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NDEB ACJ practice questions

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Question 1Clinical Judgement

A patient with a history of anaphylaxis to penicillin requires antibiotic therapy for a dental abscess. Which medication is the most appropriate alternative?

  1. Clindamycin Correct answer.
  2. Ampicillin
  3. Penicillin V
  4. Amoxicillin

Explanation

Clindamycin is a lincosamide unrelated to beta-lactam antibiotics, so it can be used when a genuine penicillin anaphylaxis history exists. Amoxicillin, penicillin V, and ampicillin all share the beta-lactam ring and risk cross-reactivity.

Question 2Clinical Judgement

Which finding most strongly suggests that facial swelling is of odontogenic rather than systemic origin?

  1. Generalized pitting edema of the limbs
  2. Bilateral periorbital edema
  3. A single swollen area adjacent to a carious tooth Correct answer.
  4. Swelling that fluctuates with dietary salt

Explanation

Odontogenic infection spreads contiguously from a source tooth, producing localized swelling adjacent to the offending dentition. Bilateral, generalized, or dietary-related edema patterns point toward systemic, renal, or allergic causes.

Question 3Clinical Judgement

A patient reports bleeding gums when brushing. Which recommendation is the first-line management?

  1. Rinse with hydrogen peroxide daily
  2. Begin a course of oral antibiotics
  3. Improve plaque control with regular brushing and interdental cleaning Correct answer.
  4. Stop brushing the affected area

Explanation

Gingival bleeding on brushing usually reflects plaque-induced inflammation, and removing the biofilm reverses it. Discontinuing brushing allows plaque to accumulate and worsens the condition; antibiotics are not indicated for routine gingivitis.

Question 4Clinical Judgement

Which radiograph is the standard initial imaging choice for assessing a single carious lesion and its proximity to the pulp?

  1. Periapical radiograph Correct answer.
  2. Lateral cephalogram
  3. Cephalometric radiograph
  4. Panoramic radiograph

Explanation

A periapical view provides high detail of a single tooth, its roots, and the adjacent alveolar bone, making it ideal for assessing caries depth and pulpal proximity. Panoramic and cephalometric images offer broader but lower-resolution overviews unsuitable for this purpose.

Question 5Clinical Judgement

A patient on warfarin requires a simple extraction and has an INR of 3.5. What is the most appropriate action?

  1. Double the warfarin dose before the procedure
  2. Give vitamin K and extract immediately
  3. Consult the prescribing physician before proceeding Correct answer.
  4. Proceed with extraction without modification

Explanation

An INR of 3.5 exceeds the usual range accepted for minor oral surgery, so the anticoagulation status must be reviewed with the managing physician before operating. Altering the warfarin dose or giving vitamin K is a physician decision, not a dental one.

Question 6Clinical Judgement

A patient with type 2 diabetes has poor glycemic control. Which oral finding is most consistent with this status?

  1. Increased salivary flow
  2. Reduced caries risk
  3. Accelerated orthodontic tooth movement
  4. Delayed wound healing and increased periodontal destruction Correct answer.

Explanation

Hyperglycemia impairs neutrophil function and collagen synthesis, slowing healing and worsening periodontal disease. Salivary flow tends to decrease rather than increase, and caries risk typically rises with dry mouth.

Question 7Clinical Judgement

Which presentation is most characteristic of a periapical abscess?

  1. A firm, painless nodule on the buccal mucosa
  2. Diffuse bilateral gingival enlargement
  3. A fluctuant swelling with a sinus tract near a nonvital tooth Correct answer.
  4. A vesicle that ruptures and leaves an ulcer on the palate

Explanation

A periapical abscess arises from pulpal necrosis and infection spreading through the apex, producing swelling and often a draining sinus near a nonvital tooth. Firm painless nodules or isolated palatal vesicles suggest other diagnoses such as fibromas or viral lesions.

Question 8Clinical Judgement

A patient requires a mandibular block and reports a previous episode of prolonged numbness after a similar injection. Which structure is most likely to have been inadvertently affected?

  1. The inferior alveolar nerve
  2. The facial nerve
  3. The lingual nerve Correct answer.
  4. The hypoglossal nerve

Explanation

Prolonged altered sensation of the tongue after a mandibular block is classically attributed to trauma to the lingual nerve, which lies close to the injection path. The inferior alveolar nerve supplies the teeth and lip, while facial and hypoglossal involvement would produce motor deficits.

Question 9Clinical Judgement

Which condition is the most common cause of halitosis of oral origin?

  1. Gastric reflux
  2. Systemic ketosis
  3. Bacterial degradation of oral debris and biofilm Correct answer.
  4. Sinus infection

Explanation

Most oral malodor results from anaerobic bacteria breaking down sulfur-containing proteins in plaque, debris, and on the tongue dorsum. Gastric, systemic, and sinus causes exist but are far less frequent sources.

Question 10Clinical Judgement

A 10-year-old child has a fractured anterior crown with pulpal exposure. The tooth is immature with an open apex. Which approach best preserves the tooth?

  1. Extraction and implant placement
  2. Partial pulpotomy or pulp capping to preserve vitality Correct answer.
  3. No treatment and review in one year
  4. Root canal treatment with immediate apexification

Explanation

In an immature tooth with an open apex, preserving pulp vitality allows continued root development and apex closure. Vital pulp therapy such as partial pulpotomy is preferred over extraction or immediate apexification when the pulp can be saved.

Question 11Clinical Judgement

Which instruction is appropriate for a patient after placement of a dental implant?

  1. Avoiding smoking and maintaining gentle oral hygiene Correct answer.
  2. Vigorous rinsing with alcohol mouthwash
  3. Chewing directly over the site immediately
  4. Skipping all cleaning around the site for two weeks

Explanation

Smoking impairs healing and osseointegration, and gentle hygiene around the site reduces infection risk without disturbing the clot. Alcohol rinses and immediate chewing over the site can irritate the wound and compromise healing.

Question 12Clinical Judgement

A patient with a history of infective endocarditis undergoing a dental extraction. Which regimen is currently recommended for prophylaxis in a high-risk patient?

  1. Amoxicillin 2 g orally one hour before the procedure Correct answer.
  2. Erythromycin 500 mg after the procedure
  3. Clindamycin 600 mg two hours after the procedure
  4. No prophylaxis for any patient

Explanation

Current guidance restricts prophylaxis to the highest-risk cardiac patients, and a single oral dose of amoxicillin two grams one hour preoperatively is standard. Post-procedure dosing and older erythromycin regimens are no longer recommended.

Question 13Clinical Judgement

Which clinical sign most reliably distinguishes irreversible pulpitis from reversible pulpitis?

  1. Sharp pain only with cold stimulus that resolves quickly
  2. Mild discomfort on chewing
  3. A small radiographically visible restoration
  4. Spontaneous lingering pain that persists after the stimulus is removed Correct answer.

Explanation

Irreversible pulpitis is characterized by spontaneous or lingering pain that continues after the stimulus ends, reflecting irreversible pulpal damage. Reversible pulpitis produces sharp pain that resolves promptly once the stimulus is removed.

Question 14Clinical Judgement

A patient has recurrent aphthous ulcers. Which factor is most commonly associated with their occurrence?

  1. Local trauma and stress Correct answer.
  2. A diet high in refined sugar
  3. Chronic periodontitis
  4. Poor oral hygiene alone

Explanation

Recurrent aphthous stomatitis is associated with local trauma, stress, and sometimes nutritional deficiencies or immune factors. Sugar intake, hygiene alone, and periodontitis are not established triggers for aphthous ulceration.

Question 15Clinical Judgement

A patient with severe dental anxiety requires a restorative appointment. Which strategy is most appropriate initially?

  1. Behavioral techniques such as explanation, relaxation, and gradual exposure Correct answer.
  2. Postponing all treatment indefinitely
  3. General anesthesia for all treatment
  4. Physical restraint

Explanation

For anxious patients, nonpharmacological behavioral approaches are the first-line strategy and often suffice for routine restorative care. General anesthesia and restraint are reserved for exceptional circumstances, and indefinite postponement allows disease to progress.

Question 16Clinical Judgement

Which is the most appropriate first step when a patient presents with a suspected fractured mandible after trauma?

  1. Immediate surgical fixation in the dental chair
  2. Reassurance and discharge
  3. Assessment of the airway and referral for definitive management Correct answer.
  4. Extraction of teeth adjacent to the fracture

Explanation

Airway assessment takes priority in any maxillofacial trauma, followed by referral to an appropriate facility for imaging and definitive fixation. Chair-side fixation, discharge, or extraction without assessment risks compromising the airway or worsening the injury.

Question 17Clinical Judgement

A patient reports a persistent white patch on the buccal mucosa that cannot be rubbed off. What is the most appropriate next step?

  1. Prescribe antifungal therapy without investigation
  2. Advise the patient to stop brushing the area
  3. Reassure and review in six months
  4. Refer for biopsy or specialist assessment Correct answer.

Explanation

A persistent, non-removable white patch is a leukoplakia, a potentially malignant disorder that warrants biopsy or specialist referral. Reassurance, empirical antifungals, or avoiding brushing delay diagnosis of possible malignancy.

Question 18Clinical Judgement

Which local anesthetic property best explains why articaine may provide better bone penetration than lidocaine?

  1. Higher pKa
  2. Larger molecular size
  3. Greater lipid solubility and protein binding Correct answer.
  4. Lower concentration of vasoconstrictor

Explanation

Articaine's greater lipid solubility and protein binding allow more rapid diffusion through bone and nerve membranes. A higher pKa would reduce the uncharged fraction and slow diffusion, and molecular size does not explain the difference.

Question 19Clinical Judgement

A patient with chronic kidney disease requires a nonsteroidal anti-inflammatory drug for dental pain. What is the main concern?

  1. Increased risk of nephrotoxicity and fluid retention Correct answer.
  2. Reduced analgesic efficacy
  3. Accelerated dental caries
  4. Excessive salivation

Explanation

NSAIDs reduce renal prostaglandin synthesis and can impair renal perfusion, especially in patients with existing kidney disease, and they promote sodium and fluid retention. Their analgesic efficacy is not inherently reduced, and they do not cause salivation or caries.

Question 20Clinical Judgement

Which preventive measure is most effective for a patient at high caries risk with exposed root surfaces?

  1. Fluoride varnish application and dietary counseling Correct answer.
  2. Frequent sucrose-containing lozenges
  3. Routine antibiotics
  4. Avoiding all dental visits

Explanation

High-risk patients benefit from topical fluoride varnish to remineralize root surfaces, combined with dietary counseling to reduce sugar exposure. Sugar-containing lozenges increase risk, antibiotics are not preventive for caries, and avoiding care worsens outcomes.

Question 21Clinical Judgement

A patient presents with a localized, painful swelling of the submandibular region that worsens at mealtimes. Which diagnosis is most likely?

  1. Trigeminal neuralgia
  2. Periapical cyst of a maxillary incisor
  3. Temporomandibular joint dislocation
  4. Sialolithiasis of the submandibular gland Correct answer.

Explanation

Mealtime-aggravated submandibular swelling suggests an obstructing salivary stone causing intermittent duct blockage. Trigeminal neuralgia causes electric-shock pain without swelling, and joint or maxillary lesions do not produce meal-related glandular swelling.

Question 22Clinical Judgement

A patient taking a bisphosphonate for osteoporosis requires an extraction. Which precaution is most appropriate?

  1. Proceed without any additional consideration
  2. Discontinue the bisphosphonate without medical advice
  3. Extract all teeth simultaneously
  4. Assess risk, obtain informed consent, and use minimally traumatic technique Correct answer.

Explanation

Patients on bisphosphonates carry a risk of medication-related osteonecrosis, so risk assessment, informed consent, and atraumatic technique are essential. Unconsidered extraction or multiple simultaneous extractions increases risk, and stopping the drug requires physician involvement.

Question 23Clinical Judgement

Which factor most increases the risk of periodontal disease progression in a patient with otherwise good oral hygiene?

  1. Cigarette smoking Correct answer.
  2. Occasional sugar intake
  3. Use of a soft toothbrush
  4. Fluoride toothpaste use

Explanation

Smoking impairs gingival microcirculation and neutrophil function, masking bleeding while accelerating attachment loss. Sugar intake relates to caries, and soft brushes and fluoride toothpaste are beneficial rather than harmful.

Question 24Clinical Judgement

A patient with a known latex allergy requires dental treatment. Which precaution is most appropriate?

  1. Use latex-free gloves and a latex-free environment Correct answer.
  2. Schedule as the last patient of the day
  3. Premedicate with an antibiotic
  4. Use latex gloves as usual

Explanation

For latex-allergic patients, latex-free gloves and avoidance of latex-containing materials in the operatory are required to prevent reactions. Continuing latex use or merely scheduling at day's end does not eliminate exposure, and antibiotics have no role.

Question 25Clinical Judgement

Which radiographic feature most suggests a benign, slow-growing lesion rather than an aggressive malignancy?

  1. Rapid irregular bone destruction
  2. A well-defined sclerotic border Correct answer.
  3. Periosteal sunburst appearance
  4. Loss of lamina dura with root resorption

Explanation

A well-defined sclerotic border indicates a slow-growing process that allows bone to respond and wall off the lesion. Irregular destruction, sunburst periosteal reaction, and aggressive root resorption suggest rapid or malignant growth.

Question 26Clinical Judgement

A patient reports a dull, throbbing pain in a lower molar that lingers for several minutes after a cold drink. The tooth is tender to percussion and the pulp tests with an exaggerated response. Which pulpal diagnosis best fits this presentation?

  1. Symptomatic irreversible pulpitis Correct answer.
  2. Reversible pulpitis
  3. Necrotic pulp
  4. Normal pulp

Explanation

Lingering pain after a thermal stimulus indicates that the pulp cannot recover, which defines irreversible pulpitis. Spontaneous, throbbing pain and tenderness to percussion further support a symptomatic irreversible state requiring endodontic treatment.

Question 27Clinical Judgement

Which measurement is used to determine the working length during root canal preparation?

  1. The distance from a stable coronal reference point to the apical constriction Correct answer.
  2. The length of the largest file that binds at the apex
  3. The distance from the cusp tip to the radiographic apex minus 1 mm
  4. The distance from the gingival margin to the furcation

Explanation

Working length is the distance from a reproducible coronal reference point to the apical constriction, confirmed by radiographs and an electronic apex locator. Using a stable reference point ensures the measurement can be reproduced at subsequent visits.

Question 28Clinical Judgement

A patient has generalized moderate chronic periodontitis with 5 mm pockets and bleeding on probing. Which adjunctive measure most improves outcomes when combined with scaling and root planing?

  1. Immediate extraction of all pockets over 4 mm
  2. Routine systemic antibiotics without debridement
  3. Oral hygiene instruction and risk-factor control Correct answer.
  4. Daily chlorhexidine rinse as the sole therapy

Explanation

Mechanical debridement is effective only when the patient controls plaque and modifiable risk factors such as smoking and glycemic status. Oral hygiene instruction therefore underpins every periodontal therapy and improves probing depth reduction.

Question 29Clinical Judgement

Which finding on a panoramic radiograph most suggests an impacted mandibular third molar is at increased risk of damaging the inferior alveolar nerve during removal?

  1. Presence of a pericoronal radiolucency
  2. A crown positioned well above the occlusal plane
  3. Radiographic interruption of the white line of the mandibular canal Correct answer.
  4. A horizontal angulation of the crown

Explanation

Loss of continuity of the radiopaque lines of the mandibular canal indicates the canal is superimposed on or intimately related to the roots. This radiographic sign raises the risk of nerve injury, and cone-beam imaging may be warranted.

Question 30Clinical Judgement

A 6-year-old child has a newly erupted first permanent molar with deep fissures. The tooth is partially erupted and cannot be isolated. What is the most appropriate management?

  1. Apply a fluoride varnish and reassess isolation at a later visit Correct answer.
  2. Place a resin sealant immediately
  3. Prepare a Class I amalgam
  4. Extract the tooth to prevent caries

Explanation

Sealants require dry isolation to bond and retain; a partially erupted tooth with operculum coverage cannot be kept dry. Fluoride varnish provides interim protection while the tooth erupts further so a sealant can be placed later.

Question 31Clinical Judgement

A patient taking warfarin has an INR of 3.8 and requires extraction of a periodontally hopeless tooth. What is the most appropriate next step?

  1. Proceed with extraction and place a pressure pack
  2. Stop warfarin for five days without medical advice
  3. Double the warfarin dose before the appointment
  4. Consult the physician before proceeding with the extraction Correct answer.

Explanation

An INR above the usual therapeutic range increases bleeding risk, so the prescribing physician should be consulted to adjust therapy before elective surgery. Local hemostatic measures alone are insufficient at this level of anticoagulation.

Question 32Clinical Judgement

A patient develops urticaria, wheezing, and hypotension minutes after receiving penicillin. Which agent is the first-line treatment?

  1. Intramuscular epinephrine Correct answer.
  2. Oral diphenhydramine
  3. Intravenous furosemide
  4. Sublingual nitroglycerin

Explanation

This is anaphylaxis, and intramuscular epinephrine into the vastus lateralis is the first-line drug because it reverses bronchospasm and hypotension. Antihistamines are adjuncts only and do not treat airway or circulatory collapse.

Question 33Clinical Judgement

A patient with a history of uncontrolled hypertension reports a blood pressure of 185/110 mmHg at the start of an elective restorative appointment. What is the most appropriate action?

  1. Proceed with the appointment as planned
  2. Defer elective treatment and refer for medical evaluation Correct answer.
  3. Give a local anesthetic containing epinephrine and proceed
  4. Perform the restoration but omit local anesthesia

Explanation

Elective dental care should be postponed when blood pressure is severely elevated, because the stress of treatment may precipitate a hypertensive crisis. The patient should be referred for medical assessment and treatment optimized before resuming care.

Question 34Clinical Judgement

Which clinical feature best distinguishes a migraine from tension-type headache in a dental patient?

  1. Bilateral pressing pain without vomiting
  2. Pain that resolves with chewing
  3. Pain localized to the temporomandibular joint on palpation
  4. Unilateral throbbing pain with photophobia and nausea Correct answer.

Explanation

Migraine typically produces unilateral, pulsating pain accompanied by photophobia, nausea, and aggravation by activity. Tension-type headache is more often bilateral and pressing without those associated features.

Question 35Clinical Judgement

A patient has a dry mouth from Sjögren syndrome and multiple new carious lesions at the gingival margins. Which recommendation is most appropriate?

  1. Discontinue all brushing to avoid enamel loss
  2. Use high-concentration fluoride and sugar-free chewing gum Correct answer.
  3. Rinse with lemon juice several times daily
  4. Increase sugary drinks to stimulate saliva

Explanation

Hyposalivation removes the protective effects of saliva, so high-fluoride products and sugar-free gum to stimulate flow help remineralize and protect root surfaces. Frequent sugar exposure and acids would accelerate the caries process.

Question 36Clinical Judgement

Which radiograph is most appropriate for assessing the bone level and root morphology of a single symptomatic tooth?

  1. Panoramic radiograph
  2. Bitewing radiograph
  3. Periapical radiograph Correct answer.
  4. Lateral cephalometric radiograph

Explanation

A periapical view provides high-resolution detail of the entire tooth and its supporting bone, which is needed to evaluate root morphology and periapical status. Bitewings show crowns and crestal bone but not the apices.

Question 37Clinical Judgement

A patient with poorly controlled epilepsy has frequent seizures. Which precaution is most relevant during dental treatment?

  1. Use a mouth prop and minimize triggering stimuli Correct answer.
  2. Keep the chair fully reclined throughout treatment
  3. Discontinue the patient's anticonvulsant before treatment
  4. Avoid scheduling appointments and use minimal instruments

Explanation

A mouth prop protects the patient and clinician if a seizure occurs, and minimizing flashing lights, stress, and sudden stimuli reduces seizure threshold. The chair should not be fully reclined because airway protection during a seizure is harder.

Question 38Clinical Judgement

Which local anesthetic formulation is contraindicated in a patient with a documented true allergy to metabisulfite?

  1. Articaine plain
  2. Plain mepivacaine
  3. Lidocaine with epinephrine Correct answer.
  4. Bupivacaine plain

Explanation

Epinephrine-containing local anesthetic cartridges include sodium metabisulfite as an antioxidant preservative. A documented sulfite allergy therefore requires a plain anesthetic without vasoconstrictor.

Question 39Clinical Judgement

A patient has a nonrestorable maxillary central incisor with a hopeless prognosis and requests replacement. Which consideration most influences the choice between an implant and a fixed partial denture?

  1. The patient's preference for a specific brand
  2. The number of previous radiographs
  3. The bone volume and the health of adjacent teeth Correct answer.
  4. The color of the adjacent teeth

Explanation

Implant planning depends on adequate bone volume and on the integrity of adjacent teeth, which would need preparation for a fixed partial denture. These biologic and structural factors drive the treatment decision more than esthetics alone.

Question 40Clinical Judgement

A patient presents with a firm, painless, slow-growing swelling of the palate that has been present for two years. Which characteristic most suggests a benign rather than malignant process?

  1. Well-defined borders and slow growth Correct answer.
  2. Paresthesia of the overlying mucosa
  3. Rapid growth over a few weeks
  4. Ill-defined borders with bone destruction

Explanation

Benign lesions typically expand slowly and show well-defined, corticated borders as they displace rather than invade tissue. Rapid growth, ill-defined margins, and paresthesia are features that raise concern for malignancy.

Question 41Clinical Judgement

A patient has a habit of clenching during sleep and reports morning jaw soreness and flattened molar cusps. Which initial management is most appropriate?

  1. Full-mouth rehabilitation with crowns
  2. Immediate orthognathic surgery
  3. A hard occlusal splint and behavioral measures Correct answer.
  4. Extraction of the most worn teeth

Explanation

An occlusal splint protects teeth from wear and reduces load on the masticatory muscles, and behavioral measures address contributing stress and habits. Reversible, conservative therapy is the appropriate first step before irreversible interventions.

Question 42Clinical Judgement

A patient has a history of infective endocarditis and is scheduled for a dental extraction. Which factor is most important in determining whether antibiotic prophylaxis is indicated?

  1. The patient's age and weight
  2. The color of the gingiva
  3. The cardiac condition and the invasiveness of the procedure Correct answer.
  4. The number of teeth to be extracted

Explanation

Prophylaxis decisions are based on whether the patient has a high-risk cardiac condition and whether the procedure involves manipulation of gingival or periapical tissue. Both elements must be present for prophylaxis to be recommended.

Question 43Clinical Judgement

A patient with type 1 diabetes reports a hypoglycemic episode during a previous dental visit. Which instruction is most appropriate before the next appointment?

  1. Double the insulin dose on the morning of the visit
  2. Avoid all carbohydrates for 24 hours before treatment
  3. Skip breakfast to keep blood sugar low
  4. Take the usual insulin and eat a normal meal before the visit Correct answer.

Explanation

The patient should follow the usual medication and meal routine so glucose remains stable during treatment, and should bring a fast-acting sugar source. Altering insulin or fasting increases the risk of intraoperative hypoglycemia.

Question 44Clinical Judgement

A patient has severe trismus and pain when opening the mouth after a mandibular block injection two days ago. Which diagnosis is most likely?

  1. Infection of the pterygomandibular space Correct answer.
  2. Myofascial pain of the masseter
  3. Trigeminal neuralgia
  4. Fracture of the mandibular condyle

Explanation

Trismus with pain developing after an injection suggests introduction of bacteria into the pterygomandibular space, producing a localized infection. Prompt evaluation and antibiotic or drainage management may be required to prevent spread.

Question 45Clinical Judgement

A patient has a deep carious lesion with a radiographically intact lamina dura and no periapical radiolucency, but the tooth is painful to cold and the pain resolves quickly. Which treatment is most appropriate?

  1. Root canal treatment
  2. Apicoectomy
  3. Removal of caries with a protective restoration Correct answer.
  4. Extraction

Explanation

A reversible pulpal response with an intact periapex indicates the pulp can recover once the irritant is removed. Excavating caries and placing a protective restoration preserves vitality and avoids unnecessary endodontics.

Question 46Clinical Judgement

A patient has a Class II division 1 malocclusion with a large overjet and reports frequent trauma to the maxillary incisors. Which benefit is most relevant when considering early orthodontic intervention?

  1. Faster eruption of the second molars
  2. Reduced risk of traumatic injury to the incisors Correct answer.
  3. Improved speech articulation only
  4. Elimination of the need for future orthodontics

Explanation

A large overjet places the maxillary incisors at greater risk of fracture or avulsion from falls and play injuries. Reducing the overjet through early intervention lowers that trauma risk, which is a recognized benefit of timely treatment.

Question 47Clinical Judgement

A patient has a swelling on the floor of the mouth that is soft, fluctuant, and bluish, and it enlarges when the patient cries or strains. What is the most likely diagnosis?

  1. Fibroma of the palate
  2. Ranula Correct answer.
  3. Pyogenic granuloma of the gingiva
  4. Mucocele of the lower lip

Explanation

A ranula arises from a blocked sublingual gland duct and presents as a soft, bluish floor-of-mouth swelling that fluctuates with salivary flow. Its location and compressibility distinguish it from other soft tissue lesions.

Question 48Clinical Judgement

A patient is undergoing chemotherapy and has a neutrophil count of 0.4 × 10⁹/L. Which management is most appropriate for a tooth with irreversible pulpitis?

  1. Defer all treatment until chemotherapy is complete
  2. Consult the oncologist and manage infection before definitive treatment Correct answer.
  3. Prescribe an antibiotic and wait six months
  4. Immediate extraction without medical consultation

Explanation

Severe neutropenia carries a high risk of overwhelming infection, so the oncologist must be involved to coordinate timing and supportive care. Infection control should be addressed promptly rather than delayed indefinitely.

Question 49Clinical Judgement

A patient reports a burning sensation of the tongue and a dry mouth, and examination shows a smooth, depapillated tongue. Which nutritional deficiency is most likely?

  1. Vitamin B12 deficiency Correct answer.
  2. Iron excess
  3. Vitamin D deficiency
  4. Vitamin C deficiency

Explanation

Vitamin B12 deficiency produces glossitis with loss of papillae, burning, and often a concomitant megaloblastic anemia. The smooth, red tongue is a classic mucosal manifestation of this deficiency.

Question 50Clinical Judgement

A patient has recurrent herpes labialis and asks how to manage an outbreak that began two hours ago with tingling. Which approach is most appropriate?

  1. Wait for a crust to form before any treatment
  2. Use an antibiotic ointment until the lesion heals
  3. Apply a topical corticosteroid to the vesicle
  4. Start topical antiviral therapy at the prodromal stage Correct answer.

Explanation

Antiviral therapy is most effective when initiated during the prodrome, before vesicles form, because viral replication peaks early. Starting at tingling can shorten the episode and reduce severity.