Free ACJ-style practice case with answers
Last reviewed 2026-09-27
A complete, original ACJ-style clinical case with answers, in the format of the NDEB Assessment of Clinical Judgement: a case history, findings, then linked single- and multi-answer questions.
How ACJ questions are scored
The ACJ has 120–150 questions over 5.5 hours, with one 30-minute break. Some questions have more than one correct answer; you earn part marks for each correct option you choose, but choosing any incorrect option scores zero for that question. So select only the options you are confident about.
Case: Constant throbbing pain, lower right
Patient: 34-year-old woman
Chief complaint: “My lower right back tooth has throbbed constantly for two days and it hurts to bite.”
| Medical history | Healthy. No medications. No known allergies. |
|---|---|
| Dental history | A large MOD restoration was placed on 46 about 3 years ago. Six weeks ago she had lingering pain to cold on the same tooth, which stopped by itself. |
| Extraoral | No swelling or lymphadenopathy. Temperature 36.8 °C. |
| Tooth 46 | Deep MOD composite with a marginal gap distally. Marked tenderness to percussion and to biting. No mobility. Probing depths within normal limits. |
| Pulp testing | No response to cold or electric pulp test on 46. Adjacent teeth respond normally. |
| Radiograph | Widened PDL space and a small radiolucency at the mesial root apex of 46. |
1. What is the most accurate pulpal and periapical diagnosis for 46?
- A. Symptomatic irreversible pulpitis; normal apical tissues
- B. Previously treated; acute apical abscess
- C. Pulp necrosis; chronic apical abscess
- D. Reversible pulpitis; asymptomatic apical periodontitis
- E. Pulp necrosis; symptomatic apical periodontitis
Show answer and explanation
Answer: E. Pulp necrosis; symptomatic apical periodontitis
No response to cold or EPT, after an earlier episode of lingering cold pain, points to pulp necrosis. Pain on percussion and biting with a widened PDL or small apical radiolucency is symptomatic apical periodontitis. There is no swelling or sinus tract, so it is not an abscess.
2. Which measures are appropriate at today’s emergency visit? (Select all that apply.)
Select all that apply — partial credit is possible.
- A. Recommend an analgesic regimen based on ibuprofen, with acetaminophen added if needed
- B. Prescribe amoxicillin routinely
- C. Leave the tooth open to drain between visits
- D. Place calcium hydroxide as an intracanal medicament and seal the access
- E. Access the tooth and carry out chemomechanical debridement of the canals with sodium hypochlorite irrigation
Show answer and explanation
Answer: A. Recommend an analgesic regimen based on ibuprofen, with acetaminophen added if needed; D. Place calcium hydroxide as an intracanal medicament and seal the access; E. Access the tooth and carry out chemomechanical debridement of the canals with sodium hypochlorite irrigation
Source control (debridement, then an inter-appointment medicament under a good seal) plus NSAID-based analgesia is the standard. Antibiotics are not indicated for localized symptomatic apical periodontitis with no swelling or systemic signs. Leaving a tooth open invites further contamination and worse outcomes.
3. Root canal treatment is completed. Which final restoration gives 46 the best long-term prognosis?
- A. Glass ionomer in the access cavity only
- B. A cuspal-coverage restoration such as an onlay or full crown
- C. A new MOD composite only
- D. No restoration; the root filling seals the tooth
- E. A long cast post in every canal with an amalgam core
Show answer and explanation
Answer: B. A cuspal-coverage restoration such as an onlay or full crown
Root-filled posterior teeth that have lost both marginal ridges fracture more often without cuspal coverage. A crown or onlay placed promptly after endodontics, with a good coronal seal, improves survival. Posts are for retaining a core and do not strengthen the root.
Practise more ACJ-style cases
PassDental has 25 original cases with 74 questions, scored with NDEB-style partial credit.
Try the free ACJ demoFree demo exam covering every blueprint area — no sign-up. Full bank from $129 CAD, one time.
Frequently asked questions
How is the ACJ different from the AFK?
The AFK tests fundamental knowledge with single-best-answer questions. The ACJ tests clinical judgement with case-based questions, radiographs and charts, and many questions have more than one correct answer.
How do partial marks work on the ACJ?
For multi-answer questions you earn part of the mark for each correct option you select, but selecting any incorrect option scores zero for that question.