the eventual extraction (performed in a hospital…
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.
Mr. David Chen, a 58-year-old man, presents urgently on a Saturday morning with severe pain from a lower right wisdom tooth. He had a coronary artery stent placed 4 months ago and takes warfarin plus aspirin 100 mg daily. His cardiologist has advised he must remain on both medications. He has an INR of 3.0 from Friday's blood test. Clinical examination reveals a partially erupted tooth 48 with pericoronitis and localised swelling but no trismus or systemic signs of infection. During the eventual extraction (performed in a hospital setting), bleeding persists despite firm pressure, an absorbable haemostatic pack, and suturing. Adequate lighting and suction reveal bleeding is occurring from a single point at the base of the socket. What is the most likely cause?
- A. Aspirin-induced impairment of platelet aggregation
- B. An arterial bleed from an aberrant vessel
- C. Alveolar osteitis developing intraoperatively
- D. An elevated INR that was not rechecked on the day of surgery
- E. The haemostatic pack was placed incorrectly and needs repositioning
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According to TG, if bleeding is not controlled with local measures, the bleeding site should be examined thoroughly with adequate lighting and suction. Possible causes include an arterial bleed from an aberrant vessel or arteriovenous malformation. The management involves applying thorough pressure, suturing the vessel proximal to the bleeding point if accessible, packing the site tightly, and arranging urgent transfer to hospital with OMFS.
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