ABOMS Oral & Maxillofacial Surgery Exam 2026 | Practice Questions, Verified Answers
& Detailed Rationales | OMS Board Certification Prep
SECTION 1: MEDICAL ASSESSMENT & MANAGEMENT OF THE SURGICAL PATIENT (Questions
1–28)
Question 1
A 68-year-old patient on warfarin (INR 3.8) requires urgent extraction of a periodontally
hopeless tooth. Which management strategy is most appropriate?
A) Proceed immediately without modification because dental extraction is a minor procedure.
B) Discontinue warfarin 5 days preoperatively without bridging.
C) Coordinate with the patient's physician to bring INR into the therapeutic range (typically ≤3.5 for
simple extractions) and use local hemostatic measures.
D) Administer fresh frozen plasma in the office before the extraction.
Answer
Answer: C
Rationale
For simple dentoalveolar surgery, an INR up to approximately 3.5 is generally acceptable with local
hemostatic measures (sutures, oxidized cellulose, tranexamic acid mouthwash, pressure). Routine
discontinuation of warfarin without bridging risks thromboembolism. Fresh frozen plasma is reserved
for emergent reversal or significant bleeding, not routine office extraction.
Question 2
Which preoperative laboratory value is most critical to evaluate before performing a major
maxillofacial procedure in a patient with chronic kidney disease?
A) Serum calcium.
B) Serum potassium and creatinine/estimated GFR.
C) Serum magnesium.
D) Serum phosphate.
Answer
Answer: B
Rationale
,CKD patients are at risk for hyperkalemia (especially with succinylcholine or acidosis) and have altered
drug clearance. Creatinine/eGFR guides dosing of renally cleared medications and anesthetics.
Potassium derangements can precipitate cardiac arrhythmias under anesthesia.
Question 3
A patient with a history of infective endocarditis and a prosthetic heart valve requires
extraction of multiple teeth. According to current AHA guidelines, which regimen is appropriate
for prophylaxis?
A) No prophylaxis is required for dental extractions.
B) Amoxicillin 2 g orally 30–60 minutes before the procedure.
C) Clindamycin 600 mg orally 30–60 minutes before the procedure.
D) Azithromycin 500 mg orally the day before the procedure.
Answer
Answer: B
Rationale
Current AHA guidelines recommend a single dose of amoxicillin 2 g (or ampicillin/cefazolin/ceftriaxone
IM/IV) 30–60 minutes before the procedure for high-risk cardiac conditions (prosthetic valve, prior IE,
certain congenital heart disease). Clindamycin is no longer routinely recommended due to C. difficile
risk; azithromycin timing is incorrect.
Question 4
A 72-year-old patient with type 2 diabetes and an HbA1c of 9.2% is scheduled for extraction of
several teeth. Which perioperative consideration is most important?
A) Withhold all diabetic medications on the day of surgery regardless of regimen.
B) Schedule morning appointments, monitor glucose, and adjust medications in coordination with the
patient's physician.
C) Proceed without glucose monitoring because dental procedures do not affect glycemia.
D) Cancel surgery indefinitely until HbA1c is below 6.0%.
Answer
Answer: B
Rationale
2
,Poorly controlled diabetics have impaired wound healing and increased infection risk. Morning
appointments, glucose monitoring, and individualized medication adjustment (e.g., insulin sliding
scale) optimize safety. An HbA1c of 9.2% warrants caution but not indefinite cancellation for urgent
care; coordination is key.
Question 5
Which medication class is most commonly associated with medication-related osteonecrosis
of the jaw (MRONJ)?
A) SSRIs.
B) Bisphosphonates and denosumab.
C) Beta-blockers.
D) Proton pump inhibitors.
Answer
Answer: B
Rationale
MRONJ is most strongly associated with antiresorptive medications—bisphosphonates (zoledronate,
alendronate) and denosumab (RANKL inhibitor). Risk increases with duration, potency, and
intravenous administration. Other medications (antiangiogenics) are also implicated but less
commonly.
Question 6
A patient on chronic corticosteroid therapy requires surgery. Which statement is correct
regarding adrenal suppression?
A) Steroid coverage is never required for dental surgery.
B) Patients on long-term steroids may have adrenal suppression and may require perioperative stress-
dose steroids for major surgery.
C) Steroids should be abruptly discontinued before surgery.
D) Only patients with Addison's disease require coverage.
Answer
Answer: B
Rationale
3
, Chronic corticosteroid use can suppress the hypothalamic-pituitary-adrenal axis. For minor procedures
under local anesthesia, coverage is often unnecessary; for major surgery or general anesthesia,
stress-dose steroids (e.g., hydrocortisone) may be indicated to prevent adrenal crisis.
Question 7
Which of the following is the most appropriate management for a patient with a history of
anaphylaxis to penicillin who requires antibiotic prophylaxis?
A) Prescribe penicillin anyway with an antihistamine.
B) Use clindamycin as the first-line alternative.
C) Use cephalexin because cross-reactivity is negligible.
D) Consider azithromycin, clarithromycin, or doxycycline depending on the clinical scenario and local
resistance patterns.
Answer
Answer: D
Rationale
For penicillin-anaphylaxis, non–beta-lactam alternatives include macrolides (azithromycin,
clarithromycin) or doxycycline for prophylaxis. Clindamycin is no longer preferred due to C. difficile
risk. Cephalosporins carry some cross-reactivity risk and are avoided in severe immediate reactions.
Question 8
A patient with severe liver disease (Child-Pugh C) requires a surgical procedure. Which
anesthetic consideration is most important?
A) Increased doses of hepatically metabolized drugs are usually required.
B) Reduced doses of hepatically metabolized drugs and careful coagulation assessment are required.
C) Liver disease has no effect on drug metabolism.
D) Only inhalational agents are safe.
Answer
Answer: B
Rationale
Child-Pugh C cirrhosis impairs drug metabolism (e.g., lidocaine, benzodiazepines, opioids) and
synthesis of clotting factors. Doses should be reduced, and coagulation (INR, platelets) should be
4
& Detailed Rationales | OMS Board Certification Prep
SECTION 1: MEDICAL ASSESSMENT & MANAGEMENT OF THE SURGICAL PATIENT (Questions
1–28)
Question 1
A 68-year-old patient on warfarin (INR 3.8) requires urgent extraction of a periodontally
hopeless tooth. Which management strategy is most appropriate?
A) Proceed immediately without modification because dental extraction is a minor procedure.
B) Discontinue warfarin 5 days preoperatively without bridging.
C) Coordinate with the patient's physician to bring INR into the therapeutic range (typically ≤3.5 for
simple extractions) and use local hemostatic measures.
D) Administer fresh frozen plasma in the office before the extraction.
Answer
Answer: C
Rationale
For simple dentoalveolar surgery, an INR up to approximately 3.5 is generally acceptable with local
hemostatic measures (sutures, oxidized cellulose, tranexamic acid mouthwash, pressure). Routine
discontinuation of warfarin without bridging risks thromboembolism. Fresh frozen plasma is reserved
for emergent reversal or significant bleeding, not routine office extraction.
Question 2
Which preoperative laboratory value is most critical to evaluate before performing a major
maxillofacial procedure in a patient with chronic kidney disease?
A) Serum calcium.
B) Serum potassium and creatinine/estimated GFR.
C) Serum magnesium.
D) Serum phosphate.
Answer
Answer: B
Rationale
,CKD patients are at risk for hyperkalemia (especially with succinylcholine or acidosis) and have altered
drug clearance. Creatinine/eGFR guides dosing of renally cleared medications and anesthetics.
Potassium derangements can precipitate cardiac arrhythmias under anesthesia.
Question 3
A patient with a history of infective endocarditis and a prosthetic heart valve requires
extraction of multiple teeth. According to current AHA guidelines, which regimen is appropriate
for prophylaxis?
A) No prophylaxis is required for dental extractions.
B) Amoxicillin 2 g orally 30–60 minutes before the procedure.
C) Clindamycin 600 mg orally 30–60 minutes before the procedure.
D) Azithromycin 500 mg orally the day before the procedure.
Answer
Answer: B
Rationale
Current AHA guidelines recommend a single dose of amoxicillin 2 g (or ampicillin/cefazolin/ceftriaxone
IM/IV) 30–60 minutes before the procedure for high-risk cardiac conditions (prosthetic valve, prior IE,
certain congenital heart disease). Clindamycin is no longer routinely recommended due to C. difficile
risk; azithromycin timing is incorrect.
Question 4
A 72-year-old patient with type 2 diabetes and an HbA1c of 9.2% is scheduled for extraction of
several teeth. Which perioperative consideration is most important?
A) Withhold all diabetic medications on the day of surgery regardless of regimen.
B) Schedule morning appointments, monitor glucose, and adjust medications in coordination with the
patient's physician.
C) Proceed without glucose monitoring because dental procedures do not affect glycemia.
D) Cancel surgery indefinitely until HbA1c is below 6.0%.
Answer
Answer: B
Rationale
2
,Poorly controlled diabetics have impaired wound healing and increased infection risk. Morning
appointments, glucose monitoring, and individualized medication adjustment (e.g., insulin sliding
scale) optimize safety. An HbA1c of 9.2% warrants caution but not indefinite cancellation for urgent
care; coordination is key.
Question 5
Which medication class is most commonly associated with medication-related osteonecrosis
of the jaw (MRONJ)?
A) SSRIs.
B) Bisphosphonates and denosumab.
C) Beta-blockers.
D) Proton pump inhibitors.
Answer
Answer: B
Rationale
MRONJ is most strongly associated with antiresorptive medications—bisphosphonates (zoledronate,
alendronate) and denosumab (RANKL inhibitor). Risk increases with duration, potency, and
intravenous administration. Other medications (antiangiogenics) are also implicated but less
commonly.
Question 6
A patient on chronic corticosteroid therapy requires surgery. Which statement is correct
regarding adrenal suppression?
A) Steroid coverage is never required for dental surgery.
B) Patients on long-term steroids may have adrenal suppression and may require perioperative stress-
dose steroids for major surgery.
C) Steroids should be abruptly discontinued before surgery.
D) Only patients with Addison's disease require coverage.
Answer
Answer: B
Rationale
3
, Chronic corticosteroid use can suppress the hypothalamic-pituitary-adrenal axis. For minor procedures
under local anesthesia, coverage is often unnecessary; for major surgery or general anesthesia,
stress-dose steroids (e.g., hydrocortisone) may be indicated to prevent adrenal crisis.
Question 7
Which of the following is the most appropriate management for a patient with a history of
anaphylaxis to penicillin who requires antibiotic prophylaxis?
A) Prescribe penicillin anyway with an antihistamine.
B) Use clindamycin as the first-line alternative.
C) Use cephalexin because cross-reactivity is negligible.
D) Consider azithromycin, clarithromycin, or doxycycline depending on the clinical scenario and local
resistance patterns.
Answer
Answer: D
Rationale
For penicillin-anaphylaxis, non–beta-lactam alternatives include macrolides (azithromycin,
clarithromycin) or doxycycline for prophylaxis. Clindamycin is no longer preferred due to C. difficile
risk. Cephalosporins carry some cross-reactivity risk and are avoided in severe immediate reactions.
Question 8
A patient with severe liver disease (Child-Pugh C) requires a surgical procedure. Which
anesthetic consideration is most important?
A) Increased doses of hepatically metabolized drugs are usually required.
B) Reduced doses of hepatically metabolized drugs and careful coagulation assessment are required.
C) Liver disease has no effect on drug metabolism.
D) Only inhalational agents are safe.
Answer
Answer: B
Rationale
Child-Pugh C cirrhosis impairs drug metabolism (e.g., lidocaine, benzodiazepines, opioids) and
synthesis of clotting factors. Doses should be reduced, and coagulation (INR, platelets) should be
4
