ADC Practice Question — Techniques and complications

What would be the most distinctive early clinical sign of methaemoglobinaemia in this patient?

Pharmacology questions in the ADC written exam test applied prescribing decisions, not rote recall of drug names. This exam-level vignette tests your ability to work through clinical details and arrive at the correct management.

Priya Sharma, a 27-year-old woman who is 12 weeks pregnant, presents to your dental practice for extraction of her impacted lower left third molar. She has a history of glucose-6-phosphate dehydrogenase (G6PD) deficiency and mentions that certain medications can cause her problems. She is otherwise healthy with no cardiovascular conditions. You are considering your local anaesthetic options and are concerned about using adrenaline during pregnancy. The procedure will likely require significant anaesthesia including a mandibular block and local infiltration. What would be the most distinctive early clinical sign of methaemoglobinaemia in this patient?

A. Drowsiness and fatigue
B. Slate-grey or blue skin, lips and nail beds
C. Tachycardia and shortness of breath
D. Severe headache and confusion
E. Localized paraesthesia at injection site

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Sources cited

Therapeutic Guidelines v4 Odell's 3rd & 4th Ed IADT 2020 Code of Conduct CMS (Evans) Infection Control + more

Show the answer and cited explanation

Correct answer: B

According to TG, the most distinctive clinical feature of methaemoglobinaemia is slate-grey or blue skin, lips and nail beds, and this can be the first sign.

Source: Ch 13: Methaemoglobinaemia clinical features

Remy's study tip — For pharmacology vignettes, read the patient’s medical history and allergies BEFORE looking at the drug options.

Exam preparation FAQ

How should I prepare for Pharmacology & Therapeutics in the ADC exam?

Build competence across all topics. The exam tests application of guidelines to clinical scenarios, not memorisation.

How do I approach an unfamiliar Techniques and complications vignette?

Extract key clinical data from the stem before reading options. There are usually 3–4 critical variables that determine the correct answer.

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