ADC Practice Question — Bisphosphonate / antiresorptive therapy — MRONJ

Ten weeks after extraction, the patient presents with…

Pharmacology questions in the ADC written exam test applied prescribing decisions, not rote recall of drug names. This exam-level vignette tests your ability to work through clinical details and arrive at the correct management.

Mr. Kenneth Marsh, a 70-year-old man with metastatic prostate cancer, has been receiving IV zoledronic acid every 3 months for the past 2 years for bone metastases. He presents with a dull ache from his lower right first molar. On examination, tooth 46 has a deep carious lesion with periapical tenderness and a periapical radiolucency on radiograph. The tooth is deemed non-restorable. He also takes docetaxel chemotherapy and dexamethasone. Ten weeks after extraction, the patient presents with exposed bone in the extraction socket. There is no pain and no inflammation. What MRONJ stage is this?

A. Stage 2 — symptomatic with pain and secondary infection
B. Stage 0 — nonspecific symptoms without exposed bone
C. Stage 1 — asymptomatic exposed bone or fistula probing to bone, no inflammation or infection
D. Not MRONJ — 10 weeks is too soon for a definitive diagnosis
E. Stage 3 — pathological fracture with exposed bone

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Sources cited

Therapeutic Guidelines v4 Odell's 3rd & 4th Ed IADT 2020 Code of Conduct CMS (Evans) Infection Control + more

Show the answer and cited explanation

Correct answer: C

According to TG, MRONJ Stage 1 is asymptomatic exposed bone or fistula probing to bone, with no inflammation or infection. Stage 0 has nonspecific symptoms but no exposed bone. Stage 2 has symptoms plus exposed bone with inflammation/infection. Stage 3 involves pathological fracture, extraoral fistula, or osteolysis. TG notes Stages 0 and 1 require monitoring only.

Source: Ch 23: MRONJ staging — Stage 1 = asymptomatic exposed bone, no inflammation

Remy's study tip — For pharmacology vignettes, read the patient’s medical history and allergies BEFORE looking at the drug options.

Exam preparation FAQ

Should I memorise guidelines word-for-word for Bisphosphonate / antiresorptive therapy — MRONJ?

Focus on decision points — when the guideline says X vs Y. The exam tests application, not recitation.

How are Bisphosphonate / antiresorptive therapy — MRONJ questions structured in the ADC written exam?

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