ADEX Patient Assessment and Diagnosis 2 — Questions and Answers
Question 1: During a head and neck examination, a dental hygienist palpates a firm, non-tender, fixed lymph node in the submandibular region. What is the most appropriate next step?
- Document and monitor at next recall
- Refer the patient to a physician immediately (Correct answer)
- Perform a biopsy in the dental office
- Apply warm compresses and reassess in one week
Correct answer: Refer the patient to a physician immediately
A firm, fixed, non-tender lymph node is a red flag for malignancy and requires immediate physician referral.
Question 2: Which of the following findings during an oral cancer screening warrants biopsy referral rather than a 2-week monitoring period?
- A 4mm aphthous ulcer on the buccal mucosa
- A white lesion on the lateral tongue that cannot be wiped off (Correct answer)
- A red area on the soft palate following recent denture trauma
- Fordyce granules scattered on the buccal mucosa
Correct answer: A white lesion on the lateral tongue that cannot be wiped off
A white lesion (leukoplakia) on the lateral tongue that cannot be wiped off may represent dysplasia or carcinoma and warrants biopsy referral.
Question 3: A patient's blood pressure reading is 148/94 mmHg at two separate appointments. How should this be classified according to the AHA guidelines?
- Normal
- Elevated
- Stage 1 hypertension (Correct answer)
- Stage 2 hypertension
Correct answer: Stage 1 hypertension
Stage 1 hypertension is defined as systolic 130-139 mmHg or diastolic 80-89 mmHg; 148/94 falls in Stage 2 (≥140/90).
Question 4: When recording the gingival margin position during a periodontal assessment, what does a negative measurement indicate?
- The probe reading extends beyond the CEJ
- The gingival margin is coronal to the CEJ (pseudopocket) (Correct answer)
- The gingival margin is at the CEJ
- Bone loss has occurred apical to the CEJ
Correct answer: The gingival margin is coronal to the CEJ (pseudopocket)
A negative gingival margin value means the gingival margin is coronal to the CEJ, indicating edematous or hyperplastic tissue rather than true recession.
Question 5: Which type of bleeding index measures the presence or absence of bleeding 30 seconds after probing?
- Gingival Index (Löe and Silness)
- Papillary-Marginal-Attached Index
- Sulcus Bleeding Index (Mühlemann) (Correct answer)
- Bleeding on Probing (Ainamo and Bay)
Correct answer: Sulcus Bleeding Index (Mühlemann)
The Sulcus Bleeding Index (Mühlemann) records bleeding within 30 seconds of gentle probing along the gingival sulcus.
Question 6: A patient presents with a chief complaint of sensitivity when drinking cold water. Which assessment tool is most useful in differentiating between pulpitis and dentinal hypersensitivity?
- Periodontal probing
- Thermal and electric pulp testing (Correct answer)
- Radiographic bone level assessment
- Oral hygiene index
Correct answer: Thermal and electric pulp testing
Thermal and electric pulp vitality testing help distinguish vital tooth sensitivity (hypersensitivity) from pulpal pathology (pulpitis).
Question 7: During a dental hygiene assessment, the hygienist notes furcation involvement on tooth #19 that allows probe penetration through the entire furcation. This is classified as:
- Class I furcation
- Class II furcation
- Class III furcation (Correct answer)
- Class IV furcation
Correct answer: Class III furcation
Class III furcation involvement means the probe passes completely through the furcation from one side to the other (through-and-through).
ADEX Patient Assessment and Diagnosis 2
During a head and neck examination, a dental hygienist palpates a firm, non-tender, fixed lymph node in the submandibular region.
What is the most appropriate next step?