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BOARD Exam MCQs on Medical Emergencies in Dental Practice – Oral and Maxillofacial Surgery

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Welcome to your BOARD Exam MCQs on Medical Emergencies in Dental Practice

A 24-year-old anxious male presents for extraction of an impacted mandibular third molar under local anesthesia. Shortly after administration of the anesthetic, he becomes pale, diaphoretic, and complains of dizziness. He then briefly loses consciousness. Which of the following is the most common medical emergency encountered in dental practice?

Angina pectoris

Hypoglycemia

Vasovagal syncope

Epileptic seizure

Acute asthma attack

None

A 30-year-old anxious woman becomes pale, sweaty, and loses consciousness immediately after receiving local anesthesia for a dental extraction. You suspect vasovagal syncope. Which of the following patient positions is contraindicated during the initial management of this medical emergency?

Supine position with legs elevated

Trendelenburg position

Upright (sitting) position

Semi-supine position

Recovery (lateral) position after regaining consciousness

None

A 38-year-old man with a known history of epilepsy develops a generalized tonic-clonic seizure during a dental extraction. The seizure persists for more than 5 minutes despite removal of instruments and appropriate supportive measures. Intravenous access cannot be obtained immediately. Which of the following is the first-line drug of choice for managing this patient in the dental setting?

Intravenous diazepam

Intramuscular midazolam

Oral phenytoin

Sublingual nitroglycerin

Intramuscular phenytoin

None

A 45-year-old man develops generalized urticaria, facial swelling, wheezing, and hypotension within minutes of receiving a local anesthetic during a dental procedure. You suspect anaphylaxis. What is the recommended initial dose and route of adrenaline (epinephrine) for this adult patient?

1:10,000 adrenaline administered as an IV bolus

0.3–0.5 mg of 1:1000 adrenaline administered intramuscularly (IM)

0.3–0.5 mg of 1:1000 adrenaline administered subcutaneously (SC)

1 mg of 1:10,000 adrenaline administered intramuscularly (IM)

0.1 mg of 1:1000 adrenaline administered intravenously (IV)

None

A 62-year-old man with a history of hypertension develops severe crushing retrosternal chest pain during a dental extraction. The pain radiates to his left arm and jaw and persists despite three doses of sublingual nitroglycerin administered 5 minutes apart. Which of the following is the most likely diagnosis?

Stable angina

Myocardial infarction

Hyperventilation syndrome

Gastroesophageal reflux disease (GERD)

Acute pericarditis

None

A 58-year-old man collapses in the dental chair and is found to be unresponsive, apneic, and pulseless. You are the only healthcare provider immediately available and begin cardiopulmonary resuscitation (CPR) while waiting for additional help. According to the latest American Heart Association (AHA) guidelines, what is the recommended compression-to-ventilation ratio for a single rescuer performing adult CPR?

15:2

30:2

5:1

10:1

15:1

None

A 35-year-old patient undergoes multiple dental procedures requiring a large dose of local anesthetic. Shortly after treatment, the patient develops cyanosis, headache, dizziness, and low pulse oximetry readings that do not improve with oxygen therapy. Methemoglobinemia is suspected. Which of the following local anesthetics is most commonly associated with this complication?

Lignocaine (Lidocaine)

Bupivacaine

Prilocaine

Mepivacaine

Articaine

None

A 54-year-old man suddenly becomes distressed while undergoing a dental procedure after aspirating a small object. He is unable to speak or cough effectively and appears panicked. Which of the following is considered the universal sign of laryngeal obstruction (choking)?

Violent coughing

Clutching the throat with both hands

Cyanosis of the lips

Unconsciousness

Stridor

None

A 22-year-old patient with Type 1 diabetes mellitus becomes restless during a dental extraction. He is confused, cold, clammy, diaphoretic, and trembling. His speech becomes slurred, and he appears anxious. Which of the following is the most likely diagnosis?

Diabetic ketoacidosis (DKA)

Hyperglycemia

Hypoglycemia

Thyroid storm

Hyperosmolar hyperglycemic state (HHS)

None

10.

A healthy 70-kg adult is scheduled for multiple dental extractions under local anesthesia using 2% lignocaine with 1:200,000 adrenaline. Before administering the anesthetic, you calculate the maximum safe dose to avoid local anesthetic systemic toxicity (LAST). What is the maximum recommended dose?

4.4 mg/kg

7.0 mg/kg

300 mg absolute

500 mg absolute

200 mg absolute

None

11.

A 29-year-old man presents to the dental clinic with severe chest pain, agitation, hypertension, and tachycardia shortly after admitting to recent cocaine use. Cocaine-induced acute coronary syndrome is suspected. Which of the following drugs is contraindicated in the initial management of this patient?

Nitroglycerin

Benzodiazepines

Beta-blockers

Aspirin

Oxygen (if hypoxemic)

None

12.

A 34-year-old woman with a history of bronchial asthma develops acute wheezing, dyspnea, and prolonged expiration during a dental procedure. She receives repeated doses of inhaled salbutamol, but her respiratory distress continues to worsen, and she has difficulty speaking in full sentences. Which of the following is the most appropriate next step in emergency management?

Intravenous aminophylline

Intramuscular adrenaline (epinephrine)

Oral theophylline

Inhaled corticosteroids

Oral prednisolone

None

13.

A 56-year-old patient with Cushing's syndrome and a history of long-term corticosteroid therapy presents for surgical removal of an impacted third molar under local anesthesia. The patient reports that they recently stopped taking their steroid medication. During the procedure, they become weak, hypotensive, confused, and collapse. Which of the following medical emergencies is the most likely diagnosis?

Adrenal crisis (Acute adrenal insufficiency)

Thyroid storm

Hyperglycemic hyperosmolar state (HHS)

Myxedema coma

Vasovagal syncope

None

14.

A 26-year-old anxious woman develops rapid, deep breathing during a dental extraction. She complains of dizziness, tingling around her mouth and fingers, and carpopedal spasm. Vital signs show tachypnea with normal oxygen saturation. Arterial blood gas (ABG) analysis is most likely to demonstrate which of the following?

Respiratory acidosis

Respiratory alkalosis

Metabolic acidosis

Metabolic alkalosis

Mixed respiratory and metabolic acidosis

None

15.

A 61-year-old man develops severe crushing retrosternal chest pain radiating to the left arm during a dental procedure. The pain persists despite administration of three doses of sublingual nitroglycerin, and an acute myocardial infarction (MI) is suspected. Which of the following correctly represents the traditional MONA acronym used in the initial management of suspected MI?

Morphine, Oxygen, Nitroglycerin, Aspirin

Midazolam, Oxygen, Nifedipine, Aspirin

Morphine, Oxygen, Nifedipine, Atropine

Metoprolol, Oxygen, Nitroglycerin, Aspirin

Morphine, Oxygen, Nitroglycerin, Atropine

None

16.

A 42-year-old man undergoing surgical extraction of an impacted mandibular third molar suddenly develops tinnitus, circumoral numbness, a metallic taste, agitation, and confusion immediately after administration of a local anesthetic. Local Anesthetic Systemic Toxicity (LAST) is suspected. What is the most appropriate initial management?

Administer IV lipid emulsion immediately

Stop the injection and manage the airway

Administer IV diazepam

Hyperventilate the patient

Place the patient in the upright position

None

17.

A 40-year-old woman with a history of hyperthyroidism presents for a dental procedure. She has a noticeable exophthalmos ("pop-eye" appearance). During treatment, she develops high fever, marked tachycardia, agitation, and delirium. Which of the following is the most likely diagnosis?

Hypothyroidism

Thyroid storm

Addisonian crisis

Pheochromocytoma

Hyperventilation syndrome

None

18.

A 64-year-old man becomes unresponsive, pulseless, and apneic while undergoing a dental procedure. You immediately begin high-quality cardiopulmonary resuscitation (CPR) while another team member activates emergency medical services and retrieves an automated external defibrillator (AED). According to the latest AHA guidelines, what is the recommended depth of chest compressions for an adult?

At least 1.5 inches (4 cm)

At least 2 inches (5 cm)

Exactly 1 inch (2.5 cm)

At least 3 inches (7.5 cm)

At least 1 inch (2.5 cm), but not more than 2 inches (5 cm)

None

19.

A 67-year-old man develops retrosternal chest pain during a dental procedure that is consistent with stable angina. You are about to administer sublingual nitroglycerin, but the patient states he took medication for erectile dysfunction the previous evening. Which of the following drugs is a contraindication to administering nitroglycerin due to the risk of profound hypotension?

Aspirin

Sildenafil (Viagra)

Warfarin

Atenolol

Clopidogrel

None

20.

A 58-year-old man with a history of diabetes mellitus becomes confused and disoriented during a dental procedure. He is conscious but unable to provide a reliable history, and a glucometer is not immediately available. You are uncertain whether he is experiencing hypoglycemia or hyperglycemia. What is the most appropriate initial management?

Administer insulin

Administer glucose

Wait for laboratory confirmation

Administer normal saline

Administer glucagon only after loss of consciousness

None

21.

A 45-year-old anxious patient receives oral diazepam for conscious sedation before an oral surgical procedure. Shortly afterward, the patient becomes excessively drowsy with depressed consciousness and respiratory depression consistent with benzodiazepine overdose. Which of the following drugs is the specific antagonist for benzodiazepine overdose?

Naloxone

Flumazenil

Atropine

Protamine sulfate

N-acetylcysteine

None

22.

A 48-year-old patient is undergoing an oral and maxillofacial procedure under intravenous sedation. During administration of thiopentone sodium, the patient complains of severe burning pain and swelling at the injection site, raising suspicion of accidental extravascular (perivascular) injection. What is the most appropriate immediate management?

Apply a cold compress and leave the area undisturbed

Leave the needle in situ and inject procaine/lidocaine

Perform immediate incision and drainage

Inject adrenaline into the affected site

Remove the needle immediately and continue the procedure

None

23.

A 59-year-old man suddenly collapses during a dental procedure. He is unresponsive, apneic, and pulseless. CPR is initiated immediately, and an Automated External Defibrillator (AED) is attached. Which of the following cardiac rhythms is shockable with an AED?

Asystole

Pulseless electrical activity (PEA)

Ventricular fibrillation (VF)

Sinus bradycardia

Normal sinus rhythm

None

24.

A 68-year-old man develops marked bradycardia (heart rate 34 beats/min) during a dental procedure. He becomes hypotensive, dizzy, and confused, indicating hemodynamic instability. Which of the following is the drug of choice for the initial management of symptomatic severe bradycardia?

Adenosine

Atropine

Amiodarone

Lidocaine

Verapamil

None

25.

A 32-year-old patient is prescribed amoxicillin following surgical extraction of an impacted mandibular third molar. Within minutes of taking the first dose, the patient develops generalized urticaria, facial swelling, difficulty breathing, and hypotension. Which of the following best describes this reaction?

Type II hypersensitivity reaction

Type I hypersensitivity reaction

Type IV hypersensitivity reaction

Toxic reaction

Type III hypersensitivity reaction

None

26.

A dental team encounters two medical emergencies on the same day: an unresponsive adult in the dental chair and an unresponsive infant in the waiting area. Before initiating CPR, the healthcare provider checks for a pulse. According to current resuscitation guidelines, which pulse sites should be assessed in the adult and the infant, respectively?

Carotid pulse in the adult; Brachial pulse in the infant

Radial pulse in the adult; Femoral pulse in the infant

Carotid pulse in both the adult and infant

Brachial pulse in the adult; Carotid pulse in the infant

Radial pulse in both the adult and infant

None

27.

A 24-year-old anxious woman develops rapid, deep breathing during a dental extraction. She complains of dizziness, tingling around the mouth, and numbness in her fingers. She is alert, with normal oxygen saturation and no history of respiratory disease. Which of the following is NOT an appropriate management step for this patient?

Calm and reassure the patient

Breathing into a paper bag (historically recommended)

Cupping the hands over the mouth and nose to slow breathing

Administering 100% oxygen

Coaching the patient to breathe slowly and deliberately

None

28.

A 58-year-old man with end-stage renal disease (ESRD) undergoing hemodialysis three times per week presents for extraction of a grossly carious molar. To minimize the risk of bleeding related to heparin used during dialysis and to optimize the patient's medical status, when should the dental procedure be scheduled?

On the day of dialysis

The day after dialysis

Immediately before dialysis

Any time without regard to the dialysis schedule

Two days after dialysis

None

29.

A 46-year-old man develops tinnitus, circumoral numbness, seizures, and hypotension immediately after administration of a local anesthetic during a dental procedure. Despite airway management and supportive care, he develops signs of Local Anesthetic Systemic Toxicity (LAST). Intravenous lipid emulsion therapy is indicated. Which concentration of lipid emulsion should be used?

10% lipid emulsion

20% lipid emulsion

50% lipid emulsion

5% lipid emulsion

40% lipid emulsion

None

30.

A 50-year-old woman with a history of fatigue, weight loss, and postural hypotension presents for dental treatment. Oral examination reveals diffuse brown hyperpigmentation of the buccal mucosa and gingiva. Laboratory investigations confirm primary adrenal insufficiency (Addison's disease). The oral pigmentation is most likely due to elevated levels of which hormone?

Cortisol

Adrenocorticotropic hormone (ACTH)

Aldosterone

Adrenaline

Thyroid-stimulating hormone (TSH)

None

31.

A 64-year-old man with a history of poorly controlled hypertension develops a severe headache, chest discomfort, blood pressure of 230/130 mmHg, and altered mental status during a dental procedure. A hypertensive emergency is suspected. Which of the following drugs is most appropriate for emergency management?

Ephedrine

Sublingual nifedipine

Labetalol or nitroglycerin

Methoxamine

Atropine

None

32.

A 66-year-old man suddenly develops facial drooping, weakness of the right arm, and slurred speech while undergoing a dental procedure. A stroke is suspected. Which of the following correctly represents the FAST mnemonic used for rapid recognition of stroke?

Face, Arm, Speech, Time

Face, Airway, Speech, Tongue

Fast, Action, Save, Time

Face, Arm, Smile, Time

Face, Airway, Swallowing, Time

None

33.

A 42-year-old man accidentally aspirates an extracted tooth during a dental extraction. He is conscious, able to speak, and coughing forcefully without signs of respiratory distress. What is the most appropriate initial management?

Perform the Heimlich (abdominal thrust) maneuver immediately

Perform back blows

Encourage the patient to continue coughing and monitor closely

Start cardiopulmonary resuscitation (CPR)

Perform blind finger sweeps to retrieve the tooth

None

34.

A 52-year-old man with a prosthetic heart valve is scheduled for a dental extraction involving manipulation of the gingival tissues. He has no history of penicillin allergy. According to current infective endocarditis prophylaxis recommendations, what is the standard antibiotic regimen?

Amoxicillin 2 g orally, 1 hour before the procedure

Amoxicillin 3 g orally, 1 hour before the procedure

Clindamycin 600 mg orally

Azithromycin 500 mg orally

Cephalexin 500 mg orally

None

35.

A 45-year-old anxious patient receives multiple cartridges of a local anesthetic containing epinephrine during a prolonged dental procedure. Shortly afterward, the patient develops palpitations, anxiety, tremors, and elevated blood pressure. Which of the following is NOT a typical sign of epinephrine overdose?

Tachycardia

Hypertension

Bradycardia

Anxiety/Fear

Tremors

None

36.

A 30-year-old patient with mild, well-controlled bronchial asthma undergoes surgical extraction of an impacted third molar. You need to prescribe an analgesic for postoperative pain. Which of the following is considered the safest analgesic for this patient?

Aspirin

Ibuprofen

Acetaminophen (Paracetamol)

Diclofenac

Naproxen

None

37.

A 68-year-old man taking warfarin for atrial fibrillation presents for a simple dental extraction. His International Normalized Ratio (INR) is 3.0, measured within the previous 24 hours. What is the most appropriate management?

Stop warfarin for 3 days before extraction

Proceed with the extraction using local hemostatic measures

Discontinue warfarin and bridge with heparin

Transfuse fresh frozen plasma before extraction

Postpone the extraction until the INR is below 2.0

None

38.

A 35-year-old woman develops generalized urticaria, facial swelling, stridor, wheezing, and hypotension within minutes of receiving amoxicillin following a dental extraction. Despite prompt recognition, her condition rapidly deteriorates. Which of the following is the main cause of death in anaphylaxis?

Cardiac arrhythmia

Upper airway obstruction (laryngeal edema)

Hypotension

Renal failure

Cerebral edema

None

39.

A 27-year-old woman who is 22 weeks pregnant presents with symptomatic dental caries requiring restorative treatment. She has an otherwise uncomplicated pregnancy. Which trimester is generally considered the safest period for routine dental treatment?

First trimester

Second trimester

Third trimester

Any trimester is equally preferred for elective treatment

None (dental treatment should be deferred until after delivery)

None

Time's up

Medical emergencies can occur unexpectedly during dental treatment, making it essential for every dental student and practicing dentist to understand their recognition and management. This collection of BOARD Exam MCQs on Medical Emergencies in Dental Practice is designed to help candidates prepare for competitive and licensing examinations through clinically oriented questions.

The MCQs in this article cover important topics such as basic life support (BLS), cardiopulmonary resuscitation (CPR), airway management, oxygen therapy, shock, tracheostomy, cricothyrotomy, endotracheal intubation, medical emergencies under general anesthesia, Ludwig’s angina, maxillofacial trauma airway management, and emergency pharmacology. Every question includes the correct answer, a concise explanation, a BOARD Exam Pearl, high-yield revision points, and references from standard textbooks.

These questions are useful for students and professionals preparing for:

BOARD Exams
BDS Professional Examinations
FCPS Part I & II Dentistry
NBDE
INBDE
ORE
NEET MDS
AIIMS MDS
DHA
HAAD
MOH
Prometric Dental Exams
ADC Australia
NZDREX

Whether you are preparing for university examinations, postgraduate entrance tests, or international dental licensing examinations, these MCQs provide an excellent resource for rapid revision and concept-based learning.

Continue practicing the questions below and test your knowledge of medical emergencies encountered in everyday dental practice.

Medical Emergencies in Dental Practice

BDS • FCPS • NBDE • INBDE • ORE • NEET MDS • AIIMS • DHA • HAAD • MOH • ADC • NZDREX

BOARD Exam MCQs on Medical Emergencies in Dental Practice – Oral and Maxillofacial Surgery

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