Dental MCQ
Hormone-driven syndromes · Renal & GI · INBDE Patient Cases

GI Hormones INBDE Patient Cases

By Dr. Isaac Sun, DDS

8 ADA INBDE-format patient cases on gi hormones. 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.

8 patient cases40 linked questionsADA INBDE formatFull distractor explanations

Eight ADA INBDE-format patient cases connecting GI hormones and clinical correlations to dentistry: hypoglycemia in the dental chair managed with oral glucose or glucagon, a GLP-1 receptor agonist (semaglutide) delaying gastric emptying and raising aspiration risk under sedation, undiagnosed diabetes presenting with xerostomia, oral candidiasis, and rapidly progressing periodontitis, uncontrolled diabetes impairing healing and the bidirectional periodontitis link, diabetic gastroparesis from autonomic neuropathy, Zollinger-Ellison syndrome from a gastrin-secreting tumor, carcinoid syndrome controlled with the somatostatin analog octreotide, and chronic pancreatitis with exocrine and endocrine failure causing steatorrhea and type 3c diabetes. Topics include gastrin, secretin, cholecystokinin, the incretin effect, somatostatin and octreotide, insulin and glucagon, and the two-way link between diabetes and oral health.

Case Coverage Map
What each case is testing
Insulin patient who skipped lunch:
Hypoglycemia recognition, oral glucose for the conscious patient, glucagon for the unconscious, and prevention by eating and timing.
On a weight-loss injection before IV sedation:
GLP-1 agonist delayed gastric emptying, aspiration risk under sedation, the incretin effect, and glucose-dependent hypoglycemia risk.
Dry mouth, thrush, and fast-moving gum disease:
Undiagnosed diabetes presenting orally with xerostomia, candidiasis, and rapid periodontitis, osmotic diuresis, and referral.
Gum infection that won't heal with high sugars:
Uncontrolled diabetes and impaired healing, the bidirectional periodontitis link, glycemic control before surgery, and infection effects.
Nausea, bloating, and swinging blood sugars:
Diabetic gastroparesis from autonomic neuropathy, erratic glucose, aspiration risk under sedation, and low-stress management.
Ulcers that keep coming back:
Zollinger-Ellison gastrinoma, excess gastrin and acid, avoiding NSAIDs, B12 with long-term acid suppression, and coordination.
Sudden flushing and diarrhea at a cleaning:
Carcinoid syndrome serotonin flushing and diarrhea, octreotide as a somatostatin analog, stress triggers, and calm management.
Greasy stools, weight loss, and new diabetes:
Chronic pancreatitis with exocrine and endocrine failure, steatorrhea, type 3c diabetes, vitamin K bleeding risk, and pre-op coordination.
Patient case: Insulin patient who skipped lunch
0 of 5 answered, 0 correct
Patient
Male, 47 years old
Chief Complaint
"I take insulin and I skipped lunch to get here on time."
Background and/or Patient History
  • Presented for a crown preparation
  • Type 1 diabetes on insulin
  • Took his usual insulin but skipped lunch before the afternoon appointment
  • Midway through, becomes shaky, sweaty, and confused
Allergies
NKDA
Medications
  • Insulin
Current Findings
  • Diaphoretic and tremulous
  • Confused but awake and able to swallow
  • Rapid pulse
  1. Question 1
    Moderate
    His shakiness, sweating, and confusion are most likely due to:
  2. Question 2
    Moderate
    Because he is awake and can swallow, the best immediate treatment is:
  3. Question 3
    Moderate
    If he lost consciousness and could not swallow, the appropriate treatment would be:
  4. Question 4
    Moderate
    Glucagon raises his blood glucose by acting on the:
  5. Question 5
    Moderate
    To prevent recurrence at future visits, the best advice is to:

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Patient case: On a weight-loss injection before IV sedation
0 of 5 answered, 0 correct
Patient
Female, 52 years old
Chief Complaint
"I'm scheduled for IV sedation to get my wisdom teeth out."
Background and/or Patient History
  • Scheduled for surgical extraction of impacted third molars with IV sedation
  • Takes semaglutide for type 2 diabetes and weight management
  • Ate a normal breakfast two hours ago
  • Otherwise healthy
Allergies
NKDA
Medications
  • Semaglutide (a GLP-1 receptor agonist)
  • Metformin
Current Findings
  • BP 126/80
  • Reports she often feels full for a long time after eating
  • Pre-sedation evaluation in progress
  1. Question 1
    Hard
    Her GLP-1 agonist raises a specific sedation concern because these drugs:
  2. Question 2
    Moderate
    The main danger of retained gastric contents under deep sedation is:
  3. Question 3
    Moderate
    The most appropriate step before proceeding is to:
  4. Question 4
    Moderate
    GLP-1 agonists help control type 2 diabetes partly by enhancing the:
  5. Question 5
    Hard
    Used as a single agent, a GLP-1 agonist's risk of causing hypoglycemia is:

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Patient case: Dry mouth, thrush, and fast-moving gum disease
0 of 5 answered, 0 correct
Patient
Male, 49 years old
Chief Complaint
"My mouth is always dry and I keep getting these white patches."
Background and/or Patient History
  • Presented with dry mouth and recurrent oral candidiasis
  • Reports increased thirst, frequent urination, and recent weight loss
  • Gums bleed easily and seem to be worsening quickly
  • No known medical diagnosis
Allergies
NKDA
Medications
  • None
Current Findings
  • Dry mucosa
  • Removable white plaques consistent with candidiasis
  • Rapidly progressing periodontitis
  1. Question 1
    Moderate
    His dry mouth, recurrent candidiasis, rapid periodontitis, thirst, and weight loss suggest undiagnosed:
  2. Question 2
    Moderate
    Candidiasis and rapid periodontitis are more common in poorly controlled diabetes because high glucose:
  3. Question 3
    Moderate
    The most appropriate action is to:
  4. Question 4
    Moderate
    His increased thirst and urination occur because high blood glucose causes:
  5. Question 5
    Moderate
    Achieving good glycemic control is expected to:

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Patient case: Gum infection that won't heal with high sugars
0 of 5 answered, 0 correct
Patient
Female, 58 years old
Chief Complaint
"The gum infection around my back teeth won't heal, and my sugars run high."
Background and/or Patient History
  • Presented with a periodontal abscess and poor healing after a prior extraction
  • Type 2 diabetes with consistently high HbA1c
  • Frequent gum infections
  • Takes metformin but admits poor adherence
Allergies
NKDA
Medications
  • Metformin (inconsistent use)
Current Findings
  • Periodontal abscess with purulence
  • Slow-healing extraction site
  • Generalized advanced periodontitis
  1. Question 1
    Moderate
    Her poor healing and recurrent periodontal infections are most directly related to:
  2. Question 2
    Moderate
    Beyond local treatment, the key to improving her oral outcomes is:
  3. Question 3
    Moderate
    Periodontal treatment in a diabetic patient can also:
  4. Question 4
    Moderate
    Before elective periodontal surgery, the most appropriate plan is to:
  5. Question 5
    Moderate
    If she developed a severe spreading oral infection, her diabetes control would likely:

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Patient case: Nausea, bloating, and swinging blood sugars
0 of 5 answered, 0 correct
Patient
Male, 61 years old
Chief Complaint
"I feel nauseated and bloated a lot, and my blood sugars are all over the place."
Background and/or Patient History
  • Presented for routine care, reports frequent nausea and early fullness
  • Long-standing type 2 diabetes with known neuropathy
  • Erratic blood glucose readings
  • Oral medications seem inconsistently absorbed
Allergies
NKDA
Medications
  • Oral hypoglycemics
  • Occasional antiemetic
Current Findings
  • Reports bloating and nausea, worse after meals
  • No acute abdominal emergency
  • Stable vitals
  1. Question 1
    Moderate
    His nausea, early fullness, and erratic glucose in long-standing diabetes suggest:
  2. Question 2
    Moderate
    Gastroparesis in diabetes is caused by:
  3. Question 3
    Hard
    His erratic glucose is partly because delayed emptying makes:
  4. Question 4
    Moderate
    A relevant dental and sedation concern in gastroparesis is:
  5. Question 5
    Moderate
    Overall dental management for this patient includes:

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Patient case: Ulcers that keep coming back
0 of 5 answered, 0 correct
Patient
Male, 45 years old
Chief Complaint
"I have stomach ulcers that keep coming back no matter what I take."
Background and/or Patient History
  • Presented for a checkup, mentions a long history of recurrent peptic ulcers
  • Ulcers persist despite high-dose proton pump inhibitor
  • Also has frequent diarrhea
  • Recently diagnosed with a gastrin-secreting tumor
Allergies
NKDA
Medications
  • High-dose omeprazole
Current Findings
  • Reports epigastric pain
  • On long-term acid suppression
  • No acute bleeding today
  1. Question 1
    Moderate
    Recurrent ulcers resistant to PPIs plus a gastrin-secreting tumor describe:
  2. Question 2
    Moderate
    The excess gastrin causes ulcers by overstimulating:
  3. Question 3
    Moderate
    A key dental prescribing implication for him is to avoid:
  4. Question 4
    Moderate
    His chronic high-dose acid suppression can, over time, reduce absorption of:
  5. Question 5
    Moderate
    The dentist's appropriate role is to:

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Patient case: Sudden flushing and diarrhea at a cleaning
0 of 5 answered, 0 correct
Patient
Female, 56 years old
Chief Complaint
"I get sudden flushing of my face and diarrhea, and I'm here for a cleaning."
Background and/or Patient History
  • Presented for routine care, reports episodic facial flushing and watery diarrhea
  • Diagnosed with a neuroendocrine (carcinoid) tumor
  • Takes octreotide injections
  • Episodes can be triggered by stress
Allergies
NKDA
Medications
  • Octreotide
Current Findings
  • Reports flushing episodes
  • Otherwise stable
  • Anxious about the appointment
  1. Question 1
    Moderate
    Her episodic flushing and diarrhea from a neuroendocrine tumor are characteristic of:
  2. Question 2
    Moderate
    Her octreotide controls symptoms because it is a:
  3. Question 3
    Moderate
    A sensible dental approach for her is to:
  4. Question 4
    Moderate
    Somatostatin (and octreotide) broadly:
  5. Question 5
    Moderate
    If she becomes very anxious and flushed during care, the appropriate response is to:

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Patient case: Greasy stools, weight loss, and new diabetes
0 of 5 answered, 0 correct
Patient
Male, 50 years old
Chief Complaint
"I've lost weight, my stools are greasy, and I was just told I'm diabetic."
Background and/or Patient History
  • Presented for extractions, reports greasy, foul-smelling stools and weight loss
  • History of chronic pancreatitis
  • Recently diagnosed with diabetes
  • Bruises easily
Allergies
NKDA
Medications
  • Pancreatic enzyme supplements
  • Newly started insulin
Current Findings
  • Thin, with signs of malnutrition
  • Reports steatorrhea
  • Easy bruising noted
  1. Question 1
    Moderate
    His greasy stools and weight loss reflect:
  2. Question 2
    Moderate
    His new diabetes occurred because pancreatic damage also reduced:
  3. Question 3
    Moderate
    His easy bruising suggests malabsorption of the fat-soluble vitamin:
  4. Question 4
    Moderate
    Before his extractions, the most appropriate step is to:
  5. Question 5
    Easy
    His overall picture reminds us that the pancreas has:

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GI Hormones core recall

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

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