Page 1 of 156
# TABLE OF CONTENTS
| Section | Topic Area | Number of Questions |
|---------|------------|---------------------|
| I | Medical Assessment and Management of the Surgical Patient | 25 |
| II | Anesthesia and Pain Control | 25 |
| III | Dentoalveolar Surgery | 25 |
| IV | Trauma | 25 |
| V | Orthognathic / Cleft / OSA | 25 |
| VI | Cosmetic Surgery | 25 |
| VII | Temporomandibular Disorders / Facial Pain | 25 |
| VIII | Pathology | 25 |
| IX | Reconstruction | 25 |
| X | Implants | 25 |
,Page 2 of 156
# SECTION I: MEDICAL ASSESSMENT AND MANAGEMENT OF THE SURGICAL
PATIENT
**Question 1**
A 72-year-old male with a history of hypertension, type 2 diabetes, and coronary artery disease
presents for elective extraction of multiple impacted teeth. His current medications include
metformin, lisinopril, aspirin 81 mg daily, and atorvastatin. His blood pressure is 168/94 mmHg
on two separate readings. Which of the following is the MOST appropriate management
regarding his blood pressure prior to proceeding with surgery?
A. Proceed with surgery as planned; the blood pressure is acceptable for an elective dental
procedure
B. Delay surgery and refer to his primary care physician for blood pressure optimization
C. Administer sublingual nifedipine immediately and proceed with surgery once pressure
normalizes
D. Proceed with surgery using intravenous sedation to lower blood pressure intraoperatively
**Correct Answer: B**
**Rationale:** Patients with a systolic blood pressure ≥160 mmHg or diastolic ≥100 mmHg
should generally have elective surgery delayed until blood pressure is optimized. This patient has
stage 2 hypertension with readings of 168/94 mmHg on two separate occasions, representing a
significant perioperative risk for cardiovascular complications including myocardial ischemia,
stroke, and arrhythmias. Sublingual nifedipine (C) is contraindicated due to the risk of rapid,
uncontrolled hypotension and cerebral hypoperfusion. Proceeding with surgery (A) is
inappropriate given the elevated risk. Intravenous sedation (D) does not address the underlying
hypertension and may mask important warning signs.
---
**Question 2**
,Page 3 of 156
A 55-year-old female is scheduled for orthognathic surgery. Her preoperative ECG reveals a QTc
interval of 480 milliseconds. Which of the following electrolyte abnormalities is MOST
commonly associated with QTc prolongation?
A. Hyperkalemia
B. Hypokalemia
C. Hypermagnesemia
D. Hypercalcemia
**Correct Answer: B**
**Rationale:** Hypokalemia is the most common electrolyte abnormality associated with QTc
prolongation. Potassium plays a critical role in cardiac repolarization, and low serum potassium
delays the repolarization phase of the action potential, prolonging the QT interval. Hypokalemia
increases the risk of torsades de pointes, a potentially fatal ventricular arrhythmia. Hyperkalemia
(A) is associated with peaked T waves and widened QRS complexes rather than QTc
prolongation. Hypermagnesemia (C) typically does not cause QTc prolongation;
hypomagnesemia does. Hypercalcemia (D) shortens the QT interval.
---
**Question 3**
A 68-year-old male with a history of heart failure (ejection fraction 35%) presents for removal of
a mandibular lesion under general anesthesia. Which of the following is the MOST important
preoperative optimization strategy in this patient?
A. Administration of beta-blockers 24 hours prior to surgery
B. Optimization of volume status with diuretics to achieve euvolemia
C. Prophylactic antibiotics to prevent infective endocarditis
D. Administration of antiplatelet agents to prevent thromboembolism
, Page 4 of 156
**Correct Answer: B**
**Rationale:** In patients with heart failure and reduced ejection fraction, achieving euvolemia
through careful diuretic management is the most critical preoperative optimization strategy. Both
hypovolemia (from over-diuresis) and hypervolemia (from inadequate diuresis) can precipitate
acute heart failure exacerbation perioperatively. Beta-blockers (A) are generally continued but
are not the primary optimization strategy. Prophylactic antibiotics (C) are indicated only for
specific procedures with high risk of bacteremia. Antiplatelet agents (D) may increase bleeding
risk and are not routine for heart failure optimization.
---
**Question 4**
A 45-year-old male with a history of chronic obstructive pulmonary disease (COPD) is scheduled
for mandibular reconstruction. His preoperative FEV1 is 55% of predicted. Which of the
following findings on preoperative assessment would MOST significantly increase his risk of
postoperative pulmonary complications?
A. FEV1/FVC ratio of 65%
B. Cough productive of purulent sputum
C. Room air oxygen saturation of 92%
D. Smoking history of 30 pack-years
**Correct Answer: B**
**Rationale:** Active pulmonary infection, manifested by productive purulent sputum, is the
most significant predictor of postoperative pulmonary complications in patients with COPD.
This indicates an acute exacerbation or uncontrolled infection that should be treated prior to
elective surgery. An FEV1/FVC ratio of 65% (A) is consistent with COPD but is a chronic
finding. Room air oxygen saturation of 92% (C) is mildly reduced but not acutely concerning.
# TABLE OF CONTENTS
| Section | Topic Area | Number of Questions |
|---------|------------|---------------------|
| I | Medical Assessment and Management of the Surgical Patient | 25 |
| II | Anesthesia and Pain Control | 25 |
| III | Dentoalveolar Surgery | 25 |
| IV | Trauma | 25 |
| V | Orthognathic / Cleft / OSA | 25 |
| VI | Cosmetic Surgery | 25 |
| VII | Temporomandibular Disorders / Facial Pain | 25 |
| VIII | Pathology | 25 |
| IX | Reconstruction | 25 |
| X | Implants | 25 |
,Page 2 of 156
# SECTION I: MEDICAL ASSESSMENT AND MANAGEMENT OF THE SURGICAL
PATIENT
**Question 1**
A 72-year-old male with a history of hypertension, type 2 diabetes, and coronary artery disease
presents for elective extraction of multiple impacted teeth. His current medications include
metformin, lisinopril, aspirin 81 mg daily, and atorvastatin. His blood pressure is 168/94 mmHg
on two separate readings. Which of the following is the MOST appropriate management
regarding his blood pressure prior to proceeding with surgery?
A. Proceed with surgery as planned; the blood pressure is acceptable for an elective dental
procedure
B. Delay surgery and refer to his primary care physician for blood pressure optimization
C. Administer sublingual nifedipine immediately and proceed with surgery once pressure
normalizes
D. Proceed with surgery using intravenous sedation to lower blood pressure intraoperatively
**Correct Answer: B**
**Rationale:** Patients with a systolic blood pressure ≥160 mmHg or diastolic ≥100 mmHg
should generally have elective surgery delayed until blood pressure is optimized. This patient has
stage 2 hypertension with readings of 168/94 mmHg on two separate occasions, representing a
significant perioperative risk for cardiovascular complications including myocardial ischemia,
stroke, and arrhythmias. Sublingual nifedipine (C) is contraindicated due to the risk of rapid,
uncontrolled hypotension and cerebral hypoperfusion. Proceeding with surgery (A) is
inappropriate given the elevated risk. Intravenous sedation (D) does not address the underlying
hypertension and may mask important warning signs.
---
**Question 2**
,Page 3 of 156
A 55-year-old female is scheduled for orthognathic surgery. Her preoperative ECG reveals a QTc
interval of 480 milliseconds. Which of the following electrolyte abnormalities is MOST
commonly associated with QTc prolongation?
A. Hyperkalemia
B. Hypokalemia
C. Hypermagnesemia
D. Hypercalcemia
**Correct Answer: B**
**Rationale:** Hypokalemia is the most common electrolyte abnormality associated with QTc
prolongation. Potassium plays a critical role in cardiac repolarization, and low serum potassium
delays the repolarization phase of the action potential, prolonging the QT interval. Hypokalemia
increases the risk of torsades de pointes, a potentially fatal ventricular arrhythmia. Hyperkalemia
(A) is associated with peaked T waves and widened QRS complexes rather than QTc
prolongation. Hypermagnesemia (C) typically does not cause QTc prolongation;
hypomagnesemia does. Hypercalcemia (D) shortens the QT interval.
---
**Question 3**
A 68-year-old male with a history of heart failure (ejection fraction 35%) presents for removal of
a mandibular lesion under general anesthesia. Which of the following is the MOST important
preoperative optimization strategy in this patient?
A. Administration of beta-blockers 24 hours prior to surgery
B. Optimization of volume status with diuretics to achieve euvolemia
C. Prophylactic antibiotics to prevent infective endocarditis
D. Administration of antiplatelet agents to prevent thromboembolism
, Page 4 of 156
**Correct Answer: B**
**Rationale:** In patients with heart failure and reduced ejection fraction, achieving euvolemia
through careful diuretic management is the most critical preoperative optimization strategy. Both
hypovolemia (from over-diuresis) and hypervolemia (from inadequate diuresis) can precipitate
acute heart failure exacerbation perioperatively. Beta-blockers (A) are generally continued but
are not the primary optimization strategy. Prophylactic antibiotics (C) are indicated only for
specific procedures with high risk of bacteremia. Antiplatelet agents (D) may increase bleeding
risk and are not routine for heart failure optimization.
---
**Question 4**
A 45-year-old male with a history of chronic obstructive pulmonary disease (COPD) is scheduled
for mandibular reconstruction. His preoperative FEV1 is 55% of predicted. Which of the
following findings on preoperative assessment would MOST significantly increase his risk of
postoperative pulmonary complications?
A. FEV1/FVC ratio of 65%
B. Cough productive of purulent sputum
C. Room air oxygen saturation of 92%
D. Smoking history of 30 pack-years
**Correct Answer: B**
**Rationale:** Active pulmonary infection, manifested by productive purulent sputum, is the
most significant predictor of postoperative pulmonary complications in patients with COPD.
This indicates an acute exacerbation or uncontrolled infection that should be treated prior to
elective surgery. An FEV1/FVC ratio of 65% (A) is consistent with COPD but is a chronic
finding. Room air oxygen saturation of 92% (C) is mildly reduced but not acutely concerning.
