NBDE General Practice 5 — Questions and Answers
Question 1: A patient experiences syncope in the dental chair. After confirming consciousness is lost, what is the FIRST action?
- Administer epinephrine 1:1000 intramuscularly
- Place the patient in Trendelenburg (supine with legs elevated) position (Correct answer)
- Perform chest compressions
- Administer oxygen via nasal cannula
Correct answer: Place the patient in Trendelenburg (supine with legs elevated) position
Vasovagal syncope is managed by placing the patient supine with legs elevated to restore cerebral blood flow; most patients recover rapidly in this position.
Question 2: Under HIPAA, which of the following is NOT considered protected health information (PHI)?
- A patient's date of birth combined with a dental diagnosis
- De-identified patient data that cannot identify the individual (Correct answer)
- A photograph showing the patient's face during treatment
- A dental treatment plan with the patient's name
Correct answer: De-identified patient data that cannot identify the individual
De-identified health information that cannot reasonably be used to identify an individual is not considered PHI and therefore not protected under HIPAA.
Question 3: Which periodontal classification term describes a site with at least 2 mm of clinical attachment loss, probing depth ≥ 4 mm, and bleeding on probing?
- Gingivitis on a reduced periodontium
- Stage I periodontitis (Correct answer)
- Localized Stage II periodontitis
- Generalized Stage III periodontitis
Correct answer: Stage I periodontitis
Stage I periodontitis is characterized by ≤2 mm interdental CAL, probing depths ≤4 mm, and radiographic bone loss limited to the coronal third of the root.
Question 4: A patient's blood pressure reads 165/100 mmHg at the dental appointment. According to ADA guidelines, what is the appropriate action?
- Proceed normally; this is within acceptable limits for dental treatment
- Defer elective treatment and refer to physician for evaluation (Correct answer)
- Administer a calcium channel blocker before proceeding
- Limit the epinephrine dose to 0.04 mg and proceed with urgent treatment only
Correct answer: Defer elective treatment and refer to physician for evaluation
A blood pressure of 165/100 mmHg (Stage 2 hypertension) warrants deferral of elective dental treatment and referral to the patient's physician for evaluation and management.
Question 5: The legal concept of 'respondeat superior' in dental practice means:
- The dentist has a duty to refer patients beyond their expertise
- An employer-dentist is liable for the negligent acts of employees acting within the scope of employment (Correct answer)
- A dentist must obtain informed consent before all procedures
- The standard of care is determined by expert testimony
Correct answer: An employer-dentist is liable for the negligent acts of employees acting within the scope of employment
Respondeat superior ('let the master answer') holds the employer vicariously liable for negligent acts committed by employees (hygienists, assistants) within their scope of employment.
Question 6: Which suture material is MOST appropriate for closure of an intraoral incision where removal may be difficult?
- Silk (non-resorbable)
- Nylon monofilament
- Chromic gut (resorbable) (Correct answer)
- Polyester (Dacron)
Correct answer: Chromic gut (resorbable)
Chromic gut is a resorbable suture that degrades via enzymatic action within 7–10 days, eliminating the need for removal in areas that are difficult to access intraorally.
Question 7: A patient presents with a white patch on the buccal mucosa that cannot be wiped off. Biopsy reveals epithelial dysplasia. What is the BEST initial management?
- Observation and reassessment in 6 months
- Complete surgical excision and close follow-up (Correct answer)
- Topical antifungal therapy for 2 weeks
- Systemic corticosteroid therapy
Correct answer: Complete surgical excision and close follow-up
Leukoplakia with confirmed epithelial dysplasia requires complete surgical excision to prevent malignant transformation, followed by regular surveillance for recurrence.
NBDE General Practice 5
A patient experiences syncope in the dental chair.
After confirming consciousness is lost, what is the FIRST action?