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Patient Evaluation & Medical Risk Management INBDE Patient Cases

By Dr. Isaac Sun, DDS

7 ADA INBDE-format patient cases on patient evaluation & medical risk management. Each case is a shared patient box (chief complaint, history, medications, allergies, exam) followed by linked multiple-choice questions with full distractor explanations. Practice the way the real exam is structured.

7 patient cases35 linked questionsADA INBDE formatFull distractor explanations

Seven ADA INBDE-format patient cases on oral surgery patient evaluation and medical risk management: continuing warfarin for a simple extraction with an INR check and local hemostasis, the high MRONJ risk of intravenous oncologic bisphosphonates and prevention before therapy, infective endocarditis antibiotic prophylaxis (amoxicillin 2 g) for a prosthetic heart valve, deferring elective surgery for uncontrolled hypertension and ASA III stratification, perioperative management of a diabetic patient to avoid hypoglycemia, imaging and informed consent before a lower third molar with inferior alveolar nerve proximity, and continuing a direct oral anticoagulant for a simple extraction. Topics include medical history and ASA classification, anticoagulants and bleeding disorders, bisphosphonates and MRONJ, antibiotic prophylaxis, and informed consent.

Case Coverage Map
What each case is testing
An extraction for a patient on a blood thinner:
Continuing warfarin for a simple extraction, checking the INR, local hemostasis, and the contrast with inherited bleeding disorders.
An extraction request from an oncology patient on IV bisphosphonates:
High MRONJ risk with IV oncologic bisphosphonates, conservative care, the prevention-before-therapy principle, and the MRONJ definition.
A patient with a prosthetic heart valve:
Infective endocarditis prophylaxis (amoxicillin 2 g), why extractions qualify, managing concurrent warfarin, and the prosthetic-joint contrast.
A high blood pressure reading at the surgery visit:
Deferring elective surgery for uncontrolled hypertension, ASA III, the value of preoperative vital signs, and the emergency-procedure contrast.
Planning surgery for a diabetic patient:
Infection/healing risk, eating and medicating as usual to avoid hypoglycemia, the common acute concern, and controlling the condition.
Consent and imaging before a third molar:
Imaging for inferior alveolar nerve proximity, disclosing nerve-injury risk, valid informed consent, and modified technique for close roots.
A patient on a newer blood thinner:
Continuing a direct oral anticoagulant for a simple extraction, no routine INR monitoring, local hemostasis, and consulting for invasive surgery.
Patient case: An extraction for a patient on a blood thinner
0 of 5 answered, 0 correct
Patient
Male, 68 years old
Chief Complaint
Needs a hopeless molar removed; takes warfarin for atrial fibrillation.
Background and/or Patient History
  • On warfarin for atrial fibrillation
  • Single simple extraction planned
  • Otherwise stable; asks whether to stop the blood thinner
Allergies
NKDA
Medications
  • Warfarin
Current Findings
  • Restorable medical status; routine simple extraction indicated
  • INR to be checked preoperatively
  1. Question 1
    Moderate
    For this single simple extraction, the warfarin should generally be:
  2. Question 2
    Moderate
    The INR is checked because a simple extraction is generally safe when it is:
  3. Question 3
    Moderate
    Bleeding that occurs is controlled by:
  4. Question 4
    Moderate
    The reason continuation is preferred over stopping is that:
  5. Question 5
    Hard
    If this patient instead had hemophilia, the management would additionally require:

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Patient case: An extraction request from an oncology patient on IV bisphosphonates
0 of 5 answered, 0 correct
Patient
Female, 64 years old
Chief Complaint
A painful molar; on intravenous bisphosphonates for cancer.
Background and/or Patient History
  • Receiving intravenous, high-dose bisphosphonate therapy for metastatic cancer
  • A molar with a poor prognosis is causing pain
  • Considering extraction
Allergies
NKDA
Medications
  • Intravenous bisphosphonate
Current Findings
  • High MRONJ risk due to IV oncologic bisphosphonate dosing
  • Tooth symptomatic; weighing extraction versus conservative care
  1. Question 1
    Moderate
    This patient's risk of medication-related osteonecrosis of the jaw (MRONJ) is:
  2. Question 2
    Moderate
    Given the symptomatic tooth, the approach favors:
  3. Question 3
    Moderate
    The single most effective MRONJ-prevention principle (for future patients) is to:
  4. Question 4
    Hard
    MRONJ is clinically defined by:
  5. Question 5
    Moderate
    This case shows that for antiresorptive patients, the decision hinges on:

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Patient case: A patient with a prosthetic heart valve
0 of 5 answered, 0 correct
Patient
Male, 59 years old
Chief Complaint
Needs an extraction; has a prosthetic heart valve.
Background and/or Patient History
  • Mechanical prosthetic heart valve
  • No penicillin allergy
  • Extraction (gingival/periapical manipulation) planned
Allergies
NKDA
Medications
  • Warfarin
Current Findings
  • High-risk cardiac condition for infective endocarditis
  • Invasive procedure planned
  1. Question 1
    Moderate
    Does this patient need antibiotic prophylaxis for the extraction?
  2. Question 2
    Moderate
    The standard regimen (no allergy) is:
  3. Question 3
    Moderate
    Prophylaxis is needed here because the extraction:
  4. Question 4
    Moderate
    This patient is also on warfarin, so the clinician should:
  5. Question 5
    Hard
    If this patient instead had only a prosthetic knee joint (no cardiac condition), prophylaxis would be:

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Patient case: A high blood pressure reading at the surgery visit
0 of 5 answered, 0 correct
Patient
Male, 61 years old
Chief Complaint
Came for an elective extraction; blood pressure is very high at check-in.
Background and/or Patient History
  • Known hypertension, admits poor medication adherence
  • Blood pressure markedly elevated at the appointment
  • Elective extraction planned
Allergies
NKDA
Medications
  • Antihypertensive (inconsistent use)
Current Findings
  • Severely elevated blood pressure; otherwise the procedure is elective
  • Risk stratification needed before proceeding
  1. Question 1
    Moderate
    Markedly uncontrolled hypertension at an elective surgery visit should prompt:
  2. Question 2
    Moderate
    This patient's significant, activity-relevant systemic disease places him at least at:
  3. Question 3
    Moderate
    Checking vital signs before surgery is valuable precisely because it:
  4. Question 4
    Hard
    If this had been an emergency (not elective) procedure, the approach would:
  5. Question 5
    Easy
    This case illustrates that risk assessment can result in:

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Patient case: Planning surgery for a diabetic patient
0 of 5 answered, 0 correct
Patient
Female, 57 years old
Chief Complaint
Needs an extraction; has type 2 diabetes.
Background and/or Patient History
  • Type 2 diabetes, reasonably controlled
  • Asks how to prepare for the appointment
  • Concerned about healing
Allergies
NKDA
Medications
  • Metformin
Current Findings
  • Diabetic patient requiring an extraction
  • Planning timing and perioperative management
  1. Question 1
    Moderate
    Poorly controlled diabetes is relevant to surgery because it:
  2. Question 2
    Moderate
    To avoid intraoperative hypoglycemia, the patient should be advised to:
  3. Question 3
    Moderate
    The most common acute diabetic emergency to anticipate in the chair is:
  4. Question 4
    Moderate
    Good glycemic control before elective surgery is encouraged because it:
  5. Question 5
    Easy
    Overall, managing this patient illustrates:

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Patient case: A patient on a newer blood thinner
0 of 5 answered, 0 correct
Patient
Male, 72 years old
Chief Complaint
Needs a simple extraction; takes a direct oral anticoagulant.
Background and/or Patient History
  • On a direct oral anticoagulant (apixaban) for atrial fibrillation
  • Single simple extraction planned
  • Asks whether to stop the medication
Allergies
NKDA
Medications
  • Apixaban
Current Findings
  • Simple extraction in a patient on a direct oral anticoagulant
  • Otherwise stable
  1. Question 1
    Moderate
    For a simple extraction, a patient on a direct oral anticoagulant (such as apixaban) is generally:
  2. Question 2
    Hard
    Unlike warfarin, direct oral anticoagulants:
  3. Question 3
    Moderate
    Bleeding from the extraction is managed by:
  4. Question 4
    Moderate
    If a more extensive surgical procedure were planned, the clinician should:
  5. Question 5
    Easy
    The shared principle across warfarin, DOACs, and antiplatelets for simple extractions is:

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Patient Evaluation & Medical Risk Management core recall

Refresh the anatomy facts these cases depend on: nerve numbers, foramina, functions, and lesion findings.

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