MFDS Part 1 - Membership of Faculty of Dental Surgery Pharmacology and Pain Control Questions and Answers — Questions and Answers
Question 1: A healthy 4-year-old child weighing 18kg requires post-operative analgesia following a dental extraction. According to the British National Formulary for Children (BNFC), what is the appropriate single oral dose of paracetamol for this child?
- 180 mg
- 270 mg (Correct answer)
- 120 mg
- 500 mg
Correct answer: 270 mg
The British National Formulary for Children (BNFC) recommends a standard oral paracetamol dose of 15 mg per kg of body weight for children aged 1 month to 18 years, administered every 4-6 hours (maximum 4 doses in 24 hours). For an 18 kg child, the calculation is 18 kg x 15 mg/kg = 270 mg.
Question 2: A 62-year-old patient requests analgesia for acute dental pain. Their medical history includes a peptic ulcer 5 years ago, well-controlled hypertension treated with ramipril, and asthma. Which of the following analgesics is generally contraindicated?
- Co-codamol 8/500
- Paracetamol 500mg
- Dihydrocodeine 30mg
- Ibuprofen 400mg (Correct answer)
Correct answer: Ibuprofen 400mg
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are contraindicated in patients with a history of peptic ulceration due to the risk of gastrointestinal bleeding. They can also exacerbate asthma and should be used with caution in patients taking ACE inhibitors like ramipril.
Question 3: A patient undergoing conscious sedation with intravenous midazolam becomes over-sedated and experiences significant respiratory depression. According to UK sedation guidelines (IACSD), which drug is the specific reversal agent for this situation?
- Flumazenil (Correct answer)
- Naloxone
- Adrenaline
- Atropine
Correct answer: Flumazenil
Flumazenil is a specific benzodiazepine receptor antagonist and is the correct agent to reverse the sedative and respiratory depressant effects of midazolam. Naloxone is an opioid antagonist, Adrenaline is used for anaphylaxis, and Atropine is used to manage bradycardia.
Question 4: A 35-year-old patient presents with a painful, localised, fluctuant swelling adjacent to a non-vital lower molar. There are no signs of systemic involvement or spreading infection. According to the Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance, what is the most appropriate initial management?
- Prescribe a 5-day course of amoxicillin 500mg TDS
- Establish drainage of the abscess without prescribing antibiotics (Correct answer)
- Prescribe a 5-day course of metronidazole 400mg TDS
- Advise analgesics and review in 48 hours
Correct answer: Establish drainage of the abscess without prescribing antibiotics
Current UK prescribing guidance, such as from SDCEP ('Drug Prescribing for Dentistry'), promotes antimicrobial stewardship. For a localised dental abscess without signs of spreading infection or systemic upset in a healthy patient, the definitive treatment is to establish drainage (e.g., via incision or root canal access). Antibiotics are not indicated as a first-line measure in this scenario.
Question 5: What is the maximum recommended dose (MRD) of 2% lidocaine with 1:80,000 adrenaline for a healthy 70 kg adult, according to the British National Formulary (BNF)?
- 4.4 mg/kg
- 2.2 mg/kg
- 7.0 mg/kg (Correct answer)
- 10.0 mg/kg
Correct answer: 7.0 mg/kg
The British National Formulary (BNF) and other authoritative sources state the maximum recommended dose of lidocaine with adrenaline for dental use is 7.0 mg/kg of body weight, with an absolute maximum not to exceed 500 mg. The dose of 4.4 mg/kg is the maximum for lidocaine without a vasoconstrictor.
Question 6: A 68-year-old patient is diagnosed with idiopathic trigeminal neuralgia, experiencing severe, lancinating pains in the V2 distribution. According to the National Institute for Health and Care Excellence (NICE) guideline [CG173], which of the following is the recommended first-line pharmacological treatment?
- Amitriptyline
- Gabapentin
- Ibuprofen
- Carbamazepine (Correct answer)
Correct answer: Carbamazepine
The NICE clinical guideline [CG173] on 'Neuropathic pain in adults' specifically recommends offering carbamazepine as the initial treatment for trigeminal neuralgia. While other drugs like amitriptyline and gabapentin are used for different neuropathic pain conditions, carbamazepine is the established first-line choice for this diagnosis. Ibuprofen is not effective for neuropathic pain.
MFDS Part 1 - Membership of Faculty of Dental Surgery Pharmacology and Pain Control Questions and Answers
A healthy 4-year-old child weighing 18kg requires post-operative analgesia following a dental extraction.
According to the British National Formulary for Children (BNFC), what is the appropriate single oral dose of paracetamol for this child?