Dentistry — Facial Swelling, Jaw Injury and Oral Pain, NMC MBBS licence examination syllabus (Nepal Medical Council).
NMC-style practice questions written for this site. They are not past questions, and no past paper has been reproduced.
A man with a week of untreated toothache has swelling under both sides of the jaw, is drooling, and his voice is muffled. What is the priority?
Answer: The airway. Bilateral floor-of-mouth swelling with drooling and voice change indicates infection in the spaces surrounding the airway, which can obstruct over hours. This needs urgent senior and surgical involvement rather than oral antibiotics and review, and the difficulty opening the mouth will also make intubation harder.
A 58-year-old man reports jaw ache that occurs when he walks uphill and resolves within minutes of stopping. Why is a dental referral the wrong first step?
Answer: Because pain reliably provoked by exertion and relieved by rest is a cardiac pattern, and cardiac pain can radiate to the jaw or be felt there alone. An ECG and cardiac assessment come first; treating it as dental delays reperfusion in a time-critical condition.
A young man is assaulted and says his teeth no longer meet properly. What else should be examined, and why?
Answer: Sensation over the lower lip and chin, since the nerve runs within the mandible and numbness suggests a fracture through its canal; and the rest of the mandible, because it forms a ring and rarely fractures in a single place. The head injury must also be assessed — a blow sufficient to fracture the jaw is a blow to the head.
A patient has several upper teeth aching together, worse when bending forward, with nasal congestion. What does this pattern suggest?
Answer: Sinus rather than dental disease. Dental pain is typically localised to one tooth that is tender to percussion, whereas maxillary sinus disease refers pain to several upper teeth at once and worsens on bending forward.
A patient returns four hours after an extraction with continued bleeding. Outline the approach.
Answer: Apply sustained firm pressure with a rolled gauze bitten continuously, since repeatedly checking prevents a clot forming. If bleeding persists, ask why — anticoagulant or antiplatelet treatment, liver disease, or an undiagnosed bleeding disorder. Prolonged socket bleeding is occasionally the first presentation of a systemic bleeding problem.
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