Wilkins Chapter 55: The Patient with Cancer

3. A 55 yr. man with stage III squamous cell carcinoma of the left retromolar area and left lateral tongue, with metastasis to the left neck, presents for a cleaning appointment prior to his continuing radiation therapy. The radiation field includes the entire neck, mandible, TMJ, and posterior of the maxilla. The examination reveals multiple teeth with cervical caries. The pt. has a well-fitting maxillary partial denture, replacing #1 to 5 and #12 to 15. Periodontal involvement includes pocketing ranging from 5 to 7 mm on the maxillary anterior teeth and generalized on the mandibular arch. The plaque level is moderate, with heavy calc and stain. The pt. drinks occasionally and smokes two packs a day. He brushes his teeth twice daily and rinses with Listerine once a day.

Which of the following is the greatest single risk factor for oral and pharyngeal cancer?

a. viruses

b. genetics

c. tobacco

d. diet.

c. tobacco

T/F Hematopoietic stem cell transplantation is used to treat cancers involving the bone marrow, including leukemia.

True

1. A 55 yr. man with stage III squamous cell carcinoma of the left retromolar area and left lateral tongue, with metastasis to the left neck, presents for a cleaning appointment prior to his continuing radiation therapy...

Cancer staging is based on the following:

a. type of cell and mode of growth of the tumor

b. rate of growth of tumor and if metastasis has occurred.

c. tumor size, lymph node involvement, and if metastasis has occurred

d. tumor type, tumor size, and rate of growth of tumor.

c. tumor size, lymph node involvement, and if metastasis has occurred.

2. A 55-yr-old man w/ Stage III squamous cell carcinoma of the left retromolar area and left lateral tongue, with metastasis to the left neck, presents for a cleaning appt prior to his continuing radiation therapy...

The patient's cervical caries most likely resulted from which of the following?

a. existing periodontal condition

b. change in types of oral bacteria

c. presence of partial denture

d. dysfunctional salivary glands

d. dysfunctional salivary glands

4. A 55-yr-old man w/ Stage III squamous cell carcinoma of the left retromolar area and left lateral tongue, with metastasis to the left neck, presents for a cleaning appt prior to his continuing radiation therapy...

All of the following dental procedures are indicated prior to head and neck radiation, except:

a) periodontal scaling and root planing.

b) extraction of teeth with questionable prognosis.

c) restoration or repair of indicated teeth.

d) periodontal surgery to eliminate pockets

d. periodontal surgery to eliminate pockets.

5. A 55-yr-old man w/ Stage III squamous cell carcinoma of the left retromolar area and left lateral tongue, with metastasis to the left neck, presents for a cleaning appt prior to his continuing radiation therapy...

During assessment of your pt. you notice signs of severe xerostomia. You would expect him to have all of the following other symptoms of radiation therapy except:

a. impaired taste

b. inability to open mouth completely

c. tooth mobility

d. oral mucositis

c. tooth mobility.

6. A 55-yr-old man w/ Stage III squamous cell carcinoma of the left retromolar area and left lateral tongue, with metastasis to the left neck, presents for a cleaning appt prior to his continuing radiation therapy...

The patient complains about having dry mouth. The best solution to this problem is to:

a. tell the patient to avoid using sugar-free gum or candy

b. recommend lemon glycerin swabs

c. tell the pt. to stop smoking

d. recommend a saliva substitute spray or gel.

d. recommend a saliva substitute spray or gel.

7. A) Internal radiation therapy involves placing radioactive implants or seeds within the body. B) More radiation is delivered to surrounding tissues by internal radiation than by external radiation.

a. Statement A is true and statement B is false.

b. Statement A is false and statement B is true.

c. Both statements are true.

d. Both statements are false.

a. Statement A is true and statement B is false.

8. All of the following are systemic side effects of chemotherapy, except:

a. alopecia.

b. bone necrosis.

c. nausea.

d. anemia.

b. bone necrosis.

9. All of the following are types of radiation therapy, except:

a. implants placed within the body.

b. seed therapy.

c. IMRT.

d. IPRT.

d. IPRT.

10. All of the following conditions are to be expected due to radiation therapy, except:

a. increased bone loss.

b. mucositis.

c. xerostomia.

d. trismus.

a. increased bone loss.

11. Bone marrow for transplantation is typically aspirated from all of the following sources, except the:

a) iliac crest.

b) carpals.

c) ribs.

d) sternum.

b) carpals.

12. Dental hygiene treatment should be postponed during chemotherapy treatment when the platelet count is less than:

a. 20,000/mm.

b. 30,000/mm.

c. 50,000/mm.

d. 60,000/mm.

c. 50,000/mm.

13. During head and neck radiation therapy all the following should be avoided, except:

a. high-sucrose foods.

b. broths.

c. lemon glycerin swabs.

d. spicy foods.

b. broths.

14. For the first 6 months after head and neck radiation therapy, recall the patient every __________ as needed for nonsurgical periodontal therapy.

a. 2 to 4 weeks

b. 4 to 8 weeks

c. 8 to 12 weeks

d. 4 to 6 months

b. 4 to 8 weeks

15. Pancytopenia means normal depression in all cellular elements of the blood.

a. True

b. False

b. False

Pancytopenia refers to an abnormal reduction in all three types of blood cells

16. Suggestions for the dental hygiene care plan for patients with cancer include all of the following, except:

a. providing positive reinforcement.

b. verbally reviewing their homecare instruction.

c. demonstrating acceptance and empathy.

d. practicing active listening skills.

b. verbally reviewing their homecare instruction.

17. The type of bone marrow transplant when the tissue comes from one's own body is:

a. allogeneic.

b. autologous.

c. hematopoietic.

d. syngeneic.

b. autologous.

18. Which grade of the World Health Organization Oral Mucositis Scale does this description fall under? Patient has oral ulcers but solid foods are tolerated.

a. 0

b. 1

c. 2

d. 3

e. 4

c. 2

19. Which of the following is a characteristic of a benign neoplasm?

a. Metastasizes to other areas of the body

b. Causes generalized effects such as anemia, weakness, and weight loss

c. Does not recur when removed

d. Cells bear little resemblance to the normal cells of the tissue from which they arose

c. Does not recur when removed

20. Which of the following is a complication related to hematopoietic cell transplantation that involves the donor's T-lymphocytes interpreting the host cell antigens as foreign and reacting against the host tissue?

a. Graft-versus-host disease

b. Jaundice

c. Mucositis

d. Leukemia

a. Graft-versus-host disease

21. Which of the following is an indication for chemotherapy, as opposed to other modalities, for treatment of cancer?

a. Tumors that are small, localized, and easy to remove

b. Debulk or remove portions of large tumors before other treatment

c. Cancer that has metastasized to other parts of the body

d. Tumors that are radiosensitive

c. Cancer that has metastasized to other parts of the body

22. Which one of the following is not a chemotherapy agent?

a. Acilating agent

b. Antibiotics

c. Antimetabolites

d. Plant alkaloids

a. Acilating agent

23. Which type of treatment is used to treat a variety of blood diseases, including leukemia?

a. Surgery

b. Hematopoietic cell transplantation

c. Radiation therapy

d. Vaccine therapy

b. Hematopoietic cell transplantation