All the following statements related to medical emergencies in oral healthcare settings are correct EXCEPT which one?
A. Diagnostic activities should be effective to establish a database that identifies those patients at-risk who may experience a medical emergency.
B. Available data on the types and incidence of medical emergencies in oral healthcare settings indicate that the rate of medical emergencies per dentist per year is quite high.
C. At a minimum, in the event of a life-threatening medical emergency, OHCP must feel comfortable to perform BLS techniques to stabilize the patient until EMS arrives.
D. It must be emphatically stated that advanced life support (ALS) activities should not be attempted without sufficient training and maintenance of skills.
All the following statements related to procedure-specific risk factors are correct EXCEPT which one?
A. Every procedure elicits a stress-response, i.e., “surgical stress,” characterized by physiological changes accompanied by psychological reactions.
B. The magnitude of surgical stress is unrelated to the severity of tissue trauma, duration of the procedure, volume of blood loss, fluid shifts, and changes in core body temperature.
C. Procedure-related surgical stress can be classified as high, intermediate, and low with estimated rates of associated major medical events of >5%, 1-5%, and <1%, respectively.
D. With low surgical stress, e.g., dental procedures, the risk of a major medical event is negligible unless strong patient-specific risk factors are present.
All the following statements are correct with respect to a determination of patient-specific risk factors EXCEPT which one?
A. Identification of patient-specific risk factors is predicated on data obtained from the physical evaluation, i.e., medical history and physical examination.
B. The stress-response is mediated primarily by the sympathoadrenal system; therefore, the medical history should also seek to determine the patient’s functional capacity (FC).
C. FC relates to a person’s functional reserve, which correlates well with maximum oxygen uptake during treadmill testing and is expressed in metabolic equivalents (METs).
D. The method to determine FC, predicated on a person’s ability to perform a spectrum of common daily activities, has not been validated.
All the following statements are correct with respect to risk assessment EXCEPT which one?
A. FC relates to a person’s functional reserve, which correlates well with maximum oxygen uptake during treadmill testing.
B. The inability of a person to climb two flights of stairs or to run a short distance is indicative of a functional capacity of <4 METs.
C. For a patient with a history of CAD who is asymptomatic and runs 30 minutes daily the risk of a medical emergency is predictable high.
D. Risk assessment must also include a determination of the patient’s baseline vital signs.
All the following statement related to the ASA PS classification system are correct EXCEPT which one? The ASA PS classification system _____________.
A. invariably is predicated on patient-specific risk factors as identified in consultation with a physician
B. provides a practical method to quantify perioperative risk for patients undergoing surgical (and by extension dental) procedures
C. correlates well with the rate of perioperative complications in medicine
D. defines ASA PS II as a patient with well-controlled mild systemic disease affecting one organ system and no substantive functional limitations, i.e., good functional capacity
Which of the following statements is correct with respect to the risk of major medical events associated with ASA FS IV?
A. Minimal risk
B. No immediate risk
C. Imminent risk
D. Possible risk
Being prepared to respond to a major medical event in oral healthcare settings requires all the following EXCEPT which one?
A. Knowing what to look for, i.e., familiarity with predisposing factors and signs and symptoms of medical emergencies.
B. Being alert, i.e., looking for evidence of distress or adverse reactions, particularly when drugs are being administered to the patient.
C. Regularly checking the status of emergency drugs and other equipment.
D. Training under real-life conditions, such as in an emergency room rotation.
When faced with an emerging medical event, the primary survey must be implemented in every situation to identify those problems that are not immediately life-threatening.
A. True
B. False
All the following statements related to a patient’s level of consciousness are correct EXCEPT which one?
A. An alert patient is awake and speaks.
B. A disoriented patient may moan, cry, or make other sound.
C. An unconscious patient is silent.
D. An unresponsive patient does not respond to verbal commands but responds to painful stimuli.
Which of the following statements related to the responsive patient as determined during the primary survey is correct?
A. Place the patient on a firm, flat board (e.g., EMS board) to allow for adequate compressions later.
B. Summon the office emergency team.
C. Notify emergency medical services (EMS).
D. Place the patient in the dental chair in an upright/semi-reclining position.
All the following statements are correct with respect to the status of the airway and actions to be taken during the primary survey EXCEPT which one?
A. If the patient is responsive (i.e., alert) but is talking only in a whisper) the airway is is completely obstructed.
B. If the patient is unresponsive (i.e., does not respond to verbal commands and painful stimuli) evaluate airway.
C. If the airway is not open, it may be due to relaxation of the soft tissues of the oropharynx - perform head-tilt/chin-lift.
D. If obstruction is caused by foreign material it must be cleared - suction thick, frothy, bloody saliva and vomitus; foreign object must be removed.
All the following statements related to a patient’s breathing and pulse and actions to be taken during the primary survey are correct EXCEPT which one?
A. During the primary survey the patient’s breathing and pulse should be checked sequentially, i.e., see if the patient’s chest rises and falls, listen for escaping air, feel the airflow against the side of your cheek; and lastly, palpate the carotid artery.
B. In an unresponsive patient with normal breathing and a definite pulse monitor vital signs until EMS arrives.
C. In an unresponsive patient, if the breathing is not normal, but the patient has definite pulse initiate rescue breathing.
D. In an unresponsive patient, in the absence of pulse, begin cardiopulmonary resuscitation (CPR) and prepare for automated external defibrillation (AED).
All the following statement related to the management of a patient who is not breathing or takes only agonal breaths (i.e., isolated or infrequent grasping) and has no pulse are correct EXCEPT which one?
A. Begin CPR, turn on AED and apply AED pads - when the AED is ready to analyze the heart rhythm, ensure that the rescuer continues performing CPR.
B. If the AED advises that a shock is not indicated, resume CPR immediately until prompted by AED to allow rhythm check (about 2 minutes).
C. If the AED advises that a shock is indicated, press the shock button and resume CPR immediately until prompted by AED to allow rhythm check (about 2 minutes).
D. Perform CPR with defibrillation until EMS takes over or the patient starts to move.
For each minute CPR and defibrillation is delayed, the patient's chances of survival is reduced by 7 to 10 percent.
A. True
B. False
All the following statements related to airway obstruction due to a foreign object are correct EXCEPT which one?
A. A conscious patient who is clutching the throat is showing the universal sign of choking - encourage the patient to cough forcefully until he/she can breathe normally.
B. If the coughs become week and ineffective, place the patient in a supine position and deliver quick, upward abdominal thrusts until the object is forced out.
C. If the patient becomes unresponsive, immediately begin CPR with chest compressions and make sure an AED is readily available.
D. Each time the airway is opened to give ventilations, look for any visible objects in the oropharynx - if a foreign object is not visible, perform a blind finger sweep.
All the following statements related to the secondary survey are correct EXCEPT which one?
A. If the patient is conscious and communicative, proceed with the secondary survey.
B. Before determining the patient’s blood pressure, reassess the pulse rate and character and the rate and character of respiration.
C. During the secondary survey correlate signs and symptoms associated with the patient’s chief complaint to a specific organ or body system.
D. The secondary survey is to identify problems that are not immediately life-threatening (e.g., hypoglycemia, angina pectoris, ventilation failure), but require timely stabilization.
All the following statements related to medical emergencies within the context to the secondary survey are correct EXCEPT which one?
A. Physical signs and symptoms are produced by physical causes and must be recognized before a physical problem can be diagnosed.
B. Without at least a presumptive or working diagnosis there is nothing to treat.
C. Based on symptoms analysis, medical emergencies can be characterized as altered consciousness; chest pain; and ventilatory, allergic (e.g., pruritus, urticaria, angioedema), and neurogenic (e.g., altered sensory, affective, motor function).
D. Common office emergencies such as thyrotoxicosis, Addisonian crises, advanced diabetic ketoacidosis, and extreme hyperglycemia are predictably diagnosed and dealt with in the primary survey.
All the following statement related to syncope are correct EXCEPT which one?
A. Syncope is defined as sudden brief loss of consciousness due to cerebral ischemia.
B. In the young adult syncope it is usually precipitated by anxiety, pain, heat, or humidity.
C. Syncope in patients over 50 years of age may likely be secondary to cardiovascular disorders (e.g., dysrhythmia, postural hypotension), hypoglycemia or cerebrovascular insufficiency.
D. In syncope, the initial cholinergic response to a stressor is followed by an overwhelming adrenergic response.
All the following statements associated with syncope are correct EXCEPT which one?
A. Signs and symptoms associated with the adrenergic component of syncope include diaphoresis (perspiration), nausea, salivation, bradycardia, hypotension, and loss of consciousness.
B. When the working diagnosis is syncope, place patient in Trendelenburg position, i.e., head and chest slightly below a line parallel to the floor and feet slightly elevated.
C. Emergency responses to syncope include the administration of oxygen, 4 to 6 L/min by nasal cannula, and stimulation of cutaneous reflexes.
D. If at any time the patient with syncope becomes unresponsive, no normal breathing, and no palpable pulse consider the diagnosis of cardiac arrest.
All the following statements related to postural hypotension are correct EXCEPT which one?
A. Postural hypotension is defined as a decline of ≥20 mm Hg in the systolic BP, and/or a decline of ≥10 mm Hg in the diastolic BP, or an increase of ≥20 beats/minute in pulse rate.
B. Signs and symptoms of postural hypotension include a distinctive prodrome.
C. Acute signs and symptoms include abrupt cerebral ischemia (syncope) following postural change from a supine to an upright position.
D. Postural hypotension may be secondary to impaired homeostatic mechanisms of blood pressure regulation; age and/or cardiovascular-disease-related physiological changes; anti-hypertensive medications; and/or recent intake of food.
All the following statements related to the emergency response to postural hypotension are correct EXCEPT which one?
A. Immediately return patient to supine position for 5-10 minutes; administer oxygen, 4 to 6 L/min by nasal cannula; and reevaluate vital signs.
B. When vital signs return to baseline values, allow patient to assume a sitting position for at least 2 minutes; reevaluate vital signs.
C. If vital signs are stable, allow patient to stand for 2 minutes; reevaluate vital signs; stable vital signs and alertness are signs of recovery.
D. Postural hypotension is often observed in younger patients and may result in significant morbidity.
All the following statements related to hypoglycemia are correct EXCEPT which one?
A. Glucagon promotes hepatic glycogenolysis and gluconeogenesis and is a hypoglycemic agent.
B. Hypoglycemia is defined as sustained plasma glucose level <70 mg/dL.
C. Heavy exercise, anxiety, and infection may cause hypoglycemia.
D. The most common cause of hypoglycemia is treatment with insulin and/or oral hypoglycemic agents and delayed, decreased, or missed meals.
All the following statements related to hypoglycemia are correct EXCEPT which one?
A. Neuroglycopenic manifestations of hypoglycemia include twitching and tremor; anxiety and nervousness; sweating, cold, clammy skin; pallor; and mydriasis.
B. If the working diagnosis is mild hypoglycemia, i.e., the patient is conscious, able to follow commands, and can swallow administer glucose tablets (if available), otherwise a glass of fruit juice or 3 tbsp of sugar with water is acceptable.
C. If the diagnosis is severe hypoglycemia, i.e., altered or loss of consciousness and/or seizure, notify EMS; apply a ribbon of sucrose paste (cake icing) on oral soft tissues or administer glucagon, 1 mg, IM or SL; administer oxygen, 4 to 6 L/min by nasal cannula; and monitor vital signs.
D. Signs of recovery include improved mental state.
All the following statements related to angina pectoris are correct EXCEPT which one?
A. Angina pectoris is a chronic coronary syndrome characterized by persistent cardiac oxygen demand.
B. Hypoxia (and at times anoxia) results from diseases and conditions which lead to atherosclerosis and obstruction of coronary arteries by fatty deposits that limits and/or impairs coronary blood flow.
C. Precipitating factors that increase cardiac oxygen demand in the presence of decreased perfusion of the myocardium include physical exertion, emotional stress, cold, recent meal.
D. Unstable angina pectoris may occur spontaneously at rest.
All the following statements related to the management of angina pectoris are correct EXCEPT which one?
A. If the working diagnosis is angina pectoris, place patient in an upright or semi-reclining position.
B. If the working diagnosis is angina pectoris, note the time and administer nitroglycerin, 0.4 mg, tablet or spray, SL and administer oxygen, 2 to 4 L/minute by nasal cannula.
C. In a conscious patient, chest pain lasting more than 5 minutes must be assumed to be due to unstable angina or myocardial infarction; notify EMS.
D. Adverse reaction to nitroglycerin includes flushing, headaches, dizziness, nausea, and vomiting; syncope and paradoxical angina pectoris due to nitrate-induced vasodilation has been reported.
All the following statements related to myocardial infarction are correct EXCEPT which one?
A. Myocardial infarction is caused by abrupt anoxia to a portion of the heart resulting in myocardial tissue necrosis.
B. Anoxia results from conditions that lead to the formation of atherosclerotic plaques, which in later stages become disrupted and contribute to thrombus formation.
C. Atherosclerotic plaques and thrombi impair blood flow to large and medium-sized veins of the heart.
D. History of cardiovascular diseases, diabetes mellitus, and cerebrovascular disease increases the overall risk of perioperative MI.
All the following statements related to myocardial infarction are correct EXCEPT which one?
A. If the working diagnosis is myocardial infarction, place patient in an upright or semi-reclining position; notify EMS; administer oxygen, 6 L/min by nasal cannula; and encourage patient to chew an adult aspirin, 325 mg, unless otherwise contraindicated.
B. If at any time the patient becomes unresponsive, no normal breathing, and no palpable pulse consider the diagnosis of cardiac arrest and initiate immediate CPR and defibrillation congruent with current recommendations.
C. Patient denial may minimize symptoms and elderly and diabetic patients have a higher incidence of silent MI characterized by vague symptoms of shortness of breath, epigastric distress, hypotension, and altered mental state.
D. More than 6 months should elapse after a MI before elective noncardiac procedures, e.g., elective dental care is considered.
All the following statements related to hypertensive emergency are correct EXCEPT which one?
A. Hypertension is defined as a blood pressure (BP) ≥140/90 mm Hg.
B. Hypertensive emergency is defined by a BP ≥180/110 mm Hg and signs and symptoms of severely elevated BP.
C. Hypertensive emergency is unlikely with the administration of sympathomimetic drugs such as high doses of epinephrine.
D. The mechanisms that lead to severely elevated BP appear to be related to a failure of normal autoregulatory function resulting in increased vascular resistance caused by endogenous vasopressors in patients with unrecognized or under-treated hypertension.
All the following statements related to hypertensive emergency or urgency are correct EXCEPT which one?
A. If the working diagnosis is hypertensive emergency, place patient in an upright or semi-reclining position; notify EMS; administer oxygen, 4 to 6 L/min by nasal cannula; and monitor vital signs.
B. In a hypertensive emergency in the oral health care setting, the BP should be promptly lowered to decrease the mean arterial pressure (MAP) to prevent cerebral ischemia.
C. If the working diagnosis is hypertensive urgency (BP ≥180/110 mm Hg, patient is asymptomatic), medical evaluation and risk modification is indicated within 24 to 48 hours.
D. Untreated hypertensive emergency can lead to altered mental state, chest pain (myocardial ischemia, infarction, or aortic dissection), seizure, cerebral hemorrhage, coma, and death.
All the following statements related to hyperventilation are correct EXCEPT which one?
A. Hyperventilation is characterized by cerebral hypoxia that leads to prolonged inspiration (i.e., deep sighs), which result in low CO2 concentration.
B. Predisposing factors in young people include pain, and personal and environmental stress.
C. Hyperventilation syndrome is especially common in young men.
D. Hyperventilation may be secondary to cardiopulmonary disease (e.g., cardiogenic shock, COPD, pulmonary edema), and central nervous system stimulants (e.g., drugs, cola, coffee, tea).
All the following statements related to hyperventilation are correct EXCEPT which one?
A. If the working diagnosis is hyperventilation, place patient in an upright or semi-reclining position; instruct the patient to take in a shallow breath and hold it as long as possible; repeat this sequence 6 to 10 times.
B. If the working diagnosis is hyperventilation, place patient in an upright or semi-reclining position and administer oxygen, 4 to 6 L/min by nasal cannula.
C. Signs and symptoms of hyperventilation include light-headedness and dizziness, paresthesia, burning or prickling feeling of the face and extremities tightness or pain in the chest, and syncope.
D. Tonic muscle spasm and tetani can occur because with severe respiratory alkalosis.
All of the following statements are correct with respect to ventilation failure EXCEPT which one?
A. Ventilation failure is defined as a rise in CO2 concentration when alveolar ventilation either falls or fails to respond adequately to increased oxygen.
B. The most common causes are acute exacerbation of asthma and chronic obstructive pulmonary disease (COPD).
C. Asthma is a diffuse airway inflammation in response to household (dust mites, pets) and environmental (pollens) allergens in genetically susceptible patients resulting in reversible bronchoconstriction.
D. COPD is a reversible airway obstruction caused an inflammatory response to toxins, e.g., cigarette smoke.
All of the following statements are correct with respect to ventilation failure EXCEPT which one?
A. Signs and symptoms of ventilation failure include coughing, wheezing, shortness of breath (dyspnea); anxiety, restlessness, agitation; pallor or cyanosis of the lips; noticeable use of the accessory muscles of respiration; and respiratory failure.
B. If the working diagnosis is ventilation failure, place patient in an upright position; administer a short acting beta2 agonist bronchodilator, two to 4 puffs of albuterol by metered-dose inhaler (up to 3 times 20 minutes apart).
C. Patients with asthma do not need O2 unless the O2 sat is <90% as measured by a pulse oximeter, 2 to 4 L/min by nasal cannula.
D. Patients with COPD must not be given O2 supplementation, as higher levels of O2 may worsen respiratory failure.
All the following statements are correct with respect to pruritus, urticaria, or angioedema EXCEPT which one?
A. Histamine, released in response to various stimuli, is one of the most significant chemical mediators associated with pruritus and itching.
B. Urticaria is the result of vasoactive substances (e.g., histamine) released by mast cells in the subcutaneous area resulting in intradermal edema caused by capillary and venous vasodilation.
C. Angioedema is considered anaphylaxis of the subcutaneous tissues and results from mast cell and basophil activation in the deeper dermis and subcutaneous tissues.
D. The causes of acute angioedema, which may be accompanied by pruritus and urticaria, include drugs and other allergens.
All the following statements are correct with respect to the appropriate emergency response to pruritus, urticaria, or angioedema EXCEPT which one?
A. If the working diagnosis is generalized pruritus, urticaria, or mild angioedema, stop exposure to suspected precipitating agents and administer oral diphenhydramine (an oral H1-receptor antagonist), 25 to 50 mg, four times daily.
B. Angioedema may be pruritic or non-pruritic and may be accompanied by urticaria.<
C. If the working diagnosis is severe angioedema stop exposure to suspected precipitating agents and administer prednisone 30 to 40 mg, once a day.
D. If the working diagnosis in a child is severe angioedema with oropharyngeal and/or laryngeal edema with stridor and wheezing stop exposure to suspected precipitating agents, notify EMS, and administer epinephrine (1:1000) – 0.3 mg. IM (anterolateral thigh).
All the following statements related to anaphylaxis are correct EXCEPT which one?
A. Anaphylaxis is a type I hypersensitivity reaction.
B. In anaphylaxis, the initial exposure to an allergen results in antigen-specific antibody production.
C. Following re-exposure, IgG antibodies bind to mast cells and basophils associated with mucosal and epithelial tissues.
D. The simultaneous binding of an antigen to antibodies fixed to Fc receptors triggers degranulation of mast cells and basophils resulting in the release of histamine, leukotrienes, prostaglandins, chemokines, enzymes and cytokines in target tissues.
All the following statements related to the emergency response to anaphylaxis are correct EXCEPT which one?
A. The onset of anaphylaxis is 1 to 15 minutes following exposure to a specific allergen characterized by pruritus, urticaria, angioedema; coughing, stridor, dyspnea, wheezing; agitation, flushing, palpitation; unresponsiveness, convulsion; and hypotension, and cardiogenic shock.
B. If the working diagnosis in an adult is anaphylaxis, place patient in a supine position; immediately administer epinephrine 1:1000 - epinephrine (EpiPen), 0.3 mg, IM (anterolateral thigh), and notify EMS.
C. If a patient with anaphylaxis does not respond to an initial dose of epinephrine a repeat dose may be administered in 5minutes.
D. If at any time a patient with anaphylaxis becomes unresponsive, no normal breathing, and no palpable pulse consider the diagnosis of cardiac arrest and initiate CPR and defibrillation congruent with current recommendations.
All the following statements related to Type IV delayed hypersensitivity reactions are correct EXCEPT which one?
A. Type IV, delayed hypersensitivity reactions are closely related to cellular immunity in that specifically sensitized CD4+ T-lymphocytes initiate the reaction.
B. With Type IV hypersensitivity, sensitization develops rapidly following exposure to a specific allergen.
C. Once sensitized, upon reexposure immunologically committed lymphocytes react with the allergen (antigen) and release cytokines (i.e., lymphokines).
D. Lymphokines activate macrophages resulting in the release of histamine, leukotrienes, prostaglandins, chemokines, enzymes, and cytokines in target tissues.
All the following statements are correct with respect to delayed hypersensitivity reaction EXCEPT which one?
A. Identify drugs and other potential allergens to which the patient may have been exposed to in the clinical process.
B. Verify that the onset of signs and symptoms was 6 to 48 hours after the initiation of pharmacological or clinical intervention.
C. In the absence of respiratory distress prescribe diphenhydramine hydrochloride, 25 to 50 mg, PO, q.i.d; and arrange supervision of patient for at least 6 hours.
D. Instruct patient or caretaker that if wheezing develops to call you immediately.
All the following statements related to seizures are correct EXCEPT which one?
A. Seizures are a group of neurological disorders caused by excessive discharge of neurons in the medulla oblongata.
B. Seizures may lead to focal (motor, sensory (somatic, visual, auditory, olfactory), or psychomotor (automatisms, psychical); or generalized myoclonic, absence (petit mal), and tonic-clonic or grand mal seizures.
C. The cause of seizure may be genetic; or head trauma, hypoxia, infection (fever) pregnancy, drug or alcohol overdose or withdrawal.
D. Seizures may result from sensory input (e.g., sound, light, touch, and smell), hypoglycemia, circulatory disturbances, degenerative disorders, and tumors.
All the following statements related to the emergency response to grand mal seizure are correct EXCEPT which one?
A. Place patient in an upright position; protect patient from injury, i.e., guide the extremities during seizure, but do not restrain.
B. After the seizure is complete suction oral cavity if needed; position patient on his/her side (recovery position); administer oxygen, 4 to 6 L/min by nasal cannula.
C. Monitor vital signs: if at any time the patient becomes unresponsive, no normal breathing, and/or no palpable pulse notify EMS.
D. Signs of deterioration include persistent unconsciousness and respiratory depression progressing to respiratory arrest.
All the following statements related to stroke are correct EXCEPT which one?
A. Cerebrovascular accident or stroke is a syndrome associated with the interruption of blood supply to a portion of the brain causing neurologic deficit.
B. A stroke may be secondary to an evolving blood clot associated with atherosclerosis that progressively blocks a cerebral artery.
C. Most commonly, stroke is the result of an embolus that lodged in a cerebral artery obstructing blood flow or result from subarachnoid or intracerebral hemorrhage into brain tissue.
D. Stroke-like symptoms lasting less than 1 hour are termed transient ischemia attacks (TIA).
All the following statements related to the emergency response to a case of suspected stoke are correct EXCEPT which one?
A. Ask patient to smile – if the patient is experiencing stroke one side of face does not move at all.
B. Ask patient to raise both arms - if the patient is experiencing stroke one arm drifts compared to the other.
C. Ask the patient to repeat “you can’t teach an old dog new tricks,” – if the patient is experiencing stroke the words are slurred or inappropriate, or mute.
D. If the patient shows any abnormal symptoms compatible with stroke, place patient in a supine position and notify EMS.
All the following statements are correct with respect to local anesthetic toxicity EXCEPT which one?
A. Nonselective voltage-gated sodium channel blockade is responsible for LAs toxic properties.
B. Toxic reactions may result from an excessive initial dosage, or repeated doses.
C. Most commonly, toxic reactions result from rapid absorption or unintentional intravascular injection.
D. Toxic reactions may be due to low plasma protein binding, and slow metabolism or elimination of the LA or its metabolites.
Which of the following statements is correct with respect to the emergency response to local anesthetic toxicity?
A. Place patient in an upright or semi-reclining position.
B. Administer oxygen, 4 to 6 L/min by nasal cannula; notify EMS; monitor vital signs.
C. Signs of recovery: mental state improves, vital signs return to baseline values.
D. Signs of deterioration: altered consciousness progressing to coma; progressive respiratory and/or cardiac depression.
