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100+ Free NDEB ACJ Practice Questions
NDEB Assessment of Clinical Judgement (ACJ) practice questions are available now; exam metadata is being verified.
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A 7-year-old prematurely loses the mandibular primary first molar. What is the most appropriate space management appliance to prevent space loss?
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Sample NDEB ACJ Practice Questions
Try these sample questions to test your NDEB ACJ exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A 58-year-old patient on warfarin presents for a single non-surgical extraction. Her INR measured this morning is 2.3 (therapeutic range 2.0-3.0). What is the most appropriate management?
A.Proceed with the extraction without interrupting warfarin, using local hemostatic measures
B.Stop warfarin for 5 days and reschedule the extraction
C.Reduce the warfarin dose by half for 3 days before treatment
D.Refer the patient to hospital for the extraction under heparin bridging
Explanation: Current evidence and the ADA/anticoagulation guidelines state that simple dental extractions can be performed safely without interrupting warfarin when the INR is within the therapeutic range (up to 3.5-4.0), using local measures such as sutures, packing, and tranexamic acid. Stopping anticoagulation needlessly exposes the patient to thromboembolic risk.
2During a restorative appointment, a patient suddenly clutches the chest, becomes diaphoretic, and reports crushing substernal pain radiating to the left arm. After stopping treatment and positioning the patient, what is the most appropriate immediate drug to administer if there is no contraindication?
A.Intramuscular epinephrine
B.Sublingual nitroglycerin
C.Oral aspirin 325 mg only
D.Intravenous diazepam
Explanation: Chest pain consistent with angina/acute coronary syndrome is managed with sublingual nitroglycerin (0.4 mg), which produces coronary vasodilation, along with supplemental oxygen and chewed aspirin while activating emergency services. Nitroglycerin is the first pharmacologic step when blood pressure permits.
3A healthy 30-year-old has a swollen face and a 3 mm vertical root fracture confirmed on CBCT of tooth #46. Which antibiotic is the appropriate first-line choice for an odontogenic infection with spreading cellulitis in a non-allergic patient?
A.Azithromycin
B.Clindamycin
C.Amoxicillin
D.Ciprofloxacin
Explanation: Amoxicillin remains the first-line empirical antibiotic for odontogenic infections in non-allergic patients because oral flora are predominantly susceptible streptococci and anaerobes. Source control (drainage/extraction) is always primary, with the antibiotic as an adjunct for spreading infection.
4A patient with a prosthetic heart valve requires a surgical extraction. According to current AHA guidelines, which antibiotic prophylaxis regimen is appropriate for this non-allergic patient?
A.No prophylaxis is indicated for valve prostheses
B.Amoxicillin 500 mg three times daily for 7 days after
C.Clindamycin 600 mg orally 1 hour before and 1 hour after
D.Amoxicillin 2 g orally 30-60 minutes before the procedure
Explanation: AHA guidelines recommend a single dose of amoxicillin 2 g orally 30-60 minutes before invasive dental procedures for patients with prosthetic cardiac valves, who are at high risk for infective endocarditis. A single pre-procedure dose is sufficient.
5A 25-year-old develops urticaria, wheezing, and hypotension minutes after receiving amoxicillin. After positioning supine and calling EMS, what is the definitive first-line drug and route?
A.Diphenhydramine 50 mg intravenously
B.Epinephrine 0.3-0.5 mg intramuscularly into the vastus lateralis
C.Hydrocortisone 100 mg intravenously
D.Albuterol via nebulizer alone
Explanation: Anaphylaxis is treated immediately with intramuscular epinephrine (1:1000, 0.3-0.5 mg adult) in the mid-outer thigh, repeated every 5-15 minutes as needed. Antihistamines and corticosteroids are adjuncts that do not reverse airway compromise or shock.
6A 70 kg adult requires local anesthesia. Using 2% lidocaine with 1:100,000 epinephrine (36 mg lidocaine per cartridge), what is the maximum number of cartridges considering the lidocaine dose limit of 4.4 mg/kg (max 300 mg)?
A.Approximately 4 cartridges
B.Approximately 13 cartridges
C.Approximately 8 cartridges
D.Approximately 20 cartridges
Explanation: The maximum lidocaine dose for a 70 kg adult is 4.4 mg/kg = 308 mg, capped at 300 mg. Each 1.8 mL cartridge of 2% lidocaine contains 36 mg. 300 mg / 36 mg = approximately 8 cartridges, which is the limit.
7A patient with poorly controlled hyperthyroidism (signs of thyrotoxicosis) requires anesthesia. Why should epinephrine-containing local anesthetic be used cautiously or avoided?
A.It increases the risk of allergic reaction to the amide anesthetic
B.It causes hypoglycemia in thyrotoxic patients
C.It reduces the duration of anesthesia in these patients
D.It can precipitate tachyarrhythmias and a thyroid storm
Explanation: In uncontrolled hyperthyroidism, excess thyroid hormone sensitizes the cardiovascular system to catecholamines, so exogenous epinephrine can trigger severe tachycardia, hypertension, arrhythmias, and potentially a thyroid storm. Elective care should be deferred until the patient is euthyroid.
8A type 2 diabetic on insulin becomes confused, shaky, and diaphoretic during a long morning appointment but is still conscious and able to swallow. What is the most appropriate immediate action?
A.Give 15-20 g of oral fast-acting carbohydrate such as juice or glucose gel
B.Administer intramuscular glucagon immediately
C.Give the patient a dose of their insulin
D.Place the patient supine and start chest compressions
Explanation: A conscious hypoglycemic patient who can swallow should receive 15-20 g of oral fast-acting carbohydrate (the rule of 15), then recheck. Glucagon is reserved for unconscious patients who cannot take oral glucose safely.
9A patient taking high-dose oral bisphosphonates for osteoporosis needs an extraction. What is the most relevant clinical concern when planning this procedure?
A.Delayed onset of local anesthesia
B.Increased risk of post-operative hemorrhage
C.Risk of medication-related osteonecrosis of the jaw (MRONJ)
D.Increased risk of malignant hyperthermia
Explanation: Antiresorptive agents such as bisphosphonates inhibit osteoclasts and impair bone remodeling, creating a risk of MRONJ following invasive dental procedures. Risk is higher with IV agents and long duration; conservative management and informed consent are essential.
10A pregnant patient in her second trimester requires a non-elective extraction. Which analgesic is generally considered the safest first choice for post-operative pain?
A.Codeine
B.Ibuprofen
C.Aspirin
D.Acetaminophen
Explanation: Acetaminophen is the analgesic of choice during pregnancy at recommended doses. NSAIDs are avoided particularly in the third trimester (risk of premature ductus arteriosus closure and oligohydramnios), and aspirin and opioids carry additional risks.
About the NDEB ACJ Practice Questions
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