Medically Compromised Pts 1Dentistry MCQs 0% Report a question What's wrong with this question? You cannot submit an empty report. Please add some details. Medically Compromised Patients Management 1 1 / 36 A patient receiving hemodialysis presents for an extraction. He last received dialysis yesterday. What modifications to care are recommended? Obtain a medical consultation; schedule the extraction the day after dialysis; avoid NSAIDs; opioids may be used if severe pain; prescribe tetracycline for infection control. Schedule the extraction the day after dialysis; avoid NSAIDs; opioids may be used if severe pain. Obtain a medical consultation; schedule the extraction the day after dialysis; avoid NSAIDs; opioids may be used if severe pain; avoid tetracycline. Perform the extraction immediately before the next dialysis session; avoid NSAIDs; opioids may be used if severe pain; avoid tetracycline. Patients on dialysis should be treated on non‑dialysis days, ideally the day after dialysis when anticoagulants have cleared. A medical consultation is advised. NSAIDs are contraindicated. Opioids may be used for severe pain (relative contraindication). Tetracycline is avoided. 2 / 36 A patient with moderate chronic obstructive pulmonary disease (ASA 3) requires restorative treatment. What is the recommended management? Obtain a medical consultation; schedule short appointments; prefer afternoon appointments for chronic bronchitis; opioids may be prescribed freely. Obtain a medical consultation; schedule short appointments; morning appointments are preferred; avoid opioids unless absolutely necessary. Schedule short appointments; prefer afternoon appointments for chronic bronchitis; avoid opioids unless absolutely necessary. Obtain a medical consultation; schedule short appointments; prefer afternoon appointments for chronic bronchitis; avoid opioids unless absolutely necessary. For ASA 3 COPD, a medical consultation is advisable. Elective care may proceed with short appointments. Opioids are relatively contraindicated and afternoon appointments are preferred in chronic bronchitis. 3 / 36 A patient with active hepatitis presents with fatigue, jaundice and dark urine. He requires non‑urgent dental care. What is the appropriate management? Defer elective treatment and obtain a medical consultation to assess liver function; monitor blood pressure; treat end‑stage liver disease in a hospital facility. Proceed with treatment; obtain a medical consultation; monitor blood pressure; treat end‑stage liver disease in a hospital facility. Defer elective treatment; monitor blood pressure; treat end‑stage liver disease in a hospital facility. Defer elective treatment and obtain a medical consultation; monitor blood pressure; treat end‑stage liver disease in a hospital facility; schedule afternoon appointments. Active hepatitis mandates deferring elective treatment. A medical consultation is required to assess liver function. Blood pressure should be monitored and end‑stage liver disease patients are treated in a hospital facility. 4 / 36 A patient consumes more than 12 alcoholic drinks per week and is suspected to have alcoholic liver disease. He needs restorative dental care. How should this be managed? Defer elective treatment; obtain a medical consultation; avoid opioids if possible; monitor blood pressure. Defer elective treatment and obtain a medical consultation; treat end‑stage disease in a hospital facility; avoid opioids if possible; monitor blood pressure; schedule afternoon appointments. Proceed with treatment; obtain a medical consultation; avoid NSAIDs; monitor blood pressure. Defer elective treatment and obtain a medical consultation to assess liver function; treat end‑stage disease in a hospital facility; avoid opioids if possible; monitor blood pressure. In untreated or end‑stage alcoholic liver disease, elective dental treatment is deferred. A medical consultation is required to assess liver function. End‑stage disease should be treated in a hospital facility. Opioids are avoided if possible; NSAIDs are not contraindicated. Blood pressure should be monitored. 5 / 36 A patient with supraventricular tachycardia is taking digoxin and requires a dental extraction. Which anesthetic and antibiotic considerations apply? Avoid local anesthetics containing epinephrine or levonordefrin; avoid erythromycin and clarithromycin; schedule afternoon appointments; consider a medical consultation. Use a local anesthetic with one carpule of epinephrine; avoid erythromycin, clarithromycin and tetracycline. Avoid local anesthetics containing epinephrine or levonordefrin; avoid erythromycin, clarithromycin and tetracycline; limit stress and consider a medical consultation. Avoid local anesthetics containing epinephrine; avoid erythromycin, clarithromycin and tetracycline. Digoxin toxicity can occur when combined with epinephrine, levonordefrin or macrolide antibiotics. Therefore, no vasoconstrictor is used and macrolides and tetracycline are avoided. 6 / 36 A patient is about to begin chemotherapy for cancer. She needs dental extractions and restorative work. What timing and management principles apply? Before chemotherapy starts, complete elective dental treatment without medical consultation; during active chemotherapy, proceed with elective treatment and provide antibiotic prophylaxis. Before chemotherapy starts, obtain a medical consultation and complete elective dental treatment; during active chemotherapy, obtain a medical consultation, delay elective treatment and provide antibiotic prophylaxis before surgical procedures. Before chemotherapy starts, obtain a medical consultation and complete elective dental treatment; during active chemotherapy, delay elective treatment and provide antibiotic prophylaxis. Before chemotherapy starts, obtain a medical consultation and complete elective treatment; during active chemotherapy, delay elective treatment and provide antibiotic prophylaxis; schedule afternoon appointments. Prior to initiation of chemotherapy, elective dental treatment should be completed after obtaining a medical consultation. During active chemotherapy, elective treatment is delayed, a medical consultation is required and antibiotic prophylaxis is provided before surgical procedures. 7 / 36 A patient with atrial fibrillation takes warfarin and presents for crown preparation. What management modifications are required? Proceed with treatment; limit epinephrine; use anxiolytics/sedatives and short morning appointments; avoid erythromycin, clarithromycin and tetracycline if the patient is on digoxin or a calcium‑channel blocker; avoid NSAIDs because of warfarin therapy. Proceed with treatment; limit epinephrine; use stress reduction; avoid NSAIDs. Proceed with treatment; limit epinephrine; use stress reduction; prescribe ibuprofen for postoperative pain; avoid macrolide antibiotics. Proceed with treatment; limit epinephrine; schedule afternoon appointments; use stress reduction; avoid NSAIDs. In atrial fibrillation treated with anticoagulants, NSAIDs are contraindicated. Epinephrine is minimized, stress reduction is used and macrolides are avoided with digoxin or calcium‑channel blockers. 8 / 36 A patient with a history of infective endocarditis is scheduled for a dental extraction. She is not allergic to penicillin. How should you manage antibiotic prophylaxis and elective treatment? Administer amoxicillin 2 g orally before the extraction; proceed with treatment. Administer amoxicillin 2 g orally 30–60 minutes before the extraction; proceed with treatment; if active endocarditis is suspected, obtain a medical consultation, avoid elective care and minimize epinephrine. Administer azithromycin 500 mg before the extraction; proceed with treatment. Administer amoxicillin 2 g orally before the extraction; proceed with treatment; if active endocarditis is suspected, obtain a medical consultation and minimize epinephrine; schedule afternoon appointments. Patients with a history of infective endocarditis require antibiotic prophylaxis: amoxicillin 2 g 30–60 minutes before the procedure. If active endocarditis is suspected, elective treatment is avoided, a medical consultation is obtained and prophylaxis is still administered. Epinephrine use is minimized in active cases. 9 / 36 A 70‑year‑old patient had an MI eight months ago. He takes low‑dose aspirin and a calcium channel blocker. He presents for root planing. What is the appropriate management? Proceed with treatment; limit epinephrine; use stress reduction; avoid erythromycin and clarithromycin; schedule afternoon appointments; avoid NSAIDs. Proceed with treatment; limit epinephrine; use stress reduction; avoid erythromycin and clarithromycin; prescribe ibuprofen for postoperative pain. Proceed with treatment; limit epinephrine; use stress reduction; avoid erythromycin and clarithromycin; avoid NSAIDs. Proceed with treatment; limit epinephrine; use anxiolytics/sedatives and short morning appointments; avoid erythromycin and clarithromycin; avoid NSAIDs because the patient takes aspirin. After one month post‑MI, elective care may proceed with caution. Limit epinephrine, use stress reduction, avoid erythromycin/clarithromycin with calcium‑channel blockers and avoid NSAIDs because of aspirin therapy. 10 / 36 A 62‑year‑old hypertensive patient presents for routine cleaning. His blood pressure is 150/95 mmHg and he is not on a calcium channel blocker. Which management is appropriate? Proceed with treatment; limit epinephrine; use anxiolytics/sedatives and short morning appointments; advise medical consultation for BP ≥140/90; use NSAIDs with caution. Proceed with treatment; limit epinephrine; use stress reduction; advise medical consultation; schedule afternoon appointments; use NSAIDs with caution. Proceed with treatment; use stress reduction; advise medical consultation for BP ≥140/90; use NSAIDs with caution. Proceed with treatment; limit epinephrine; use stress reduction; advise medical consultation; avoid NSAIDs entirely and avoid macrolides even though no calcium‑channel blocker is present. Routine care may proceed if BP <180/110 mmHg. Limit epinephrine, consider a medical consultation for BP ≥140/90, use stress reduction and use NSAIDs with caution. Macrolides are only avoided with calcium‑channel blockers. 11 / 36 A patient has a prolonged QT interval and is taking a class III antiarrhythmic. Which antibiotic group should be avoided? Azithromycin, erythromycin and clarithromycin should be avoided because they can further prolong the QT interval. Erythromycin and clarithromycin should be avoided; azithromycin is acceptable. Amoxicillin should be avoided; azithromycin is acceptable. Clindamycin and doxycycline should be avoided because they prolong the QT interval. Macrolide antibiotics (azithromycin, erythromycin, clarithromycin) prolong the QT interval and are avoided when class III or IA antiarrhythmics are used. 12 / 36 A patient with HIV infection is stable on antiretroviral therapy and has a CD4 count above 500. She requests routine dental care. What is the recommended approach? Obtain a medical consultation; proceed with routine dental treatment since no special considerations are needed. Proceed with routine dental treatment since no special considerations are needed. Defer routine treatment and refer to a hospital facility for care. Obtain a medical consultation; proceed with routine dental treatment; schedule afternoon appointments for patient comfort. HIV‑positive patients who are stable on therapy generally require no special considerations beyond a medical consultation. Routine dental treatment can be performed. 13 / 36 A patient with congestive heart failure not on digoxin requires restorative treatment. Which statement describes appropriate management? Use any amount of epinephrine; use stress reduction; obtain a medical consultation; avoid NSAIDs. Limit epinephrine; use stress reduction; obtain a medical consultation; schedule afternoon appointments; avoid NSAIDs. Limit epinephrine (1 carpule 1:50 000, 2 of 1:100 000, 4 of 1:200 000); use anxiolytics/sedatives and short morning appointments; obtain a medical consultation; avoid NSAIDs. Limit epinephrine; use stress reduction; avoid NSAIDs. When digoxin is not used, vasoconstrictors may be used in limited amounts. Stress reduction and a medical consultation are recommended and NSAIDs should be avoided. 14 / 36 A patient had an MI two weeks ago and requires a non‑urgent dental extraction. What is the appropriate management? Defer elective treatment and obtain a medical consultation; administer prophylactic nitroglycerin if urgent care is required; use anxiolytics/sedatives and short morning appointments; limit epinephrine; avoid erythromycin and clarithromycin if a calcium channel blocker is used; avoid NSAIDs. Defer elective treatment and obtain a medical consultation; administer prophylactic nitroglycerin; use stress reduction; limit epinephrine; avoid erythromycin and clarithromycin; schedule afternoon appointments; avoid NSAIDs. Proceed with the extraction; administer prophylactic nitroglycerin; use stress reduction; limit epinephrine; avoid erythromycin and clarithromycin; avoid NSAIDs. Defer elective treatment and obtain a medical consultation; use stress reduction; limit epinephrine; avoid erythromycin and clarithromycin; avoid NSAIDs. Within one month of an MI, elective care is deferred. A medical consultation is obtained, prophylactic nitroglycerin is given if urgent care is needed, stress reduction is used, epinephrine is minimized and macrolides and NSAIDs are avoided if indicated. 15 / 36 A patient with mild intermittent asthma uses only a salbutamol inhaler. She presents for dental fillings. What management modifications apply? Use short appointments and stress reduction; avoid aspirin; use NSAIDs cautiously; opioids may be used for severe pain. Use short appointments and stress reduction; avoid aspirin; opioids may be used for severe pain. Use short appointments and stress reduction; prescribe aspirin for postoperative pain; opioids may be used for severe pain. Use short appointments; avoid aspirin; avoid NSAIDs even though the asthma is mild; opioids may be used for severe pain. Short appointments with stress reduction are recommended in asthma. Aspirin is avoided in all cases. NSAIDs may be used cautiously in mild intermittent asthma. Opioids may be used for severe pain. 16 / 36 A patient suffered a stroke over a year ago and has stabilized. He requires periodontal surgery. Which management plan is appropriate? Proceed with treatment; limit epinephrine; use stress reduction; prescribe ibuprofen for postoperative pain. Proceed with treatment; limit epinephrine; schedule afternoon appointments; use stress reduction; avoid NSAIDs. Proceed with treatment; limit epinephrine; use anxiolytics/sedatives and short morning appointments; avoid NSAIDs. Proceed with treatment; use stress reduction; avoid NSAIDs. After six months post‑stroke, elective treatment may proceed. Epinephrine is limited, stress reduction is employed and NSAIDs are avoided. 17 / 36 A patient with AIDS (advanced HIV infection) presents for a non‑urgent dental procedure. What is the appropriate management? Delay routine dental treatment; treat the patient in a hospital facility. Obtain a medical consultation; delay routine dental treatment; treat the patient in a hospital facility; schedule afternoon appointments. Proceed with routine dental treatment in the office; obtain a medical consultation. Obtain a medical consultation; delay routine dental treatment; treat the patient in a hospital facility. AIDS patients require a medical consultation. Routine treatment is delayed and care should be provided in a hospital facility due to immunosuppression. 18 / 36 A patient experienced a stroke three months ago and presents for routine dental care. What is the recommended management? Defer elective care and obtain a medical consultation; limit epinephrine; schedule afternoon appointments; avoid NSAIDs. Defer elective care; limit epinephrine; use stress reduction; avoid NSAIDs. Proceed with elective care; limit epinephrine; use stress reduction; avoid NSAIDs. Defer elective care and obtain a medical consultation; for urgent care, limit epinephrine; use anxiolytics/sedatives and short morning appointments; avoid NSAIDs. Elective dental treatment is deferred for six months following a stroke. A medical consultation is advised. For urgent care, epinephrine is limited, stress reduction is employed and NSAIDs are avoided. 19 / 36 A patient with an active peptic ulcer complains of stomach pain and has a history of recent hospitalization. She requires restorative treatment. What is the appropriate management? Use ibuprofen for postoperative pain; schedule short appointments; delay routine treatment and obtain a medical consultation. Avoid NSAIDs; schedule short appointments; delay routine treatment and obtain a medical consultation because the disease is active. Avoid NSAIDs; schedule afternoon appointments; delay routine treatment and obtain a medical consultation. Avoid NSAIDs; schedule short appointments; delay routine treatment. NSAIDs are contraindicated in peptic ulcer disease. Short appointments are better tolerated. Routine treatment is delayed and a medical consultation is obtained if the disease is active or poorly controlled. 20 / 36 A patient with epilepsy reports good seizure control with medication. She is anxious about dental treatment but has not had a seizure in over a year. How should you manage the appointment? Consider a medical consultation; schedule an afternoon appointment; use anxiolytics or sedatives only if uncontrolled; proceed with elective treatment. Schedule a short appointment; use anxiolytics or sedatives only if the patient is uncontrolled or very anxious; proceed with elective treatment. Schedule a short appointment; administer sedatives routinely to all epilepsy patients; proceed with elective treatment. Consider a medical consultation; schedule a short appointment; use anxiolytics or sedatives only if the patient is uncontrolled or extremely anxious; proceed with elective treatment since seizures are well controlled. A medical consultation may be considered for epilepsy. Short appointments are recommended. Anxiolytics or sedatives are used only if the patient is uncontrolled or very anxious; elective treatment is deferred if seizures are uncontrolled. 21 / 36 A patient with stable angina is taking a calcium channel blocker but no anticoagulants. He needs restorative treatment and postoperative analgesia. Which analgesic plan is appropriate? Recommend acetaminophen first and, if necessary, use NSAIDs cautiously; avoid erythromycin and clarithromycin because of the calcium channel blocker. Recommend acetaminophen first; avoid erythromycin and clarithromycin. Recommend ibuprofen as the analgesic of choice; avoid erythromycin and clarithromycin. Recommend acetaminophen; avoid erythromycin and clarithromycin; avoid all NSAIDs regardless of anticoagulant status. NSAIDs may be used cautiously when anticoagulants are not prescribed. Acetaminophen is first line and macrolides are avoided with calcium‑channel blockers. 22 / 36 A patient with congestive heart failure takes digoxin and requires a dental extraction. What management modifications are required? Limit epinephrine to one carpule; avoid erythromycin, clarithromycin and tetracycline; use stress reduction; obtain a medical consultation; avoid NSAIDs. Avoid local anesthetics containing epinephrine; avoid erythromycin and clarithromycin; use stress reduction; obtain a medical consultation; schedule afternoon appointments; avoid NSAIDs. Avoid local anesthetics containing epinephrine; avoid erythromycin, clarithromycin and tetracycline; use stress reduction; obtain a medical consultation; avoid NSAIDs. Avoid local anesthetics containing epinephrine or levonordefrin; avoid erythromycin, clarithromycin and tetracycline; use anxiolytics/sedatives and short morning appointments; obtain a medical consultation; avoid NSAIDs. Digoxin interacts with epinephrine and levonordefrin, so no vasoconstrictor is used. Macrolides and tetracycline elevate digoxin levels and are avoided. Stress reduction and a medical consultation are needed, and NSAIDs are contraindicated. 23 / 36 A patient has uncontrolled hyperthyroidism and exhibits symptoms of weight loss, tremor and heat intolerance. She needs non‑urgent dental care. What is the correct management? Proceed with elective treatment; avoid levonordefrin but use epinephrine as needed. Avoid elective treatment; avoid vasoconstrictors; schedule afternoon appointments instead of morning. Avoid elective treatment and obtain a medical consultation; avoid the use of vasoconstrictors such as epinephrine and levonordefrin. Avoid elective treatment and obtain a medical consultation; limit epinephrine but do not avoid it entirely. Uncontrolled hyperthyroidism requires avoiding elective dental treatment and obtaining a medical consultation. Vasoconstrictors such as epinephrine and levonordefrin are avoided. 24 / 36 A 58‑year‑old patient presents for a dental extraction. His blood pressure is 185/120 mmHg and he takes a calcium channel blocker. What is the most appropriate management? Defer elective care; obtain a medical consultation; use anxiolytics/sedatives and short morning appointments; avoid erythromycin and clarithromycin; use NSAIDs with caution. Defer elective care; obtain a medical consultation; limit epinephrine (1 carpule 1:50 000, 2 of 1:100 000, 4 of 1:200 000); use anxiolytics/sedatives and short morning appointments; avoid erythromycin and clarithromycin; use NSAIDs with caution. Proceed with the extraction; limit epinephrine; use stress reduction; avoid erythromycin and clarithromycin; use NSAIDs with caution. Defer elective care; obtain a medical consultation; limit epinephrine; use anxiolytics/sedatives but schedule afternoon appointments; avoid erythromycin and clarithromycin; use NSAIDs with caution. Elective care is deferred when BP ≥180/110 mmHg. A medical consultation is required, epinephrine is limited, stress reduction is used, macrolide antibiotics are avoided with calcium‑channel blockers and NSAIDs are used cautiously. 25 / 36 A patient with a history of substance abuse presents for extraction. He admits to using cocaine earlier today. What is the appropriate dental management? Proceed with treatment; avoid prescribing opioids if possible; use epinephrine cautiously. Obtain a medical consultation; avoid prescribing opioids if possible; do not use epinephrine because the patient used cocaine within the last 24 hours. Obtain a medical consultation; avoid prescribing opioids if possible; do not use epinephrine. Obtain a medical consultation; avoid prescribing opioids if possible; avoid epinephrine; schedule afternoon appointments. A medical consultation is advised for substance abuse. Opioids should be avoided if possible. Patients who have used cocaine or methamphetamine in the past 24 hours should not receive epinephrine. 26 / 36 A patient with uncontrolled asthma is cyanotic and has frequent attacks despite medication. She requires urgent dental care. How should you proceed? Avoid aspirin and NSAIDs; opioids may be used for severe pain. Defer elective treatment and obtain a medical consultation; avoid aspirin and NSAIDs; opioids may be used for severe pain. Proceed with treatment; avoid aspirin; NSAIDs may be used cautiously; opioids may be used for severe pain. Defer elective treatment and obtain a medical consultation; avoid aspirin; allow NSAIDs for short‑term pain; opioids may be used for severe pain. Uncontrolled asthma requires deferring elective treatment and obtaining a medical consultation. Aspirin and NSAIDs are avoided. Opioids may be used for severe pain. 27 / 36 A patient with Crohn’s disease is currently experiencing an acute exacerbation. She is taking prednisone and an immunosuppressant. She requires a dental cleaning. How should you manage this patient? Proceed with treatment; avoid NSAIDs; schedule flexible appointments; recognise immunosuppression. Delay routine treatment; avoid NSAIDs; schedule flexible appointments. Delay routine treatment and obtain a medical consultation; avoid NSAIDs; schedule flexible appointments because of disease unpredictability; recognise that the patient may be immunosuppressed due to steroids and immunosuppressants. Delay routine treatment and obtain a medical consultation; avoid NSAIDs; schedule rigid morning appointments; recognise immunosuppression. During acute exacerbations of Crohn’s disease, routine treatment is delayed and a medical consultation is obtained. NSAIDs are contraindicated. Appointments should be flexible due to the unpredictable nature of the disease and immunosuppression is considered when prescribing. 28 / 36 A patient with Addison’s disease has been poorly controlled and requires dental surgery. Which management modifications are necessary? Avoid elective treatment and obtain a medical consultation; monitor blood pressure; use stress reduction; provide supplemental corticosteroids; schedule afternoon appointments. Avoid elective treatment and obtain a medical consultation; monitor blood pressure; use anxiolytics/sedatives and short morning appointments; provide supplemental corticosteroids before the procedure. Proceed with treatment; monitor blood pressure; use stress reduction; provide supplemental corticosteroids before the procedure. Avoid elective treatment and obtain a medical consultation; monitor blood pressure; use stress reduction; provide supplemental corticosteroids before the procedure. In poorly controlled Addison’s disease, elective treatment is avoided and a medical consultation is obtained. Blood pressure should be monitored, stress reduction is employed and supplemental corticosteroids are provided before surgical procedures. 29 / 36 A pregnant patient in her first trimester requires non‑urgent dental care. How should her dental treatment be managed? Schedule short appointments; proceed with routine treatment during the first trimester; avoid tetracyclines; avoid NSAIDs only in the second trimester. Schedule short appointments; delay routine treatment during the first trimester; avoid tetracyclines; avoid NSAIDs in the third trimester; schedule afternoon appointments. Schedule short appointments; delay routine treatment during the first trimester; avoid tetracyclines; avoid NSAIDs in the third trimester. Schedule short appointments; delay routine treatment during the first trimester; avoid tetracyclines; avoid NSAIDs in the third trimester; acetaminophen or aspirin, diflunisal and flurbiprofen may be used in early pregnancy. In pregnancy, short appointments are recommended. Routine treatment is delayed in the first trimester and after the middle of the third trimester. Tetracyclines are contraindicated and NSAIDs are contraindicated in the third trimester. Aspirin, diflunisal and flurbiprofen may be used in the first and second trimesters. 30 / 36 A patient presents with a persistent cough, weight loss, night sweats and positive sputum smear for Mycobacterium tuberculosis. He needs non‑urgent dental care. Which management is appropriate? Delay routine treatment and obtain a medical consultation; treat in a hospital facility because the disease is active; manage all symptomatic cases as active tuberculosis. Proceed with routine dental care in the office with standard precautions; obtain a medical consultation. Delay routine treatment; treat in a hospital facility; manage symptomatic cases as active; schedule afternoon appointments for patient comfort. Delay routine treatment; obtain a medical consultation; manage symptomatic cases as active. Active tuberculosis requires delaying routine dental treatment. Treatment should occur in a hospital facility. If signs and symptoms suggest active disease, manage as active and obtain a medical consultation. 31 / 36 A patient with end‑stage renal disease requires non‑urgent dental treatment. What is the proper management? Defer elective treatment and obtain a medical consultation; treat in a hospital facility; avoid NSAIDs; opioids may be used; allow tetracycline for infection control. Defer elective treatment and obtain a medical consultation; treat the patient in a hospital facility; avoid NSAIDs; opioids may be used if severe pain; avoid tetracycline. Proceed with treatment in the dental office; avoid NSAIDs; opioids may be used if severe pain; avoid tetracycline. Defer elective treatment and obtain a medical consultation; avoid NSAIDs; opioids may be used if severe pain; avoid tetracycline. Patients with end‑stage renal disease should be treated in a hospital facility. Elective treatment is deferred. A medical consultation is necessary. NSAIDs are contraindicated. Opioids are acceptable for severe pain and tetracycline is avoided. 32 / 36 A patient with unstable angina controlled on a calcium channel blocker requires emergency dental care. What should be administered before treatment? Administer a prophylactic dose of nitroglycerin; limit epinephrine; avoid erythromycin and clarithromycin; avoid NSAIDs. Administer prophylactic nitroglycerin; avoid erythromycin and clarithromycin; avoid NSAIDs; schedule afternoon appointments. Limit epinephrine; avoid erythromycin and clarithromycin; avoid NSAIDs. Administer ibuprofen before treatment; limit epinephrine; avoid erythromycin and clarithromycin; avoid NSAIDs. In unstable angina, prophylactic nitroglycerin is given. Macrolides are avoided with calcium‑channel blockers and NSAIDs are avoided. 33 / 36 A patient with severe COPD (ASA 4) presents for a non‑urgent dental procedure. Which statement is correct? Avoid elective dental treatment; obtain a medical consultation; perform the procedure in the office under short morning appointments. Avoid elective dental treatment and refer the patient to a hospital facility; obtain a medical consultation. Proceed with the procedure in the dental office; obtain a medical consultation. Avoid elective dental treatment; obtain a medical consultation. In severe COPD (ASA 4), elective dental treatment is avoided and the patient should be treated in a hospital facility. 34 / 36 A patient with poorly controlled hypothyroidism reports fatigue, cold intolerance and weight gain. She requires restorative treatment. What management is appropriate? Defer elective treatment and obtain a medical consultation; schedule short appointments; avoid opioids and CNS depressants. Proceed with treatment; schedule short appointments; prescribe opioids for postoperative pain because they are well tolerated in hypothyroidism. Defer elective treatment and obtain a medical consultation; schedule short appointments; avoid opioids and other CNS depressants; if NSAIDs are contraindicated, opioids may be used only for severe pain. Defer elective treatment and obtain a medical consultation; schedule afternoon appointments; avoid opioids and CNS depressants; use opioids freely if NSAIDs are contraindicated. In symptomatic or uncontrolled hypothyroidism, elective treatment is deferred and a medical consultation is obtained. Short appointments are preferred. Opioids and other CNS depressants are avoided unless NSAIDs are contraindicated, in which case opioids may be used for severe pain. 35 / 36 A patient received a kidney transplant four months ago and is taking immunosuppressive medication. She requires surgical extraction. What management is indicated? Defer elective treatment because the transplant was four months ago; obtain a medical consultation; prescribe antibiotic prophylaxis before the surgical extraction due to immunosuppression; avoid NSAIDs. Defer elective treatment; obtain a medical consultation; prescribe antibiotic prophylaxis; avoid NSAIDs; schedule afternoon appointments. Defer elective treatment; obtain a medical consultation; avoid NSAIDs. Proceed with the surgical extraction; obtain a medical consultation; prescribe antibiotic prophylaxis; avoid NSAIDs. Elective treatment is deferred for transplant patients within six months of transplantation. A medical consultation is required. If the patient is immunosuppressed, antibiotic prophylaxis is recommended for surgical procedures. NSAIDs are contraindicated. 36 / 36 A patient with type 2 diabetes has an HbA1c of 9.0% and takes glyburide (a sulfonylurea). She requires surgical extraction. What is the recommended management? Defer elective treatment and obtain a medical consultation; schedule short morning appointments; avoid aspirin with sulfonylureas; consider antibiotic prophylaxis. Defer elective treatment and obtain a medical consultation; confirm HbA1c is <7% before proceeding; schedule short morning appointments; avoid aspirin with sulfonylureas; consider antibiotic prophylaxis for the surgical extraction. Proceed with the extraction; schedule short morning appointments; avoid aspirin; consider antibiotic prophylaxis; no need for medical consultation. Defer elective treatment and obtain a medical consultation; confirm HbA1c <7% before proceeding; schedule afternoon appointments; avoid aspirin with sulfonylureas; consider antibiotic prophylaxis. Poorly controlled diabetes (HbA1c > 7%) warrants deferring elective care. Short morning appointments are preferred. A medical consultation is advised, aspirin should be avoided when sulfonylureas are used, and antibiotic prophylaxis is considered for surgical procedures in poorly controlled patients. Your score is 0% Restart quiz
