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Flashcards in Local Anesthesia Review 2 Deck (42):
1

#1. a drug combination we should avoid is: vasoconstrictors and general anesthesia
#2. a drug combination we should avoid is: cocaine and epinephrine
a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

a. both statements are true

2

The following are true about cocaine and local anesthesia use except:
a. don't use a vasoconstrictor if patient is on cocaine
b. cocaine and vasoconstrictors can lead to tachycardia and cardiac arrest
c. cocaine increases norepinephrine release and blocks its reuptake
d. if patient has just used cocaine, it is ok to use a vasoconstrictor if you wait 2 hours; 1 hour if they feel relaxed

d. if patient has just used cocaine, it is ok to use a vasoconstrictor if you wait 2 hours; 1 hour if they feel relaxed

3

#1. Cimetidine increases the half life of lidocaine. #2. Because of this, you must never ever give lidocaine to any patient taking cimetidine.
a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

c. #1 is true and #2 is false

4

True OR False
The combination of nonselective beta blockers and epinephrine can lead to a serious elevation of blood pressure.

True

5

True OR False
Tricyclic Antidepressants can increase the effects of levonordefrin & norepinephrine 5 to 10 fold.

True

6

True OR False
If a patient is on anticoagulants you should consult with their MD before treating.

True

7

True OR False
If a patient has had a heart attack (infarct), you should not do elective treatment for 6 months.

True

8

True OR False
Syncope is usually from a patient's nervousness and not the drug itself.

True

9

True OR False
Administration of injectable prilocaine (in large doses) can produce methemoglobinemia in patients with subclinical methemoglobinemia.

True

10

The following are true about the middle superior alveolar nerve block except:
a. only 28% of patients have that nerve
b. is meant to anesthetize the pulps of maxillary premolars and MB root of maxillary first molar
c. use a short needle and deposit about 0.9 ml to 1.2 ml of solution
d. can be done when there is active infection at the site of injection

d. can be done when there is active infection at the site of injection

11

The following is true about the posterior superior alveolar nerve block except:
a. relative higher risk of hematoma compared to most other injections
b. use a short needle and leave about 1/4 or 4-6 mm of needle remaining visible (penetration depth about 16 mm)
c. you may want to aspirate two times (rotate quarter turn for second time)
d. deposit about 0.3 ml of solution
e. if too far posteriorly can be in the pterygoid plexus of veins

d. deposit about 0.3 ml of solution

(0.6 ml)

12

The angles we must follow for a correct PSA are:

Upward and inward 45 degrees to the occlusal plane and backward 45 degrees to the mid-sagittal plane (long axis of second molar)

13

The following is/are true about the inferior alveolar nerve block:
a. highest rate of inadequate anesthesia (31 to 81%)
b. positive aspiration rate of 10-15%
c. anesthetizes the inferior alveolar nerve, incisive, mental and usually lingual nerves.
d. depth of penetration is 20-25 mm, 2/3 to 3/4 of long needle and you may want to aspirate 2 times
e. all of the above

e. all of the above

14

When performing an inferior alveolar nerve block the following are true except:
a. height of injection is about 6-10 mm above the mandibular occlusal plane
b. height of injection is where raphe turns upward
c. height of injection is about 1-3 mm above mandibular occlusal plane
d. depth of penetration is 2/3 to 3/4 long needle

c. height of injection is about 1-3 mm above mandibular occlusal plane

15

To help make palatal injections less traumatic the following are true except:
a. apply topical for two minutes
b. faster deposition rate of solution than 1 minute per cartridge
c. pressure with cotton stick to blanch area of injection site
d. believe in yourself

b. faster deposition rate of solution than 1 minute per cartridge

16

The following are true about the nasopalatine nerve block except:
a. target area is the nerve in the incisive foramen
b. inject just lateral to incisive papilla not directly into it
c. is mainly for pulpal anesthesia
d. it is the most traumatic intraoral injection

c. is mainly for pulpal anesthesia

17

The greater palatine nerve block usually numbs:
a. pulps of maxillary canine and premolars
b. posterior part of hard palate and overlying soft tissue, anteriorly up to first premolar
c. upper pulps of wisdom teeth unilaterally

b. posterior part of hard palate and overlying soft tissue, anteriorly up to first premolar

18

The following is true about the buccal nerve block except:
a. soft tissue and periosteum buccal to the mandibular molars are affected
b. it will numb up the pulps of the molar teeth
c. penetration site is distal and buccal to the most distal molar

b. it will numb up the pulps of the molar teeth

19

The following is/are true about a mental nerve block:
a. a symptom is a tingling of the lower lip
b. target is the mental nerve as it exits the mental foramen
c. use a radiograph and palpation to help locate foramen
d. all of the above

d. all of the above

20

Transient facial paralysis after an inferior alveolar block is from:
a. too fast an injection rate
b. depositing solution in the parotid gland by the facial nerve
c. use of too much vasoconstrictor
d. interaction with carbocaine and arrestin

b. depositing solution in the parotid gland by the facial nerve

21

The inferior alveolar nerve block is intended to anesthetize the pulps (nerves) of:
a. only the pulps of the posterior teeth of one mandibular quadrant
b. only the pulps of the anterior teeth of both mandibular quadrants
c. the pulps of both the anterior and posterior teeth of one lower quad
d. it is not intended to numb the pulps of any teeth but intended only for soft tissue anesthesia

c. the pulps of both the anterior and posterior teeth of one lower quad

22

The penetration site for the ASA is:
a. height of mucobuccal fold just distal to canine eminence
b. height of mucobuccal fold just mesial to lateral incisors
c. height of mucobuccal fold on the mesial aspect of the canine eminence
d. height of mucobuccal fold between 1st and 2nd premolars

c. height of mucobuccal fold on the mesial aspect of the canine eminence

23

When administering the MSA block you should:
a. insert about 9 mm and deposit 1/4 cartridge
b. insert a few mm, no more than 6 mm and deposit 1/4 cartridge
c. try to deposit the solution apical to the apex of the second premolar
d. always insert 5 mm and deposit 1 full cartridge

c. try to deposit the solution apical to the apex of the second premolar

24

When administering the PSA nerve block the following are true except:
a. depth of insertion on normal size adult is 24 mm
b. deposit 0.9 to 1.8 ml of solution
c. don't insert to hub of needle

a. depth of insertion on normal size adult is 24 mm

(16)

25

The following statements are true except:
a. the mental and incisive nerve block technique differ in that you massage the fluid into the mental foramen for the mental nerve block
b. the mental foramen is usually between the 1st and 2nd premolars or apex of the 2nd premolar
c. a successful IA will numb both the mental and incisive nerves

a. the mental and incisive nerve block technique differ in that you massage the fluid into the mental foramen for the mental nerve block

(massage for incisive)

26

In the IA nerve block technique, if bone is contacted too soon we:
a. withdraw most of needle and swing barrel over molars
b. withdraw most of needle and swing barrel over canine/lateral
c. continue with injection, it just might work
d. we don't want to contact bone anyway

b. withdraw most of needle and swing barrel over canine/lateral

27

A hematoma can occur from an incorrectly administered PSA nerve block if the needle is over inserted and penetrates the:
a. floor of the nose
b. mandibular artery
c. parotid salivary gland
d. cavernous venous sinus
e. pterygoid plexus of veins

e. pterygoid plexus of veins

28

Which of the following nerves is not anesthetized during an inferior alveolar nerve block?
a. mental nerve
b. buccal
c. incisive

b. buccal

29

True OR False
When doing the IA we should consider 3 parameters; 10 height of the injection, 2) anteroposterior placement of the needle, and 3) depth of injection

True

30

In regards to the American Society of Anesthesiologists' Physical Status Classification:
a. if a patient is rated 4 or above we do not do elective treatment
b. a patient rated V is healthier than a patient rated I
c. a patient rated II would be someone who has mild systemic disease without limits of daily activities
d. a, c

d. a, c

31

The following are true except:
a. paresthesia is usually total and not partial
b. can be caused by trauma by needle, hemorrhage and alcohol contamination
c. usually injury concerning paresthesia is from biting, chemical or thermal sources

a. paresthesia is usually total and not partial

32

The following is true about paresthesia management except:
a. it is usually permanent
b. most cases resolve by 8 weeks
c. try to avoid injections into same area that was affected until it is completely gone

a. it is usually permanent

33

Which of the following can cause trismus?
a. hemorrhage
b. trauma to muscle by needle
c. diffusion of alcohol/cold sterilization into cartridge
d. low grade infection
e. all of the above
f. b, c, and d

e. all of the above

34

#1. The myotoxic effect of local anesthesia on muscle can cause necrosis leading to trismus. #2. Multiple injections can cause trismus from excess fluid.
a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

a. both statements are true

35

Trismus can be defined as:
a. a tingly feeling in the tongue and buccal soft tissue
b. restricted jaw movement regardless of etiology, usually with pain
c. redness, numbness and swelling and usually from an infection

b. restricted jaw movement regardless of etiology, usually with pain

36

#1. If trismus doesn't begin to improve after 48 hours, give antibiotics for 7 days. #2. If no improvement after 5-7 days with antibiotics, refer to oral surgeon.
a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

a. both statements are true

37

The following are physiotherapy for trismus except:
a. open and closing with lateral excursions for 5 minutes every 3 to 4 hours
b. chewing gum
c. do not let patient move affected areas as any movement will probably make it worse

c. do not let patient move affected areas as any movement will probably make it worse

38

The following are true about soft tissue injury except:
a. pulpal anesthesia lasts longer than soft tissue anesthesia, so there is an increased risk
b. usually it is self-inflicted by patient
c. put a sticker on the forehead and remind patient/caregiver
d. use a short acting anesthetic if possible

a. pulpal anesthesia lasts longer than soft tissue anesthesia, so there is an increased risk

39

Which injections carry the higher risk of hematoma?
a. PSA and nasopalatine
b. PSA and IA
c. IA and greater palatine
d. it does not make a difference; the frequency is the same for all injections

b. PSA and IA

40

Which of the following statements is true?
a. the bleeding from nicking an artery or vein stops when the extravascular pressure exceeds the intravascular pressure, or until clotting occurs
b. the bleeding from nicking an artery or vein stops when the extravascular pressure is less than intravascular, or until clotting occurs
c. using a long needle lessens the chance of a hematoma during a PSA
d. hematomas usually have severe and possibly deadly consequences

a. the bleeding from nicking an artery or vein stops when the extravascular pressure exceeds the intravascular pressure, or until clotting occurs

41

In treating a hematoma:
#1. Where possible apply direct pressure
#2. Apply ice immediately
a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

a. both statements are true

42

If there is swelling in the airway following local anesthesia, the best thing to do is:
a. reassure patient, and dismiss and have them call if does not improve
b. basic life support, 911 and give valium to relax them
c. basic life support, 911 and give epinephrine until resolved
d. always perform a cricothyrotomy before EMS arrives to limit liability

c. basic life support, 911 and give epinephrine until resolved