MFDS Human Disease and Pharmacology 2

Question 1

A patient with chronic kidney disease (eGFR 20 mL/min) requires a dental prescription for pain relief. Which analgesic is contraindicated and what is the recommended alternative?

Accepted Answer

NSAIDs (e.g., ibuprofen) are contraindicated as they reduce renal blood flow and can precipitate acute kidney injury; paracetamol is the recommended first-line analgesic

Answer

Paracetamol is contraindicated; use ibuprofen instead

Answer

Codeine is contraindicated; use diclofenac instead

Answer

All analgesics are safe in renal impairment

Question 2

What is the significance of an INR result for a patient taking warfarin, and what is the generally accepted safe range for dental extractions?

Accepted Answer

INR measures the degree of anticoagulation; dental extractions can generally be performed safely if the INR is 4.0 or below, with local haemostatic measures

Answer

INR measures liver function; no range is relevant for dentistry

Answer

INR must be below 1.0 for any dental procedure

Answer

INR is only relevant for patients on heparin, not warfarin

Question 3

A patient with a history of asthma experiences an acute asthma attack during dental treatment. What is the appropriate emergency management in the dental surgery?

Accepted Answer

Sit the patient upright, administer salbutamol 100 mcg via spacer (2-10 puffs), give high-flow oxygen, and call 999 if not responding

Answer

Administer intramuscular adrenaline immediately

Answer

Lay the patient flat and administer oral prednisolone

Answer

Give intravenous aminophylline and prepare for intubation

Question 4

Which hepatitis virus is most commonly transmitted through needlestick injuries in dental practice, and what is the post-exposure prophylaxis protocol?

Accepted Answer

Hepatitis B — post-exposure prophylaxis includes hepatitis B immunoglobulin (HBIG) and/or accelerated hepatitis B vaccination course if the recipient is not immune

Answer

Hepatitis A — no prophylaxis needed

Answer

Hepatitis C — immediate interferon treatment

Answer

Hepatitis E — oral ribavirin prophylaxis

Question 5

A patient taking a selective serotonin reuptake inhibitor (SSRI) antidepressant requires dental treatment. What is the most clinically significant drug interaction to be aware of?

Accepted Answer

SSRIs inhibit platelet aggregation, increasing the risk of post-operative bleeding, and there is a potential interaction with tramadol increasing the risk of serotonin syndrome

Answer

SSRIs potentiate the effect of local anaesthetics, causing prolonged numbness

Answer

SSRIs cause severe hypertension when combined with adrenaline-containing local anaesthetics

Answer

SSRIs have no clinically significant interactions relevant to dentistry

Question 6

What are the oral manifestations of iron deficiency anaemia?

Accepted Answer

Angular cheilitis, glossitis (smooth depapillated tongue), recurrent aphthous ulceration, and generalised oral mucosal pallor and atrophy

Answer

Gingival hyperplasia and excessive bleeding

Answer

Blue-black pigmentation of the gingivae

Answer

Bilateral parotid gland enlargement

A patient with chronic kidney disease (eGFR 20 mL/min) requires a dental prescription for pain relief.Which analgesic is contraindicated and what is the recommended alternative?

A patient with chronic kidney disease (eGFR 20 mL/min) requires a dental prescription for pain relief.
Which analgesic is contraindicated and what is the recommended alternative?