Question 1

Which of the following types of health professionals can make the diagnosis of hypertension and decide on its treatment?&#10;A) physician&#10;B) dentist&#10;C) dental hygienist&#10;D) a, b, and c&#10;E) a and c only

Accepted Answer

Only a physician can make the diagnosis of hypertension and decide on its treatment.The dentist,however,should detect abnormal blood pressure measurements,which then become the basis for referral to or consultation with a physician.

Question 2

In prehypertension,diastolic pressure ranges from ________ mm Hg.&#10;A) 80 to 89&#10;B) 90 to 99&#10;C) 100 to 109&#10;D) 110 to 119

Accepted Answer

The Seventh Report of the Joint National Committee on Prevention,Detection,Evaluation,and Treatment of High Blood Pressure (JNC 7)introduced the new category of prehypertension,which encompasses the previously designated categories of normal and borderline hypertension.Normal blood pressure is 120/80 mm Hg.Prehypertension is systolic blood pressure ranging from 120 to 139 and diastolic pressure ranging from 80 to 89 mm Hg.

Question 3

Which of the following is recommended for stress management for dental patients with hypertension?&#10;A) afternoon appointments&#10;B) premedication with a barbiturate&#10;C) nitrous oxide plus oxygen for inhalation sedation&#10;D) keeping the dental chair in an upright position during treatment

Accepted Answer

Nitrous oxide plus oxygen for inhalation sedation is an excellent intraoperative anxiolytic for use in patients with hypertension.Care is indicated to ensure adequate oxygenation at all times,avoiding post-diffusion hypoxia at the termination of administration.Short morning appointments seem best tolerated.Oral premedication with a short-acting benzodiazepine can reduce anxiety for many patients.Because many of the antihypertensive agents tend to produce orthostatic hypotension as a side effect,rapid changes in chair position during dental treatment should be avoided.

Question 4

Which of the following is the most common cardiac condition in America?&#10;A) congestive heart failure&#10;B) cardiac arrhythmia&#10;C) hypertension&#10;D) angina

Accepted Answer

With 35 million office visits annually,hypertension is the most common primary diagnosis in America.According to National Health and Nutrition Examination Survey (NHANES)data for the period 1999 to 2000,at least 65 million adults in the United States have high blood pressure (HBP)or are taking antihypertensive medication.This estimate equals about one-fourth of the population and represents a 30% increase from 1988 to 1994.In a typical practice population of 2,000 patients,therefore,around 500 will have hypertension.

Question 5

Use of how many cartridges of 2% lidocaine with 1:100,000 epinephrine at one time is considered to have little clinical risk for dental treatment of a patient with hypertension?&#10;A) 2&#10;B) 4&#10;C) 6&#10;D) 8

Accepted Answer

The existing evidence indicates that use of modest doses (one or two cartridges of 2% lidocaine with 1:100,000 epinephrine)carries little clinical risk in patients with hypertension,the benefits of its use far outweighing any potential problems.Use of more than this amount at one time may be tolerated well enough but with increasing risk for adverse hemodynamic changes.

Question 6

Which of the following is an adverse drug interaction that may occur if a dental anesthetic containing a vasoconstrictor is administered to a patient being treated for hypertension with a non-selective β-adrenergic blocking agent?

A) hypotension
B) hypertension
C) respiratory alkalosis
D) respiratory acidosis

Accepted Answer

The basis for concern with use of non-selective β-adrenergic blocking agents (e.g.,propranolol)is that the normal compensatory vasodilation of skeletal muscle vasculature mediated by beta 2 receptors is inhibited by these drugs,and injection of epinephrine,levonordefrin,or any other pressor agent may result in uncompensated peripheral vasoconstriction because of unopposed stimulation of alpha 1 receptors.This vasoconstrictive effect could potentially cause a significant elevation in blood pressure and a compensatory bradycardia.

Question 7

Which of the following is most often the first drug category of choice if lifestyle modification is ineffective at lowering blood pressure?&#10;A) beta blockers (BBs)&#10;B) thiazide diuretics&#10;C) angiotensin-converting enzyme inhibitors (ACEIs)&#10;D) angiotensin receptor blockers (ARBs)

Accepted Answer

Thiazide diuretics are most often the first drugs of choice,given either alone or in combination with ACEIs,ARBs,BBs,or calcium channel blockers (CCBs),depending on the degree of elevation of blood pressure.For early stage 1 hypertension,single-drug therapy may be effective; however,for later stage 1 and for stage 2 hypertension,two or more drug combinations are necessary.The presence of certain comorbid conditions or factors,such as heart failure,previous MI,diabetes,or kidney disease,may be a compelling reason to select specific drugs or classes of drugs that have been found to be beneficial in clinical trials.

Question 8

It is estimated that about __% of all blood pressure-related deaths from coronary heart disease occur in persons with blood pressure in the prehypertensive range.&#10;A) less than 1&#10;B) 5&#10;C) 15&#10;D) 25

Accepted Answer

About 15%.However,the higher the blood pressure,the greater the chances of heart attack,heart failure,stroke,and kidney disease.For every increase in blood pressure of 20 mm Hg systolic and 10 mm Hg diastolic,a doubling of mortality related to ischemic heart disease and stroke occurs.

Question 9

Deferral of elective dental care and referral to a physician for evaluation and treatment within 1 week are indicated for patients found to have asymptomatic blood pressure of greater than or equal to ________ mm Hg.

A) 160/90
B) 160/110
C) 180/90
D) 180/110

Accepted Answer

Patients with blood pressures less than 180/110 mm Hg can undergo any necessary dental treatment,both surgical and nonsurgical,with very little risk of an adverse outcome.For patients found to have asymptomatic blood pressure of 180/110 mm Hg or greater (uncontrolled hypertension),elective dental care should be deferred,and physician referral for evaluation and treatment within 1 week is indicated.Patients with uncontrolled blood pressure associated with symptoms such as headache,shortness of breath,or chest pain should be referred to a physician for immediate evaluation.

Deck 3: Hypertension