Clinical Medicine Exam 1

When discussing ischemic heart disease, which of the following statements is TRUE?

A: Vasodilation of the coronary arteries may lead to ischemia of the myocardium.

B: Occlusion can be caused by the presence of a large intraluminal atherosclerotic plaque.

C: Angina often arises during periods of decreased myocardial demand.

D: Commonly reported symptoms include seizures, hyperglycemia and wheezing.

B

The correct response when managing a patient with dental pain who presents with a heart rate of 106 and a blood pressure of 165/101 would include:

A: recheck the patient's vital signs ensuring the use of a properly sized blood pressure cuff.

B: anesthetize the patient using 2% lidocaine w/ 1:100,000 epinephrine and determine if the vitals normalize afterwards.

C: have the patient take a double dose of their antihypertensive medication.

D: proceed with elective dental treatment, as long as it is not extremely invasive and stimulating.

A

Which of the following correctly matches the antihypertensive medication and the associated fact?

A: Hydrochlorothiazide is a thiazide diuretic and has strong diuretic activity and causes hypokalemia.

B: Metoprolol is a nonselective beta antagonist (blocker) and acts on β1 and β2 receptors.

C: ACE inhibitors like lisinopril prevent the production of angiotensin II.

D: Calcium channel blockers all have activity on vascular smooth muscle and the heart.

C

Which of the following statements is TRUE regarding hypotension?

A: Orthostatic hypotension occurs when progressive blood loss leads to impaired systemic perfusion.

B: Vasovagal syncope is common and should be managed initially by sitting the patient upright.

C: Pregnant patients in the 3rd trimester should be placed in the lateral decubitus position to prevent compression of the ascending aorta.

D: Hypotension can result from non-neurogenic causes such as aortic stenosis or congestive heart failure.

D

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

All of the following answers correctly pair the component of the cardiovascular system with the appropriate function EXCEPT?

A: Blood vessels = conduits for fluid flow

B: Heart = pump to drive fluid

C: Kidneys = regulates systemic pressure and fluid volume

D: Blood = fluid responsible for transporting oxygen only

D

The class of antihypertensive medications that is most likely to have a potentially serious drug interaction when administering local anesthetics with vasoconstrictors is:

A. selective beta blockers.

B. nonselective beta blockers.

C. calcium channel blockers.

D. ACE inhibitors.

B. nonselective beta blockers - due to unopposed alpha1

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

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 3 seizures in the last week. What would be the most appropriate way to organize your medical consultation for this patient?

A. a 30 y.o 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 y.o 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 y.o 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 y.o 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

Dental management considerations of patients with psychiatric disease will include all of the following EXCEPT one. Which one is the EXCEPTION?

A. caries risk

B. antisialogogues

C. diet counseling

D. fluoride pastes and varnishes

B

Which of the following oral agents can cause hypoglycemia?

A. Glipizide (sulfonylurea)

B. Metformin (biguanides)

C. Acarbose (gamma-glucosidase inhibitors)

D. Pioglitazone (thiazolidinediones)

A

A 25 y.o 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

In Emergency Cardiac care (CPR), what maneuver comes first after a cardiac arrest?

A. give 2 breaths

B. open the airway with head-tilt

C. chest compressions

D. start an IV line

C

Public Access Defibrillators ___________ the survival rate following out-of-hospital cardiac arrest.

A. can quadruple

B. can triple

C. can double

D. has no effect on

C

The most important part of the medical history to quantify medical risk is the:

A. chief dental complaint

B. social history

C. allergies

D. review of systems

D

The chief complaint in the medical history is:

A. a summary you make of the symptoms

B. the patient's complaints verbatim

C. a review of the body systems

D. all pervious surgeries the patient has had

B

A patient who is malingering is:

A. making a child sick

B. making themselves sick

C. deliberately feigning illness

D. mentally ill

C

Secondary hypertension is different than essential hypertension in that it:

A. is not life threatening

B. occurs in older people

C. is curable

D. is less severe

C

Stage II Hypertension is defined as:

A. 140/90

B. 139/89

C. >160/>100

D. 120/80

C

In Stage I Hypertension, what types of drug therapy are recommended?

A. always use combo therapy

B. begin with monotherapy

C. never start with a diuretic

D. always include an ACE inhibitor

B

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

All of the following factors increases the possibility of a medical emergency occurring during a dental appointment EXCEPT one. Which one is the EXCEPTION?

A. advanced pharmacological therapeutics

B. illicit drug use

C. novel surgical techniques

D. declining age of the general population

D

An effective response to an emergency in a dental office:

A. must involve immediate action by the doctor

B. should include multiple drugs for each possibility

C. is directly related to practicing the appropriate response prior to the actual event

D. must include only those team members directly...

C

Epinephrine is a catecholamine that interacts:

A. indirectly on alpha-1, beta-1, and beta-2 adrenergic receptors

B. indirectly on alpha-1, alpha-2, beta-1, and beta-2 cholinergic receptors

C. directly on alpha-1, alpha 2, beta-1, and beta-2 adrenergic receptors

D. directly on beta-1 cholinergic receptors

C

Albuterol is a direct acting agonist that primarily interacts with:

A. beta-1 receptors in the heart

B. beta-1 receptors in the lungs

C. beta-2 receptors in the heart

D. beta-2 receptors in the lungs

D

All of the following are acceptable treatment modalities for a patient with a suspected myocardial infarction EXCEPT one. Which one is the EXCEPTION?

A. nitroglycerin

B. aspirin

C. oxygen

D. atropine

D

atropine will make their heart explode

Which of the following is an advanced airway technique requiring intensive additional educational training?

A. successful bag-valve-mask ventilation

B. placement of an oral airway

C. placement of a nasopharyngeal airway

D. placement of an endotracheal tube

D

Unconscious patients often demonstrate significant airway obstruction due to soft tissue collapse that may require:

A. cricoid pressure (Sellicks maneuver)

B. placement of a nasal cannula

C. anterior retraction of the tongue

D. placement of the patient into steep Trendele

C

Which of the following routes of administration provides rapid delivery of drugs and the ability to titrate dosages?

A. intravenous route

B. subcutaneous route

C. intramuscular route

D. rectal route

A

The most common perioperative medical emergency to occur in a dental setting is:

A. acute anxiety attack

B. vasovagal syncope

C. hypoglycemia

D. status asthmaticus

B

A patient who presents to your office with signs suggestive of unstable angina requires:

A. immediate administration of meperidine

B. immediate administration of 81 mg of aspirin

C. continuous monitoring throughout the dental appointment

D. prompt activation of emergency medical services (EMS)

D

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

Risk factors associated with coronary artery disease include:

A. hypokalemia

B. increased physical activity

C. hyperlipidemia

D. diabetes insipidus

C

Medical management of a patient with ischemic heart disease may include all of the following EXCEPT:

A. beta blockers or nitrates

B. antiplatelet medications and catecholamines

C. lifestyle modifications such as salt restriction

D. surgical approaches including placement of stents

B

At what blood glucose level does WBCs become dysfunctional?

A. 100

B. 126

C. 250

D. 385

C

Essential hypertension is a problem because it damages:

A. target organs

B. elastin of blood vessel wall

C. the right atrium

D. bony skeleton

A

Which of the following is not a medication used for hypertension?

A. beta blocker

B. clonidine

C. Digoxin

D. calcium channel blocker

C

Digoxin is used to treat heart failure and some types of irregular heartbeats (such as chronic atrial fibrillation)

What causes isolated systolic hypertension?

A. high renin

B. too much sodium intake

C. compliant ventricle

D. decreased elasticity of aorta

D

Which of the following is an obstructive lung disease?

A. sarcoidosis

B. obesity

C. pregnancy

D. asthma

D

Patients with asthma:

A. demonstrate wheezing during auscultation

B. are classified as pink puffers

C. are classified as blue bloaters

D. present with tachycardia as their first sign

A

Obese patients:

A. have reduced functional residual capacity

B. breath more efficiently when supine

C. should always be given supplemental O2 for appointments

D. have a parenchymal lung disorder

A

When diagnosing a patient who reports anginal chest pain, which of the following statements is TRUE?

A. angina pectoris tends to follow a decrescendo-crescendo pattern

B. chest pain consistent with Prinzmetal's angina tends to resolve with rest

C. a recent change in the location or intensity of chest pain is suggestive of angina pectoris

D. a sense of impending doom may accompany a patient having a myocardial infarction

D

A leftward shift refers to a(n):

A. increase in pH

B. increase in pCO2

C. increase in temperature

D. decrease in pH

A

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 elderly or medically compromised patient functional status should always be evaluated, when initially obtaining their history or prior to considering performing a procedure. Using the METS (metabolic equivalents), the ability to climb a flight of stairs is associated with what value?

A. 1

B. 4

C. 8

D. 10

B

The risk of ischemia is increased with an ejection fraction below what maximal level?

A. 25%

B. 35%

C. 45%

D. 55%

B

All of the following answers correctly pair the component of the cardiovascular system with the appropriate function EXCEPT:

A. blood vessels = conduits for fluid flow

B. heart = pump to drive fluid

C. kidneys = regulates systemic pressure and fluid volume

D. blood = fluid responsible for transporting oxygen only

D

What is the number one condition in the differential diagnosis of seizures in dental office?

A. stroke

B. TIA

C. porphyria

D. syncope

D

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

A. fluids (IVF)

B. magnesium

C. insulin

D. glucagon

C

A full oxygen "E"tank (2100 psi) is set at a flow of 10 L/min. For approximately what duration will oxygen be administered at this flow?

A. 40 minutes

B. 50 minutes

C. 60 minutes

D. 70 minutes

C

Which airway device should be considered to assist in maintaining an open airway in the semiconscious patient?

A. nasal cannula

B. nasopharyngeal airway

C. oropharyngeal airway

D. face mask with ambu bag

C

Which route of administration would provide a slow continuous administration of medication (bronchial dilator) to the wheezing patient?

A. inhalation

B. subcutaneous

C. intramuscular

D. intravenous

B

In differentiating between vasovagal syncope and a seizure, which clinical sign more strongly suggests a diagnosis of seizure?

A. olfactory sensation reported by patient

B. orthostatic hypotension associated with change in position

C. loss of continence

D. vital signs

C

A 64 y.o male with a history of mild to moderate coronary artery disease is having an allergic reaction to the antibiotic that you prescribed to be taken prior to dental treatment b/c he had a knee replacement w/in the past year. About 1.5 hours into the procedure, 2.5 hours after the patient has taken the medication, you notice that his lips and tongue appear swollen. In discussion with the patient, he states that he may be having mild difficulty with breathing. The patient's vital signs are BP: 138/88, HR 84, RR: 16. You activate EMS. Which drug and route is most appropriate to be administered initially?

A. epinephrine 1:1000 intralingual injection

B. epinephrine 1:1000 subcutaneous injection

C. epinephrine 1:10,000 intralingual injection

D. epinephrine 1:10,000 intramuscular deltoid injection

B

Asthma, a reversible obstructive airway disease, can be characterized by which of the following?

A. bronchodilation

B. restrictive airway disease

C. bihilar lymphadenopathy

D. chronic mucosal inflammation

D

Which statement(s) is/are 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 form 2-3 sputum specimens sent for aerobic and anaerobic cultures

A and C

Your 23 y.o patient gives you a history of asthma. You ask all appropriate questions. Which response makes you most concerned about treating this patient?

A. last asthma attack was age 16

B. uses inhaler (albuterol) when the weather gets cold

C. was hospitalized 3 months ago and intubated

D. takes albuterol and atrovent

C

The preoperative blood pressure measurement at which it is not recommended to proceed with elective dental treatment for an otherwise asymptomatic patient is:

A. normal (systolic 120 mmHg and diastolic 80 mmHg)

B. prehypertension (systolic 120-139 mmHg or diastolic 80-89mmHg)

C. Stage I hypertension (systolic 140-159mmHg orr diastolic 90-99mmHg)

D. Stage II hypertension (systolic >160 mmHg or diastolic > 100 mmHg)

D

A patient who has a history of occasional chest pain with exertion that resolves with rest presents for routine dental treatment. Preoperatively he reports feeling persistent chest pain that is different in intensity than normal. This patient is best managed by presuming a possible diagnosis of:

A. stable angina

B. Prinzmetal's angina

C. unstable angina

D. angina pectoris

C

An acute asthma attack has a ________ pattern on pulmonary function testing

A. obstruction

B. restrictive

C. normal

D. mixed

A

Wheezing is a clinical feature of:

A. both asthma and COPD

B. COPD only

C. asthma only

D. neither asthma nor COPD

A

Salmeterol is:

A. a short acting beta-agonist

B. a long acting beta-agonist

C. a leukotriene inhibitor

D. none of the above

B

What are the 2 major types of stroke?

A. TIA and low-flow states

B. meningitis associated stroke and TIA

C. ischemic and hemorrhagic

D. none of the above

C

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

A 40 y.o Hispanic female arrives at your office in the afternoon with pale gray skin, cyanotic nail beds, and blue lips. You remember treating this patient at 9:30AM. She appears to be in respiratory distress; however, a quick review of her paperwork does NOT reveal a history of cardiac or respiratory disease. Which of the following local anesthetics is most likely responsible?

A. articaine

B. bupivacaine

C. lidocaine

D. prilocaine

D

The maximum amount of epinephrine a patient with a known heart condition (ASA III and ASA IV) should be administered is which of the following? (1.8 mL per cartridge)

A. 0.02 mg

B. 0.04 mg

C. 0.06 mg

D. 0.08 mg

B

0.04 mg is 2 carpules of 2% lidocaine 1:100,000 epi

A 66 y.o male presents to your office seeking extraction of tooth #19 due to throbbing pain is considered high cardiac risk due to extensive cardiovascular disease. The max amount of 4% Septocaine; 1:100,000 epi that can be administered is approximately?

A. 2 carpules

B. 3 carpules

C. 4 carpules

D. 5 carpules

A. 2 carpules = 0.018 x 2 = 0.036

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 seizures 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 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

The percent oxygen flow administered via a nasal cannula:

A. is decreased when the patient breathes through their mouth.

B. is maximized at a concentration of 40% at an oxygen flow of 6 L/min

C. is best adjusted prior to placing the nasal cannula on the patient

D. provides an appropriate concentration of O2 for a MI without increasing anxiety

B

The formula of hypertension is BP = CO x _____.

A. HR

B. respiratory rate

C. blood volume

D. PVR (peripheral vascular resistance)

D

A patient is found to be unresponsive secondary to severe hypoglycemia while receiving dental treatment. The appropriate steps in managing this patient include administration of:

A. intramuscular glucagon

B. oral glucose (Insta-Glucose)

C. intramuscular insulin

D. intramuscular atopine

A

-intramuscular glucagon = used for unconscious patients

-oral glucose = used for conscious patients

-intramuscular atropine = used for syncope

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

Unconscious patients often demonstrate airway obstruction due to soft tissue collapse that may require:

1. jaw thrust

2. nasal cannula placement

3. nasopharyngeal airway

4. head tilt/chin lift

5. cricoid pressure (Sellick's maneuver)

A. 1, 5

B. 1, 3, 4

C. 2, 3, 4

D. 5 only

B

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