Mini-Residency Entrance Exam | Dental Sleep Medicine Training for Dentists

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Question 1 of 42

1. Question
1. According to Merriam Webster Dictionary, what are the key characteristics of sleep?

Select all correct answers:
- A. Spontaneous
- B. Permanent
- C. Loss of memory
- D. Natural
- E. Reversible
- F. Loss of consciousness of one's surroundings
- G. Inessential
- H. Essential
- I. Irreversible
- J. Recovery
Question 2 of 42

2. Question
2: According to the 2015 American Academy of Sleep Medicine Practice Parameters, we recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy
- True
- False
Question 3 of 42

3. Question
3: What percentage of motor vehicle accidents are sleep related?
- A. 5%
- B. 10%
- C. 15%
- D. 20%
- E. 25%
Question 4 of 42

4. Question
4: Match the sleep apnea diagnosis with the correct definition.
Sort elements
- No airflow with effort
- No airflow and no effort
- A combination of obstructive and central sleep apnea
- Central Sleep Apnea
- Mixed Sleep Apnea
- Obstructive Sleep Apnea
Question 5 of 42

5. Question
5: Match the sleep stage with the correct percentage of adult sleep.
Sort elements
- 25%
- 5%
- 45%
- 25%
- REM
- Stage 2
- Stage 3
- Stage 1
Question 6 of 42

6. Question
6: According to the American Academy of Sleep Medicine, what was the estimated economic cost of untreated obstructive sleep apnea (OSA) in 2015?
- A. $50 billion
- B. $100 billion
- C. $125 billion
- D. $150 billion
- E. $200 billion
Question 7 of 42

7. Question
7: Select all of the following options that accurately describe the potential consequences of impaired growth hormone (GH) secretion due to poor sleep on overall health and development.
- A. Reduced muscle mass and strength
- B. Decreased bone density
- C. Impaired immune function
- D. Increased risk of obesity
- E. Enhanced cognitive function

Question 8 of 42

8. Question

8: Categorize the following characteristics of REM and NREM sleep.

Sort elements

REM
NREM

Includes sleep stages 1-3.
Stages progress from most wakefulness to deepest sleep.
EEG activity varies.
Low muscle tone and brain activity.
Removes unnecessary neural connections.

Not deep sleep.
Most important stage of sleep.
Brain activity increased.
Eyes move rapidly.
Atonicity.
Dreaming.
More EEG activity.
Longer duration in the second half of the night.
Memory consolidation of emotional events.
Reduces emotional tone of memories.

Question 9 of 42

9. Question
9: According to the American Academy of Sleep Medicine, the estimated economic cost of untreated obstructive sleep apnea (OSA) in 2015 is attributed to what?

Select all correct answers:
- A. Environmental pollution
- B. Foodborne illnesses
- C. Workplace accidents
- D. Lost productivity
- E. Sports injuries
- F. Comorbid diseases
- G. Motor vehicle accidents
Question 10 of 42

10. Question
10: According to the 2015 American Academy of Sleep Medicine Practice Parameters, we recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea).
- True
- False
Question 11 of 42

11. Question
11: Which hormone plays a role in preventing urine production and thus may explain why individuals with fragmented sleep or an undiagnosed sleep related breathing disorder may wake up during the night to urinate (nocturia)?
- A. Growth hormone
- B. Antidiuretic hormone
- C. Oxytocin
- D. Prolactin
Question 12 of 42

12. Question
12: In which stage of sleep are K complexes and sleep spindles typically observed on a sleep study?
- A. Stage 1
- B. Stage 2
- C. Stage 3
- D. REM sleep
Question 13 of 42

13. Question
13: Select all of the following options that accurately describe the effects of chronic sleep deprivation on cognitive function and performance.
- A. Impaired memory consolidation
- B. Decreased attention and concentration
- C. Increased reaction time
- D. Enhanced problem-solving skills
Question 14 of 42

14. Question
14: Which of the following best describes how poor sleep affects growth hormone (GH) secretion in children?
- A. Poor sleep increases GH secretion, leading to accelerated growth.
- B. Sleep disturbances have no effect on GH secretion in children.
- C. Inadequate or disrupted sleep can reduce overall GH secretion during the night.
- D. GH secretion in children is primarily influenced by dietary factors rather than sleep quality.
Question 15 of 42

15. Question
15: Mutual inhibition is the process by which neurons that promote wakefulness inhibit those that promote sleep, and vice versa, contributing to the stability of wakefulness and sleep cycles.
- True
- False

Question 16 of 42

16. Question

16: Categorize the following into Wake Promoting agonists and antagonists.

Sort elements

Agonists
Antagonists

Benzodiazepines, anti-histamines, anti-psychotic medications, norepinephrine receptor agonists (i.e. clonidine), melatonin, adenosine receptor agonists, tricyclic antidepressants (i.e. amitriptyline), serotonin-norepinephrine reuptake inhibitors (i.e. duloxetine, Effexor), orexin antagonists (i.e. Suvorexant), herbal supplements (i.e. chamomile)

Caffeine, Modafinil/Armodafinil, Stimulants, SSRI’s, antipsychotics, ADHD medications, histamine receptor agonists, stress, anxiety, noise, light

Question 17 of 42

17. Question
17: Which of the following statements accurately describes the effects of alcohol on wake-promoting neurons?
- A. Enhances dopamine and norepinephrine causing stimulation with higher blood alcohol levels.
- B. Initial consumption leads to increased wakefulness and arousal.
- C. Disrupts normal sleep patterns and interferes with the sleep-wake cycle.
- D. Facilitates sleep onset, but leads to fragmented and disrupted sleep later in the night.
- E. Reduces REM sleep duration and intensity and affects dreaming and dream recall.
- F. All of the above.
Question 18 of 42

18. Question
18: Bruxism can be a sign of a sleep related breathing disorder and a nightguard can make OSA worse if present and undiagnosed.
- True
- False
Question 19 of 42

19. Question
19: You calculate AHI by adding the total apneas and hypopneas and dividing by the sleep time.
- True
- False
Question 20 of 42

20. Question
20: Which of the following are common conditions that a dentist can identify during a regular exam that aid in screening for sleep-related breathing disorders?

Select all that apply:
- A. Scalloped tongue
- B. Excessive overbite/overjet
- C. Missing premolars or crowding (narrow arch)
- D. High palate
- E. Decay
- F. Mandibular Tori
- G. Bruxism
- H. Abfraction
- I. Aphthous Ulcers
- J. Acid erosion (Reflux/GERD)
Question 21 of 42

21. Question
21: The duration of NREM sleep increases toward the end of the night.
- True
- False
Question 22 of 42

22. Question
22: What is one of the predominant immediate responses of an apneic event?
- A. Parasympathetic nervous response
- B. Sympathetic nervous response
- C. Activation of the endocrine system
- D. Decrease in heart rate
Question 23 of 42

23. Question
23: Where is master clock of the brain that controls the timing of Circadian Rhythm located?
- A. Cerebellum
- B. Frontal Cortex
- C. Suprachiasmatic Nuclei (SCN)
- D. Amygdala
Question 24 of 42

24. Question
24: Select the key characteristics of sleep spindles and K complexes:
- A. Found in Stage 1 sleep
- B. Hallmark of memory activation
- C. Found in Stage 2 sleep
- D. Block out noise to help someone stay asleep
- E. Present during REM sleep
Question 25 of 42

25. Question
25: How is an oral appliance effective at treating obstructive sleep apnea (OSA)?
- A. By delivering continuous positive airway pressure (CPAP) to keep the airway open during sleep
- B. By administering medication to relax the muscles of the throat and prevent collapse of the airway
- C. By delivering oxygen directly to the lungs to improve breathing efficiency during sleep
- D. By using a custom-made appliance with a mechanism that supports the jaw in a protrusive position to maintain the airway and prevent obstruction
Question 26 of 42

26. Question
26: Which of the following are common signs and symptoms of possible sleep-related breathing disorders in children?
- A. Snoring loudly or gasping for air during sleep
- B. Chronic mouth breathing during the day
- C. Difficulty concentrating or behavioral problems at school or diagnosis of ADHD
- D. Dental abnormalities such as narrow dental arch, high palatal vault, or malocclusion
- E. Large tonsils
- F. All of the above
Question 27 of 42

27. Question
27: Which of the following options represents the best approach for referring patients for further sleep health screening and sleep studies?
- A. Option 1: Patient sees their PCP for screening and sleep study
- B. Option 2: Dentist refers to local board-certified sleep physician for screening and sleep study
- C. Option 3: Dentist helps patient schedule via telemedicine platform for screening and sleep study when appropriate
- D. Option 4: Patient self-refers to a sleep center without consultation from a healthcare provider
- E. Option 5: Patient relies solely on over-the-counter sleep aids without seeking professional evaluation
Question 28 of 42

28. Question
28: Sleep disorders are 85-90% undiagnosed. Obstructive sleep apnea is approximately 80% undiagnosed.
- True
- False
Question 29 of 42

29. Question
29: What is the most prevalent sleep disorder?
- A. Narcolepsy
- B. Obstructive Sleep Apnea (OSA)
- C. Insomnia
- D. Restless Leg Syndrome
Question 30 of 42

30. Question
30: Match the OSA diagnosis with the correct definition.
Sort elements
- Reduction in airflow by >30% from baseline with a decrease in oxygen saturation by > 3% or arousal lasting at least 10 seconds.
- Reduction in airflow by >90% for 10 seconds or more.
- A respiratory event that doesn’t meet hypopnea or apnea criteria, but causes an arousal.
- RERA
- Apnea
- Hypopnea
Question 31 of 42

31. Question
31: Match the AHI criteria with the correct severity.
Sort elements
- AHI <5
- AHI 5-14
- AHI 15-29
- AHI > 30
- Severe
- Normal
- Moderate
- Mild
Question 32 of 42

32. Question
32: What is hypercapnia?
- A. Elevated blood glucose levels
- B. Excessive carbon dioxide levels in the bloodstream
- C. Increased levels of adrenaline in the body
- D. Elevated blood pressure readings
Question 33 of 42

33. Question
33: Poor sleep in children is often misdiagnosed and treated as ADHD.
- True
- False
Question 34 of 42

34. Question
34: Identify the correct Mallampati Classification.
Sort elements
- Soft palate, uvula, fauces, and tonsillar pillars visible
- Soft palate, uvula, and fauces visible; tonsillar pillars not visible
- Only base of uvula visible
- Uvula not visible; no structures seen, only soft tissue
- Class II
- Class III
- Class IV
- Class I
Question 35 of 42

35. Question
35: Identify the correct Brodsky Pharyngeal Grading.
Sort elements
- Tonsils surgically removed
- Tonsils hidden within tonsillar pillars
- Tonsils extending to the pillars
- Tonsils beyond the pillars
- Tonsils extend toward midline
- Grade 4
- Grade 3
- Grade 2
- Grade 1
- Grade 0
Question 36 of 42

36. Question
36: A dentist can fabricate a snore guard without a sleep study.
- True
- False
Question 37 of 42

37. Question
37: Improper mouth breathing affects development, leading to various dental and craniofacial issues. Which of the following is a consequence of improper mouth breathing?
- A. Decreased risk of malocclusion
- B. Widening of the dental arch
- C. Enhanced development of the midface
- D. Increased risk of obstructive sleep apnea (OSA) as an adult
Question 38 of 42

38. Question
38: What is the main difference between CPAP, APAP, and BiPAP?
- A. CPAP delivers a fixed continuous pressure, APAP adjusts pressure automatically based on breathing patterns, and BiPAP delivers two levels of pressure during inhalation and exhalation.
- B. CPAP adjusts pressure automatically based on breathing patterns, APAP delivers two levels of pressure during inhalation and exhalation, and BiPAP delivers a fixed continuous pressure.
- C. CPAP delivers two levels of pressure during inhalation and exhalation, APAP delivers a fixed continuous pressure, and BiPAP adjusts pressure automatically based on breathing patterns.
- D. CPAP delivers a fixed continuous pressure, APAP delivers a fixed continuous pressure, and BiPAP delivers a fixed continuous pressure.
Question 39 of 42

39. Question
39: Nose cones can be an effective treatment modality to aid in maintaining nasal breathing.
- True
- False
Question 40 of 42

40. Question
40: What are the best ways to start the sleep screening conversation with patients?
- A. Obtain and review a comprehensive medical history including family and social history.
- B. Ask the patient about their sleep habits and whether they experience any snoring or daytime sleepiness.
- C. Share your dental findings with the patient and relate them to existing and potential medical conditions associated with sleep-related breathing disorders.
- D. Be aware of the defensive patient and don’t pressure them. Encourage the patient to reach out to their physician for further screening and offer to send a letter summarizing your findings.
- E. Avoid using specific terms such as "sleep apnea" until the patient has a diagnosis by a board certified sleep physician.
- F. Have options available to refer patients directly to a sleep physician to maintain urgency and to help patients move through the screening, diagnosis, and treatment process efficiently.
- G. All of the above.
Question 41 of 42

41. Question
41: Why is it important to send letters to patient’s physicians during the screening and treatment of obstructive sleep apnea in the dental practice?
- A. Sending letters ensures that the dental practice receives timely payments for services rendered.
- B. Letters serve as a legal requirement for documenting patient care and treatment protocols.
- C. Sending letters facilitates collaboration between the dental and medical team and establishes trust. Consistent communication between dental and medical teams regarding patient care strengthens relationships, improves quality of care for patients, and increases referrals leading to practice growth.
- D. Letters provide patients with detailed instructions on how to use oral appliances for sleep apnea treatment.
Question 42 of 42

42. Question
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