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Chapter 15: Adrenal Insufficiency
Little: Dental Management of the Medically Compromised Patient, 9th Edition

MULTIPLE CHOICE

1. Which of the following is the predominant product of the zona glomerulosa of the adrenal
cortex?
a. Glucocorticoids
b. Aldosterone
c. Androgens
d. Epinephrine
ANS: B
The predominant hormone of the zona glomerulosa is aldosterone, a mineralocorticoid that
responds to hormones made by the kidneys (i.e., renin and angiotensin). Aldosterone regulates
physiologic levels of sodium and potassium; these two electrolytes are important for control
of intravascular volume and blood pressure. The zona fasciculata secretes glucocorticoids, and
the zona reticularis secretes androgens, or sex hormones.

2. Which of the following is true of the physiologic actions of cortisol?

a. Insulin agonist
b. Increases blood pressure
c. Anti-inflammatory action
d. A and B
e. B and C
ANS: E GRADESMORE.COM
Cortisol acts as an insulin antagonist, increasing blood levels and peripheral use of glucose by
activating key enzymes involved in hepatic gluconeogenesis and inhibiting glucose uptake in
peripheral tissue. Cortisol increases blood pressure by potentiating the vasoconstrictor action
of catecholamines and angiotensin II on the kidney and vasculature. Its anti-inflammatory
action is modulated by its inhibitory action on (1) lysosome release, (2) prostaglandin
production, (3) eicosanoid and cytokine release, (4) endothelial cell expression of intracellular
and extracellular adhesion molecules that attract neutrophils, and (5) leukocyte function.

3. Which of the following stimulates secretion of aldosterone?

a. Stress
b. Hypoglycemia
c. A decrease in renal blood pressure
d. An increase in renal blood pressure
ANS: C
Aldosterone secretion is predominately regulated by the renin–angiotensin system and
extracellular potassium levels, and less so by plasma sodium levels. Aldosterone secretion is
stimulated by a fall in renal blood pressure, which results from decreased intravascular
volume or a sodium imbalance. The drop in volume and/or pressure causes renin release from
the kidney which activates angiotensinogen to form angiotensin I and II. Angiotensin II, in
turn, stimulates secretion of aldosterone from the adrenal cortex. When blood pressure rises,
renin–angiotensin release diminishes, serving as a negative feedback loop that inhibits
additional production of aldosterone.

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4. Primary adrenocortical insufficiency is known as _ .

a. Addison’s disease
b. Cushing syndrome
c. hypoglycemia
d. hyperglycemia
ANS: A
Adrenal insufficiency is divided into three categories: primary, secondary, and tertiary.
Primary adrenocortical insufficiency, also known as Addison’s disease, occurs when the
adrenal cortex is destroyed or the gland is removed. Secondary adrenocortical insufficiency is
the consequence of pituitary disease, or a lack of responsiveness of the adrenal glands to
ACTH (corticotrophin) or due to critical illness. Tertiary adrenal insufficiency results from
processes that impair function of the hypothalamus, which is most commonly due to chronic
use corticosteroids. In as much as abnormal adrenal function can be life-threatening, these
conditions are of significant concern in clinical practice.

5. Why do most medial regimens limit dosages of corticosteroids?

a. To induce adrenal suppression
b. To allow the HPA axis to regain its responsiveness
c. To avoid adrenal suppression
d. To reduce circulating levels of glucocorticoids
ANS: C
Corticosteroids can be administered by a variety of routes, and most medical regimens attempt
to limit the dose so elevated cortisol levels, and thus adrenal suppression, do not occur.

6. Hyperpigmentation of the skinGaRnA

dDmEuS
coMuO
s RE.bCrO
mem anMes is associated with a deficiency of
.
a. androgen
b. estrogen
c. mineralocorticoids and glucocorticoids
d. adrenocortical hormones (aldosterone, cortisol, androgens)
ANS: D
Primary adrenal insufficiency (Addison’s disease) produces signs and symptoms that relate to
a deficiency of all adrenocortical hormones (aldosterone, cortisol, androgens). The most
common complaints are weakness, fatigue, abdominal pain, and hyperpigmentation of the
skin and mucous membranes. Hypotension, anorexia, salt craving, myalgia, hypoglycemia,
and weight loss are additional commonly associated features.

7. “Moon facies” is associated with .

a. mineralocorticoid excess
b. mineralocorticoid deficiency
c. glucocorticoid excess
d. glucocorticoid deficiency
ANS: C

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Cushing syndrome classically produces weight gain, a broad and round face (“moon facies”),
a “buffalo hump” on the upper back, abdominal striae, hypertension, hirsutism, and acne.
Other findings may include glucose intolerance, heart failure, osteoporosis and bone fractures,
impaired healing, and psychiatric disorders. Long-term steroid use also may increase risks for
insomnia, peptic ulceration, cataract formation, glaucoma, growth suppression, and delayed
wound healing.

8. Which of the following is the most reliable and most commonly used laboratory test to
determine adrenal insufficiency?
a. Dexamethasone suppression test
b. CRH test
c. Standard-dose corticotropin test
d. Insulin tolerance test
ANS: C
The most common and reliable provocation test is the standard-dose corticotropin test. It is
carried out by injecting 250 µg of exogenous corticotropin IV or IM, and blood is collected 30
minutes and 60 minutes after injection to determine stimulated cortisol levels. A positive
response is indicative of adrenal reserve and function. A subnormal test response is suggestive
of adrenal insufficiency, but has limited correlation with the patient’s clinical ability to
respond to stress.

9. According to current recommendations, which of the following groups of patients should

receive additional (supplemental) corticosteroids to prevent adrenal crisis during and after
surgery?
a. Patients with either primary adrenal insufficiency or secondary adrenal
insufficiency should receivGeRaA
ddDitEioSnM
alOcR
orEti.
coCsO
teM
roids.
b. Patients with primary adrenal insufficiency, but not patients with secondary
adrenal insufficiency, should receive additional corticosteroids.
c. Patients with secondary adrenal insufficiency, but not patients with primary
adrenal insufficiency, should receive additional corticosteroids.
d. Neither patients with primary adrenal insufficiency nor patients with secondary
adrenal insufficiency should receive additional corticosteroids.
ANS: B
The new recommendations, based on evidence-based reviews, suggest that only patients with
primary adrenal insufficiency receive supplemental doses of steroid, whereas those with
secondary adrenal insufficiency, who take daily corticosteroids, regardless of the type of
surgery, should receive only their usual daily dose of corticosteroids before the surgery.

10. Immediate treatment during an adrenal crisis consists of the administration of .

a. 1000 µg beclomethasone dipropionate
b. 100-mg hydrocortisone bolus
c. 30 mg cortisone
d. 0.2 mg fludrocortisone
ANS: B

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This condition requires timely diagnosis and immediate treatment, including intravenous
injection of a glucocorticoid—usually a 100-mg hydrocortisone bolus—and fluid and
electrolyte replacement to reverse the hypotension, cortisol deficiency, and electrolyte
abnormalities. After the initial bolus, 50 mg hydrocortisone is administered IV slowly every 6
to 8 hours for 24 hours, for a typical total dose of 100 to 200 mg per 24 hours; along with
fluid replacement, vasopressors, continuous infusion of saline, and correction of
hypoglycemia, if needed.

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Chapter 16: Thyroid Diseases
Little: Dental Management of the Medically Compromised Patient, 9th Edition

MULTIPLE CHOICE

1. Which of the following is a form of thyroid hyperfunction?

a. Myxedema
b. Cretinism
c. Thyrotoxicosis
d. Hashimoto’s thyroiditis

ANS: C
Hyperfunction of the thyroid gland is hyperthyroidism or thyrotoxicosis; hypofunction of the
gland is hypothyroidism or myxedema or cretinism. Hashimoto’s thyroiditis is the most
common cause of primary hypothyroidism in the United States.

2. Graves’ disease is a form of .

a. primary goiter
b. thyrostimulatory secondary goiter
c. thyroinvasive secondary goiter
d. metastatic tumor to the thyroid
ANS: B
On a functional basis, thyroid enlargement can be divided into three types: primary goiter
(simple goiter and thyroid cancer), thyrostimulatory secondary goiter (Graves’ disease and
congenital hereditary goiter), and thyroinvasive secondary goiter (Hashimoto’s thyroiditis,
subacute painful thyroiditis, RGieR
deAlD
’sEthSyM
roOidRitEis.
,C
anOdMmetastatic tumors to the thyroid). The
goiter of Graves’ disease is associated with hyperthyroidism.

3. Which of the following is true regarding the incidence and prevalence of thyroid diseases?
a. Graves’ disease is usually detected prior to adolescence.
b. During the past 10 years or so, the incidence of thyroid cancer has increased at a
rate of about 5% per year.
c. Postpartum thyroiditis is a form of subacute painful thyroiditis.
d. Riedel’s thyroiditis is a form of congenital hypothyroidism present in about 1 in
4000 newborns.
ANS: B
Thyroid nodules can be found in about 5% of the adult population in the United States. The
frequency of cancer in solitary thyroid nodules has been reported to be about 1% to 5%.
During the past decade, the incidence of thyroid cancer has increased at a rate of about 5% per
year. For 2015, the National Cancer Institute estimated a total of 62,450 new cases of thyroid
cancer, with about 1950 deaths. The 5-year survival rate for thyroid cancer is 97%. In an
average dental practice of 2000 patients, an estimated 20 to 150 patients will have some form
of thyroid disease.

4. Which of the following is the correct sequence leading to the release of thyroid hormones?
1. Thyroid-stimulating hormone (TSH) is released.
2. T4 and T3 are secreted.
3. Thyrotropin-releasing hormone (TRH) is released.

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a. 1, 2, 3
b. 1, 3, 2
c. 2, 1, 3
d. 3, 1, 2
ANS: D
Under normal conditions, thyrotropin-releasing hormone (TRH) is released by the
hypothalamus in response to external stress (e.g., illness, metabolic demand, low levels of T3,
and to a lesser extent, T4). TRH stimulates the pituitary to release thyroid-stimulating
hormone (TSH), which causes the thyroid gland to secrete T4 and T3. T4 and T3 also have a
direct influence on the pituitary. High levels turn off the release of TSH, and low levels turn it
on. In the blood, T4 and T3 are almost entirely bound to plasma proteins.

5. The term _ refers to an excess of T4 and T3 in the bloodstream.

a. thyrotoxicosis
b. myxedema
c. cretinism
d. acropachy
ANS: A
Thyrotoxicosis refers to an excess of T4 and T3 in the bloodstream. This excess may be the
result of production by ectopic thyroid tissue, multinodular goiter, or thyroid adenoma, or may
it be associated with subacute thyroiditis (painful and painless), ingestion of thyroid hormone
(thyrotoxicosis factitia) or foodstuffs containing thyroid hormone, or pituitary disease
involving the anterior portion of the gland.
6. Which of the following signs and symptoms are associated with Graves’ disease?
1. Weight loss GRADESMORE.COM
2. Weight gain
3. Rapid heartbeat
4. Slow heartbeat
a. 1, 3
b. 2, 3
c. 1, 4
d. 2, 4
ANS: A
The most common signs and symptoms in Graves’ disease are nervousness, fatigue, rapid
heartbeat or palpitations, heat intolerance, and weight loss. These manifestations are reported
in more than 50% of all diagnosed patients. With increasing age, weight loss and decreased
appetite become more common, and irritability and heat intolerance are less common. Atrial
fibrillation is rare in patients younger than 50 years of age, but it occurs in approximately 20%
of older patients.

7. Ophthalmopathy is strongly linked to which of the following thyroid diseases?

a. Hashimoto’s thyroiditis
b. Multiple endocrine neoplasia type 2 (MEN2)
c. Graves’ disease
d. Myxedema
ANS: C

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Graves’ ophthalmopathy, which is identified in approximately 50% of patients, is
characterized by edema and inflammation of the extraocular muscles, as well as an increase in
orbital connective tissue and fat. Ophthalmopathy is an organ-specific autoimmune process
that is strongly linked to Graves’ hyperthyroidism. Although hyperthyroidism may be
successfully treated, ophthalmopathy often produces the greatest long-term disability for
patients with this disease.

8. Which of the following is the preferred initial treatment for patients with Graves’ disease in
North America?
a. Subtotal thyroidectomy
b. Antithyroid agents that block hormone synthesis
c. Radioactive iodine
d. Iodides
ANS: C
Administration of radioactive iodine is the preferred initial treatment for patients with Graves’
disease in North America. This agent is contraindicated in pregnant women and in those who
are breast-feeding. Radioactive iodine can induce or worsen ophthalmopathy, particularly in
smokers. The main adverse effect associated with radioactive iodine treatment is
hypothyroidism.

9. Which of the following populations is most commonly affected by Hashimoto’s thyroiditis?

a. Young and middle-aged women
b. Elderly men
c. Children of both genders
d. Adolescents
ANS: A GRADESMORE.COM
Hashimoto’s thyroiditis usually affects young and middle-aged women and is three to four
times more frequent in women than men. By the time the diagnosis has been established, most
patients are hypothyroid. A family history of Hashimoto’s thyroiditis or other autoimmune
thyroid disorder often is reported. It may be associated with other autoimmune diseases such
as pernicious anemia and type 1 diabetes mellitus.

10. Which of the following is a characteristic of hypothyroidism in older children and adults?
a. Warm, moist skin
b. Alopecia of the outer third of the eyebrows
c. Increased size of the tongue
d. A and B
e. B and C
ANS: E
The onset of hypothyroidism in older children and adults is manifested by characteristic
changes in physical appearance: dull expression; puffy eyelids; alopecia of the outer third of
the eyebrows; palmar yellowing; dry, rough skin; dry, brittle, coarse hair; and increased
tongue size. Other features include slowing of physical and mental activity, slurred and hoarse
speech, anemia, constipation, increased sensitivity to cold, increased capillary fragility, weight
gain, muscle weakness, and deafness.

11. Multiple endocrine neoplasia type 2 (MEN2) involves which of the following histologic types
of cancer?

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a. Differentiated
b. Medullary
c. Anaplastic
d. Hürthle cell
ANS: B
Multiple endocrine neoplasia type 2 (MEN2) involves the thyroid gland. MEN2 consists of
medullary thyroid carcinoma (MTC), pheochromocytoma in 50% of cases, and parathyroid
hyperplasia or adenoma in 10% to 35% of cases. In rare cases, cancer from other locations
may metastasize to the thyroid gland. The kidney is the most common site of origin for
metastasis to the thyroid gland; other sites include cancer of the breast and lung, and
melanoma.

12. Which of the following is the best type of medication to treat myxedematous coma?
a. Narcotic analgesic
b. Hydrocortisone
c. Central nervous system depressant
d. Sedative

ANS: B
If myxedema coma should occur, the dentist should call for medical aid; while waiting for this
assistance, the dentist can inject 100 to 300 mg of hydrocortisone, cover the patient to
conserve heat, and apply cardiopulmonary resuscitation (CPR) as indicated. Once medical aid
becomes available, parenteral levothyroxine is administered, and intravenous hypertonic
saline and glucose are given as needed.
13. Which of the following oral changes is most likely encountered in adults with acquired
hypothyroidism? GRADESMORE.COM
a. Pemphigoid
b. An enlarged tongue
c. Sicca syndrome
d. Leukoedema
ANS: B
Infants with cretinism may present with thick lips, enlarged tongue, and delayed eruption of
teeth with resulting malocclusion. Adults with acquired hypothyroidism can display an
enlarged tongue and low salivary flow.

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Chapter 17: Pregnancy and Breast Feeding
Little: Dental Management of the Medically Compromised Patient, 9th Edition

MULTIPLE CHOICE

1. Supine hypotensive syndrome during late pregnancy is due to .

a. an increase in blood volume
b. compression of the inferior vena cava by the gravid uterus
c. a fall in maternal hematocrit
d. a benign systolic ejection murmur

ANS: B
Supine hypotensive syndrome manifests as an abrupt fall in blood pressure, bradycardia,
sweating, nausea, weakness, and air hunger when the patient is in a supine position.
Symptoms and signs are caused by impaired venous return to the heart resulting from
compression of the inferior vena cava. This leads to decreased blood pressure, reduced cardiac
output, and impairment or loss of consciousness.

2. Which of the following normally decreases during pregnancy?

a. Blood volume
b. Blood clotting factors
c. White blood cell count
d. Hematocrit
ANS: D
Blood changes during pregnancy include anemia and a decreased hematocrit value. Anemia
occurs because blood volume G inR
crAeaDsE
esSm
MoOrR
eE
ra.
piC
dlOyMthan red blood cell mass. As a result, a
fall in hemoglobin and a marked need for additional folate and iron occur. Several blood
clotting factors, especially fibrinogen and factors VII, VIII, IX, and X, are increased. The
white blood cell count increases progressively throughout pregnancy, primarily because of an
increase in neutrophils, and is nearly doubled by term.

3. The most common cause of spontaneous abortion is .

a. immune suppression due to a shift in helper T cell type dominance
b. morphologic or chromosomal abnormalities that prevent successful implantation
c. the development of gestational diabetes
d. a benign systolic ejection murmur in the mother
ANS: B
Morphologic or chromosomal abnormalities that prevent successful implantation are the most
common cause. It is most unlikely that any dental procedure would be implicated in
spontaneous abortion, provided fetal hypoxia and exposure of the fetus to teratogens are
avoided.

4. Which of the following is the safest period during which to provide routine dental care for the
pregnant patient?
a. The first trimester
b. The second trimester
c. The third trimester
d. The immediate postpartum period

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ANS: B
The second trimester is the safest period during which to provide routine dental care.
Emphasis should be placed on controlling active disease and eliminating potential problems
that could occur later in pregnancy or during the immediate postpartum period, because
providing dental care during these periods is often difficult. Other than as part of a good
plaque control program, elective dental care is best avoided during the first trimester because
of the potential vulnerability of the fetus. The early part of the third trimester is still a good
time to provide routine dental care. After the middle of the third trimester, elective dental care
is best postponed.

5. The gonadal/fetal dose incurred with two periapical dental films (when a lead apron is used) is
that for 1 day of average exposure to natural background radiation in the United
States.
a. 700 times less than
b. 7 times less than
c. equal to
d. 7 times more than
ANS: A
It is 700 times less than that for 1 day of average exposure to natural background radiation in
the United States. Despite the negligible risks of dental radiography, radiographs should be
obtained selectively and only when necessary and appropriate to aid in diagnosis and
treatment. To further reduce the radiation dose, the following measures should be employed:
rectangular collimation, E-speed or F-speed film or faster techniques, lead shielding,
high-kilovoltage (kV) or constant beams, and an ongoing quality-assurance program for
equipment and technique.
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6. What should a pregnant dental auxiliary or dentist do to protect herself and her baby from
potential fetal exposure to x-radiation?
a. Stay in a remote area of the dental office, and avoid locations where x-radiation is
utilized.
b. Wear a lead apron the entire time in the office, and avoid circumstances of
exposing x-ray films.
c. Utilize digital radiography rather than film-based radiography.
d. Wear a film badge, stand more than 6 feet from the tubehead, and position herself
at between 90 and 130 degrees of the beam, preferably behind a protective wall.
ANS: D
When these guidelines are followed, no clinical contraindication to operation of the x-ray
machine by pregnant women arises. However, dentists should familiarize themselves with
federal and state regulations that would supersede these guidelines.

7. Which of the following is the analgesic of choice during pregnancy?

a. Aspirin
b. Acetaminophen
c. Nonsteroidal anti-inflammatory
d. Codeine
ANS: B

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Acetaminophen is the analgesic of choice during pregnancy. Aspirin and nonsteroidal
anti-inflammatory drugs convey risks for constriction of the ductus arteriosus, as well as for
postpartum hemorrhage and delayed labor. The risk of these adverse events increases when
agents are administered during the third trimester. Codeine and propoxyphene are associated
with multiple congenital defects and should be used cautiously and only if needed.

8. Which of the following is the most common oral complication of pregnancy?

a. Xerostomia
b. Pyogenic granuloma
c. Pregnancy gingivitis
d. Dental caries
ANS: C
The most common oral complication of pregnancy is pregnancy gingivitis. This condition
results from an exaggerated inflammatory response to local irritants and less-than-meticulous
oral hygiene during periods of increased secretion of estrogen and progesterone and altered
fibrinolysis. In approximately 1% of gravid women, the hyperplastic response may exacerbate
in a localized area, resulting in a pyogenic granuloma or “pregnancy tumor.” A relationship
between dental caries and the physiologic process of pregnancy has not been demonstrated.

9. What newer method for point-of-care osteoporosis screening and diagnostics has proven to be
effective for early diagnosis of osteoporosis?
a. Conventional radiography
b. Biophosphate regimen
c. Injections of estrogen
d. Ultrasound
ANS: D GRADESMORE.COM
The results of recent studies suggest applicability of ultrasound method for osteoporosis
diagnostics at primary health care. Conventional radiography is used for the diagnosis of
osteoporosis, however approximately 75% of cases are not diagnosed until late in the disease
process as imaging is not a routine part of primary medical care. Biophosphate and estrogen
regimens fall under the medical management and not diagnostic approach.

10. Which of the following statements about osteonecrosis is NOT true?

a. It is a potentially serious oral complication of cancer treatment.
b. It is a condition limited to the use of bisphosphonate drugs.
c. Several medications have been associated with the onset of osteonecrosis of the
jaw (MRONJ).
d. Bisphosphonates will arrest bone loss and increase bone density in ostenonecrosis
patients, decreasing the risk of pathologic fracture.
ANS: B
Originally, the condition when associated with bisphosphonate drug use was referred to as:
bisphosphonate-associated osteonecrosis (BON). However, more recently other associated
drugs and co-mordibities have been identified. Therefore, it is not appropriate to refer to this
condition as only bisphosphonate-related.

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Chapter 18: AIDS, HIV Infection, and Related Conditions
Little: Dental Management of the Medically Compromised Patient, 9th Edition

MULTIPLE CHOICE

1. The current definition of AIDS is the laboratory-confirmed evidence of HIV infection in a

person who has stage 3 HIV infection, meaning that the CD4+ lymphocyte count is less than
cells/µL.
a. 400
b. 200
c. 100
d. 50
ANS: B
Stage 3 HIV infection means that the CD4+ lymphocyte count is less than 200 cells/µìL.
The current definition of AIDS also includes HIV-infected persons whose CD4+ count may
be above 200 but who have an AIDS-defining condition.

2. Which of the following is the most common method of sexual transmission of HIV in the
United States?
a. Transmission from injection drug use
b. Anal intercourse in men who have sex with men (MSM)
c. Male-to-female heterosexual transmission
d. Female-to-male heterosexual transmission
ANS: B GRADESMORE.COM
The most common method of sexual transmission in the United States is anal intercourse in
MSM, in whom the risk of HIV infection is 40 times higher than in other men and in
women. Heterosexual transmission (male to female, or female to male) is the second most
common form of transmission in the United States, but it accounts for 80% of the world’s
HIV infections. Injection drug use is the third most common mode of transmission in the
United States.

3. The median time from primary infection to the development of AIDS in untreated patients is
about following HIV exposure.
a. 2 to 6 weeks
b. 6 months
c. 2 to 3 years
d. 10 years
ANS: D
It is about 10 years. About 30% of patients with AIDS can be expected to live
approximately 2 to 3 years, with most others living 10 years or longer. Long-term survival
with HIV infection (beyond 15 years) occurs and is associated with less virulent HIV
strains, lower-level viremia, highly active antiretroviral therapy (HAART), and robust
immune responses.

4. Which of the following is a characteristic of stage 2 of HIV infection?

a. Predomination of opportunistic infections

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b. Progressive immunosuppression
c. HIV antibody-positive
d. CD4+ T count approximates 200 cells/µL
ANS: B
Stage 2 is characterized by progressive immunosuppression and symptomatic disease.
Patients who demonstrate various laboratory changes (i.e., lymphopenia: T helper/T
suppressor ratio usually less than 1) in addition to HIV antibody positivity also may show
clinical signs or symptoms, such as enlarged lymph nodes, night sweats, weight loss, oral
candidiasis, fever, malaise, and diarrhea.

5. Which of the following should be a major consideration when planning dental treatment for
the patient with HIV infection/AIDS?
a. Current CD4+ lymphocyte count
b. Immunosuppression level
c. Level of viral load
d. All of the above.
ANS: D
A major consideration in dental treatment of the patient with HIV infection/AIDS involves
determining the current CD4+ lymphocyte count and level of immunosuppression of the
patient. Another point of emphasis in dental treatment planning is the level of viral load,
which may be related to susceptibility to opportunistic infections and rate of progression of
AIDS.

6. Which of the following is a legitimate reason for a general dentist to make a referral of an
asymptomatic HIV-positive G paRtiAeD
ntEtoSaMnOeR
ndo
E.dC
onOtM
ist for endodontic treatment of a molar
tooth?
a. The general dentist simply does not want to treat a person who is HIV-positive.
b. The general dentist feels that the patient is immunocompromised, but the patient
refuses to undergo testing for HIV.
c. The general dentist does not perform endodontic treatment for molar teeth.
d. A and B
e. B and C
ANS: C
No medical or scientific reason exists to justify why patients with AIDS who seek routine
dental care may be declined treatment by the dentist, regardless of the practitioner’s
personal reason. Dental treatment may not be withheld if the patient refuses to undergo
testing for HIV exposure. The dentist may refer a patient to another provider who is better
suited to provide treatment.

7. The risk of HIV transmission from infected patients to health care workers is about % in
cases in which a needlestick or other sharp instrument transmitted blood from patient to
health care worker.
a. 0.03
b. 0.3
c. 3.0
d. 30.0
ANS: B

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The risk of HIV transmission from infected patients to health care workers is very low,
reportedly about 3 of every 1000 cases (0.3%) in which a needlestick or other sharp
instrument transmitted blood from patient to health care worker. In comparison, the risk of
infection from a needlestick is 3% for hepatitis C and 30% for hepatitis B.

8. Which of the following represents an acceptable expanded postexposure prophylaxis

regimen (PEP) after exposure to HIV-infected blood?
1. Tenofovir plus emtricitabine
2. Zidovudine plus lamivudine
3. Ritonavir-boosted (/r) lopinavir
a. 1, 2, 3
b. 1, 2
c. 1, 3
d. 3
ANS: C
The recommended basic regimen for HIV PEP is tenofovir plus emtricitabine or zidovudine
plus lamivudine. The expanded regimen includes a standard two-drug regimen plus a
protease inhibitor such as ritonavir-boosted (/r) lopinavir, darunavir/r, atazanavir/r, or
raltegravir. PEP should be continued for 4 weeks, during which time the exposed clinician
should be provided expert consultation, and follow-up monitoring for compliance, adverse
events, and possible seroconversion. Tests for seroconversion should be performed at 3, 6,
and 12 months.

9. Which of the following types of gingival is associated with the HIV-positive patient?
a. Papillary gingivitis
b. Diffuse gingivitis GRADESMORE.COM
c. Linear gingival erythema
d. Desquamative gingivitis
ANS: C
Candidiasis, hairy leukoplakia, specific forms of periodontal disease (i.e., linear gingival
erythema and necrotizing ulcerative periodontitis), Kaposi sarcoma, and non-Hodgkin
lymphoma are believed to be strongly associated with HIV infection.

10. What is the most common oral manifestation of HIV infection worldwide?
a. Hairy leukoplakia
b. Kaposi sarcoma
c. Necrotizing stomatitis
d. Candidiasis
ANS: D
Worldwide, candidiasis is the most common oral manifestation of HIV infection. Oral
candidiasis diagnosed in HIV-infected patients with persistent generalized lymphadenopathy
may be of predictive value for the subsequent development of AIDS. The erythematous
form of candidiasis also indicates progression toward AIDS.

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