ADC Practice Question — Management of surgical haemorrhage

new INR comes back at 3.8. Given this result and her…

Q: Should I memorise guidelines word-for-word for Management of surgical haemorrhage?

Focus on decision points — when the guideline says X vs Y. The exam tests application, not recitation.

Q: How are Management of surgical haemorrhage questions structured in the ADC written exam?

ADC Management of surgical haemorrhage questions present as clinical vignettes requiring management decisions. The correct answer is always traceable to a guideline source.

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.

Mrs. Fatima Al-Rashid, a 75-year-old woman, presents for a routine dental check-up. She takes warfarin for atrial fibrillation. During examination, you discover a mobile, tender lower incisor (tooth 41) that she wishes to have removed. She also mentions she has been applying miconazole oral gel for oral thrush diagnosed by her GP last week. Her other medications include ramipril 5 mg and frusemide 20 mg daily. Her INR from 3 days ago was 2.6, but she does not have a more recent result. The new INR comes back at 3.8. Given this result and her medication list, what is the most appropriate plan?

A. The INR is too close to 4; defer the extraction until the miconazole course is complete and INR has stabilised
B. The INR is below 4; proceed with extraction using local haemostatic measures
C. Stop the miconazole oral gel immediately to bring the INR down before extraction
D. Refer to hospital for extraction under general anaesthesia due to the elevated INR
E. The INR of 3.8 is above the safe range for dental procedures; urgently refer to the medical practitioner

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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 Figure 13.73 in TG, while an INR of 3.8 is below 4, this patient has multiple additional risk factors that heighten bleeding risk: age >65 years (she is 75) and suboptimal anticoagulation control (elevated INR likely due to miconazole interaction with warfarin). The presence of these additional factors requires seeking advice from the medical practitioner before proceeding with invasive dental procedures.

Source: Ch 23: INR <4 — proceed with local haemostatic measures

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

Exam preparation FAQ

Should I memorise guidelines word-for-word for Management of surgical haemorrhage?

Focus on decision points — when the guideline says X vs Y. The exam tests application, not recitation.

How are Management of surgical haemorrhage questions structured in the ADC written exam?

ADC Management of surgical haemorrhage questions present as clinical vignettes requiring management decisions. The correct answer is always traceable to a guideline source.

Every answer, traced to the source.

Remy — the AI tutor inside Reviz — drills you on 7,000+ ADC-style cited questions with spaced repetition, on WhatsApp and the web.

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new INR comes back at 3.8. Given this result and her…

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