ADC Practice Question — Spreading infections without severe features

Which clinical feature most strongly indicates this patient requires urgent hospital management?

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 24-year-old pregnant woman at 28 weeks gestation, presents to the emergency department with severe facial swelling and difficulty swallowing that started 2 days ago following dental pain from a lower left molar. She appears anxious and is sitting upright, leaning forward. On examination, there is bilateral swelling of the floor of mouth extending to the neck, trismus limiting mouth opening to 15mm, and muffled speech. Her temperature is 38.2°C, pulse 110 bpm, BP 125/85 mmHg, oxygen saturation 94% on room air. She reports increasing difficulty swallowing saliva. Which clinical feature most strongly indicates this patient requires urgent hospital management?

A. Dental pain from lower molar
B. Bilateral facial swelling
C. Temperature of 38.2°C
D. Swelling of floor of mouth
E. Pregnancy at 28 weeks

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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, swelling of floor of mouth is listed as a severe local feature that indicates risk of airway compromise and requires urgent hospital transfer.

Source: Ch 13: Acute odontogenic infections with severe features

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 Spreading infections without severe features 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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