ADC Practice Question — Spreading infections without severe features

What is the most serious potential complication that could develop in this patient?

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.

Raj Patel, a 56-year-old man with type 2 diabetes and hypertension, presents to the emergency department with a 3-day history of severe facial swelling and difficulty swallowing. He developed toothache in his lower left molar 5 days ago but delayed seeking treatment. On examination, he has marked bilateral submandibular swelling extending to the submental area, with a woody, non-fluctuant consistency. His floor of mouth is swollen and elevated, pushing his tongue upward. He is sitting upright, leaning forward, and appears anxious. Vital signs show temperature 38.2°C, pulse 110 bpm, BP 145/90 mmHg, respiratory rate 22/min, oxygen saturation 96% on room air. He is taking metformin, ramipril, and amlodipine. What is the most serious potential complication that could develop in this patient?

A. Complete airway obstruction requiring emergency airway intervention
B. Spread to cavernous sinus causing brain abscess
C. Mandibular osteomyelitis requiring jaw reconstruction
D. Necrotising fasciitis of the neck and chest
E. Septic shock from overwhelming bacterial infection

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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: A

According to TG, Ludwig angina involves risk of airway compromise, and severe local features that indicate risk of airway compromise include difficulty breathing and swelling of floor of mouth.

Source: Ch 13: Ludwig angina and airway compromise risk

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 Spreading infections without severe features?

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

How are Spreading infections without severe features questions structured in the ADC written exam?

ADC Spreading infections without severe features questions present as clinical vignettes requiring management decisions. The correct answer is always traceable to a guideline source.

Every answer, traced to the source.

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