Dental MCQ
Chair-side emergencies · Cardio & Respiratory · INBDE Patient Cases

Clinical Correlations INBDE Patient Cases

By Dr. Isaac Sun, DDS

8 ADA INBDE-format patient cases on clinical correlations. Each case is a shared patient box (chief complaint, history, medications, allergies, exam) followed by linked multiple-choice questions with full distractor explanations. Practice the way the real exam is structured.

8 patient cases40 linked questionsADA INBDE formatFull distractor explanations

Eight ADA INBDE-format patient cases on chair-side cardiovascular and respiratory emergencies in dentistry: stable angina versus myocardial infarction with nitroglycerin and aspirin, an acute asthma attack treated with albuterol, anxiety-driven hyperventilation syndrome, opioid-induced respiratory depression reversed with naloxone, acute pulmonary edema from decompensated heart failure, a COPD exacerbation with titrated oxygen, anaphylaxis to amoxicillin treated with intramuscular epinephrine, and local anesthetic systemic toxicity (LAST). Topics include angina and the coronary supply, bronchodilators, the epinephrine cardiac dose limit, the nonselective beta-blocker interaction, hypertensive emergency versus urgency, vasovagal syncope positioning, and the emergency drugs a dentist uses.

Case Coverage Map
What each case is testing
Chest pressure during a stressful appointment:
Stable angina vs MI, nitroglycerin, EMS and aspirin for suspected MI, preload and oxygen demand.
Sudden wheeze and breathlessness during a filling:
Acute asthma, bronchoconstriction, albuterol first-line, upright positioning, when to call EMS.
Fast breathing and tingling hands before an extraction:
Hyperventilation syndrome, respiratory alkalosis, coached breathing, why oxygen does not help.
Hard to wake after extra pain pills:
Opioid respiratory depression, the toxidrome, airway and oxygen, naloxone and re-sedation.
Sudden severe breathlessness in the chair:
Acute pulmonary edema, left heart failure, upright positioning, oxygen and EMS, low saturation.
Worse-than-usual breathing in a COPD patient:
COPD exacerbation, bronchodilator, titrated oxygen and the hypoxic-drive caution, deferral.
Hives and throat tightness after an antibiotic:
Anaphylaxis to amoxicillin, vasodilation and capillary leak, intramuscular epinephrine, EMS.
Ringing ears and numbness after many cartridges:
Local anesthetic systemic toxicity, CNS signs to collapse, weight-based dose limits, oxygen and EMS.
Patient case: Chest pressure during a stressful appointment
0 of 5 answered, 0 correct
Patient
Male, 62 years old
Chief Complaint
"I'm getting chest pressure, like before," he says mid-appointment.
Background and/or Patient History
  • Presented for a crown preparation
  • History of stable angina with prescribed nitroglycerin
  • Chest pressure began during the stressful appointment
  • Brought his own nitroglycerin
Allergies
NKDA
Medications
  • Nitroglycerin (as needed)
  • Atorvastatin
Current Findings
  • Mild substernal pressure
  • Pulse 92, BP 150/88
  • No diaphoresis yet
  • Alert and talking
  1. Question 1
    Easy
    The best immediate step is to:
  2. Question 2
    Moderate
    If the pain resolves within minutes after rest and nitroglycerin, it was most likely:
  3. Question 3
    Moderate
    If the chest pain persists, radiates to the arm or jaw, and he becomes diaphoretic, you should suspect:
  4. Question 4
    Moderate
    After activating EMS for a suspected MI, a reasonable measure (if not contraindicated) is:
  5. Question 5
    Moderate
    Nitroglycerin relieves angina mainly by:

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Patient case: Sudden wheeze and breathlessness during a filling
0 of 5 answered, 0 correct
Patient
Female, 24 years old
Chief Complaint
"I can't catch my breath," she says, wheezing, during a filling.
Background and/or Patient History
  • Presented for a restoration
  • Known asthma
  • Began wheezing after stress and material odors
  • Forgot her rescue inhaler today
Allergies
NKDA
Medications
  • Albuterol rescue inhaler
  • Inhaled corticosteroid
Current Findings
  • Audible wheeze with prolonged expiration
  • Using accessory muscles
  • SpO2 92%
  • Speaking in short phrases
  1. Question 1
    Easy
    Her wheeze and difficulty exhaling indicate:
  2. Question 2
    Moderate
    The airflow limitation is due mainly to:
  3. Question 3
    Easy
    The most appropriate first treatment is:
  4. Question 4
    Easy
    While treating her, you should:
  5. Question 5
    Moderate
    You should activate EMS if she:

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Patient case: Fast breathing and tingling hands before an extraction
0 of 5 answered, 0 correct
Patient
Female, 30 years old
Chief Complaint
"My hands are tingling and I feel dizzy," she says, breathing fast.
Background and/or Patient History
  • Presented for an extraction
  • Very anxious about the procedure
  • Began breathing rapidly before the injection
  • Perioral and finger tingling
Allergies
NKDA
Medications
  • None
Current Findings
  • Rapid, deep breathing
  • Perioral and finger paresthesia
  • SpO2 99%
  • No wheeze, no chest pain
  1. Question 1
    Easy
    Her rapid breathing with tingling and a normal oxygen level suggests:
  2. Question 2
    Moderate
    The tingling is caused by:
  3. Question 3
    Moderate
    The best management is to:
  4. Question 4
    Moderate
    Supplemental oxygen here is generally:
  5. Question 5
    Moderate
    To reduce recurrence, the best approach is:

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Patient case: Hard to wake after extra pain pills
0 of 5 answered, 0 correct
Patient
Male, 35 years old
Chief Complaint
Escort: "He took extra pain pills and now he's hard to wake."
Background and/or Patient History
  • Recovering after a surgical extraction
  • Took more than the prescribed opioid for pain
  • Became increasingly drowsy
  • Difficult to arouse
Allergies
NKDA
Medications
  • Prescribed opioid analgesic
Current Findings
  • Slow respiratory rate, about 8 per minute
  • Pinpoint pupils
  • SpO2 falling to 89%
  • Responds only to vigorous stimulation
  1. Question 1
    Easy
    Slow breathing, pinpoint pupils, and deep drowsiness suggest:
  2. Question 2
    Moderate
    The first priority is to:
  3. Question 3
    Moderate
    The specific reversal agent is:
  4. Question 4
    Hard
    Opioids depress breathing by reducing the brainstem response to:
  5. Question 5
    Moderate
    After giving naloxone, you must keep monitoring because:

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Patient case: Sudden severe breathlessness in the chair
0 of 5 answered, 0 correct
Patient
Male, 75 years old
Chief Complaint
"I suddenly can't breathe, I feel like I'm drowning," he says.
Background and/or Patient History
  • Presented for denture work
  • Known heart failure
  • Acute severe shortness of breath during the appointment
  • Cannot lie back at all
Allergies
NKDA
Medications
  • Furosemide
  • Lisinopril
Current Findings
  • Severe dyspnea, sitting bolt upright
  • Crackles throughout both lungs
  • SpO2 86%
  • Frothy cough
  1. Question 1
    Moderate
    Acute severe dyspnea with diffuse crackles and low oxygen suggests:
  2. Question 2
    Moderate
    Fluid is backing up into the:
  3. Question 3
    Easy
    The best position for him is:
  4. Question 4
    Moderate
    The most appropriate actions are to:
  5. Question 5
    Moderate
    Unlike anxiety hyperventilation, his oxygen saturation is:

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Patient case: Worse-than-usual breathing in a COPD patient
0 of 5 answered, 0 correct
Patient
Male, 68 years old
Chief Complaint
"My breathing is much worse than usual today," he says.
Background and/or Patient History
  • Presented for an extraction
  • Severe COPD
  • Increased cough and breathlessness over two days
  • Using his rescue inhaler more often
Allergies
NKDA
Medications
  • Tiotropium
  • Albuterol
  • Home oxygen at low flow
Current Findings
  • Increased work of breathing with wheeze
  • SpO2 88% (baseline around 90%)
  • Speaking in short phrases
  • Afebrile
  1. Question 1
    Easy
    His worsening cough, wheeze, and breathlessness indicate:
  2. Question 2
    Moderate
    A reasonable first treatment is:
  3. Question 3
    Hard
    If he needs oxygen, the safest approach is to:
  4. Question 4
    Moderate
    Excessive oxygen in some chronic CO₂ retainers can:
  5. Question 5
    Moderate
    The best plan for the appointment is to:

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Patient case: Hives and throat tightness after an antibiotic
0 of 5 answered, 0 correct
Patient
Female, 40 years old
Chief Complaint
"My throat feels tight and I'm breaking out," she says soon after the medication.
Background and/or Patient History
  • Took the first dose of amoxicillin for a dental infection
  • Within minutes developed hives and throat tightness
  • Feels faint
  • No previously known drug allergy
Allergies
No previously known drug allergy
Medications
  • Amoxicillin (just started)
Current Findings
  • Diffuse hives and facial swelling
  • Wheeze and throat tightness
  • BP 84/50, pulse 120
  • Anxious and flushed
  1. Question 1
    Easy
    Hives, swelling, wheeze, and hypotension after a drug indicate:
  2. Question 2
    Easy
    The first-line treatment is:
  3. Question 3
    Moderate
    Her hypotension is mainly from:
  4. Question 4
    Moderate
    Epinephrine helps by causing vasoconstriction, supporting the heart, and:
  5. Question 5
    Moderate
    Alongside epinephrine, you should:

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Patient case: Ringing ears and numbness after many cartridges
0 of 5 answered, 0 correct
Patient
Male, 28 years old
Chief Complaint
"My mouth feels numb all over and my ears are ringing," he says after several injections.
Background and/or Patient History
  • Received multiple local anesthetic cartridges for extensive work
  • Reports perioral numbness, a metallic taste, and ringing ears
  • Becoming agitated, then drowsy
  • Small-framed adult
Allergies
NKDA
Medications
  • None
Current Findings
  • Perioral numbness and tinnitus
  • Muscle twitching
  • Progressing toward a seizure
  • Total anesthetic dose was high for his weight
  1. Question 1
    Moderate
    Perioral numbness, tinnitus, and twitching after a high anesthetic dose suggest:
  2. Question 2
    Moderate
    These early signs reflect effects on the:
  3. Question 3
    Hard
    If toxicity worsens, it can progress to:
  4. Question 4
    Moderate
    The key way to prevent this is to:
  5. Question 5
    Moderate
    The immediate management is to:

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Keep studying
Clinical Correlations core recall

Refresh the anatomy facts these cases depend on: nerve numbers, foramina, functions, and lesion findings.

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