ADC Practice Question — Local anaesthetic toxicity

What serious complication should you be most concerned about if Priya's condition progresses?

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.

Priya Sharma, a 33-year-old software engineer, presents for extraction of her lower right wisdom tooth. She mentions she might be pregnant but hasn't confirmed it yet. During the procedure, you administer 3.6 mL of 2% lidocaine with adrenaline via inferior alveolar nerve block. Five minutes after injection, Priya becomes restless and anxious, complaining of ringing in her ears and dizziness. Her speech becomes slightly slurred and she appears drowsy. What serious complication should you be most concerned about if Priya's condition progresses?

A. Permanent facial nerve paralysis
B. Prolonged anaesthesia lasting weeks
C. Anaphylactic shock requiring adrenaline
D. Seizures and cardiovascular toxicity
E. Methaemoglobinaemia with cyanosis

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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: D

According to TG, serious systemic effects include seizures and cardiovascular toxicity as progression from early CNS symptoms.

Source: Ch 8: Serious systemic effects

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 toxicity 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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What serious complication should you be most concerned about if Priya's condition progresses?

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