ADC Practice Question — Vasoconstrictors in local anaesthetics

What serious complication could develop if Rajesh'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.

Rajesh Patel, a 58-year-old man, presents for extraction of his lower left first molar. His medical history includes type 2 diabetes mellitus, hypertension controlled with amlodipine and ramipril, and a myocardial infarction 4 months ago. He takes metformin, gliclazide, aspirin, and atorvastatin. The dentist administers 3.6 mL of articaine 4% with adrenaline 1:100,000 for an inferior alveolar nerve block. Ten minutes later, Rajesh becomes restless and anxious, complaining of tinnitus and dizziness. His heart rate increases to 110 bpm, and he appears confused. What serious complication could develop if Rajesh's condition progresses?

A. Seizures and cardiovascular toxicity
B. Anaphylactic shock from delayed hypersensitivity
C. Methaemoglobinaemia from articaine overdose
D. Permanent facial nerve paralysis
E. Muscle trismus from intramuscular injection

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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, serious systemic effects of local anaesthetic toxicity include seizures and cardiovascular toxicity.

Source: Ch 8: Systemic toxicity of local anaesthetics

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 Vasoconstrictors in local anaesthetics vignette?

Extract key clinical data from the stem before reading options. There are usually 3–4 critical variables that determine the correct answer.

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