Behaviour, communication and quitting

Correct answer: B. Set a specific quit date

• A. Referral is appropriate as part of Arrange, providing follow-up and specialist support, but it comes after a quit plan exists.
• B. Correct. Within the 5 A's framework of Ask, Advise, Assess, Assist and Arrange, the first concrete action once willingness is established is to agree a quit date, ideally within the next two weeks. A specific date converts intention into a plan, and preparation such as removing cigarettes and telling family is organised around it.
• C. Abrupt cessation on a set date is more effective than indefinite gradual reduction, which tends to stall.
• D. Pharmacotherapy is offered as part of Assist, but it supports the plan rather than replacing it.

Correct answer: A. What makes you think you have a problem with your gums?

• A. Correct. An open-ended question cannot be answered with yes, no or a forced choice. It invites the patient to describe their concerns, reasoning and history in their own words, which surfaces information a checklist never reaches. Open questions are foundational to motivational interviewing.
• B. This invites a yes or no answer and is closed.
• C. This is also closed, answerable in a single word.
• D. This offers a forced choice between two alternatives, which is a closed question even though it looks conversational.

Correct answer: D. Decline to prescribe, offer a full examination and appropriate non-opioid management, and check the prescription monitoring programme

• A. Abrupt dismissal abandons someone who may have a substance use disorder and needs referral. Offer appropriate care and, where indicated, referral to treatment services.
• B. Prescribing to preserve rapport is how these patterns are sustained and puts the patient at risk.
• C. A smaller quantity of an unindicated opioid is still an unindicated opioid.
• D. Correct. Naming a specific drug, reporting lost prescriptions and refusing examination are classic signals. The professional response is neither to accuse nor to accommodate: decline the opioid, offer a proper diagnostic workup, treat the underlying cause, use NSAIDs which outperform opioids for dental pain, and consult the state prescription monitoring programme.

Correct answer: B. Group A beta-haemolytic Streptococcus

• A. Clostridium perfringens causes gas gangrene, a necrotising infection of a completely different character.
• B. Correct. Erysipelas is a superficial dermal cellulitis with prominent lymphatic involvement caused by Streptococcus pyogenes, a group A beta-haemolytic organism. It produces a sharply demarcated, raised, fiery red plaque, most often on the face or lower leg, and responds to penicillin.
• C. Actinomyces israelii causes cervicofacial actinomycosis with a woody induration and draining sinuses containing sulphur granules.
• D. Staphylococcus aureus causes deeper cellulitis, abscesses and impetigo, and its borders are typically indistinct rather than sharply demarcated.

Correct answer: B. A mesial concavity in the cervical third of the root and crown

• A. Both maxillary premolars have a lingual cusp; the first premolar's buccal cusp is notably longer and sharper than its lingual.
• B. Correct. The maxillary first premolar has a distinct mesial developmental depression running from the crown onto the root, and it is most often two-rooted. That concavity is clinically important because it complicates scaling, root planing and crown margin placement, and it predisposes to furcation involvement.
• C. The maxillary first premolar is most commonly two-rooted, with buccal and palatal roots, while the second is usually single-rooted.
• D. A distal marginal ridge groove is a feature of the maxillary first premolar in some descriptions but the mesial concavity is the definitive distinguishing feature.

Correct answer: B. The cervical line

• A. The cingulum is a prominent bulge on the cervical third of the lingual surface and is clearly visible from the occlusal aspect.
• B. Correct, and this is the exception. The cervical line, the cementoenamel junction, encircles the tooth in a plane perpendicular to the line of sight from the occlusal aspect, so it is not visible from directly above. It is seen from the facial, lingual and proximal views.
• C. Developmental grooves on the lingual surface are visible from the occlusal view.
• D. The mesiolingual and distolingual fossae flank the lingual ridge and are visible from above.