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Invasion and multiplication of bacteria in body tissues result in local cellular injury due to all of the following factors, EXCEPT for one. Which one is the exception?

A. competitive metabolism B. toxin production C. immune-mediated reactions D. genomic alteration.

All of the following statements are correct with respect to Gram-positive and Gram-negative bacteria, EXCEPT for one. Which one is the exception?

A. Acetone extracts lipids from the outer membrane, cell wall, and cytoplasmic membrane of bacteria. B. Gram negative bacteria possess a thick peptidoglycan cell wall. C. The damage to gram-negative organisms is more extensive and they lose their crystal violet-iodine complexes, i.e., they are decolorized; and when counterstained with safranin, they appear red. D. Gram-positive bacteria retain their crystal violet-iodine complexes and appear deep purple.

All of the following statements is correct with respect to odontogenic infections EXCEPT for one. Which one is the exception?

A. Most odontogenic infections are polymicrobial. B. The predominant flora create an ecosystem of synergism by elaborating a more favorable alkaline environment and increased oxygenation to support the growth and proliferation of its members. C. In odontogenic infections, the number of isolated strains ranges from 1 to 10 organisms. D. The average number of organisms responsible for an odontogenic infection is 4.

Pharmacological strategies are predicated on targeting differences between prokaryotic bacterial and eukaryotic host cells. Selective toxicity can be achieved by all of the following, EXCEPT for one. Which one is the exception?

A. attacking targets unique to eukaryotic cells. B. attacking targets unique to bacteria. C. attacking targets in bacteria similar but not identical to those in host cells. D. attacking targets that are shared, but vary in importance between bacteria and host cells.

All of the following statements are correct with respect to bacterial cell walls, EXCEPT for one. Which one is the exception?

A. Monomers are synthesized in the cytoplasm from amino acid and sugar building blocks. B. Bactoperol transfers the monomers across the cytoplasmic membrane where they are polymerized into linear peptidoglycan chains. C. Transpeptidase cross-links peptidoglycan chains into a three-dimensional mat. D. Monomers are synthesized in the nucleus from fatty acid and sugar building blocks.

All of the following statements are correct with respect to inhibitors of cell wall synthesis EXCEPT which one?

A. Vancomycin targets monomer polymerization, it is bactericidal, but does not have the requisite spectrum to be considered an empirical option in treating odontogenic infections. B. Penicillin V potassium and amoxicillin formulations, which block polymer cross-linking, are bactericidal, and have the requisite spectra to be considered as empirical options in treating odontogenic infections. C. Second generation cephalosporins have an overlapping spectra with those of penicillin V potassium and amoxicillin formulations. D. Second generation cephalosporins are more β-lactamase resistant and offer a significant therapeutic advantage over the penicillins as empirical options.

All of the following statements relative to inhibitors of DNA synthesis and integrity are correct EXCEPT for one. Which one is the exception?

A. Fluoroquinolones block topoisomerase type II activity, disrupt the integrity of bacterial DNA, and are bactericidal. B. Sulfamethoxazole (SMX) and trimethoprim (TMP), block succeeding steps in folate synthesis and the combination is bactericidal. C. A metabolite of metronidazole directly binds DNA, causes loss of its helical structure, effect strand breakage, and is bactericidal. D. Metronidazole, in combination with penicillin V potassium or amoxicillin, is an empirical option in treating odontogenic infections.

All of the following statements are correct with respect to inhibitors of transcription and translation, EXCEPT for one. Which one is the exception?

A. Tetracyclines are teratogenic and produce higher rates of neuronal-tube defect, cleft palate, and multiple congenital abnormalities. B. Clindamycin has excellent activity against gram-positive aerobes and anaerobes, as well as gram-negative anaerobes. C. Macrolides are highly effective against anaerobic gram negative organisms. D. Azithromycin has an extended spectrum that includes some anaerobic gram-positive cocci and gram-negative bacilli.

Uncomplicated odontogenic infections manifest primarily as caries; and pulpal, periodontal, and pericoronal problems with signs and symptoms that include pain, erythema, edema, and difficulty chewing.

A. True B. False

Complicated odontogenic infections reflect the extension of an uncomplicated odontogenic infection into surrounding tissue with Signs and symptoms that include lymphadenitis, trismus, difficulty swallowing or breathing; and less frequently, fever and hypotension.

A. True B. False

All of the following statements about the routine use of antibacterial agents in the treatment of uncomplicated infections are is correct, EXCEPT for one. Which one is the exception?

A. Reversible pulpitis is a reactive process and there is no evidence that antibacterial agents would have any effect on clinical outcome. B. In untreated irreversible pulpitis, penicillin does not reduce spontaneous pain, percussion induced pain, or the intake of analgesics. C. In the treatment of acute apical periodontitis, once the source of infection is eliminated, the administration of penicillin provides no added benefit. D. In the treatment of acute apical periodontitis, the administration of penicillin significantly reduced pain.

In a prospective study, a five-day course of penicillin administered to patients with acute pain related to a tooth with an amalgam restoration without clinical signs of infection, in the absence of definitive dental care, did not prevent the emergence of clinical signs of infection within 5 days.

A. True B. False

In a prospective study, a five-day course of penicillin administered to patients with acute pain related to a tooth with large periapical radiolucency, but without clinical signs of infection, in the absence of debridement did not prevent the development of clinical signs of infection within 5 days.

A. True B. False

In the treatment of draining sinus tract, there is convincing evidence that the routine administration of an antibacterial agent improves therapeutic outcome.

A. True B. False

There is convincing evidence that the routine administration of an antibacterial agent does not improves therapeutic outcome in association with all of the following conditions, EXCEPT for one. Which one is the exception?

A. gingival and periodontal abscesses B. necrotizing ulcerative gingivitis C. alveolar osteitis D. progressing pericoronitis.

Regarding pericoronitis, when a subacute condition has been attained, usually within 48 hours, and the tooth is to be maintained, the operculum should be removed at this time; otherwise, the tooth may now be extracted.

A. True B. False

All of the following conditions should be considered a complicated odontogenic infection and an indication for adjunctive antibacterial chemotherapy, EXCEPT for one. Which one is the exception?

A. pain B. cellulitis C. osteomyelitis D. space infections

Based on best available evidence, penicillin V potassium or amoxicillin formulations, alone or in combination with metronidazole; and clindamycin are reasonable empirical options to consider for the treatment of complicated odontogenic infections.

A. True B. False

The empirical antibacterial agent drug of choice should be an effective agent with the narrowest spectrum and the least potential for adverse drug effects.

A. True B. False

All of the following statements are correct with respect to primary line antibacterial chemotherapy, EXCEPT for one. Which one is the exception?

A. Unless the patient has an allergy to the penicillins, the empirical drug of first choice for the treatment of odontogenic infections is narrow spectrum penicillin V potassium. B. Most infections require 5 days of antibacterial chemotherapy - an initial loading dose followed by maintenance doses for the remainder of the time. C. If significant improvement is not noted in 48 to 72 hours, the addition (for 5 days) of metronidazole to penicillin V potassium is reasonable. D. Metronidazole provides excellent coverage for obligate aerobes.

All of the following statements are correct with respect to secondary line antibacterial chemotherapy, EXCEPT for one. Which one is the exception?

A. A macrolide is an empirical option for the treatment of odontogenic infections in patients allergic to β-lactam antibiotics. B. Azithromycin use is not associated with an increased arrhythmia risk. C. While there is a paucity of data demonstrating the efficacy of azithromycin in the treatment of odontogenic infections, it appears to be the best choice because of its extended spectrum against facultative and some obligate anaerobes. D. Clindamycin may be a better empirical option in patients allergic to β-lactam antibacterial agents.

All Which of the following statements areis correct with respect to tertiary line antibacterial chemotherapy, EXCEPT for one. Which one is the exception?

A. Clindamycin is the empirical drug of choice for unresolved infections following treatment with a β-lactam antibacterial agent. B. Clindamycin is the initial empirical drug of choice for the treatment of severe complicated odontogenic infections. C. Clindamycin is β-lactamase resistant and has excellent activity against gram-positive cocci and most gram-negative anaerobes. D. Clindamycin use is associated with a very low risk of developing a Clostridioides difficile-associated superinfection.

All of the following statements are correct with respect to the prevention of surgical-site infection in patients undergoing tooth extractions, EXCEPT for one. Which one is the exception?

A. There is no evidence that antibacterial agents prevent pain, reduce fever, swelling, or trismus. B. Antibacterial drugs administered just before and/or just after third molar extractions may reduce the risk of infection and dry socket. C. The number needed to treat (NNT) to prevent one individual from having an extraction-related infection was estimated to be 19. D. There is solid evidence that an antibacterial agent given to healthy people in association with third molar extractions is more beneficial than harmful.

All of the following statements are correct with respect to the prevention of surgical-site infection in patients undergoing placement of dental implants, EXCEPT for one. Which one is the exception?

A. Bacteria introduced during the placement of dental implants can lead to infection and implant failure. B. The number needed to treat (NNT) to prevent one individual from having an implant failure was estimated to be 19. C. The evidence to suggest that amoxicillin 2g. administered 1 hour preoperatively reduces the failure rate of dental implants placed under ordinary conditions is statistically insignificant. D. There is no statistically significant evidence that postoperative antibacterial agents are beneficial to reduce infection and implant failure.

All of the following statements are correct with respect to the prevention of infective endocarditis in patients undergoing dental procedures EXCEPT for one. Which one is the exception?

A. The 2021 guideline stratifies cardiac conditions as to the risk of developing endocarditis and the severity of associated morbidity. B. Only patients with the highest-risk of adverse outcome from endocarditis require antibacterial prophylaxis prior to dental procedures. C. Antibacterial prophylaxis is indicated before procedures that involve manipulation of gingival tissue, periapical region of teeth, or perforation of the oral mucosa. D. In situations where no chemoprophylaxis was given, but in which unexpected bleeding occurred, the institution of antibacterial therapy within 24 hours is recommended.

All of the following statements are correct with respect to the conclusions of the 2014 Panel relative to prophylactic antibacterial chemotherapy in patients with prosthetic joints undergoing dental treatment, EXCEPT for one. Which one is the exception?

A. The Panel found no association between dental procedure-related transient bacteremia and prosthetic joint infection. B. The Panel found clear evidence that antibacterial agents administered prior to dental procedures prevent joint infarctions. C. The Panel concluded that because of potential harmful effects of antibacterial agents such as allergic reaction and superinfections, the risks of antibacterial prophylaxis may exceed any benefit for most patients. D. The Panel concluded that, in general, the administration of antibacterial prophylaxis is not recommended for patients with prosthetic joints undergoing dental procedures.

All of the following statements are correct with respect to the prevention of infection in patients with various medical conditions undergoing dental procedures, EXCEPT for one. Which one is the exception?

A. Evidence that a particular bacteremia-producing dental procedure caused a specific case of infection is circumstantial at best. B. No definitive, scientific evidence supports the use of prophylactic antibiotics in patients with various medical conditions undergoing dental procedures. C. Clinicians should amplify their efforts to ensure that all patients understand the critical importance of maintaining optimal oral health, which could serve to reduce the severity of both self-induced and treatment-induced bacteremia. D. The potential adverse effects associated with antibacterial prophylaxis has no bearing on the decision to use prophylaxis in patients with a medical condition.

All of the following statements are correct with respect to the prevention of surgical-site infection in patients undergoing open reduction and fixation of mandibular fractures, EXCEPT for one. Which one is the exception?

A. The benefit of pre- and intra-operative antibacterial chemotherapy when treating open mandibular fractures has long been established. B. A prospective randomized trial evaluated the efficacy of post-operative prophylactic antibacterial chemotherapy in association with open reduction and internal fixation of mandibular fractures and found no statistically significant benefit. C. A prospective randomized trial evaluated the efficacy of post-operative prophylactic antibacterial chemotherapy in association with open reduction and internal fixation of mandibular fractures concluded that tobacco and alcohol appear to be negligible risk factors for post-operative infections. D. A prospective randomized trial evaluated the efficacy of post-operative prophylactic antibacterial chemotherapy in association with open reduction and internal fixation of mandibular fractures concluded that tobacco and alcohol appear to be significant risk factors for post-operative infections.

All of the following statements are correct with respect to the prevention of surgical-site infection in patients undergoing head and neck oncology surgery, EXCEPT for one. Which one is the exception?

A. The incidence of wound infection in patients undergoing head and neck oncology surgery has been reported to be as high as 87%, often with devastating effect. B. Based on the best current evidence, it is recommended that prophylactic antibacterial agents, covering aerobic gram-positive cocci and gram-negative bacilli, and anaerobic bacteria be administered in association with clean and clean-contaminated head and neck oncology surgery. C. There is no evidence that prophylactic antibacterial agents offer any benefit in clean surgery for benign disease. D. There is strong evidence that prophylactic antibacterial agents offer clear benefits in clean surgery for benign disease.

All of the following statements are correct with respect to antibacterial drug-resistance, EXCEPT for one. Which one is the exception?

A. The widespread and ever-increasing use of antibacterial agents contributes to the development of antibacterial drug-resistance. B. Unless healthcare providers change their practices, many currently available antibacterial agents may become ineffective. C. When other therapeutic means are available, antibacterial agents should not be routinely prescribed to treat or to prevent infections. D. Prescribing habits indicate the profession of dentistry does not tangibly contribute to problem of antibacterial drug resistance.

All of the following statements are correct with respect to gastrointestinal disturbances in association with antibacterial agents, EXCEPT for one. Which one is the exception?

A. Common ADEs associated with antibacterial agents, but especially with macrolides, are nausea, vomiting, epigastric distress, and diarrhea. B. Gastrointestinal symptoms may be amplified in patients on clindamycin with concurrent use of alcohol. C. When a patient has been taking an antibacterial agent for 1 to 2 days, diarrhea is probably due to the mild irritating action of the drug. D. Bloody diarrhea with abdominal cramping is highly suggestive of pseudomembranous colitis, a superinfection with Clostridioides difficile.

All of the following statements are correct with respect to hypersensitivity or other immune-related reactions to antibacterial agents, EXCEPT for one. Which one is the exception?

A. Maculopapular to exfoliative dermatitis, urticaria, angioedema, and rarely, anaphylaxis may occur with all antibacterial agents. B. Allergic reaction to the penicillins is more likely to occur in individuals with sensitivity to multiple allergens and in those with asthma. C. Rare instances of erythema multiforme and Stevens-Johnson syndrome have been reported with clindamycin and azithromycin. D. Hypersensitivity reactions appear to rarely occur with the β-lactams.

All of the following statements are correct with respect to potential cardiac complications associated with macrolides antibacterial agents, EXCEPT for one. Which one is the exception?

A. Antiarrhythmic drugs appear to protect against azithromycin-induced arrhythmia risk. B. Azithromycin and other macrolides can cause abnormal electrical activity in the heart that may lead to a potentially fatal irregular heart rhythm. C. Patients at particular risk for developing cardiac complications include those with existing QT internal prolongation and bradycardia; and those taking medications for the treatment of abnormal heart rhythm or arrhythmias. D. Increased risk of death from cardiovascular causes has been reported in persons treated with a 5-day course of azithromycin.

Penicillins should be administered with caution to patients with central nervous system disorders because severe convulsive seizures and peripheral neuropathy, characterized by numbness or paresthesia of the extremities are common.

A. True B. False

Superinfections with Candida sp. can occur in association with all, but especially broad-spectrum antibacterial agents.

A. True B. False

All of the following statements are correct with respect to antibacterial agents and pregnancy, EXCEPT for one. Which one is the exception?

A. There is no firm evidence that the penicillins, metronidazole, azithromycin, and clindamycin are teratogenic in humans. B. The penicillins, metronidazole, azithromycin, and clindamycin all have an FDA Pregnancy Category B rating, i.e., animal studies have revealed no evidence of harm to the fetus and there are multiple well-controlled studies in pregnant women. C. The new labeling requirement addressing pregnancy and lactation includes three detailed subsections that more accurately explain the real-world risks associated with a given drug exposure for a pregnant woman. D. Since animal studies are not always predictive of a drug’s teratogenic effect in humans, antibacterial agents should only be prescribed during pregnancy if clearly indicated.

All of the following statements are correct with respect to antibacterial agents and nursing, EXCEPT for one. Which one is the exception?

A. The penicillins are excreted in breast milk and may lead to sensitization of infants. B. Metronidazole, which has been shown to be carcinogenic in rats and mice, is excreted in breast milk in concentrations similar to those found in plasma. C. Considering the potential risks to the nursing infant, a decision should be made whether to discontinue nursing or not to prescribe an antibacterial agent to the mother. D. Clindamycin is not excreted in breast milk.

All of the following statements are correct in relation to interactions between antibacterial agents and oral contraceptives, EXCEPT for one. Which one is the exception?

A. There are no pharmacokinetic data at this time to support the contention that antibacterial agents reduce the efficacy of oral contraceptives, except for rifampin, an antituberculin drug. B. The United States District Court for the Northern District of California concluded that "scientific evidence regarding alleged interaction between antibacterial agents and oral contraceptives" did not satisfy the "Daubert standard of causality." C. According to the American Medical Association, such interactions cannot be completely discounted. D. The American Dental Association Council on Scientific Affairs concluded that dentists need not be concerned about potential drug interactions affecting contraception efficacy.

The ADA recommends that patients prescribed an antibacterial agent while also taking an oral contraceptive be advised of all of the following EXCEPT for one. Which one is the exception?

A. Be advised of the potential risk. B. Comply with their oral contraceptive regimen. C. Consider alternative contraception during periods of antibacterial. chemotherapy. D. Practice abstinence for 2 weeks after the completion of antimicrobial. therapy.

All of the following statements are correct with respect to the administration of antibacterial agents in oral healthcare settings EXCEPT for one. Which one is the exception?

A. The routine use of antibacterial agents in the treatment of uncomplicated odontogenic infections has not been shown to be effective. B. When treating complicated odontogenic infections, the adjunctive use of antibacterial agents is justified. C. Prophylactic antibacterial chemotherapy in dentistry should be limited to the prevention of those infections that have been proven or are strongly suspected to be procedure-specific. D. The empirical drug of choice should be the most effective and least toxic agent with the broadest spectrum.

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