Chapter 09: Oral Manifestations of Systemic Diseases

Ibsen: Oral Pathology for the Dental Hygienist, 7th Edition

Multiple Choice

1. Excess production by the anterior pituitary gland is termed a. hyperparathyroidism. b. hyperthyroidism. c. hyperpituitarism. d. hyperglycemia.

ANS: C

Excess production by the anterior pituitary gland is termed hyperpituitarism. Hyperparathyroidism results from excess secretion of parathyroid hormone, which is secreted by the parathyroid glands. Hyperthyroidism is characterized by excessive production of thyroid hormone. Hyperglycemia can result from a lack of the hormone insulin, defective insulin that does not work effectively to lower blood glucose levels, or increased insulin resistance because of obesity.

REF: Hyperpituitarism, page 272 OBJ: 1

2. The most common cause of hyperpituitarism is a. hepatomegaly. b. hypercalcemia. c. pituitary adenoma. d. hyperglycemia.

ANS: C

The most common cause of hyperpituitarism is pituitary adenoma. Hepatomegaly is an enlargement of the liver. Hypercalcemia is an excess of calcium in the blood. Hyperglycemia is an excess of glucose in the blood.

REF: Hyperpituitarism, page 272 OBJ: 1

3. Characteristics of acromegaly include a. an increase in growth hormone production before the closure of long bones. b. a rapid and dramatic onset. c. thinned lips and microglossia. d. enlargement of the maxilla and mandible, resulting in separation of the teeth and malocclusion.

ANS: D

Characteristics of acromegaly include enlargement of the maxilla and mandible, resulting in separation of the teeth and malocclusion. Acromegaly is an increase in growth hormone production during adult life. Gigantism results when there is an increase in growth hormone production before the closure of long bones. Acromegaly affects both men and women and most commonly occurs in the fourth decade of life. The onset of acromegaly is slow and insidious. Mucosal changes such as thickened lips and macroglossia have been described in patients with acromegaly.

REF: Hyperpituitarism, page 272 OBJ: 2

4. The most common cause of hyperthyroidism is a. hyperplasia of the gland. b. benign and malignant tumors of the gland. c. pituitary gland disease. d. an autoimmune disorder.

ANS: D

The most common cause of hyperthyroidism is an autoimmune disorder called Graves’ disease. The exact cause of Graves’ disease is not clear, but a substance is produced that abnormally stimulates the thyroid gland. Other causes of hyperthyroidism include hyperplasia of the gland, benign and malignant tumors of the thyroid, pituitary gland disease, and metastatic tumors. Hyperplasia of the thyroid gland is one of the causes of hyperthyroidism; however, the most common cause of hyperthyroidism is an autoimmune disorder called Graves’ disease. Benign and malignant tumors of the thyroid gland are one of the causes of hyperthyroidism; however, the most common cause of hyperthyroidism is an autoimmune disorder called Graves’ disease. Pituitary gland disease is one of the causes of hyperthyroidism; however, the most common cause of hyperthyroidism is an autoimmune disorder called Graves’ disease.

REF: Hyperthyroidism (Thyrotoxicosis, Graves Disease), page 272

OBJ: 3 a. Gigantism b. Exophthalmos c. Myxedema d. Hypercalcemia

5. Which clinical feature is associated with hyperthyroidism?

ANS: B

In addition to exophthalmos, clinical features of hyperthyroidism include rosy complexion, erythema of the palms, excessive sweating, fine hair, and softened nails. Anxiety, weakness, restlessness, and cardiac problems may be associated with the disorder. Gigantism results if an increase in growth hormone production occurs before the closure of long bones. Myxedema occurs when a decreased output of thyroid hormone in older children and adults exists. When hypothyroidism is present during infancy and childhood, it is known as cretinism. Hypercalcemia is associated with hyperparathyroidism.

REF: Hyperthyroidism (Thyrotoxicosis, Graves Disease), Clinical Features and Oral Manifestations, page 273 OBJ: 3

6. An enlarged tongue is associated with a. hyperpituitarism. b. hyperthyroidism. c. hypothyroidism. d. hyperparathyroidism.

ANS: C

An enlarged tongue is associated with hypothyroidism. Causes of hypothyroidism include developmental disturbances, autoimmune disease, iodine deficiency, drugs, and pituitary disease. In infants, facial and oral changes include thickened lips, enlarged tongue, and delayed eruption of teeth. Clinical features of hyperpituitarism include gigantism if the increase in growth hormone production occurs before the closure of long bones and acromegaly after the closure of long bones. Clinical features of hyperthyroidism include rosy complexion, erythema of the palms, excessive sweating, fine hair, and softened nails. Clinical manifestations associated with hyperparathyroidism are varied. Joint pain or stiffness may be present. The disease can affect the kidneys, skeletal system, and gastrointestinal system. Lethargy and coma can occur in severe disease.

REF: Hypothyroidism (Cretinism, Myxedema), page 273 OBJ: 3 a. It is characterized by low blood levels of calcium. b. It is characterized by high levels of blood phosphorus. c. Primary hyperparathyroidism occurs when calcium is abnormally excreted by the kidneys and the parathyroid glands increase their production of parathyroid hormone to maintain adequate blood levels of calcium. d. Kidney failure is the most common cause of secondary hyperparathyroidism.

7. Which statement is characteristic of hyperparathyroidism?

ANS: D

Kidney failure is the most common cause of secondary hyperparathyroidism.

Hyperparathyroidism is characterized by elevated blood levels of calcium. Hyperparathyroidism is characterized by low levels of blood phosphorus. Primary hyperparathyroidism results from an abnormality of the parathyroid glands. Secondary hyperparathyroidism occurs when calcium is abnormally excreted by the kidneys and the parathyroid glands increase their production of parathyroid hormone to maintain adequate blood levels of calcium.

REF: Hyperparathyroidism, page 273 OBJ: 4

8. Hyperparathyroidism may result in bone lesions that appear microscopically to be indistinguishable from a(n) a. osteogenic sarcoma. b. osteoma. c. cemento-osseous dysplasia. d. central giant cell granuloma.

ANS: D

Hyperparathyroidism may result in bone lesions that appear microscopically to be indistinguishable from a central giant cell granuloma. Other radiographic changes that occur in hyperparathyroidism include a generalized mottled appearance of the bone and partial loss of the lamina dura. Loosening of teeth can also occur. Hyperparathyroidism may result in bone lesions that appear microscopically to be indistinguishable from a central giant cell granuloma rather than osteogenic sarcoma. Hyperparathyroidism may result in bone lesions that appear microscopically to be indistinguishable from a central giant cell granuloma rather than osteoma. Hyperparathyroidism may result in bone lesions that appear microscopically to be indistinguishable from a central giant cell granuloma rather than cemento-osseous dysplasia.

REF: Hyperparathyroidism, Clinical Features and Oral Manifestations, page 273

OBJ: 4

9. Insulin is manufactured by a. fatty tissue in long bones. b. beta cells of the pancreas. c. the liver. d. the gallbladder.

ANS: B

Insulin is manufactured by beta cells of the pancreas. Insulin is then secreted directly into the bloodstream to facilitate the uptake of glucose into fat and skeletal muscle cells. Fat and skeletal muscle cells can use glucose as an energy source in the presence of insulin. The cells are starved of energy when insulin is lacking. Insulin is manufactured by beta cells of the pancreas rather than by fatty tissue in long bones. Insulin is manufactured by beta cells of the pancreas rather than by the liver. Insulin is manufactured by beta cells of the pancreas rather than by the gallbladder.

REF: Diabetes Mellitus, page 274 OBJ: 6 a. It is called non-insulin–dependent diabetes mellitus. b. About 30% of all patients with diabetes have type 1 diabetes. c. The onset of this type of diabetes is gradual and usually occurs in patients who are 35 to 40 years of age or older. d. It can be complicated by polydipsia, polyuria, and polyphagia.

10. Which statement about type 1 diabetes is true?

ANS: D

Type 1 diabetes can be complicated by polydipsia (excessive thirst and intake of fluid), polyuria (excessive urination), and polyphagia (excessive appetite). It is called insulindependent diabetes mellitus. Only 3% of all diabetic patients have this type of diabetes. Type 1 diabetes can occur at any age, but its time of onset is usually at a peak age of 20 years. The onset is abrupt.

REF: Insulin-Dependent Diabetes Mellitus, Pathology, and Clinical Management, page 275

OBJ: 6

11. Advantages of an insulin pump for therapy of type 1 diabetes include a. blood sugar levels no longer need to be monitored. b. the pump is internal. c. the pump can maintain a more predictable control of blood sugar levels than multiple insulin injections. d. the insulin dosage with the pump is limited to once-a-day dosing.

ANS: C

Advantages of an insulin pump for therapy of type 1 diabetes include the ability of the pump to maintain more predictable control of blood sugar levels than multiple insulin injections. The patient must still monitor blood sugar levels by testing several times a day. The insulin pump is external and approximately the size of a pager; it delivers insulin through plastic tubing placed under the skin. The patient programs the pump to deliver small amounts of rapidly acting insulin on the hour over a 24-hour period according to the patient’s metabolic needs.

REF: The Insulin Pump, page 276 OBJ: 6

12. The most common cause of death among patients with diabetes is a. stroke. b. gangrene. c. heart attack. d. kidney failure.

ANS: C

The most common cause of death among diabetics is heart attack. Atherosclerosis of the coronary arteries increases the risk of ulceration and gangrene of the feet, high blood pressure, kidney failure, and stroke. Gangrene of the lower extremities is about 100 times more common in patients with diabetes than in the general population. The most common cause of death among patients with diabetes is heart attack and not stroke. Heart attack is caused by atherosclerosis of the coronary arteries, which also increases the risk for stroke. The most common cause of death among patients with diabetes is heart attack and not gangrene. Heart attack is caused by atherosclerosis of the coronary arteries, which also increases the risk for gangrene of the feet. The most common cause of death among patients with diabetes is heart attack and not kidney failure. Heart attack is caused by atherosclerosis of the coronary arteries, which also increases the risk for kidney failure.

REF: Complications of Type 1 Diabetes., page 276

OBJ: 6 a. Patients with diabetes mellitus have a decreased response to plaque. b. Slow wound healing and decreased susceptibility to infection occur as a result of the immunologic changes and defective collagen production. c. The gingiva can be hyperplastic and erythematous. d. Periodontal disease is not considered to be a complication of diabetes.

13. Which statement is true concerning oral complications for adult patients with diabetes mellitus?

ANS: C

The gingiva can be hyperplastic and erythematous, and acute and fulminating gingival abscesses can occur. Patients with diabetes mellitus have an accentuated response to plaque. Excessive periodontal bone loss, tooth mobility, and early tooth loss can also be associated with diabetes mellitus. Slow wound healing and increased susceptibility to infection occur as a result of the immunologic changes and defective collagen production. Periodontal disease is considered to be a complication of diabetes.

REF: Gestational Diabetes, Clinical Features and Oral Manifestations of Diabetes, page 278

OBJ: 6

14. Pernicious anemia is caused by a deficiency of intrinsic factor, which is secreted by a. beta cells of the pancreas. b. parietal cells of the stomach. c. the gallbladder. d. the adrenal glands.

ANS: B

Pernicious anemia is caused by a deficiency of intrinsic factor, which is secreted by parietal cells of the stomach. Intrinsic factor is necessary for the absorption of vitamin B12. Normally, vitamin B12 is transported across the intestinal mucosa by intrinsic factor. Insulin is secreted by beta cells of the pancreas. Bile is secreted by the gallbladder. Adrenalin is secreted by the adrenal glands.

REF: Pernicious Anemia, page 280 OBJ: 8

15. A megaloblastic anemia is characterized by red blood cells that are a. hypochromic and macrocytic. b. hyperchromic and macrocytic. c. microcytic and have nuclei. d. macrocytic and have nuclei.

ANS: D

A megaloblastic anemia is characterized by red blood cells that are immature, macrocytic (abnormally large), and have nuclei (megaloblasts). Immature neutrophils and platelets are also seen both in the bone marrow and the circulating blood. A megaloblastic anemia is characterized by red blood cells that are macrocytic and have nuclei. In iron deficiency anemia the red blood cells appear lighter in color (hypochromic) and smaller than normal (microcytic). A megaloblastic anemia is characterized by red blood cells that are macrocytic and have nuclei. In iron deficiency anemia, the red blood cells appear lighter in color (hypochromic) and smaller than normal (microcytic). A megaloblastic anemia is characterized by red blood cells that are immature, macrocytic (abnormally large), and have nuclei (megaloblasts).

REF: Pernicious Anemia, Diagnosis and Treatment, page 281 OBJ: 8

16. Thalassemia is a. caused by an abnormal type of hemoglobin in red blood cells. b. a disorder of hemoglobin synthesis. c. caused by a severe depression of bone marrow activity. d. caused by an increase in the number of circulating red blood cells.

ANS: B

Thalassemia is a disorder of hemoglobin synthesis. It has an autosomal inheritance pattern; no predilection for either sex is seen. Sickle cell anemia is caused by an abnormal type of hemoglobin in red blood cells. Aplastic anemia is caused by a severe depression in bone marrow activity. Polycythemia is caused by an increase in the number of circulating red blood cells.

REF: Thalassemia, page 281 OBJ: 9

17. Mediterranean or Cooley anemia a. is caused by a deficiency of vitamin B12. b. has a sex-linked inheritance pattern and occurs predominantly in males. c. is called thalassemia major in the homozygous form. d. is caused by a dietary deficiency of folic acid.

ANS: C

Mediterranean or Cooley anemia is called thalassemia major in the homozygous form, in which the genes on both chromosomes are involved. It is associated with severe hemolytic anemia, which results from damage to the red blood cell membranes and destruction of the red blood cells. Pernicious anemia is a vitamin B12 deficiency that is caused by a deficiency of intrinsic factor. Mediterranean or Cooley anemia has an autosomal inheritance pattern, and no predilection for either sex is seen. Dietary deficiencies of folic acid and vitamin B12 can result in anemia and can occur in association with malnutrition and increased metabolic requirements; however, Mediterranean or Cooley anemia is not caused by a dietary or folic acid deficiency.

REF: Thalassemia, page 281 OBJ: 9 a. Sickle cell anemia b. Aplastic anemia c. Thalassemia d. Pernicious anemia

18. A “salt and pepper” effect may be noted on intraoral radiographic images of a patient with which type of anemia?

ANS: C

A “salt and pepper” effect may be noted on intraoral radiographic images of a patient with thalassemia. Intraoral radiographs of a patient with thalassemia show a peculiar trabecular pattern of the maxilla and mandible. The “salt and pepper” effect is the result of the prominence of some trabeculae and a blurring and disappearance of others. Thinning of the lamina dura and circular radiolucencies in the alveolar bone have also been described. Changes in the skulls of patients with sickle cell anemia have been described as a “hair-onend” pattern because the trabeculae radiate outward. In aplastic anemia, patients experience a dramatic decrease in all circulating blood cells because of a severe depression of bone marrow activity. The diagnosis of pernicious anemia is made by laboratory testing.

REF: Thalassemia, Clinical Features and Oral Manifestations, page 282

OBJ: 9

19. Because of an abnormal type of hemoglobin in the red blood cells of a patient with sickle cell anemia, the cells develop a sickle shape in the presence of a. low blood sugar. b. decreased oxygen. c. wheat gluten. d. increased carbon dioxide.

ANS: B

Because of an abnormal type of hemoglobin in the red blood cells of a patient with sickle cell anemia, the cells develop a sickle shape in the presence of decreased oxygen. Exercise, exertion, administration of a general anesthetic, pregnancy, or even sleep can trigger a sickling of the red blood cells. Low blood sugar is associated with insulin and diabetes. Celiac sprue is a chronic disorder associated with a sensitivity to dietary gluten, a protein found in wheat and wheat products. The cells develop a sickle shape in the presence of decreased oxygen rather than increased carbon dioxide.

REF: Sickle Cell Anemia, page 282 OBJ: 9

20. A “hair-on-end” pattern may be noted on skull radiographic images of a patient with a. polycythemia. b. aplastic anemia. c. sickle cell anemia. d. thalassemia.

ANS: C

A “hair-on-end” pattern may be noted on skull radiographic images of a patient with sickle cell anemia. This occurs because the trabeculae radiate outward. Oral manifestations are seen on dental radiographs. A loss of trabeculations takes place, with the appearance of large, irregular marrow spaces. Polycythemia is characterized by an increase in the number of circulating red blood cells. Aplastic anemia is characterized by a generalized decrease in circulating blood cells. Thalassemia is the name of a group of inherited disorders of hemoglobin synthesis.

REF: Sickle Cell Anemia, Clinical Features and Oral Manifestations, page 283

OBJ: 9 a. Aplastic anemia b. Polycythemia vera c. Secondary polycythemia d. Celiac sprue

21. Which disorder of red blood cells and hemoglobin is associated with sensitivity to dietary gluten found in wheat and wheat products?

ANS: D

Celiac sprue is associated with sensitivity to dietary gluten found in wheat and wheat products. When gluten is ingested, injury to the intestinal mucosa results. Malabsorption of other nutrients such as vitamin B12 and folic acid occurs as a result of mucosal injury. Aplastic anemia is characterized by a generalized decrease in circulating blood cells. Polycythemia vera is characterized by a neoplastic proliferation of bone marrow stem cells resulting in an abnormally high number of circulating red blood cells. Secondary polycythemia is characterized by an increase in red blood cells caused by a physiologic response to decreased oxygen. A decrease in oxygen in blood cells triggers an increase in erythropoietin by the kidneys, which results in increased production of red blood cells.

REF: Celiac Disease, page 286 OBJ: 10 a. It is caused by a virus. b. The bone marrow failure is the result of a drug or chemical agent. c. It is associated with chemotherapy, radioactive isotopes, radium, or radiant energy. d. The cause is unknown.

22. Which statement about primary aplastic anemia is true?

ANS: D

The cause of primary aplastic anemia is unknown. In secondary aplastic anemia, bone marrow failure is the result of a drug or chemical agent. Chemotherapy, radioactive isotopes, radium, or radiant energy has been associated with the development of aplastic anemia. Primary aplastic anemia occurs most frequently in young adults. It is not caused by a virus. In secondary aplastic anemia, bone marrow failure is a result of a drug or chemical agent.

REF: Aplastic Anemia, page 283 OBJ: 11

23. Polycythemia vera is caused by a. a neoplastic proliferation of bone marrow stem cells. b. a physiologic response to decreased oxygen. c. decreased plasma volume. d. smoking.

ANS: A

Polycythemia vera is caused by a neoplastic proliferation of bone marrow stem cells. It results in an abnormally high number of circulating red blood cells. The production of red blood cells is uncontrolled. It is not caused by a physiologic response to decreased oxygen. It is not caused by decreased plasma volume. It is not caused by smoking.

REF: Polycythemia Vera (Primary Polycythemia), page 283 OBJ: 13 a. It may be caused by living at high altitudes or by an elevation in carbon monoxide. b. Causes include use of diuretics, vomiting, diarrhea, and excessive sweating. c. It occurs primarily in children. d. The cause is unknown.

24. Which statement concerning polycythemia vera is true?

ANS: D

The cause of polycythemia vera is unknown. It is somewhat more common in men than in women, and the age of onset is usually between 40 and 60 years of age. Symptoms include headache, dizziness, and itching. Pulmonary disease, heart disease, living at high altitudes, and an elevation in carbon monoxide are all associated with secondary polycythemia rather than polycythemia vera. Causes of acute relative polycythemia rather than polycythemia vera include use of diuretics, vomiting, diarrhea, and excessive sweating. Polycythemia vera is somewhat more common in men than in women, and the age of onset is usually between 40 and 60 years of age.

REF: Polycythemia Vera (Primary Polycythemia), page 283 OBJ: 13

25. Leukopenia most commonly involves a. neutrophils. b. basophils. c. eosinophils. d. monocytes.

ANS: A

Leukopenia most commonly involves neutrophils, although any of the white blood cells can be involved. Leukopenia most commonly involves neutrophils rather than basophils, although any of the white blood cells can be involved. Leukopenia most commonly involves neutrophils rather than eosinophils, although any of the white blood cells can be involved. Leukopenia most commonly involves neutrophils rather than monocytes, although any of the white blood cells can be involved.

REF: Aplastic Anemia, Diagnosis and Treatment, page 283 OBJ: 15 a. Acute lymphoblastic leukemia primarily affects children and young adults and has a poor prognosis. b. Acute myeloblastic leukemia primarily affects children and young adults and has a poor prognosis. c. Acute lymphoblastic leukemia primarily affects children and young adults and has a good prognosis. d. Acute myeloblastic leukemia primarily affects children and young adults and has a good prognosis.

26. Which statement is true concerning acute lymphoblastic leukemia versus acute myeloblastic leukemia?

ANS: C

Acute lymphoblastic leukemia primarily affects children and young adults and has a good prognosis. Acute myeloblastic leukemia involves adolescents and young adults (age range, 15 to 39 years), and the prognosis is not as good. Acute myeloblastic leukemia involves adolescents and young adults (age range, 15 to 39 years), and the prognosis is not as good as with acute lymphoblastic leukemia. Acute myeloblastic leukemia involves adolescents and young adults (age range, 15 to 39 years), and the prognosis is not as good.

REF: Acute Leukemias, page 285 OBJ: 15 a. acute lymphoblastic b. acute nonlymphoblastic c. chronic lymphoblastic d. chronic granulocytic

27. The Philadelphia chromosome is associated with _____________________ leukemia.

ANS: D

The Philadelphia chromosome is associated with chronic granulocytic (myeloid) leukemia. Chronic lymphocytic leukemia is the most common form and accounts for about one quarter of the total cases of leukemia. About half of the patients with this type of leukemia have abnormal karyotypes; however, the abnormality is different from the Philadelphia chromosome. The Philadelphia chromosome is associated with chronic granulocytic (myeloid) leukemia, not acute lymphoblastic leukemia. The Philadelphia chromosome is associated with chronic granulocytic (myeloid) leukemia, not acute nonlymphoblastic leukemia. The Philadelphia chromosome is associated with chronic granulocytic (myeloid) leukemia, not chronic lymphoblastic leukemia.

REF: Chronic Leukemias, page 286 OBJ: 14

28. The normal laboratory value for prothrombin time is a. 1 to 3 seconds. b. 11 to 16 seconds. c. 25 to 40 seconds. d. 1 to 6 minutes.

ANS: B

The normal laboratory value for prothrombin time is 11 to 16 seconds. The normal value for partial thromboplastin time is 25 to 40 seconds. The normal value for bleeding time is 1 to 6 minutes. The normal laboratory value for prothrombin time is 11 to 16 seconds, not 1 to 3 seconds. The normal laboratory value for prothrombin time is 11 to 16 seconds, not 25 to 40 seconds. The normal laboratory value for prothrombin time is 11 to 16 seconds, not 1 to 6 minutes.

REF: Prothrombin Time, page 288 OBJ: 16

29. The International Normalized Ratio (INR) is an expression of the ratio of prothrombin time to a. fibrinogen. b. thromboplastin activity. c. proaccelerin. d. proconvertin.

ANS: B

The INR is an expression of the ratio of prothrombin time to thromboplastin activity. Values less than 3 are considered within normal range. Patients taking anticoagulants such as warfarin may have INR values of 4 to 5. The INR is an expression of the ratio of prothrombin time to thromboplastin activity and not fibrinogen. Fibrinogen is factor I in coagulation. The INR is an expression of the ratio of prothrombin time to thromboplastin activity and not proaccelerin. Proaccelerin is factor V in coagulation. The INR is an expression of the ratio of prothrombin time to thromboplastin activity and not proconvertin. Proconvertin is factor VII in coagulation.

REF: Prothrombin Time, page 288 OBJ: 16

30. Thrombocytopenic purpura results from a a. defect in the capillary walls. b. disorder of platelet function. c. severe reduction in circulating platelets. d. reduction in white blood cells.

ANS: C

Thrombocytopenic purpura results from a severe reduction in circulating platelets. When the cause is unknown, the condition is called idiopathic thrombocytopenic purpura.

Nonthrombocytopenic purpuras are bleeding disorders that can result from either a defect in the capillary walls or disorders of platelet function. Nonthrombocytopenic purpuras are bleeding disorders that can result from either a defect in the capillary walls or disorders of platelet function. Nonthrombocytopenic purpuras are bleeding disorders that can result from either a defect in the capillary walls or disorders of platelet function. Thrombocytopenic purpura results from a severe reduction in circulating platelets rather than a reduction in white blood cells.

REF: Thrombocytopenic Purpura, page 288

OBJ: 17 a. Prednisone b. Pilocarpine hydrochloride c. Aspirin d. Nonsteroidal anti-inflammatory drugs

31. Which drug may be taken during the course of radiation treatment to reduce the severity of radiation-induced xerostomia?

ANS: B

Pilocarpine hydrochloride may be taken during the course of radiation treatment to reduce the severity of radiation-induced xerostomia. A patient who has received radiation therapy for oral cancer is also at risk for the development of osteoradionecrosis because of decreased blood supply to the bone after radiation therapy. Aspirin is a peripheral, nonnarcotic analgesic. Nonsteroidal anti-inflammatory drugs are peripheral, nonnarcotic analgesics.

REF: Radiation Therapy, page 290 OBJ: 21 a. Phenytoin b. Nifedipine c. Bisphosphonate d. Cyclosporine

32. Osteonecrosis of the maxilla and mandible is a complication associated with what type of drug?

ANS: C

Bisphosphonate therapy can cause osteonecrosis of the maxilla and mandible. Phenytoin can cause gingival enlargement but not osteonecrosis. Nifedipine can cause gingival enlargement but not osteonecrosis. Cyclosporine can cause gingival enlargement but not osteonecrosis.

REF: Medication-Related Osteonecrosis of the Jaw, page 291 OBJ: 22 | 23 a. Hyperparathyroidism b. Osteoporosis c. Multiple myeloma d. Metastatic breast cancer

33. Bisphosphonate therapy is used to treat all diseases except one. Which is the exception?

ANS: A

Endocrine disorders are commonly treated with surgery and some nonbisphosphonate medications. Oral bisphosphonate therapy is used to treat osteoporosis. Intravenous bisphosphonate therapy is used to treat multiple myeloma. Intravenous bisphosphonate therapy is used to treat metastatic breast cancer.

REF: Medication-Related Osteonecrosis of the Jaw, page 292 OBJ: 23 a. Bisphosphonates b. Cyclosporine c. Indomethacin d. Pilocarpine hydrochloride

34. Which medication can decrease the severity of radiation-induced xerostomia in patients with oral cancer?

ANS: D

Pilocarpine hydrochloride taken during the course of radiation treatment decreases the severity of radiation-induced xerostomia. Bisphosphonates increase patient susceptibility to osteonecrosis. They do not decrease the severity of xerostomia in patients undergoing radiation treatment for oral cancer. Cyclosporine is an immunosuppressant drug used to prevent rejection of transplanted organs and can cause gingival enlargement. It does not decrease the severity of xerostomia in patients undergoing radiation treatment for oral cancer. Indomethacin is a nonsteroidal anti-inflammatory drug that can affect platelet function. Indomethacin does not decrease the severity of xerostomia in patients undergoing radiation treatment for oral cancer.

REF: Radiation Therapy, page 290 OBJ: 21 a. Both statements are true. b. Both statements are false. c. The first statement is true; the second is false. d. The first statement is false; the second is true.

35. Type A hemophilia is less common than type B hemophilia. Type A hemophilia is caused by a deficiency of the clotting factor called plasma thromboplastinogen or factor VIII.

ANS: D

The first statement is false; type A hemophilia is more common than type B hemophilia. The second statement is true; type A hemophilia is caused by a deficiency of the clotting factor called plasma thromboplastinogen or factor VIII. The first statement is false; type A hemophilia is more common than type B hemophilia. The second statement is true; type A hemophilia is caused by a deficiency of the clotting factor called plasma thromboplastinogen or factor VIII. The first statement is false; the second is true.

REF: Types of Hemophilia, page 289 OBJ: 19

36. A reddish-blue or purple discoloration of the skin or mucosa that results from spontaneous extravasation of blood and is caused by an increase in capillary fragility or a deficiency in blood platelets is termed a. hemophilia. b. Bruton disease. c. purpura. d. pernicious anemia.

ANS: C

Purpura is a reddish-blue or purple discoloration of the skin or mucosa that results from spontaneous extravasation of blood and is caused by an increase in capillary fragility or a deficiency in blood platelets. Hemophilia is a disorder of blood coagulation that results in severely prolonged clotting time. Bruton disease is a disorder in which B cells do not mature and plasma cells are deficient. Pernicious anemia is a vitamin B12 deficiency that is caused by a deficiency of intrinsic factor, a substance secreted by the parietal cells of the stomach.

REF: Purpura, page 288 OBJ: 18

37. A malignant neoplasm of the hematopoietic stem cells and characterized by an excessive number of abnormal white blood cells is termed a. leukemia. b. hemophilia. c. thrombocytopenic purpura. d. DiGeorge syndrome.

ANS: A

Leukemia is a malignant neoplasm of the hematopoietic stem cells characterized by an excessive number of abnormal white blood cells. Hemophilia is a disorder of blood coagulation that results in severely prolonged clotting time. Thrombocytopenic purpura is a bleeding disorder that results from a severe reduction in circulating platelets. DiGeorge syndrome is a disorder in which the thymus is deficient or lacking.

REF: Leukemia, page 285 OBJ: 15 a. Celiac disease b. Gluten-sensitive enteropathy c. Celiac sprue d. Sickle cell trait

38. Which is not a chronic disorder associated with sensitivity to dietary gluten?

ANS: D

Sickle cell trait is an inherited disorder of blood and not a chronic disorder associated with sensitivity to dietary gluten. Celiac disease is a chronic disorder associated with sensitivity to dietary gluten. Gluten-sensitive enteropathy is another name for celiac disease and is a chronic disorder associated with sensitivity to dietary gluten. Celiac sprue is another name for celiac disease and is a chronic disorder associated with sensitivity to dietary gluten.

REF: Sickle Cell Anemia, page 282 OBJ: 10 a. Both the statement and reason are correct and related. b. Both the statement and reason are correct but not related. c. The statement is correct, but the reason is not. d. The statement is not correct, but the reason is correct. e. Neither the statement nor the reason is correct.

39. In aplastic anemia, patients experience a dramatic decrease in all the circulating blood cells because of a severe depression of bone marrow activity.

ANS: A

Both the statement and reason are correct and related. In aplastic anemia, patients experience a dramatic decrease in all the circulating blood cells because of a severe depression of bone marrow activity. Both the statement and reason are correct and related. Both the statement and reason are correct and related. Both the statement and reason are correct and related. Both the statement and reason are correct and related.

REF: Aplastic Anemia, page 283 OBJ: 11

40. The recommended treatment for folic acid and vitamin B12 deficiency anemias is a. surgery. b. dietary supplements. c. medications. d. radiation therapy.

ANS: B

Dietary supplements of folic acid and vitamin B12 are recommended for these anemias. Surgery is not the recommended treatment for folic acid and vitamin B12 deficiency anemias. Medications are not the recommended treatment for folic acid and vitamin B12 deficiency anemias. Radiation therapy is not the recommended treatment for folic acid and vitamin B12 deficiency anemias.

REF: Folic Acid and Vitamin B12 Deficiency Anemia, Diagnosis and Treatment, page 281

OBJ: 8 a. It is non-insulin–dependent. b. The majority of patients are diagnosed with type 2 diabetes. c. Contributing factors include a decrease in metabolic rate and weight gain. d. Complications include polydipsia, polyuria, and polyphagia.

41. All statements are true regarding type 2 diabetes mellitus except one. Which is the exception?

ANS: D

Type 1 diabetes can be complicated by polydipsia (excessive thirst and intake of fluid), polyuria (excessive urination), and polyphagia (excessive appetite). These complications are not commonly found in type 2 diabetes. It is also referred to as non-insulin–dependent diabetes mellitus. Approximately 95% of all diabetic patients have type 2 diabetes. Contributing factors include a decrease in metabolic rate and weight gain.

REF: Non–Insulin-Dependent Diabetes Mellitus, page 276 OBJ: 6 a. Thiamin b. Vitamin B12 c. Riboflavin d. Vitamin C

42. Which vitamin is needed for deoxyribonucleic acid (DNA) synthesis and, when lacking, affects the development of rapidly dividing cells in bone marrow and epithelium?

ANS: B

Vitamin B12 is needed for deoxyribonucleic acid (DNA) synthesis and, when lacking, affects the development of rapidly dividing cells in bone marrow and epithelium. Thiamin is needed for energy metabolism and is important in nerve function. Riboflavin is needed for energy metabolism and is important for vision and skin health. Vitamin C is an antioxidant. It is needed for protein metabolism and is important for immune system health and iron absorption.

REF: Folic Acid and Vitamin B12 Deficiency Anemia, page 281

OBJ: 8 a. Hyperpituitarism b. Hyperthyroidism c. Hypothyroidism d. Hyperparathyroidism

43. Elevated blood levels of calcium, low levels of blood phosphorus, and abnormal bone metabolism are characteristic of which endocrine disorder?

ANS: D

Elevated blood levels of calcium, low levels of blood phosphorus, and abnormal bone metabolism are all characteristics of hyperparathyroidism. Hyperpituitarism is characterized by excess hormone production by the anterior pituitary gland. The diagnosis involves measurement of serum growth hormones after ingestion of glucose. Hyperthyroidism is characterized by excessive production of thyroid hormone. Characteristics of hypothyroidism include a decreased output of thyroid hormone.

REF: Hyperparathyroidism, page 273 OBJ: 4 a. Primary hyperparathyroidism b. Secondary hyperparathyroidism c. Tertiary hyperparathyroidism d. Familial hyperparathyroidism

44. Which type of hyperparathyroidism is the result of an overproduction of parathyroid hormone (PTH) in response to long-term decreased levels of serum calcium often associated with chronic renal disease?

ANS: B

Secondary hyperparathyroidism is the result of an overproduction of PTH in response to longterm decreased levels of serum calcium often associated with chronic renal disease. Primary hyperparathyroidism may be the result of hyperplasia of the parathyroid glands, a benign tumor of one or more of the parathyroid glands, or a malignant parathyroid tumor. It is not the result of an overproduction of PTH in response to long-term decreased levels of serum calcium often associated with chronic renal disease. Tertiary hyperparathyroidism is not a type of hyperparathyroidism. Familial hyperparathyroidism is not a designated type of hyperparathyroidism. However, studies show that some hyperparathyroidism may be familial.

REF: Hyperparathyroidism, page 273 OBJ: 4 a. hypersecretion; thyroid b. hyposecretion; thyroid c. hypersecretion; adrenal d. hyposecretion; adrenal

45. Myxedema is caused by _____________ of the ____________ gland.

ANS: B

When hypothyroidism occurs in older children and adults, it is referred to as myxedema. Myx-edema is not caused by an excessive production of the thyroid gland. Myxedema is caused by hyposecretion of the thyroid gland, not hypersecretion of the adrenal gland. Myxedema is not a function of the adrenal gland; it is caused by hyposecretion of the thyroid gland.

REF: Hypothyroidism (Cretinism, Myxedema), page 273 OBJ: 3 a. phosphorus b. calcium c. glucose d. neutrophil

46. Diabetes is characterized by abnormally high blood _________ levels.

ANS: C

Diabetes is characterized by abnormally high blood glucose levels. These high levels result from a lack of the hormone insulin, defective insulin that does not work effectively to lower blood glucose levels, or increased insulin resistance because of obesity. Diabetes is characterized by abnormally high blood glucose and not phosphorus levels. Hyperparathyroidism is characterized by elevated levels of blood calcium and low levels of blood phosphorus. Diabetes is characterized by abnormally high blood glucose and not calcium levels. Diabetes is characterized by abnormally high blood glucose and not neutrophil levels. Leukemia is characterized by an overproduction of atypical white blood cells.

REF: Diabetes Mellitus, page 274 OBJ: 6 a. Addison disease b. Addison syndrome c. Cushing disease d. Cushing syndrome

47. ______________ is characterized by insufficient production of adrenal steroids.

ANS: A

Addison disease is characterized by insufficient production of adrenal steroids. Addison disease, rather than Addison syndrome, is characterized by insufficient production of adrenal steroids. Addison syndrome does not exist. Cushing syndrome, rather than Cushing disease, is characterized by excess production of adrenal steroids. Cushing syndrome rather than Cushing disease is characterized by excess production of adrenal steroids.

REF: Addison Disease (Primary Hypoadrenocorticism), page 278

OBJ: 7

48. The production of adrenal steroids is normally stimulated by release of hormone from the pituitary gland. a. follicle-stimulating b. luteinizing c. adrenocorticotropic d. growth

ANS: C

The production of adrenal steroids is normally stimulated by release of adrenocorticotropic hormone from the pituitary gland. As a result of decreased production of adrenal steroids caused by Addison disease, the pituitary gland increases its production of adrenocorticotropic hormone. This hormone is similar to melanin-stimulating hormone and causes stimulation of melanocytes. Brown pigmentation (bronzing) of the skin occurs, and melanotic macules can appear on the oral mucosa. Follicle-stimulating hormone and luteinizing hormone stimulate the release of estrogen and progesterone in females and testosterone in males. Growth hormone is also released by the pituitary gland.

REF: Addison Disease (Primary Hypoadrenocorticism), Clinical Features and Oral Manifestations, page 279 OBJ: 8 a. pernicious b. iron-deficiency c. thalassemia d. aplastic

49. Plummer–Vinson syndrome can develop as a result of long-standing __________ anemia.

ANS: B

Plummer–Vinson syndrome can develop as a result of long-standing iron deficiency anemia. This syndrome includes dysphagia, atrophy of the upper alimentary tract, and a predisposition to the development of oral cancer. Pernicious anemia is a vitamin B12 deficiency caused by a deficiency of intrinsic factor, which is secreted by the parietal cells of the stomach.

Thalassemia is the name of a group of inherited disorders of hemoglobin synthesis. Aplastic anemia results in a dramatic decrease in all the circulating blood cells because of a severe depression of bone marrow activity.

REF: Iron Deficiency Anemia, page 280 OBJ: 8 a. filiform b. fungiform c. circumvallate d. foliate

50. Iron deficiency anemia may first result in loss of __________ papillae on the dorsum of the tongue because these papillae have the highest metabolic requirement.

ANS: A

Iron deficiency anemia may first result in loss of filiform papillae on the dorsum of the tongue because these papillae have the highest metabolic requirement. Disappearance of the fungiform papillae can also occur in chronic and severe cases. Disappearance of the fungiform papillae can also occur in chronic and severe cases; however, the filiform papillae on the dorsum of the tongue disappear first because these papillae have the highest metabolic requirement. Iron deficiency anemia may first result in loss of filiform papillae on the dorsum of the tongue rather than circumvallate papillae because filiform papillae have the highest metabolic requirement. Iron deficiency anemia may first result in loss of filiform papillae on the dorsum of the tongue rather than foliate papillae because filiform papillae have the highest metabolic requirement.

REF: Iron Deficiency Anemia, Clinical Features and Oral Manifestations, page 280

OBJ: 8 a. microcytic; hypochromic b. microcytic; hyperchromic c. macrocytic; hypochromic d. macrocytic; hyperchromic

51. The red blood cells appear __________ and __________ in cases of iron deficiency anemia.

ANS: A

The red blood cells appear microcytic and hypochromic in cases of iron deficiency anemia. Microcytic means smaller than normal, and hypochromic means lighter in color than normal. The red blood cells appear microcytic and hypochromic rather than hyperchromic in cases of iron deficiency anemia. The red blood cells appear microcytic rather than macrocytic and hypochromic in cases of iron deficiency anemia. The red blood cells appear microcytic rather than macrocytic and hypochromic rather than hyperchromic in cases of iron deficiency anemia.

REF: Iron Deficiency Anemia, Diagnosis and Treatment, page 280

OBJ: 8 a. B6 b. B12 c. C d. E

52. The Schilling test detects an inability to absorb an oral dose of vitamin _____.

ANS: B

The Schilling test detects an inability to absorb an oral dose of vitamin B12. It may be used in the diagnosis of pernicious anemia. Diagnostic features of pernicious anemia include low serum vitamin B12 levels and gastric achlorhydria. The treatment of pernicious anemia consists of injections of vitamin B12. The oral mucosa improves in time, but the papillae on the dorsum of the tongue may not completely regenerate. The Schilling test detects an inability to absorb an oral dose of vitamin B12 rather than vitamin B6. The Schilling test detects an inability to absorb an oral dose of vitamin B12 rather than vitamin C. The Schilling test detects an inability to absorb an oral dose of vitamin B12 rather than vitamin E.

REF: Pernicious Anemia, Diagnosis and Treatment, page 281 OBJ: 8 a. 20,000 b. 100,000 c. 150,000 d. 400,000

53. A platelet count of less than ________/mm3 is considered thrombocytopenia.

ANS: B

A platelet count of less than 100,000/mm3 is considered thrombocytopenia. Spontaneous gingival bleeding can occur when a patient’s platelet count is less than 20,000/mm3. A normal platelet count should be 150,000 to 400,000/mm3. A platelet count of less than 100,000/mm3 rather than 20,000/mm3 is considered thrombocytopenia. A platelet count of less than 100,000/ mm3 rather than 150,000/mm3 is considered thrombocytopenia.

REF: Platelet Count, page 287 OBJ: 16 a. Bruton disease b. von Willebrand disease c. DiGeorge syndrome d. Hemophilia

54. ___________________ is an autosomal-dominant inherited disorder of platelet function.

ANS: B von Willebrand disease is an autosomal-dominant inherited disorder of platelet function. Bruton disease is a disorder in which B cells do not mature. DiGeorge syndrome is a disorder in which the thymus is lacking and T cells do not mature. Hemophilia is a disorder of blood coagulation that results in severely prolonged clotting time.

REF: Nonthrombocytopenic Purpura, page 289 a. VII

55. Type A hemophilia is caused by a deficiency of factor _____.

OBJ: 18 b. VIII c. IX d. X

ANS: B

Type A hemophilia is caused by a deficiency of factor VIII, the clotting factor called plasma thromboplastinogen. This deficiency is characterized by severe hemorrhage after even mildto-moderate injury or surgery. Type A hemophilia is caused by a deficiency of factor VIII, the clotting factor called plasma thromboplastinogen, rather than factor VII, which is proconvertin. Type B hemophilia, or Christmas disease, is less common than type A hemophilia. The clotting defect is in plasma thromboplastin, or factor IX. Type A hemophilia is caused by a deficiency of factor VIII, the clotting factor called plasma thromboplastinogen, rather than factor X, which is Stuart factor.

REF: Types of Hemophilia, page 289 OBJ: 19 a. Polycythemia b. Arthralgia c. Hemolysis d. Neutropenia

56. Which term describes an opposite condition to anemia?

ANS: A

Anemia is the reduction of the number of red blood cells, and polycythemia is the increase in the total red blood cell mass in the blood. Arthralgia is severe pain in a joint. Hemolysis is the release of hemoglobin from red blood cells by destruction of the cells. Neutropenia is a decreased number of neutrophils in the blood.

REF: Vocabulary, page 271 OBJ: 1 a. Hemostasis b. Ketoacidosis c. Insulin shock d. Myalgia

57. Which condition necessitates emergency intervention?

ANS: C

Insulin shock refers to a state of profound hypoglycemia (or low blood sugar) that necessitates emergency intervention. Hemostasis is the stoppage or cessation of bleeding. Ketoacidosis is the accumulation of acid in the body resulting from the accumulation of ketone bodies. Myalgia is a term to describe muscle pain.

REF: Vocabulary, page 271 OBJ: 1 a. Thrombocytopenia b. Anemia c. Hypochromic d. Neutropenia

58. All terms describe a decrease in circulating red or white blood cells except one. Which is the exception?

ANS: C

Hypochromic refers to being stained less intensely than normal; this term does not relate to a decrease in cells. Thrombocytopenia is a decrease in the number of platelets in circulating blood. Anemia is a reduction of the number of red blood cells to less than normal.

Neutropenia is a decreased number of neutrophils in the blood.

REF: Vocabulary, page 271 OBJ: 1 a. Endocrine b. Viral c. Neoplastic d. Immune

59. Which system consists of a group of integrated glands and cells that secrete hormones?

ANS: A

The endocrine system consists of a group of integrated glands and cells that secrete hormones. The viral system is involved with viruses. Neoplastic refers to new growth or the formation of tumors. The immune system does not secrete hormones.

REF: Endocrine Disorders, page 272 OBJ: 1 a. Headache b. Chronic fatigue c. Extreme height d. Gastrointestinal issues

60. All are clinical features of gigantism except one. Which is the exception?

ANS: D

Gastrointestinal issues are not typically seen in cases of gigantism. Persons affected with gigantism experience headaches. Persons affected with gigantism experience chronic fatigue. Gigantism includes excessive growth of the overall skeleton, and individuals may be over 7 feet tall.

REF: Hyperpituitarism, Clinical Features and Oral Manifestations, page 272

OBJ: 2 a. Deeper voice b. Nasal septum deformities c. Perforation of the oral mucosa d. Maxillary molars requiring endodontic treatment

61. Persons with acromegaly may experience an enlargement of the maxillary sinuses that may lead to what condition?

ANS: A

An enlargement of the maxillary sinus causes a characteristically deep voice. Acromegaly may cause an enlargement of the nasal bones but not septum deformities. Perforation of the oral mucosa is not seen in persons with acromegaly. Maxillary molars do not require endodontic therapy in cases of acromegaly.

REF: Hyperpituitarism, Clinical Features and Oral Manifestations, page 272

OBJ: 2 a. Lack of energy b. Fatigue c. Hyperactivity d. Dry skin

62. Children affected with hyperthyroidism may demonstrate which characteristic?

ANS: C

Too much thyroid hormone is produced causing an increase in metabolism that may mimic hyperactivity, especially in children. Hyperthyroidism is characterized by excessive thyroid hormone production; a lack of energy is not seen. The increased thyroid hormone levels increase the patient metabolism; fatigue is not a characteristic finding. Dry skin is not related to hyperthyroidism.

REF: Hyperthyroidism (Thyrotoxicosis, Graves Disease), page 272 OBJ: 3 a. Diabetes b. Hyperthyroidism c. Hypothyroidism d. Hyperparathyroidism

63. Which condition may cause children to demonstrate premature exfoliation of the primary dentition as well as premature eruption of the permanent teeth?

ANS: B

Hyperthyroidism in children may lead to premature exfoliation of deciduous teeth and premature eruption of permanent teeth. Diabetes does not cause premature exfoliation or eruption of teeth. Hypothyroidism may cause delayed eruption of teeth. The chief oral manifestation of hyperparathyroidism is the appearance of well-defined unilocular and multilocular radiolucencies.

REF: Hyperthyroidism (Thyrotoxicosis, Graves Disease), Clinical Features and Oral Manifestations, page 273 OBJ: 3 a. Thickened lips b. Delayed eruption of teeth c. Macroglossia d. Exophthalmos

64. In infants, facial and oral changes in hypothyroidism include these characteristics except one. Which is the exception?

ANS: D

Exophthalmos is a significant clinical characteristic of hyperthyroidism. Thickened lips may be seen in infants with hypothyroidism. Delayed eruption of teeth may be seen as the child grows to ages 2 to 4. Macroglossia is another oral manifestation of hypothyroidism.

REF: Hypothyroidism (Cretinism, Myxedema), page 273 OBJ: 3 a. Both statements are true. b. Both statements are false. c. The first statement is true; the second statement is false. d. The first statement is false; the second statement is true.

65. Secondary hyperparathyroidism occurs when calcium is abnormally excreted by the liver. The most common cause of secondary hyperparathyroidism is liver failure.

ANS: B

Secondary hyperparathyroidism occurs when calcium is abnormally excreted by the kidneys. The most common cause of secondary hyperparathyroidism is kidney failure. Both statements are false.

REF: Hyperparathyroidism, page 273 OBJ: 3 a. Intraoral melanotic macules b. Gingival hyperplasia c. Tooth mobility d. Macroglossia

66. Oral manifestations of a person with Addison disease include which finding?

ANS: A

Stimulation of melanocytes occurs causing bronzing of the skin and melanotic macules on the oral mucosa. Addison disease is not associated with gingival hyperplasia. Tooth mobility is not a feature of Addison disease. Macroglossia is not an oral manifestation of Addison disease.

REF: Addison Disease (Primary Hypoadrenocorticism), Clinical Features and Oral Manifestations, page 279 OBJ: 7

67. Identify a common nutritional deficiency associated with anemia: a. Calcium b. Phosphorus c. Iron d. Vitamin D

ANS: C

Nutritional anemias occur when a necessary substance for the normal development of red blood cells is in limited supply in the bone marrow. Iron is a common deficiency. A calcium deficiency is not associated with anemia. Anemia is not associated with deficiency in phosphorus. A vitamin D deficiency is not related to anemia.

REF: Anemia, page 280 OBJ: 9 a. Type 1 diabetes b. Cretinism c. Graves’ disease d. Anemia

68. Skin and mucosal pallor, angular cheilitis, and loss of filiform and fungiform papilla on the tongue are characteristics of what condition?

ANS: D

Oral manifestations for anemia include skin and mucosal pallor, angular cheilitis, atrophy of the oral mucosa, and loss of filiform and fungiform papilla on the dorsum of the tongue. Type 1 diabetes does not exhibit these oral manifestations. Cretinism may cause thickened lips, enlarged tongue, and delayed eruption of teeth. Graves’ disease may cause premature exfoliation and eruption of teeth.

REF: Anemia, page 280

OBJ: 9 a. Peak age of 50 years b. Thin body build c. Polydipsia, polyuria, polyphagia d. Abrupt onset

69. Physical characteristics of a person with type 1 diabetes include all except one. Which is the exception?

ANS: A

Type 1 diabetes can occur at any age, but its time of onset is usually at a peak age of 20 years. Patients usually have a thin body build. The primary signs of type 1 diabetes are the 3 P’s: polydipsia, polyuria, and polyphagia. The onset of type 1 diabetes is abrupt.

REF: Insulin-Dependent Diabetes Mellitus, Pathology, and Clinical Management, page 275

OBJ: 6 a. Risk of candidiasis b. Xerostomia c. Tooth discoloration d. Gingival enlargement

70. When a patient is taking long-term antibiotic therapy, what is a common oral manifestation that may be seen?

ANS: A

Antibiotics can increase the risk of candidiasis. Xerostomia may be seen in persons taking drugs to control blood pressure. Tooth discoloration is seen if a person has taken tetracycline during tooth development. Gingival enlargement may be seen in an epileptic patient or one who has experienced a transplanted organ.

REF: Effects of Drugs on the Oral Cavity, page 291

Matching

OBJ: 22 a. Severe pain in a joint b. Reduction of the number of red blood cells c. Chronic excessive thirst and intake of fluid d. Small, flat, hemorrhagic patch larger than a petechia on the skin e. Cell surface protein to which a specific molecule (e.g., a hormone) can bind f. Stoppage or cessation of bleeding g. Decrease in number of granulocytes h. Muscle pain i. Insoluble protein that is essential for the clotting of blood j. Platelet k. Enlargement of the liver l. Increase in the total red blood cell mass in the blood m. Abnormal rarefaction of bone n. Decrease in the number of platelets in circulating blood

For each vocabulary word below, select the corresponding definition from the list provided.

1. Hepatomegaly

5.

6.

7.

8.

9.

10.

11.

1. ANS: K REF: Vocabulary, page 271

2. ANS: H REF: Vocabulary, page 271

3. ANS: C REF: Vocabulary, page 271

4. ANS: J REF: Vocabulary, page 271

5. ANS: M REF: Vocabulary, page 271

6. ANS: L REF: Vocabulary, page 271

7. ANS: D REF: Vocabulary, page 271

8. ANS: E REF: Vocabulary, page 271

9. ANS: I REF: Vocabulary, page 271

10. ANS: B REF: Vocabulary, page 271

11. ANS: G REF: Vocabulary, page 270

12. ANS: N REF: Vocabulary, page 271

13. ANS: A REF: Vocabulary, page 270

14. ANS: F REF: Vocabulary, page 271

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