Medically Compromised Pts 2Dentistry 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 2 1 / 18 A 65‑year‑old patient on chronic hemodialysis (end‑stage renal disease) has severe toothache requiring extraction. Which of the following best reflects the recommended management? Defer elective treatment and arrange care in a hospital; obtain medical consultation; avoid NSAIDs and tetracycline, using opioids only if severe pain. Defer treatment and prescribe tetracycline and NSAIDs because opioids are contraindicated. Treat the patient after dialysis in the dental office; avoid tetracycline but use NSAIDs for pain control. Proceed with extraction in the dental office; NSAIDs are acceptable and opioids should never be used. Patients with end‑stage renal disease should receive dental care in a hospital facility. Elective treatment should be deferred. A medical consultation is required. NSAIDs are contraindicated, and opioids are acceptable only if severe pain (relative). Tetracycline should also be avoided. 2 / 18 A 45‑year‑old patient received a kidney transplant four months ago and is taking immunosuppressive medications. She requires an impacted wisdom tooth extraction. What is the appropriate management? Defer extraction but prescribe NSAIDs and omit antibiotic prophylaxis. Treat immediately with NSAIDs for pain and no antibiotic prophylaxis, since the transplant is healed. Proceed with extraction because four months have passed; give prophylactic antibiotics but do not consult the physician. Defer the extraction (transplant <6 months); obtain medical consultation; provide antibiotic prophylaxis and avoid NSAIDs. After kidney transplant, elective dental care should be deferred for six months. A medical consultation is required. The patient may need antibiotic prophylaxis before surgical procedures due to immunosuppression. NSAIDs are contraindicated. 3 / 18 A 45‑year‑old patient with symptoms of uncontrolled hyperthyroidism presents for periodontal surgery. How should this appointment be managed? Proceed with surgery using local anesthetic without epinephrine but no consultation is needed. Defer surgery but use levonordefrin for anesthesia because it is safer than epinephrine. Defer periodontal surgery; obtain medical consultation and avoid use of epinephrine or levonordefrin. Proceed with surgery using standard epinephrine doses because vasoconstrictors reduce bleeding. Uncontrolled hyperthyroidism requires postponement of elective dental care and a medical consultation. Use of vasoconstrictors (epinephrine/levonordefrin) should be avoided. 4 / 18 A 60‑year‑old man consumes more than 12 alcoholic drinks per week and has been diagnosed with cirrhosis. He requires a molar extraction due to caries. What is the recommended management? Proceed with extraction in the dental office but avoid opioids and monitor blood pressure. Defer treatment but prescribe opioids and perform the procedure without hospital referral. Treat in the dental office and prescribe opioids because NSAIDs are contraindicated. Defer elective treatment and arrange for hospital management; obtain a medical consultation and avoid opioid analgesics, monitoring blood pressure throughout. In alcoholic liver disease, elective treatment should be deferred if the disease is untreated or end‑stage (cirrhosis), and the patient should be treated in a hospital facility. A medical consultation is required, and opioids should be avoided if possible. There is no NSAID contraindication, but blood pressure should be monitored. 5 / 18 A 58‑year‑old patient suffered a stroke three months ago and requires a dental extraction. She has no residual deficits. What is the recommended approach? Defer the extraction; obtain medical consultation; minimize epinephrine and use stress reduction; avoid NSAIDs. Proceed with the extraction using minimal epinephrine and stress reduction but without consulting the physician. Perform the extraction and use standard epinephrine doses; prescribe NSAIDs for postoperative pain. Defer treatment but prescribe NSAIDs since stroke does not affect analgesic choice. Elective dental care should be deferred within six months of a cerebrovascular accident. A medical consultation is required. Epinephrine doses must be minimized. Stress reduction and short morning appointments are recommended. NSAIDs are contraindicated. 6 / 18 A 60‑year‑old patient presents for crown placement. Her blood pressure is 185/115 mmHg with no acute symptoms. She is taking a calcium channel blocker. How should the appointment be managed? Defer treatment but use erythromycin because it does not interact with calcium channel blockers. Proceed with the crown placement while minimizing epinephrine and avoiding macrolides, but no medical consultation is needed. Treat as planned and administer two carpules of 1:50,000 epinephrine; prescribe erythromycin for postoperative infection. Defer elective treatment and obtain medical consultation; minimize epinephrine doses and use stress reduction protocols; avoid erythromycin and clarithromycin with the calcium channel blocker. Blood pressure ≥180/110 mmHg indicates uncontrolled hypertension, and elective dental treatment should be deferred. A medical consultation is warranted. Epinephrine doses must be minimized (1:50,000→1 carpule, 1:100,000→2, 1:200,000→4) and stress reduction is essential. Erythromycin and clarithromycin are contraindicated with calcium channel blockers. NSAIDs should be used with caution. 7 / 18 A patient with a history of infective endocarditis requires periodontal surgery and has no penicillin allergy. Which antibiotic regimen is appropriate for prophylaxis? Administer 250 mg of amoxicillin immediately after the procedure. Administer 500 mg of clarithromycin 30 minutes before the procedure. Administer 2 g of amoxicillin orally 30 minutes to 1 hour prior to the procedure. No antibiotic prophylaxis is needed if the patient is asymptomatic. For patients with a history of infective endocarditis, antibiotic prophylaxis is required. The first‑line regimen is amoxicillin 2 g given 30 minutes to 1 hour before the appointment. 8 / 18 A 70‑year‑old patient with chronic bronchitis (ASA III COPD) requires a tooth extraction. He reports dyspnea on exertion but is stable with medical management. What is the most appropriate analgesic and management plan? Administer prophylactic nitroglycerin and prescribe opioid analgesics for pain control. Provide long morning appointments and prescribe opioid analgesics, as COPD has no analgesic restrictions. Schedule a short afternoon appointment after obtaining a medical consultation; avoid opioid analgesics and use NSAIDs if there are no contraindications. Schedule a short appointment and use NSAIDs, but no medical consultation is required. In patients with COPD, elective treatment should be avoided in severe cases (ASA IV). For ASA III patients a medical consultation is indicated. Short afternoon appointments are recommended. Opioids are a relative contraindication, so analgesia should rely on NSAIDs if tolerated. Opioids should be avoided unless severe pain and no NSAID contraindication exists. 9 / 18 A 52‑year‑old patient with Addison’s disease who is poorly controlled requires an extraction. Which of the following is the correct management? Defer treatment but avoid corticosteroid supplementation because it is unnecessary. Defer the extraction; obtain medical consultation; monitor blood pressure; provide stress reduction and administer supplemental corticosteroids before the procedure. Proceed with extraction and administer epinephrine without providing corticosteroids. Proceed with extraction using stress reduction and monitor blood pressure, but skip the medical consultation. Poorly controlled primary adrenal insufficiency necessitates deferring elective dental care and obtaining a medical consultation. Monitor blood pressure, use stress reduction protocols, and provide supplemental corticosteroids before surgical procedures. 10 / 18 A patient with a history of infective endocarditis and a penicillin allergy needs a root canal. What is the appropriate antibiotic prophylaxis? Administer 100 mg of azithromycin immediately after the procedure. Administer 2 g of amoxicillin 1 hour before the procedure. Administer 500 mg of azithromycin or 500 mg of clarithromycin 30 minutes to 1 hour prior to the procedure. Give no antibiotic prophylaxis because macrolides are contraindicated. In penicillin‑allergic patients with a history of infective endocarditis, the second‑line antibiotic prophylaxis is azithromycin 500 mg or clarithromycin 500 mg given 30 minutes to 1 hour before the procedure. 11 / 18 A patient with signs of active infective endocarditis (aching joints, chest pain on breathing, fatigue) requests extraction of a painful tooth. How should this be managed? Proceed with extraction and provide amoxicillin 2 g after the procedure. Perform extraction with standard anesthetic and no antibiotic prophylaxis. Defer the extraction; arrange for medical consultation; administer antibiotic prophylaxis and minimize epinephrine use. Defer treatment but avoid prophylactic antibiotics because the infection is already active. Active infective endocarditis necessitates medical consultation and avoidance of elective dental care. Antibiotic prophylaxis is required. Use of epinephrine should be minimized. 12 / 18 A 30‑year‑old patient with uncontrolled epilepsy experiences frequent seizures and needs a restorative procedure. What is the recommended approach? Defer the procedure and obtain medical consultation; schedule a short appointment and reserve anxiolytics/sedatives for uncontrolled or anxious situations. Proceed with treatment and avoid sedation, since epilepsy patients do not require special management. Proceed with the procedure using long appointments and provide benzodiazepines routinely. Defer treatment but provide benzodiazepines for all epilepsy patients irrespective of control. In uncontrolled epilepsy, elective dental treatment should be deferred. A medical consultation is warranted. Appointments should be short. Anxiolytics or sedatives are used only if the patient is uncontrolled or anxious. 13 / 18 A 35‑year‑old patient with a history of substance dependence uses cocaine recreationally. He presents for a dental extraction 12 hours after last cocaine use and requests pain medication. Which management is most appropriate? Proceed with extraction but avoid epinephrine; prescribe opioids for pain because of severe discomfort. Schedule treatment immediately and prescribe opioids, as NSAIDs are contraindicated in substance abuse. Administer epinephrine to counteract cocaine effects and prescribe opioids for pain. Defer elective care; obtain a medical consultation; avoid opioids and epinephrine and use NSAIDs for analgesia. For patients with substance dependence, a medical consultation is advised. Opioids should be avoided if possible as there is no NSAID contraindication. Epinephrine should be avoided if the patient has taken cocaine or crystal meth within 24 hours. 14 / 18 A 67‑year‑old patient has a history of myocardial infarction two weeks ago and continues to experience chest pain at rest. He needs a dental filling. What management is recommended? Treat as usual and give two carpules of 1:50,000 epinephrine; prescribe erythromycin for infection. Defer treatment but do not administer nitroglycerin; provide standard epinephrine doses. Proceed with the filling using minimal epinephrine and prophylactic nitroglycerin, without deferring treatment. Defer the filling and obtain medical consultation; administer prophylactic nitroglycerin and use stress reduction; minimize epinephrine and avoid macrolides with calcium channel blockers. Unstable angina or MI within the past month is a contraindication to elective dental care. Elective treatment should be deferred and a medical consultation obtained. Prophylactic nitroglycerin should be administered, stress reduction protocols used, and epinephrine minimized. Erythromycin and clarithromycin should be avoided with calcium channel blockers. NSAIDs should be avoided if the patient is taking anticoagulants or aspirin. 15 / 18 A patient with a history of peptic ulcer presents for routine scaling. He reports pain, black stool, and recent hospitalization for bleeding ulcers. What is the recommended dental management? Delay treatment but prescribe NSAIDs because ulcers are unrelated to analgesics. Delay routine treatment and obtain medical consultation; avoid NSAIDs and schedule short appointments. Proceed with scaling but avoid NSAIDs and schedule short appointments. Continue with scaling and prescribe NSAIDs for postoperative pain. Active or poorly controlled peptic ulcer disease warrants delaying routine dental treatment and obtaining a medical consultation. NSAIDs are contraindicated. Short appointments are better tolerated. 16 / 18 A 50‑year‑old patient with type 1 diabetes mellitus has an HbA1C of 10%. She requires scaling and root planing. What is the appropriate management? Treat immediately without regard to HbA1C; prescribe aspirin for pain and avoid antibiotic prophylaxis. Defer the procedure and obtain medical consultation; schedule a short morning appointment; confirm HbA1C is controlled (<7%) and provide antibiotic prophylaxis if necessary. Defer treatment but advise taking aspirin with sulfonylurea medications. Proceed with scaling but schedule it in the afternoon and avoid aspirin; no medical consultation needed. For poorly controlled diabetes (ASA IV), elective treatment should be deferred and a medical consultation obtained. Short morning appointments are advisable. HbA1C should ideally be <7%. Avoid aspirin when used with sulfonylureas. Antibiotic prophylaxis may be indicated for surgical procedures in poorly controlled patients. 17 / 18 A 55‑year‑old patient with poorly controlled hypothyroidism presents with dental pain from a broken molar. She is symptomatic and cannot tolerate NSAIDs due to gastric ulcer. Which analgesic approach is appropriate? Defer elective treatment and obtain medical consultation; avoid CNS depressants, but because NSAIDs are contraindicated, a short course of opioids may be used for severe pain. Defer treatment, but prescribe NSAIDs even though the patient has gastric ulcer, since opioids are contraindicated. Proceed with extraction and prescribe opioids for pain because the patient cannot take NSAIDs. Prescribe erythromycin for pain relief and proceed with treatment without consultation. For symptomatic or uncontrolled hypothyroidism, elective dental care should be deferred and a medical consultation obtained. Opioids and CNS depressants should be avoided in poorly controlled disease. If the patient cannot take NSAIDs, opioids may be used for severe pain. 18 / 18 A patient with Crohn’s disease arrives for a crown preparation during an acute exacerbation characterized by abdominal pain and diarrhea. Which management plan is appropriate? Delay the procedure and obtain medical consultation; avoid NSAIDs; schedule flexible appointments due to unpredictable symptoms. Continue with the procedure and prescribe NSAIDs because they reduce inflammation in Crohn’s disease. Delay treatment but prescribe NSAIDs and no medical consultation is necessary. Proceed with the crown preparation but avoid NSAIDs and allow the patient to reschedule if symptoms worsen. During an acute exacerbation of Crohn’s disease, routine dental care should be delayed and a medical consultation obtained. NSAIDs are contraindicated. Appointments should be flexible due to the disease’s unpredictability. Patients may be immunosuppressed if taking steroids or immunosuppressants. 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