ABOMS ORAL & MAXILLOFACIAL SURGERY EXAM 2026 |
EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALE | 2027 Q&A | INSTANT
DOWNLOAD PDF
1. A 62-year-old patient with stable angina is scheduled for elective third molar removal.
He reports that his angina now occurs with minimal exertion and has been more
frequent over the past two weeks. His cardiologist has not yet been informed of the
surgery. What is the most appropriate next step?
A. Proceed with surgery under local anesthesia with epinephrine 1:100,000
**B. Obtain cardiology clearance and delay elective surgery until the angina is
stabilised**
C. Cancel the procedure permanently and refer the patient to cardiothoracic surgery
D. Perform the extraction under general anesthesia in a hospital setting
*Rationale: New or worsening angina with minimal exertion represents unstable
coronary disease. Elective surgery should be deferred until the patient is evaluated and
stabilised, because the perioperative stress response can precipitate myocardial
infarction or arrhythmia. Proceeding with local anaesthesia alone does not remove the
risk, and permanent cancellation is an overreaction before cardiology assessment.*
2. A patient chronically taking metoprolol for hypertension is booked for dentoalveolar
surgery. Which perioperative consideration is most important?
A. Stop the beta-blocker 48 hours before surgery to avoid bradycardia
**B. Continue the beta-blocker and monitor for rebound hypertension if omitted**
C. Substitute an ACE inhibitor on the morning of surgery
D. Withhold all antihypertensives until the patient is in the recovery room
*Rationale: Abrupt withdrawal of beta-blockers can cause rebound sympathetic activity,
tachycardia, hypertension, and myocardial ischaemia. The medication should be
,continued perioperatively unless a specific contraindication exists. Stopping it routinely
is unsafe, and substituting another class without indication is not appropriate.*
3. Which preoperative laboratory finding in an otherwise asymptomatic patient most
strongly warrants postponing elective oral surgery?
A. Haemoglobin A1c of 7.1%
B. International normalised ratio of 1.1
**C. Platelet count of 95,000/µL with active bruising**
D. Fasting glucose of 118 mg/dL
*Rationale: A platelet count below 100,000/µL accompanied by active bruising suggests
a clinically significant bleeding tendency that requires haematological evaluation before
elective surgery. Mildly elevated HbA1c and fasting glucose indicate suboptimal but not
emergent glycaemic control, and an INR of 1.1 is within the normal range.*
4. A patient with severe aortic stenosis is referred for elective implant placement. Which
feature of the history most increases the perioperative risk?
A. A systolic murmur that has been unchanged for ten years
**B. A history of syncope on exertion**
C. Mild left ventricular hypertrophy on echocardiography
D. Controlled hypertension on a single agent
*Rationale: Syncope on exertion in a patient with severe aortic stenosis is a marker of
haemodynamic compromise and identifies a high-risk cardiac lesion. Elective surgery
should be deferred for cardiology evaluation. An unchanged murmur, mild hypertrophy,
and controlled hypertension are less predictive of perioperative decompensation.*
5. A patient reports a documented allergy to penicillin with a reaction of facial swelling
and urticaria. He requires antibiotic prophylaxis for a contaminated dentoalveolar
procedure. Which regimen is most appropriate?
A. Amoxicillin 2 g orally one hour before surgery
,B. Clindamycin 600 mg orally one hour before surgery
C. Cephalexin 2 g orally one hour before surgery
**D. Azithromycin 500 mg orally one hour before surgery**
*Rationale: A history of urticaria and facial swelling to penicillin is a type I
hypersensitivity reaction, so beta-lactams, including cephalosporins, should be avoided
because of potential cross-reactivity. Clindamycin has historically been used, but current
guidance favours non-beta-lactam alternatives such as azithromycin or doxycycline
when prophylaxis is indicated, depending on local resistance patterns. Amoxicillin and
cephalexin are contraindicated.*
6. During administration of a local anaesthetic block, the patient suddenly becomes
agitated, reports a metallic taste, and exhibits muscle twitching. What is the most
immediate priority?
A. Administer a further dose of local anaesthetic to complete the block
**B. Stop the injection and manage the patient for local anaesthetic systemic toxicity**
C. Reassure the patient and continue at a slower injection rate
D. Place the patient in a supine position and observe for ten minutes
*Rationale: A metallic taste, agitation, and muscle twitching are early features of local
anaesthetic systemic toxicity. The injection must be stopped immediately, and the
patient should be managed with airway support, oxygenation, and, if seizures or
cardiovascular instability develop, lipid emulsion therapy. Continuing the injection would
worsen the toxicity.*
7. A 4-year-old child requires dental treatment under general anaesthesia. Which
preoperative fasting instruction is consistent with current paediatric anaesthesia
guidance?
**A. Clear fluids may be taken up to two hours before induction**
B. Breast milk should be withheld for at least eight hours
C. Formula feeds should be withheld for at least four hours
, D. Solid food should be withheld for at least twelve hours
*Rationale: Current paediatric fasting guidelines generally permit clear fluids up to two
hours before anaesthesia, breast milk up to four hours, formula up to six hours, and
solids up to eight hours. Prolonged fasting offers no benefit and increases the risk of
dehydration and hypoglycaemia. The other options impose unnecessarily long fasting
intervals.*
8. A patient undergoing deep sedation begins to desaturate despite supplemental
oxygen. Which manoeuvre should be performed first?
A. Increase the depth of sedation to suppress respiratory effort
**B. Perform a jaw-thrust manoeuvre and consider a nasopharyngeal airway**
C. Administer a reversal agent before repositioning the airway
D. Immediately perform a surgical cricothyrotomy
*Rationale: In a sedated patient with desaturation, the first priority is to open the airway.
Jaw thrust and placement of a nasopharyngeal airway are appropriate initial steps.
Deepening sedation would worsen respiratory depression, and reversal or surgical
airway is reserved for situations that do not respond to basic airway manoeuvres.*
9. Which analgesic strategy best reflects modern multimodal analgesia for office-based
oral surgery?
A. Routine high-dose opioid monotherapy for all patients
**B. Scheduled acetaminophen and ibuprofen with opioid reserved for breakthrough
pain**
C. Avoidance of all non-steroidal anti-inflammatory drugs because of bleeding risk
D. Long-acting opioid patches applied before surgery in every patient
*Rationale: Multimodal analgesia combines agents with different mechanisms, such as
acetaminophen and NSAIDs, to reduce opioid requirements and improve pain control.
Opioids should be reserved for breakthrough pain rather than used as routine
EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALE | 2027 Q&A | INSTANT
DOWNLOAD PDF
1. A 62-year-old patient with stable angina is scheduled for elective third molar removal.
He reports that his angina now occurs with minimal exertion and has been more
frequent over the past two weeks. His cardiologist has not yet been informed of the
surgery. What is the most appropriate next step?
A. Proceed with surgery under local anesthesia with epinephrine 1:100,000
**B. Obtain cardiology clearance and delay elective surgery until the angina is
stabilised**
C. Cancel the procedure permanently and refer the patient to cardiothoracic surgery
D. Perform the extraction under general anesthesia in a hospital setting
*Rationale: New or worsening angina with minimal exertion represents unstable
coronary disease. Elective surgery should be deferred until the patient is evaluated and
stabilised, because the perioperative stress response can precipitate myocardial
infarction or arrhythmia. Proceeding with local anaesthesia alone does not remove the
risk, and permanent cancellation is an overreaction before cardiology assessment.*
2. A patient chronically taking metoprolol for hypertension is booked for dentoalveolar
surgery. Which perioperative consideration is most important?
A. Stop the beta-blocker 48 hours before surgery to avoid bradycardia
**B. Continue the beta-blocker and monitor for rebound hypertension if omitted**
C. Substitute an ACE inhibitor on the morning of surgery
D. Withhold all antihypertensives until the patient is in the recovery room
*Rationale: Abrupt withdrawal of beta-blockers can cause rebound sympathetic activity,
tachycardia, hypertension, and myocardial ischaemia. The medication should be
,continued perioperatively unless a specific contraindication exists. Stopping it routinely
is unsafe, and substituting another class without indication is not appropriate.*
3. Which preoperative laboratory finding in an otherwise asymptomatic patient most
strongly warrants postponing elective oral surgery?
A. Haemoglobin A1c of 7.1%
B. International normalised ratio of 1.1
**C. Platelet count of 95,000/µL with active bruising**
D. Fasting glucose of 118 mg/dL
*Rationale: A platelet count below 100,000/µL accompanied by active bruising suggests
a clinically significant bleeding tendency that requires haematological evaluation before
elective surgery. Mildly elevated HbA1c and fasting glucose indicate suboptimal but not
emergent glycaemic control, and an INR of 1.1 is within the normal range.*
4. A patient with severe aortic stenosis is referred for elective implant placement. Which
feature of the history most increases the perioperative risk?
A. A systolic murmur that has been unchanged for ten years
**B. A history of syncope on exertion**
C. Mild left ventricular hypertrophy on echocardiography
D. Controlled hypertension on a single agent
*Rationale: Syncope on exertion in a patient with severe aortic stenosis is a marker of
haemodynamic compromise and identifies a high-risk cardiac lesion. Elective surgery
should be deferred for cardiology evaluation. An unchanged murmur, mild hypertrophy,
and controlled hypertension are less predictive of perioperative decompensation.*
5. A patient reports a documented allergy to penicillin with a reaction of facial swelling
and urticaria. He requires antibiotic prophylaxis for a contaminated dentoalveolar
procedure. Which regimen is most appropriate?
A. Amoxicillin 2 g orally one hour before surgery
,B. Clindamycin 600 mg orally one hour before surgery
C. Cephalexin 2 g orally one hour before surgery
**D. Azithromycin 500 mg orally one hour before surgery**
*Rationale: A history of urticaria and facial swelling to penicillin is a type I
hypersensitivity reaction, so beta-lactams, including cephalosporins, should be avoided
because of potential cross-reactivity. Clindamycin has historically been used, but current
guidance favours non-beta-lactam alternatives such as azithromycin or doxycycline
when prophylaxis is indicated, depending on local resistance patterns. Amoxicillin and
cephalexin are contraindicated.*
6. During administration of a local anaesthetic block, the patient suddenly becomes
agitated, reports a metallic taste, and exhibits muscle twitching. What is the most
immediate priority?
A. Administer a further dose of local anaesthetic to complete the block
**B. Stop the injection and manage the patient for local anaesthetic systemic toxicity**
C. Reassure the patient and continue at a slower injection rate
D. Place the patient in a supine position and observe for ten minutes
*Rationale: A metallic taste, agitation, and muscle twitching are early features of local
anaesthetic systemic toxicity. The injection must be stopped immediately, and the
patient should be managed with airway support, oxygenation, and, if seizures or
cardiovascular instability develop, lipid emulsion therapy. Continuing the injection would
worsen the toxicity.*
7. A 4-year-old child requires dental treatment under general anaesthesia. Which
preoperative fasting instruction is consistent with current paediatric anaesthesia
guidance?
**A. Clear fluids may be taken up to two hours before induction**
B. Breast milk should be withheld for at least eight hours
C. Formula feeds should be withheld for at least four hours
, D. Solid food should be withheld for at least twelve hours
*Rationale: Current paediatric fasting guidelines generally permit clear fluids up to two
hours before anaesthesia, breast milk up to four hours, formula up to six hours, and
solids up to eight hours. Prolonged fasting offers no benefit and increases the risk of
dehydration and hypoglycaemia. The other options impose unnecessarily long fasting
intervals.*
8. A patient undergoing deep sedation begins to desaturate despite supplemental
oxygen. Which manoeuvre should be performed first?
A. Increase the depth of sedation to suppress respiratory effort
**B. Perform a jaw-thrust manoeuvre and consider a nasopharyngeal airway**
C. Administer a reversal agent before repositioning the airway
D. Immediately perform a surgical cricothyrotomy
*Rationale: In a sedated patient with desaturation, the first priority is to open the airway.
Jaw thrust and placement of a nasopharyngeal airway are appropriate initial steps.
Deepening sedation would worsen respiratory depression, and reversal or surgical
airway is reserved for situations that do not respond to basic airway manoeuvres.*
9. Which analgesic strategy best reflects modern multimodal analgesia for office-based
oral surgery?
A. Routine high-dose opioid monotherapy for all patients
**B. Scheduled acetaminophen and ibuprofen with opioid reserved for breakthrough
pain**
C. Avoidance of all non-steroidal anti-inflammatory drugs because of bleeding risk
D. Long-acting opioid patches applied before surgery in every patient
*Rationale: Multimodal analgesia combines agents with different mechanisms, such as
acetaminophen and NSAIDs, to reduce opioid requirements and improve pain control.
Opioids should be reserved for breakthrough pain rather than used as routine
