Dental MCQ
Recognize and respond · Oral Surgery · INBDE Patient Cases

Medical Emergencies in the Dental Office INBDE Patient Cases

By Dr. Isaac Sun, DDS

8 ADA INBDE-format patient cases on medical emergencies in the dental office. 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 medical emergencies in the dental office: vasovagal syncope managed by laying the patient supine with the legs elevated, anaphylaxis treated with intramuscular epinephrine, an asthma attack treated with albuterol and oxygen, chest pain distinguishing angina from a myocardial infarction with aspirin and EMS, conscious hypoglycemia treated with oral glucose (and glucagon if unconscious), a seizure managed by protecting the patient without restraint, hyperventilation syndrome managed by rebreathing rather than oxygen, and aspiration of a dental object managed by airway clearance with imaging and rubber dam prevention. Topics include syncope, anaphylaxis, airway obstruction and aspiration, angina and myocardial infarction, hypoglycemia, seizures, asthma, and local anesthetic toxicity.

Case Coverage Map
What each case is testing
A patient who faints during an injection:
Syncope as the most common office emergency, supine-with-legs-up management, the prodrome, rapid recovery, and prevention.
Hives, wheeze, and a falling blood pressure:
Anaphylaxis recognition, intramuscular epinephrine as first-line, antihistamines/steroids as adjuncts, and the isolated-hives contrast.
Wheezing and shortness of breath:
Asthma attack treated with albuterol and oxygen, upright positioning, escalation for severe attacks, and the hyperventilation contrast.
Chest pain in the dental chair:
Angina management (rest, nitroglycerin, oxygen), distinguishing it from a myocardial infarction, MI management (EMS, aspirin), and arrest/CPR.
A shaky, confused diabetic patient:
Conscious hypoglycemia treated with oral glucose, the unconscious-patient glucagon/IV-dextrose contrast, prevention, and the airway rationale.
A patient who begins convulsing:
Seizure management (protect, do not restrain or place objects in the mouth, time it), post-ictal care, status epilepticus, and the hypoglycemic-seizure caveat.
An anxious patient breathing too fast:
Hyperventilation syndrome (low CO2), rebreathing exhaled air, why oxygen is not the treatment, and the asthma contrast.
A patient who chokes on a dental object:
Airway management for aspiration (encourage cough, then abdominal thrusts), imaging for an unaccounted-for object, and rubber dam prevention.
Patient case: A patient who faints during an injection
0 of 5 answered, 0 correct
Patient
Male, 22 years old
Chief Complaint
Became pale and lightheaded, then briefly lost consciousness during a local anesthetic injection.
Background and/or Patient History
  • Anxious, healthy young patient
  • Felt nauseated, pale, and sweaty, then fainted in the chair
  • Brief loss of consciousness
Allergies
NKDA
Medications
  • None
Current Findings
  • Vasovagal syncope during the injection
  • Breathing spontaneously; pulse present
  1. Question 1
    Easy
    This is the most common office emergency, namely:
  2. Question 2
    Moderate
    The immediate management is to:
  3. Question 3
    Moderate
    The warning signs that preceded this event were:
  4. Question 4
    Moderate
    The expected course after correct positioning is:
  5. Question 5
    Moderate
    Prevention of recurrence focuses on:

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Patient case: Hives, wheeze, and a falling blood pressure
0 of 5 answered, 0 correct
Patient
Female, 39 years old
Chief Complaint
Rapidly developed hives, facial swelling, wheezing, and lightheadedness after a medication.
Background and/or Patient History
  • Received a medication, then within minutes developed widespread hives and swelling
  • Wheezing and a dropping blood pressure
  • Rapidly progressing
Allergies
Penicillin (reported)
Medications
  • None
Current Findings
  • Multisystem reaction: urticaria, angioedema, bronchospasm, hypotension
  • Consistent with anaphylaxis
  1. Question 1
    Moderate
    A rapid reaction with hives, swelling, wheeze, and hypotension is:
  2. Question 2
    Moderate
    The first-line treatment is:
  3. Question 3
    Moderate
    Antihistamines and corticosteroids in anaphylaxis are:
  4. Question 4
    Moderate
    Alongside epinephrine, the clinician should:
  5. Question 5
    Moderate
    If instead the patient had only isolated hives without airway or cardiovascular signs, the treatment would be:

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Patient case: Wheezing and shortness of breath
0 of 5 answered, 0 correct
Patient
Female, 31 years old
Chief Complaint
Sudden wheezing and difficulty breathing during a stressful procedure.
Background and/or Patient History
  • Known asthmatic
  • Audible wheeze, chest tightness, and dyspnea
  • Has her rescue inhaler
Allergies
NKDA
Medications
  • Albuterol inhaler
Current Findings
  • Acute bronchospasm (asthma attack) with wheeze and dyspnea
  • Conscious and able to use an inhaler
  1. Question 1
    Moderate
    The first-line treatment for this acute asthma attack is:
  2. Question 2
    Moderate
    Position and support for this patient include:
  3. Question 3
    Moderate
    If the attack is severe and not responding to albuterol, the clinician should:
  4. Question 4
    Moderate
    The recognition of an asthma attack rests on:
  5. Question 5
    Hard
    Compared with hyperventilation syndrome, an asthma attack:

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Patient case: Chest pain in the dental chair
0 of 5 answered, 0 correct
Patient
Male, 64 years old
Chief Complaint
Crushing chest pain that began during a stressful procedure.
Background and/or Patient History
  • History of coronary artery disease and angina
  • Chest pressure radiating to the left arm
  • Has nitroglycerin
Allergies
NKDA
Medications
  • Nitroglycerin (as needed)
Current Findings
  • Acute chest pain in a cardiac patient
  • Distinguishing angina from a myocardial infarction
  1. Question 1
    Moderate
    The immediate management of chest pain (angina) is to:
  2. Question 2
    Moderate
    If the chest pain resolves with rest and nitroglycerin, it was likely:
  3. Question 3
    Moderate
    If the chest pain persists despite rest and nitroglycerin, the clinician should suspect:
  4. Question 4
    Moderate
    Management of the suspected myocardial infarction includes:
  5. Question 5
    Moderate
    If the patient becomes unresponsive and stops breathing normally, the clinician should:

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Patient case: A shaky, confused diabetic patient
0 of 5 answered, 0 correct
Patient
Female, 54 years old
Chief Complaint
Became shaky, sweaty, and confused during a long appointment.
Background and/or Patient History
  • Type 1 diabetic who took her insulin but skipped breakfast
  • Shaky, diaphoretic, and confused but conscious and able to swallow
  • Long morning appointment
Allergies
NKDA
Medications
  • Insulin
Current Findings
  • Conscious hypoglycemia (shakiness, sweating, confusion)
  • Able to swallow
  1. Question 1
    Moderate
    Shakiness, sweating, and confusion in a diabetic who took insulin but skipped a meal suggest:
  2. Question 2
    Moderate
    Because she is conscious and can swallow, the treatment is:
  3. Question 3
    Hard
    If she had instead been unconscious, the appropriate treatment would be:
  4. Question 4
    Moderate
    This event could have been prevented by advising her to:
  5. Question 5
    Moderate
    The reason oral glucose is safe here but not in an unconscious patient is:

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Patient case: A patient who begins convulsing
0 of 5 answered, 0 correct
Patient
Male, 28 years old
Chief Complaint
Began a generalized convulsion during treatment.
Background and/or Patient History
  • Known epilepsy
  • Sudden generalized tonic-clonic seizure in the chair
  • Surrounding instruments and hard surfaces nearby
Allergies
NKDA
Medications
  • Antiseizure medication
Current Findings
  • Active generalized seizure
  • Need to protect the patient and time the event
  1. Question 1
    Moderate
    During an active seizure, the clinician should:
  2. Question 2
    Moderate
    After the seizure stops, the patient should be:
  3. Question 3
    Hard
    A prolonged or repeated seizure without recovery (status epilepticus) requires:
  4. Question 4
    Moderate
    Placing objects in the mouth of a seizing patient is:
  5. Question 5
    Hard
    If the seizure had been caused by hypoglycemia (e.g., in a diabetic), the additional key treatment would be:

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Patient case: An anxious patient breathing too fast
0 of 5 answered, 0 correct
Patient
Female, 25 years old
Chief Complaint
Very anxious, breathing rapidly, with tingling in the hands and lightheadedness.
Background and/or Patient History
  • Extremely anxious before a procedure
  • Rapid, deep breathing with circumoral and finger tingling and lightheadedness
  • No wheeze; no hives; conscious
Allergies
NKDA
Medications
  • None
Current Findings
  • Hyperventilation syndrome (anxiety-driven) with low carbon dioxide symptoms
  • No signs of asthma or anaphylaxis
  1. Question 1
    Moderate
    Rapid breathing with tingling and lightheadedness in an anxious patient (no wheeze) is:
  2. Question 2
    Hard
    The tingling and lightheadedness are caused by:
  3. Question 3
    Hard
    The appropriate management is to:
  4. Question 4
    Hard
    Supplemental oxygen is NOT given because:
  5. Question 5
    Moderate
    This contrasts with an asthma attack, which:

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Patient case: A patient who chokes on a dental object
0 of 5 answered, 0 correct
Patient
Male, 47 years old
Chief Complaint
Suddenly began choking after a small dental object slipped toward the throat.
Background and/or Patient History
  • A crown/instrument fragment slipped posteriorly during treatment
  • The patient is coughing forcefully and able to speak
  • No rubber dam was in place
Allergies
NKDA
Medications
  • None
Current Findings
  • Possible aspiration/swallowing of a dental object; effective cough present
  • Airway currently patent
  1. Question 1
    Moderate
    For a conscious patient with an effective, forceful cough, the first step is to:
  2. Question 2
    Moderate
    If the airway becomes obstructed (the patient cannot cough, speak, or breathe), the response is:
  3. Question 3
    Moderate
    If the object cannot be accounted for after the event, the patient needs:
  4. Question 4
    Moderate
    An aspirated object is dangerous because it can:
  5. Question 5
    Moderate
    A simple measure that helps prevent this complication is:

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Keep studying
Medical Emergencies in the Dental Office core recall

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

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