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Blood, balance, and homeostasis · Endocrine & Neuromuscular Physiology · INBDE Patient Cases

Hematology, Acid-Base & Temperature INBDE Patient Cases

By Dr. Isaac Sun, DDS

8 ADA INBDE-format patient cases on hematology, acid-base & temperature. 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 hematology, acid-base, and temperature: chronic kidney disease anemia driven by reduced kidney-derived erythropoietin with exogenous EPO replacement and the hypertension/thrombosis caution at over-aggressive targets, simple extraction on warfarin with INR in range continued with local hemostasis and metronidazole/azole INR-rising interactions, aspirin's irreversible platelet COX-1 acetylation lasting 7-10 days with most simple extractions continued, respiratory acidosis from benzodiazepine + opioid additive depression with airway-first and titrated naloxone + flumazenil reversal, diabetic ketoacidosis as high anion-gap metabolic acidosis with Kussmaul respiratory compensation and the MUDPILES differential, malignant hyperthermia from succinylcholine or volatile anesthetics in RYR1-susceptible patients treated with dantrolene plus supportive care, serotonin syndrome from tramadol plus SSRI with the mental-status/autonomic/neuromuscular triad and management with cyproheptadine in severe cases, and chemotherapy-related neutropenia with ANC and platelet checks before invasive work. Topics include blood composition and erythropoiesis, the hemostasis cascade with PT/INR vs PTT, antiplatelets and anticoagulants, ABO/Rh, Henderson-Hasselbalch and acid-base compensation, hypothalamic temperature regulation, and a basic immune cell overview.

Case Coverage Map
What each case is testing
Anemia in chronic kidney disease:
EPO deficiency drives CKD anemia; exogenous EPO replaces it; over-aggressive targets bring hypertension and thrombotic risk.
Simple extraction in a warfarin patient:
Continue warfarin (INR in range) with local hemostasis; PT/INR vs PTT; metronidazole/azole-INR interaction.
Aspirin and the 7-10 day platelet effect:
Irreversible platelet COX-1 acetylation; lasts 7-10 days (platelet lifespan); usually continue for simple extractions; dual antiplatelet caveat.
Respiratory acidosis from oversedation:
Benzo + opioid additive depression; airway/oxygen/bag-mask first; titrate naloxone + flumazenil; renal compensation hours-days.
DKA: high anion-gap metabolic acidosis:
Ketoacid-driven anion-gap metabolic acidosis; Kussmaul breathing as respiratory compensation; MUDPILES differential; defer elective work.
Malignant hyperthermia and dantrolene:
RYR1-susceptible + succinylcholine/volatile trigger; dantrolene blocks SR Ca2+ release; supportive care (stop trigger, O2, cooling, correct K+ and pH).
Serotonin syndrome from tramadol + SSRI:
Tramadol SNRI + mu agonist; triad (mental + autonomic + neuromuscular); seizure threshold lowered; non-serotonergic opioids for SSRI patients.
Immune cells, neutropenia, and chemotherapy:
Neutrophil first-responder; ANC <500 severe neutropenia; check ANC + platelets before invasive work; B-cell antibody vs T-cell cytotoxic roles.
Patient case: Anemia in chronic kidney disease
0 of 5 answered, 0 correct
Patient
Female, 70 years old
Chief Complaint
Fatigue and pallor; chronic kidney disease stage 4.
Background and/or Patient History
  • Stage 4 CKD
  • Hemoglobin 9 g/dL (normocytic, normochromic)
  • Receiving exogenous erythropoietin (epoetin alfa)
Allergies
NKDA
Medications
  • Epoetin alfa
  • Iron supplement
Current Findings
  • CKD anemia from EPO deficiency
  • Treated with exogenous EPO
  1. Question 1
    Moderate
    CKD anemia is caused primarily by:
  2. Question 2
    Moderate
    Exogenous EPO (epoetin alfa, darbepoetin) treats CKD anemia by:
  3. Question 3
    Hard
    An over-aggressive EPO target carries risk of:
  4. Question 4
    Moderate
    CKD also affects dental care because of:
  5. Question 5
    Easy
    The teaching point is that hematopoiesis:

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Patient case: Simple extraction in a warfarin patient
0 of 5 answered, 0 correct
Patient
Male, 72 years old
Chief Complaint
Non-restorable molar needs extraction; on warfarin for atrial fibrillation.
Background and/or Patient History
  • AFib on warfarin
  • Recent INR in target range
  • Routine single-tooth extraction planned
Allergies
NKDA
Medications
  • Warfarin
Current Findings
  • Anticoagulated patient needing simple extraction
  1. Question 1
    Moderate
    For a simple extraction on warfarin with INR in range, the approach is:
  2. Question 2
    Moderate
    PT/INR tests:
  3. Question 3
    Moderate
    Local hemostatic measures include:
  4. Question 4
    Moderate
    An antibiotic interaction that raises the INR is:
  5. Question 5
    Easy
    The teaching point is that warfarin patients:

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Patient case: Aspirin and the 7-10 day platelet effect
0 of 5 answered, 0 correct
Patient
Male, 65 years old
Chief Complaint
On daily low-dose aspirin for secondary prevention after MI; planning multiple extractions.
Background and/or Patient History
  • Post-MI on daily aspirin 81 mg
  • Multiple extractions planned
  • Discussion of aspirin's effect on bleeding
Allergies
NKDA
Medications
  • Aspirin 81 mg daily
  • Atorvastatin
  • Lisinopril
Current Findings
  • Cardiac aspirin patient needing extractions
  1. Question 1
    Easy
    Aspirin's antiplatelet effect lasts:
  2. Question 2
    Moderate
    Stopping low-dose aspirin before simple dental extractions in a cardiac patient is:
  3. Question 3
    Moderate
    Aspirin is mechanistically:
  4. Question 4
    Moderate
    A patient on aspirin + clopidogrel (dual antiplatelet) has:
  5. Question 5
    Easy
    The teaching point is that aspirin:

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Patient case: Respiratory acidosis from oversedation
0 of 5 answered, 0 correct
Patient
Male, 60 years old
Chief Complaint
Deeply sedated and slow respirations during a sedation case.
Background and/or Patient History
  • Moderate sedation with IV midazolam and IV fentanyl
  • Respiratory rate 6, SpO2 88%, end-tidal CO2 rising
  • Concern for additive CNS/respiratory depression
Allergies
NKDA
Medications
  • Midazolam + fentanyl (intraop)
Current Findings
  • Oversedation with hypoventilation and rising pCO2
  1. Question 1
    Moderate
    The acid-base disturbance is:
  2. Question 2
    Moderate
    Immediate management is:
  3. Question 3
    Moderate
    Reversal of the opioid and benzodiazepine uses:
  4. Question 4
    Hard
    Renal compensation for chronic respiratory acidosis would:
  5. Question 5
    Easy
    The teaching point is that combining benzodiazepine + opioid for sedation:

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Patient case: DKA: high anion-gap metabolic acidosis
0 of 5 answered, 0 correct
Patient
Male, 22 years old
Chief Complaint
Newly diagnosed type 1 diabetes presenting with polyuria, abdominal pain, Kussmaul breathing, and fruity breath.
Background and/or Patient History
  • Newly diagnosed type 1 diabetes
  • Polyuria, polydipsia, abdominal pain
  • Kussmaul (deep, rapid) breathing and fruity (ketotic) breath
Allergies
NKDA
Medications
  • None
Current Findings
  • Diabetic ketoacidosis (DKA): high anion-gap metabolic acidosis
  1. Question 1
    Moderate
    DKA is a:
  2. Question 2
    Hard
    Kussmaul breathing in DKA represents:
  3. Question 3
    Hard
    Other anion-gap metabolic acidoses (MUDPILES) include:
  4. Question 4
    Easy
    Elective dental care in this patient should:
  5. Question 5
    Easy
    The teaching point is that the acid-base panel:

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Patient case: Malignant hyperthermia and dantrolene
0 of 5 answered, 0 correct
Patient
Male, 30 years old
Chief Complaint
Sudden severe muscle rigidity, hyperthermia, and rising end-tidal CO2 under general anesthesia.
Background and/or Patient History
  • GA induced with sevoflurane and succinylcholine
  • Sudden masseter rigidity and rising end-tidal CO2
  • Temperature 39.5 °C and rising
Allergies
NKDA
Medications
  • Sevoflurane + succinylcholine (intraop)
Current Findings
  • Suspected malignant hyperthermia
  1. Question 1
    Moderate
    MH is triggered by:
  2. Question 2
    Moderate
    The MH antidote is:
  3. Question 3
    Moderate
    Supportive care in MH includes:
  4. Question 4
    Hard
    MH susceptibility is confirmed by:
  5. Question 5
    Easy
    The teaching point is that MH:

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Patient case: Serotonin syndrome from tramadol + SSRI
0 of 5 answered, 0 correct
Patient
Female, 38 years old
Chief Complaint
Confusion, tremor, sweating, hyperthermia, and clonus after starting tramadol while on fluoxetine.
Background and/or Patient History
  • Long-standing depression on fluoxetine (SSRI)
  • Started tramadol for dental postoperative pain
  • Two days later: confusion, tremor, sweating, hyperthermia, clonus
Allergies
NKDA
Medications
  • Fluoxetine
  • Tramadol (recent)
Current Findings
  • Suspected serotonin syndrome
  1. Question 1
    Hard
    Serotonin syndrome typically presents with:
  2. Question 2
    Moderate
    Tramadol is mechanistically unusual because it is:
  3. Question 3
    Hard
    Tramadol also:
  4. Question 4
    Hard
    Management of serotonin syndrome is:
  5. Question 5
    Moderate
    For dental analgesia in patients on SSRIs/SNRIs/MAOIs, the safer choices are:

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Patient case: Immune cells, neutropenia, and chemotherapy
0 of 5 answered, 0 correct
Patient
Male, 50 years old
Chief Complaint
Receiving chemotherapy for colorectal cancer; needs invasive dental work; ANC 800/uL.
Background and/or Patient History
  • 5-FU-based chemotherapy
  • Absolute neutrophil count (ANC) 800/uL (neutropenia)
  • Painful tooth requiring extraction
Allergies
NKDA
Medications
  • 5-FU-based chemotherapy
Current Findings
  • Neutropenic chemotherapy patient needing extraction
  1. Question 1
    Easy
    The first-responder phagocyte in innate immunity is the:
  2. Question 2
    Moderate
    ANC less than 500/uL defines:
  3. Question 3
    Moderate
    Before invasive dental work in a chemotherapy patient, check:
  4. Question 4
    Moderate
    B LYMPHOCYTES are responsible for:
  5. Question 5
    Easy
    The teaching point is that immune status:

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Hematology, Acid-Base & Temperature core recall

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