OMFS BOARD EXAM QUESTIONS AND ANSWERS
You are extracting a maxillary third molar & you displace it into the sinus & get profuse bleeding. Where
is the bleeding coming from? - CORRECT ANSWER✅✅✅a. Posterior Superior Alveolar Artery
Best way to close an oro-antral fistula from a 1st molar? - CORRECT ANSWER✅✅✅a. 1-4mm usually
heals on ownb. Buccal Advancement
Indications for Buccal Fat pad closure of O-A fistula, & how it heals. - CORRECT ANSWER✅✅✅a.
Defects 7 mm and biggerb. Reepithelializes in 2-4 weeks
A pediatric patient presents to our office 2 weeks following trauma to a primary centralincisor. The
tooth is now discolored, but otherwise asymptomatic. What is your treatment? - CORRECT
ANSWER✅✅✅a. Observe
What type of mandibular fracture poses the greatest risk of airway obstruction? - CORRECT
ANSWER✅✅✅a. Bilateral angle fractureb. Bilateral parasymphysis fracture - not an option on the
exam
Child bitten by a dog 3 days ago, now infected, what is the most likely organism? - CORRECT
ANSWER✅✅✅a. Pasturella multicedinsTimely and copious irrigation with normal saline or Ringer's
lactate solution may reduce the rate of infection markedly. Injection of the tissue with irrigant solution
should be avoided, because this can spread the infectionPuncture wounds, wounds that appear clinically
infected and wounds more than 24 hours old may have a better outcome with delayed primary closure
or healing by secondary intention.5,6 Some physicians close wounds that are less than eight hours old
and wounds located on the faceprophylactic antibiotics for three to seven days is appropriate for dog
bite wounds, unless the risk of infection is low or the wound is superficial. If frank cellulitis is evident, a
10- to 14-day course of treatment is more appropriate. Amoxicillin-clavulanate potassium (Augmentin) is
the antibiotic of choice for a dog bite. For patients who are allergic to penicillin, doxycycline
(Vibramycin) is an acceptable alternative, except for children younger than eight years and pregnant
women. Erythromycin can also be used, but the risk of treatment failure is greater because of
antimicrobial resistance
Patient with Hamman's Sign following MVA, what type of injury? - CORRECT ANSWER✅✅✅Tracheo-
bronchial tree injuryis a crunching, rasping sound, synchronous with the heartbeat,[3] heard over the
precordium in spontaneous mediastinal emphysema.Hamman's crunch is caused by
,pneumomediastinum or pneumopericardium, and is associated with tracheobronchial injury due to
trauma, medical procedures (e.g., bronchoscopy)
8. When you bite on your anterior teeth describe the forces applied over an angle fracture? - CORRECT
ANSWER✅✅✅Tension at the alveolus, compression at the inferior border
9.Patient has flaccid elbow & wrist reflex, but normal triceps reflex following MVA, what is the level of C-
spine injury? - CORRECT ANSWER✅✅✅a. C 5-6 (triceps is C 6-7). waiter tipTraction or Tear of the
upper trunk C5-C6 roots.infants-lateral traction on the neck during deliverAdult traumaMuscle deficite
with Deltoid, Supraspinatus, InfraspinatusKlumpake Palsyy Truction or tear lower trunk c8-T1Total claw
hand ( loss of wrist flexion
. Bone-bone contact & compression across the fracture site - CORRECT ANSWER✅✅✅a. Bone-bone
contact & compression across the fracture site
What type of plate & screw fixation provides the most stable fixation? - CORRECT
ANSWER✅✅✅Neutral zone
i. However, this is not possible in the mandible, since the neutral zone is in direct line w/ the IAN
What is the thickness of the superior tarsal plate? - CORRECT ANSWER✅✅✅10 mm
The tarsal plates are composed of dense fibrous tissue and are responsible for the structural integrity of
the lids. Each tarsus is approximately 29 mm long and 1 mm thick. The crescentic superior tarsus is 10
mm in vertical height centrally, narrowing medially and laterally
What is the position of the upper eyelid, at primary gaze, in relation to the limbus - CORRECT
ANSWER✅✅✅2-3mm inferior
The normal resting position of the upper lid is 2 mm below the junction of the superior cornea with the
sclera, and that of the lower lid is at the junction of the inferior cornea with the sclera
Nerve supply of the eyelids
The eyelid is supplied by three cranial nerves (III, V, VII) and sympathetic nerve fibers.
Aniscoria
,status post trauma, what does it mean? - CORRECT ANSWER✅✅✅Anisocoria is a condition in which
the pupil of one eye differs in size from the pupil of the other eye. Yourpupils are the black circles in the
center of your eyes. They are usually the same size. Anisocoria can be caused by several things. You can
be born with this condition or develop it later
a. All the following can be the cause s/p trauma
Normal
Horner's
CN III injury
Tonic pupil
Anisocoria is a common condition, defined by a difference of 0.4 mm or more between the sizes of the
pupils of the eyes.[1]
Anisocoria has various causes:[2]
Physiological anisocoria: About 20% of normal people have a slight difference in pupil size which is
known as physiological anisocoria. In this condition, the difference between pupils is usually less than 1
mm.[3]
Horner's syndrome
Mechanical anisocoria: Occasionally previous trauma, eye surgery, or inflammation (uveitis, angle
closure glaucoma) can lead to adhesions between the iris and the lens.
Adie tonic pupil: Tonic pupil is usually an isolated benign entity, presenting in young women. It may be
associated with loss of deep tendon reflex (Adie's syndrome). Tonic pupil is characterized by delayed
dilation of iris especially after near stimulus, segmental iris constriction, and sensitivity of pupil to a
weak solution of pilocarpine.
Oculomotor nerve palsy: Ischemia, intracranial aneurysm, demyelinating diseases (e.g., multiple
sclerosis), head trauma, and brain tumors are the most common causes of oculomotor nerve palsy in
adults. In ischemic lesions of the oculomotor nerve, pupillary function is usually spared whereas in
compressive lesions the pupil is involved.
Pharmacological agents with anticholinergic or sympathomimetic properties will cause anisocoria,
particularly if instilled in one eye. Some examples of pharmacological agents which may affect the pupils
include piloc
Which fracture would you use a compression plate for - CORRECT ANSWER✅✅✅Ramus fracture
Oblique symphysis fracture (not correct - according to Fonseca's textbook,
, oblique fractures are contraindication to compression plate)
Best screening test for cardiac contusion - CORRECT ANSWER✅✅✅It has been documented that
implementing ECG in the first stage of treating a person with a traumatic contusion (significant thoracic
trauma) on the chest shows if the probability of contusion is high; thus, it is a class I recommended
diagnostic test.
What is the best way to monitor blood loss & fluid status in a trauma patient? - CORRECT
ANSWER✅✅✅CVP
Because urine output does not provide a minute-to-minute indication, measures of preload may be
helpful in guiding fluid resuscitation for critically ill patients. Central venous pressure (CVP) is the mean
pressure in the superior vena cava, reflecting right ventricular end-diastolic pressure or preload. Normal
CVP ranges from 2 to 7 mm Hg (3 to 9 cm water). A sick or injured patient with a CVP < 3 mm Hg is
presumed to be volume depleted and may be given fluids with relative safety. When the CVP is within
the normal range, volume depletion cannot be excluded, and the response to 100- to 200-mL fluid
boluses should be assessed; a modest increase in CVP in response to fluid generally indicates
hypovolemia. An increase of > 3 to 5 mm Hg in response to a 100-mL fluid bolus suggests limited cardiac
reserve. A CVP > 12 to 15 mm Hg casts doubt on hypovolemia as the sole etiology of hypoperfusion, and
fluid administration risks fluid overload
fluid replacement therapy - CORRECT ANSWER✅✅✅Fluids
Choice of resuscitation fluid depends on the cause of the deficit.
Hemorrhage
Loss of red blood cells diminishes oxygen-carrying capacity. However, the body increases cardiac output
to maintain oxygen delivery (DO2) and increases oxygen extraction. These factors provide a safety
margin of about 9 times the resting oxygen requirement. Thus, non-oxygen-carrying fluids (eg,
crystalloid or colloid solutions) may be used to restore intravascular volume in mild to moderate blood
loss. However, in severe hemorrhagic shock, blood products are required. Early administration of plasma
and platelets probably helps minimize the dilutional and consumptive coagulopathy that accompanies
major hemorrhage. A ratio of 1 unit of plasma for each 1 unit of blood and each 1 unit of platelets is
currently recommended (1). When the patient is stable, if the hemoglobin is < 7 g/dL (70 g/L), in the
absence of cardiac or cerebral vascular disease, oxygen-carrying capacity should be restored by infusion
of additional blood (or in the future by blood substitutes). Patients with active coronary or cerebral
vascular disease or ongoing hemorrhage require blood for hemoglobin < 10 g/dL (100 g/L).
Crystalloid solutions for intravascular volume replenishment are typically isotonic (eg, 0.9% saline or
Ringer's lactate). Water freely travels outside the vasculature, so as little as 10% of isotonic fluid remains
in the intravascular space. With hypotonic fluid (eg, 0.45% saline), even less remains in the vasculature,
and, thus, this fluid is not used for resuscitation. Both 0.9% saline and Ringer's lactate are equally
You are extracting a maxillary third molar & you displace it into the sinus & get profuse bleeding. Where
is the bleeding coming from? - CORRECT ANSWER✅✅✅a. Posterior Superior Alveolar Artery
Best way to close an oro-antral fistula from a 1st molar? - CORRECT ANSWER✅✅✅a. 1-4mm usually
heals on ownb. Buccal Advancement
Indications for Buccal Fat pad closure of O-A fistula, & how it heals. - CORRECT ANSWER✅✅✅a.
Defects 7 mm and biggerb. Reepithelializes in 2-4 weeks
A pediatric patient presents to our office 2 weeks following trauma to a primary centralincisor. The
tooth is now discolored, but otherwise asymptomatic. What is your treatment? - CORRECT
ANSWER✅✅✅a. Observe
What type of mandibular fracture poses the greatest risk of airway obstruction? - CORRECT
ANSWER✅✅✅a. Bilateral angle fractureb. Bilateral parasymphysis fracture - not an option on the
exam
Child bitten by a dog 3 days ago, now infected, what is the most likely organism? - CORRECT
ANSWER✅✅✅a. Pasturella multicedinsTimely and copious irrigation with normal saline or Ringer's
lactate solution may reduce the rate of infection markedly. Injection of the tissue with irrigant solution
should be avoided, because this can spread the infectionPuncture wounds, wounds that appear clinically
infected and wounds more than 24 hours old may have a better outcome with delayed primary closure
or healing by secondary intention.5,6 Some physicians close wounds that are less than eight hours old
and wounds located on the faceprophylactic antibiotics for three to seven days is appropriate for dog
bite wounds, unless the risk of infection is low or the wound is superficial. If frank cellulitis is evident, a
10- to 14-day course of treatment is more appropriate. Amoxicillin-clavulanate potassium (Augmentin) is
the antibiotic of choice for a dog bite. For patients who are allergic to penicillin, doxycycline
(Vibramycin) is an acceptable alternative, except for children younger than eight years and pregnant
women. Erythromycin can also be used, but the risk of treatment failure is greater because of
antimicrobial resistance
Patient with Hamman's Sign following MVA, what type of injury? - CORRECT ANSWER✅✅✅Tracheo-
bronchial tree injuryis a crunching, rasping sound, synchronous with the heartbeat,[3] heard over the
precordium in spontaneous mediastinal emphysema.Hamman's crunch is caused by
,pneumomediastinum or pneumopericardium, and is associated with tracheobronchial injury due to
trauma, medical procedures (e.g., bronchoscopy)
8. When you bite on your anterior teeth describe the forces applied over an angle fracture? - CORRECT
ANSWER✅✅✅Tension at the alveolus, compression at the inferior border
9.Patient has flaccid elbow & wrist reflex, but normal triceps reflex following MVA, what is the level of C-
spine injury? - CORRECT ANSWER✅✅✅a. C 5-6 (triceps is C 6-7). waiter tipTraction or Tear of the
upper trunk C5-C6 roots.infants-lateral traction on the neck during deliverAdult traumaMuscle deficite
with Deltoid, Supraspinatus, InfraspinatusKlumpake Palsyy Truction or tear lower trunk c8-T1Total claw
hand ( loss of wrist flexion
. Bone-bone contact & compression across the fracture site - CORRECT ANSWER✅✅✅a. Bone-bone
contact & compression across the fracture site
What type of plate & screw fixation provides the most stable fixation? - CORRECT
ANSWER✅✅✅Neutral zone
i. However, this is not possible in the mandible, since the neutral zone is in direct line w/ the IAN
What is the thickness of the superior tarsal plate? - CORRECT ANSWER✅✅✅10 mm
The tarsal plates are composed of dense fibrous tissue and are responsible for the structural integrity of
the lids. Each tarsus is approximately 29 mm long and 1 mm thick. The crescentic superior tarsus is 10
mm in vertical height centrally, narrowing medially and laterally
What is the position of the upper eyelid, at primary gaze, in relation to the limbus - CORRECT
ANSWER✅✅✅2-3mm inferior
The normal resting position of the upper lid is 2 mm below the junction of the superior cornea with the
sclera, and that of the lower lid is at the junction of the inferior cornea with the sclera
Nerve supply of the eyelids
The eyelid is supplied by three cranial nerves (III, V, VII) and sympathetic nerve fibers.
Aniscoria
,status post trauma, what does it mean? - CORRECT ANSWER✅✅✅Anisocoria is a condition in which
the pupil of one eye differs in size from the pupil of the other eye. Yourpupils are the black circles in the
center of your eyes. They are usually the same size. Anisocoria can be caused by several things. You can
be born with this condition or develop it later
a. All the following can be the cause s/p trauma
Normal
Horner's
CN III injury
Tonic pupil
Anisocoria is a common condition, defined by a difference of 0.4 mm or more between the sizes of the
pupils of the eyes.[1]
Anisocoria has various causes:[2]
Physiological anisocoria: About 20% of normal people have a slight difference in pupil size which is
known as physiological anisocoria. In this condition, the difference between pupils is usually less than 1
mm.[3]
Horner's syndrome
Mechanical anisocoria: Occasionally previous trauma, eye surgery, or inflammation (uveitis, angle
closure glaucoma) can lead to adhesions between the iris and the lens.
Adie tonic pupil: Tonic pupil is usually an isolated benign entity, presenting in young women. It may be
associated with loss of deep tendon reflex (Adie's syndrome). Tonic pupil is characterized by delayed
dilation of iris especially after near stimulus, segmental iris constriction, and sensitivity of pupil to a
weak solution of pilocarpine.
Oculomotor nerve palsy: Ischemia, intracranial aneurysm, demyelinating diseases (e.g., multiple
sclerosis), head trauma, and brain tumors are the most common causes of oculomotor nerve palsy in
adults. In ischemic lesions of the oculomotor nerve, pupillary function is usually spared whereas in
compressive lesions the pupil is involved.
Pharmacological agents with anticholinergic or sympathomimetic properties will cause anisocoria,
particularly if instilled in one eye. Some examples of pharmacological agents which may affect the pupils
include piloc
Which fracture would you use a compression plate for - CORRECT ANSWER✅✅✅Ramus fracture
Oblique symphysis fracture (not correct - according to Fonseca's textbook,
, oblique fractures are contraindication to compression plate)
Best screening test for cardiac contusion - CORRECT ANSWER✅✅✅It has been documented that
implementing ECG in the first stage of treating a person with a traumatic contusion (significant thoracic
trauma) on the chest shows if the probability of contusion is high; thus, it is a class I recommended
diagnostic test.
What is the best way to monitor blood loss & fluid status in a trauma patient? - CORRECT
ANSWER✅✅✅CVP
Because urine output does not provide a minute-to-minute indication, measures of preload may be
helpful in guiding fluid resuscitation for critically ill patients. Central venous pressure (CVP) is the mean
pressure in the superior vena cava, reflecting right ventricular end-diastolic pressure or preload. Normal
CVP ranges from 2 to 7 mm Hg (3 to 9 cm water). A sick or injured patient with a CVP < 3 mm Hg is
presumed to be volume depleted and may be given fluids with relative safety. When the CVP is within
the normal range, volume depletion cannot be excluded, and the response to 100- to 200-mL fluid
boluses should be assessed; a modest increase in CVP in response to fluid generally indicates
hypovolemia. An increase of > 3 to 5 mm Hg in response to a 100-mL fluid bolus suggests limited cardiac
reserve. A CVP > 12 to 15 mm Hg casts doubt on hypovolemia as the sole etiology of hypoperfusion, and
fluid administration risks fluid overload
fluid replacement therapy - CORRECT ANSWER✅✅✅Fluids
Choice of resuscitation fluid depends on the cause of the deficit.
Hemorrhage
Loss of red blood cells diminishes oxygen-carrying capacity. However, the body increases cardiac output
to maintain oxygen delivery (DO2) and increases oxygen extraction. These factors provide a safety
margin of about 9 times the resting oxygen requirement. Thus, non-oxygen-carrying fluids (eg,
crystalloid or colloid solutions) may be used to restore intravascular volume in mild to moderate blood
loss. However, in severe hemorrhagic shock, blood products are required. Early administration of plasma
and platelets probably helps minimize the dilutional and consumptive coagulopathy that accompanies
major hemorrhage. A ratio of 1 unit of plasma for each 1 unit of blood and each 1 unit of platelets is
currently recommended (1). When the patient is stable, if the hemoglobin is < 7 g/dL (70 g/L), in the
absence of cardiac or cerebral vascular disease, oxygen-carrying capacity should be restored by infusion
of additional blood (or in the future by blood substitutes). Patients with active coronary or cerebral
vascular disease or ongoing hemorrhage require blood for hemoglobin < 10 g/dL (100 g/L).
Crystalloid solutions for intravascular volume replenishment are typically isotonic (eg, 0.9% saline or
Ringer's lactate). Water freely travels outside the vasculature, so as little as 10% of isotonic fluid remains
in the intravascular space. With hypotonic fluid (eg, 0.45% saline), even less remains in the vasculature,
and, thus, this fluid is not used for resuscitation. Both 0.9% saline and Ringer's lactate are equally
