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Guyz, I composed this document to put together the testlets shared

by Sam MJ. Thanks to Sam MJ. Hope this helps. All the Best guyz- Siri
Nbde.
Testlet 1.
A 23-year-old female present with complaints of difficulty in opening
her mouth and a low-grade fever of several days duration. The medical
history indicates a recent positive PPD skin test, and the patient is
taking rifampin (Rifadin). The extra-oral exam shows diffuse swelling
at the angle of the right mandible and lateral neck. Oral exam shows
gingival swelling and erythema around partially erupted Tooth #32.
A44. Rifampin (Rifadin) is effective in treating active tuberculosis
because it targets which of the following pathways?
A. Mitosis
B. Replication
C. Translation
D. Transcription
E. mRNA splicing
Testlet 2.
A 15-year-old male presents for emergency care. He is non-compliant
with his type I diabetes regimen, and he suffered a fall while having an
insulin reaction. He struck his chin and lacerated his tongue. Upon
opening, his mandible deviates to the left. A panoramic radiograph
reveals a fracture of the left condylar neck.
A45. Before examining this patient, the dentist notes that the standard
medical emergency kit contains an ampule of glucagon. For which of the
following reasons would glucagon be used?
A. Acts as a source of glucose for the hypoglycemic patient.
B. Promotes glycogen formation in the hyperglycemic patient.
C. Promotes glycogenolysis in the hypoglycemic patient.
D. Stimulates secretion of insulin in the hyperglycemic patient.
A46. The patients insulin reaction represented a sudden fall in blood
glucose because he had taken his normal insulin dose but did not eat
breakfast. Each of the following is a clinical manifestation of
hypoglycemia EXCEPT one. Which one is this EXCEPTION?

A. Coma
B. Dizziness
C. Confusion
D. Convulsion
E. Hyperventilation
A47. Which of the following glucose transporters was responsible for
the patients insulin reaction?
A. GLUT-1
B. GLUT-2
C. GLUT-3
D. GLUT-4
E. GLUT-5
Testlet 3.
An 80-year-old female with a history of cardiovascular disease presents
with a complaint of pain under her complete dentures when biting. She
has worn them for 15 years, but seldom removes or cleans them.
Removal of the dentures reveals diffuse erythema of underlying
mucosal tissue. Bone resorption is noted from detectable reduction in
height of the alveolar ridges due to the ill-fitting denture.
A48. The bone resorption seen in elderly patients with low dietary
calcium is enhanced by which of the following hormones?
A. Insulin
B. Estrogen
C. Aldosterone
D. Thyroid stimulating hormone
E. Parathyroid hormone
A49. Administration of a local anesthetic with epinephrine will MOST
likely produce which of the following cardiovascular effects?
A. Increased heart rate
B. Decreased heart rate
C. Increased diastolic blood pressure
D. Decreased systolic blood pressure


Test items 6770 refer to the following
testlet.
A 30-year-old woman comes to your office for a dental examination. She
has not been to the dentist in 2 years. The patient has type I diabetes,
which requires her to take insulin. She is otherwise in good health. On
intraoral examination, you notice that the dorsum of her tongue has a
thick, matted appearance and diagnose her with hairy tongue. You also
find that the patient has deep caries in her upper second maxillary
molar.
67. Which type of papillae is affected that causes the hair-like
appearance of her tongue?
A. Foliate.
B. Circumvallate.
C. Fungiform.
D. Filiform.
68. On the patients radiograph, you notice that the pulp chamber in the
carious molar appears smaller than the surrounding teeth. This is most
likely due to the deposition of which type of dentin?
A. Secondary.
B. Tertiary.
C. Mantle.
D. Sclerotic.
D. Oxygenated blood to the lungs from the hear
E. Oxygenated blood from the heart to the lungs
69. You decide to remove the caries and prepare the patient for
anesthesia. Which nerve must you anesthetize to ensure adequate
anesthesia for the patient?
A. Nasopalatine nerve.
B. Greater palatine nerve.
C. Anterior superior alveolar nerve.
D. Middle superior alveolar nerve.
E. Posterior superior alveolar nerve.
70. After administering the anesthetic, the patient complains that her
heart feels like its racing. You explain to her that it may be from the
epinephrine in the anesthesia. Which of the following glands could most
likely cause the same symptoms in the patient?
A. Hypophysis.
B. Thyroid.

C. Pineal.
D. Suprarenal.
Answers: 67. D. The elongation and overgrowth of filiform papillae
results in hairy tongue. Filiform papillae are thin, pointy projections that
make up the most numerous papillae and gives the tongues dorsal
surface its characteristic rough texture.
Note: a loss of filiform papillae results in glossitis.
68. B. Tertiary dentin, or reactive/reparative dentin, is dentin that is
formed in localized areas in response to trauma or other stimuli, such as
caries, tooth wear or dental work. Histologically, its consistency and
organization varies; it has no defined dentinal tubule pattern.
69. E. Innervation to the maxillary second molar, as well as the palatal
and distobuccal root of the maxillary first molar and the maxillary sinus,
is provided by the Posterior superior alveolar nerve. The nerve is a
branch of the maxillary nerve (CN V).
70. D. The suprarenal glands secrete epinephrine.
Specifically, chromaffin cells of the the adrenal medulla, which act as
modified postganglionic sympathetic neurons that synthesize, store and
secrete catecholamines, produce epinephrine. It also produces
norepinephrine.
A 24-year-old man presents to your office for an emergency visit, after
being hit on the left side of his face with a soccer ball. He complains that
his tooth got knocked out and that his jaw feels out of place. He has
no other medical conditions.
21. During intraoral examination, you find that the patients lower
second premolar is missing. Which type of alveolodental fibers was least
involved in resisting the force that pulled this patients tooth out of its
socket?
A. Apical.
B. Oblique.
C. Alveolar crest.
D. Interradicular.
22. You also notice that a cusp of his mandibular second molar has
fractured off and that dentin is exposed. If this patient were to drink
something cold, what will he sense?
A. Pain.
B. Pressure.

C. Vibration.
D. Temperature.
23. You decide to take a radiograph of the fractured tooth. On the first
film you miss the apex of the tooth, so you decide to take another
radiograph. Relaxation of which of the patients muscles would help you
in taking the second film?
A. Geniohyoid.
B. Stylohyoid.
C. Mylohyoid.
D. Levator veli palatine.
E. Palatopharyngeus.
24. On further examination, you determine that the articular disc of the
patients temporomandibular joint has been displaced. If the patient
contracts his lateral pterygoid muscle, the disc will move _______.
A.Posteriorly and medially
B. Anteriorly and medially
C. Posteriorly and laterally
D. Anteriorly and laterally
25. During the examination, the patient observes that he cannot feel it
when you touch part of his cheek and his upper lip. Which of the
following nerves was probably damaged during the accident?
A. Lingual.
B. Maxillary.
C. Long buccal.
D. Superior alveolar.
E. Inferior alveolar.
26. You decide to restore the missing cusp on the patients molar.
During the administration of the inferior alveolar nerve block, which of
the following ligaments is most likely damaged?
A. Sphenomandibular.
B. Stylomandibular.
C. Temporomandibular.
D. Interdental.
Answers: 21. B. Oblique alveolodental fibers resist occlusal forces that
occur along the long axis of the tooth. The rest of the alveolodental
(PDL) fibers listed provide resistance against forces which pull the tooth
in an occlusal direction (i.e., forces that try to pull the tooth from its

socket).
22. A. When pulpal nerves are stimulated, they can only transmit one
signal: pain.
23. C. The mylohyoid muscle forms the floor of the mouth. Relaxation of
this muscle would help the dentist push the film down, to help ensure
that the apical root is captured on the radiograph.
24. B. Fibers of the lateral pterygoid muscle are attached to the anterior
end of the disc. Contraction of this muscle pulls the disc in an anterior
and medial direction.
25. B. The sensory distribution for the maxillary nerve (CN V2) includes
the cheek and upper lip, and lower eyelid, upper lip, nasopharynx,
tonsils, palate, and maxillary teeth. The sensory distribution for the long
buccal also includes the (lower) cheek; however, it does not include the
upper lip. The long buccal is a branch of the mandibular nerve (CN V3)
and provides sensory nerves to the cheek, buccal gingiva of the
posterior mandibular teeth, and buccal mucosa.
26. A. The inferior alveolar nerve (IAN) courses between the
sphenomandibular ligament and the ramus of the mandible before
entering the mandibular foramen. The sphenomandibular ligament may
therefore be damaged during the administration of an IAN block.
A 43-year-old man presents for an emergency dental appointment
complaining of a burning sensation in his mouth. Upon examination,
white plaques are observed along the oral mucosa. The patient
otherwise appears healthy. There is no history of systemic illness, but
the patient did state that he had a blood transfusion more than 10 years
ago following a car accident. The doctor referred the patient to
emergency room for further tests.
38. Upon further evaluation, the doctor requests an HIV and hepatitis
test. The laboratory performed both an ELISA test and Western blot,
revealing that the patient is HIV-positive. The Western blot is used to
identify which of the following?
A. Antibodies.
B. DNA.
C. RNA.
D. Proteins.
E. Plaque-forming units.
39. Given the patients history, if the patient was later diagnosed with
active hepatitis, which of the following would most likely be the

causative agent?
A. Hepatitis A.
B. Hepatitis B.
C. Hepatitis C.
D. Hepatitis D.
E. Hepatitis E.
40. Which of the following would the doctor likely prescribe for the
patients intraoral infection?
A. Amoxicillin.
B. Vancomycin.
C. Ciprofloxacin.
D. Nystatin.
E. Chlorhexidine.
41. All of the following molecules may be found within the nucleocapsid
of an HIV virus except one. Which one is the exception?
A. Reverse transcriptase.
B. Integrase.
C. Neuraminidase.
D. Protease.
E. Ribonucleic acid.
42. The patient is referred to an infectious disease specialist and placed
on triple therapy. Two years later, the patient is admitted to the
emergency room with a dry cough and shortness of breath. His
temperature is 101 degrees F. The most likely cause of the patients
pneumonia is _____.
A. Staphylococcus aureus
B. Haemophilus influenzae
C. Pneumocystis jiroveci (carinii)
D. Klebsiella pneumoniae
E. Streptococcus pneumonia
Answers- 38. D
The Western blot tests for HIV proteins. The ELISA tests for HIV
antibodies. When these two tests are used together, a 99% accuracy rate
is achieved.
39.
C. Since 90% of blood transfusion-related hepatitis cases are caused by
hepatitis C, and the patient has a history of having had a blood
transfusion, the answer is C.

40. D. Opportunistic infections are a serious problem with patients

infected with HIV. This patients intraoral thrush is such an infection,
which is caused by Candida albicans. Treatment for candidiasis includes
nystatin.
41. C. The HIV is an RNA virus that contains three enzymes: reverse
transcriptase, integrase, and protease. Neuraminidase is a protein found
on the surface of the influenza virus.
42. C. Although all of the microbes listed cause pneumonia, the most
common cause of pneumonia in
patientswith AIDS is P. jiroveci (carinii).
43. A. McCune-Albrights syndrome is a type of fibrous
A mother brings her 6-year-old daughter in for an examination because
she noticed brown macules on her daughters leg. The macules have
jagged edges but do not appear raised. The mother is worried that her
daughter may have a malignancy. After further evaluation and tests, the
macules are identified as caf au lait spots.
43. Caf au lait spots are seen in conjunction with polyostotic fibrous
dysplasia and endocrine abnormalities in which of the following
disorders?
A. McCune-Albrights syndrome.
B. Stevens-Johnson syndrome.
C. Marfans syndrome.
D. Gorlin-Goltz syndrome.
E. Peutz-Jeghers syndrome.
44. The patients radiographs could be described as having what type of
characteristic appearance?
A. Cotton wool.
B. Ground glass.
C. Cobweb.
D. Soap bubble.
E. Starry sky.
45. A bone biopsy was taken from the patient. Which of the following
would most likely be observed under the microscope?
A. A dense inflammatory infiltrate.
B. Fibrous tissue.
C. Pleomorphic cells.
D. Metastatic calcifications.
E. Giant cells.

Answers: 43. A. McCune-Albrights syndrome is a type of fibrous

dysplasia that presents with a triad of symptoms including polyostotic
fibrous dysplasia, caf au lait spots, and endocrine abnormalities.
44. B. Fibrous dysplasia is caused by replacement of normal bone with
an irregular bone containing fibrous connective tissue. This gives the
radiographs a characteristic ground glass appearance.
45. B. Fibrous dysplasia is caused by replacement of normal bone with
an irregular bone containing fibrous connective tissue. Therefore, the
pathology report usually describes abnormally shaped trabeculae in
loosely arranged fibrous tissue.
A 6-year-old boy presents with a history of severe epistaxis. For the past
3 years the patient has experienced these nose bleeds, often without any
apparent cause. The patient is otherwise in good health, but his mother
has noticed that he bruises easily. Laboratory tests are ordered.
46. The laboratory test results show a normal PT but a prolonged PTT. A
prolonged PTT test suggests that the patient has an abnormality
affecting which component of the coagulation cascade?
A. Activation of platelets.
B. Activation of thromboplastin.
C. Activation of plasminogen.
D. Intrinsic pathway .
E. Extrinsic pathway.
47. The diagnosis of hemophilia A is made. This disease is caused by a
deficiency of _____.
A. Factor V.
B. Factor VII.
C. Factor VIII.
D. Factor IX.
E. Factor X.
48. Which of the following describes the hereditary transmission of this
disease?
A. Autosomal dominant.
B. Autosomal recessive.
C. X-linked.
D. It is not genetically transmitted.
49. The clinical presentation of hemophilia B is indistinguishable from
hemophilia A. Which of the following best describes the laboratory

method needed to distinguish these two conditions?

A. Bleeding time.
B. Assay of coagulation factor levels.
C. Assay of von Willebrands factor.
D. Blood smear.
E. Platelet count.
Answers: 46. D. The partial thromboplastin time (PTT) test measures
the intrinsic and common pathways of the coagulation cascade. A
prolonged PTT could result from a deficiency of factor V, VIII, IX, X, XI, or
XII or of prothrombin or fibrinogen.
47. C. Hemophilia A is caused by a deficiency of factor 8 (antihemophilic
factor).
48. C. Hemophilia A is a hereditary disorder that is X-linked; thus, it only
affects males. However, females can be carriers.
49. B. The only way to distinguish hemophilia A from hemophilia B is to
assay the levels of coagula-
A 60-year-old homeless man who lives in a community shelter presents
with history of coughing for
the past 6 months. He has a slight fever, hemoptysis, and productive
cough with a yellowish sputum discharge. After further examination and
tests, the patient is diagnosed with active tuberculosis.
87. When the sputum samples were taken to the laboratory, what test
did the doctor order to be performed to help make the diagnosis?
A. Gram stain.
B. Acid-fast stain.
C. Spore stain.
D. PPD test (tuberculin test).
E. Voges-Proskauer test.
88. After 2 weeks, the bacterial cultures came back from the lab
confirming the initial diagnosis, positively identifying the organism
Mycobacterium tuberculosis. M. tuberculosis is known to infect which of
the following cells?
A. Fibroblasts.
B. Basal cells.
C. Type I pneumocytes.
D. Macrophages.
E. Erythrocytes.

89. Which of the following is a glycolipid found on the surface of M.

tuberculosis that plays a role in its pathogenesis?
A. Cord factor.
B. O antigen.
C. Protein A.
D. Exotoxin A.
E. Lecithinase.
90. Since the patient was living in a homeless shelter, the tuberculin test
was administered to all of the staff and residents living at the shelter.
This test is based on a delayed type hypersensitivity reaction that is
mediated by
_____.
A. Only IgG
B. IgG and IgM
C. IgE
D. T cells and macrophages
E. Mast cells and basophils
91. Which of the following is the most appropriate drug used in
combination therapy for tuberculosis to treat the patient?
A. Amoxicillin.
B. Clindamycin.
C. Cephalosporin.
D. Tetracycline.
E. Rifampin.
92. After 3 weeks, the patient was feeling much better and was
discharged from the hospital, although he remained on his drug therapy
for another 6 months. Which of the following best describes the calcified
scar that later formed in the affected lung parenchyma and hilar lymph
node?
A. Gumma.
B. Chancre.
C. Metastatic calcifications.
D. Tubercle.
E. Ghon complex.
Answers: 87. B. Tuberculosis is caused by the bacteria Mycobacterium
tuberculosis. These bacteria cannot be Gram stained due to their waxy
cell walls. Therefore, to identify these bacteria, an acid-fast stain must
be ordered.

88. D. M. tuberculosis infects macrophages, which are initially unable to

kill the phagocytosed bacteria.
89. A. Cord factor is a glycolipid found on the surface of M. tuberculosis.
90. D. Type IV delayed type hypersensitivity reactions are the only type
of hypersensitivity immune reactions that are not mediated by
antibodies. They are mainly mediated by T cells.
91. E. Treatment for tuberculosis includes a multidrug therapy.
Rifampin, isoniazid, and ethambutol are three of the first-line drugs
used.
92. E. Ghon complex describes the calcified scar that remains following
the primary infection. It is usually found in the lung and includes the
primary lesion and its regional lymph node.
Test items 98100 refer to the following
testlet.
A 3-year-old African girl presents in the emergency room with a
palpable mass in her lower right mandible. She is currently in the United
States visiting relatives with her parents. Her mom claims that a few
days ago she noticed a growing mass in her daughters jaw.
Thereappears to be slight swellingaroundthe area, although it is
painless and not tender to the touch. After further examination, a biopsy
was taken, and the diagnosis of Burkitts lymphoma was made.
98. Burkitts lymphoma is a malignancy that affects which of the
following cells?
A. Macrophages.
B. T lymphocytes.
C. B lymphocytes.
D. Neutrophils.
E. Keratinocytes.
99. The pathology report reveals a characteristic pattern of tumor cells
that is classically associated with Burkitts lymphoma. Which of the
following describes this histopathologic pattern?
A. Honeycomb.
B. Cobweb.
C. Cotton wool.
D. Sun ray.
E. Starry sky.
100. The African form of Burkitts lymphoma has been linked to the

Epstein-Barr virus. This virus is also responsible for which of the

following diseases?
A. Mononucleosis.
B. Shingles.
C. Chicken pox.
D. Kaposis sarcoma.
E. Herpangina.
Answers: 98.
C. Burkitts lymphoma is an aggressive lymphoma that affects B
lymphocytes.
99.
E. Histologic evaluation of Burkitts lymphoma reveals a characteristic
starry-sky appearance, which results from the lighter-colored
macrophages present.
100. A. Epstein-Barr virus is responsible for causing mononucleosis, a
disease that also affects B lymphocytes.
A 55-year-old man presents with malaise and dyspnea. He has a low-
grade fever and reports that
his shortness of breath has increased steadily over the past week and a
half. He has a history of rheumatic fever and denies ever using
recreational drugs. He is currently being treated by a dentist for full
mouth reconstruction.
139. Upon further examination, a heart murmur was detected. Given the
patients past medical history, which heart valve is most likely affected?
A. Mitral valve.
B. Tricuspid valve.
C. Aortic valve.
D. Pulmonary valve.
140. Before the patients development of rheumatic fever, he likely
suffered from which of the following conditions?
A. Cystitis.
B. Pharyngitis.
C. Food poisoning.
D. Thrombocytopenia.
E. Meninigitis.
141. After further evaluation and tests, the patient is diagnosed with
subacute endocarditis. If the infecting microbe was cultured in the

laboratory, the results would most likely show that this microbe is
positive for _____.
A. -hemolysis
B. -hemolysis
C. -hemolysis
D. Coagulase
E. Lecithinase
142. Which of the following is the most likely complication that may
occur from the vegetations forming on the patients defective heart
valve?
A. Myocardial infarction.
B. Hemorrhage.
C. Petechiae.
D. Cor pulmonale.
E. Embolus.
143. After the diagnosis is made, the patient is immediately placed on
high-dose, IV antibiotics. One of the antibiotics that is administered to
the patient is streptomycin, an aminoglycoside. The antimicrobial effect
of streptomycin is to inhibit the synthesis of _____.
A. The bacterial cell wall
B. Folate
C. Proteins
D. Nucleic acids
E. -lactamase
Answers: 139. A. Given the patients history of rheumatic fever, the
heart murmur is most likely from a dysfunctioning mitral valve.
Rheumatic fever most commonly affects the mitral valve, resulting in
mitral valve stenosis, regurgitation, or both.
140. B. Rheumatic fever is usually preceded by a group A streptococcus
respiratory infection (e.g.,
strep throat or pharyngitis).
141. A. The most common cause of subacute endocarditis is
Streptococcus
viridans. S. viridans is a -hemolytic streptococci, representing
incomplete lysis of red blood cells in laboratory cultures.
142. E. During subacute endocarditis, vegetations, or thrombi, form on
previously damaged heart valves. Complications can arise if the

thrombus embolizes, (i.e. when a fragment separates and enters the

circulation), causing septic infarcts. Other complications include
valvular dysfunction or abscess formation.
143. C. Aminoglycosides block the 30S ribosomal subunit to inhibit
protein synthesis.