ADEX CSCE OSCE Exam ACTUAL
EXAM 2026/2027 | ADEX Clinical Skills
Assessment | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1 – Patient Assessment & Medical History Review (Questions 1–20)
Q1: A 62-year-old patient reports taking warfarin for atrial fibrillation. Today's dental treatment includes
a simple extraction of a mobile tooth. What is the most appropriate management?
A. Stop warfarin 72 hours before the procedure.
B. Obtain an INR level before proceeding. [CORRECT]
C. Proceed with extraction without any changes.
D. Refer all extractions to an oral surgeon.
Correct Answer: B
Rationale: Obtaining an INR determines bleeding risk; most simple extractions can be performed safely
with INR ≤ 3.5 without discontinuing anticoagulation per current dental guidelines.
Q2: A 28-year-old patient has a blood pressure of 158/94 mmHg on two separate visits. They have no
other medical conditions. What is the best next step?
A. Proceed with routine dental treatment.
B. Prescribe a thiazide diuretic.
C. Refer to primary care physician for evaluation. [CORRECT]
D. Recheck blood pressure at the end of the appointment.
Correct Answer: C
Rationale: Persistent BP ≥ 140/90 mmHg in a young patient without known hypertension warrants
medical evaluation to rule out secondary causes before proceeding with elective dental treatment.
Q3: A 45-year-old patient with type 2 diabetes presents for a morning appointment. They took their
usual insulin dose but skipped breakfast due to anxiety about the dental visit. Mid-procedure, they
become diaphoretic, tremulous, and confused. What is the most appropriate immediate action?
A. Administer 100% oxygen and call 911.
B. Give 15 grams of oral glucose or glucagon if unconscious. [CORRECT]
C. Administer nitroglycerin sublingually.
D. Place the patient in Trendelenburg position and monitor.
Correct Answer: B
,Rationale: Hypoglycemia is the most likely cause given the clinical picture; immediate glucose
administration reverses neuroglycopenic symptoms and prevents progression to seizure or coma.
Q4: A 55-year-old patient reports a history of infective endocarditis five years ago. They require scaling
and root planing for moderate periodontitis. According to current AHA guidelines, what is the
appropriate management?
A. Administer amoxicillin 2g one hour before the procedure.
B. Administer clindamycin 600mg one hour before the procedure.
C. No antibiotic prophylaxis is indicated for dental procedures. [CORRECT]
D. Administer amoxicillin 2g one hour before and 1g six hours after.
Correct Answer: C
Rationale: Current AHA guidelines limit prophylaxis to specific cardiac conditions with the highest risk of
adverse outcomes; a history of endocarditis alone no longer qualifies without ongoing high-risk cardiac
pathology.
Q5: A 70-year-old patient with severe chronic obstructive pulmonary disease (COPD) is on home oxygen
at 2 L/min via nasal cannula. They need multiple extractions. What is the safest approach to oxygen
management during the procedure?
A. Remove home oxygen and use 100% nitrous oxide for sedation.
B. Continue home oxygen at 2 L/min and use minimal local anesthetic with epinephrine.
C. Continue home oxygen and avoid nitrous oxide; use local anesthetic judiciously. [CORRECT]
D. Increase oxygen to 6 L/min during the procedure for safety.
Correct Answer: C
Rationale: Nitrous oxide is contraindicated in COPD due to diffusion hypoxia risk; maintaining baseline
oxygen and using judicious local anesthesia with limited epinephrine prevents hypoxic episodes and
cardiac stress.
Q6: A 38-year-old patient reports taking bisphosphonates (alendronate) for osteoporosis for three years.
They need an extraction of tooth #19. What is the most appropriate management?
A. Proceed with extraction without special precautions.
B. Discontinue bisphosphonate for three months before extraction.
C. Perform atraumatic extraction with antibiotic coverage and informed consent regarding osteonecrosis
risk. [CORRECT]
D. Refer to medical oncology for bisphosphonate holiday.
Correct Answer: C
Rationale: For oral bisphosphonate use under four years, atraumatic technique with pre- and post-
operative antibiotics and documented informed consent represents the standard of care; drug holidays
are not indicated for oral agents.
Q7: A 50-year-old patient with a prosthetic heart valve presents for routine prophylaxis. Their physician
has recommended antibiotic prophylaxis. Which antibiotic regimen is appropriate?
A. Amoxicillin 2g orally one hour before the procedure. [CORRECT]
B. Clindamycin 300mg orally one hour before the procedure.
,C. Azithromycin 250mg orally one hour before the procedure.
D. Cephalexin 500mg orally one hour before the procedure.
Correct Answer: A
Rationale: Amoxicillin 2g is the first-line agent for dental prophylaxis in patients with prosthetic heart
valves per AHA guidelines, providing adequate coverage against viridans group streptococci.
Q8: A patient with a history of liver cirrhosis requires multiple restorations. Which local anesthetic
adjustment is most appropriate?
A. Avoid all local anesthetics due to hepatic metabolism.
B. Use normal doses of lidocaine; reduce doses of articaine.
C. Use reduced doses and avoid repeat dosing; prefer amide anesthetics with caution. [CORRECT]
D. Use only ester-type local anesthetics like procaine.
Correct Answer: C
Rationale: Amide local anesthetics are hepatically metabolized; in cirrhosis, reduced doses with
extended intervals between administrations prevent accumulation and toxicity while still providing
adequate anesthesia.
Q9: A pregnant patient at 14 weeks gestation requires emergency treatment for a dental abscess. Which
management approach is most appropriate?
A. Defer all treatment until after delivery.
B. Perform incision and drainage with antibiotic coverage; avoid tetracyclines and NSAIDs. [CORRECT]
C. Prescribe tetracycline 500mg four times daily for seven days.
D. Perform extraction under general anesthesia in the hospital.
Correct Answer: B
Rationale: Emergency dental infections during the second trimester require definitive treatment;
avoiding tetracyclines (fetal bone and tooth discoloration) and NSAIDs (fetal ductus arteriosus closure
risk) protects fetal development while addressing the infection.
Q10: A 60-year-old patient on chronic corticosteroid therapy (prednisone 10mg daily for rheumatoid
arthritis) presents for multiple extractions. What is the most appropriate management regarding steroid
supplementation?
A. Double the steroid dose the day before, day of, and day after surgery.
B. No supplemental steroids are needed for routine dental extractions at this dose. [CORRECT]
C. Administer 100mg hydrocortisone IV before the procedure.
D. Consult endocrinology before any dental surgery.
Correct Answer: B
Rationale: Patients on chronic prednisone ≤ 10mg daily or alternate-day dosing have intact
hypothalamic-pituitary-adrenal axis function and do not require perioperative steroid supplementation
for routine dental procedures.
Q11: A patient with sickle cell trait presents for dental treatment. Which consideration is most
important?
A. Avoid all dental treatment due to bleeding risk.
, B. Ensure adequate oxygenation, hydration, and avoid hypoxia-inducing agents. [CORRECT]
C. Administer prophylactic antibiotics for all procedures.
D. Use only general anesthesia for all procedures.
Correct Answer: B
Rationale: Sickle cell trait carriers can experience sickling under hypoxic conditions; maintaining
oxygenation and hydration prevents vaso-occlusive crises during dental procedures.
Q12: A patient with a pacemaker requires dental treatment. Which precaution is most important?
A. Avoid all electronic dental equipment.
B. Use ultrasonic scalers cautiously and avoid placing devices directly over the pacemaker generator.
[CORRECT]
C. Administer antibiotic prophylaxis before all procedures.
D. Schedule all treatment in a hospital setting.
Correct Answer: B
Rationale: Modern pacemakers are generally safe with dental equipment, but ultrasonic scalers should
be used cautiously and not positioned directly over the generator to minimize electromagnetic
interference risk.
Q13: A 42-year-old patient with HIV (CD4 count 450, undetectable viral load) requires extraction of
tooth #3. What is the most appropriate management?
A. Refer to hospital-based oral surgery due to immunocompromise.
B. Treat in standard dental setting with standard precautions; no antibiotic prophylaxis needed.
[CORRECT]
C. Administer prophylactic antibiotics for all dental procedures.
D. Defer treatment until CD4 count exceeds 500.
Correct Answer: B
Rationale: With CD4 > 200 and undetectable viral load, immune function is adequate for routine dental
care; standard universal precautions protect both patient and provider without additional prophylaxis.
Q14: A patient with hereditary angioedema requires dental extractions. What is the most important
preoperative consideration?
A. Avoid all dental extractions permanently.
B. Administer prophylactic C1 esterase inhibitor concentrate or androgens before the procedure.
[CORRECT]
C. Use only local anesthesia without epinephrine.
D. Perform extractions only under general anesthesia.
Correct Answer: B
Rationale: Dental trauma can trigger angioedema attacks; prophylactic C1 esterase inhibitor
replacement or attenuated androgens prevents life-threatening airway edema during and after dental
procedures.
Q15: A patient with a history of radiation therapy to the head and neck (60 Gy) two years ago requires
extraction. What is the most critical consideration?
EXAM 2026/2027 | ADEX Clinical Skills
Assessment | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1 – Patient Assessment & Medical History Review (Questions 1–20)
Q1: A 62-year-old patient reports taking warfarin for atrial fibrillation. Today's dental treatment includes
a simple extraction of a mobile tooth. What is the most appropriate management?
A. Stop warfarin 72 hours before the procedure.
B. Obtain an INR level before proceeding. [CORRECT]
C. Proceed with extraction without any changes.
D. Refer all extractions to an oral surgeon.
Correct Answer: B
Rationale: Obtaining an INR determines bleeding risk; most simple extractions can be performed safely
with INR ≤ 3.5 without discontinuing anticoagulation per current dental guidelines.
Q2: A 28-year-old patient has a blood pressure of 158/94 mmHg on two separate visits. They have no
other medical conditions. What is the best next step?
A. Proceed with routine dental treatment.
B. Prescribe a thiazide diuretic.
C. Refer to primary care physician for evaluation. [CORRECT]
D. Recheck blood pressure at the end of the appointment.
Correct Answer: C
Rationale: Persistent BP ≥ 140/90 mmHg in a young patient without known hypertension warrants
medical evaluation to rule out secondary causes before proceeding with elective dental treatment.
Q3: A 45-year-old patient with type 2 diabetes presents for a morning appointment. They took their
usual insulin dose but skipped breakfast due to anxiety about the dental visit. Mid-procedure, they
become diaphoretic, tremulous, and confused. What is the most appropriate immediate action?
A. Administer 100% oxygen and call 911.
B. Give 15 grams of oral glucose or glucagon if unconscious. [CORRECT]
C. Administer nitroglycerin sublingually.
D. Place the patient in Trendelenburg position and monitor.
Correct Answer: B
,Rationale: Hypoglycemia is the most likely cause given the clinical picture; immediate glucose
administration reverses neuroglycopenic symptoms and prevents progression to seizure or coma.
Q4: A 55-year-old patient reports a history of infective endocarditis five years ago. They require scaling
and root planing for moderate periodontitis. According to current AHA guidelines, what is the
appropriate management?
A. Administer amoxicillin 2g one hour before the procedure.
B. Administer clindamycin 600mg one hour before the procedure.
C. No antibiotic prophylaxis is indicated for dental procedures. [CORRECT]
D. Administer amoxicillin 2g one hour before and 1g six hours after.
Correct Answer: C
Rationale: Current AHA guidelines limit prophylaxis to specific cardiac conditions with the highest risk of
adverse outcomes; a history of endocarditis alone no longer qualifies without ongoing high-risk cardiac
pathology.
Q5: A 70-year-old patient with severe chronic obstructive pulmonary disease (COPD) is on home oxygen
at 2 L/min via nasal cannula. They need multiple extractions. What is the safest approach to oxygen
management during the procedure?
A. Remove home oxygen and use 100% nitrous oxide for sedation.
B. Continue home oxygen at 2 L/min and use minimal local anesthetic with epinephrine.
C. Continue home oxygen and avoid nitrous oxide; use local anesthetic judiciously. [CORRECT]
D. Increase oxygen to 6 L/min during the procedure for safety.
Correct Answer: C
Rationale: Nitrous oxide is contraindicated in COPD due to diffusion hypoxia risk; maintaining baseline
oxygen and using judicious local anesthesia with limited epinephrine prevents hypoxic episodes and
cardiac stress.
Q6: A 38-year-old patient reports taking bisphosphonates (alendronate) for osteoporosis for three years.
They need an extraction of tooth #19. What is the most appropriate management?
A. Proceed with extraction without special precautions.
B. Discontinue bisphosphonate for three months before extraction.
C. Perform atraumatic extraction with antibiotic coverage and informed consent regarding osteonecrosis
risk. [CORRECT]
D. Refer to medical oncology for bisphosphonate holiday.
Correct Answer: C
Rationale: For oral bisphosphonate use under four years, atraumatic technique with pre- and post-
operative antibiotics and documented informed consent represents the standard of care; drug holidays
are not indicated for oral agents.
Q7: A 50-year-old patient with a prosthetic heart valve presents for routine prophylaxis. Their physician
has recommended antibiotic prophylaxis. Which antibiotic regimen is appropriate?
A. Amoxicillin 2g orally one hour before the procedure. [CORRECT]
B. Clindamycin 300mg orally one hour before the procedure.
,C. Azithromycin 250mg orally one hour before the procedure.
D. Cephalexin 500mg orally one hour before the procedure.
Correct Answer: A
Rationale: Amoxicillin 2g is the first-line agent for dental prophylaxis in patients with prosthetic heart
valves per AHA guidelines, providing adequate coverage against viridans group streptococci.
Q8: A patient with a history of liver cirrhosis requires multiple restorations. Which local anesthetic
adjustment is most appropriate?
A. Avoid all local anesthetics due to hepatic metabolism.
B. Use normal doses of lidocaine; reduce doses of articaine.
C. Use reduced doses and avoid repeat dosing; prefer amide anesthetics with caution. [CORRECT]
D. Use only ester-type local anesthetics like procaine.
Correct Answer: C
Rationale: Amide local anesthetics are hepatically metabolized; in cirrhosis, reduced doses with
extended intervals between administrations prevent accumulation and toxicity while still providing
adequate anesthesia.
Q9: A pregnant patient at 14 weeks gestation requires emergency treatment for a dental abscess. Which
management approach is most appropriate?
A. Defer all treatment until after delivery.
B. Perform incision and drainage with antibiotic coverage; avoid tetracyclines and NSAIDs. [CORRECT]
C. Prescribe tetracycline 500mg four times daily for seven days.
D. Perform extraction under general anesthesia in the hospital.
Correct Answer: B
Rationale: Emergency dental infections during the second trimester require definitive treatment;
avoiding tetracyclines (fetal bone and tooth discoloration) and NSAIDs (fetal ductus arteriosus closure
risk) protects fetal development while addressing the infection.
Q10: A 60-year-old patient on chronic corticosteroid therapy (prednisone 10mg daily for rheumatoid
arthritis) presents for multiple extractions. What is the most appropriate management regarding steroid
supplementation?
A. Double the steroid dose the day before, day of, and day after surgery.
B. No supplemental steroids are needed for routine dental extractions at this dose. [CORRECT]
C. Administer 100mg hydrocortisone IV before the procedure.
D. Consult endocrinology before any dental surgery.
Correct Answer: B
Rationale: Patients on chronic prednisone ≤ 10mg daily or alternate-day dosing have intact
hypothalamic-pituitary-adrenal axis function and do not require perioperative steroid supplementation
for routine dental procedures.
Q11: A patient with sickle cell trait presents for dental treatment. Which consideration is most
important?
A. Avoid all dental treatment due to bleeding risk.
, B. Ensure adequate oxygenation, hydration, and avoid hypoxia-inducing agents. [CORRECT]
C. Administer prophylactic antibiotics for all procedures.
D. Use only general anesthesia for all procedures.
Correct Answer: B
Rationale: Sickle cell trait carriers can experience sickling under hypoxic conditions; maintaining
oxygenation and hydration prevents vaso-occlusive crises during dental procedures.
Q12: A patient with a pacemaker requires dental treatment. Which precaution is most important?
A. Avoid all electronic dental equipment.
B. Use ultrasonic scalers cautiously and avoid placing devices directly over the pacemaker generator.
[CORRECT]
C. Administer antibiotic prophylaxis before all procedures.
D. Schedule all treatment in a hospital setting.
Correct Answer: B
Rationale: Modern pacemakers are generally safe with dental equipment, but ultrasonic scalers should
be used cautiously and not positioned directly over the generator to minimize electromagnetic
interference risk.
Q13: A 42-year-old patient with HIV (CD4 count 450, undetectable viral load) requires extraction of
tooth #3. What is the most appropriate management?
A. Refer to hospital-based oral surgery due to immunocompromise.
B. Treat in standard dental setting with standard precautions; no antibiotic prophylaxis needed.
[CORRECT]
C. Administer prophylactic antibiotics for all dental procedures.
D. Defer treatment until CD4 count exceeds 500.
Correct Answer: B
Rationale: With CD4 > 200 and undetectable viral load, immune function is adequate for routine dental
care; standard universal precautions protect both patient and provider without additional prophylaxis.
Q14: A patient with hereditary angioedema requires dental extractions. What is the most important
preoperative consideration?
A. Avoid all dental extractions permanently.
B. Administer prophylactic C1 esterase inhibitor concentrate or androgens before the procedure.
[CORRECT]
C. Use only local anesthesia without epinephrine.
D. Perform extractions only under general anesthesia.
Correct Answer: B
Rationale: Dental trauma can trigger angioedema attacks; prophylactic C1 esterase inhibitor
replacement or attenuated androgens prevents life-threatening airway edema during and after dental
procedures.
Q15: A patient with a history of radiation therapy to the head and neck (60 Gy) two years ago requires
extraction. What is the most critical consideration?
