DAANCE Managing Systemic Diseases 4 — Questions and Answers
Question 1: A patient with poorly controlled type 2 diabetes presents for dental anesthesia. Which blood glucose range is generally considered acceptable for proceeding with elective sedation?
- Below 70 mg/dL
- 70–180 mg/dL (Correct answer)
- 180–250 mg/dL
- Above 250 mg/dL
Correct answer: 70–180 mg/dL
A fasting blood glucose of 70–180 mg/dL is generally accepted as safe for elective dental procedures under sedation.
Question 2: Which systemic condition most significantly increases the risk of laryngospasm during dental sedation due to airway hyperreactivity?
- Hypertension
- Asthma (Correct answer)
- Type 1 diabetes
- Hypothyroidism
Correct answer: Asthma
Asthma causes bronchial hyperreactivity, significantly raising the risk of laryngospasm and bronchospasm during sedation.
Question 3: A patient on warfarin for atrial fibrillation has an INR of 3.8 on the day of the procedure. What is the most appropriate action?
- Proceed with sedation as planned
- Administer vitamin K and proceed
- Postpone and consult with the patient's physician (Correct answer)
- Administer protamine sulfate
Correct answer: Postpone and consult with the patient's physician
An INR of 3.8 is supratherapeutic and poses significant bleeding risk; the procedure should be postponed pending physician guidance.
Question 4: During sedation, a patient with a known pheochromocytoma develops a sudden spike in blood pressure to 220/130 mmHg. Which drug is most appropriate for acute management?
- Metoprolol IV
- Phentolamine IV (Correct answer)
- Epinephrine IV
- Atropine IV
Correct answer: Phentolamine IV
Phentolamine, an alpha-adrenergic blocker, is the drug of choice for hypertensive crises caused by catecholamine excess from pheochromocytoma.
Question 5: A patient with end-stage renal disease on hemodialysis is scheduled for sedation. Which opioid is MOST SAFELY used due to inactive metabolites?
- Morphine
- Meperidine
- Fentanyl (Correct answer)
- Codeine
Correct answer: Fentanyl
Fentanyl is preferred in renal failure because its metabolites are inactive and do not accumulate to cause toxicity.
Question 6: Which ASA classification applies to a patient who has had a myocardial infarction within the past 30 days?
- ASA II
- ASA III
- ASA IV (Correct answer)
- ASA V
Correct answer: ASA IV
A recent myocardial infarction (within 30 days) represents a severe systemic disease with an immediate life threat, placing the patient in ASA IV.
Question 7: A patient with myasthenia gravis requires dental sedation. Which sedative/anesthetic interaction is of greatest concern?
- Benzodiazepines causing respiratory depression
- Ketamine causing bronchospasm
- Neuromuscular blocking agents causing prolonged paralysis (Correct answer)
- Nitrous oxide causing vitamin B12 depletion
Correct answer: Neuromuscular blocking agents causing prolonged paralysis
Patients with myasthenia gravis have abnormal neuromuscular junctions and are exquisitely sensitive to neuromuscular blocking agents, risking prolonged or profound paralysis.
DAANCE Managing Systemic Diseases 4
A patient with poorly controlled type 2 diabetes presents for dental anesthesia.
Which blood glucose range is generally considered acceptable for proceeding with elective sedation?