14 vignette
WEEK 1- Full Mock Test –
Crash Course
🟦 VIGNETTE 1 —
CONSENT, AUTONOMY & COMMUNICATION
A
36-year-old woman attends your clinic with sensitivity in the lower right molar
region for one week. She is anxious but cooperative. After examination, you
diagnose symptomatic irreversible pulpitis on tooth 46. You explain that root
canal treatment is indicated. She asks whether extraction is a cheaper
alternative. She speaks English but with limited health literacy and struggles
to understand technical terms. She appears distressed about costs and asks
repeatedly whether the treatment is “safe.”
Her
medical history:
- Controlled hypothyroidism
- No medications except
levothyroxine
- No allergies
- No pregnancy
- Vital signs normal
You have
20 minutes before your next appointment.
SBQ 1.1
What is
the MOST appropriate next step?
A. Give a
brief explanation and ask her to sign the consent form
B. Provide detailed explanation using simple language, check understanding, and
document the discussion
C. Recommend extraction because it is cheaper and faster
D. Proceed with RCT since the diagnosis is clear
E. Ask the dental assistant to explain the procedure
Correct Answer: B
Explanation:
ADC
emphasizes patient-centred communication and shared decision-making.
Simplified explanation + confirming understanding + documenting = gold
standard.
SBQ 1.2
Which
principle of ethics is MOST relevant in ensuring she understands the procedure?
A.
Non-maleficence
B. Justice
C. Autonomy
D. Beneficence
E. Veracity
Correct Answer: C
Explanation:
Respecting
autonomy requires that patients make informed decisions with adequate
understanding.
SBQ 1.3
What is
the MOST appropriate method to check her understanding?
A. Ask
her to repeat the information in her own words
B. Ask if she has “any questions”
C. Provide written information only
D. Give her a pamphlet to read
E. Assume understanding if she nods
Correct Answer: A
Explanation:
The teach-back
method is essential in low-literacy scenarios.
SBQ 1.4
If she
remains uncertain, what should you do?
A. Delay
treatment and re-explain using diagrams
B. Proceed because she verbally agreed earlier
C. Ask a family member to decide
D. Document refusal only
E. Refer to another dentist immediately
Correct Answer: A
Explanation:
Use
visual aids + further discussion. Consent must be informed.
SBQ 1.5
When is
consent considered valid?
A. When
the patient signs the form
B. When the dentist explains risks
C. When it is voluntary, informed, and documented
D. When treatment is essential
E. When the patient verbally agrees
Correct Answer: C
Explanation:
Valid
consent = informed + capacity + voluntary + documented.
🟦 VIGNETTE 2 —
INFECTION CONTROL & EXPOSURE INCIDENT
A dental
assistant accidentally pricks her finger on an endodontic file used on a
patient with unknown medical history. The incident occurred during cleaning.
She washed the area but did not report it. You notice minor bleeding and ask
what happened. She says, “It’s fine, I don’t want to make it a big deal.”
The
patient whose instrument caused injury has left the clinic.
SBQ 2.1
What is
your FIRST action?
A.
Continue working and review later
B. Report incident and follow your practice’s exposure protocol
C. Ask her to continue cleaning
D. Tell her to go home and rest
E. Call the patient immediately
Correct Answer: B
SBQ 2.2
What is
the MOST appropriate management regarding the dental assistant?
A. Start
empiric antibiotics
B. Send her to emergency department
C. Facilitate risk assessment, blood tests, documentation
D. No action if the wound is superficial
E. Ask her to self-assess risk
Correct Answer: C
SBQ 2.3
What is
the MOST appropriate step regarding the patient?
A. Do
nothing
B. Contact the patient respectfully, explain incident, and request consent for
serology
C. Report patient to authorities
D. Recall the patient only if assistant develops symptoms
E. Ask assistant to call the patient privately
Correct Answer: B
SBQ 2.4
Which
guideline applies here?
A. DBA
Advertising guidelines
B. ARPANSA guidelines
C. NHMRC Infection Control guidelines
D. TGA guidelines
E. ADA Code of Ethics
Correct Answer: C
SBQ 2.5
Which
documentation is REQUIRED?
A. Injury
severity only
B. Only the name of the assistant
C. Time, nature of exposure, actions taken, follow-up
D. Only patient details
E. No documentation needed
Correct Answer: C
🟦 VIGNETTE 3 —
RADIATION JUSTIFICATION & ALADAIP
A
14-year-old boy presents with pain on biting on tooth 36. His mother insists on
“a full mouth set of X-rays” because their previous dentist always did that.
The child is anxious and says he hates radiographs. Clinical exam reveals deep
occlusal caries on 36 and no other obvious pathology.
SBQ 3.1
What is
the MOST appropriate radiograph?
A. Full
mouth series
B. Panoramic radiograph
C. Bitewing radiographs
D. Periapical of 36
E. CBCT
Correct Answer: D
(Pain on
biting + single symptomatic tooth → periapical.)
SBQ 3.2
Which
principle guides radiographic selection?
A. ALARA
B. ALADAIP
C. Inverse square law
D. Bremsstrahlung
E. Absorption coefficient
Correct Answer: B
(ALADAIP
is the updated principle.)
SBQ 3.3
How
should you respond to the mother's request?
A. Take
full mouth radiographs as requested
B. Refuse all radiographs
C. Explain justification, benefits vs risks, take only indicated view
D. Tell her guidelines prohibit full mouth radiographs
E. Blame previous dentist
Correct Answer: C
SBQ 3.4
Radiation
exposure in children requires:
A. Higher
exposure settings
B. Justification + minimal exposure
C. Same exposure as adults
D. CBCT as routine
E. Full mouth series every 6 months
Correct Answer: B
SBQ 3.5
Which
documentation is required?
A. Only
type of radiograph
B. Reason + findings + interpretation + patient discussion
C. Exposure time only
D. Child’s anxiety only
E. No documentation
Correct Answer: B
🟦 VIGNETTE 4 —
MEDICAL HISTORY & RISK ASSESSMENT
A
58-year-old man presents with dull pain in the upper right region. Medical
history:
- Hypertension (controlled)
- Type II diabetes (HbA1c =
8.5%)
- Past smoker
- Metformin, amlodipine
- No allergies
Extraoral
exam: WNL
Intraoral exam: 16 has deep caries; slight swelling.
Vitals stable.
SBQ 4.1
What is
his ASA classification?
A. ASA I
B. ASA II
C. ASA III
D. ASA IV
E. ASA V
Correct Answer: C
(HbA1c
8.5% = poorly controlled diabetes → ASA III.)
SBQ 4.2
What is
your FIRST step before initiating treatment?
A.
Immediate extraction
B. Full RCT without delay
C. Check BGL + further history + consider infection control of swelling
D. Refer urgently
E. Prescribe opioids for pain
Correct Answer: C
SBQ 4.3
Which
condition increases his risk of delayed healing?
A.
Hypertension
B. Diabetes
C. Smoking in the past
D. Metformin use
E. Age
Correct Answer: B
SBQ 4.4
If
extraction is planned, what is MOST appropriate?
A. Delay
treatment for 6 months until diabetes improves
B. Proceed without precautions
C. Perform atraumatic extraction + good post-op care
D. Avoid extraction entirely
E. Prescribe NSAIDs only
Correct Answer: C
SBQ 4.5
Which
postoperative advice is MOST important?
A.
Smoking cessation
B. Avoid sugary drinks
C. Use chlorhexidine daily
D. Avoid brushing
E. Eat hard foods
Correct Answer: A
🟦 VIGNETTE 5 —
COMMUNICATION, CULTURAL SAFETY & CONSENT
A
46-year-old Aboriginal woman presents for dental pain but appears withdrawn and
avoids eye contact. She brings a relative who speaks on her behalf. She says
little during the consultation. The relative insists on making decisions for
her. You suspect she may not feel culturally safe.
SBQ 5.1
What is
the MOST appropriate approach?
A. Allow
relative to answer all questions
B. Direct conversation to the patient respectfully
C. Proceed with relative’s consent
D. Assume she prefers silence
E. Ask questions rapidly to finish
Correct Answer: B
SBQ 5.2
Which
concept is MOST relevant here?
A.
Cultural safety
B. Informed refusal
C. Financial consent
D. Justice
E. Sedation consent
Correct Answer: A
SBQ 5.3
What is
the BEST way to ensure culturally safe care?
A. Use
technical dental terminology
B. Speak loudly and with authority
C. Ask permission before examination, explain steps
D. Delegate conversation to assistant
E. Ignore communication style
Correct Answer: C
SBQ 5.4
If she
does not understand, what should you do?
A. Ask
the relative to interpret
B. Use a trained interpreter
C. Skip the explanation
D. Delay care indefinitely
E. Ask the patient to sign the form regardless
Correct Answer: B
SBQ 5.5
Which
documentation is ESSENTIAL?
A. Her
ethnicity
B. Consent discussion + interpreter use + her decisions
C. Relative’s opinion
D. Only treatment provided
E. Only treatment plan
Correct Answer: B
🟦 VIGNETTE 6 —
MEDICAL EMERGENCY: SYNCOPE & ANXIETY
A
22-year-old student attends for a restorative appointment. She is extremely
anxious and has been hyperventilating in the waiting area. During local anaesthetic
administration, she becomes pale, light-headed, and loses consciousness
briefly. No seizure activity observed. After elevation of legs and reassurance,
she regains consciousness. BP returns to normal within minutes.
She
apologises and says she feels embarrassed and wants to continue treatment
immediately.
SBQ 6.1
What is
the MOST likely diagnosis?
A.
Vasovagal syncope
B. Epileptic seizure
C. Hypoglycaemia
D. Hyperthyroid crisis
E. Stroke
Correct
Answer: A
Explanation: Signs are classic for vasovagal episode in an anxious
patient.
SBQ 6.2
What is
the FIRST step in management?
A. Give
oxygen immediately
B. Place patient supine with legs elevated
C. Administer oral glucose
D. Inject adrenaline
E. Begin chest compressions
Correct
Answer: B
Explanation: Standard management is supine, legs elevated → restore
cerebral perfusion.
SBQ 6.3
After
recovery, what is the MOST appropriate next step?
A.
Continue the dental procedure immediately
B. Reschedule; address anxiety first
C. Send her home with no treatment
D. Refer for neurological evaluation
E. Proceed with LA using higher dose
Correct
Answer: B
Explanation: Address anxiety, consider desensitisation, short
appointments, nitrous if needed.
SBQ 6.4
Which of
the following is a KEY prevention strategy?
A.
Fasting before appointments
B. Rapid movements during injections
C. Placing patient upright during LA
D. Good communication + slow LA administration
E. Using high adrenaline concentrations
Correct
Answer: D
SBQ 6.5
Which
documentation is essential?
A. Only
the diagnosis
B. All symptoms + vital signs + management steps
C. Only patient apology
D. Only medical history
E. No documentation needed for minor events
Correct
Answer: B
🟦 VIGNETTE 7 —
INFECTION CONTROL: AIRBORNE PRECAUTIONS
A 45-year-old
male presents for tooth pain. He reports a chronic cough, night sweats, and
recent weight loss. He says he has been “waiting for TB test results.” He looks
tired and has a persistent productive cough in the chair.
You are
in a normal dental operatory with standard ventilation.
SBQ 7.1
What is
the MOST appropriate action?
A. Treat
him with full PPE
B. Proceed with emergency treatment only
C. Postpone elective treatment and refer for urgent medical assessment
D. Give antibiotics and continue
E. Treat him in a closed room with windows open
Correct
Answer: C
Explanation: Suspected TB = airborne disease → defer elective care,
refer urgently.
SBQ 7.2
Which
precaution category applies?
A.
Standard
B. Contact
C. Droplet
D. Airborne
E. Bloodborne
Correct
Answer: D
SBQ 7.3
What PPE
is appropriate if emergency care MUST be provided?
A.
Surgical mask
B. Gloves only
C. N95 mask + eye protection + gown
D. Face shield only
E. Lead apron
Correct
Answer: C
SBQ 7.4
If
aerosol-generating procedures (AGPs) are necessary:
A.
Proceed normally
B. Minimise AGPs; consider referral to hospital setting
C. Use chlorhexidine rinse and continue
D. Increase suction only
E. Use high-speed handpiece carefully
Correct
Answer: B
SBQ 7.5
Which
documentation is essential?
A. Only
symptoms
B. Only treatment provided
C. Symptoms + reason for deferral + referral details
D. Only medical referral
E. No need for documentation
Correct
Answer: C
🟦 VIGNETTE 8 —
COMMUNICATION & DE-ESCALATION
A
32-year-old man becomes angry after waiting 25 minutes past his appointment
time. He raises his voice and says, “This clinic never respects patients! I’m
leaving and complaining to AHPRA!”
Your
schedule is running late because of an earlier emergency.
SBQ 8.1
What is
the MOST appropriate initial response?
A. Tell
him to calm down
B. Ignore him and continue working
C. Acknowledge frustration and apologise for delay
D. Explain that emergencies are unavoidable
E. Ask the receptionist to handle him
Correct
Answer: C
Explanation: Validation + apology = ADC-approved professional behaviour.
SBQ 8.2
Which
communication strategy is BEST?
A.
Defensive explanation
B. Blaming staff
C. Active listening and empathy
D. Minimising his concerns
E. Matching his tone to show authority
Correct
Answer: C
SBQ 8.3
What
should you avoid?
A.
Offering solution
B. Providing explanation
C. Becoming defensive
D. Apologising
E. Discussing options
Correct
Answer: C
SBQ 8.4
If he
decides to stay, what should you do?
A. Rush
treatment
B. Provide clear timeline and expectations
C. Double-book more patients
D. Treat him last
E. Ignore discussion
Correct
Answer: B
SBQ 8.5
If he
leaves and files a complaint:
A. Delete
his records
B. Alter notes to justify delay
C. Document interaction factually
D. Stop treating him permanently
E. Ignore the complaint
Correct
Answer: C
🟦 VIGNETTE 9 —
RADIOLOGY REQUEST, CONSENT & ETHICS
A
29-year-old pregnant woman (12 weeks) presents with dental pain on 37. You
recommend a periapical radiograph. She becomes worried and says, “My family
told me X-rays can harm the baby. Is this safe?”
She has
no medical conditions. Pain is moderate.
SBQ 9.1
What is
the MOST appropriate response?
A. Tell
her there is zero radiation risk
B. Refuse to take the radiograph
C. Explain risks, benefits, and safety measures
D. Ask her to sign a waiver
E. Avoid explaining details
Correct
Answer: C
SBQ 9.2
Which of
the following is TRUE?
A. Dental
radiographs are contraindicated in pregnancy
B. Radiographs are allowed if justified
C. Lead apron must always be used for pregnancy
D. CBCT should be used instead
E. Delay radiographs until after delivery
Correct
Answer: B
SBQ 9.3
Which
protective measure is recommended?
A. Higher
kVp
B. Thyroid collar + proper collimation
C. Repeat exposures if image unclear
D. Increase exposure time
E. Use lead apron only
Correct
Answer: B
SBQ 9.4
What
principle governs this scenario?
A. ALARA
B. ALADAIP
C. Inverse square law
D. Reciprocity law
E. Doppler principle
Correct
Answer: B
SBQ 9.5
What
should be documented?
A. Only
type of radiograph
B. Only pregnancy status
C. Reason, discussion of risks, patient agreement
D. Only findings
E. Nothing (pregnancy is private)
Correct
Answer: C
🟦 VIGNETTE 10 —
HISTORY-TAKING & DIAGNOSTIC REASONING
A
41-year-old woman reports spontaneous episodes of severe, sharp pain lasting
seconds in the lower right jaw. She says eating triggers it. Pain is electric
in character. Exam shows normal teeth, no caries, and normal radiographs.
SBQ 10.1
What is
the MOST likely diagnosis?
A.
Reversible pulpitis
B. Irreversible pulpitis
C. Cracked tooth syndrome
D. Trigeminal neuralgia
E. Periapical abscess
Correct
Answer: D
SBQ 10.2
What is a
characteristic feature?
A. Dull
ache
B. Pain worse at night
C. Electric shock-like pain
D. Tenderness to percussion
E. Swelling
Correct
Answer: C
SBQ 10.3
What is
the FIRST management step?
A. RCT of
all lower teeth
B. Prescribe carbamazepine and refer to neurologist
C. Extraction of suspected tooth
D. Panoramic radiograph
E. Antibiotics
Correct
Answer: B
SBQ 10.4
Why must
dental causes still be ruled out?
A. Dental
pain always precedes neuralgia
B. Neuralgia is extremely rare
C. Dental pathology is more common
D. Because ADA guidelines require it
E. To satisfy medicolegal concerns only
Correct
Answer: C
SBQ 10.5
What
documentation is critical?
A. Only
symptoms
B. Only tests done
C. Full pain history + tests + referral details
D. Only prescription
E. No documentation needed
Correct
Answer: C
🟦 VIGNETTE 11 —
CHILD SAFETY, CONSENT & MANDATORY REPORTING
A
9-year-old boy attends with his mother complaining of tooth pain. During
conversation, the child avoids eye contact and appears anxious. You notice
multiple bruises on his arms in different stages of healing. When you gently
ask about them, he hesitates and says, “I fell,” while the mother quickly
interrupts and says they are from “playing rough.”
Medical
history unremarkable.
Radiographs indicate deep caries on 75.
SBQ 11.1
What is
your FIRST responsibility?
A. Ignore
bruises unless child reports abuse
B. Proceed with dental treatment only
C. Document findings and initiate mandatory reporting if concerns persist
D. Confront the mother directly
E. Ask the child privately if he is being abused
Correct
Answer: C
Explanation: Mandatory reporting applies when reasonable suspicion
exists.
SBQ 11.2
Which
principle guides this scenario?
A.
Autonomy
B. Beneficence
C. Non-maleficence
D. Justice
E. Confidentiality
Correct
Answer: C
Protecting the child from harm overrides other concerns.
SBQ 11.3
How
should consent for treatment be handled?
A. Obtain
consent from mother as legal guardian
B. Allow child to provide consent independently
C. Refuse treatment until Social Services approves
D. Proceed without consent
E. Ask a relative to consent
Correct
Answer: A
SBQ 11.4
What is
the MOST appropriate communication?
A.
Discuss abuse suspicion in front of child
B. Record findings objectively without making allegations
C. Suggest the mother is lying
D. Remove child from parent’s custody
E. Downplay findings
Correct
Answer: B
SBQ 11.5
Which
documentation is mandatory?
A. Only
dental findings
B. Only mother’s statements
C. Objective details of bruising + location + behaviour + your concerns
D. Photographs only
E. No documentation required
Correct
Answer: C
🟦 VIGNETTE 12 —
INFECTION CONTROL: STERILIZATION ERROR
During
routine quality assurance, you discover that the autoclave failed a biological
indicator test from the previous week, and the staff did not repeat the test.
Instruments sterilized during that week were used on about 45 patients. No
staff member reported any error.
SBQ 12.1
What is
the MOST appropriate next action?
A. Ignore
since no patients complained
B. Stop using the autoclave immediately and quarantine instruments
C. Continue using it and repeat test later
D. Blame staff and write warning letters
E. Report to police
Correct
Answer: B
SBQ 12.2
Which
guideline applies?
A.
ARPANSA radiation guidelines
B. NHMRC Infection Prevention and Control
C. TGA medical devices
D. ADA advertising guidelines
E. DBA sedation guidelines
Correct
Answer: B
SBQ 12.3
What
should be done about affected patients?
A. Recall
all patients and disclose the incident
B. Do nothing
C. Only recall immunocompromised patients
D. Send mass SMS messages
E. Ask staff to decide whom to contact
Correct
Answer: A
SBQ 12.4
How
should staff behaviour be addressed?
A.
Immediate dismissal
B. Educate, retrain, and establish clear protocols
C. Reduce workload
D. Suspend assistant for one month
E. Ignore the error
Correct
Answer: B
SBQ 12.5
Which
documentation is essential?
A. Only
autoclave serial number
B. Incident details + actions taken + patient communication + retesting results
C. Only patient names
D. Only load numbers
E. No documentation
Correct
Answer: B
🟦 VIGNETTE 13 —
MEDICAL HISTORY: CARDIAC PATIENT & CONSENT
A
72-year-old man presents with severe pain associated with tooth 27.
History:
- MI 4 months ago
- On aspirin + clopidogrel
- Controlled hypertension
- No allergies
- Mild COPD
He is
anxious and asks for extraction “as soon as possible.”
SBQ 13.1
What is
his ASA status?
A. ASA I
B. ASA II
C. ASA III
D. ASA IV
E. ASA V
Correct
Answer: C
(MI <6 months = ASA III, sometimes approaching IV depending on severity.)
SBQ 13.2
What is
the MOST appropriate action now?
A.
Extraction today with local anesthesia
B. Delay elective extraction and seek cardiologist opinion
C. Stop antiplatelets before extraction
D. Perform extraction under GA
E. Start prophylactic antibiotics
Correct
Answer: B
Because MI <6 months = elective care postponed.
SBQ 13.3
If
extraction becomes unavoidable, what is correct?
A. Stop
aspirin
B. Stop clopidogrel
C. Continue both antiplatelets
D. Discontinue all medications
E. Give vitamin K
Correct
Answer: C
Stopping antiplatelets is dangerous; bleeding can be managed locally.
SBQ 13.4
Which
local measure prevents bleeding?
A. Ice
pack only
B. Atraumatic technique + sutures + pressure pack + tranexamic acid
C. High-speed handpiece with water spray
D. Delayed closure
E. Antibiotics
Correct Answer:
B
SBQ 13.5
What
documentation is critical?
A. Only
tooth number
B. Detailed medical history + discussion with cardiologist + patient consent
C. Only consent
D. Only anesthetic used
E. No documentation
Correct
Answer: B
🟦 VIGNETTE 14 — COMMUNICATION
& ETHICS: REFUSAL OF TREATMENT
A
55-year-old woman with severe periodontitis requires scaling and root planing.
You explain the need for multiple visits and strict oral hygiene. She refuses
treatment, saying, “I don’t believe in gum disease. Just give me antibiotics.”
She has
no medical comorbidities.
SBQ 14.1
What is
the MOST appropriate response?
A.
Prescribe antibiotics as requested
B. Respectfully explain condition and consequences of no treatment
C. Discharge her from clinic immediately
D. Argue with her until she agrees
E. Force treatment due to urgency
Correct
Answer: B
SBQ 14.2
This
scenario MOST relates to:
A.
Autonomy
B. Justice
C. Veracity
D. Coercion
E. Malpractice
Correct
Answer: A
SBQ 14.3
What is
the best next step?
A. Document
refusal + provide written information
B. Treat without consent
C. Insist on immediate treatment
D. Ignore her opinion
E. Prescribe opioids
Correct
Answer: A
SBQ 14.4
Which
principle applies to antibiotic misuse?
A.
Justice
B. Stewardship
C. Empathy
D. Fidelity
E. Beneficence
Correct
Answer: B
SBQ 14.5
What
should ALWAYS be documented?
A. Only
her refusal
B. Explanation given + risks + alternative options + refusal
C. Only treatment plan
D. Only patient’s argument
E. Only cost discussion
Correct
Answer: B