Little and Falaces Dental Management

of the Medically Compromised Patient

8th Edition Little Test Bank
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 Little: Dental Management of the Medically Compromised Patient,
8th Edition
Chapter 10: Liver Disease

Test Bank

MULTIPLE CHOICE

1. Which of the following is a form of infectious (rather than serum) hepatitis?

A. hepatitis A
B. hepatitis B
C. hepatitis C
D. hepatitis D

ANS: A
Hepatitis A and hepatitis E are forms of infectious hepatitis; they are spread largely by
the fecal-oral route, are associated with poor sanitary conditions, are highly contagious,
occur in outbreaks as well as sporadically, and cause self-limited hepatitis only. Hepatitis
B, hepatitis C, and hepatitis D are forms of serum hepatitis, are spread largely by
parenteral routes and less commonly by intimate or sexual exposure, and are not highly
contagious but instead occur sporadically and rarely cause outbreaks.

PTS: 1 REF: p. 145

2. Which of the following is thought to be the major factor in the pathogenesis of liver
injury?
A. antibody-dependent cellular cytotoxicity
B. proinflammatory cytokines
C. cytotoxic T cell responses
D. natural killer cell activity

ANS: C
The timing and histologic appearance of hepatocyte injury in viral hepatitis suggest that
immune responses, particularly cytotoxic T cell responses to viral antigens expressed on
hepatocyte cell membranes, may be the major effectors of injury. Other proinflammatory
cytokines, natural killer cell activity, and antibody-dependent cellular cytotoxicity also
may play modulating roles in cell injury and inflammation during acute viral hepatitis
infection.

PTS: 1 REF: p. 145

3. Which of the following is the most reliable prognostic factor in acute hepatic failure due
to hepatitis?
A. changes in personality
B. the degree of prolongation of prothrombin time

Copyright © 2013 by Mosby, an imprint of Elsevier Inc.

 Test Bank 10-2

C. serum aminotransferase levels

D. viral titers

ANS: B
Prolongation of the prothrombin time is the most reliable prognostic factor. The initial
symptoms, such as changes in personality, aggressive behavior, and abnormal sleep
patterns, may be subtle or misunderstood. Serum aminotransferase levels and viral titers
have little prognostic value and often decrease with worsening hepatic failure.

PTS: 1 REF: p. 146

4. (A/An) _______________ syndrome develops during the preicteric phase in

approximately 10% to 20% of patients with acute hepatitis.
A. chronic fatigue
B. irritable bowel
C. serum sickness–like
D. aspirin triad syndrome

ANS: C
In 10% to 20% of patients with acute hepatitis, a serum sickness–like syndrome marked
by variable combinations of rash, arthralgias, and fever develops during the preicteric
phase. This immune complex syndrome often is mistakenly attributed to other illnesses
until the onset of jaundice, at which time the fever, hives, and arthralgias quickly resolve.

PTS: 1 REF: p. 146

5. Which of the following is true regarding the diagnosis of acute viral hepatitis?
A. Acute viral hepatitis is marked by a prominent fibrosis observed during histologic
evaluation.
B. Immunohistochemical stains for hepatitis antigens are positive during the acute
disease.
C. There are reliably distinctive features in the liver that separate the five viral forms
of acute hepatitis from one another.
D. Serologic tests are adequate for the diagnosis of acute viral hepatitis, so liver
biopsy is not recommended unless the diagnosis remains unclear and a therapeutic
decision is needed.

ANS: D
Serologic tests are adequate for diagnosis. If biopsy is required, the histologic pattern in
acute viral hepatitis is characterized by widespread parenchymal inflammation and spotty
necrosis. Inflammatory cells are predominantly lymphocytes, macrophages, and
histiocytes. Fibrosis is absent. Immunohistochemical stains for hepatitis antigens
generally are negative during the acute disease, and there are no reliably distinctive
anatomic features in the liver that separate the five viral forms of acute hepatitis from
each other.

Copyright © 2013 by Mosby, an imprint of Elsevier Inc.

 Test Bank 10-3

PTS: 1 REF: p. 146-147

6. Which of the following is the most common means by which hepatitis A is spread?
A. consumption of shellfish from contaminated waterways
B. fecal contamination of food or water
C. direct person-to-person exposure
D. blood transfusions

ANS: C
Investigation of the sources of infection for hepatitis A reveals that most cases are due to
direct person-to-person exposure and, to a lesser extent, to direct fecal contamination of
food or water. Consumption of shellfish from contaminated waterways is a well-known
but quite uncommon means of acquiring hepatitis A. Rare instances of hepatitis A being
spread by blood transfusions and administration of pooled plasma products have been
described.

PTS: 1 REF: p. 148

7. Which of the following is associated with immunity to hepatitis B?

A. HBsAg
B. HBcAg
C. HBeAg
D. Anti-HBs
E. Anti-HBe

ANS: D
Anti-HBs is a long-lasting antibody that is associated with immunity. Generally, HBV
DNA and HBeAg begin to fall at the onset of illness and may be undetectable at the time
of peak clinical illness. HBsAg becomes undetectable and anti-HBs appears during
recovery, several weeks to months after loss of HBsAg.

PTS: 1 REF: p. 150

8. Which of the following is true regarding prevaccination screening and booster doses of
hepatitis B vaccine?
A. Prevaccination screening and booster doses are recommended for all persons
receiving the hepatitis B vaccination.
B. Prevaccination screening is not recommended; however, booster doses are
recommended for all persons receiving the hepatitis B vaccination.
C. Prevaccination screening is not recommended except for adults in high-risk
groups. Booster doses are not routinely recommended but may be appropriate for
persons at high risk if titers of anti-HBs fall below what is considered protective.
D. Neither prevaccination screening, nor booster doses of hepatitis B vaccine are
recommended for anyone.

ANS: C

Copyright © 2013 by Mosby, an imprint of Elsevier Inc.

 Test Bank 10-4

Prevaccination screening for anti-HBs is not recommended except in adults in high-risk

groups. Postvaccination testing for anti-HBs to document seroconversion is not
recommended routinely except in persons whose subsequent clinical management
depends on knowledge of their immune status, particularly health care and public safety
workers. At present, booster doses are not recommended but may be appropriate for
persons at high risk if titers of anti-HBs fall below what is considered protective (10
IU/mL). Current guidelines published by the Centers for Disease Control and Prevention
(CDC) Advisory Committee on Immunization Practices recommend booster doses only
for persons who did not respond to the primary vaccine series.

PTS: 1 REF: pp. 150

9. Which of the following is the most common means of transmission of hepatitis C?

A. maternal-infant
B. sexual exposure
C. injection drug use
D. needlestick accidents

ANS: C
Current studies of acute hepatitis C indicate that more than 60% of cases are attributable
to injection drug use; 15% to 20% to sexual exposure; and only a small proportion to
maternal-infant spread, needlestick accidents, and iatrogenic causes. Approximately 10%
of cases are not associated with any history of potential exposure and remain
unexplained.

PTS: 1 REF: p. 151

10. Which of the following hepatitis viruses is second most likely (following hepatitis B) to
be transmitted occupationally to a dental healthcare worker?
A. HAV
B. HCV
C. HEV
D. non-A-E

ANS: B
Little to no risk exists for transmission of HAV, HEV, and non-A-E hepatitis viruses
from occupational exposure of dental health care workers to persons infected with these
viruses. Risk for transmission of HBV is well recognized, and a lesser risk is present for
HCV infection after occupational exposure to infected blood or body fluids containing
infected blood. After percutaneous or other sharps injury in health care workers involving
exposure to contaminated blood, the risk of contracting HBV infection is reported to
range from 6% to 30%. The seroconversion rate for accidental blood exposure to HCV is
between 2% and 8%.

PTS: 1 REF: p. 154

Copyright © 2013 by Mosby, an imprint of Elsevier Inc.

 Test Bank 10-5

11. Chronic active hepatitis B is diagnosed by the presence of ______ in blood serum.
A. HBsAg
B. HBcAg
C. HBeAg
D. a, b, and c
E. a and c

ANS: E
Chronic active hepatitis B is characterized by HBsAg and HBeAg in the serum, signs and
symptoms of chronic liver disease, persistent hepatic cellular necrosis, and elevation of
liver enzymes for longer than 6 months.

PTS: 1 REF: p. 149

12. According to CDC guidelines, what should be done first if a vaccinated health care
worker sustains a needlestick or puncture wound involving exposure to blood from a
patient known to be HBsAg-positive?
A. Nothing, because the health care worker has already been vaccinated.
B. The health care worker should be tested for an adequate titer of anti-HBs if those
levels are unknown.
C. The health care worker should immediately receive an injection of HBIG.
D. The health care worker should immediately receive an injection of the hepatitis B
vaccine as a booster dose.

ANS: B
The health care worker should be tested for an adequate titer of anti-HBs. If the levels are
inadequate, the worker should immediately receive an injection of HBIG and a vaccine
booster dose. If the antibody titer is adequate, however, nothing further is required.

PTS: 1 REF: p. 162

13. Which of the following is true of the pathophysiology of alcoholic liver disease?
A. Fatty liver is not reversible.
B. Alcoholic hepatitis may be fatal if damage is widespread.
C. In some patients with cirrhosis, blood from bleeding ulcers and esophageal varices
is incompletely metabolized to ammonia.
D. a and b
E. b and c

ANS: E
Fatty liver is considered completely reversible. For the most part, alcoholic hepatitis is
considered a reversible condition; however, it can be fatal if damage is widespread. In
some patients with cirrhosis, blood is metabolized to ammonia, which travels to the brain
and contributes to encephalopathy.

PTS: 1 REF: p. 163

Copyright © 2013 by Mosby, an imprint of Elsevier Inc.

 Test Bank 10-6

14. Which of the following tests is the best way to screen for problems before dental
treatment of an alcoholic patient?
A. bilirubin total
B. alkaline phosphatase total
C. LDH total
D. a complete blood count (CBC)

ANS: D
A CBC with differential and determinations of AST and ALT, bleeding time, thrombin
time, and prothrombin time are sufficient to screen for potential problems. Abnormal
laboratory values, on a background of suggestive findings on the clinical examination or
a positive history, constitute the basis for referral to a physician for definitive diagnosis
and treatment.

PTS: 1 REF: p. 165-166

15. Which of the following types of breath odor is associated with liver failure?
A. sweet, musty
B. breadlike
C. ammonia
D. garlic

ANS: A
A sweet, musty odor to the breath is associated with liver failure, as is jaundiced mucosal
tissue.

PTS: 1 REF: p. 166-167

Copyright © 2013 by Mosby, an imprint of Elsevier Inc.