Free practice quiz
Oral Surgery Board Prep Course (OMFS): free quiz
10 questions from the program. See your score right away, then unlock the explanation of every answer.
- Question 1 of 10
A 28-year-old man presents to the emergency department 3 hours after an assault with mandibular pain and swelling. He reports that his teeth “do not fit together,” but he is speaking in full sentences and has no active oral bleeding. Before deciding on imaging and operative urgency, which focused history element most directly supports suspected mandibular fracture and guides OMFS treatment planning?
Focused OMFS Trauma History
B is correct: mechanism and immediate malocclusion are high-yield mandibular fracture clues and affect imaging, urgency, and fixation planning. A is useful for prior treatment but does not best establish fracture pattern or urgency. C may affect scarring risk but is not central to acute mandibular trauma assessment. D may explain baseline occlusion, yet it is secondary to documenting traumatic occlusal change.
Decision Framework: IDENTIFY suspected facial fracture; ANALYZE history for mechanism and occlusal change; SELECT the question that confirms trauma pattern; JUSTIFY alternatives as less urgent planning data. Review Focused OMFS History Elements — focus on mechanism, occlusion, and red flags. - Question 2 of 10
A 28-year-old healthy patient is scheduled for elective removal of four erupted third molars under office-based deep IV sedation. History reveals no bleeding disorder, no anticoagulant use, no liver or kidney disease, and no systemic medications. Vital signs and examination are normal. Pregnancy status is uncertain. Which preoperative laboratory plan is most appropriate?
Selective preoperative laboratory testing
A is correct: preoperative tests should be driven by comorbidity, procedure risk, and anesthesia plan; uncertain pregnancy status can justify testing before elective sedation. A overuses screening labs in a healthy patient. C is tempting because surgery involves bleeding, but coagulation tests are indicated by history, anticoagulants, liver disease, or high-risk surgery, not routine dentoalveolar extraction. A overestimates expected blood loss; type and screen is unnecessary for routine third-molar surgery.
Decision Framework: Identify need for labs; analyze medical history, bleeding risk, and sedation; select targeted pregnancy testing only; justify alternatives by absence of indications. Review Selective Preoperative Testing — focus on history- and risk-based ordering. - Question 3 of 10
A 28-year-old patient with a displaced mandibular angle fracture is scheduled for open reduction and internal fixation. He is alert, asks appropriate questions, and wants to proceed. Before obtaining signature, which consent approach best meets the surgeon’s obligation?
Review Informed Consent Components — focus on process, capacity, alternatives, and material risks
C is correct: consent is a process requiring capacity plus diagnosis, proposed treatment, alternatives, benefits, material risks such as bleeding, infection, nerve injury, malocclusion, further surgery, and no-treatment option. B is tempting but a signed form alone is insufficient. D is incomplete because surgical risks and alternatives must also be covered. A is inappropriate when the adult patient has capacity; surrogate consent is for incapacity or authorized exceptions.
Decision Framework: Identify the consent decision; analyze capacity and required disclosures; select C; justify alternatives as incomplete or invalid. - Question 4 of 10
A 27-year-old healthy patient is scheduled for mandibular third-molar removal under IV sedation. You plan inferior alveolar and long buccal blocks using 2% lidocaine with epinephrine 1:100,000 rather than plain lidocaine. Which pharmacologic effect best explains the expected longer pulpal anesthesia and improved surgical field hemostasis?
Review Local Anesthetic Vasoconstrictors — focus on reduced absorption
A is correct: epinephrine causes alpha-mediated vasoconstriction, decreasing local blood flow, slowing systemic absorption, prolonging anesthesia, and improving hemostasis. B is tempting because pKa affects onset, but epinephrine does not lower lidocaine pKa. D is tempting because protein binding affects duration, but epinephrine does not meaningfully increase lidocaine channel binding. C is incorrect because lidocaine remains an amide metabolized primarily hepatically; ester metabolism is not induced.
Identify the goal: longer anesthesia and hemostasis. Analyze mechanisms: vasoconstriction best fits both. Select A. Alternatives fail because they alter pKa, protein binding, or metabolism rather than tissue perfusion. - Question 5 of 10
A 42-year-old ASA II patient is scheduled for office removal of four impacted third molars with planned IV moderate sedation. The surgeon expects stimulation, possible airway obstruction, and variable sedative sensitivity. Which monitoring and staffing plan best matches the intended sedation depth and anticipated rescue needs?
Sedation Depth and Monitoring
C is correct: moderate sedation can deepen, so ventilation, oxygenation, circulation, ECG, trained observation, and recovery criteria are planned. A is tempting for minimal sedation, but lacks an independent monitor and objective ventilation assessment. A includes useful monitors, but capnography is recommended for moderate/deep sedation unless precluded. A monitors intraoperatively but fails discharge standards, which are part of the anesthetic plan.
Decision Framework: IDENTIFY intended moderate sedation with possible deeper rescue; ANALYZE airway and physiologic monitoring needs; SELECT C; JUSTIFY alternatives by missing monitor, capnography, or discharge criteria.Review Sedation Depth and Monitoring — focus on anticipating unintended deeper sedation.
- Question 6 of 10
A 24-year-old anxious patient in an OMFS office becomes pale, diaphoretic, nauseated, and lightheaded immediately after local anesthetic injection for third-molar removal. He briefly slumps but responds to voice. Pulse is 46/min, blood pressure is 82/50 mm Hg, respirations are unlabored, and oxygen saturation is 99%. No tonic-clonic activity or perioral numbness is present. What is the best immediate management?
Review Syncope And Vasovagal Events
C is correct: prodrome, pallor, hypotension, and bradycardia indicate vasovagal syncope; initial care is positioning, oxygen, stimulation, and reassessment. B is tempting for altered responsiveness, but hypoglycemia usually lacks abrupt bradycardic prodrome and should not be assumed. D is tempting after injection, but LAST usually includes CNS symptoms, seizures, or cardiovascular collapse. A is incorrect because there is no seizure activity.
Decision Framework: IDENTIFY transient instability after injection; ANALYZE prodrome and vital signs; SELECT supportive syncope care; JUSTIFY alternatives by absent hypoglycemic, toxic, or seizure features. - Question 7 of 10
A 68-year-old man requests extraction of painful mandibular tooth #19. The tooth has recurrent caries but may be restorable. He received 70 Gy external-beam radiation to the left mandible for oropharyngeal cancer 2 years ago and takes daily aspirin after coronary stenting. He is afebrile with no fascial space swelling. What is the best next step in extraction case selection?
Review Extraction Case Selection
C is correct: high-dose mandibular radiation makes avoidable extraction hazardous; confirm dose/field, consider salvage, and consent for osteoradionecrosis. A is tempting because aspirin affects bleeding, but stent thrombosis risk and local hemostasis usually outweigh routine cessation. B is plausible, but hyperbaric oxygen is not universally mandatory. D confuses radiation risk with antiresorptive-related osteonecrosis.
IDENTIFY irradiated mandible. ANALYZE restorability, infection, medical risk, and alternatives. SELECT conservative planning before extraction. JUSTIFY: bleeding planning, HBO, or drug holiday alone does not address the dominant radiation-related risk. - Question 8 of 10
A healthy 24-year-old is evaluated before elective removal of mandibular third molar #17. Panoramic imaging shows the crown directed mesially, the distal crown partially covered by the anterior ramus, and the highest portion of the tooth between the occlusal plane and cervical line of the second molar. Roots are about two-thirds formed, with no enlarged follicle. Which documentation and counseling statement best links the impaction classification to operative planning?
Mandibular third-molar classification
C is correct: mesioangular describes crown angulation; class II reflects partial ramus coverage; position B places tooth height between the second-molar occlusal plane and CEJ. A understates difficulty by calling it class I/D/vertical. A overstates depth and ramus involvement, and classification alone does not mandate hospital anesthesia. A mismatches angulation and depth; incomplete roots often favor, rather than prohibit, timely removal when otherwise indicated.
Decision Framework: Identify angulation, ramus relationship, and depth; analyze risk; select the matching classification; justify eliminating mismatched descriptions. Review Mandibular Third-Molar Classification — focus on Winter and Pell-Gregory criteria. - Question 9 of 10
A 58-year-old man returns 2 hours after extraction of a mandibular molar with persistent bleeding through gauze. He is alert, BP 148/86, HR 82, and takes apixaban for atrial fibrillation; last dose was this morning. The socket contains a large gelatinous clot with intermittent bright oozing from within the socket and no expanding floor-of-mouth swelling. After suction and adequate lighting, what is the most appropriate immediate management?
Postextraction Bleeding Control
B is correct: stable socket bleeding is treated first with visualization, clot removal, source assessment, local hemostatic packing or suturing, and pressure. D is tempting because apixaban increases bleeding, but reversal or ED escalation is reserved for uncontrolled or unstable hemorrhage after local control attempts. A fits minor oozing, but a persistent clot-filled socket needs inspection for socket-source bleeding. A may be an adjunct in anticoagulated patients, but discharge without inspecting an active socket misses correctable local causes.
IDENTIFY persistent stable socket bleeding; ANALYZE local versus systemic causes; SELECT local exploration, hemostatic agent, suture, and pressure; JUSTIFY: alternatives delay source control or over-escalate.Review Postextraction Bleeding Control — focus on source-directed local hemostasis before systemic escalation.
- Question 10 of 10
A 27-year-old restrained driver arrives after a high-speed collision. He is agitated, gurgling blood, and has mobile maxillary segments with an expanding floor-of-mouth hematoma. Oxygen saturation is 89% on nonrebreather; blood pressure is 104/68 mm Hg. CT is not yet obtained. As the OMFS consultant in the trauma bay, what is the most appropriate next step?
Primary Survey OMFS Priorities
D is correct: gurgling blood, hypoxemia, unstable midface, and expanding hematoma make airway the immediate ABC priority. A is tempting for operative planning, but imaging follows stabilization. A may later aid occlusion and fracture control, but intermaxillary fixation can worsen an unsecured airway. A may reduce bleeding, but laceration repair must not delay airway protection.
Decision Framework: IDENTIFY airway threat; ANALYZE hypoxemia, blood, hematoma, and facial instability; SELECT airway control; JUSTIFY alternatives fail because they delay life-saving primary-survey management. Review Primary Survey OMFS Priorities — focus on airway before fixation.
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