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NDEB Virtual OSCE study materials
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NDEB Virtual OSCE practice questions

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Question 1History Taking and Patient Interviewing

During a new-patient interview, which opening approach best establishes rapport while still obtaining a focused history?

  1. State your provisional diagnosis so the patient can confirm or deny it
  2. Immediately list each review-of-systems item for a yes-or-no response
  3. Begin with an open-ended invitation for the patient to describe the concern in their own words Correct answer.
  4. Ask the patient to complete a written form before any verbal exchange

Explanation

An open-ended opening lets patients frame their own concern, reveals priorities, and builds rapport before structured questioning. Closed or checklist-first approaches narrow the story prematurely and can miss the patient's main worry. Sharing a diagnosis before hearing the history biases the interview and can reduce trust.

Question 2History Taking and Patient Interviewing

Which element is the chief complaint in a dental history?

  1. The patient's own statement of the main reason for the visit Correct answer.
  2. The list of medications the patient takes
  3. The dentist's working diagnosis
  4. The most recent radiograph finding

Explanation

The chief complaint is recorded in the patient's words and identifies the primary reason for seeking care. It anchors the rest of the history and guides the focus of questioning. Radiographic findings, medication lists, and diagnoses are separate components of the record.

Question 3History Taking and Patient Interviewing

A patient reports pain that began three days ago after biting on a hard nut. Which questioning sequence best characterizes this pain?

  1. Onset, location, quality, intensity, duration, triggers, and relieving factors Correct answer.
  2. Only whether the pain is present at this moment
  3. Only the patient's age and occupation
  4. Only the patient's insurance coverage and referral source

Explanation

A structured symptom analysis covers onset, location, quality, severity, timing, aggravating and relieving factors, and associated symptoms. This framework distinguishes pulpal, periodontal, and musculoskeletal sources of pain. Asking only about current presence or demographic data leaves the diagnosis poorly supported.

Question 4History Taking and Patient Interviewing

Which question best screens for a history of infective endocarditis risk before dental treatment?

  1. Have you ever been told you have a heart murmur or had heart valve surgery? Correct answer.
  2. Do you floss your teeth every day?
  3. How many cups of coffee do you drink daily?
  4. Have you ever had a filling replaced?

Explanation

Cardiac conditions such as prior valve surgery or a prosthetic valve are relevant to antibiotic prophylaxis decisions. A direct question about murmurs and valve surgery identifies patients needing further cardiology clarification. Dietary and restorative details do not address endocarditis risk.

Question 5History Taking and Patient Interviewing

When a patient describes a reaction to a medication, which detail is most important to record?

  1. Only the pharmacy where it was dispensed
  2. The specific drug, the reaction type, and the timing relative to the dose Correct answer.
  3. Only the patient's opinion that the drug was strong
  4. Only the name of the prescribing physician

Explanation

A useful allergy entry distinguishes true hypersensitivity from side effects by capturing the drug, reaction characteristics, and timing. This prevents unnecessary avoidance of safe drugs and guides alternative selection. Vague labels such as strong or prescriber names alone do not support safe prescribing.

Question 6History Taking and Patient Interviewing

Which social-history item most directly affects periodontal risk assessment?

  1. Preferred music genre
  2. Distance traveled to the clinic
  3. Number of siblings
  4. Current tobacco use and frequency Correct answer.

Explanation

Tobacco use is a major modifiable risk factor for periodontal disease and affects healing after treatment. Quantifying current use and frequency supports risk assessment and counseling. Siblings, music preference, and travel distance have no direct bearing on periodontal status.

Question 7History Taking and Patient Interviewing

Which statement best describes the purpose of summarizing during a patient interview?

  1. It allows the clinician to begin treatment without consent
  2. It replaces the need for a written record
  3. It verifies that the clinician understood the patient's account before moving on Correct answer.
  4. It shortens the visit by skipping the patient's concerns

Explanation

Summarizing restates the patient's key points in the clinician's words and invites correction, confirming shared understanding. This improves accuracy and signals that the patient was heard. It does not replace documentation or consent, nor should it be used to skip concerns.

Question 8History Taking and Patient Interviewing

A patient becomes tearful while describing a recent loss. What is the most appropriate immediate response?

  1. End the appointment and reschedule
  2. Continue reading questions without comment
  3. Acknowledge the emotion and pause before continuing the history Correct answer.
  4. Change the subject quickly to a review of systems

Explanation

Acknowledging distress with a brief empathic statement and allowing silence supports the therapeutic relationship. Rushing past emotion can reduce disclosure and trust. The interview can resume once the patient is ready, without abandoning the appointment.

Question 9History Taking and Patient Interviewing

A patient says, I only get a little bleeding when I brush. Which follow-up question best clarifies the symptom?

  1. Did you choose your current dentist or were you referred?
  2. What time of day do you usually schedule appointments?
  3. Do you prefer mint or cinnamon toothpaste?
  4. How often does this happen, and is it limited to certain areas of the mouth? Correct answer.

Explanation

Clarifying frequency and location turns a vague report into usable clinical information about gingival inflammation. This guides examination and diagnosis. Preference, referral, and scheduling questions do not clarify the symptom.

Question 10History Taking and Patient Interviewing

Which technique best helps a talkative patient who repeatedly drifts off topic during history taking?

  1. Interrupt repeatedly and raise your voice
  2. Politely redirect with a focused question tied to the clinical topic Correct answer.
  3. Allow unlimited time regardless of the schedule
  4. Skip the remaining history entirely

Explanation

Gentle redirection acknowledges the patient's narrative while steering back to clinically relevant information. This preserves rapport and uses time efficiently. Interrupting harshly or abandoning the history harms the relationship and the record.

Question 11History Taking and Patient Interviewing

Which question is most appropriate to assess a patient's ability to give informed consent for treatment?

  1. Have you ever missed a dental appointment?
  2. Do you have dental insurance?
  3. Can you tell me in your own words what the proposed treatment involves and its main risks? Correct answer.
  4. Which dentist referred you to this clinic?

Explanation

Teach-back confirms understanding of the procedure, alternatives, and risks, which is central to valid consent. Insurance, attendance, and referral details do not establish comprehension. Comprehension must be demonstrated, not assumed from a signature.

Question 12History Taking and Patient Interviewing

A patient reports taking warfarin. Which additional history is most relevant before planning an extraction?

  1. The patient's occupation
  2. The indication, current INR if known, and coordination with the prescribing clinician Correct answer.
  3. The number of years since the last cleaning
  4. The patient's preferred anesthetic flavor

Explanation

For anticoagulated patients, knowing the indication and recent INR guides bleeding risk and whether the prescriber should be consulted. Coordination avoids unplanned interruption of therapy. Anesthetic preference and unrelated history do not address bleeding risk.

Question 13History Taking and Patient Interviewing

Which approach best obtains a reliable history from a patient with limited English proficiency?

  1. Speak more loudly in the clinician's language
  2. Omit the history and proceed with treatment
  3. Use a qualified medical interpreter and speak directly to the patient Correct answer.
  4. Ask a child relative to translate sensitive information

Explanation

Qualified interpreters improve accuracy and confidentiality, and speaking to the patient directly maintains rapport. Using children as interpreters risks errors and inappropriate role burden. Raising volume does not improve comprehension, and skipping history is unsafe.

Question 14History Taking and Patient Interviewing

A patient's spouse answers every question for the patient. What is the best response?

  1. Ask the spouse to leave the room immediately
  2. Politely redirect questions to the patient while acknowledging the spouse's support Correct answer.
  3. End the interview and document noncompliance
  4. Direct all further questions to the spouse

Explanation

The patient's own account is primary; redirecting questions respectfully preserves autonomy while valuing the companion. This maintains rapport and improves accuracy. Excluding the companion abruptly or ending the visit is unnecessarily adversarial.

Question 15History Taking and Patient Interviewing

Which item in a medical history most strongly prompts consultation before elective oral surgery?

  1. Use of orthodontic retainers
  2. A recent myocardial infarction within the past month Correct answer.
  3. A childhood history of chickenpox
  4. A preference for morning appointments

Explanation

Recent myocardial infarction increases perioperative cardiac risk and typically warrants medical consultation and deferral of elective care. Childhood illness and appliance use do not carry comparable acute risk. Scheduling preference is not a medical risk factor.

Question 16History Taking and Patient Interviewing

When documenting a patient's pain history, which descriptor set best supports differentiating odontogenic from non-odontogenic pain?

  1. Provocation by thermal stimuli, spontaneous onset, and response to analgesics Correct answer.
  2. The patient's marital status and housing
  3. The patient's favorite food and beverage
  4. The name of the patient's employer

Explanation

Thermal provocation, spontaneity, and analgesic response help distinguish pulpal, periodontal, and neuropathic patterns. These features guide examination and diagnosis. Personal and occupational details do not differentiate pain mechanisms.

Question 17History Taking and Patient Interviewing

Which question best screens for a bleeding disorder before periodontal surgery?

  1. Do you use mouthwash daily?
  2. Do you bleed for a long time after minor cuts, or have you needed blood products? Correct answer.
  3. Have you ever had a crown?
  4. Do you drink tea with sugar?

Explanation

Prolonged bleeding after minor trauma or a history of transfusion suggests a possible coagulopathy requiring evaluation. This history helps anticipate surgical bleeding risk. Hygiene habits, restorations, and beverage preferences do not screen for bleeding disorders.

Question 18History Taking and Patient Interviewing

A patient reports jaw clicking and locking. Which history element most helps distinguish disc displacement with reduction from without reduction?

  1. The patient's height and weight
  2. Whether the click occurs on opening and closing and whether the jaw ever locks closed Correct answer.
  3. The number of amalgam restorations
  4. The patient's preferred chewing side only

Explanation

A reciprocal click that occurs on opening and closing suggests displacement with reduction, whereas locking without reduction lacks the reducing click. Asking about locking episodes clarifies the pattern. Chewing side, body habitus, and restoration count do not define disc position.

Question 19History Taking and Patient Interviewing

Which statement about using leading questions in the dental interview is most accurate?

  1. They can bias responses and should generally be avoided in favor of neutral phrasing Correct answer.
  2. They improve accuracy because patients prefer being told the answer
  3. They are the best way to obtain a substance-use history
  4. They are required for every review-of-systems item

Explanation

Leading questions suggest a desired answer and can distort recall, so neutral, open phrasing yields more reliable information. Sensitive topics especially benefit from nonjudgmental wording. Requiring leading questions or assuming patient preference for them is incorrect.

Question 20History Taking and Patient Interviewing

A patient with suspected dementia is accompanied by a caregiver. How should the clinician proceed?

  1. Defer all history to a future visit without assessment
  2. Attempt direct questioning, involve the caregiver as needed, and assess decision-making capacity Correct answer.
  3. Address all questions only to the caregiver
  4. Assume the patient cannot participate at all

Explanation

Many patients with cognitive impairment can provide meaningful history, so direct questioning should be attempted with caregiver support. Capacity for specific decisions is assessed functionally rather than assumed. Excluding the patient entirely undermines autonomy.

Question 21History Taking and Patient Interviewing

During the interview, a patient discloses past physical abuse at home. Which response best reflects appropriate practice?

  1. Promise absolute confidentiality regardless of legal duties
  2. Ignore the disclosure to avoid distress
  3. Confront the alleged abuser directly
  4. Respond with empathy, document the disclosure, and follow local safeguarding or reporting protocols Correct answer.

Explanation

Clinicians should acknowledge the disclosure supportively, document it, and follow jurisdiction-specific safeguarding and reporting requirements. Absolute confidentiality cannot be promised when legal duties apply. Confrontation or ignoring the disclosure risks harm and breaches professional obligations.

Question 22History Taking and Patient Interviewing

A patient with a history of opioid use disorder requests a specific analgesic. Which interviewing approach best supports safe prescribing?

  1. Prescribe the requested drug without further history
  2. Use a nonjudgmental, structured substance-use history and clarify goals and prior treatments Correct answer.
  3. Refuse to discuss analgesia and end the visit
  4. Ask the receptionist to obtain the substance history

Explanation

A nonjudgmental structured history identifies current use, treatment engagement, and safe analgesic options. Clarifying goals supports shared decision-making and risk mitigation. Refusal, unverified prescribing, or delegating sensitive history to nonclinical staff compromises care.

Question 23History Taking and Patient Interviewing

A patient gives inconsistent answers about the timing of a swelling. Which approach best resolves the discrepancy?

  1. Record only the first answer without clarification
  2. Ask a family member to decide the timeline
  3. Accuse the patient of lying about the symptoms
  4. Ask the question again in different neutral ways and reconcile the timeline with the patient Correct answer.

Explanation

Inconsistencies often reflect recall difficulty or misunderstanding, so rephrasing neutrally and reconciling details improves accuracy. Accusation damages rapport and may reduce disclosure. Recording one answer without clarification or delegating to a relative weakens the record.

Question 24History Taking and Patient Interviewing

Which interviewing strategy best elicits a complete medication history, including over-the-counter and herbal products?

  1. Rely solely on the pharmacy's dispensing record
  2. Ask only whether the patient takes any pills
  3. Ask an open question, then prompt with categories such as prescriptions, supplements, and topicals Correct answer.
  4. Ask only about medications started in the past week

Explanation

Combining an open question with category prompts captures prescriptions, over-the-counter drugs, supplements, and topicals that patients may not consider medicines. Dispensing records may be incomplete or outdated. A single yes-or-no question or a one-week window misses much use.

Question 25History Taking and Patient Interviewing

A patient requests that a sensitive diagnosis not be shared with a family member who is present. What is the best action?

  1. Disclose the diagnosis because the relative is present
  2. Ask the relative to decide whether disclosure occurs
  3. Respect confidentiality, offer to discuss the information privately, and document the preference Correct answer.
  4. Refuse to discuss the diagnosis at all in the future

Explanation

Confidentiality belongs to the patient, so the clinician should honor the request, create a private opportunity to discuss care, and document the preference. Disclosing to the relative or letting them decide violates patient autonomy. Refusing future discussion denies needed care.

Question 26History Taking and Patient Interviewing

During a new-patient interview, which element of the history of the present illness most helps the clinician distinguish a chronic, slowly progressing problem from an acute one?

  1. The patient's own idea of what caused the symptom
  2. The patient's description of the character of the symptom
  3. The chronological onset and duration of the symptom Correct answer.
  4. The impact of the symptom on daily activities

Explanation

The history of the present illness should establish the timing of the problem, because onset, duration, and progression separate acute from chronic conditions and guide the pace of management. Character, patient beliefs, and functional impact add useful detail but do not by themselves reveal whether the process is recent or long-standing.

Question 27History Taking and Patient Interviewing

A patient mentions several hospitalizations in passing and then continues describing a toothache. What is the most appropriate interviewing response?

  1. Allow the narrative to continue and return to the hospitalizations at the end
  2. Ask the patient to complete a written form instead of discussing it
  3. Interrupt briefly to explore the reason for each hospitalization now Correct answer.
  4. Record the hospitalizations as stated and move on to the chief complaint

Explanation

A passing mention of repeated hospitalizations may signal significant systemic disease relevant to dental care, so a brief, focused clarification at the moment it arises prevents loss of important detail. Deferring the topic risks the patient omitting or forgetting key information once the conversation moves on.

Question 28History Taking and Patient Interviewing

Before prescribing a course of antibiotics, which history item obtained during the interview most directly informs the choice of agent?

  1. The patient's usual oral hygiene routine
  2. The patient's preferred appointment time
  3. Previous adverse reactions to antimicrobials Correct answer.
  4. The date of the patient's last dental radiographs

Explanation

Documented allergy and previous adverse drug reactions determine which antimicrobial classes can be safely prescribed and are therefore essential before selecting an agent. Oral hygiene, radiograph dates, and scheduling preferences do not influence drug selection.

Question 29History Taking and Patient Interviewing

A patient describes pain that wakes them at night and is poorly localized. Which additional history element best helps the clinician characterize the pain?

  1. The patient's family history of cardiovascular disease
  2. Whether the pain is provoked by thermal stimuli and how long it lingers Correct answer.
  3. The patient's preferred analgesic and how often it is taken
  4. The patient's typical daily caffeine intake

Explanation

Provocation by heat or cold and the duration of lingering pain help separate reversible pulpal and dentinal sensitivity from irreversible pulpal disease, and they clarify whether the pain is stimulus-dependent. Analgesic habits, family cardiac history, and caffeine intake do not localize or characterize odontogenic pain.

Question 30History Taking and Patient Interviewing

An anxious patient repeatedly asks whether a procedure will hurt before any history has been gathered. Which approach best preserves both the therapeutic relationship and the accuracy of the history?

  1. Ask the accompanying family member to supply the entire history instead
  2. Postpone all history taking until the patient's anxiety has fully resolved
  3. Answer the concern briefly, then guide the patient back to the specific history questions Correct answer.
  4. Tell the patient that questions about pain will be answered only at the end

Explanation

Briefly acknowledging the concern and then redirecting to structured questions respects the patient's anxiety while ensuring the history is completed. Postponing, deferring all reassurance, or delegating the history to a relative undermines rapport and the reliability of the information obtained.

Question 31Clinical Reasoning and Differential Diagnosis

A patient reports sharp, lancinating facial pain triggered by light touch on the cheek, lasting seconds, with pain-free intervals. Which diagnosis is most consistent with this presentation?

  1. Temporomandibular joint arthralgia
  2. Atypical odontalgia
  3. Trigeminal neuralgia Correct answer.
  4. Pulpitis of the upper molar

Explanation

Brief electric-shock-like pain provoked by innocuous stimuli with pain-free intervals is the classic pattern of trigeminal neuralgia. The paroxysmal, seconds-long character and trigger zones distinguish it from continuous dental or joint pain.

Question 32Clinical Reasoning and Differential Diagnosis

Which clinical finding most strongly suggests that a patient's oral ulceration is due to recurrent aphthous stomatitis rather than squamous cell carcinoma?

  1. A single ulcer persisting for eight weeks
  2. A painful ulcer that heals spontaneously within two weeks Correct answer.
  3. Induration with rolled, everted margins
  4. Fixation to underlying tissue with paresthesia

Explanation

Recurrent aphthous ulcers are painful, shallow, and self-limiting, typically healing within one to two weeks without scarring in minor forms. Malignancy is suggested by persistence beyond two to three weeks, induration, and rolled margins.

Question 33Clinical Reasoning and Differential Diagnosis

A patient has a firm, nontender, rubbery submandibular swelling that has slowly enlarged over months without pain or fever. Which diagnostic category should be prioritized?

  1. Neoplastic or lymphoproliferative disease Correct answer.
  2. Odontogenic abscess
  3. Acute suppurative sialadenitis
  4. Sialolithiasis with colic

Explanation

A painless, slowly enlarging, firm mass without inflammatory signs raises concern for a neoplasm or lymphoproliferative disorder and warrants imaging and tissue diagnosis. Inflammatory and obstructive causes typically present with pain, tenderness, or swelling related to meals.

Question 34Clinical Reasoning and Differential Diagnosis

Which feature best distinguishes pain of temporomandibular joint origin from pain of muscular origin in a patient with a temporomandibular disorder?

  1. Pain that is bilateral and constant
  2. Pain reproduced by joint loading and palpation of the condyle Correct answer.
  3. Pain reproduced by palpation of the masseter and temporalis
  4. Pain accompanied by limited mouth opening

Explanation

Joint pain is provoked by loading or palpating the condylar region, whereas muscle pain is reproduced by palpating the masticatory muscles. Both may coexist, so careful examination localizes the dominant source.

Question 35Clinical Reasoning and Differential Diagnosis

A patient reports a bitter taste and a salty discharge from a parotid swelling that increases while eating. Which diagnosis is most likely?

  1. Sjögren syndrome
  2. Bell palsy
  3. Parotid duct obstruction with sialadenitis Correct answer.
  4. Parotid malignancy

Explanation

Meal-related swelling with discharge suggests duct obstruction with secondary inflammation, often from a sialolith or stricture. The salty or bitter taste reflects stagnant, inflamed saliva.

Question 36Clinical Reasoning and Differential Diagnosis

Which finding most strongly suggests that a white oral lesion is leukoplakia rather than a frictional keratosis?

  1. Bilateral location on the buccal mucosa
  2. A white patch that disappears after removing a sharp cusp
  3. A white patch that does not rub off and has no identifiable cause Correct answer.
  4. Symmetrical appearance on the alveolar ridge

Explanation

Leukoplakia is a clinical diagnosis of exclusion: a white patch that cannot be wiped off and has no identifiable cause. Frictional keratosis resolves when the irritant is removed, which supports a reactive cause.

Question 37Clinical Reasoning and Differential Diagnosis

A patient has recurrent episodes of swelling of the upper lip, eyelids, and tongue without urticaria, each resolving over two to three days, with a family history of similar episodes. Which diagnosis should be considered?

  1. Hereditary angioedema Correct answer.
  2. Angina bullosa haemorrhagica
  3. Acute urticaria
  4. Allergic contact dermatitis

Explanation

Recurrent, self-limiting angioedema without urticaria, often with a family history and abdominal symptoms, suggests hereditary angioedema from C1 inhibitor deficiency. Allergic angioedema is typically accompanied by urticaria and an identifiable trigger.

Question 38Clinical Reasoning and Differential Diagnosis

A patient has burning mouth symptoms that are absent during sleep and improve with distraction, with normal mucosa and normal blood tests. Which diagnosis is most likely?

  1. Oral candidiasis
  2. Burning mouth syndrome Correct answer.
  3. Iron deficiency anemia
  4. Diabetes-related neuropathy

Explanation

Burning mouth syndrome is a chronic intraoral burning with normal mucosa and no identifiable systemic cause, often improved by distraction and absent during sleep. Secondary causes such as anemia, diabetes, and candidiasis must be excluded first.

Question 39Clinical Reasoning and Differential Diagnosis

A patient presents with a sudden, painless loss of taste on one side of the tongue with normal oral mucosa. Which step is most appropriate in the differential workup?

  1. Empirical antifungal therapy
  2. Immediate biopsy of the tongue
  3. Reassurance without further assessment
  4. Assessment of cranial nerve function and medication history Correct answer.

Explanation

Isolated taste loss requires evaluation of cranial nerve function, medication effects, and systemic causes such as anemia or zinc deficiency. A structured history and examination guide the differential before any invasive step.

Question 40Clinical Reasoning and Differential Diagnosis

A patient has a well-demarcated, painful, erythematous lesion with multiple small vesicles on the hard palate that appeared two days ago. Which diagnosis is most likely?

  1. Erythema multiforme
  2. Herpes zoster of the maxillary division
  3. Nicotinic stomatitis
  4. Recurrent herpes simplex infection Correct answer.

Explanation

Recurrent herpes simplex typically affects keratinized mucosa such as the hard palate with clustered vesicles on an erythematous base. Herpes zoster would follow a dermatomal distribution and cross the midline.

Question 41Clinical Reasoning and Differential Diagnosis

A patient with a history of recurrent oral and genital ulcers has a positive pathergy test. Which diagnosis is most consistent?

  1. Lichen planus
  2. Erythema multiforme
  3. Pemphigus vulgaris
  4. Behçet disease Correct answer.

Explanation

Recurrent oral and genital ulceration with a positive pathergy test supports Behçet disease, a multisystem vasculitis. Ocular and cutaneous findings may also be present.

Question 42Clinical Reasoning and Differential Diagnosis

A patient has bilateral parotid enlargement, dry eyes, and dry mouth, with anti-Ro antibodies detected. Which diagnosis is most likely?

  1. HIV-associated salivary disease
  2. Sialadenosis
  3. Sjögren syndrome Correct answer.
  4. Mikulicz disease

Explanation

Sicca symptoms with bilateral parotid enlargement and anti-Ro antibodies are characteristic of Sjögren syndrome. Confirmatory testing includes labial gland biopsy and ocular staining.

Question 43Clinical Reasoning and Differential Diagnosis

A patient has a pigmented lesion on the palate that has enlarged and become irregular over six months. Which feature most increases concern for mucosal melanoma?

  1. Uniform brown color with sharp borders
  2. Recent change in size and irregular pigmentation Correct answer.
  3. Bilateral symmetry
  4. Presence since childhood with stable appearance

Explanation

Recent growth and irregular pigmentation in an adult palatal lesion raise concern for mucosal melanoma. Any new or changing pigmented lesion warrants biopsy.

Question 44Clinical Reasoning and Differential Diagnosis

A patient with poorly controlled diabetes develops a rapidly spreading, tender, erythematous facial swelling with systemic fever. Which step is most appropriate?

  1. Elective extraction in two weeks
  2. Observation with oral antibiotics at home
  3. Topical antiseptic rinses only
  4. Urgent referral for incision and drainage with systemic antibiotics Correct answer.

Explanation

Rapidly spreading facial infection with systemic signs in an immunocompromised patient requires urgent surgical drainage and systemic antibiotics. Delay risks airway compromise and sepsis.

Question 45Clinical Reasoning and Differential Diagnosis

A patient has a persistent, unilateral, deep otalgia with normal ear examination and no dental cause identified. Which region should be examined next?

  1. Cervical spine
  2. Thyroid gland
  3. Temporomandibular joint and masticatory muscles Correct answer.
  4. Maxillary sinus

Explanation

Referred otalgia with a normal ear examination often originates from the temporomandibular joint or masticatory muscles. Palpation and jaw movement testing help localize the source.

Question 46Clinical Reasoning and Differential Diagnosis

A patient has a diffuse, nonulcerated, erythematous gingiva with desquamative change, and direct immunofluorescence shows intercellular IgG deposition. Which diagnosis is most likely?

  1. Mucous membrane pemphigoid
  2. Lichen planus
  3. Plasma cell gingivitis
  4. Pemphigus vulgaris Correct answer.

Explanation

Intercellular IgG deposition on direct immunofluorescence is diagnostic of pemphigus vulgaris, which often presents with desquamative gingivitis and oral erosions. Mucous membrane pemphigoid shows linear deposition along the basement membrane.

Question 47Clinical Reasoning and Differential Diagnosis

A patient reports a metallic taste and a burning sensation on the tongue, with angular cheilitis and a smooth, depapillated tongue. Which underlying deficiency is most likely?

  1. Vitamin C deficiency
  2. Zinc excess
  3. Vitamin B12 or iron deficiency Correct answer.
  4. Vitamin D deficiency

Explanation

Atrophic glossitis, angular cheilitis, and taste disturbance are classic for vitamin B12 or iron deficiency. Hematologic testing confirms the diagnosis.

Question 48Clinical Reasoning and Differential Diagnosis

A patient has a painless, fluctuant swelling in the floor of the mouth that increases when the mouth is opened and transilluminates brightly. Which diagnosis is most likely?

  1. Dermoid cyst
  2. Ranula Correct answer.
  3. Submandibular sialolith
  4. Lymphangioma

Explanation

A translucent, fluctuant floor-of-mouth swelling that enlarges with mouth opening is typical of a ranula, a mucocele of the sublingual gland. Transillumination supports a fluid-filled lesion.

Question 49Clinical Reasoning and Differential Diagnosis

A patient has a chronic, well-demarcated, slightly raised erythematous plaque on the hard palate with a history of denture wear. Which diagnosis should be considered first?

  1. Oral lichen planus
  2. Denture stomatitis Correct answer.
  3. Squamous cell carcinoma
  4. Erythema multiforme

Explanation

Chronic erythema limited to the denture-bearing palatal mucosa is typical of denture stomatitis, often associated with Candida. Improvement with denture hygiene and antifungal therapy supports the diagnosis.

Question 50Clinical Reasoning and Differential Diagnosis

A patient has a history of a mandibular third molar extraction two weeks ago with persistent dull pain, a bad taste, and an empty socket with exposed bone. Which diagnosis is most likely?

  1. Dry socket Correct answer.
  2. Postoperative hematoma
  3. Trigeminal neuralgia
  4. Osteomyelitis

Explanation

Persistent pain, bad taste, and an empty socket with exposed bone after extraction are classic for alveolar osteitis. Management includes socket irrigation and palliative dressing.