ADC Practice Question — Local anaesthetic toxicity

What is the most likely cause of Rajesh's current symptoms?

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. What is the most likely cause of Rajesh's current symptoms?

A. Anxiety reaction to dental procedure
B. Allergic reaction to articaine
C. Vasovagal response to the injection
D. Adrenaline overdose from vasoconstrictor
E. Local anaesthetic systemic toxicity

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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: E

According to TG, minor central nervous system effects including restlessness, anxiety, tinnitus, dizziness are early indicators of systemic toxicity from local anaesthetics.

Source: Ch 8: Systemic toxicity of local anaesthetics

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

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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.

How do I approach an unfamiliar Local anaesthetic toxicity vignette?

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

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