Dental OSCE (Objective Structured Clinical Examination) Practice Exam

What could be a possible cause for a patient's angina that does not improve after taking one nitroglycerin tablet in the dental chair?

1. Anxiety

2. Myocardial infarction (MI)

3. Hyperventilation

4. Acid reflux

The correct answer is: Myocardial infarction (MI)

A possible cause for a patient's angina that does not improve after taking one nitroglycerin tablet is a myocardial infarction (MI). Angina typically represents a temporary restriction of blood flow to the heart muscle, often due to factors like coronary artery disease. When a patient experiences angina that does not relieve with nitroglycerin, it may indicate that the heart tissue is undergoing more serious damage, such as in the case of an MI. During an MI, blood flow is significantly impaired or blocked for a longer duration, leading to chest pain that persists despite the use of nitroglycerin, which is designed to alleviate angina through vasodilation. In contrast, while anxiety can exacerbate feelings of chest pain, it usually does not directly cause angina that is unresponsive to nitroglycerin. Hyperventilation may mimic angina symptoms due to stress or anxiety, but it typically involves respiratory changes that don’t correspond with coronary artery issues requiring nitroglycerin. Acid reflux can also produce chest discomfort but does not typically respond to nitroglycerin since its mechanism is unrelated to cardiac ischemia. Thus, the inability of nitroglycerin to relieve the angina is a critical sign of potential myocardial infarction and warrants