ADC Practice Question — Local anaesthetic agents and properties

Given Rajesh's medical history, what was the primary contraindication to using adrenaline-containing local anaesthetic?

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.

Rajesh Patel, a 58-year-old man, presents for extraction of his lower left first molar. His medical history includes type 2 diabetes mellitus, hypertension controlled with amlodipine and ramipril, and a myocardial infarction 4 months ago. He takes metformin, gliclazide, aspirin, and atorvastatin. The dentist administers 3.6 mL of articaine 4% with adrenaline 1:100,000 for an inferior alveolar nerve block. Ten minutes later, Rajesh becomes restless and anxious, complaining of tinnitus and dizziness. His heart rate increases to 110 bpm, and he appears confused. Given Rajesh's medical history, what was the primary contraindication to using adrenaline-containing local anaesthetic?

A. The combination of multiple cardiac medications
B. His age making him more sensitive to local anaesthetics
C. His recent myocardial infarction
D. His current antihypertensive medications
E. His diabetes mellitus and current medications

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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, adrenaline-containing solutions should be avoided in patients who have had a myocardial infarction in the previous 6 months. Rajesh had his MI only 4 months ago.

Source: Ch 8: Adding vasoconstrictors to local anaesthetics

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

Exam preparation FAQ

How do I approach an unfamiliar Local anaesthetic agents and properties vignette?

Extract key clinical data from the stem before reading options. There are usually 3–4 critical variables that determine the correct answer.

How should I prepare for Pharmacology & Therapeutics in the ADC exam?

Build competence across all topics. The exam tests application of guidelines to clinical scenarios, not memorisation.

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Given Rajesh's medical history, what was the primary contraindication to using adrenaline-containing local anaesthetic?

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