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Flashcards in Weekly Quizzes Deck (61):
1

Which of the following actions will be necessary to successfully complete this course?
1. Attend every lecture without fail.
2. Achieve an overall passing grade on quizzes and over 60% on the final examination.
3. Anesthetize at least two classmates.
4. Participate in your assigned clinical session, both giving and receiving local anesthesia.
a. 1 and 3
b. 2 and 4
c. 1 only
d. All of the above

b. 2 and 4

2

The nerve tissue layer most resistant to local anesthetic penetration is the:
a. endoneurium
b. perineurium
c. epineurium
d. microneurium

b. perineurium

3

The nerve types responsible for transmission of nociception (pain) are:
a. A-delta and B.
b. A-delta and C.
c. A-alpha and A-beta.
d. A-gamma and A-delta.

b. A-delta and C.

4

When the sodium channel is ready for activation, the activation gate is ___ and the inactivation gate is ___.
a. open, open.
b. closed, open.
c. closed, closed.
d. open, closed.

b. closed, open.

5

Sensory nerves with the fastest signal transmission have ___ diameters and ___ distances between nodes of Ranvier compared to slower conducting nerves.
a. larger, shorter.
b. larger, longer.
c. smaller, longer.
d. smaller, shorter.

b. larger, longer.

6

Anesthetic A has a pKa of 7.8 and Anesthetic B has pKa of 8.9. When in jected into healthy submucosal tissue, Anesthetic A will be ___ ionized and have a ___ onset time than Anesthetic B.
a. more, slower
b. less, slower
c. less, faster
d. more, faster

c. less, faster

7

Which of the following substances is NOT found in a dental cartridge of 2% lidocaine with 1:100,000 epinephrine?
a. epinephrine
b. sodium metabisulfite
c. methylparaben
d. lidocaine

c. methylparaben

8

A patient is given an excessive dose of plain lidocaine (no epinephrine). Which of the following symptoms is most likely to appear first?
a. respiratory tract
b. drowsiness and slurred speech
c. disorientation
d. seizures

b. drowsiness and slurred speech

9

The first clinical sign of anesthesia onset would be loss of ___. The signal for this sensation is carried by type ___ fibers.
a. dull pain, A-delta
b. sharp pain, C
c. sharp pain, A-delta
d. dull pain, C

d. dull pain, C

10

Which of the following factors INCREASES the plasma concentration of circulating, unbound amide-type local anesthetic after drug injection?
a. Injecting into a more vascular area.
b. Reducing the quantity injected.
c. Inactive plasma pseudocholinesterase.
d. Using a more lipophilic anesthetic.

a. Injecting into a more vascular area.

11

Dental local anesthetic solutions contain a vasoconstrictor in order to:
a. Reduce stinging on injection.
b. Improve duration of anesthesia.
c. Prevent blood pressure changes.
d. Greatly reduce peak plasma anesthetic levels.

b. Improve duration of anesthesia.

12

Five minutes ago you injected a patient with a large quantity of 2% lidocaine with 1:100,000 epinephrine. The patient takes a tricyclic antidepressant medication regularly. If you retake the patient’s vital signs, you would expect to see the BP ___ and the HR ___ from baseline values.
a. decreased, increased
b. increased, decreased
c. increased, increased
d. decreased, decreased

c. increased, increased

13

Five minutes ago you injected a patient with a large quantity of 2% lidocaine with 1:100,000 epinephrine. The patient takes a beta blocker medication regularly. If you retake the patient’s vital signs, you would expect to see the BP ___ and the HR ___ from baseline values.
a. decreased, decreased
b. increased, increased
c. increased, decreased
d. decreased, increased

c. increased, decreased

14

Yet another patient is given a large dose of lidocaine with epinephrine. This one takes both a phenothiazine and a cardio-selective beta blocker. Five minutes later, what will this patient’s blood pressure and heart rate be compared to baseline?
a. decreased pressure and heart rate
b. decreased pressure, no change in heart rate
c. no pressure change, increased heart heart
d. increased pressure and heart rate

b. decreased pressure, no change in heart rate

15

Which will have a clinical effect?
a. Non-selective b blockade
b. MAO inhibitor
c. Selective b blockade
d. All of the above

a. Non-selective b blockade

16

Acquired methemoglobinemia is most likely to occur with injection of:
a. lidocaine
b. prilocaine
c. carbocaine
d. mepevacaine

b. prilocaine

17

A new patient tells you that she was just diagnosed with hyperthyroidism. Your best course of is to:
a. proceed with routine dental care with you usual LA selection and dosage.
b. proceed with routine dental care but avoid epinephrine in you Las.
c. defer elective care until thyroid hormone levels are normal, then use your usual LA selection and dosing.
d. defer elective care until thyroid hormone levels are normal, then proceed without using epinephrine-containing LAs.

c. defer elective care until thyroid hormone levels are normal, then use your usual LA selection and dosing.

18

Which of the following medical conditions poses a risk of significant epinephrine toxicity?
a. Cocaine use 1-2 days ago.
b. Controlled mild hypertension
c. MI 3 weeks ago
d. Asymptomatic (controlled) congestive heart failure

c. MI 3 weeks ago

19

A patient with which of the following diseases is most likely to react badly to epinephrine in a dental LA?
a. Malignant hyperthermia
b. Controlled hypertension
c. Kidney failure requiring dialysis
d. Angina at rest

d. Angina at rest

20

Which of the following conditions causes an exaggerated effect of epinephrine?
a. Use of cardioselective beta blockers.
b. Use of MAO inhibitors.
c. Recent (

c. Recent (

21

In a dental office, the MOST important consideration when selecting a syringe type is the ability of the syringe to:
a. be cost effective
b. aspirate
c. accept 30 guage needle
d. does not frighten the patient.

b. aspirate

22

All of the following methods will reduce the chance of needle breakage except one – which one is the exception:
a. establishing a firm hand rest
b. using a larger gauge needle
c. burying the needle to the hub
d. minimizing the need for redirection in the tissue.

c. burying the needle to the hub

23

At what time are professionals MOST at risk for a needle stick?
a. disassembly the syringe
b. recapping
c. assembling the syringe
d. giving the injection

b. recapping

24

The antioxidant used to preserve epinephrine in a LA solution is:
a. sodium bisulfite
b. sodium chloride
c. sodium bicarbonate
d. sodium hypochloride

a. sodium bisulfite

25

Which of the following needle gauges represents the SMALLEST lumen size?
a. 23
b. 25
c. 27
d. 30

d. 30

26

The technique reported to be the most painful in the maxillary anesthesia is:
a. posterior superior alveolar nerve block (PSA)
b. the incisive nerve block
c. anterior superior alveolar nerve block (ASA)
d. the greater palatine block

b. the incisive nerve block

27

The penetration site for the greater palatine nerve block is
a. anterior to the foramen
b. posterior to the foramen
c. medial to the foramen
d. lateral to the foramen

a. anterior to the foramen

28

In the infraorbital nerve block, the nerves anesthetized are:
a. ASA, PSA, lateral nasal
b. ASA, MSA, lateral nasal
c. ASA, PSA, superior labial
d. PSA, MSA, superior labial

b. ASA, MSA, lateral nasal

29

Extraction of tooth #15 requires which nerve/s to be anesthetized:
a. MSA
b. MSA and greater palatine
c. PSA and greater palatine
d. PSA

c. PSA and greater palatine

30

The posterior superior alveolar nerve injection is
a. Half of the short needle inserted
b. The point of needle insertion is at the mucogingival junction
c. The needle is parallel to the occlusal plane
d. Half the long needle inserted

d. Half the long needle inserted

31

The deposition site for the inferior alveolar nerve block should be
a. inferior to the mandibular foramen
b. anterior to the lingual
c. superior to the mandibular foramen
d. posterior to the lingula

c. superior to the mandibular foramen

32

Inferior alveolar nerve block will anesthetize each of the following EXCEPT:
a. buccal mucoperiosteum of the area anterior to the firs tmolar to the midline in the quadrant at the side of the injection.
b. pulp of all teeth in the quadrant at the side of injection
c. alveolar bone around teeth of the quadrant at the injection site
d. lingual mucoperiostium of the quadrant at the side of injection

d. lingual mucoperiostium of the quadrant at the side of injection

33

Nerves required to be anesthetized in order to achieve painless extraction of tooth #18 are:
a. mental and lingual nerves
b. inferior alveolar and long buccal nerves
c. inferior alveolar, lingual, and long buccal nerves
d. mental and long buccal nerves

c. inferior alveolar, lingual, and long buccal nerves

34

The needle penetrates the ___ muscle during an IAN block.
a. masseter
b. medial pterygoid
c. buccinator
d. lateral pterygoid

c. buccinator

35

In Gow-Gates technique, the target area is:
a. Lateral side of the neck of the condyle
b. Medial side of the head of the condyle
c. Superior to the insertion of the medial pterygoid
d. Superior to the insertion of the lateral pterygoid

a. Lateral side of the neck of the condyle

36

You plan to anesthetize a healthy 25kg child for a dental procedure, using 2% lidocaine with 1:100,000 epinephrine. The maximum number of cartridges that may be given is: (assume no effect of the epinephrine)
a. 3
b. 4
c. 5
d. 6

c. 5

37

A patient with a history of heart disease needs maxillary scaling and root planing. You and his physician have agreed to use no more than “low dose” epinephrine. How many mL (note the unit!) of 4% articaine with 1:100,000 epinephrine can be infiltrated.
a. 1
b. 2
c. 3
d. 4

d. 4

38

The maximum safe dose of mepivacine for a healthy adult is:
a. 90 mg
b. 400 mg
c. 500 mg
d. 700 mg

b. 400 mg

39

=How many cartridges of 4% articaine with 1:100,000 epinephrine can a healthy adult receive?
a. 6
b. 10
c. 11
d. 14

b. 10

40

After giving a patient about 5.5 cartridges of 2% lidocaine with 1:100,000 epinephrine, you want to continue injecting in another area with 4% articaine with 1:100,000 epinephrine. How many cartridges of the articaine can you safely inject?
a. 5
b. 7
c. 10
d. 11

a. 5

41

A 45 year-old woman with a full compliment of permanent teeth needs scaling and root planing of her entire dentition. She has no significant medical problems or allergies. She is petite, weighing only 45 kg. You plan to treat her over several appointments. For 2% lidocaine with 1:100,000 epinephrine, the maximum safe number of cartridges that can be given, based on her weight, is (round down):
a. 5
b. 7
c. 9
d. 11

c. 9

42

A 45 year-old woman with a full compliment of permanent teeth needs scaling and root planing of her entire dentition. She has no significant medical problems or allergies. She is petite, weighing only 45 kg. You plan to treat her over several appointments. Assuming that every injection you give works perfectly as you intend, what is the minimum number of needlesticks you need to anesthetize her entire mandibular dentition?
a. 2
b. 4
c. 5
d. 7

a. 2 (Gow-Gates)
b. 4 (his intended answer)

43

Her left maxilla is not very sensitive and you are able to scale almost all the posterior teeth without pain. However, the soft tissue palatal to #15 is sensitive and painful. You solve this by giving:
a. a posterior superior alveolar injection.
b. a middle superior alveolar injection.
c. a palatal infiltration injection.
d. applying topical to the sensitive area.

c. a palatal infiltration injection.

44

Around the maxillary central incisors, the palatal tissue is also too painful to treat without anesthesia. However, she hates injections on the roof of her mouth. You solve this by:
a. applying topical anesthetic to the area and hoping for the best.
b. infiltrating the labial, then injecting between the teeth through the papillae toward the palate.
c. continuing to scale the area until she is willing to have the injection.
d. suggesting that she return another day for treatment under deep sedation.

b. infiltrating the labial, then injecting between the teeth through the papillae toward the palate.

45

Which of the following techniques will produce anesthesia in the gingiva lingual to the mandibular incisors?
a. Bilateral lingual blocks
b. Direct infiltration into the area
c. Infiltration through the papillae from the buccal to the lingual.
d. All of the above will work

d. All of the above will work

46

Which of the following techniques will produce anesthesia in the gingiva lingual to the mandibular incisors?
a. Bilateral lingual blocks
b. Direct infiltration into the area
c. Infiltration through the papillae from the buccal to the lingual.
d. All of the above will work

d. All of the above will work

47

T/F: A special syringe is always required to administer periodontal ligament injection.

False

48

T/F: PDL injection is more beneficial to use in a mandible than the maxilla.

True

49

T/F: PDL injection can be used for diagnostic purposes for pain localization.

True

50

T/F: Success of intra-septal injections is confirmed by sensation of lip numbness following the injection.

False

51

T/F: High incidence of nerve parasthesia is reported when using 4% Articaine for inferior alveolar nerve block.

True

52

T/F: The risk of developing inferior alveolar nerve parasthesia is higher when using articaine 4% compared to the gold standard lidocaine 2%.

True

53

Phentolamine myesylate is:
a. alpha receptor antagonist producing vasoconstriction.
b. alpha receptor agonist producing vasodilation.
c. alpha receptor antagonist producing vasodilation.
d. alpha receptor agonist producing vasoconstriction

c. alpha receptor antagonist producing vasodilation.

54

Mandibular infiltration in adults is sometimes desirable because:
a. It can provide hemostasis.
b. Decrease the risk of injury to the main nerve trunk.
c. Decrease the risk of toxicity.
d. All of the above.

d. All of the above.

55

T/F: The tactile feedback and ease of handling the needle are considered main advantages for using the Wand System.

True

56

T/F: The use of tetracaine is still under investigation to provide intranasal free anesthesia.

True

57

Local anesthetic overdose can be due to:
a. Total dose is too large.
b. Absorption is too rapid.
c. Intravascular injection.
d. All of the above.

d. All of the above.

58

Adding a vasoconstriction to local anesthetic solution can:
a. Provide hemostasis.
b. Decrease toxicity.
c. Increase the anesthetic duration of action.
d. All of the above.

d. All of the above.

59

Patients diagnosed with atypical pseudocholinesterase enzyme should avoid having:
a. Amide LA
b. Ester LA
c. Both amide and ester LA
d. Nerve block injections

b. Ester LA

60

During IANB, the risk of needle breakage can be minimized by:
a. Avoid using short needles.
b. Avoid using 30 gauge needles.
c. Avoid hubbing the needle.
d. All of the above.

d. All of the above.

61

T/F: Allergic reaction from local anesthetic medications is dose dependent.

False