SA.txt

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emm64
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152163
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SA.txt
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2012-05-04 14:14:22
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S2 final SA
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S2-final SA
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  1. Your patient with hypothyroidism who takes daily thyroid replacement medication tells you that she is presently in an euthyroid state. You should:
    • A. Treat her as a normal patient without any change needed in your regular dental protocol.
    • B. Have her double her dose of Synthroid on the morning of dental procedures.
    • C. Have her hold her dose of Synthroid on the morning of dental procedures.
    • D. Avoid epinephrine impregnated retraction cord
    • E. Avoid the use of sedative medications to calm her prior to stressful procedures.
  2. Correct Answer: A
  3. 2. The presence of TSH receptor stimulating autoantibodies (TSH-R Ab [stim]) may cause:
    • A. Hypothyroidism
    • B. Hyperthyroidism
    • C. Thyroid cysts
    • D. Thyroid cancer
  4. Correct Answer: B
  5. 3. The above patient loses consciousness. Now you should:
    • A. Have the patient take an oral glucose source.
    • B. Treat as if he is hyperglycemic and administer 20 units of regular insulin subcutaneously
    • C. Treat as if he is hypoglycemic and administer 50% dextrose intramuscularly
    • D. Administer 1 mg glucagon intramuscularly
    • E. Administer no medications, since you cannot be sure whether this is hyperglycemia or hypoglycemia.
  6. Correct Answer: D
  7. 4. Hypocalcemia may ultimately lead to:
    • A. Delayed ventricular repolarization
    • B. Paresthesias of lips
    • C. Tetany
    • D. All of the above
  8. Correct Answer: D
  9. 5. The net effect of aldosterone includes
    • A. Na retention
    • B. Water loss
    • C. K depletion
    • D. A and C
  10. Correct Answer: D
  11. 6. Blood calcium level is regulated by:
    • A. TSH
    • B. PTH
    • C. Calciferol
    • D. B and C
  12. Correct Answer: D
  13. 7. These photos are of a 35 year old caucasian who complains of anorexia, vomits and diarrhea. He feels weak and has lost 10 pounds in 5 months. His clinical history reveals that 10 years ago he had a severe TB infection in his lung, he was aggressively treated and recovered well. Which is the most likely explanation for this man's condition?
    • A. He has a malignant melanoma
    • B. He suffers from Cushing's syndrome
    • C. He has a pheochromocytoma
    • D. He suffers from Hashimoto disease
    • E. He suffers from Addison's disease
  14. Correct Answer: E
  15. 8. Which of the statements is correct regarding the illustrations above?
    • A. Figs 1, 2 and 3 show the thyroid gland in different physiological stages
    • B. Figs 4 and 5 show the lesions of a patient whose thyroid biopsy is shown in fig. 1
    • C. Fig. 1 shows the typical appearance of a carcinoma of the thyroid
    • D. Figs. 4 and 5 show the facial and skin lesions commonly seen in adult hypothyroid patients
    • E. Fig 2 shows a biopsy of the thyroid from a patient with Hashimoto disease
  16. Correct Answer: D
  17. 9. Hypercalcemia may ultimately lead to:
    • A. Nephrolithiasis
    • B. Osteoporosis
    • C. Muscle hypertrophy
    • D. Seizures
  18. Correct Answer: A
  19. 10. The net effect of cortisol includes:
    • A. Increased gluconeogenesis
    • B. Increased nucleic acid synthesis
    • C. Decreased protein breakdown in muscles and bones
    • D. Decreased lypolysis
  20. Correct Answer: A
  21. 11. This 45 year old male presented with dry gangrene in his left foot (fig. 3), which became infected, progressed to wet gangrene and had to be amputated. The infection however progressed, the patient became septicemic and died 48 hours later. At post mortem, the kidney and aorta had the lesions shown in figs. 1 and 2. Which of these statements is correct?
    • A. The patient's death was caused by the lesions shown in fig. 4.
    • B. Either of the lesions 9n figs 4 or 5 could have caused the lesions and ultimately, the patient's death.
    • C. The patient's death was caused by the lesions shown in fig. 5.
  22. Correct Answer: B
  23. 12. TRUE OR FALSE: Thyroid storm may be associated with atrial fibrillation.
    Answer
  24. Correct Answer: True
  25. 13. A patient with Cushing’s disease has:
    • A. High plasma cortisol & high ACTH
    • B. High plasma cortisol and low ACTH
    • C. Low plasma cortisol and low ACTH
    • D. Low plasma cortisol and high ACTH
  26. Correct Answer: A
  27. 14. Your new dental patient reports that she has no medical problems and takes no medications. You notice from her history that she has had unexplained weight loss. You notice that she has a mild tremor and her eyes appear slightly protrusive. Her blood pressure is noted to be 145/80 and her heart rate is 110. For which of the following potentially undiagnosed diseases are you most concerned?
    • A. Diabetes mellitus
    • B. Addison’s disease
    • C. Hyperthyroidism
    • D. Hypothyroidism
    • E. None of the above
  28. Correct Answer: C
  29. 15. Your well-controlled type 1 diabetic patient is scheduled for a simple amalgam filling under local anesthesia. You should:
    • A. Have the patient increase his normal insulin dose by 50% on the morning of the procedure.
    • B. Have the patient decrease his normal insulin dose by 50% on the morning of the procedure.
    • C. Have the patient eat normally and take his normal insulin dose on the morning of the procedure.
    • D. Contact the patient’s physician for recommendations on insulin dosages prior to each dental procedure.
  30. Correct Answer: C
  31. 16. The fig.s above show lesions seen in patients with endocrine diseases.Which of the statements below can not be correct?
    • A. Fig. 2 shows the histological abnormalities found at necropsy of the patient in fig. 3
    • B. Figs 1 and 2 show the gross and histological abnormalities found at necropsy of the patient in fig. 5
    • C. Fig. 2 shows the histological abnormalities found at necropsy of the patient in fig. 4
    • D. Fig. 2 is of a benign adenoma of the pituitary
    • E. Figs 1, 2 and 6 belong to the same patient.
  32. Correct Answer: C
  33. 17. TRUE OR FALSE: The green arrow points at a lymphoid follicle that formed in the thyroid of this patient who suffered of Hashimoto thyroiditis.
  34. Correct Answer: False
  35. 18. Which is a major function of insulin?
    • A. Activating glucose transporters for glucose entry in cells
    • B. Inhibiting glycogen synthesis and storage in the liver & muscles
    • C. Promoting protein synthesis in the muscle tissues
    • D. Inhibiting triglyceride storage in adipose tissues
    • E. A and C
  36. Correct Answer: E
  37. 19. Your patient had a flare up of ulcerative colitis and was placed on prednisone, 10mg per day for one month, but has now been off the prednisone for the past 4 months. Before an extremely stressful but elective dental procedure, you should:
    • A. Postpone the procedure for another 2 months to give the adrenal glands sufficient time to recover.
    • B. Postpone the procedure for another 6 months to give the adrenal glands sufficient time to recover.
    • C. Proceed with the procedure, but have the patient take additional prednisone on the morning of the procedure.
    • D. Treat without any need for concern about potential adrenal suppression, because the prior dose of prednisone was not sufficiently high to be of concern.
  38. Correct Answer: C
  39. 20. You are treating a diabetic patient and during treatment he becomes disoriented, confused, and with slurred speech. You should:
    • A. Have the patient take an oral glucose source.
    • B. Treat as if he is hyperglycemic and administer 20 units of regular insulin subcutaneously
    • C. Treat as if he is hypoglycemic and administer 50% dextrose intramuscularly
    • D. Administer 1 mg glucagon intramuscularly
    • E. Administer no medications, since you cannot be sure whether this is hyperglycemia or hypoglycemia.
  40. Correct Answer: A
  41. 21. Which of the following clinical presentations does NOT represent a complication of uncontrolled diabetes?
    • A. Liver cirrhosis
    • B. Skin paresthesia
    • C. Blindness
    • D. Gangrene of extremities
    • E. Heart attack
  42. Correct Answer: A
  43. 22. Which statement is FALSE about type 1 diabetes?
    • A. It involves pancreatic beta cell destruction
    • B. It is considered to be related to autoimmunity
    • C. It as not ketoacidosis prone
    • D. It requires insulin replacement
  44. Correct Answer: C
  45. 23. Myxedema coma is associated with:
    • A. Hypothermia
    • B. Hypoventilation
    • C. Hypoglycemia
    • D. All of the above
  46. Correct Answer: D
  47. 24. TRUE OR FALSE: Adenomas derived from the cell type pointed by the green arrow, are very rare.
    Answer
  48. Correct Answer: True
  49. 1. Which one of the following statements about mineralization of hard tissues of the oral cavity is incorrect?
    • A. Enamel is almost 100% mineralized
    • B. Fluoride is not essential to healthy bone formation
    • C. You need half as much magnesium as calcium for tooth mineralization
    • D. Magnesium is only available in a few foods
    • E. In the presence of adequate dietary calcium, vitamin D is not needed for mineralization of the tooth
  50. Correct Answer: E
  51. 2. One of the following statements about androgens is incorrect.
    • A. Leydig cells express a cell surface receptor for luteinizing hormone (LH).
    • B. In response to LH, Leydig cells convert cholesterol to testosterone.
    • C. The androgen receptor binds either testosterone or dihydrotestosterone.
    • D. 5-alpha-reductase is critical for converting dihydrotestosterone to testosterone.
    • E. The development of external male genitalia are dependent on dihydrotestosterone.
  52. Correct Answer: D
  53. 3. Reduction in plasma calcium will lead to all, EXCEPT:
    • A. Increased release of PTH from the parathyroid gland.
    • B. Increased expression of RANK ligand on the surface of osteoblasts.
    • C. Increased secretion of osteoprotegrin (OPG) from osteoblasts.
    • D. Increased conversion of pre-osteoclasts to osteoclasts.
    • E. Increased number of resorping pits on the bone surface.
  54. Correct Answer: C
  55. 4. All the following are correct, except:
    • A. Deficiency in the biologically active form of vitamin D results in rickets.
    • B. Deficiencies in the biologically active form of vitamin D in adults results in resorption of the mandible.
    • C. Hypervitaminosis D results in low blood calcium levels.
    • D. Periodontitis is more severe in many patients with osteoporosis.
    • E. Maximum bone density is generally observed in men and women aged about 25 years old (the approximate age of many in the class).
  56. Correct Answer: C
  57. 5. Which of the following clinical symptoms is not a complication of diabetes mellitus?
    • A. retinopathy
    • B. hypocholesterolemia
    • C. peripheral polyneuropathy
    • D. nephropathy
    • E. foot ulcer
  58. Correct Answer: B
  59. 6. One statements about the vitamin D receptor (VDR) is incorrect.
    • A. VDR complexes with RXR to bind to a DNA response element.
    • B. Activation of intestinal VDR decreases phosphate absorption.
    • C. Vitamin D, also known as cholecalciferol, does not activate VDR.
    • D. 1,25-dihydroxyvitamin D3 is an activator of VDR.
    • E. Absorption of dietary calcium requires VDR and the VDR ligand to be present in the enterocytes of the small intestine
  60. Correct Answer: B
  61. 7. Whole Grains are good sources of all of these nutrients except:
    • A. Phosphorus
    • B. Magnesium
    • C. Calcium
    • D. Arginine
    • E. Copper
  62. Correct Answer: B
  63. 8. All of the following statements describing the mechanism of action of thiazolidinediones are correct, except:
  64. A. improve sensitivity to insulin in muscle
    • B. improve sensitivity to insulin in adipose tissue
    • C. inhibit hepatic gluconeogenesis
    • D. inhibit ATP-dependent K+ channel and then reduce intestinal absorption of
    • E. bind to peroxisome proliferators-activated receptor-gamma (PPARg), which activates insulin responsive genes
  65. Correct Answer: D
  66. 9. One statement about steroid hormones is NOT CORRECT.
    • A. Destruction of adrenals, either by TB or in response to autoimmunity, can result in Addison’s disease.
    • B. Treatment of patients with Addison’s disease includes long term cortisol administration.
    • C. Cushing’s disease results from a pituitary tumor.
    • D. Patients taking excess glucocorticoids long-term because of asthma have reduced cortisol production.
    • E. Patients with Cushing’s disease may have low plasma glucose levels.
  67. Correct Answer: E
  68. 10. All of the following agents increase effects of the action of sulfonylureas, except:
  69. A. oral anti-coagulants
    • B. thyroid hormones
    • C. salicylates
    • D. antihistamine (H2 antagoinist)
    • E. beta-adrenergic receptor blocker
  70. Correct Answer: B
  71. 11. Which of these nutrients is not essential for wound healing?.
    • A. Magnesium
    • B. The ACED vitamins
    • C. Arginine
    • D. Copper
    • E. Essential Fatty Acids
  72. Correct Answer: A
  73. 12. One comment about bone and bone-related diseases is incorrect.
    • A. Osteoblasts and odontoblasts both secrete collagen type 1.
    • B. Many solid breast tumors secrete PTH-related protein that promotes bone resorption.
    • C. Osteoporosis is often reduced when patients are treated for 18 months with injections of Forteo (amino acid 1-34 of PTH).
    • D. Forteo binds to and activates the PTH receptor.
    • E. Bisphosphonates impair bone loss by inducing RANK ligand on osteoblasts.
  74. Correct Answer: E
  75. 13. Which of the following minerals is not a constituent of Dentin?
    • A. Calcium
    • B. Phosphorus
    • C. Zinc
    • D. Sodium
    • E. Chloride
  76. Correct Answer: C
  77. 14. 21-hydroxylase deficiency results in all of the following except:
    • A. High plasma levels of aldosterone.
    • B. Low plasma levels of cortisol.
    • C. Abnormally high androgen levels at birth.
    • D. Premature puberty of male children.
    • E. Stunted growth development of males.
  78. Correct Answer: A
  79. 15. All the following statements are correct except
    • A. UV light converts 7-dehydrocholesterol to cholecalciferol in the skin.
    • B. The liver contains a 25-hydroxylase enzyme that is important in the synthesis of the ligand for VDR.
    • C. The kidney contains a 1-alpha-hydroxylase enzyme that is important in the synthesis of the ligand for VDR.
    • D. The 1-alpha-hydroxylase enzyme activity is decreased by PTH.
    • E. Cod liver oil contains particularly high levels of vitamin D.
  80. Correct Answer: D
  81. 16. Low blood pressure will result in all the following except:
    • A. Increased renin release from the kidney.
    • B. Increased angiotensin II levels in blood.
    • C. Increased lipase activity in the zona glomerolosa (adrenals)
    • D. Increased plasma aldosterone levels.
    • E. Increased H2O excretion in urine.
  82. Correct Answer: E
  83. 17. Which of the following statements about glycemic index is incorrect?
    • A. The glycemic index is a measure of serum glucose responsiveness to a food.
    • B. Only foods with carbohydrates have a glycemic index
    • C. You can not alter the glycemic indices of foods but you can alter the glycemic load
    • D. Sucrose and Glucose have different glycemic indices
    • E. Foods with high glycemic indices are always cariogenic
  84. Correct Answer: C
  85. 18. Which of the following statements about Vitamin D is incorrect?
    • A. Vitamin D is an endogenously produced hormone
    • B. Vitamin D is an important component of dentin
    • C. Low Vitamin D is a risk factor for prostate cancer
    • D. Rickets is an expression of vitamin D deficiency
    • E. You can meet the RDAs for vitamin D by eating fish
  86. Correct Answer: B
  87. 19. Synthetic glucocorticoids are used as anti-inflammatory agents. One of the following statements is incorrect?
    • A. ACTH binds to receptors on the surface of specific cells in adrenals.
    • B. Desmolase activity is increased when ACTH binds to its receptor.
    • C. Desmolase converts cholesterol to cholesterol ester.
    • D. Glucocorticoid receptors are soluble proteins that can be present in the cytosol and nucleus.
    • E. Treatment of patients with cortisol will decrease plasma ACTH levels.
  88. Correct Answer: C
  89. 20. High blood pressure can be treated as follows, except:
    • A. Drugs that inhibit ACE.
    • B. Drugs that inhibit the ATI, the Angiotensin II receptor.
    • C. Drugs that activate the mineralocorticoid receptor.
    • D. Reduce consumption of licorice.
    • E. Reduce Na+ intake in diet.
  90. Correct Answer: C
  91. 1. Which statement is TRUE about herpes simplex infections?
    • A. Oral infections are predominantly HSV 1-related
    • B. Many newly diagnosed genital infections are due to HSV-1
    • C. Once infected, the host can develop protective immunity against the virus
    • D. There are effective anti viral treatments available for this virus
    • E. A and B
  92. Correct Answer: E
  93. 2. Which of the following agents can be used for treatment of postmenopausal osteoporosis?
    • A. prempro
    • B. tamoxifen
    • C. raloxifen
    • D. diethylstilbesterol
    • E. methoxyprogesterone
  94. Correct Answer: C
  95. 3. What is TRUE about the corpus luteum and its physiological functions?
    • A. The corpus luteum is derived from the ovulated follicle in response to the LH surge acting on LH receptors on both the theca and granulosa cells at the end of the follicular phase/ovulatory phase.
    • B. In humans, the corpus luteum secretes progesterone but not estradiol.
    • C. Human chorionic gonadotropin (hCG) stimulates apoptosis of the corpus luteum, signaling its programmed cell death at the end of the luteal phase.
    • D. The corpus luteum does not play an important role in maintenance of early pregnancy.
    • E. All of the above
  96. Correct Answer: A
  97. 4. What condition may contribute to an elevated blood PSA level?
    • A. Urinary tract infection
    • B. Benign prostate hyperplasia
    • C. Gonorrhea
    • D. Epidydimits
  98. Correct Answer: B
  99. 5. What is TRUE regarding gender differences in luteinizing hormone (LH) secretion?
    • A. Males exhibit a pulsatile pattern of LH secretion.
    • B. Females exhibit a pulsatile pattern of LH secretion.
    • C. Both males and females exhibit a surge pattern of LH secretion.
    • D. Neither males nor females show changes in the pattern of pulsatile secretion of LH over time.
    • E. A and B
  100. Correct Answer: E
  101. 6. The developing trophoblast and placenta secrete numerous hormones that play important roles in pregnancy. Which of the following is TRUE regarding the functions of those hormones during pregnancy?
    • A. Human chorionic gonadotropin (hCG) plays an important role in directly stimulating vascularization of the uterine endometrium.
    • B. Progesterone inhibits uterine myometrial contractions.
    • C. Estradiol inhibits expression of oxytocin receptors on the uterine myometrium, thereby preventing premature contractions.
    • D. Oxytocin inhibits uterine myometrial contractions.
    • E. A and C
  102. Correct Answer: B
  103. 8. Identify the following structures in the female reproductive tract. What are the images listed in order labeled 1, 2, and 3?
    • A. Graafian follicle, primordial follicle, vagina
    • B. secondary follicle, oviduct, breast
    • C. primary follicle, breast, tunica albuginea, corpus luteum
    • D. primary follicle, corpus albicans, mammary gland
    • E. primordial follicle, Graafian follicle, mammary gland









    Correct Answer: D
  104. 7. Which of the following hormones associates with gingival inflammation and increases in tooth mobility and pocket depth?
    • A. dihydrotestosterone
    • B. thyroid hormones
    • C. parathyroid hormones
    • D. female sex hormones
  105. Correct Answer: D
  106. 9. All of the following statements are correct about the reproductive tract EXCEPT:
    • A. The infundibulum has fringelike projections to transport the ovulated oocyte into the oviduct.
    • B. After ovulation, thecal cells and granulosa cells form the corpus luteum.
    • C. The functionalis of the endometrium undergoes cyclical changes in response to hormones.
    • D. The basalis of the endometrium regenerates the functionalis after menstruation.
    • E. Alveolar cells in the breast secrete IgA into milk to provide passive immunity to the newborn.
  107. Correct Answer: E
  108. 10. Which cells secrete testosterone?
    • A. Leydig cells
    • B. Principal cells
    • C. Sertoli cells
    • D. Spermatogonia
    • E. Thecal cells
  109. Correct Answer: A
  110. 11. You have a patient who has been trying to get pregnant for the past 12 months. She found out that she is not ovulating. What are the normal endocrine and physiological events leading up to ovulation and fertilization?
    • A. There is an increase in estradiol negative feedback during the follicular phase.
    • B. Elevated progesterone during the follicular phase creates a watery cervical mucous, thereby facilitating sperm transport from the vagina into the uterus.
    • C. There is estradiol positive feedback towards the end of the follicular phase, leading to the LH surge and consequent ovulation.
    • D. The corpus luteum plays a critical role in ovulation and fertilization of the oocyte.
    • E. Very high frequency (e.g., > 5 pulses/hr) or constant GnRH secretion will upregulate GnRH receptors on pituitary gonadotropes, leading to enhanced LH and FSH secretion, and consequent super-ovulation.
  111. Correct Answer: C
  112. 12. Which of the following bacterium is NOT acquired by sexual contact?
    • A. C. trachomatis
    • B. H. ducreyi
    • C. N. gonorrhoeae
    • D. E. coli
  113. Correct Answer: D
  114. 13. The cells in the image are found in which organ?
    • A. Seminal Vesicle
    • B. Prostate
    • C. Ovary
    • D. Epididymis
    • E. Testis
  115. Correct Answer: E
  116. 14. Symptoms of neurosyphilis may include:
    • A. Tabes dorsalis
    • B. Optic nerve atrophy
    • C. Screwdriver incisor teeth
    • D. A and B
  117. Correct Answer: D
  118. 15. Which of the following tests is used for syphilis screening?
    • A. VDRL
    • B. FTA-ABS
    • C. RPR
    • D. MHA-TP
    • E. A and C
  119. Correct Answer: E
  120. 16. You have an XY patient who has a mutation of the androgen receptor that completely ‘knocks out’ its function. What are the expected consequences of this mutation?
    • A. The patient will not develop testes
    • B. The patient’s Wolffian ducts will not develop into male internal genitalia.
    • C. The patient’s external appearance will be phenotypically female.
    • D. All of the above
    • E. B and C
  121. Correct Answer: E
  122. 17. All of the following statements regarding the side effects of estrogen are true except:
    • A. breast engorgement, endometrial hyperplasia
    • B. thromboembolic events
    • C. heart attack, stroke, and hyperlipidemia
    • D. infertility and weight loss
    • E. viginal and cervical carcinoma
  123. Correct Answer: D
  124. 18. You have an XY patient who has a mutation of the SRY gene that completely ‘knocks out’ its function. What are the expected consequences of this mutation?
    • A. The patient will not develop testes
    • B. The patient’s Wolffian ducts will not develop into male internal genitalia.
    • C. The patient’s external appearance will be phenotypically female.
    • D. All of the above
    • E. B and C
  125. Correct Answer: D
  126. 19. Which of the following statement is CORRECT about human papillomaviruses (HPV)?
    • A. Viral early genes encode viral structure proteins
    • B. HPV produce virions in basal cell layer.
    • C. Gardasil vaccine can prevent skin cancer
    • D. HPV genome is replicated by a cellular DNA dependent DNA polymerase
  127. Correct Answer: D
  128. 20. TRUE OR FALSE: Under the influence of follicle stimulating hormone (FSH), the cells of the thecal synthesize estrogen that enters the blood vessels, and is distributed throughout the body.
    Answer
  129. Correct Answer: False
  130. 21. What is the erectile tissue of the penis that contains the urethra?
    • A. Corpus cavernosum
    • B. Corpus spongiosum
    • C. Corpus venosum
    • D. Tunica albuginea
    • E. Seminiferous tubules
  131. Correct Answer: B
  132. 22. Herpesviruses (HSV) are characterized by their ability to establish latency. Which of the following statement is CORRECT about latency?
    • A. Latency is nonproductive infection established by a defective virus
    • B. Latency is a strategy successfully used by HSV to avoid the clearance of the host immune responses
    • C. Latency is a non-reversible process but viral genome is maintained via integration into cellular chromosome
    • D. Latency is normally maintained in epithelial cells
  133. Correct Answer: B
  134. 23. Oral Mucous patch is associated with:
    • A. Primary syphilis
    • B. Secondary syphilis
    • C. Gonococcal stomatitis
    • D. Trachoma pallidum
  135. Correct Answer: B
  136. 24. Treatment of breast cancer may involve:
    • A. Surgical excision
    • B. Chemotherapy
    • C. Adjuvant therapy with estrogen receptor modulators
    • D. All of the above
  137. Correct Answer: D
  138. 1. In thyroid disease all is true EXCEPT:
    • A. Autoimmune disease can cause hypo- and hyper- thyroidism
    • B. The most sensitive marker is T4 levels
    • C. The thyroid can be normal in size or enlarged
    • D. The follicular cells can undergo metaplastic changes
    • E. Mostly female predominant
  139. The most sensitive test is TSH levels. (T4 can be bound to proteins in the blood and is not accurate for evaluation)
    Correct Answer: B
  140. 2. Your diabetic patient presents for several amalgam restorations. He brings his glucometer to the office, and upon checking his blood sugar just prior to your treatment you find that it is 130 mg/dl. You should:
    • A. Refuse to treat him until his blood sugar is under better control.
    • B. Advise him to eat something with sugar prior to starting treatment.
    • C. Advise him to administer 20U NPH insulin subcutaneously prior to starting treatment.
    • D. None of the above.
  141. Correct Answer: D
  142. 3. A patient experiencing myxedema coma may manifest all of the following EXCEPT:
    • A. Hypothermia
    • B. Hypoventilation
    • C. Tachycardia
    • D. Hypoglycemia
  143. Correct Answer: C
  144. 4. The medical emergency kit in a dental office should contain insulin to treat a hyperglycemic emergency.
    • A. True
    • B. False
  145. Correct Answer: B
  146. 5. Thyroid storm may be associated with atrial fibrillation:
    • A. True
    • B. False
  147. Correct Answer: A
  148. 6. A patient with Cushing’s disease has:
    • A. High plasma cortisol & high ACTH
    • B. High plasma cortisol and low ACTH
    • C. Low plasma cortisol and low ACTH
    • D. Low plasma cortisol and high ACTH
  149. Correct Answer: A
  150. 7. The 40 year old woman seen in the photograph above is suffering from diabetes. She is now complaining of hirsutism and depression. A test showed elevated serum corticosteroids and low ACTH. Dexamethasone suppression test does not lower corticotrophic hormone levels. This patient most likely has a tumor in one of the flowing locations:
    • A. Adrenal cortex, zona fasciculata
    • B. Adrenal cortex, zona glomerulosa
    • C. Adrenal cortex, zona reticularis
    • D. Adrenal medulla
    • E. Anterior pituitary
  151. Cushing syndrome due to adrenal adenoma secreting glucocorticoid hormones (Buffalo hump, moon face hirsutism, low ACTH and no response in dexamethasone suppression test).
    • Points Earned: 1/1
    • Correct Answer: A
  152. 8. Hypercalcemia may lead to:
    • A. Nephrolithiasis
    • B. Osteoporosis
    • C. Muscle hypertrophy
    • D. Seizures
  153. Correct Answer: A
  154. 9. Your diabetic patient becomes lethargic during treatment. Her speech is slightly slurred, she is perspiring, and tachycardic at 120/min. She remains conscious and can respond to commands. You should:
    • A. Phone 911 immediately and provide supportive care until paramedics arrive.
    • B. Administer 30U NPH insulin subcutaneously and continue to monitor.
    • C. Ask her to drink some orange juice and continue to monitor.
    • D. Phone the patient’s physician, but otherwise do not treat her, as you cannot be sure whether she is suffering from hyperglycemia or hypoglycemia.
  155. Correct Answer: C
  156. 10. The net effect of cortisol includes:
    • A. Increased gluconeogenesis
    • B. Increased nucleic acid synthesis
    • C. Decreased protein breakdown in muscles and bones
    • D. Decreased lypolysis
  157. Correct Answer: A
  158. 11. Why is it important to know the specific name of the steroid medication that a patient stopped taking over two months ago?
    • A. Some steroids are known to have interactions with the epinephrine in dental anesthetics.
    • B. Cessation of some steroids can result in a rebound increase in endogenous steroid production which can result in Cushing’s disease.
    • C. Some steroids suppress the adrenal glands at lower doses.
    • D. Some steroids increase the risk for hypoglycemia in the dental setting.
  159. Correct Answer: C
  160. A 42 year old woman has the above lesion in her thyroid gland. This woman ALSO has the following:
    • A. Elevated TSH levels
    • B. Autoimmune disease
    • C. Increased risk to develop lymphoma
    • D. Cell mediated cytotoxic effect on follicular cells
    • E. All of the above
  161. Picture of lymphocytic thyroiditis – Hashimoto’s, All are true - Pt will have hypothyroidism due to destruction of tissue by lymphocytes.
    • Points Earned: 1/1
    • Correct Answer: E
  162. 13. Regarding diabetes mellitus, all is TRUE EXCEPT:
    • A. Key feature is hyperglycemia and glucose toxicity in both Type 1 and Type 2.
    • B. Accelerated atherosclerosis is the major cause of death
    • C. Kimmelstiel-Wilson is a retinopathy caused in diabetes
    • D. A patient presenting to your office with a Hemoglobin A1C of 10 most likely has periodontitis
    • E. This lesion can be seen with diabetes Type 1:
  163. Kimmelstiel-Wilson is the type of nephropathy in diabetes.
    Correct Answer: C
  164. A 32 year old woman presented with a non-tender solitary firm nodule on the anterior left side of the neck. Thyroid function tests are within normal limits. Following a fine needle aspiration this tumor is excised. All of the following are TRUE regarding the lesion seen in the photograph above EXCEPT:
    • A. This lesion has a good prognosis
    • B. The patient has a thyroid follicular adenoma
    • C. This lesion is associated with radiation
    • D. Nuclear features are most important for the diagnosis
    • E. This lesion tends to spread via lymphatics
  165. This is a papillary thyroid carcinoma (notice the papillary architecture and nuclear inclusions and grooves)
    • Points Earned: 0/1
    • Correct Answer: B
  166. 15. The presence of TSH receptor stimulating autoantibodies (TSH-R Ab [stim]) may cause:
    • A. Hypothyroidism
    • B. Hyperthyroidism
    • C. Thyroid cysts
    • D. Thyroid cancer
  167. Correct Answer: B
  168. 16. Hypocalcemia may be associated with all of the following EXCEPT:
    • A. Delayed ventricular repolarization
    • B. Metastatic calcifications
    • C. Paresthesias of lips
    • D. Tetany
  169. Correct Answer: B
  170. One statement is incorrect about the above neoplasm:
    • A. It is benign
    • B. It can cause hypertension
    • C. It can cause amenorrhea and galactorrhea
    • D. Mass effect is common in a functional neoplasia
  171. Pituitary adenoma from acidophilic cells – prolactinoma.
    • If the adenoma is functional patient will have symptoms and will be diagnosed before it grows to create a mass effect
    • Correct Answer: D
  172. 18. The net effect of aldosterone includes
    • A. Na retention
    • B. Water loss
    • C. K retention
    • D. Calcium loss
  173. Correct Answer: A
  174. 19. Your dental patient informs you that she has hypothyroidism being treated with Levothyroxine (Synthroid®). She brings a report of her blood tests, and you notice that her TSH levels have been checked every six months, and for the last 2 years, all levels have all been within the normal reference range. She reports no recent changes in her dosage of Levothyroxine. You plan to perform an amalgam restoration. You should:
    • A. Contact her physician for treatment recommendations.
    • B. Avoid epinephrine in the local anesthetic.
    • C. Avoid epinephrine in the retraction cord.
    • D. Proceed without any treatment modifications.
    • E. B and C only
  175. Correct Answer: D
  176. 20. Blood calcium level is regulated by
    • A. TSH
    • B. PTH
    • C. Calcitonin
    • D. FSH
  177. Correct Answer: B
  178. 21. Your patient presents for a relatively stressful procedure which includes several dental extractions and immediate placement of dental implants, and she is somewhat anxious. Her medical history is significant for rheumatoid arthritis for which she was recently taking Prednisone. She reports that she took 10mg Prednisone per day for 7 days, but stopped three weeks ago. Which of the following treatment options is most reasonable?
    • A. Instruct her to take 10mg Prednisone one hour prior to the dental procedure.
    • B. Delay the procedure until she has been off the Prednisone for at least 2 months.
    • C. Check an ACTH level prior to treatment to be sure it has returned to the normal level.
    • D. Proceed without any treatment modifications.
  179. Correct Answer: D
  180. 1. Dietary impacts on biofilm are a function of
    • A. Cellulose fiber intake
    • B. Protein content of the diet
    • C. Carbohydrate content of the diet
    • D. Sodium intake
  181. Correct Answer: C
  182. 2. Control of normal calcium homeostasis is important for all your patients. Identify the INCORRECT statement.
    • A. Calcium oxalate crystals can form stones in the kidney
    • B. Oxalate absorption from the diet is increased when dietary calcium levels are low.
    • C. People absorp about 2 g calcium from the diet each day to maintain calcium homeostasis.
    • D. Approximately 45% blood calcium is in the ionized form.
  183. Correct Answer: C
  184. 3. One statement about steroid hormones and/or steroidogenic tissue is INCORRECT.
    • A. Steroidogenic tissues contain cholesterol ester lipid droplets.
    • B. All steroidogenic tissues express the enzyme desmolase.
    • C. Desmolase converts pregnenolone to cholesterol.
    • D. Cortisol promotes movement of the glucocorticoid receptor from the cytosol to the nucleus.
    • E. Long term treatment with prednisone (a glucocorticoid) can cause adrenals to atrophy.
  185. Correct Answer: C
  186. 4. Which of the following is not true of Vitamin C?
    • A. Deficiency can cause a breakdown of connective tissue
    • B. Patients in the wound healing process can always benefit from supplementation
    • C. Enhances iron absorption
    • D. At-risk populations for deficiency include the elderly and cigarette smokers
  187. Correct Answer: B
  188. 5. Patients with Pseudohypoparathyroidism (Albright Hereditary Osteodystrophy) have all but one of the following:
    • A. Crowded teeth.
    • B. High blood PTH.
    • C. High plasma calcium.
    • D. Short stature.
    • E. Inactivating mutations in Gαs.
  189. Correct Answer: C
  190. 6. A patient with Cushing’s disease (not Cushing’s Syndrome) is likely to have all EXCEPT one of the following:
    • A. High levels of ACTH in the blood.
    • B. High levels of cortisol in the blood.
    • C. Muscle wasting and weakness
    • D. Low levels of glucose in the blood.
  191. Correct Answer: D
  192. 7. Which of the following does not play a critical role in wound healing?
    • A. Copper; component of critical enzymes for formation of connective tissue
    • B. Vitamin D; plays a role in calcium homeostasis
    • C. Zinc; protein synthesis, structural role in membranes
    • D. Vitamin B; promotes growth of red blood cells
  193. Correct Answer: D
  194. 8. Severe reduction in plasma calcium leads to all except one of the following:
    • A. Increased release of PTH from the parathyroid gland.
    • B. Increased conversion of pre-osteoclasts to osteoclasts.
    • C. Increased number of resorbing pits on bone.
    • D. Increased conversion of 1-25-dihydroxyvitamin D to 1,24 dihydroxyvitamin D.
    • E. Increased absorption of calcium from the diet.
  195. Correct Answer: D
  196. 9. Mutations in both genes encoding the adrenal 21-hydroxylase enzyme (also known as Congenital Adrenal Hyperplasia Type 1) can result in all the following in a newborn female (XX) child EXCEPT:
    • A. Low plasma cortisol levels.
    • B. High plasma testosterone levels.
    • C. A penis-like structure.
    • D. Low plasma ACTH levels.
  197. Correct Answer: D
  198. 10. Which of the following are post-bariatric surgery dental risk factors?
    • A. High plaque index and cariogenicity
    • B. Low salivary production with low buffering capacity
    • C. High acidic levels in the oral cavity due to vomiting
    • D. Low salivary production with low buffering capacity
    • E. All of the above
  199. Correct Answer: E
  200. 11. Because of his bent legs and short stature you think a child, recently arrived from northern Russia, may have rickets. One statement about Vitamin D metabolism that could be related to this disease, or to treatment, is INCORRECT.
    • A. Cod liver oil contains particularly high levels of Vitamin D (cholecalciferol).
    • B. UV light is necessary to increase the conversion of 7-dehydrocholesterol to cholecalciferol in the skin.
    • C. The liver converts cholecalciferol to the biologically active 1,25-dihydroxyVitamin D3.
    • D. Rickets could be due to inactivating mutations in the gene encoding 1α-hydroxylase.
    • E. Rickets can be the result of mutations within the VDR gene.
  201. Correct Answer: C
  202. 12. Which is the case regarding nutritional recommendations during wound healing in the oral cavity?
    • A. Saturated fats are needed for membrane repair.
    • B. Normal caloric requirements increase during healing but most people are in positive energy balance and do not need to eat more during the would healing process
    • C. Copper supplementation is recommended to prevent scurvy
    • D. Iron intakes are generally low in the population and more iron is needed during healing to prevent macrocytic anemia
  203. Correct Answer: B
  204. 13. You are treating a patient when they become faint as a result of a drop in blood pressure (BP). This drop in BP will result in all but one of the following:
    • A. Increased proteolytic cleavage of angiotensinogen to form angiotensin I.
    • B. Conversion of Angiotensin I to Angiotensin II by renin.
    • C. Increase aldosterone synthesis in the adrenals.
    • D. Vasoconstriction as a result of Angiotensin II binding to ATl receptors on vascular smooth muscle cells.
  205. Correct Answer: B
  206. 14. Your patient has decreased mandibular bone density, indicating that she may have advanced osteoporosis. There are a number of possible treatments or alternative explanations for the findings. Which one of the following statements is INCORRECT.
    • A. Bisphosphonates will promote apoptosis of osteoclasts.
    • B. Bisphosphonates can be given orally or intravenously.
    • C. Calcium absorption from the diet is increased when 1,25-dihydroxyvitamin D3 binds to the Vitamin D Receptor (VDR) in enterocytes
    • D. Forteo (corresponding to the 34 amino terminal portion of PTH) is given orally to reduce bone resorption and increase bone deposition.
    • E. The patient may have elevated blood PTHrP from a solid breast tumor.
  207. Correct Answer: D
  208. 15. One statement about Testosterone is INCORRECT:
    • A. Testosterone is synthesized in Leydig cells in the testes.
    • B. LH (luteinizing hormone) activates a lipase in Leydig cells.
    • C. LH causes the secretion of testosterone stored in intracellular vesicles.
    • D. Testosterone can be converted to estrogens in peripheral tissues.
  209. Correct Answer: C
  210. 16. A 26 year old vegetarian female presents with dental decay. Which of her eating behaviors is most likely to contribute to the decay?
    • A. She appears to be anorexic.
    • B. She eats raw organic vegetables.
    • C. She is iron deficient.
    • D. She eats tofu daily
    • E. She regularly orders a baked potato when eating out with friends
  211. Correct Answer: E
  212. 17. One statement about bone resorption below is INCORRECT.
    • A. Trabecular bone turns over faster than cortical bone.
    • B. Bone resorption is increased in patients with hyperparathyroidism.
    • C. Hyperparathyroidism results in increased expression of RANKL on osteoblasts.
    • D. Gram negative bacteria release proteins that decrease RANKL expression on osteoblasts.
  213. Correct Answer: D
  214. 18. One statement about estradiol synthesis is INCORRECT:
    • A. Granulosa cells synthesize the androgen androstenedione from cholesterol in response to luteinizing hormone (LH).
    • B. Granulosa cells convert androstenedione into estradiol.
    • C. Granulosa cells contain the enzyme Aromatase.
    • D. Aromatase is expressed in adipose tissue of males and females.
    • E. Aromatase inhibitors are used clinically to treat patients with estrogen-dependent cancers.
  215. Correct Answer: A

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