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Flashcards in Surgery2 Deck (110):
1

Which of the following local anesthetics are available in North America? Select all that apply.
• prilocaine
• bupivacaine
• procaine
• lidocaine
• tetracaine
• articaine

• prilocaine
• bupivacaine
• lidocaine
• articaine these are Amide group not a Ester
(to remember that the drug name contains an i plus Caine (lidocaine, bupivacaine, and bupivacaine). Esters such as procaine, benzocaine, and tetracaine contain no i.) (Most topical local anesthetic ointments and gels contain benzocaine )

2

? is most commonly used. Allergic reactions are far more common with ?

• Tetracaine
• esters not amides

3

The drug of choice in management of an acute allergic reaction involving bronchospasm and hypotension is ?

epinephrine

4

Allergic reactions to local anesthetic are usually caused by ?

an antigen-antibody reaction

5

Which of the following are appropriate treatments for an impending vasovagal syncopal episode? Select all that apply.
• sit patient in upright position
• place patient in supine position
• monitor vitals
• oxygen administration
• loosen tight clothing
• place a cold compress on patients forehead

• place patient in supine position
• monitor vitals
• oxygen administration
• loosen tight clothing
• place a cold compress on patients forehead

6

For local anesthetics, for every 1% solution there is:
• 0.10 mg/mL of anesthetic
• 1 mg/mL of anesthetic
• 10 mg/mL of anesthetic
• 100 mg/mL of anesthetic

10 mg/mL of anesthetic (For vasoconstrictor, 1;100,000 means 1 gram per 100,000 mL. This equates to 0.01 mg/mL)

7

each lidocaine capsule 2%, 1;100,000 contains how much of anesthetic or vasoconstrictor ?

• anesthetic = 34mg lido
• vasoconstrictor = .017 mg epi

8

Which of the following are needed in combination to produce neuroleptanesthesia? Select all that apply.
• narcotic analgesic
• neuroleptic agent
• nitrous oxide

• narcotic analgesic (administration)
• neuroleptic agent (administration)
• nitrous oxide (inhalation)

9

Neuroleptanesthesia is a state of ?

neuroleptanalgesia (by narcotic analgesic + neuroleptic agent) and unconsciousness (by nitrous oxide)

10

The most common cause of loss of consciousness in the dental office is:
• anaphylaxis
• syncope
• heart attack
• seizure

syncope (never occur when lying)- fainting

11

Once the blood pressure drops below levels necessary to sustain consciousness, ? occurs

syncope (by stress-induced release of catecholamines that cause the following: a decrease in peripheral vascular resistance, tachycardia, and sweating)

12

The single most important drug to use in any medical emergency, including chronic obstructive pulmonary disease, is ?

oxygen

13

The primary airway hazard for an unconscious dental patient in a supine position is ?. Remember ?

• tongue obstruction
• Head tilt/chin lift

14

Trauma to muscles or blood vessels in the ? is the most common etiological factor in trismus associated with dental injections of local anesthetics.
• pterygoid fossa
• temporal fossa
• submandibular fossa
• infratemporal fossa

infratemporal fossa (The medial pterygoid muscle is most often affected)

15

Management of trismus?

• Apply hot, moist towels to the site for approximately 20 minutes every hour
• Warm saline rinses
• Use analgesics as required
• Benzodiazepine (e.g., diazepam) for muscle relaxation if deemed necessary
• The patient should gradually open and close mouth as a means of physiotherapy

16

The most common cause of paresthesia of the lower lip is ?

the removal of mandibular third molar (especially horizontally impacted ones).

17

There are no contraindications for the use of nitrous oxide sedation in asthmatic patients.
Because anxiety is a stimulus for an asthmatic attack, nitrous oxide sedation is actually beneficial for these patients.
• both statements are true
• both statements are false
• the first statement is true, the second is false
• the first statement is false, the second is true

both statements are true

18

The most common complication associated with nitrous oxide sedation is ?

a behavioral problem (laughing, giddy)

19

A normal platelet count is:
• 15,000 - 45,000/mm3
• 75,000 - 100,000/mm3
• 150,000 - 450,000/mm3
• 450,000 - 600,000/mm3

150,000 - 450,000/mm3

20

Which of the following pairings are correct regarding the amount of epinephrine in 1.7cc of solution? Select all that apply.
• 2% lidocaine 1:200,000 / .0085 mg epinephrine
• 2% lidocaine 1:200,000 / .017 mg epinephrine
• 2% lidocaine 1:50,000 / .034 mg epinephrine
• 2% lidocaine 1:50,000 /.017 mg epinephrine

• 2% lidocaine 1:200,000 / .0085 mg epinephrine
• 2% lidocaine 1:50,000 / .034 mg epinephrine

21

The primary site of biotransformation of amide drugs is the:
• plasma
• lung
• kidney
• liver

liver (not for ester local anesthetics which are hydrolyzed in the plasma)

22

Allergic reactions to amide-type local anesthetics are rare but may occur as a result of hypersensitivity to the local anesthetic agent itself or due to an allergy to ?

methylparaben or other preservatives used in many solutions

23

For those patients allergic to both ester and amide-type local anesthetics, ? is a safe and effective alternative.

diphenhydramine

24

The initial clinical signs and symptoms of CNS toxicity for local anesthetics are usually excitatory in nature. However, it is also possible that the excitatory phase of the reaction may be extremely brief or may not occur at all. This is true especially with which local aneshetics? Select all that apply.
• lidocaine
• tetracaine
• etidocaine
• procaine
• bupivacaine

• lidocaine
• procaine

25

The pH of normal tissue is ?; the pH of an inflamed area is ?
• 9.0; 3 to 4
• 7.4; 5 to 6
• 3.6; 8 to 9
• 8.0; 2 to 3

7.4; 5 to 6

26

Nitrous oxide works on the:
• peripheral nervous system (PNS)
• central nervous system (CNS)
• autonomic nervous system (ANS)

central nervous system (CNS) (main effects on the reticular activating system and the limbic system)

27

The maximum limitation dose is ? nitrous oxide and 40% oxygen

60%

28

• The first symptom of nitrous oxide analgesia is ?
• ? is the most common side effect of nitrous oxide analgesia

• tingling of the hands
• Nausea

29

The primary action of local anesthetics in producing a conduction block is to decrease the permeability of the ion channels to:
• calcium ions
• chloride ions
• potassium ions
• sodium ions

sodium ions

30

Nerve block produced by local anesthetics is called a ? nerve block.

nondepolarizing

31

? nerve fibers that conduct pain and temperature sensations are affected first, followed by touch, proprioception, and skeletal muscle tone.

Smallest, unmyelinated

32

Emergence from a local anesthetic nerve block follows the same diffusion patterns as induction; however, it does so in ? order

reverse

33

Which of the following is the phase of anesthesia that begins with the administration of anesthetic and continues until the desired level of patient unresponsiveness is reached?
• induction
• maintenance
• recovery

induction

34

The behavior of patients under general anesthesia suggests that the most resistant part of the CNS is the ?

medulla oblongata (cardiac, vasomotor and respiratory centers of the brain).

35

Volatile liquids require a vaporizer for inhalational administration. Which one additionally requires a heating component to allow delivery at room temperature?
• enflurane
• halothane
• sevoflurane
• desflurane
• isoflurane

desflurane
(inhalation anesthetics means volatile anesthetics)

36

All the potent inhalation agents are capable of triggering ?, a rare inherited disorder that is potentially fatal

malignant hyperthermia (MH)

37

The optimum site for IV sedation for an outpatient is the:
• median basilic vein
• median cephalic vein
• median antebrachial vein
• axillary vein

median cephalic vein

38

popular drug for IV sedation for an outpatient is ? but is contraindicated for use in a patient with a history of ?

• Valium (diazepam)
• narrow-angle glaucoma

39

Dissociative anesthesia is a unique method of pain control that reduces anxiety and produces a trancelike state in which the person is not asleep, but rather feels separated from his or her body. The primary medication used is:
• demerol
• ketamine
• pentobarbital
• promethazine hydrochloride

ketamine (used for short procedures that are painful, such as changing bandages. This method is safe and lasts only a short time. Because a person does not usually recall the procedure, this method is useful in children)

40

ketamine used for dissociative anesthesia increases BP, heart rate, and cardiac output , but not ?

respirations

41

Malignant hyperthermia (MH) is a pharmacogenetic disorder in which a genetic variant in the individual alters that person's response to certain drugs. Which of the following describe the major clinical characteristics of MH? Select all that apply.
• rigidity
• fever
• hypermetabolism
• myoglobinuria
• alkalosis

• rigidity
• fever
• hypermetabolism
• myoglobinuria

42

The following signs: nausea, pallor, cold perspiration, widely dilated pupils, eyes rolled up, and brief convulsions are indicative of a patient having a ? reaction.
• somatogenic
• psychogenic
• either of the above
• none of the above

psychogenic (caused by psychological factors rather than physical factors such as Vasovagal syncope which clinical signs closely resemble those of shock and readily respond to placing the patient in a supine position)

43

Postoperative hypotension is usually due to the effect of:
• transfusion reactions
• a fat embolism
• the anesthetic or analgesics on the myocardium
• liver failure

the anesthetic or analgesics on the myocardium (leading to myocardial depression)

44

Postoperative hypertension is most often due to ?

post-op pain

45

Anesthesia performed with general anesthetics occurs in four stages which may or may not be observable because they can occur very rapidly. Which stage is the one in which skeletal muscles relax and the patient's breathing becomes regular?
• analgesia
• excitement
• surgical anesthesia
• medullary paralysis

surgical anesthesia

46

the most reliable sign of "oxygen want" while monitoring a patient during general anesthesia is ?. Cyanosis may also be present

an increased pulse rate

47

the emergency most frequently experienced during outpatient general anesthesia is ?

respiratory obstruction

48

the best anesthetic technique used in oral surgery to avoid aspiration of blood or other debris when a patient is under general anesthesia is ?

endotracheal intubation with pharyngeal packs

49

The propylene glycol in IV valium can cause:
• cellulitis
• a unilateral facial paralysis
• phlebitis
• syncope

phlebitis (irritation or inflammation of a vein that is sometimes seen after IV administration of valium)

50

The most frequent respiratory complications following oral and maxillofacial surgery are:

pulmonary atelectasis (most often in smokers), aspiration pneumonia (most likely to manifest initially in the patient's right lung), and pulmonary embolus (most originate in the deep venous systems of the lower extremities, especially in nonambulatory patients)

51

When a biopsy is being performed, it is important to:
• incise perpendicular to the long axis of any muscle fibers beneath the lesion
• incise parallel to the long axis of any muscle fibers beneath the lesion
• incise as deep as possible into muscle fibers beneath the lesion
• incise at a 45-degree angle to the long axis of any muscle fibers beneath the lesion

incise perpendicular to the long axis of any muscle fibers beneath the lesion

52

Biopsy incisions on the face should be oriented to follow ?

Langer's lines

53

How long should one wait before obtaining a biopsy of an oral ulcer?
• 4 days
• 7 days
• 14 days
• 30 days

14 days (almost all oral ulcers caused by trauma will heal within 14 days) it is mandatory!

54

after tissue removal for biopsy, the tissue should be immediately placed in ? solution that is at least 20 times the volume of the surgical specimen

10% formalin

55

A negative incisional biopsy report of a highly suspicious oral lesion suggests that another biopsy specimen is necessary in view of the clinical impressions. The key is ? oral lesion

a highly suspicious

56

An incisional biopsy is indicated for which of the following lesions?
• a 0.5-cm papillary fibroma of the gingiva
• a 2.0-cm exostosis of the hard palate
• a 2.0-cm area of Fordyce disease of the cheek
• a 3.0-cm hemangiorna of the tongue
• a 3.0-cm area of leukoplakia of the soft palate

a 3.0-cm area of leukoplakia of the soft palate (Leukoplakia is a premalignant lesion)

57

Which of the following symptoms that suggest that your patient is dehydrated? Select all that apply.
• pale or gray skin color
• dry mouth
• decreased skin turgor (fullness)
• modified state of consciousness
• high blood pressure
• rapid pulse
• reduced urine output

• pale or gray skin color
• dry mouth
• decreased skin turgor
• modified state of consciousness
• rapid pulse
• reduced urine output

58

More severe degrees of fluid loss are accompanied by a shift of water from ? to ?, a process that causes severe cell dysfunction, particularly in the brain.

• the intracellular space
• the extracellular space

59

Patients with a fasting plasma glucose level higher than ? or a random plasma glucose of greater than ? have diabetes mellitus.
• 50 mg/dL, 125 mg/dL
• 75 mg/dL, 150 mg/dL
• 100 mg/dL, 175 mg/dL
• 126 mg/dL, 200 mg/dL

126 mg/dL, 200 mg/dL

60

The major concern for the dentist treating a patient who has diabetes mellitus is ?

hypoglycemia

61

Symptoms of hypoglycemia:

weakness, nervousness, excessive sweating, tremulousness (shaking due to become nervous), and palpitations (if you have palpitations, your heart beats quickly in an irregular way )

62

people with well-controlled diabetes are no more susceptible to infections than people without diabetes, but they have more difficulty ? infections

containing (this is caused by altered leukocyte function).

63

patients who take insulin daily and check their urine regularly for sugar and ketones (controlled diabetics), do they need medication before dental surgery?

can be treated in the normal manner without additional drugs of diet alterations

64

Your 60-year-old patient presents with congestive heart failure. They note cardiac symptoms with mild activity but are asymptomatic at rest. What is the functional classification of heart failure in your patient?
• class i
• class II
• class III
• class IV

class III
• Class I congestive heart failure is defined as no cardiac symptoms with activity,
• Class II is symptoms with marked activity,
• Class III is symptoms with mild activity,
• Class IV is symptoms at rest

65

aspirin, NSAIDs, and calcium channel blockers in congestive heart failure?

should be avoided

66

hypercapnia
hypocapnia
respiratory arrest
hyperventilation
hypoventilation
dyspnea
hyperpnea
apnea

excess CO2 in arterial blood
below normal CO2 in arterial blood
permanent cessation of breathing (unless corrected)
an increase in both rate and depth of respiration
a reduced rate and depth of respiration
the unpleasant sensation of difficulty in breathing
increase in depth of respiration
transient cessation or absence of breathing

67

Diminished volume affecting all or part of a lung is called:
• bronchiectasis
• atelectasis
• pneumothorax
• pneumonia

atelectasis (occurs when mucus or a foreign object obstructs airflow in a main stem bronchus causing collapse of the affected lung tissue into an airless state. It typically occurs 36 hours postoperatively)

68

Prolonged atelectasis can lead to ?

pneumonia

69

? are two of the most common causes of fever in a patient who has had general anesthesia

Pneumonitis (inflammation of the lung) and atelectasis

70

the most common post-op complication of outpatient general anesthesia is ?

nausea

71

A 55-year-old male presents to your office with a long history of a productive cough. The patient states that the cough has been present for 6 months during each of the last 3 years. The patient is afebrile (fever) and chest x-ray is unremarkable.
• viral pneumonia
• chronic bronchitis
• emphysema
• asthma

chronic bronchitis

72

COPD patients taking theophylline should not be prescribed ?

erythromycin. Erythromycin increases the metabolism of theophylline and may cause toxicity

73

Which of the following acid-base abnormalities will develop in a patient with recurrent vomiting of gastric contents?
• respiratory acidosis
• respiratory alkalosis
• metabolic acidosis
• metabolic alkalosis

metabolic alkalosis

74

Which statement below is true regarding type 2 diabetes?
• was formally known as insulin-dependent diabetes
• patients have little or no insulin secretion capacity
• symptoms appear abruptly and include polyuria, polydipsia, polyphagia, and weight loss
• accounts for 90% of all cases of clinical diabetes

accounts for 90% of all cases of clinical diabetes

75

The clinical presentation of acute asthma includes which of the following? Select all that apply.
• dyspnea or tachypnea
• wheezing
• hypoxemia
• occasionally hypercapnia
• hemoptysis

• dyspnea or tachypnea
• wheezing
• hypoxemia
• occasionally hypercapnia

76

local anesthesia dosage in asthmatic patients?

up to 2 carpules of 2% lidocaine with 1:100,000 epinephrine may be used (avoid antihistamines!!)

77

Hemophilia A and B are inherited as ? trait by which males are affected and females are carriers

a sex-linked recessive

78

• Which coagulation factors is deficient in hemophilia A?
• Which coagulation factors is deficient in hemophilia B (Christmas disease)?
• Which coagulation factors is deficient in hemophilia C (not sex linked)?

• VIII
• IX
• XI

79

true hemophiliac is characterized by having the following lab test results?

• Prolonged partial thromboplastin time (PTT)
• Normal prothrombin time (PT)
• Normal platelet count
• Normal bleeding time

80

A history of rheumatic fever, IV drug abuse, or heart murmur should alert the dentist to the possibility of:
• diabetes mellitus
• AIDS
• valvular disease
• end-stage renal disease

valvular disease (Patients with valvular heart disease are also at risk for bacterial endocarditis)

81

A heart murmur may have no pathological significance or may be an important clue to ?

the presence of valvular, congenital, or other structural abnormalities of the heart

82

A tall, thin patient presents to your office with shortness of breath. On examination, you note the patient is breathing through "pursed" lips, his expiratory phase is prolonged, and lung sounds are distant. Which of the following is the most likely diagnosis?
• asthma
• bronchiectasis
• cystic fibrosis
• emphysema

emphysema (also called pink puffer, destructive changes to the alveoli walls and enlargement of air spaces)

83

Patients with ? may be predisposed to lung cancer

chronic bronchitis

84

Special considerations must be taken when treating a patient on renal dialysis. Which of the following should be considered? Select all that apply.
• treat the day before dialysis
• treat the day after dialysis
• NSAIDs are the best analgesic to use
• morphine is acceptable for use as an analgesic
• be aware of shunts when taking the patients blood pressure
• consider that the patient may be on steroid therapy

• treat the day after dialysis
• be aware of shunts when taking the patients blood pressure
• consider that the patient may be on steroid therapy
(avoid the following analgesics: aspirin, acetaminophen, NSAlDs, meperidine, and morphine)

85

Codeine, a widely used analgesic in dentistry:
• is a natural constituent of opium
• may be given only by injection
• has a calming effect on gastric mucosa
• is stronger than morphine, more addictive, and more constipating

is a natural constituent of opium

86

? is the least lipid soluble of the three main benzodiazepines, resulting in a slow onset of action but a long duration of action.
• midazolam (Versed)
• lorazepam (Ativan)
• diazepam (Valium)

lorazepam

87

? is a sedative and hypnotic that is widely used for pediatric sedation

chloral hydrate

88

effect of emotional stress on the rate of absorption of a drug when given orally?

decreases the rate of absorption of a drug when given orally

89

Which of the following drugs would be BEST given to a patient with a history of gastric ulcers?
• aspirin
• ibuprofen
• acetaminophen
• naproxen

acetaminophen (Tylenol is the only over-the-counter non-antiinflammatory analgesic commonly available in the USA)

90

which analgesic should be given in children with viral infections ?

acetaminophen (since are at a risk for Reye syndrome if they take aspirin)

91

Which of these barbiturates can be classified as an ultra-short-acting compound?
• amobarbital
• thiopental
• phenobarbital
• pentobarbital

thiopental

92

Barbiturates are contraindicated in patients with ?

respiratory disease or those who are pregnant

93

? should be used cautiously in the elderly. It should never be given to patients on monoamine oxidase inhibitors for psychiatric disease and is generally contraindicated in patients receiving phenytoin (Dilantin) for seizure disorders.
• ibuprofen
• acetaminophen
• meperidine
• codeine

meperidine (=Demerol, most widely used narcotic in American hospitals)

94

? is the most abused drug by health professionals

Meperidine (The onset of action is more rapid, but the duration of action is shorter, than that of morphine)

95

? is the standard drug to which all analgesic drugs are compared, causes ?

• Morphine
• euphoria and respiratory depression.

96

Atropine and scopolamine have similar pharmacologic effects. Which of the following actions do they share?
Select all that apply:
• reduction of salivation
• prevention of cardiac slowing during general anesthesia
• cns depression
• mydriasis
• cycloplegia

• mydriasis
• cycloplegia
• reduction of salivation
• prevention of cardiac slowing during general anesthesia

97

The cholinergic blocking (anticholinergic) drugs (atropine and scopolamine) ? the action of acetylcholine at parasympathetic postganglionic neuroeffector sites

competitively inhibit

98

Anticholinergic drugs contraindication?

in patients with glaucoma, prostate hypertrophy and intestinal obstruction

99

A sedative dose of a barbiturate should be expected to produce:
• respiratory depression
• minor analgesia
• decreased BMR
• all of the above effects
• none of the above effects

none of the above effects (no analgesic effect )

100

After IV administration of barbiturate, the last tissue to become saturated as a result of redistribution is ?

fat (as compared to liver, brain, and muscle tissue)

101

All of the following are true statements concerning the principles of suturing technique EXCEPT one. Which one is the EXCEPTION?
• the needle should be perpendicular when it enters the tissue
• sutures should be placed at an equal distance from the wound margin (2-3 mm) and at equal depths
• sutures should be placed from mobile tissue to thick tissue
• sutures should be placed from thin tissue to thick tissue
• sutures should not be overtightened
• tissues should be closed under tension
• sutures should be 2-3 mm apart

tissues should be closed under tension

102

What areas are impacted maxillary third molars occasionally displaced into? Select all that apply?
• canine space
• pterygomaxillary space
• infratemporal space
• pharyngeal space
• maxillary sinus

• infratemporal space
• maxillary sinus

103

The major disadvantage of interrupted suture over continuous pattern is ?

the time required for placement of this pattern of sutures

104

if an impacted maxillary third molars are displaced into maxillary sinus (antrum), what approach is used to remove it?

Caldwell-Luc approach

105

if an impacted maxillary third molars are displaced into infratemporal space, what approach is used to remove it?

if the tooth is not retrieved after a short amount of time with a hemostat, the area should be closed and the patient is referred to an oral surgeon

106

when performing a surgical removal of a mandibular molar, do not section through the entire tooth. The lingual plate is often thin, and complete sectioning may ?

perforate the plate and injure the lingual nerve

107

position of the inferior alveolar nerve regarding a mandibular third molar?

lies buccal and slightly apical to the root of a mandibular third molar

108

For maxillary extractions, the upper jaw of the patient should be:
• below the height of the operator's shoulder
• above the height of the operator's shoulder
• at the same height of the operator's shoulder
• it makes no difference where the patient's upper jaw is in relation to the operator's shoulder

at the same height of the operator's shoulder

109

position of the patient for mandibular extractions?

the occlusal plane of the mandibular arch is parallel to the floor when the mouth is opened

110

Which of the following are contraindications to tooth extraction. Select all that apply.
• acute pericoronitis
• acute apical abscess
• end-stage renal disease
• acute infectious stomatitis

• acute pericoronitis
• end-stage renal disease
• acute infectious stomatitis