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Best of Fives for Dentistry > Human disease > Flashcards

Human disease Flashcards

1
Q
  1. Which one of the following statements regards the resuscitation council’s recommendations of the ratio of compressions to breaths is correct?
    a. 15 compressions to 2 breaths if there is one rescuer
    b. 15 compressions to 2 breaths if there are two rescuers
    c. 30 compressions to 2 breaths if there is one rescuer
    d. 5 compressions to 1 breath if there are two rescuers
    e. The aim is to give 200 compressions per minute
A

 C. 30 compressions to 2 breaths if there is one rescuer
 The current resuscitation guidelines state that the aim is 30 compressions to 2 breaths, and that there should be 100 compressions per minute. This is the same regardless of the number of rescuers.

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2
Q
  1. A patient complains of severe chest pain while in the dental chair. Which one of the following is regarded as appropriate management?
    a. Administer glucose tablets orally.
    b. Lie the patient flat
    c. Lie the patient in the recovery position
    d. Administer intravenous glyceryl trinitrate (GTN)
    e. Give the patient oxygen
A

 E. Give the patient oxygen
 Sublingual GTN would be the correct route of administration in dental setting, not intravenous administration. Glucose would be useful if the patient was hypoglycaemic. Lying the patient flat or in the recovery position may make breathing more difficult for the patient, so this should be avoided.

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3
Q
  1. Which one of the following statements regarding Down’s syndrome is incorrect?
    a. It is caused by trisomy 21
    b. The incidence increases with the age of the mother
    c. Down’s patients suffer from microglossia
    d. Down’s patients suffer from cardiac anomalies
    e. Down’s patients have delayed eruption of their dentition.
A

 C. Down’s patients suffer from microglossia
 Down’s patients generally have macroglossia. They frequently have congenital cardiac anomalies which require antibiotic cover.

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4
Q
  1. A 35-year-old smoker has a productive cough with weight loss and drenching night sweats. A chest x-ray shows a right hilar mass with partial collapse of the upper lobe. What is the likely diagnosis?
    a. Pulmonary embolus
    b. Pneumonia
    c. Tuberculosis
    d. Smoker’s cough
    e. Asthma
A

 C. Tuberculosis
 This is the classic description of tuberculosis. Nodal enlargement is usually unilateral and may cause bronchial compression. Bronchial carcinoma is unlikely in someone so young but should be ruled out anyway. Pneumonia would be more acute and the patient would have dyspnoea.

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5
Q
  1. A 45-year-old alcoholic man is admitted with confusion, ataxia and ophthalmoplegia. He is thin and wasted. What vitamin deficiency does he have?
    a. Vitamin A
    b. Vitamin B1 (thiamine)
    c. Vitamin B12
    d. Vitamin D
    e. Vitamin K
A

 B. Vitamin B1 (thiamine)
 This patient has Wernicke’s encephalopathy (acute confusion, nystagmus, ataxia, variable ophthalmoplegia), caused by thiamine deficiency. If untreated this will lead to irreversible neurological damage.

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6
Q
  1. Which one of the following is not a feature of congestive cardiac failure?
    a. Breathlessness
    b. Bradycardia
    c. Raised jugular venous pressure
    d. Ankle oedema
    e. Central cyanosis
A

 B. Bradycardia
 As the cardiac output is decreased due to the cardiac failure, the heart rate will increase (tachycardia) to try to make up for this.

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7
Q
  1. Which one of the following statements regarding bacterial endocarditis is correct?
    a. It does not affect prosthetic heart valves.
    b. It does not occur while using a CPITN probe.
    c. In the UK, it is usually caused by streptococcus viridians.
    d. It may cause a hypochromic microcytic anaemia
    e. Is usually responds well to 2-week course of amoxicillin.
A

 C. In the UK, it is usually caused by streptococcus viridians.
 Bacterial endocarditis affects prosthetic heart valves as well as human heart valves. It can a occur during any probing procedure, scaling, use of a matrix band or extraction. It can cause a normochromic normocytic anaemia, and requires weeks of intravenous antibiotic to cure it.

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8
Q
  1. Which one of the following statements regarding atrial fibrillation is correct?
    a. It is uncommon in elderly people.
    b. It is treated with digoxin.
    c. It does not cause fainting in elderly people.
    d. There is a ‘p’ wave on an electrocardiogram (ECG).
    e. The thromboembolic risk is reduced by aspirin more than warfarin.
A

 B. It is treated with digoxin.
 Atrial fibrillation is common in elderly people and is diagnosed on an ECG due to the lack of a ‘p’wave. The fibrillation causes fainting in elderly people and can be treated with digoxin. Warfarin is more efficacious than aspirin at reducing the thromboembolic risk.

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9
Q
  1. Which one of the following statements regarding severe acute asthma is incorrect?
    a. The chest is never wheezy
    b. Both pulse and respiratory rate are high
    c. Sedation may be used to reduce anxiety
    d. Nebulised salbutamol may cause muscular tremors
    e. High percentage oxygen is required
A

 C. Sedation may be used to reduce anxiety
 Sedation will reduce the respiratory rate, which is entirely the opposite of what is required in severe acute asthma. Oxygen, nebulised salbutamol, steroids and theophylline are used to treat severe acute asthma.

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10
Q
  1. Sudden-onset shortness of breath is not associated with which one of the following conditions?
    a. Asthma
    b. Emphysema
    c. Pulmonary embolism
    d. Pneumothorax
    e. Foreign body inhalation
A

 B. Emphysema
 Emphysema is a chronic disease that leads to a decrease in lung function over a period of time, but it does not present with an acute shortness of breath.

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11
Q
  1. Which one of the following is not a feature of chronic liver disease?
    a. Spider naevi
    b. Ascites
    c. Dupuytren’s contracture
    d. Palmar erythema
    e. Pale stools
A

 E. Pale stools
 In chronic liver disease, the patient is likely to have dark stools. They are also likely to have jaundice, weight loss, and generalised pruritus.

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12
Q
  1. Which one of the following statements regarding jaundice is correct?
    a. It is always accompanied by dark stools and dark urine
    b. It is only caused by viral infections
    c. It is associated with pain and weight gain in carcinoma of the pancreas
    d. It causes the alanine aminotransferase (ALT) and alkaline phosphatase levels to be reduced
    e. It can be associated with post-extraction haemorrhage
A

 E. It can be associated with post-extraction haemorrhage
 Not all patients with jaundice have dark stools and dark urine. Jaundice can also be by bacterial infection, alcohol, prescription drugs and many other things. Carcinoma of the pancreas is generally painless and is associated with weight loss. ALT and alkaline phosphatase levels tend to increase rather than decrease in jaundice.

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13
Q
  1. Dysphagia is associated with which one of the following conditions?
    a. Lobal pneumonia
    b. Oesophageal carcinoma
    c. Hyperthyroidism
    d. Hypothyroidism
    e. Atrial fibrillation
A

 B. Oesophageal carcinoma
 Only in rare circumstances would a thyroid goitre lead to difficulties in swallowing. Oesophageal carcinoma causes progressive dysphagia, and this can have very rapid onset.

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14
Q
  1. A patient with uncontrolled thyrotoxicosis is unlikely to have:
    a. Increased sweating
    b. Heart block
    c. Resting tremor
    d. Lid retraction
    e. Diarrhoea
A

 B. Heart block
 Thyrotoxicosis is likely to cause atrial fibrillation and increased chronotropic rate rather than heart block.

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15
Q
  1. Weight gain is a feature of:
    a. Over-treatment with steroids
    b. Carcinoma of the stomach
    c. Inflammatory bowel disease
    d. Thyrotoxicosis
    e. Chemotherapy
A

 A. Over-treatment with steroids
 When patients are over-treated with steroids, they have a tendency to have centripetal weight gain. The distribution is known as a buffalo hump, and the patients is described as having a moot face. They are also at risk of osteoporosis, diabetes and immunosuppression.

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16
Q
  1. Patients who are on dialysis treatment are at risk of:
    a. Infections
    b. Malnutrition
    c. Bleeding diathesis
    d. All of the above
    e. None of the above
A

 D. All of the above
 Patients who are undertaking dialysis are at risk of infections, malnutrition and bleeding diathesis.

17
Q
  1. Which one of the following conditions are renal transplant patients not a risk of?
    a. Opportunistic infections
    b. Cancer
    c. Lymphomas
    d. Peptic ulcers
    e. Osteoporosis
A

 D. Peptic ulcers
 Transplant patients are prescribed steroids and immunosuppressants, which can lead to opportunistic infections and osteoporosis. They are also at an increased risk of cancer, especially lymphomas.

18
Q
  1. One of the physical signs of a left lower motor neurone lesion of the seventh cranial nerve is:
    a. Sparing of the muscles of the forehead on the same side
    b. An inability to close the right eye
    c. Loss of power in the left muscle of mastication
    d. Hyperacusis if the nerve to stapedius is involved
    e. Decreased sensation over the left maxilla and mandible
A

 D. Hyperacusis if the nerve to stapedius is involved.
 The muscles of mastication and the sensory innervations of the muscles of facial expression are served by the trigeminal nerve. The right eye will not be affected. If it is an upper motor neurone lesion, the muscle of the forehead will be spared. There is hyperacusis when the nerve to stapedius is involved

19
Q
  1. Which one of the following statements regarding trigeminal neuralgia is correct?
    a. The pain is continuous
    b. The pain involves more than one branch of the trigeminal nerve.
    c. There is a precise trigger point.
    d. Dental extraction may help.
    e. The drug of choice is a steroid.
A

 C. There is a precise trigger point.
 Trigeminal neuralgia is characterised by an electric shock-like shooting pain which involves one branch of the trigeminal nerve. There is a trigger point, or movement which precipitates the pain. It may be cold wind on the face, or shaving, or something like that. Patients often describe this pain as the worst pain imaginable and find no relief from conventional analgesia. It is treated with carbamazepine, which requires monitoring as it may cause deranged liver function tests and rarely an aplastic anaemia.

20
Q
  1. Which one of the following statements regarding warfarin is true?
    a. Warfarin treatment for a pulmonary embolus can be interrupted safely for 1 week when dental treatment is required.
    b. Warfarin causes reduction of clotting factors II, VII, IX and X
    c. Its effects can be reversed by protamine sulphate.
    d. Bleeding time is the monitoring test for warfarin
    e. It has a short life
A

 B. Warfarin causes reduction of clotting factors II, VII, IX and X
 Warfarin causes the production of altered clotting factors II, VII, IX and X. It has a long half life of between 48 and 72 hours. It is metabolised in the liver. IT is monitored using INR, and patients carry a yellow anticoagulation booklet. It is a teratogenic drug and should be avoided in pregnancy. Protamine sulphate is the reversal agent for heparin. The reversal agent for warfarin is vitamin K.

21
Q
  1. Which one of the following is not a cause of a neck lump?
    a. Goitre
    b. Lymphadenopathy
    c. Cystic hygroma
    d. Thyroglossal duct cyst
    e. Subungual naevus
A

 E. Subungual naevus
 A subungual naevus is found under the nail of a toe or less commonly a finger, therefore is not found in the neck. It may be a premalignant lesion.

22
Q
  1. Which one of the following is not used in the treatment of anaphylaxis?
    a. Intramuscular adrenaline injection
    b. Intramuscular chlorphenamine injection
    c. Hydrocortisone intravenous injection
    d. Intravenous diazepam
    e. Oxygen
A

 D. Intravenous diazepam
 The treatment of anaphylaxis consists of adrenaline, chlorphenamine (anti-histamine), hydrocortisone (steroid), oxygen, intravenous normal saline.

23
Q
  1. A patient who weight 90kg and is 1m and 82cm tall has a body mass index of:
    a. 18
    b. 21
    c. 24
    d. 27
    e. 30
A

 D. 27
 The body mass index is calculated by the weight (in kg) divided by the height squared (in metres).

24
Q
  1. Which one of the following circumstances would not raise suspicion of physical abuse in a child?
    a. A skull fracture in a 6-week-old baby who allegedly rolled off the bed.
    b. A torn lingual fraenum in a 2-year-old child.
    c. Bruises of various ages over the shins of a 6-year-old child.
    d. Bruises of various ages over the back and buttocks of an 8-year-old child.
    e. A report by an 8-year-old sibling of an excessive beating.
A

 D. Bruises of various ages over the shins of a 6-year-old child.
 When a child is brought to hospital with an injury, a number of features may raise suspicion of abuse. These include injuries incompatible with the child’s age (6-week-old babies cannot roll over), injuries in unusual places and a direct allegation of abuse by the child, a sibling or another adult.

25
Q
  1. Which one of the following is a general contraindication to immunisation?
    a. The presence of coryzal symptoms without significant fever.
    b. A history of a fever up to 38*C following a previous vaccine.
    c. High-dose corticosteroid therapy when using a live vaccine.
    d. A family history of febrile convulsions.
    e. A history of severe eczema
A

 C. High-dose corticosteroid therapy when using a live vaccine.
 Ture contraindications to immunisation include acute illnesses, not minor infections without fever or systemic upset. A history of a previous severe local reaction or a severe general reaction within 72 hours of vaccination is a valid contraindication. Live virus vaccines should not be administered to immunosuppressed individuals, including patients receiving high-dose corticosteroids for more than 1 week in the past 3 months, those with malignancies and those receiving chemotherapy.

26
Q
  1. Which one of the following statements about chickenpox is incorrect?
    a. It may be contracted by contract with fluid from vesicles.
    b. It is infectious for 7 days after all vesicles have crusted over
    c. It is potentially life-threatening in children receiving cancer chemotherapy.
    d. Encephalitis is generally benign and, in most cases, resolves completely.
    e. It is a recognised cause of congenital malformation when the mother is affected in the first 5 months of pregnancy.
A

 B. It is infectious for 7 days after all vesicles have crusted over.
 Varicella virus is spread by respiratory tract droplets or by contact with fluid from vesicles which contain large amounts of virus. Affected individuals cease to be infectious once the last crop of vesicles has dried out. Chicken pox is generally a benign illness but is potentially dangerous to the immunocompromised and to the fetus.

27
Q
  1. Which one of the following statements regarding HIV in children is false?
    a. In most cases it is due to administration of contaminated blood products.
    b. It may present with Pneumocystis pneumoniae
    c. It may present with neurological signs in the absence of immunodeficiency.
    d. It is more likely to present with recurrent bacterial infections that in adults.
    e. It may be acquired by breastfeeding from an infected mother.
A

 A. In most cases it is due to administration of contaminated blood products.
 Most HIV infection in children results from vertical transmission from an infected mother. Symptomatic disease presents with infections typical of immunocompromised individual, but bacterial infection is more common in infants than in adults, probably because of the infant’s relative immunoglobulin deficiency.

28
Q
  1. A 4-month-old boy requires surgery if he is found to have:
    a. A non-retractile foreskin
    b. Bilateral hydrocoeles
    c. A left inguinal hernia
    d. An undescended right testis
    e. An umbilical hernia
A

 C. Left inguinal hernia

29
Q
  1. Which one of the following findings make a diagnosis of asthma unlikely?
    a. Lobar collapse identified on a chest x-ray.
    b. Cough that only occurs during vigorous exercise.
    c. Absence of a family history of asthma.
    d. Failure to improve after 2 weeks on high-dose oral steroids.
    e. A cough productive of sputum.
A

 D. Failure to improve after 2 weeks on high-dose oral steroids.
 A central component of asthma is airway inflammation, and if there is no improvement with corticosteroids, the diagnosis should be reconsidered. The inflammation causes hypersecretion of mucus which may lead to lobar collapse by mucus plugging or a productive cough. Although a family history of asthma in children is common, it is not necessary for the diagnosis. Some children’s symptoms are exclusively induced by exercise.

30
Q
  1. In the treatment of asthma:
    a. Most children over 6 years of age can use a metered dose of aerosol effectively without a spacer.
    b. The use of regular inhaled steroid is limited by a high incidence of side effects.
    c. Advise should be given to restrict the child’s participation in sport.
    d. Oral corticosteroids should be reserved only for children who require hospital admission.
    e. Regular anti-inflammatory treatment should be recommended for a child who requires a bronchodilator most days.
A

 E. Regular anti-inflammatory treatment should be recommended for a child who requires a bronchodilator most days.
 Frequent bronchodilator use suggests chronic asthma for which anti-inflammatory treatment would be appropriate. Children (and many adults) have difficulty with the co-ordination required to use metered dose inhalers effectively. Asthmatic children are best treated with inhaled drug delivered via a spacer device or dry metered powder inhaler. The aim of therapy should be to control symptoms to permit a normal life, including participation in sport. Oral corticosteroids are useful in controlling chronic symptoms refractors to inhaled therapy, or in preventing deterioration which would be likely to lead to hospital admission.

31
Q
  1. Which two drugs should be given to a patient you suspect as having myocardial infarction?
    a. Aspirin and warfarin
    b. Aspirin and paracetamol
    c. Aspirin and clopidogrel
    d. Paracetamol and warfarin
    e. Paracetamol and clopidogrel
A

 C. Aspirin and clopidogrel
 The correct treatment for a patient suspected of having a myocardial infarction is 300mg aspirin and 600mg clopidogrel.

32
Q
  1. A 58-year-old woman who has a history of breast cancer presents with jaundice. What is the likely diagnosis?
    a. Hepatitis B
    b. Metastatic disease
    c. Biliary cirrhosis
    d. Anaemia
    e. Hepatocellular carcinoma
A

 B. Metastatic disease
 Breast cancer metastasises to bone and to the liver. Therefore this is the most likely diagnosis. A patient would be unlikely to have had breast cancer and then have a hepatocellular carcinoma.

33
Q
  1. A 25-year-old Asian man presents with fever, night sweats and cervical lymphadenopathy. What is the likely diagnosis?
    a. Oral cancer
    b. Human immunodeficiency virus (HIV) infection
    c. Tuberculosis
    d. Lung cancer
    e. Pneumonia
A

 C. Tuberculosis
 The most likely diagnosis is tuberculosis. A 25-year-old is unlikely to have a malignancy. The fever, night sweats and lymphadenopathy in a patient of Asian origin is a classical history of tuberculosis.

34
Q
  1. A 65-year-old man presents with a markedly raised white cell count and an enlarged spleen. What is the likely diagnosis?
    a. Leukaemia
    b. Hepatocellular carcinoma
    c. Pneumonia
    d. Ovarian carcinoma
    e. Adenocarcinoma
A

 A. Leukaemia
 A patient with splenic enlargement and a markedly raised white cell count is likely to have chronic myeloid leukaemia. The patient is also likely to be tired and have reduced exercise tolerance.

35
Q
  1. A patient has stayed in a hotel for a week and contracts pneumonia. The likely causative organism is:
    a. Chlamydia psittaci
    b. Streptococcus pneumoniae
    c. Legionella pneumophila
    d. Mycoplasma pneumoniae
    e. Haemophilus influenzae
A

 C. Legionella pneumophila
 Legionnaire disease is a potentially fatal form of pneumonia that can affect anybody, but which principally affects those who are susceptible because of age, illness, immunosuppression, smoking etc.

36
Q
  1. A Yorkshire man who races pigeons presents with a pneumonia. The most likely causative organism is:
    a. Chlamydia psittaci
    b. Streptococcus pneumoniae
    c. Legionella pneumophilia
    d. Mycoplasma pneumoniae
    e. Haemophilus influenzae
A

 B. Streptococcus pneumoniae

Best of Fives for Dentistry (10 decks)

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