450 Answer Key • Sample Examination
24. C. Lisinopril, by virtue of the fact that it inhibits
angiotensin-converting enzyme (also called pep-
tidyl dipeptidase), inhibits the breakdown of
bradykinin.
25. D. Diazepam, epinephrine, and insulin act at ion
channel receptors, G-protein–linked receptors,
and tyrosine kinase–linked receptors, respectively.
ese three receptor types are cell surface recep-
tors. yroid hormone and steroid hormones or
drugs, such as prednisone, act on nuclear recep-
tors, accounting for much of their action. e tive potassium channels in the cell membranes of
action of heparin is to stimulate antithrombin III
in the plasma. Its action is extracellular.
26. A. All of the choices are oral hypoglycemic agents.
Only acarbose inhibits α-glucosidase.
27. D. Spironolactone, a potassium-sparing diuretic use-
ful in treating edema and heart failure, is a com-
petitive antagonist at the aldosterone receptor.
28. B. Aldosterone and udrocortisone are selective min-
eralocorticosteroids. Hydrocortisone has signi -
cant mineralocorticoid and glucocorticoid activity.
Dexamethasone has very little mineralocorticoid
activity.
29. B. Glucocorticoids characteristically stimulate gluco-
neogenesis and lipolysis. Insulin has the opposite
e ects. e other hormones listed have minor or
negligible e ects.
30. C. Renal tubular acidosis, aminoaciduria, and hyper-
phosphaturia are some of the manifestations of
proximal tubule damage in Fanconi’s syndrome.
31. D. Of the choices given, only vancomycin is e ective
against many methicillin-resistant staphylococci.
Various penicillins, macrolides, and clindamycin
are ine ective.
32. C. Because it lacks a cell wall, M. pneumoniae is not
sensitive to cell wall inhibitors such as penicillin
V. e macrolides (e.g., clarithromycin) are ri-
bosomal protein synthesis inhibitors that are
e ective against M. pneumoniae. Viridans strepto-
coccus, S. pneumoniae, and S. pyogenes are gram-
positive cocci. L. buccalis is a gram-negative oral
bacillus.
33. A. e short elimination half-time for penicillin V is
due to rapid excretion of penicillin in the urine.
About 90% of this renal excretion is a result of
active tubular transport, a rapid and e cient
process. (Very little metabolism of penicillin
occurs.)
34. E. Amoxicillin, clarithromycin, and clindamycin are
e ective against some anaerobes, but their spec-
trum is not limited to anaerobic bacteria. Amino-
glycosides are e ective only against aerobes. e
action of metronidazole requires a reduced envi-
ronment. Its antibacterial spectrum is limited to
anaerobes. Metronidazole is also e ective against
many parasites.
35. B, D. Nonspeci c esterase in the plasma can metabo-
lize various esters. Articaine and acetylcholine
have ester bonds that are susceptible to these
enzymes. Bethanechol and carbachol are designed
to be resistant to hydrolysis by acetylcholinesterase
and plasma esterases. Pilocarpine is an alkaloid
that is not signi cantly a ected by these enzymes.
36. A—4; B—5; C—2; D—3; E—1. Glibenclamide is a
newer sulfonylurea-type drug that increases insulin
secretion by closing adenosine triphosphate–sensi-
β cells. Activating AMP kinase has an e ect of
regulating energy production, leading to the e ects
indicated above. An increase in glucagonlike
peptide leads to stimulation of insulin release, inhi-
bition of glucagon release, and reduced food intake.
37. A, E. Inhibitors of the α2/δ-1 protein subunit of
high-voltage–activated calcium channels have
selective antiepileptic e ects and have been
found to be useful in treating neuropathic pain.
Phenobarbital enhances chloride channel activity.
Carbamazepine is a sodium channel blocker,
and ethosuximide is an inhibitor of T-type
calcium channels.
38. D, E. e half-lives are as follows: chlordiazepoxide, 5
to 30 hours; diazepam, 30 to 60 hours; lorazepam,
10 to 18 hours; midazolam, 2 to 5 hours; triazolam,
1 to 2 hours.
39. B, E. Cleavage of the aromatic ring rarely, if ever,
occurs in the metabolism of local anesthetics.
Lidocaine does not possess an ester bond to be
metabolized.
40. C, D, E. Flumazenil blocks both types of benzodiaz-
epine receptors associated with γ-aminobutyric
acid A (GABAA) channels, blocking the e ects of
diazepam, zaleplon, and zolpidem, the latter
two being selective for the Bz1 receptor. Baclofen
stimulates GABAB receptors, and buspirone is a
partial agonist at serotonin 5-hydroxytryptamine
1A receptors.
Prosthodontics
1. A. e incisive papilla provides a guide for the ante-
rior-posterior position of the maxillary anterior
teeth. e labial surfaces of the central incisors are
usually 8 to 10 mm in front of the papilla. is
distance varies depending of the amount of resorp-
tion of the residual ridge, the size of the teeth, and
the labiolingual thickness of the alveolar process.
2. E. All of the statements are correct. VDR is a physi-
ologic rest position; it is the position of the man-
dible when the muscles are in their minimum state
of tonicity, which occurs when a patient is relaxed
with the trunk upright and the head unsupported.

In this position, the interocclusal distance is
usually 2 to 4 mm when observed at the rst
premolar area.
3. C. Stability is resistance to movement toward the
residual ridge. e function of the posterior palatal
seal is to improve retention, not stability. Stability
is determined by the size, height, or shape of the
ridge.
4. A. “Failure of an occlusal rest rarely results from a
structural defect in the metal and rarely if ever is
caused by distortion. erefore the blame for such
failure must o en be assumed by the dentist for not
having provided su cient space for the rest during
mouth preparations” (Carr AB, et al: McCracken’s
Removable Partial Prosthodontics, ed 11. St Louis,
Mosby, 2005).
5. D. To preserve the mounting relationship in the artic-
ulator of the maxillary cast (face-bow record) a er
processing a denture, an occlusal index of the max-
illary denture is made a er occlusal adjustments
and before decasting the denture. is procedure
has nothing to do with the mandible’s relationship
to the maxilla.
6. D. Angular cheilosis is described as in amed and
cracked corners of the mouth that can become
infected with bacterial and fungal organisms. It is
commonly seen in patients with dentures with
diminished vertical dimension of occlusion. It is
best treated with antifungal creams and correcting
the vertical dimension of occlusion.
7. A. When performing an occlusal adjustment, the goal
is to make centric relation and maximum intercus-
pation to coincide. None of the other choices
allows one to mount the casts reliably in centric
relation or allows one to perform this procedure
accurately.
8. B. e main purpose is to capture the in uence of the
mylohyoid muscle. e extent of this ange is
determined by the elevation of the oor of the
mouth when the patient wets the lips with the tip
of tongue. Pursing the lips forms the extension of
the buccal vestibule. e buccal vestibule is in u-
enced by the buccinator muscle, which extends
from the modiolus anteriorly to the pterygoman-
dibular raphe posteriorly and has its lower bers
attached to the buccal shelf and the external oblique
ridge.
9. B. e function of the direct retainer is to retain the
removable partial denture by means of the abut-
ments. Stabilization is provided by the minor con-
nector. Support is provided by the rest. e indirect
retainers improve the e ciency of the direct retain-
ers. Direct retainers do not add strength to the
major connector.
10. D. Tooth mobility is prevented or diminished
during function by the reciprocating clasp. e is commonly seen with large tuberosities.
Answer Key • Sample Examination 451
reciprocating clasp should contact the tooth on or
above the height of contour of the tooth, allowing
for insertion and removal with passive force. Dis-
placement of the RPD toward the tissue, causing
tissue recession, is a function of the lack of occlusal
rests.
11. D. is meets the de nition of centric relation and the
normal anatomic relationships of the temporo-
mandibular discs to the condyles. Centric relation
is a clinically repeatable mandibular position pri-
marily de ned by the temporomandibular joints,
not the teeth.
12. A. e retromolar pad should always be covered for
support of the mandibular denture base. e ret-
romolar pads and the buccal shelf are considered
primary areas of support for a mandibular distal
extension RPD or complete denture.
13. B. Anatomic landmarks to be used as guides in ar-
ranging the anterior teeth are the incisive papilla,
midsagittal suture, and ala of the nose (canine
lines). e incisive papilla is a good guide for the
anterior-posterior positioning of the maxillary an-
terior teeth. e labial surfaces of the central inci-
sors are usually 8 to 10 mm in front of the papillae.
is distance varies depending on the size of the
teeth and the labiolingual thickness of the alveolar
process, so it is not an absolute relationship.
14. A. e vibrating line is located by nding the ptery-
gomaxillary (hamular) notches and continues to
the median line of the anterior part of the so
palate slightly anterior to the foveae palatinae. A
V-shaped groove 1 to 1.5 mm deep and 1.5 mm
broad at its base is carved into the cast at the vibrat-
ing line. e narrow and sharp bead sinks easily
into the so tissue to provide a seal against air
being forced under the denture. Stability is resis-
tance to movement toward the residual ridge. e
post dam improves retention, not stability. It is
carved shallow in the midpalatal suture area. Sta-
bility is determined by the size, height, or shape of
the ridge.
15. D. e ala-tragus line posteriorly and the interpupil-
lary line anteriorly are used as guides to align the
occlusal plane for complete dentures. e Camper’s
line is also known as the ala-tragus line.
16. A. Teeth come together every time a patient swallows.
is can dislodge dentures secondary to breaking
the denture seal.
17. B. Epulis ssurata is a reactive growth to an overex-
tended or ill- tting denture ange. It is best
removed surgically. Papillary hyperplasia is found
in the palatal vault. It is caused by local irritation,
poor- tting dentures, poor oral hygiene, or leaving
dentures in 24 hours a day. Candidiasis is associ-
ated with papillary hyperplasia. Fibrous tuberosity
452 Answer Key • Sample Examination
18. C. “Failure of an occlusal rest rarely results from a
structural defect in the metal and rarely if ever is
caused by accidental distortion. erefore the
blame for such failure must o en be assumed by
the dentist for not having provided su cient space
for the rest during mouth preparations” (Carr AB,
et al: McCracken’s Removable Partial Prosthodon-
tics, ed 11. St Louis, Mosby, 2005).
19. B. Resin-modi ed glass ionomers combine some of
the advantages of glass-ionomer cements, such as
uoride release and adhesion, but provide higher
strength and low solubility. ese materials are
less susceptible to early moisture exposure than
glass-ionomer cements, but they exhibit increased
thermal expansion because of the addition of resin.
20. A. e width of an anterior tooth is usually identi ed
by the mesiofacial and distofacial position of
the line angles, the shape of the surface contour,
and light re ection between these line angles. e
contralateral tooth features should be duplicated
closely in the pontic, and the space discrepancy can
be compensated by modifying the shape of the
proximal areas.
21. C. e carboxylate groups in the polymer molecule
chelate to calcium.
22. B. Gold alloys are heavier for a given volume. Gold
alloys are so er. Base metals are cast at higher tem-
peratures, leading to greater shrinkage.
23. B. Polysul de has the highest tear strength of all elas-
tomeric impression materials.
24. B. Chroma is the saturation or intensity of the color
or shade. Value is the relative lightness or darkness
of a color. Opalescence is the light e ect of a trans-
lucent material.
25. B. Noble metals are gold, platinum, and palladium.
Silver is not considered noble; it is reactive but
improves castability. Noble alloys (old term was
semiprecious metal) have a noble metal content
greater than or equal to 25%. To be classi ed as
noble, palladium-copper, palladium-gold, and
palladium-cobalt alloys have no stipulation for
gold. High noble alloys have a high content of
gold (>60%).
26. D. All these reasons are correct. e provisional is
placed to protect the tooth and preserve healthy
tissues if proper contours and marginal integrity
are present. is is an excellent time to evaluate
and give feedback to the patient on how well he or
she is brushing and ossing.
27. C. Compomer cements (also known as resin-modi ed
glass ionomer cements) have low solubility, low
adhesion, and low microleakage. ey are not rec-
ommended to be used with all-ceramic restora-
tions because they have been associated with
fracture, which is probably due to water absorption
and expansion.
28. D. An important factor that a ects the metal-ceramic
bond is the surface treatment of the alloy before
ring porcelain. Air-abrasion of the cast alloy is
typically performed before the oxidation step to
help remove surface contaminants that remain
from devesting and to help clean the casting and
provide microscopic surface irregularities for
mechanical retention of the ceramic. e oxidation
step for the alloy can be performed in air or by
using the reduced atmospheric pressure (approxi-
mately 0.1 atm) available in dental porcelain
furnaces.
29. D. e casting alloy and luting agent have been shown
to have a minimal e ect on the retention of a
crown. e geometry of the preparation, parallel-
ism between the walls (taper), and surface texture
of the preparation have an e ect on the retention
of a crown.
30. B. e arcon articulator is capable of duplicating a
wide range of mandibular movements but is gener-
ally set to follow the patient’s border movements.
e terminal hinge axis is located, and a panto-
graph is used to record the mandibular move-
ments. ese mandibular movement tracings or
recordings are used to set the articulator.
31. A. If there is an existing pulp chamber and remaining
sound tooth structure, there is no need to place a
post. Placement of a post tends to require taking
additional tooth structure, which weakens a tooth.
32. E. A tooth moves within the limits of its periodontal
ligament during function. e relative immobility
of the osseointegrated implant compared with the
functional mobility of a natural tooth can create
stresses at the neck of the implant up to two times
the implied load on the prosthesis. Potential prob-
lems when connecting an implant with a tooth
include (1) breakdown of the osseointegration, (2)
cement failure on the natural abutment, (3) screw
or abutment loosening, and (4) failure of the
implant prosthetic component. Fracture in the
connector area is rarely seen in this situation.
33. C. e minor connector must have su cient bulk to
be rigid so that it transfers functional stresses e ec-
tively to the abutment or supporting teeth and
tissues. It should be located in the interdental
embrasure where it does not disturb the tongue
and should be thickest in the lingual surface, taper-
ing toward the contact area but not located on a
convex surface.
34. E. e posterior and anterior factors, position in the
mouth, and side shi in uence the occlusal
anatomy of a restoration.
35. E. e contact of the framework with parallel tooth
surfaces acting as guide planes provides a positive
path of placement and removal for the RPD. In
addition, guide planes can provide retention by

limiting the movement of the framework. e 43. B.
rest on the RPD prevents vertical or cervical
movement.
36. C. e clasps are meant to be exible to engage in
undercut. e rest of the components of the RPD
should be rigid.
37. A. Circumferential cast clasps are more rigid than
combination clasps or wrought wire clasps. Because
there is good stability of the prosthesis when the
tooth is supported, there is no need for the added
exibility in a normal situation.
38. E. e impression should be rinsed and disinfected
with glutaraldehyde or iodophor and should be
poured within 15 minutes from the time the
impression was removed from the mouth.
39. B. Isolation is the most important factor because it
prevents bacterial contamination, increasing the
success of the pulp cap procedure.
40. E. On a tooth-supported RPD with a circumferential
cast clasp assembly, there should be more than 180
degrees of encirclement by the clasp in the greatest
circumference of the tooth (that passes from di-
verging axial surfaces to converging axial surfaces).
Mesial and distal rests anterior and posterior to the
edentulous areas, respectively, are generally used.
41. A. Nonrigid connectors are used when it is not pos-
sible to prepare two abutments for a xed partial
denture (FPD) with a common path of placement
or to segment a large or complex FPD into shorter
components. Nonrigid connectors can be prefabri-
cated plastic patterns (female or keyway portion
and male or key portion) that are embedded in the
waxed crown and pontic patterns or custom-milled
in the cast crown. e second part is custom- tted
to the milled retainer and cast.
42. C. e recommended space or distance between the
border of the framework and the marginal gingiva
should be at least 6 mm.
Answer Key • Sample Examination 453
e minor connectors are the components that
serve as the part of the removable partial denture
that connect the major connector and other com-
ponents, such as the clasp assembly, indirect retain-
ers, occlusal rests, or cingulum rests.
44. D. e Munsell Color System, which is the basis of
shade guides such as Vita Lumin, is divided into
three dimensions: hue is the shade or color of an
object, chroma is the saturation or intensity of the
color or shade, and value is the relative lightness or
darkness of a color.
45. D. Opaque porcelain is used for masking the oxide
layer of the metal and provides the porcelain-metal
bond. e minimum thickness of the opaque is
about 0.1 mm.
46. B. Chroma is the saturation or intensity of the color
or shade. Value is the relative lightness or darkness
of a color. Metamerism is the phenomenon in
which a color match under a lighting condition
appears di erent under a di erent lighting condi-
tion. Fluorescence is the physical property in which
an object emits visible light when exposed to ultra-
violet light.
47. B, C, D. Silver is not considered noble. It is reactive.
It improves castability but can cause porcelain
“greening.”
48. B. e base paste in polyether impression material
contains a polyether polymer. Polydimethylsilox-
ane is the main base component of condensation
silicone. Polysul de polymer is found in polysul-
de impression material. None of these is a revers-
ible impression material.
49. A, B, C, D. Electrosurgery is contraindicated under all
of the conditions listed.
50. A, D. Retentive clasps need to be occlusal to the
survey line because they approach the tooth from
the occlusal. e I bar and T bar engage the under-
cuts of teeth by way of a gingival approach.