Canadian NDEB 2012 Clinical Judgment Practice

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Hi,
I am starting a new thread for preparation of NDEB 2012 Clinical Judgment.
Therefore, I request all to participate to answer & complete all questions that has appeared on NDEB website.
Some important point to follow:
1)It is better to get the answer from a well known Textbook (preferably recommended textbook if you have) Give your references. e.g. Dental Decks 2010 (DD2010) etc.
2) Some of Ans are very simple, just mention it once to prevent repetition. There may be other ans forgotten.
3) Be short & up to the point. Mention Key Points(KP.) for easy recall.
4)If Not Sure of your Ans. then note (NS). on your ans.
5)Questions will be 1, 2,... & sub Ques A, B,C....
6) We write all possible conditions for that Q, sub Q
I will post all Q & sub Q one after another.
If you have any idea to improve this, you are most welcome.

Good luck for all.
F.A Dandani

Question: 1 (Select ONE OR MORE correct answers.)
In addition to periodontal probing and palpation, which of the following is/are indicated to establish a diagnosis for this patient?

(Or when we Use these investigations)

A. Periapical radiograph(s).
B. Bitewing radiograph(s).
C. Panoramic radiograph.
D. Tooth percussion.
E. Application of pressure on individual cusps.
F. Assessment of tooth mobility.
G. Electric pulp testing.
H. Thermal test(s).
I. Evaluation of the occlusion.
J. Selective local anesthesia.
K. Blood testing.
L. Microbial testing.
M. Cytological smear.
N. Incisional biopsy.
O. Excisional biopsy.

A) Periapical radiograph
To see: Detail of tooth, crown ,root length & periapical pathology. Periodontal area, Bone, Anomaly of teeth, supernumerary tooth. Localization of other object ( Buccal object rule SLOB).
Pt. records documentation.

B) Bitewing
Proximal caries, Occl. caries, Crest of alveolar bone(NS) .

DD2007-8
any thing else?/

Originally Posted by Dandani

A) Periapical radiograph
To see: Detail of tooth, crown ,root length & periapical pathology. Periodontal area, Bone, Anomaly of teeth, supernumerary tooth. Localization of other object ( Buccal object rule SLOB).
Pt. records documentation.

B) Bitewing
Proximal caries, Occl. caries, Crest of alveolar bone(NS) .

DD2007-8
any thing else?/

You do see crest of alveolar height in bitewings - it is more accurate in bitewings than in periapicals, (Oral Radiology, White and Pharoah 4th edition)

Originally Posted by tigger1986

You do see crest of alveolar height in bitewings - it is more accurate in bitewings than in periapicals, (Oral Radiology, White and Pharoah 4th edition)

I did not have X-ray books
Thanks a lot

Your welcome, Do you know what the management is for Recurrent Apthous Ulceration - minor, major, herpetiform is? Can't find the answer in dental decks. I think its topical steroids, but not sure

Originally Posted by tigger1986

Your welcome, Do you know what the management is for Recurrent Apthous Ulceration - minor, major, herpetiform is? Can't find the answer in dental decks. I think its topical steroids, but not sure

We will come to this topics later but for your info.

Cause Unknown but evidence of focal immune dysfunction >>T lymphocytes
No definitive Tx. But Topical Steroids suggested
Triamcinolone (kenalog) oralbase 0.1% (DD2007-8)

In severe cases systemic steroids in low doses (10–20 mg prednisone) for four
to eight days can reduce the symptoms dramatically.(Pocket Atlas of Oral Diseases
George Laskaris, 2nd revised and enlarged edition)

Panoramic radiograph
Dx of oral ptho that may not see on PA X-ray or oral cavity
Tx. planning (ortho)
Evaluation of anomalies
Surgery & trauma cases follow up
Edentulous Pt. b4 full dentures contraction (DD2007-8)
Pt. unable to tolerate PA & uncooperative Pt.

3rd Molar Ext. surgery
Missing & supernumerary tooth/teeth (myself)

any thing else??

Originally Posted by Dandani

Panoramic radiograph
Dx of oral ptho that may not see on PA X-ray or oral cavity
Tx. planning (ortho)
Evaluation of anomalies
Surgery & trauma cases follow up
Edentulous Pt. b4 full dentures contraction (DD2007-8)
Pt. unable to tolerate PA & uncooperative Pt.

3rd Molar Ext. surgery
Missing & supernumerary tooth/teeth (myself)

any thing else??

I think thats everything. I had assess jaw/dental development but I think that comes under ortho tx planning

Tooth percussion
if positive – indicates tooth is extruded due to exudates in apical/lateral periodontal tissues (oxford handbook of clinical dentistry – Laura Mitchell)

Dental Decks 2011-2012:
Percussion Test:
• Does not indicate the health of the pulp
• Sensitivity of proprioceptive fibres does reveal inflammation of the apical PDL
• Positive response to percussion - indicates presence of inflammation of PDL, and extent of inflammatory process
• A tooth with percussion sensitivtiy could just need caries control with a sedative temporary filling or occlusal adjustment (which can cause reversible pulpitis as well)

- Signs/symptoms of pulpal disease (Pulplal Necrosis) – late stages of irreversible pulpitis, acute periapical abscess, chronic periapical abscess (maybe slight TTP) Phoenix abscess, granuloma, radicular cyst, trauma to teeth e.g. concussion (DD11/12)
- Trauma from occlusion (DD11/12)
- Signs/symptoms of periodontal infection – Periodontal abscess? – haven’t found a reference but I think it is TTP

Originally Posted by tigger1986

I think thats everything. I had assess jaw/dental development but I think that comes under ortho tx planning

That is Cephalo X-ray primary objective.

Hi there, is anybody you know taking the exam at McGill?

Please reply

Originally Posted by Domident

Hi there, is anybody you know taking the exam at McGill?

Please reply

No, But I am taking it at University of Montreal

Any one wants to answer E & F?

Originally Posted by Dandani

Any one wants to answer E & F?

do you have anything to add to D:tooth percussion?

I dont have much for E and F. From my own knowledge

E. Application of pressure on individual cusps:
- test for cracked cusps

F. Assessment of tooth mobility
- Periodontal disease
- Tooth fractures
- Malignant disease (mobility is often a manifestation)

Originally Posted by tigger1986

No, But I am taking it at University of Montreal

Ok, I am looking for someone to split the cost of hotel (female).....

I'm looking for a female to split hotel costs in montreal...

Originally Posted by Domident

I'm looking for a female to split hotel costs in montreal...

Sorry, My husband is going to be driving me to Montreal and staying with me till the exams are done. If I know of anyone, will let you know.

Originally Posted by tigger1986

I dont have much for E and F. From my own knowledge

E. Application of pressure on individual cusps:
- test for cracked cusps

F. Assessment of tooth mobility
- Periodontal disease
- Tooth fractures
- Malignant disease (mobility is often a manifestation)

I. Evaluation of the occlusion: To assess if occlusion is the cause the tooth is tender to percussion, to see if occlusion is the cause of periodontal breakdown\
J. Selective anesthesia :I don't know, any ideas?

Originally Posted by tigger1986

Sorry, My husband is going to be driving me to Montreal and staying with me till the exams are done. If I know of anyone, will let you know.

Ok, thanks I would greatly appreciate it....

Originally Posted by Domident

I. Evaluation of the occlusion: To assess if occlusion is the cause the tooth is tender to percussion, to see if occlusion is the cause of periodontal breakdown\
J. Selective anesthesia :I don't know, any ideas?

J: Selective Anaesthesia: I think this means not anaesthetizing the tooth you suspect is the problem. Like 'Test Cavity'. This is used as a last resort if unable to determine the problematic tooth. You drill a cavity into the tooth to determine if it is vital or not. If a patient doesn't feel anything as you are drilling, its most likely non-vital.

selective anesthesia: for suspected "referred"pain...due to nerve anastomosis...

Originally Posted by prismatic

selective anesthesia: for suspected "referred"pain...due to nerve anastomosis...

I was totally off lol, Do you have a reference for that?

Originally Posted by tigger1986

do you have anything to add to D:tooth percussion?

Nothing much. it can be used too roll out preapical & periodontal pathology of specific tooth.

Originally Posted by tigger1986

I dont have much for E and F. From my own knowledge

E. Application of pressure on individual cusps:
- test for cracked cusps

F. Assessment of tooth mobility
- Periodontal disease
- Tooth fractures
- Malignant disease (mobility is often a manifestation)

For F: to assess trauma of occlusion (overfilling, highpoint filling/restoration)

Originally Posted by prismatic

selective anesthesia: for suspected "referred"pain...due to nerve anastomosis...

J: Selective Anaesthesia: To anaesthetizing a particular tooth you suspect is the problem or source of pain, if pain disappear >>> help to localized & identify the suspect tooth/teeth. This is particularly useful for referred pain in oral cavity. Usually infiltration or intraligament injection used

K. Blood testing.
These test are routinely request for preoperative workup for Pt admitted in hospital for surgery. General anesthesia (GA)

• Complete Blood Cont (CBC)
• Total WBC count
• Assessment of circulating Platelets
• Urinalysis (DD2007-8)

Pt. with systemic condition, bloodcell dyscrasias & malfunction, for Minor Surgery & Ext. also blood workup needed. (My note, NS)

anything else ?...

Originally Posted by Dandani

Question: 1 (Select ONE OR MORE correct answers.)
In addition to periodontal probing and palpation, which of the following is/are indicated to establish a diagnosis for this patient?

(Or when we Use these investigations)

A. Periapical radiograph(s).
B. Bitewing radiograph(s).
C. Panoramic radiograph.
D. Tooth percussion.
E. Application of pressure on individual cusps.
F. Assessment of tooth mobility.
G. Electric pulp testing.
H. Thermal test(s).
I. Evaluation of the occlusion.
J. Selective local anesthesia.
K. Blood testing.
L. Microbial testing.
M. Cytological smear.
N. Incisional biopsy.
O. Excisional biopsy.

i think if the patient's chief complaint is tooth pain due to caries, letters a.d.e.f.g.h.i are needed to be done in order to come up with proper diagnosis. if patient has perio problem, letter b is important to assess bone loss. f and i are also important. selective anes could be chosen probably if it is indicated that patient could not pinpoint where pain is coming from. blood test if medical history reveals systemic conditions or if there are no known disease by patient and theres presence of spontaneous gingival bleeding (to diagnose certain possible diseases).. i think microbial could be chosen if patient presents severe infection and antibiotic is not working.. microbial tests are recommended for proper antibiotic prescription. for patients presenting with leukoplakia or erythroplakia, biopsy is recommended especially if it says in the history that patient smokes. incisional biopsy if it is big, excisional if small.. but im not sure if you can do this for hemangiomas.. for fibromas and other exophytic lesion, biopsy also..

not sure about cytologic smear.. any idea?

is anyone taking the clinical judgement in toronto? did they open a test center in toronto? i am from toronto and took AFK in toronto convention center.. when i registered for judgement, no toronto venue was available.. will be travelling to montreal for the judgement exam...

is there anyone here who have taken the clinical judgement already? how was it? and just wondering, how many questions would there be???

Originally Posted by JVP

is anyone taking the clinical judgement in toronto? did they open a test center in toronto? i am from toronto and took AFK in toronto convention center.. when i registered for judgement, no toronto venue was available.. will be travelling to montreal for the judgement exam...

is there anyone here who have taken the clinical judgement already? how was it? and just wondering, how many questions would there be???

I am taking the clinical judgement and clinical skills in Montreal too. Are you taking clinical skills aswell?
I experienced the same problem, I wanted either UWO,London or UofT but both were full when I went to register.

Originally Posted by JVP

i think if the patient's chief complaint is tooth pain due to caries, letters a.d.e.f.g.h.i are needed to be done in order to come up with proper diagnosis. if patient has perio problem, letter b is important to assess bone loss. f and i are also important. selective anes could be chosen probably if it is indicated that patient could not pinpoint where pain is coming from. blood test if medical history reveals systemic conditions or if there are no known disease by patient and theres presence of spontaneous gingival bleeding (to diagnose certain possible diseases).. i think microbial could be chosen if patient presents severe infection and antibiotic is not working.. microbial tests are recommended for proper antibiotic prescription. for patients presenting with leukoplakia or erythroplakia, biopsy is recommended especially if it says in the history that patient smokes. incisional biopsy if it is big, excisional if small.. but im not sure if you can do this for hemangiomas.. for fibromas and other exophytic lesion, biopsy also..

not sure about cytologic smear.. any idea?

Cytological smear:
- Adjunct to biopsy
- Monitor large mucosal areas for dysplastic change
Herpes
Pemphigus
Candida

Dental Decks (11/12)

Originally Posted by Dandani

K. Blood testing.
These test are routinely request for preoperative workup for Pt admitted in hospital for surgery. General anesthesia (GA)

• Complete Blood Cont (CBC)
• Total WBC count
• Assessment of circulating Platelets
• Urinalysis (DD2007-8)

Pt. with systemic condition, bloodcell dyscrasias & malfunction, for Minor Surgery & Ext. also blood workup needed. (My note, NS)

anything else ?...

check INR for patients on warfarin

Prior to prescribing antiobiotics or other antimicrobials
i.e when patient presents with signs/symptoms of infection
- abscesses with systemic involvement
- cellulitis
- osteomyelitis
- Ludwig's angina

anything else to add?

Hi Guys;

I passed the AFK this year with 90%
I have all the released qs and answers checked by university professors from 2001 until 2012.
65% of the exam qs came from these qs.
i HAVE SOFT COPY.
U CAN CONTACT ME ON
KOTABHARU2008@YAHOO.COM

Good luck to every body

Originally Posted by kelantan

Hi Guys;

I passed the AFK this year with 90%
I have all the released qs and answers checked by university professors from 2001 until 2012.
65% of the exam qs came from these qs.
i HAVE SOFT COPY.
U CAN CONTACT ME ON
KOTABHARU2008@YAHOO.COM

Good luck to every body

Are you taking clinical judgement?

Originally Posted by tigger1986

I am taking the clinical judgement and clinical skills in Montreal too. Are you taking clinical skills aswell?
I experienced the same problem, I wanted either UWO,London or UofT but both were full when I went to register.

Hi Tigger! i'm only taking the clinical judgement.. Are you taking both? I registered like 11am during the first day of registration, i dunno if toronto venues got full right away or if they didn't open one in toronto..
Based on your username, you're in your 20's..?

Originally Posted by tigger1986

Cytological smear:
- Adjunct to biopsy
- Monitor large mucosal areas for dysplastic change
Herpes
Pemphigus
Candida

Dental Decks (11/12)

Thanks tigger!!

Originally Posted by tigger1986

Prior to prescribing antiobiotics or other antimicrobials
i.e when patient presents with signs/symptoms of infection
- abscesses with systemic involvement
- cellulitis
- osteomyelitis
- Ludwig's angina

anything else to add?

Another parameter: when previously prescribed antibiotics are not taking effect

Does anyone know what the maximum daily dosage for Ibuprofen is? Finding different answers everywhere!

Originally Posted by JVP

Hi Tigger! i'm only taking the clinical judgement.. Are you taking both? I registered like 11am during the first day of registration, i dunno if toronto venues got full right away or if they didn't open one in toronto..
Based on your username, you're in your 20's..?

Yes I am taking both (dont know if that was a wise choice or not :s) I registered at 9.05am that morning and no option was present for toronto or UWO. Yes I am in my 20's.

Originally Posted by tigger1986

Yes I am taking both (dont know if that was a wise choice or not :s) I registered at 9.05am that morning and no option was present for toronto or UWO. Yes I am in my 20's.

Wonder why they didnt open in toronto.. Now we have to travel and spend another couple of dollars.. good luck for the clinical skills what are you reviewing for the judgement? Im reading books now and it's kind of time consuming, haha! Do you have any idea how much items would there be, and feedback from the last batch as well?

Originally Posted by JVP

Wonder why they didnt open in toronto.. Now we have to travel and spend another couple of dollars.. good luck for the clinical skills what are you reviewing for the judgement? Im reading books now and it's kind of time consuming, haha! Do you have any idea how much items would there be, and feedback from the last batch as well?

They did open in Toronto, and UWO they just got filled very quickly! For clinical judgement I am not reviewing anything in particular, just going through the questions, and referring to any texts I have on hand to get the answers. Books are time consuming for me right now. I have no idea on the format of the exam and how many questions there will be. How comes you are not taking the clinical skills?

N. Incisional biopsy
- lesion >1cm in diameter
- hazardous location
- suspicion of malignancy

O. Excisional biopsy
- lesion <1cm in diameter
- benign

there are 42 questions to go through plus the few from radiography, at the speed this forum is going, I dont think all these questions will be covered! - (Worries) I have just finished question 1 - lets move on!

Originally Posted by tigger1986

They did open in Toronto, and UWO they just got filled very quickly! For clinical judgement I am not reviewing anything in particular, just going through the questions, and referring to any texts I have on hand to get the answers. Books are time consuming for me right now. I have no idea on the format of the exam and how many questions there will be. How comes you are not taking the clinical skills?

I just want to focus first on one exam, clinical skills is too expensive for me not to put 100% focus.. Im also referring to any texts now, but i read oral path (regezi) for the questions with photo and diagnosis.. Now im reading contemporary orth (proffit).. Chapter 6 is helpful for the ortho questions..

Dear friends & participants
I start this thread for answering the Questions that published on NDEB web site last year. PLEASE use the other pages of this forum for other stuff you may need. As you know time is short & lots of Qs has to be answer. Please be focused as this assessment appears to be more difficult than it looks.
Please Do Not waste your Time & Money
These Qs can be found at
http://www.ndeb.ca/sites/default/fil...th%20Ortho.pdf

Good luck.

Originally Posted by tigger1986

Cytological smear:
- Adjunct to biopsy
- Monitor large mucosal areas for dysplastic change
Herpes
Pemphigus
Candida

Dental Decks (11/12)

Thanks Tigger. That was Ans to "M"

Any one , any thing else to add?

Originally Posted by tigger1986

there are 42 questions to go through plus the few from radiography, at the speed this forum is going, I dont think all these questions will be covered! - (Worries) I have just finished question 1 - lets move on!

Agree whit you 100%
Lets do it fast & accurate.

question #2 which should be included in tx plan:

A. no special consideration

B. prophylactic antibiotic
- http://www.nsdental.org/media_uploads/pdf/37.pdf (page 4-6 has tables)

C. short appointment
-anxious patients
-with systemmic condition: DM, history of angina, MI, stroke, HF, COPD, epilepsy.. etc.

D. anxiolytic admin
-very anxious patients
-optional: to reduce anxiety that may trigger attack: patient with history of MI, angina, stroke, heart failure, asthma (stress induced), epilepsy.. etc

E. prophylactic nitroglycerin
-unstable angina
-MI: only if directed by physician

F. Avoid NSAID
-allergies
-on anticoagulant
-has defect in blood clotting
-peptic ulcer
-impaired kidney or liver
-asthmatic patients

G. Avoid opioid
-allergies
-significant respiratory disease
-current substance abuse
-pregnancy(unless benefits>risks)

H. avoid epi
-allergic to epi
-narrow angle glaucoma
-thyrotoxicosis
-hypertensives (max of 0.04mg)
-hyperthyroid
-shock

I. minimize epi
-hypertensives (max of 0.04mg)
-hyperthyroid

J. avoid local anes
-pateints needing gen anes.. patients with disabilities??
-NOT FAMILIAR.. KINDLY ADD..

K. adust current meds

L. stop current meds prior to appointment

M. delay routine tx
-unstable angina
-MI < 6 months
-pregnant esp 1st and 3rd semester

N. treat at end of day
-COPD patients

O. must tx in hospital

please feel free to correct or add on the answers.. thanks!!