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1

How are Local Anaesthetic Drugs classified as?

Amides
Esters

2

Which is the gold standard Local Anaesthetic Drug?

Lidocaine

3

What properties should an anaesthetic should have?

 A specific and reversible action
 Good shelf life
 Non-irritant
 Produces no permanent damage
 No systemic toxicity
 High therapeutic ratio
 Active topically and by injection
 RAPID ONSET
 Suitable duration of action
 Chemically stable and sterilizable
 Combinable with other agents
 Non-allergenic
 Non- addictive

4

Which of the following local anaesthetic agent would be preferred in prolonged surgical procedure?

-Cocaine
-Bupivacaine
-Xylocaine
-Lidocaine
-Prilocaine

-Bupivacaine

5

Which Local Anaesthetic Drug is not used for pregnant women?

•Lidocaine 2%
•Prilocaine 3%
•Mepivacaine 2%
•Articaine 4%

•Prilocaine 3% (Felypressin)

6

Which is the reducing agent component of a local anaesthetic cartridge?

sodium metabisulphite (be careful with the name !!)

7

The antioxidant used to preserve epinephrine in a local anaesthetic solution is:

•Sodium chloride
•Sodium pentanthol
•Sodium hypochloride
•Sodium disulphide
•Sodium bisulphite

•Sodium bisulphite

8

Which period of action potential do anesthesiologic drugs last?

refractory period

9

How is an ester metabolized?

-in plasma by pseudocholinesterase
-hydrolysis in liver
-excreted in urine

10

How is an amide metabolized?

Biotransformation takes place where?

hydrolysis in liver apart from prilocaine and articaine

-Lidocaine in liver
-Articaine undergoes hydrolysis in plasma by pseudocholinesterase
-Prilocaine partly in lung

-excretion in urine

11

Which is the most potent vasodilator?

Procaine

12

Which local anesthetic induces methemoglobinemia?

a. Articaine
b. Lidocaine
c. Prilocaine
d. Procaine

c. Prilocaine

(Monoethylglycinexylidide and glycine xylidide produce Sedation - Lidocaine)

13

When Procaine undergoes metabolic breakdown the major metabolic product (metabolite) is what?

-PAMA
-para-aminobenzoic acid
-chloroprocaine
-pseudocholinesterase
-succinylcholine

para-aminobenzoic acid = PABA (be careful with the name !!)

14

Which is the size of a cartridge used by dentists?

1,8 ml or 2,2 ml

15

Procaine excretion - appears in urine as:

PABA

16

What are the benefits of a vasoconstrictor in a local anesthetic?

 More profound anaesthesia
 More prolonged anaesthesia
 Reduced operative haemorrhage

17

Activation of α and β receptors:
excitatory vs inhibitory
contraction vs dilation

 Activation of α receptors – contraction of smooth muscle – vasoconstriction
• α 1 – excitatory postsynaptic
• α 2 – inhibitory postsynaptic

 Activation of β receptors – smooth muscle relaxation
• β 1 – in the heart and small intestine causing cardiac stimulation and increased heart rate and lipolysis
• β 2 – brochi, vascular beds and uterus producing brochodilation and vasodilation

18

Which nerve is for motor innervation of muscles of mastication?
-CN V
-CN VII
-CN VI
-CN IV

-CN V

19

What is the name of the foramen that maxillary nerve exits the skull?

foramen rotundum

20

Anterior trunk of mandibular innervation:
Posterior trunk of mandibular innervation:

Anterior trunk:
• Sensory - buccal nerve
• Motor – lateral pterygoid, deep temporal and masseteric nerves

Posterior trunk:
• Sensory – auriculotemporal and lingual
• Mixed sensory and motor – inferior alveolar nerve

21

Which nerves are for sensory innervation of tongue?

-chondra tympani nerve and glossopharyngeal nerve
-lingual nerve and glossopharyngeal nerve
-hypoglossal nerve and glossopharyngeal nerve
-chondra tympani nerve and lingual nerve

-lingual nerve and glossopharyngeal n

22

Advantages and Disadvantages of the Metallic, Breech-loading Aspirating Syringe:

Advantages:
Visible cartridge
Aspiration with one hand
Autoclavable
Rust resistant
Long lasting with proper maintenance

Disadvantages:
Weight – heavier than plastic syringe
Syringe may be too big for small operators
Possibility of infection with improper care
Non-disposable

23

Advantages and Disadvantages of Pressure Syringes:

Advantages:
Measured dose
Overcomes tissue resistance
Nonthreatening (new devices)
Cartridges protected

Disadvantages:
Cost
Easy to inject too rapidly
Threatening (original device)

24

What is the use of Pressure Syringe?

for periodontal ligament injection

25

What is the ASA for a healthy 60 year old heavy smoker with no systemic conditions?

ASA II

26

The major factor influencing the ability to aspirate is what?

•Site of injection
•Size of clinicians hands
•Gauge of needle
•Harpoon being sterilised
•Size of thumb ring

•Gauge of needle

27

All of the following methods will REDUCE the chance of needle breakage, EXCEPT one - which one is the exception?

-establish a firm hand rest
-buring the needle to the hub
-using a larger gauge needle
-not bending the needle excessively
-minimising the need of redirection into the tissues

-buring the needle to the hub

28

What is the maximum dose of xylocaine without adrenaline that can be given in a 60 kg adult is?
•300 mg
•450 mg
•600 mg
•700 mg

•300 mg

29

What is the maximum epinephrine for cardiac patient?
•0,04 mg
•0,02 mg
•0,05 mg

•0,04 mg

30

Which anesthesia is called infiltration?

supraperiosteal

31

Why is the patient in pain after PSA N Block?

because MB root of maxillary molar isn't consistently innervated by PSA but also can be by MSA therefore a second local/subperiosteal infiltration is needed

32

Hematoma caused by which nerve blocks?

Greater Palatine Nerve
Anterior Superior Alveolar Nerve Block
Posterior Superior Alveolar Nerve Block

33

What is the target area of inferior alveolar nerve block?
•At mandibular foramen
•Superior to mandibular foramen
•Inferior to mandibular foramen

•Superior to mandibular foramen

34

What needs to be anesthetized for lower third molar extraction?
•Long buccal nerve and Lingual nerve
•Inferior alveolar nerve block and Long buccal nerve
•Inferior alveolar nerve block and Lingual nerve
•Mental nerve block and Inferior alveolar nerve block

•Inferior alveolar nerve block and Long buccal nerve

35

Inferior alveolar nerve block is given in:

-sublingual space
-pterygomandibular space
-submental space
-submandibular space
-retromolar space

pterygomandibular raphe

36

What nerve block to use for a maxillary canine restoration with the use of a rubber clamp on soft tissue?

Nasopalatine nerve and Anterior superior alveolar nerve block

37

Height of injection for Inferior Alveolar Nerve Block?

Imaginary line - place thumb of your left hand in the coronoid notch

38

Which are the Supplemental Injection Techniques?

-Intraosseous Injection
-Periodontal Ligament Injection and Intraseptal Injection are modification of traditional IO anaesthesia
-Intrapulpal Injection

39

How is facial nerve paralysis caused? By which anesthesias?

caused by introduction of local anaesthetic into the capsule of parotid gland
– Inferior Alveolar nerve block or Vazirani-Akinosi block

40

What happens if you don't aspirate with inferior alveolar nerve block?

fasial n paralysis

41

What is the dose of epinephrine in anaphylactic shock?
•500 micrograms
•500 miligrams

Adrenaline injection (1:1000, 1 mg/ml)
•500 micrograms

42

Relative contraindication for epinephrine?
•Hypothyroidism
•Hyperthyroidism

•Hyperthyroidism

43

What antibody is activated in anaphylaxis?
•IgE
•IgM
•IgG
•IgD

•IgE

44

What are the causes for pain and burning?

pH of the solution (being deposited to soft tissues and rapidly disappears), rapid injection, contaminated solution, overly warm solution

45

What are the causes of sloughing of tissues?

 Causes of epithelial desqumation
• Prolonged application of topical anaesthetic
• Heightened sensitivity of tissues to topical or injectable local anaesthetic

 Causes of sterile abscess
• Secondary or prolonged ischemia due to local anaesthetic with vasoconstrictor
• Usually develops on palate

46

Toxicity is Reduced by:

 Limiting the dose
 Avoid intravascular injection
 INJECTING SLOWLY

47

Colour coding for Oxygen Vs Nitrous oxide:

Oxygen: white
Nitrous oxide: blue

48

What levels of local anaesthetic can cause convulsions?

at levels greater than 7.5 μg
- tonic clonic seizures occur

49

One of the major proprietary names of Lidocaine is what?
-prilocaine
-mepivicaine
-xylocaine hcl
-sandonest hcl
-candicaine

-xylocaine hcl

50

After properly loading the cartridge into the syringe, a few drops of local anaesthetic should be expelled. Why?

-to ensure free flow of the solution
-to ensure the needle has not been barbed
-to ensure the ability to aspirate
-to ensure correct anaesthetic is used
-to ensure proper placement of harpoon

-to ensure free flow of the solution

51

Alpha adrenergic agonists are used in combination with local anaesthetics to:

-increase the rate of liver metabolism of local anaesthetic
-stimulate myocardial contraction
-increase the concentration of LA at receptor site
-increase vascular absorption of LA

-increase the concentration of LA at receptor site

52

Which of the following muscles is pierced by the needle while giving an inferior alveolar nerve block?

-medial pterygoid
-temporalis
-buccinator
-masseter
-superior constrictor

-buccinator

53

All of the following are reasons to include a vasoconstrictor, EXCEPT one. Which one is the EXCEPTION?

-lower toxicity of local anaesthetic
-improve field of vision for treatment
-increase duration of local anaesthetic
-increase anaesthetic blood levels
-lower blood flow to injection site

-increase anaesthetic blood levels

54

What is one important way that local anaesthetic drugs differ from all other drugs used in dentistry?

-rate of uptake into bloodstream
-high potential of overdose
-route of administration
-blood levels must be sufficient to expert effect
-action ceased when absorbed into bloodstream

-action ceased when absorbed into bloodstream

55

In the dental office, the MOST important consideration when selecting a syringe type is the ability of the syringe to:

-aspirate
-accept 30 gauge needle
-deliver anaesthetic to the patient
-not frighten the patient
-be cost effective

-aspirate

56

In case of Gow-Gates technique, the target area is:

-medial side of ramus
-lateral side of condyle
-neck of condyle
-coronoid notch
-head of condyle

-neck of condyle

57

It is difficult to obtain local infiltration anaesthesia in the presence of inflammation because of:

-pain
-oedema
-increased pH
-decreased pH
-increased vascularity

-decreased pH

58

Which portion of the nerve do local anaesthetics work on?

-myelinated sheath
-neuron
-dendrites
-cell membrane
-schwann cells

-cell membrane

anesthesia only works on the nerve membrane

59

The closed mouth technique for mandibular nerve block is:

-Gow Gates technique
-None of the rest
-Clark and Holmes technique
-Angelo sergenti technique
-Akinosi, Vazirani technique

-Akinosi, Vazirani technique

indication: when limited mouth opening precludes the use of other mandibular injection (trismus)

60

Which of the following is NOT a characteristic of the basic sedation procedure?

-minimally depressed level of consciousness
-airway protective reflexes are maintained
-patient easily aroused
-patient unable to respond appropriately to verbal/physical stimuli

-patient unable to respond appropriately to verbal/physical stimuli

61

The possible adverse effect of most concern with using Midazolam is:

-cardiac arrhythmias
-seizures
-respiratory depression
-flaccid paralysis

-respiratory depression

62

Reversal of Midazolam is produced by IV administration of:

a. 0.2 mg Flumazenil per 60 seconds
b. 2.0 mg of Flumazenil per 60 seconds
c. 0.1 mg Naloxone per 60 seconds
d. 1.0 mg Naloxone per 60 seconds

a. 0.2 mg Flumazenil per 60 seconds

63

Adequate conscious sedation is achieved when the patient:

a.Begins to relax
b.No longer has gag reflex
c.Can no longer initiate respirations
d.No longer responds to painful stimuli

a.Begins to relax

(b not how you check it, c and d over sedated)

64

IF reversal is administered recommended minimum time of observation prior to discharge is:

a. 1 hr
b. 2 hr
c. 3 hr
d. 4 hr

b. 2 hr

65

Patients who have been given Midazolam should be instructed to avoid operating a car, consuming alcohol or signing legal papers for 24hours after receiving medication.

a.True
b.False

a.True

66

When benzodiazepines are combined with narcotics the risk of respiratory depression is decreased.

a.True
b.False

b.False

(both are depressants so they increase the risk)

67

A stable 62 year old patient with Type 2 Diabetes, peripheral vascular disease and mild nephropathy would have an ASA of:

a.ASA I
b.ASA II
c.ASA III
d. ASA IV

c.ASA III

(both are depressans so they increase the risk)

68

How to achieve rapid induction and how to maintain the conscious sedation?

rapid induction with intravenous and then maintained with inhalation anesthesia

69

Which one of these methods allows rapid change in level of sedation?

N2O/O2

70

Which is the receptor for anxiolytic effects of Benzodiazepines?

-GABA A
-GABA B
-Opioid

-GABA A

71

Nitrous oxide adv and disadv:

Advantages:
Fast onset and recovery
Analgesic and hypnotic
Minimal effect on CVS and Respiratory system
No metabolites •Drug not metabolised
Extensively Documented, virtually no mortality
Easy to use
•Rapid peak action: 3-5 minutes
•Depth of sedation easily regulated
•Duration of sedation flexible
•Moderate analgesia
•No injection
•Few side effects
•No adverse effects on the liver, kidneys, brain, cardiovascular system or respiratory systems

Disadvantages:
Low potency (only for specific patients)
Toxicity
Pressure effects in gas filled cavities
Elaborate delivery system
Danger of hypoxia?
Recreational abuse
Cost of equipment
Space occupying equipment
Not a potent agent
A degree of co-operation is necessary
Possibility of chronic exposure
Technique of administration is operator sensitive

72

What is Conscious Sedation?

= A minimally depressed level of consciousness that retains patient’s ability to maintain an airway independently and respond appropriately to physical stimulation and verbal command

73

Continuum of Sedation:

Minimal sedation (anxiolysis):
Moderate sedation and or/analgesia:
Deep sedation and or/analgesia:
General anesthesia:

Minimal sedation (anxiolysis): normal response

Moderate sedation and or/analgesia: Purposeful response to verbal or tactile stimulation

Deep sedation and or/analgesia: Purposeful response after repeated or painful stimulation

General anesthesia: unarousable even with painful stimulus

74

Inhalation Anaesthetics:

High Solubility in Blood:
Low Solubility in Blood:

High Solubility in Lipid:
Low Solubility in Lipid:

High Solubility in Blood:
-slow induction and recovery
-slow adjustment of anaesthesia depth

Low Solubility in Blood:
-rapid induction and recovery
-rapid adjustment of anaesthesia depth
-the anaesthetic passes quicker in brain b/c of small resevoir

High Solubility in Lipid:
-high oil/gas partition coefficient
-more potent GA

Low Solubility in Lipid:
-low oil/gas partition coefficient
-less potent GA

75

If you see a small bubble from what is it cause?
-CO2
-N2
-O2

-N2

76

Dental needles are available in each length, EXCEPT one. Which is the EXCEPTION?

a. Long.
b. Short.
c. Medium.
d. Ultrashort.

c. Medium.

3 lengths – ultrashort, short and long