nucleus, it becomes a:

A. mature RBC

B. mast cell

C. reticulocyte

D. pro-erythroblast

C

Erythropoietin is released by the kidney and the:

A. lung

B. bone marrow

C. adrenal glands

D. liver

D

Angular cheilitis and glossitis may be seen most often in which condition?

A. anemia

B. lymphoma

C. leukemia

D. errythrocytosis

A

Anemia due to RBC destruction may be due to which of the following?

A. inadequate production

B. sequestration in the spleen

C. hemolysis

D. excessive thrombosis

C

In sickle cell anemia, what amino acid replaces glutamic acid in the hemoglobin chain?

A. leucine

B. valine

C. tyrosine

D. methionine

B

On a blood smear, iron deficiency anemia appears?

A. macrocytic-hypochromic

B. microcytic-hypochromic

C. normochromic

D. sickled

B

Von Willebrand factor is released by megakarocytes and:

A. RBCs

B. WBCs

C. fibroblasts

D. endothelial cells

D

Which of the following factors opposes primary hemostasis?

A. TXA2

B. serotonin

C. epinephrine

D. PGE2

D

What would the platelet count be with serious intra-cranial bleeds?

A. 150,000

B. 300,000

C. <10,000

D. none of the above; this never happens

C

Platelet aggregation requires which of the following?

A. fibrinogen

B. PGE2

C. fibrin

D. Clopidogrel (Plavix)

A

Which of the following conditions does NOT cause gingival bleeding?

A. hemophilia

B. ITP

C. Von Willebrand disease

D. sarcoidosis

D

Giving Coumadin (Warfarin) to a patient inhibits:

A. vitamin C

B. vitamin K

C. B vitamins

D. vitamin D

B

Clinical signs and symptoms of myelosuppression related to decreased WBC function include all of the following EXCEPT:

A. fever of unknown origin

B. pallor, fatigue

C. microbial infections

D. lymphadenopathy

E. non-specific cough

B

Which of the following statements is FALSE?

A. stem cell transplantation is feasible b/c of the large numbers of stem cells found in circulating blood

B. stem cell transplantation is feasible b/c hematopoietic growth factors speed engraftment and recovery

C. stem cell transplantation is feasible b/c the stem cell can be cryopreserved

D. stem cell transplantation is feasible b/c of the remarkable regenerative capacity of the stem cell

A

A 20 y.o male patient presents for his 6 month dental appointment with complaint of bleeding gums for approximately 3 weeks. Upon review of systems, medical history, medications, the patient reports that he has not been feeling well, has a sore throat, and he has recently developed a rash on his legs. He is obviously sweating and has a fever. Oral exam reveals generalized, enlarged, bleeding gingival tissues, lymphadenopathy, enlarged tonsils, and palatal petechiae. Your immediate plan for this patient should be to:

A. tell the patient to go home and call when he feels better

B. full mouth radiographic series and immediate periodontal debridement

C. prescribe antibiotics and reschedule the patient in 2 weeks

D. order a complete blood count including differentials and platelets

D

A 20 y.o male patient presents for his 6 month dental appointment with complaint of bleeding gums for approximately 3 weeks. Upon review of systems, medical history, medications, the patient reports that he has not been feeling well, has a sore throat, and he has recently developed a rash on his legs. He is obviously sweating and has a fever. Oral exam reveals generalized, enlarged, bleeding gingival tissues, lymphadenopathy, enlarged tonsils, and palatal petechiae. With regards to his signs and symptoms, which of the following diagnoses is most likely?

A. sickle cell anemia

B. vitamin B12 deficiency

C. acute myeloid leukemia

D. chronic renal failure

E. non-Hodgkin's lymphoma

C

Which of the following characterizes iron deficiency anemia?

A. increased erythrocyte production and increased erythrocyte destruction

B. decreased hematocrit with an increased hemoglobin

C. most common form of hemolytic anemia

D. microcytosis and hypochromia demonstrated on peripheral blood smear

D

Gastroesophageal reflux disease is associated:

A. with acid from the stomach damaging the lining of the esophagus

B. with an incompetent upper esophageal sphincter (LES)

C. with gastric acid hyposecretion

D. less with pregnancy and obesity

A

Treatment of gastroesophageal disease includes:

A. life style modification with avoidance of non-spicy foods and non-carbonated beverages

B. prescribing medication including beta blockers, calcium channel blockers, and adrenergic agonists

C. wearing tight clothes around the waist to keep food down

D. prescribing medication including proton pump inhibitors, H2 blockers, and prokinetic agents

D

What is the most common organism associated with gastritis?

A. escherichia coli

B. staphylococcus aureus

C. helicobacter pylori

D. enterococcus faecalis

C

Which of the following signs/symptoms are common to all anemias?

A. jaundice, dark urine, blue sclera

B. pallor, fatigue, headache

C. parrasthesias, ataxia, dementia

D. neutropenia, thrombocytopenia

E. pancytopenia, hypersegmented neutrophils

B

Crohn's disease typical presentation differs from ulcerative colitis in that ulcerative colitis:

A. may affect any part of the GI tract from mouth to anus causing a wide variety of symptoms

B. is a disease of the large intestine that includes characteristic ulcers with an increased risk of colon carcinoma

C. is an acute inflammatory bowel disease with known etiology

D. has evidence of extraintestinal manifestations above 80% of patients affected

B

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

All clotting factors are solely made in the liver with the EXCEPTION of:

A. factor V

B. factor VI

C. factor VII

D. factor VIII

D

Prior to and when providing dental treatments for patients with sickle cell anemia, which of the following measures should be considered?

A. prophylactic parenteral B12

B. prophylactic antibiotic coverage

C. B12 and folic acid supplementation

D. avoidance of oxidative triggers

B

What is the blood supply of the liver?

A. the hepatic artery provides 75% and the hepatic portal vein provides 25%

B. the hepatic portal artery provides 25% and the hepatic vein provides 75%

C. the hepatic portal vein provides 75% and the hepatic artery provides 25%

D. the hepatic artery provides 100%

C

When evaluating liver injury from a liver function test, which enzyme is more specific in making the diagnosis?

A. aspartate aminotransferase (AST)

B. alanine aminotransferase (ALT)

C. alkaline phosphatase

D. renin

B

Hepatitis A and Hepatitis E are similar in a number of ways such as:

A. they are both DNA viruses

B. they both have carrier states

C. transmission is by an enteric (fecal-oral) route

D. there are no vaccines available

C

Bipolar disorder is considered to be an ______ syndrome.

A. Axis I

B. Axis II

C. Axis III

D. Axis IV

A

What neurotransmitter is thought to play a key role in neuroplasticity?

A. GABA

B. norepinephrine

C. glutamate

D. acetylcholine

C

Which of the following is an add-on drug used in the treatment of major depression?

A. valium (BDZ)

B. amphetamine

C. ritalinsup

D. abilify

D

Which area of the membrane surfaces do the SSRI type drugs act?

A. post-synaptic

B. pre-synaptic

C. G-protein channel

D. Na/K ATPase pump

B

Decreased need for sleep, racing thoughts, unusually talkative and engaging in risky behavior is characteristic for:

A. panic disorder

B. major depression

C. mania

D. PTSD

C

The nucleus accumbens floods with ______ when an addict is offered a drug.

A. norepinephrine

B. serotonin

C. acetylcholine

D. dopamine

D

Clinically, this (I'm assuming the situation in the previous question, i.e addict is offered a drug) produces the emotion of __________

A. dysphoria

B. euphoria

C. depression

D. fear

B

Where do dopamine neurons originate in the reward pathway of our brain?

A. cingulate cortex

B. hippocampus

C. ventral tegmental area

D. mediodorsal thalamus

C

The genetic vulnerability to addiction is approximately:

A. 90%

B. 40-60%

C. 10%

D. near zero

B

In alcoholism, if you suddenly withdraw ethanol, you can precipitate a severe case of:

A. gastritis

B. cirrhosis

C. neuropathy

D. delirium tremens

D

What organ is involved most in the breakdown of cortisol?

A. kidney

B. lungs

C. liver

D. adrenal cortex

C

Liver disease ________ the level of BUN.

A. raises

B. lowers

C. has no effect on

D. none of the above

B

T/F: The megakaryocyte is the precursor to RBC and monocytes.

False

Hematopoeitic stem cells:

1. differentiate into erythrocytes, mast cells, T-cells, megakaryocytes and granulocytes

2. are the central durable source of immune cells

3. produce tens of billions of blood cells daily

4. cannot be cryopreserved

5. are found in the bone marrow

A. 1, 2, 4

B. 2, 3, 4, 5

C. 1, 2, 4, 5

D. 1, 2, 3, 5

D

The myelosuppressed patient may present with which of the following oral symptoms?

A. petechiae, dyspnea, enlarged gingiva, and candidiasis

B. herpes, fatigue, and gingival bleeding

C. gingival edema, petechiae, and candidiasis

D. infection, ecchymosis, and shortness of breath

C

In males, the hemoglobin level and hematocrit value are higher due to:

A. cortisol

B. growth hormone

C. androgens

D. hypoxia

C

Polycythemia vera is a stem-cell disorder in which too many _______ are formed.

A. platelets

B. granulocytes

C. eosinophils

D. RBC

D

An International Normalized Ratio (INR) value of 1 is:

A. normal

B. twice the normal value

C. common while on coumadin

D. less than normal

A

Splenomegaly may result in bleeding b/c of:

A. sequestration of Factor VIII

B. low platelets

C. rupture of the spleen capsule

D. portal hypertension

B

NSAIDs affect the platelet for:

A. 5 days

B. 24 hours

C. life span

D. none of the above; they have no effect

B

I think?

T/F: Myeloid tissue is found in bone marrow and contains cells derived from bone marrow.

True

Hematopoietic stem cells:

A. are pluripotential cells that serve as progenitors of more differentiated cell types

B. are the central source of immune cells

C. exist to generate, maintain, and repair tissues

D. all of the above are correct

D

T/F: Patients who have had a stem cell transplant may have an indwelling catheter. This is not of concern and the dentist may proceed with treatment as usual.

False

T/F: Thrombocytopenia is a decrease in RBCs and manifests as bleeding in the oral cavity.

False

Peripheral blood stem cell transplant is made possible b/c of the potential of which of the following cell types?

A. granulocyte

B. erythrocyte

C. hemopoietic stem cell

D. eosinophil

E. mast cell

C

T/F: For an autologous stem cell transplant, stem cells are harvested from a matched related donorr.

False

The myelosuppressed patient may present with which of the following symptoms?

A. oral bleeding

B. petechiae

C. herpes simplex

D. pale oral mucosa

E. all of the above

E

T/F: The role of the dentist is to identify and manage oral infection or potential sources of oral infection prior to transplant.

True

Which of the following would explain the "combined" oral symptomatology of spontaneous gingival hemorrhage, pale mucous membranes, herpetic lesions, enlarged boggy gingiva, and swollen tonsils?

A. pancytopenia

B. anemia

C. leukopenia

D. thrombocytopenia

E. polycythemia

A

Which of the following statements is true of anemia?

A. anemia is characterized by a decrease in hematocrit or an increase in hemoglobin

B. anemia can result from increased red cell destruction or increased production

C. anemia is most often a sign of an underlying disease or condition

D. anemia is abnormally high circulating RBC mass reflected in low serum hemoglobin

C

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

Depression is a mood disorder broken down into which of the following types?

A. manic, hypomanic, cyclothymic

B. somatoform, conversion, factitious

C. catatonic, disorganized, paranoid

D. major, dysthymic, not otherwise specified

D

A 37 y.o female who reports a history of bipolar disorder and taking lithium presents with complaint of dental pain and swelling. Which of the following medications should you AVOID prescribing?

A. ibuprofen

B. hydrocodone

C. amoxicillin

D. aspirin

A and D

Which of the following patient is considered to have AIDS?

A. viral load of 2,000

B. CD4 of 201

C. oral candidiasis

D. disseminated tuberculosis

D

Dental management of the patient who presents for evaluation prior to peripheral blood stem cell transplant includes identifying and eliminating potential sources of infection which includes all but one of the following. Which one is NOT considered a problem for the patient who will be receiving a PBSCT?

A. partially erupted teeth

B. teeth with sharp edges

C. teeth with incipient caries

D. periodontal pocketing

E. apical periodontitis

C

Which statement is TRUE regarding tuberculosis?

A. The 4 first line drugs used for treatment are Isoniazid, Rifampin, Pyrazinamide, and Ethambutol

B. HIV, elderly , and women are at low risk

C. tuberculosis is most commonly spread by aerosolized droplets

D. diagnosis is made from 2-3 sputum specimens sent for aerobic and anaerobic cultures.

A and C

Which of the following is TRUE regarding the prescription of Bactrim in AIDS patients?

A. Bactrim is given prophylactically for cytomegalovirus

B. Bactrim is given prophylactically for mycobacterium atrium complex

C. Bactrim is given prophylactically for Pneumocytosis jirovecil

D. Trimethoprim-azithromycin is generic for Bactrim.

C

Which statement is TRUE regarding tuberculosis?

A. The 4 first line drugs used for treatment are Isoniazid, Rifampin, Pyrazinamide, and Ethambutol.

B. HIV, elderly, and women are at low risk

C. Tuberculosis is most commonly spread by aerosolized droplets

D. Diagnosis is made from 2-3 sputum specimens sent for aerobic and anaerobic cultures

A and C

Highly active antiretroviral therapy includes which medication?

A. nucleoside and nucleotide reverse transcriptase inhibitors

B. azithromycin

C. bactrim

D. nucleoside and nucleotide antireverse transcriptase inhibitorrs

A

Addiction is most characterized by which of the following?

A. substance used in dangerous situations

B. daily substance use

C. tolerance

D. recurring legal problems

C

Which of the following has created the most concern with respect to abuse potential?

A. narcotics for acute pain

B. marijuana

C. OTC sudafed

D. narcotics for chronic pain

D

The Child Classification for liver injury includes a number of parameters. One such is:

A. pain

B. ascites

C. pre-albumin

D. scar formation

B

Acetaldehyde/alcohol induced liver damage involves:

A. fatty liver stage, liver fibrosis stage, cirrhosis stage

B. scar tissue formation, fat deposits, connective tissue growth

C. an irreversible process once the fatty acid liver stage is attained

D. recovery at the cirrhotic stage once strict abstinence is adhered to.

A

Which of the following statements pertaining to pharmacologic therapy is most accurate?

A. antiplatelet drugs work better on the arterial system than anticoagulant drugs (ex. coumadin)

B. aspirin reversibly binds to the enzyme cyclooxygenase preventing platelet aggregation

C. coumadin acts as a vitamin K metabolite interfering with synthesis of factors 2, 9, 10

D. heparin inhibits the activity of thrombin 3, inactivating serine proteases except factor 7 and 9

A

An increase in mortality due to substance abuse can be attributed in part to:

A. pharmaceutical companies

B. stressful lifestyles

C. professional negligence

D. all of the above

D

The primary basis for addiction is:

A. behavioral

B. failure to receive treatment

C. alternation in dopamine circuits

D. genetic

C

Which of the following is NOT a function of the hepatocyte?

A. albumin production

B. bilirubin metabolism

C. production of clotting factors

D. insulin production

D

In a patient with liver disease, albumin production:

A. is not a function in the normal hepatocyte

B. is a prognostic sign if it does not correct with proper nutrition

C. requires vitamin K to be produced

D. is a function which produces bilirubin as a ...

B

Why is ALT a more specific test for liver function than AST?

A. ALT is produced in only the liver

B. ALT is produced in skeletal and heart muscle

C. because the AST/ALT ratio is 2:1

D. AST rises too quickly after epithelial cell...

A

Immunity to Hepatitis C virus is:

A. very strong

B. very weak

C. undetectable

D. none of the above

B

Which of the following is a factor producing GERD?

A. thin patient

B. lower LES pressure

C. acid hypo-secretion

D. absence of H. pylori

B

"Coffee-grounds" emesis is another term for:

A. gastritis

B. cirrhosis

C. hematemesis

D. vomiting due to GERD

C

Amoxicillin and _______ can be used to eradicate H.pylori.

A. clindamycin

B. levaquin

C. azithromycin

D. metronidazole

D

Antibiotic associated colitis is another term for:

A. gastritis

B. peritonitis

C. pseudomembranous colitis

D. ulcerative colitis

C

In patients with ulcerative colitis, what percentage have systemic diseases?

A. none

B. 1-2%

C. 25%

D. nearly 100%

C