Emergencies, angioedema and closing items

Correct answer: B. Albuterol by inhaler

• A. Epinephrine is reserved for an attack that fails to respond to the bronchodilator, or where anaphylaxis is suspected.
• B. Correct. Stop treatment, sit the patient upright, and give the short-acting beta-2 agonist — the patient's own inhaler or the one in the emergency kit — with supplemental oxygen.
• C. Nitroglycerin is for angina and would drop the blood pressure without helping the airway.
• D. Antihistamines have no role in an acute asthma attack.

Note: Prevention matters more: ask the patient to bring their inhaler, schedule morning appointments, and avoid aspirin and NSAIDs in aspirin-sensitive asthma.

Correct answer: C. Angioedema

• A. Cellulitis would be firm, hot, erythematous and tender, with systemic signs and an identifiable odontogenic source.
• B. An injection haematoma would be bruised and discoloured, and appears immediately rather than the following day.
• C. Correct. Diffuse, non-pitting, non-erythematous swelling of the lip appearing within hours to a day points to angioedema — commonly a reaction to latex, an anaesthetic component, or a drug such as an ACE inhibitor.
• D. A mucocele is a discrete bluish translucent nodule, not diffuse lip swelling.

Note: The danger is airway involvement. Any swelling of the tongue, floor of mouth or larynx is a medical emergency.

Correct answer: A. Metronidazole

• A. Correct. Metronidazole targets the anaerobic flora — fusiform bacteria and spirochaetes — driving the necrotising process, and the clinical response is usually rapid.
• B. Azithromycin has useful activity in periodontal disease but is not the drug of choice for anaerobic necrotising infection.
• C. Doxycycline is used in periodontal therapy for its anticollagenase effect at subantimicrobial dose, not for acute necrotising disease.
• D. Cephalexin covers gram-positive aerobes and offers little against strict anaerobes.

Note: Antibiotics are adjunctive. Debridement, oxygenating rinses, pain control and addressing the predisposing factors — smoking, stress, immunosuppression — do the real work. Warn patients about the disulfiram-like reaction with alcohol.

Correct answer: D. The path the mandible follows on opening

• A. The quality of the pain is central: dull and aching suggests muscular origin, while sharp and localised suggests intracapsular pathology.
• B. The type of pain matters for the same reason and helps separate myofascial from arthrogenous sources.
• C. Limitation of movement is a core part of the history and drives the diagnosis toward disc displacement without reduction, or toward muscular guarding.
• D. Correct per the reasoning below. The opening path — deviation or deflection — is an examination finding you observe, not something elicited in the pain history.

Note: ⚑ No key was marked for this item in the recall and the four options overlap considerably. The rationale above rests on separating history from examination. Treat this one as unresolved and worth discussing rather than memorising.