Kaplan Medical Item Writing Audition – NBDE and INBDE

I. Editing an Item
A. The following item was written for first year dental students. This item is flawed. Included are
some comments from an educator and item analysis from student answers. Using this information
and Word “track changes”, please improve this item.

Teacher Comments: This item seems too easy. Improve this question to really test ABO Blood
typing to the test-taker. Edit the question and answers to be more difficult and direct their
learning to discriminate between test-takers who understand ABO blood typing and those who
need to study the topic more.

What blood type is known as the “universal donor”?

A. Type A-
B. Type B
C. Type AB+
D. Type Rh

II. Writing an Item

Please write a single best answer multiple choice item on a topic of your choice that you believe
would be difficult for a pre-dental student to answer but possible for a 3rd year dental student to
answer.

⦁ The item should not use “EXCEPT”, “None of the above”, or “all of the above”.
⦁ The item should not be a simple recall question (sometimes called a single jump or first
order item).
⦁ For example the following would NOT be acceptable: “Q: Cardiac output in a
normal 40 year old male would be ______. A: 6 l/min.”
⦁ The following is also NOT acceptable: “Q: What illness would be diagnosed if
the patient had kayser fleischer rings? A: Wilson’s Disease.”
⦁ However the following would be acceptable: “Q: In a patient with kayser
fleischer rings which of the following would be the best first pharmacologic
treatment? A: D-penicillamine.”

III. Writing an Explanation

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Please write an explanation for your submitted question. In addition to explaining why the
correct answer is correct, please also explain why the incorrect answers are not correct. It is not
acceptable to just say: “B is incorrect because A is correct.” Rather, you should address reasons
why a student answering this question incorrectly might have mistakenly chosen this answer.

IV. Improve an Item

Below, please see 3 Dental QBank items – 2 for the NBDE and one for the INBDE. Using track
changes, please comment on both items and improve as necessary.

NBDE - Basic Biomedical Science

Q1. One of the enzymes of the citric acid cycle, which is on the inner mitochondrial\ membrane,
also functions as complex II of the electron transport chain. This enzyme is also responsible for
converting succinate to fumarate, producing FADH2. The enzyme is

A. isocitrate dehydrogenase.
B. a-ketoglutarate dehydrogenase.
C. succinate dehydrogenase.
D. succinyl CoA synthase.

Explanation:
The correct answer is choice C. All Krebs cycle components are in the matrix of the
mitochondria except succinate dehydrogenase, which is in the inner mitochondrial membrane.
Succinate dehydrogenase reoxidizes FADH2 and passes electrons directly to Coenzyme Q.

Choice A - Isocitrate dehydrogenase, the rate limiting enzyme of citric acid cycle, produces
NADH. It is activated by ADP and inhibited by NADH.

Choice B - a ketoglutarate dehydrogenase, like pyruvate dehydrogenase, requires thiamine, lipoic

acid, CoA, FAD, NAD, and produces NADH.

Choice D - Succinyl CoA synthase catalyzes a substrate level phosphorylation of GDP to GTP.

NBDE - Dental Science

Q1. During access preparation of the mandibular central incisor, perforation is a possible
complication and is LEAST likely associated with

A. the lingual surface.

B. the mesial surface.
C. the distal surface.
D. the labial surface.
E. none; equally likely on all of the above surfaces.

Explanation:
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The correct answer is choice A. Lingual perforation is difficult because as you move the bur
toward the lingual, the shank will move toward the labial and will usually hit the incisal edge. It
is the incisal edge that acts to block any additional movement that would lead to a lingual
perforation. The access opening into the lingual surface of the mandibular central incisor points
the bur downward and towards the labial at an acute angle relative to the vertical. The dentist
must be careful not to move the bur too far toward the labial, which could result in a perforation
somewhere along the labial surface (choice D).

Mesial (choice B) or distal (choice C) perforation is also of concern, and the dentist needs to
make sure that the bur is along the axis of the tooth centered between the mesial and distal
aspects of the crown.

INBDE - Integrated Board Prep (Item Set - patient box with 2 questions)

Patient
Female, 13 years old

Chief Complaint
Routine dental exam
Background and/or Patient History

Current Findings
Class I occlusal caries in tooth 28.

Q1: What is the most likely orientation of the pulpal floor within the cavity preparation?

⦁ It is at the same level on the linguo-occlusal to the bucco-occlusal aspect

⦁ It is perpendicular to the long axis of the tooth.
⦁ It slopes downward from linguo-occlusal to the bucco-occlusal aspect
⦁ It slopes upward from the linguoocclusal to the buccoocclusal aspect.

Explanation:

The correct answer is D. Tooth 28 is a mandibular first premolar. In performing operative

dentistry on specific teeth, certain anatomic considerations may exist. Before proceeding with an
operative procedure, the doctor should examine the preoperative radiographs to identify possible
problems. The pulp of the mandibular first premolar follows the anatomy of the tooth. Therefore,
it has a very prominent buccal pulp horn and a much smaller lingual. The buccal pulp horn often
can be positioned near the center of the tooth, making it difficult to prepare the occlusal portion
for restoration. When the occlusal portion is involved, it is recommended that the floor of the
preparation be sloped upward from lingual to buccal to help avoid the pulp horn. Therefore,
choices A, B, and C are incorrect.

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Q2: Which one would be the most likely result of preparing the occlusal surface of the
preparation in only one plane?

⦁ It will help in achieving the desirable retention and resistance form.

⦁ It will help in conserving the tooth structure
⦁ It will help remove all the carious dentin
⦁ It will lead to pulp exposure.

Explanation:

The correct answer is D. The pulp of the mandibular first premolar follows the anatomy of the
tooth. Therefore, it has a very prominent buccal pulp horn and a much smaller lingual. The
buccal pulp horn often can be positioned near the center of the tooth, making it difficult to
prepare the occlusal portion for restoration. When the occlusal portion is involved, it is
recommended that the floor of the preparation be sloped upward from lingual to buccal to help
avoid the pulp horn. If the occlusal surface is prepared in one plane it will lead to pulp exposure.
All other choices A, B, and C are incorrect.